1.This Act may be cited as the
Indian Health Care Improvement
Act Amendments of 2005
.
2.Indian Health Care Improvement Act
amended
(a)The Indian Health Care
Improvement Act (25 U.S.C. 1601 et seq.) is amended to read as
follows:
1.Short title; table of
contents
(a)This Act may be cited as the Indian
Health Care Improvement Act
.
(b)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. Funding for tribes for
scholarship programs
Sec. 107. Indian Health Service extern
programs
Sec. 108. Continuing education
allowances
Sec. 109. Community health
representative program
Sec. 110. Indian Health Service loan
repayment program
Sec. 111. Scholarship and Loan Repayment
Recovery Fund
Sec. 112. Recruitment
activities
Sec. 113. Indian recruitment and
retention program
Sec. 114. Advanced training and
research
Sec. 115. Quentin N. Burdick American
Indians Into Nursing program
Sec. 116. Tribal cultural
orientation
Sec. 117. INMED program
Sec. 118. Health training programs of
community colleges
Sec. 119. Retention bonus
Sec. 120. Nursing residency
program
Sec. 121. Community health aide program
for Alaska
Sec. 122. Tribal health program
administration
Sec. 123. Health professional chronic
shortage demonstration programs
Sec. 124. 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. Authorization of
appropriations
TITLE III—FACILITIES
Sec. 301. Consultation: construction and
renovation of facilities; reports
Sec. 302. Sanitation
facilities
Sec. 303. Preference to Indians and
Indian firms
Sec. 304. Expenditure of nonservice
funds for renovation
Sec. 305. Funding for the construction,
expansion, and modernization of small ambulatory care facilities
Sec. 306. Indian health care delivery
demonstration project
Sec. 307. Land transfer
Sec. 308. Leases, contracts, and other
agreements
Sec. 309. Loans, loan guarantees, and
loan repayment
Sec. 310. Tribal leasing
Sec. 311. Indian Health Service/tribal
facilities joint venture program
Sec. 312. Location of
facilities
Sec. 313. Maintenance and improvement of
health care facilities
Sec. 314. Tribal management of Federally
owned quarters
Sec. 315. Applicability of
Buy American Act
requirement
Sec. 316. Other funding for
facilities
Sec. 317. Authorization of
appropriations
TITLE IV—ACCESS TO HEALTH
SERVICES
Sec. 401. Treatment of payments under
Social Security Act health care
programs
Sec. 402. Grants to and 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. Office of Urban Indian
Health
Sec. 511. Grants for alcohol and
substance abuse-related services
Sec. 512. Treatment of certain
demonstration projects
Sec. 513. Urban NIAAA transferred
programs
Sec. 514. Consultation with Urban Indian
Organizations
Sec. 515. Federal Tort 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. Regulations
Sec. 521. Eligibility for
services
Sec. 522. Authorization of
appropriations
TITLE VI—ORGANIZATIONAL
IMPROVEMENTS
Sec. 601. Establishment of the Indian
Health Service as an agency of the Public Health Service
Sec. 602. Automated management
information system
Sec. 603. Authorization of
appropriations
TITLE VII—BEHAVIORAL HEALTH
PROGRAMS
Sec. 701. Behavioral health prevention
and treatment services
Sec. 702. Memoranda of agreement with
the Department of the Interior
Sec. 703. Comprehensive behavioral
health prevention and treatment program
Sec. 704. Mental health technician
program
Sec. 705. Licensing requirement for
mental health care workers
Sec. 706. Indian women treatment
programs
Sec. 707. Indian youth
program
Sec. 708. Inpatient and community-based
mental health facilities design, construction, and staffing
Sec. 709. Training and community
education
Sec. 710. Behavioral health
program
Sec. 711. Fetal alcohol disorder
funding
Sec. 712. Child sexual abuse and
prevention treatment programs
Sec. 713. Behavioral health
research
Sec. 714. Definitions
Sec. 715. Authorization of
appropriations
TITLE VIII—MISCELLANEOUS
Sec. 801. Reports
Sec. 802. Regulations
Sec. 803. Plan of
implementation
Sec. 804. Availability of
funds
Sec. 805. Limitation on use of funds
appropriated to the Indian Health Service
Sec. 806. Eligibility of California
Indians
Sec. 807. Health services for ineligible
persons
Sec. 808. Reallocation of base
resources
Sec. 809. Results of demonstration
projects
Sec. 810. Provision of services in
Montana
Sec. 811. Moratorium
Sec. 812. Tribal employment
Sec. 813. Severability
provisions
Sec. 814. Establishment of National
Bipartisan Commission on Indian Health Care
Sec. 815. Appropriations;
availability
Sec. 816. Authorization of
appropriations
2.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.
3.Declaration of
National Indian Health policyCongress 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.
4.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)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 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 April 30, 1908 (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, including physical, mental, and spiritual 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 Alaskan Native.
(C)The individual is
considered by the Secretary of the Interior to be an Indian for any
purpose.
(D)The individual is
determined to be an Indian under regulations promulgated by the
Secretary.
(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).
<enum>I</enum><header>INDIAN HEALTH,
HUMAN RESOURCES, AND DEVELOPMENT</header>
<section changed="deleted" committee-id="SLIA00" id="ID9148AE852FD148699C18FF921C5ABC25" reported-display-style="strikethrough"><enum>101.</enum><header>Purpose</header><text display-inline="no-display-inline">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.</text>
</section><section changed="deleted" committee-id="SLIA00" id="ID879EF388816C4C5195CFCDFEE2BE7A8B" reported-display-style="strikethrough"><enum>102.</enum><header>Health
professions recruitment Program for Indians</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID1512F3CA85114BBC83D8E1C95642F254" reported-display-style="strikethrough"><enum>(a)</enum><header>In
General</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDCCD871CCC9B84351B7A2C8D92265C80C" reported-display-style="strikethrough"><enum>(1)</enum><text>identifying
Indians with a potential for education or training in the health professions
and encouraging and assisting them—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID4F2B50C9BBED40CCB355FA288807CEF5" reported-display-style="strikethrough"><enum>(A)</enum><text>to enroll in
courses of study in such health professions; or</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID5E5D84B9E1174913A28BCBA8341C9322" reported-display-style="strikethrough"><enum>(B)</enum><text>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;</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID2080E1E5159A4B6E866BB8C2410687BA" reported-display-style="strikethrough"><enum>(2)</enum><text>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</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID4D4ED816E2D746CB9833153AC4A29CD5" reported-display-style="strikethrough"><enum>(3)</enum><text>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).</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDC9324A9BB29A4385AF7500D4381911EB" reported-display-style="strikethrough"><enum>(b)</enum><header>Funding</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID44E753D2D82D4389A1EB4EB83F0BFBEB" reported-display-style="strikethrough"><enum>(1)</enum><header>Application</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDD4957180F28D44E38D43FD06E339A893" reported-display-style="strikethrough"><enum>(2)</enum><header>Amount of funds;
payment</header><text>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.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="ID55A8CD7DE8374F00B3A859DEC1BEBD3B" reported-display-style="strikethrough"><enum>103.</enum><header>Health
professions preparatory scholarship Program for Indians</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID80C390A221B44029BC079DCC72C0819E" reported-display-style="strikethrough"><enum>(a)</enum><header>Scholarships
Authorized</header><text>The Secretary, acting through the Service, shall
provide scholarship grants to Indians who—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID1A5DCF541D144B9EA4F6635F2EEA7654" reported-display-style="strikethrough"><enum>(1)</enum><text>have successfully
completed their high school education or high school equivalency; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID07489B037C6C452AA00033929F726A21" reported-display-style="strikethrough"><enum>(2)</enum><text>have demonstrated
the potential to successfully complete courses of study in the health
professions.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDAA5D50761E204CA6B1518770E00C1F81" reported-display-style="strikethrough"><enum>(b)</enum><header>Purposes</header><text>Scholarships
provided pursuant to this section shall be for the following purposes:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID9A3C5218DA2A4D6C9C0560D88C516049" reported-display-style="strikethrough"><enum>(1)</enum><text>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).</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID1C4D57EF2891434F8AAA873D0FAA5091" reported-display-style="strikethrough"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID914072585BF047CD81078E724F73AB8D" reported-display-style="strikethrough"><enum>(c)</enum><header>Other
Conditions</header><text>Scholarships under this section—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID2E5C68796A634EAA9F41308AC7301240" reported-display-style="strikethrough"><enum>(1)</enum><text>may cover costs of
tuition, books, transportation, board, and other necessary related expenses of
a recipient while attending school;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF32D0E069BAD412ABB62F170571F56E4" reported-display-style="strikethrough"><enum>(2)</enum><text>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</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF7E48BAE571A44CBA798360FCE1D5799" reported-display-style="strikethrough"><enum>(3)</enum><text>shall not be
denied solely by reason of such applicant’s eligibility for assistance or
benefits under any other Federal program.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="ID8CA14A896D0F49FA911A9A5321ACFE67" reported-display-style="strikethrough"><enum>104.</enum><header>Indian Health
professions scholarships</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID40F07C6B328B4C69846542CE82EFBD01" reported-display-style="strikethrough"><enum>(a)</enum><header>In
General</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID575850C3A47D486BA1C6ADE68F356CF9" reported-display-style="strikethrough"><enum>(1)</enum><header>Authority</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID56A68F5B76C84630A50E8613C0F6BD3B" reported-display-style="strikethrough"><enum>(2)</enum><header>Allocation by
formula</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID87B390B546E6446C8C277BE65EFE4F7C" reported-display-style="strikethrough"><enum>(3)</enum><header>Continuity of
prior scholarships</header><text>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 <act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name> Amendments
of 2005) until such time as the individual completes the course of study that
is supported through such scholarship.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDEE32A1AB7E694198A2CBADACAE1AA82F" reported-display-style="strikethrough"><enum>(4)</enum><header>Certain
delegation not allowed</header><text>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 <act-name parsable-cite="ISDA">Indian
Self-Determination and Education Assistance Act</act-name> (25 U.S.C. 450 et
seq.).</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDFA281B25CED048E289B053D4AACD8AF9" reported-display-style="strikethrough"><enum>(b)</enum><header>Active Duty
Service Obligation</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID3E3626829CC648AF81578300E1FF2F21" reported-display-style="strikethrough"><enum>(1)</enum><header>Obligation
met</header><text>The active duty service obligation under a written contract
with the Secretary under section 338A of the <act-name parsable-cite="PHSA">Public Health Service Act</act-name> (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:</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID41E87AF7027540608169FA599E21F099" reported-display-style="strikethrough"><enum>(A)</enum><text>In an Indian
Health Program.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID76956C7EAA22415BA4521E49CA76B73E" reported-display-style="strikethrough"><enum>(B)</enum><text>In a program
assisted under title V of this Act.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID102CAB3C17D2434F8DE1A5153F18E694" reported-display-style="strikethrough"><enum>(C)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID0000729F5BBD49C49338609730B88D28" reported-display-style="strikethrough"><enum>(2)</enum><header>Obligation
deferred</header><text>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:</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDC1D969F638484E5595A3A6B7E2BF2CFE" reported-display-style="strikethrough"><enum>(A)</enum><text>No period of
internship, residency, or other advanced clinical training shall be counted as
satisfying any period of obligated service under this subsection.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID5B1D3E1303DB4060898A760A6FD120D8" reported-display-style="strikethrough"><enum>(B)</enum><text>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).</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDEFF188F7B03A4A3B974A48E52AB8828B" reported-display-style="strikethrough"><enum>(C)</enum><text>The active duty
service obligation will be served in the health profession of that individual
in a manner consistent with paragraph (1).</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID0AAE6C20B7AD466F818F5C1B27790F3F" reported-display-style="strikethrough"><enum>(D)</enum><text>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—</text>
<clause changed="deleted" committee-id="SLIA00" id="ID61B83BB6D73E4DE38B4F7F5D841B39CF" reported-display-style="strikethrough"><enum>(i)</enum><text>is located on the
reservation of the Indian Tribe in which the recipient is enrolled; or</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="ID0B827F8341E74761A66A3D438AE4A680" reported-display-style="strikethrough"><enum>(ii)</enum><text>serves the Indian
Tribe in which the recipient is enrolled.</text>
</clause></subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB0C60F0A8F044D67B41F44D626714692" reported-display-style="strikethrough"><enum>(3)</enum><header>Priority when
making assignments</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID8CDC26C670444D199AA84B2539E75F94" reported-display-style="strikethrough"><enum>(c)</enum><header>Part-Time
Students</header><text>In the case of an individual receiving a scholarship
under this section who is enrolled part time in an approved course of
study—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID97C3944840824F2CB8C777E79A0FA0D7" reported-display-style="strikethrough"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDDF9E24E137FF4EFB8B125B6355863226" reported-display-style="strikethrough"><enum>(2)</enum><text>the period of
obligated service described in subsection (b)(1) shall be equal to the greater
of—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID6BCFCD4DF0C44A16A1A6DE9D316AA520" reported-display-style="strikethrough"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDA0B679BFA4914AF79E29D9ACE92F538E" reported-display-style="strikethrough"><enum>(B)</enum><text>2 years;
and</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB3DE8B6F853A40AD94269DFE10F9B6D4" reported-display-style="strikethrough"><enum>(3)</enum><text>the amount of the
monthly stipend specified in section 338A(g)(1)(B) of the
<act-name parsable-cite="PHSA">Public Health Service Act</act-name> (42 U.S.C.
254<added-phrase>l</added-phrase>(g)(1)(B)) shall be reduced pro rata (as
determined by the Secretary) based on the number of hours such student is
enrolled.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID14DA63935932476E8604A8125829EFCA" reported-display-style="strikethrough"><enum>(d)</enum><header>Breach of
Contract</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID24846D9B5F8A4F56BAE8D3B710FA7B82" reported-display-style="strikethrough"><enum>(1)</enum><header>Specified
breaches</header><text>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 <act-name parsable-cite="IHCIA">Indian
Health Care Improvement Act</act-name> Amendments of 2005 if that
individual—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDC9D443EBF0A44B298CA0B398E436F864" reported-display-style="strikethrough"><enum>(A)</enum><text>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);</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID1A3273AFB7D34DE0A6FF36C2A0E507BD" reported-display-style="strikethrough"><enum>(B)</enum><text>is dismissed from
such educational institution for disciplinary reasons;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID1CF7222F8BD943D0AD21DE8B64847823" reported-display-style="strikethrough"><enum>(C)</enum><text>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</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID1440CE421ADB4FA49C05F27B5A8BF797" reported-display-style="strikethrough"><enum>(D)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID5D0D16CCF26E4680B7B0F5B7A639B923" reported-display-style="strikethrough"><enum>(2)</enum><header>Other
breaches</header><text>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 (<added-phrase>l</added-phrase>) of section 110 in the manner
provided for in such subsection.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDFDF9A176D13A464BB43825787B1076E3" reported-display-style="strikethrough"><enum>(3)</enum><header>Cancellation
upon death of recipient</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID160580FDBD364915964C1F2BA3EB7564" reported-display-style="strikethrough"><enum>(4)</enum><header>Waivers and
suspensions</header><text>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—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDF4A4303C0A5A4771BACCD0F905B9E580" reported-display-style="strikethrough"><enum>(A)</enum><text>it is not possible
for the recipient to meet that obligation or make that payment;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDC506169A34B84807AC6FBA3DBA7BEE15" reported-display-style="strikethrough"><enum>(B)</enum><text>requiring that
recipient to meet that obligation or make that payment would result in extreme
hardship to the recipient; or</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID0D52C7F3FCAA47D698EBEE2BB85720F7" reported-display-style="strikethrough"><enum>(C)</enum><text>the enforcement of
the requirement to meet the obligation or make the payment would be
unconscionable.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDDB8CEC0CE5F149B1B9D1513D1007477A" reported-display-style="strikethrough"><enum>(5)</enum><header>Extreme
hardship</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID5FD5C857EFB846A7A091788165DC36CA" reported-display-style="strikethrough"><enum>(6)</enum><header>Bankruptcy</header><text>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.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="ID469341932E694E9989F01D9A8B21039B" reported-display-style="strikethrough"><enum>105.</enum><header>American
Indians Into Psychology Program</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID39FA0B54405E4A12A3AEF5599BC78398" reported-display-style="strikethrough"><enum>(a)</enum><header>Grants
Authorized</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID8111CF5202674081B37A8049F88DEB93" reported-display-style="strikethrough"><enum>(b)</enum><header>Quentin N.
Burdick Program Grant</header><text>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 <quote>Quentin N. Burdick
American Indians Into Psychology Program</quote>. 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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID084A8DA5DB474270AFECCDC62FD8E0A0" reported-display-style="strikethrough"><enum>(c)</enum><header>Regulations</header><text>The
Secretary shall issue regulations pursuant to this Act for the competitive
awarding of grants provided under this section.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDA986F02880D3404682813CFB87FC4DDC" reported-display-style="strikethrough"><enum>(d)</enum><header>Conditions of
Grant</header><text>Applicants under this section shall agree to provide a
program which, at a minimum—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID74A3A498B88C4EB5BA64BD1FA064349C" reported-display-style="strikethrough"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDEEADB70BCF874B8F97EDF38A9E4AF2F9" reported-display-style="strikethrough"><enum>(2)</enum><text>incorporates a
program advisory board comprised of representatives from the tribes and
communities that will be served by the program;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDCA9CFBED9F6F4D5FA41616D576E6DF8D" reported-display-style="strikethrough"><enum>(3)</enum><text>provides summer
enrichment programs to expose Indian students to the various fields of
psychology through research, clinical, and experimental activities;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID20F8FD83951E4D879CB73001638528DB" reported-display-style="strikethrough"><enum>(4)</enum><text>provides stipends
to undergraduate and graduate students to pursue a career in psychology;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID81A4921C86014D72BE4E64FC818BCA1D" reported-display-style="strikethrough"><enum>(5)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDFA0696C9BFE8425ABB5D0033BD55A20F" reported-display-style="strikethrough"><enum>(6)</enum><text>to the maximum
extent feasible, uses existing university tutoring, counseling, and student
support services; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDEDCDC70BE74947E2B90BD2359C647F31" reported-display-style="strikethrough"><enum>(7)</enum><text>to the maximum
extent feasible, employs qualified Indians in the program.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID602CAA9E7F4F45E38EACEB02E1774BF5" reported-display-style="strikethrough"><enum>(e)</enum><header>Active Duty
Service Requirement</header><text>The active duty service obligation prescribed
under section 338C of the <act-name parsable-cite="PHSA">Public Health Service
Act</act-name> (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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID3598238450F046C7A527B7A00C1DAA47" reported-display-style="strikethrough"><enum>(1)</enum><text>in an Indian
Health Program;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID95A1D0B5B548460CAB0D487FEFFE7769" reported-display-style="strikethrough"><enum>(2)</enum><text>in a program
assisted under title V of this Act; or</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID9EE51D262F7E44C6BA284A3ACFEC31C3" reported-display-style="strikethrough"><enum>(3)</enum><text>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.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="ID21D6A487832F40A2B92DD79C01ADAC64" reported-display-style="strikethrough"><enum>106.</enum><header>Funding for
Tribes for scholarship Programs</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID01B43FB663444A8C84A306DFC1352B04" reported-display-style="strikethrough"><enum>(a)</enum><header>In
General</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID40CD5216AD4B4F2F943AD5ADAE895526" reported-display-style="strikethrough"><enum>(1)</enum><header>Grants
authorized</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDE6896E73C5F048C99AC883CD4A78DF70" reported-display-style="strikethrough"><enum>(2)</enum><header>Amount</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDFE57E1027DB64970B57EB3C9DBA0F381" reported-display-style="strikethrough"><enum>(3)</enum><header>Application</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID14DF43AAF49E4DFA8536B72CAADAD667" reported-display-style="strikethrough"><enum>(b)</enum><header>Requirements</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDDE046195079244788E1736543578D7AC" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>A Tribal Health Program receiving a grant under
subsection (a) shall provide scholarships to Indians in accordance with the
requirements of this section.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID0A0985A6F6CD4A43ABE553F0FC53630A" reported-display-style="strikethrough"><enum>(2)</enum><header>Costs</header><text>With
respect to costs of providing any scholarship pursuant to subsection
(a)—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID188420A24D0349CFBDA3A2EC1C10CBEB" reported-display-style="strikethrough"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDD45430C4046F48408DC1BA03FD96D464" reported-display-style="strikethrough"><enum>(B)</enum><text>20 percent of such
costs may be paid from any other source of funds.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID34F6DE0C06754687A0A13AF7EF7CE009" reported-display-style="strikethrough"><enum>(c)</enum><header>Course of
Study</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDE0B8254880FC4920BD6D38248087473A" reported-display-style="strikethrough"><enum>(d)</enum><header>Contract</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID6F70167FFFD642729DB631E6E8B0565B" reported-display-style="strikethrough"><enum>(1)</enum><text>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—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID04D41AC2F3474DEB8CD95F5E67DE3767" reported-display-style="strikethrough"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDEB85AA393A404A809D549055265C96FF" reported-display-style="strikethrough"><enum>(B)</enum><text>such greater
period of time as the recipient and the Tribal Health Program may agree;</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDC43822998F3748A4B054762BA435FCC7" reported-display-style="strikethrough"><enum>(2)</enum><text>provide that the
amount of the scholarship—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDD8103B055A644C1B9E22C85A8D1EE8DB" reported-display-style="strikethrough"><enum>(A)</enum><text>may only be
expended for—</text>
<clause changed="deleted" committee-id="SLIA00" id="IDD40E3B34EC214C24A2BB2D47571F6631" reported-display-style="strikethrough"><enum>(i)</enum><text>tuition expenses,
other reasonable educational expenses, and reasonable living expenses incurred
in attendance at the educational institution; and</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="ID9404D0B3692D43778489F024B5DDF9BE" reported-display-style="strikethrough"><enum>(ii)</enum><text>payment to the
recipient of a monthly stipend of not more than the amount authorized by
section 338(g)(1)(B) of the <act-name parsable-cite="PHSA">Public Health
Service Act</act-name> (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</text>
</clause></subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID7EDA67045C27413AA3102265EB650C5C" reported-display-style="strikethrough"><enum>(B)</enum><text>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);</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID9309C313233F4909B744B04C7BB3002E" reported-display-style="strikethrough"><enum>(3)</enum><text>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</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB917B43465AC4721BD34405201D5256A" reported-display-style="strikethrough"><enum>(4)</enum><text>require the
recipient of such scholarship to meet the educational and licensure
requirements appropriate to each health profession.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID9E47AF5E331442129F90EEEBD7FAAD11" reported-display-style="strikethrough"><enum>(e)</enum><header>Breach of
Contract</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID67F016BF60A14417BFB5E94E9846013F" reported-display-style="strikethrough"><enum>(1)</enum><header>Specific
breaches</header><text>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—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID4935B27DBA9C4B3DAE45AB89035B6628" reported-display-style="strikethrough"><enum>(A)</enum><text>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);</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDF939B0E0829A4B1A83075662ACFDF45A" reported-display-style="strikethrough"><enum>(B)</enum><text>is dismissed from
such educational institution for disciplinary reasons;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID3D0FBDA1E34843ACB13DE42F79EA54F8" reported-display-style="strikethrough"><enum>(C)</enum><text>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</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID83513A88CC754687A7A1E2D69E9BBE6E" reported-display-style="strikethrough"><enum>(D)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID21A013A3420047B19A405A6B00A6B9AB" reported-display-style="strikethrough"><enum>(2)</enum><header>Other
breaches</header><text>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 (<added-phrase>l</added-phrase>) of section 110 in the manner
provided for in such subsection.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID38AC3D93076740B2B5DE972A18D107C1" reported-display-style="strikethrough"><enum>(3)</enum><header>Cancellation
upon death of recipient</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB37D49A578EC4381A704A82E5F7998D3" reported-display-style="strikethrough"><enum>(4)</enum><header>Information</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDB03099143E37418E84AADD6B1A22FDE3" reported-display-style="strikethrough"><enum>(f)</enum><header>Relation to
<act-name parsable-cite="SSA">Social Security Act</act-name></header><text>The
recipient of a scholarship under this section shall agree, in providing health
care pursuant to the requirements herein—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID52A48700D92D47859CB412D6166935D3" reported-display-style="strikethrough"><enum>(1)</enum><text>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
<act-name parsable-cite="SSA">Social Security Act</act-name> or pursuant to the
programs established in title XIX or title XXI of such Act; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB583357ED0A44AADB35130F1E660CF4E" reported-display-style="strikethrough"><enum>(2)</enum><text>to accept
assignment under section 1842(b)(3)(B)(ii) of the <act-name parsable-cite="SSA">Social Security Act</act-name> 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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID0FB7E3D2CDE74CDE9C83A3EEA7263290" reported-display-style="strikethrough"><enum>(g)</enum><header>Continuance of
Funding</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID998FCB3F1E9746ABA06398320701F9C9" reported-display-style="strikethrough"><enum>107.</enum><header>Indian Health
Service extern Programs</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDF55D427F85AB4FFCA7BB4CD15E648F33" reported-display-style="strikethrough"><enum>(a)</enum><header>Employment
Preference</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID32B73175831948209835C32640217173" reported-display-style="strikethrough"><enum>(b)</enum><header>Not Counted
Toward Active Duty Service Obligation</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID2F46B8ECB54445759977A60B95FBE6E8" reported-display-style="strikethrough"><enum>(c)</enum><header>Timing; Length
of Employment</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID717AB38B7A9B4A68B3EDDB476EBE1FD3" reported-display-style="strikethrough"><enum>(d)</enum><header>Nonapplicability
of Competitive Personnel System</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID5C833FFF1F6C42A5B7C0C5226347E4F5" reported-display-style="strikethrough"><enum>108.</enum><header>Continuing
education allowances</header><text display-inline="no-display-inline">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.</text>
</section><section changed="deleted" committee-id="SLIA00" id="ID6A885F860D4B4D948E50D932BB0355F7" reported-display-style="strikethrough"><enum>109.</enum><header>Community
Health Representative Program</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID99AD0F5A857548AAB17F55E1255C0D2D" reported-display-style="strikethrough"><enum>(a)</enum><header>In
General</header><text>Under the authority of the Act of November 2, 1921 (25
U.S.C. 13) (commonly known as the <quote>Snyder Act</quote>), the Secretary,
acting through the Service, shall maintain a Community Health Representative
Program under which Indian Health Programs—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID674D5F8925FA43ED93ED9604675C01F8" reported-display-style="strikethrough"><enum>(1)</enum><text>provide for the
training of Indians as community health representatives; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDE5A09B7ECBF9477D9E33D4A5C15F79A3" reported-display-style="strikethrough"><enum>(2)</enum><text>use such community
health representatives in the provision of health care, health promotion, and
disease prevention services to Indian communities.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDCBC84453791342EE93AE1873DC99E940" reported-display-style="strikethrough"><enum>(b)</enum><header>Duties</header><text>The
Community Health Representative Program of the Service, shall—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID54FB8F9C5461411E9775C0EACA2765C7" reported-display-style="strikethrough"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDDFCB810D8C5741F4907E94A4D8FDB6F0" reported-display-style="strikethrough"><enum>(2)</enum><text>in order to
provide such training, develop and maintain a curriculum that—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDBC5B8632DB5349FA8B81118306B89CB0" reported-display-style="strikethrough"><enum>(A)</enum><text>combines education
in the theory of health care with supervised practical experience in the
provision of health care; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDEF8E263154FF49BEB1B847A49A130C36" reported-display-style="strikethrough"><enum>(B)</enum><text>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;</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDDEF9C13930EF41A4BF8DD911FD26E184" reported-display-style="strikethrough"><enum>(3)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID420D98BD551744EAA0D294C412AF634B" reported-display-style="strikethrough"><enum>(4)</enum><text>maintain a system
that provides close supervision of Community Health Representatives;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDD53A798516F34F50A09A756CD4AC0C37" reported-display-style="strikethrough"><enum>(5)</enum><text>maintain a system
under which the work of Community Health Representatives is reviewed and
evaluated; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID58E7ABB99E4F44F385B046E221E95735" reported-display-style="strikethrough"><enum>(6)</enum><text>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.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="ID663CA218141B4D1680C71BBBAADA9857" reported-display-style="strikethrough"><enum>110.</enum><header>Indian Health
Service Loan Repayment Program</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID9572D8B04E7A4676981650964341F518" reported-display-style="strikethrough"><enum>(a)</enum><header>Establishment</header><text>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 <quote>Loan Repayment Program</quote>) 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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID6BEA998B89184EFCA387174C8AD5E24A" reported-display-style="strikethrough"><enum>(b)</enum><header>Eligible
Individuals</header><text>To be eligible to participate in the Loan Repayment
Program, an individual must—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID8792BE197DC24466978F3B4B64F4C709" reported-display-style="strikethrough"><enum>(1)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="ID7163268B4C4A4BDD9D0B7B1DE81B3ED5"><enum>(A)</enum><text>be enrolled—</text>
<clause changed="deleted" committee-id="SLIA00" id="ID833F0A6B845945F2B29B10C5B2E95EA7" indent="up1" reported-display-style="strikethrough"><enum>(i)</enum><text>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 <act-name parsable-cite="PHSA">Public Health Service Act</act-name> (42 U.S.C.
254<added-phrase>l</added-phrase>–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</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="ID92C489DE720A4FFBB396CDF62B829C79" indent="up1" reported-display-style="strikethrough"><enum>(ii)</enum><text>in an approved
graduate training program in a health profession; or</text>
</clause></subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID4C3F7AC1C76847CE90F044DA07DD4A49" indent="up1" reported-display-style="strikethrough"><enum>(B)</enum><text>have—</text>
<clause changed="deleted" committee-id="SLIA00" id="ID9A31153E9648464BA7DCF8253F1EBCC8" reported-display-style="strikethrough"><enum>(i)</enum><text>a degree in a
health profession; and</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="ID5BB7D2AFB5F9407887636AA443536B42" reported-display-style="strikethrough"><enum>(ii)</enum><text>a license to
practice a health profession;</text>
</clause></subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID21B3C77D55D1436988F7AF97F8278F6A" reported-display-style="strikethrough"><enum>(2)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="ID0E4EAF6767EE4F27BD2EE2D395519EA5"><enum>(A)</enum><text>be eligible for, or
hold, an appointment as a commissioned officer in the Regular or Reserve Corps
of the Public Health Service;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID539BF462263E44C498C54AC973084882" indent="up1" reported-display-style="strikethrough"><enum>(B)</enum><text>be eligible for
selection for civilian service in the Regular or Reserve Corps of the Public
Health Service;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID466F14FDBE46422EA9BFAFCD91C55345" indent="up1" reported-display-style="strikethrough"><enum>(C)</enum><text>meet the
professional standards for civil service employment in the Service; or</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID79345C6D51C54768B4E777EE3BEC14C8" indent="up1" reported-display-style="strikethrough"><enum>(D)</enum><text>be employed in an
Indian Health Program or Urban Indian Organization without a service
obligation; and</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB7918EBF4D6E41F7A865674BBA2E0E8F" reported-display-style="strikethrough"><enum>(3)</enum><text>submit to the
Secretary an application for a contract described in subsection (e).</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID773B9250EF82425EAAE8F82316DE1C9C" reported-display-style="strikethrough"><enum>(c)</enum><header>Application</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDA97DC98B2D594F2B9416687CDAA0256F" reported-display-style="strikethrough"><enum>(1)</enum><header>Information to
be included with forms</header><text>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 (<added-phrase>l</added-phrase>) 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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF631F5401ED34E3B98452556F65BA217" reported-display-style="strikethrough"><enum>(2)</enum><header>Clear
language</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID86AAC4066E664CBDBFE27CC21680A290" reported-display-style="strikethrough"><enum>(3)</enum><header>Timely
availability of forms</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID581862F0669C434E8D938882283640BA" reported-display-style="strikethrough"><enum>(d)</enum><header>Priorities</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDCED3A1032B374958B95EED1B5AAC4D78" reported-display-style="strikethrough"><enum>(1)</enum><header>List</header><text>Consistent
with subsection (k), the Secretary shall annually—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID7C0238FB89184861A2EC220214BBE06A" reported-display-style="strikethrough"><enum>(A)</enum><text>identify the
positions in each Indian Health Program or Urban Indian Organization for which
there is a need or a vacancy; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID80E8DB268157468880545CA93AF38E80" reported-display-style="strikethrough"><enum>(B)</enum><text>rank those
positions in order of priority.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDC9ECB2365E7247EDBCE720B64504A0A7" reported-display-style="strikethrough"><enum>(2)</enum><header>Approvals</header><text>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—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID36985C6021BA4B9CBE4DB75BE42425C2" reported-display-style="strikethrough"><enum>(A)</enum><text>give first
priority to applications made by individual Indians; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID2AE5F6A9D31044AB84252F02111692A8" reported-display-style="strikethrough"><enum>(B)</enum><text>after making
determinations on all applications submitted by individual Indians as required
under subparagraph (A), give priority to—</text>
<clause changed="deleted" committee-id="SLIA00" id="IDFCA2C40D2A1E4ABB89265EB8588BDEB6" reported-display-style="strikethrough"><enum>(i)</enum><text>individuals
recruited through the efforts of an Indian Health Program or Urban Indian
Organization; and</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="IDAD54C5112CF3420B82EBECFCA2666D22" reported-display-style="strikethrough"><enum>(ii)</enum><text>other individuals
based on the priority rankings under paragraph (1).</text>
</clause></subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDCD9574C240654AE39084291D891C5C01" reported-display-style="strikethrough"><enum>(e)</enum><header>Recipient
Contracts</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID89F43D410F924A4FBFE69303133B934A" reported-display-style="strikethrough"><enum>(1)</enum><header>Contract
required</header><text>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).</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDE3EB0AAD62824F51907FA6D9BAA47F1C" reported-display-style="strikethrough"><enum>(2)</enum><header>Contents of
contract</header><text>The written contract referred to in this section between
the Secretary and an individual shall contain—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDE84E45B5CB1146ACB2681C7E31FC496A" reported-display-style="strikethrough"><enum>(A)</enum><text>an agreement under
which—</text>
<clause changed="deleted" committee-id="SLIA00" id="IDED22079D947C48699B013C61FBECC309" reported-display-style="strikethrough"><enum>(i)</enum><text>subject to
subparagraph (C), the Secretary agrees—</text>
<subclause changed="deleted" committee-id="SLIA00" id="IDA18B86F6D5F749FDA4FC3012ED48F19B" reported-display-style="strikethrough"><enum>(I)</enum><text>to pay loans on
behalf of the individual in accordance with the provisions of this section;
and</text>
</subclause><subclause changed="deleted" committee-id="SLIA00" id="IDCD6428C4AFE64E33B285EC479F876C19" reported-display-style="strikethrough"><enum>(II)</enum><text>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</text>
</subclause></clause><clause changed="deleted" committee-id="SLIA00" id="IDA6595D15131B4F5087B124F222A9D254" reported-display-style="strikethrough"><enum>(ii)</enum><text>subject to
subparagraph (C), the individual agrees—</text>
<subclause changed="deleted" committee-id="SLIA00" id="IDD07E9724A4C746EFB54AC82DB8FC9FAE" reported-display-style="strikethrough"><enum>(I)</enum><text>to accept loan
payments on behalf of the individual;</text>
</subclause><subclause changed="deleted" committee-id="SLIA00" id="IDEE926C827A304AFAB6EAE62E077AAC5B" reported-display-style="strikethrough"><enum>(II)</enum><text>in the case of an
individual described in subsection (b)(1)—</text>
<item changed="deleted" committee-id="SLIA00" id="IDAE9B91314875495BA2CAE44847EA7E33" reported-display-style="strikethrough"><enum>(aa)</enum><text>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</text>
</item><item changed="deleted" committee-id="SLIA00" id="IDD73E6B7985504C86A512D37AF6BA7CD4" reported-display-style="strikethrough"><enum>(bb)</enum><text>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</text>
</item></subclause><subclause changed="deleted" committee-id="SLIA00" id="IDAFD9E4A584534151B6AC74248DB6D9BD" reported-display-style="strikethrough"><enum>(III)</enum><text>to serve for a
time period (hereinafter in this section referred to as the <quote>period of
obligated service</quote>) 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;</text>
</subclause></clause></subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDDEF171B4A7554308866674ECBBEA51AB" reported-display-style="strikethrough"><enum>(B)</enum><text>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);</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID78830D1FAD5145258256069EC684A3F6" reported-display-style="strikethrough"><enum>(C)</enum><text>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;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID532433B0DAB54A298C2448BF45CD3894" reported-display-style="strikethrough"><enum>(D)</enum><text>a statement of the
damages to which the United States is entitled under subsection
(<added-phrase>l</added-phrase>) for the individual’s breach of the contract;
and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDAF5E010598DC4D1D875725071FCDBD79" reported-display-style="strikethrough"><enum>(E)</enum><text>such other
statements of the rights and liabilities of the Secretary and of the
individual, not inconsistent with this section.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID5D1B07F10EFD4D22A5607F0B976FE790" reported-display-style="strikethrough"><enum>(f)</enum><header>Deadline for
Decision on Application</header><text>The Secretary shall provide written
notice to an individual within 21 days on—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID62DE5F2D28624C1C816A756541ECC94B" reported-display-style="strikethrough"><enum>(1)</enum><text>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</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID838733958FCD4CA59AA50D414D6D7377" reported-display-style="strikethrough"><enum>(2)</enum><text>the Secretary’s
disapproving an individual’s participation in such Program.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID4A3AF90E5E5F41E49AB1231C5AC9889F" reported-display-style="strikethrough"><enum>(g)</enum><header>Payments</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDAD843941F6784C89884F0B4B6E33BCE9" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>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—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID992D22575AD24F888CB87227FBE69B71" reported-display-style="strikethrough"><enum>(A)</enum><text>tuition
expenses;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID9EDA8261885E4F85A60D5763E1FA1007" reported-display-style="strikethrough"><enum>(B)</enum><text>all other
reasonable educational expenses, including fees, books, and laboratory
expenses, incurred by the individual; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDA086F45F6FBA4EAE81D7B63BC8E417D9" reported-display-style="strikethrough"><enum>(C)</enum><text>reasonable living
expenses as determined by the Secretary.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID4425E728A1C3480680A9C710D90B8F6B" reported-display-style="strikethrough"><enum>(2)</enum><header>Amount</header><text>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 <act-name parsable-cite="PHSA">Public Health Service Act</act-name>, 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—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID227DD3057F88412C846FEDB19F8ADAC6" reported-display-style="strikethrough"><enum>(A)</enum><text>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;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID312AFEF5D6044CE899EB025FE4FF0D3A" reported-display-style="strikethrough"><enum>(B)</enum><text>provides an
incentive to serve in Indian Health Programs and Urban Indian Organizations
with the greatest shortages of health professionals; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID5022C40F884445E183DC8FAEA9EFC811" reported-display-style="strikethrough"><enum>(C)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID33BFEC3B506F4752AF78A52C95EF3B08" reported-display-style="strikethrough"><enum>(3)</enum><header>Timing</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDAA58A774ED244DE396384EF93DAB11F9" reported-display-style="strikethrough"><enum>(4)</enum><header>Reimbursements
for tax liability</header><text>For the purpose of providing reimbursements for
tax liability resulting from a payment under paragraph (2) on behalf of an
individual, the Secretary—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID59605F4853A04FC09810A282526F0428" reported-display-style="strikethrough"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID81ACCD6FC5B94988B1AD3562E9355E73" reported-display-style="strikethrough"><enum>(B)</enum><text>may make such
additional payments as the Secretary determines to be appropriate with respect
to such purpose.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB3B59211FA324A18898EBE4DC78FF20A" reported-display-style="strikethrough"><enum>(5)</enum><header>Payment
schedule</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID8B198C6A28A74B6B9454E0FD1A3CB794" reported-display-style="strikethrough"><enum>(h)</enum><header>Employment
Ceiling</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID265C0E43CC5E42B7865096218740BDFD" reported-display-style="strikethrough"><enum>(i)</enum><header>Recruitment</header><text>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).</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID5E3607BF0D1E465A98BDEA3BE44E1E67" reported-display-style="strikethrough"><enum>(j)</enum><header>Applicability of
Law</header><text>Section 214 of the <act-name parsable-cite="PHSA">Public
Health Service Act</act-name> (42 U.S.C. 215) shall not apply to individuals
during their period of obligated service under the Loan Repayment
Program.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID246D327647F647918695D6C268497437" reported-display-style="strikethrough"><enum>(k)</enum><header>Assignment of
Individuals</header><text>The Secretary, in assigning individuals to serve in
Indian Health Programs or Urban Indian Organizations pursuant to contracts
entered into under this section, shall—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDF2A27D076EB14412830632DB296DEB9B" reported-display-style="strikethrough"><enum>(1)</enum><text>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</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID6AECB3168EDD499E9B8C4E40D7D601E7" reported-display-style="strikethrough"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID5436A5C055BD4DA68EC82C3A40281477" reported-display-style="strikethrough"><enum>(<added-phrase>l</added-phrase>)</enum><header>Breach
of Contract</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID258C723AC7494E718D432CE6C63A7925" reported-display-style="strikethrough"><enum>(1)</enum><header>Specific
breaches</header><text>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—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID5BDB35B021164439B304935E2ACCA3BF" reported-display-style="strikethrough"><enum>(A)</enum><text>is enrolled in the
final year of a course of study and—</text>
<clause changed="deleted" committee-id="SLIA00" id="IDCE86A4EF3E2F4F2B8DBA073158F2EF5F" reported-display-style="strikethrough"><enum>(i)</enum><text>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);</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="ID6419054988A6455589063FE3D9B026FC" reported-display-style="strikethrough"><enum>(ii)</enum><text>voluntarily
terminates such enrollment; or</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="ID7874CB87CF57456F949B5BA40E6AF4A1" reported-display-style="strikethrough"><enum>(iii)</enum><text>is dismissed
from such educational institution before completion of such course of study;
or</text>
</clause></subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID283A3E5E17D64DAAB87287F34C7FD4FF" reported-display-style="strikethrough"><enum>(B)</enum><text>is enrolled in a
graduate training program and fails to complete such training program.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID1E45C91537AB4A76B5EF066B1FACB4BD" reported-display-style="strikethrough"><enum>(2)</enum><header>Other breaches;
formula for amount owed</header><text>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—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDD60E514939484D559296695FC23310BF" reported-display-style="strikethrough"><enum>(A)</enum><text><quote>A</quote>
is the amount the United States is entitled to recover;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDCFDB6D2F3DE64427BD7FDB570F1597F7" reported-display-style="strikethrough"><enum>(B)</enum><text><quote>Z</quote>
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;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDA1376F58290745D8AC47A18236E7F4BD" reported-display-style="strikethrough"><enum>(C)</enum><text><quote>t</quote>
is the total number of months in the individual’s period of obligated service
in accordance with subsection (f); and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDDA323DCFDCE94FD495519FF4E13941F2" reported-display-style="strikethrough"><enum>(D)</enum><text><quote>s</quote>
is the number of months of such period served by such individual in accordance
with this section.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID7920B4E87C204E619A2130EED0D525BB" reported-display-style="strikethrough"><enum>(3)</enum><header>Deductions in
medicare payments</header><text>Amounts not paid within such period shall be
subject to collection through deductions in medicare payments pursuant to
section 1892 of the <act-name parsable-cite="SSA">Social Security
Act</act-name>.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID74395526664C4F71BE809CD503C5EE25" reported-display-style="strikethrough"><enum>(4)</enum><header>Time period for
repayment</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF1B881937D4A4DE1AA5CA4E266B3BFCA" reported-display-style="strikethrough"><enum>(5)</enum><header>Recovery of
delinquency</header>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID2C89C1D4D1B644C0867D57D1580C2E37" reported-display-style="strikethrough"><enum>(A)</enum><header>In
general</header><text>If damages described in paragraph (4) are delinquent for
3 months, the Secretary shall, for the purpose of recovering such
damages—</text>
<clause changed="deleted" committee-id="SLIA00" id="IDDE80D3D863C7451890A9A16C31F3263F" reported-display-style="strikethrough"><enum>(i)</enum><text>use collection
agencies contracted with by the Administrator of General Services; or</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="ID38088B0FCAAB4ACABDCBB920CB710CE6" reported-display-style="strikethrough"><enum>(ii)</enum><text>enter into
contracts for the recovery of such damages with collection agencies selected by
the Secretary.</text>
</clause></subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID066288FDEAF14AEA90CC7FD8F2543430" reported-display-style="strikethrough"><enum>(B)</enum><header>Report</header><text>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.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDF1975AEA6C0E49408420F6AFD8682A7C" reported-display-style="strikethrough"><enum>(m)</enum><header>Waiver or
Suspension of Obligation</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID945889DF37254564B780BF19CB47A4AF" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF71B0B43A2E046E9AB4B22AA237B102E" reported-display-style="strikethrough"><enum>(2)</enum><header>Canceled upon
death</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDFC3F26228DA44D98AEEBE5CBB474F96E" reported-display-style="strikethrough"><enum>(3)</enum><header>Hardship
waiver</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID634A944E628E4EF482466F3CB367E079" reported-display-style="strikethrough"><enum>(4)</enum><header>Bankruptcy</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDCED1679FCAFA448CA4E662B6829240F9" reported-display-style="strikethrough"><enum>(n)</enum><header>Report</header><text>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:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDD306C4934C4241F6B184E13E8AA8B5CC" reported-display-style="strikethrough"><enum>(1)</enum><text>A list of the
health professional positions maintained by Indian Health Programs and Urban
Indian Organizations for which recruitment or retention is difficult.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID389034CB547C434B8003989E77CEBEA7" reported-display-style="strikethrough"><enum>(2)</enum><text>The number of Loan
Repayment Program applications filed with respect to each type of health
profession.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDC4C0686710864421A606B1757DCAB734" reported-display-style="strikethrough"><enum>(3)</enum><text>The number of
contracts described in subsection (e) that are entered into with respect to
each health profession.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID9676174AA4B1435BAAB8CBCD73C4523A" reported-display-style="strikethrough"><enum>(4)</enum><text>The amount of loan
payments made under this section, in total and by health profession.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDBCB8489FA57F4E2CAD4147BE34849D24" reported-display-style="strikethrough"><enum>(5)</enum><text>The number of
scholarships that are provided under sections 104 and 106 with respect to each
health profession.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDC2DCA6BEAFB94ABABA552700FC73D46E" reported-display-style="strikethrough"><enum>(6)</enum><text>The amount of
scholarship grants provided under section 104 and 106, in total and by health
profession.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID8F3B9271C91A42A5BF85856AD142C1C6" reported-display-style="strikethrough"><enum>(7)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID14C5F586AD7246E3A53B72378E271523" reported-display-style="strikethrough"><enum>(8)</enum><text>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.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="ID68A462E8D7F745BDB748DB76AF844EBE" reported-display-style="strikethrough"><enum>111.</enum><header>Scholarship and
Loan Repayment Recovery Fund</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDAD09D2ED3D51493D813BDE753EA12FC9" reported-display-style="strikethrough"><enum>(a)</enum><header>Establishment</header><text>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 <quote>LRRF</quote>). The LRRF shall consist of such
amounts as may be collected from individuals under section 104(d), section
106(e), and section 110(<added-phrase>l</added-phrase>) 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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDA49B457DE6924A35AACEA600CD14EA90" reported-display-style="strikethrough"><enum>(b)</enum><header>Use of
Funds</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID6696B5B32FB744A1A6D1173BD4045D2D" reported-display-style="strikethrough"><enum>(1)</enum><header>By
secretary</header><text>Amounts in the LRRF may be expended by the Secretary,
acting through the Service, to make payments to an Indian Health
Program—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID29BD56AF834B45C78CB1DE7D8AB7427C" reported-display-style="strikethrough"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID82B255407807414BAE89A1C25E6BB79D" reported-display-style="strikethrough"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID42A3A32507344F76908386D41B183484" reported-display-style="strikethrough"><enum>(2)</enum><header>By tribal health
programs</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID65A8BB581DB44EF2BD8D9CE00EE5860E" reported-display-style="strikethrough"><enum>(c)</enum><header>Investment of
Funds</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDF5DD0B90F0D34489A27F15B0C69AD837" reported-display-style="strikethrough"><enum>(d)</enum><header>Sale of
Obligations</header><text>Any obligation acquired by the LRRF may be sold by
the Secretary of the Treasury at the market price.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID0223B7E980B34AC3BA74ADA18D95EA22" reported-display-style="strikethrough"><enum>112.</enum><header>Recruitment
activities</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID8A86C55027114AF9BE0FB808ABB1101F" reported-display-style="strikethrough"><enum>(a)</enum><header>Reimbursement
for Travel</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDCD4CA0B9141D49B8A3772D63EC960D26" reported-display-style="strikethrough"><enum>(b)</enum><header>Recruitment
Personnel</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDD9478E4C8BFD42BBB631CC1D8B30DB58" reported-display-style="strikethrough"><enum>113.</enum><header>Indian
recruitment and retention Program</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDB2B414C533F94486A303CD90C8319B0F" reported-display-style="strikethrough"><enum>(a)</enum><header>In
General</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDCDD280EDF3EE479295DCF406600B748C" reported-display-style="strikethrough"><enum>(b)</enum><header>Eligible
Entities; Application</header><text>Any Tribal Health Program or Urban Indian
Organization may submit an application for funding of a project pursuant to
this section.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDCEF00E3A2C8E40E8B0B653EFBC85119E" reported-display-style="strikethrough"><enum>114.</enum><header>Advanced
training and research</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID28CF315ECE80454D99BE67DA44F4F1B0" reported-display-style="strikethrough"><enum>(a)</enum><header>Demonstration
Program</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID756F1217D7E24AB89319DAE1CE0A8628" reported-display-style="strikethrough"><enum>(b)</enum><header>Service
Obligation</header><text>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 <act-name parsable-cite="IHCIA">Indian Health Care Improvement
Act</act-name> 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 (<added-phrase>l</added-phrase>) of section 110
in the manner provided for in such subsection.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID9CDCC4082A9048A18D6FA502BD544DEF" reported-display-style="strikethrough"><enum>(c)</enum><header>Equal
Opportunity for Participation</header><text>Health professionals from Tribal
Health Programs and Urban Indian Organizations shall be given an equal
opportunity to participate in the program under subsection (a).</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDD77F354F01154EA281C1D9C6B82DD4A2" reported-display-style="strikethrough"><enum>115.</enum><header>Quentin N.
Burdick American Indians Into Nursing Program</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDED0FE595A7F048D5AAB9FA9813B79C1C" reported-display-style="strikethrough"><enum>(a)</enum><header>Grants
Authorized</header><text>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:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID71B4F9BCB07B494A995834071437D652" reported-display-style="strikethrough"><enum>(1)</enum><text>Public or private
schools of nursing.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDFCBFCF2097BB4DEB9BF8CC8509FFBE91" reported-display-style="strikethrough"><enum>(2)</enum><text>Tribal colleges or
universities.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID2CD016F7CEA94DF99A3FED567BCA54F7" reported-display-style="strikethrough"><enum>(3)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDF3843E6FAC984154AC4145929FEC2DDA" reported-display-style="strikethrough"><enum>(b)</enum><header>Use of
Grants</header><text>Grants provided under subsection (a) may be used for one
or more of the following:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDAED3966842D1461F950821F9C7B5D29F" reported-display-style="strikethrough"><enum>(1)</enum><text>To recruit
individuals for programs which train individuals to be nurses, nurse midwives,
or advanced practice nurses.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID39E9F6B8A81545F182AECE8D29B608F9" reported-display-style="strikethrough"><enum>(2)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID405E742121344DFABF46FE3B6C90BD4D" reported-display-style="strikethrough"><enum>(3)</enum><text>To provide a
program that encourages nurses, nurse midwives, and advanced practice nurses to
provide, or continue to provide, health care services to Indians.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID89845D37CE644036A2042CD4C965AFDE" reported-display-style="strikethrough"><enum>(4)</enum><text>To provide a
program that increases the skills of, and provides continuing education to,
nurses, nurse midwives, and advanced practice nurses.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID024CEE2233524DE88319776D402576F4" reported-display-style="strikethrough"><enum>(5)</enum><text>To provide any
program that is designed to achieve the purpose described in subsection
(a).</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDC3749AF563E64DF88C3750DD04247331" reported-display-style="strikethrough"><enum>(c)</enum><header>Applications</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDFDB35A6B2F144ED88C734F38B8DF4E20" reported-display-style="strikethrough"><enum>(d)</enum><header>Preferences for
Grant Recipients</header><text>In providing grants under subsection (a), the
Secretary shall extend a preference to the following:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID9555A90B652F4F91A1CBE0BE5568C15C" reported-display-style="strikethrough"><enum>(1)</enum><text>Programs that
provide a preference to Indians.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDBE75F67697AA485E93F29EAB6BCF0F77" reported-display-style="strikethrough"><enum>(2)</enum><text>Programs that
train nurse midwives or advanced practice nurses.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID44F37046F7724628B80212DC2EB04B3F" reported-display-style="strikethrough"><enum>(3)</enum><text>Programs that are
interdisciplinary.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID61CDD0FCD0124AFBB118CEF4A5FE92A9" reported-display-style="strikethrough"><enum>(4)</enum><text>Programs that are
conducted in cooperation with a program for gifted and talented Indian
students.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID843F24068BB0450A8E533F6FF0D49F2C" reported-display-style="strikethrough"><enum>(e)</enum><header>Quentin N.
Burdick Program Grant</header><text>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 <quote>Quentin N. Burdick
American Indians Into Nursing Program</quote>. 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).</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID8270D2322289465A9BB52AA14A869EC8" reported-display-style="strikethrough"><enum>(f)</enum><header>Active Duty
Service Obligation</header><text>The active duty service obligation prescribed
under section 338C of the <act-name parsable-cite="PHSA">Public Health Service
Act</act-name> (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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDB346B613F3F44B1E961D7F3943AF8E63" reported-display-style="strikethrough"><enum>(1)</enum><text>in the
Service;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA30A8E4F1D0642C6A90B8EF709707EEF" reported-display-style="strikethrough"><enum>(2)</enum><text>in a program of an
Indian Tribe or Tribal Organization conducted under the
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (including programs under agreements with the Bureau
of Indian Affairs);</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF63B4E34948446BBA82684776B4B8F10" reported-display-style="strikethrough"><enum>(3)</enum><text>in a program
assisted under title V of this Act; or</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID742C2180F02449149B5A90109B4F476B" reported-display-style="strikethrough"><enum>(4)</enum><text>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.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="IDEEF27C1B97804B5D87623C6CC9917295" reported-display-style="strikethrough"><enum>116.</enum><header>Tribal cultural
orientation</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDFE7B7448457B4936B15867E2345226DA" reported-display-style="strikethrough"><enum>(a)</enum><header>Cultural
Education of Employees</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDB1859172D71A4DABBED1408E23E5172F" reported-display-style="strikethrough"><enum>(b)</enum><header>Program</header><text>In
carrying out subsection (a), the Secretary shall establish a program which
shall, to the extent feasible—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID4AF10BE97AB44E7BA9B8A5D2112D9CBF" reported-display-style="strikethrough"><enum>(1)</enum><text>be developed in
consultation with the affected Indian Tribes, Tribal Organizations, and Urban
Indian Organizations;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDCEA26C436F99460FBB990270DD80C0FE" reported-display-style="strikethrough"><enum>(2)</enum><text>be carried out
through tribal colleges or universities;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID7B33682CBD934180992E58F2BAF27EE3" reported-display-style="strikethrough"><enum>(3)</enum><text>include
instruction in American Indian studies; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID24A19CE20B4E4D63B4F3D8F5745A34C5" reported-display-style="strikethrough"><enum>(4)</enum><text>describe the use
and place of Traditional Health Care Practices of the Indian Tribes in the
Service Area.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="IDDB737D82BA6843E1ABB67CFE4A3EA0B1" reported-display-style="strikethrough"><enum>117.</enum><header>INMED
Program</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDB00D44AD0B914731903D718A021A9C8D" reported-display-style="strikethrough"><enum>(a)</enum><header>Grants
Authorized</header><text>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 <quote>Indians Into Medicine Program</quote> (hereinafter in this
section referred to as <quote>INMED</quote>) as a means of encouraging Indians
to enter the health professions.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID52662328CFBA4B63A26074B261F8E2F2" reported-display-style="strikethrough"><enum>(b)</enum><header>Quentin N.
