[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 1057 Reported in Senate (RS)]







                                                       Calendar No. 375
109th CONGRESS
  2d Session
                                S. 1057

                          [Report No. 109-222]

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


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 17, 2005

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

               March 16 (legislative day, March 15), 2006

               Reported by Mr. McCain, 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.</DELETED>

<DELETED>    This Act may be cited as the ``Indian Health Care 
Improvement Act Amendments of 2005''.</DELETED>

<DELETED>SEC. 2. INDIAN HEALTH CARE IMPROVEMENT ACT AMENDED.</DELETED>

<DELETED>    (a) In General.--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 National Indian health policy
<DELETED>``Sec. 4. Definitions
  <DELETED>``TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT

<DELETED>``Sec. 101. Purpose
<DELETED>``Sec. 102. Health professions recruitment program for Indians
<DELETED>``Sec. 103. Health professions preparatory scholarship program 
                            for Indians
<DELETED>``Sec. 104. Indian health professions scholarships
<DELETED>``Sec. 105. American Indians Into Psychology program
<DELETED>``Sec. 106. Funding for tribes for scholarship programs
<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. Indian recruitment and retention program
<DELETED>``Sec. 114. Advanced training and research
<DELETED>``Sec. 115. Quentin N. Burdick American Indians Into Nursing 
                            program
<DELETED>``Sec. 116. Tribal cultural orientation
<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 
                            programs
<DELETED>``Sec. 124. National Health Service Corps
<DELETED>``Sec. 125. Substance abuse counselor educational curricula 
                            demonstration programs
<DELETED>``Sec. 126. Behavioral health training and community education 
                            programs
<DELETED>``Sec. 127. 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 for long-term care
<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 and South Dakota as a contract 
                            health service delivery area
<DELETED>``Sec. 217. California contract health services 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. Notification of provision of 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. Sanitation facilities
<DELETED>``Sec. 303. Preference to Indians and Indian firms
<DELETED>``Sec. 304. Expenditure of nonservice funds for renovation
<DELETED>``Sec. 305. Funding for the construction, expansion, and 
                            modernization of small ambulatory care 
                            facilities
<DELETED>``Sec. 306. Indian health care delivery demonstration project
<DELETED>``Sec. 307. Land transfer
<DELETED>``Sec. 308. Leases, contracts, and other agreements
<DELETED>``Sec. 309. Loans, loan guarantees, and loan repayment
<DELETED>``Sec. 310. Tribal leasing
<DELETED>``Sec. 311. Indian Health Service/tribal facilities joint 
                            venture program
<DELETED>``Sec. 312. Location of facilities
<DELETED>``Sec. 313. Maintenance and improvement of health care 
                            facilities
<DELETED>``Sec. 314. Tribal management of Federally owned quarters
<DELETED>``Sec. 315. Applicability of Buy American Act requirement
<DELETED>``Sec. 316. Other funding for facilities
<DELETED>``Sec. 317. Authorization of appropriations
             <DELETED>``TITLE IV--ACCESS TO HEALTH SERVICES

<DELETED>``Sec. 401. Treatment of payments under Social Security Act 
                            health care programs
<DELETED>``Sec. 402. Grants to and contracts with the Service, Indian 
                            tribes, Tribal Organizations, and Urban 
                            Indian Organizations
<DELETED>``Sec. 403. Reimbursement from certain third parties of costs 
                            of health services
<DELETED>``Sec. 404. Crediting of reimbursements
<DELETED>``Sec. 405. Purchasing health care coverage
<DELETED>``Sec. 406. Sharing arrangements with Federal agencies
<DELETED>``Sec. 407. Payor of last resort
<DELETED>``Sec. 408. Nondiscrimination in qualifications for 
                            reimbursement for services
<DELETED>``Sec. 409. Consultation
<DELETED>``Sec. 410. State Children's Health Insurance Program (SCHIP)
<DELETED>``Sec. 411. Social Security Act sanctions
<DELETED>``Sec. 412. Cost sharing
<DELETED>``Sec. 413. Treatment under Medicaid managed care
<DELETED>``Sec. 414. Navajo Nation Medicaid Agency feasibility study
<DELETED>``Sec. 415. 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 Claim 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. Eligibility for services
<DELETED>``Sec. 522. 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. Memoranda 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
<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 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. Severability provisions
<DELETED>``Sec. 814. Establishment of National Bipartisan Commission on 
                            Indian Health Care
<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 health services 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, and resulting responsibility to, the 
        American Indian people.</DELETED>
        <DELETED>    ``(2) 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 to be raised to the 
        highest possible level and to encourage the maximum 
        participation of Indians in the planning and management of 
        those services.</DELETED>
        <DELETED>    ``(3) Federal health services to Indians have 
        resulted in a reduction in the prevalence and incidence of 
        preventable illnesses among, and unnecessary and premature 
        deaths of, Indians.</DELETED>
        <DELETED>    ``(4) Despite such services, the unmet health 
        needs of the American Indian people are severe and the health 
        status of the Indians is far below that of the general 
        population of the United States.</DELETED>

<DELETED>``SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH 
              POLICY.</DELETED>

<DELETED>    ``Congress declares that it is the policy of this Nation, 
in fulfillment of its special trust responsibilities and legal 
obligations to Indians--</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 successor 
        objectives;</DELETED>
        <DELETED>    ``(3) to the greatest extent possible, to allow 
        Indians 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 Service Area is raised to at least 
        the level of that of the general population;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>

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

<DELETED>    ``For purposes of this Act:</DELETED>
        <DELETED>    ``(1) The term `accredited and accessible' means 
        on or near a reservation and accredited by a national or 
        regional organization with accrediting authority.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(3) The term `Assistant Secretary' means the 
        Assistant Secretary of Indian Health.</DELETED>
        <DELETED>    ``(4)(A) The term `behavioral health' means the 
        blending of substance (alcohol, drugs, inhalants, and tobacco) 
        abuse and mental health prevention and treatment, for the 
        purpose of providing comprehensive services.</DELETED>
        <DELETED>    ``(B) The term `behavioral health' includes the 
        joint development of substance abuse and mental health 
        treatment planning and coordinated case management using a 
        multidisciplinary approach.</DELETED>
        <DELETED>    ``(5) The term `California Indians' means those 
        Indians who are eligible for health services of the Service 
        pursuant to section 806.</DELETED>
        <DELETED>    ``(6) The term `community college' means--
        </DELETED>
                <DELETED>    ``(A) a tribal college or university, 
                or</DELETED>
                <DELETED>    ``(B) a junior or community 
                college.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(8) The term `Department' means, unless 
        otherwise designated, the Department of Health and Human 
        Services.</DELETED>
        <DELETED>    ``(9) The term `disease prevention' means the 
        reduction, limitation, and prevention of disease and its 
        complications and reduction in the consequences of disease, 
        including--</DELETED>
                <DELETED>    ``(A) controlling--</DELETED>
                        <DELETED>    ``(i) development of 
                        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) fluoridation of water; 
                        and</DELETED>
                        <DELETED>    ``(ii) immunizations.</DELETED>
        <DELETED>    ``(10) The term `health profession' means 
        allopathic medicine, family medicine, internal medicine, 
        pediatrics, geriatric medicine, obstetrics and gynecology, 
        podiatric medicine, nursing, public health nursing, dentistry, 
        psychiatry, osteopathy, optometry, pharmacy, psychology, public 
        health, social work, marriage and family therapy, chiropractic 
        medicine, environmental health and engineering, allied health 
        professions, and any other health profession.</DELETED>
        <DELETED>    ``(11) The term `health promotion' means--
        </DELETED>
                <DELETED>    ``(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;</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 Health Care 
                Practices; and</DELETED>
                <DELETED>    ``(G) providing 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) immunization and other 
                        prevention of communicable diseases, including 
                        HIV/AIDS;</DELETED>
                        <DELETED>    ``(vii) environmental 
                        health;</DELETED>
                        <DELETED>    ``(viii) exercise and physical 
                        fitness;</DELETED>
                        <DELETED>    ``(ix) avoidance of 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) behavioral 
                        health;</DELETED>
                        <DELETED>    ``(xiv) monitoring of disease 
                        indicators between health care provider visits, 
                        through appropriate means, including Internet-
                        based health care management systems;</DELETED>
                        <DELETED>    ``(xv) personal health and 
                        wellness practices;</DELETED>
                        <DELETED>    ``(xvi) personal capacity 
                        building;</DELETED>
                        <DELETED>    ``(xvii) prenatal, pregnancy, and 
                        infant care;</DELETED>
                        <DELETED>    ``(xviii) psychological well-
                        being;</DELETED>
                        <DELETED>    ``(xix) reproductive health and 
                        family planning;</DELETED>
                        <DELETED>    ``(xx) safe and adequate 
                        water;</DELETED>
                        <DELETED>    ``(xxi) safe housing, relating to 
                        elimination, reduction, and prevention of 
                        contaminants that create unhealthy housing 
                        conditions;</DELETED>
                        <DELETED>    ``(xxii) safe work 
                        environments;</DELETED>
                        <DELETED>    ``(xxiii) stress 
                        control;</DELETED>
                        <DELETED>    ``(xxiv) substance 
                        abuse;</DELETED>
                        <DELETED>    ``(xxv) sanitary 
                        facilities;</DELETED>
                        <DELETED>    ``(xxvi) sudden infant death 
                        syndrome prevention;</DELETED>
                        <DELETED>    ``(xxvii) tobacco use cessation 
                        and reduction;</DELETED>
                        <DELETED>    ``(xxviii) violence prevention; 
                        and</DELETED>
                        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(12) The term `Indian', unless otherwise 
        designated, means any person who is a member of an Indian tribe 
        or is eligible for health services under section 806, except 
        that, for the purpose of sections 102 and 103, the term also 
        means any individual who--</DELETED>
                <DELETED>    ``(A)(i) irrespective of whether the 
                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 recognized now or in the future by 
                the State in which they reside; or</DELETED>
                <DELETED>    ``(ii) is a descendant, in the first or 
                second degree, of any such member;</DELETED>
                <DELETED>    ``(B) is an Eskimo or Aleut or other 
                Alaska 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 be an Indian under 
                regulations promulgated by the Secretary.</DELETED>
        <DELETED>    ``(13) The term `Indian Health Program' means--
        </DELETED>
                <DELETED>    ``(A) any health program administered 
                directly by the Service;</DELETED>
                <DELETED>    ``(B) any Tribal Health Program; 
                or</DELETED>
                <DELETED>    ``(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'.</DELETED>
        <DELETED>    ``(14) 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.).</DELETED>
        <DELETED>    ``(15) 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)).</DELETED>
        <DELETED>    ``(16) 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.).</DELETED>
        <DELETED>    ``(17) The term `Secretary', unless otherwise 
        designated, means the Secretary of Health and Human 
        Services.</DELETED>
        <DELETED>    ``(18) The term `Service' means the Indian Health 
        Service.</DELETED>
        <DELETED>    ``(19) The term `Service Area' means the 
        geographical area served by each Area Office.</DELETED>
        <DELETED>    ``(20) 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.</DELETED>
        <DELETED>    ``(21) 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)).</DELETED>
        <DELETED>    ``(22) 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.</DELETED>
        <DELETED>    ``(23) 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.</DELETED>
        <DELETED>    ``(24) 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)).</DELETED>
        <DELETED>    ``(25) 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 
        contract or compact with the Service under the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 450 et 
        seq.).</DELETED>
        <DELETED>    ``(26) 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.).</DELETED>
        <DELETED>    ``(27) 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.</DELETED>
        <DELETED>    ``(28) The term `Urban Indian' means any 
        individual who resides in an Urban Center and who meets 1 or 
        more of the following criteria:</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(B) The individual is an Eskimo, Aleut, 
                or other Alaskan Native.</DELETED>
                <DELETED>    ``(C) The individual is considered by the 
                Secretary of the Interior to be an Indian for any 
                purpose.</DELETED>
                <DELETED>    ``(D) The individual is determined to be 
                an Indian under regulations promulgated by the 
                Secretary.</DELETED>
        <DELETED>    ``(29) 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).</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 Indian Health Programs and Urban Indian 
Organizations involved in the provision of health services to 
Indians.</DELETED>

<DELETED>``SEC. 102. HEALTH PROFESSIONS RECRUITMENT PROGRAM FOR 
              INDIANS.</DELETED>

<DELETED>    ``(a) In General.--The Secretary, acting through the 
Service, shall make grants 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--
</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 
        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).</DELETED>
<DELETED>    ``(b) Funding.--</DELETED>
        <DELETED>    ``(1) Application.--The Secretary shall not make a 
        grant under this section unless 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.</DELETED>
        <DELETED>    ``(2) Amount of funds; payment.--The amount of a 
        grant 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.</DELETED>

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

<DELETED>    ``(a) Scholarships Authorized.--The Secretary, acting 
through the Service, shall provide scholarship grants to Indians who--
</DELETED>
        <DELETED>    ``(1) have successfully completed their high 
        school education or high school equivalency; and</DELETED>
        <DELETED>    ``(2) have demonstrated the potential to 
        successfully complete courses of study in the health 
        professions.</DELETED>
<DELETED>    ``(b) Purposes.--Scholarships provided pursuant to this 
section shall be for the following purposes:</DELETED>
        <DELETED>    ``(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).</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. 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.</DELETED>
<DELETED>    ``(c) Other Conditions.--Scholarships under this section--
</DELETED>
        <DELETED>    ``(1) may cover costs of tuition, books, 
        transportation, board, and other necessary related expenses of 
        a recipient while attending school;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(3) shall not be denied solely by reason of such 
        applicant's eligibility for assistance or benefits under any 
        other Federal program.</DELETED>

<DELETED>``SEC. 104. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.</DELETED>

<DELETED>    ``(a) In General.--</DELETED>
        <DELETED>    ``(1) Authority.--The Secretary, acting through 
        the Service, shall make scholarship grants to Indians who are 
        enrolled full or part time in accredited schools pursuing 
        courses of study in the health professions. Such scholarships 
        shall be designated Indian Health Scholarships and shall be 
        made in accordance with section 338A of the Public Health 
        Services Act (42 U.S.C. 2541), except as provided in subsection 
        (b) of this section.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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 enactment of the Indian Health Care 
        Improvement Act Amendments of 2005) until such time as the 
        individual completes the course of study that is supported 
        through such scholarship.</DELETED>
        <DELETED>    ``(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 contract or 
        compact under the Indian Self-Determination and Education 
        Assistance Act (25 U.S.C. 450 et seq.).</DELETED>
<DELETED>    ``(b) Active Duty Service Obligation.--</DELETED>
        <DELETED>    ``(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:</DELETED>
                <DELETED>    ``(A) In an Indian Health 
                Program.</DELETED>
                <DELETED>    ``(B) In a program assisted under title V 
                of this Act.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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:</DELETED>
                <DELETED>    ``(A) No period of internship, residency, 
                or other advanced clinical training shall be counted as 
                satisfying any period of obligated service under this 
                subsection.</DELETED>
                <DELETED>    ``(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).</DELETED>
                <DELETED>    ``(C) The active duty service obligation 
                will be served in the health profession of that 
                individual in a manner consistent with paragraph 
                (1).</DELETED>
                <DELETED>    ``(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--</DELETED>
                        <DELETED>    ``(i) is located on the 
                        reservation of the Indian Tribe in which the 
                        recipient is enrolled; or</DELETED>
                        <DELETED>    ``(ii) serves the Indian Tribe in 
                        which the recipient is enrolled.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) such scholarship shall be for a period of 
        years not to exceed the part-time equivalent of 4 years, as 
        determined by the Area Office;</DELETED>
        <DELETED>    ``(2) the period of obligated service described in 
        subsection (b)(1) shall be equal to the greater of--</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(B) 2 years; and</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(d) Breach of Contract.--</DELETED>
        <DELETED>    ``(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 enactment of the Indian Health Care 
        Improvement Act Amendments of 2005 if that individual--
        </DELETED>
                <DELETED>    ``(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);</DELETED>
                <DELETED>    ``(B) is dismissed from such educational 
                institution for disciplinary reasons;</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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 affected Area Office, Indian Tribes, Tribal 
        Organizations, and Urban Indian Organizations, determines 
        that--</DELETED>
                <DELETED>    ``(A) it is not possible for the recipient 
                to meet that obligation or make that payment;</DELETED>
                <DELETED>    ``(B) requiring that recipient to meet 
                that obligation or make that payment would result in 
                extreme hardship to the recipient; or</DELETED>
                <DELETED>    ``(C) the enforcement of the requirement 
                to meet the obligation or make the payment would be 
                unconscionable.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 105. AMERICAN INDIANS INTO PSYCHOLOGY 
              PROGRAM.</DELETED>

<DELETED>    ``(a) Grants Authorized.--The Secretary, acting through 
the Service, shall make 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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Regulations.--The Secretary shall issue regulations 
pursuant to this Act for the competitive awarding of grants provided 
under this section.</DELETED>
<DELETED>    ``(d) Conditions of Grant.--Applicants under this section 
shall agree to provide a program which, at a minimum--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(2) incorporates a program advisory board 
        comprised of representatives from the tribes and communities 
        that will be served by the program;</DELETED>
        <DELETED>    ``(3) provides summer enrichment programs to 
        expose Indian students to the various fields of psychology 
        through research, clinical, and experimental 
        activities;</DELETED>
        <DELETED>    ``(4) provides stipends to undergraduate and 
        graduate students to pursue a career in psychology;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(6) to the maximum extent feasible, uses 
        existing university tutoring, counseling, and student support 
        services; and</DELETED>
        <DELETED>    ``(7) to the maximum extent feasible, employs 
        qualified Indians in the program.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) in an Indian Health Program;</DELETED>
        <DELETED>    ``(2) in a program assisted under title V of this 
        Act; or</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 106. FUNDING FOR TRIBES FOR SCHOLARSHIP 
              PROGRAMS.</DELETED>

<DELETED>    ``(a) In General.--</DELETED>
        <DELETED>    ``(1) Grants authorized.--The Secretary, acting 
        through the Service, shall make grants to Tribal Health 
        Programs for the purpose of providing scholarships for Indians 
        to serve as health professionals in Indian 
        communities.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(3) Application.--An application for a grant 
        under paragraph (1) shall be in such form and contain such 
        agreements, assurances, and information as consistent with this 
        section.</DELETED>
<DELETED>    ``(b) Requirements.--</DELETED>
        <DELETED>    ``(1) In general.--A Tribal Health Program 
        receiving a grant under subsection (a) shall provide 
        scholarships to Indians in accordance with the requirements of 
        this section.</DELETED>
        <DELETED>    ``(2) Costs.--With respect to costs of providing 
        any scholarship pursuant to subsection (a)--</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(B) 20 percent of such costs may be paid 
                from any other source of funds.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(B) such greater period of time as the 
                recipient and the Tribal Health Program may 
                agree;</DELETED>
        <DELETED>    ``(2) provide that the amount of the scholarship--
        </DELETED>
                <DELETED>    ``(A) 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)), with such amount to be reduced 
                        pro rata (as determined by the Secretary) based 
                        on the number of hours such student is 
                        enrolled, and not to 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</DELETED>
                <DELETED>    ``(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);</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(4) require the recipient of such scholarship to 
        meet the educational and licensure requirements appropriate to 
        each health profession.</DELETED>
<DELETED>    ``(e) Breach of Contract.--</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(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);</DELETED>
                <DELETED>    ``(B) is dismissed from such educational 
                institution for disciplinary reasons;</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

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

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

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

<DELETED>    ``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.</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, acting through the Service, shall maintain a Community 
Health Representative Program under which Indian Health Programs--
</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) Duties.--The Community Health Representative Program 
of the Service, 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 the 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 
        develop programs that meet the needs for 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.--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.</DELETED>
<DELETED>    ``(b) Eligible Individuals.--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 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</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;</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 Service; or</DELETED>
        <DELETED>    ``(D) be employed in an Indian Health Program or 
        Urban Indian Organization without a service obligation; 
        and</DELETED>
        <DELETED>    ``(3) submit to the Secretary an application for a 
        contract described in subsection (e).</DELETED>
<DELETED>    ``(c) Application.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(d) Priorities.--</DELETED>
        <DELETED>    ``(1) List.--Consistent with subsection (k), the 
        Secretary shall annually--</DELETED>
                <DELETED>    ``(A) identify the positions in each 
                Indian Health Program or Urban Indian Organization for 
                which there is a need or a vacancy; and</DELETED>
                <DELETED>    ``(B) rank those positions in order of 
                priority.</DELETED>
        <DELETED>    ``(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--</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 of an Indian Health Program 
                        or Urban Indian Organization; and</DELETED>
                        <DELETED>    ``(ii) other individuals based on 
                        the priority rankings under paragraph 
                        (1).</DELETED>
<DELETED>    ``(e) Recipient Contracts.--</DELETED>
        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(2) Contents of contract.--The written contract 
        referred to in this section between the Secretary and an 
        individual shall contain--</DELETED>
                <DELETED>    ``(A) an agreement under which--</DELETED>
                        <DELETED>    ``(i) subject to subparagraph (C), 
                        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 Tribal 
                                Health Program or Urban Indian 
                                Organization as provided in clause 
                                (ii)(III); and</DELETED>
                        <DELETED>    ``(ii) subject to subparagraph 
                        (C), 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>    ``(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</DELETED>
                                        <DELETED>    ``(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</DELETED>
                                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(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);</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(E) such other statements of the rights 
                and liabilities of the Secretary and of the individual, 
                not inconsistent with this section.</DELETED>
<DELETED>    ``(f) Deadline for Decision on Application.--The Secretary 
shall provide written notice to an individual within 21 days on--
</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(2) the Secretary's disapproving an individual's 
        participation in such Program.</DELETED>
<DELETED>    ``(g) Payments.--</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.--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--</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(B) provides an incentive to serve in 
                Indian Health Programs and Urban Indian Organizations 
                with the greatest shortages of health professionals; 
                and</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(4) Reimbursements for tax liability.--For the 
        purpose of providing reimbursements for tax liability resulting 
        from a payment under paragraph (2) on behalf of an individual, 
        the Secretary--</DELETED>
                <DELETED>    ``(A) in addition to such payments, may 
                make payments to the individual in an amount equal to 
                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</DELETED>
                <DELETED>    ``(B) may make such additional payments as 
                the Secretary determines to be appropriate with respect 
                to such purpose.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(i) Recruitment.--The Secretary shall conduct recruiting 
programs for the Loan Repayment Program and other Service manpower 
programs of the Service at educational institutions training health 
professionals or specialists identified in subsection (a).</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(l) Breach of Contract.--</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) is enrolled in the final year of a 
                course of study and--</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) 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 fails to complete such training 
                program.</DELETED>
        <DELETED>    ``(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--
        </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 Secretary of the 
                Treasury;</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>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(5) Recovery of delinquency.--</DELETED>
                <DELETED>    ``(A) In general.--If damages described in 
                paragraph (4) are delinquent for 3 months, the 
                Secretary shall, for the purpose of recovering such 
                damages--</DELETED>
                        <DELETED>    ``(i) use collection agencies 
                        contracted with by the Administrator of General 
                        Services; or</DELETED>
                        <DELETED>    ``(ii) enter into contracts for 
                        the recovery of such damages with collection 
                        agencies selected by the Secretary.</DELETED>
                <DELETED>    ``(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.</DELETED>
<DELETED>    ``(m) Waiver or Suspension of Obligation.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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:</DELETED>
        <DELETED>    ``(1) A list of the health professional positions 
        maintained by Indian Health Programs and Urban 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 (e) 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 scholarships that are provided 
        under sections 104 and 106 with respect to each health 
        profession.</DELETED>
        <DELETED>    ``(6) The amount of scholarship grants provided 
        under section 104 and 106, in total and by health 
        profession.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>

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

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Use of Funds.--</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(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</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 104, 106, or 
                section 110.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Investment of Funds.--The Secretary of the Treasury 
shall invest such amounts of the LRRF as the Secretary of Health and 
Human Services determines are not required to meet current withdrawals 
from the LRRF. Such investments may be made only in interest bearing 
obligations of the United States. For such purpose, such obligations 
may be acquired on original issue at the issue price, or by purchase of 
outstanding obligations at the market price.</DELETED>
<DELETED>    ``(d) Sale of Obligations.--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 for Travel.--The Secretary, acting 
through the Service, may reimburse health professionals seeking 
positions with Indian Health Programs or Urban Indian Organizations, 
including 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) 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.</DELETED>

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

<DELETED>    ``(a) In General.--The Secretary, acting through the 
Service, shall fund, on a competitive basis, 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.</DELETED>
<DELETED>    ``(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.</DELETED>

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

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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 enactment of the Indian Health Care 
Improvement Act Amendments of 2005, 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) 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).</DELETED>

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

<DELETED>    ``(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:</DELETED>
        <DELETED>    ``(1) Public or private schools of 
        nursing.</DELETED>
        <DELETED>    ``(2) Tribal colleges or universities.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Use of Grants.--Grants provided under subsection (a) 
may be used for one or more of the following:</DELETED>
        <DELETED>    ``(1) To recruit individuals for programs which 
        train individuals to be nurses, nurse midwives, or advanced 
        practice nurses.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(4) To provide a program that increases the 
        skills of, and provides continuing education to, nurses, nurse 
        midwives, and advanced practice nurses.</DELETED>
        <DELETED>    ``(5) To provide any program that is designed to 
        achieve the purpose described in subsection (a).</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(d) Preferences for Grant Recipients.--In providing 
grants under subsection (a), the Secretary shall extend a preference to 
the following:</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.</DELETED>
        <DELETED>    ``(4) Programs that are conducted in cooperation 
        with a program for gifted and talented Indian 
        students.</DELETED>
<DELETED>    ``(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).</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) in the Service;</DELETED>
        <DELETED>    ``(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);</DELETED>
        <DELETED>    ``(3) in a program assisted under title V of this 
        Act; 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 shortage area and addresses the 
        health care needs of a substantial number of Indians.</DELETED>

<DELETED>``SEC. 116. TRIBAL CULTURAL ORIENTATION.</DELETED>

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

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

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Regulations.--The Secretary, pursuant to this Act, 
shall develop regulations to govern grants pursuant to this 
section.</DELETED>
<DELETED>    ``(d) Requirements.--Applicants for grants provided under 
this section shall agree to provide a program which--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(2) incorporates a program advisory board 
        comprised of representatives from the Indian Tribes and Indian 
        communities which will be served by the program;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(5) to the maximum extent feasible, employs 
        qualified Indians in the program.</DELETED>

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

<DELETED>    ``(a) Grants To Establish Programs.--</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 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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Grants for Maintenance and Recruiting.--</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) Requirements.--Grants may only be made under 
        this section to a community college which--</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 Indian 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) 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) Advanced Training.--</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) has already received a degree or 
                diploma in such health profession; and</DELETED>
                <DELETED>    ``(B) provides clinical services on or 
                near a reservation or for an Indian Health 
                Program.</DELETED>
        <DELETED>    ``(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).</DELETED>
<DELETED>    ``(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.</DELETED>

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

<DELETED>    ``(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--</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 Indian 
        Health Programs and Urban Indian Organizations;</DELETED>
        <DELETED>    ``(3) has--</DELETED>
                <DELETED>    ``(A) completed 3 years of employment with 
                an Indian Health Program or Urban Indian 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 an Indian 
        Health Program 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) 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).</DELETED>
<DELETED>    ``(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--</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 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 certifications in nursing and public 
health.</DELETED>
<DELETED>    ``(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.</DELETED>