Burdick Grant</header><text>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 <quote>Quentin N. Burdick Indian Health
Programs</quote>, 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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID1C5E8020A23946BB8F7EF3497FFB54E6" reported-display-style="strikethrough"><enum>(c)</enum><header>Regulations</header><text>The
Secretary, pursuant to this Act, shall develop regulations to govern grants
pursuant to this section.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID607AB784ACFC434E87A713AD85B6944B" reported-display-style="strikethrough"><enum>(d)</enum><header>Requirements</header><text>Applicants
for grants provided under this section shall agree to provide a program
which—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID648D03A29ACF45F6B79ACA7832D32B29" reported-display-style="strikethrough"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID9341A83A2E7E4BB8A075C590D74FF80F" reported-display-style="strikethrough"><enum>(2)</enum><text>incorporates a
program advisory board comprised of representatives from the Indian Tribes and
Indian communities which will be served by the program;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDDD67578DBA7B4075AC39CE6CAAB2E3B4" reported-display-style="strikethrough"><enum>(3)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID2D4CEB248FC84BBAB9B67E7EEAF79C12" reported-display-style="strikethrough"><enum>(4)</enum><text>provides tutoring,
counseling, and support to students who are enrolled in a health career program
of study at the respective college or university; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB4DB16D6EC684662AA934F6B014B3B5B" reported-display-style="strikethrough"><enum>(5)</enum><text>to the maximum
extent feasible, employs qualified Indians in the program.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="ID3FBA361423C04B78B37D04D44855BC38" reported-display-style="strikethrough"><enum>118.</enum><header>Health training
Programs of community colleges</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID4C06205D89DD4D9EA1E735108BC95850" reported-display-style="strikethrough"><enum>(a)</enum><header>Grants To
Establish Programs</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID58F87766FAE4443B801622AFA8E0E5BE" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID6DFB8D0B0213463883E60DAD90A49DD8" reported-display-style="strikethrough"><enum>(2)</enum><header>Amount of
grants</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID409FD262C24643E09B409E3AEE130476" reported-display-style="strikethrough"><enum>(b)</enum><header>Grants for
Maintenance and Recruiting</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID4EB04D4298384C36BD9660449F7A81D4" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDCF70077987834E12B86FFA6AEEBB3F61" reported-display-style="strikethrough"><enum>(2)</enum><header>Requirements</header><text>Grants
may only be made under this section to a community college which—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDF3F5C988D99D4D4DB832A5C3A6F58A1A" reported-display-style="strikethrough"><enum>(A)</enum><text>is
accredited;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDB8DAA8FEEA844407836D6174109A2BB5" reported-display-style="strikethrough"><enum>(B)</enum><text>has a relationship
with a hospital facility, Service facility, or hospital that could provide
training of nurses or health professionals;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDB5A7A795023448618EED5A12ABAFF145" reported-display-style="strikethrough"><enum>(C)</enum><text>has entered into
an agreement with an accredited college or university medical school, the terms
of which—</text>
<clause changed="deleted" committee-id="SLIA00" id="IDFC4EF0697FDB43B6B853B336B8B74DE5" reported-display-style="strikethrough"><enum>(i)</enum><text>provide a program
that enhances the transition and recruitment of students into advanced
baccalaureate or graduate programs which train health professionals; and</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="IDDD0707BB18FF403C88A0F9D74BF51B8C" reported-display-style="strikethrough"><enum>(ii)</enum><text>stipulate
certifications necessary to approve internship and field placement
opportunities at Indian Health Programs;</text>
</clause></subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID51B64E7E66E34FBC83E2038996F74493" reported-display-style="strikethrough"><enum>(D)</enum><text>has a qualified
staff which has the appropriate certifications;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDDDF001531436417FB05B8A1DB5261754" reported-display-style="strikethrough"><enum>(E)</enum><text>is capable of
obtaining State or regional accreditation of the program described in
subsection (a)(1); and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID08BBC0C177BD420FAA9873F43F340BD1" reported-display-style="strikethrough"><enum>(F)</enum><text>agrees to provide
for Indian preference for applicants for programs under this section.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID3F122FE1190E4CD9B10DDD5CD6A3CB1B" reported-display-style="strikethrough"><enum>(c)</enum><header>Technical
Assistance</header><text>The Secretary shall encourage community colleges
described in subsection (b)(2) to establish and maintain programs described in
subsection (a)(1) by—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID9E9B6D447BCB4B6F9FA00C83D10F9D29" reported-display-style="strikethrough"><enum>(1)</enum><text>entering into
agreements with such colleges for the provision of qualified personnel of the
Service to teach courses of study in such programs; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDEE2FD0204FE14EAA9F45F047E2188E10" reported-display-style="strikethrough"><enum>(2)</enum><text>providing
technical assistance and support to such colleges.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDB20EB8FB4D194D0AAC89F705CEC12F0F" reported-display-style="strikethrough"><enum>(d)</enum><header>Advanced
Training</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID3BB801FAB29D464E9AACCA5028DD4EF5" reported-display-style="strikethrough"><enum>(1)</enum><header>Required</header><text>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—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID64F27595B01E44109835D83C8CC6495C" reported-display-style="strikethrough"><enum>(A)</enum><text>has already
received a degree or diploma in such health profession; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID217F9C929C8A4C538658779369027738" reported-display-style="strikethrough"><enum>(B)</enum><text>provides clinical
services on or near a reservation or for an Indian Health Program.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDC43F1E95A59042B4BC35612CB3315422" reported-display-style="strikethrough"><enum>(2)</enum><header>May be offered
at alternate site</header><text>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).</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDD579DB04D5F04BDAAFB0CDC40CF96DE9" reported-display-style="strikethrough"><enum>(e)</enum><header>Funding
Priority</header><text>Where the requirements of subsection (b) are met,
funding priority shall be provided to tribal colleges and universities in
Service Areas where they exist.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDD6C424F1CC634AB7A5B9C9E6CE47C24B" reported-display-style="strikethrough"><enum>119.</enum><header>Retention
bonus</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID39C432ED1E564E14BB21A75AE03D78B5" reported-display-style="strikethrough"><enum>(a)</enum><header>Bonus
Authorized</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDBE43C859376B4399A1640C3F27F7D7D1" reported-display-style="strikethrough"><enum>(1)</enum><text>is assigned to,
and serving in, a position for which recruitment or retention of personnel is
difficult;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID34C475A2B6DC4A3295C0C2BA69B5AA05" reported-display-style="strikethrough"><enum>(2)</enum><text>the Secretary
determines is needed by Indian Health Programs and Urban Indian
Organizations;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID5FE4CE3912444EBCBBE419FFCF75DB9F" reported-display-style="strikethrough"><enum>(3)</enum><text>has—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDBB5FE69A52C6461887E811283485784F" reported-display-style="strikethrough"><enum>(A)</enum><text>completed 3 years
of employment with an Indian Health Program or Urban Indian Organization;
or</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID666C370AB9574858886D92E94EB3DDF6" reported-display-style="strikethrough"><enum>(B)</enum><text>completed any
service obligations incurred as a requirement of—</text>
<clause changed="deleted" committee-id="SLIA00" id="ID75E3FEE1DB7343F2A8DD48F0D8E70849" reported-display-style="strikethrough"><enum>(i)</enum><text>any Federal
scholarship program; or</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="IDF161C65426414FBA92B7F7E5C1978CA2" reported-display-style="strikethrough"><enum>(ii)</enum><text>any Federal
education loan repayment program; and</text>
</clause></subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID23C372714E614D12818DDB69AEFED8D8" reported-display-style="strikethrough"><enum>(4)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDA88C6577B9D44BEFB196B00AE29FE96F" reported-display-style="strikethrough"><enum>(b)</enum><header>Rates</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDB9B17883024B4FC0B6D209E55E143993" reported-display-style="strikethrough"><enum>(c)</enum><header>Default of
Retention Agreement</header><text>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(<added-phrase>l</added-phrase>)(2)(B).</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID09C11C1433A9455FBED2212E2397701E" reported-display-style="strikethrough"><enum>(d)</enum><header>Other Retention
Bonus</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDC2B1ED39E228404BB434B34C7037AE35" reported-display-style="strikethrough"><enum>(1)</enum><text>a position for
which recruitment or retention is difficult; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID97811571FB3F4028AFE979D76F38EFC5" reported-display-style="strikethrough"><enum>(2)</enum><text>necessary for
providing health care services to Indians.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="IDB8993647CDF34D069645161BD5BA1450" reported-display-style="strikethrough"><enum>120.</enum><header>Nursing
residency Program</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDCF03DE6319984C03BFA717D652789B86" reported-display-style="strikethrough"><enum>(a)</enum><header>Establishment of
Program</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID150F52E3158942988B26945282B0AF5E" reported-display-style="strikethrough"><enum>(b)</enum><header>Service
Obligation</header><text>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 (<added-phrase>l</added-phrase>) of
section 110 in the manner provided for in such subsection.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID742AEC09876146BF9274EE039903FBC7" reported-display-style="strikethrough"><enum>121.</enum><header>Community
Health Aide Program for Alaska</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDD6385254EF0849EF845DE74C4DD4D3B1" reported-display-style="strikethrough"><enum>(a)</enum><header>General Purposes
of Program</header><text>Under the authority of the Act of November 2, 1921 (25
U.S.C. 13) (commonly known as the <quote>Snyder Act</quote>), the Secretary,
acting through the Service, shall develop and operate a Community Health Aide
Program in Alaska under which the Service—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID900E730A35F6457F8AD5F1464FDC66BC" reported-display-style="strikethrough"><enum>(1)</enum><text>provides for the
training of Alaska Natives as health aides or community health
practitioners;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID2E1264D762794B8590CE917CF2953BB5" reported-display-style="strikethrough"><enum>(2)</enum><text>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</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDDC4A8213372A4826BC1D4ED0F550F7A0" reported-display-style="strikethrough"><enum>(3)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID53768C3C76144C2A9C692A24A2028D24" reported-display-style="strikethrough"><enum>(b)</enum><header>Specific Program
Requirements</header><text>The Secretary, acting through the Community Health
Aide Program of the Service, shall—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDEB81B97C9078491D9FB5F10AEDA1506D" reported-display-style="strikethrough"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID45CB690C55A242D8824BAB2FB184A95B" reported-display-style="strikethrough"><enum>(2)</enum><text>in order to
provide such training, develop a curriculum that—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDF8C01EB0BB214726863805F53AA10BDA" reported-display-style="strikethrough"><enum>(A)</enum><text>combines education
in the theory of health care with supervised practical experience in the
provision of health care;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDDBD64BD58B0A421CBF9F3F431416CDFC" reported-display-style="strikethrough"><enum>(B)</enum><text>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</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID453FC9FD502A499AB3CC5ED2FB4051C5" reported-display-style="strikethrough"><enum>(C)</enum><text>promotes the
achievement of the health status objectives specified in section 3(2);</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDE04638AC11A04004B250C0F9AFF3B582" reported-display-style="strikethrough"><enum>(3)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID40BE54B78D6444F68A919BBACA98A888" reported-display-style="strikethrough"><enum>(4)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID3061931427CA4635B6B562FF7E75F369" reported-display-style="strikethrough"><enum>(5)</enum><text>develop and
maintain a system that provides close supervision of community health aides and
community health practitioners; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID247D3AB069F14C3AADAC538CE266B0B7" reported-display-style="strikethrough"><enum>(6)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID9521B90C81EB40359F215416CFF214DF" reported-display-style="strikethrough"><enum>(c)</enum><header>National
Community Health Aide Program</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID0A2015D09FD744239BAD8EE93A691AD3" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDD5F8EC3FABE04B859D2622CB8668613E" reported-display-style="strikethrough"><enum>(2)</enum><header>Limited
certification</header><text>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—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDB8EC62196B4944AABAF0D3F978025609" reported-display-style="strikethrough"><enum>(A)</enum><text>early childhood
dental disease prevention and reversible dental procedures; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID1A2A7EDEBDB04C0F839A60336AF5B5A3" reported-display-style="strikethrough"><enum>(B)</enum><text>the development of
local capacity to provide those dental services.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDDFFE2C3AEC174C399B6A7CEB464499D2" reported-display-style="strikethrough"><enum>(3)</enum><header>Review</header>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID5B7EC84503A849688A0C1508F8301FBB" reported-display-style="strikethrough"><enum>(A)</enum><header>In
general</header><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID8DD53E90E56C43CC83A4908A29950E59" reported-display-style="strikethrough"><enum>(B)</enum><header>Report</header><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID53E21FBF84AD4EF1B0C5C4C4FF97624B" reported-display-style="strikethrough"><enum>(C)</enum><header>Future
authorization of certifications</header><text>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.</text>
</subparagraph></paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="IDF2A6B22FC03A437C8D49C722647D1FE2" reported-display-style="strikethrough"><enum>122.</enum><header>Tribal Health
Program Administration</header><text display-inline="no-display-inline">The
Secretary, acting through the Service, shall, by contract or otherwise, provide
training for Indians in the administration and planning of Tribal Health
Programs.</text>
</section><section changed="deleted" committee-id="SLIA00" id="ID357A26514EC94E44919FD70AD4A5B62F" reported-display-style="strikethrough"><enum>123.</enum><header>Health
professional chronic shortage demonstration Programs</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDA161BDE7BB7E4700899055BF922ECC62" reported-display-style="strikethrough"><enum>(a)</enum><header>Demonstration
Programs Authorized</header><text>The Secretary, acting through the Service,
may fund demonstration programs for Tribal Health Programs to address the
chronic shortages of health professionals.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID7FD32EC6F012441981B566FE4CF4A5B3" reported-display-style="strikethrough"><enum>(b)</enum><header>Purposes of
Programs</header><text>The purposes of demonstration programs funded under
subsection (a) shall be—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID8C768F96F79842DA8B1DE9564F031988" reported-display-style="strikethrough"><enum>(1)</enum><text>to provide direct
clinical and practical experience at a Service Unit to health profession
students and residents from medical schools;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID39DC157743884A8AB966E4B180B12D47" reported-display-style="strikethrough"><enum>(2)</enum><text>to improve the
quality of health care for Indians by assuring access to qualified health care
professionals; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID6A09A7D57278498F8E2A95C37E488B65" reported-display-style="strikethrough"><enum>(3)</enum><text>to provide
academic and scholarly opportunities for health professionals serving Indians
by identifying all academic and scholarly resources of the region.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID60C56EE03C504D72B46B975698A7AA36" reported-display-style="strikethrough"><enum>(c)</enum><header>Advisory
Board</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID693D8CDF054B47FEB8632066B15A476E" reported-display-style="strikethrough"><enum>124.</enum><header>National Health
Service Corps</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID59F594A8C3D84AD795CFD935FF8C255E" reported-display-style="strikethrough"><enum>(a)</enum><header>No Reduction in
Services</header><text>The Secretary shall not—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID93303B634DED411A8340C37CC8326E25" reported-display-style="strikethrough"><enum>(1)</enum><text>remove a member of
the National Health Service Corps from an Indian Health Program or Urban Indian
Organization; or</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDC5394DA781434AB18A15E7B790EDA694" reported-display-style="strikethrough"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDE56148F728B8482EA599A3DBE75F344C" reported-display-style="strikethrough"><enum>(b)</enum><header>Exemption From
Limitations</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID8D6AE669CB32470587D3334ECDA7A8C2" reported-display-style="strikethrough"><enum>125.</enum><header>Substance abuse
counselor educational curricula demonstration Programs</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDAD40BB5651424BB9997D5893BD8BF016" reported-display-style="strikethrough"><enum>(a)</enum><header>Grants and
Contracts</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID8CA72C9651384636B8C804592B8B2771" reported-display-style="strikethrough"><enum>(b)</enum><header>Use of
Funds</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDC48CE35AA9324DAD934CA53ED517CB08" reported-display-style="strikethrough"><enum>(c)</enum><header>Time Period of
Assistance; Renewal</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID84380D73AE324CC3BD3CD56CE1645440" reported-display-style="strikethrough"><enum>(d)</enum><header>Criteria for
Review and Approval of Applications</header><text>Not later than 180 days after
the date of enactment of the <act-name parsable-cite="IHCIA">Indian Health Care
Improvement Act</act-name> 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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDC98A79E110ED4BCD8FDB286A021FD9D8" reported-display-style="strikethrough"><enum>(e)</enum><header>Assistance</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDCDE17DD43A7B41ADB78DFE6BCCF35077" reported-display-style="strikethrough"><enum>(f)</enum><header>Report</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDE4F3CCDB9C73406C9F6E6E5A894D1339" reported-display-style="strikethrough"><enum>(g)</enum><header>Definition</header><text>For
the purposes of this section, the term <term>educational curriculum</term>
means 1 or more of the following:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID2A1F0E3F3B4944FF981495FD8A9A686B" reported-display-style="strikethrough"><enum>(1)</enum><text>Classroom
education.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID252A9C08130B4EA89DCAAB896111DEAF" reported-display-style="strikethrough"><enum>(2)</enum><text>Clinical work
experience.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID9C0A7474EBDC41C892850FCEE3C128F5" reported-display-style="strikethrough"><enum>(3)</enum><text>Continuing
education workshops.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="IDD94B2FE860054F36936223B187C35EF4" reported-display-style="strikethrough"><enum>126.</enum><header>Behavioral
Health training and community education Programs</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID6EEFF10E0FDE4731B80375D002E20243" reported-display-style="strikethrough"><enum>(a)</enum><header>Study;
List</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDF8C62304A05640BBBE82657FB516B92B" reported-display-style="strikethrough"><enum>(b)</enum><header>Positions</header><text>The
positions referred to in subsection (a) are—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID6D69A370DDFB443DB4DBC635F0C42EEA" reported-display-style="strikethrough"><enum>(1)</enum><text>staff positions
within the Bureau of Indian Affairs, including existing positions, in the
fields of—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID92C2A96FADBE490F93354AA60158882A" reported-display-style="strikethrough"><enum>(A)</enum><text>elementary and
secondary education;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDD630E1C9513E49B4A0AB24E165D3138C" reported-display-style="strikethrough"><enum>(B)</enum><text>social services
and family and child welfare;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDDE7FF2207575425DACC6FC2501072B46" reported-display-style="strikethrough"><enum>(C)</enum><text>law enforcement
and judicial services; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID78C5D58E45384681AE95E86502323371" reported-display-style="strikethrough"><enum>(D)</enum><text>alcohol and
substance abuse;</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF8727302AC044CDC934F2B9B4D90EE15" reported-display-style="strikethrough"><enum>(2)</enum><text>staff positions
within the Service; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID2E1B17B652234C788A2F86B921113A12" reported-display-style="strikethrough"><enum>(3)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID35AF8300448448D6955EFAAC1B65AA78" reported-display-style="strikethrough"><enum>(c)</enum><header>Training
Criteria</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDA53EC492D36240D3B2F90B58D72CB0DA" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>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 <act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID5585075B38F94D029C6A5C5EE0A11476" reported-display-style="strikethrough"><enum>(2)</enum><header>Position
specific training criteria</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDB123F8794BBC4F77AEB7474DDCEDCFD7" reported-display-style="strikethrough"><enum>(d)</enum><header>Community
Education on Mental Illness</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDA8637E826D4842BA9523F34F5F21ED3F" reported-display-style="strikethrough"><enum>(e)</enum><header>Plan</header><text>Not
later than 90 days after the date of enactment of the
<act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name>
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 <quote>Snyder
Act</quote>).</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID1E20A8A8FA634A57B7F20EB6DB45CAA3" reported-display-style="strikethrough"><enum>127.</enum><header>Authorization
of appropriations</header><text display-inline="no-display-inline">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.</text>
</section><enum>II</enum><header>HEALTH
SERVICES</header>
<section changed="deleted" committee-id="SLIA00" id="IDA2E2710025D84C4FA67C2C4556C4C690" reported-display-style="strikethrough"><enum>201.</enum><header>Indian Health
Care Improvement Fund</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID0A48587089AD49818A1A6EA1EB5EDA59" reported-display-style="strikethrough"><enum>(a)</enum><header>Use of
Funds</header><text>The Secretary, acting through the Service, is authorized to
expend funds, directly or under the authority of the
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (25 U.S.C. 450 et seq.), which are appropriated under
the authority of this section, for the purposes of—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID6A182B80083545D1BB76CB1E1AEB58BF" reported-display-style="strikethrough"><enum>(1)</enum><text>eliminating the
deficiencies in health status and health resources of all Indian Tribes;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDEB4C876C37FB4F9BA57ED466F60FC02A" reported-display-style="strikethrough"><enum>(2)</enum><text>eliminating
backlogs in the provision of health care services to Indians;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID54A5C7D889D14F8EB964DEE48CAB30FC" reported-display-style="strikethrough"><enum>(3)</enum><text>meeting the health
needs of Indians in an efficient and equitable manner, including the use of
telehealth and telemedicine when appropriate;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID4FDF4409A7C1425783993ED4CB04408B" reported-display-style="strikethrough"><enum>(4)</enum><text>eliminating
inequities in funding for both direct care and contract health service
programs; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDAC3F083459224E1DA8C0ACA8A4B134F1" reported-display-style="strikethrough"><enum>(5)</enum><text>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:</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID18183D11F8D74BD0A69E94DE29EDCDF0" reported-display-style="strikethrough"><enum>(A)</enum><text>Clinical care,
including inpatient care, outpatient care (including audiology, clinical eye,
and vision care), primary care, secondary and tertiary care, and long-term
care.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID5D944F210ACD4D19BA7D18A9027E73AD" reported-display-style="strikethrough"><enum>(B)</enum><text>Preventive health,
including mammography and other cancer screening in accordance with section
207.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID5F9315CFFEBB425C8353C5AB5402E566" reported-display-style="strikethrough"><enum>(C)</enum><text>Dental
care.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID8C3B85A2FA0443DBBA7DB36484C2E18E" reported-display-style="strikethrough"><enum>(D)</enum><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID3E699D4828FE4D6A9F75ED2A8976C4DD" reported-display-style="strikethrough"><enum>(E)</enum><text>Emergency medical
services.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDB5D2F1FA77DE4BA1B2D448B9F78B0BE6" reported-display-style="strikethrough"><enum>(F)</enum><text>Treatment and
control of, and rehabilitative care related to, alcoholism and drug abuse
(including fetal alcohol syndrome) among Indians.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDFD811F79873B49C1B777B8E4CCA81A0E" reported-display-style="strikethrough"><enum>(G)</enum><text>Accident
prevention programs.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID7142C60AC67C49408063CEEFC3B7DAEB" reported-display-style="strikethrough"><enum>(H)</enum><text>Home health
care.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDCA457DF49F31482B9D15587D3FD274E0" reported-display-style="strikethrough"><enum>(I)</enum><text>Community health
representatives.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDFA00F58EE0A842B49958C84777254F37" reported-display-style="strikethrough"><enum>(J)</enum><text>Maintenance and
repair.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID9DA88CCE1786451FB96EC6AEE3C14EF8" reported-display-style="strikethrough"><enum>(K)</enum><text>Traditional Health
Care Practices.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID78402A69F65643D2AFFD630105A4E515" reported-display-style="strikethrough"><enum>(b)</enum><header>No Offset or
Limitation</header><text>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 <quote>Snyder Act</quote>), or any other provision of
law.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID5BBAADFE32E24780880D4850A444A48D" reported-display-style="strikethrough"><enum>(c)</enum><header>Allocation;
Use</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID2ED331C5B858488EBE9E9C80A3FB8B5C" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID28E9B8FF481C40F4871064CE5C326A70" reported-display-style="strikethrough"><enum>(2)</enum><header>Apportionment of
allocated funds</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDB1105FF213BD44749FF8F3E0A7059A32" reported-display-style="strikethrough"><enum>(d)</enum><header>Provisions
Relating to Health Status and Resource Deficiencies</header><text>For the
purposes of this section, the following definitions apply:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID4DD50A41F87E40E6B01C8A0E416A5C66" reported-display-style="strikethrough"><enum>(1)</enum><header>Definition</header><text>The
term <term>health status and resource deficiency</term> means the extent to
which—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID2F5DB6CC72A143E1A2E46367B6CEFE8F" reported-display-style="strikethrough"><enum>(A)</enum><text>the health status
objectives set forth in section 3(2) are not being achieved; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID38BF449236C94245800503D10F169CAD" reported-display-style="strikethrough"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDC62D07684E274153BB4C7F8008D08449" reported-display-style="strikethrough"><enum>(2)</enum><header>Available
resources</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID87D198A5538C40E0AB11D9F2E2C9A18F" reported-display-style="strikethrough"><enum>(3)</enum><header>Process for
review of determinations</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDF7DF755A48634B75999A6F2E44785327" reported-display-style="strikethrough"><enum>(e)</enum><header>Eligibility for
Funds</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDAAFF186EB0074ECC824BE3DB27D35B2B" reported-display-style="strikethrough"><enum>(f)</enum><header>Report</header><text>By
no later than the date that is 3 years after the date of enactment of the
<act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name>
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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDE2E2B1DB27974F95BB9CB2E932F66910" reported-display-style="strikethrough"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA234A522A9344E7386B763B5F196ADBC" reported-display-style="strikethrough"><enum>(2)</enum><text>the extent of the
health status and resource deficiency of each Indian Tribe served by the
Service or a Tribal Health Program;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID1B1DCE4640DB4BD1AE803BDA2861CE45" reported-display-style="strikethrough"><enum>(3)</enum><text>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</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID0CBF3C426EE843A7B29A6BC6EAE6284C" reported-display-style="strikethrough"><enum>(4)</enum><text>an estimate
of—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID1C348FAFD6994FFEB6533FAFD2FA1632" reported-display-style="strikethrough"><enum>(A)</enum><text>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;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDF8AAF3F1A0DA415D9EF56040EEBDC924" reported-display-style="strikethrough"><enum>(B)</enum><text>the number of
Indians eligible for health services in each Service Unit or Indian Tribe or
Tribal Organization; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDAA91BC8FA5E044DB88EBE4B721AB94FD" reported-display-style="strikethrough"><enum>(C)</enum><text>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.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID57453BDA8A3840458DF68D09153C7800" reported-display-style="strikethrough"><enum>(g)</enum><header>Inclusion in
Base Budget</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDE312666439BC4762A26963C5D60C636E" reported-display-style="strikethrough"><enum>(h)</enum><header>Clarification</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID7673CF7FF05243B79E0D1B3BF4D112AB" reported-display-style="strikethrough"><enum>(i)</enum><header>Funding
Designation</header><text>Any funds appropriated under the authority of this
section shall be designated as the <quote>Indian Health Care Improvement
Fund</quote>.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDD004B7BE6F7C4FB488659B36AB2E0674" reported-display-style="strikethrough"><enum>202.</enum><header>Catastrophic
Health Emergency Fund</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDEB2AC67071944F8FB0651458EAD423DC" reported-display-style="strikethrough"><enum>(a)</enum><header>Establishment</header><text>There
is established an Indian Catastrophic Health Emergency Fund (hereafter in this
section referred to as the <quote>CHEF</quote>) consisting of—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID44A3DE60B57E42C29C5BB17679B67337" reported-display-style="strikethrough"><enum>(1)</enum><text>the amounts
deposited under subsection (f); and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA3E649969A1E42D7978467C6A2E94039" reported-display-style="strikethrough"><enum>(2)</enum><text>the amounts
appropriated to CHEF under this section.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDBD32323EB6DD4334B3F4BEB02701C51F" reported-display-style="strikethrough"><enum>(b)</enum><header>Administration</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDC6CE3DB1B0E748ED802AAEB05A009D29" reported-display-style="strikethrough"><enum>(c)</enum><header>Conditions on
Use of Fund</header><text>No part of CHEF or its administration shall be
subject to contract or grant under any law, including the
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID14BC56B723CF4405ADD06687620CEF06" reported-display-style="strikethrough"><enum>(d)</enum><header>Regulations</header><text>The
Secretary shall, through the negotiated rulemaking process under title VIII,
promulgate regulations consistent with the provisions of this section
to—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID080CCB9BEC8540E4A16AF6989BA9512F" reported-display-style="strikethrough"><enum>(1)</enum><text>establish a
definition of disasters and catastrophic illnesses for which the cost of the
treatment provided under contract would qualify for payment from CHEF;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDC63295B07D5C4B519E8F94B3A58C4C8B" reported-display-style="strikethrough"><enum>(2)</enum><text>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—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID3C2169E2F0EB4C46A65CECE9046717D4" reported-display-style="strikethrough"><enum>(A)</enum><text>the 2000 level of
$19,000; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID7C37194D9F66471BAC3635B58A885F2E" reported-display-style="strikethrough"><enum>(B)</enum><text>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;</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID8B5EEB3C48614BB8A05331C73D5256CB" reported-display-style="strikethrough"><enum>(3)</enum><text>establish a
procedure for the reimbursement of the portion of the costs that exceeds such
threshold cost incurred by—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID4AFD84F9D87B424C90D2CD8204A252E3" reported-display-style="strikethrough"><enum>(A)</enum><text>Service Units;
or</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID37CFF30AA14E446C9F08A1E83EBEDB88" reported-display-style="strikethrough"><enum>(B)</enum><text>whenever otherwise
authorized by the Service, non-Service facilities or providers;</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDDA05095396BE4DC69795848D27A09CA3" reported-display-style="strikethrough"><enum>(4)</enum><text>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</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA2EE0C71752A492A999C037712988D4B" reported-display-style="strikethrough"><enum>(5)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID1F4BFA0BBBAF487286D45D4623DC3CBF" reported-display-style="strikethrough"><enum>(e)</enum><header>No Offset or
Limitation</header><text>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
<quote>Snyder Act</quote>), or any other law.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID369724E48512452A912243C93A05818E" reported-display-style="strikethrough"><enum>(f)</enum><header>Deposit of
Reimbursement Funds</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID6F68CAD7D67C46C9B4678A4478DBABBD" reported-display-style="strikethrough"><enum>203.</enum><header>Health
promotion and disease prevention Services</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID6AA4E3A0BAB343C3AEDB8D470FE55355" reported-display-style="strikethrough"><enum>(a)</enum><header>Findings</header><text>Congress
finds that health promotion and disease prevention activities—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID08FE1C37BCF4489CA15A33FB9E19E38E" reported-display-style="strikethrough"><enum>(1)</enum><text>improve the health
and well-being of Indians; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB3E3499DDBF744DB8EDBE04C87DECD94" reported-display-style="strikethrough"><enum>(2)</enum><text>reduce the
expenses for health care of Indians.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDDBB9B6B2334948BC8E77E4F0F219819C" reported-display-style="strikethrough"><enum>(b)</enum><header>Provision of
Services</header><text>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).</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID710D354A49424ACEBF489D52AE67B7E8" reported-display-style="strikethrough"><enum>(c)</enum><header>Evaluation</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID47104EBF61904E569462B8B8B890F394" reported-display-style="strikethrough"><enum>(1)</enum><text>the health
promotion and disease prevention needs of Indians;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB9C0B47A985844BC834DA8209C169A9A" reported-display-style="strikethrough"><enum>(2)</enum><text>the health
promotion and disease prevention activities which would best meet such
needs;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID52F2B01ADD384EB7B0435BA54E014CCE" reported-display-style="strikethrough"><enum>(3)</enum><text>the internal
capacity of the Service and Tribal Health Programs to meet such needs;
and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID230FDEE3B19E4645902074420CF25301" reported-display-style="strikethrough"><enum>(4)</enum><text>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.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="ID5824A72322BE4CE6AEFDD79535349B9F" reported-display-style="strikethrough"><enum>204.</enum><header>Diabetes
prevention, treatment, and control</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID697991305D49407195298FC322D6E09A" reported-display-style="strikethrough"><enum>(a)</enum><header>Determinations
Regarding Diabetes</header><text>The Secretary, acting through the Service, and
in consultation with Indian Tribes and Tribal Organizations, shall
determine—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID702D0581FE9340F2B615F5FFD3A5ABE4" reported-display-style="strikethrough"><enum>(1)</enum><text>by Indian Tribe
and by Service Unit, the incidence of, and the types of complications resulting
from, diabetes among Indians; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID4C7BD5583331488884BE8F8268132A10" reported-display-style="strikethrough"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID1D3CEB8B4703414DA95CB6B073525320" reported-display-style="strikethrough"><enum>(b)</enum><header>Diabetes
Screening</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID4B91E619F1DE4430858D1D383B9A0AC7" reported-display-style="strikethrough"><enum>(c)</enum><header>Funding for
Diabetes</header><text>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
<act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name>
Amendments of 2005 and for projects which are added and funded
thereafter.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID3A70B7AF53EC4B609ACB0BDF857B56FF" reported-display-style="strikethrough"><enum>(d)</enum><header>Funding for
Dialysis Programs</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDF6428E86EEAA48A5A54C3DD1E1C31775" reported-display-style="strikethrough"><enum>(e)</enum><header>Other Duties of
the Secretary</header><text>The Secretary shall, to the extent funding is
available—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID9D9AC77DB8F74008AE434B1B704D06AB" reported-display-style="strikethrough"><enum>(1)</enum><text>in each Area
Office, consult with Indian Tribes and Tribal Organizations regarding programs
for the prevention, treatment, and control of diabetes;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB1314F2D36B04BF297D645C9D8F84EDB" reported-display-style="strikethrough"><enum>(2)</enum><text>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</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDAAE8BE7514104656A2B7CF307C9260F6" reported-display-style="strikethrough"><enum>(3)</enum><text>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.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="ID2CCD53FA04F04EBDBBDB1BC92AEC0B85" reported-display-style="strikethrough"><enum>205.</enum><header>Shared Services
for Long-Term care</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDFF6122F21399498AAD2629ED6A6B8564" reported-display-style="strikethrough"><enum>(a)</enum><header>Long-Term
Care</header><text>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 <act-name parsable-cite="ISDA">Indian
Self-Determination and Education Assistance Act</act-name> (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
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (25 U.S.C. 450 et seq.)) by such Indian Tribe or
Tribal Organization.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDBB39DB0C9B6A42F8ABD1F5F1553550BB" reported-display-style="strikethrough"><enum>(b)</enum><header>Contents of
Agreements</header><text>An agreement entered into pursuant to subsection
(a)—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDB05744C274D345E59E073BAA4785C42D" reported-display-style="strikethrough"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID9D5C44B48F0F4770BAC11987FB50B80A" reported-display-style="strikethrough"><enum>(2)</enum><text>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</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA9361D7EABEB4613ABD761E80DB8E5D6" reported-display-style="strikethrough"><enum>(3)</enum><text>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).</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID55929F657B4C47EDB1E48FBD51FAB94D" reported-display-style="strikethrough"><enum>(c)</enum><header>Minimum
Requirement</header><text>Any nursing facility provided for under this section
shall meet the requirements for nursing facilities under section 1919 of the
<act-name parsable-cite="SSA">Social Security Act</act-name>.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID610947C888DA489BA52B7593295CDD5F" reported-display-style="strikethrough"><enum>(d)</enum><header>Other
Assistance</header><text>The Secretary shall provide such technical and other
assistance as may be necessary to enable applicants to comply with the
provisions of this section.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDAC604EF69EF54E3CB25725C29D993CFE" reported-display-style="strikethrough"><enum>(e)</enum><header>Use of Existing
or Underused Facilities</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID53FA4B83B3774906B66FA7638F6B5E65" reported-display-style="strikethrough"><enum>206.</enum><header>Health Services
research</header><text display-inline="no-display-inline">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.</text>
</section><section changed="deleted" committee-id="SLIA00" id="IDF7C622F5AB0C4036AD0C05ED1C11E85F" reported-display-style="strikethrough"><enum>207.</enum><header>Mammography and
other cancer screening</header><text display-inline="no-display-inline">The
Secretary, acting through the Service or Tribal Health Programs, shall provide
for screening as follows:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID04A9C63704C14D1594F500F5ACD02FCB" reported-display-style="strikethrough"><enum>(1)</enum><text>Screening
mammography (as defined in section 1861(jj) of the
<act-name parsable-cite="SSA">Social Security Act</act-name>) 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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID9A92923CD75D49F4A86F4B12BF2AB510" reported-display-style="strikethrough"><enum>(2)</enum><text>Other cancer
screening meeting accepted and appropriate national standards.</text>
</paragraph></section><section changed="deleted" committee-id="SLIA00" id="ID5405D159239E4E73B0242E0286891F98" reported-display-style="strikethrough"><enum>208.</enum><header>Patient travel
costs</header><text display-inline="no-display-inline">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 <act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (25 U.S.C. 450 et seq.)) under this Act—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID6E509500A80B4F28B9A5A24842F54D4F" reported-display-style="strikethrough"><enum>(1)</enum><text>emergency air
transportation and non-emergency air transportation where ground transportation
is infeasible;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF3C7C23B33DB435BBA9CD9ACF6FBD07D" reported-display-style="strikethrough"><enum>(2)</enum><text>transportation by
private vehicle (where no other means of transportation is available),
specially equipped vehicle, and ambulance; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID148F864E14C84A54AF4B51E49CF73250" reported-display-style="strikethrough"><enum>(3)</enum><text>transportation by
such other means as may be available and required when air or motor vehicle
transportation is not available.</text>
</paragraph></section><section changed="deleted" committee-id="SLIA00" id="IDB6084C0EF3CA4756B18E2B9E851C3D50" reported-display-style="strikethrough"><enum>209.</enum><header>Epidemiology
Centers</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID3D0C3C10A8FC40F8BCCD9FE0563312E3" reported-display-style="strikethrough"><enum>(a)</enum><header>Additional
Centers</header><text>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 <act-name parsable-cite="IHCIA">Indian Health Care Improvement
Act</act-name> 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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID8F5F7238AFBD46CE847F36E2B3F2EC67" reported-display-style="strikethrough"><enum>(b)</enum><header>Functions of
Centers</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID7DF236DE193C4928874D646843A3910E" reported-display-style="strikethrough"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID1542B680A59C4E96B6E2F87FFAF88E92" reported-display-style="strikethrough"><enum>(2)</enum><text>evaluate existing
delivery systems, data systems, and other systems that impact the improvement
of Indian health;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF15CFF7C0F354B5AB20411B564238FCB" reported-display-style="strikethrough"><enum>(3)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID2E1478DC25704997ABF7741765DDCFC0" reported-display-style="strikethrough"><enum>(4)</enum><text>make
recommendations for the targeting of services needed by the populations
served;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID3D8AEA8C08EC43CFAAC7AEE60D2AFE4C" reported-display-style="strikethrough"><enum>(5)</enum><text>make
recommendations to improve health care delivery systems for Indians and Urban
Indians;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA41A8A7E13FC4CD28E5DAFD2BAC4C655" reported-display-style="strikethrough"><enum>(6)</enum><text>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</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID0DE7C184EE0A49C2BBA9D86E93E6A4BB" reported-display-style="strikethrough"><enum>(7)</enum><text>provide disease
surveillance and assist Indian Tribes, Tribal Organizations, and Urban Indian
Organizations to promote public health.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDE263FB37894948D7893D8B2047EE6698" reported-display-style="strikethrough"><enum>(c)</enum><header>Technical
Assistance</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDE46D91482E75402AB7C9A3A9FBD60439" reported-display-style="strikethrough"><enum>(d)</enum><header>Funding for
Studies</header><text>The Secretary may make funding available to Indian
Tribes, Tribal Organizations, and Urban Indian Organizations to conduct
epidemiological studies of Indian communities.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDE1F83B68994C41E9802F8ADC9F0BC702" reported-display-style="strikethrough"><enum>210.</enum><header>Comprehensive
school Health education Programs</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID9D220B97E2F94090850F7F5C79EAC1A8" reported-display-style="strikethrough"><enum>(a)</enum><header>Funding for
Development of Programs</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID1E04D6D5A1994F3EACB4CA667D9FE7FA" reported-display-style="strikethrough"><enum>(b)</enum><header>Use of
Funds</header><text>Funding provided under this section may be used for
purposes which may include, but are not limited to, the following:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID0FD54EAA3BF246C9BA3C9C4E830F11A1" reported-display-style="strikethrough"><enum>(1)</enum><text>Developing and
implementing health education curricula both for regular school programs and
afterschool programs.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID482DC5D7F8494178861EBFD245E25CB5" reported-display-style="strikethrough"><enum>(2)</enum><text>Training teachers
in comprehensive school health education curricula.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID46E5E3E465214376A5461D7C7DDAD188" reported-display-style="strikethrough"><enum>(3)</enum><text>Integrating
school-based, community-based, and other public and private health promotion
efforts.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID012E777CFF824400B9C2E2AEA6E65D59" reported-display-style="strikethrough"><enum>(4)</enum><text>Encouraging
healthy, tobacco-free school environments.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID044CA0AFF29E49018348AFE198A82A53" reported-display-style="strikethrough"><enum>(5)</enum><text>Coordinating
school-based health programs with existing services and programs available in
the community.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF2FE403E4048451CB496DB093779A88B" reported-display-style="strikethrough"><enum>(6)</enum><text>Developing school
programs on nutrition education, personal health, oral health, and
fitness.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB3C0213CA6684591947D41873D05E958" reported-display-style="strikethrough"><enum>(7)</enum><text>Developing
behavioral health wellness programs.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID4D84675DB80A4A05B01A1B839284B459" reported-display-style="strikethrough"><enum>(8)</enum><text>Developing chronic
disease prevention programs.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDD8EB318DCD434241BB844A6D6AD99535" reported-display-style="strikethrough"><enum>(9)</enum><text>Developing
substance abuse prevention programs.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID8B918A0629344B7E80AD347EE51B8B89" reported-display-style="strikethrough"><enum>(10)</enum><text>Developing injury
prevention and safety education programs.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID81D2961493C745F6AA317E7ED63DD65C" reported-display-style="strikethrough"><enum>(11)</enum><text>Developing
activities for the prevention and control of communicable diseases.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID849F4FD8ED7E495181397822CC574705" reported-display-style="strikethrough"><enum>(12)</enum><text>Developing
community and environmental health education programs that include traditional
health care practitioners.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID3D6EF475F1CC4D77B62D56A8E093183F" reported-display-style="strikethrough"><enum>(13)</enum><text>Violence
prevention.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID94AA00C4D8A542E982D0BB0491B5ABFF" reported-display-style="strikethrough"><enum>(14)</enum><text>Such other health
issues as are appropriate.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID8FAF6DA07C5A4226860E2277D9655559" reported-display-style="strikethrough"><enum>(c)</enum><header>Technical
Assistance</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID93335D6D851C4E348164A78FE21A6C2E" reported-display-style="strikethrough"><enum>(d)</enum><header>Criteria for
Review and Approval of Applications</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID8942484BAFE14CF0B3223D90EE3615A2" reported-display-style="strikethrough"><enum>(e)</enum><header>Development of
Program for BIA Funded Schools</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID342BC0B806344311A59ACDC5A0283F44" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID570BFEF3876B41C2A05B8A59DA28B6B1" reported-display-style="strikethrough"><enum>(2)</enum><header>Requirements for
programs</header><text>Such programs shall include—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID52D5AA261FDC40B8A8417C6FF26993CF" reported-display-style="strikethrough"><enum>(A)</enum><text>school programs on
nutrition education, personal health, oral health, and fitness;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID312C474C481540358088B0A6B148C86C" reported-display-style="strikethrough"><enum>(B)</enum><text>behavioral health
wellness programs;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID37315F634A4C4B8B8C6148BA5920E926" reported-display-style="strikethrough"><enum>(C)</enum><text>chronic disease
prevention programs;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDACB963597F3140769B646BA7DA2CF3CF" reported-display-style="strikethrough"><enum>(D)</enum><text>substance abuse
prevention programs;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID52B00AA3438B48EF8C92CD867B3F413D" reported-display-style="strikethrough"><enum>(E)</enum><text>injury prevention
and safety education programs; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID42DE85A449A348DB84356CA6212D93FE" reported-display-style="strikethrough"><enum>(F)</enum><text>activities for the
prevention and control of communicable diseases.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID80D6D2E878C54DE3A6D969E66E2C1181" reported-display-style="strikethrough"><enum>(3)</enum><header>Duties of the
secretary</header><text>The Secretary of the Interior shall—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDB40AC1B6323641509FC94C36A7598AFF" reported-display-style="strikethrough"><enum>(A)</enum><text>provide training
to teachers in comprehensive school health education curricula;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID6048AA1C11C34D8C80EEC853800C50F7" reported-display-style="strikethrough"><enum>(B)</enum><text>ensure the
integration and coordination of school-based programs with existing services
and health programs available in the community; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID137D1D572E2A438081D233B0191A091D" reported-display-style="strikethrough"><enum>(C)</enum><text>encourage healthy,
tobacco-free school environments.</text>
</subparagraph></paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="ID566D2E9E669F49E4BF45BA576C3A11B5" reported-display-style="strikethrough"><enum>211.</enum><header>Indian youth
Program</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID36E651D65F1545C7B0FDAA713D66F94A" reported-display-style="strikethrough"><enum>(a)</enum><header>Program
Authorized</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID9FF8133F3DDF49D5840C6F1AF00F5AD9" reported-display-style="strikethrough"><enum>(b)</enum><header>Use of
Funds</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDE4F23AB71596469A9D13818AF461E3E1" reported-display-style="strikethrough"><enum>(1)</enum><header>Allowable
uses</header><text>Funds made available under this section may be used
to—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDE75360D3E24A41FEA47F299AB3479207" reported-display-style="strikethrough"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID380AFD10EC3B40E79AD69AD96C291259" reported-display-style="strikethrough"><enum>(B)</enum><text>develop and
provide community training and education.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID3A5B226C2EAC4F6EA36C1A3B0C0A6B41" reported-display-style="strikethrough"><enum>(2)</enum><header>Prohibited
use</header><text>Funds made available under this section may not be used to
provide services described in section 707(c).</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID34A0AAB453224952B8F32B182522EB3C" reported-display-style="strikethrough"><enum>(c)</enum><header>Duties of the
Secretary</header><text>The Secretary shall—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID76FDFB41F9CC4568BBBE5F1A7BDD552B" reported-display-style="strikethrough"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID4988856696B94327BC6346F85B33F57C" reported-display-style="strikethrough"><enum>(2)</enum><text>encourage the
implementation of such models; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB05294246D2B4852AAA073A8C508924B" reported-display-style="strikethrough"><enum>(3)</enum><text>at the request of
an Indian Tribe, Tribal Organization, or Urban Indian Organization, provide
technical assistance in the implementation of such models.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID5A393327BC704034A652BFB669CDA00B" reported-display-style="strikethrough"><enum>(d)</enum><header>Criteria for
Review and Approval of Applications</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID88FDDE2EB4FF491D86D87917D637800E" reported-display-style="strikethrough"><enum>212.</enum><header>Prevention,
control, and elimination of communicable and infectious diseases</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDEADAF2E21D8A46F1B90747CB3CC6C423" reported-display-style="strikethrough"><enum>(a)</enum><header>Funding
Authorized</header><text>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:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDBE3FA7EC5C9E432AB3DEEEFD350E021F" reported-display-style="strikethrough"><enum>(1)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID981DC3026AE9474DB9951CA236B489EB" reported-display-style="strikethrough"><enum>(2)</enum><text>Public information
and education programs for the prevention, control, and elimination of
communicable and infectious diseases.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID297307AE17214EA1B5FC951715604A7F" reported-display-style="strikethrough"><enum>(3)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID52F63C97E15D4E7EA3EAB5F1EA92EFB3" reported-display-style="strikethrough"><enum>(4)</enum><text>Demonstration
projects for the screening, treatment, and prevention of hepatitis C virus
(HCV).</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDF0314CFFBB4C490D965C9D2A7C3E1100" reported-display-style="strikethrough"><enum>(b)</enum><header>Application
Required</header><text>The Secretary may provide funding under subsection (a)
only if an application or proposal for funding is submitted to the
Secretary.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID2315C3791B0F4560AE1C8849EB918BD3" reported-display-style="strikethrough"><enum>(c)</enum><header>Coordination
With Health Agencies</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDA7CF634224D34CA8949385A5DA670206" reported-display-style="strikethrough"><enum>(d)</enum><header>Technical
Assistance; Report</header><text>In carrying out this section, the
Secretary—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID2A66A3006F9340AB881D19865938DA76" reported-display-style="strikethrough"><enum>(1)</enum><text>may, at the
request of an Indian Tribe, Tribal Organization, or Urban Indian Organization,
provide technical assistance; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA0EA451EFAB04516A751FA4F091D1763" reported-display-style="strikethrough"><enum>(2)</enum><text>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.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="IDA83C4AAFDA08420E9CFB94AF43BA954B" reported-display-style="strikethrough"><enum>213.</enum><header>Authority for
provision of other Services</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID6549A131942A45CB9C51458F1D38AC7F" reported-display-style="strikethrough"><enum>(a)</enum><header>Funding
Authorized</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID8E7A753819884FA999D652D92B2EDF8D" reported-display-style="strikethrough"><enum>(1)</enum><text>hospice
care;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID2ECF8221291342E19B31C141DED2B9E3" reported-display-style="strikethrough"><enum>(2)</enum><text>assisted
living;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID07876EC007F14E978F577B838EA46A1E" reported-display-style="strikethrough"><enum>(3)</enum><text>long-term health
care;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA08DC9B13587417AA20562B692D72AA4" reported-display-style="strikethrough"><enum>(4)</enum><text>home- and
community-based services; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID14A79E8A5B6A4728A4E7929EC00039CB" reported-display-style="strikethrough"><enum>(5)</enum><text>public health
functions.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDDBCE2E33D28C4CDC8DF409EB35F3E240" reported-display-style="strikethrough"><enum>(b)</enum><header>Services to
Otherwise Ineligible Persons</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDB415881479064FFBA50A4ADCD46075A3" reported-display-style="strikethrough"><enum>(c)</enum><header>Definitions</header><text>For
the purposes of this section, the following definitions shall apply:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID652B8333DD814F3DA984021ACB8B10F9" reported-display-style="strikethrough"><enum>(1)</enum><text>The term
<term>home- and community-based services</term> means 1 or more of the
following:</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDB0239B5F44D9470BB4DA4AC6F044800B" reported-display-style="strikethrough"><enum>(A)</enum><text>Homemaker/home
health aide services.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDD5A1E62D8261487F9ED0F4F9AB1EEDC6" reported-display-style="strikethrough"><enum>(B)</enum><text>Chore
services.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID99BEFE86BC5E43368AA23ACE5C9A3673" reported-display-style="strikethrough"><enum>(C)</enum><text>Personal care
services.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID6D852A2531014DAABD0520C1FE67B34A" reported-display-style="strikethrough"><enum>(D)</enum><text>Nursing care
services provided outside of a nursing facility by, or under the supervision
of, a registered nurse.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID313AA7C20FD84716B9FE03DC9BB101DC" reported-display-style="strikethrough"><enum>(E)</enum><text>Respite
care.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDF0D3760CA0A742BF9BE4DABEAB72873E" reported-display-style="strikethrough"><enum>(F)</enum><text>Training for
family members.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDDCAC423DD70945C48031C947F7F918A7" reported-display-style="strikethrough"><enum>(G)</enum><text>Adult day
care.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID68B05D5ED3DB4C6785E90E7D2C7A7616" reported-display-style="strikethrough"><enum>(H)</enum><text>Such other home-
and community-based services as the Secretary, an Indian tribe, or a Tribal
Organization may approve.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID7C3B97DB8CE0441690851325CD21AE38" reported-display-style="strikethrough"><enum>(2)</enum><text>The term
<term>hospice care</term> means the items and services specified in
subparagraphs (A) through (H) of section 1861(dd)(1) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID3E79C37C0C634491905A99B1CACDFEAC" reported-display-style="strikethrough"><enum>(3)</enum><text>The term
<term>public health functions</term> 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.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="ID29168C20BBDC470797A3C8A9A1A97114" reported-display-style="strikethrough"><enum>214.</enum><header>Indian women’s
Health care</header><text display-inline="no-display-inline">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.</text>
</section><section changed="deleted" committee-id="SLIA00" id="ID9F2EFDDE58754B4992081891D5DFCAFF" reported-display-style="strikethrough"><enum>215.</enum><header>Environmental
and nuclear Health hazards</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID265A2AEB23994DF1A851A6705F4785A9" reported-display-style="strikethrough"><enum>(a)</enum><header>Studies and
Monitoring</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID5CB6F68EB95447CDA571FE488034FAE2" reported-display-style="strikethrough"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID9123782342864EDE8454E98F9A2018E3" reported-display-style="strikethrough"><enum>(2)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID3B7B9E868B10428AAD097BF71FA8A828" reported-display-style="strikethrough"><enum>(3)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID9D7C9C7ED6784363907CE747041BA4CB" reported-display-style="strikethrough"><enum>(4)</enum><text>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 <act-name parsable-cite="IHCIA">Indian Health Care Improvement
Act</act-name> Amendments of 2005 that directly or indirectly relate to the
activities, practices, and conditions affecting the health or safety of such
Indians; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID4FDA492F11034D9292E747B1BFD42C63" reported-display-style="strikethrough"><enum>(5)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDCBFAE1FEA42E44D4829DF5E7A1CC5DD0" reported-display-style="strikethrough"><enum>(b)</enum><header>Health Care
Plans</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID4CAC13652B2642D4B322B757F5158F17" reported-display-style="strikethrough"><enum>(1)</enum><text>methods for
diagnosing and treating Indians currently exhibiting such health
problems;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID7092DD99CB6A414DB2407C97A53C77FF" reported-display-style="strikethrough"><enum>(2)</enum><text>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</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID761990A8ADA646EE9DB103410C17895D" reported-display-style="strikethrough"><enum>(3)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID17DDA5F4A44F47709DFA7F4DCE6830EB" reported-display-style="strikethrough"><enum>(c)</enum><header>Submission of
Report and Plan to Congress</header><text>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 <act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name> 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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID58F5C66B485647C88943FC15DB35F55F" reported-display-style="strikethrough"><enum>(d)</enum><header>Intergovernmental
Task Force</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDF46684E404FF4CCEA6EFD95B8004888C" reported-display-style="strikethrough"><enum>(1)</enum><header>Establishment;
members</header><text>There is established an Intergovernmental Task Force to
be composed of the following individuals (or their designees):</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID01C826CF667043719A9BCA058434CCE0" reported-display-style="strikethrough"><enum>(A)</enum><text>The Secretary of
Energy.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID59A9D44B665C45B991F8EFB74082B428" reported-display-style="strikethrough"><enum>(B)</enum><text>The Secretary of
the Environmental Protection Agency.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID3D3D17865E6C44E4BE0C33A67B230FCD" reported-display-style="strikethrough"><enum>(C)</enum><text>The Director of
the Bureau of Mines.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDBB1BF35549FE49C88E00199AB02B022E" reported-display-style="strikethrough"><enum>(D)</enum><text>The Assistant
Secretary for Occupational Safety and Health.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDB1390F9EE021482B9A2EBB74F2976E3E" reported-display-style="strikethrough"><enum>(E)</enum><text>The Secretary of
the Interior.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID66F3885EC750435791D325EDEC6ED166" reported-display-style="strikethrough"><enum>(F)</enum><text>The Secretary of
Health and Human Services.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID264AC76184B546BEBC8EDFA6F3214BFB" reported-display-style="strikethrough"><enum>(G)</enum><text>The Director of
the Indian Health Service.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA705A3B5F7B744F8BDF07885B6768F8D" reported-display-style="strikethrough"><enum>(2)</enum><header>Duties</header><text>The
Task Force shall—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID2492EFBA5EFC4FC68038BDEB1B38C725" reported-display-style="strikethrough"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDB0E8AA524A274A6C999173798E1F0F67" reported-display-style="strikethrough"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID1B19D1CDF35D4491A930134917F97AFC" reported-display-style="strikethrough"><enum>(3)</enum><header>Chairman;
meetings</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID96A0AC2703F54DB5B709EBE28EEAC4F2" reported-display-style="strikethrough"><enum>(e)</enum><header>Health Services
to Certain Employees</header><text>In the case of any Indian who—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID67628F2B983C4FCEAC53EA604F36FFE2" reported-display-style="strikethrough"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID093C30276B7E4FE6AFBB5FE5E4952E0D" reported-display-style="strikethrough"><enum>(2)</enum><text>is eligible to
receive diagnosis and treatment services from an Indian Health Program;
and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID8CC93785015F4CE484376D791C891309" reported-display-style="strikethrough"><enum>(3)</enum><text>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.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="ID5212BDC0318D4FFFA032EF26DC8FCF4C" reported-display-style="strikethrough"><enum>216.</enum><header>Arizona as a
contract Health Service delivery Area</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID846E70346A6240FB8EFFF43353E7246E" reported-display-style="strikethrough"><enum>(a)</enum><header>In
General</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID9463E89DB56146C0B5D3A7919AE9C0B9" reported-display-style="strikethrough"><enum>(b)</enum><header>Maintenance of
Services</header><text>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).</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDF7F6078E19144C65AA3A27303FFBF83D" reported-display-style="strikethrough"><enum>216A.</enum><header>North Dakota
and South Dakota as contract Health Service delivery Area</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID28CAD616BE56419A9DE4380FCDA73750" reported-display-style="strikethrough"><enum>(a)</enum><header>In
General</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID41E5E639554744108E37C94F07D0AE0F" reported-display-style="strikethrough"><enum>(b)</enum><header>Limitation</header><text>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).</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID93CE2C6C42E64D95B80D785963456EE4" reported-display-style="strikethrough"><enum>217.</enum><header>California
contract Health Services Program</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDB1A1EA6648CC44999B880034CE7EC0DD" reported-display-style="strikethrough"><enum>(a)</enum><header>Funding
Authorized</header><text>The Secretary is authorized to fund a program using
the California Rural Indian Health Board (hereafter in this section referred to
as the <quote>CRIHB</quote>) as a contract care intermediary to improve the
accessibility of health services to California Indians.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID1CD190CCEE3C4D9DB71A594D2E348ACE" reported-display-style="strikethrough"><enum>(b)</enum><header>Reimbursement
Contract</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID37B34E5BEE1B472A9779E34C4640C341" reported-display-style="strikethrough"><enum>(c)</enum><header>Administrative
Expenses</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID885337500F6A48D481F741DFD52E6237" reported-display-style="strikethrough"><enum>(d)</enum><header>Limitation on
Payment</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDAB8FB6CC69EB4717AD5F956F32BF3767" reported-display-style="strikethrough"><enum>(e)</enum><header>Advisory
Board</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID7FBB37C0DF434578AE0BE3F91C1B39CE" reported-display-style="strikethrough"><enum>218.</enum><header>California as a
contract Health Service delivery Area</header><text display-inline="no-display-inline">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.</text>
</section><section changed="deleted" committee-id="SLIA00" id="IDBF1779D2C95F47CD9979AB3DE12C959E" reported-display-style="strikethrough"><enum>219.</enum><header>Contract Health
Services for the Trenton Service Area</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID71FF33874C6B4EE38E0634D8E0146129" reported-display-style="strikethrough"><enum>(a)</enum><header>Authorization
for Services</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID709A0349A28644CB8F2F4E281D935CC4" reported-display-style="strikethrough"><enum>(b)</enum><header>No Expansion of
Eligibility</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDB84218250AC54EA283ECE943813374F2" reported-display-style="strikethrough"><enum>220.</enum><header>Programs
operated by Indian Tribes and Tribal Organizations</header><text display-inline="no-display-inline">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.</text>
</section><section changed="deleted" committee-id="SLIA00" id="ID4E28326AD20049B7BE78AD86A0480EC1" reported-display-style="strikethrough"><enum>221.</enum><header>Licensing</header><text display-inline="no-display-inline">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
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (25 U.S.C. 450 et seq.).</text>
</section><section changed="deleted" committee-id="SLIA00" id="IDB070B3161B024703B3E6524A5AA5507A" reported-display-style="strikethrough"><enum>222.</enum><header>Notification of
provision of emergency contract Health Services</header><text display-inline="no-display-inline">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.</text>
</section><section changed="deleted" committee-id="SLIA00" id="ID8E5B5021C53347E39E23CDBA9A83B29C" reported-display-style="strikethrough"><enum>223.</enum><header>Prompt action
on payment of claims</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID2913944EEBFD48589D0886E13E15E6DA" reported-display-style="strikethrough"><enum>(a)</enum><header>Deadline for
Response</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID89F265B6D3FA4372AF41090CBB6311CF" reported-display-style="strikethrough"><enum>(b)</enum><header>Effect of
Untimely Response</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID7137927863CC44039AB4052C443E8FA1" reported-display-style="strikethrough"><enum>(c)</enum><header>Deadline for
Payment of Valid Claim</header><text>The Service shall pay a valid contract
care service claim within 30 days after the completion of the claim.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDC1809CF87E714583835F1CE732439E43" reported-display-style="strikethrough"><enum>224.</enum><header>Liability for
payment</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDCCA4A497177B47678E896F00B78EEA7D" reported-display-style="strikethrough"><enum>(a)</enum><header>No Patient
Liability</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDED2C3519FEEA4D3E8A4C9F3C8792C79A" reported-display-style="strikethrough"><enum>(b)</enum><header>Notification</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID1D93E67A68DA40CD8192AC49B0B80B64" reported-display-style="strikethrough"><enum>(c)</enum><header>No
Recourse</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDFD45892256234FBA9D014D01E5BF0168" reported-display-style="strikethrough"><enum>225.</enum><header>Authorization
of appropriations</header><text display-inline="no-display-inline">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.</text>
</section><enum>III</enum><header>FACILITIES</header>
<section changed="deleted" committee-id="SLIA00" id="ID2A943F6EB4444A2AB79415695535F42E" reported-display-style="strikethrough"><enum>301.</enum><header>Consultation:
construction and renovation of facilities; reports</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDD6B1FDA2B91F4778A70B3B70D0B3A50F" reported-display-style="strikethrough"><enum>(a)</enum><header>Prerequisites
for Expenditure of Funds</header><text>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 <quote>Snyder
Act</quote>), the Secretary, acting through the Service, shall—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID5DB48BB903974EF1BE81FAF59684EADE" reported-display-style="strikethrough"><enum>(1)</enum><text>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</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB634B9F4CB3E48999EBE1FE623FE7C64" reported-display-style="strikethrough"><enum>(2)</enum><text>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
<act-name parsable-cite="SSA">Social Security Act</act-name> by not later than
1 year after the date on which the construction or renovation of such facility
is completed.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID3931FBF346784CF78C0DD9F2032260BC" reported-display-style="strikethrough"><enum>(b)</enum><header>Closures</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDA58A63817CDE4E4E9DC7ED41AC433E52" reported-display-style="strikethrough"><enum>(1)</enum><header>Evaluation
required</header><text>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—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDDDD39224C4D94805AB3075C3C33BEE3C" reported-display-style="strikethrough"><enum>(A)</enum><text>the accessibility
of alternative health care resources for the population served by such
facility;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID0EA7F6F7F1694EBFA11FB0DFA79BD981" reported-display-style="strikethrough"><enum>(B)</enum><text>the
cost-effectiveness of such closure;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDB2B5D533608F4B5C8954FE63C0E0A3B6" reported-display-style="strikethrough"><enum>(C)</enum><text>the quality of
health care to be provided to the population served by such facility after such
closure;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID644C55960A2F42BBB66F19EE7E854015" reported-display-style="strikethrough"><enum>(D)</enum><text>the availability
of contract health care funds to maintain existing levels of service;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID087391D2DD2142F19D6D49873E257DBA" reported-display-style="strikethrough"><enum>(E)</enum><text>the views of the
Indian Tribes served by such facility concerning such closure;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDAD160279C724402FB705534DEA3DB860" reported-display-style="strikethrough"><enum>(F)</enum><text>the level of use
of such facility by all eligible Indians; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID39334547AD664F0E8246882A5A8516A2" reported-display-style="strikethrough"><enum>(G)</enum><text>the distance
between such facility and the nearest operating Service hospital.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID4D4629C891F84B78BC8AF20272DC1B37" reported-display-style="strikethrough"><enum>(2)</enum><header>Exception for
certain temporary closures</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID3BA99D8FA79743B79245263C09B80D8B" reported-display-style="strikethrough"><enum>(c)</enum><header>Health Care
Facility Priority System</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDE8521FD806C643AEA94068E3A04D18F5" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDB8DC2B2A036C43E58CF6A75A65900E02" reported-display-style="strikethrough"><enum>(A)</enum><header>Establishment</header><text>The
Secretary, acting through the Service, shall establish a health care facility
priority system, which shall—</text>
<clause changed="deleted" committee-id="SLIA00" id="IDA555459E94F04F7BAA60535C89F1013E" reported-display-style="strikethrough"><enum>(i)</enum><text>be developed with
Indian Tribes and Tribal Organizations through negotiated rulemaking under
section 802;</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="ID3FB26DF5D87449769F73B3AD138F590F" reported-display-style="strikethrough"><enum>(ii)</enum><text>give Indian
Tribes’ needs the highest priority; and</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="IDA866D992A2DA4DE58BD106EA484CFCAE" reported-display-style="strikethrough"><enum>(iii)</enum><text>at a minimum,
include the lists required in paragraph (2)(B) and the methodology required in
paragraph (2)(E).</text>
</clause></subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID74F221B13F864F77B400B05BE59B7612" reported-display-style="strikethrough"><enum>(B)</enum><header>Priority of
certain projects protected</header><text>The priority of any project
established under the construction priority system in effect on the date of the
<act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name>
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.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID1941740D3F0540D0B575EB5D21A8908E" reported-display-style="strikethrough"><enum>(2)</enum><header>Report;
contents</header><text>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:</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID3951D991DE3F4B68847C73E8E2D1CF49" reported-display-style="strikethrough"><enum>(A)</enum><text>A description of
the health care facility priority system of the Service, established under
paragraph (1).</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID9495D1FDC3CB4812B11B852A9C17D43B" reported-display-style="strikethrough"><enum>(B)</enum><text>Health care
facilities lists, including—</text>
<clause changed="deleted" committee-id="SLIA00" id="ID13687EF39ABE40BFB97D34E4947FA172" reported-display-style="strikethrough"><enum>(i)</enum><text>the 10
top-priority inpatient health care facilities;</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="ID04BEECF7504B4820AF7FA8AB398B3612" reported-display-style="strikethrough"><enum>(ii)</enum><text>the 10
top-priority outpatient health care facilities;</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="IDA645C6270D9341B1AC354BC1AE659FCE" reported-display-style="strikethrough"><enum>(iii)</enum><text>the 10
top-priority specialized health care facilities (such as long-term care and
alcohol and drug abuse treatment);</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="ID0BB6F8659BF24415AF004468F62ED18C" reported-display-style="strikethrough"><enum>(iv)</enum><text>the 10
top-priority staff quarters developments associated with health care
facilities; and</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="ID9E368C8F8C994CC28078EA534DFF444F" reported-display-style="strikethrough"><enum>(v)</enum><text>the 10
top-priority hostels associated with health care facilities.</text>
</clause></subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDE6FBFAAE2B7F495CACA4E9B74D7A2607" reported-display-style="strikethrough"><enum>(C)</enum><text>The justification
for such order of priority.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDF1CAE91382D242F398EDA149BB6B6247" reported-display-style="strikethrough"><enum>(D)</enum><text>The projected cost
of such projects.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDE7663FCDBA1D49EA8FD30455E21CBC46" reported-display-style="strikethrough"><enum>(E)</enum><text>The methodology
adopted by the Service in establishing priorities under its health care
facility priority system.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID3AA95007830547759DCC13D952781881" reported-display-style="strikethrough"><enum>(3)</enum><header>Requirements for
preparation of reports</header><text>In preparing each report required under
paragraph (2) (other than the initial report), the Secretary shall
annually—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID7780036A5DA94168A46C77BCCB1A7E8D" reported-display-style="strikethrough"><enum>(A)</enum><text>consult with and
obtain information on all health care facilities needs from Indian Tribes,
Tribal Organizations, and Urban Indian Organizations; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID8DA559516994423D898FB01F080AED91" reported-display-style="strikethrough"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID7110E22201DA4235BA63003242519242" reported-display-style="strikethrough"><enum>(4)</enum><header>Criteria for
evaluating needs</header><text>For purposes of this subsection, the Secretary
shall, in evaluating the needs of facilities operated under any contract or
compact under the <act-name parsable-cite="ISDA">Indian Self-Determination and
Education Assistance Act</act-name> (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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID35D4A3C7E5CE4E6A9D6779B73551D151" reported-display-style="strikethrough"><enum>(5)</enum><header>Needs of
facilities under isdeaa agreements</header><text>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 <act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (25 U.S.C. 450 et seq.) are fully and equitably
integrated into the health care facility priority system.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID0B8E6FB472F645E098B1E186C3C1095A" reported-display-style="strikethrough"><enum>(d)</enum><header>Review of Need
for Facilities</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDB27CA98B8720475182C8398DAC23F185" reported-display-style="strikethrough"><enum>(1)</enum><header>Initial
report</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDBE4DF0D5ABF446738153061DD1597B2A" reported-display-style="strikethrough"><enum>(2)</enum><text>Beginning in the
year 2006, the Secretary shall update the report required under paragraph (1)
every 5 years.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID92CD5F7570DC4CF59E5A3CA8D0A04CC6" reported-display-style="strikethrough"><enum>(3)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID7D653F958F02496EAD3C1E5F942C0AD3" reported-display-style="strikethrough"><enum>(4)</enum><text>For purposes of
this subsection, the reports shall, regarding the needs of facilities operated
under any contract or compact under the <act-name parsable-cite="ISDA">Indian
Self-Determination and Education Assistance Act</act-name> (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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID520019EC4F5147D19A9C2B59BE89C1C6" reported-display-style="strikethrough"><enum>(5)</enum><text>The planning,
design, construction, and renovation needs of facilities operated under
contracts or compacts under the <act-name parsable-cite="ISDA">Indian
Self-Determination and Education Assistance Act</act-name> (25 U.S.C. 450 et
seq.) shall be fully and equitably integrated into the development of the
health facility priority system.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID3CD1AA7E52534FDEB8A5E03EBDB9C746" reported-display-style="strikethrough"><enum>(6)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDC1EDEFDE4F0C4D7CA778510FC102D5D5" reported-display-style="strikethrough"><enum>(e)</enum><header>Funding
Condition</header><text>All funds appropriated under the Act of November 2,
1921 (25 U.S.C. 13) (commonly known as the <quote>Snyder Act</quote>), 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
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (25 U.S.C. 450 et seq.).</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID02AD21F8E82C4CCCAB85BD046AC9F4F5" reported-display-style="strikethrough"><enum>(f)</enum><header>Development of
Innovative Approaches</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDF7D8386FDBE2467F8F9675724956C7D7" reported-display-style="strikethrough"><enum>302.</enum><header>Sanitation
facilities</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID5B02E195B5EF4488A4AE87BADBF49425" reported-display-style="strikethrough"><enum>(a)</enum><header>Findings</header><text>Congress
finds the following:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDE45EF3143ED3411DB7D56D9C597264E7" reported-display-style="strikethrough"><enum>(1)</enum><text>The provision of
sanitation facilities is primarily a health consideration and function.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID6B53C4DF8D6B44D1858514A6A325FF1B" reported-display-style="strikethrough"><enum>(2)</enum><text>Indian people
suffer an inordinately high incidence of disease, injury, and illness directly
attributable to the absence or inadequacy of sanitation facilities.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDEC5ECA35A853428CACF7D4AB7D395A95" reported-display-style="strikethrough"><enum>(3)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF64C2597D9AB4FFB82A37AA273C8D048" reported-display-style="strikethrough"><enum>(4)</enum><text>Many Indian homes
and Indian communities still lack sanitation facilities.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID0CC9AD579730461F95257CA7302A7A95" reported-display-style="strikethrough"><enum>(5)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID04EA39AECC664AD1BD3E16379D4C22FD" reported-display-style="strikethrough"><enum>(b)</enum><header>Facilities and
Services</header><text>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:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDD5532C1D77F04988BB5DF44412D19E48" reported-display-style="strikethrough"><enum>(1)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA5D1CCE05805435FA3BE957BC1C272B9" reported-display-style="strikethrough"><enum>(2)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID9DE45C7E304B47C7A8B61DE322250CC6" reported-display-style="strikethrough"><enum>(3)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDD35F69342A00412FB29AE84A5145D502" reported-display-style="strikethrough"><enum>(c)</enum><header>Funding</header><text>Notwithstanding
any other provision of law—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID698E364976B541F5A2C40DEDB916F454" reported-display-style="strikethrough"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID8539B2798FF64FACB97756C400B183A2" reported-display-style="strikethrough"><enum>(2)</enum><text>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);</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDD8682CC2BD4143658C78554C35D597B3" reported-display-style="strikethrough"><enum>(3)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDFBE1B9E5625D45D39D78EFE91526E5AB" reported-display-style="strikethrough"><enum>(4)</enum><text>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 <act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (25 U.S.C. 450 et seq.);</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID4693F07FCE1B40F69032CA4B1A73B9A3" reported-display-style="strikethrough"><enum>(5)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID6B74275696A349FE94CC1A96127F0C61" reported-display-style="strikethrough"><enum>(6)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID02DA980800F9423EB0D74752DC9D9CB1" reported-display-style="strikethrough"><enum>(7)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID3C0EFAC0E07041B8885DEC58706ED284" reported-display-style="strikethrough"><enum>(8)</enum><text>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</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID0D6F6D17BA70412F9A4A18FFD859D568" reported-display-style="strikethrough"><enum>(9)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID1B83B77F139D4AB6A45662F8B42668F9" reported-display-style="strikethrough"><enum>(d)</enum><header>Certain
Capabilities Not Prerequisite</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID318B0FEE14AD49CB874C8A691708D687" reported-display-style="strikethrough"><enum>(e)</enum><header>Financial
Assistance</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID0E27E22E9B0F4B5A86D216FD64F80BB3" reported-display-style="strikethrough"><enum>(f)</enum><header>Operation,
Management, and Maintenance of Facilities</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDB0282AE5F29049689D7AB269C7D941AF" reported-display-style="strikethrough"><enum>(g)</enum><header>ISDEAA Program
Funded on Equal Basis</header><text>Tribal Health Programs shall be eligible
(on an equal basis with programs that are administered directly by the Service)
for—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID1F2899608CEC4E87A9BF47A58325157E" reported-display-style="strikethrough"><enum>(1)</enum><text>any funds
appropriated pursuant to this section; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDC032954BF87F46FE91E6BABE1695882B" reported-display-style="strikethrough"><enum>(2)</enum><text>any funds
appropriated for the purpose of providing sanitation facilities.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDD2B5A8D679C8455F9361D49D7B046A28" reported-display-style="strikethrough"><enum>(h)</enum><header>Report</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDE0F04354734E4B01924A0C48119BA826" reported-display-style="strikethrough"><enum>(1)</enum><header>Required;
contents</header><text>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—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID5E730518AC194A478CB450DF2CAA3A80" reported-display-style="strikethrough"><enum>(A)</enum><text>the current Indian
sanitation facility priority system of the Service;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID82425DEA1D194118A14F0E42555E0CDC" reported-display-style="strikethrough"><enum>(B)</enum><text>the methodology
for determining sanitation deficiencies and needs;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID335F8EF20C93445CA5EDC6BDA98E038B" reported-display-style="strikethrough"><enum>(C)</enum><text>the level of
initial and final sanitation deficiency for each type of sanitation facility
for each project of each Indian Tribe or Indian community;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDDA0F17C5BB9940259B0A5E7FC4C39884" reported-display-style="strikethrough"><enum>(D)</enum><text>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</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDB071AEFC8B134E92A5B01F1149A083C2" reported-display-style="strikethrough"><enum>(E)</enum><text>a 10-year plan to
provide sanitation facilities to serve existing Indian homes and Indian
communities and new and renovated Indian homes.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID5255316FB87C45F29D4330B6679220F5" reported-display-style="strikethrough"><enum>(2)</enum><header>Criteria</header><text>The
criteria on which the deficiencies and needs will be evaluated shall be
developed through negotiated rulemaking pursuant to section 802.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID0EB780FE4BDA40A1B1A0D25C3EDB7FA4" reported-display-style="strikethrough"><enum>(3)</enum><header>Uniform
methodology</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF87A5B5C634D4F8597A2BBE797F1E035" reported-display-style="strikethrough"><enum>(4)</enum><header>Sanitation
deficiency levels</header><text>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:</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDBB93B8147B4642F2A0E92396CEE0A428" reported-display-style="strikethrough"><enum>(A)</enum><text>A level I
deficiency exists if a sanitation facility serving an individual, Indian Tribe,
or Indian community—</text>
<clause changed="deleted" committee-id="SLIA00" id="IDCD37A73FF91E4431BE80E5D228D1B82C" reported-display-style="strikethrough"><enum>(i)</enum><text>complies with all
applicable water supply, pollution control, and solid waste disposal laws;
and</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="ID960FD7DF35B04F39A3958DBA0A28E50E" reported-display-style="strikethrough"><enum>(ii)</enum><text>deficiencies
relate to routine replacement, repair, or maintenance needs.</text>
</clause></subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDB397BB922E874EA596017427988115FA" reported-display-style="strikethrough"><enum>(B)</enum><text>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—</text>
<clause changed="deleted" committee-id="SLIA00" id="ID5834232B55E14518A36041E7C3B2977E" reported-display-style="strikethrough"><enum>(i)</enum><text>small or minor
capital improvements needed to bring the facility back into compliance;</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="ID0431F032CE71499C843FF1A812F83289" reported-display-style="strikethrough"><enum>(ii)</enum><text>capital
improvements that are necessary to enlarge or improve the facilities in order
to meet the current needs for domestic sanitation facilities; or</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="IDE7CAB0F9298C442D9AC0178798B7D020" reported-display-style="strikethrough"><enum>(iii)</enum><text>the lack of
equipment or training by an Indian Tribe, Tribal Organization, or an Indian
community to properly operate and maintain the sanitation facilities.</text>
</clause></subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDEB98ACCFC47C4ADF921DB9B33762D5FC" reported-display-style="strikethrough"><enum>(C)</enum><text>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—</text>
<clause changed="deleted" committee-id="SLIA00" id="IDE58458D29C7149BA8C89D31DEC4D94EE" reported-display-style="strikethrough"><enum>(i)</enum><text>water or sewer
service in the home is provided by a haul system with holding tanks and
interior plumbing;</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="ID614BDFAE846948829469F64E78E682FC" reported-display-style="strikethrough"><enum>(ii)</enum><text>major significant
interruptions to water supply or sewage disposal occur frequently, requiring
major capital improvements to correct the deficiencies; or</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="IDED847FA1B0EE44EA8F6F6152426216BF" reported-display-style="strikethrough"><enum>(iii)</enum><text>there is no
access to or no approved or permitted solid waste facility available.</text>
</clause></subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID90EB8743EE1E4103AAFBBAB82A188471" reported-display-style="strikethrough"><enum>(D)</enum><text>A level IV
deficiency exists if—</text>
<clause changed="deleted" committee-id="SLIA00" id="IDC786E06470554118BBC08727B19B83AD" reported-display-style="strikethrough"><enum>(i)</enum><text>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</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="ID49D898A348B44F49925721F43A5BA109" reported-display-style="strikethrough"><enum>(ii)</enum><text>where only a
washeteria or central facility exists in the community.</text>
</clause></subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID09F17F04AC8B444F893E43BB2D0767B4" reported-display-style="strikethrough"><enum>(E)</enum><text>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.</text>
<clause changed="deleted" committee-id="SLIA00" id="IDBA8F44A773E740DDBC57E90C887D8FEF" indent="up3" reported-display-style="strikethrough"><enum>(i)</enum><header>Definitions</header><text>For
purposes of this section, the following terms apply:</text>
</clause></subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID6A62DE4265554418999C39C417F6C68B" reported-display-style="strikethrough"><enum>(1)</enum><header>Indian
community</header><text>The term <term>Indian community</term> 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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF3FDD6A50CD1494B9CBEDC196B4ED3C5" reported-display-style="strikethrough"><enum>(2)</enum><header>Sanitation
facilities</header><text>The terms <term>sanitation facility</term> and
<term>sanitation facilities</term> mean safe and adequate water supply systems,
sanitary sewage disposal systems, and sanitary solid waste systems (and all
related equipment and support infrastructure).</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="ID4A40F155C93148848D0304161DBD4FA2" reported-display-style="strikethrough"><enum>303.</enum><header>Preference to
Indians and Indian firms</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID2464DE7746C9422DB49C8A606F77F0EB" reported-display-style="strikethrough"><enum>(a)</enum><header>Buy Indian
Act</header><text>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 <quote>Buy Indian Act</quote>), 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 <quote>Indian firm</quote>) 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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID813BFE6C3C9449A483C44A63584A47C3" reported-display-style="strikethrough"><enum>(1)</enum><text>ownership and
control by Indians;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID93F344D8ECF94B4CB696511AA61390F8" reported-display-style="strikethrough"><enum>(2)</enum><text>equipment;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA9F2B9E6D5344EC4A100D4A1429C29C3" reported-display-style="strikethrough"><enum>(3)</enum><text>bookkeeping and
accounting procedures;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDEA75D49BE9AB431DA6C692429535F205" reported-display-style="strikethrough"><enum>(4)</enum><text>substantive
knowledge of the project or function to be contracted for;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID9D3193A2928F44CB82F9237B411777AF" reported-display-style="strikethrough"><enum>(5)</enum><text>adequately trained
personnel; or</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID6D3B3CF856B04D12B860D9BD7C7C3D77" reported-display-style="strikethrough"><enum>(6)</enum><text>other necessary
components of contract performance.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID3AD3CEB7F87B4E749AD9C14E8E95E2CB" reported-display-style="strikethrough"><enum>(b)</enum><header>Labor
Standards</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID6DDD2476C63D4A5E8F13879448888B03" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>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 <quote><act-name parsable-cite="DBA">Davis-Bacon Act</act-name></quote>), unless such
construction or renovation—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID487C47CFDAE64EB0916C5E0982F0CE42" reported-display-style="strikethrough"><enum>(A)</enum><text>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
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name>, or other statutory authority; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID2EB1C05AAF80436286A8D0C07A91B32F" reported-display-style="strikethrough"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID0EAD4C538FD04AF28C1E4948F1AB175E" reported-display-style="strikethrough"><enum>(2)</enum><header>Exception</header><text>This
subsection shall not apply to construction or renovation carried out by an
Indian Tribe or Tribal Organization with its own employees.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="ID4BD2D45667D648BBAA7EB6470476DA2C" reported-display-style="strikethrough"><enum>304.</enum><header>Expenditure of
nonservice funds for renovation</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDB4757C8D3947409EA35BA25C0E4D83C7" reported-display-style="strikethrough"><enum>(a)</enum><header>In
General</header><text>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 <act-name parsable-cite="ISDA">Indian Self-Determination
and Education Assistance Act</act-name> (25 U.S.C. 450 et seq.),
including—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDFF7C7EFE88E6434D9E750444E2E69B7C" reported-display-style="strikethrough"><enum>(1)</enum><text>any plans or
designs for such expansion, renovation, or modernization; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID3F15602D75DE47F0A53F89D96E2B9F0B" reported-display-style="strikethrough"><enum>(2)</enum><text>any expansion,
renovation, or modernization for which funds appropriated under any Federal law
were lawfully expended.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID6C0F90A568FE4F69A32D465695B512CF" reported-display-style="strikethrough"><enum>(b)</enum><header>Priority
List</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID70A85451DC1A4D3D8EC60D5ACBC152D6" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDAC020244976041E1822DEF65CFEBBD93" reported-display-style="strikethrough"><enum>(2)</enum><header>Report</header><text>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).</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID5D114AE9F09D4253986A65AE41E63002" reported-display-style="strikethrough"><enum>(c)</enum><header>Requirements</header><text>The
requirements of this subsection are met with respect to any expansion,
renovation, or modernization if—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDB3E39F73E0CC42B3921A0D3B7D653C9A" reported-display-style="strikethrough"><enum>(1)</enum><text>the Indian Tribe
or Tribal Organization—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDE60F7BDC1CE44BDC9995FA7543726560" reported-display-style="strikethrough"><enum>(A)</enum><text>provides notice to
the Secretary of its intent to expand, renovate, or modernize; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID9B23F7AF51184502A8E6014472C61090" reported-display-style="strikethrough"><enum>(B)</enum><text>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</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF56DD514177B4414A9BA19DAC198C35D" reported-display-style="strikethrough"><enum>(2)</enum><text>the expansion,
renovation, or modernization—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDBFB7B02C5C9A4FEFB08E74CFB9861363" reported-display-style="strikethrough"><enum>(A)</enum><text>is approved by the
appropriate area director of the Service for Federal facilities; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID2AB8E8D138994D0298BFCC1A909C3D78" reported-display-style="strikethrough"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDFACEB98533D74578BDB86B072A3312B8" reported-display-style="strikethrough"><enum>(d)</enum><header>Additional
Requirement for Expansion</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID8A88BB1222D04F30AE53E28EC8A85227" reported-display-style="strikethrough"><enum>(e)</enum><header>Closure or
Conversion of Facilities</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID328298FA9F9F4FA4B01F7600F56FE590" reported-display-style="strikethrough"><enum>305.</enum><header>Funding for the
construction, expansion, and modernization of small ambulatory care
facilities</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID8CFE15A58D4E4593B64B447D237F65AD" reported-display-style="strikethrough"><enum>(a)</enum><header>Funding</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDE9DD102E100346B08CD8CA50709E3A7F" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>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 <term>construction</term> includes the replacement of an
existing facility.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID29B8122848E044BC8A9E20FBF906D888" reported-display-style="strikethrough"><enum>(2)</enum><header>Agreement
required</header><text>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).</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID05D6DC41785A454C8B7691D0DCDDBEBC" reported-display-style="strikethrough"><enum>(b)</enum><header>Use of
Funds</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID9E946435FF9541D089B43A60936D3AA7" reported-display-style="strikethrough"><enum>(1)</enum><header>Allowable
uses</header><text>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—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDFDABD93BF2A6436FA2DA77E9AA96D23B" reported-display-style="strikethrough"><enum>(A)</enum><text>located apart from
a hospital;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID5F593488ECA74D10894D75B82BDE52DA" reported-display-style="strikethrough"><enum>(B)</enum><text>not funded under
section 301 or section 307; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID1B789D4C53C14B2DB956E4579C28AFDD" reported-display-style="strikethrough"><enum>(C)</enum><text>which, upon
completion of such construction or modernization will—</text>
<clause changed="deleted" committee-id="SLIA00" id="ID35EF41010E1D47AF9B7B20D71F2429E7" reported-display-style="strikethrough"><enum>(i)</enum><text>have a total
capacity appropriate to its projected service population;</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="IDE87CC6D9CD0A437B9121DF479CC504B1" reported-display-style="strikethrough"><enum>(ii)</enum><text>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</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="IDB2E7C194E59A4E98AC57139B7F4DD0C0" reported-display-style="strikethrough"><enum>(iii)</enum><text>provide
ambulatory care in a Service Area (specified in the contract or compact under
the <act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (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).</text>
</clause></subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID47F67A48AEDF4069BD6757432D76878B" reported-display-style="strikethrough"><enum>(2)</enum><header>Additional
allowable use</header><text>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).</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF1EB81C97E6A423EABD01D8D5B0FF6DD" reported-display-style="strikethrough"><enum>(3)</enum><header>Use only for
certain portion of costs</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID959C8CDE3E614B88B62A68C5CF7A37B0" reported-display-style="strikethrough"><enum>(c)</enum><header>Funding</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDBA28DD6E35D44A7DB9227F8CDE3E5F19" reported-display-style="strikethrough"><enum>(1)</enum><header>Application</header><text>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—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDC081AF934DF44BBC84EECAC096B9E725" reported-display-style="strikethrough"><enum>(A)</enum><text>adequate financial
support will be available for the provision of services at such
facility;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDD473F9B911884110A5C24711D008509E" reported-display-style="strikethrough"><enum>(B)</enum><text>such facility will
be available to eligible Indians without regard to ability to pay or source of
payment; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID80E96FA5E6C6455B874E631823F20AA7" reported-display-style="strikethrough"><enum>(C)</enum><text>such facility
will, as feasible without diminishing the quality or quantity of services
provided to eligible Indians, serve noneligible persons on a cost basis.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF661DBAB123B4058A5770B472A9962C3" reported-display-style="strikethrough"><enum>(2)</enum><header>Priority</header><text>In
awarding funding under this section, the Secretary shall give priority to
Indian Tribes and Tribal Organizations that demonstrate—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDA96A88E56B614257AB99BE058A576715" reported-display-style="strikethrough"><enum>(A)</enum><text>a need for
increased ambulatory care services; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID41748AF47778401A9F7BD727FED2B4D0" reported-display-style="strikethrough"><enum>(B)</enum><text>insufficient
capacity to deliver such services.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID8E5981105A9447A5BA937235F8088DB7" reported-display-style="strikethrough"><enum>(3)</enum><header>Peer review
panels</header><text>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).</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDF6D7D1A2624B4DD8BE018C48C9DBA7A3" reported-display-style="strikethrough"><enum>(d)</enum><header>Reversion of
Facilities</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID0B10351281F84DF3A93FA8A341EFDA69" reported-display-style="strikethrough"><enum>(e)</enum><header>Funding
Nonrecurring</header><text>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 <act-name parsable-cite="ISDA">Indian Self-Determination and Education Assistance
Act</act-name> or for reallocation or redesign thereunder.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID9F27BDB188CF477AADD94E5900BCBBC4" reported-display-style="strikethrough"><enum>306.</enum><header>Indian Health
care delivery demonstration project</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID2FE68ECB6EB54D5897B9FC174698BC37" reported-display-style="strikethrough"><enum>(a)</enum><header>Health Care
Demonstration Projects</header><text>The Secretary, acting through the Service,
and in consultation with Indian Tribes and Tribal Organizations, is authorized
to enter into construction agreements under the <act-name parsable-cite="ISDA">Indian Self-Determination and Education Assistance
Act</act-name> (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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID26FECF0FF5AA40B8A4949A0F0F5CE288" reported-display-style="strikethrough"><enum>(b)</enum><header>Use of
Funds</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID27480D32893B467BB1C6CDC764FB399F" reported-display-style="strikethrough"><enum>(1)</enum><text>waive any leasing
prohibition;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID0415125ED917407FA107B166F9BF798B" reported-display-style="strikethrough"><enum>(2)</enum><text>permit carryover
of funds appropriated for the provision of health care services;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID4CC9B8BFFC43416791CE0D4411BC10EC" reported-display-style="strikethrough"><enum>(3)</enum><text>permit the use of
other available funds;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID1A6380C7C95E4739A04E016DD80E8805" reported-display-style="strikethrough"><enum>(4)</enum><text>permit the use of
funds or property donated from any source for project purposes;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID1E1DAFBEA61348399CCAAE4815DDAF09" reported-display-style="strikethrough"><enum>(5)</enum><text>provide for the
reversion of donated real or personal property to the donor; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID05FF94BDEDEA4A27B908A5DC38FCFF00" reported-display-style="strikethrough"><enum>(6)</enum><text>permit the use of
Service funds to match other funds, including Federal funds.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID537CC055BCE94479A3CB9E93EA4F6BAA" reported-display-style="strikethrough"><enum>(c)</enum><header>Regulations</header><text>The
Secretary shall develop and promulgate regulations not later than 1 year after
the date of enactment of the <act-name parsable-cite="IHCIA">Indian Health Care
Improvement Act</act-name> 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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDBE8026CF39A5482D938E058F0D1F0FFD" reported-display-style="strikethrough"><enum>(d)</enum><header>Criteria</header><text>The
Secretary may approve projects that meet the following criteria:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDADE19E14C5BC4FC4A5F02D99BD28B560" reported-display-style="strikethrough"><enum>(1)</enum><text>There is a need
for a new facility or program or the reorientation of an existing facility or
program.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID6B6C4D6C28244399B3DE46C93B440971" reported-display-style="strikethrough"><enum>(2)</enum><text>A significant
number of Indians, including those with low health status, will be served by
the project.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID7B39E0DFB5EE402C97CD07874CAF665F" reported-display-style="strikethrough"><enum>(3)</enum><text>The project has
the potential to deliver services in an efficient and effective manner.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID4676C752ECF4418DAC6A5068CC821A26" reported-display-style="strikethrough"><enum>(4)</enum><text>The project is
economically viable.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDE028CDA81333424D8AF6C1C33EBF0151" reported-display-style="strikethrough"><enum>(5)</enum><text>The Indian Tribe
or Tribal Organization has the administrative and financial capability to
administer the project.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID1C50D2EB90B34876A14E2D8E354BA8C0" reported-display-style="strikethrough"><enum>(6)</enum><text>The project is
integrated with providers of related health and social services and is
coordinated with, and avoids duplication of, existing services.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID9A6D09213E6745BC8F3274983C71C3AD" reported-display-style="strikethrough"><enum>(e)</enum><header>Peer Review
Panels</header><text>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).</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID0A39599CABA741F789804A10C4CC9DC7" reported-display-style="strikethrough"><enum>(f)</enum><header>Priority</header><text>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):</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID1F1D5D18A5E244458A38CD53A77CB517" reported-display-style="strikethrough"><enum>(1)</enum><text>Cass Lake,
Minnesota.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID1C70580C32074DA295DB0916BE4AE115" reported-display-style="strikethrough"><enum>(2)</enum><text>Clinton,
Oklahoma.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID3B57CA67459C4115AA1E6E03B291ACF3" reported-display-style="strikethrough"><enum>(3)</enum><text>Harlem,
Montana.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA067363938E946F9A9834F19870275E4" reported-display-style="strikethrough"><enum>(4)</enum><text>Mescalero, New
Mexico.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID8B4D829D5D8F489DB1FAE87200AF38FA" reported-display-style="strikethrough"><enum>(5)</enum><text>Owyhee,
Nevada.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID217783C09A7C40EDB5B301C0693484ED" reported-display-style="strikethrough"><enum>(6)</enum><text>Parker,
Arizona.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID1A26BD5F2974453EBFD59400A1029043" reported-display-style="strikethrough"><enum>(7)</enum><text>Schurz,
Nevada.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID0B216A7031694E08887677D6F14DBD56" reported-display-style="strikethrough"><enum>(8)</enum><text>Winnebago,
Nebraska.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID0302A419C2D64C6C93DC06353B8EFA2B" reported-display-style="strikethrough"><enum>(9)</enum><text>Ft. Yuma,
California.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID02FDF3DF748348F7B975AB89850308D0" reported-display-style="strikethrough"><enum>(g)</enum><header>Technical
Assistance</header><text>The Secretary shall provide such technical and other
assistance as may be necessary to enable applicants to comply with the
provisions of this section.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID9AB499A390DD4D3EB08231DA70F5D509" reported-display-style="strikethrough"><enum>(h)</enum><header>Service to
Ineligible Persons</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID268FEBE36DD544F282F281C595E8A5CF" reported-display-style="strikethrough"><enum>(i)</enum><header>Equitable
Treatment</header><text>For purposes of subsection (d)(1), the Secretary shall,
in evaluating facilities operated under any contract or compact under the
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (25 U.S.C. 450 et seq.), use the same criteria that
the Secretary uses in evaluating facilities operated directly by the
Service.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID4E05CB368417462596C2D4BDA3CB59CA" reported-display-style="strikethrough"><enum>(j)</enum><header>Equitable
Integration of Facilities</header><text>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
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDF3FC73BAFEE24FF5A94F1B1840D9E00B" reported-display-style="strikethrough"><enum>307.</enum><header>Land
transfer</header><text display-inline="no-display-inline">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.</text>
</section><section changed="deleted" committee-id="SLIA00" id="ID2336B1E4DB094FDF91E3DE8B9C75B845" reported-display-style="strikethrough"><enum>308.</enum><header>Leases,
contracts, and other agreements</header><text display-inline="no-display-inline">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(<added-phrase>l</added-phrase>) of the <act-name parsable-cite="ISDA">Indian Self-Determination and Education Assistance
Act</act-name> and regulations thereunder.</text>
</section><section changed="deleted" committee-id="SLIA00" id="ID416E934C23B64F1FB047437FE3793063" reported-display-style="strikethrough"><enum>309.</enum><header>Study on loans,
loan guarantees, and loan repayment</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDAFAC0326FF39403BAB133F6B4BE8F628" reported-display-style="strikethrough"><enum>(a)</enum><header>In
General</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDA6C07E648CD645329D36F5A44AE9B0EC" reported-display-style="strikethrough"><enum>(1)</enum><text>inpatient
facilities;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID65278885496147F09F2FCF41959C56E0" reported-display-style="strikethrough"><enum>(2)</enum><text>outpatient
facilities;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDD672F3130BED4E4CA2930E7E7B044751" reported-display-style="strikethrough"><enum>(3)</enum><text>staff
quarters;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID2C4E4448AE5548CF8AF87C4E6F011E33" reported-display-style="strikethrough"><enum>(4)</enum><text>hostels;
and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID424A38FDE15A422DB5CCD77A6BC740AF" reported-display-style="strikethrough"><enum>(5)</enum><text>specialized care
facilities, such as behavioral health and elder care facilities.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDDE6D5C10AA3546E89B0A7B2567204C5C" reported-display-style="strikethrough"><enum>(b)</enum><header>Determinations</header><text>In
carrying out the study under subsection (a), the Secretary shall
determine—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID2E961F91C60E4A2BADF06ED212744782" reported-display-style="strikethrough"><enum>(1)</enum><text>the maximum
principal amount of a loan or loan guarantee that should be offered to a
recipient from the loan fund;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID1B60674783D34F3BBF6EA01C092B62C8" reported-display-style="strikethrough"><enum>(2)</enum><text>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));</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA747C5F18DA0432A92B746AD32BE786D" reported-display-style="strikethrough"><enum>(3)</enum><text>the cumulative
total of the principal of direct loans and loan guarantees, respectively, that
may be outstanding at any 1 time;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID54B90D43AD0F43B296A736AB8508D118" reported-display-style="strikethrough"><enum>(4)</enum><text>the maximum term
of a loan or loan guarantee that may be made for a facility from the loan
fund;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID52BE2FADAD1248C9A28EFED14C22C44E" reported-display-style="strikethrough"><enum>(5)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID1A4B34D3CDD648F083B90A2E6B4EE75E" reported-display-style="strikethrough"><enum>(6)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB33FF85C25FA4754AB9A346B1E508A50" reported-display-style="strikethrough"><enum>(7)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID1DF6D59AFA994DF585852197E5EFDB55" reported-display-style="strikethrough"><enum>(8)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID55C40E94AA0C455794AE322829193D06" reported-display-style="strikethrough"><enum>(9)</enum><text>the
appropriateness of, and best methods for, coordinating the loan fund with the
health care priority system of the Service under section 301; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID8569BA4F4231415AB9635DC9A08A93B3" reported-display-style="strikethrough"><enum>(10)</enum><text>any legislative
or regulatory changes required to implement recommendations of the Secretary
based on results of the study.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID7C6E6AE8B8D44AE0B2D93B787D3AF777" reported-display-style="strikethrough"><enum>(c)</enum><header>Report</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDEB202B780A6C48E29821CF526F10DD57" reported-display-style="strikethrough"><enum>(1)</enum><text>the manner of
consultation made as required by subsection (a); and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID49D27E1D203843E08C2EA4402D1E9C7E" reported-display-style="strikethrough"><enum>(2)</enum><text>the results of the
study, including any recommendations of the Secretary based on results of the
study.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="ID2EFE9291548E4E608B069A1BCFFBA438" reported-display-style="strikethrough"><enum>310.</enum><header>Tribal
leasing</header><text display-inline="no-display-inline">A Tribal Health
Program may lease permanent structures for the purpose of providing health care
services without obtaining advance approval in appropriation Acts.</text>
</section><section changed="deleted" committee-id="SLIA00" id="IDFED3758014604C7FB14BBEB1B4EA0744" reported-display-style="strikethrough"><enum>311.</enum><header>Indian Health
Service/tribal facilities joint venture Program</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDFF0E15C72AC14F629B0DC3BC996CF6F4" reported-display-style="strikethrough"><enum>(a)</enum><header>In
General</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID665D11E44EB342D7A05475138EEA17BD" reported-display-style="strikethrough"><enum>(1)</enum><text>has begun but not
completed the process of acquisition or construction of a health facility to be
used in the joint venture project; or</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID23DB8DFA511D4A438AE76D93B55C5326" reported-display-style="strikethrough"><enum>(2)</enum><text>has not begun the
process of acquisition or construction of a health facility for use in the
joint venture project.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDF720316E1EA0422C93F76D5D7C9F19CD" reported-display-style="strikethrough"><enum>(b)</enum><header>Requirements</header><text>The
Secretary shall make such an arrangement with an Indian Tribe or Tribal
Organization only if—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID789FE05B526F42938E1ADC23402164D9" reported-display-style="strikethrough"><enum>(1)</enum><text>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</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID69A5FED214E949DDA2B8B2FF3FC750E7" reported-display-style="strikethrough"><enum>(2)</enum><text>the Indian Tribe
or Tribal Organization meets the need criteria which shall be developed through
the negotiated rulemaking process provided for under section 802.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID45392231D6CE4826B5FC296FFF3471E6" reported-display-style="strikethrough"><enum>(c)</enum><header>Continued
Operation</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDD8287A816E3E438F8626D005A1315773" reported-display-style="strikethrough"><enum>(d)</enum><header>Breach of
Agreement</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID3BB467BB36364B5C8787367E764CE9C6" reported-display-style="strikethrough"><enum>(e)</enum><header>Recovery for
Nonuse</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDE3E1436B18934DE79956C1E4836CBFC2" reported-display-style="strikethrough"><enum>(f)</enum><header>Definition</header><text>For
the purposes of this section, the term <term>health facility</term> or
<term>health facilities</term> includes quarters needed to provide housing for
staff of the relevant Tribal Health Program.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDCF3B92A5FEC24ED5A2BA413C470EC2A7" reported-display-style="strikethrough"><enum>312.</enum><header>Location of
facilities</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDCA814A10240F427DB9A8FF2D3BFC1254" reported-display-style="strikethrough"><enum>(a)</enum><header>In
General</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID90B757E0104243C7A044B464D16AF8EE" reported-display-style="strikethrough"><enum>(b)</enum><header>Definition</header><text>For
purposes of this section, the term <term>Indian lands</term> means—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID86B4D81DDA024422ABC9AE44AEB427E8" reported-display-style="strikethrough"><enum>(1)</enum><text>all lands within
the exterior boundaries of any reservation; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID0EF13F9CF9AE4E76A13E1C75511B48B6" reported-display-style="strikethrough"><enum>(2)</enum><text>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.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="IDD912705F2C20418EA987378B0ABADD54" reported-display-style="strikethrough"><enum>313.</enum><header>Maintenance and
improvement of Health care facilities</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDF7F0036E05D74A459DBCC65550757235" reported-display-style="strikethrough"><enum>(a)</enum><header>Report</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDE834BA7123954602A4770B8AD983FD3E" reported-display-style="strikethrough"><enum>(b)</enum><header>Maintenance of
Newly Constructed Space</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDEC46CDF7FC344A78AB91459DB356EC2A" reported-display-style="strikethrough"><enum>(c)</enum><header>Replacement
Facilities</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDAD3BB6D711904708B7BD9C27A57B207A" reported-display-style="strikethrough"><enum>314.</enum><header>Tribal
management of Federally owned quarters</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID88BDB9E8F56B4B03BC4EFBAC8FAC4D3E" reported-display-style="strikethrough"><enum>(a)</enum><header>Rental
Rates</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDBFCE3F34BDF742A3B7B11CAAF301BC41" reported-display-style="strikethrough"><enum>(1)</enum><header>Establishment</header><text>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 <act-name parsable-cite="ISDA">Indian Self-Determination and Education Assistance
Act</act-name> (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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID849A134D26D4462F89087491DC9B4E49" reported-display-style="strikethrough"><enum>(2)</enum><header>Objectives</header><text>In
establishing rental rates pursuant to authority of this subsection, a Tribal
Health Program shall endeavor to achieve the following objectives:</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID13247EA8D1CE44D8BB8D670D91D03D7E" reported-display-style="strikethrough"><enum>(A)</enum><text>To base such
rental rates on the reasonable value of the quarters to the occupants
thereof.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID9706318ECFD14CBD93361F737A1D6A7C" reported-display-style="strikethrough"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID36B4451D9AA54A9BBBBE356A1D4074F9" reported-display-style="strikethrough"><enum>(3)</enum><header>Equitable
funding</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDADDF5320D03643049F3FA889B31C92B9" reported-display-style="strikethrough"><enum>(4)</enum><header>Notice of rate
change</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID376B5470696C4FDF8671672C18C52573" reported-display-style="strikethrough"><enum>(b)</enum><header>Direct
Collection of Rent</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID7522568963F64EE49C236DB3157B5F4C" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>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:</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID348E3BF3B6DF4AF8847976F60830A6DC" reported-display-style="strikethrough"><enum>(A)</enum><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID01685D7DB7D1442AB6E01E1A0BC01B6D" reported-display-style="strikethrough"><enum>(B)</enum><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID43B6FC4420A944D48183F109FE3D950E" reported-display-style="strikethrough"><enum>(C)</enum><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDC57FD6C9D0654AD3BF58ED74985200AD" reported-display-style="strikethrough"><enum>(D)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA1970D0C2B7448638B4A47A264822C95" reported-display-style="strikethrough"><enum>(2)</enum><header>Retrocession of
authority</header><text>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—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDA8656FE606A24E28A366CCFEA06D520A" reported-display-style="strikethrough"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID7E7D4D459D814F46873CD18F610E504D" reported-display-style="strikethrough"><enum>(B)</enum><text>such other date as
may be mutually agreed by the Secretary and the Tribal Health Program.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDBF35D31B81CC482BBBBFFF8D3C2E7B27" reported-display-style="strikethrough"><enum>(c)</enum><header>Rates in
Alaska</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID0E8323F1017A4C72A93E408A051FC65B" reported-display-style="strikethrough"><enum>315.</enum><header>Applicability
of <act-name parsable-cite="BAA">Buy American Act</act-name>
requirement</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID9FAA2E2EBFBF4E7F80F6409B7CFDFABF" reported-display-style="strikethrough"><enum>(a)</enum><header>Applicability</header><text>The
Secretary shall ensure that the requirements of the
<act-name parsable-cite="BAA">Buy American Act</act-name> apply to all
procurements made with funds provided pursuant to section 317. Indian Tribes
and Tribal Organizations shall be exempt from these requirements.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDDE2A22EF39B74297966A6E1A9AD71A48" reported-display-style="strikethrough"><enum>(b)</enum><header>Effect of
Violation</header><text>If it has been finally determined by a court or Federal
agency that any person intentionally affixed a label bearing a <quote>Made in
America</quote> 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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDC3C448BA89E74598B8AB0096DCFBA660" reported-display-style="strikethrough"><enum>(c)</enum><header>Definitions</header><text>For
purposes of this section, the term <term><act-name parsable-cite="BAA">Buy
American Act</act-name></term> means title III of the Act entitled <quote>An
Act making appropriations for the Treasury and Post Office Departments for the
fiscal year ending June 30, 1934, and for other purposes</quote>, approved
March 3, 1933 (41 U.S.C. 10a et seq.).</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID63E17358D6194A06BE57DBCD580FB359" reported-display-style="strikethrough"><enum>316.</enum><header>Other funding
for facilities</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID94BE9BE122DC4EF890A2B5EC4DF30D1C" reported-display-style="strikethrough"><enum>(a)</enum><header>Authority To
Accept Funds</header><text>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 <act-name parsable-cite="ISDA">Indian
Self-Determination and Education Assistance Act</act-name> (25 U.S.C. 450 et
seq.). Receipt of such funds shall have no effect on the priorities established
pursuant to section 301.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDE8441D0BB52B47DA9CE966438613180E" reported-display-style="strikethrough"><enum>(b)</enum><header>Interagency
Agreements</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID7032EF295C654924A13843AFDE659FB4" reported-display-style="strikethrough"><enum>(c)</enum><header>Transferred
Funds</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDE372062A01F34751B31782564591B984" reported-display-style="strikethrough"><enum>(d)</enum><header>Establishment of
Standards</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID902E77D8CE27419CA93341AEBC0B028F" reported-display-style="strikethrough"><enum>317.</enum><header>Authorization
of appropriations</header><text display-inline="no-display-inline">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.</text>
</section><enum>IV</enum><header>ACCESS TO HEALTH
SERVICES</header>
<section changed="deleted" committee-id="SLIA00" id="IDAC1CA396BFC640E7B7C0DDBB4530C397" reported-display-style="strikethrough"><enum>401.</enum><header>Treatment of
payments under <act-name parsable-cite="SSA">Social Security Act</act-name>
Health care Programs</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID71F51B4D662E4165B00F34129E59F70A" reported-display-style="strikethrough"><enum>(a)</enum><header>Disregard of
Medicare, Medicaid, and SCHIP Payments in Determining
Appropriations</header><text>Any payments received by an Indian Health Program
or by an Urban Indian Organization made under title XVIII, XIX, or XXI of the
<act-name parsable-cite="SSA">Social Security Act</act-name> 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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID5684C20B86794AF3B347A61335F4084F" reported-display-style="strikethrough"><enum>(b)</enum><header>Nonpreferential
Treatment</header><text>Nothing in this Act authorizes the Secretary to provide
services to an Indian with coverage under title XVIII, XIX, or XXI of the
<act-name parsable-cite="SSA">Social Security Act</act-name> in preference to
an Indian without such coverage.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID58422659196340B381D50473E12D057A" reported-display-style="strikethrough"><enum>(c)</enum><header>Use of
Funds</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDA64B064325DF42C9A0BE19F81ABAFD1C" reported-display-style="strikethrough"><enum>(1)</enum><header>Special
fund</header><text>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 <act-name parsable-cite="SSA">Social Security
Act</act-name> 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
<act-name parsable-cite="SSA">Social Security Act</act-name>. 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
<act-name parsable-cite="SSA">Social Security Act</act-name>.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID6C7CA2D69FE54F129413005D206BE976" reported-display-style="strikethrough"><enum>(2)</enum><header>Direct payment
option</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDC8AB9D4B54D44B7192D857A4CFC9D34D" reported-display-style="strikethrough"><enum>(d)</enum><header>Direct
Billing</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDD1817CA313A8475FBD38B26D8F226565" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>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 <act-name parsable-cite="SSA">Social Security Act</act-name> or
from any other third party payor.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID54DE9B8394984A059FF8BB187280429B" reported-display-style="strikethrough"><enum>(2)</enum><header>Direct
reimbursement</header>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID0395E461389C4060B2F405BF4E34A1A3" reported-display-style="strikethrough"><enum>(A)</enum><header>Use of
funds</header><text>Each Tribal Health Program exercising the option described
in paragraph (1) with respect to a program under a title of the
<act-name parsable-cite="SSA">Social Security Act</act-name> 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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDDDAB77FD11F8461EBAD28D30482D2A8D" reported-display-style="strikethrough"><enum>(B)</enum><header>Audits</header><text>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
<act-name parsable-cite="SSA">Social Security Act</act-name> shall be subject
to all auditing requirements applicable to programs administered by an Indian
Health Program.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID4777A430B43F48E487D29FBC07337EDD" reported-display-style="strikethrough"><enum>(C)</enum><header>Identification
of source of payments</header><text>If an Indian Tribe or Tribal Organization
receives funding from the Service under the <act-name parsable-cite="ISDA">Indian Self-Determination and Education Assistance
Act</act-name> 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 <act-name parsable-cite="SSA">Social Security
Act</act-name>, 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.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDEE3E9C0A06954630A0CC9CDBD3793CA4" reported-display-style="strikethrough"><enum>(3)</enum><header>Examination and
implementation of changes</header><text>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
<act-name parsable-cite="SSA">Social Security Act</act-name>.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF20A138198F04F9B85C92A3D17FC033B" reported-display-style="strikethrough"><enum>(4)</enum><header>Withdrawal from
program</header><text>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 <act-name parsable-cite="ISDA">Indian Self-Determination and
Education Assistance Act</act-name> (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.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="IDF3DC26CEAC144B829A7492FBDEC3A271" reported-display-style="strikethrough"><enum>402.</enum><header>Grants to and
contracts with the Service, Indian Tribes, Tribal Organizations, and Urban
Indian Organizations</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID71E60B793C0B4F43B1B17BAA08B4FB8E" reported-display-style="strikethrough"><enum>(a)</enum><header>Indian Tribes
and Tribal Organizations</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID53CA316F3DAC44B3AC7326EAFEC88BE0" reported-display-style="strikethrough"><enum>(1)</enum><text>to enroll for
benefits under title XVIII, XIX, or XXI of the <act-name parsable-cite="SSA">Social Security Act</act-name> and other health benefits
programs; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF409E9D97E43434093487E52689E344B" reported-display-style="strikethrough"><enum>(2)</enum><text>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).</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID4F2CE22E81594CA4A8A0979EDAE600B4" reported-display-style="strikethrough"><enum>(b)</enum><header>Conditions</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID04F24F4FE6594BBF8C877949F267FD4B" reported-display-style="strikethrough"><enum>(1)</enum><text>to determine the
population of Indians eligible for the benefits described in subsection
(a);</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID41642591162A4DC186E136DA987D837D" reported-display-style="strikethrough"><enum>(2)</enum><text>to educate Indians
with respect to the benefits available under the respective programs;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF175597FED6A4FB6A5D3E9A011F2D95F" reported-display-style="strikethrough"><enum>(3)</enum><text>to provide
transportation for such individual Indians to the appropriate offices for
enrollment or applications for such benefits; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA2AA9659249D4E8A9083DBDB02FFB3DC" reported-display-style="strikethrough"><enum>(4)</enum><text>to develop and
implement methods of improving the participation of Indians in receiving the
benefits provided under titles XVIII, XIX, and XXI of the
<act-name parsable-cite="SSA">Social Security Act</act-name>.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID6D4F6F1A7F884CB194B60474987C212A" reported-display-style="strikethrough"><enum>(c)</enum><header>Agreements
Relating to Improving Enrollment of Indians Under <act-name parsable-cite="SSA">Social Security Act</act-name> Programs</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID108468CBF24F41848805986DD5606D99" reported-display-style="strikethrough"><enum>(1)</enum><header>Agreements with
secretary to improve receipt and processing of applications</header>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID28EC06222F9E41BF98DD6E06035FB9B6" reported-display-style="strikethrough"><enum>(A)</enum><header>Authorization</header><text>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 <act-name parsable-cite="SSA">Social Security
Act</act-name>, and benefits under title XVIII of such Act, by an Indian Health
Program or Urban Indian Organization.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDDAC6DB657B7A4418AC9B522E67566126" reported-display-style="strikethrough"><enum>(B)</enum><header>Reimbursement of
costs</header><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDEBCA9B61EC344A1F930EB0F2B10C9F32" reported-display-style="strikethrough"><enum>(C)</enum><header>Processing
clarified</header><text>In this paragraph, the term <term>processing</term>
does not include a final determination of eligibility.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID6AF64AFD06EB4366B1578A7CE5F25FEA" reported-display-style="strikethrough"><enum>(2)</enum><header>Agreements with
states for outreach on or near reservation</header>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID679281C88F584216A8B184CFD1E8B078" reported-display-style="strikethrough"><enum>(A)</enum><header>In
general</header><text>In order to improve the access of Indians residing on or
near a reservation to obtain benefits under title XIX or XXI of the
<act-name parsable-cite="SSA">Social Security Act</act-name>, 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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID9A8510AE9DD94EB2858D6451025DF38B" reported-display-style="strikethrough"><enum>(B)</enum><header>Construction</header><text>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.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID0BD399F0F81848AF9674E05E98B30404" reported-display-style="strikethrough"><enum>(d)</enum><header>Facilitating
Cooperation</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDEE0D8DB53D1F4F5E89C70941B5D3F3C1" reported-display-style="strikethrough"><enum>(e)</enum><header>Application to
Urban Indian Organizations</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID0874E504FCE240FCA330CBF3D4F2B71B" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDAB1ACA3B773E435F8F45129CF589B683" reported-display-style="strikethrough"><enum>(2)</enum><header>Requirements</header><text>The
Secretary shall include in the grants or contracts made or provided under
paragraph (1) requirements that are—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID93A0B76E322C4F2EAE62DC286F05F30A" reported-display-style="strikethrough"><enum>(A)</enum><text>consistent with
the requirements imposed by the Secretary under subsection (b);</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID259FE25AD7AA4DB2822FF0E0B6C03BDF" reported-display-style="strikethrough"><enum>(B)</enum><text>appropriate to
Urban Indian Organizations and Urban Indians; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID2CCD93904CF34DF8B5B8C2E122FE11EA" reported-display-style="strikethrough"><enum>(C)</enum><text>necessary to
effect the purposes of this section.</text>
</subparagraph></paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="ID71D4962B4E11460885532DFDE862F0B5" reported-display-style="strikethrough"><enum>403.</enum><header>Reimbursement
from certain third parties of costs of Health Services</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID3794C53FF8B7456292E6895FB59D5858" reported-display-style="strikethrough"><enum>(a)</enum><header>Right of
Recovery</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID0E62FF5F01044835BE8FF9B9206293BD" reported-display-style="strikethrough"><enum>(1)</enum><text>such services had
been provided by a nongovernmental provider; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID786AE6CC9C0549F1AD8AF63B1C051B46" reported-display-style="strikethrough"><enum>(2)</enum><text>such individual
had been required to pay such charges or expenses and did pay such charges or
expenses.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDD923A1023E334247B9650D83866DAD2A" reported-display-style="strikethrough"><enum>(b)</enum><header>Limitations on
Recoveries From States</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID79F858168F104F3989FC68877D767C40" reported-display-style="strikethrough"><enum>(1)</enum><text>workers’
compensation laws; or</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID26E1574B2E1940D59E2D0890931E71AF" reported-display-style="strikethrough"><enum>(2)</enum><text>a no-fault
automobile accident insurance plan or program.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID04EA61EF05BC4C3B9F04BEDB1A1AADBB" reported-display-style="strikethrough"><enum>(c)</enum><header>Nonapplication
of Other Laws</header><text>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).</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID17D24BBC64BD42A9AE94BB0D00D0DA00" reported-display-style="strikethrough"><enum>(d)</enum><header>No Effect on
Private Rights of Action</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID43A7094C52AE4ED6B9DE257169FB9991" reported-display-style="strikethrough"><enum>(e)</enum><header>Enforcement</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID70B479FEE00F4466928E34EAF6D2A779" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>The United States, an Indian Tribe, or Tribal
Organization may enforce the right of recovery provided under subsection (a)
by—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDD03709615BD7442682EB8D4D65A6B15F" reported-display-style="strikethrough"><enum>(A)</enum><text>intervening or
joining in any civil action or proceeding brought—</text>
<clause changed="deleted" committee-id="SLIA00" id="ID1C9C810871B94802B0943D3EC42FA314" reported-display-style="strikethrough"><enum>(i)</enum><text>by the individual
for whom health services were provided by the Secretary, an Indian Tribe, or
Tribal Organization; or</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="ID334B965EC1BC470194ACF1972F7243CF" reported-display-style="strikethrough"><enum>(ii)</enum><text>by any
representative or heirs of such individual, or</text>
</clause></subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID90CA0C205EDA4CA69DDDECA7D8F70549" reported-display-style="strikethrough"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID88D8E122A36E49598713DD23CD75B886" reported-display-style="strikethrough"><enum>(2)</enum><header>Notice</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID11AC2836AD3B496882B7CCF1A5F35522" reported-display-style="strikethrough"><enum>(f)</enum><header>Limitation</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID6C2E4FFE76F34E6C80FE7E66BC29E394" reported-display-style="strikethrough"><enum>(g)</enum><header>Costs and
Attorneys’ Fees</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID7885C88BE8D74DFB8408BA92709CD887" reported-display-style="strikethrough"><enum>(h)</enum><header>Nonapplication
of Claims Filing Requirements</header><text>An insurance company, health
maintenance organization, self-insurance plan, managed care plan, or other
health care plan or program (under the <act-name parsable-cite="SSA">Social
Security Act</act-name> 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
<act-name parsable-cite="SSA">Social Security Act</act-name> or recognized
under section 1175 of such Act.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID8033F1F418914CDF9D7032B08531F2A9" reported-display-style="strikethrough"><enum>(i)</enum><header>Application to
Urban Indian Organizations</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID8AD7100BC4F545E4A0D947C65D99BE75" reported-display-style="strikethrough"><enum>(j)</enum><header>Statute of
Limitations</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDB3577A51E0444452AF102063C12F7EF5" reported-display-style="strikethrough"><enum>(k)</enum><header>Savings</header><text>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.).</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID4311F19EDC024138A7F9EB28385EEED2" reported-display-style="strikethrough"><enum>404.</enum><header>Crediting of
reimbursements</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID639EFABF3AD94BEB97AD093A147FFAB1" reported-display-style="strikethrough"><enum>(a)</enum><header>Use of
Amounts</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID44EC454F3CAF4D59ACE955246EEEBEEC" reported-display-style="strikethrough"><enum>(1)</enum><header>Retention by
program</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID460316E0DFE843CEA52900893BF19F65" reported-display-style="strikethrough"><enum>(2)</enum><header>Programs
covered</header><text>The programs referred to in paragraph (1) are the
following:</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID00A515EF1BAD4F75A9B452C8F0F58AC4" reported-display-style="strikethrough"><enum>(A)</enum><text>Titles XVIII, XIX,
and XXI of the <act-name parsable-cite="SSA">Social Security
Act</act-name>.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDB2F3F300ECCD46C3B26919FE8BA760B9" reported-display-style="strikethrough"><enum>(B)</enum><text>This Act,
including section 807.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDA47B216C28D84AE2BA07441953D08E47" reported-display-style="strikethrough"><enum>(C)</enum><text>Public Law
87–693.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDB5B7DC202E384F36AB9E52BA50210186" reported-display-style="strikethrough"><enum>(D)</enum><text>Any other
provision of law.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID4E73399F63EC4810B8810CDBCD08E608" reported-display-style="strikethrough"><enum>(b)</enum><header>No Offset of
Amounts</header><text>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).</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID3D645E51F52149088B061DDDB1961A24" reported-display-style="strikethrough"><enum>405.</enum><header>Purchasing
Health care coverage</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID6FB4B706CD8A45448E36394C3F3FAD02" reported-display-style="strikethrough"><enum>(a)</enum><header>In
General</header><text>Insofar as amounts are made available under law
(including a provision of the <act-name parsable-cite="SSA">Social Security
Act</act-name>, the <act-name parsable-cite="ISDA">Indian Self-Determination
and Education Assistance Act</act-name>, 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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDA4CE7790F0B9440095921102DEF4C47E" reported-display-style="strikethrough"><enum>(1)</enum><text>a tribally owned
and operated health care plan;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID2546CFE4F2CD4A609E98204AB5BEF5D0" reported-display-style="strikethrough"><enum>(2)</enum><text>a State or locally
authorized or licensed health care plan;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID33AFB312991D49C6BD2F68EFF61EB0EA" reported-display-style="strikethrough"><enum>(3)</enum><text>a health insurance