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

<DELETED>    ``(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--</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) Specific Program Requirements.--The Secretary, 
acting through the Community Health Aide Program of the Service, 
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 objectives specified in section 
                3(2);</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 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>    ``(c) National Community Health Aide Program.--</DELETED>
        <DELETED>    ``(1) In general.--The Secretary, acting through 
        the Service, is authorized to establish a national Community 
        Health Aide Program in accordance with subsection (a), except 
        as provided in paragraphs (2) and (3), without reducing funds 
        for the Community Health Aide Program for Alaska.</DELETED>
        <DELETED>    ``(2) Limited certification.--Except for any 
        dental health aide in the State of Alaska, the Secretary, 
        acting through the Community Health Aide Program of the 
        Service, shall ensure that, for a period of 4 years, dental 
        health aides are certified only to provide services relating 
        to--</DELETED>
                <DELETED>    ``(A) early childhood dental disease 
                prevention and reversible dental procedures; 
                and</DELETED>
                <DELETED>    ``(B) the development of local capacity to 
                provide those dental services.</DELETED>
        <DELETED>    ``(3) Review.--</DELETED>
                <DELETED>    ``(A) In general.--During the 4-year 
                period described in paragraph (2), the Secretary, 
                acting through the Community Health Aide Program of the 
                Service, shall conduct a review of the dental health 
                aide program in the State of Alaska to determine the 
                ability of the program to address the dental care needs 
                of Native Alaskans, the quality of care provided 
                (including any training, improvement, or additional 
                oversight needed), and whether the program is 
                appropriate and necessary to carry out in any other 
                Indian community.</DELETED>
                <DELETED>    ``(B) Report.--After conducting the review 
                under subparagraph (A), the Secretary shall submit to 
                the Committee on Indian Affairs of the Senate and the 
                Committee on Resources of the House of Representatives 
                a report describing any finding of the Secretary under 
                the review.</DELETED>
                <DELETED>    ``(C) Future authorization of 
                certifications.--Before authorizing any dental 
                procedure not described in paragraph (2)(A), the 
                Secretary shall consult with Indian tribes, Tribal 
                Organizations, Urban Indian Organizations, and other 
                interested parties to ensure that the safety and 
                quality of care of the Community Health Aide Program 
                are adequate and appropriate.</DELETED>

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

<DELETED>    ``The Secretary, acting through the Service, shall, by 
contract or otherwise, provide training for Indians in the 
administration and planning of Tribal Health Programs.</DELETED>

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

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Purposes of Programs.--The purposes of demonstration 
programs funded under subsection (a) shall be--</DELETED>
        <DELETED>    ``(1) to provide direct clinical and practical 
        experience at a Service Unit to health profession students and 
        residents from medical schools;</DELETED>
        <DELETED>    ``(2) to improve the quality of health care for 
        Indians by assuring access to qualified health care 
        professionals; and</DELETED>
        <DELETED>    ``(3) to provide academic and scholarly 
        opportunities for health professionals serving Indians by 
        identifying all academic and scholarly resources of the 
        region.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 124. NATIONAL HEALTH SERVICE CORPS.</DELETED>

<DELETED>    ``(a) No Reduction in Services.--The Secretary shall not--
</DELETED>
        <DELETED>    ``(1) remove a member of the National Health 
        Service Corps from an Indian Health Program or Urban Indian 
        Organization; or</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 125. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL CURRICULA 
              DEMONSTRATION PROGRAMS.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(d) Criteria for Review and Approval of Applications.--
Not later than 180 days after the date of enactment of the Indian 
Health Care Improvement Act Amendments of 2005, 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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(g) Definition.--For the purposes of this section, the 
term `educational curriculum' means 1 or more of the 
following:</DELETED>
        <DELETED>    ``(1) Classroom education.</DELETED>
        <DELETED>    ``(2) Clinical work experience.</DELETED>
        <DELETED>    ``(3) Continuing education workshops.</DELETED>

<DELETED>``SEC. 126. BEHAVIORAL HEALTH TRAINING AND COMMUNITY EDUCATION 
              PROGRAMS.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Positions.--The positions referred to in subsection 
(a) are--</DELETED>
        <DELETED>    ``(1) staff positions within the Bureau of Indian 
        Affairs, including existing positions, in the fields of--
        </DELETED>
                <DELETED>    ``(A) elementary and secondary 
                education;</DELETED>
                <DELETED>    ``(B) social services and family and child 
                welfare;</DELETED>
                <DELETED>    ``(C) law enforcement and judicial 
                services; and</DELETED>
                <DELETED>    ``(D) alcohol and substance 
                abuse;</DELETED>
        <DELETED>    ``(2) staff positions within the Service; 
        and</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Training Criteria.--</DELETED>
        <DELETED>    ``(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 contract or compact under the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 450 et seq.), the 
        appropriate Secretary shall ensure that such training costs are 
        included in the contract or compact, as the Secretary 
        determines necessary.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(e) Plan.--Not later than 90 days after the date of 
enactment of the Indian Health Care Improvement Act Amendments of 2005, 
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 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').</DELETED>

<DELETED>``SEC. 127. 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) 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 (25 
U.S.C. 450 et seq.), which are appropriated under the authority of this 
section, for the purposes of--</DELETED>
        <DELETED>    ``(1) eliminating the deficiencies in health 
        status and health 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, including the use of telehealth 
        and telemedicine when appropriate;</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 
        deficiencies 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.</DELETED>
                <DELETED>    ``(K) Traditional Health Care 
                Practices.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Allocation; Use.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(d) Provisions Relating to Health Status and Resource 
Deficiencies.--For the purposes of this section, the following 
definitions apply:</DELETED>
        <DELETED>    ``(1) Definition.--The term `health status and 
        resource deficiency' means the extent to which--</DELETED>
                <DELETED>    ``(A) the health status objectives set 
                forth in section 3(2) are 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) 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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(f) Report.--By no later than the date that is 3 years 
after the date of enactment of the Indian Health Care Improvement Act 
Amendments of 2005, 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--</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 or a 
        Tribal Health Program;</DELETED>
        <DELETED>    ``(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</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 Tribal Organization;</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, 
                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>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(i) Funding 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.--There is established an Indian 
Catastrophic Health Emergency Fund (hereafter in this section referred 
to as the `CHEF') consisting of--</DELETED>
        <DELETED>    ``(1) the amounts deposited under subsection (f); 
        and</DELETED>
        <DELETED>    ``(2) the amounts appropriated to CHEF under this 
        section.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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 
(25 U.S.C. 450 et seq.), nor shall CHEF funds be allocated, 
apportioned, or delegated on an Area Office, Service Unit, or other 
similar basis.</DELETED>
<DELETED>    ``(d) Regulations.--The Secretary shall, through the 
negotiated rulemaking process under title VIII, promulgate regulations 
consistent with the provisions of this section to--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) the 2000 level of $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 that exceeds such threshold cost 
        incurred by--</DELETED>
                <DELETED>    ``(A) Service Units; or</DELETED>
                <DELETED>    ``(B) whenever otherwise authorized by the 
                Service, non-Service facilities or providers;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

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

<DELETED>    ``(a) Findings.--Congress finds that health promotion and 
disease prevention activities--</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 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).</DELETED>
<DELETED>    ``(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--</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 and 
        Tribal Health Programs to meet such needs; and</DELETED>
        <DELETED>    ``(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.</DELETED>

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

<DELETED>    ``(a) Determinations Regarding Diabetes.--The Secretary, 
acting through the Service, and in consultation with Indian Tribes and 
Tribal Organizations, shall determine--</DELETED>
        <DELETED>    ``(1) by Indian Tribe and by Service Unit, the 
        incidence of, and the types of complications resulting from, 
        diabetes among Indians; and</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Funding for Diabetes.--The Secretary shall continue 
to maintain each model diabetes project in existence on the date of 
enactment of the Indian Health Amendments Care Improvement Act of 2005, 
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 2005 and for projects which 
are added and funded thereafter.</DELETED>
<DELETED>    ``(d) Funding for Dialysis Programs.--The Secretary is 
authorized to provide funding through the Service, Indian Tribes, and 
Tribal Organizations to establish dialysis programs, including funding 
to purchase dialysis equipment and provide necessary 
staffing.</DELETED>
<DELETED>    ``(e) Other Duties of the Secretary.--The Secretary shall, 
to the extent funding is available--</DELETED>
        <DELETED>    ``(1) in each Area Office, 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 a registry of 
        patients with diabetes to track the incidence 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 are disseminated to all other Area Offices, subject to 
        applicable patient privacy laws.</DELETED>

<DELETED>``SEC. 205. SHARED SERVICES FOR LONG-TERM CARE.</DELETED>

<DELETED>    ``(a) Long-Term Care.--Notwithstanding any other provision 
of law, the Secretary, acting through the Service, is authorized to 
provide directly, or enter into contracts or compacts under the Indian 
Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) 
with Indian Tribes or Tribal Organizations for, the delivery of long-
term care and similar services to Indians. Such agreements 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 contract or compact 
under the Indian Self-Determination and Education Assistance Act (25 
U.S.C. 450 et seq.)) by such Indian Tribe or Tribal 
Organization.</DELETED>
<DELETED>    ``(b) Contents of Agreements.--An agreement entered into 
pursuant to subsection (a)--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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).</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

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

<DELETED>    ``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. The Secretary shall 
also, to the maximum extent practicable, coordinate departmental 
research resources and activities to address relevant Indian Health 
Program 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.</DELETED>

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

<DELETED>    ``The Secretary, acting through the Service or Tribal 
Health Programs, shall provide for screening as follows:</DELETED>
        <DELETED>    ``(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 accepted and 
        appropriate national standards, and under such terms and 
        conditions as are consistent with standards established by the 
        Secretary to ensure the safety and accuracy of screening 
        mammography under part B of title XVIII of such Act.</DELETED>
        <DELETED>    ``(2) Other cancer screening meeting accepted and 
        appropriate national standards.</DELETED>

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

<DELETED>    ``The Secretary, acting through the Service and Tribal 
Health Programs, is authorized to 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 a contract or 
compact under the Indian Self-Determination and Education Assistance 
Act (25 U.S.C. 450 et seq.)) under this Act--</DELETED>
        <DELETED>    ``(1) emergency air transportation and non-
        emergency air transportation where ground transportation is 
        infeasible;</DELETED>
        <DELETED>    ``(2) transportation by private vehicle (where no 
        other means of transportation is available), specially equipped 
        vehicle, and ambulance; and</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) Additional Centers.--In addition to those 
epidemiology centers already established as of the date of enactment of 
this Act, and without reducing the funding levels for such centers, not 
later than 180 days after the date of enactment of the Indian Health 
Care Improvement Act Amendments of 2005, 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.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(2) evaluate existing delivery systems, data 
        systems, and other systems that impact the improvement of 
        Indian health;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(4) make recommendations for the targeting of 
        services needed by the populations served;</DELETED>
        <DELETED>    ``(5) make recommendations to improve health care 
        delivery systems for Indians and Urban Indians;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(7) provide disease surveillance and assist 
        Indian Tribes, Tribal Organizations, and Urban Indian 
        Organizations to promote public health.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

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

<DELETED>    ``(a) Funding for Development of Programs.--In addition to 
carrying out any other program for health promotion or disease 
prevention, the Secretary, acting through the Service, is authorized to 
award grants 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.</DELETED>
<DELETED>    ``(b) Use of Funds.--Funding provided under this section 
may be used for purposes which may include, but are not limited to, the 
following:</DELETED>
        <DELETED>    ``(1) Developing and implementing health education 
        curricula both for regular school programs and afterschool 
        programs.</DELETED>
        <DELETED>    ``(2) Training teachers in comprehensive school 
        health education curricula.</DELETED>
        <DELETED>    ``(3) Integrating school-based, community-based, 
        and other public and private health promotion 
        efforts.</DELETED>
        <DELETED>    ``(4) Encouraging healthy, tobacco-free school 
        environments.</DELETED>
        <DELETED>    ``(5) Coordinating school-based health programs 
        with existing services and programs available in the 
        community.</DELETED>
        <DELETED>    ``(6) Developing school programs on nutrition 
        education, personal health, oral health, and fitness.</DELETED>
        <DELETED>    ``(7) Developing behavioral health wellness 
        programs.</DELETED>
        <DELETED>    ``(8) Developing chronic disease prevention 
        programs.</DELETED>
        <DELETED>    ``(9) Developing substance abuse prevention 
        programs.</DELETED>
        <DELETED>    ``(10) Developing injury prevention and safety 
        education programs.</DELETED>
        <DELETED>    ``(11) Developing activities for the prevention 
        and control of communicable diseases.</DELETED>
        <DELETED>    ``(12) Developing community and environmental 
        health education programs that include traditional health care 
        practitioners.</DELETED>
        <DELETED>    ``(13) Violence prevention.</DELETED>
        <DELETED>    ``(14) Such other health issues as are 
        appropriate.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(e) Development of Program for BIA Funded Schools.--
</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Requirements for programs.--Such programs 
        shall include--</DELETED>
                <DELETED>    ``(A) school programs on nutrition 
                education, personal health, oral health, and 
                fitness;</DELETED>
                <DELETED>    ``(B) behavioral 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) Duties of the secretary.--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) 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.</DELETED>
<DELETED>    ``(b) Use of Funds.--</DELETED>
        <DELETED>    ``(1) Allowable uses.--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) Prohibited use.--Funds made available under 
        this section may not be used to provide services described in 
        section 707(c).</DELETED>
<DELETED>    ``(c) Duties of the Secretary.--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 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.</DELETED>

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

<DELETED>    ``(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:</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.</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.</DELETED>
        <DELETED>    ``(4) Demonstration projects for the screening, 
        treatment, and prevention of hepatitis C virus (HCV).</DELETED>
<DELETED>    ``(b) Application Required.--The Secretary may provide 
funding under subsection (a) only if an application or proposal for 
funding is submitted to the Secretary.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(d) Technical Assistance; Report.--In carrying out this 
section, the Secretary--</DELETED>
        <DELETED>    ``(1) may, at the request of an Indian Tribe, 
        Tribal Organization, or Urban Indian Organization, provide 
        technical assistance; and</DELETED>
        <DELETED>    ``(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.</DELETED>

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

<DELETED>    ``(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, including--</DELETED>
        <DELETED>    ``(1) hospice care;</DELETED>
        <DELETED>    ``(2) assisted living;</DELETED>
        <DELETED>    ``(3) long-term health care;</DELETED>
        <DELETED>    ``(4) home- and community-based services; 
        and</DELETED>
        <DELETED>    ``(5) public health functions.</DELETED>
<DELETED>    ``(b) Services to Otherwise Ineligible Persons.--Subject 
to section 807, at the discretion of the Service, Indian Tribes, or 
Tribal Organizations, services provided for hospice care, home- and 
community-based care, assisted living, and long-term care may be 
provided (subject to reimbursement) 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 the Service or an Indian Tribe or Tribal Organization.</DELETED>
<DELETED>    ``(c) Definitions.--For the purposes of this section, the 
following definitions shall apply:</DELETED>
        <DELETED>    ``(1) 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) Respite care.</DELETED>
                <DELETED>    ``(F) Training for family 
                members.</DELETED>
                <DELETED>    ``(G) Adult day care.</DELETED>
                <DELETED>    ``(H) Such other home- and community-based 
                services as the Secretary, an Indian tribe, or a Tribal 
                Organization may approve.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(3) The term `public health functions' means the 
        provision of public health-related programs, functions, and 
        services, including 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.</DELETED>

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

<DELETED>    ``The Secretary, acting through the Service and Indian 
Tribes, Tribal Organizations, and Urban Indian Organizations, shall 
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) 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--</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 reservations and Indian communities, including the 
        cumulative effect 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 reservations or Indian 
        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 and 
        recommendations provided in Federal and State studies, reports, 
        investigations, and inspections during the 5 years prior to the 
        date of enactment of the Indian Health Care Improvement Act 
        Amendments of 2005 that directly or indirectly relate to the 
        activities, practices, and conditions affecting the health or 
        safety of such Indians; and</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--</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 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 
enactment of the Indian Health Care Improvement Act Amendments of 2005. 
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.</DELETED>
<DELETED>    ``(d) Intergovernmental Task Force.--</DELETED>
        <DELETED>    ``(1) Establishment; members.--There is 
        established an Intergovernmental Task Force to be composed of 
        the following individuals (or their designees):</DELETED>
                <DELETED>    ``(A) The Secretary of Energy.</DELETED>
                <DELETED>    ``(B) The Secretary 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>    ``(F) The Secretary of Health and Human 
                Services.</DELETED>
                <DELETED>    ``(G) The Director of the Indian Health 
                Service.</DELETED>
        <DELETED>    ``(2) Duties.--The Task Force shall--</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(e) Health Services to Certain Employees.--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 an Indian Health Program; 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, 
        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.</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) 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).</DELETED>

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

<DELETED>    ``(a) In General.--Beginning in fiscal year 2003, the 
States of North Dakota and 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 North Dakota and South Dakota.</DELETED>
<DELETED>    ``(b) Limitation.--The Service shall not curtail any 
health care services provided to Indians residing on any reservation, 
or in any county that has a common boundary with any reservation, in 
the State of North Dakota or South Dakota if such curtailment is due to 
the provision of contract services in such States pursuant to the 
designation of such States as a contract health service delivery area 
pursuant to subsection (a).</DELETED>

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

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(e) Advisory Board.--There is established an advisory 
board which shall advise the CRIHB in carrying out this section. The 
advisory board shall be composed of representatives, selected by the 
CRIHB, from not less than 8 Tribal Health Programs serving California 
Indians covered under this section at least one half of whom of whom 
are not affiliated with the CRIHB.</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 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.</DELETED>

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

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</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 Tribal Health Programs 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 a Tribal Health 
Program shall, if licensed in any State, be exempt from the licensing 
requirements of the State in which the Tribal Health Program performs 
the services described in its contract or compact under the Indian 
Self-Determination and Education Assistance Act (25 U.S.C. 450 et 
seq.).</DELETED>

<DELETED>``SEC. 222. NOTIFICATION OF PROVISION OF 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) 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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

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

<DELETED>    ``(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.</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 not later than 5 business days after receipt of a 
notification of a claim by a provider of contract care 
services.</DELETED>
<DELETED>    ``(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.</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) 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--</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 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.</DELETED>
<DELETED>    ``(b) Closures.--</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) the accessibility of alternative 
                health care resources for the population served by such 
                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 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 facility concerning such 
                closure;</DELETED>
                <DELETED>    ``(F) the level of use of such facility by 
                all eligible Indians; and</DELETED>
                <DELETED>    ``(G) the distance between such facility 
                and the nearest operating Service hospital.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Health Care Facility Priority System.--</DELETED>
        <DELETED>    ``(1) In general.--</DELETED>
                <DELETED>    ``(A) Establishment.--The Secretary, 
                acting through the Service, shall establish a health 
                care facility priority system, which shall--</DELETED>
                        <DELETED>    ``(i) be developed with Indian 
                        Tribes and Tribal Organizations through 
                        negotiated rulemaking under section 
                        802;</DELETED>
                        <DELETED>    ``(ii) give Indian Tribes' needs 
                        the highest priority; and</DELETED>
                        <DELETED>    ``(iii) at a minimum, include the 
                        lists required in paragraph (2)(B) and the 
                        methodology required in paragraph 
                        (2)(E).</DELETED>
                <DELETED>    ``(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 2005 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 enactment of such Act.</DELETED>
        <DELETED>    ``(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:</DELETED>
                <DELETED>    ``(A) A description of the health care 
                facility priority system of the Service, established 
                under paragraph (1).</DELETED>
                <DELETED>    ``(B) Health care facilities lists, 
                including--</DELETED>
                        <DELETED>    ``(i) the 10 top-priority 
                        inpatient health care facilities;</DELETED>
                        <DELETED>    ``(ii) the 10 top-priority 
                        outpatient health care facilities;</DELETED>
                        <DELETED>    ``(iii) the 10 top-priority 
                        specialized health care facilities (such as 
                        long-term care and alcohol and drug abuse 
                        treatment);</DELETED>
                        <DELETED>    ``(iv) the 10 top-priority staff 
                        quarters developments associated with health 
                        care facilities; and</DELETED>
                        <DELETED>    ``(v) the 10 top-priority hostels 
                        associated with health care 
                        facilities.</DELETED>
                <DELETED>    ``(C) The justification for such order of 
                priority.</DELETED>
                <DELETED>    ``(D) The projected cost of such 
                projects.</DELETED>
                <DELETED>    ``(E) The methodology adopted by the 
                Service in establishing priorities under its health 
                care facility priority system.</DELETED>
        <DELETED>    ``(3) Requirements for preparation of reports.--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, 
                Tribal Organizations, and Urban Indian Organizations; 
                and</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(4) Criteria for evaluating needs.--For purposes 
        of this subsection, the Secretary shall, in evaluating the 
        needs of facilities operated under any contract or compact 
        under the Indian Self-Determination and Education Assistance 
        Act (25 U.S.C. 450 et seq.) use the same criteria that the 
        Secretary uses in evaluating the needs of facilities operated 
        directly by the Service.</DELETED>
        <DELETED>    ``(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 contracts or compacts 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.</DELETED>
<DELETED>    ``(d) Review of Need for Facilities.--</DELETED>
        <DELETED>    ``(1) Initial report.--In the year 2006, 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.</DELETED>
        <DELETED>    ``(2) Beginning in the year 2006, the Secretary 
        shall update the report required under paragraph (1) every 5 
        years.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(4) For purposes of this subsection, the reports 
        shall, regarding the needs of facilities operated under any 
        contract or compact under the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 450 et seq.), be based on 
        the same criteria that the Secretary uses in evaluating the 
        needs of facilities operated directly by the Service.</DELETED>
        <DELETED>    ``(5) The planning, design, construction, and 
        renovation needs of facilities operated under contracts or 
        compacts under the Indian Self-Determination and Education 
        Assistance Act (25 U.S.C. 450 et seq.) shall be fully and 
        equitably integrated into the development of the health 
        facility priority system.</DELETED>
        <DELETED>    ``(6) Beginning in 2007 and each fiscal year 
        thereafter, the Secretary shall provide an opportunity for 
        nomination of planning, design, and construction projects by 
        the Service, Indian Tribes, Tribal Organizations, and Urban 
        Indian Organizations for consideration under the health care 
        facility priority system.</DELETED>
<DELETED>    ``(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.).</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 302. SANITATION FACILITIES.</DELETED>

<DELETED>    ``(a) Findings.--Congress finds the following:</DELETED>
        <DELETED>    ``(1) The provision of sanitation 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 sanitation 
        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 
        sanitation facilities and other preventive health 
        measures.</DELETED>
        <DELETED>    ``(4) Many Indian homes and Indian communities 
        still lack sanitation facilities.</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 sanitation facilities.</DELETED>
<DELETED>    ``(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:</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Funding.--Notwithstanding any other provision of 
law--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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);</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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 contracts or 
        compacts under the Indian Self-Determination and Education 
        Assistance Act (25 U.S.C. 450 et seq.);</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(f) Operation, Management, and Maintenance of 
Facilities.--The Indian Tribe 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 or Tribal Organization 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.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) any funds appropriated pursuant to this 
        section; and</DELETED>
        <DELETED>    ``(2) any funds appropriated for the purpose of 
        providing sanitation facilities.</DELETED>
<DELETED>    ``(h) Report.--</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) the current Indian sanitation 
                facility priority system of the Service;</DELETED>
                <DELETED>    ``(B) the methodology for determining 
                sanitation deficiencies and needs;</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(E) a 10-year plan to provide sanitation 
                facilities to serve existing Indian homes and Indian 
                communities and new and renovated Indian 
                homes.</DELETED>
        <DELETED>    ``(2) Criteria.--The criteria on which the 
        deficiencies and needs will be evaluated shall be developed 
        through negotiated rulemaking pursuant to section 
        802.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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:</DELETED>
                <DELETED>    ``(A) A level I deficiency exists if a 
                sanitation facility serving an individual, Indian 
                Tribe, or Indian community--</DELETED>
                        <DELETED>    ``(i) complies with all applicable 
                        water supply, pollution control, and solid 
                        waste disposal laws; and</DELETED>
                        <DELETED>    ``(ii) deficiencies relate to 
                        routine replacement, repair, or maintenance 
                        needs.</DELETED>
                <DELETED>    ``(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--</DELETED>
                        <DELETED>    ``(i) small or minor capital 
                        improvements needed to bring the facility back 
                        into compliance;</DELETED>
                        <DELETED>    ``(ii) 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) the lack of equipment or 
                        training by an Indian Tribe, Tribal 
                        Organization, or an Indian community to 
                        properly operate and maintain the sanitation 
                        facilities.</DELETED>
                <DELETED>    ``(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--</DELETED>
                        <DELETED>    ``(i) water or sewer service in 
                        the home is provided by a haul system with 
                        holding tanks and interior plumbing;</DELETED>
                        <DELETED>    ``(ii) major significant 
                        interruptions to water supply or sewage 
                        disposal occur frequently, requiring major 
                        capital improvements to correct the 
                        deficiencies; or</DELETED>
                        <DELETED>    ``(iii) there is no access to or 
                        no approved or permitted solid waste facility 
                        available.</DELETED>
                <DELETED>    ``(D) A level IV deficiency exists if--
                </DELETED>
                        <DELETED>    ``(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</DELETED>
                        <DELETED>    ``(ii) where only a washeteria or 
                        central facility exists in the 
                        community.</DELETED>
                <DELETED>    ``(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.</DELETED>
<DELETED>    ``(i) Definitions.--For purposes of this section, the 
following terms apply:</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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).</DELETED>

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

<DELETED>    ``(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--</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) Labor Standards.--</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) is performed by a contractor 
                pursuant to a contract with an Indian Tribe or Tribal 
                Organization with funds supplied through a contract or 
                compact authorized by the Indian Self-Determination and 
                Education Assistance Act, or other statutory authority; 
                and</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Exception.--This subsection shall not apply 
        to construction or renovation carried out by an Indian Tribe or 
        Tribal Organization with its own employees.</DELETED>

<DELETED>``SEC. 304. EXPENDITURE OF NONSERVICE FUNDS FOR 
              RENOVATION.</DELETED>

<DELETED>    ``(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 contract or compact under the Indian 
Self-Determination and Education Assistance Act (25 U.S.C. 450 et 
seq.), including--</DELETED>
        <DELETED>    ``(1) any plans or designs for such expansion, 
        renovation, or modernization; and</DELETED>
        <DELETED>    ``(2) any expansion, renovation, or modernization 
        for which funds appropriated under any Federal law were 
        lawfully expended.</DELETED>
<DELETED>    ``(b) Priority List.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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).</DELETED>
<DELETED>    ``(c) Requirements.--The requirements of this subsection 
are met with respect to any expansion, renovation, or modernization 
if--</DELETED>
        <DELETED>    ``(1) the Indian 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>    ``(d) Additional Requirement for Expansion.--In addition 
to the requirements under subsection (c), for any expansion, 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.</DELETED>
<DELETED>    ``(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.</DELETED>

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

<DELETED>    ``(a) Funding.--</DELETED>
        <DELETED>    ``(1) In general.--The Secretary, acting through 
        the Service, in consultation with Indian Tribes and Tribal 
        Organizations, shall make grants 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.</DELETED>
        <DELETED>    ``(2) 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).</DELETED>
<DELETED>    ``(b) Use of Funds.--</DELETED>
        <DELETED>    ``(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--</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 or modernization will--</DELETED>
                        <DELETED>    ``(i) have a total capacity 
                        appropriate to its projected service 
                        population;</DELETED>
                        <DELETED>    ``(ii) provide annually no fewer 
                        than 150 patient visits by eligible Indians and 
                        other users who are eligible for services in 
                        such facility in accordance with section 
                        807(c)(2); and</DELETED>
                        <DELETED>    ``(iii) provide ambulatory care in 
                        a Service Area (specified in the contract or 
                        compact under the Indian Self-Determination and 
                        Education Assistance Act (25 U.S.C. 450 et 
                        seq.)) 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).</DELETED>
        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(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 that benefits the Service population 
        identified above in subsection (b)(1)(C) (ii) and (iii). The 
        requirements of clauses (ii) and (iii) of paragraph (1)(C) 
        shall not apply to an Indian Tribe or Tribal Organization 
        applying for funding under this section 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.</DELETED>
<DELETED>    ``(c) Funding.--</DELETED>
        <DELETED>    ``(1) Application.--No funding may be made 
        available under this section unless an application or proposal 
        for such funding has been approved by the Secretary in 
        accordance with applicable regulations and has forth reasonable 
        assurance by the applicant that, at all times after the 
        construction, expansion, or modernization of a facility carried 
        out pursuant to funding received under this section--</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 funding under this 
        section, the Secretary shall give priority to Indian 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>    ``(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).</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRATION 
              PROJECT.</DELETED>