provider or managed care organization; or</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA079EE389ACE4E71A1372C2A92B8B182" reported-display-style="strikethrough"><enum>(4)</enum><text>a self-insured
plan.</text>
</paragraph><continuation-text changed="deleted" committee-id="SLIA00" continuation-text-level="subsection" reported-display-style="strikethrough">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).</continuation-text></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID63FDFB8C81884E1DACAD6BAAF75D90D5" reported-display-style="strikethrough"><enum>(b)</enum><header>Expenses for
Self-Insured Plan</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID5E12D6D9E8A54E788FBA12628A9D7FD4" reported-display-style="strikethrough"><enum>(c)</enum><header>Construction</header><text>Nothing
in this section shall be construed as affecting the use of any amounts not
referred to in subsection (a).</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID111DE9F4AEB945A2A1BC32CD532DDEBE" reported-display-style="strikethrough"><enum>406.</enum><header>Sharing
arrangements with Federal agencies</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID572DD15FA7814240A7327333963211DC" reported-display-style="strikethrough"><enum>(a)</enum><header>Authority</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID5A118CB3E2354F5483DEFB48008133D6" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID9AF0744CBFDA4898817187B612E57325" reported-display-style="strikethrough"><enum>(2)</enum><header>Consultation by
secretary required</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID51A0AB45B6244F5A9B52845098045B8F" reported-display-style="strikethrough"><enum>(b)</enum><header>Limitations</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDD74E9B42BB374C1087F8F1E376DF2CA7" reported-display-style="strikethrough"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID7DDBC5E69FDB41D88055B13D1B8D664A" reported-display-style="strikethrough"><enum>(2)</enum><text>the quality of
health care services provided to any Indian through the Service;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDC478E850644E43FBB75D3217B728EE84" reported-display-style="strikethrough"><enum>(3)</enum><text>the priority
access of any veteran to health care services provided by the Department of
Veterans Affairs;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDFAE161AAE649421EA6B57B587F69B730" reported-display-style="strikethrough"><enum>(4)</enum><text>the quality of
health care services provided by the Department of Veterans Affairs or the
Department of Defense; or</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA110E6D9A8C14778B4D6EAD5D181C912" reported-display-style="strikethrough"><enum>(5)</enum><text>the eligibility of
any Indian who is a veteran to receive health services through the Department
of Veterans Affairs.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID57CB09773D10477EBB0188FA3A391116" reported-display-style="strikethrough"><enum>(c)</enum><header>Reimbursement</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID754C6DE6332644EB86FFA6E147A939DD" reported-display-style="strikethrough"><enum>(d)</enum><header>Construction</header><text>Nothing
in this section may be construed as creating any right of a non-Indian veteran
to obtain health services from the Service.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID631A83352344412780E931CA54D8CD48" reported-display-style="strikethrough"><enum>407.</enum><header>Payor of last
resort</header><text display-inline="no-display-inline">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.</text>
</section><section changed="deleted" committee-id="SLIA00" id="ID8CD278F7D9D840AC8C97DA2C25DB8049" reported-display-style="strikethrough"><enum>408.</enum><header>Nondiscrimination
in qualifications for reimbursement for Services</header><text display-inline="no-display-inline">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.</text>
</section><section changed="deleted" committee-id="SLIA00" id="IDBCE8922D73314E9583B3975E22790EEE" reported-display-style="strikethrough"><enum>409.</enum><header>Consultation</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDA02544938A3D4E78B7F245A3E73BF99D" reported-display-style="strikethrough"><enum>(a)</enum><header>Tribal Technical
Advisory Group (TTAG)</header><text>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)).</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID7AB1F8428B2E4AD39BEC120598ECD0D3" reported-display-style="strikethrough"><enum>(b)</enum><header>Solicitation of
Medicaid Advice</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID5EBF5AE073CB44FABDC7EEA044F80CD9" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>As part of its plan under title XIX of the
<act-name parsable-cite="SSA">Social Security Act</act-name>, 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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID983994C68C23477ABCB49AA7E197A9CD" reported-display-style="strikethrough"><enum>(2)</enum><header>Manner of
advice</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDE26BCB3E50764A5C951076850380DDA9" reported-display-style="strikethrough"><enum>(3)</enum><header>Payment of
expenses</header><text>The reasonable expenses of carrying out this subsection
shall be eligible for reimbursement under section 1903(a) of the
<act-name parsable-cite="SSA">Social Security Act</act-name>.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDF716F2526B7A479CBAA3C1F79DA88FAC" reported-display-style="strikethrough"><enum>(c)</enum><header>Construction</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDB97DE5E670304BA9B377E49F8F65E20A" reported-display-style="strikethrough"><enum>410.</enum><header>State
children’s Health insurance Program (schip)</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDEE460E6E13CE476DA2F6F4795257884B" reported-display-style="strikethrough"><enum>(a)</enum><header>Optional Use of
Funds for Indian Health Program Payments</header><text>Subject to the
succeeding provisions of this section, a State may provide under its State
child health plan under title XXI of the <act-name parsable-cite="SSA">Social
Security Act</act-name> (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
<act-name parsable-cite="SSA">Social Security Act</act-name> as expenditures
described in section 2105(a)(1)(A) of such Act.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID99E3EF953B97435A908D8210C42F0E37" reported-display-style="strikethrough"><enum>(b)</enum><header>Use of
Funds</header><text>Payments under this section may be used only for
expenditures described in clauses (i) through (iii) of section 2105(a)(1)(D) of
the <act-name parsable-cite="SSA">Social Security Act</act-name> for targeted
low-income children or other low-income children (as defined in 2110 of such
Act) who are—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDC74675D467E646769562C490C7706815" reported-display-style="strikethrough"><enum>(1)</enum><text>Indians; or</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID1B8B34546DCC4BCE92CCA37396614A61" reported-display-style="strikethrough"><enum>(2)</enum><text>otherwise eligible
for health services from the Indian Health Program involved.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDEF31E667D94A4853BC3A3BC7376B96A0" reported-display-style="strikethrough"><enum>(c)</enum><header>Special
Restrictions</header><text>The following conditions apply to a State electing
to provide payments under this section:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID1BAC2C3107BF41D4895CA614949D2A21" reported-display-style="strikethrough"><enum>(1)</enum><header>No limitation on
other schip participation of, or provider payments to, indian health
programs</header><text>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 <act-name parsable-cite="SSA">Social Security
Act</act-name> 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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA4EF2F7148434F1DBAC564AE0B45472A" reported-display-style="strikethrough"><enum>(2)</enum><header>No limitation on
other schip eligibility of indians</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID1E2ACD08DEAB43F5B2F523E5424CC730" reported-display-style="strikethrough"><enum>(3)</enum><header>Limitation on
acceptance of contributions</header>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID376A639900F94E07887345D8463129DD" reported-display-style="strikethrough"><enum>(A)</enum><header>In
general</header><text>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 <act-name parsable-cite="SSA">Social Security Act</act-name>.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID7F9E977726B64128B6548C623DF5F9F1" reported-display-style="strikethrough"><enum>(B)</enum><header>Contribution
defined</header><text>For purposes of subparagraph (A), the term
<term>contribution</term> includes any tax, donation, fee, or other payment
made, whether made voluntarily or involuntarily.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID9392BB053FFD46799B3F267CBDF97629" reported-display-style="strikethrough"><enum>(d)</enum><header>Application of
Separate 10 Percent Limitation</header><text>Payment may be made under section
2105(a) of the <act-name parsable-cite="SSA">Social Security Act</act-name> 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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID5E644C08B72E46D39FC4ED7A1376AFFA" reported-display-style="strikethrough"><enum>(e)</enum><header>General
Terms</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDF8827EE00E234B5F9B806EAD78BE859C" reported-display-style="strikethrough"><enum>411.</enum><header><act-name parsable-cite="SSA">Social Security Act</act-name> sanctions</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDFD040F0D05EF44A6A135C4FFA6D7DD08" reported-display-style="strikethrough"><enum>(a)</enum><header>Requests for
Waiver of Sanctions</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID5C175B21D09B4E47B38091530D76C763" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>For purposes of applying any authority under a provision
of title XI, XVIII, XIX, or XXI of the <act-name parsable-cite="SSA">Social
Security Act</act-name> 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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID4BB2725BC8D44B20ADF08FFF074EF587" reported-display-style="strikethrough"><enum>(2)</enum><header>Procedure</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID7D6A95F2D10E4D2089856F8C77C98445" reported-display-style="strikethrough"><enum>(b)</enum><header>Safe Harbor for
Transactions Between and Among Indian Health Care Programs</header><text>For
purposes of applying section 1128B(b) of the <act-name parsable-cite="SSA">Social Security Act</act-name>, 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:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID036218C933894B8D8B1CB22E4E6B78F8" reported-display-style="strikethrough"><enum>(1)</enum><text>An exchange
between or among the following:</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDB48CA41AD9234C739753AC16D348437F" reported-display-style="strikethrough"><enum>(A)</enum><text>Any Indian Health
Program.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDF39F3DD7A1B94AD9A181883B4A4B3E8E" reported-display-style="strikethrough"><enum>(B)</enum><text>Any Urban Indian
Organization.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID5AA361081AB94761A6BACDF9E7B2C3AD" reported-display-style="strikethrough"><enum>(2)</enum><text>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—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID8906B30742B8419790BD3E68FFB428FF" reported-display-style="strikethrough"><enum>(A)</enum><text>is for the purpose
of transporting the patient for the provision of health care items or
services;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID3DEC33A444AD4EC3A311C94FE9DAA92A" reported-display-style="strikethrough"><enum>(B)</enum><text>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;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDE97CC2650AE0414CB1806E6A90F99C7F" reported-display-style="strikethrough"><enum>(C)</enum><text>is for the purpose
of paying premiums, copayments, deductibles, or other cost-sharing on behalf of
patients; or</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID30BC00FB2DC4416281A98F3E4BAFDFCA" reported-display-style="strikethrough"><enum>(D)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID0F1B9679A4724B70AC990BA21CD51D92" reported-display-style="strikethrough"><enum>(3)</enum><text>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.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="IDAD66FCE471D64A9D9FFBE90AE33257B0" reported-display-style="strikethrough"><enum>412.</enum><header>Cost
sharing</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID546228B46572456AA06F2104CD610E37" reported-display-style="strikethrough"><enum>(a)</enum><header>Coinsurance,
Copayments, and Deductibles</header><text>Notwithstanding any other provision
of Federal or State law—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID6057BC02B34D488B8AA330AB395BB887" reported-display-style="strikethrough"><enum>(1)</enum><header>Protection for
eligible indians under social security act health programs</header><text>No
Indian who is furnished an item or service for which payment may be made under
title XIX or XXI of the <act-name parsable-cite="SSA">Social Security
Act</act-name> may be charged a deductible, copayment, or coinsurance.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB0A7AB38EE2145EC95E9A67B1B7D3DB7" reported-display-style="strikethrough"><enum>(2)</enum><header>Protection for
indians</header><text>No Indian who is furnished an item or service by the
Service may be charged a deductible, copayment, or coinsurance.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID5E9E86F5C6F446AB95D03578D7B36FA0" reported-display-style="strikethrough"><enum>(3)</enum><header>No reduction in
amount of payment to indian health providers</header><text>The payment or
reimbursement due to the Service, Indian Tribe, Tribal Organization, or Urban
Indian Organization under title XIX or XXI of the <act-name parsable-cite="SSA">Social Security Act</act-name> 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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID67128FAB0E804E349E173BC50E7BF4B2" reported-display-style="strikethrough"><enum>(b)</enum><header>Exemption From
Medicaid and SCHIP Premiums</header><text>Notwithstanding any other provision
of Federal or State law, no Indian who is otherwise eligible for services under
title XIX of the <act-name parsable-cite="SSA">Social Security Act</act-name>
(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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID146173E2958B4F1BA10C02B3DE9D75A4" reported-display-style="strikethrough"><enum>(c)</enum><header>Treatment of
Certain Property for Medicaid Eligibility</header><text>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
<act-name parsable-cite="SSA">Social Security Act</act-name>:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID778A6DE088BC46CDB9CEB5533DA0964C" reported-display-style="strikethrough"><enum>(1)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA6373C6EEBE84A85B4946532D5E472E5" reported-display-style="strikethrough"><enum>(2)</enum><text>For any federally
recognized Tribe not described in paragraph (1), property located within the
most recent boundaries of a prior Federal reservation.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID4C1825D19BF8449A99906E03D67AF945" reported-display-style="strikethrough"><enum>(3)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID8EB95B3D8B84472B92281B3734BA9407" reported-display-style="strikethrough"><enum>(4)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID6908DC35A4C74F1D9B0C83416C44D1E0" reported-display-style="strikethrough"><enum>(d)</enum><header>Continuation of
Current Law Protections of Certain Indian Property From Medicaid Estate
Recovery</header><text>Income, resources, and property that are exempt from
medicaid estate recovery under title XIX of the <act-name parsable-cite="SSA">Social Security Act</act-name> 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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDAB059C36EF6444C4A690925761F77F62" reported-display-style="strikethrough"><enum>413.</enum><header>Treatment under
Medicaid managed care</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDFD71AB068C9C40E39A9D4C3B00297253" reported-display-style="strikethrough"><enum>(a)</enum><header>Provision of
Services, to Enrollees With Non-Indian Medicaid Managed Care Entities, by
Indian Health Programs and Urban Indian Organizations</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID0B61B6C9293A45A6B2817A9C46731297" reported-display-style="strikethrough"><enum>(1)</enum><header>Payment
rules</header>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDEA27387DB07D4AF3A6FA7CE275150917" reported-display-style="strikethrough"><enum>(A)</enum><header>In
general</header><text>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:</text>
<clause changed="deleted" committee-id="SLIA00" id="ID0FF92B41DBD144A8B325611237431E60" reported-display-style="strikethrough"><enum>(i)</enum><header>Direct
payment</header><text>The entity shall make prompt payment (in accordance with
rules applicable to medicaid managed care entities under title XIX of the
<act-name parsable-cite="SSA">Social Security Act</act-name>) 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.</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="IDF3F22B457CB241D6A00F4A79A2AA388A" reported-display-style="strikethrough"><enum>(ii)</enum><header>Payment through
state</header><text>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.</text>
</clause></subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID1C290DF17A1A413B929659B707DE0FC9" reported-display-style="strikethrough"><enum>(B)</enum><header>Compliance with
generally applicable requirements</header>
<clause changed="deleted" committee-id="SLIA00" id="ID6442F7853C5145C0A77399B4462BAD73" reported-display-style="strikethrough"><enum>(i)</enum><header>In
general</header><text>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
<act-name parsable-cite="SSA">Social Security Act</act-name> with respect to
covered services.</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="ID98EB8094BDC54517ADDEADC1E485076A" reported-display-style="strikethrough"><enum>(ii)</enum><header>Satisfaction of
claim requirement</header><text>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).</text>
</clause></subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID4EF63640BF0D4249A4DB42CB9D6115C5" reported-display-style="strikethrough"><enum>(C)</enum><header>Construction</header><text>Nothing
in this subsection shall be construed as waiving the application of section
1902(a)(30)(A) of the <act-name parsable-cite="SSA">Social Security
Act</act-name> (relating to application of standards to assure that payments
are consistent with efficiency, economy, and quality of care).</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDE8346B61195046ACB066ED05EF59BECC" reported-display-style="strikethrough"><enum>(2)</enum><header>Enrollee option
to select an indian health program or urban indian organization as primary care
provider</header><text>In the case of a non-Indian medicaid managed care entity
that—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDEEC0EA10E1DA4ECBB869958D825018A5" reported-display-style="strikethrough"><enum>(A)</enum><text>has an Indian
enrolled with the entity; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDED84755DE5D34AA284A8A218A25FEEAC" reported-display-style="strikethrough"><enum>(B)</enum><text>has an Indian
Health Program or Urban Indian Organization that is participating as a primary
care provider within the network of the entity,</text>
</subparagraph><continuation-text changed="deleted" committee-id="SLIA00" continuation-text-level="paragraph" reported-display-style="strikethrough">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.</continuation-text></paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDAA2416606DCB4B96938576FB01B243DE" reported-display-style="strikethrough"><enum>(b)</enum><header>Offering of
Managed Care Through Indian Medicaid Managed Care
Entities</header><text>If—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDC90421CC5C8B460C99845A6BC7340499" reported-display-style="strikethrough"><enum>(1)</enum><text>a State elects to
provide services through medicaid managed care entities under its medicaid
managed care program; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID7B170F0D3D4C401692483EC64D506C7E" reported-display-style="strikethrough"><enum>(2)</enum><text>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,</text>
</paragraph><continuation-text changed="deleted" committee-id="SLIA00" continuation-text-level="subsection" reported-display-style="strikethrough">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.</continuation-text></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDBAC53E62F3E8410AB3706C387260DBF6" reported-display-style="strikethrough"><enum>(c)</enum><header>Special Rules
for Indian Managed Care Entities</header><text>The following are special rules
regarding the application of a medicaid managed care program to Indian medicaid
managed care entities:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDF476605B3C8748709F51F91E5E543BFD" reported-display-style="strikethrough"><enum>(1)</enum><header>Enrollment</header>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID8AC033322D464FFE92570C1DDD26DA73" reported-display-style="strikethrough"><enum>(A)</enum><header>Limitation to
indians</header><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID700BACCC49424FAA93BB0FC182356FD6" reported-display-style="strikethrough"><enum>(B)</enum><header>No less choice
of plans</header><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID7148C9DCA15B4D19BAD920F46BC68A45" reported-display-style="strikethrough"><enum>(C)</enum><header>Default
enrollment</header>
<clause changed="deleted" committee-id="SLIA00" id="IDFB40A5A76B684AECB1BD8824594EE4CD" reported-display-style="strikethrough"><enum>(i)</enum><header>In
general</header><text>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.</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="IDA47978AA2B244EE8B28BE3DBE09B7D7C" reported-display-style="strikethrough"><enum>(ii)</enum><header>Indian
described</header><text>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).</text>
</clause></subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDE065DE5970FB4B38AC51648B7BD89C7A" reported-display-style="strikethrough"><enum>(D)</enum><header>Exception to
state lock-in</header><text>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.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDAC99752584A04CFBAB7AF6D96778B241" reported-display-style="strikethrough"><enum>(2)</enum><header>Flexibility in
application of solvency</header><text>In applying section 1903(m)(1) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> to an Indian
medicaid managed care entity—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID092E746C91B6418097043A284481EFB7" reported-display-style="strikethrough"><enum>(A)</enum><text>any reference to a
<quote>State</quote> in subparagraph (A)(ii) of that section shall be deemed to
be a reference to the <quote>Secretary</quote>; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID515C433F2195403F96B3AAFCC57F21F8" reported-display-style="strikethrough"><enum>(B)</enum><text>the entity shall
be deemed to be a public entity described in subparagraph (C)(ii) of that
section.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID7D661A4BE7EC405590934EDF92699A2C" reported-display-style="strikethrough"><enum>(3)</enum><header>Exceptions to
advance directives</header><text>The Secretary may modify or waive the
requirements of section 1902(w) of the <act-name parsable-cite="SSA">Social
Security Act</act-name> (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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDFBCB8FE99EE148B58F7157FF2EEB8244" reported-display-style="strikethrough"><enum>(4)</enum><header>Flexibility in
information and marketing</header>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID663B712898BD4DF39CFFF52EB156B3CA" reported-display-style="strikethrough"><enum>(A)</enum><header>Materials</header><text>The
Secretary may modify requirements under section 1932(a)(5) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> 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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDC656741448DF413D8270BC748E6B94D1" reported-display-style="strikethrough"><enum>(B)</enum><header>Distribution of
marketing materials</header><text>The provisions of section 1932(d)(2)(B) of
the <act-name parsable-cite="SSA">Social Security Act</act-name> 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.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID1BE3546FB05243149F8419FA29C797A7" reported-display-style="strikethrough"><enum>(d)</enum><header>Malpractice
Insurance</header><text>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
<act-name parsable-cite="SSA">Social Security Act</act-name>, that is covered
under the Federal Tort Claims Act (28 U.S.C. 1346(b), 2671 et seq.) is deemed
to satisfy such requirement.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDA9D37E3C9F9D4188B254AB3AFC0C192D" reported-display-style="strikethrough"><enum>(e)</enum><header>Definitions</header><text>For
purposes of this section:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID0B1B571E249147E1B29C83A97D99054F" reported-display-style="strikethrough"><enum>(1)</enum><header>Medicaid managed
care entity</header><text>The term <term>medicaid managed care entity</term>
means a managed care entity (whether a managed care organization or a primary
care case manager) under title XIX of the <act-name parsable-cite="SSA">Social
Security Act</act-name>, 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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDCF6DE3E07F254A6A837D1C6184B0CDA7" reported-display-style="strikethrough"><enum>(2)</enum><header>Indian medicaid
managed care entity</header><text>The term <term>Indian medicaid managed care
entity</term> means a managed care entity that is controlled (within the
meaning of the last sentence of section 1903(m)(1)(C) of the
<act-name parsable-cite="SSA">Social Security Act</act-name>) 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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID1955B0B75A494EBD8AB3AF595AF8CD85" reported-display-style="strikethrough"><enum>(3)</enum><header>Non-Indian
medicaid managed care entity</header><text>The term <term>non-Indian medicaid
managed care entity</term> means a medicaid managed care entity that is not an
Indian medicaid managed care entity.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID3734ABA8DAB74B7CAE14E19CCD6F315F" reported-display-style="strikethrough"><enum>(4)</enum><header>Covered medicaid
managed care services</header><text>The term <term>covered medicaid managed
care services</term> 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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDFCFB6BA65FED4D43A1329EEA15149A8C" reported-display-style="strikethrough"><enum>(5)</enum><header>Medicaid managed
care program</header><text>The term <term>medicaid managed care program</term>
means a program under sections 1903(m) and 1932 of the
<act-name parsable-cite="SSA">Social Security Act</act-name> and includes a
managed care program operating under a waiver under section 1915(b) or 1115 of
such Act or otherwise.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="ID79C9AD28D6804C42AD0D293AE241999C" reported-display-style="strikethrough"><enum>414.</enum><header>Navajo Nation
Medicaid Agency feasibility study</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID7EE467642A384A4C82704668E16A644E" reported-display-style="strikethrough"><enum>(a)</enum><header>Study</header><text>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
<act-name parsable-cite="SSA">Social Security Act</act-name>, 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 <act-name parsable-cite="SSA">Social
Security Act</act-name>.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID06DE31337F2343C09F2312E475665F2C" reported-display-style="strikethrough"><enum>(b)</enum><header>Considerations</header><text>In
conducting the study, the Secretary shall consider the feasibility of—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID6674789DC518426AADEAF4977F3A8807" reported-display-style="strikethrough"><enum>(1)</enum><text>assigning and
paying all expenditures for the provision of services and related
administration funds, under title XIX of the <act-name parsable-cite="SSA">Social Security Act</act-name>, 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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDFD8548F2D1A34D39B039677FF8E14E00" reported-display-style="strikethrough"><enum>(2)</enum><text>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 <act-name parsable-cite="SSA">Social Security
Act</act-name>;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID61CCD627725E41C8930611A0DF389F52" reported-display-style="strikethrough"><enum>(3)</enum><text>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</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF8464FCC57DF475FBE1D2769BA6586CC" reported-display-style="strikethrough"><enum>(4)</enum><text>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 <act-name parsable-cite="SSA">Social
Security Act</act-name> (relating to the State children’s health insurance
program) under terms equivalent to those described in paragraphs (2) through
(4).</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID0915FC425EA2434FBE42E66F3A654970" reported-display-style="strikethrough"><enum>(c)</enum><header>Report</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDFFC5888A03B94C4E9F2EEBC7406A7556" reported-display-style="strikethrough"><enum>(1)</enum><text>the results of the
study under this section;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID46D25EA460674809897AF1E182490C7A" reported-display-style="strikethrough"><enum>(2)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID3E5DC0D4A5204BA1B9279BCAA8698187" reported-display-style="strikethrough"><enum>(3)</enum><text>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</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID60753922356A417AB2C462625E621EF4" reported-display-style="strikethrough"><enum>(4)</enum><text>legislative
actions that would be required to authorize the establishment of such entity if
such entity is determined by the Secretary to be feasible.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="ID199D98E119034FA1B8F1597C358BAFEF" reported-display-style="strikethrough"><enum>415.</enum><header>Authorization
of appropriations</header><text display-inline="no-display-inline">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.</text>
</section><enum>V</enum><header>HEALTH SERVICES
FOR URBAN INDIANS</header>
<section changed="deleted" committee-id="SLIA00" id="ID1C078F02E9224E45A11B11CD51F90BA6" reported-display-style="strikethrough"><enum>501.</enum><header>Purpose</header><text display-inline="no-display-inline">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.</text>
</section><section changed="deleted" committee-id="SLIA00" id="ID5430C8EB5DCC45F2A448BB99C59856C4" reported-display-style="strikethrough"><enum>502.</enum><header>Contracts with,
and Grants to, Urban Indian Organizations</header><text display-inline="no-display-inline">Under authority of the Act of November 2,
1921 (25 U.S.C. 13) (commonly known as the <quote>Snyder Act</quote>), 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.</text>
</section><section changed="deleted" committee-id="SLIA00" id="ID0B5021417F4B43BB8C7074CB869067A9" reported-display-style="strikethrough"><enum>503.</enum><header>Contracts and
grants for the provision of Health care and referral Services</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID35E45CF41D2940FFB26541C33AA0DA95" reported-display-style="strikethrough"><enum>(a)</enum><header>Requirements for
Grants and Contracts</header><text>Under authority of the Act of November 2,
1921 (25 U.S.C. 13) (commonly known as the <quote>Snyder Act</quote>), 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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID39A0DE4165D84948BBBA657730E10170" reported-display-style="strikethrough"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID50990126C9424839818AD9176AE0CA2C" reported-display-style="strikethrough"><enum>(2)</enum><text>estimate the
current health status of Urban Indians residing in such Urban Center or
centers;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID467CF03A84DA42989ECAC3409912980C" reported-display-style="strikethrough"><enum>(3)</enum><text>estimate the
current health care needs of Urban Indians residing in such Urban Center or
centers;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID03FCB33004424FC79CE5FB7713450FD6" reported-display-style="strikethrough"><enum>(4)</enum><text>provide basic
health education, including health promotion and disease prevention education,
to Urban Indians;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDCE3F87A4A9B548BEADFA462907226920" reported-display-style="strikethrough"><enum>(5)</enum><text>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</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID43A707F9E08948BF94A22935AFB351AB" reported-display-style="strikethrough"><enum>(6)</enum><text>where necessary,
provide, or enter into contracts for the provision of, health care services for
Urban Indians.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDCEA3C682F5094508A5AD5C191462409B" reported-display-style="strikethrough"><enum>(b)</enum><header>Criteria</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID011EFC2BEBF1419AA768FD5A53CC5EEF" reported-display-style="strikethrough"><enum>(1)</enum><text>the extent of
unmet health care needs of Urban Indians in the Urban Center or centers
involved;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDC9ADA16DD6914635B6FE7B043FB060AC" reported-display-style="strikethrough"><enum>(2)</enum><text>the size of the
Urban Indian population in the Urban Center or centers involved;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA422F31B4E7D4C8B99FEC94B6D68A3D6" reported-display-style="strikethrough"><enum>(3)</enum><text>the extent, if
any, to which the activities set forth in subsection (a) would duplicate any
project funded under this title;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID37BAC0C24B9A4397BF28AC5690772F0E" reported-display-style="strikethrough"><enum>(4)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID1E4C35F078B443BA823D47B22FFCD2A3" reported-display-style="strikethrough"><enum>(5)</enum><text>the satisfactory
performance and successful completion by an Urban Indian Organization of other
contracts with the Secretary under this title;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDCAD30FB19AD6407FABDA0606E79A5433" reported-display-style="strikethrough"><enum>(6)</enum><text>the
appropriateness and likely effectiveness of conducting the activities set forth
in subsection (a) in an Urban Center or centers; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDC5D232A400A84B7F94735E5109545D59" reported-display-style="strikethrough"><enum>(7)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDA21449E1DCE54ECAA29BCFE74FCC914B" reported-display-style="strikethrough"><enum>(c)</enum><header>Access to Health
Promotion and Disease Prevention Programs</header><text>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).</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID757903AB6AD54442B1D4C4B1731B72AB" reported-display-style="strikethrough"><enum>(d)</enum><header>Immunization
Services</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID8259CFAE46C847F2B198493C00757DE0" reported-display-style="strikethrough"><enum>(1)</enum><header>Access or
services provided</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDAC36E29008C34E54B8309E29E24985C3" reported-display-style="strikethrough"><enum>(2)</enum><header>Definition</header><text>For
purposes of this subsection, the term <term>immunization services</term> means
services to provide without charge immunizations against vaccine-preventable
diseases.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDB12C50860FCD408D94CE357328F964CF" reported-display-style="strikethrough"><enum>(e)</enum><header>Behavioral
Health Services</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID9E770574491743A6A9D6C75F6253B0E5" reported-display-style="strikethrough"><enum>(1)</enum><header>Access or
services provided</header><text>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).</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID9E1082A3BA0E4F21BD9E4C4FCE2F28D9" reported-display-style="strikethrough"><enum>(2)</enum><header>Assessment
required</header><text>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:</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDE6B8B9CE759B4C64B482E8DAB64CCB87" reported-display-style="strikethrough"><enum>(A)</enum><text>The behavioral
health needs of the Urban Indian population concerned.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID6DC9863AA89946AF95C67881BA639476" reported-display-style="strikethrough"><enum>(B)</enum><text>The behavioral
health services and other related resources available to that
population.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID34CDA0D4434B4AC6BA28EA5D9663E1A7" reported-display-style="strikethrough"><enum>(C)</enum><text>The barriers to
obtaining those services and resources.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID32E4C1E157A34964B3A6E5C2D717877F" reported-display-style="strikethrough"><enum>(D)</enum><text>The needs that are
unmet by such services and resources.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID08ADCA0E4BC24F21AF32E39CEDBDDA91" reported-display-style="strikethrough"><enum>(3)</enum><header>Purposes of
grants</header><text>Grants may be made under this subsection for the
following:</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID6B64F1B74DAE4F5E8FF9F7D876CF245C" reported-display-style="strikethrough"><enum>(A)</enum><text>To prepare
assessments required under paragraph (2).</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID7B10A9F4E2BC498785B7F783DD8A9371" reported-display-style="strikethrough"><enum>(B)</enum><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDB7125CBB140445A9B084FD92360876B0" reported-display-style="strikethrough"><enum>(C)</enum><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID62189410569445B3A2512391AB4F7F4A" reported-display-style="strikethrough"><enum>(D)</enum><text>To develop
innovative behavioral health service delivery models which incorporate Indian
cultural support systems and resources.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDF16767E00CDE450EBB239DF8D85BEDCE" reported-display-style="strikethrough"><enum>(f)</enum><header>Prevention of
Child Abuse</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDEA4A87BD92154513B3D67D0E9745C2AC" reported-display-style="strikethrough"><enum>(1)</enum><header>Access or
services provided</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID1A48A811F02A48C08F14609A669E2912" reported-display-style="strikethrough"><enum>(2)</enum><header>Evaluation
required</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID4289A10A0C644C03A2B26FEC5D6FB084" reported-display-style="strikethrough"><enum>(3)</enum><header>Purposes of
grants</header><text>Grants may be made under this subsection for the
following:</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID220BAC7FBECC4B04A13B3C50A2896BEE" reported-display-style="strikethrough"><enum>(A)</enum><text>To prepare
assessments required under paragraph (2).</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDA538175D85B54A1881B7B592A03970D6" reported-display-style="strikethrough"><enum>(B)</enum><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID792E678EC6ED4ABD8A2954673E32A1A0" reported-display-style="strikethrough"><enum>(C)</enum><text>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).</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA15FD21510684B0A83D2CCB3A83FD4F2" reported-display-style="strikethrough"><enum>(4)</enum><header>Considerations
when making grants</header><text>In making grants to carry out this subsection,
the Secretary shall take into consideration—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDAF55ED729444433DADEBDCA733628C76" reported-display-style="strikethrough"><enum>(A)</enum><text>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;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID05EA96682236435FA7502919B4FB4C17" reported-display-style="strikethrough"><enum>(B)</enum><text>the capability and
expertise demonstrated by the Urban Indian Organization to address the complex
problem of child sexual abuse in the community; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID1A95029B61D24764B9D9E6FEAA970DD7" reported-display-style="strikethrough"><enum>(C)</enum><text>the assessment
required under paragraph (2).</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDE5DECB5EAD5B4DE980420CCD55717C75" reported-display-style="strikethrough"><enum>(g)</enum><header>Other
Grants</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID4D0FA4C79E0D422A809D3BF44A6D90F6" reported-display-style="strikethrough"><enum>504.</enum><header>Contracts and
grants for the determination of unmet Health care needs</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID9C03A7AF7D504B3892AF210596E4A38E" reported-display-style="strikethrough"><enum>(a)</enum><header>Grants and
Contracts Authorized</header><text>Under authority of the Act of November 2,
1921 (25 U.S.C. 13) (commonly known as the <quote>Snyder Act</quote>), 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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID33576346872C41468BA6EFB15755B4BC" reported-display-style="strikethrough"><enum>(b)</enum><header>Purpose</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDD1A97989117F43DFA952DEF72F85BF59" reported-display-style="strikethrough"><enum>(c)</enum><header>Grant and
Contract Requirements</header><text>Any contract entered into, or grant made,
by the Secretary under this section shall include requirements that—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDBDA4C3EF5B014AB09913335986641CC5" reported-display-style="strikethrough"><enum>(1)</enum><text>the Urban Indian
Organization successfully undertakes to—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID7DDAE5046DE048FA94A8716B9318F6CB" reported-display-style="strikethrough"><enum>(A)</enum><text>document the
health care status and unmet health care needs of Urban Indians in the Urban
Center involved; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDD2F5AD019FBF4F668248A396E960F3EE" reported-display-style="strikethrough"><enum>(B)</enum><text>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</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDDC6F70BECCFE497E9E80FB0F38A4D4A6" reported-display-style="strikethrough"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDD4590C9A870241A8831C9BC33BBE54E7" reported-display-style="strikethrough"><enum>(d)</enum><header>No
Renewals</header><text>The Secretary may not renew any contract entered into or
grant made under this section.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID63C4EEA9130C4764906AC86A97204F80" reported-display-style="strikethrough"><enum>505.</enum><header>Evaluations;
renewals</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDF7157BDFA27848EBAE8EB346AF971882" reported-display-style="strikethrough"><enum>(a)</enum><header>Procedures for
Evaluations</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID5508953A090F49E6975CEA58F965B34E" reported-display-style="strikethrough"><enum>(b)</enum><header>Evaluations</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDFF6F363E9A954C7AAB431108316ECE7F" reported-display-style="strikethrough"><enum>(1)</enum><text>acting through the
Service, conduct an annual onsite evaluation of the organization; or</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID8AC31F235D5C4D0ABF479218B2B9FCF2" reported-display-style="strikethrough"><enum>(2)</enum><text>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 <act-name parsable-cite="SSA">Social
Security Act</act-name>.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDC656D70BB99C4036A7A2B16E98849812" reported-display-style="strikethrough"><enum>(c)</enum><header>Noncompliance;
Unsatisfactory Performance</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDEB928480668A4DC7BB939D0D06F4F78B" reported-display-style="strikethrough"><enum>(d)</enum><header>Considerations
for Renewals</header><text>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).</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID4C0855E7B2604BE1BB004616F3D0CE9C" reported-display-style="strikethrough"><enum>506.</enum><header>Other contract
and grant requirements</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDCB1D64A375E04C80B04AB33A6A87B6CB" reported-display-style="strikethrough"><enum>(a)</enum><header>Procurement</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID39E7055F26364353AD102A687DD25451" reported-display-style="strikethrough"><enum>(b)</enum><header>Payments Under
Contracts or Grants</header><text>Payments under any contracts or grants
pursuant to this title shall, notwithstanding any term or condition of such
contract or grant—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID5712D2B959FB4C888C1EC96D44248427" reported-display-style="strikethrough"><enum>(1)</enum><text>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</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID2B7AB7B49A0D4E6EB40DA601B3EE769C" reported-display-style="strikethrough"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDECC8199345E14FBC856E473464779FD1" reported-display-style="strikethrough"><enum>(c)</enum><header>Revision or
Amendment of Contracts</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDEAA374B120E94E479F723302000F0AC4" reported-display-style="strikethrough"><enum>(d)</enum><header>Fair and Uniform
Services and Assistance</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID60A94BEC02B744CE967D3394CFC73653" reported-display-style="strikethrough"><enum>507.</enum><header>Reports and
records</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDBC92D8A36424456491DB29F667E321F0" reported-display-style="strikethrough"><enum>(a)</enum><header>Reports</header><text>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:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID1214CE8820814611BB3D37F7D609F397" reported-display-style="strikethrough"><enum>(1)</enum><text>In the case of a
contract or grant under section 503, recommendations pursuant to section
503(a)(5).</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID6B6304B2B3BE4CEE9020A31E90B2F400" reported-display-style="strikethrough"><enum>(2)</enum><text>Information on
activities conducted by the organization pursuant to the contract or
grant.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID94DF80E4CFD34B40A2A9DD3DF06B0CF5" reported-display-style="strikethrough"><enum>(3)</enum><text>An accounting of
the amounts and purpose for which Federal funds were expended.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID2D4F808D77EE491B81938DDA5721F0FA" reported-display-style="strikethrough"><enum>(4)</enum><text>A minimum set of
data, using uniformly defined elements, as specified by the Secretary after
consultation with Urban Indian Organizations.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID410D2B10B19641F8A8AD4455A8B40BA8" reported-display-style="strikethrough"><enum>(b)</enum><header>Audit</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID11ADAEF058C34DFEA31A69ABF7C30A89" reported-display-style="strikethrough"><enum>(c)</enum><header>Costs of
Audits</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDD1DA8BF88EDE41EDA7AD7218A91CDD43" reported-display-style="strikethrough"><enum>(1)</enum><text>a certified public
accountant; or</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID1FED6A169DC342DE8B38FA6C914E1298" reported-display-style="strikethrough"><enum>(2)</enum><text>a certified public
accounting firm qualified to conduct Federal compliance audits.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="ID86254C3781794B89967D73AD4B485E79" reported-display-style="strikethrough"><enum>508.</enum><header>Limitation on
contract authority</header><text display-inline="no-display-inline">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.</text>
</section><section changed="deleted" committee-id="SLIA00" id="IDB8E3E1CD75344EBBAE78DB8435B949B3" reported-display-style="strikethrough"><enum>509.</enum><header>Facilities</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID4445496AA6EC414E811CB49A90C0D6FB" reported-display-style="strikethrough"><enum>(a)</enum><header>Grants</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDD485EF883D804707AB540A49E9E0ED51" reported-display-style="strikethrough"><enum>(b)</enum><header>Loan Fund
Study</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDFA70F8D8D03A40E0BE5FCA95C30DB35B" reported-display-style="strikethrough"><enum>510.</enum><header>Office of Urban
Indian Health</header><text display-inline="no-display-inline">There is
established within the Service an Office of Urban Indian Health, which shall be
responsible for—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID481A7E4651D0413CB8938DD0C2CA5173" reported-display-style="strikethrough"><enum>(1)</enum><text>carrying out the
provisions of this title;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID5C92F5B8246D4148AA03A36D02F2ED48" reported-display-style="strikethrough"><enum>(2)</enum><text>providing central
oversight of the programs and services authorized under this title; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID8B936551ECD1419684FC3C73A8DA4DDC" reported-display-style="strikethrough"><enum>(3)</enum><text>providing
technical assistance to Urban Indian Organizations.</text>
</paragraph></section><section changed="deleted" committee-id="SLIA00" id="ID3E533AD4B6A14A2D8153B4BC3D20EE05" reported-display-style="strikethrough"><enum>511.</enum><header>Grants for
alcohol and substance abuse-related Services</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID90C35CD016DD45599486EBAE2ED493EE" reported-display-style="strikethrough"><enum>(a)</enum><header>Grants
Authorized</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDA5E2197DF34E41C8AA662108035FB21C" reported-display-style="strikethrough"><enum>(b)</enum><header>Goals</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID670D4C15D9894F4D88C3279566442D3C" reported-display-style="strikethrough"><enum>(c)</enum><header>Criteria</header><text>The
Secretary shall establish criteria for the grants made under subsection (a),
including criteria relating to the following:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID4FC1CE639D574B27B6D149256F32B0A9" reported-display-style="strikethrough"><enum>(1)</enum><text>The size of the
Urban Indian population.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB2B2B1E2642D43A9A3BFF94DE452C86B" reported-display-style="strikethrough"><enum>(2)</enum><text>Capability of the
organization to adequately perform the activities required under the
grant.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDCFF777463CFF41BEBB569380361F0B0D" reported-display-style="strikethrough"><enum>(3)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID0E6B245EBDCC43D08978CCE96E44B9DE" reported-display-style="strikethrough"><enum>(4)</enum><text>Identification of
the need for services.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDD2BF7AC0CE024A5FAE4F1EB2C2ADE3D6" reported-display-style="strikethrough"><enum>(d)</enum><header>Allocation of
Grants</header><text>The Secretary shall develop a methodology for allocating
grants made pursuant to this section based on the criteria established pursuant
to subsection (c).</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID646E9CD34BCA417AA56228FBC55CF7A9" reported-display-style="strikethrough"><enum>(e)</enum><header>Grants Subject
to Criteria</header><text>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).</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID9D4D9CA308E14AB788E7D295F428B057" reported-display-style="strikethrough"><enum>512.</enum><header>Treatment of
certain demonstration projects</header><text display-inline="no-display-inline">Notwithstanding any other provision of law,
the Tulsa Clinic and Oklahoma City Clinic demonstration projects shall—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID1D62FD89D5AB40F090A76F6384F99BE8" reported-display-style="strikethrough"><enum>(1)</enum><text>be permanent
programs within the Service’s direct care program;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID51BD76FAF2154022B1137BF5D937C770" reported-display-style="strikethrough"><enum>(2)</enum><text>continue to be
treated as Service Units in the allocation of resources and coordination of
care; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA34452EF3997470DAB568328FA3341CF" reported-display-style="strikethrough"><enum>(3)</enum><text>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
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name>.</text>
</paragraph></section><section changed="deleted" committee-id="SLIA00" id="IDF19867448D874AF3BAEEC9B23215BB53" reported-display-style="strikethrough"><enum>513.</enum><header>Urban NIAAA
transferred Programs</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID55AE47DD92AE486AA30504D57BF136B6" reported-display-style="strikethrough"><enum>(a)</enum><header>Grants and
Contracts</header><text>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 <quote>NIAAA</quote>) and
transferred to the Service. Such grants and contracts shall become effective no
later than September 30, 2008.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDEF71C3E1E96C4F47B3DFC259057D206F" reported-display-style="strikethrough"><enum>(b)</enum><header>Use of
Funds</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID641ABD62258C46BC927968B524947495" reported-display-style="strikethrough"><enum>(c)</enum><header>Eligibility</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID88C4732B357E4032BD14809474D4AAAC" reported-display-style="strikethrough"><enum>(d)</enum><header>Report</header><text>The
Secretary shall evaluate and report to Congress on the activities of programs
funded under this section not less than every 5 years.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID2049FD533947450AB78611AEA2DA6729" reported-display-style="strikethrough"><enum>514.</enum><header>Consultation
with Urban Indian Organizations</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDA02DCB64E8D7416AAF20D076930117FF" reported-display-style="strikethrough"><enum>(a)</enum><header>In
General</header><text>The Secretary shall ensure that the Service consults, to
the greatest extent practicable, with Urban Indian Organizations.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID51AC98F0DCC9401CBDC5174D1A02EF40" reported-display-style="strikethrough"><enum>(b)</enum><header>Definition of
Consultation</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDA06D487949824B34AA53E7EB11D41952" reported-display-style="strikethrough"><enum>515.</enum><header>Federal Tort
Claim Act coverage</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDF517105BD859430D9DAF19503AC41B45" reported-display-style="strikethrough"><enum>(a)</enum><header>In
General</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID69A224552A474CE49FE8BF98932D2111" reported-display-style="strikethrough"><enum>(b)</enum><header>Claims Resulting
From Performance of Contract or Grant</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID58CAB6D73D14486FA29FBF3C7F41977A" reported-display-style="strikethrough"><enum>516.</enum><header>Urban youth
treatment center demonstration</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDE0B1F5A3EF2B4380A0EC43B05260100D" reported-display-style="strikethrough"><enum>(a)</enum><header>Construction and
Operation</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDA6A3218298184C989DAB3AE7C4214BE6" reported-display-style="strikethrough"><enum>(b)</enum><header>Definition of
State</header><text>A State described in this subsection is a State in
which—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID1436D140D5D84A62ADF7506D5CBF28AB" reported-display-style="strikethrough"><enum>(1)</enum><text>there resides
Urban Indian youth with need for alcohol and substance abuse treatment services
in a residential setting; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDC786B751582E48BDBFF037193B303335" reported-display-style="strikethrough"><enum>(2)</enum><text>there is a
significant shortage of culturally competent residential treatment services for
Urban Indian youth.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="IDD175430895904F0D8E57267646F39654" reported-display-style="strikethrough"><enum>517.</enum><header>Use of Federal
Government facilities and sources of supply</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID98E84ACAC9234FAC8FBD8C9DAA13A70F" reported-display-style="strikethrough"><enum>(a)</enum><header>Authorization
for Use</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID474AF61947C44B5FB6C1137700F3FD71" reported-display-style="strikethrough"><enum>(b)</enum><header>Donations</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID7139FB80AACA44358234578545FF4CA6" reported-display-style="strikethrough"><enum>(c)</enum><header>Acquisition of
Property for Donation</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID8E0E4CC661E5439987A79A70733C5A3B" reported-display-style="strikethrough"><enum>(d)</enum><header>Priority</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDC1F650F03EF648E5812209239C0B9F25" reported-display-style="strikethrough"><enum>(e)</enum><header>Urban Indian
Organizations Deemed Executive Agency for Certain Purposes</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID1A40DEFF14A249ACA2077F4438E3779C" reported-display-style="strikethrough"><enum>518.</enum><header>Grants for
diabetes prevention, treatment, and control</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID2014CD6E405F4A998FBEB24C80AA2B26" reported-display-style="strikethrough"><enum>(a)</enum><header>Grants
Authorized</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDAE46BFC65CD9407A90096A4A3231248F" reported-display-style="strikethrough"><enum>(b)</enum><header>Goals</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID4EE30B687F6E4843A0987EE0B234672B" reported-display-style="strikethrough"><enum>(c)</enum><header>Establishment of
Criteria</header><text>The Secretary shall establish criteria for the grants
made under subsection (a) relating to—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID5B5596A83A664F51B676830A628434D0" reported-display-style="strikethrough"><enum>(1)</enum><text>the size and
location of the Urban Indian population to be served;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID1C52DEEEA91849889F4485EC722C0515" reported-display-style="strikethrough"><enum>(2)</enum><text>the need for
prevention of and treatment of, and control of the complications resulting
from, diabetes among the Urban Indian population to be served;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID35D22B141D8643188D678C9985B2D90B" reported-display-style="strikethrough"><enum>(3)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF1FCB19EA39747CA93934932E2E43A48" reported-display-style="strikethrough"><enum>(4)</enum><text>the capability of
the organization to adequately perform the activities required under the grant;
and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF460FB5BDDB84AC0BBEFAFC609E3E565" reported-display-style="strikethrough"><enum>(5)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDA0A4D6F75F024E858B0462982833F3A8" reported-display-style="strikethrough"><enum>(d)</enum><header>Funds Subject to
Criteria</header><text>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).</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDDCA88ECA51D544C1A2B6B471B826DD03" reported-display-style="strikethrough"><enum>519.</enum><header>Community
Health Representatives</header><text display-inline="no-display-inline">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.</text>
</section><section changed="deleted" committee-id="SLIA00" id="ID1C8C2293FEC647D0BB84D354F0205085" reported-display-style="strikethrough"><enum>520.</enum><header>Regulations</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID887BEAD787C94CB89037FE8C0FCD3466" reported-display-style="strikethrough"><enum>(a)</enum><header>Requirements for
Regulations</header><text>The Secretary may promulgate regulations to implement
the provisions of this title in accordance with the following:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDE80E88798FEC4FA29EAF7F3A9C0C17D0" reported-display-style="strikethrough"><enum>(1)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDC00707F4028B49F7A0818D2532B9A3BC" reported-display-style="strikethrough"><enum>(2)</enum><text>The authority to
promulgate regulations under this Act shall expire 18 months from the date of
enactment of this Act.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID4663395EC70A444797C2AAAE862E4ECA" reported-display-style="strikethrough"><enum>(b)</enum><header>Effective Date
of Title</header><text>The amendments to this title made by the
<act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name>
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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDFF6A0AB085EA45EB98D591923A3F4878" reported-display-style="strikethrough"><enum>521.</enum><header>Eligibility for
Services</header><text display-inline="no-display-inline">Urban Indians shall
be eligible and the ultimate beneficiaries for health care or referral services
provided pursuant to this title.</text>
</section><section changed="deleted" committee-id="SLIA00" id="ID8F68946DBD164681A5676F2709812FDD" reported-display-style="strikethrough"><enum>522.</enum><header>Authorization
of appropriations</header><text display-inline="no-display-inline">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.</text>
</section><enum>VI</enum><header>ORGANIZATIONAL
IMPROVEMENTS</header>
<section changed="deleted" committee-id="SLIA00" id="IDD9498258F8594A1A86170EEBFD10BF47" reported-display-style="strikethrough"><enum>601.</enum><header>Establishment
of the Indian Health Service as an agency of the public Health Service</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID8F186290B8CF4BE989B94660451052C3" reported-display-style="strikethrough"><enum>(a)</enum><header>Establishment</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDF356ED174CFE4A6787DDCCD071898DA4" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID865A84B05C3641ADB27073265E75DF6E" reported-display-style="strikethrough"><enum>(2)</enum><header>Assistant
secretary of indian health</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID6DB2D9B841FB4DF494DD7B4509A1821A" reported-display-style="strikethrough"><enum>(3)</enum><header>Incumbent</header><text>The
individual serving in the position of Director of the Indian Health Service on
the day before the date of enactment of the <act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name> Amendments
of 2005 shall serve as Assistant Secretary.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDFA2A04AE51624E67A3F20CA30021B211" reported-display-style="strikethrough"><enum>(4)</enum><header>Advocacy and
consultation</header><text>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—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID82DBFB74E13D483D97F2F877DF241C25" reported-display-style="strikethrough"><enum>(A)</enum><text>facilitate
advocacy for the development of appropriate Indian health policy; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID510578FFD2A34A20A6B38AFEAEEE4C31" reported-display-style="strikethrough"><enum>(B)</enum><text>promote
consultation on matters relating to Indian health.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDE5CE91EABA874D64A842000FE7EC5B9E" reported-display-style="strikethrough"><enum>(b)</enum><header>Agency</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID3E6EB8D2DB374727AEB4BD0E2A7005DF" reported-display-style="strikethrough"><enum>(c)</enum><header>Duties</header><text>The
Assistant Secretary of Indian Health shall—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID5CB2D73F6DC740369B24AB957DE9229E" reported-display-style="strikethrough"><enum>(1)</enum><text>perform all
functions that were, on the day before the date of enactment of the
<act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name>
Amendments of 2005, carried out by or under the direction of the individual
serving as Director of the Service on that day;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID2B5563E591244103A35CCDF68B6B0ACD" reported-display-style="strikethrough"><enum>(2)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID6A8DC8EE08C24B0FA88B42EB3AFE16E9" reported-display-style="strikethrough"><enum>(3)</enum><text>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—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID4DB48605472D4397BC13391C3665DC2E" reported-display-style="strikethrough"><enum>(A)</enum><text>this Act;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDFD87C3234D6B497E95F38655B62E434D" reported-display-style="strikethrough"><enum>(B)</enum><text>the Act of
November 2, 1921 (25 U.S.C. 13);</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID551B4C32B1F44A4A80CA9965A0E6FC35" reported-display-style="strikethrough"><enum>(C)</enum><text>the Act of August
5, 1954 (42 U.S.C. 2001 et seq.);</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID61C7D9C6D2CC49668B8FA97DCC4975A5" reported-display-style="strikethrough"><enum>(D)</enum><text>the Act of August
16, 1957 (42 U.S.C. 2005 et seq.); and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDA7A3848A5A9D44648749465E299659CC" reported-display-style="strikethrough"><enum>(E)</enum><text>the
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (25 U.S.C. 450 et seq.);</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB78A73337A8E4FE9A3488BE6566A4591" reported-display-style="strikethrough"><enum>(4)</enum><text>administer all
scholarship and loan functions carried out under title I;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID3C27B679A66E41919D23BBE451CC08C8" reported-display-style="strikethrough"><enum>(5)</enum><text>report directly to
the Secretary concerning all policy- and budget-related matters affecting
Indian health;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDCE75809B4B864FE5BBBA64239BD6F26F" reported-display-style="strikethrough"><enum>(6)</enum><text>collaborate with
the Assistant Secretary for Health concerning appropriate matters of Indian
health that affect the agencies of the Public Health Service;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA3B8CE9C5203462686E627AC8F70E85C" reported-display-style="strikethrough"><enum>(7)</enum><text>advise each
Assistant Secretary of the Department concerning matters of Indian health with
respect to which that Assistant Secretary has authority and
responsibility;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID29E2F837A36E4ACB992A9A57AAD0649B" reported-display-style="strikethrough"><enum>(8)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID3061CDC6627349418C58823BA553AA80" reported-display-style="strikethrough"><enum>(9)</enum><text>coordinate the
activities of the Department concerning matters of Indian health; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDE92C346EA9D84A7D8A6D43016E38E6DB" reported-display-style="strikethrough"><enum>(10)</enum><text>perform such
other functions as the Secretary may designate.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDB2BE4F491ABF4A1098393B2754557259" reported-display-style="strikethrough"><enum>(d)</enum><header>Authority</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID4E6B20A1F9484B63A7540974481670BE" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>The Secretary, acting through the Assistant Secretary,
shall have the authority—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID0E53E460D3B94EDAA4F685D3890EB2AF" reported-display-style="strikethrough"><enum>(A)</enum><text>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;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID84A33F149F3843CC8560CA2C31056EA8" reported-display-style="strikethrough"><enum>(B)</enum><text>to enter into
contracts for the procurement of goods and services to carry out the functions
of the Service; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID7BA753EE21A845E4A47E7FA8070A34D4" reported-display-style="strikethrough"><enum>(C)</enum><text>to manage, expend,
and obligate all funds appropriated for the Service.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID49C1DFE067D54756983FB3B8AB8ADB3F" reported-display-style="strikethrough"><enum>(2)</enum><header>Personnel
actions</header><text>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).</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID117D172866634259A491E72A7618F3C8" reported-display-style="strikethrough"><enum>(e)</enum><header>References</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID8137F590EF3C453384B99E3887DFF5B1" reported-display-style="strikethrough"><enum>602.</enum><header>Automated
management information system</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID9DEA8EB48DCE43E5A1C1F4F5569ECF7C" reported-display-style="strikethrough"><enum>(a)</enum><header>Establishment</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID58C6E24D52914668B02F633CB31C3800" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>The Secretary shall establish an automated management
information system for the Service.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID7B9DEBF3C7864FB3A5E1BCBB2613E0D8" reported-display-style="strikethrough"><enum>(2)</enum><header>Requirements of
system</header><text>The information system established under paragraph (1)
shall include—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDB8FB54A8D2734BB59325F9CAC8C58612" reported-display-style="strikethrough"><enum>(A)</enum><text>a financial
management system;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID05B4AF16B30842309E5CE47C9DCEA4E2" reported-display-style="strikethrough"><enum>(B)</enum><text>a patient care
information system for each area served by the Service;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID26336CCA4CE64E4F8F1C9B242DBBE865" reported-display-style="strikethrough"><enum>(C)</enum><text>a privacy
component that protects the privacy of patient information held by, or on
behalf of, the Service;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID60CAB12D85114932ABCF94FF62792789" reported-display-style="strikethrough"><enum>(D)</enum><text>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;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID60BB0609A52A4FEDB729687B42137D21" reported-display-style="strikethrough"><enum>(E)</enum><text>an interface
mechanism for patient billing and accounts receivable system; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID50E92D48CC01479EA7F6D81ACE3AC525" reported-display-style="strikethrough"><enum>(F)</enum><text>a training
component.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID7205BE744C7548D3AF84EF96E3CB8991" reported-display-style="strikethrough"><enum>(b)</enum><header>Provision of
Systems to Tribes and Organizations</header><text>The Secretary shall provide
each Tribal Health Program automated management information systems
which—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDE640AD43FDCC4AF59260105515C8F075" reported-display-style="strikethrough"><enum>(1)</enum><text>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</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDEE3BC41DA79D494CB96A540452D03BB3" reported-display-style="strikethrough"><enum>(2)</enum><text>meet the
management information needs of the Service.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID8260B1869D6E4A4C8015414CBEB08D21" reported-display-style="strikethrough"><enum>(c)</enum><header>Access to
Records</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID4EF9624885CB4171A28A0F48EE41D88B" reported-display-style="strikethrough"><enum>(d)</enum><header>Authority To
Enhance Information Technology</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDE1AE146D44DE4AF2AC1D30A9D1CFC05C" reported-display-style="strikethrough"><enum>603.</enum><header>Authorization
of appropriations</header><text display-inline="no-display-inline">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.</text>
</section><enum>VII</enum><header>BEHAVIORAL
HEALTH PROGRAMS</header>
<section changed="deleted" committee-id="SLIA00" id="ID2E21DE311B1C4A22BA059AFF7087D47E" reported-display-style="strikethrough"><enum>701.</enum><header>Behavioral
Health prevention and treatment Services</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID2E129C8B28D5418A940EF9C732B560DF" reported-display-style="strikethrough"><enum>(a)</enum><header>Purposes</header><text>The
purposes of this section are as follows:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDBC94DB2F8EDA48EDA1AC616F717B8E28" reported-display-style="strikethrough"><enum>(1)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB69870869B7A4E088828FAF6D49265D0" reported-display-style="strikethrough"><enum>(2)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID97E545F00CC94D44B97F941112E14B8B" reported-display-style="strikethrough"><enum>(3)</enum><text>To assist Indian
Tribes to identify services and resources available to address mental illness
and dysfunctional and self-destructive behavior.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDC208E30642BC4F75A5AFB8E641241BD6" reported-display-style="strikethrough"><enum>(4)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDFF99BBEA29364525A33F906FB0C8904A" reported-display-style="strikethrough"><enum>(5)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA1D18A97D8FA44A08225FFED8AE6A7A1" reported-display-style="strikethrough"><enum>(6)</enum><text>To modify or
supplement existing programs and authorities in the areas identified in
paragraph (2).</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDC0A1FE587F2C416B92E32E108C187072" reported-display-style="strikethrough"><enum>(b)</enum><header>Plans</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID307732E0D3774BD3BD9D20626CB2FBB0" reported-display-style="strikethrough"><enum>(1)</enum><header>Development</header><text>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:</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID5DDB8C6B62244AC0832AF1F9A88CE0A9" reported-display-style="strikethrough"><enum>(A)</enum><text>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—</text>
<clause changed="deleted" committee-id="SLIA00" id="ID52E423BDA07145B28C85013000123A93" reported-display-style="strikethrough"><enum>(i)</enum><text>the number of
Indians served who are directly or indirectly affected by such illness or
behavior; or</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="IDEBFE4613F2C549828A61D9791E672690" reported-display-style="strikethrough"><enum>(ii)</enum><text>an estimate of
the financial and human cost attributable to such illness or behavior.</text>
</clause></subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID476AEB3880F4443D874F1B9B6B52F391" reported-display-style="strikethrough"><enum>(B)</enum><text>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).</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID4DE63FE33FF84D719CC91FF05478FF55" reported-display-style="strikethrough"><enum>(C)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA3FC477072284BB68C41CFDAD5845B77" reported-display-style="strikethrough"><enum>(2)</enum><header>National
clearinghouse</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID691B8B942C9745449B464B01AC85DE78" reported-display-style="strikethrough"><enum>(3)</enum><header>Technical
assistance</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID893B74E37D234F26A465867585335D1B" reported-display-style="strikethrough"><enum>(c)</enum><header>Programs</header><text>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:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID889F95EA555248E08C48FEBDD123DB07" reported-display-style="strikethrough"><enum>(1)</enum><header>Comprehensive
care</header><text>A comprehensive continuum of behavioral health care which
provides—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID0ED6A054E5854F7392E2AD374545A648" reported-display-style="strikethrough"><enum>(A)</enum><text>community-based
prevention, intervention, outpatient, and behavioral health aftercare;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID08C760C23A524C37A7D8CFC5BB193250" reported-display-style="strikethrough"><enum>(B)</enum><text>detoxification
(social and medical);</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDC909C612A40843F59566CD32DDB48D61" reported-display-style="strikethrough"><enum>(C)</enum><text>acute
hospitalization;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID12944B59C0144157BF2CF772A4EFAF72" reported-display-style="strikethrough"><enum>(D)</enum><text>intensive
outpatient/day treatment;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDCB9ADDE6D2CF4C16A3DBFB8DC9C8C00E" reported-display-style="strikethrough"><enum>(E)</enum><text>residential
treatment;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID9982CE23B94B406E8EAFA6BA0CE49670" reported-display-style="strikethrough"><enum>(F)</enum><text>transitional
living for those needing a temporary, stable living environment that is
supportive of treatment and recovery goals;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDE5635607F9004C50BEBD0AC656C77E8A" reported-display-style="strikethrough"><enum>(G)</enum><text>emergency
shelter;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID1C568A2FC1B243F099E49F5EA71A942F" reported-display-style="strikethrough"><enum>(H)</enum><text>intensive case
management;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID3479AF5433F94B098A8CE0EA6B605CD9" reported-display-style="strikethrough"><enum>(I)</enum><text>Traditional Health
Care Practices; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID41999CEAE70B41A9A421AC748E4570F7" reported-display-style="strikethrough"><enum>(J)</enum><text>diagnostic
services.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID926B233528EE4CA586402E34ADD4C2E9" reported-display-style="strikethrough"><enum>(2)</enum><header>Child
care</header><text>Behavioral health services for Indians from birth through
age 17, including—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID55A1E49FFD574C10B0C8E00CB333DFA3" reported-display-style="strikethrough"><enum>(A)</enum><text>preschool and
school age fetal alcohol disorder services, including assessment and behavioral
intervention;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID8799208ABD094D928B7579D76047DDA9" reported-display-style="strikethrough"><enum>(B)</enum><text>mental health and
substance abuse services (emotional, organic, alcohol, drug, inhalant, and
tobacco);</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDF41F228BAA7B40408EE0ED8A7A1C7F0D" reported-display-style="strikethrough"><enum>(C)</enum><text>identification and
treatment of co-occurring disorders and comorbidity;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDB1E72AC3B6AC4C7C964C222E4305036E" reported-display-style="strikethrough"><enum>(D)</enum><text>prevention of
alcohol, drug, inhalant, and tobacco use;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID339818828DC9426C947A168B4E30011B" reported-display-style="strikethrough"><enum>(E)</enum><text>early
intervention, treatment, and aftercare;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID25A2AAD5D3AE447C9CE81AD2065B3E2F" reported-display-style="strikethrough"><enum>(F)</enum><text>promotion of
healthy approaches to risk and safety issues; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID23AA32C7E99B4BA8926503495651295C" reported-display-style="strikethrough"><enum>(G)</enum><text>identification and
treatment of neglect and physical, mental, and sexual abuse.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID4D49BE91D7EE444CA13AB540257184FC" reported-display-style="strikethrough"><enum>(3)</enum><header>Adult
care</header><text>Behavioral health services for Indians from age 18 through
55, including—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID1574E4E7F6B543518256D94A6EEF3202" reported-display-style="strikethrough"><enum>(A)</enum><text>early
intervention, treatment, and aftercare;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID40A81D09FDB14DA5B3B8C1B2FE626765" reported-display-style="strikethrough"><enum>(B)</enum><text>mental health and
substance abuse services (emotional, alcohol, drug, inhalant, and tobacco),
including sex specific services;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID51385DAF1225469CB12C2F8E8709D788" reported-display-style="strikethrough"><enum>(C)</enum><text>identification and
treatment of co-occurring disorders (dual diagnosis) and comorbidity;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDBAC7EBB7BAAA48E38A68F2675E5FF45D" reported-display-style="strikethrough"><enum>(D)</enum><text>promotion of
healthy approaches for risk-related behavior;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID099E858455BA4B218E6481D6642E2437" reported-display-style="strikethrough"><enum>(E)</enum><text>treatment services
for women at risk of giving birth to a child with a fetal alcohol disorder;
and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID277FBB3FA0A64310BE547F6C1F5A5457" reported-display-style="strikethrough"><enum>(F)</enum><text>sex specific
treatment for sexual assault and domestic violence.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID02D7B6F3DF874D7297C673CF2E1A7965" reported-display-style="strikethrough"><enum>(4)</enum><header>Family
care</header><text>Behavioral health services for families, including—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID27D4C897DC654040BBC37F34BF55FA7C" reported-display-style="strikethrough"><enum>(A)</enum><text>early
intervention, treatment, and aftercare for affected families;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID8F8A2EDDF71B4DE887F22A40E9C51DBE" reported-display-style="strikethrough"><enum>(B)</enum><text>treatment for
sexual assault and domestic violence; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDA2CCE513DEF048E684FBBA63AB744B86" reported-display-style="strikethrough"><enum>(C)</enum><text>promotion of
healthy approaches relating to parenting, domestic violence, and other abuse
issues.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID1C1A86E49A5B464A9475CC67886BF9EE" reported-display-style="strikethrough"><enum>(5)</enum><header>Elder
care</header><text>Behavioral health services for Indians 56 years of age and
older, including—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDC9F15236E31249DC844B9B28DD01ADFB" reported-display-style="strikethrough"><enum>(A)</enum><text>early
intervention, treatment, and aftercare;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID1F63EF3A48654764BAAE3635824A7319" reported-display-style="strikethrough"><enum>(B)</enum><text>mental health and
substance abuse services (emotional, alcohol, drug, inhalant, and tobacco),
including sex specific services;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID0F385E470BF34EAFBA382E8985DD1154" reported-display-style="strikethrough"><enum>(C)</enum><text>identification and
treatment of co-occurring disorders (dual diagnosis) and comorbidity;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDD2FC96B882EE40C38B96ED31BEB2BF17" reported-display-style="strikethrough"><enum>(D)</enum><text>promotion of
healthy approaches to managing conditions related to aging;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID92CE4D7D9AF4414F9FB31E54F50F816B" reported-display-style="strikethrough"><enum>(E)</enum><text>sex specific
treatment for sexual assault, domestic violence, neglect, physical and mental
abuse and exploitation; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID351FE54D3214499CA371B8CD379B8359" reported-display-style="strikethrough"><enum>(F)</enum><text>identification and
treatment of dementias regardless of cause.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID23572F050D514056AF5F9670CC5E701D" reported-display-style="strikethrough"><enum>(d)</enum><header>Community
Behavioral Health Plan</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID778FA37A184946EB8AD84043868E7703" reported-display-style="strikethrough"><enum>(1)</enum><header>Establishment</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID7BA81811FD0C430E9F42C3110BBD8592" reported-display-style="strikethrough"><enum>(2)</enum><header>Technical
assistance</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDD29C9E46E08949DDB529CE2A6B0255D5" reported-display-style="strikethrough"><enum>(3)</enum><header>Funding</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID30D8601B92B54F45B340951F4CA8448E" reported-display-style="strikethrough"><enum>(e)</enum><header>Coordination for
Availability of Services</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID272CFC1501D44AA68241E2CB4B875EB1" reported-display-style="strikethrough"><enum>(f)</enum><header>Mental Health
Care Need Assessment</header><text>Not later than 1 year after the date of
enactment of the <act-name parsable-cite="IHCIA">Indian Health Care Improvement
Act</act-name> 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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDE5792F57B5274D8382851C29BF7F3C91" reported-display-style="strikethrough"><enum>702.</enum><header>Memoranda of
agreement with the Department of the Interior</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID7F4536DD154F488B8C052F00E7B1F51A" reported-display-style="strikethrough"><enum>(a)</enum><header>Contents</header><text>Not
later than 12 months after the date of enactment of the
<act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name>
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:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDE82B29F03A994032BBA6A8A36EDD6264" reported-display-style="strikethrough"><enum>(1)</enum><text>The scope and
nature of mental illness and dysfunctional and self-destructive behavior,
including child abuse and family violence, among Indians.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDEA1B8D56875E4939BA1C42B8C5A4F334" reported-display-style="strikethrough"><enum>(2)</enum><text>The existing
Federal, tribal, State, local, and private services, resources, and programs
available to provide behavioral health services for Indians.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID4AF844AB6ED0436AB112A0ED87E0A4C1" reported-display-style="strikethrough"><enum>(3)</enum><text>The unmet need for
additional services, resources, and programs necessary to meet the needs
identified pursuant to paragraph (1).</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID0A2DA82864324D4282A2133BB1122AE5" reported-display-style="strikethrough"><enum>(4)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="IDC91E0006373246D490B481CAD9590034"><enum>(A)</enum><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID8B757C16D3A84128AA35341059B78351" indent="up1" reported-display-style="strikethrough"><enum>(B)</enum><text>The right of
Indians to participate in, and receive the benefit of, such services.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDCBF44ED0E1544A3A86DAEBADABAF7687" indent="up1" reported-display-style="strikethrough"><enum>(C)</enum><text>The actions
necessary to protect the exercise of such right.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDEB781BE37C094601BD4D944086A68066" reported-display-style="strikethrough"><enum>(5)</enum><text>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).</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID222ABF9000FA416A9956E372E6B1BCDA" reported-display-style="strikethrough"><enum>(6)</enum><text>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—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDF5F5734E90474194A5E6C3D0E8A0D3A2" reported-display-style="strikethrough"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID61E8D6316E5A4EEE93373B538317334A" reported-display-style="strikethrough"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID2B047E32637A4FA4BCD45B63E5FBD58B" reported-display-style="strikethrough"><enum>(7)</enum><text>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).</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF55C9C718B484C4AA5BDB46E9C1DFF53" reported-display-style="strikethrough"><enum>(8)</enum><text>Providing for an
annual review of such agreement by the Secretaries which shall be provided to
Congress and Indian Tribes and Tribal Organizations.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID5B2E37435BDA478BBC83A33FF04911AD" reported-display-style="strikethrough"><enum>(b)</enum><header>Specific
Provisions Required</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDCBCAFA7A98AF436DBAD51D094E0A960F" reported-display-style="strikethrough"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID42889F2CB77D40C0BBEC1ECA375D548F" reported-display-style="strikethrough"><enum>(2)</enum><text>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</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA49BC434F7414B35A4CB1703FAA85E8E" reported-display-style="strikethrough"><enum>(3)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID09409CDAD5C2494FB614BD3AAAE5C4DF" reported-display-style="strikethrough"><enum>(c)</enum><header>Consultation</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID557C298B7CF94994A9D0DD9D5F6BE9E8" reported-display-style="strikethrough"><enum>(1)</enum><text>Indian Tribes and
Tribal Organizations;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA1BAFFCAA7714FDB9ED5139406CB04D4" reported-display-style="strikethrough"><enum>(2)</enum><text>Indians;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB2EE54682F754F848CE3E8550BC56CDB" reported-display-style="strikethrough"><enum>(3)</enum><text>Urban Indian
Organizations and other Indian organizations; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB5D60CC789FC442DA3047341B880E810" reported-display-style="strikethrough"><enum>(4)</enum><text>behavioral health
service providers.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID69EBF3DA7963416E98596298E97782AF" reported-display-style="strikethrough"><enum>(d)</enum><header>Publication</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID86A73BCE2C5D444CB306D7945FB853CA" reported-display-style="strikethrough"><enum>703.</enum><header>Comprehensive
behavioral Health prevention and treatment Program</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID7BA455FD63A24D57AA29CDDECF191DD6" reported-display-style="strikethrough"><enum>(a)</enum><header>Establishment</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDD736AD214F464312B14E3D83A2D7D74F" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>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—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID28B178D6DD6646BB926DB91F31388A76" reported-display-style="strikethrough"><enum>(A)</enum><text>prevention,
through educational intervention, in Indian communities;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID5396B8D6A7C14EB9A9C14853FE16B513" reported-display-style="strikethrough"><enum>(B)</enum><text>acute
detoxification, psychiatric hospitalization, residential, and intensive
outpatient treatment;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID3CC0828F28CC4530A0C6500DCBA45DA6" reported-display-style="strikethrough"><enum>(C)</enum><text>community-based
rehabilitation and aftercare;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDEADCAB73885F4FDC9CCF71FF2096BA08" reported-display-style="strikethrough"><enum>(D)</enum><text>community
education and involvement, including extensive training of health care,
educational, and community-based personnel;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDCB1DD8D163FA45008F679B850DDC9CD7" reported-display-style="strikethrough"><enum>(E)</enum><text>specialized
residential treatment programs for high-risk populations, including pregnant
and postpartum women and their children; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID09CB873721E240FA897D8D1BA156F598" reported-display-style="strikethrough"><enum>(F)</enum><text>diagnostic
services.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID6741FF7B5EE445C691FFF2A3F5472650" reported-display-style="strikethrough"><enum>(2)</enum><header>Target
populations</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID911CE90FF3714062B2D99CDA74DE6020" reported-display-style="strikethrough"><enum>(b)</enum><header>Contract Health
Services</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID99A8DB7142D94194AB10B5CA09B14D8C" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>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).</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDECD78E25970E4C0A8BD9A0CCE3A9FE69" reported-display-style="strikethrough"><enum>(2)</enum><header>Provision of
assistance</header><text>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.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="ID3408DFEF4B2C442997E5E6EE4BEA8350" reported-display-style="strikethrough"><enum>704.</enum><header>Mental Health
technician Program</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID52FE4B0FB7B741208E6DC366CBA754E1" reported-display-style="strikethrough"><enum>(a)</enum><header>In
General</header><text>Under the authority of the Act of November 2, 1921 (25
U.S.C. 13) (commonly known as the <quote>Snyder Act</quote>), the Secretary
shall establish and maintain a mental health technician program within the
Service which—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDF5F6D89FE3DD4666A10FFFDCE9AADA18" reported-display-style="strikethrough"><enum>(1)</enum><text>provides for the
training of Indians as mental health technicians; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDD971F911BFD443258908FCD2723C8113" reported-display-style="strikethrough"><enum>(2)</enum><text>employs such
technicians in the provision of community-based mental health care that
includes identification, prevention, education, referral, and treatment
services.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID45407492CDD6431DAF4CE3A8A527459C" reported-display-style="strikethrough"><enum>(b)</enum><header>Paraprofessional
Training</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDE2392E7534C943B28239B64F263E6AB7" reported-display-style="strikethrough"><enum>(c)</enum><header>Supervision and
Evaluation of Technicians</header><text>The Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, shall supervise and evaluate
the mental health technicians in the training program.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID84AEFA63A4224B9EBA6B0F4492356B6D" reported-display-style="strikethrough"><enum>(d)</enum><header>Traditional
Health Care Practices</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDFA91BCB7E21940D5A5FBF181F6E23F49" reported-display-style="strikethrough"><enum>705.</enum><header>Licensing
requirement for mental Health care workers</header><text display-inline="no-display-inline">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.</text>
</section><section changed="deleted" committee-id="SLIA00" id="ID11EFAF25BF184189AE2D8C303439045E" reported-display-style="strikethrough"><enum>706.</enum><header>Indian women
treatment Programs</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDE817A40862FB46DFAFA2F56D994B8219" reported-display-style="strikethrough"><enum>(a)</enum><header>Funding</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID0F55F2DD7D774F1FB65B387F9D2E5A95" reported-display-style="strikethrough"><enum>(b)</enum><header>Use of
Funds</header><text>Funds made available pursuant to this section may be used
to—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID2427615970954D518797F560CF0C3B0E" reported-display-style="strikethrough"><enum>(1)</enum><text>develop and
provide community training, education, and prevention programs for Indian women
relating to behavioral health issues, including fetal alcohol disorders;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA84FBBFFA1E94A0E8D45A6943F73AF17" reported-display-style="strikethrough"><enum>(2)</enum><text>identify and
provide psychological services, counseling, advocacy, support, and relapse
prevention to Indian women and their families; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID12360E45058F49C394880FFEDB77BA1D" reported-display-style="strikethrough"><enum>(3)</enum><text>develop prevention
and intervention models for Indian women which incorporate Traditional Health
Care Practices, cultural values, and community and family involvement.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDBCB9BEF416AD44E39F4EE1FFD6B360E8" reported-display-style="strikethrough"><enum>(c)</enum><header>Criteria</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDBF48DB07C6354A03834A44B0FD30274C" reported-display-style="strikethrough"><enum>(d)</enum><header>Earmark of
Certain Funds</header><text>Twenty percent of the funds appropriated pursuant
to this section shall be used to make grants to Urban Indian
Organizations.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID653F0A0DFAF840BDB31CE24A286CBDFD" reported-display-style="strikethrough"><enum>707.</enum><header>Indian youth
Program</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDCCFA1E32D2F64E7E985A000D482CC3CE" reported-display-style="strikethrough"><enum>(a)</enum><header>Detoxification
and Rehabilitation</header><text>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 <act-name parsable-cite="ISDA">Indian
Self-Determination and Education Assistance Act</act-name>. Regional centers
shall be integrated with the intake and rehabilitation programs based in the
referring Indian community.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID7A2589D2E7D54638A3A95430BF1EE42E" reported-display-style="strikethrough"><enum>(b)</enum><header>Alcohol and
Substance Abuse Treatment Centers or Facilities</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDC443867E16D848849D01066F8A027DEC" reported-display-style="strikethrough"><enum>(1)</enum><header>Establishment</header>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDE9E9C966E32D4908AF8A324118C62847" reported-display-style="strikethrough"><enum>(A)</enum><header>In
general</header><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID00CE52FBB4AF4200B936805FEBA3F3C2" reported-display-style="strikethrough"><enum>(B)</enum><header>Area office in
california</header><text>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.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID2DD6A6A1B3754A46A7B852352EC33FC3" reported-display-style="strikethrough"><enum>(2)</enum><header>Funding</header><text>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).</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDC967FC2C0A454665BBAAABE7D49AB659" reported-display-style="strikethrough"><enum>(3)</enum><header>Location</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA36F91498D4C48BC8E9D19B4D50ECEC4" reported-display-style="strikethrough"><enum>(4)</enum><header>Specific
provision of funds</header>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDED628818DB5848438347370DE683E25E" reported-display-style="strikethrough"><enum>(A)</enum><header>In
general</header><text>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—</text>
<clause changed="deleted" committee-id="SLIA00" id="ID7813403268414B92B5C77D6EDF44BE1D" reported-display-style="strikethrough"><enum>(i)</enum><text>the Tanana Chiefs
Conference, Incorporated, for the purpose of leasing, constructing, renovating,
operating, and maintaining a residential youth treatment facility in Fairbanks,
Alaska; and</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="ID9DC97F7037AF47BA860342B784096C87" reported-display-style="strikethrough"><enum>(ii)</enum><text>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(<added-phrase>l</added-phrase>) of the <act-name parsable-cite="ISDA">Indian
Self-Determination and Education Assistance Act</act-name> (25 U.S.C.
450b(<added-phrase>l</added-phrase>)).</text>
</clause></subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID1C89F9E1BBEF48E19E56376DDE5B76D5" reported-display-style="strikethrough"><enum>(B)</enum><header>Provision of
services to eligible youths</header><text>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.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDA7FD9F4058AF462B8A9E45BC3C51F201" reported-display-style="strikethrough"><enum>(c)</enum><header>Intermediate
Adolescent Behavioral Health Services</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDB16F41517CAE4CA497501DC0E2DC164E" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>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—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID49583B6EF65A4AB9BAC07A7E6178FAE1" reported-display-style="strikethrough"><enum>(A)</enum><text>pretreatment
assistance;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDDF30311BADA04F05B1F15AEF187EDE3D" reported-display-style="strikethrough"><enum>(B)</enum><text>inpatient,
outpatient, and aftercare services;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDEAF2F41D59C9425EA0556446DB1CF5C0" reported-display-style="strikethrough"><enum>(C)</enum><text>emergency
care;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID9531EB77CD0A499D9E922B15ADE62A94" reported-display-style="strikethrough"><enum>(D)</enum><text>suicide prevention
and crisis intervention; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID49E68688FE1D46309E922668F440FA4F" reported-display-style="strikethrough"><enum>(E)</enum><text>prevention and
treatment of mental illness and dysfunctional and self-destructive behavior,
including child abuse and family violence.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID0DE57A4E66FA479EB59CA89820B894AD" reported-display-style="strikethrough"><enum>(2)</enum><header>Use of
funds</header><text>Funds provided under this subsection may be used—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDA8E8C0079D8541EE993D68CD92FA15D6" reported-display-style="strikethrough"><enum>(A)</enum><text>to construct or
renovate an existing health facility to provide intermediate behavioral health
services;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID4048C528FD1F4C50924080777BBDAF0A" reported-display-style="strikethrough"><enum>(B)</enum><text>to hire behavioral
health professionals;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID8F04DEFB5ABC40968FB906F6D3E9FC99" reported-display-style="strikethrough"><enum>(C)</enum><text>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;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID90589709C22A4A48B667E244669A28D7" reported-display-style="strikethrough"><enum>(D)</enum><text>to make
renovations and hire appropriate staff to convert existing hospital beds into
adolescent psychiatric units; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDC2E0B031DE0C46D7979CB2B3631994B6" reported-display-style="strikethrough"><enum>(E)</enum><text>for intensive
home- and community-based services.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDDDD43533112040FD8444DD365107DBB9" reported-display-style="strikethrough"><enum>(3)</enum><header>Criteria</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDED9D84D429D14C01BABAE6A08B76CC7A" reported-display-style="strikethrough"><enum>(d)</enum><header>Federally Owned
Structures</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDFD2906C23BE9471692DBC6B5643D5E0F" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>The Secretary, in consultation with Indian Tribes and
Tribal Organizations, shall—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID8482104383B44B94880518558862746D" reported-display-style="strikethrough"><enum>(A)</enum><text>identify and use,
where appropriate, federally owned structures suitable for local residential or
regional behavioral health treatment for Indian youths; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID175C4474B2AF49DDA0A1E582D077CE9D" reported-display-style="strikethrough"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID004F69589979491B9FD2821BB781B717" reported-display-style="strikethrough"><enum>(2)</enum><header>Terms and
conditions for use of structure</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID0295C52A79F442C2BFC2BC77BD26491C" reported-display-style="strikethrough"><enum>(e)</enum><header>Rehabilitation
and Aftercare Services</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDD86721B174FC480E92C1816DF0B76017" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID518D034D81F8422895EDFE8D687A0A3A" reported-display-style="strikethrough"><enum>(2)</enum><header>Administration</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID1E46B442A53B400C948682C9BC76C514" reported-display-style="strikethrough"><enum>(f)</enum><header>Inclusion of
Family in Youth Treatment Program</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDC908E1A4C4F2481AA6F3A15332F33218" reported-display-style="strikethrough"><enum>(g)</enum><header>Multidrug Abuse
Program</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID4BF2A5270FA046AB958C30361F505846" reported-display-style="strikethrough"><enum>708.</enum><header>Inpatient and
community-based mental Health facilities design, construction, and
staffing</header><text display-inline="no-display-inline">Not later than 1 year
after the date of enactment of the <act-name parsable-cite="IHCIA">Indian
Health Care Improvement Act</act-name> 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.</text>
</section><section changed="deleted" committee-id="SLIA00" id="ID7F5AF45C157740B0AFF3B258BF79B00D" reported-display-style="strikethrough"><enum>709.</enum><header>Training and
community education</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID6F85FADFC61E43CB81DCC84CBE2D5408" reported-display-style="strikethrough"><enum>(a)</enum><header>Program</header><text>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).</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDD9789065D230420AA126EC342179ABD7" reported-display-style="strikethrough"><enum>(b)</enum><header>Instruction</header><text>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).</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID775AF509B0C648EA9CD20ABD0B160FDA" reported-display-style="strikethrough"><enum>(c)</enum><header>Training
Models</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDEB49DF3DF08C4A5DB05A6A69AEB3530A" reported-display-style="strikethrough"><enum>(1)</enum><text>the elevated risk
of alcohol and behavioral health problems faced by children of
alcoholics;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID2BA574E4B652480ABD0B96BBF76CF1A0" reported-display-style="strikethrough"><enum>(2)</enum><text>the cultural,
spiritual, and multigenerational aspects of behavioral health problem
prevention and recovery; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID0AFCF1D92C224685B825621A067F3F1C" reported-display-style="strikethrough"><enum>(3)</enum><text>community-based
and multidisciplinary strategies for preventing and treating behavioral health
problems.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="ID3527462DCC1243EEB9E107E34DE546F5" reported-display-style="strikethrough"><enum>710.</enum><header>Behavioral
Health Program</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID5EBC68C2573D4D799BF8AA294DD7E29C" reported-display-style="strikethrough"><enum>(a)</enum><header>Innovative
Programs</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDA8CC58B299884BF5BBBF818354C72B8F" reported-display-style="strikethrough"><enum>(b)</enum><header>Funding;
Criteria</header><text>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:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDD843970A1B5645279A71E522F370B0B3" reported-display-style="strikethrough"><enum>(1)</enum><text>The project will
address significant unmet behavioral health needs among Indians.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDDC4B613CEFC74D669672696C089FFBC3" reported-display-style="strikethrough"><enum>(2)</enum><text>The project will
serve a significant number of Indians.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDD21339D5D398494087F6DF3083F8C5DD" reported-display-style="strikethrough"><enum>(3)</enum><text>The project has
the potential to deliver services in an efficient and effective manner.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB70C6BAC956B4141B74785C5AF9F1805" reported-display-style="strikethrough"><enum>(4)</enum><text>The Indian Tribe
or Tribal Organization has the administrative and financial capability to
administer the project.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDE8AB25AC35704EB38314A0574188E31D" reported-display-style="strikethrough"><enum>(5)</enum><text>The project may
deliver services in a manner consistent with Traditional Health Care
Practices.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDD60E7E183D9C4323B22FBF074B6C240A" reported-display-style="strikethrough"><enum>(6)</enum><text>The project is
coordinated with, and avoids duplication of, existing services.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID3456ABD26CA9415C8BB02283A2763C4F" reported-display-style="strikethrough"><enum>(c)</enum><header>Equitable
Treatment</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID262CE36C02194C76B563BABAAB4464A3" reported-display-style="strikethrough"><enum>711.</enum><header>Fetal alcohol
disorder funding</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID613868B76330477E8CD033C0A2890820" reported-display-style="strikethrough"><enum>(a)</enum><header>Programs</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDC9EF25CD0C034F21B07E841A8C304CA5" reported-display-style="strikethrough"><enum>(1)</enum><header>Establishment</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID0704876469EF4369A2F59A6925BFEACF" reported-display-style="strikethrough"><enum>(2)</enum><header>Use of
funds</header><text>Funding provided pursuant to this section shall be used for
the following:</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDA4335E8C37C240149D89527C9DBFDD22" reported-display-style="strikethrough"><enum>(A)</enum><text>To develop and
provide for Indians community and in school training, education, and prevention
programs relating to fetal alcohol disorders.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID7B43923F03524BC4973ABE61F9F42BAC" reported-display-style="strikethrough"><enum>(B)</enum><text>To identify and
provide behavioral health treatment to high-risk Indian women and high-risk
women pregnant with an Indian’s child.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID57AA98B167DB4A3DBAA34E518962173B" reported-display-style="strikethrough"><enum>(C)</enum><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID8CD0EF993D724E86A80097045F1D7E76" reported-display-style="strikethrough"><enum>(D)</enum><text>To develop and
implement counseling and support programs in schools for fetal alcohol disorder
affected Indian children.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID97A7CFC4B35B4DB0924DF298AB3AA8D0" reported-display-style="strikethrough"><enum>(E)</enum><text>To develop
prevention and intervention models which incorporate practitioners of
Traditional Health Care Practices, cultural and spiritual values, and community
involvement.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDD67CBC597C0342FF8ACA0E5E8F4D582D" reported-display-style="strikethrough"><enum>(F)</enum><text>To develop, print,
and disseminate education and prevention materials on fetal alcohol
disorder.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDCC5457E7B2E741268259C2EFDC8ADA43" reported-display-style="strikethrough"><enum>(G)</enum><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID3CC8F35EBF3247F186310F0FE606944F" reported-display-style="strikethrough"><enum>(H)</enum><text>To develop early
childhood intervention projects from birth on to mitigate the effects of fetal
alcohol disorder among Indians.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDF0AD34760B89478E816AFEB790E5D1AE" reported-display-style="strikethrough"><enum>(I)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDE57D23D4A7D44FC78FA524EEC7D1AC48" reported-display-style="strikethrough"><enum>(3)</enum><header>Criteria for
applications</header><text>The Secretary shall establish criteria for the
review and approval of applications for funding under this section.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID0AAAA3A9EB6B4C5182767D6BEA809A47" reported-display-style="strikethrough"><enum>(b)</enum><header>Services</header><text>The
Secretary, acting through the Service and Indian Tribes, Tribal Organizations,
and Urban Indian Organizations, shall—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID4AACB3DFDB464D68B6B8490EB8582905" reported-display-style="strikethrough"><enum>(1)</enum><text>develop and
provide services for the prevention, intervention, treatment, and aftercare for
those affected by fetal alcohol disorder in Indian communities; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID680E0498D47948BAB5F6886BA0A417DB" reported-display-style="strikethrough"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID0E78E6856DEB483AA5E3C011D97855AA" reported-display-style="strikethrough"><enum>(c)</enum><header>Task
Force</header><text>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:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDD5EEEDADE40B41029E0397F546B7BF56" reported-display-style="strikethrough"><enum>(1)</enum><text>The National
Institute on Drug Abuse.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDD72524D780A64F7D8BFFE27F76A0ED0D" reported-display-style="strikethrough"><enum>(2)</enum><text>The National
Institute on Alcohol and Alcoholism.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDBF9A899DE38C4E14A36D9B1773DCCC9C" reported-display-style="strikethrough"><enum>(3)</enum><text>The Office of
Substance Abuse Prevention.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID94714D48B71B4334B77A6FED058B4F82" reported-display-style="strikethrough"><enum>(4)</enum><text>The National
Institute of Mental Health.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDCE0FFFE056C048FDA4DB27CBC581DEE8" reported-display-style="strikethrough"><enum>(5)</enum><text>The
Service.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB15D1D6DFD564913A297A2B5F3C7304B" reported-display-style="strikethrough"><enum>(6)</enum><text>The Office of
Minority Health of the Department of Health and Human Services.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDED0D20191D424ED287442C6709BF49DB" reported-display-style="strikethrough"><enum>(7)</enum><text>The Administration
for Native Americans.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDC8784E4070D34AE7A9DEE357C7CDBFE4" reported-display-style="strikethrough"><enum>(8)</enum><text>The National
Institute of Child Health and Human Development (NICHD).</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID551232F322CE476C832CB4FE58F73B71" reported-display-style="strikethrough"><enum>(9)</enum><text>The Centers for
Disease Control and Prevention.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDEA9171D5644746ADAE4E16E1274B0B6E" reported-display-style="strikethrough"><enum>(10)</enum><text>The Bureau of
Indian Affairs.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB9012535A3724684812DC0B548B4BE15" reported-display-style="strikethrough"><enum>(11)</enum><text>Indian
Tribes.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDBCB969339A554C82876A4FA6F22B3D34" reported-display-style="strikethrough"><enum>(12)</enum><text>Tribal
Organizations.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDC800790A7CEC4D52AF4CDE9AAAB16F39" reported-display-style="strikethrough"><enum>(13)</enum><text>Urban Indian
Organizations.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID05D43DF13C5349E0A853EFE98333B1CE" reported-display-style="strikethrough"><enum>(14)</enum><text>Indian fetal
alcohol disorder experts.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID2F2F24C6B64C4E0FA769BCE939DE215F" reported-display-style="strikethrough"><enum>(d)</enum><header>Applied Research
Projects</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID093608D5C3D242F5BC9C77050ECB37DD" reported-display-style="strikethrough"><enum>(e)</enum><header>Funding for
Urban Indian Organizations</header><text>Ten percent of the funds appropriated
pursuant to this section shall be used to make grants to Urban Indian
Organizations funded under title V.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID42A7BBFA2D6B41B59EDBD1C2AE8CE2F2" reported-display-style="strikethrough"><enum>712.</enum><header>Child sexual
abuse and prevention treatment Programs</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID039A7A93043E41E394D67C20054EEA56" reported-display-style="strikethrough"><enum>(a)</enum><header>Establishment</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDAD3445B40F864951AF3F32F651F48103" reported-display-style="strikethrough"><enum>(1)</enum><text>victims of sexual
abuse who are Indian children or children in an Indian household; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID144D7CC2D8F3495E8872C1D39DCA9E83" reported-display-style="strikethrough"><enum>(2)</enum><text>perpetrators of
child sexual abuse who are Indian or members of an Indian household.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID170EE09B498447C3A2446CC64E19CA6A" reported-display-style="strikethrough"><enum>(b)</enum><header>Use of
Funds</header><text>Funding provided pursuant to this section shall be used for
the following:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDC2241D3445594FA9994E75FD7F9A8B92" reported-display-style="strikethrough"><enum>(1)</enum><text>To develop and
provide community education and prevention programs related to sexual abuse of
Indian children or children in an Indian household.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID0CADFD90B67A42569DC65D2A2161F55C" reported-display-style="strikethrough"><enum>(2)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDCF560482589F4365BEF614EA765A7404" reported-display-style="strikethrough"><enum>(3)</enum><text>To develop
prevention and intervention models which incorporate Traditional Health Care
Practices, cultural and spiritual values, and community involvement.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDD82002C2A5954217AA781A506DE073E5" reported-display-style="strikethrough"><enum>(4)</enum><text>To develop and
implement, through the tribal consultation process, culturally sensitive
assessment and diagnostic tools for use in Indian communities and Urban
Centers.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDEADFAF506DA64F2CA1E0AF48B7D3E878" reported-display-style="strikethrough"><enum>(5)</enum><text>To identify and
provide behavioral health treatment to Indian perpetrators and perpetrators who
are members of an Indian household—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDE8ECBBB069E8440F87DD06615C8CE316" reported-display-style="strikethrough"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID156C722B054A413D98D98187F3A35E4B" reported-display-style="strikethrough"><enum>(B)</enum><text>providing
treatment after the perpetrator is released, until it is determined that the
perpetrator is not a threat to children.</text>
</subparagraph></paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="IDF00BBB39091D48CDBAC3281A8494FFFA" reported-display-style="strikethrough"><enum>713.</enum><header>Behavioral
Health research</header><text display-inline="no-display-inline">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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID5D28F39FD637415099E91C6B8A0B0659" reported-display-style="strikethrough"><enum>(1)</enum><text>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</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID5F2CF65028BD46B8B307C2CA17EAA123" reported-display-style="strikethrough"><enum>(2)</enum><text>the development of
models of prevention techniques.</text>
</paragraph><continuation-text changed="deleted" committee-id="SLIA00" continuation-text-level="section" reported-display-style="strikethrough">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.</continuation-text></section><section changed="deleted" committee-id="SLIA00" id="ID065CBF7EFD6642889E99411A340011C2" reported-display-style="strikethrough"><enum>714.</enum><header>Definitions</header><text display-inline="no-display-inline">For the purpose of this title, the following
definitions shall apply:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID32617FAA2E0D43208612BFD5C1C81A1F" reported-display-style="strikethrough"><enum>(1)</enum><header>Assessment</header><text>The
term <term>assessment</term> means the systematic collection, analysis, and
dissemination of information on health status, health needs, and health
problems.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDC904A08E7FC9492C9CFAB086C193E4D3" reported-display-style="strikethrough"><enum>(2)</enum><header>Alcohol-related
neurodevelopmental disorders or arnd</header><text>The term
<term>alcohol-related neurodevelopmental disorders</term> or <term>ARND</term>
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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID6FF3F80E195542A786EA984E7497F024" reported-display-style="strikethrough"><enum>(3)</enum><header>Behavioral
health aftercare</header><text>The term <term>behavioral health
aftercare</term> 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.)</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDC7DEFB710C9D42C5B65B28370E50C7FB" reported-display-style="strikethrough"><enum>(4)</enum><header>Dual
diagnosis</header><text>The term <term>dual diagnosis</term> means coexisting
substance abuse and mental illness conditions or diagnosis. Such clients are
sometimes referred to as mentally ill chemical abusers (MICAs).</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID9A6128190AAB445BA42FD90B87300EFA" reported-display-style="strikethrough"><enum>(5)</enum><header>Fetal alcohol
disorders</header><text>The term <term>fetal alcohol disorders</term> means
fetal alcohol syndrome, partial fetal alcohol syndrome and alcohol related
neurodevelopmental disorder (ARND).</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID4EBD671BD6804A2F96EE6EF31E181023" reported-display-style="strikethrough"><enum>(6)</enum><header>Fetal alcohol
syndrome or fas</header><text>The term <term>fetal alcohol syndrome</term> or
<term>FAS</term> means a syndrome in which, with a history of maternal alcohol
consumption during pregnancy, the following criteria are met:</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDCA3035F0754F43CAB95EBEC283747D09" reported-display-style="strikethrough"><enum>(A)</enum><text>Central nervous
system involvement such as developmental delay, intellectual deficit,
microencephaly, or neurologic abnormalities.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID36EF5797681A4EB89DB412E19BDE5E00" reported-display-style="strikethrough"><enum>(B)</enum><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID80AE0ED6423545D9A598B74915783310" reported-display-style="strikethrough"><enum>(C)</enum><text>Prenatal or
postnatal growth delay.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID7AE5D6F706334450978F68F3BCBBF3A7" reported-display-style="strikethrough"><enum>(7)</enum><header>Partial
fas</header><text>The term <term>partial FAS</term> 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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID030AA4E4A3A3438292F4AE8893BA7C26" reported-display-style="strikethrough"><enum>(8)</enum><header>Rehabilitation</header><text>The
term <term>rehabilitation</term> means to restore the ability or capacity to
engage in usual and customary life activities through education and
therapy.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID192CCBBE33D54E9DB367476F4BD132C5" reported-display-style="strikethrough"><enum>(9)</enum><header>Substance
abuse</header><text>The term <term>substance abuse</term> includes inhalant
abuse.</text>
</paragraph></section><section changed="deleted" committee-id="SLIA00" id="ID9D9E98F85BE64CD1ABCD46D8F17190C5" reported-display-style="strikethrough"><enum>715.</enum><header>Authorization
of appropriations</header><text display-inline="no-display-inline">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.</text>
</section><enum>VIII</enum><header>MISCELLANEOUS</header>
<section changed="deleted" committee-id="SLIA00" id="ID4D6DCDCC90EE406E9DA3D6AC46756C40" reported-display-style="strikethrough"><enum>801.</enum><header>Reports</header><text display-inline="no-display-inline">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:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID668390B1241246B48B06334A520FC02A" reported-display-style="strikethrough"><enum>(1)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID7FBD47F77EC040CA8F44B4294706B075" reported-display-style="strikethrough"><enum>(2)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID1D31A3B096EF4295ABAC068FB9FA5771" reported-display-style="strikethrough"><enum>(3)</enum><text>A report on the
use of health services by Indians—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDA2A8467686AE47CBB385B72E097C6F22" reported-display-style="strikethrough"><enum>(A)</enum><text>on a national and
area or other relevant geographical basis;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDE6F1FB8705154E1D88B7B9A7DE74BA8A" reported-display-style="strikethrough"><enum>(B)</enum><text>by gender and
age;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDFB9DF25396D24F3B9E09BF1C03518B45" reported-display-style="strikethrough"><enum>(C)</enum><text>by source of
payment and type of service;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID6A7174ADB88A48FEA0EE3F4F04CC373D" reported-display-style="strikethrough"><enum>(D)</enum><text>comparing such
rates of use with rates of use among comparable non-Indian populations;
and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID0B4BDD6021044B37A3C91913D2D6B278" reported-display-style="strikethrough"><enum>(E)</enum><text>provided under
contracts.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID382DA69EC18647B480A774623E615695" reported-display-style="strikethrough"><enum>(4)</enum><text>A report of
contractors to the Secretary on Health Care Educational Loan Repayments every 6
months required by section 110.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDDD88B613CC214190BCC5B631E3514F5C" reported-display-style="strikethrough"><enum>(5)</enum><text>A general audit
report of the Secretary on the Health Care Educational Loan Repayment Program
as required by section 110(n).</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF5922DBAF42441EDA5DE77A68365815F" reported-display-style="strikethrough"><enum>(6)</enum><text>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).</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDDA602201100444EEAA12553AF46BE335" reported-display-style="strikethrough"><enum>(7)</enum><text>A separate
statement which specifies the amount of funds requested to carry out the
provisions of section 201.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDAD182B1BEA9E4478A9243D16B487B8F9" reported-display-style="strikethrough"><enum>(8)</enum><text>A report of the
evaluations of health promotion and disease prevention as required in section
203(c).</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID6FA9574508C24A67971584016A07E46F" reported-display-style="strikethrough"><enum>(9)</enum><text>A biennial report
to Congress on infectious diseases as required by section 212.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDC1D0BF5C121B4587BEDF0E9406FB8B11" reported-display-style="strikethrough"><enum>(10)</enum><text>A report on
environmental and nuclear health hazards as required by section 215.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDD62858231D0148B1BBAFFF57CB0D9E6F" reported-display-style="strikethrough"><enum>(11)</enum><text>An annual report
on the status of all health care facilities needs as required by section
301(c)(2) and 301(d).</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID4C99CAA289AD450D8DBCB5515C4188BF" reported-display-style="strikethrough"><enum>(12)</enum><text>Reports on safe
water and sanitary waste disposal facilities as required by section
302(h).</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDADE6DE74D3F64931BDE6A67CB5BC2F09" reported-display-style="strikethrough"><enum>(13)</enum><text>An annual report
on the expenditure of nonservice funds for renovation as required by sections
304(b)(2).</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID4E27E20504EB4AD08606516774E30609" reported-display-style="strikethrough"><enum>(14)</enum><text>A report
identifying the backlog of maintenance and repair required at Service and
tribal facilities required by section 313(a).</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID4FCADC2AD95D4533B2C6E265FA1260C2" reported-display-style="strikethrough"><enum>(15)</enum><text>A report
providing an accounting of reimbursement funds made available to the Secretary
under titles XVIII, XIX, and XXI of the <act-name parsable-cite="SSA">Social
Security Act</act-name>.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDC32B8156E2404CB69548FFCC1B607B7D" reported-display-style="strikethrough"><enum>(16)</enum><text>A report on any
arrangements for the sharing of medical facilities or services, as authorized
by section 406.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDB29199C7B2ED417EAC9C97B1120C754B" reported-display-style="strikethrough"><enum>(17)</enum><text>A report on
evaluation and renewal of Urban Indian programs under section 505.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID316184C8A3CB4256A241B585090B0F18" reported-display-style="strikethrough"><enum>(18)</enum><text>A report on the
evaluation of programs as required by section 513(d).</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID4192BB3A2F254CF2A96CE89DAC30D982" reported-display-style="strikethrough"><enum>(19)</enum><text>A report on
alcohol and substance abuse as required by section 701(f).</text>
</paragraph></section><section changed="deleted" committee-id="SLIA00" id="ID233EFD2E1C1049A8B4E99BD48A150D3C" reported-display-style="strikethrough"><enum>802.</enum><header>Regulations</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDFBA0E74F8AEA4359A4597BCC854BC5D5" reported-display-style="strikethrough"><enum>(a)</enum><header>Deadlines</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID5CF71BBE8BAC4E7EABD932304CF9CCE5" reported-display-style="strikethrough"><enum>(1)</enum><header>Procedures</header><text>Not
later than 90 days after the date of enactment of the
<act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name>
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 <quote>Administrative Procedure Act</quote>). The
Secretary shall issue no regulations to carry out titles VI and VIII.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDDE3FDB9605664838BBC86BC4829EBB8B" reported-display-style="strikethrough"><enum>(2)</enum><header>Proposed
regulations</header><text>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 <act-name parsable-cite="IHCIA">Indian Health Care
Improvement Act</act-name> Amendments of 2005 and shall have no less than a
120-day comment period.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID08AE31B026964D8AB0995D45B3EC3FD4" reported-display-style="strikethrough"><enum>(3)</enum><header>Expiration of
authority</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID781E5E08505740429A0D34A47C4A1D38" reported-display-style="strikethrough"><enum>(b)</enum><header>Committee</header><text>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)).</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID011DDA247AC54F6CA5F9DFC02F2C496B" reported-display-style="strikethrough"><enum>(c)</enum><header>Adaptation of
Procedures</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID006304BD873843A3B21A7DE71E787F59" reported-display-style="strikethrough"><enum>(d)</enum><header>Lack of
Regulations</header><text>The lack of promulgated regulations shall not limit
the effect of this Act.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID1FB82A7A41044365A54631D41870EB03" reported-display-style="strikethrough"><enum>(e)</enum><header>Inconsistent
Regulations</header><text>The provisions of this Act shall supersede any
conflicting provisions of law) in effect on the day before the date of
enactment of the <act-name parsable-cite="IHCIA">Indian Health Care Improvement
Act</act-name> Amendments of 2005, and the Secretary is authorized to repeal
any regulation inconsistent with the provisions of this Act.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDCF844B3FB6B84C19A858FE66667C8562" reported-display-style="strikethrough"><enum>803.</enum><header>Plan of
implementation</header><text display-inline="no-display-inline">Not later than
9 months after the date of enactment of the <act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name> 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.</text>
</section><section changed="deleted" committee-id="SLIA00" id="ID7B73E6E820324099BF972DAE3A62D0A6" reported-display-style="strikethrough"><enum>804.</enum><header>Availability of
funds</header><text display-inline="no-display-inline">The funds appropriated
pursuant to this Act shall remain available until expended.</text>
</section><section changed="deleted" committee-id="SLIA00" id="ID5872C0D083D34CE89645B08D26878272" reported-display-style="strikethrough"><enum>805.</enum><header>Limitation on
use of funds appropriated to the Indian Health Service</header><text display-inline="no-display-inline">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.</text>
</section><section changed="deleted" committee-id="SLIA00" id="IDE5F58CB632A94271B61B49D95979E933" reported-display-style="strikethrough"><enum>806.</enum><header>Eligibility of
California Indians</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID3BE9F283EDA94D1ABB3E40941395F331" reported-display-style="strikethrough"><enum>(a)</enum><header>In
General</header><text>The following California Indians shall be eligible for
health services provided by the Service:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDB321503F21964318944AF28B19E6106A" reported-display-style="strikethrough"><enum>(1)</enum><text>Any member of a
federally recognized Indian Tribe.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID38ACB80C6B2B49BCB6DBC4D84FDE78BF" reported-display-style="strikethrough"><enum>(2)</enum><text>Any descendant of
an Indian who was residing in California on June 1, 1852, if such
descendant—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDED40F09C74494716BF11AE653A2ED422" reported-display-style="strikethrough"><enum>(A)</enum><text>is a member of the
Indian community served by a local program of the Service; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDBA65194708ED4349A9D6EBBD180A7F68" reported-display-style="strikethrough"><enum>(B)</enum><text>is regarded as an
Indian by the community in which such descendant lives.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDD81D45BCCCF34C3AA3DFD2BFB529B34E" reported-display-style="strikethrough"><enum>(3)</enum><text>Any Indian who
holds trust interests in public domain, national forest, or reservation
allotments in California.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID2719DFA469224428A3234748E01C5B4D" reported-display-style="strikethrough"><enum>(4)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID52BEBE35B2E24F68A904E4F7B3D61CCE" reported-display-style="strikethrough"><enum>(b)</enum><header>Clarification</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDE14300FE17DD43B387023FABF9B02D6F" reported-display-style="strikethrough"><enum>807.</enum><header>Health Services
for ineligible persons</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID1844D716151942B2A4B576450F485E6F" reported-display-style="strikethrough"><enum>(a)</enum><header>Children</header><text>Any
individual who—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID1D4992A4430F4DDC879EF230FCDAF0D9" reported-display-style="strikethrough"><enum>(1)</enum><text>has not attained
19 years of age;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID2572022754CE40E4B523C5F18E4F4D86" reported-display-style="strikethrough"><enum>(2)</enum><text>is the natural or
adopted child, stepchild, foster child, legal ward, or orphan of an eligible
Indian; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID21AC7C5E6995408BB11F98823BF76325" reported-display-style="strikethrough"><enum>(3)</enum><text>is not otherwise
eligible for health services provided by the Service,</text>
</paragraph><continuation-text changed="deleted" committee-id="SLIA00" continuation-text-level="subsection" reported-display-style="strikethrough">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.</continuation-text></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID7F21AC247B314C74BCB17264685C5A9F" reported-display-style="strikethrough"><enum>(b)</enum><header>Spouses</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDBDFD8093DF414DF6BEC64335DFAAF210" reported-display-style="strikethrough"><enum>(c)</enum><header>Provision of
Services to Other Individuals</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID72D3DDD9B4884514B2A236271442FD7F" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>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—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID1D6596F5FA6B46A4A6C1EEFF837F73A7" reported-display-style="strikethrough"><enum>(A)</enum><text>the Indian Tribes
served by such Service Unit request such provision of health services to such
individuals; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID8F4FF1CD426E46CEAA943A1EFD35056E" reported-display-style="strikethrough"><enum>(B)</enum><text>the Secretary and
the served Indian Tribes have jointly determined that—</text>
<clause changed="deleted" committee-id="SLIA00" id="IDB3CAE571446B4A25B3A18648BD006323" reported-display-style="strikethrough"><enum>(i)</enum><text>the provision of
such health services will not result in a denial or diminution of health
services to eligible Indians; and</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="ID78CF31B8B5B24AE38F29FBCC025FBEB0" reported-display-style="strikethrough"><enum>(ii)</enum><text>there is no
reasonable alternative health facilities or services, within or without the
Service Unit, available to meet the health needs of such individuals.</text>
</clause></subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID348E41DBD6DC44CE9E93419BA3636BE9" reported-display-style="strikethrough"><enum>(2)</enum><header>ISDEAA
programs</header><text>In the case of health programs and facilities operated
under a contract or compact entered into under the
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (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).</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDC10B0C1B47784EF9B8CD8624BE84B73A" reported-display-style="strikethrough"><enum>(3)</enum><header>Payment for
services</header>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID667B72D1C1FD4562A3F9216A8D8B8B89" reported-display-style="strikethrough"><enum>(A)</enum><header>In
general</header><text>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 <act-name parsable-cite="SSA">Social Security
Act</act-name>, 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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDBE3A44BB4F054CFCAD410A8F058C0C96" reported-display-style="strikethrough"><enum>(B)</enum><header>Indigent
people</header><text>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.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID67763B8F2D6640A9988480A21DCF3CB6" reported-display-style="strikethrough"><enum>(4)</enum><header>Revocation of
consent for services</header>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDDA22A11F75944CA78C502126CAD0949C" reported-display-style="strikethrough"><enum>(A)</enum><header>Single tribe
service area</header><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID8EA8F151217E4EC3BBA0F92A4046A8CB" reported-display-style="strikethrough"><enum>(B)</enum><header>Multitribal
service area</header><text>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.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDBDA82118BE234BD8AEE606DE62D52004" reported-display-style="strikethrough"><enum>(d)</enum><header>Other
Services</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID9AD24C4177E84089A46268A802FBF618" reported-display-style="strikethrough"><enum>(1)</enum><text>achieve stability
in a medical emergency;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID89D89F2684954654B35DD0512C14D9AE" reported-display-style="strikethrough"><enum>(2)</enum><text>prevent the spread
of a communicable disease or otherwise deal with a public health hazard;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDCA250625695346F2AD6ECF98F8CA98B0" reported-display-style="strikethrough"><enum>(3)</enum><text>provide care to
non-Indian women pregnant with an eligible Indian’s child for the duration of
the pregnancy through postpartum; or</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDE2F0BD04A5314C20B8D4A2E371DF8F9F" reported-display-style="strikethrough"><enum>(4)</enum><text>provide care to
immediate family members of an eligible individual if such care is directly
related to the treatment of the eligible individual.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID772CFC9C91484171A0033C850A526597" reported-display-style="strikethrough"><enum>(e)</enum><header>Hospital
Privileges for Practitioners</header><text>Hospital privileges in health
facilities operated and maintained by the Service or operated under a contract
or compact pursuant to the <act-name parsable-cite="ISDA">Indian
Self-Determination and Education Assistance Act</act-name> (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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID33792330FC7548D9B7EFBDEC2D7A7BB8" reported-display-style="strikethrough"><enum>(f)</enum><header>Eligible
Indian</header><text>For purposes of this section, the term <term>eligible
Indian</term> means any Indian who is eligible for health services provided by
the Service without regard to the provisions of this section.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDD8550F4FC8BB479E991AE39BDBFCD8AF" reported-display-style="strikethrough"><enum>808.</enum><header>Reallocation of
base resources</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDA8D04AA0D94F4D37B6ED6B0832C2C975" reported-display-style="strikethrough"><enum>(a)</enum><header>Report
Required</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID08F02C0ED47D4B6AB8F010E4BC072C68" reported-display-style="strikethrough"><enum>(b)</enum><header>Exception</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID49EC8D8CC5B643748DE64757730FBB00" reported-display-style="strikethrough"><enum>809.</enum><header>Results of
demonstration projects</header><text display-inline="no-display-inline">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.</text>
</section><section changed="deleted" committee-id="SLIA00" id="ID1F9E83C519114128B010315A5549337B" reported-display-style="strikethrough"><enum>810.</enum><header>Provision of
Services in Montana</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDCFEF944F1E9044A3B928EC4E035D73D9" reported-display-style="strikethrough"><enum>(a)</enum><header>Consistent With
Court Decision</header><text>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).</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID1EB5CF5AA8014E868B47CD716FE3AFD1" reported-display-style="strikethrough"><enum>(b)</enum><header>Clarification</header><text>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.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="ID1F97B36BFC0348238DE53309A2AE63CF" reported-display-style="strikethrough"><enum>811.</enum><header>Moratorium</header><text display-inline="no-display-inline">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.</text>
</section><section changed="deleted" committee-id="SLIA00" id="IDDF0E42B99C094279AAA7E11B2C40AFC0" reported-display-style="strikethrough"><enum>812.</enum><header>Tribal
employment</header><text display-inline="no-display-inline">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
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (25 U.S.C. 450 et seq.) shall not be considered an
<quote>employer</quote>.</text>
</section><section changed="deleted" committee-id="SLIA00" id="ID34C5CAFA73B9484998780FF815775EDB" reported-display-style="strikethrough"><enum>813.</enum><header>Severability
provisions</header><text display-inline="no-display-inline">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.</text>
</section><section changed="deleted" committee-id="SLIA00" id="ID949A551E9E9840549E36950126153C4A" reported-display-style="strikethrough"><enum>814.</enum><header>Establishment
of National Bipartisan Commission on Indian Health Care</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID76532034AFA24A39B9756AD7C07B6F38" reported-display-style="strikethrough"><enum>(a)</enum><header>Establishment</header><text>There
is established the National Bipartisan Indian Health Care Commission (the
<quote>Commission</quote>).</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID92DF2EAB7219465DB392D63C5D0C585F" reported-display-style="strikethrough"><enum>(b)</enum><header>Duties of
Commission</header><text>The duties of the Commission are the following:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID9A475A6AFE8C447C843F5DD3657A4C74" reported-display-style="strikethrough"><enum>(1)</enum><text>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:</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID682E304FC9794F7E8CB00CD6DAF69AF8" reported-display-style="strikethrough"><enum>(A)</enum><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID4ADB2FF7EB6A4795B06477D5AFD1E54E" reported-display-style="strikethrough"><enum>(B)</enum><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID12BBAEE3648F4B56BBCD47B6BDC91362" reported-display-style="strikethrough"><enum>(C)</enum><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID3FB92431D3F64144982623C0797A8EF5" reported-display-style="strikethrough"><enum>(D)</enum><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID5F064685265A4FFD8B3CD9CE69C8B34C" reported-display-style="strikethrough"><enum>(E)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDEF0DD1F3E87B4699BFE58BC6CD71C59C" reported-display-style="strikethrough"><enum>(2)</enum><text>To review and
analyze the recommendations of the report of the study committee.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID887A84823F7046FF8BE59CE9EF5C7EEB" reported-display-style="strikethrough"><enum>(3)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF53E3C2F67C444A7A27397A21065D732" reported-display-style="strikethrough"><enum>(4)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDE53515C9BAE84D94B4E975BA6FDFEB64" reported-display-style="strikethrough"><enum>(c)</enum><header>Members</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID2ACD6751C8584BB7BAB6644202B328D8" reported-display-style="strikethrough"><enum>(1)</enum><header>Appointment</header><text>The
Commission shall be composed of 25 members, appointed as follows:</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID62294A413C2B48F4A1F209868205FCF1" reported-display-style="strikethrough"><enum>(A)</enum><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID0009809CCFD745A8AA521B0B0102EE74" reported-display-style="strikethrough"><enum>(B)</enum><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDEF7C970BD80C45DF81F3B2CB844A2223" reported-display-style="strikethrough"><enum>(C)</enum><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID01ADE6CE81BD42E2A8AF7A7A094572F1" reported-display-style="strikethrough"><enum>(D)</enum><text>All those persons
chosen by the congressional members of the Commission and by the Director shall
be members of federally recognized Indian Tribes.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDBFF0C020A40A4E519821BA1C69BC6758" reported-display-style="strikethrough"><enum>(2)</enum><header>Chair; vice
chair</header><text>The Chair and Vice Chair of the Commission shall be
selected by the congressional members of the Commission.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID4601966F4B774F39AB8184C26FF364CB" reported-display-style="strikethrough"><enum>(3)</enum><header>Terms</header><text>The
terms of members of the Commission shall be for the life of the
Commission.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDBAD1FB641B78464A8E0664D0D43E7D29" reported-display-style="strikethrough"><enum>(4)</enum><header>Deadline for
appointments</header><text>Congressional members of the Commission shall be
appointed not later than 180 days after the date of enactment of the
<act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name>
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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDCCA14E1A224B403ABF555B1D694FD12B" reported-display-style="strikethrough"><enum>(5)</enum><header>Vacancy</header><text>A
vacancy in the Commission shall be filled in the manner in which the original
appointment was made.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDEBD9C022B2814F89BCD72692EB28F5BE" reported-display-style="strikethrough"><enum>(d)</enum><header>Compensation</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID33DBAD30424147CA8F3CF923D7759352" reported-display-style="strikethrough"><enum>(1)</enum><header>Congressional
members</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID15EB2AE66989428E90D7A433FEBD5CC4" reported-display-style="strikethrough"><enum>(2)</enum><header>Other
members</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID62A38C9A17024AFEB428A4014FBE602C" reported-display-style="strikethrough"><enum>(e)</enum><header>Meetings</header><text>The
Commission shall meet at the call of the Chair.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID440DF3FB39E94986AEBD20BF8183B381" reported-display-style="strikethrough"><enum>(f)</enum><header>Quorum</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID513FEE008B7B45ACBDFC596F6F2A25EF" reported-display-style="strikethrough"><enum>(g)</enum><header>Executive
Director; Staff; Facilities</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID77B96E3C084144398560D6826E9F5FAF" reported-display-style="strikethrough"><enum>(1)</enum><header>Appointment;
pay</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDD06E4C9EB6EB428485C7B08F1CCA334F" reported-display-style="strikethrough"><enum>(2)</enum><header>Staff
appointment</header><text>With the approval of the Commission, the executive
director may appoint such personnel as the executive director deems
appropriate.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID48CAB818DF40414BB5EE145ED216EB57" reported-display-style="strikethrough"><enum>(3)</enum><header>Staff
pay</header><text>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).</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF6BFC8EBCECA472B8D6BDA800AC0B198" reported-display-style="strikethrough"><enum>(4)</enum><header>Temporary
services</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID6C74C185AB1644C88A38B4DC89790415" reported-display-style="strikethrough"><enum>(5)</enum><header>Facilities</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDFE896E9BF96645AFAFFF5E015B4CCC38" reported-display-style="strikethrough"><enum>(h)</enum><header>Hearings</header><paragraph commented="no" display-inline="yes-display-inline" id="ID0B05F4635EC24BE5A0AEA805DBF21D1F"><enum>(1)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID8CDE50C5B5FE44C089785E652342E335" indent="up1" reported-display-style="strikethrough"><enum>(2)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID1E3953E7FE864FBFACC26336B0F102B0" indent="up1" reported-display-style="strikethrough"><enum>(3)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="IDC7986809EC45477C9881F27B952443A6"><enum>(A)</enum><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID0E932867C837490681E4FEBA9BF565B0" indent="up1" reported-display-style="strikethrough"><enum>(B)</enum><text>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).</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDE17269F392754B05B88FBBA5797CE3C4" indent="up1" reported-display-style="strikethrough"><enum>(4)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID52C350B71E0A4A619F874167A25D0B24" indent="up1" reported-display-style="strikethrough"><enum>(5)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID4CED440D331E427BB84E119F00C77CA4" indent="up1" reported-display-style="strikethrough"><enum>(6)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDCEDEEED8EB924689B879EAF082B5D6B2" indent="up1" reported-display-style="strikethrough"><enum>(7)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF04E5CAA618E4D1CAAFDC7A2D803BA76" indent="up1" reported-display-style="strikethrough"><enum>(8)</enum><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID925C816E38394C07BB455E8FCD888054" indent="up1" reported-display-style="strikethrough"><enum>(9)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID58D60A4CAB0A4B32944411E042C6069A" reported-display-style="strikethrough"><enum>(i)</enum><header>Authorization of
Appropriations</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="IDF2188930C34B485B93E81ED09024E271" reported-display-style="strikethrough"><enum>(j)</enum><header>FACA</header><text>The
<act-name parsable-cite="FACA">Federal Advisory Committee Act</act-name> (5
U.S.C. App.) shall not apply to the Commission.</text>
</subsection></section><section changed="deleted" committee-id="SLIA00" id="IDC59D7721101346638D137ACDD8A95940" reported-display-style="strikethrough"><enum>815.</enum><header>Appropriations;
availability</header><text display-inline="no-display-inline">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.</text>
</section><section changed="deleted" committee-id="SLIA00" id="ID3C1E1501CC3F4379926EB7839EF9F245" reported-display-style="strikethrough"><enum>816.</enum><header>Authorization
of appropriations</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDE21C2651C0424C9BAF1E9E7F8AF044A5" reported-display-style="strikethrough"><enum>(a)</enum><header>In
General</header><text>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.</text>
</subsection></section>.