<DELETED>    ``(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 
agreements 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.</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) 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 2005. 
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.</DELETED>
<DELETED>    ``(d) Criteria.--The Secretary may approve projects that 
meet the following criteria:</DELETED>
        <DELETED>    ``(1) There is a need for a new facility or 
        program or the reorientation of an existing facility or 
        program.</DELETED>
        <DELETED>    ``(2) A significant number of Indians, including 
        those with low health status, will be served by the 
        project.</DELETED>
        <DELETED>    ``(3) The project has the potential to deliver 
        services in an efficient and effective manner.</DELETED>
        <DELETED>    ``(4) The project is economically 
        viable.</DELETED>
        <DELETED>    ``(5) The Indian Tribe or Tribal Organization has 
        the administrative and financial capability to administer the 
        project.</DELETED>
        <DELETED>    ``(6) The project is integrated with providers of 
        related health and social services and is coordinated with, and 
        avoids duplication of, existing services.</DELETED>
<DELETED>    ``(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).</DELETED>
<DELETED>    ``(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):</DELETED>
        <DELETED>    ``(1) Cass Lake, Minnesota.</DELETED>
        <DELETED>    ``(2) Clinton, Oklahoma.</DELETED>
        <DELETED>    ``(3) Harlem, Montana.</DELETED>
        <DELETED>    ``(4) Mescalero, New Mexico.</DELETED>
        <DELETED>    ``(5) Owyhee, Nevada.</DELETED>
        <DELETED>    ``(6) Parker, Arizona.</DELETED>
        <DELETED>    ``(7) Schurz, Nevada.</DELETED>
        <DELETED>    ``(8) Winnebago, Nebraska.</DELETED>
        <DELETED>    ``(9) Ft. Yuma, California.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(h) Service to Ineligible Persons.--Subject to section 
807, 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.</DELETED>
<DELETED>    ``(i) Equitable Treatment.--For purposes of subsection 
(d)(1), the Secretary shall, in evaluating facilities operated under 
any contract or compact under the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450 et seq.), use the same criteria 
that the Secretary uses in evaluating facilities operated directly by 
the Service.</DELETED>
<DELETED>    ``(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 contract or compact under the Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450 et seq.) for health 
services are fully and equitably integrated into the implementation of 
the health care delivery demonstration projects under this 
section.</DELETED>

<DELETED>``SEC. 307. LAND TRANSFER.</DELETED>

<DELETED>    ``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>``SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND LOAN 
              REPAYMENT.</DELETED>

<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) inpatient facilities;</DELETED>
        <DELETED>    ``(2) outpatient facilities;</DELETED>
        <DELETED>    ``(3) staff quarters;</DELETED>
        <DELETED>    ``(4) hostels; and</DELETED>
        <DELETED>    ``(5) specialized care facilities, such as 
        behavioral health and elder care facilities.</DELETED>
<DELETED>    ``(b) Determinations.--In carrying out the study under 
subsection (a), the Secretary shall determine--</DELETED>
        <DELETED>    ``(1) the maximum principal amount of a loan or 
        loan guarantee that should be offered to a recipient from the 
        loan fund;</DELETED>
        <DELETED>    ``(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));</DELETED>
        <DELETED>    ``(3) the cumulative total of the principal of 
        direct loans and loan guarantees, respectively, that may be 
        outstanding at any 1 time;</DELETED>
        <DELETED>    ``(4) the maximum term of a loan or loan guarantee 
        that may be made for a facility from the loan fund;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(10) any legislative or regulatory changes 
        required to implement recommendations of the Secretary based on 
        results of the study.</DELETED>
<DELETED>    ``(c) Report.--Not later than September 30, 2007, 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--</DELETED>
        <DELETED>    ``(1) the manner of consultation made as required 
        by subsection (a); and</DELETED>
        <DELETED>    ``(2) the results of the study, including any 
        recommendations of the Secretary based on results of the 
        study.</DELETED>

<DELETED>``SEC. 310. TRIBAL LEASING.</DELETED>

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

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

<DELETED>    ``(a) In General.--The Secretary, acting through the 
Service, shall make arrangements with Indian Tribes and Tribal 
Organizations to establish joint venture demonstration projects under 
which an Indian Tribe or Tribal Organization shall expend tribal, 
private, or other available funds, for the acquisition or construction 
of a health facility for a minimum of 10 years, under a no-cost lease, 
in exchange for agreement by the Service to provide the equipment, 
supplies, and staffing for the operation and maintenance of such a 
health facility. An Indian Tribe or Tribal Organization may use tribal 
funds, private sector, or other available resources, including loan 
guarantees, to fulfill its commitment under a joint venture entered 
into under this subsection. An Indian Tribe or Tribal Organization 
shall be eligible to establish a joint venture project if, when it 
submits a letter of intent, it--</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(2) has not begun the process of acquisition or 
        construction of a health facility for use in the joint venture 
        project.</DELETED>
<DELETED>    ``(b) Requirements.--The Secretary shall make such an 
arrangement with an Indian Tribe or Tribal Organization only if--
</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 312. LOCATION OF FACILITIES.</DELETED>

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

<DELETED>``SEC. 313. 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 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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY OWNED 
              QUARTERS.</DELETED>

<DELETED>    ``(a) Rental Rates.--</DELETED>
        <DELETED>    ``(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 contract or compact 
        under the Indian Self-Determination and Education Assistance 
        Act (25 U.S.C. 450 et seq.) 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.</DELETED>
        <DELETED>    ``(2) Objectives.--In establishing rental rates 
        pursuant to authority of this subsection, a Tribal Health 
        Program shall endeavor to achieve the following 
        objectives:</DELETED>
                <DELETED>    ``(A) To base such rental rates on the 
                reasonable value of the quarters to the occupants 
                thereof.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Direct Collection of Rent.--</DELETED>
        <DELETED>    ``(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:</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(B) such other date as may be mutually 
                agreed by the Secretary and the Tribal Health 
                Program.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 315. APPLICABILITY OF BUY AMERICAN ACT 
              REQUIREMENT.</DELETED>

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

<DELETED>``SEC. 316. OTHER FUNDING FOR FACILITIES.</DELETED>

<DELETED>    ``(a) Authority To Accept Funds.--The Secretary is 
authorized to accept from any source, including Federal and State 
agencies, funds that are available for the construction of health care 
facilities and use such funds to plan, design, and construct health 
care facilities for Indians and to place such funds into a contract or 
compact 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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 317. 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 IV--ACCESS TO HEALTH SERVICES</DELETED>

<DELETED>``SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SECURITY ACT 
              HEALTH CARE PROGRAMS.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Use of Funds.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(d) Direct Billing.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Direct reimbursement.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 402. GRANTS TO AND CONTRACTS WITH THE SERVICE, INDIAN 
              TRIBES, TRIBAL ORGANIZATIONS, AND URBAN INDIAN 
              ORGANIZATIONS.</DELETED>

<DELETED>    ``(a) Indian Tribes and Tribal Organizations.--The 
Secretary, acting through the Service, shall make grants to or enter 
into contracts 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--</DELETED>
        <DELETED>    ``(1) to enroll for benefits under title XVIII, 
        XIX, or XXI of the Social Security Act and other health 
        benefits programs; and</DELETED>
        <DELETED>    ``(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).</DELETED>
<DELETED>    ``(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 contract 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--</DELETED>
        <DELETED>    ``(1) to determine the population of Indians 
        eligible for the benefits described in subsection 
        (a);</DELETED>
        <DELETED>    ``(2) to educate Indians with respect to the 
        benefits available under the respective programs;</DELETED>
        <DELETED>    ``(3) to provide transportation for such 
        individual Indians to the appropriate offices for enrollment or 
        applications for such benefits; and</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Agreements Relating to Improving Enrollment of 
Indians Under Social Security Act Programs.--</DELETED>
        <DELETED>    ``(1) Agreements with secretary to improve receipt 
        and processing of applications.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(C) Processing clarified.--In this 
                paragraph, the term `processing' does not include a 
                final determination of eligibility.</DELETED>
        <DELETED>    ``(2) Agreements with states for outreach on or 
        near reservation.--</DELETED>
                <DELETED>    ``(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, the Secretary shall encourage the State 
                to take steps 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.</DELETED>
                <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(e) Application to Urban Indian Organizations.--
</DELETED>
        <DELETED>    ``(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 contracts with Indian Tribes and Tribal Organizations with 
        respect to programs on or near reservations.</DELETED>
        <DELETED>    ``(2) Requirements.--The Secretary shall include 
        in the grants or contracts made or provided under paragraph (1) 
        requirements that are--</DELETED>
                <DELETED>    ``(A) consistent with the requirements 
                imposed by the Secretary under subsection 
                (b);</DELETED>
                <DELETED>    ``(B) appropriate to Urban Indian 
                Organizations and Urban Indians; and</DELETED>
                <DELETED>    ``(C) necessary to effect the purposes of 
                this section.</DELETED>

<DELETED>``SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS 
              OF HEALTH SERVICES.</DELETED>

<DELETED>    ``(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 as determined by the Secretary, and billed 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--</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 charges or 
        expenses.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) workers' compensation laws; or</DELETED>
        <DELETED>    ``(2) a no-fault automobile accident insurance 
        plan or program.</DELETED>
<DELETED>    ``(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).</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(e) Enforcement.--</DELETED>
        <DELETED>    ``(1) In general.--The United States, an Indian 
        Tribe, or Tribal Organization may enforce the right of recovery 
        provided under subsection (a) 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</DELETED>
                        <DELETED>    ``(ii) by any representative or 
                        heirs of such individual, or</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(h) 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.</DELETED>
<DELETED>    ``(i) 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.</DELETED>
<DELETED>    ``(j) 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.</DELETED>
<DELETED>    ``(k) 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.).</DELETED>

<DELETED>``SEC. 404. CREDITING OF REIMBURSEMENTS.</DELETED>

<DELETED>    ``(a) Use of Amounts.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Programs covered.--The programs referred to 
        in paragraph (1) are the following:</DELETED>
                <DELETED>    ``(A) Titles XVIII, XIX, and XXI of the 
                Social Security Act.</DELETED>
                <DELETED>    ``(B) This Act, including section 
                807.</DELETED>
                <DELETED>    ``(C) Public Law 87-693.</DELETED>
                <DELETED>    ``(D) Any other provision of 
                law.</DELETED>
<DELETED>    ``(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).</DELETED>

<DELETED>``SEC. 405. PURCHASING HEALTH CARE COVERAGE.</DELETED>

<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) a tribally owned and operated health care 
        plan;</DELETED>
        <DELETED>    ``(2) a State or locally authorized or licensed 
        health care plan;</DELETED>
        <DELETED>    ``(3) a health insurance provider or managed care 
        organization; or</DELETED>
        <DELETED>    ``(4) a self-insured plan.</DELETED>
<DELETED>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).</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Construction.--Nothing in this section shall be 
construed as affecting the use of any amounts not referred to in 
subsection (a).</DELETED>

<DELETED>``SEC. 406. SHARING ARRANGEMENTS WITH FEDERAL 
              AGENCIES.</DELETED>

<DELETED>    ``(a) Authority.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</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 and the eligibility 
        of any Indian to receive health services 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 Department of Veterans 
        Affairs;</DELETED>
        <DELETED>    ``(4) the quality of health care services provided 
        by the Department of Veterans Affairs or the Department of 
        Defense; or</DELETED>
        <DELETED>    ``(5) the eligibility of any Indian who is a 
        veteran to receive health services through the Department of 
        Veterans Affairs.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 407. PAYOR OF LAST RESORT.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 408. NONDISCRIMINATION IN QUALIFICATIONS FOR 
              REIMBURSEMENT FOR SERVICES.</DELETED>

<DELETED>    ``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. Such program must provide that such entity, 
meeting generally applicable State or other requirements applicable for 
participation, must be accepted as a provider on the same basis as any 
other qualified provider, except that 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 or other documentation. 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.</DELETED>

<DELETED>``SEC. 409. CONSULTATION.</DELETED>

<DELETED>    ``(a) Tribal Technical Advisory Group (TTAG).--The 
Secretary shall maintain within the Centers for Medicaid & Medicare 
Services (CMS) a Tribal Technical Advisory Group, established in 
accordance with requirements of the charter dated September 30, 2003, 
and in such group shall include a representative of the Urban Indian 
Organizations and the Service. The representative of the Urban Indian 
Organization shall be deemed to be an elected officer of a tribal 
government for purposes of applying section 204(b) of the Unfunded 
Mandates Reform Act of 1995 (2 U.S.C. 1534(b)).</DELETED>
<DELETED>    ``(b) Solicitation of Medicaid Advice.--</DELETED>
        <DELETED>    ``(1) In general.--As part of its plan under title 
        XIX of the Social Security Act, 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, 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 likely to have a direct effect on such Indian 
        Health Programs and Urban Indian Organizations.</DELETED>
        <DELETED>    ``(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 likely to have a direct 
        effect on Indians, Indian Health Programs, or Urban Indian 
        Organizations. 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.</DELETED>
        <DELETED>    ``(3) Payment of expenses.--The reasonable 
        expenses of carrying out this subsection shall be eligible for 
        reimbursement under section 1903(a) of the Social Security 
        Act.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 410. STATE CHILDREN'S HEALTH INSURANCE PROGRAM 
              (SCHIP).</DELETED>

<DELETED>    ``(a) Optional Use of Funds for Indian Health Program 
Payments.--Subject to the succeeding provisions of this section, a 
State may provide under its State child health plan under title XXI of 
the Social Security Act (regardless of whether such plan is implemented 
under such title, title XIX of such Act, or both) for payments under 
this section to Indian Health Programs and Urban Indian Organizations 
operating in the State. Such payments shall be treated under title XXI 
of the Social Security Act as expenditures described in section 
2105(a)(1)(A) of such Act.</DELETED>
<DELETED>    ``(b) Use of Funds.--Payments under this section may be 
used only for expenditures described in clauses (i) through (iii) of 
section 2105(a)(1)(D) of the Social Security Act for targeted low-
income children or other low-income children (as defined in 2110 of 
such Act) who are--</DELETED>
        <DELETED>    ``(1) Indians; or</DELETED>
        <DELETED>    ``(2) otherwise eligible for health services from 
        the Indian Health Program involved.</DELETED>
<DELETED>    ``(c) Special Restrictions.--The following conditions 
apply to a State electing to provide payments under this 
section:</DELETED>
        <DELETED>    ``(1) No limitation on other schip participation 
        of, or provider payments to, indian health programs.--The State 
        may not exclude or limit participation of otherwise eligible 
        Indian Health Programs in its State child health program under 
        title XXI of the Social Security Act or its medicaid program 
        under title XIX of such Act or pay such Programs less than they 
        otherwise would as participating providers on the basis that 
        payments are made to such Programs under this 
        section.</DELETED>
        <DELETED>    ``(2) No limitation on other schip eligibility of 
        indians.--The State may not exclude or limit participation of 
        otherwise eligible Indian children in such State child health 
        or medicaid program on the basis that payments are made for 
        assistance for such children under this section.</DELETED>
        <DELETED>    ``(3) Limitation on acceptance of contributions.--
        </DELETED>
                <DELETED>    ``(A) In general.--The State may not 
                accept contributions or condition making of payments 
                under this section upon contribution of funds from any 
                Indian Health Program to meet the State's non-Federal 
                matching fund requirements under titles XIX and XXI of 
                the Social Security Act.</DELETED>
                <DELETED>    ``(B) Contribution defined.--For purposes 
                of subparagraph (A), the term `contribution' includes 
                any tax, donation, fee, or other payment made, whether 
                made voluntarily or involuntarily.</DELETED>
<DELETED>    ``(d) Application of Separate 10 Percent Limitation.--
Payment may be made under section 2105(a) of the Social Security Act to 
a State for a fiscal year for payments under this section up to an 
amount equal to 10 percent of the total amount available under title 
XXI of such Act (including allotments and reallotments available from 
previous fiscal years) to the State with respect to the fiscal 
year.</DELETED>
<DELETED>    ``(e) General Terms.--A payment under this section shall 
only be made upon application to the State from the Indian Health 
Program involved and under such terms and conditions, and in a form and 
manner, as the Secretary determines appropriate.</DELETED>

<DELETED>``SEC. 411. SOCIAL SECURITY ACT SANCTIONS.</DELETED>

<DELETED>    ``(a) Requests for Waiver of Sanctions.--</DELETED>
        <DELETED>    ``(1) In general.--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, the Indian Health Program shall request the State to 
        seek such waiver, and if such State has not sought the waiver 
        within 60 days of the Indian Health Program request, the Indian 
        Health Program itself may petition the Secretary for such 
        waiver.</DELETED>
        <DELETED>    ``(2) Procedure.--In seeking a waiver under 
        paragraph (1), the Indian Health Program must provide notice 
        and a copy of the request, including the reasons for the waiver 
        sought, to the State. The Secretary may consider the State's 
        views in the determination of the waiver request, but may not 
        withhold or delay a determination based on the lack of the 
        State's views.</DELETED>
<DELETED>    ``(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:</DELETED>
        <DELETED>    ``(1) An exchange between or among the 
        following:</DELETED>
                <DELETED>    ``(A) Any Indian Health Program.</DELETED>
                <DELETED>    ``(B) Any Urban Indian 
                Organization.</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) is for the purpose of transporting 
                the patient for the provision of health care items or 
                services;</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(C) is for the purpose of paying 
                premiums, copayments, deductibles, or other cost-
                sharing on behalf of patients; or</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 412. COST SHARING.</DELETED>

<DELETED>    ``(a) Coinsurance, Copayments, and Deductibles.--
Notwithstanding any other provision of Federal or State law--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Protection for indians.--No Indian who is 
        furnished an item or service by the Service may be charged a 
        deductible, copayment, or coinsurance.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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, enrollment fee, or similar charge as a condition of 
receiving benefits under the program under the respective 
title.</DELETED>
<DELETED>    ``(c) 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:</DELETED>
        <DELETED>    ``(1) Property, including real property and 
        improvements, located on a reservation, including any federally 
        recognized Indian Tribe's reservation, Pueblo, or Colony, 
        including former reservations in Oklahoma, Alaska Native 
        regions established by the Alaska Native Claims Settlement Act 
        and Indian allotments on or near a reservation as designated 
        and approved by the Bureau of Indian Affairs of the Department 
        of the Interior.</DELETED>
        <DELETED>    ``(2) For any federally recognized Tribe not 
        described in paragraph (1), property located within the most 
        recent boundaries of a prior Federal reservation.</DELETED>
        <DELETED>    ``(3) Ownership interests in rents, leases, 
        royalties, or usage rights related to natural resources 
        (including extraction of natural resources or harvesting of 
        timber, other plants and plant products, animals, fish, and 
        shellfish) resulting from the exercise of federally protected 
        rights.</DELETED>
        <DELETED>    ``(4) Ownership interests in or usage rights to 
        items not covered by paragraphs (1) through (3) that have 
        unique religious, spiritual, traditional, or cultural 
        significance or rights that support subsistence or a 
        traditional life style according to applicable tribal law or 
        custom.</DELETED>
<DELETED>    ``(d) 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.</DELETED>

<DELETED>``SEC. 413. TREATMENT UNDER MEDICAID MANAGED CARE.</DELETED>

<DELETED>    ``(a) Provision of Services, to Enrollees With Non-Indian 
Medicaid Managed Care Entities, by Indian Health Programs and Urban 
Indian Organizations.--</DELETED>
        <DELETED>    ``(1) Payment rules.--</DELETED>
                <DELETED>    ``(A) In general.--Subject to subparagraph 
                (B), in the case of an Indian who is enrolled with a 
                non-Indian medicaid managed care entity (as defined in 
                subsection (c)) and who receives covered medicaid 
                managed care services from an Indian Health Program or 
                an Urban Indian Organization, whether or not it is a 
                participating provider with respect to such entity, the 
                following rules apply:</DELETED>
                        <DELETED>    ``(i) Direct payment.--The entity 
                        shall make prompt payment (in accordance with 
                        rules applicable to medicaid managed care 
                        entities under title XIX of the Social Security 
                        Act) to the Indian Health Program or Urban 
                        Indian Organization at a rate established by 
                        the entity for such services that is equal to 
                        the rate negotiated between such entity and the 
                        Program or Organization involved or, if such a 
                        rate has not been negotiated, a rate that is 
                        not less than the level and amount of payment 
                        which the entity would make for the services if 
                        the services were furnished by a provider which 
                        is not such a Program or 
                        Organization.</DELETED>
                        <DELETED>    ``(ii) Payment through state.--If 
                        there is no arrangement for direct payment 
                        under clause (i) or if a State provides for 
                        this clause to apply in lieu of clause (i), the 
                        State shall provide for payment to the Indian 
                        Health Program or Urban Indian Organization 
                        under its State program under title XIX of such 
                        Act at the rate that would be otherwise 
                        applicable for such services under such program 
                        and shall provide for an appropriate adjustment 
                        of the capitation payment made to the entity to 
                        take into account such payment.</DELETED>
                <DELETED>    ``(B) Compliance with generally applicable 
                requirements.--</DELETED>
                        <DELETED>    ``(i) In general.--Except as 
                        otherwise provided, as a condition of payment 
                        under subparagraph (A), the Indian Health 
                        Program or Urban Indian Organization shall 
                        comply with the generally applicable 
                        requirements of title XIX of the Social 
                        Security Act with respect to covered 
                        services.</DELETED>
                        <DELETED>    ``(ii) Satisfaction of claim 
                        requirement.--Any requirement for the 
                        submission of a claim or other documentation 
                        for services covered under subparagraph (A) by 
                        the enrollee is deemed to be satisfied through 
                        the submission of a claim or other 
                        documentation by the Indian Health Program or 
                        Urban Indian Organization consistent with 
                        section 403(h).</DELETED>
                <DELETED>    ``(C) Construction.--Nothing in this 
                subsection shall be construed as waiving the 
                application of section 1902(a)(30)(A) of the Social 
                Security Act (relating to application of standards to 
                assure that payments are consistent with efficiency, 
                economy, and quality of care).</DELETED>
        <DELETED>    ``(2) Enrollee option to select an indian health 
        program or urban indian organization as primary care 
        provider.--In the case of a non-Indian medicaid managed care 
        entity that--</DELETED>
                <DELETED>    ``(A) has an Indian enrolled with the 
                entity; and</DELETED>
                <DELETED>    ``(B) has an Indian Health Program or 
                Urban Indian Organization that is participating as a 
                primary care provider within the network of the 
                entity,</DELETED>
        <DELETED>insofar as the Indian is otherwise eligible to receive 
        services from such Program or Organization and the Program or 
        Organization has the capacity to provide primary care services 
        to such Indian, the Indian shall be allowed to choose such 
        Program or Organization as the Indian's primary care provider 
        under the entity.</DELETED>
<DELETED>    ``(b) Offering of Managed Care Through Indian Medicaid 
Managed Care Entities.--If--</DELETED>
        <DELETED>    ``(1) a State elects to provide services through 
        medicaid managed care entities under its medicaid managed care 
        program; and</DELETED>
        <DELETED>    ``(2) an Indian Health Program or Urban Indian 
        Organization that is funded in whole or in part by the Service, 
        or a consortium thereof, has established an Indian medicaid 
        managed care entity in the State that meets generally 
        applicable standards required of such an entity under such 
        medicaid managed care program,</DELETED>
<DELETED>the State shall offer to enter into an agreement with the 
entity to serve as a medicaid managed care entity with respect to 
eligible Indians served by such entity under such program.</DELETED>
<DELETED>    ``(c) Special Rules for Indian Managed Care Entities.--The 
following are special rules regarding the application of a medicaid 
managed care program to Indian medicaid managed care 
entities:</DELETED>
        <DELETED>    ``(1) Enrollment.--</DELETED>
                <DELETED>    ``(A) Limitation to indians.--An Indian 
                medicaid managed care entity may restrict enrollment 
                under such program to Indians and to members of 
                specific Tribes in the same manner as Indian Health 
                Programs may restrict the delivery of services to such 
                Indians and tribal members.</DELETED>
                <DELETED>    ``(B) No less choice of plans.--Under such 
                program the State may not limit the choice of an Indian 
                among medicaid managed care entities only to Indian 
                medicaid managed care entities or to be more 
                restrictive than the choice of managed care entities 
                offered to individuals who are not Indians.</DELETED>
                <DELETED>    ``(C) Default enrollment.--</DELETED>
                        <DELETED>    ``(i) In general.--If such program 
                        of a State requires the enrollment of Indians 
                        in a medicaid managed care entity in order to 
                        receive benefits, the State shall provide for 
                        the enrollment of Indians described in clause 
                        (ii) who are not otherwise enrolled with such 
                        an entity in an Indian medicaid managed care 
                        entity described in such clause.</DELETED>
                        <DELETED>    ``(ii) Indian described.--An 
                        Indian described in this clause, with respect 
                        to an Indian medicaid managed care entity, is 
                        an Indian who, based upon the service area and 
                        capacity of the entity, is eligible to be 
                        enrolled with the entity consistent with 
                        subparagraph (A).</DELETED>
                <DELETED>    ``(D) Exception to state lock-in.--A 
                request by an Indian who is enrolled under such program 
                with a non-Indian medicaid managed care entity to 
                change enrollment with that entity to enrollment with 
                an Indian medicaid managed care entity shall be 
                considered cause for granting such request under 
                procedures specified by the Secretary.</DELETED>
        <DELETED>    ``(2) Flexibility in application of solvency.--In 
        applying section 1903(m)(1) of the Social Security Act to an 
        Indian medicaid managed care entity--</DELETED>
                <DELETED>    ``(A) any reference to a `State' in 
                subparagraph (A)(ii) of that section shall be deemed to 
                be a reference to the `Secretary'; and</DELETED>
                <DELETED>    ``(B) the entity shall be deemed to be a 
                public entity described in subparagraph (C)(ii) of that 
                section.</DELETED>
        <DELETED>    ``(3) Exceptions to advance directives.--The 
        Secretary may modify or waive the requirements of section 
        1902(w) of the Social Security Act (relating to provision of 
        written materials on advance directives) insofar as the 
        Secretary finds that the requirements otherwise imposed are not 
        an appropriate or effective way of communicating the 
        information to Indians.</DELETED>
        <DELETED>    ``(4) Flexibility in information and marketing.--
        </DELETED>
                <DELETED>    ``(A) Materials.--The Secretary may modify 
                requirements under section 1932(a)(5) of the Social 
                Security Act in a manner that improves the materials to 
                take into account the special circumstances of such 
                entities and their enrollees while maintaining and 
                clearly communicating to potential enrollees their 
                rights, protections, and benefits.</DELETED>
                <DELETED>    ``(B) Distribution of marketing 
                materials.--The provisions of section 1932(d)(2)(B) of 
                the Social Security Act requiring the distribution of 
                marketing materials to an entire service area shall be 
                deemed satisfied in the case of an Indian medicaid 
                managed care entity that distributes appropriate 
                materials only to those Indians who are potentially 
                eligible to enroll with the entity in the service 
                area.</DELETED>
<DELETED>    ``(d) Malpractice Insurance.--Insofar as, under a medicaid 
managed care program, a health care provider is required to have 
medical malpractice insurance coverage as a condition of contracting as 
a provider with a medicaid managed care entity, an Indian Health 
Program, or an Urban Indian Organization that is a Federally-qualified 
health center under title XIX of the Social Security Act, that is 
covered under the Federal Tort Claims Act (28 U.S.C. 1346(b), 2671 et 
seq.) is deemed to satisfy such requirement.</DELETED>
<DELETED>    ``(e) Definitions.--For purposes of this 
section:</DELETED>
        <DELETED>    ``(1) Medicaid managed care entity.--The term 
        `medicaid managed care entity' means a managed care entity 
        (whether a managed care organization or a primary care case 
        manager) under title XIX of the Social Security Act, whether 
        pursuant to section 1903(m) or section 1932 of such Act, a 
        waiver under section 1115 or 1915(b) of such Act, or 
        otherwise.</DELETED>
        <DELETED>    ``(2) Indian medicaid managed care entity.--The 
        term `Indian medicaid managed care entity' means a managed care 
        entity that is controlled (within the meaning of the last 
        sentence of section 1903(m)(1)(C) of the Social Security Act) 
        by the Indian Health Service, a Tribe, Tribal Organization, or 
        Urban Indian Organization (as such terms are defined in section 
        4), or a consortium, which may be composed of 1 or more Tribes, 
        Tribal Organizations, or Urban Indian Organizations, and which 
        also may include the Service.</DELETED>
        <DELETED>    ``(3) Non-indian medicaid managed care entity.--
        The term `non-Indian medicaid managed care entity' means a 
        medicaid managed care entity that is not an Indian medicaid 
        managed care entity.</DELETED>
        <DELETED>    ``(4) Covered medicaid managed care services.--The 
        term `covered medicaid managed care services' means, with 
        respect to an individual enrolled with a medicaid managed care 
        entity, items and services that are within the scope of items 
        and services for which benefits are available with respect to 
        the individual under the contract between the entity and the 
        State involved.</DELETED>
        <DELETED>    ``(5) Medicaid managed care program.--The term 
        `medicaid managed care program' means a program under sections 
        1903(m) and 1932 of the Social Security Act and includes a 
        managed care program operating under a waiver under section 
        1915(b) or 1115 of such Act or otherwise.</DELETED>