(b)
(1)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)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)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:
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
.
3.Soboba sanitation
facilitiesThe Act of December
17, 1970 (84 Stat. 1465), is amended by adding at the end the following new
section:
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).
.
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 servicesSection 1911 of the
Social Security Act (42 U.S.C. 1396j)
is amended—
(A)by amending the
heading to read as follows:
;
and
(B)by amending
subsection (a) to read as follows:
(a)Eligibility for
Reimbursement for Medical AssistanceThe 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 provisionSuch section is amended by striking
subsection (b).
(3)Revision of
authority to enter into agreementsSubsection (c) of such section
is redesignated as subsection (b) and is amended to read as follows:
(b)Authority To
Enter Into AgreementsThe 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)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)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
EntitiesA 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)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
OrganizationsSection 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 paymentsFor 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
.
5.Native American
Health and Wellness Foundation
(a)The Indian
Self-Determination and Education Assistance Act (25 U.S.C. 450 et
seq.) is amended by adding at the end the following:
<enum>VIII</enum><header>NATIVE AMERICAN
HEALTH AND WELLNESS FOUNDATION</header>
<section changed="deleted" committee-id="SLIA00" id="ID53CBF88A3D8846008E9D9C97E98A4910" reported-display-style="strikethrough"><enum>801.</enum><header>Definitions</header><text display-inline="no-display-inline">In this title:</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDDE83E6BCE8A54E679B462E6603414F51" reported-display-style="strikethrough"><enum>(1)</enum><header>Board</header><text>The
term <term>Board</term> means the Board of Directors of the Foundation.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID8F1777FBDBA8400FA11A6FE194157A55" reported-display-style="strikethrough"><enum>(2)</enum><header>Committee</header><text>The
term <term>Committee</term> means the Committee for the Establishment of Native
American Health and Wellness Foundation established under section
802(f).</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID105AD242CCF94B8CB524AF3A7A851644" reported-display-style="strikethrough"><enum>(3)</enum><header>Foundation</header><text>The
term <term>Foundation</term> means the Native American Health and Wellness
Foundation established under section 802.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID2A4B052BC8A5484C9A5FB1783876A467" reported-display-style="strikethrough"><enum>(4)</enum><header>Secretary</header><text>The
term <term>Secretary</term> means the Secretary of Health and Human
Services.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID3151D854007A41DBA1C06143BC8A3293" reported-display-style="strikethrough"><enum>(5)</enum><header>Service</header><text>The
term <term>Service</term> means the Indian Health Service of the Department of
Health and Human Services.</text>
</paragraph></section><section changed="deleted" committee-id="SLIA00" id="ID80FC4B93C0884B61B152573DB0C78E53" reported-display-style="strikethrough"><enum>802.</enum><header>Native American
Health and Wellness Foundation</header>
<subsection changed="deleted" committee-id="SLIA00" id="ID20C042AA1CA449AFB98C5D211BEF6906" reported-display-style="strikethrough"><enum>(a)</enum><header>In
General</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID66AB9B3D63A7454484EF397B34A06615" reported-display-style="strikethrough"><enum>(b)</enum><header>Perpetual
Existence</header><text>The Foundation shall have perpetual existence.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID50A10EB099144CF3A904127864C63BD8" reported-display-style="strikethrough"><enum>(c)</enum><header>Nature of
Corporation</header><text>The Foundation—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDD94024DF6CC04A86BBBD76D0C659B292" reported-display-style="strikethrough"><enum>(1)</enum><text>shall be a
charitable and nonprofit federally chartered corporation; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID3331542C5BDA4BCCBA71E052539F7E87" reported-display-style="strikethrough"><enum>(2)</enum><text>shall not be an
agency or instrumentality of the United States.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID729FC946C8D0451AB3E93C21DF1B70D3" reported-display-style="strikethrough"><enum>(d)</enum><header>Place of
Incorporation and Domicile</header><text>The Foundation shall be incorporated
and domiciled in the District of Columbia.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID4F4D390A5E234188822C1EF052F12888" reported-display-style="strikethrough"><enum>(e)</enum><header>Duties</header><text>The
Foundation shall—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDB549D395F8A84D71AA63EBD08EDA1EAE" reported-display-style="strikethrough"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID6E9C77C5D02A4A16B09C7C3573DA95D1" reported-display-style="strikethrough"><enum>(2)</enum><text>undertake and
conduct such other activities as will further the health and wellness
activities and opportunities of Native Americans; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDE9D138A3872841B78B5C568B6A854B05" reported-display-style="strikethrough"><enum>(3)</enum><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID04F27628135544149744FDDDF744354A" reported-display-style="strikethrough"><enum>(f)</enum><header>Committee for
the Establishment of Native American Health and Wellness Foundation</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID068A4098C9564CA5925590CBF631D117" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>The Secretary shall establish the Committee for the
Establishment of Native American Health and Wellness Foundation to assist the
Secretary in establishing the Foundation.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDDB58D02EAAEE4CCA9B5047E92D9C1A04" reported-display-style="strikethrough"><enum>(2)</enum><header>Duties</header><text>Not
later than 180 days after the date of enactment of this section, the Committee
shall—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID2E7B9126283841C68A10D929DEFADE54" reported-display-style="strikethrough"><enum>(A)</enum><text>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;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDBB27CE7423994391AAAF256D888F5B90" reported-display-style="strikethrough"><enum>(B)</enum><text>ensure that the
Foundation qualifies for and maintains the status required to carry out this
section, until the Board is established;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID4774D914D3614ACDAF345D2F3EB31F9A" reported-display-style="strikethrough"><enum>(C)</enum><text>establish the
constitution and initial bylaws of the Foundation;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID61EB26DD3B234416919B4AB8506A5CDB" reported-display-style="strikethrough"><enum>(D)</enum><text>provide for the
initial operation of the Foundation, including providing for temporary or
interim quarters, equipment, and staff; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID9985D249C20045C9A5B9D028336D8724" reported-display-style="strikethrough"><enum>(E)</enum><text>appoint the
initial members of the Board in accordance with the constitution and initial
bylaws of the Foundation.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID8DD27A532B264A43A7B1A9CB4837A982" reported-display-style="strikethrough"><enum>(g)</enum><header>Board of
Directors</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID1D62F196592A480FB93D07B2DEBCB1B0" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>The Board of Directors shall be the governing body of the
Foundation.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID959F59AB135E465F933D6DD8CD417EB2" reported-display-style="strikethrough"><enum>(2)</enum><header>Powers</header><text>The
Board may exercise, or provide for the exercise of, the powers of the
Foundation.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDDA27CA280E0E401AAF6ACC88F1ED69A2" reported-display-style="strikethrough"><enum>(3)</enum><header>Selection</header>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID4A32741CD2994B38838ABD8821FF5F61" reported-display-style="strikethrough"><enum>(A)</enum><header>In
general</header><text>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.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID9874625A4DC44A6686DED9306983635C" reported-display-style="strikethrough"><enum>(B)</enum><header>Requirements</header>
<clause changed="deleted" committee-id="SLIA00" id="ID40988FA857374E20AEA95E31EE285C2B" reported-display-style="strikethrough"><enum>(i)</enum><header>Number of
members</header><text>The Board shall have at least 11 members, who shall have
staggered terms.</text>
</clause><clause changed="deleted" committee-id="SLIA00" id="IDDA12E9FCD1F64DB3829F64ACCD66C170" reported-display-style="strikethrough"><enum>(ii)</enum><header>Initial voting
members</header><text>The initial voting members of the Board—</text>
<subclause changed="deleted" committee-id="SLIA00" id="ID75AADC7E6EC147299A174535F7287D11" reported-display-style="strikethrough"><enum>(I)</enum><text>shall be appointed
by the Committee not later than 180 days after the date on which the Foundation
is established; and</text>
</subclause><subclause changed="deleted" committee-id="SLIA00" id="IDBD76CDD93D84421D9651071FE2C81FF3" reported-display-style="strikethrough"><enum>(II)</enum><text>shall have
staggered terms.</text>
</subclause></clause><clause changed="deleted" committee-id="SLIA00" id="IDEBCB79D588DD4F6B895ED0580021B3B5" reported-display-style="strikethrough"><enum>(iii)</enum><header>Qualification</header><text>The
members of the Board shall be United States citizens who are knowledgeable or
experienced in Native American health care and related matters.</text>
</clause></subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID90DB701D78484F93BFFD1E5968ACF1D4" reported-display-style="strikethrough"><enum>(C)</enum><header>Compensation</header><text>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.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDEE005B3FA4E74E1E832DC4CABFE7ABDA" reported-display-style="strikethrough"><enum>(h)</enum><header>Officers</header>
<paragraph changed="deleted" committee-id="SLIA00" id="IDE6389430E7B845968B67164245227730" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>The officers of the Foundation shall be—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDDA5C23F8DF1340BFA42F4035AFF7AE3A" reported-display-style="strikethrough"><enum>(A)</enum><text>a secretary,
elected from among the members of the Board; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID300318BBB4104B44BD8C0ED55C3974D1" reported-display-style="strikethrough"><enum>(B)</enum><text>any other officers
provided for in the constitution and bylaws of the Foundation.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF4CF7C585CFA48E9A466F4041793896E" reported-display-style="strikethrough"><enum>(2)</enum><header>Secretary</header><text>The
secretary of the Foundation shall serve, at the direction of the Board, as the
chief operating officer of the Foundation.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID4AA7C245DC0A4FAE9EF2D8EA148611EE" reported-display-style="strikethrough"><enum>(3)</enum><header>Election</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID3C95FFC960C54569849454D452574218" reported-display-style="strikethrough"><enum>(i)</enum><header>Powers</header><text>The
Foundation—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID598661C4729B4CE39651C2F350863AC7" reported-display-style="strikethrough"><enum>(1)</enum><text>shall adopt a
constitution and bylaws for the management of the property of the Foundation
and the regulation of the affairs of the Foundation;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID85F6580D3A1146E0AC33348A25F96347" reported-display-style="strikethrough"><enum>(2)</enum><text>may adopt and
alter a corporate seal;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDDA9CBA50A7904F5EA2BA55A81259CFF8" reported-display-style="strikethrough"><enum>(3)</enum><text>may enter into
contracts;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDCE9B4CC71B9C4650984A20E5F32F76D3" reported-display-style="strikethrough"><enum>(4)</enum><text>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;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDA32B63F3BFC64783AB90E40FF7B6FFE0" reported-display-style="strikethrough"><enum>(5)</enum><text>may sue and be
sued; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID08002C79A8EE4700805997ECE5F0E0A8" reported-display-style="strikethrough"><enum>(6)</enum><text>may perform any
other act necessary and proper to carry out the purposes of the
Foundation.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID32E9B11A622B4ACE9596D1BD0714197B" reported-display-style="strikethrough"><enum>(j)</enum><header>Principal
Office</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID3BBB9E7A60E84D7B93588EB045152FDC" reported-display-style="strikethrough"><enum>(1)</enum><header>In
General</header><text>The principal office of the Foundation shall be in the
District of Columbia.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID8897CE16064749F9A4E448F6D3267E3A" reported-display-style="strikethrough"><enum>(2)</enum><header>Activities;
offices</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID8D1EBE75A1CB4672B2E31539B399E69C" reported-display-style="strikethrough"><enum>(k)</enum><header>Service of
Process</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID796AA4CBE76549DC96C40DAA73A2A90F" reported-display-style="strikethrough"><enum>(l)</enum><header>Liability of
Officers, Employees, and Agents</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID02ABEBBE199A43AEB895B8380BE31D04" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>The Foundation shall be liable for the acts of the
officers, employees, and agents of the Foundation acting within the scope of
their authority.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDE7F0B8B157C847448770435865D4ED5E" reported-display-style="strikethrough"><enum>(2)</enum><header>Personal
liability</header><text>A member of the Board shall be personally liable only
for gross negligence in the performance of the duties of the member.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID9058BE223DBA4DE48162FA8E130CDE04" reported-display-style="strikethrough"><enum>(m)</enum><header>Restrictions</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID61BFDA6C49B0493A9268B4964DAF1098" reported-display-style="strikethrough"><enum>(1)</enum><header>Limitation on
spending</header><text>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—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="ID531D47B1C7CC4F99BC42DFD8D916ED90" reported-display-style="strikethrough"><enum>(A)</enum><text>the amounts
transferred to the Foundation under subsection (o) during the preceding fiscal
year; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="ID852878E38ADB4DDCACE28B4244B9D207" reported-display-style="strikethrough"><enum>(B)</enum><text>donations received
from private sources during the preceding fiscal year.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDC4FD20260C2247E7BAB027B8E2590D51" reported-display-style="strikethrough"><enum>(2)</enum><header>Appointment and
hiring</header><text>The appointment of officers and employees of the
Foundation shall be subject to the availability of funds.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID3943278E64354BDFAB2F2ED2563B4641" reported-display-style="strikethrough"><enum>(3)</enum><header>Status</header><text>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.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="IDFA791D215B8145E597B5B8520FBFB09C" reported-display-style="strikethrough"><enum>(n)</enum><header>Audits</header><text>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.</text>
</subsection><subsection changed="deleted" committee-id="SLIA00" id="ID5342970CDE0B44D486AA0D5DDE8CA090" reported-display-style="strikethrough"><enum>(o)</enum><header>Funding</header>
<paragraph changed="deleted" committee-id="SLIA00" id="ID9A10D6BAB6D94CF184FE56494AAFA68F" reported-display-style="strikethrough"><enum>(1)</enum><header>Authorization of
appropriations</header><text>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.</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF3B080A48EFF4E73A42DBB5B5626C6FE" reported-display-style="strikethrough"><enum>(2)</enum><header>Transfer of
donated funds</header><text>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.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SLIA00" id="ID63C6FD9303824AED9DF50ADE2E0C2864" reported-display-style="strikethrough"><enum>803.</enum><header>Administrative
Services and support</header>
<subsection changed="deleted" committee-id="SLIA00" id="IDEB2365F2BB584F319B871BC5BB62849F" reported-display-style="strikethrough"><enum>(a)</enum><header>Provision of
Support by Secretary</header><text>Subject to subsection (b), during the 5-year
period beginning on the date on which the Foundation is established, the
Secretary—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDF11A3EB98B634261AFE50EEE24044C24" reported-display-style="strikethrough"><enum>(1)</enum><text>may provide
personnel, facilities, and other administrative support services to the
Foundation;</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID94379BE98E894233BB6448D8428F7FB6" reported-display-style="strikethrough"><enum>(2)</enum><text>may provide funds
for initial operating costs and to reimburse the travel expenses of the members
of the Board; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDE70A4CD49B2E41E7B6B900F90FE56304" reported-display-style="strikethrough"><enum>(3)</enum><text>shall require and
accept reimbursements from the Foundation for—</text>
<subparagraph changed="deleted" committee-id="SLIA00" id="IDA14233ACAAE141F1907B3AD54A102992" reported-display-style="strikethrough"><enum>(A)</enum><text>services provided
under paragraph (1); and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SLIA00" id="IDD01BED946387476A82695B80D93BACA8" reported-display-style="strikethrough"><enum>(B)</enum><text>funds provided
under paragraph (2).</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID3EF67FB223654D2BA7106C99995F9C91" reported-display-style="strikethrough"><enum>(b)</enum><header>Reimbursement</header><text>Reimbursements
accepted under subsection (a)(3)—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="IDCF2AC5D2D46C4D209FB6C45738BCF08D" reported-display-style="strikethrough"><enum>(1)</enum><text>shall be deposited
in the Treasury of the United States to the credit of the applicable
appropriations account; and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="ID5C8DEA5CD4F6465D9F3FCB940031E5F7" reported-display-style="strikethrough"><enum>(2)</enum><text>shall be
chargeable for the cost of providing services described in subsection (a)(1)
and travel expenses described in subsection (a)(2).</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SLIA00" id="ID7C46BAF4C7D74ABABA44787A00D59B59" reported-display-style="strikethrough"><enum>(c)</enum><header>Continuation of
Certain Services</header><text>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—</text>
<paragraph changed="deleted" committee-id="SLIA00" id="ID4A7391B30BAA4ACD9E74F9415335CFDE" reported-display-style="strikethrough"><enum>(1)</enum><text>are available;
and</text>
</paragraph><paragraph changed="deleted" committee-id="SLIA00" id="IDF8A94A6EA7924B218C8D91475ADCED54" reported-display-style="strikethrough"><enum>(2)</enum><text>are provided on
reimbursable cost
basis.</text>
</paragraph></subsection></section>.
(b)The Indian
Self-Determination and Education Assistance Act is amended—
(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;
(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
(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
.
1.This Act may be cited as the
Indian Health Care Improvement
Act Amendments of 2005
.
2.Indian Health Care Improvement Act
amended
(a)The Indian Health Care
Improvement Act (25 U.S.C. 1601 et seq.) is amended to read as
follows:
1.Short title; table of
contents
(a)This Act may be cited as the Indian
Health Care Improvement Act
.
(b)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.
2.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.
3.Declaration of National
Indian Health policyCongress
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.
4.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).
<enum>I</enum><header>INDIAN HEALTH, HUMAN
RESOURCES, AND DEVELOPMENT</header>
<section changed="added" committee-id="SLIA00" id="IDE71470BEDCA84ECCB1DC4BAA938C46FC" reported-display-style="italic"><enum>101.</enum><header>Purpose</header><text display-inline="no-display-inline">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.</text>
</section><section changed="added" committee-id="SLIA00" id="IDB9DD3676388F44CF8AF0228E6E61A4B7" reported-display-style="italic"><enum>102.</enum><header>Health professions
recruitment Program for Indians</header>
<subsection changed="added" committee-id="SLIA00" id="IDE99C20D1A71D4109BE5DFC6BB0F6A241" reported-display-style="italic"><enum>(a)</enum><header>In
General</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDEF8AFAF497764BE9B667FC7BC35B6E69" reported-display-style="italic"><enum>(1)</enum><text>identifying Indians with
a potential for education or training in the health professions and encouraging
and assisting them—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID18AE5F18BAB74F82AA9DFCD9A51A6F1C" reported-display-style="italic"><enum>(A)</enum><text>to enroll in courses of
study in such health professions; or</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID60E67F8351654007A23B1FAFB0A611AA" reported-display-style="italic"><enum>(B)</enum><text>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;</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID7958E2F48DF54F3F9B873FCCE97CDF4D" reported-display-style="italic"><enum>(2)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDD5FB2A59C8E34A0082353CD75E3A0536" reported-display-style="italic"><enum>(3)</enum><text>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).</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID69AEBCEECD0E46E5A7CB6648A54339FA" reported-display-style="italic"><enum>(b)</enum><header>Funding</header>
<paragraph changed="added" committee-id="SLIA00" id="ID74EFB18B98DE4C05A1515D7AF7BF3B5D" reported-display-style="italic"><enum>(1)</enum><header>Application</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDED845EB9242D45ADB38BAD416FCFAD36" reported-display-style="italic"><enum>(2)</enum><header>Amount of grants;
payment</header><text>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.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="ID2AF56ED459DA4758B9748B04ECD84AB3" reported-display-style="italic"><enum>103.</enum><header>Health professions
preparatory scholarship Program for Indians</header>
<subsection changed="added" committee-id="SLIA00" id="ID1D71ED7CF3F148BDA4DC39683DEC162F" reported-display-style="italic"><enum>(a)</enum><header>Scholarships
Authorized</header><text>The Secretary, acting through the Service, shall
provide scholarship grants to Indians who—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID5673A3020C5D4A03967D7464B525F781" reported-display-style="italic"><enum>(1)</enum><text>have successfully
completed their high school education or high school equivalency; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDE247687046284EAAB448920303DC6FA1" reported-display-style="italic"><enum>(2)</enum><text>have demonstrated the
potential to successfully complete courses of study in the health
professions.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDE56B7FCD6A0D40438E4BB92AEC3FB89B" reported-display-style="italic"><enum>(b)</enum><header>Purposes</header><text>Scholarship
grants provided pursuant to this section shall be for the following
purposes:</text>
<paragraph changed="added" committee-id="SLIA00" id="ID8EAB7C342B434899A89BD5322AAD157F" reported-display-style="italic"><enum>(1)</enum><text>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).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID8682446C09F842389FA39BE43BEE3E63" reported-display-style="italic"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDE9FB4F6DE7894ABD9871A60A804622D9" reported-display-style="italic"><enum>(c)</enum><header>Other
Conditions</header><text>Scholarships under this section—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID16C97C4BB9F3438CADEE3888C28B4B9F" reported-display-style="italic"><enum>(1)</enum><text>may cover costs of
tuition, books, transportation, board, and other necessary related expenses of
a recipient while attending school;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID2752E4378E024370A34E4D572DB8E897" reported-display-style="italic"><enum>(2)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID2DBC08B9900A4F14960FE7C991912E04" reported-display-style="italic"><enum>(3)</enum><text>shall not be denied
solely by reason of such applicant’s eligibility for assistance or benefits
under any other Federal program.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="ID7BA33E498DD54952B4A9B15118B21268" reported-display-style="italic"><enum>104.</enum><header>Indian Health
professions scholarships</header>
<subsection changed="added" committee-id="SLIA00" id="IDCFCB96A838944C52963945A5BC4D80F3" reported-display-style="italic"><enum>(a)</enum><header>In General</header>
<paragraph changed="added" committee-id="SLIA00" id="ID7A994699872C42E886886C232D889A02" reported-display-style="italic"><enum>(1)</enum><header>Authority</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="id8ADD1B88E0804FE2B753055972F7EB6A" reported-display-style="italic"><enum>(2)</enum><header>Determinations by
Secretary</header><text>The Secretary, acting through the Service, shall
determine—</text>
<subparagraph changed="added" committee-id="SLIA00" id="id045A477E6A1F488F87E6AA98F26DACA5" reported-display-style="italic"><enum>(A)</enum><text>who shall receive
scholarship grants under subsection (a); and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="idFE50CBA0AC6B42AB97266E5588AF2A7D" reported-display-style="italic"><enum>(B)</enum><text>the distribution of the
scholarships among health professions on the basis of the relative needs of
Indians for additional service in the health professions.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDA7D75F722CB14A278E0A3271745D4CF1" reported-display-style="italic"><enum>(3)</enum><header>Certain delegation not
allowed</header><text>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 <act-name parsable-cite="ISDA">Indian
Self-Determination and Education Assistance Act</act-name> (25 U.S.C. 450 et
seq.).</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID3D8681DFD83D4DEBBAEA06C12C2F9540" reported-display-style="italic"><enum>(b)</enum><header>Active Duty Service
Obligation</header>
<paragraph changed="added" committee-id="SLIA00" id="ID5B9F1713D57C4E78BB1CFF869CC6AC8F" reported-display-style="italic"><enum>(1)</enum><header>Obligation
met</header><text>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:</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID6DF88B1BF15F4601AE93C1FB96E3E29B" reported-display-style="italic"><enum>(A)</enum><text>In an Indian Health
Program.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID3487D71DC0E14960A5E9C17E71D91FE9" reported-display-style="italic"><enum>(B)</enum><text>In a program assisted
under title V of this Act.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDCAEEA5C196AB46DBBC5EF023DF129CB8" reported-display-style="italic"><enum>(C)</enum><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="id12B571AD7D03472D93CDC968592E7E9C" reported-display-style="italic"><enum>(D)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDC6872AB365E449E49AB88F415B9ED682" reported-display-style="italic"><enum>(2)</enum><header>Obligation
deferred</header><text>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:</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDA289277C4AE9402A80289FAA59DB7CBD" reported-display-style="italic"><enum>(A)</enum><text>No period of internship,
residency, or other advanced clinical training shall be counted as satisfying
any period of obligated service under this subsection.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDE87FCC09584E4005856FA746C93CCF5D" reported-display-style="italic"><enum>(B)</enum><text>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).</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID802E1082FB9942A095C80CE54C9358F1" reported-display-style="italic"><enum>(C)</enum><text>The active duty service
obligation will be served in the health profession of that individual in a
manner consistent with paragraph (1).</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDEEBC301416D64CF9995D76046BCC4008" reported-display-style="italic"><enum>(D)</enum><text>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—</text>
<clause changed="added" committee-id="SLIA00" id="IDC71746DADE3E4B78B19C8CFB4632686E" reported-display-style="italic"><enum>(i)</enum><text>is located on the
reservation of the Indian Tribe in which the recipient is enrolled; or</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID63DCB512F95B4FCBB359903F252646C1" reported-display-style="italic"><enum>(ii)</enum><text>serves the Indian Tribe
in which the recipient is enrolled.</text>
</clause></subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID48AC188E4AE844F797E91C91D68E577C" reported-display-style="italic"><enum>(3)</enum><header>Priority when making
assignments</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID6D67780865E54B0EA16C814AF5E1B9D1" reported-display-style="italic"><enum>(c)</enum><header>Part-Time
Students</header><text>In the case of an individual receiving a scholarship
under this section who is enrolled part time in an approved course of
study—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDBCDE07409F7F4F4D9337665380CC0A85" reported-display-style="italic"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDCFD1C779B2904E13A6797663A67C297A" reported-display-style="italic"><enum>(2)</enum><text>the period of obligated
service described in subsection (b)(1) shall be equal to the greater of—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDD7D7EFAB810D4195AB7FA6041429DB5D" reported-display-style="italic"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID2A9BCA9061F24307B691578ED55CB98B" reported-display-style="italic"><enum>(B)</enum><text>2 years; and</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDB42849A817454C00A1CFE96444577341" reported-display-style="italic"><enum>(3)</enum><text>the amount of the monthly
stipend specified in section 338A(g)(1)(B) of the
<act-name parsable-cite="PHSA">Public Health Service Act</act-name> (42 U.S.C.
254<added-phrase>l</added-phrase>(g)(1)(B)) shall be reduced pro rata (as
determined by the Secretary) based on the number of hours such student is
enrolled.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID894C223F0D6F4AD68471EA928D20A4C0" reported-display-style="italic"><enum>(d)</enum><header>Breach of
Contract</header>
<paragraph changed="added" committee-id="SLIA00" id="ID8175DED4E05F4676875A5C0277152CA9" reported-display-style="italic"><enum>(1)</enum><header>Specified
breaches</header><text>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 <act-name parsable-cite="IHCIA">Indian
Health Care Improvement Act</act-name> Amendments of 2005 if that
individual—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDC920EF7360B74615829B84EC9EB2B4A8" reported-display-style="italic"><enum>(A)</enum><text>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);</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDE914BDF4464042678BD0843D6284E43D" reported-display-style="italic"><enum>(B)</enum><text>is dismissed from such
educational institution for disciplinary reasons;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID0FC5E4BC82F84BCE98D189AE8D934D92" reported-display-style="italic"><enum>(C)</enum><text>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</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID3371D239EFB54DD3B8B570C576320A1E" reported-display-style="italic"><enum>(D)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID7BB3D437A72A4E2EBBD34C857D252F60" reported-display-style="italic"><enum>(2)</enum><header>Other
breaches</header><text>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 (<added-phrase>l</added-phrase>) of section 110 in the manner
provided for in such subsection.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDBB1EF1F61FDE4DCFA7F1FE2091D70629" reported-display-style="italic"><enum>(3)</enum><header>Cancellation upon death
of recipient</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID1EE0357674AD481C98119654F53AB459" reported-display-style="italic"><enum>(4)</enum><header>Waivers and
suspensions</header>
<subparagraph changed="added" committee-id="SLIA00" id="idBBBCA779647F48D298E463913393713E" reported-display-style="italic"><enum>(A)</enum><header>In
general</header><text>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—</text>
<clause changed="added" committee-id="SLIA00" id="IDB81F076EBAD641A88206F1FADEE2086F" reported-display-style="italic"><enum>(i)</enum><text>it is not possible for
the recipient to meet that obligation or make that payment;</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID72194C19F8794707A4763CD2AF0C2DBD" reported-display-style="italic"><enum>(ii)</enum><text>requiring that recipient
to meet that obligation or make that payment would result in extreme hardship
to the recipient; or</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID4C1578E807BE4687BDBF7B9B4F50401A" reported-display-style="italic"><enum>(iii)</enum><text>the enforcement of the
requirement to meet the obligation or make the payment would be
unconscionable.</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SLIA00" id="id2514DE559285489AB26285760F27B786" reported-display-style="italic"><enum>(B)</enum><header>Factors for
consideration</header><text>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).</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDBDB6DDEE57F74C2E8D0B0130EC16F2A7" reported-display-style="italic"><enum>(5)</enum><header>Extreme
hardship</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDBFB2522AF19A403AB81898618823D714" reported-display-style="italic"><enum>(6)</enum><header>Bankruptcy</header><text>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.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="ID0B767F810A804B85A94EE1174ABD6687" reported-display-style="italic"><enum>105.</enum><header>American Indians Into
Psychology Program</header>
<subsection changed="added" committee-id="SLIA00" id="ID73367C89E67847C68586D724DC127732" reported-display-style="italic"><enum>(a)</enum><header>Grants
Authorized</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDE085F35FD0C2406AACD56CB6E9AAE4BA" reported-display-style="italic"><enum>(b)</enum><header>Quentin N. Burdick
Program Grant</header><text>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 <quote>Quentin N. Burdick American Indians Into
Psychology Program</quote>. 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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDA921F1D465124FD68688D009ADB20A0D" reported-display-style="italic"><enum>(c)</enum><header>Regulations</header><text>The
Secretary shall issue regulations pursuant to this Act for the competitive
awarding of grants provided under this section.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDD90D29A3704746E0A3FAE8270E4D7B52" reported-display-style="italic"><enum>(d)</enum><header>Conditions of
Grant</header><text>Applicants under this section shall agree to provide a
program which, at a minimum—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID45D5C199D5114AB3B571A26925BC2CA8" reported-display-style="italic"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID7F339DFEF14848B2876185BAEDB0C4BC" reported-display-style="italic"><enum>(2)</enum><text>incorporates a program
advisory board comprised of representatives from the tribes and communities
that will be served by the program;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID39E9FFFA5E4744CE9E414685C0D3AD0C" reported-display-style="italic"><enum>(3)</enum><text>provides summer
enrichment programs to expose Indian students to the various fields of
psychology through research, clinical, and experimental activities;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDF599BBE3A850483B9F8DAB7F7DBC4072" reported-display-style="italic"><enum>(4)</enum><text>provides stipends to
undergraduate and graduate students to pursue a career in psychology;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID8BD9ED90472B4BA89568DC2278EEB274" reported-display-style="italic"><enum>(5)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDEDCA01FBF14948FB959C1FE1979BE23F" reported-display-style="italic"><enum>(6)</enum><text>to the maximum extent
feasible, uses existing university tutoring, counseling, and student support
services; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID18B80A74CA4A4BCD940373399C80D398" reported-display-style="italic"><enum>(7)</enum><text>to the maximum extent
feasible, employs qualified Indians in the program.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID0260946D56464281ADAED67DEB523A85" reported-display-style="italic"><enum>(e)</enum><header>Active Duty Service
Requirement</header><text>The active duty service obligation prescribed under
section 338C of the <act-name parsable-cite="PHSA">Public Health Service
Act</act-name> (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—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID0B4321599E3245AC92F57D20DEA7C1DE" reported-display-style="italic"><enum>(1)</enum><text>in an Indian Health
Program;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDE08CCA2A8F3E4F0E9FDB002761ACD995" reported-display-style="italic"><enum>(2)</enum><text>in a program assisted
under title V of this Act; or</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID0289A2276E984C5088A5996C1B93315F" reported-display-style="italic"><enum>(3)</enum><text>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.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id87E9A49900A747BF9A70DEBD9BFFA489"><enum>(f)</enum><header>Authorization
of appropriations</header><text display-inline="yes-display-inline">There is
authorized to be appropriated to carry out this section $2,700,000 for each of
fiscal years 2006 through 2015.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID270CB48164BE4D09BC0A85126B40815B" reported-display-style="italic"><enum>106.</enum><header>Scholarship programs
for Indian Tribes</header>
<subsection changed="added" committee-id="SLIA00" id="IDACFDD814E94441E4A0CBC417EDCC7E81" reported-display-style="italic"><enum>(a)</enum><header>In General</header>
<paragraph changed="added" committee-id="SLIA00" id="ID41841A29A090467A8AAA58A0C466BBCD" reported-display-style="italic"><enum>(1)</enum><header>Grants
authorized</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDB07A26BCDC54471DA1F43C6465351536" reported-display-style="italic"><enum>(2)</enum><header>Amount</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID6FF322E660144DE99C6808B3D2D6CEDC" reported-display-style="italic"><enum>(3)</enum><header>Application</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID6009209BAAF64B46A46874BE33BF5D7C" reported-display-style="italic"><enum>(b)</enum><header>Requirements</header>
<paragraph changed="added" committee-id="SLIA00" id="ID974AC7115AB44C19BCB9440E46A32FDB" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>A Tribal Health Program receiving a grant under
subsection (a) shall provide scholarships to Indians in accordance with the
requirements of this section.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID7AFBD892A4A74AE2BC9E4D97CDE1A128" reported-display-style="italic"><enum>(2)</enum><header>Costs</header><text>With
respect to costs of providing any scholarship pursuant to subsection
(a)—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID2E17701C256C4A4295C3F867B755A091" reported-display-style="italic"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDB46C5C0290CF4840BF7C9E76B085DED2" reported-display-style="italic"><enum>(B)</enum><text>20 percent of such costs
may be paid from any other source of funds.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDF9253200222F4BF8B8C98511C886C7D0" reported-display-style="italic"><enum>(c)</enum><header>Course of
Study</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID9E51CF33DBE44300AFDE6BCC5FBB7C30" reported-display-style="italic"><enum>(d)</enum><header>Contract</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDBFB5106203024E11836CED58788DA96A" reported-display-style="italic"><enum>(1)</enum><text>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—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDA863BDF3572D40D1A7BD143AC2A91E9B" reported-display-style="italic"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDB65185EFE1B7421E8B9858190F05F192" reported-display-style="italic"><enum>(B)</enum><text>such greater period of
time as the recipient and the Tribal Health Program may agree;</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID289BB3960F974ADF935DE905CEB8445A" reported-display-style="italic"><enum>(2)</enum><text>provide that the amount
of the scholarship—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDA094CAB58E85445A851A3AAB5BEAC41D" reported-display-style="italic"><enum>(A)</enum><text>may only be expended
for—</text>
<clause changed="added" committee-id="SLIA00" id="IDEC4BAD944D5A48A18CEE7B1EEFB1C270" reported-display-style="italic"><enum>(i)</enum><text>tuition expenses, other
reasonable educational expenses, and reasonable living expenses incurred in
attendance at the educational institution; and</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID34C94C1A9E0B44AEB5F1972F9888CA4A" reported-display-style="italic"><enum>(ii)</enum><text>payment to the recipient
of a monthly stipend of not more than the amount authorized by section
338(g)(1)(B) of the <act-name parsable-cite="PHSA">Public Health Service
Act</act-name> (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</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID4BA96CD7C8E64351BB8D45C4D7ED35D6" reported-display-style="italic"><enum>(B)</enum><text>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);</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID7D59F15124954A189D353FE4966608E3" reported-display-style="italic"><enum>(3)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDADF1EAC0DFCE40F6952F5D70BCA55F75" reported-display-style="italic"><enum>(4)</enum><text>require the recipient of
such scholarship to meet the educational and licensure requirements appropriate
to each health profession.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDEE3BA0E99413420EB86A2283A23E6187" reported-display-style="italic"><enum>(e)</enum><header>Breach of
Contract</header>
<paragraph changed="added" committee-id="SLIA00" id="ID19854F6458F540F3BF16BFD79446EEA8" reported-display-style="italic"><enum>(1)</enum><header>Specific
breaches</header><text>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—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID06B2B49B9FED49DFA3F97194BE55B9BD" reported-display-style="italic"><enum>(A)</enum><text>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);</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDFAD2A223A42D47558EDFC042873A9549" reported-display-style="italic"><enum>(B)</enum><text>is dismissed from such
educational institution for disciplinary reasons;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDB282D5BF2A0F4FE1A3983D1B668820DF" reported-display-style="italic"><enum>(C)</enum><text>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</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID23E2949D312248EE9C68B837765A407A" reported-display-style="italic"><enum>(D)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID2CCAA965A5CA480598E967296E4EBCBE" reported-display-style="italic"><enum>(2)</enum><header>Other
breaches</header><text>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 (<added-phrase>l</added-phrase>) of section 110 in the manner
provided for in such subsection.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID8BA5FD3A59BA493198C4F5C21484CDA8" reported-display-style="italic"><enum>(3)</enum><header>Cancellation upon death
of recipient</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDFBCE778DE4C440D7B4D388299230A24A" reported-display-style="italic"><enum>(4)</enum><header>Information</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID984FABCA95774B5A8870812232885B57" reported-display-style="italic"><enum>(f)</enum><header>Relation to
<act-name parsable-cite="SSA">Social Security Act</act-name></header><text>The
recipient of a scholarship under this section shall agree, in providing health
care pursuant to the requirements herein—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID3B6B70B3E9C94E5584650B9A0F0C9338" reported-display-style="italic"><enum>(1)</enum><text>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
<act-name parsable-cite="SSA">Social Security Act</act-name> or pursuant to the
programs established in title XIX or title XXI of such Act; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID70049B5AF5664D6CB6B6812B326B31AA" reported-display-style="italic"><enum>(2)</enum><text>to accept assignment
under section 1842(b)(3)(B)(ii) of the <act-name parsable-cite="SSA">Social
Security Act</act-name> 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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID07588156A6F540C5B89E2E4CCEDABEEA" reported-display-style="italic"><enum>(g)</enum><header>Continuance of
Funding</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID6E30EEACAC1D485689AB6D7FD30052F5" reported-display-style="italic"><enum>107.</enum><header>Indian Health Service
extern Programs</header>
<subsection changed="added" committee-id="SLIA00" id="ID607146D937F54025899E13E26890B0CC" reported-display-style="italic"><enum>(a)</enum><header>Employment
Preference</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID1290E9EFD9014F41BDE92DC4B4E81923" reported-display-style="italic"><enum>(b)</enum><header>Not Counted Toward
Active Duty Service Obligation</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDB493E68B956C431ABFB50B56A6D2BA59" reported-display-style="italic"><enum>(c)</enum><header>Timing; Length of
Employment</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID21B6EA3DA8D347F88031A356D20B99AD" reported-display-style="italic"><enum>(d)</enum><header>Nonapplicability of
Competitive Personnel System</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID93031CA4122C4C0EAF77C29494EE5D4F" reported-display-style="italic"><enum>108.</enum><header>Continuing education
allowances</header><text display-inline="no-display-inline">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.</text>
</section><section changed="added" committee-id="SLIA00" id="ID8C74A1ABDD1747D7B95980021C669935" reported-display-style="italic"><enum>109.</enum><header>Community Health
Representative Program</header>
<subsection changed="added" committee-id="SLIA00" id="ID47778098EFC84CDB8C437BDA2920237F" reported-display-style="italic"><enum>(a)</enum><header>In
General</header><text>Under the authority of the Act of November 2, 1921 (25
U.S.C. 13) (commonly known as the <quote>Snyder Act</quote>), the Secretary,
acting through the Service, shall maintain a Community Health Representative
Program under which Indian Health Programs—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDE8B6E654A53240199561E52B2FDF0F59" reported-display-style="italic"><enum>(1)</enum><text>provide for the training
of Indians as community health representatives; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDD17AF02F93AA453A95FAAFDDD49742A9" reported-display-style="italic"><enum>(2)</enum><text>use such community health
representatives in the provision of health care, health promotion, and disease
prevention services to Indian communities.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID9AA8E912DC74408F872CFF3A63E0EA8F" reported-display-style="italic"><enum>(b)</enum><header>Duties</header><text>The
Community Health Representative Program of the Service, shall—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDF4EAA255687F467CB2CD034BEAEC566C" reported-display-style="italic"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDEA301D2952CA40CE907D26F633CC9593" reported-display-style="italic"><enum>(2)</enum><text>in order to provide such
training, develop and maintain a curriculum that—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDC3C5522CF2F640629295A9DA0697648B" reported-display-style="italic"><enum>(A)</enum><text>combines education in the
theory of health care with supervised practical experience in the provision of
health care; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID55F1EB4A62FD4AC2925B59B82AFB26AE" reported-display-style="italic"><enum>(B)</enum><text>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;</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDB3F7645ED8ED4F5692E7BF1126F1B02B" reported-display-style="italic"><enum>(3)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID7C127210733643CFA4FFA9266CDBDE8C" reported-display-style="italic"><enum>(4)</enum><text>maintain a system that
provides close supervision of Community Health Representatives;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID0C4B08067CB44958B96BBE5C8336141C" reported-display-style="italic"><enum>(5)</enum><text>maintain a system under
which the work of Community Health Representatives is reviewed and evaluated;
and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID50B38F2C59984F9D9D528E8C0AF921DC" reported-display-style="italic"><enum>(6)</enum><text>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.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="IDF5EAD1D5AE364F0982CD8670D9A4DF5C" reported-display-style="italic"><enum>110.</enum><header>Indian Health Service
Loan Repayment Program</header>
<subsection changed="added" committee-id="SLIA00" id="ID0AA17311DDFB42A9B1E0B0F27990CF6A" reported-display-style="italic"><enum>(a)</enum><header>Establishment</header><text>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 <quote>Loan Repayment Program</quote>) 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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID7C1F44B214804023AFBD47DF224C493D" reported-display-style="italic"><enum>(b)</enum><header>Eligible
Individuals</header><text>To be eligible to participate in the Loan Repayment
Program, an individual must—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDBC42B0B2B7624FDA8428D1C8C78851BB" reported-display-style="italic"><enum>(1)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="ID0CB33E4FDC0B4327BEE9D275B46FC9BF"><enum>(A)</enum><text>be enrolled—</text>
<clause changed="added" committee-id="SLIA00" id="ID8BC6A49E5B44472EB9F1D22AA1826F8A" indent="up1" reported-display-style="italic"><enum>(i)</enum><text>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 <act-name parsable-cite="PHSA">Public Health Service Act</act-name> (42 U.S.C.