<DELETED>``SEC. 414. NAVAJO NATION MEDICAID AGENCY FEASIBILITY 
              STUDY.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Considerations.--In conducting the study, the 
Secretary shall consider the feasibility of--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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).</DELETED>
<DELETED>    ``(c) Report.--Not later then 3 years after the date of 
enactment of the Indian Health Act Improvement Act Amendments of 2005, 
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 of the House of Representatives a report 
that includes--</DELETED>
        <DELETED>    ``(1) the results of the study under this 
        section;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 415. 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 V--HEALTH SERVICES FOR URBAN INDIANS</DELETED>

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

<DELETED>    ``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.</DELETED>

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

<DELETED>    ``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.</DELETED>

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

<DELETED>    ``(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, 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) 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).</DELETED>
<DELETED>    ``(d) Immunization Services.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Definition.--For purposes of this 
        subsection, the term `immunization services' means services to 
        provide without charge immunizations against vaccine-
        preventable diseases.</DELETED>
<DELETED>    ``(e) Behavioral Health Services.--</DELETED>
        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(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:</DELETED>
                <DELETED>    ``(A) The behavioral health needs of the 
                Urban Indian population concerned.</DELETED>
                <DELETED>    ``(B) The behavioral health services and 
                other related resources available to that 
                population.</DELETED>
                <DELETED>    ``(C) The barriers to obtaining those 
                services and resources.</DELETED>
                <DELETED>    ``(D) The needs that are unmet by such 
                services and resources.</DELETED>
        <DELETED>    ``(3) Purposes of grants.--Grants may be made 
        under this subsection for the following:</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.</DELETED>
                <DELETED>    ``(D) To develop innovative behavioral 
                health service delivery models which incorporate Indian 
                cultural support systems and resources.</DELETED>
<DELETED>    ``(f) Prevention of Child Abuse.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(3) Purposes of grants.--Grants may be made 
        under this subsection for the following:</DELETED>
                <DELETED>    ``(A) To prepare assessments required 
                under paragraph (2).</DELETED>
                <DELETED>    ``(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.</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 when making grants.--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) 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.</DELETED>

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

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Grant and Contract 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 
        undertakes 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>    ``(d) No Renewals.--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 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.</DELETED>
<DELETED>    ``(b) Evaluations.--The Secretary, acting through the 
Service, shall evaluate the compliance of each Urban Indian 
Organization which has entered into a contract or received a grant 
under section 503 with the terms of such contract or grant. For 
purposes of this evaluation, in determining the capacity of an Urban 
Indian Organization to deliver quality patient care the Secretary 
shall, at the option of the organization--</DELETED>
        <DELETED>    ``(1) acting through the Service, conduct an 
        annual onsite evaluation of the organization; or</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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).</DELETED>

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

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Revision or Amendment of Contracts.--Notwithstanding 
any provision of law to the contrary, the Secretary may, at the request 
and 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 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.</DELETED>

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

<DELETED>    ``(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:</DELETED>
        <DELETED>    ``(1) In the case of a contract or grant under 
        section 503, recommendations pursuant to section 
        503(a)(5).</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 purpose for 
        which Federal funds were expended.</DELETED>
        <DELETED>    ``(4) A minimum set of data, using uniformly 
        defined elements, as specified by the Secretary after 
        consultation with Urban Indian Organizations.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--
</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, 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.</DELETED>
<DELETED>    ``(b) Loan Fund Study.--The Secretary, acting through the 
Services, may carry out a study to determine the feasibility of 
establishing a loan fund to provide to Urban Indian Organizations 
direct loans or guarantees for loans for the construction of health 
care facilities in a manner consistent with section 309.</DELETED>

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

<DELETED>    ``There is 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 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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Criteria.--The Secretary shall establish criteria 
for the grants made under subsection (a), including criteria relating 
to the following:</DELETED>
        <DELETED>    ``(1) The 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. The 
        standards shall be negotiated and agreed to between the 
        Secretary and the grantee on a grant-by-grant basis.</DELETED>
        <DELETED>    ``(4) Identification of the need for 
        services.</DELETED>
<DELETED>    ``(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).</DELETED>
<DELETED>    ``(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).</DELETED>

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

<DELETED>    ``Notwithstanding any other provision of law, the Tulsa 
Clinic and Oklahoma City Clinic demonstration projects shall--
</DELETED>
        <DELETED>    ``(1) be permanent programs within the Service's 
        direct care program;</DELETED>
        <DELETED>    ``(2) continue to be treated as Service Units in 
        the allocation of resources and coordination of care; 
        and</DELETED>
        <DELETED>    ``(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.</DELETED>

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

<DELETED>    ``(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, 2008.</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 the NIAAA and 
subsequently transferred to the Service are eligible for grants or 
contracts under this section.</DELETED>
<DELETED>    ``(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.</DELETED>

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

<DELETED>    ``(a) In General.--The Secretary shall ensure that the 
Service consults, to the greatest extent practicable, with Urban Indian 
Organizations.</DELETED>
<DELETED>    ``(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.</DELETED>

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

<DELETED>    ``(a) In General.--With respect to claims resulting from 
the performance of functions during fiscal year 2005 and thereafter, or 
claims asserted after September 30, 2004, but resulting from the 
performance of functions prior to fiscal year 2005, 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.). Future coverage 
under that Act shall be contingent on cooperation of the Urban Indian 
Organization with the Attorney General in prosecuting past 
claims.</DELETED>
<DELETED>    ``(b) Claims Resulting From Performance of Contract or 
Grant.--Beginning for fiscal year 2005 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.</DELETED>

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

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Definition of State.--A State described in this 
subsection is a State in which--</DELETED>
        <DELETED>    ``(1) there resides Urban Indian youth with 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) Authorization for Use.--The Secretary, acting 
through the Service, shall allow an Urban Indian Organization that has 
entered into a contract or received a grant pursuant to this title, in 
carrying out such contract or grant, to use existing facilities and all 
equipment therein or pertaining thereto and other personal property 
owned by the Federal Government within the Secretary's jurisdiction 
under such terms and conditions as may be agreed upon for their use and 
maintenance.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

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

<DELETED>    ``(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.</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 to between the Secretary and 
the grantee.</DELETED>
<DELETED>    ``(c) Establishment of Criteria.--The Secretary shall 
establish criteria for the 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 prevention of and 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 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 organization to 
        adequately perform the activities required under the grant; 
        and</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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).</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 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.</DELETED>

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

<DELETED>    ``(a) Requirements for Regulations.--The Secretary may 
promulgate regulations to implement the provisions of this title in 
accordance with the following:</DELETED>
        <DELETED>    ``(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 enactment of this Act and 
        shall have no less than a 4-month comment period.</DELETED>
        <DELETED>    ``(2) The authority to promulgate regulations 
        under this Act shall expire 18 months from the date of 
        enactment of this Act.</DELETED>
<DELETED>    ``(b) Effective Date of Title.--The amendments to this 
title made by the Indian Health Care Improvement Act Amendments of 2005 
shall be effective on the date of enactment of such amendments, 
regardless of whether the Secretary has promulgated regulations 
implementing such amendments have been promulgated.</DELETED>

<DELETED>``SEC. 521. ELIGIBILITY FOR SERVICES.</DELETED>

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

<DELETED>``SEC. 522. 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 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 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.</DELETED>
        <DELETED>    ``(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 2005 shall serve as Assistant 
        Secretary.</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) facilitate advocacy for the 
                development of appropriate Indian health policy; 
                and</DELETED>
                <DELETED>    ``(B) promote consultation on matters 
                relating to Indian health.</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) Duties.--The Assistant Secretary of Indian Health 
shall--</DELETED>
        <DELETED>    ``(1) perform all functions that were, on the day 
        before the date of enactment of the Indian Health Care 
        Improvement Act Amendments of 2005, carried out by or under the 
        direction of the individual serving as Director of the Service 
        on that day;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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--</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 and 
                Education Assistance Act (25 U.S.C. 450 et 
                seq.);</DELETED>
        <DELETED>    ``(4) administer all scholarship and loan 
        functions carried out under title I;</DELETED>
        <DELETED>    ``(5) report directly to the Secretary concerning 
        all policy- and budget-related matters affecting Indian 
        health;</DELETED>
        <DELETED>    ``(6) collaborate with the Assistant Secretary for 
        Health concerning appropriate matters of Indian health that 
        affect the agencies of the Public Health Service;</DELETED>
        <DELETED>    ``(7) advise each Assistant Secretary of the 
        Department concerning matters of Indian health with respect to 
        which that Assistant Secretary has authority and 
        responsibility;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(9) coordinate the activities of the Department 
        concerning matters of Indian health; and</DELETED>
        <DELETED>    ``(10) perform such other functions as the 
        Secretary may designate.</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>    ``(e) References.--Any reference to the Director of the 
Indian Health Service in any other 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.</DELETED>

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

<DELETED>    ``(a) Establishment.--</DELETED>
        <DELETED>    ``(1) In general.--The Secretary 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 
                for each area served by the Service;</DELETED>
                <DELETED>    ``(C) a privacy component that protects 
                the privacy of patient information held by, or on 
                behalf of, the Service;</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 Tribal Health Program automated 
management information systems which--</DELETED>
        <DELETED>    ``(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</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.--The purposes of this section are as 
follows:</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(3) To assist Indian Tribes to identify services 
        and resources available to address mental illness and 
        dysfunctional and self-destructive behavior.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(6) To modify or supplement existing programs 
        and authorities in the areas identified in paragraph 
        (2).</DELETED>
<DELETED>    ``(b) Plans.--</DELETED>
        <DELETED>    ``(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:</DELETED>
                <DELETED>    ``(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--</DELETED>
                        <DELETED>    ``(i) the number of Indians served 
                        who are directly or indirectly affected by such 
                        illness or behavior; or</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).</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, 
        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.</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 used and adopted locally.</DELETED>
<DELETED>    ``(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:</DELETED>
        <DELETED>    ``(1) Comprehensive care.--A comprehensive 
        continuum of behavioral health care which provides--</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/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 and 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.</DELETED>
        <DELETED>    ``(2) Child care.--Behavioral health services for 
        Indians from birth through age 17, including--</DELETED>
                <DELETED>    ``(A) preschool and school age fetal 
                alcohol disorder services, including assessment and 
                behavioral intervention;</DELETED>
                <DELETED>    ``(B) mental health and substance abuse 
                services (emotional, organic, alcohol, drug, inhalant, 
                and tobacco);</DELETED>
                <DELETED>    ``(C) identification and treatment of co-
                occurring disorders and comorbidity;</DELETED>
                <DELETED>    ``(D) prevention of alcohol, drug, 
                inhalant, and tobacco use;</DELETED>
                <DELETED>    ``(E) early intervention, treatment, and 
                aftercare;</DELETED>
                <DELETED>    ``(F) promotion of healthy approaches to 
                risk and safety issues; and</DELETED>
                <DELETED>    ``(G) identification and treatment of 
                neglect and physical, mental, and sexual 
                abuse.</DELETED>
        <DELETED>    ``(3) Adult care.--Behavioral health services for 
        Indians from age 18 through 55, including--</DELETED>
                <DELETED>    ``(A) early intervention, treatment, and 
                aftercare;</DELETED>
                <DELETED>    ``(B) mental health and substance abuse 
                services (emotional, alcohol, drug, inhalant, and 
                tobacco), including sex specific services;</DELETED>
                <DELETED>    ``(C) identification and treatment of co-
                occurring disorders (dual diagnosis) and 
                comorbidity;</DELETED>
                <DELETED>    ``(D) promotion of healthy approaches for 
                risk-related behavior;</DELETED>
                <DELETED>    ``(E) treatment services for women at risk 
                of giving birth to a child with a fetal alcohol 
                disorder; and</DELETED>
                <DELETED>    ``(F) sex specific treatment for sexual 
                assault and domestic violence.</DELETED>
        <DELETED>    ``(4) Family care.--Behavioral health services for 
        families, including--</DELETED>
                <DELETED>    ``(A) early intervention, treatment, and 
                aftercare for affected families;</DELETED>
                <DELETED>    ``(B) treatment for sexual assault and 
                domestic violence; and</DELETED>
                <DELETED>    ``(C) promotion of healthy approaches 
                relating to parenting, domestic violence, and other 
                abuse issues.</DELETED>
        <DELETED>    ``(5) Elder care.--Behavioral health services for 
        Indians 56 years of age and older, including--</DELETED>
                <DELETED>    ``(A) early intervention, treatment, and 
                aftercare;</DELETED>
                <DELETED>    ``(B) mental health and substance abuse 
                services (emotional, alcohol, drug, inhalant, and 
                tobacco), including sex specific services;</DELETED>
                <DELETED>    ``(C) identification and treatment of co-
                occurring disorders (dual diagnosis) and 
                comorbidity;</DELETED>
                <DELETED>    ``(D) promotion of healthy approaches to 
                managing conditions related to aging;</DELETED>
                <DELETED>    ``(E) sex specific treatment for sexual 
                assault, domestic violence, neglect, physical and 
                mental abuse and exploitation; and</DELETED>
                <DELETED>    ``(F) identification and treatment of 
                dementias regardless of cause.</DELETED>
<DELETED>    ``(d) Community Behavioral Health Plan.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(f) Mental Health Care Need Assessment.--Not later than 
1 year after the date of enactment of the Indian Health Care 
Improvement Act Amendments of 2005, 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.</DELETED>

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

<DELETED>    ``(a) Contents.--Not later than 12 months after the date 
of enactment of the Indian Health Care Improvement Act Amendments of 
2005, 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:</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 behavioral 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 behavioral 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.</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 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).</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(8) Providing for an annual review of such 
        agreement by the Secretaries which shall be provided to 
        Congress and Indian Tribes and Tribal Organizations.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(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;</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, 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--</DELETED>
        <DELETED>    ``(1) Indian Tribes and Tribal 
        Organizations;</DELETED>
        <DELETED>    ``(2) Indians;</DELETED>
        <DELETED>    ``(3) Urban Indian Organizations and other Indian 
        organizations; and</DELETED>
        <DELETED>    ``(4) behavioral health service 
        providers.</DELETED>
<DELETED>    ``(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.</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, shall 
        provide a program of comprehensive behavioral health, 
        prevention, treatment, and aftercare, including Traditional 
        Health Care Practices, which shall include--</DELETED>
                <DELETED>    ``(A) prevention, through educational 
                intervention, in Indian communities;</DELETED>
                <DELETED>    ``(B) acute detoxification, psychiatric 
                hospitalization, residential, and intensive outpatient 
                treatment;</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 postpartum women and their children; and</DELETED>
                <DELETED>    ``(F) diagnostic services.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Contract Health Services.--</DELETED>
        <DELETED>    ``(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).</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) 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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

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

<DELETED>    ``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 is required to 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.</DELETED>

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

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Use of Funds.--Funds made available 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 
funds appropriated pursuant to this section shall be used to make 
grants to Urban Indian Organizations.</DELETED>

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

<DELETED>    ``(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.</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, 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.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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).</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) agreed upon (by appropriate tribal 
        resolution) by a majority of the Indian 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; and</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>    ``(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.</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) pretreatment assistance;</DELETED>
                <DELETED>    ``(B) inpatient, outpatient, and aftercare 
                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;</DELETED>
                <DELETED>    ``(D) to make renovations and hire 
                appropriate staff to convert existing hospital beds 
                into adolescent psychiatric units; and</DELETED>
                <DELETED>    ``(E) for intensive home- and community-
                based services.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(d) Federally Owned Structures.--</DELETED>
        <DELETED>    ``(1) In general.--The Secretary, in consultation 
        with Indian Tribes and Tribal Organizations, shall--</DELETED>
                <DELETED>    ``(A) identify and use, where appropriate, 
                federally owned structures suitable for local 
                residential or regional behavioral health treatment for 
                Indian youths; 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 youths.</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, 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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</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 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.</DELETED>

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

<DELETED>    ``Not later than 1 year after the date of enactment of the 
Indian Health Care Improvement Act Amendments of 2005, 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.</DELETED>

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

<DELETED>    ``(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).</DELETED>
<DELETED>    ``(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).</DELETED>
<DELETED>    ``(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--</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) 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.</DELETED>
<DELETED>    ``(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:</DELETED>
        <DELETED>    ``(1) The project will address significant unmet 
        behavioral health needs among Indians.</DELETED>
        <DELETED>    ``(2) The project will serve a significant number 
        of Indians.</DELETED>
        <DELETED>    ``(3) The project has the potential to deliver 
        services in an efficient and effective manner.</DELETED>
        <DELETED>    ``(4) The Indian Tribe or Tribal Organization has 
        the administrative and financial capability to administer the 
        project.</DELETED>
        <DELETED>    ``(5) The project may deliver services in a manner 
        consistent with Traditional Health Care Practices.</DELETED>
        <DELETED>    ``(6) The project is coordinated with, and avoids 
        duplication of, existing services.</DELETED>
<DELETED>    ``(c) Equitable Treatment.--For purposes of this 
subsection, the Secretary shall, in evaluating project applications or 
proposals, 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) Programs.--</DELETED>
        <DELETED>    ``(1) Establishment.--The Secretary, consistent 
        with section 701, acting through the Service, Indian Tribes, 
        and Tribal Organizations, is authorized to 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.</DELETED>
        <DELETED>    ``(2) Use of funds.--Funding provided pursuant to 
        this section shall be used for the following:</DELETED>
                <DELETED>    ``(A) To develop and provide for Indians 
                community and in school training, education, and 
                prevention programs relating to fetal alcohol 
                disorders.</DELETED>
                <DELETED>    ``(B) To identify and provide behavioral 
                health treatment to high-risk Indian women and high-
                risk women pregnant with an Indian's child.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(D) To develop and implement counseling 
                and support programs in schools for fetal alcohol 
                disorder affected Indian children.</DELETED>
                <DELETED>    ``(E) To develop prevention and 
                intervention models which incorporate practitioners of 
                Traditional Health Care Practices, cultural and 
                spiritual values, and community involvement.</DELETED>
                <DELETED>    ``(F) To develop, print, and disseminate 
                education and prevention materials on fetal alcohol 
                disorder.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(H) To develop early childhood 
                intervention projects from birth on to mitigate the 
                effects of fetal alcohol disorder among 
                Indians.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(3) Criteria for applications.--The Secretary 
        shall establish criteria for the review and approval of 
        applications for funding under this section.</DELETED>
<DELETED>    ``(b) Services.--The Secretary, acting through the Service 
and 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 disorder 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 disorder.</DELETED>
<DELETED>    ``(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:</DELETED>
        <DELETED>    ``(1) The National Institute on Drug 
        Abuse.</DELETED>
        <DELETED>    ``(2) The National Institute on Alcohol and 
        Alcoholism.</DELETED>
        <DELETED>    ``(3) The Office of Substance Abuse 
        Prevention.</DELETED>
        <DELETED>    ``(4) The National Institute of Mental 
        Health.</DELETED>
        <DELETED>    ``(5) The Service.</DELETED>
        <DELETED>    ``(6) The Office of Minority Health of the 
        Department of Health and Human Services.</DELETED>
        <DELETED>    ``(7) The Administration for Native 
        Americans.</DELETED>
        <DELETED>    ``(8) The National Institute of Child Health and 
        Human Development (NICHD).</DELETED>
        <DELETED>    ``(9) The Centers for Disease Control and 
        Prevention.</DELETED>
        <DELETED>    ``(10) The Bureau of Indian Affairs.</DELETED>
        <DELETED>    ``(11) Indian Tribes.</DELETED>
        <DELETED>    ``(12) Tribal Organizations.</DELETED>
        <DELETED>    ``(13) Urban Indian Organizations.</DELETED>
        <DELETED>    ``(14) Indian fetal alcohol disorder 
        experts.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

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

<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) victims of sexual abuse who are Indian 
        children or children in an Indian household; and</DELETED>
        <DELETED>    ``(2) perpetrators of child sexual abuse who are 
        Indian or members of an Indian household.</DELETED>
<DELETED>    ``(b) Use of Funds.--Funding provided pursuant to this 
section shall be used for the following:</DELETED>
        <DELETED>    ``(1) To develop and provide community education 
        and prevention programs related to sexual abuse of Indian 
        children or children in an Indian household.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(3) To develop prevention and intervention 
        models which incorporate Traditional Health Care Practices, 
        cultural and spiritual values, and community 
        involvement.</DELETED>
        <DELETED>    ``(4) To develop and implement, through the tribal 
        consultation process, culturally sensitive assessment and 
        diagnostic tools for use in Indian communities and Urban 
        Centers.</DELETED>
        <DELETED>    ``(5) To identify and provide behavioral health 
        treatment to Indian perpetrators and perpetrators who are 
        members of an Indian household--</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(B) providing treatment after the 
                perpetrator is released, until it is determined that 
                the perpetrator is not a threat to children.</DELETED>

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

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

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

<DELETED>    ``For the purpose of this title, the following definitions 
shall apply:</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 
        or arnd.--The term `alcohol-related neurodevelopmental 
        disorders' or `ARND' means, with a history of maternal alcohol 
        consumption during pregnancy, central nervous system 
        involvement such as developmental delay, intellectual deficit, 
        or neurologic abnormalities. Behaviorally, there can be 
        problems with irritability, and failure to thrive as infants. 
        As children become older there will likely be hyperactivity, 
        attention deficit, language dysfunction, and perceptual and 
        judgment problems.</DELETED>
        <DELETED>    ``(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 a as 
        community-based therapeutic group, transitional living 
        facilities, a 12-step sponsor, a local 12-step or other related 
        support group, and other community-based providers (mental 
        health professionals, traditional health care practitioners, 
        community health aides, community health representatives, 
        mental health technicians, ministers, etc.)</DELETED>
        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(5) Fetal alcohol disorders.--The term `fetal 
        alcohol disorders' means fetal alcohol syndrome, partial fetal 
        alcohol syndrome and alcohol related neurodevelopmental 
        disorder (ARND).</DELETED>
        <DELETED>    ``(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:</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: microophthalmia, 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>    ``(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.</DELETED>
        <DELETED>    ``(8) 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>    ``(9) 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 
the provisions of 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 Congress a report containing the following:</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 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.</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, Tribal Organizations, and Urban Indian 
        Organizations to address such impact, including a report on 
        proposed changes in 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) provided under contracts.</DELETED>
        <DELETED>    ``(4) A report of contractors to the Secretary on 
        Health Care Educational Loan Repayments every 6 months required 
        by section 110.</DELETED>
        <DELETED>    ``(5) A general audit report of the Secretary on 
        the Health Care Educational Loan Repayment Program as required 
        by section 110(n).</DELETED>
        <DELETED>    ``(6) A report of the findings and conclusions of 
        demonstration programs on development of educational curricula 
        for substance abuse counseling as required in section 
        125(f).</DELETED>
        <DELETED>    ``(7) A separate statement which specifies the 
        amount of funds requested to carry out the provisions of 
        section 201.</DELETED>
        <DELETED>    ``(8) A report of the evaluations of health 
        promotion and disease prevention as required in section 
        203(c).</DELETED>
        <DELETED>    ``(9) A biennial report to Congress on infectious 
        diseases as required by section 212.</DELETED>
        <DELETED>    ``(10) A report on environmental and nuclear 
        health hazards as required by section 215.</DELETED>
        <DELETED>    ``(11) An annual report on the status of all 
        health care facilities needs as required by section 301(c)(2) 
        and 301(d).</DELETED>
        <DELETED>    ``(12) Reports on safe water and sanitary waste 
        disposal facilities as required by section 302(h).</DELETED>
        <DELETED>    ``(13) An annual report on the expenditure of 
        nonservice funds for renovation as required by sections 
        304(b)(2).</DELETED>
        <DELETED>    ``(14) A report identifying the backlog of 
        maintenance and repair required at Service and tribal 
        facilities required by section 313(a).</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(16) A report on any arrangements for the 
        sharing of medical facilities or services, as authorized by 
        section 406.</DELETED>
        <DELETED>    ``(17) A report on evaluation and renewal of Urban 
        Indian programs under section 505.</DELETED>
        <DELETED>    ``(18) A report on the evaluation of programs as 
        required by section 513(d).</DELETED>
        <DELETED>    ``(19) A report on alcohol and substance abuse as 
        required by section 701(f).</DELETED>

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

<DELETED>    ``(a) Deadlines.--</DELETED>
        <DELETED>    ``(1) Procedures.--Not later than 90 days after 
        the date of enactment of the Indian Health Care Improvement Act 
        Amendments of 2005, 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 
        (except sections 105, 115, and 117), II, III, and VII. 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.</DELETED>
        <DELETED>    ``(2) Proposed regulations.--Proposed regulations 
        to implement this Act shall be published in the Federal 
        Register by the Secretary no later than 1 year after the date 
        of enactment of the Indian Health Care Improvement Act 
        Amendments of 2005 and shall have no less than a 120-day 
        comment period.</DELETED>
        <DELETED>    ``(3) Expiration of authority.--Except as 
        otherwise provided herein, the authority to promulgate 
        regulations under this Act shall expire 24 months from the date 
        of enactment of this Act.</DELETED>
<DELETED>    ``(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. The representative of the 
Urban Indian Organization shall be deemed to be an elected officer of a 
tribal government for purposes of applying section 204(b) of the 
Unfunded Mandates Reform Act of 1995 (2 U.S.C. 1534(b)).</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(d) Lack of Regulations.--The lack of promulgated 
regulations shall not limit the effect of this Act.</DELETED>
<DELETED>    ``(e) Inconsistent Regulations.--The provisions of this 
Act shall supersede any conflicting provisions of law) in effect on the 
day before the date of enactment of the Indian Health Care Improvement 
Act Amendments of 2005, and the Secretary is authorized to repeal any 
regulation inconsistent with the provisions of this Act.</DELETED>