254<added-phrase>l</added-phrase>–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</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID25BD358BBDE447A487FD91BC2505466B" indent="up1" reported-display-style="italic"><enum>(ii)</enum><text>in an approved graduate
training program in a health profession; or</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDEC9A78F55F24496DA0D45F8D880C12D8" indent="up1" reported-display-style="italic"><enum>(B)</enum><text>have—</text>
<clause changed="added" committee-id="SLIA00" id="IDD8CFA04CC2EF4C79A1F8E4B92B1C5E08" reported-display-style="italic"><enum>(i)</enum><text>a degree in a health
profession; and</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID203C14CD4FEA45A6AB0C289B1BF8FE42" reported-display-style="italic"><enum>(ii)</enum><text>a license to practice a
health profession;</text>
</clause></subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDDFA22584C4C64C2CB673036175523FC0" reported-display-style="italic"><enum>(2)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="ID3A565710E1B142CE8B949DC4CD8C06DF"><enum>(A)</enum><text>be eligible for, or
hold, an appointment as a commissioned officer in the Regular or Reserve Corps
of the Public Health Service;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDFF62B65DD9684A3F888353BFCBFDB498" indent="up1" reported-display-style="italic"><enum>(B)</enum><text>be eligible for selection
for civilian service in the Regular or Reserve Corps of the Public Health
Service;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDA1711055B0534BE58DF33318AFEBC035" indent="up1" reported-display-style="italic"><enum>(C)</enum><text>meet the professional
standards for civil service employment in the Service; or</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID86BF189D076C4443841D30B6452962DB" indent="up1" reported-display-style="italic"><enum>(D)</enum><text>be employed in an Indian
Health Program or Urban Indian Organization without a service obligation;
and</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID0EB0E435A37743558561CBDD9162B17C" reported-display-style="italic"><enum>(3)</enum><text>submit to the Secretary
an application for a contract described in subsection (e).</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDF67B183A45D94DFD80C3E14034F27F4B" reported-display-style="italic"><enum>(c)</enum><header>Application</header>
<paragraph changed="added" committee-id="SLIA00" id="IDA9714A65A01C4B5E923AEDAD918527F0" reported-display-style="italic"><enum>(1)</enum><header>Information to be
included with forms</header><text>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 (<added-phrase>l</added-phrase>) 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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID3D4769161DF14C9EA2B16B24CAA66B57" reported-display-style="italic"><enum>(2)</enum><header>Clear
language</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDBD63462B309A4234AD8194354B43DF39" reported-display-style="italic"><enum>(3)</enum><header>Timely availability of
forms</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDB5B2D70AA9C743089CFD22CE0F4E7EEF" reported-display-style="italic"><enum>(d)</enum><header>Priorities</header>
<paragraph changed="added" committee-id="SLIA00" id="ID2236E01BE9904B9AAF9439CF87F78C39" reported-display-style="italic"><enum>(1)</enum><header>List</header><text>Consistent
with subsection (k), the Secretary shall annually—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDD8C1A72C2A5B4E82B74B7003B92038E6" reported-display-style="italic"><enum>(A)</enum><text>identify the positions in
each Indian Health Program or Urban Indian Organization for which there is a
need or a vacancy; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDA57C68BF05D54233BC2BED9E8F8717DD" reported-display-style="italic"><enum>(B)</enum><text>rank those positions in
order of priority.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID538643EE5716472BBE36668187504C23" reported-display-style="italic"><enum>(2)</enum><header>Approvals</header><text>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—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID4D31FF24845E4DD5843FFD811FE7CE59" reported-display-style="italic"><enum>(A)</enum><text>give first priority to
applications made by individual Indians; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID6FFC8C2F406144EFB9B5F167CA8C304D" reported-display-style="italic"><enum>(B)</enum><text>after making
determinations on all applications submitted by individual Indians as required
under subparagraph (A), give priority to—</text>
<clause changed="added" committee-id="SLIA00" id="ID044AFE0E039748259B72D9ADE314F6E9" reported-display-style="italic"><enum>(i)</enum><text>individuals recruited
through the efforts of an Indian Health Program or Urban Indian Organization;
and</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID6221C19085E94637BEEBF6DBF6F1E503" reported-display-style="italic"><enum>(ii)</enum><text>other individuals based
on the priority rankings under paragraph (1).</text>
</clause></subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID3D9C95EE1EA64ACF860694C6A5D70807" reported-display-style="italic"><enum>(e)</enum><header>Recipient
Contracts</header>
<paragraph changed="added" committee-id="SLIA00" id="ID13DE1CCA51164688A42270934E2C76CF" reported-display-style="italic"><enum>(1)</enum><header>Contract
required</header><text>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).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID5E696D0E286E434CA1D535D44A11DD1A" reported-display-style="italic"><enum>(2)</enum><header>Contents of
contract</header><text>The written contract referred to in this section between
the Secretary and an individual shall contain—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID4180B175B4A94E4AB815FF9302D4697C" reported-display-style="italic"><enum>(A)</enum><text>an agreement under
which—</text>
<clause changed="added" committee-id="SLIA00" id="ID6F19326A99D74E42B1C33C6926537F69" reported-display-style="italic"><enum>(i)</enum><text>subject to subparagraph
(C), the Secretary agrees—</text>
<subclause changed="added" committee-id="SLIA00" id="ID664AEDF8DBAD49A59C7EDA91D777604A" reported-display-style="italic"><enum>(I)</enum><text>to pay loans on behalf of
the individual in accordance with the provisions of this section; and</text>
</subclause><subclause changed="added" committee-id="SLIA00" id="ID954265A09CF245B1B3685441129F09BF" reported-display-style="italic"><enum>(II)</enum><text>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</text>
</subclause></clause><clause changed="added" committee-id="SLIA00" id="IDFD6054B20E714EAC89F22A1BB16A0B34" reported-display-style="italic"><enum>(ii)</enum><text>subject to subparagraph
(C), the individual agrees—</text>
<subclause changed="added" committee-id="SLIA00" id="IDCAC78FDC113A4A43AC251D74B3E205E6" reported-display-style="italic"><enum>(I)</enum><text>to accept loan payments
on behalf of the individual;</text>
</subclause><subclause changed="added" committee-id="SLIA00" id="ID35E44E9C526648119241E273DA9C2226" reported-display-style="italic"><enum>(II)</enum><text>in the case of an
individual described in subsection (b)(1)—</text>
<item changed="added" committee-id="SLIA00" id="IDF8B7AE1D35834C4A913BB32899372F64" reported-display-style="italic"><enum>(aa)</enum><text>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</text>
</item><item changed="added" committee-id="SLIA00" id="ID0AFB57F2E9C940A2B7423F69ED092FCC" reported-display-style="italic"><enum>(bb)</enum><text>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</text>
</item></subclause><subclause changed="added" committee-id="SLIA00" id="IDF78291E4497942C5BD86E3C66FD2022C" reported-display-style="italic"><enum>(III)</enum><text>to serve for a time
period (hereinafter in this section referred to as the <quote>period of
obligated service</quote>) 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;</text>
</subclause></clause></subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDF8FF2A5F09A4460F94717BC3BABE9362" reported-display-style="italic"><enum>(B)</enum><text>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);</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID2D0880EE39EB4192A4B279F3BBA9B5B9" reported-display-style="italic"><enum>(C)</enum><text>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;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDC7E5632F5B914A55B3EAD84B98BEA4E4" reported-display-style="italic"><enum>(D)</enum><text>a statement of the
damages to which the United States is entitled under subsection
(<added-phrase>l</added-phrase>) for the individual’s breach of the contract;
and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDAE963951706F4BFEB9CDED7769C98683" reported-display-style="italic"><enum>(E)</enum><text>such other statements of
the rights and liabilities of the Secretary and of the individual, not
inconsistent with this section.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID3748B6D9F0804372AFA0A9CA42288DF2" reported-display-style="italic"><enum>(f)</enum><header>Deadline for Decision
on Application</header><text>The Secretary shall provide written notice to an
individual within 21 days on—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID5BAFC552D2C746628D72FD18E2581DF3" reported-display-style="italic"><enum>(1)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID38A249FD694440C795AC7292E57E91D2" reported-display-style="italic"><enum>(2)</enum><text>the Secretary’s
disapproving an individual’s participation in such Program.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDD19142DF986543D0B8038FC8D8699CB6" reported-display-style="italic"><enum>(g)</enum><header>Payments</header>
<paragraph changed="added" committee-id="SLIA00" id="IDD7877BA3462B43B1B43F9EB5AD5AB463" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>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—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDDD2F726B91A74114A1E1A67C50AFCE58" reported-display-style="italic"><enum>(A)</enum><text>tuition expenses;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDB115946AFBA342F88D6D4DB66BD94E1D" reported-display-style="italic"><enum>(B)</enum><text>all other reasonable
educational expenses, including fees, books, and laboratory expenses, incurred
by the individual; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDB55C30F0F1CD4886B09CF58EC7CA7C77" reported-display-style="italic"><enum>(C)</enum><text>reasonable living
expenses as determined by the Secretary.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID7B299059456146ADA53908247B3ED67F" reported-display-style="italic"><enum>(2)</enum><header>Amount</header><text>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 <act-name parsable-cite="PHSA">Public Health Service Act</act-name>, 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—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDF71C0B35C1304E9FA0B83F66FA090061" reported-display-style="italic"><enum>(A)</enum><text>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;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDE832EC512C2D49F9ACCC7FF8830C8BCA" reported-display-style="italic"><enum>(B)</enum><text>provides an incentive to
serve in Indian Health Programs and Urban Indian Organizations with the
greatest shortages of health professionals; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDEFBD37F5D674424491B39B19BD450F24" reported-display-style="italic"><enum>(C)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID88140F43978D4113B4F82B71B9BCA7E0" reported-display-style="italic"><enum>(3)</enum><header>Timing</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDAB620EBF46384648A3D2B4ED2940CB0C" reported-display-style="italic"><enum>(4)</enum><header>Reimbursements for tax
liability</header><text>For the purpose of providing reimbursements for tax
liability resulting from a payment under paragraph (2) on behalf of an
individual, the Secretary—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID2AB8614A5EDD4AB4BBC6660603F5EA34" reported-display-style="italic"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID290A139CE33E4504B60EF563BBB7C676" reported-display-style="italic"><enum>(B)</enum><text>may make such additional
payments as the Secretary determines to be appropriate with respect to such
purpose.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID4AD1BFD850A44570B4EC4C8B3EA24423" reported-display-style="italic"><enum>(5)</enum><header>Payment
schedule</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID6F2A5E7FB72B4C808B1BC6E1451241F6" reported-display-style="italic"><enum>(h)</enum><header>Employment
Ceiling</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID7F50C05BFEEA4E55BA52683CE359752B" reported-display-style="italic"><enum>(i)</enum><header>Recruitment</header><text>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).</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDAE767D897B2147909B73E9E61F77978E" reported-display-style="italic"><enum>(j)</enum><header>Applicability of
Law</header><text>Section 214 of the <act-name parsable-cite="PHSA">Public
Health Service Act</act-name> (42 U.S.C. 215) shall not apply to individuals
during their period of obligated service under the Loan Repayment
Program.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDA7D89BF97AE14D0FB87D6EE75E524FCB" reported-display-style="italic"><enum>(k)</enum><header>Assignment of
Individuals</header><text>The Secretary, in assigning individuals to serve in
Indian Health Programs or Urban Indian Organizations pursuant to contracts
entered into under this section, shall—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDA7D1558F511A4FF98C59E0A8D779EBB0" reported-display-style="italic"><enum>(1)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID8040711CFB2E493980F3B43619E731A0" reported-display-style="italic"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID2E1164EB565746C7A712BE91EED78A3D" reported-display-style="italic"><enum>(l)</enum><header>Breach of
Contract</header>
<paragraph changed="added" committee-id="SLIA00" id="ID63638D79DF394CE8B26B3175FB02C4B0" reported-display-style="italic"><enum>(1)</enum><header>Specific
breaches</header><text>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—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDDE1E8CB9529F4B469934221C500B5994" reported-display-style="italic"><enum>(A)</enum><text>is enrolled in the final
year of a course of study and—</text>
<clause changed="added" committee-id="SLIA00" id="ID773C65B7EB0645BFB52E96D02BCFBCC2" reported-display-style="italic"><enum>(i)</enum><text>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);</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID73A3424560BE4EE6BD1E3FF51DA2E5D2" reported-display-style="italic"><enum>(ii)</enum><text>voluntarily terminates
such enrollment; or</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID884523F55E9F4F2CB5D420DDA4617A93" reported-display-style="italic"><enum>(iii)</enum><text>is dismissed from such
educational institution before completion of such course of study; or</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID15E70FB2CF994CCB95DF690857743D19" reported-display-style="italic"><enum>(B)</enum><text>is enrolled in a graduate
training program and fails to complete such training program.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID38DA04AB05BF4745A808F3700472A7C7" reported-display-style="italic"><enum>(2)</enum><header>Other breaches; formula
for amount owed</header><text>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—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID07546E25320F4B7CAC2F843D3042DCDC" reported-display-style="italic"><enum>(A)</enum><text><quote>A</quote> is the
amount the United States is entitled to recover;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID4786762F80154B7FA59EC6344C252AC3" reported-display-style="italic"><enum>(B)</enum><text><quote>Z</quote> 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;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDE5FD21CC8A7C4FCEAAB02D3A9DCEF601" reported-display-style="italic"><enum>(C)</enum><text><quote>t</quote> is the
total number of months in the individual’s period of obligated service in
accordance with subsection (f); and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID8DAD5FF7BC5F476EB0F363DA875C0984" reported-display-style="italic"><enum>(D)</enum><text><quote>s</quote> is the
number of months of such period served by such individual in accordance with
this section.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID43E2F2C714FC41C68ACA787C830AD7C9" reported-display-style="italic"><enum>(3)</enum><header>Deductions in medicare
payments</header><text>Amounts not paid within such period shall be subject to
collection through deductions in medicare payments pursuant to section 1892 of
the <act-name parsable-cite="SSA">Social Security Act</act-name>.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID07E3593E96C24C178FAA8573219B477E" reported-display-style="italic"><enum>(4)</enum><header>Time period for
repayment</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID67AA76859AEF4311AA04ADB4828329F5" reported-display-style="italic"><enum>(5)</enum><header>Recovery of
delinquency</header>
<subparagraph changed="added" committee-id="SLIA00" id="ID71C925FC1D994731AB7106620FB4D2C4" reported-display-style="italic"><enum>(A)</enum><header>In
general</header><text>If damages described in paragraph (4) are delinquent for
3 months, the Secretary shall, for the purpose of recovering such
damages—</text>
<clause changed="added" committee-id="SLIA00" id="ID3B26A24BD75B4438AF00DB194006E5B6" reported-display-style="italic"><enum>(i)</enum><text>use collection agencies
contracted with by the Administrator of General Services; or</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID092295C107604BEE84F289C4087E8B8E" reported-display-style="italic"><enum>(ii)</enum><text>enter into contracts for
the recovery of such damages with collection agencies selected by the
Secretary.</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDD03B6942331F4E19B72CA80F49C29B17" reported-display-style="italic"><enum>(B)</enum><header>Report</header><text>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.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID7F172B0FB5604FC48E6080143E189B62" reported-display-style="italic"><enum>(m)</enum><header>Waiver or Suspension of
Obligation</header>
<paragraph changed="added" committee-id="SLIA00" id="ID43E27A40DFBF43579220FB4D6AB86648" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID09411F5E05924350982FA4F762A32447" reported-display-style="italic"><enum>(2)</enum><header>Canceled upon
death</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID7E037D088BB54B12A544875F99672DB6" reported-display-style="italic"><enum>(3)</enum><header>Hardship
waiver</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID7EC7C8038001473F9D898D276E1B3469" reported-display-style="italic"><enum>(4)</enum><header>Bankruptcy</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDEC211E7BEC5E45BEB178F6820E45A468" reported-display-style="italic"><enum>(n)</enum><header>Report</header><text>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:</text>
<paragraph changed="added" committee-id="SLIA00" id="IDD36440F70E3549FFAB9844CD7AE92516" reported-display-style="italic"><enum>(1)</enum><text>A list of the health
professional positions maintained by Indian Health Programs and Urban Indian
Organizations for which recruitment or retention is difficult.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID6C82442B6C124C09A069D084754A43A4" reported-display-style="italic"><enum>(2)</enum><text>The number of Loan
Repayment Program applications filed with respect to each type of health
profession.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID07C3AFEEAAD04885924AD838BC9AB1B3" reported-display-style="italic"><enum>(3)</enum><text>The number of contracts
described in subsection (e) that are entered into with respect to each health
profession.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDFA464C5930464C08BE544688C363C4D5" reported-display-style="italic"><enum>(4)</enum><text>The amount of loan
payments made under this section, in total and by health profession.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDE980F7CD8B7848D68AF11FEEBEBA8C8E" reported-display-style="italic"><enum>(5)</enum><text>The number of
scholarships that are provided under sections 104 and 106 with respect to each
health profession.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID9EC5696A63AE4ACE81CFE9B7B4004A16" reported-display-style="italic"><enum>(6)</enum><text>The amount of scholarship
grants provided under section 104 and 106, in total and by health
profession.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDA876052278F54E74B0AFAA38FBD11BF9" reported-display-style="italic"><enum>(7)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID2DE777FCD14F484F813CC58D347F9AE3" reported-display-style="italic"><enum>(8)</enum><text>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.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="IDDCB20D651D3B43088BB1548BC430132C" reported-display-style="italic"><enum>111.</enum><header>Scholarship and Loan
Repayment Recovery Fund</header>
<subsection changed="added" committee-id="SLIA00" id="ID0477E234987E4218910FEE576BA340DA" reported-display-style="italic"><enum>(a)</enum><header>Establishment</header><text>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 <quote>LRRF</quote>). The LRRF shall consist of such
amounts as may be collected from individuals under section 104(d), section
106(e), and section 110(<added-phrase>l</added-phrase>) 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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID29703F5D60464421BC05AA1587B49691" reported-display-style="italic"><enum>(b)</enum><header>Use of Funds</header>
<paragraph changed="added" committee-id="SLIA00" id="ID6964CC46DC7140B7880E26AC94A2A6EF" reported-display-style="italic"><enum>(1)</enum><header>By
secretary</header><text>Amounts in the LRRF may be expended by the Secretary,
acting through the Service, to make payments to an Indian Health
Program—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDF962681D408D46A2965BDF18447C1D72" reported-display-style="italic"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDA88790234EB543F99301F0DC846B4D34" reported-display-style="italic"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID5449A82FB2A04810A79C6C83F1902AE6" reported-display-style="italic"><enum>(2)</enum><header>By tribal health
programs</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID93E9FFDE003A474CBD1D013A381CE337" reported-display-style="italic"><enum>(c)</enum><header>Investment of
Funds</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID72544CEF7EE54B19A08EF04A3DFEFEDC" reported-display-style="italic"><enum>(d)</enum><header>Sale of
Obligations</header><text>Any obligation acquired by the LRRF may be sold by
the Secretary of the Treasury at the market price.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID24D26DA5158C4DA2A227133110346843" reported-display-style="italic"><enum>112.</enum><header>Recruitment
activities</header>
<subsection changed="added" committee-id="SLIA00" id="IDFEE8C5B0807D4CC4ACE80F2BBB99ACA2" reported-display-style="italic"><enum>(a)</enum><header>Reimbursement for
Travel</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID44D675D703D24E55B6DCAF946C6A8B64" reported-display-style="italic"><enum>(b)</enum><header>Recruitment
Personnel</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID4E0F520C6F644E8FBA0602A42138A856" reported-display-style="italic"><enum>113.</enum><header>Indian recruitment and
retention Program</header>
<subsection changed="added" committee-id="SLIA00" id="ID57FFD48060B546C6837CEC79236468B4" reported-display-style="italic"><enum>(a)</enum><header>In
General</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID3693349D040546A6AE07A1F0E5DE1410" reported-display-style="italic"><enum>(b)</enum><header>Eligible Entities;
Application</header><text>Any Tribal Health Program or Urban Indian
Organization may submit an application for funding of a project pursuant to
this section.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID7179D2596CAF42A28D60AEEFA49BF88B" reported-display-style="italic"><enum>114.</enum><header>Advanced training and
research</header>
<subsection changed="added" committee-id="SLIA00" id="ID27DAB384680B44098C220A64F3F6AA76" reported-display-style="italic"><enum>(a)</enum><header>Demonstration
Program</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDB4F0BD36A43A4CDA88E3873164929674" reported-display-style="italic"><enum>(b)</enum><header>Service
Obligation</header><text>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 <act-name parsable-cite="IHCIA">Indian Health Care Improvement
Act</act-name> 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 (<added-phrase>l</added-phrase>) of section 110
in the manner provided for in such subsection.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDC135D85F7FA54029A237174FD5715A0A" reported-display-style="italic"><enum>(c)</enum><header>Equal Opportunity for
Participation</header><text>Health professionals from Tribal Health Programs
and Urban Indian Organizations shall be given an equal opportunity to
participate in the program under subsection (a).</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID832331CD426C4883B33AC334472C1741" reported-display-style="italic"><enum>115.</enum><header>Quentin N. Burdick
American Indians Into Nursing Program</header>
<subsection changed="added" committee-id="SLIA00" id="ID1519F1AF325749A09E17D17BB984428A" reported-display-style="italic"><enum>(a)</enum><header>Grants
Authorized</header><text>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:</text>
<paragraph changed="added" committee-id="SLIA00" id="ID91F2FD2E42214C8AAADADE8E516AE5AB" reported-display-style="italic"><enum>(1)</enum><text>Public or private schools
of nursing.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID184D5F050B2442388F841B0FFE6230CA" reported-display-style="italic"><enum>(2)</enum><text>Tribal colleges or
universities.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID5F62986DB0B345AE82CD24218BAD4D5E" reported-display-style="italic"><enum>(3)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDCD51399558FB4C959CCAFF03A303E643" reported-display-style="italic"><enum>(b)</enum><header>Use of
Grants</header><text>Grants provided under subsection (a) may be used for 1 or
more of the following:</text>
<paragraph changed="added" committee-id="SLIA00" id="ID5BD274C0666645D2B0320ABA0EF34AC1" reported-display-style="italic"><enum>(1)</enum><text>To recruit individuals
for programs which train individuals to be nurses, nurse midwives, or advanced
practice nurses.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDF9B1BED8BCBE4C2AA8FB9200190D7458" reported-display-style="italic"><enum>(2)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDB8D042F1AF94435495AA957CE4551AB9" reported-display-style="italic"><enum>(3)</enum><text>To provide a program that
encourages nurses, nurse midwives, and advanced practice nurses to provide, or
continue to provide, health care services to Indians.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDB52F26D550DB4FB6B482E19F12D2028F" reported-display-style="italic"><enum>(4)</enum><text>To provide a program that
increases the skills of, and provides continuing education to, nurses, nurse
midwives, and advanced practice nurses.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID55A7FA1F8E63419C8B5F3F920207BF69" reported-display-style="italic"><enum>(5)</enum><text>To provide any program
that is designed to achieve the purpose described in subsection (a).</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID12FAEF8ABC5245E3A783FDE62F8BCF0D" reported-display-style="italic"><enum>(c)</enum><header>Applications</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID0C1B76D730AA4F788E7566EEC9CDB59E" reported-display-style="italic"><enum>(d)</enum><header>Preferences for Grant
Recipients</header><text>In providing grants under subsection (a), the
Secretary shall extend a preference to the following:</text>
<paragraph changed="added" committee-id="SLIA00" id="ID635CDA8FE9EF47AF86956AF35105D16A" reported-display-style="italic"><enum>(1)</enum><text>Programs that provide a
preference to Indians.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID3853F7672D9F43669E2D2EC4BDA5CEB3" reported-display-style="italic"><enum>(2)</enum><text>Programs that train nurse
midwives or advanced practice nurses.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID4C03AD7AB3054FE1AC4145CB7BA68D6C" reported-display-style="italic"><enum>(3)</enum><text>Programs that are
interdisciplinary.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDF27D3C88AFD84FA2A88919AC786A0C08" reported-display-style="italic"><enum>(4)</enum><text>Programs that are
conducted in cooperation with a program for gifted and talented Indian
students.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="idE8A286A24E9A4E26843391D5577286CC" reported-display-style="italic"><enum>(5)</enum><text>Programs conducted by
tribal colleges and universities.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID22C97D7F67074BB6B27F58D1768ED1F0" reported-display-style="italic"><enum>(e)</enum><header>Quentin N. Burdick
Program Grant</header><text>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 <quote>Quentin N. Burdick
American Indians Into Nursing Program</quote>. 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).</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID56802BAB7DAA411F922B6CB556C19CF4" reported-display-style="italic"><enum>(f)</enum><header>Active Duty Service
Obligation</header><text>The active duty service obligation prescribed under
section 338C of the <act-name parsable-cite="PHSA">Public Health Service
Act</act-name> (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—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDFF218264C77149AE9447EF697E4F91BA" reported-display-style="italic"><enum>(1)</enum><text>in the Service;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID0F999637161C4834BB82233881AA97B8" reported-display-style="italic"><enum>(2)</enum><text>in a program of an Indian
Tribe or Tribal Organization conducted under the <act-name parsable-cite="ISDA">Indian Self-Determination and Education Assistance Act (25
U.S.C. 450 et seq.)</act-name> (including programs under agreements with the
Bureau of Indian Affairs);</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID16DECBAC9C63462EBA7FC5521013366B" reported-display-style="italic"><enum>(3)</enum><text>in a program assisted
under title V of this Act;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID2271991737C34AD89724D3AFC079D430" reported-display-style="italic"><enum>(4)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="id4A9F4EF99DFE453386F97EF629ABC93A" reported-display-style="italic"><enum>(5)</enum><text>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.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="ID672B2050D4DA4EEEA14BEACACC574268" reported-display-style="italic"><enum>116.</enum><header>Tribal cultural
orientation</header>
<subsection changed="added" committee-id="SLIA00" id="ID2D0C2CD5C02143D7AD0DA1854CBEDF0B" reported-display-style="italic"><enum>(a)</enum><header>Cultural Education of
Employees</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID26AD81ADA1194995ADD2ECA4859C79E0" reported-display-style="italic"><enum>(b)</enum><header>Program</header><text>In
carrying out subsection (a), the Secretary shall establish a program which
shall, to the extent feasible—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID4AC2DC999D7743319F1FC0E4673A8B71" reported-display-style="italic"><enum>(1)</enum><text>be developed in
consultation with the affected Indian Tribes, Tribal Organizations, and Urban
Indian Organizations;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID956257E62DD146E7B97313683EA594A3" reported-display-style="italic"><enum>(2)</enum><text>be carried out through
tribal colleges or universities;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDF327BDB9481D46AF972F492900B74D79" reported-display-style="italic"><enum>(3)</enum><text>include instruction in
American Indian studies; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDBC0AADFF595C47F7A85DB6E5CEA052F2" reported-display-style="italic"><enum>(4)</enum><text>describe the use and
place of Traditional Health Care Practices of the Indian Tribes in the Service
Area.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="ID8C51453E8FA7476FAE718740F2C130E8" reported-display-style="italic"><enum>117.</enum><header>INMED Program</header>
<subsection changed="added" committee-id="SLIA00" id="IDC4EF7DE39B724F6D97D06AD6C91D3B80" reported-display-style="italic"><enum>(a)</enum><header>Grants
Authorized</header><text>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 <quote>Indians Into Medicine Program</quote> (hereinafter in this
section referred to as <quote>INMED</quote>) as a means of encouraging Indians
to enter the health professions.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDF496F59968BB4182837AD0BB11D5E05E" reported-display-style="italic"><enum>(b)</enum><header>Quentin N. Burdick
Grant</header><text>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 <quote>Quentin N. Burdick Indian Health
Programs</quote>, 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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID1321603FEB7C437085928B3E9708D72E" reported-display-style="italic"><enum>(c)</enum><header>Regulations</header><text>The
Secretary, pursuant to this Act, shall develop regulations to govern grants
pursuant to this section.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID21E00C82AEE64FDCBB1F3287B80ADCAE" reported-display-style="italic"><enum>(d)</enum><header>Requirements</header><text>Applicants
for grants provided under this section shall agree to provide a program
which—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID7D4C83EC6F574AA19104A8BA12A04BF7" reported-display-style="italic"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID2ABC601B05AA47888EAE89640D17670A" reported-display-style="italic"><enum>(2)</enum><text>incorporates a program
advisory board comprised of representatives from the Indian Tribes and Indian
communities which will be served by the program;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDA7749B5277FC430196CD5C2C8F9A4D3B" reported-display-style="italic"><enum>(3)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID3ACD49A32EAA4C67AB3F8C55BBEBAFB9" reported-display-style="italic"><enum>(4)</enum><text>provides tutoring,
counseling, and support to students who are enrolled in a health career program
of study at the respective college or university; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID4F52CCD9B18B4D1A86A2513EDBD68FBD" reported-display-style="italic"><enum>(5)</enum><text>to the maximum extent
feasible, employs qualified Indians in the program.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="ID46BDD85D79E34BEF9A27AF3C3EB39CF2" reported-display-style="italic"><enum>118.</enum><header>Health training
Programs of community colleges</header>
<subsection changed="added" committee-id="SLIA00" id="ID5916CADD19914CFEB40FE1A100ACC188" reported-display-style="italic"><enum>(a)</enum><header>Grants To Establish
Programs</header>
<paragraph changed="added" committee-id="SLIA00" id="ID2E7E85346941408FBABEB22DB701BDBF" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDFC7CE9B5F8954BBA964EFA2EFA28E673" reported-display-style="italic"><enum>(2)</enum><header>Amount of
grants</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID6A9DBD3E28CE4B109DCA1B96E9C58CB9" reported-display-style="italic"><enum>(b)</enum><header>Grants for Maintenance
and Recruiting</header>
<paragraph changed="added" committee-id="SLIA00" id="ID1F6E721B646646E2ADF9E0A96E73ADF2" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID1730D7855C994FF59BD50F41D6AB4D03" reported-display-style="italic"><enum>(2)</enum><header>Requirements</header><text>Grants
may only be made under this section to a community college which—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID93F8BBC14AE34BE28202C48CD4D0020C" reported-display-style="italic"><enum>(A)</enum><text>is accredited;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID541F6B3C501645E2BC7A87C9F7A256E7" reported-display-style="italic"><enum>(B)</enum><text>has a relationship with a
hospital facility, Service facility, or hospital that could provide training of
nurses or health professionals;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID3B11DDF92917433D8CB061EB0B60E160" reported-display-style="italic"><enum>(C)</enum><text>has entered into an
agreement with an accredited college or university medical school, the terms of
which—</text>
<clause changed="added" committee-id="SLIA00" id="ID994704018A2241B5BDB6B19349B90AE0" reported-display-style="italic"><enum>(i)</enum><text>provide a program that
enhances the transition and recruitment of students into advanced baccalaureate
or graduate programs that train health professionals; and</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID4A617A414DCE40E1B1D08D78204AE624" reported-display-style="italic"><enum>(ii)</enum><text>stipulate certifications
necessary to approve internship and field placement opportunities at Indian
Health Programs;</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDD4E18BB23AE34A93AF4C6382BBD586B0" reported-display-style="italic"><enum>(D)</enum><text>has a qualified staff
which has the appropriate certifications;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDD262A347740143DB9865DB5569185DBF" reported-display-style="italic"><enum>(E)</enum><text>is capable of obtaining
State or regional accreditation of the program described in subsection (a)(1);
and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID13159D364C2F4E96A045BC00479799BD" reported-display-style="italic"><enum>(F)</enum><text>agrees to provide for
Indian preference for applicants for programs under this section.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID32E3629E625249309542746EB586EE91" reported-display-style="italic"><enum>(c)</enum><header>Technical
Assistance</header><text>The Secretary shall encourage community colleges
described in subsection (b)(2) to establish and maintain programs described in
subsection (a)(1) by—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID839833C070C04C9C8A19FCBA03F84B36" reported-display-style="italic"><enum>(1)</enum><text>entering into agreements
with such colleges for the provision of qualified personnel of the Service to
teach courses of study in such programs; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDED1ABE8304AD4B009DF675EE5D534112" reported-display-style="italic"><enum>(2)</enum><text>providing technical
assistance and support to such colleges.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDA6ABBF6E5E724599B6F563D4E72BEE35" reported-display-style="italic"><enum>(d)</enum><header>Advanced
Training</header>
<paragraph changed="added" committee-id="SLIA00" id="ID912F4F9D1C954BC0A485501045A3F63B" reported-display-style="italic"><enum>(1)</enum><header>Required</header><text>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—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID32407250FACE4594BACFEB9CD09CF6DC" reported-display-style="italic"><enum>(A)</enum><text>has already received a
degree or diploma in such health profession; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDBFF47944A15E4B588B8562F0E1C54D43" reported-display-style="italic"><enum>(B)</enum><text>provides clinical
services on or near a reservation or for an Indian Health Program.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDFF8175F3E6704A4387E95596BDB6E9F0" reported-display-style="italic"><enum>(2)</enum><header>May be offered at
alternate site</header><text>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).</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID10F3ED1F1C0D41AA96D42001A3D09918" reported-display-style="italic"><enum>(e)</enum><header>Funding
Priority</header><text>Where the requirements of subsection (b) are met,
funding priority shall be provided to tribal colleges and universities in
Service Areas where they exist.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID08C8180C2A204B80BAE124D21EF56312" reported-display-style="italic"><enum>119.</enum><header>Retention
bonus</header>
<subsection changed="added" committee-id="SLIA00" id="ID8AFEACC713E640D5BA2D77D07D7A1DAF" reported-display-style="italic"><enum>(a)</enum><header>Bonus
Authorized</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID8114D0BA9B3B4618B5F6C2A9024F952C" reported-display-style="italic"><enum>(1)</enum><text>is assigned to, and
serving in, a position for which recruitment or retention of personnel is
difficult;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDB3F18179ADD74EDB9A028FAB7E1E73F7" reported-display-style="italic"><enum>(2)</enum><text>the Secretary determines
is needed by Indian Health Programs and Urban Indian Organizations;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID74730B695F294637A5D1D0A293425F17" reported-display-style="italic"><enum>(3)</enum><text>has—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID07186247E163499982A84A1599C636F3" reported-display-style="italic"><enum>(A)</enum><text>completed 3 years of
employment with an Indian Health Program or Urban Indian Organization;
or</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID8AFF84BAE91D4BE2B119F596FD585646" reported-display-style="italic"><enum>(B)</enum><text>completed any service
obligations incurred as a requirement of—</text>
<clause changed="added" committee-id="SLIA00" id="ID70646724357740A89AD96E6F08C9A79E" reported-display-style="italic"><enum>(i)</enum><text>any Federal scholarship
program; or</text>
</clause><clause changed="added" committee-id="SLIA00" id="IDF1A837775A774BD7A3722BE9DB35238D" reported-display-style="italic"><enum>(ii)</enum><text>any Federal education
loan repayment program; and</text>
</clause></subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID05F7372FF97C4843B30DEF1CFEE979EB" reported-display-style="italic"><enum>(4)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID2FAE295675034FAE9F850BF50D492A2F" reported-display-style="italic"><enum>(b)</enum><header>Rates</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID313B8A97CA3541EEA98EC4B061EC580E" reported-display-style="italic"><enum>(c)</enum><header>Default of Retention
Agreement</header><text>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(<added-phrase>l</added-phrase>)(2)(B).</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDD178883ACA394E4396EE86DD03B0BCDB" reported-display-style="italic"><enum>(d)</enum><header>Other Retention
Bonus</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDF4245F535EFB464B891EEE20492EC751" reported-display-style="italic"><enum>(1)</enum><text>a position for which
recruitment or retention is difficult; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID03F6CDD287134B41B8CE6B38A307D8A1" reported-display-style="italic"><enum>(2)</enum><text>necessary for providing
health care services to Indians.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="ID008CD4595B0548CD9F78AD96B5A6A1C1" reported-display-style="italic"><enum>120.</enum><header>Nursing residency
Program</header>
<subsection changed="added" committee-id="SLIA00" id="ID1C869DD8B98F4D44B06FB531877C987F" reported-display-style="italic"><enum>(a)</enum><header>Establishment of
Program</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID7ED0E59C421A41F18D66777DB764EDD0" reported-display-style="italic"><enum>(b)</enum><header>Service
Obligation</header><text>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 (<added-phrase>l</added-phrase>) of
section 110 in the manner provided for in such subsection.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID594247BA0CC6451487FE10E6A5106E3E" reported-display-style="italic"><enum>121.</enum><header>Community Health Aide
Program</header>
<subsection changed="added" committee-id="SLIA00" id="IDD0E60AB5D75245D980C4E93776DBD2B7" reported-display-style="italic"><enum>(a)</enum><header>General Purposes of
Program</header><text>Under the authority of the Act of November 2, 1921 (25
U.S.C. 13) (commonly known as the <quote>Snyder Act</quote>), the Secretary,
acting through the Service, shall develop and operate a Community Health Aide
Program in Alaska under which the Service—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDC6115E1F27184FED93A1CE8175612A20" reported-display-style="italic"><enum>(1)</enum><text>provides for the training
of Alaska Natives as health aides or community health practitioners;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID40F45B45B4B64A2FA158906E92882802" reported-display-style="italic"><enum>(2)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID9ED8ECFF0D1A4E1589C6D07B499642AD" reported-display-style="italic"><enum>(3)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID07CC587B7F984BD4A0A34D0AA8BC0438" reported-display-style="italic"><enum>(b)</enum><header>Specific Program
Requirements</header><text>The Secretary, acting through the Community Health
Aide Program of the Service, shall—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID59205F4FE35346489007D7804775EFC2" reported-display-style="italic"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID0257B16204DD49BC86BFF2CAC2C1564A" reported-display-style="italic"><enum>(2)</enum><text>in order to provide such
training, develop a curriculum that—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID53E1C0325D8348C8AC28497BA744C231" reported-display-style="italic"><enum>(A)</enum><text>combines education in the
theory of health care with supervised practical experience in the provision of
health care;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDFF939F42CC104E2687C64659B091AA9A" reported-display-style="italic"><enum>(B)</enum><text>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</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID861AC053B5A44C80B13343DDB286F244" reported-display-style="italic"><enum>(C)</enum><text>promotes the achievement
of the health status objectives specified in section 3(2);</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID2843BDC7BC8B40D794FADE4155CF13F8" reported-display-style="italic"><enum>(3)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDDDC042E0BF2349CE8087359F1DE31041" reported-display-style="italic"><enum>(4)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDD00F5649FAC8482E91A9FC9BA5909B6F" reported-display-style="italic"><enum>(5)</enum><text>develop and maintain a
system that provides close supervision of community health aides and community
health practitioners; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID44EB8EF1AC104ADAB818AFE1DFC230D2" reported-display-style="italic"><enum>(6)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID5b323ea58bb6457abc86e5a0ffad17bb" reported-display-style="italic"><enum>(c)</enum><header>Program review</header>
<paragraph changed="added" committee-id="SLIA00" id="idC4AB6EF7C35D44C89A8244168D066E77" reported-display-style="italic"><enum>(1)</enum><header>Neutral panel</header>
<subparagraph changed="added" committee-id="SLIA00" id="id9F8EFA61DC4741D7938559B4B91E1AB3" reported-display-style="italic"><enum>(A)</enum><header>Establishment</header><text>The
Secretary, acting through the Service, shall establish a neutral panel to carry
out the study under paragraph (2).</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="id959B9C485ECB4229936545B2A2044BC2" reported-display-style="italic"><enum>(B)</enum><header>Membership</header><text>Members
of the neutral panel shall be appointed by the Secretary from among clinicians,
economists, community practitioners, oral epidemiologists, and Alaska
Natives.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="id5577690AB6A64686B010829934978822" reported-display-style="italic"><enum>(2)</enum><header>Study</header>
<subparagraph changed="added" committee-id="SLIA00" id="id14338D76E2504AB68DAAC9E3F7EAED97" reported-display-style="italic"><enum>(A)</enum><header>In
general</header><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="id031EBCF53CE548498622863541A12E70" reported-display-style="italic"><enum>(B)</enum><header>Parameters of
study</header><text>The Secretary, in consultation with interested parties,
including professional dental organizations, shall develop the parameters of
the study.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="id3396B96838C541B3A6C2A1097D9DAC04" reported-display-style="italic"><enum>(C)</enum><header>Inclusions</header><text>The
study shall include a determination by the neutral panel with respect
to—</text>
<clause changed="added" committee-id="SLIA00" id="IDb77e224526c743f1b795b28f2cf1ccb5" reported-display-style="italic"><enum>(i)</enum><text>the ability of the dental
health aide therapist services under this section to address the dental care
needs of Alaska Natives;</text>
</clause><clause changed="added" committee-id="SLIA00" id="IDe5343e62f06840389eaa24c6b38a2f99" reported-display-style="italic"><enum>(ii)</enum><text>the quality of care
provided through those services, including any training, improvement, or
additional oversight required to improve the quality of care; and</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID5e31e00d462e499ea49c02d2ace97fc4" reported-display-style="italic"><enum>(iii)</enum><text>whether safer and less
costly alternatives to the dental health aide therapist services exist.</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SLIA00" id="id0C08BA412070455D8377C562A994D842" reported-display-style="italic"><enum>(D)</enum><header>Consultation</header><text>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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="idA73F46075C1F4C10BF90584C5B9A59F3" reported-display-style="italic"><enum>(3)</enum><header>Report</header><text>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—</text>
<subparagraph changed="added" committee-id="SLIA00" id="id53654C265EEB43DB9E7D9BA22974F975" reported-display-style="italic"><enum>(A)</enum><text>any determination of the
neutral panel under paragraph (2)(C); and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="id2377DCF6DD354B81AB7D38B934746A0B" reported-display-style="italic"><enum>(B)</enum><text>any comments received
from an Alaska Tribal Organization under paragraph (2)(D).</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="idF648E02A66124096A1C0FFC3F11F1452" reported-display-style="italic"><enum>(d)</enum><header>Nationalization of
program</header>
<paragraph changed="added" committee-id="SLIA00" id="idBD726E3C59A74CCDB64A95FC9628973A" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="id2FA5B0B5B0CE4B8887F344358D7C1055" reported-display-style="italic"><enum>(2)</enum><header>Exception</header><text>The
national Community Health Aide Program under paragraph (1) shall not include
dental health aide therapist services.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="idA9B7946A7AEF4D198A326FACDD1D6323" reported-display-style="italic"><enum>(3)</enum><header>Requirement</header><text>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).</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="IDA2FAEDED70804675966A8D171C4F660F" reported-display-style="italic"><enum>122.</enum><header>Tribal Health Program
Administration</header><text display-inline="no-display-inline">The Secretary,
acting through the Service, shall, by contract or otherwise, provide training
for Indians in the administration and planning of Tribal Health
Programs.</text>
</section><section changed="added" committee-id="SLIA00" id="ID73ABFEBACDB34EA3B48D23AA8FB61790" reported-display-style="italic"><enum>123.</enum><header>Health professional
chronic shortage demonstration Programs</header>
<subsection changed="added" committee-id="SLIA00" id="IDFB5797AB1C1449768532687AD008CA71" reported-display-style="italic"><enum>(a)</enum><header>Demonstration Programs
Authorized</header><text>The Secretary, acting through the Service, may fund
demonstration programs for Tribal Health Programs to address the chronic
shortages of health professionals.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID84206C7055B64D89BEE7B97B1A95B61C" reported-display-style="italic"><enum>(b)</enum><header>Purposes of
Programs</header><text>The purposes of demonstration programs funded under
subsection (a) shall be—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDD01F512E116F4B4EADC5F4C201E31BCA" reported-display-style="italic"><enum>(1)</enum><text>to provide direct
clinical and practical experience at a Service Unit to health profession
students and residents from medical schools;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID4C90E68FCF2E4312AB8836F2E67D2677" reported-display-style="italic"><enum>(2)</enum><text>to improve the quality of
health care for Indians by assuring access to qualified health care
professionals; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID5637F5E97BA347518D3C1F8F900340B7" reported-display-style="italic"><enum>(3)</enum><text>to provide academic and
scholarly opportunities for health professionals serving Indians by identifying
all academic and scholarly resources of the region.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDCA25D46D3E254548BCFABF01C67CAA34" reported-display-style="italic"><enum>(c)</enum><header>Advisory
Board</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="IDBC0A435124444DF6B8962EDD6AA05C25" reported-display-style="italic"><enum>124.</enum><header>National Health
Service Corps</header>
<subsection changed="added" committee-id="SLIA00" id="ID04462428333A4FCCB808E25148F9CB0B" reported-display-style="italic"><enum>(a)</enum><header>No Reduction in
Services</header><text>The Secretary shall not—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDB11C1D27D46042A68645DDE809230577" reported-display-style="italic"><enum>(1)</enum><text>remove a member of the
National Health Service Corps from an Indian Health Program or Urban Indian
Organization; or</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID06A3E82E0D3A4F32918384F810CC3B74" reported-display-style="italic"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID157F9000B8E4494C8597FDE8B47C953B" reported-display-style="italic"><enum>(b)</enum><header>Exemption From
Limitations</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID4C6FE6AA8ADE4BAFB891DE9F6677F1AC" reported-display-style="italic"><enum>125.</enum><header>Substance abuse
counselor educational curricula demonstration Programs</header>
<subsection changed="added" committee-id="SLIA00" id="ID28802E3DFB014F8B8A73CEC95E7D2ADC" reported-display-style="italic"><enum>(a)</enum><header>Grants and
Contracts</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDE08665D2FDFC4F849B80CDF88E020947" reported-display-style="italic"><enum>(b)</enum><header>Use of
Funds</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID6AA705BFD3D14DE18FA082CE73A78E4F" reported-display-style="italic"><enum>(c)</enum><header>Time Period of
Assistance; Renewal</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID6249D5B94D1A484E8C9E4466A71D254F" reported-display-style="italic"><enum>(d)</enum><header>Criteria for Review and
Approval of Applications</header><text>Not later than 180 days after the date
of enactment of the <act-name parsable-cite="IHCIA">Indian Health Care
Improvement Act</act-name> 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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID5F4993B1C34243C08209E24795111F44" reported-display-style="italic"><enum>(e)</enum><header>Assistance</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID8C27C6A2F6FF4B4ABAF3DE7A0BA29516" reported-display-style="italic"><enum>(f)</enum><header>Report</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID16FF92C836CC4ABBAFAE986333969A08" reported-display-style="italic"><enum>(g)</enum><header>Definition</header><text>For
the purposes of this section, the term <term>educational curriculum</term>
means 1 or more of the following:</text>
<paragraph changed="added" committee-id="SLIA00" id="IDD2B7D78F4C484282B09DFA4FB2961203" reported-display-style="italic"><enum>(1)</enum><text>Classroom
education.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID51B7151B54954E7E9A4A2A50B2B2C908" reported-display-style="italic"><enum>(2)</enum><text>Clinical work
experience.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDEA0C97747FE348E186CB73D5CC697C04" reported-display-style="italic"><enum>(3)</enum><text>Continuing education
workshops.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="IDB08D86CBAB2B4C8E87D965E410A8AF25" reported-display-style="italic"><enum>126.</enum><header>Behavioral Health
training and community education Programs</header>
<subsection changed="added" committee-id="SLIA00" id="IDABB590F036204CFABEA51C8D95AF9512" reported-display-style="italic"><enum>(a)</enum><header>Study;
List</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID77730D4A54CC4FA9AD54814E2C09CC1C" reported-display-style="italic"><enum>(b)</enum><header>Positions</header><text>The
positions referred to in subsection (a) are—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDDFD01E512F0248CD99252739B3EF8A5A" reported-display-style="italic"><enum>(1)</enum><text>staff positions within
the Bureau of Indian Affairs, including existing positions, in the fields
of—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDC850CDA7F2BC46C8A34E72E0B23B0B5F" reported-display-style="italic"><enum>(A)</enum><text>elementary and secondary
education;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDF390BDF08068425F8704BC3126E343C6" reported-display-style="italic"><enum>(B)</enum><text>social services and
family and child welfare;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID44CD82B311AA47BC833781D13F35029F" reported-display-style="italic"><enum>(C)</enum><text>law enforcement and
judicial services; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID8EBE9856E43149269879DEC25C1534E9" reported-display-style="italic"><enum>(D)</enum><text>alcohol and substance
abuse;</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID798B3B6A9F3542BBBA6DB0247BDF12E6" reported-display-style="italic"><enum>(2)</enum><text>staff positions within
the Service; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDFF494FFBFBB54AB8A6571244E952FF7E" reported-display-style="italic"><enum>(3)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDC5E5635BE50E46BA82782F45F437E844" reported-display-style="italic"><enum>(c)</enum><header>Training
Criteria</header>
<paragraph changed="added" committee-id="SLIA00" id="ID25F11EBFB51349DF9FFD3ADC6C173FFF" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>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 <act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDE81B0BB0625C4F4087DB7EE7827C365E" reported-display-style="italic"><enum>(2)</enum><header>Position specific
training criteria</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDD04205AD62CB4620BCAF1A5084DD1516" reported-display-style="italic"><enum>(d)</enum><header>Community Education on
Mental Illness</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDC8543DCBE5CB483FA388FA96018F3BF1" reported-display-style="italic"><enum>(e)</enum><header>Plan</header><text>Not
later than 90 days after the date of enactment of the
<act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name>
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 <quote>Snyder
Act</quote>).</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="IDDF2CA674A4E74178947F875D5FEDEDE7" reported-display-style="italic"><enum>127.</enum><header>Authorization of
appropriations</header><text display-inline="no-display-inline">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.</text>
</section><enum>II</enum><header>HEALTH SERVICES</header>
<section changed="added" committee-id="SLIA00" id="IDA232021277D54DEC8C06C5FB32ABAF56" reported-display-style="italic"><enum>201.</enum><header>Indian Health Care
Improvement Fund</header>
<subsection changed="added" committee-id="SLIA00" id="ID5567DFD1135B463281D888912DE7C773" reported-display-style="italic"><enum>(a)</enum><header>Use of
Funds</header><text>The Secretary, acting through the Service, is authorized to
expend funds, directly or under the authority of the
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (25 U.S.C. 450 et seq.), which are appropriated under
the authority of this section, for the purposes of—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID50E1E296BDEC4F98BC675EEEA2AE9C79" reported-display-style="italic"><enum>(1)</enum><text>eliminating the
deficiencies in health status and health resources of all Indian Tribes;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID6947C66F72D04FB7B9134CF7CAFD10B1" reported-display-style="italic"><enum>(2)</enum><text>eliminating backlogs in
the provision of health care services to Indians;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID47BB129821DD4C72947557B653383745" reported-display-style="italic"><enum>(3)</enum><text>meeting the health needs
of Indians in an efficient and equitable manner, including the use of
telehealth and telemedicine when appropriate;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDFD3372D6BCB14FF9A9CB0F11E7E43728" reported-display-style="italic"><enum>(4)</enum><text>eliminating inequities in
funding for both direct care and contract health service programs; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID62743A4C817C45CABDF8442BF18CF3BD" reported-display-style="italic"><enum>(5)</enum><text>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:</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDFEBD329CFC944FAF997C41063954D0FD" reported-display-style="italic"><enum>(A)</enum><text>Clinical care, including
inpatient care, outpatient care (including audiology, clinical eye, and vision
care), primary care, secondary and tertiary care, and long-term care.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID88943E7BE1EA4BFAAEBE56398C2F8472" reported-display-style="italic"><enum>(B)</enum><text>Preventive health,
including mammography and other cancer screening in accordance with section
207.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDBB78591E0DFE4202A8B88C95E1328894" reported-display-style="italic"><enum>(C)</enum><text>Dental care.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDD929589208854DAC813FC0FDBDE8A0F7" reported-display-style="italic"><enum>(D)</enum><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID781D3C0E62EF495982955DDE71351304" reported-display-style="italic"><enum>(E)</enum><text>Emergency medical
services.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID0183D17481DA4537A348019AE1C25F8A" reported-display-style="italic"><enum>(F)</enum><text>Treatment and control of,
and rehabilitative care related to, alcoholism and drug abuse (including fetal
alcohol syndrome) among Indians.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID14F4883088164D038A648B759343DAE2" reported-display-style="italic"><enum>(G)</enum><text>Injury prevention
programs.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDB6647DC9217249BE87C8B7CE3E4C1256" reported-display-style="italic"><enum>(H)</enum><text>Home health care.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID264BEDD8F6D24AC98A493F6E76E94673" reported-display-style="italic"><enum>(I)</enum><text>Community health
representatives.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDB916046027434DFD94EE6FCE6B4023D7" reported-display-style="italic"><enum>(J)</enum><text>Maintenance and
improvement.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID48331A36356343C6A73B077A1773E6B5" reported-display-style="italic"><enum>(K)</enum><text>Traditional Health Care
Practices.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDD3408FF9B1CE4668A630FA2D7148862A" reported-display-style="italic"><enum>(b)</enum><header>No Offset or
Limitation</header><text>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 <quote>Snyder Act</quote>), or any other provision of
law.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID92EDF06C0B7944EF905049F227537D1C" reported-display-style="italic"><enum>(c)</enum><header>Allocation;
Use</header>
<paragraph changed="added" committee-id="SLIA00" id="ID4FA65BD83E274626A4BC6D5C3C831C82" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDCE09312D5038406182C41CAA77CC8D27" reported-display-style="italic"><enum>(2)</enum><header>Apportionment of
allocated funds</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDB826D39DF95A4FAE9F04A2A39668165C" reported-display-style="italic"><enum>(d)</enum><header>Provisions Relating to
Health Status and Resource Deficiencies</header><text>For the purposes of this
section, the following definitions apply:</text>
<paragraph changed="added" committee-id="SLIA00" id="ID40DF53A4B2B64058B1185BF8D4B0CA33" reported-display-style="italic"><enum>(1)</enum><header>Definition</header><text>The
term <term>health status and resource deficiency</term> means the extent to
which—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID20F8F81C8FB64ACF8FF264E01FD08268" reported-display-style="italic"><enum>(A)</enum><text>the health status
objectives set forth in section 3(2) are not being achieved; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID2AA27989955F4B9690D467065BF2B8E0" reported-display-style="italic"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID7300FE9480B94A5E805A3BF51583B57E" reported-display-style="italic"><enum>(2)</enum><header>Available
resources</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID3A3F57141192496ABEBC9402F93EC054" reported-display-style="italic"><enum>(3)</enum><header>Process for review of
determinations</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDC25C64F420C94346B3704D00EEA02444" reported-display-style="italic"><enum>(e)</enum><header>Eligibility for
Funds</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID913DDF8E4ECA482EB69E7FB42E71E91C" reported-display-style="italic"><enum>(f)</enum><header>Report</header><text>By
no later than the date that is 3 years after the date of enactment of the
<act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name>
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—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDA9A9DD79A48849B9B0448EE984887720" reported-display-style="italic"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDB6952E842C5F49BBA453FAAB19129010" reported-display-style="italic"><enum>(2)</enum><text>the extent of the health
status and resource deficiency of each Indian Tribe served by the Service or a
Tribal Health Program;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID3124C8ECFBCA46548EFA8596ADE8787E" reported-display-style="italic"><enum>(3)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDF36F086C32194D928FA218E46653A02E" reported-display-style="italic"><enum>(4)</enum><text>an estimate of—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID689F4A7261B545949EA86872BBA9AA2E" reported-display-style="italic"><enum>(A)</enum><text>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;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID7C68D2222FD6493698639B90C5869FDC" reported-display-style="italic"><enum>(B)</enum><text>the number of Indians
eligible for health services in each Service Unit or Indian Tribe or Tribal
Organization; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID1AB7CD9CAA564D40B3D93306D5BDAEED" reported-display-style="italic"><enum>(C)</enum><text>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.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDEA2110CE138A492F846AA22434243EC5" reported-display-style="italic"><enum>(g)</enum><header>Inclusion in Base
Budget</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID551B8F20B0DA478DBED2F09D5A592183" reported-display-style="italic"><enum>(h)</enum><header>Clarification</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID03CFBA5ED48840189007C34BCC508D76" reported-display-style="italic"><enum>(i)</enum><header>Funding
Designation</header><text>Any funds appropriated under the authority of this
section shall be designated as the <quote>Indian Health Care Improvement
Fund</quote>.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID3D6A363E63F7419191AAA86FB11D5B43" reported-display-style="italic"><enum>202.</enum><header>Catastrophic Health
Emergency Fund</header>
<subsection changed="added" committee-id="SLIA00" id="ID5A6F2118C8AD4BFDBD46DE193B02651F" reported-display-style="italic"><enum>(a)</enum><header>Establishment</header><text>There
is established an Indian Catastrophic Health Emergency Fund (hereafter in this
section referred to as the <quote>CHEF</quote>) consisting of—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID91C5609329F34C8683421E922AD6B737" reported-display-style="italic"><enum>(1)</enum><text>the amounts deposited
under subsection (f); and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDFE807B65E59B4404926D373477ABCC49" reported-display-style="italic"><enum>(2)</enum><text>the amounts appropriated
to CHEF under this section.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID5949BB73CEF349A3951F2004D172D409" reported-display-style="italic"><enum>(b)</enum><header>Administration</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID2EDBC4B9EEEA4D03BAB973028FA425E3" reported-display-style="italic"><enum>(c)</enum><header>Conditions on Use of
Fund</header><text>No part of CHEF or its administration shall be subject to
contract or grant under any law, including the <act-name parsable-cite="ISDA">Indian Self-Determination and Education Assistance
Act</act-name> (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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDFEBB8215664D4BABAC53A021218735B7" reported-display-style="italic"><enum>(d)</enum><header>Regulations</header><text>The
Secretary shall, through the negotiated rulemaking process under title VIII,
promulgate regulations consistent with the provisions of this section
to—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID32DB947F3827489D9DDB93C5595CFCA9" reported-display-style="italic"><enum>(1)</enum><text>establish a definition of
disasters and catastrophic illnesses for which the cost of the treatment
provided under contract would qualify for payment from CHEF;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDD754495B77634E0BA629F542010AF0D4" reported-display-style="italic"><enum>(2)</enum><text>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—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDD8EA7DE0F6194CE6B79FF04DA29B9E59" reported-display-style="italic"><enum>(A)</enum><text>the 2000 level of
$19,000; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDA3016A47AEF546FBBAB86A5C0BA5305A" reported-display-style="italic"><enum>(B)</enum><text>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;</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID18B3ADA393114CFDB879A853E188B6C5" reported-display-style="italic"><enum>(3)</enum><text>establish a procedure for
the reimbursement of the portion of the costs that exceeds such threshold cost
incurred by—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDC7B0316CE5234945908EF440E4F264C8" reported-display-style="italic"><enum>(A)</enum><text>Service Units; or</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID7B86B7EB01844618A37B6E9360A0522D" reported-display-style="italic"><enum>(B)</enum><text>whenever otherwise
authorized by the Service, non-Service facilities or providers;</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDED1D7C99F3B54C77B531F16ABE23B6B2" reported-display-style="italic"><enum>(4)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID9E17D97EDD494DE3BCF8573178887706" reported-display-style="italic"><enum>(5)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID208E1AB3AADB494EBB48456726C01CEB" reported-display-style="italic"><enum>(e)</enum><header>No Offset or
Limitation</header><text>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
<quote>Snyder Act</quote>), or any other law.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID1F4134AF73374864927FC1764A8DE319" reported-display-style="italic"><enum>(f)</enum><header>Deposit of
Reimbursement Funds</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID584B9BF90CEA4087A8C3B6B84ABEE849" reported-display-style="italic"><enum>203.</enum><header>Health promotion and
disease prevention Services</header>
<subsection changed="added" committee-id="SLIA00" id="ID9A5107B602944FC3B78D553F9F1938BF" reported-display-style="italic"><enum>(a)</enum><header>Findings</header><text>Congress
finds that health promotion and disease prevention activities—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID1E14BFB79FDA408FB2EAF936E30921D6" reported-display-style="italic"><enum>(1)</enum><text>improve the health and
well-being of Indians; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID282C1D77A3A148C680151F9AB77BAA86" reported-display-style="italic"><enum>(2)</enum><text>reduce the expenses for
health care of Indians.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID7D1D593D3D4F4D0B92A75E6F008EDB95" reported-display-style="italic"><enum>(b)</enum><header>Provision of
Services</header><text>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).</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID65C84B0881C240C58EBA581739C16FF5" reported-display-style="italic"><enum>(c)</enum><header>Evaluation</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDE597DEF885DF457DAB09CA5BCDC53578" reported-display-style="italic"><enum>(1)</enum><text>the health promotion and
disease prevention needs of Indians;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDD5D52828F4564C38AA82B089DEF075DE" reported-display-style="italic"><enum>(2)</enum><text>the health promotion and
disease prevention activities which would best meet such needs;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDB93E6F867D804871A7C454A68068C656" reported-display-style="italic"><enum>(3)</enum><text>the internal capacity of