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

<DELETED>    ``Not later than 9 months after the date of enactment of 
the Indian Health Care Improvement Act Amendments of 2005, 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.</DELETED>

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

<DELETED>    ``The funds appropriated pursuant to 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) In General.--The following California Indians shall 
be eligible for health services provided by the Service:</DELETED>
        <DELETED>    ``(1) Any member of a federally recognized Indian 
        Tribe.</DELETED>
        <DELETED>    ``(2) Any descendant of an Indian who was residing 
        in California on June 1, 1852, if such descendant--</DELETED>
                <DELETED>    ``(A) is a member of the Indian community 
                served by a local program of the Service; and</DELETED>
                <DELETED>    ``(B) is regarded as an Indian by the 
                community in which such descendant lives.</DELETED>
        <DELETED>    ``(3) Any Indian who holds trust interests in 
        public domain, national forest, or reservation allotments in 
        California.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

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

<DELETED>    ``(a) Children.--Any individual who--</DELETED>
        <DELETED>    ``(1) has not attained 19 years of age;</DELETED>
        <DELETED>    ``(2) is the natural or adopted child, stepchild, 
        foster child, legal ward, or orphan of an eligible Indian; 
        and</DELETED>
        <DELETED>    ``(3) is not otherwise eligible for 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 1 year after the date of a determination of 
competency.</DELETED>
<DELETED>    ``(b) Spouses.--Any spouse of an eligible Indian who is 
not an Indian, or who is of Indian descent but is 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 each 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>    ``(c) Provision of Services to Other Individuals.--
</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) the Indian Tribes served by such 
                Service Unit request such provision of health services 
                to such individuals; and</DELETED>
                <DELETED>    ``(B) the Secretary and the served Indian 
                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 facilities or services, 
                        within or without the Service Unit, available 
                        to meet the health needs of such 
                        individuals.</DELETED>
        <DELETED>    ``(2) ISDEAA programs.--In the case of health 
        programs and facilities operated under a contract or compact 
        entered into under the Indian Self-Determination and Education 
        Assistance Act (25 U.S.C. 450 et seq.), the governing body of 
        the Indian Tribe or Tribal Organization providing health 
        services under such contract or compact is authorized to 
        determine whether health services should be provided under such 
        contract or compact to individuals who are not otherwise 
        eligible for such services under any other subsection of this 
        section or under any other provision of law. In making such 
        determination, the governing body of the Indian Tribe or Tribal 
        organization shall take into account the considerations 
        described in clauses (i) and (ii) of paragraph 
        (1)(B).</DELETED>
        <DELETED>    ``(3) Payment for services.--</DELETED>
                <DELETED>    ``(A) In general.--Persons receiving 
                health services provided by the Service under of this 
                subsection shall be liable for payment of such health 
                services under a schedule of charges prescribed by the 
                Secretary which, in the judgment of the Secretary, 
                results in reimbursement in an amount not less than the 
                actual cost of providing the health services. 
                Notwithstanding section 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.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(4) Revocation of consent for services.--
        </DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--</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 postpartum; or</DELETED>
        <DELETED>    ``(4) provide care to immediate family members of 
        an eligible individual if such care is directly related to the 
        treatment of the eligible individual.</DELETED>
<DELETED>    ``(e) Hospital Privileges for Practitioners.--Hospital 
privileges in health facilities operated and maintained by the Service 
or operated under a contract or compact pursuant to the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et seq.) 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 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.</DELETED>
<DELETED>    ``(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.</DELETED>

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

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

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

<DELETED>    ``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.</DELETED>

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

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

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

<DELETED>    ``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.</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 contract or compact pursuant to the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et seq.) 
shall not be considered an `employer'.</DELETED>

<DELETED>``SEC. 813. 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. 814. ESTABLISHMENT OF NATIONAL BIPARTISAN COMMISSION ON 
              INDIAN HEALTH CARE.</DELETED>

<DELETED>    ``(a) Establishment.--There is established the National 
Bipartisan Indian Health Care Commission (the `Commission').</DELETED>
<DELETED>    ``(b) Duties of Commission.--The duties of the Commission 
are the following:</DELETED>
        <DELETED>    ``(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:</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, 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.</DELETED>
                <DELETED>    ``(B) To make legislative recommendations 
                to the Commission regarding the delivery of Federal 
                health care services to Indians. Such recommendations 
                shall include those related to issues of eligibility, 
                benefits, the range of service providers, the cost of 
                such services, financing such services, and the optimal 
                manner in which to provide such services.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) To review and analyze the recommendations of 
        the report of the study committee.</DELETED>
        <DELETED>    ``(3) To make legislative recommendations to 
        Congress regarding the delivery of Federal health care services 
        to Indians. Such recommendations shall include those related to 
        issues of eligibility, benefits, the range of service 
        providers, the cost of such services, financing such services, 
        and the optimal manner in which to provide such 
        services.</DELETED>
        <DELETED>    ``(4) Not later than 18 months following the date 
        of appointment of all members of the Commission, submit a 
        written report to Congress regarding the delivery of Federal 
        health care services to Indians. Such recommendations shall 
        include those related to issues of eligibility, benefits, the 
        range of service providers, the cost of such services, 
        financing such services, and the optimal manner in which to 
        provide such services.</DELETED>
<DELETED>    ``(c) Members.--</DELETED>
        <DELETED>    ``(1) Appointment.--The Commission shall be 
        composed of 25 members, appointed as follows:</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(D) All those persons chosen by the 
                congressional members of the Commission and by the 
                Director shall be members of federally recognized 
                Indian Tribes.</DELETED>
        <DELETED>    ``(2) Chair; vice chair.--The Chair and Vice Chair 
        of the Commission shall be selected by the congressional 
        members of the Commission.</DELETED>
        <DELETED>    ``(3) Terms.--The terms of members of the 
        Commission shall be for the life of the Commission.</DELETED>
        <DELETED>    ``(4) Deadline for appointments.--Congressional 
        members of the Commission shall be appointed not later than 180 
        days after the date of enactment of the Indian Health Care 
        Improvement Act Amendments of 2005, and the remaining members 
        of the Commission shall be appointed not later than 60 days 
        following the appointment of the congressional 
        members.</DELETED>
        <DELETED>    ``(5) Vacancy.--A vacancy in the Commission shall 
        be filled in the manner in which the original appointment was 
        made.</DELETED>
<DELETED>    ``(d) Compensation.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(e) Meetings.--The Commission shall meet at the call of 
the Chair.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(g) Executive Director; Staff; Facilities.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Staff appointment.--With the approval of the 
        Commission, the executive director may appoint such personnel 
        as the executive director deems appropriate.</DELETED>
        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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).</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(j) FACA.--The Federal Advisory Committee Act (5 U.S.C. 
App.) shall not apply to the Commission.</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>    ``(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.''.</DELETED>
<DELETED>    (b) Rate of Pay.--</DELETED>
        <DELETED>    (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)''.</DELETED>
        <DELETED>    (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''.</DELETED>
<DELETED>    (c) Amendments to Other Provisions of Law.--</DELETED>
        <DELETED>    (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''.</DELETED>
        <DELETED>    (2) The Indian Lands Open Dump Cleanup Act of 1994 
        is amended--</DELETED>
                <DELETED>    (A) in section 3 (25 U.S.C. 3902)--
                </DELETED>
                        <DELETED>    (i) by striking paragraph 
                        (2);</DELETED>
                        <DELETED>    (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</DELETED>
                        <DELETED>    (iii) by inserting before 
                        paragraph (4) (as redesignated by subclause 
                        (II)) the following:</DELETED>
        <DELETED>    ``(3) Assistant secretary.--The term `Assistant 
        Secretary' means the Assistant Secretary for Indian 
        Health.'';</DELETED>
                <DELETED>    (B) in section 5 (25 U.S.C. 3904), by 
                striking the section heading and inserting the 
                following:</DELETED>

<DELETED>``SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR INDIAN 
              HEALTH.'';</DELETED>

                <DELETED>    (C) in section 6(a) (25 U.S.C. 3905(a)), 
                in the subsection heading, by striking ``Director'' and 
                inserting ``Assistant Secretary'';</DELETED>
                <DELETED>    (D) in section 9(a) (25 U.S.C. 3908(a)), 
                in the subsection heading, by striking ``Director'' and 
                inserting ``Assistant Secretary''; and</DELETED>
                <DELETED>    (E) by striking ``Director'' each place it 
                appears and inserting ``Assistant 
                Secretary''.</DELETED>
        <DELETED>    (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''.</DELETED>
        <DELETED>    (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''.</DELETED>
        <DELETED>    (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''.</DELETED>
        <DELETED>    (6) Section 317M(b) of the Public Health Service 
        Act (42 U.S.C. 247b-14(b)) is amended--</DELETED>
                <DELETED>    (A) by striking ``Director of the Indian 
                Health Service'' each place it appears and inserting 
                ``Assistant Secretary for Indian Health''; 
                and</DELETED>
                <DELETED>    (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''.</DELETED>
        <DELETED>    (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''.</DELETED>
        <DELETED>    (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''.</DELETED>
        <DELETED>    (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''.</DELETED>
        <DELETED>    (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''.</DELETED>

<DELETED>SEC. 3. SOBOBA SANITATION FACILITIES.</DELETED>

<DELETED>    The Act of December 17, 1970 (84 Stat. 1465), is amended 
by adding at the end the following new section:</DELETED>

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

<DELETED>SEC. 4. AMENDMENTS TO THE MEDICAID AND STATE CHILDREN'S HEALTH 
              INSURANCE PROGRAMS.</DELETED>

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

<DELETED>``SEC. INDIAN HEALTH PROGRAMS.''; AND</DELETED>

                <DELETED>    (B) by amending subsection (a) to read as 
                follows:</DELETED>
<DELETED>    ``(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.''.</DELETED>
        <DELETED>    (2) Elimination of temporary deeming provision.--
        Such section is amended by striking subsection (b).</DELETED>
        <DELETED>    (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:</DELETED>
<DELETED>    ``(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.''.</DELETED>
        <DELETED>    (4) Reference correction.--Subsection (d) of such 
        section is redesignated as subsection (c) and is amended--
        </DELETED>
                <DELETED>    (A) by striking ``For'' and inserting 
                ``direct billing.--For''; and</DELETED>
                <DELETED>    (B) by striking ``section 405'' and 
                inserting ``section 401(d)''.</DELETED>
<DELETED>    (b) Special Rules for Indians, Indian Health Care 
Providers, and Indian Managed Care Entities.--</DELETED>
        <DELETED>    (1) In general.--Section 1932 of the Social 
        Security Act (42 U.S.C. 1396u-2) is amended by adding at the 
        end the following new subsection:</DELETED>
<DELETED>    ``(h) Special Rules for Indians, Indian Health Care 
Providers, and Indian Managed Care Entities.--A State shall comply with 
the provisions of section 413 of the Indian Health Care Improvement Act 
(relating to the treatment of Indians, Indian health care providers, 
and Indian managed care entities under a medicaid managed care 
program).''.</DELETED>
        <DELETED>    (2) Application to schip.--Section 2107(e)(1) of 
        the Social Security Act (42 U.S.C. 1397gg(1)) is amended by 
        adding at the end the following:</DELETED>
                <DELETED>    ``(E) Subsections (a)(2)(C) and (h) of 
                section 1932.''.</DELETED>
<DELETED>    (c) SCHIP Treatment of Indian Tribes, Tribal 
Organizations, and Urban Indian Organizations.--Section 2105(c) of the 
Social Security Act (42 U.S.C. 1397ee(c)) is amended--</DELETED>
        <DELETED>    (1) in paragraph (2), by adding at the end the 
        following:</DELETED>
                <DELETED>    ``(C) Indian health program payments.--For 
                provisions relating to authorizing use of allotments 
                under this title for payments to Indian Health Programs 
                and Urban Indian Organizations, see section 410 of the 
                Indian Health Care Improvement Act.''; and</DELETED>
        <DELETED>    (2) in paragraph (6)(B), by inserting ``or by an 
        Indian Tribe, Tribal Organization, or Urban Indian Organization 
        (as such terms are defined in section 4 of the Indian Health 
        Care Improvement Act)'' after ``Service''.</DELETED>

<DELETED>SEC. 5. NATIVE AMERICAN HEALTH AND WELLNESS 
              FOUNDATION.</DELETED>

<DELETED>    (a) In General.--The Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450 et seq.) is amended by adding 
at the end the following:</DELETED>

      <DELETED>``TITLE VIII--NATIVE AMERICAN HEALTH AND WELLNESS 
                          FOUNDATION</DELETED>

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

<DELETED>    ``In this title:</DELETED>
        <DELETED>    ``(1) Board.--The term `Board' means the Board of 
        Directors of the Foundation.</DELETED>
        <DELETED>    ``(2) Committee.--The term `Committee' means the 
        Committee for the Establishment of Native American Health and 
        Wellness Foundation established under section 802(f).</DELETED>
        <DELETED>    ``(3) Foundation.--The term `Foundation' means the 
        Native American Health and Wellness Foundation established 
        under section 802.</DELETED>
        <DELETED>    ``(4) Secretary.--The term `Secretary' means the 
        Secretary of Health and Human Services.</DELETED>
        <DELETED>    ``(5) Service.--The term `Service' means the 
        Indian Health Service of the Department of Health and Human 
        Services.</DELETED>

<DELETED>``SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS 
              FOUNDATION.</DELETED>

<DELETED>    ``(a) In General.--As soon as practicable after the date 
of enactment of this title, the Secretary shall establish, under the 
laws of the District of Columbia and in accordance with this title, the 
Native American Health and Wellness Foundation.</DELETED>
<DELETED>    ``(b) Perpetual Existence.--The Foundation shall have 
perpetual existence.</DELETED>
<DELETED>    ``(c) Nature of Corporation.--The Foundation--</DELETED>
        <DELETED>    ``(1) shall be a charitable and nonprofit 
        federally chartered corporation; and</DELETED>
        <DELETED>    ``(2) shall not be an agency or instrumentality of 
        the United States.</DELETED>
<DELETED>    ``(d) Place of Incorporation and Domicile.--The Foundation 
shall be incorporated and domiciled in the District of 
Columbia.</DELETED>
<DELETED>    ``(e) Duties.--The Foundation shall--</DELETED>
        <DELETED>    ``(1) encourage, accept, and administer private 
        gifts of real and personal property, and any income from or 
        interest in such gifts, for the benefit of, or in support of, 
        the mission of the Service;</DELETED>
        <DELETED>    ``(2) undertake and conduct such other activities 
        as will further the health and wellness activities and 
        opportunities of Native Americans; and</DELETED>
        <DELETED>    ``(3) participate with and assist Federal, State, 
        and tribal governments, agencies, entities, and individuals in 
        undertaking and conducting activities that will further the 
        health and wellness activities and opportunities of Native 
        Americans.</DELETED>
<DELETED>    ``(f) Committee for the Establishment of Native American 
Health and Wellness Foundation.--</DELETED>
        <DELETED>    ``(1) In general.--The Secretary shall establish 
        the Committee for the Establishment of Native American Health 
        and Wellness Foundation to assist the Secretary in establishing 
        the Foundation.</DELETED>
        <DELETED>    ``(2) Duties.--Not later than 180 days after the 
        date of enactment of this section, the Committee shall--
        </DELETED>
                <DELETED>    ``(A) carry out such activities as are 
                necessary to incorporate the Foundation under the laws 
                of the District of Columbia, including acting as 
                incorporators of the Foundation;</DELETED>
                <DELETED>    ``(B) ensure that the Foundation qualifies 
                for and maintains the status required to carry out this 
                section, until the Board is established;</DELETED>
                <DELETED>    ``(C) establish the constitution and 
                initial bylaws of the Foundation;</DELETED>
                <DELETED>    ``(D) provide for the initial operation of 
                the Foundation, including providing for temporary or 
                interim quarters, equipment, and staff; and</DELETED>
                <DELETED>    ``(E) appoint the initial members of the 
                Board in accordance with the constitution and initial 
                bylaws of the Foundation.</DELETED>
<DELETED>    ``(g) Board of Directors.--</DELETED>
        <DELETED>    ``(1) In general.--The Board of Directors shall be 
        the governing body of the Foundation.</DELETED>
        <DELETED>    ``(2) Powers.--The Board may exercise, or provide 
        for the exercise of, the powers of the Foundation.</DELETED>
        <DELETED>    ``(3) Selection.--</DELETED>
                <DELETED>    ``(A) In general.--Subject to subparagraph 
                (B), the number of members of the Board, the manner of 
                selection of the members (including the filling of 
                vacancies), and the terms of office of the members 
                shall be as provided in the constitution and bylaws of 
                the Foundation.</DELETED>
                <DELETED>    ``(B) Requirements.--</DELETED>
                        <DELETED>    ``(i) Number of members.--The 
                        Board shall have at least 11 members, who shall 
                        have staggered terms.</DELETED>
                        <DELETED>    ``(ii) Initial voting members.--
                        The initial voting members of the Board--
                        </DELETED>
                                <DELETED>    ``(I) shall be appointed 
                                by the Committee not later than 180 
                                days after the date on which the 
                                Foundation is established; 
                                and</DELETED>
                                <DELETED>    ``(II) shall have 
                                staggered terms.</DELETED>
                        <DELETED>    ``(iii) Qualification.--The 
                        members of the Board shall be United States 
                        citizens who are knowledgeable or experienced 
                        in Native American health care and related 
                        matters.</DELETED>
                <DELETED>    ``(C) Compensation.--A member of the Board 
                shall not receive compensation for service as a member, 
                but shall be reimbursed for actual and necessary travel 
                and subsistence expenses incurred in the performance of 
                the duties of the Foundation.</DELETED>
<DELETED>    ``(h) Officers.--</DELETED>
        <DELETED>    ``(1) In general.--The officers of the Foundation 
        shall be--</DELETED>
                <DELETED>    ``(A) a secretary, elected from among the 
                members of the Board; and</DELETED>
                <DELETED>    ``(B) any other officers provided for in 
                the constitution and bylaws of the 
                Foundation.</DELETED>
        <DELETED>    ``(2) Secretary.--The secretary of the Foundation 
        shall serve, at the direction of the Board, as the chief 
        operating officer of the Foundation.</DELETED>
        <DELETED>    ``(3) Election.--The manner of election, term of 
        office, and duties of the officers of the Foundation shall be 
        as provided in the constitution and bylaws of the 
        Foundation.</DELETED>
<DELETED>    ``(i) Powers.--The Foundation--</DELETED>
        <DELETED>    ``(1) shall adopt a constitution and bylaws for 
        the management of the property of the Foundation and the 
        regulation of the affairs of the Foundation;</DELETED>
        <DELETED>    ``(2) may adopt and alter a corporate 
        seal;</DELETED>
        <DELETED>    ``(3) may enter into contracts;</DELETED>
        <DELETED>    ``(4) may acquire (through a gift or otherwise), 
        own, lease, encumber, and transfer real or personal property as 
        necessary or convenient to carry out the purposes of the 
        Foundation;</DELETED>
        <DELETED>    ``(5) may sue and be sued; and</DELETED>
        <DELETED>    ``(6) may perform any other act necessary and 
        proper to carry out the purposes of the Foundation.</DELETED>
<DELETED>    ``(j) Principal Office.--</DELETED>
        <DELETED>    ``(1) In general.--The principal office of the 
        Foundation shall be in the District of Columbia.</DELETED>
        <DELETED>    ``(2) Activities; offices.--The activities of the 
        Foundation may be conducted, and offices may be maintained, 
        throughout the United States in accordance with the 
        constitution and bylaws of the Foundation.</DELETED>
<DELETED>    ``(k) Service of Process.--The Foundation shall comply 
with the law on service of process of each State in which the 
Foundation is incorporated and of each State in which the Foundation 
carries on activities.</DELETED>
<DELETED>    ``(l) Liability of Officers, Employees, and Agents.--
</DELETED>
        <DELETED>    ``(1) In general.--The Foundation shall be liable 
        for the acts of the officers, employees, and agents of the 
        Foundation acting within the scope of their 
        authority.</DELETED>
        <DELETED>    ``(2) Personal liability.--A member of the Board 
        shall be personally liable only for gross negligence in the 
        performance of the duties of the member.</DELETED>
<DELETED>    ``(m) Restrictions.--</DELETED>
        <DELETED>    ``(1) Limitation on spending.--Beginning with the 
        fiscal year following the first full fiscal year during which 
        the Foundation is in operation, the administrative costs of the 
        Foundation shall not exceed 10 percent of the sum of--
        </DELETED>
                <DELETED>    ``(A) the amounts transferred to the 
                Foundation under subsection (o) during the preceding 
                fiscal year; and</DELETED>
                <DELETED>    ``(B) donations received from private 
                sources during the preceding fiscal year.</DELETED>
        <DELETED>    ``(2) Appointment and hiring.--The appointment of 
        officers and employees of the Foundation shall be subject to 
        the availability of funds.</DELETED>
        <DELETED>    ``(3) Status.--A member of the Board or officer, 
        employee, or agent of the Foundation shall not by reason of 
        association with the Foundation be considered to be an officer, 
        employee, or agent of the United States.</DELETED>
<DELETED>    ``(n) Audits.--The Foundation shall comply with section 
10101 of title 36, United States Code, as if the Foundation were a 
corporation under part B of subtitle II of that title.</DELETED>
<DELETED>    ``(o) Funding.--</DELETED>
        <DELETED>    ``(1) Authorization of appropriations.--There is 
        authorized to be appropriated to carry out subsection (e)(1) 
        $500,000 for each fiscal year, as adjusted to reflect changes 
        in the Consumer Price Index for all-urban consumers published 
        by the Department of Labor.</DELETED>
        <DELETED>    ``(2) Transfer of donated funds.--The Secretary 
        shall transfer to the Foundation funds held by the Department 
        of Health and Human Services under the Act of August 5, 1954 
        (42 U.S.C. 2001 et seq.), if the transfer or use of the funds 
        is not prohibited by any term under which the funds were 
        donated.</DELETED>

<DELETED>``SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT.</DELETED>

<DELETED>    ``(a) Provision of Support by Secretary.--Subject to 
subsection (b), during the 5-year period beginning on the date on which 
the Foundation is established, the Secretary--</DELETED>
        <DELETED>    ``(1) may provide personnel, facilities, and other 
        administrative support services to the Foundation;</DELETED>
        <DELETED>    ``(2) may provide funds for initial operating 
        costs and to reimburse the travel expenses of the members of 
        the Board; and</DELETED>
        <DELETED>    ``(3) shall require and accept reimbursements from 
        the Foundation for--</DELETED>
                <DELETED>    ``(A) services provided under paragraph 
                (1); and</DELETED>
                <DELETED>    ``(B) funds provided under paragraph 
                (2).</DELETED>
<DELETED>    ``(b) Reimbursement.--Reimbursements accepted under 
subsection (a)(3)--</DELETED>
        <DELETED>    ``(1) shall be deposited in the Treasury of the 
        United States to the credit of the applicable appropriations 
        account; and</DELETED>
        <DELETED>    ``(2) shall be chargeable for the cost of 
        providing services described in subsection (a)(1) and travel 
        expenses described in subsection (a)(2).</DELETED>
<DELETED>    ``(c) Continuation of Certain Services.--The Secretary may 
continue to provide facilities and necessary support services to the 
Foundation after the termination of the 5-year period specified in 
subsection (a) if the facilities and services--</DELETED>
        <DELETED>    ``(1) are available; and</DELETED>
        <DELETED>    ``(2) are provided on reimbursable cost 
        basis.''.</DELETED>
<DELETED>    (b) Technical Amendments.--The Indian Self-Determination 
and Education Assistance Act is amended--</DELETED>
        <DELETED>    (1) by redesignating title V (as added by section 
        1302 of the American Indian Education Foundation Act of 2000) 
        (25 U.S.C. 458bbb et seq.)) as title VII;</DELETED>
        <DELETED>    (2) by redesignating sections 501, 502, and 503 
        (as added by section 1302 of the American Indian Education 
        Foundation Act of 2000) as sections 701, 702, and 703, 
        respectively; and</DELETED>
        <DELETED>    (3) in subsection (a)(2) of section 702 and 
        paragraph (2) of section 703 (as redesignated by paragraph 
        (2)), by striking ``section 501'' and inserting ``section 
        701''.</DELETED>

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Indian Health Care Improvement Act 
Amendments of 2005''.

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; 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. Scholarship programs for Indian Tribes.
``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.
``Sec. 122. Tribal health program administration.
``Sec. 123. Health professional chronic shortage demonstration 
                            programs.
``Sec. 124. National Health Service Corps.
``Sec. 125. Substance abuse counselor educational curricula 
                            demonstration programs.
``Sec. 126. Behavioral health training and community education 
                            programs.
``Sec. 127. Authorization of appropriations.

                      ``TITLE II--HEALTH SERVICES

``Sec. 201. Indian Health Care Improvement Fund.
``Sec. 202. Catastrophic Health Emergency Fund.
``Sec. 203. Health promotion and disease prevention services.
``Sec. 204. Diabetes prevention, treatment, and control.
``Sec. 205. Shared services for long-term care.
``Sec. 206. Health services research.
``Sec. 207. Mammography and other cancer screening.
``Sec. 208. Patient travel costs.
``Sec. 209. Epidemiology centers.
``Sec. 210. Comprehensive school health education programs.
``Sec. 211. Indian youth program.
``Sec. 212. Prevention, control, and elimination of communicable and 
                            infectious diseases.
``Sec. 213. Authority for provision of other services.
``Sec. 214. Indian women's health care.
``Sec. 215. Environmental and nuclear health hazards.
``Sec. 216. Arizona as a contract health service delivery area.
``Sec. 216A. North Dakota and South Dakota as a contract health service 
                            delivery area.
``Sec. 217. California contract health services program.
``Sec. 218. California as a contract health service delivery area.
``Sec. 219. Contract health services for the Trenton service area.
``Sec. 220. Programs operated by Indian Tribes and Tribal 
                            Organizations.
``Sec. 221. Licensing.
``Sec. 222. Notification of provision of emergency contract health 
                            services.
``Sec. 223. Prompt action on payment of claims.
``Sec. 224. Liability for payment.
``Sec. 225. Office of Indian Men's Health.
``Sec. 226. 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 contracts 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. Division 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 Claim Act coverage.
``Sec. 516. Urban youth treatment center demonstration.
``Sec. 517. Use of Federal Government facilities and sources of supply.
``Sec. 518. Grants for diabetes prevention, treatment, and control.
``Sec. 519. Community health representatives.
``Sec. 520. Effective date.
``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. Indian youth telemental health demonstration project.
``Sec. 709. Inpatient and community-based mental health facilities 
                            design, construction, and staffing.
``Sec. 710. Training and community education.
``Sec. 711. Behavioral health program.
``Sec. 712. Fetal alcohol disorder programs.
``Sec. 713. Child sexual abuse and prevention treatment programs.
``Sec. 714. Behavioral health research.
``Sec. 715. Definitions.
``Sec. 716. 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. Severability provisions.
``Sec. 814. Establishment of National Bipartisan Commission on Indian 
                            Health Care.
``Sec. 815. Appropriations; availability.
``Sec. 816. Authorization of appropriations.

``SEC. 2. FINDINGS.

    ``Congress makes the following findings:
            ``(1) Federal health services 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, and resulting responsibility to, the American Indian 
        people.
            ``(2) 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 to be raised to the highest 
        possible level and to encourage the maximum participation of 
        Indians in the planning and management of those services.
            ``(3) Federal health services to Indians have resulted in a 
        reduction in the prevalence and incidence of preventable 
        illnesses among, and unnecessary and premature deaths of, 
        Indians.
            ``(4) Despite such services, the unmet health needs of the 
        American Indian people are severe and the health status of the 
        Indians is far below that of the general population of the 
        United States.

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

    ``Congress 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)(A) The term `behavioral health' means the blending of 
        substance (alcohol, drugs, inhalants, and tobacco) abuse and 
        mental health prevention and treatment, for the purpose of 
        providing comprehensive services.
            ``(B) The term `behavioral health' includes the joint 
        development of substance abuse and mental health treatment 
        planning and coordinated case management using a 
        multidisciplinary approach.
            ``(5) The term `California Indians' means 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) the 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 `health profession' means allopathic 
        medicine, family medicine, internal medicine, pediatrics, 
        geriatric medicine, obstetrics and gynecology, podiatric 
        medicine, nursing, public health nursing, dentistry, 
        psychiatry, osteopathy, optometry, pharmacy, psychology, public 
        health, social work, marriage and family therapy, chiropractic 
        medicine, environmental health and engineering, allied health 
        professions, and any other health profession.
            ``(11) 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--
                            ``(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, relating to 
                        elimination, reduction, and prevention of 
                        contaminants that 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).
            ``(12) The term `Indian', unless otherwise designated, 
        means any person who is a member of an Indian Tribe or is 
        eligible for health services under section 806, except that, 
        for the purpose of sections 102 and 103, the term also means 
        any individual who--
                    ``(A)(i) irrespective of whether the 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 recognized now or in the future by the State 
                in which they reside; or
                    ``(ii) is a descendant, in the first or second 
                degree, of any such member;
                    ``(B) is an Eskimo or Aleut or other Alaska Native;
                    ``(C) is considered by the Secretary of the 
                Interior to be an Indian for any purpose; or
                    ``(D) is determined to be an Indian under 
                regulations promulgated by the Secretary.
            ``(13) 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 June 25, 1910 (25 U.S.C. 47) 
                (commonly known as the `Buy Indian Act').
            ``(14) 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.).
            ``(15) 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)).
            ``(16) 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.).
            ``(17) The term `Secretary', unless otherwise designated, 
        means the Secretary of Health and Human Services.
            ``(18) The term `Service' means the Indian Health Service.
            ``(19) The term `Service Area' means the geographical area 
        served by each Area Office.
            ``(20) 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.
            ``(21) 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)).
            ``(22) 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.
            ``(23) 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 in the promotion, restoration, 
        preservation, and maintenance of health, well-being, and life's 
        harmony.
            ``(24) 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)).
            ``(25) 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 contract or 
        compact with the Service under the Indian Self-Determination 
        and Education Assistance Act (25 U.S.C. 450 et seq.).
            ``(26) 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.).
            ``(27) 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.
            ``(28) 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 
                Alaska 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.
            ``(29) 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 grants 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.--The Secretary shall not make a grant 
        under this section unless 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 grants; payment.--The amount of a grant 
        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.

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

    ``(a) Scholarships Authorized.--The Secretary, acting through the 
Service, shall provide scholarship grants 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.--Scholarship grants 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 scholarship grants to Indians who are 
        enrolled full or part time in accredited schools pursuing 
        courses of study in the health professions. Such scholarships 
        shall be designated Indian Health Scholarships and shall be 
        made in accordance with section 338A of the Public Health 
        Services Act (42 U.S.C. 2541), except as provided in subsection 
        (b) of this section.
            ``(2) Determinations by secretary.--The Secretary, acting 
        through the Service, shall determine--
                    ``(A) who shall receive scholarship grants under 
                subsection (a); and
                    ``(B) the distribution of the scholarships among 
                health professions on the basis of the relative needs 
                of Indians for additional service in the health 
                professions.
            ``(3) Certain delegation not allowed.--The administration 
        of this section shall be a responsibility of the Assistant 
        Secretary and shall not be delegated in a contract or compact 
        under the Indian Self-Determination and Education Assistance 
        Act (25 U.S.C. 450 et seq.).
    ``(b) Active Duty Service Obligation.--
            ``(1) Obligation met.--The active duty service obligation 
        under a written contract with the Secretary under this section 
        that an Indian has entered into 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 1 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.
                    ``(D) In a teaching capacity in a tribal college or 
                university nursing program (or a related health 
                profession program) if, as determined by the Secretary, 
                the health service provided to Indians would not 
                decrease.
            ``(2) Obligation deferred.--At the request of any 
        individual who has entered into a contract referred to in 
        paragraph (1) and who receives a degree in medicine (including 
        osteopathic or allopathic medicine), dentistry, optometry, 
        podiatry, or pharmacy, the Secretary shall defer the active 
        duty service obligation of that individual under that contract, 
        in order that such individual may complete any internship, 
        residency, or other advanced clinical training that is required 
        for the practice of that health profession, for an appropriate 
        period (in years, as determined by the Secretary), subject to 
        the following conditions:
                    ``(A) No period of internship, residency, or other 
                advanced clinical training shall be counted as 
                satisfying any period of obligated service under this 
                subsection.
                    ``(B) The active duty service obligation of that 
                individual shall commence not later than 90 days after 
                the completion of that advanced clinical training (or 
                by a date specified by the Secretary).
                    ``(C) The active duty service obligation will be 
                served in the health profession of that individual in a 
                manner consistent with paragraph (1).
                    ``(D) A recipient of a scholarship under this 
                section may, at the election of the recipient, meet the 
                active duty service obligation described in paragraph 
                (1) by service in a program specified under that 
                paragraph that--
                            ``(i) is located on the reservation of the 
                        Indian Tribe in which the recipient is 
                        enrolled; or
                            ``(ii) serves the Indian Tribe in which the 
                        recipient is enrolled.
            ``(3) Priority when making assignments.--Subject to 
        paragraph (2), the Secretary, in making assignments of Indian 
        Health Scholarship recipients required to meet the active duty 
        service obligation described in paragraph (1), shall give 
        priority to assigning individuals to service in those programs 
        specified in paragraph (1) that have a need for health 
        professionals to provide health care services as a result of 
        individuals having breached contracts entered into under this 
        section.
    ``(c) Part-Time Students.--In the case of an individual receiving a 
scholarship under this section who is enrolled part time in an approved 
course of study--
            ``(1) such scholarship shall be for a period of years not 
        to exceed the part-time equivalent of 4 years, as determined by 
        the Area Office;
            ``(2) the period of obligated service described in 
        subsection (b)(1) shall be equal to the greater of--
                    ``(A) the part-time equivalent of 1 year for each 
                year for which the individual was provided a 
                scholarship (as determined by the Area Office); or
                    ``(B) 2 years; and
            ``(3) the amount of the monthly stipend specified in 
        section 338A(g)(1)(B) of the Public Health Service Act (42 
        U.S.C. 254l(g)(1)(B)) shall be reduced pro rata (as determined 
        by the Secretary) based on the number of hours such student is 
        enrolled.
    ``(d) Breach of Contract.--
            ``(1) Specified breaches.--An individual shall be liable to 
        the United States for the amount which has been paid to the 
        individual, or on behalf of the individual, under a contract 
        entered into with the Secretary under this section on or after 
        the date of enactment of the Indian Health Care Improvement Act 
        Amendments of 2005 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.--
                    ``(A) In general.--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 affected Area Office, Indian 
                Tribes, Tribal Organizations, and Urban Indian 
                Organizations, determines that--
                            ``(i) it is not possible for the recipient 
                        to meet that obligation or make that payment;
                            ``(ii) requiring that recipient to meet 
                        that obligation or make that payment would 
                        result in extreme hardship to the recipient; or
                            ``(iii) the enforcement of the requirement 
                        to meet the obligation or make the payment 
                        would be unconscionable.
                    ``(B) Factors for consideration.--Before waiving or 
                suspending an obligation of service or payment under 
                subparagraph (A), the Secretary may take into 
                consideration whether the obligation may be satisfied 
                in a teaching capacity at a tribal college or 
                university nursing program under subsection (b)(1)(D).
            ``(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 make grants of not more than $300,000 to each of 9 
colleges and universities for the purpose of developing and maintaining 
Indian psychology career recruitment programs as a means of encouraging 
Indians to enter the behavioral 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 grants 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.
    ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $2,700,000 for each of fiscal 
years 2006 through 2015.

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

    ``(a) In General.--
            ``(1) Grants authorized.--The Secretary, acting through the 
        Service, shall make grants 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 a grant 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 a 
        grant 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 1 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)), with such amount to be reduced 
                        pro rata (as determined by the Secretary) based 
                        on the number of hours such student is 
                        enrolled, and not to 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) Reimbursements for tax liability.--For the purpose of 
        providing reimbursements for tax liability resulting from a 
        payment 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 equal to 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 manpower programs of the 
Service at educational institutions training health professionals or 
specialists identified in subsection (a).
    ``(j) Applicability of Law.--Section 214 of the Public Health 
Service Act (42 U.S.C. 215) shall not apply to individuals during their 
period of obligated service under the Loan Repayment Program.
    ``(k) Assignment of Individuals.--The Secretary, in assigning 
individuals to serve in Indian Health Programs or Urban Indian 
Organizations pursuant to contracts entered into under this section, 
shall--
            ``(1) ensure that the staffing needs of Tribal Health 
        Programs and Urban Indian Organizations receive consideration 
        on an equal basis with programs that are administered directly 
        by the Service; and
            ``(2) give priority to assigning individuals to Indian 
        Health Programs and Urban Indian Organizations that have a need 
        for health professionals to provide health care services as a 
        result of individuals having breached contracts entered into 
        under this section.
    ``(l) Breach of Contract.--
            ``(1) Specific breaches.--An individual who has entered 
        into a written contract with the Secretary under this section 
        and has not received a waiver under subsection (m) shall be 
        liable, in lieu of any service obligation arising under such 
        contract, to the United States for the amount which has been 
        paid on such individual's behalf under the contract if that 
        individual--
                    ``(A) is enrolled in the final year of a course of 
                study and--
                            ``(i) fails to maintain an acceptable level 
                        of academic standing in the educational 
                        institution in which he or she is enrolled 
                        (such level determined by the educational 
                        institution under regulations of the 
                        Secretary);
                            ``(ii) voluntarily terminates such 
                        enrollment; or
                            ``(iii) is dismissed from such educational 
                        institution before completion of such course of 
                        study; or
                    ``(B) is enrolled in a graduate training program 
                and fails to complete such training program.
            ``(2) Other breaches; formula for amount owed.--If, for any 
        reason not specified in paragraph (1), an individual breaches 
        his or her written contract under this section by failing 
        either to begin, or complete, such individual's period of 
        obligated service in accordance with subsection (e)(2), the 
        United States shall be entitled to recover from such individual 
        an amount to be determined in accordance with the following 
        formula: A=3Z(t-s/t) in which--
                    ``(A) `A' is the amount the United States is 
                entitled to recover;
                    ``(B) `Z' is the sum of the amounts paid under this 
                section to, or on behalf of, the individual and the 
                interest on such amounts which would be payable if, at 
                the time the amounts were paid, they were loans bearing 
                interest at the maximum legal prevailing rate, as 
                determined by the Secretary of the Treasury;
                    ``(C) `t' is the total number of months in the 
                individual's period of obligated service in accordance 
                with subsection (f); and
                    ``(D) `s' is the number of months of such period 
                served by such individual in accordance with this 
                section.
            ``(3) Deductions in medicare payments.--Amounts not paid 
        within such period shall be subject to collection through 
        deductions in medicare payments pursuant to section 1892 of the 
        Social Security Act.
            ``(4) Time period for repayment.--Any amount of damages 
        which the United States is entitled to recover under this 
        subsection shall be paid to the United States within the 1-year 
        period beginning on the date of the breach or such longer 
        period beginning on such date as shall be specified by the 
        Secretary.
            ``(5) Recovery of delinquency.--
                    ``(A) In general.--If damages described in 
                paragraph (4) are delinquent for 3 months, the 
                Secretary shall, for the purpose of recovering such 
                damages--
                            ``(i) use collection agencies contracted 
                        with by the Administrator of General Services; 
                        or
                            ``(ii) enter into contracts for the 
                        recovery of such damages with collection 
                        agencies selected by the Secretary.
                    ``(B) Report.--Each contract for recovering damages 
                pursuant to this subsection shall provide that the 
                contractor will, not less than once each 6 months, 
                submit to the Secretary a status report on the success 
                of the contractor in collecting such damages. Section 
                3718 of title 31, United States Code, shall apply to 
                any such contract to the extent not inconsistent with 
                this subsection.
    ``(m) Waiver or Suspension of Obligation.--
            ``(1) In general.--The Secretary shall by regulation 
        provide for the partial or total waiver or suspension of any 
        obligation of service or payment by an individual under the 
        Loan Repayment Program whenever compliance by the individual is 
        impossible or would involve extreme hardship to the individual 
        and if enforcement of such obligation with respect to any 
        individual would be unconscionable.
            ``(2) Canceled upon death.--Any obligation of an individual 
        under the Loan Repayment Program for service or payment of 
        damages shall be canceled upon the death of the individual.
            ``(3) Hardship waiver.--The Secretary may waive, in whole 
        or in part, the rights of the United States to recover amounts 
        under this section in any case of extreme hardship or other 
        good cause shown, as determined by the Secretary.
            ``(4) Bankruptcy.--Any obligation of an individual under 
        the Loan Repayment Program for payment of damages may be 
        released by a discharge in bankruptcy under title 11 of the 
        United States Code only if such discharge is granted after the 
        expiration of the 5-year period beginning on the first date 
        that payment of such damages is required, and only if the 
        bankruptcy court finds that nondischarge of the obligation 
        would be unconscionable.
    ``(n) Report.--The Secretary shall submit to the President, for 
inclusion in the 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 as the Secretary of Health and Human 
Services determines are not required to meet current withdrawals from 
the LRRF. Such investments may be made only in interest bearing 
obligations of the United States. For such purpose, such obligations 
may be acquired on original issue at the issue price, or by purchase of 
outstanding obligations at the market price.
    ``(d) Sale of Obligations.--Any obligation acquired by the LRRF may 
be sold by the Secretary of the Treasury at the market price.

``SEC. 112. RECRUITMENT ACTIVITIES.

    ``(a) Reimbursement for Travel.--The Secretary, acting through the 
Service, may reimburse health professionals seeking positions with 
Indian Health Programs or Urban Indian Organizations, including 
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 1 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, on a competitive basis, 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 enactment 
of the Indian Health Care Improvement Act Amendments of 2005, 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 1 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.
            ``(5) Programs conducted by tribal colleges and 
        universities.
    ``(e) Quentin N. Burdick Program Grant.--The Secretary shall 
provide 1 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 (25 U.S.C. 450 et seq.) (including 
        programs under agreements with the Bureau of Indian Affairs);
            ``(3) in a program assisted under title V of this Act;
            ``(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; or
            ``(5) in a teaching capacity in a tribal college or 
        university nursing program (or a related health profession 
        program) if, as determined by the Secretary, health services 
        provided to Indians would not decrease.

``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 1 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 $250,000.
    ``(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 
                        that 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 certifications 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.

    ``(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) Program Review.--
            ``(1) Neutral panel.--
                    ``(A) Establishment.--The Secretary, acting through 
                the Service, shall establish a neutral panel to carry 
                out the study under paragraph (2).
                    ``(B) Membership.--Members of the neutral panel 
                shall be appointed by the Secretary from among 
                clinicians, economists, community practitioners, oral 
                epidemiologists, and Alaska Natives.
            ``(2) Study.--
                    ``(A) In general.--The neutral panel established 
                under paragraph (1) shall conduct a study of the dental 
                health aide therapist services provided by the 
                Community Health Aide Program under this section to 
                ensure that the quality of care provided through those 
                services is adequate and appropriate.
                    ``(B) Parameters of study.--The Secretary, in 
                consultation with interested parties, including 
                professional dental organizations, shall develop the 
                parameters of the study.
                    ``(C) Inclusions.--The study shall include a 
                determination by the neutral panel with respect to--
                            ``(i) the ability of the dental health aide 
                        therapist services under this section to 
                        address the dental care needs of Alaska 
                        Natives;
                            ``(ii) the quality of care provided through 
                        those services, including any training, 
                        improvement, or additional oversight required 
                        to improve the quality of care; and
                            ``(iii) whether safer and less costly 
                        alternatives to the dental health aide 
                        therapist services exist.
                    ``(D) Consultation.--In carrying out the study 
                under this paragraph, the neutral panel shall consult 
                with Alaska Tribal Organizations with respect to the 
                adequacy and accuracy of the study.
            ``(3) Report.--The neutral panel shall submit to the 
        Secretary, the Committee on Indian Affairs of the Senate, and 
        the Committee on Resources of the House of Representatives a 
        report describing the results of the study under paragraph (2), 
        including a description of--
                    ``(A) any determination of the neutral panel under 
                paragraph (2)(C); and
                    ``(B) any comments received from an Alaska Tribal 
                Organization under paragraph (2)(D).
    ``(d) Nationalization of Program.--
            ``(1) In general.--Except as provided in paragraph (2), the 
        Secretary, acting through the Service, may establish a national 
        Community Health Aide Program in accordance with the program 
        under this section, as the Secretary determines to be 
        appropriate.
            ``(2) Exception.--The national Community Health Aide 
        Program under paragraph (1) shall not include dental health 
        aide therapist services.
            ``(3) Requirement.--In establishing a national program 
        under paragraph (1), the Secretary shall not reduce the amount 
        of funds provided for the Community Health Aide Program 
        described in subsections (a) and (b).

``SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION.

    ``The Secretary, acting through the Service, shall, by contract 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. 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. 125. 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 3 
years. Such contract or grant may be renewed for an additional 2-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 enactment of the Indian Health Care 
Improvement Act Amendments of 2005, 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. 126. 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 contract or compact under the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 450 et seq.), the 
        appropriate Secretary shall ensure that such training costs are 
        included in the contract or compact, as the Secretary 
        determines necessary.
            ``(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 enactment of 
the Indian Health Care Improvement Act Amendments of 2005, 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 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. 127. 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 (25 U.S.C. 450 
et seq.), 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 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) Injury prevention programs.
                    ``(H) Home health care.
                    ``(I) Community health representatives.
                    ``(J) Maintenance and improvement.
                    ``(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 enactment of the Indian Health Care Improvement Act Amendments 
of 2005, 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 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 
(25 U.S.C. 450 et seq.), 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 the 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 Indian Tribe 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 
maintain each model diabetes project in existence on the date of 
enactment of the Indian Health Care Improvement Act Amendments of 2005, 
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 2005 and for projects which 
are added and funded thereafter.
    ``(d) Funding for Dialysis Programs.--The Secretary is authorized 
to 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.--
            ``(1) In general.--The Secretary shall, to the extent 
        funding is available--
                    ``(A) in each Area Office, consult with Indian 
                Tribes and Tribal Organizations regarding programs for 
                the prevention, treatment, and control of diabetes;
                    ``(B) 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
                    ``(C) 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.
            ``(2) Diabetes control officers.--
                    ``(A) In general.--The Secretary may establish and 
                maintain in each Area Office a position of diabetes 
                control officer to coordinate and manage any activity 
                of that Area Office relating to the prevention, 
                treatment, or control of diabetes to assist the 
                Secretary in carrying out a program under this section 
                or section 330C of the Public Health Service Act (42 
                U.S.C. 254c-3).
                    ``(B) Certain activities.--Any activity carried out 
                by a diabetes control officer under subparagraph (A) 
                that is the subject of a contract or compact under the 
                Indian Self-Determination and Education Assistance Act 
                (25 U.S.C. 450 et seq.), and any funds made available 
                to carry out such an activity, shall not be divisible 
                for purposes of that Act.

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

    ``(a) Long-Term Care.--Notwithstanding any other provision of law, 
the Secretary, acting through the Service, is authorized to provide 
directly, or enter into contracts or compacts under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et seq.) with 
Indian Tribes or Tribal Organizations for, the delivery of long-term 
care and similar services to Indians. Such agreements 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 contract or compact under the Indian 
Self-Determination and Education Assistance Act (25 U.S.C. 450 et 
seq.)) by such Indian Tribe or Tribal Organization.
    ``(b) Contents of Agreements.--An agreement 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. The Secretary shall also, 
to the maximum extent practicable, coordinate departmental research 
resources and activities to address relevant Indian Health Program 
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 accepted and appropriate 
        national standards, and under such terms and conditions as are 
        consistent with standards established by the Secretary to 
        ensure the safety and accuracy of screening mammography under 
        part B of title XVIII of such Act.
            ``(2) Other cancer screening meeting accepted and 
        appropriate national standards.

``SEC. 208. PATIENT TRAVEL COSTS.

    ``The Secretary, acting through the Service and Tribal Health 
Programs, is authorized to 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 a contract or compact under the 
Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 
et seq.)) 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 as of the date of enactment of this Act, 
and without reducing the funding levels for such centers, not later 
than 180 days after the date of enactment of the Indian Health Care 
Improvement Act Amendments of 2005, the Secretary, acting through the 
Service, shall establish an epidemiology center in each Service Area 
which does not yet have one to carry out the functions described in 
subsection (b). Any new centers so established may be operated by 
Tribal Health Programs, but such funding shall not be divisible.
    ``(b) Functions of Centers.--In consultation with and upon the 
request of Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations, each Service Area epidemiology center established under 
this subsection shall, with respect to such Service Area--
            ``(1) collect data relating to, and monitor progress made 
        toward meeting, each of the health status objectives of the 
        Service, the Indian Tribes, Tribal Organizations, and Urban 
        Indian Organizations in the Service Area;
            ``(2) evaluate existing delivery systems, data systems, and 
        other systems that impact the improvement of Indian health;
            ``(3) assist Indian Tribes, Tribal Organizations, and Urban 
        Indian Organizations in identifying their highest priority 
        health status objectives and the services needed to achieve 
        such objectives, based on epidemiological data;
            ``(4) make recommendations for the targeting of services 
        needed by the populations served;
            ``(5) make recommendations to improve health care delivery 
        systems for Indians and Urban Indians;
            ``(6) provide requested technical assistance to Indian 
        Tribes, Tribal Organizations, and Urban Indian Organizations in 
        the development of local health service priorities and 
        incidence and prevalence rates of disease and other illness in 
        the community; and
            ``(7) provide disease surveillance and assist Indian 
        Tribes, Tribal Organizations, and Urban Indian Organizations to 
        promote public health.
    ``(c) Technical Assistance.--The Director of the Centers for 
Disease Control and Prevention shall provide technical assistance to 
the centers in carrying out the requirements of this subsection.
    ``(d) Funding for Studies.--The Secretary may make funding 
available to Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations to conduct epidemiological studies of Indian communities.

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

    ``(a) Funding for Development of Programs.--In addition to carrying 
out any other program for health promotion or disease prevention, the 
Secretary, acting through the Service, is authorized to award grants 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 Grant Funds.--A grant awarded 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 
grants awarded under 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 
grants 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 
        tuberculosis, hepatitis, HIV, respiratory syncitial virus, 
        hanta virus, sexually transmitted diseases, and H. Pylori.
            ``(2) Public information and education programs for the 
        prevention, control, and elimination of communicable and 
        infectious diseases.
            ``(3) Education, training, and clinical skills improvement 
        activities in the prevention, control, and elimination of 
        communicable and infectious diseases for health professionals, 
        including allied health professionals.
            ``(4) Demonstration projects for the screening, treatment, 
        and prevention of hepatitis C virus (HCV).
    ``(b) Application Required.--The Secretary may provide funding 
under subsection (a) only if an application or proposal for funding is 
submitted to the Secretary.
    ``(c) Coordination With Health Agencies.--Indian Tribes, 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, including--
            ``(1) hospice care;
            ``(2) assisted living;
            ``(3) long-term health care;
            ``(4) home- and community-based services, in accordance 
        with subsection (d); and
            ``(5) public health functions.
    ``(b) Services to Otherwise Ineligible Persons.--Subject to section 
807, at the discretion of the Service, Indian Tribes, or Tribal 
Organizations, services provided for hospice care, home- and community-
based care, assisted living, and long-term care may be provided 
(subject to reimbursement) 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 the Service or an Indian Tribe or Tribal Organization.
    ``(c) Terms and Conditions.--The Secretary shall require that any 
service provided under this section shall be in accordance with such 
terms and conditions as the Secretary determines to be consistent with 
accepted and appropriate standards relating to the service, including 
any licensing term or condition under this Act.
    ``(d) Definitions.--For the purposes of this section, the following 
definitions shall apply:
            ``(1)(A) The term `home- and community-based services' 
        means 1 or more of the following:
                    ``(i) Home health aide services.
                    ``(ii) Personal care services.
                    ``(iii) Nursing care services provided outside of a 
                nursing facility by, or under the supervision of, a 
                registered nurse.
                    ``(iv) Respite care.
                    ``(v) Training for family members.
                    ``(vi) Adult day care.
                    ``(vii) Such other home- and community-based 
                services as the Secretary, an Indian Tribe, or a Tribal 
                Organization may approve.
            ``(B) The term `home- and community-based services' does 
        not include a service provided by an individual that is legally 
        responsible for providing the service.
            ``(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)(A) The term `personal care services' means services 
        relating to assistance in carrying out activities of daily 
        living.
            ``(B) The term `personal care services' does not include a 
        service solely relating to assistance in carrying out an 
        ancillary activity, such as housekeeping or household chores, 
        as determined by the Secretary.
            ``(4) The term `public health functions' means the 
        provision of public health-related programs, functions, and 
        services, including 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 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 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 
        enactment of the Indian Health Care Improvement Act Amendments 
        of 2005 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 enactment of 
the Indian Health Care Improvement Act Amendments of 2005. 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 AND SOUTH DAKOTA AS CONTRACT HEALTH SERVICE 
              DELIVERY AREA.

    ``(a) In General.--Beginning in fiscal year 2003, the States of 
North Dakota and 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 North Dakota and South Dakota.
    ``(b) Limitation.--The Service shall not curtail any health care 
services provided to Indians residing on any reservation, or in any 
county that has a common boundary with any reservation, in the State of 
North Dakota or South Dakota if such curtailment is due to the 
provision of contract services in such States pursuant to the 
designation of such States 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 established an advisory board which 
shall advise the CRIHB in carrying out this section. The advisory board 
shall be composed of representatives, selected by the CRIHB, from not 
less than 8 Tribal Health Programs serving California Indians covered 
under this section at least one half of whom of whom are not affiliated 
with the CRIHB.

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

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

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

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

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

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

``SEC. 221. LICENSING.

    ``Health care professionals employed by a Tribal Health Program 
shall, if licensed in any State, be exempt from the licensing 
requirements of the State in which the Tribal Health Program performs 
the services described in its contract or compact under the Indian 
Self-Determination and Education Assistance Act (25 U.S.C. 450 et 
seq.).

``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. OFFICE OF INDIAN MEN'S HEALTH.

    ``(a) Establishment.--The Secretary shall establish within the 
Service an office to be known as the `Office of Indian Men's Health' 
(referred to in this section as the `Office').
    ``(b) Director.--
            ``(1) In general.--The Office shall be headed by a 
        Director, to be appointed by the Secretary.
            ``(2) Duties.--The Director shall coordinate and promote 
        the status of the health of Indian men in the United States.
    ``(c) Report.--Not later than 2 years after the date of enactment 
of the Indian Health Care Improvement Act Amendments of 2005, the 
Secretary, acting through the Director of the Office, shall submit to 
Congress a report describing--
            ``(1) any activity carried out by the Director as of the 
        date on which the report is prepared; and
            ``(2) any finding of the Director with respect to the 
        health of Indian men.

``SEC. 226. 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 
                2005 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 
                enactment of such Act.
            ``(2) Report; contents.--The Secretary shall submit to the 
        President, for inclusion in the 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--
                            ``(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 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 contract or compact under the 
        Indian Self-Determination and Education Assistance Act (25 
        U.S.C. 450 et seq.) 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 contracts or compacts 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 2006, 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 types of 
        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) In preparing an updated report under paragraph (2), 
        the Secretary shall consult with Indian Tribes, Tribal 
        Organizations, and Urban Indian Organizations. The Secretary 
        shall submit the report under paragraph (2) 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 contract 
        or compact under the Indian Self-Determination and Education 
        Assistance Act (25 U.S.C. 450 et seq.), 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 contracts or compacts under 
        the Indian Self-Determination and Education Assistance Act (25 
        U.S.C. 450 et seq.) shall be fully and equitably integrated 
        into the development of the health facility priority system.
            ``(6) Beginning in 2007 and each fiscal year thereafter, 
        the Secretary shall provide an opportunity for nomination of 
        planning, design, and construction projects by the Service, 
        Indian Tribes, Tribal Organizations, and Urban Indian 
        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 contracts or 
        compacts under the Indian Self-Determination and Education 
        Assistance Act (25 U.S.C. 450 et seq.);
            ``(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 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 or Tribal Organization 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 
        the 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 1 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--
                            ``(i) if a sanitation facility for an 
                        individual home, an Indian Tribe, or an Indian 
                        community exists but--
                                    ``(I) lacks--
                                            ``(aa) a safe water supply 
                                        system; or
                                            ``(bb) a waste disposal 
                                        system;
                                    ``(II) contains no piped water or 
                                sewer facilities; or
                                    ``(III) has become inoperable due 
                                to a major component failure; or
                            ``(ii) if 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.
    ``(i) 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 or compact 
                authorized by the Indian Self-Determination and 
                Education Assistance Act (25 U.S.C. 450 et seq.), 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 contract or compact under the Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450 et seq.), 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 the 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 under subsection (c), for any expansion, 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, shall make grants 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)). A grant 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) Grant agreement required.--A grant 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 Grant Funds.--
            ``(1) Allowable uses.--A grant awarded 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 
                        patient visits by eligible Indians and other 
                        users who are eligible for services in such 
                        facility in accordance with section 807(c)(2); 
                        and
                            ``(iii) provide ambulatory care in a 
                        Service Area (specified in the contract or 
                        compact under the Indian Self-Determination and 
                        Education Assistance Act (25 U.S.C. 450 et 
                        seq.)) 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.--A grant 
        provided under this section may be used only for the cost of 
        that portion of a construction, expansion, or modernization 
        project that benefits the Service population identified above 
        in subsection (b)(1)(C) (ii) and (iii). The requirements of 
        clauses (ii) and (iii) of paragraph (1)(C) shall not apply to 
        an Indian Tribe or Tribal Organization applying for a grant 
        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) Grants.--
            ``(1) Application.--No grant may be made under this section 
        unless an application or proposal for the grant has been 
        approved by the Secretary in accordance with applicable 
        regulations and has forth reasonable assurance by the applicant 
        that, at all times after the construction, expansion, or 
        modernization of a facility carried out using a grant 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 grants 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 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 (25 U.S.C. 450 et seq.) 
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 agreements 
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.
    ``(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 2005. 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.--Subject to section 807, 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 contract 
or compact under the Indian Self-Determination and Education Assistance 
Act (25 U.S.C. 450 et seq.), 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 contract or compact under the Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450 et seq.) 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 (25 U.S.C. 450j(l)) and 
regulations thereunder.

``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, 2007, 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, shall 
make arrangements with Indian Tribes and Tribal Organizations to 
establish joint venture demonstration projects under which an Indian 
Tribe or Tribal Organization shall expend tribal, private, or other 
available funds, for the acquisition or construction of a health 
facility for a minimum of 10 years, under a no-cost lease, in exchange 
for agreement by the Service to provide the equipment, supplies, and 
staffing for the operation and maintenance of such a health facility. 
An Indian Tribe or Tribal Organization may use tribal funds, private 
sector, or other available resources, including loan guarantees, to 
fulfill its commitment under a joint venture entered into under this 
subsection. An Indian Tribe or Tribal Organization shall be eligible to 
establish a joint venture project if, when it submits a letter of 
intent, it--
            ``(1) has begun but not completed the process of 
        acquisition or construction of a health facility to be used in 
        the joint venture project; or
            ``(2) has not begun the process of acquisition or 
        construction of a health facility for use in the joint venture 
        project.
    ``(b) Requirements.--The Secretary shall make such an arrangement 
with an Indian Tribe or Tribal Organization only if--
            ``(1) the Secretary first determines that the Indian Tribe 
        or Tribal Organization has the administrative and financial 
        capabilities necessary to complete the timely acquisition or 
        construction of the relevant health facility; and
            ``(2) the Indian Tribe or Tribal Organization meets the 
        need criteria which shall be developed through the negotiated 
        rulemaking process provided for under section 802.
    ``(c) Continued Operation.--The Secretary shall negotiate an 
agreement with the Indian Tribe or Tribal Organization regarding the 
continued operation of the facility at the end of the initial 10 year 
no-cost lease period.
    ``(d) Breach of Agreement.--An Indian Tribe or Tribal Organization 
that has entered into a written agreement with the Secretary under this 
section, and that breaches or terminates without cause such agreement, 
shall be liable to the United States for the amount that has been paid 
to the Indian Tribe or Tribal Organization, or paid to a third party on 
the Indian Tribe's or Tribal Organization's behalf, under the 
agreement. The Secretary has the right to recover tangible property 
(including supplies) and equipment, less depreciation, and any funds 
expended for operations and maintenance under this section. The 
preceding sentence does not apply to any funds expended for the 
delivery of health care services, personnel, or staffing.
    ``(e) Recovery for Nonuse.--An Indian Tribe or Tribal Organization 
that has entered into a written agreement with the Secretary under this 
subsection shall be entitled to recover from the United States an 
amount that is proportional to the value of such facility if, at any 
time within the 10-year term of the agreement, the Service ceases to 
use the facility or otherwise breaches the agreement.
    ``(f) Definition.--For the purposes of this section, the term 
`health facility' or `health facilities' includes quarters needed to 
provide housing for staff of the relevant Tribal Health Program.

``SEC. 312. LOCATION OF FACILITIES.

    ``(a) In General.--In all matters involving the reorganization or 
development of Service facilities or in the establishment of related 
employment projects to address unemployment conditions in economically 
depressed areas, the Bureau of Indian Affairs and the Service shall 
give priority to locating such facilities and projects on Indian lands, 
or 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, 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; and
            ``(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.

``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 contract or compact under 
        the Indian Self-Determination and Education Assistance Act (25 
        U.S.C. 450 et seq.) shall have the authority to establish the 
        rental rates charged to the occupants of such quarters by 
        providing notice to the Secretary of its election to exercise 
        such authority.
            ``(2) Objectives.--In establishing rental rates pursuant to 
        authority of this subsection, a Tribal Health Program shall 
        endeavor to achieve the following objectives:
                    ``(A) To base such rental rates on the reasonable 
                value of the quarters to the occupants thereof.
                    ``(B) To generate sufficient funds to prudently 
                provide for the operation and maintenance of the 
                quarters, and subject to the discretion of the Tribal 
                Health Program, to supply reserve funds for capital 
                repairs and replacement of the quarters.
            ``(3) Equitable funding.--Any quarters whose rental rates 
        are established by a Tribal Health Program pursuant to this 
        subsection shall remain eligible for quarters improvement and 
        repair funds to the same extent as all federally owned quarters 
        used to house personnel in Services-supported programs.
            ``(4) Notice of rate change.--A Tribal Health Program which 
        exercises the authority provided under this subsection shall 
        provide occupants with no less than 60 days notice of any 
        change in rental rates.
    ``(b) Direct Collection of Rent.--
            ``(1) In general.--Notwithstanding any other provision of 
        law, and subject to paragraph (2), a Tribal Health Program 
        shall have the authority to collect rents directly from Federal 
        employees who occupy such quarters in accordance with the 
        following:
                    ``(A) The Tribal Health Program shall notify the 
                Secretary and the subject Federal employees of its 
                election to exercise its authority to collect rents 
                directly from such Federal employees.
                    ``(B) Upon receipt of a notice described in 
                subparagraph (A), the Federal employees shall pay rents 
                for occupancy of such quarters directly to the Tribal 
                Health Program and the Secretary shall have no further 
                authority to collect rents from such employees through 
                payroll deduction or otherwise.
                    ``(C) Such rent payments shall be retained by the 
                Tribal Health Program and shall not be made payable to 
                or otherwise be deposited with the United States.
                    ``(D) Such rent payments shall be deposited into a 
                separate account which shall be used by the Tribal 
                Health Program for the maintenance (including capital 
                repairs and replacement) and operation of the quarters 
                and facilities as the Tribal Health Program shall 
                determine.
            ``(2) Retrocession of authority.--If a Tribal Health 
        Program which has made an election under paragraph (1) requests 
        retrocession of its authority to directly collect rents from 
        Federal employees occupying federally owned quarters, such 
        retrocession shall become effective on the earlier of--
                    ``(A) the first day of the month that begins no 
                less than 180 days after the Tribal Health Program 
                notifies the Secretary of its desire to retrocede; or
                    ``(B) such other date as may be mutually agreed by 
                the Secretary and the Tribal Health Program.
    ``(c) Rates in Alaska.--To the extent that a Tribal Health Program, 
pursuant to authority granted in subsection (a), establishes rental 
rates for federally owned quarters provided to a Federal employee in 
Alaska, such rents may be based on the cost of comparable private 
rental housing in the nearest established community with a year-round 
population of 1,500 or more individuals.

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

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

``SEC. 316. OTHER FUNDING FOR FACILITIES.

    ``(a) Authority To Accept Funds.--The Secretary is authorized to 
accept from any source, including Federal and State agencies, funds 
that are available for the construction of health care facilities and 
use such funds to plan, design, and construct health care facilities 
for Indians and to place such funds into a contract or compact 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 (25 U.S.C. 450 et seq.) 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 CONTRACTS 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 
contracts 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 contract 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, the Secretary shall encourage the State to take 
                steps 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 
        contracts with Indian Tribes and Tribal Organizations with 
        respect to programs on or near reservations.
            ``(2) Requirements.--The Secretary shall include in the 
        grants or contracts 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 as determined by the Secretary, and billed 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) 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.
    ``(i) 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.
    ``(j) 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.
    ``(k) 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 (25 U.S.C. 450 et seq.), 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, such program must provide that such entity, 
meeting generally applicable State or other requirements applicable for 
participation, must be accepted as a provider on the same basis as any 
other qualified provider, except that 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 or other documentation. 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) Tribal Technical Advisory Group (TTAG).--The Secretary shall 
maintain within the Centers for Medicaid & Medicare Services (CMS) a 
Tribal Technical Advisory Group, established in accordance with 
requirements of the charter dated September 30, 2003, and in such group 
shall include a representative of the Urban Indian Organizations and 
the Service. The representative of the Urban Indian Organization shall 
be deemed to be an elected officer of a tribal government for purposes 
of applying section 204(b) of the Unfunded Mandates Reform Act of 1995 
(2 U.S.C. 1534(b)).
    ``(b) Solicitation of Medicaid Advice.--
            ``(1) In general.--As part of its plan under title XIX of 
        the Social Security Act, 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, 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 likely 
        to have 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 likely to have a direct effect on 
        Indians, Indian Health Programs, or Urban Indian Organizations. 
        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.--The reasonable expenses of 
        carrying out this subsection shall be eligible for 
        reimbursement under section 1903(a) of the Social Security Act.
    ``(c) Construction.--Nothing in this section shall be construed as 
superseding existing advisory committees, working groups, or other 
advisory procedures established by the Secretary or by any State.

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

    ``(a) Optional Use of Funds for Indian Health Program Payments.--
Subject to the succeeding provisions of this section, a State may 
provide under its State child health plan under title XXI of the Social 
Security Act (regardless of whether such plan is implemented under such 
title, title XIX of such Act, or both) for payments under this section 
to Indian Health Programs and Urban Indian Organizations operating in 
the State. Such payments shall be treated under title XXI of the Social 
Security Act as expenditures described in section 2105(a)(1)(A) of such 
Act.
    ``(b) Use of Funds.--Payments under this section may be used only 
for expenditures described in clauses (i) through (iii) of section 
2105(a)(1)(D) of the Social Security Act for targeted low-income 
children or other low-income children (as defined in 2110 of such Act) 
who are--
            ``(1) Indians; or
            ``(2) otherwise eligible for health services from the 
        Indian Health Program involved.
    ``(c) Special Restrictions.--The following conditions apply to a 
State electing to provide payments under this section:
            ``(1) No limitation on other schip participation of, or 
        provider payments to, indian health programs.--The State may 
        not exclude or limit participation of otherwise eligible Indian 
        Health Programs in its State child health program under title 
        XXI of the Social Security Act or its medicaid program under 
        title XIX of such Act or pay such Programs less than they 
        otherwise would as participating providers on the basis that 
        payments are made to such Programs under this section.
            ``(2) No limitation on other schip eligibility of 
        indians.--The State may not exclude or limit participation of 
        otherwise eligible Indian children in such State child health 
        or medicaid program on the basis that payments are made for 
        assistance for such children under this section.
            ``(3) Limitation on acceptance of contributions.--
                    ``(A) In general.--The State may not accept 
                contributions or condition making of payments under 
                this section upon contribution of funds from any Indian 
                Health Program to meet the State's non-Federal matching 
                fund requirements under titles XIX and XXI of the 
                Social Security Act.
                    ``(B) Contribution defined.--For purposes of 
                subparagraph (A), the term `contribution' includes any 
                tax, donation, fee, or other payment made, whether made 
                voluntarily or involuntarily.
    ``(d) Application of Separate 10 Percent Limitation.--Payment may 
be made under section 2105(a) of the Social Security Act to a State for 
a fiscal year for payments under this section up to an amount equal to 
10 percent of the total amount available under title XXI of such Act 
(including allotments and reallotments available from previous fiscal 
years) to the State with respect to the fiscal year.
    ``(e) General Terms.--A payment under this section shall only be 
made upon application to the State from the Indian Health Program 
involved and under such terms and conditions, and in a form and manner, 
as the Secretary determines appropriate.

``SEC. 411. SOCIAL SECURITY ACT SANCTIONS.

    ``(a) Requests for Waiver of Sanctions.--
            ``(1) In general.--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, the Indian 
        Health Program shall request the State to seek such waiver, and 
        if such State has not sought the waiver within 60 days of the 
        Indian Health Program request, the Indian Health Program itself 
        may petition the Secretary for such waiver.
            ``(2) Procedure.--In seeking a waiver under paragraph (1), 
        the Indian Health Program must provide notice and a copy of the 
        request, including the reasons for the waiver sought, to the 
        State. The Secretary may consider the State's views in the 
        determination of the waiver request, but may not withhold or 
        delay a determination based on the lack of the State's views.
    ``(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.
            ``(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, enrollment fee, or similar charge as a condition of receiving 
benefits under the program under the respective title.
    ``(c) 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 real property and improvements, 
        located on a reservation, including any federally recognized 
        Indian Tribe's reservation, Pueblo, or Colony, including former 
        reservations in Oklahoma, Alaska Native regions established by 
        the Alaska Native Claims Settlement Act and Indian allotments 
        on or near a reservation as designated and approved by the 
        Bureau of Indian Affairs of the Department of the Interior.
            ``(2) For any federally recognized Tribe not described in 
        paragraph (1), property located within the most recent 
        boundaries of a prior Federal reservation.
            ``(3) Ownership interests in rents, leases, royalties, or 
        usage rights related to natural resources (including extraction 
        of natural resources or harvesting of timber, other plants and 
        plant products, animals, fish, and shellfish) resulting from 
        the exercise of federally protected rights.
            ``(4) Ownership interests in or usage rights to items not 
        covered by paragraphs (1) through (3) that have unique 
        religious, spiritual, traditional, or cultural significance or 
        rights that support subsistence or a traditional life style 
        according to applicable tribal law or custom.
    ``(d) 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) Provision of Services, to Enrollees With Non-Indian Medicaid 
Managed Care Entities, by Indian Health Programs and Urban Indian 
Organizations.--
            ``(1) Payment rules.--
                    ``(A) In general.--Subject to subparagraph (B), in 
                the case of an Indian who is enrolled with a non-Indian 
                medicaid managed care entity (as defined in subsection 
                (c)) and who receives covered medicaid managed care 
                services from an Indian Health Program or an Urban 
                Indian Organization, whether or not it is a 
                participating provider with respect to such entity, the 
                following rules apply:
                            ``(i) Direct payment.--The entity shall 
                        make prompt payment (in accordance with rules 
                        applicable to medicaid managed care entities 
                        under title XIX of the Social Security Act) to 
                        the Indian Health Program or Urban Indian 
                        Organization at a rate established by the 
                        entity for such services that is equal to the 
                        rate negotiated between such entity and the 
                        Program or Organization involved or, if such a 
                        rate has not been negotiated, a rate that is 
                        not less than the level and amount of payment 
                        which the entity would make for the services if 
                        the services were furnished by a provider which 
                        is not such a Program or Organization.
                            ``(ii) Payment through state.--If there is 
                        no arrangement for direct payment under clause 
                        (i) or if a State provides for this clause to 
                        apply in lieu of clause (i), the State shall 
                        provide for payment to the Indian Health 
                        Program or Urban Indian Organization under its 
                        State program under title XIX of such Act at 
                        the rate that would be otherwise applicable for 
                        such services under such program and shall 
                        provide for an appropriate adjustment of the 
                        capitation payment made to the entity to take 
                        into account such payment.
                    ``(B) Compliance with generally applicable 
                requirements.--
                            ``(i) In general.--Except as otherwise 
                        provided, as a condition of payment under 
                        subparagraph (A), the Indian Health Program or 
                        Urban Indian Organization shall comply with the 
                        generally applicable requirements of title XIX 
                        of the Social Security Act with respect to 
                        covered services.
                            ``(ii) Satisfaction of claim requirement.--
                        Any requirement for the submission of a claim 
                        or other documentation for services covered 
                        under subparagraph (A) by the enrollee is 
                        deemed to be satisfied through the submission 
                        of a claim or other documentation by the Indian 
                        Health Program or Urban Indian Organization 
                        consistent with section 403(h).
                    ``(C) Construction.--Nothing in this subsection 
                shall be construed as waiving the application of 
                section 1902(a)(30)(A) of the Social Security Act 
                (relating to application of standards to assure that 
                payments are consistent with efficiency, economy, and 
                quality of care).
            ``(2) Enrollee option to select an indian health program or 
        urban indian organization as primary care provider.--In the 
        case of a non-Indian medicaid managed care entity that--
                    ``(A) has an Indian enrolled with the entity; and
                    ``(B) has an Indian Health Program or Urban Indian 
                Organization that is participating as a primary care 
                provider within the network of the entity,
        insofar as the Indian is otherwise eligible to receive services 
        from such Program or Organization and the Program or 
        Organization has the capacity to provide primary care services 
        to such Indian, the Indian shall be allowed to choose such 
        Program or Organization as the Indian's primary care provider 
        under the entity.
    ``(b) Offering of Managed Care Through Indian Medicaid Managed Care 
Entities.--If--
            ``(1) a State elects to provide services through medicaid 
        managed care entities under its medicaid managed care program; 
        and
            ``(2) an Indian Health Program or Urban Indian Organization 
        that is funded in whole or in part by the Service, or a 
        consortium thereof, has established an Indian medicaid managed 
        care entity in the State that meets generally applicable 
        standards required of such an entity under such medicaid 
        managed care program,
the State shall offer to enter into an agreement with the entity to 
serve as a medicaid managed care entity with respect to eligible 
Indians served by such entity under such program.
    ``(c) Special Rules for Indian Managed Care Entities.--The 
following are special rules regarding the application of a medicaid 
managed care program to Indian medicaid managed care entities:
            ``(1) Enrollment.--
                    ``(A) Limitation to indians.--An Indian medicaid 
                managed care entity may restrict enrollment under such 
                program to Indians and to members of specific Tribes in 
                the same manner as Indian Health Programs may restrict 
                the delivery of services to such Indians and tribal 
                members.
                    ``(B) No less choice of plans.--Under such program 
                the State may not limit the choice of an Indian among 
                medicaid managed care entities only to Indian medicaid 
                managed care entities or to be more restrictive than 
                the choice of managed care entities offered to 
                individuals who are not Indians.
                    ``(C) Default enrollment.--
                            ``(i) In general.--If such program of a 
                        State requires the enrollment of Indians in a 
                        medicaid managed care entity in order to 
                        receive benefits, the State shall provide for 
                        the enrollment of Indians described in clause 
                        (ii) who are not otherwise enrolled with such 
                        an entity in an Indian medicaid managed care 
                        entity described in such clause.
                            ``(ii) Indian described.--An Indian 
                        described in this clause, with respect to an 
                        Indian medicaid managed care entity, is an 
                        Indian who, based upon the service area and 
                        capacity of the entity, is eligible to be 
                        enrolled with the entity consistent with 
                        subparagraph (A).
                    ``(D) Exception to state lock-in.--A request by an 
                Indian who is enrolled under such program with a non-
                Indian medicaid managed care entity to change 
                enrollment with that entity to enrollment with an 
                Indian medicaid managed care entity shall be considered 
                cause for granting such request under procedures 
                specified by the Secretary.
            ``(2) Flexibility in application of solvency.--In applying 
        section 1903(m)(1) of the Social Security Act to an Indian 
        medicaid managed care entity--
                    ``(A) any reference to a `State' in subparagraph 
                (A)(ii) of that section shall be deemed to be a 
                reference to the `Secretary'; and
                    ``(B) the entity shall be deemed to be a public 
                entity described in subparagraph (C)(ii) of that 
                section.
            ``(3) Exceptions to advance directives.--The Secretary may 
        modify or waive the requirements of section 1902(w) of the 
        Social Security Act (relating to provision of written materials 
        on advance directives) insofar as the Secretary finds that the 
        requirements otherwise imposed are not an appropriate or 
        effective way of communicating the information to Indians.
            ``(4) Flexibility in information and marketing.--
                    ``(A) Materials.--The Secretary may modify 
                requirements under section 1932(a)(5) of the Social 
                Security Act in a manner that improves the materials to 
                take into account the special circumstances of such 
                entities and their enrollees while maintaining and 
                clearly communicating to potential enrollees their 
                rights, protections, and benefits.
                    ``(B) Distribution of marketing materials.--The 
                provisions of section 1932(d)(2)(B) of the Social 
                Security Act requiring the distribution of marketing 
                materials to an entire service area shall be deemed 
                satisfied in the case of an Indian medicaid managed 
                care entity that distributes appropriate materials only 
                to those Indians who are potentially eligible to enroll 
                with the entity in the service area.
    ``(d) Malpractice Insurance.--Insofar as, under a medicaid managed 
care program, a health care provider is required to have medical 
malpractice insurance coverage as a condition of contracting as a 
provider with a medicaid managed care entity, an Indian Health Program, 
or an Urban Indian Organization that is a Federally-qualified health 
center under title XIX of the Social Security Act, that is covered 
under the Federal Tort Claims Act (28 U.S.C. 1346(b), 2671 et seq.) is 
deemed to satisfy such requirement.
    ``(e) Definitions.--For purposes of this section:
            ``(1) Medicaid managed care entity.--The term `medicaid 
        managed care entity' means a managed care entity (whether a 
        managed care organization or a primary care case manager) under 
        title XIX of the Social Security Act, whether pursuant to 
        section 1903(m) or section 1932 of such Act, a waiver under 
        section 1115 or 1915(b) of such Act, or otherwise.
            ``(2) Indian medicaid managed care entity.--The term 
        `Indian medicaid managed care entity' means a managed care 
        entity that is controlled (within the meaning of the last 
        sentence of section 1903(m)(1)(C) of the Social Security Act) 
        by the Indian Health Service, a Tribe, Tribal Organization, or 
        Urban Indian Organization (as such terms are defined in section 
        4), or a consortium, which may be composed of 1 or more Tribes, 
        Tribal Organizations, or Urban Indian Organizations, and which 
        also may include the Service.
            ``(3) Non-indian medicaid managed care entity.--The term 
        `non-Indian medicaid managed care entity' means a medicaid 
        managed care entity that is not an Indian medicaid managed care 
        entity.
            ``(4) Covered medicaid managed care services.--The term 
        `covered medicaid managed care services' means, with respect to 
        an individual enrolled with a medicaid managed care entity, 
        items and services that are within the scope of items and 
        services for which benefits are available with respect to the 
        individual under the contract between the entity and the State 
        involved.
            ``(5) Medicaid managed care program.--The term `medicaid 
        managed care program' means a program under sections 1903(m) 
        and 1932 of the Social Security Act and includes a managed care 
        program operating under a waiver under section 1915(b) or 1115 
        of such Act or otherwise.

``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 2005, the 
Secretary shall submit to the Committee on Indian Affairs and Committee 
on Finance of the Senate and the Committee on Resources and Committee 
on Energy and Commerce of 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, and make grants to, Urban Indian Organizations for 
the provision of health care and referral services for Urban Indians. 
Any such contract or grant shall include requirements that the Urban 
Indian Organization successfully undertake to--
            ``(1) estimate the population of Urban Indians residing in 
        the Urban Center or centers that the organization proposes to 
        serve who are or could be recipients of health care or referral 
        services;
            ``(2) estimate the current health status of Urban Indians 
        residing in such Urban Center or centers;
            ``(3) estimate the current health care needs of Urban 
        Indians residing in such Urban Center or centers;
            ``(4) provide basic health education, including health 
        promotion and disease prevention education, to Urban Indians;
            ``(5) make recommendations to the Secretary and Federal, 
        State, local, and other resource agencies on methods of 
        improving health service programs to meet the needs of Urban 
        Indians; and
            ``(6) where necessary, provide, or enter into contracts for 
        the provision of, health care services for Urban Indians.
    ``(b) Criteria.--The Secretary, acting through the Service, shall, 
by regulation, 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 and 
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, as specified by the Secretary after consultation 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) Loan Fund Study.--The Secretary, acting through the Services, 
may carry out a study to determine the feasibility of establishing a 
loan fund to provide to Urban Indian Organizations direct loans or 
guarantees for loans for the construction of health care facilities in 
a manner consistent with section 309.

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

    ``There is established within the Service a Division 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 (25 U.S.C. 450 et seq.).

``SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS.

    ``(a) Grants and Contracts.--The Secretary, through the Division of 
Urban Indian Health, shall make grants or enter into contracts with 
Urban Indian Organizations, to take effect not later than September 30, 
2008, for the administration of Urban Indian alcohol programs that were 
originally established under the National Institute on Alcoholism and 
Alcohol Abuse (hereafter in this section referred to as `NIAAA') and 
transferred to the Service.
    ``(b) 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 2005 and thereafter, or 
claims asserted after September 30, 2004, but resulting from the 
performance of functions prior to fiscal year 2005, 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.). Future coverage 
under that Act shall be contingent on cooperation of the Urban Indian 
Organization with the Attorney General in prosecuting past claims.
    ``(b) Claims Resulting From Performance of Contract or Grant.--
Beginning for fiscal year 2005 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 GOVERNMENT FACILITIES AND SOURCES OF SUPPLY.

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

``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. EFFECTIVE DATE.

    ``The amendments made by the Indian Health Care Improvement Act 
Amendments of 2005 to this title shall take effect beginning on the 
date of enactment of that Act, regardless of whether the Secretary has 
promulgated regulations implementing such amendments.

``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 2005 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 2005, 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 other 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 approaches to risk and 
                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 sex specific services;
                    ``(C) identification and treatment of co-occurring 
                disorders (dual diagnosis) and comorbidity;
                    ``(D) promotion of healthy approaches for risk-
                related behavior;
                    ``(E) treatment services for women at risk of 
                giving birth to a child with a fetal alcohol disorder; 
                and
                    ``(F) sex 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 approaches relating to 
                parenting, 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 sex specific services;
                    ``(C) identification and treatment of co-occurring 
                disorders (dual diagnosis) and comorbidity;
                    ``(D) promotion of healthy approaches to managing 
                conditions related to aging;
                    ``(E) sex 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 enactment of the Indian Health Care Improvement Act 
Amendments of 2005, 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 
enactment of the Indian Health Care Improvement Act Amendments of 2005, 
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 (25 U.S.C. 2401 et 
                seq.)) 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 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 is required to 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) Grants.--The Secretary, consistent with section 701, may make 
grants 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 Grant Funds.--A grant made 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 (25 U.S.C. 450 et seq.). 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 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.
    ``(h) Indian Youth Mental Health.--The Secretary, acting through 
the Service, shall collect data for the report under section 801 with 
respect to--
            ``(1) the number of Indian youth who are being provided 
        mental health services through the Service and Tribal Health 
        Programs;
            ``(2) a description of, and costs associated with, the 
        mental health services provided for Indian youth through the 
        Service and Tribal Health Programs;
            ``(3) the number of youth referred to the Service or Tribal 
        Health Programs for mental health services;
            ``(4) the number of Indian youth provided residential 
        treatment for mental health and behavioral problems through the 
        Service and Tribal Health Programs, reported separately for on- 
        and off-reservation facilities; and
            ``(5) the costs of the services described in paragraph (4).

``SEC. 708. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRATION PROJECT.

    ``(a) Purpose.--The purpose of this section is to authorize the 
Secretary to carry out a demonstration project to test the use of 
telemental health services in suicide prevention, intervention and 
treatment of Indian youth, including through--
            ``(1) the use of psychotherapy, psychiatric assessments, 
        diagnostic interviews, therapies for mental health conditions 
        predisposing to suicide, and alcohol and substance abuse 
        treatment;
            ``(2) the provision of clinical expertise to, consultation 
        services with, and medical advice and training for frontline 
        health care providers working with Indian youth;
            ``(3) training and related support for community leaders, 
        family members and health and education workers who work with 
        Indian youth;
            ``(4) the development of culturally-relevant educational 
        materials on suicide; and
            ``(5) data collection and reporting.
    ``(b) Definitions.--For the purpose of this section, the following 
definitions shall apply:
            ``(1) Demonstration project.--The term `demonstration 
        project' means the Indian youth telemental health demonstration 
        project authorized under subsection (c).
            ``(2) Telemental health.--The term `telemental health' 
        means the use of electronic information and telecommunications 
        technologies to support long distance mental health care, 
        patient and professional-related education, public health, and 
        health administration.
    ``(c) Authorization.--
            ``(1) In general.--The Secretary is authorized to award 
        grants under the demonstration project for the provision of 
        telemental health services to Indian youth who--
                    ``(A) have expressed suicidal ideas;
                    ``(B) have attempted suicide; or
                    ``(C) have mental health conditions that increase 
                or could increase the risk of suicide.
            ``(2) Eligibility for grants.--Such grants shall be awarded 
        to Indian Tribes, Tribal Organizations, and Urban Indian 
        Organizations that operate 1 or more facilities--
                    ``(A) located in Alaska and part of the Alaska 
                Federal Health Care Access Network;
                    ``(B) reporting active clinical telehealth 
                capabilities; or
                    ``(C) offering school-based telemental health 
                services relating to psychiatry to Indian youth.
            ``(3) Grant period.--The Secretary shall award grants under 
        this section for a period of up to 4 years.
            ``(4) Awarding of grants.--Not more than 5 grants shall be 
        provided under paragraph (1), with priority consideration given 
        to Indian Tribes, Tribal Organizations, and Urban Indian 
        Organizations that--
                    ``(A) serve a particular community or geographic 
                area where there is a demonstrated need to address 
                Indian youth suicide;
                    ``(B) enter in to collaborative partnerships with 
                Indian Health Service or other Tribal Health Programs 
                or facilities to provide services under this 
                demonstration project;
                    ``(C) serve an isolated community or geographic 
                area which has limited or no access to behavioral 
                health services; or
                    ``(D) operate a detention facility at which youth 
                are detained.
    ``(d) Use of Funds.--An Indian Tribe, Tribal Organization, or Urban 
Indian Organization shall use a grant received under subsection (c) for 
the following purposes:
            ``(1) To provide telemental health services to Indian 
        youth, including the provision of--
                    ``(A) psychotherapy;
                    ``(B) psychiatric assessments and diagnostic 
                interviews, therapies for mental health conditions 
                predisposing to suicide, and treatment; and
                    ``(C) alcohol and substance abuse treatment.
            ``(2) To provide clinician-interactive medical advice, 
        guidance and training, assistance in diagnosis and 
        interpretation, crisis counseling and intervention, and related 
        assistance to Service, tribal, or urban clinicians and health 
        services providers working with youth being served under this 
        demonstration project.
            ``(3) To assist, educate and train community leaders, 
        health education professionals and paraprofessionals, tribal 
        outreach workers, and family members who work with the youth 
        receiving telemental health services under this demonstration 
        project, including with identification of suicidal tendencies, 
        crisis intervention and suicide prevention, emergency skill 
        development, and building and expanding networks among these 
        individuals and with State and local health services providers.
            ``(4) To develop and distribute culturally appropriate 
        community educational materials on--
                    ``(A) suicide prevention;
                    ``(B) suicide education;
                    ``(C) suicide screening;
                    ``(D) suicide intervention; and
                    ``(E) ways to mobilize communities with respect to 
                the identification of risk factors for suicide.
            ``(5) For data collection and reporting related to Indian 
        youth suicide prevention efforts.
    ``(e) Applications.--To be eligible to receive a grant under 
subsection (c), an Indian Tribe, Tribal Organization, or Urban Indian 
Organization shall prepare and submit to the Secretary an application, 
at such time, in such manner, and containing such information as the 
Secretary may require, including--
            ``(1) a description of the project that the Indian Tribe, 
        Tribal Organization, or Urban Indian Organization will carry 
        out using the funds provided under the grant;
            ``(2) a description of the manner in which the project 
        funded under the grant would--
                    ``(A) meet the telemental health care needs of the 
                Indian youth population to be served by the project; or
                    ``(B) improve the access of the Indian youth 
                population to be served to suicide prevention and 
                treatment services;
            ``(3) evidence of support for the project from the local 
        community to be served by the project;
            ``(4) a description of how the families and leadership of 
        the communities or populations to be served by the project 
        would be involved in the development and ongoing operations of 
        the project;
            ``(5) a plan to involve the tribal community of the youth 
        who are provided services by the project in planning and 
        evaluating the mental health care and suicide prevention 
        efforts provided, in order to ensure the integration of 
        community, clinical, environmental, and cultural components of 
        the treatment; and
            ``(6) a plan for sustaining the project after Federal 
        assistance for the demonstration project has terminated.
    ``(f) Traditional Health Care Practices.--The Secretary, acting 
through the Service, shall ensure that the demonstration project 
established pursuant to this section involves the use and promotion of 
the Traditional Health Care Practices of the Indian Tribes of the youth 
to be served.
    ``(g) Collaboration; Reporting to National Clearinghouse.--
            ``(1) Collaboration.--The Secretary, acting through the 
        Service, shall encourage Indian Tribes, Tribal Organizations, 
        and Urban Indian Organizations receiving grants under this 
        section to collaborate to enable comparisons about best 
        practices across projects.
            ``(2) Reporting to national clearinghouse.--The Secretary, 
        acting through the Service, shall also encourage Indian Tribes, 
        Tribal Organizations, and Urban Indian Organizations receiving 
        grants under this section to submit relevant, declassified 
        project information to the national clearinghouse authorized 
        under section 701(b)(2) in order to better facilitate program 
        performance and improve suicide prevention, intervention, and 
        treatment services.
    ``(h) Annual Report.--Each grant recipient shall submit to the 
Secretary an annual report that--
            ``(1) describes the number of telemental health services 
        provided; and
            ``(2) includes any other information that the Secretary may 
        require.
    ``(i) Report to Congress.--Not later than 270 days after the 
termination of the demonstration project, the Secretary shall submit to 
the Committee on Indian Affairs of the Senate and the Committee on 
Resources and Committee on Energy and Commerce of the House of 
Representatives a final report, based on the annual reports provided by 
grant recipients under subsection (h), that--
            ``(1) describes the results of the projects funded by 
        grants awarded under this section, including any data available 
        which indicates the number of attempted suicides; and
            ``(2) evaluates the impact of the telemental health 
        services funded by the grants in reducing the number of 
        completed suicides among Indian youth.
    ``(j) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $1,500,000 for each of fiscal 
years 2006 through 2009.

``SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL HEALTH FACILITIES 
              DESIGN, CONSTRUCTION, AND STAFFING.

    ``Not later than 1 year after the date of enactment of the Indian 
Health Care Improvement Act Amendments of 2005, 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. 710. 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. 711. 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 project applications or proposals, use 
the same criteria that the Secretary uses in evaluating any other 
application or proposal for such funding.

``SEC. 712. FETAL ALCOHOL DISORDER PROGRAMS.

    ``(a) Programs.--
            ``(1) Establishment.--The Secretary, consistent with 
        section 701, acting through the Service, Indian Tribes, and 
        Tribal Organizations, is authorized to 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, in consultation 
                with Indian Tribes, Tribal Organizations, and Urban 
                Indian Organizations, 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--
                            ``(i) community-based support services for 
                        Indians and women pregnant with Indian 
                        children; and
                            ``(ii) to the extent funding is available, 
                        community-based housing for adult Indians with 
                        fetal alcohol disorder.
            ``(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, 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 
grants 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. 713. 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, in consultation with Indian 
        Tribes, Tribal Organizations, and Urban Indian Organizations, 
        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. 714. BEHAVIORAL HEALTH RESEARCH.

    ``The Secretary, in consultation with appropriate Federal agencies, 
shall make grants to, or enter into contracts with, 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 multifactorial causes of Indian youth suicide, 
        including--
                    ``(A) protective and risk factors and scientific 
                data that identifies those factors; and
                    ``(B) the effects of loss of cultural identity and 
                the development of scientific data on those effects;
            ``(2) 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
            ``(3) the development of models of prevention techniques.
The effect of the interrelationships and interdependencies referred to 
in paragraph (2) on children, and the development of prevention 
techniques under paragraph (3) applicable to children, shall be 
emphasized.

``SEC. 715. DEFINITIONS.

    ``For the purpose of this title, the following definitions shall 
apply:
            ``(1) Assessment.--The term `assessment' means the 
        systematic collection, analysis, and dissemination of 
        information on health status, health needs, and health 
        problems.
            ``(2) Alcohol-related neurodevelopmental disorders or 
        arnd.--The term `alcohol-related neurodevelopmental disorders' 
        or `ARND' means, with a history of maternal alcohol consumption 
        during pregnancy, central nervous system involvement such as 
        developmental delay, intellectual deficit, or neurologic 
        abnormalities. Behaviorally, there can be problems with 
        irritability, and failure to thrive as infants. As children 
        become older there will likely be hyperactivity, attention 
        deficit, language dysfunction, and perceptual and judgment 
        problems.
            ``(3) Behavioral health aftercare.--The term `behavioral 
        health aftercare' includes those activities and resources used 
        to support recovery following inpatient, residential, intensive 
        substance abuse, or mental health outpatient or outpatient 
        treatment. The purpose is to help prevent or deal with relapse 
        by ensuring that by the time a client or patient is discharged 
        from a level of care, such as outpatient treatment, an 
        aftercare plan has been developed with the client. An aftercare 
        plan may use such resources a as community-based therapeutic 
        group, transitional living facilities, a 12-step sponsor, a 
        local 12-step or other related support group, and other 
        community-based providers (mental health professionals, 
        traditional health care practitioners, community health aides, 
        community health representatives, mental health technicians, 
        ministers, etc.)
            ``(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. 716. 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.

    ``For each fiscal year following the date of enactment of the 
Indian Health Care Improvement Act Amendments of 2005, the Secretary 
shall 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 contracts.
            ``(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 125(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, 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).
            ``(20) A report on Indian youth mental health services as 
        required by section 707(h).

``SEC. 802. REGULATIONS.

    ``(a) Deadlines.--
            ``(1) Procedures.--Not later than 90 days after the date of 
        enactment of the Indian Health Care Improvement Act Amendments 
        of 2005, 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 (except sections 105, 
        115, and 117), II, III, and VII. 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.
            ``(2) Proposed regulations.--Proposed regulations to 
        implement this Act shall be published in the Federal Register 
        by the Secretary no later than 1 year after the date of 
        enactment of the Indian Health Care Improvement Act Amendments 
        of 2005 and shall have no less than a 120-day comment period.
            ``(3) Expiration of authority.--Except as otherwise 
        provided herein, the authority to promulgate regulations under 
        this Act shall expire 24 months from the date of enactment of 
        this Act.
    ``(b) Committee.--A negotiated rulemaking committee established 
pursuant to section 565 of title 5, United States Code, to carry out 
this section shall have as its members only representatives of the 
Federal Government and representatives of Indian Tribes and Tribal 
Organizations, a majority of whom shall be nominated by and be 
representatives of Indian Tribes, Tribal Organizations, and Urban 
Indian Organizations from each Service Area. The representative of the 
Urban Indian Organization shall be deemed to be an elected officer of a 
tribal government for purposes of applying section 204(b) of the 
Unfunded Mandates Reform Act of 1995 (2 U.S.C. 1534(b)).
    ``(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 enactment of the Indian Health Care Improvement Act 
Amendments of 2005, and the Secretary is authorized to repeal any 
regulation inconsistent with the provisions of this Act.

``SEC. 803. PLAN OF IMPLEMENTATION.

    ``Not later than 9 months after the date of enactment of the Indian 
Health Care Improvement Act Amendments of 2005, 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 is 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 each 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.
    ``(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 health programs and 
        facilities operated under a contract or compact entered into 
        under the Indian Self-Determination and Education Assistance 
        Act (25 U.S.C. 450 et seq.), the governing body of the Indian 
        Tribe or Tribal Organization providing health services under 
        such contract or compact is authorized to determine whether 
        health services should be provided under such contract or 
        compact to individuals who are not otherwise eligible for such 
        services under any other subsection of this section or under 
        any other provision of law. In making such determination, the 
        governing body of the Indian Tribe or Tribal Organization 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 contract or compact pursuant to the Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450 et seq.) 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 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 contract or compact pursuant to the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450 et seq.) shall not be 
considered an `employer'.

``SEC. 813. 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. 814. ESTABLISHMENT OF NATIONAL BIPARTISAN COMMISSION ON INDIAN 
              HEALTH CARE.

    ``(a) Establishment.--There is established the National Bipartisan 
Indian Health Care 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 legislative recommendations to the 
                Commission regarding the delivery of Federal health 
                care services to Indians. Such recommendations shall 
                include those related to issues of eligibility, 
                benefits, the range of service providers, the cost of 
                such services, financing such services, and the optimal 
                manner in which to provide such services.
                    ``(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 legislative recommendations to Congress 
        regarding the delivery of Federal health care services to 
        Indians. Such recommendations shall include those related to 
        issues of eligibility, benefits, the range of service 
        providers, the cost of such services, financing such services, 
        and the optimal manner in which to provide such services.
            ``(4) Not later than 18 months following the date of 
        appointment of all members of the Commission, submit a written 
        report to Congress regarding the delivery of Federal health 
        care services to Indians. Such recommendations shall include 
        those related to issues of eligibility, benefits, the range of 
        service providers, the cost of such services, financing such 
        services, and the optimal manner in which to provide such 
        services.
    ``(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 180 days after 
        the date of enactment of the Indian Health Care Improvement Act 
        Amendments of 2005, 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. 815. APPROPRIATIONS; AVAILABILITY.

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

``SEC. 816. AUTHORIZATION OF APPROPRIATIONS.

    ``(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) 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:

``SEC. 1911. 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) Special Rules for Indians, Indian Health Care Providers, and 
Indian Managed Care Entities.--
            (1) In general.--Section 1932 of the Social Security Act 
        (42 U.S.C. 1396u-2) is amended by adding at the end the 
        following new subsection:
    ``(h) Special Rules for Indians, Indian Health Care Providers, and 
Indian Managed Care Entities.--A State shall comply with the provisions 
of section 413 of the Indian Health Care Improvement Act (relating to 
the treatment of Indians, Indian health care providers, and Indian 
managed care entities under a medicaid managed care program).''.
            (2) Application to schip.--Section 2107(e)(1) of the Social 
        Security Act (42 U.S.C. 1397gg(1)) is amended by adding at the 
        end the following:
                    ``(E) Subsections (a)(2)(C) and (h) of section 
                1932.''.
    (c) SCHIP Treatment of Indian Tribes, Tribal Organizations, and 
Urban Indian Organizations.--Section 2105(c) of the Social Security Act 
(42 U.S.C. 1397ee(c)) is amended--
            (1) in paragraph (2), by adding at the end the following:
                    ``(C) Indian health program payments.--For 
                provisions relating to authorizing use of allotments 
                under this title for payments to Indian Health Programs 
                and Urban Indian Organizations, see section 410 of the 
                Indian Health Care Improvement Act.''; and
            (2) in paragraph (6)(B), by inserting ``or by an Indian 
        Tribe, Tribal Organization, or Urban Indian Organization (as 
        such terms are defined in section 4 of the Indian Health Care 
        Improvement Act)'' after ``Service''.

SEC. 5. NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION.

    (a) In General.--The Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 450 et seq.) is amended by adding at the end 
the following:

      ``TITLE VIII--NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION

``SEC. 801. DEFINITIONS.

    ``In this title:
            ``(1) Board.--The term `Board' means the Board of Directors 
        of the Foundation.
            ``(2) Committee.--The term `Committee' means the Committee 
        for the Establishment of Native American Health and Wellness 
        Foundation established under section 802(f).
            ``(3) Foundation.--The term `Foundation' means the Native 
        American Health and Wellness Foundation established under 
        section 802.
            ``(4) Secretary.--The term `Secretary' means the Secretary 
        of Health and Human Services.
            ``(5) Service.--The term `Service' means the Indian Health 
        Service of the Department of Health and Human Services.

``SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION.

    ``(a) Establishment.--
            ``(1) In general.--As soon as practicable after the date of 
        enactment of this title, the Secretary shall establish, under 
        the laws of the District of Columbia and in accordance with 
        this title, the Native American Health and Wellness Foundation.
            ``(2) Funding determinations.--No funds, gift, property, or 
        other item of value (including any interest accrued on such an 
        item) acquired by the Foundation shall--
                    ``(A) be taken into consideration for purposes of 
                determining Federal appropriations relating to the 
                provision of health care and services to Indians; or
                    ``(B) otherwise limit, diminish, or affect the 
                Federal responsibility for the provision of health care 
                and services to Indians.
    ``(b) Perpetual Existence.--The Foundation shall have perpetual 
existence.
    ``(c) Nature of Corporation.--The Foundation--
            ``(1) shall be a charitable and nonprofit federally 
        chartered corporation; and
            ``(2) shall not be an agency or instrumentality of the 
        United States.
    ``(d) Place of Incorporation and Domicile.--The Foundation shall be 
incorporated and domiciled in the District of Columbia.
    ``(e) Duties.--The Foundation shall--
            ``(1) encourage, accept, and administer private gifts of 
        real and personal property, and any income from or interest in 
        such gifts, for the benefit of, or in support of, the mission 
        of the Service;
            ``(2) undertake and conduct such other activities as will 
        further the health and wellness activities and opportunities of 
        Native Americans; and
            ``(3) participate with and assist Federal, State, and 
        tribal governments, agencies, entities, and individuals in 
        undertaking and conducting activities that will further the 
        health and wellness activities and opportunities of Native 
        Americans.
    ``(f) Committee for the Establishment of Native American Health and 
Wellness Foundation.--
            ``(1) In general.--The Secretary shall establish the 
        Committee for the Establishment of Native American Health and 
        Wellness Foundation to assist the Secretary in establishing the 
        Foundation.
            ``(2) Duties.--Not later than 180 days after the date of 
        enactment of this section, the Committee shall--
                    ``(A) carry out such activities as are necessary to 
                incorporate the Foundation under the laws of the 
                District of Columbia, including acting as incorporators 
                of the Foundation;
                    ``(B) ensure that the Foundation qualifies for and 
                maintains the status required to carry out this 
                section, until the Board is established;
                    ``(C) establish the constitution and initial bylaws 
                of the Foundation;
                    ``(D) provide for the initial operation of the 
                Foundation, including providing for temporary or 
                interim quarters, equipment, and staff; and
                    ``(E) appoint the initial members of the Board in 
                accordance with the constitution and initial bylaws of 
                the Foundation.
    ``(g) Board of Directors.--
            ``(1) In general.--The Board of Directors shall be the 
        governing body of the Foundation.
            ``(2) Powers.--The Board may exercise, or provide for the 
        exercise of, the powers of the Foundation.
            ``(3) Selection.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                number of members of the Board, the manner of selection 
                of the members (including the filling of vacancies), 
                and the terms of office of the members shall be as 
                provided in the constitution and bylaws of the 
                Foundation.
                    ``(B) Requirements.--
                            ``(i) Number of members.--The Board shall 
                        have at least 11 members, who shall have 
                        staggered terms.
                            ``(ii) Initial voting members.--The initial 
                        voting members of the Board--
                                    ``(I) shall be appointed by the 
                                Committee not later than 180 days after 
                                the date on which the Foundation is 
                                established; and
                                    ``(II) shall have staggered terms.
                            ``(iii) Qualification.--The members of the 
                        Board shall be United States citizens who are 
                        knowledgeable or experienced in Native American 
                        health care and related matters.
                    ``(C) Compensation.--A member of the Board shall 
                not receive compensation for service as a member, but 
                shall be reimbursed for actual and necessary travel and 
                subsistence expenses incurred in the performance of the 
                duties of the Foundation.
    ``(h) Officers.--
            ``(1) In general.--The officers of the Foundation shall 
        be--
                    ``(A) a secretary, elected from among the members 
                of the Board; and
                    ``(B) any other officers provided for in the 
                constitution and bylaws of the Foundation.
            ``(2) Secretary.--The secretary of the Foundation shall 
        serve, at the direction of the Board, as the chief operating 
        officer of the Foundation.
            ``(3) Election.--The manner of election, term of office, 
        and duties of the officers of the Foundation shall be as 
        provided in the constitution and bylaws of the Foundation.
    ``(i) Powers.--The Foundation--
            ``(1) shall adopt a constitution and bylaws for the 
        management of the property of the Foundation and the regulation 
        of the affairs of the Foundation;
            ``(2) may adopt and alter a corporate seal;
            ``(3) may enter into contracts;
            ``(4) may acquire (through a gift or otherwise), own, 
        lease, encumber, and transfer real or personal property as 
        necessary or convenient to carry out the purposes of the 
        Foundation;
            ``(5) may sue and be sued; and
            ``(6) may perform any other act necessary and proper to 
        carry out the purposes of the Foundation.
    ``(j) Principal Office.--
            ``(1) In general.--The principal office of the Foundation 
        shall be in the District of Columbia.
            ``(2) Activities; offices.--The activities of the 
        Foundation may be conducted, and offices may be maintained, 
        throughout the United States in accordance with the 
        constitution and bylaws of the Foundation.
    ``(k) Service of Process.--The Foundation shall comply with the law 
on service of process of each State in which the Foundation is 
incorporated and of each State in which the Foundation carries on 
activities.
    ``(l) Liability of Officers, Employees, and Agents.--
            ``(1) In general.--The Foundation shall be liable for the 
        acts of the officers, employees, and agents of the Foundation 
        acting within the scope of their authority.
            ``(2) Personal liability.--A member of the Board shall be 
        personally liable only for gross negligence in the performance 
        of the duties of the member.
    ``(m) Restrictions.--
            ``(1) Limitation on spending.--Beginning with the fiscal 
        year following the first full fiscal year during which the 
        Foundation is in operation, the administrative costs of the 
        Foundation shall not exceed 10 percent of the sum of--
                    ``(A) the amounts transferred to the Foundation 
                under subsection (o) during the preceding fiscal year; 
                and
                    ``(B) donations received from private sources 
                during the preceding fiscal year.
            ``(2) Appointment and hiring.--The appointment of officers 
        and employees of the Foundation shall be subject to the 
        availability of funds.
            ``(3) Status.--A member of the Board or officer, employee, 
        or agent of the Foundation shall not by reason of association 
        with the Foundation be considered to be an officer, employee, 
        or agent of the United States.
    ``(n) Audits.--The Foundation shall comply with section 10101 of 
title 36, United States Code, as if the Foundation were a corporation 
under part B of subtitle II of that title.
    ``(o) Funding.--
            ``(1) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out subsection (e)(1) $500,000 for 
        each fiscal year, as adjusted to reflect changes in the 
        Consumer Price Index for all-urban consumers published by the 
        Department of Labor.
            ``(2) Transfer of donated funds.--The Secretary shall 
        transfer to the Foundation funds held by the Department of 
        Health and Human Services under the Act of August 5, 1954 (42 
        U.S.C. 2001 et seq.), if the transfer or use of the funds is 
        not prohibited by any term under which the funds were donated.

``SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT.

    ``(a) Provision of Support by Secretary.--Subject to subsection 
(b), during the 5-year period beginning on the date on which the 
Foundation is established, the Secretary--
            ``(1) may provide personnel, facilities, and other 
        administrative support services to the Foundation;
            ``(2) may provide funds for initial operating costs and to 
        reimburse the travel expenses of the members of the Board; and
            ``(3) shall require and accept reimbursements from the 
        Foundation for--
                    ``(A) services provided under paragraph (1); and
                    ``(B) funds provided under paragraph (2).
    ``(b) Reimbursement.--Reimbursements accepted under subsection 
(a)(3)--
            ``(1) shall be deposited in the Treasury of the United 
        States to the credit of the applicable appropriations account; 
        and
            ``(2) shall be chargeable for the cost of providing 
        services described in subsection (a)(1) and travel expenses 
        described in subsection (a)(2).
    ``(c) Continuation of Certain Services.--The Secretary may continue 
to provide facilities and necessary support services to the Foundation 
after the termination of the 5-year period specified in subsection (a) 
if the facilities and services--
            ``(1) are available; and
            ``(2) are provided on reimbursable cost basis.''.
    (b) Technical Amendments.--The Indian Self-Determination and 
Education Assistance Act is amended--
            (1) by redesignating title V (25 U.S.C. 458bbb et seq.)) as 
        title VII;
            (2) by redesignating sections 501, 502, and 503 (25 U.S.C. 
        458bbb, 458bbb-1, 458bbb-2) as sections 701, 702, and 703, 
        respectively; and
            (3) in subsection (a)(2) of section 702 and paragraph (2) 
        of section 703 (as redesignated by paragraph (2)), by striking 
        ``section 501'' and inserting ``section 701''.
                                                       Calendar No. 375

109th CONGRESS

  2d Session

                                S. 1057

                          [Report No. 109-222]

_______________________________________________________________________

                                 A BILL

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

_______________________________________________________________________

               March 16 (legislative day, March 15), 2006

                       Reported with an amendment