the Service and Tribal Health Programs to meet such needs; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID1D5354680B57487090D815C31651F387" reported-display-style="italic"><enum>(4)</enum><text>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.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="ID6C02AD73BFB74BE3BBDDB70E97253B2A" reported-display-style="italic"><enum>204.</enum><header>Diabetes prevention,
treatment, and control</header>
<subsection changed="added" committee-id="SLIA00" id="IDA52C389DB570429E8129ADE06D23D86F" reported-display-style="italic"><enum>(a)</enum><header>Determinations
Regarding Diabetes</header><text>The Secretary, acting through the Service, and
in consultation with Indian Tribes and Tribal Organizations, shall
determine—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID838ACBE5F29A4001851CD40FB8AC8D8D" reported-display-style="italic"><enum>(1)</enum><text>by Indian Tribe and by
Service Unit, the incidence of, and the types of complications resulting from,
diabetes among Indians; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID30EB8135FFBD4F5CB071461B8B2AE225" reported-display-style="italic"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID0D89ED48957B447F86B74ADBD10A0012" reported-display-style="italic"><enum>(b)</enum><header>Diabetes
Screening</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID5C46ADE9D0E84B1D93D6561DBE3B8E0F" reported-display-style="italic"><enum>(c)</enum><header>Funding for
Diabetes</header><text>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
<act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name>
Amendments of 2005 and for projects which are added and funded
thereafter.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID9D64AF9B171747EFAF9A9FB586ADE46A" reported-display-style="italic"><enum>(d)</enum><header>Funding for Dialysis
Programs</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID8E2BEC7FE9674A8B9CADD3FA7BD294EA" reported-display-style="italic"><enum>(e)</enum><header>Other Duties of the
Secretary</header>
<paragraph changed="added" committee-id="SLIA00" id="idBFC5F55C228E4DAAB80DF7DAE74A54C3" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>The Secretary shall, to the extent funding is
available—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID50ECD888781340B5883E828E8E2636F9" reported-display-style="italic"><enum>(A)</enum><text>in each Area Office,
consult with Indian Tribes and Tribal Organizations regarding programs for the
prevention, treatment, and control of diabetes;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDD1094ECBF3C748E28C717B7B01F4220C" reported-display-style="italic"><enum>(B)</enum><text>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</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID580C9F3A73C14EBDAB3A7782CD37486C" reported-display-style="italic"><enum>(C)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="idFD06589046AF4FFA96A5C61C37E44C5C" reported-display-style="italic"><enum>(2)</enum><header>Diabetes control
officers</header>
<subparagraph changed="added" committee-id="SLIA00" id="idE034FEE5685040AA99E48848A471DBC2" reported-display-style="italic"><enum>(A)</enum><header>In
general</header><text>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).</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="idC25F13E75B2C400F9856F584B1EAA943" reported-display-style="italic"><enum>(B)</enum><header>Certain
activities</header><text>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.</text>
</subparagraph></paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="IDA1E09498CE4248B5A63A44509098B0B7" reported-display-style="italic"><enum>205.</enum><header>Shared Services for
Long-Term care</header>
<subsection changed="added" committee-id="SLIA00" id="IDE0D57744EE984255A6EE3F4D7BEE7A1A" reported-display-style="italic"><enum>(a)</enum><header>Long-Term
Care</header><text>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 <act-name parsable-cite="ISDA">Indian
Self-Determination and Education Assistance Act</act-name> (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
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (25 U.S.C. 450 et seq.)) by such Indian Tribe or
Tribal Organization.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID62AE5CC139644A9F91EECF3014879A07" reported-display-style="italic"><enum>(b)</enum><header>Contents of
Agreements</header><text>An agreement entered into pursuant to subsection
(a)—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID13BF0E8EB497449388B184EA15D0A1B5" reported-display-style="italic"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID33642957D40D4C2D9F7C684A3478C5DA" reported-display-style="italic"><enum>(2)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID6EA97DCCCCEA4A27BE57AC565F342151" reported-display-style="italic"><enum>(3)</enum><text>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).</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID7E09EA479CA5467E9A6EF94AB622A2EB" reported-display-style="italic"><enum>(c)</enum><header>Minimum
Requirement</header><text>Any nursing facility provided for under this section
shall meet the requirements for nursing facilities under section 1919 of the
<act-name parsable-cite="SSA">Social Security Act</act-name>.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDB4B5D973A66A4F0E9881BF710353029A" reported-display-style="italic"><enum>(d)</enum><header>Other
Assistance</header><text>The Secretary shall provide such technical and other
assistance as may be necessary to enable applicants to comply with the
provisions of this section.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID56E1850B59FE4FBB9EC59757537D834E" reported-display-style="italic"><enum>(e)</enum><header>Use of Existing or
Underused Facilities</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID20C06B24827F47E78534C86FFC2E77C1" reported-display-style="italic"><enum>206.</enum><header>Health Services
research</header><text display-inline="no-display-inline">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.</text>
</section><section changed="added" committee-id="SLIA00" id="IDC6EC43E5FEB0451D949770F5F4B71C6F" reported-display-style="italic"><enum>207.</enum><header>Mammography and other
cancer screening</header><text display-inline="no-display-inline">The
Secretary, acting through the Service or Tribal Health Programs, shall provide
for screening as follows:</text>
<paragraph changed="added" committee-id="SLIA00" id="ID5F57D4F0EC2E4BEBA0EDCFEB1CFC3748" reported-display-style="italic"><enum>(1)</enum><text>Screening mammography (as
defined in section 1861(jj) of the <act-name parsable-cite="SSA">Social
Security Act</act-name>) 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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDBE44D6A07C244C56A8946A8A68B305C8" reported-display-style="italic"><enum>(2)</enum><text>Other cancer screening
meeting accepted and appropriate national standards.</text>
</paragraph></section><section changed="added" committee-id="SLIA00" id="ID777976F6E67E44AD9A55EDD861731C74" reported-display-style="italic"><enum>208.</enum><header>Patient travel
costs</header><text display-inline="no-display-inline">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 <act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (25 U.S.C. 450 et seq.)) under this Act—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID5E652938285945FD9E62EBCA923B9F4C" reported-display-style="italic"><enum>(1)</enum><text>emergency air
transportation and non-emergency air transportation where ground transportation
is infeasible;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDAFE2B5BF9374461D8CAC2F38AE2AFCE5" reported-display-style="italic"><enum>(2)</enum><text>transportation by private
vehicle (where no other means of transportation is available), specially
equipped vehicle, and ambulance; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID381C1FDC11184239B3A2996024A6A6DF" reported-display-style="italic"><enum>(3)</enum><text>transportation by such
other means as may be available and required when air or motor vehicle
transportation is not available.</text>
</paragraph></section><section changed="added" committee-id="SLIA00" id="ID96C00E2A7B524D54AAC24F9DB598168B" reported-display-style="italic"><enum>209.</enum><header>Epidemiology
Centers</header>
<subsection changed="added" committee-id="SLIA00" id="ID36D859A292F94515A9BD881F2591CEFB" reported-display-style="italic"><enum>(a)</enum><header>Additional
Centers</header><text>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 <act-name parsable-cite="IHCIA">Indian Health Care Improvement
Act</act-name> 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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDBD4A4812B5EB4F4B858D63AA8668A5AA" reported-display-style="italic"><enum>(b)</enum><header>Functions of
Centers</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDAAA409C067C145718193BDCC31B58E15" reported-display-style="italic"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID127C9B9EE83E473D8CBE54C64610F9FE" reported-display-style="italic"><enum>(2)</enum><text>evaluate existing
delivery systems, data systems, and other systems that impact the improvement
of Indian health;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDDC9143C101C94778964CE1282FBF9C6B" reported-display-style="italic"><enum>(3)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID2E2E47FA65114D43BCAA769BC0F985A2" reported-display-style="italic"><enum>(4)</enum><text>make recommendations for
the targeting of services needed by the populations served;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID87420FC9AA5447BE917802B258126EEB" reported-display-style="italic"><enum>(5)</enum><text>make recommendations to
improve health care delivery systems for Indians and Urban Indians;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID5B8FCF275EBE436CB66B7A2BB338DFA0" reported-display-style="italic"><enum>(6)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID0FDD81AB75544084A5CB6D6337E4DDD5" reported-display-style="italic"><enum>(7)</enum><text>provide disease
surveillance and assist Indian Tribes, Tribal Organizations, and Urban Indian
Organizations to promote public health.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID2946789860744A5DBD1E3F93D3F2315C" reported-display-style="italic"><enum>(c)</enum><header>Technical
Assistance</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID26B449CE5EA245ECBB3DDF3F01718E9C" reported-display-style="italic"><enum>(d)</enum><header>Funding for
Studies</header><text>The Secretary may make funding available to Indian
Tribes, Tribal Organizations, and Urban Indian Organizations to conduct
epidemiological studies of Indian communities.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID700A0F7CE54D4A10867DB63E74EA322F" reported-display-style="italic"><enum>210.</enum><header>Comprehensive school
Health education Programs</header>
<subsection changed="added" committee-id="SLIA00" id="ID73B6737AD5314031BEB899A29F1CC91C" reported-display-style="italic"><enum>(a)</enum><header>Funding for Development
of Programs</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDC75421D09D784512A45ADD67387A5D25" reported-display-style="italic"><enum>(b)</enum><header>Use of grant
funds</header><text>A grant awarded under this section may be used for purposes
which may include, but are not limited to, the following:</text>
<paragraph changed="added" committee-id="SLIA00" id="IDE2C36E3544C94DC7B39BE220918197EA" reported-display-style="italic"><enum>(1)</enum><text>Developing and
implementing health education curricula both for regular school programs and
afterschool programs.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDA7AD3FCF46F34E1BA9B20FC761A3B4FE" reported-display-style="italic"><enum>(2)</enum><text>Training teachers in
comprehensive school health education curricula.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDC94AA76999824D2CB541C02B81D8230C" reported-display-style="italic"><enum>(3)</enum><text>Integrating school-based,
community-based, and other public and private health promotion efforts.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID67B9A9DF0526479283B9A4EFA5F04383" reported-display-style="italic"><enum>(4)</enum><text>Encouraging healthy,
tobacco-free school environments.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDFA5F65D6B34B464C9DD8D93AF40DB491" reported-display-style="italic"><enum>(5)</enum><text>Coordinating school-based
health programs with existing services and programs available in the
community.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDEF551886CFA74202A80192CE6DA5F4FD" reported-display-style="italic"><enum>(6)</enum><text>Developing school
programs on nutrition education, personal health, oral health, and
fitness.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID2167A20B44E247C5B5742460C2B40F5C" reported-display-style="italic"><enum>(7)</enum><text>Developing behavioral
health wellness programs.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID55F7F6F0861C498B996CC3C20D8390B1" reported-display-style="italic"><enum>(8)</enum><text>Developing chronic
disease prevention programs.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID6B24E748878B4595871AA05642F17F51" reported-display-style="italic"><enum>(9)</enum><text>Developing substance
abuse prevention programs.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDE57FB9CF45D043A0B9BF0454E747A3DB" reported-display-style="italic"><enum>(10)</enum><text>Developing injury
prevention and safety education programs.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID0A5901E8BCB548FCA122239537C52B8D" reported-display-style="italic"><enum>(11)</enum><text>Developing activities
for the prevention and control of communicable diseases.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID67C144C1DE6F4E4DA9B2E7345B5587A4" reported-display-style="italic"><enum>(12)</enum><text>Developing community and
environmental health education programs that include traditional health care
practitioners.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID67C89C133C86462BBE2BFEDFE885DCA1" reported-display-style="italic"><enum>(13)</enum><text>Violence
prevention.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDA5EAE69135BD45CE89BA779176588F83" reported-display-style="italic"><enum>(14)</enum><text>Such other health issues
as are appropriate.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID3D4CEF587457492B8346547BF2158556" reported-display-style="italic"><enum>(c)</enum><header>Technical
Assistance</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDE37D3493AB3F442B97BEA25A2C5A5E8D" reported-display-style="italic"><enum>(d)</enum><header>Criteria for Review and
Approval of Applications</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDE51FBF64145B4B32AB554DF398646CC6" reported-display-style="italic"><enum>(e)</enum><header>Development of Program
for BIA Funded Schools</header>
<paragraph changed="added" committee-id="SLIA00" id="ID53435E7CED064F7790BA48300F715FC8" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID052BD39226B7445E9D340C1530A491AE" reported-display-style="italic"><enum>(2)</enum><header>Requirements for
programs</header><text>Such programs shall include—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID6A4076231353469693C7E02642E85C7C" reported-display-style="italic"><enum>(A)</enum><text>school programs on
nutrition education, personal health, oral health, and fitness;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID260ED2FD23A145C597FD75981D47D63F" reported-display-style="italic"><enum>(B)</enum><text>behavioral health
wellness programs;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID452EBC656B0C4E06923E7AC70763FA7D" reported-display-style="italic"><enum>(C)</enum><text>chronic disease
prevention programs;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDDF1FC29A7C8344108EB76A071DF32034" reported-display-style="italic"><enum>(D)</enum><text>substance abuse
prevention programs;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID12521EA3E5A7437E8E7FC4B7C1F20F78" reported-display-style="italic"><enum>(E)</enum><text>injury prevention and
safety education programs; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDF375837469034B139893A907E8650925" reported-display-style="italic"><enum>(F)</enum><text>activities for the
prevention and control of communicable diseases.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDFA2D8C4415C24BB1B1F650CED211EFCA" reported-display-style="italic"><enum>(3)</enum><header>Duties of the
secretary</header><text>The Secretary of the Interior shall—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID1DB60FF7866C4AC2AC017C3CF9E959D8" reported-display-style="italic"><enum>(A)</enum><text>provide training to
teachers in comprehensive school health education curricula;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDE99914FCC7C64BFE8DE3E2CAABF5697D" reported-display-style="italic"><enum>(B)</enum><text>ensure the integration
and coordination of school-based programs with existing services and health
programs available in the community; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDC381CE40A68D466FB7ED1A56D65AC977" reported-display-style="italic"><enum>(C)</enum><text>encourage healthy,
tobacco-free school environments.</text>
</subparagraph></paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="ID15BDC0DFD2AF44DEB97D137BA65C8258" reported-display-style="italic"><enum>211.</enum><header>Indian youth
Program</header>
<subsection changed="added" committee-id="SLIA00" id="ID030CF84D23A84467BD1044D0EAE9ED85" reported-display-style="italic"><enum>(a)</enum><header>Program
Authorized</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID9082CA91F36A42E1BDEB4AB9F532F240" reported-display-style="italic"><enum>(b)</enum><header>Use of Funds</header>
<paragraph changed="added" committee-id="SLIA00" id="ID20F335351B6948C6840398733E2DF1BA" reported-display-style="italic"><enum>(1)</enum><header>Allowable
uses</header><text>Funds made available under this section may be used
to—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDDEA0418DE6C440939ABEF2D89363FB6C" reported-display-style="italic"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID1515D82D36934993A368D49BE6AF478B" reported-display-style="italic"><enum>(B)</enum><text>develop and provide
community training and education.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDB7CB9BAD4764425FBF40593C1F95049B" reported-display-style="italic"><enum>(2)</enum><header>Prohibited
use</header><text>Funds made available under this section may not be used to
provide services described in section 707(c).</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDACC1EA252DC44EDAAF4C29C8CE496FAA" reported-display-style="italic"><enum>(c)</enum><header>Duties of the
Secretary</header><text>The Secretary shall—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID6B5896B6122945C4848B3DE643B587D3" reported-display-style="italic"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDDF087327E6554913A44B3071C252C283" reported-display-style="italic"><enum>(2)</enum><text>encourage the
implementation of such models; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDF138080602A8483BBF520D0AB3932372" reported-display-style="italic"><enum>(3)</enum><text>at the request of an
Indian Tribe, Tribal Organization, or Urban Indian Organization, provide
technical assistance in the implementation of such models.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID2181294ADB7A467EA1B4BE19E892F52C" reported-display-style="italic"><enum>(d)</enum><header>Criteria for Review and
Approval of Applications</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID43AA6B592463481FA63E028DBDDBE770" reported-display-style="italic"><enum>212.</enum><header>Prevention, control,
and elimination of communicable and infectious diseases</header>
<subsection changed="added" committee-id="SLIA00" id="IDFC92ED79C02F4F80A00407B31746BE4D" reported-display-style="italic"><enum>(a)</enum><header>Funding
Authorized</header><text>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:</text>
<paragraph changed="added" committee-id="SLIA00" id="IDADFB4073D1CE4FF48DDF949549A78E2E" reported-display-style="italic"><enum>(1)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID348A7EFAF47246D4A5D5D7C53A35DD61" reported-display-style="italic"><enum>(2)</enum><text>Public information and
education programs for the prevention, control, and elimination of communicable
and infectious diseases.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID0BC2ACA1113248959D8020490CD73DEB" reported-display-style="italic"><enum>(3)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDC3AD9472F1DD4CE59681F865E02C086F" reported-display-style="italic"><enum>(4)</enum><text>Demonstration projects
for the screening, treatment, and prevention of hepatitis C virus (HCV).</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDB1D9424AC7604E3FA208F5A44D7D0EFC" reported-display-style="italic"><enum>(b)</enum><header>Application
Required</header><text>The Secretary may provide funding under subsection (a)
only if an application or proposal for funding is submitted to the
Secretary.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID3542FB0A2FC24747A967DADC81E17967" reported-display-style="italic"><enum>(c)</enum><header>Coordination With
Health Agencies</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID16FFC4CAF4C644D1AB6E6B6E67C2741C" reported-display-style="italic"><enum>(d)</enum><header>Technical Assistance;
Report</header><text>In carrying out this section, the Secretary—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDD49E7BF49A8349FF92FACB5ED017A2FB" reported-display-style="italic"><enum>(1)</enum><text>may, at the request of an
Indian Tribe, Tribal Organization, or Urban Indian Organization, provide
technical assistance; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID6081786D3ED44B73822FC0B663076B7A" reported-display-style="italic"><enum>(2)</enum><text>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.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="ID8D25F6CE005A40968CCB3D2548300442" reported-display-style="italic"><enum>213.</enum><header>Authority for
provision of other Services</header>
<subsection changed="added" committee-id="SLIA00" id="ID7FE4C4D76D59442083DFB1B4DB007376" reported-display-style="italic"><enum>(a)</enum><header>Funding
Authorized</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID0F85FC56EFD94EE6B45055E061E5B7CA" reported-display-style="italic"><enum>(1)</enum><text>hospice care;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID7D7D4E1C984A42FBA7C5D87445CF60D0" reported-display-style="italic"><enum>(2)</enum><text>assisted living;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID385BFEA9E33A470CB6BB5A7E28F61BCB" reported-display-style="italic"><enum>(3)</enum><text>long-term health
care;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDE20404B9487A4C1F9341F6903FBE183A" reported-display-style="italic"><enum>(4)</enum><text>home- and community-based
services, in accordance with subsection (d); and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDFB76874C63FD45AAB8B4FD96D14FDFA6" reported-display-style="italic"><enum>(5)</enum><text>public health
functions.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID5B270E045579495DBED708ACBE88DF57" reported-display-style="italic"><enum>(b)</enum><header>Services to Otherwise
Ineligible Persons</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="idAC96DE052F3B4CEFBC77A91F26A58FA3" reported-display-style="italic"><enum>(c)</enum><header>Terms and
conditions</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID6E38FD32333C4B81AC885FFCD01A6357" reported-display-style="italic"><enum>(d)</enum><header>Definitions</header><text>For
the purposes of this section, the following definitions shall apply:</text>
<paragraph changed="added" committee-id="SLIA00" id="IDEE4F047ECB6542FB9BC3E03CB3983EC6" reported-display-style="italic"><enum>(1)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id036D8989359945268CD6F40F74D9E240"><enum>(A)</enum><text>The term <term>home-
and community-based services</term> means 1 or more of the following:</text>
<clause changed="added" committee-id="SLIA00" id="IDBA0310D7E23748FAB16BE3ADC1D0A991" indent="up1" reported-display-style="italic"><enum>(i)</enum><text>Home health aide
services.</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID9854CE850D054C9381C79879033F5751" indent="up1" reported-display-style="italic"><enum>(ii)</enum><text>Personal care
services.</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID9E25A36FE1A24D42AC36903EB1EB60D8" indent="up1" reported-display-style="italic"><enum>(iii)</enum><text>Nursing care services
provided outside of a nursing facility by, or under the supervision of, a
registered nurse.</text>
</clause><clause changed="added" committee-id="SLIA00" id="IDC7C32AC8C4AC429DA762FD8CEF8B13DE" indent="up1" reported-display-style="italic"><enum>(iv)</enum><text>Respite care.</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID5009833B62B946E2B61793C390768F4E" indent="up1" reported-display-style="italic"><enum>(v)</enum><text>Training for family
members.</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID7C216DEF24B34D94B39810E036905B25" indent="up1" reported-display-style="italic"><enum>(vi)</enum><text>Adult day care.</text>
</clause><clause changed="added" committee-id="SLIA00" id="IDB31407B94A844E86B6D0AAFDFFBF05E8" indent="up1" reported-display-style="italic"><enum>(vii)</enum><text>Such other home- and
community-based services as the Secretary, an Indian Tribe, or a Tribal
Organization may approve.</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SLIA00" id="id592F74A88D814147BF13634ABD7818E5" indent="up1" reported-display-style="italic"><enum>(B)</enum><text>The term <term>home- and
community-based services</term> does not include a service provided by an
individual that is legally responsible for providing the service.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID35A0F62EACD64D9091273F95EAE1B3CF" reported-display-style="italic"><enum>(2)</enum><text>The term <term>hospice
care</term> means the items and services specified in subparagraphs (A) through
(H) of section 1861(dd)(1) of the <act-name parsable-cite="SSA">Social Security
Act</act-name> (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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="id63FCDDF3C45243D3AE3C626AA5BAE02A" reported-display-style="italic"><enum>(3)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id9ECC17FFE0514321858120D54AA5BFDF"><enum>(A)</enum><text>The term <term>personal
care services</term> means services relating to assistance in carrying out
activities of daily living.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="idCEEA93B721A5421C8668D0750F1BE021" indent="up1" reported-display-style="italic"><enum>(B)</enum><text>The term <term>personal
care services</term> 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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID977C7D0666AA4846BBD5A1023B20F5F5" reported-display-style="italic"><enum>(4)</enum><text>The term <term>public
health functions</term> 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.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="ID495C2DE2740A4BE2945B98FE8126717E" reported-display-style="italic"><enum>214.</enum><header>Indian women’s Health
care</header><text display-inline="no-display-inline">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.</text>
</section><section changed="added" committee-id="SLIA00" id="ID30ABBDE5177E4046A49E9C631F30B8AB" reported-display-style="italic"><enum>215.</enum><header>Environmental and
nuclear Health hazards</header>
<subsection changed="added" committee-id="SLIA00" id="IDE615D4849259480692850358F5F450FD" reported-display-style="italic"><enum>(a)</enum><header>Studies and
Monitoring</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID15500AE520FC452AA4E8CE5AC9B78C93" reported-display-style="italic"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID95C2D23F523441CAB88C518ACC457AB6" reported-display-style="italic"><enum>(2)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID35D72E286FDA4D9887AC69AC6D8F2333" reported-display-style="italic"><enum>(3)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID4D09F54999BF4F70996BAD24804ABEAA" reported-display-style="italic"><enum>(4)</enum><text>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 <act-name parsable-cite="IHCIA">Indian Health Care Improvement
Act</act-name> Amendments of 2005 that directly or indirectly relate to the
activities, practices, and conditions affecting the health or safety of such
Indians; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID155B1443D6D941E495CA3CAA4FD649EA" reported-display-style="italic"><enum>(5)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID73EDE30F47A64989B17ADE890676E3F7" reported-display-style="italic"><enum>(b)</enum><header>Health Care
Plans</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDA12BD2F80E0E4C77978861C99A89405A" reported-display-style="italic"><enum>(1)</enum><text>methods for diagnosing
and treating Indians currently exhibiting such health problems;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID981620B551C64D88992BB71E45A0028A" reported-display-style="italic"><enum>(2)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDC9F2ED7419564B3683A87E3C562218CF" reported-display-style="italic"><enum>(3)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID79D5DAEE32F74DC7B658460DD4CD2935" reported-display-style="italic"><enum>(c)</enum><header>Submission of Report
and Plan to Congress</header><text>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 <act-name parsable-cite="IHCIA">Indian
Health Care Improvement Act</act-name> 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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDC460D761C2C4458EBB6CB36B6BC3CAE4" reported-display-style="italic"><enum>(d)</enum><header>Intergovernmental Task
Force</header>
<paragraph changed="added" committee-id="SLIA00" id="ID41ACD607EA4E4119B48A2965AA1B3DFF" reported-display-style="italic"><enum>(1)</enum><header>Establishment;
members</header><text>There is established an Intergovernmental Task Force to
be composed of the following individuals (or their designees):</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID5AA7A4E1A6B442F2A0C37AB1E36CEE9B" reported-display-style="italic"><enum>(A)</enum><text>The Secretary of
Energy.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID41F3F157E2524D688AD34319018836E2" reported-display-style="italic"><enum>(B)</enum><text>The Secretary of the
Environmental Protection Agency.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDBE881DFBF0B24D42A5452BD0AACE98C9" reported-display-style="italic"><enum>(C)</enum><text>The Director of the
Bureau of Mines.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID59A41D1B20D3452EB1096151EB87AC58" reported-display-style="italic"><enum>(D)</enum><text>The Assistant Secretary
for Occupational Safety and Health.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDCFE8512E6AC74809A6569E55FE5B6F96" reported-display-style="italic"><enum>(E)</enum><text>The Secretary of the
Interior.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID4A506461D51E4344A13C153983B7D641" reported-display-style="italic"><enum>(F)</enum><text>The Secretary of Health
and Human Services.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID859181DA40BF4B60A788A66E8E8F6A7E" reported-display-style="italic"><enum>(G)</enum><text>The Director of the
Indian Health Service.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDC78404FA32CC49B9AF26CD72B4EB0D02" reported-display-style="italic"><enum>(2)</enum><header>Duties</header><text>The
Task Force shall—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDA82794E5E2F24765A7E52D0221DA3EEE" reported-display-style="italic"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID65018D1437444D829CD10AD1AFEA9E87" reported-display-style="italic"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID6F981E0D7B3D4D7FB031C5681390501E" reported-display-style="italic"><enum>(3)</enum><header>Chairman;
meetings</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID5A8F6D8E215A417B8D6924EB04A2D7FE" reported-display-style="italic"><enum>(e)</enum><header>Health Services to
Certain Employees</header><text>In the case of any Indian who—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDD1B3EA9D059B40CA970C0F244274807F" reported-display-style="italic"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDD6CC1FD99F634DACA02AB1719D9D972A" reported-display-style="italic"><enum>(2)</enum><text>is eligible to receive
diagnosis and treatment services from an Indian Health Program; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID3500288FBDC54C05A2F75DF1A63D497D" reported-display-style="italic"><enum>(3)</enum><text>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.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="IDA3BA5C4D719649D8B67E207172D2D083" reported-display-style="italic"><enum>216.</enum><header>Arizona as a contract
Health Service delivery Area</header>
<subsection changed="added" committee-id="SLIA00" id="ID4FE7B720C8A44AF08689B7B008997F2E" reported-display-style="italic"><enum>(a)</enum><header>In
General</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID708458366FE44754A593E136F6586BDF" reported-display-style="italic"><enum>(b)</enum><header>Maintenance of
Services</header><text>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).</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID9B3997B3C8A24EB39131C56EB86C0350" reported-display-style="italic"><enum>216A.</enum><header>North Dakota and
South Dakota as contract Health Service delivery Area</header>
<subsection changed="added" committee-id="SLIA00" id="IDB88A54AB80DF4F71A12811235536BDD3" reported-display-style="italic"><enum>(a)</enum><header>In
General</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID94D7D2A785E54442A862DC76A837FBD8" reported-display-style="italic"><enum>(b)</enum><header>Limitation</header><text>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).</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="IDE4FCB50B133A4AA48FD9CD98C3DF8895" reported-display-style="italic"><enum>217.</enum><header>California contract
Health Services Program</header>
<subsection changed="added" committee-id="SLIA00" id="IDA9EEC11B558F4F31A807D60920B40873" reported-display-style="italic"><enum>(a)</enum><header>Funding
Authorized</header><text>The Secretary is authorized to fund a program using
the California Rural Indian Health Board (hereafter in this section referred to
as the <quote>CRIHB</quote>) as a contract care intermediary to improve the
accessibility of health services to California Indians.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDF530B3D9387747C890D1C78C89D84E69" reported-display-style="italic"><enum>(b)</enum><header>Reimbursement
Contract</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID681277BB661B4D98B52D290643999CB2" reported-display-style="italic"><enum>(c)</enum><header>Administrative
Expenses</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID14A1449C93F147079B12E59456430DF6" reported-display-style="italic"><enum>(d)</enum><header>Limitation on
Payment</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID8CB44310BC4C4A01A3AD6A2BD1EB0436" reported-display-style="italic"><enum>(e)</enum><header>Advisory
Board</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID22767CC31FF44A64B536ED784DABF537" reported-display-style="italic"><enum>218.</enum><header>California as a
contract Health Service delivery Area</header><text display-inline="no-display-inline">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.</text>
</section><section changed="added" committee-id="SLIA00" id="IDC9CD1687F2524B1C9BDC82C5F1AFC915" reported-display-style="italic"><enum>219.</enum><header>Contract Health
Services for the Trenton Service Area</header>
<subsection changed="added" committee-id="SLIA00" id="IDC856973D79DE408FBB30A2C1F6D5AA1A" reported-display-style="italic"><enum>(a)</enum><header>Authorization for
Services</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID2FBECE1DDBAC4C9FB7BB47175AF523F1" reported-display-style="italic"><enum>(b)</enum><header>No Expansion of
Eligibility</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="IDD5518B7F530E4CE4AA29FB76F98CE123" reported-display-style="italic"><enum>220.</enum><header>Programs operated by
Indian Tribes and Tribal Organizations</header><text display-inline="no-display-inline">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.</text>
</section><section changed="added" committee-id="SLIA00" id="ID6DBF696E47DD497AB8C373CFD138A18E" reported-display-style="italic"><enum>221.</enum><header>Licensing</header><text display-inline="no-display-inline">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
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (25 U.S.C. 450 et seq.).</text>
</section><section changed="added" committee-id="SLIA00" id="ID8365C9E879AA4769AC4F64E309158957" reported-display-style="italic"><enum>222.</enum><header>Notification of
provision of emergency contract Health Services</header><text display-inline="no-display-inline">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.</text>
</section><section changed="added" committee-id="SLIA00" id="ID477BBB0A71504351A052F25281E7FD0A" reported-display-style="italic"><enum>223.</enum><header>Prompt action on
payment of claims</header>
<subsection changed="added" committee-id="SLIA00" id="ID81B2CA34941944B189FFD1A5282CC07D" reported-display-style="italic"><enum>(a)</enum><header>Deadline for
Response</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDD1CA5A08E9894669B8E7A0C7C32011FC" reported-display-style="italic"><enum>(b)</enum><header>Effect of Untimely
Response</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDE805CD6DC2754650AF6930DF7C93AFF7" reported-display-style="italic"><enum>(c)</enum><header>Deadline for Payment of
Valid Claim</header><text>The Service shall pay a valid contract care service
claim within 30 days after the completion of the claim.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID120C986CB44D46E48F86512F355BC40B" reported-display-style="italic"><enum>224.</enum><header>Liability for
payment</header>
<subsection changed="added" committee-id="SLIA00" id="ID5B3361129823457AA83C3B9E42292369" reported-display-style="italic"><enum>(a)</enum><header>No Patient
Liability</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID57B1E388F30743D49C5A621ED6643E44" reported-display-style="italic"><enum>(b)</enum><header>Notification</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID8A20CE0FC4494EB398770143D68713BF" reported-display-style="italic"><enum>(c)</enum><header>No
Recourse</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="id059B4FCB774943639EADE3AA5F2AE465" reported-display-style="italic"><enum>225.</enum><header>Office of Indian Men's
Health</header>
<subsection changed="added" committee-id="SLIA00" id="id07DEEFF48B6E4261BE2850BDFB29B896" reported-display-style="italic"><enum>(a)</enum><header>Establishment</header><text>The
Secretary shall establish within the Service an office to be known as the
<quote>Office of Indian Men's Health</quote> (referred to in this section as
the <quote>Office</quote>).</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="id4549F298FB9D42538230E84483ED6E72" reported-display-style="italic"><enum>(b)</enum><header>Director</header>
<paragraph changed="added" committee-id="SLIA00" id="idC94AD8AA29DE414485A2D060877B2696" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>The Office shall be headed by a Director, to be appointed
by the Secretary.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="id7F300FA0DC654D018997F517D614C5E7" reported-display-style="italic"><enum>(2)</enum><header>Duties</header><text>The
Director shall coordinate and promote the status of the health of Indian men in
the United States.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="idEA1D7DED36DB48B388618E0FB243186C" reported-display-style="italic"><enum>(c)</enum><header>Report</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="id259B9EA8B5AC45B8A98F5E2AF235AA0A" reported-display-style="italic"><enum>(1)</enum><text>any activity carried out
by the Director as of the date on which the report is prepared; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="id5ADFE6BE605446C8B1DF2313777F5D4F" reported-display-style="italic"><enum>(2)</enum><text>any finding of the
Director with respect to the health of Indian men.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="IDEFEE06637C9E4F2097A912666F822D2B" reported-display-style="italic"><enum>226.</enum><header>Authorization of
appropriations</header><text display-inline="no-display-inline">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.</text>
</section><enum>III</enum><header>FACILITIES</header>
<section changed="added" committee-id="SLIA00" id="ID501CD142B8E044F3A3C0B07417F091B3" reported-display-style="italic"><enum>301.</enum><header>Consultation;
construction and renovation of facilities; reports</header>
<subsection changed="added" committee-id="SLIA00" id="ID3CFDDEA40BB043AD984D7AAD99FF6B57" reported-display-style="italic"><enum>(a)</enum><header>Prerequisites for
Expenditure of Funds</header><text>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 <quote>Snyder
Act</quote>), the Secretary, acting through the Service, shall—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDCD02B6886B3547F3B8FE0B35C081FCED" reported-display-style="italic"><enum>(1)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDB67888C6A505482DA3C5835B64EA1D60" reported-display-style="italic"><enum>(2)</enum><text>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
<act-name parsable-cite="SSA">Social Security Act</act-name> by not later than
1 year after the date on which the construction or renovation of such facility
is completed.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDF10C2B2533A7498AB7E7D2C6881AFFAB" reported-display-style="italic"><enum>(b)</enum><header>Closures</header>
<paragraph changed="added" committee-id="SLIA00" id="ID8861332EB620420985FD78F4B1DE430C" reported-display-style="italic"><enum>(1)</enum><header>Evaluation
required</header><text>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—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID657DCE7231114C84B7D10B4031D21FAF" reported-display-style="italic"><enum>(A)</enum><text>the accessibility of
alternative health care resources for the population served by such
facility;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDCBDA6C75999E48AFA97EF86553DA5809" reported-display-style="italic"><enum>(B)</enum><text>the cost-effectiveness of
such closure;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID860FEE3861BC470D83538125D0562C3D" reported-display-style="italic"><enum>(C)</enum><text>the quality of health
care to be provided to the population served by such facility after such
closure;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDEE4C31524FE94EBCA3E18875C268BD34" reported-display-style="italic"><enum>(D)</enum><text>the availability of
contract health care funds to maintain existing levels of service;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID13D9978256774D15BF44062A91BB34C1" reported-display-style="italic"><enum>(E)</enum><text>the views of the Indian
Tribes served by such facility concerning such closure;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDEC09603CD89A43D5971B56DDDC5E29DB" reported-display-style="italic"><enum>(F)</enum><text>the level of use of such
facility by all eligible Indians; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDC7553552EC114C83848CE14923E3FF49" reported-display-style="italic"><enum>(G)</enum><text>the distance between such
facility and the nearest operating Service hospital.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID96569E79BD314038B020F953411F8F92" reported-display-style="italic"><enum>(2)</enum><header>Exception for certain
temporary closures</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID1E75FF39087C4BC4A4C27D52070DC99E" reported-display-style="italic"><enum>(c)</enum><header>Health Care Facility
Priority System</header>
<paragraph changed="added" committee-id="SLIA00" id="ID8AD3F84450ED4A5D92A20EE18F550A36" reported-display-style="italic"><enum>(1)</enum><header>In general</header>
<subparagraph changed="added" committee-id="SLIA00" id="ID97EBDB0AC270440F81F6C8B4B145714E" reported-display-style="italic"><enum>(A)</enum><header>Establishment</header><text>The
Secretary, acting through the Service, shall establish a health care facility
priority system, which shall—</text>
<clause changed="added" committee-id="SLIA00" id="ID62A9339F82DA4747AB11FA771D162D23" reported-display-style="italic"><enum>(i)</enum><text>be developed with Indian
Tribes and Tribal Organizations through negotiated rulemaking under section
802;</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID3D244149428B45F7A1DFB10B04B9A54F" reported-display-style="italic"><enum>(ii)</enum><text>give Indian Tribes’
needs the highest priority; and</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID4B3535AE52484035AC486F8DA51F019A" reported-display-style="italic"><enum>(iii)</enum><text>at a minimum, include
the lists required in paragraph (2)(B) and the methodology required in
paragraph (2)(E).</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID461494AC2426424C845398441609AFC7" reported-display-style="italic"><enum>(B)</enum><header>Priority of certain
projects protected</header><text>The priority of any project established under
the construction priority system in effect on the date of the
<act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name>
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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDF8F3A333A4B84E1FAE5BB74CC3C95A4E" reported-display-style="italic"><enum>(2)</enum><header>Report;
contents</header><text>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:</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDB9B43D868F3D49FCA863FC0B836A4B4B" reported-display-style="italic"><enum>(A)</enum><text>A description of the
health care facility priority system of the Service, established under
paragraph (1).</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDC89A1210B5A943329D6ADE9CB9711B2F" reported-display-style="italic"><enum>(B)</enum><text>Health care facilities
lists, including—</text>
<clause changed="added" committee-id="SLIA00" id="ID937EE5166CE54F5795AF70139953AA8F" reported-display-style="italic"><enum>(i)</enum><text>the 10 top-priority
inpatient health care facilities;</text>
</clause><clause changed="added" committee-id="SLIA00" id="IDE5F48CAAC939469A9E83BF55AF8C8BCD" reported-display-style="italic"><enum>(ii)</enum><text>the 10 top-priority
outpatient health care facilities;</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID0D03ED32B86E4B1E9311D5D5DEEDCE2F" reported-display-style="italic"><enum>(iii)</enum><text>the 10 top-priority
specialized health care facilities (such as long-term care and alcohol and drug
abuse treatment);</text>
</clause><clause changed="added" committee-id="SLIA00" id="IDA2F0AEA3112048558174A03FE8C8AC0F" reported-display-style="italic"><enum>(iv)</enum><text>the 10 top-priority
staff quarters developments associated with health care facilities; and</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID250F3E63AF824E2496BB37F094D261E1" reported-display-style="italic"><enum>(v)</enum><text>the 10 top-priority
hostels associated with health care facilities.</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDEF26A86E649B493DBC7DB29FBA87CA9E" reported-display-style="italic"><enum>(C)</enum><text>The justification for
such order of priority.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDB05AB3F605AB49C5A0E9CFC013C6C416" reported-display-style="italic"><enum>(D)</enum><text>The projected cost of
such projects.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID295351E426A34181B3CA7AF85FAEBB97" reported-display-style="italic"><enum>(E)</enum><text>The methodology adopted
by the Service in establishing priorities under its health care facility
priority system.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID36AE7CDFDA8146FFA5F9FC6BDC47ECF1" reported-display-style="italic"><enum>(3)</enum><header>Requirements for
preparation of reports</header><text>In preparing each report required under
paragraph (2) (other than the initial report), the Secretary shall
annually—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID5E96CAB0D0B54E839DD864F993DB95EF" reported-display-style="italic"><enum>(A)</enum><text>consult with and obtain
information on all health care facilities needs from Indian Tribes, Tribal
Organizations, and Urban Indian Organizations; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID6F94F87744B143DD830ACBDCA396F775" reported-display-style="italic"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDF47B1C35685F43129E4084C258C92C83" reported-display-style="italic"><enum>(4)</enum><header>Criteria for evaluating
needs</header><text>For purposes of this subsection, the Secretary shall, in
evaluating the needs of facilities operated under any contract or compact under
the <act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDCD8CE2C098B643D79E549F9E40D51B25" reported-display-style="italic"><enum>(5)</enum><header>Needs of facilities
under isdeaa agreements</header><text>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
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (25 U.S.C. 450 et seq.) are fully and equitably
integrated into the health care facility priority system.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDCBB1B875AE7B471E868258D77C50937D" reported-display-style="italic"><enum>(d)</enum><header>Review of Need for
Facilities</header>
<paragraph changed="added" committee-id="SLIA00" id="ID5F8EAF6EC756403FBDB3CADDBB5A5AE3" reported-display-style="italic"><enum>(1)</enum><header>Initial
report</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDA30926A30AFD454683EA174C9FE7517D" reported-display-style="italic"><enum>(2)</enum><text>Beginning in the year
2006, the Secretary shall update the report required under paragraph (1) every
5 years.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID641B32C8F5154134A2B9D2E2591182D8" reported-display-style="italic"><enum>(3)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID946392B558BA492398D3815BDED58BC3" reported-display-style="italic"><enum>(4)</enum><text>For purposes of this
subsection, the reports shall, regarding the needs of facilities operated under
any contract or compact under the <act-name parsable-cite="ISDA">Indian
Self-Determination and Education Assistance Act</act-name> (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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID46F52FA7D6DB4893B09DEE2E65467C41" reported-display-style="italic"><enum>(5)</enum><text>The planning, design,
construction, and renovation needs of facilities operated under contracts or
compacts under the <act-name parsable-cite="ISDA">Indian Self-Determination and
Education Assistance Act</act-name> (25 U.S.C. 450 et seq.) shall be fully and
equitably integrated into the development of the health facility priority
system.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID3A8562CD1A86482CAC06500BAAA712C7" reported-display-style="italic"><enum>(6)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDB241076163EF4C32A30CF6EAF0B20C04" reported-display-style="italic"><enum>(e)</enum><header>Funding
Condition</header><text>All funds appropriated under the Act of November 2,
1921 (25 U.S.C. 13) (commonly known as the <quote>Snyder Act</quote>), 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
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (25 U.S.C. 450 et seq.).</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID283684F148D64D759481D784369CF638" reported-display-style="italic"><enum>(f)</enum><header>Development of
Innovative Approaches</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID5DF6BA84FB4B47C6AB750ACCFD9B02AE" reported-display-style="italic"><enum>302.</enum><header>Sanitation
facilities</header>
<subsection changed="added" committee-id="SLIA00" id="ID1E8060952E974D3481C07B25098842B8" reported-display-style="italic"><enum>(a)</enum><header>Findings</header><text>Congress
finds the following:</text>
<paragraph changed="added" committee-id="SLIA00" id="ID8B591CF1F2F543F2990CBB25F4315C1F" reported-display-style="italic"><enum>(1)</enum><text>The provision of
sanitation facilities is primarily a health consideration and function.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID26AAC6B767434F01A1A64229DDC85CD6" reported-display-style="italic"><enum>(2)</enum><text>Indian people suffer an
inordinately high incidence of disease, injury, and illness directly
attributable to the absence or inadequacy of sanitation facilities.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID735DC6947ECC41AA997BA84D9C96EAEE" reported-display-style="italic"><enum>(3)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDF845D231DDEB442498D4472F7C6F701E" reported-display-style="italic"><enum>(4)</enum><text>Many Indian homes and
Indian communities still lack sanitation facilities.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDBEE22104B2694323B4EBA803A1C42E9D" reported-display-style="italic"><enum>(5)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDC1417DF749E1450E8C141ED9F0057A9F" reported-display-style="italic"><enum>(b)</enum><header>Facilities and
Services</header><text>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:</text>
<paragraph changed="added" committee-id="SLIA00" id="IDC801B40B101E41799200CED55BF1E63E" reported-display-style="italic"><enum>(1)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID2677CB5EB5E144F7AB3F453EA5B33780" reported-display-style="italic"><enum>(2)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID42749F2CD6284D67AB7E36A446D5E06C" reported-display-style="italic"><enum>(3)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID5560E2DF906B4D4A921E60A352D35297" reported-display-style="italic"><enum>(c)</enum><header>Funding</header><text>Notwithstanding
any other provision of law—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID84B770B9F43B4D13984B45B6EF99008D" reported-display-style="italic"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDFE9542E87ED8449BA08820F5CC2D5991" reported-display-style="italic"><enum>(2)</enum><text>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);</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID556D1528C83F4B738E7050BE5B0DBCD2" reported-display-style="italic"><enum>(3)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID7DB1644D64E349EAB82DACCF6948B88D" reported-display-style="italic"><enum>(4)</enum><text>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
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (25 U.S.C. 450 et seq.);</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDFD64F2BBE4934FEDB00DEC71313D37F2" reported-display-style="italic"><enum>(5)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID168EC7BC51354F09843B43210DC688A9" reported-display-style="italic"><enum>(6)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID45C930434D9643199894E85798C8931B" reported-display-style="italic"><enum>(7)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID6CD05AE30B1D44E0A186CA6A4EB3A61C" reported-display-style="italic"><enum>(8)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID54DD8E72D1FC41EDBD6B100BE4F6380E" reported-display-style="italic"><enum>(9)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDC2AB6FC359F84280855957A17B6EDC3C" reported-display-style="italic"><enum>(d)</enum><header>Certain Capabilities
Not Prerequisite</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID6867A5A398BC4722815CA00012F920F5" reported-display-style="italic"><enum>(e)</enum><header>Financial
Assistance</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID2FBA8D5341634C4985D0FD520A6C32B3" reported-display-style="italic"><enum>(f)</enum><header>Operation, Management,
and Maintenance of Facilities</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDEC86AFC59F174376A5CC6B0E66DCF66C" reported-display-style="italic"><enum>(g)</enum><header>ISDEAA Program Funded
on Equal Basis</header><text>Tribal Health Programs shall be eligible (on an
equal basis with programs that are administered directly by the Service)
for—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID4FB9DA23747B4CDBAF8DF272AE35F69E" reported-display-style="italic"><enum>(1)</enum><text>any funds appropriated
pursuant to this section; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDB2453A4DC415463293755D95717FC19D" reported-display-style="italic"><enum>(2)</enum><text>any funds appropriated
for the purpose of providing sanitation facilities.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID7970866840724E9AA6CD1272DC1F1C1D" reported-display-style="italic"><enum>(h)</enum><header>Report</header>
<paragraph changed="added" committee-id="SLIA00" id="ID282CFBDB5E6B451B9E5F9440C1AD13A5" reported-display-style="italic"><enum>(1)</enum><header>Required;
contents</header><text>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—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID1B72A9158B6249BAA9C43B51810B0CCC" reported-display-style="italic"><enum>(A)</enum><text>the current Indian
sanitation facility priority system of the Service;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID6EB5E131FCB84BA78909263E7CE5E952" reported-display-style="italic"><enum>(B)</enum><text>the methodology for
determining sanitation deficiencies and needs;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDE599B9B8C7694F64BE53BE5DEBD2BFC7" reported-display-style="italic"><enum>(C)</enum><text>the level of initial and
final sanitation deficiency for each type of sanitation facility for each
project of each Indian Tribe or Indian community;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID24B3124A99B74A4EAAE81513840A5747" reported-display-style="italic"><enum>(D)</enum><text>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</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID7D6A6467D2C64D1EB14CD65608D2F249" reported-display-style="italic"><enum>(E)</enum><text>a 10-year plan to provide
sanitation facilities to serve existing Indian homes and Indian communities and
new and renovated Indian homes.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDE7887731454541A0B3E7CFFE39643A10" reported-display-style="italic"><enum>(2)</enum><header>Criteria</header><text>The
criteria on which the deficiencies and needs will be evaluated shall be
developed through negotiated rulemaking pursuant to section 802.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDDA35017343524939BF96FFBDD1841FDA" reported-display-style="italic"><enum>(3)</enum><header>Uniform
methodology</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDFE100D9F971D4B1DBB7F3A6AEEA62FCD" reported-display-style="italic"><enum>(4)</enum><header>Sanitation deficiency
levels</header><text>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:</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID6839049AF1D145C4BDB49D334A4DE05E" reported-display-style="italic"><enum>(A)</enum><text>A level I deficiency
exists if a sanitation facility serving an individual, Indian Tribe, or Indian
community—</text>
<clause changed="added" committee-id="SLIA00" id="ID601C773B63F9449DA0E6D1F2D01DEED2" reported-display-style="italic"><enum>(i)</enum><text>complies with all
applicable water supply, pollution control, and solid waste disposal laws;
and</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID95FC96151896414CBF099E1F1740A34D" reported-display-style="italic"><enum>(ii)</enum><text>deficiencies relate to
routine replacement, repair, or maintenance needs.</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDD14B6557700C41D1B8B3EB9FDDA66853" reported-display-style="italic"><enum>(B)</enum><text>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—</text>
<clause changed="added" committee-id="SLIA00" id="IDBE3C5601F7864643AB0363EE8E8BB592" reported-display-style="italic"><enum>(i)</enum><text>small or minor capital
improvements needed to bring the facility back into compliance;</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID94059090134C4D658FBBDA02B45E04E1" reported-display-style="italic"><enum>(ii)</enum><text>capital improvements
that are necessary to enlarge or improve the facilities in order to meet the
current needs for domestic sanitation facilities; or</text>
</clause><clause changed="added" committee-id="SLIA00" id="IDF0463591658E4EFEBC70555EAE432559" reported-display-style="italic"><enum>(iii)</enum><text>the lack of equipment
or training by an Indian Tribe, Tribal Organization, or an Indian community to
properly operate and maintain the sanitation facilities.</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID067042A3348C4D4A96FF3ADF7518640E" reported-display-style="italic"><enum>(C)</enum><text>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—</text>
<clause changed="added" committee-id="SLIA00" id="ID87629B92B4544A2A9FFE595F3E5F5962" reported-display-style="italic"><enum>(i)</enum><text>water or sewer service in
the home is provided by a haul system with holding tanks and interior
plumbing;</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID93B67709196B4632ACF4B5C54046DFD5" reported-display-style="italic"><enum>(ii)</enum><text>major significant
interruptions to water supply or sewage disposal occur frequently, requiring
major capital improvements to correct the deficiencies; or</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID66660E64CDC740E1A1F39784DF0887D1" reported-display-style="italic"><enum>(iii)</enum><text>there is no access to
or no approved or permitted solid waste facility available.</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID51F9069C48BA44A387C62C06AF211016" reported-display-style="italic"><enum>(D)</enum><text>A level IV deficiency
exists—</text>
<clause changed="added" committee-id="SLIA00" id="IDC0BCA88B36C241788784C5957447D7DA" reported-display-style="italic"><enum>(i)</enum><text>if a sanitation facility
for an individual home, an Indian Tribe, or an Indian community exists
but—</text>
<subclause changed="added" committee-id="SLIA00" id="id47A7D2F9691E4A428AB987B382DDABD8" reported-display-style="italic"><enum>(I)</enum><text>lacks—</text>
<item changed="added" committee-id="SLIA00" id="id1D62EC58B0764DE7970E1E83B38CCAFF" reported-display-style="italic"><enum>(aa)</enum><text>a safe water supply
system; or</text>
</item><item changed="added" committee-id="SLIA00" id="idB98E29577B664BDEA565068A9C1FB5B6" reported-display-style="italic"><enum>(bb)</enum><text>a waste disposal
system;</text>
</item></subclause><subclause changed="added" committee-id="SLIA00" id="idB1A92CC965EA4D7CB308B4650A0D86CF" reported-display-style="italic"><enum>(II)</enum><text>contains no piped water
or sewer facilities; or</text>
</subclause><subclause changed="added" committee-id="SLIA00" id="idB991C1E9782A43EC8193FADDA91B9A82" reported-display-style="italic"><enum>(III)</enum><text>has become inoperable
due to a major component failure; or</text>
</subclause></clause><clause changed="added" committee-id="SLIA00" id="IDC65D715735A54673830EA031B68B7ADD" reported-display-style="italic"><enum>(ii)</enum><text>if only a washeteria or
central facility exists in the community.</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDA73203E3ED7146859F2DF2D06BFF56A9" reported-display-style="italic"><enum>(E)</enum><text>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.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID52B756D15FB94F039E01F27489B43B88" reported-display-style="italic"><enum>(i)</enum><header>Definitions</header><text>For
purposes of this section, the following terms apply:</text>
<paragraph changed="added" committee-id="SLIA00" id="IDBA72A22B3DC145C387CE5A5AE10725A5" reported-display-style="italic"><enum>(1)</enum><header>Indian
community</header><text>The term <term>Indian community</term> 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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID6060FE3CEA4F49FFA2E7B2735E99A6C9" reported-display-style="italic"><enum>(2)</enum><header>Sanitation
facilities</header><text>The terms <term>sanitation facility</term> and
<term>sanitation facilities</term> mean safe and adequate water supply systems,
sanitary sewage disposal systems, and sanitary solid waste systems (and all
related equipment and support infrastructure).</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="IDB710B2A0D15540F4BEE251304985A5BF" reported-display-style="italic"><enum>303.</enum><header>Preference to Indians
and Indian firms</header>
<subsection changed="added" committee-id="SLIA00" id="ID845B1A34F1764CA390A617A23422C92B" reported-display-style="italic"><enum>(a)</enum><header>Buy Indian
Act</header><text>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 <quote>Buy Indian Act</quote>), 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 <quote>Indian firm</quote>) 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—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDF88949CD04D947FD9E0B7482CA3F2AC0" reported-display-style="italic"><enum>(1)</enum><text>ownership and control by
Indians;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDAA2A111ABF8C4F6B9CDD32817A3DA4D2" reported-display-style="italic"><enum>(2)</enum><text>equipment;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID75446CD85F5747819F66A93C461ECBB9" reported-display-style="italic"><enum>(3)</enum><text>bookkeeping and
accounting procedures;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDB9FF7D5F7DD5403CB8E6994782C95D5C" reported-display-style="italic"><enum>(4)</enum><text>substantive knowledge of
the project or function to be contracted for;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDCB0747FA97B94A92A8398F353004B2D2" reported-display-style="italic"><enum>(5)</enum><text>adequately trained
personnel; or</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDAD698A498AB946C1A1B39B631641EFFE" reported-display-style="italic"><enum>(6)</enum><text>other necessary
components of contract performance.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDA090DA1F41FD4B0D82842B2E754217B2" reported-display-style="italic"><enum>(b)</enum><header>Labor
Standards</header>
<paragraph changed="added" committee-id="SLIA00" id="ID12AA390F5E724167A0F4AC7F215C3302" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>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 <quote><act-name parsable-cite="DBA">Davis-Bacon Act</act-name></quote>), unless such
construction or renovation—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID8631961A60E1454280DFC8D5B13D5D1E" reported-display-style="italic"><enum>(A)</enum><text>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
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.)</act-name>, or other statutory
authority; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDFFD240AF380245FAA867FE6F8516697B" reported-display-style="italic"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID89551159289B4132AB2C5BF8F7985DEF" reported-display-style="italic"><enum>(2)</enum><header>Exception</header><text>This
subsection shall not apply to construction or renovation carried out by an
Indian Tribe or Tribal Organization with its own employees.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="IDEE4DE0DC75B949E6953F6C63D6E5A9F4" reported-display-style="italic"><enum>304.</enum><header>Expenditure of
nonservice funds for renovation</header>
<subsection changed="added" committee-id="SLIA00" id="IDF4505400387D4696A470E9CB9BF8B2C8" reported-display-style="italic"><enum>(a)</enum><header>In
General</header><text>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 <act-name parsable-cite="ISDA">Indian Self-Determination
and Education Assistance Act</act-name> (25 U.S.C. 450 et seq.),
including—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID759CE41809644128AA6BDA3DEC7D3056" reported-display-style="italic"><enum>(1)</enum><text>any plans or designs for
such expansion, renovation, or modernization; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID32100FB699BA442ABDCC2E33A470FCC7" reported-display-style="italic"><enum>(2)</enum><text>any expansion,
renovation, or modernization for which funds appropriated under any Federal law
were lawfully expended.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDFCCA6BED67F9418AA7798F1346657CA5" reported-display-style="italic"><enum>(b)</enum><header>Priority List</header>
<paragraph changed="added" committee-id="SLIA00" id="IDD19F396836294F1AB8AF93B16A131B56" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID5CFE277A4B354EC8A98A4713DFEDE746" reported-display-style="italic"><enum>(2)</enum><header>Report</header><text>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).</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID053E0C8CAB9041BEBD30A7B0DA4B4FA3" reported-display-style="italic"><enum>(c)</enum><header>Requirements</header><text>The
requirements of this subsection are met with respect to any expansion,
renovation, or modernization if—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID84997F50B3A8434089D0D35636DBCCFF" reported-display-style="italic"><enum>(1)</enum><text>the Indian Tribe or
Tribal Organization—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDC087A9B87F614909BF9F7D6598271DCD" reported-display-style="italic"><enum>(A)</enum><text>provides notice to the
Secretary of its intent to expand, renovate, or modernize; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDA66DE3F5FC3C49988DF6DC9A7EDCA25B" reported-display-style="italic"><enum>(B)</enum><text>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</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID07F9B135D36C4386BC4396388B1799DB" reported-display-style="italic"><enum>(2)</enum><text>the expansion,
renovation, or modernization—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID095ECD13A4D54A36B27D4A54F508EA9F" reported-display-style="italic"><enum>(A)</enum><text>is approved by the
appropriate area director of the Service for Federal facilities; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID5D0BC25BE4484482940F08E109938306" reported-display-style="italic"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDB5743D1F12D0445EB5CAF012FC2209FD" reported-display-style="italic"><enum>(d)</enum><header>Additional Requirement
for Expansion</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID4B05C4530B9D47B6BBCCB1ECD493FBC5" reported-display-style="italic"><enum>(e)</enum><header>Closure or Conversion
of Facilities</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="IDE94B8765DE044DCFB5255CFD519EC01B" reported-display-style="italic"><enum>305.</enum><header>Funding for the
construction, expansion, and modernization of small ambulatory care
facilities</header>
<subsection changed="added" committee-id="SLIA00" id="ID323D132192084F1F82582D42E84A76F1" reported-display-style="italic"><enum>(a)</enum><header>Funding</header>
<paragraph changed="added" committee-id="SLIA00" id="ID483471D050EA45E0B2AA579422D28DB0" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>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 <term>construction</term> includes the
replacement of an existing facility.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID7E7E68DF1CDC4A8B95DCF9675FB05C1F" reported-display-style="italic"><enum>(2)</enum><header>Grant agreement
required</header><text>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).</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID2B048F51AB6546259ADDF3C17A6F239B" reported-display-style="italic"><enum>(b)</enum><header>Use of grant
funds</header>
<paragraph changed="added" committee-id="SLIA00" id="ID3EDBD0C5576F40DB99F5EB023DD9FB03" reported-display-style="italic"><enum>(1)</enum><header>Allowable
uses</header><text>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—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID1311865C2CFD4DB4A5C711B2EDB8376D" reported-display-style="italic"><enum>(A)</enum><text>located apart from a
hospital;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDDF36B8246E3141D3AD38F089555DADBE" reported-display-style="italic"><enum>(B)</enum><text>not funded under section
301 or section 307; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID814B6F645577461E948C68D24EA5E630" reported-display-style="italic"><enum>(C)</enum><text>which, upon completion of
such construction or modernization will—</text>
<clause changed="added" committee-id="SLIA00" id="ID573CA68EC45E46E7A11F798777B2A6C2" reported-display-style="italic"><enum>(i)</enum><text>have a total capacity
appropriate to its projected service population;</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID34470C1B2D1A4344AEB9F228011DC6AB" reported-display-style="italic"><enum>(ii)</enum><text>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</text>
</clause><clause changed="added" committee-id="SLIA00" id="IDCF93365AFD5042A19ED809BA38A1192E" reported-display-style="italic"><enum>(iii)</enum><text>provide ambulatory care
in a Service Area (specified in the contract or compact under the
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (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).</text>
</clause></subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID6211360C7A6642A9B44797163105604A" reported-display-style="italic"><enum>(2)</enum><header>Additional allowable
use</header><text>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).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID4799CDE189484A3682AE8BD8851DB940" reported-display-style="italic"><enum>(3)</enum><header>Use only for certain
portion of costs</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID18A87F38AFA04173AC1B8989BF2C345D" reported-display-style="italic"><enum>(c)</enum><header>Grants</header>
<paragraph changed="added" committee-id="SLIA00" id="ID4AC4071C3CAF4F5884914F1E120BC519" reported-display-style="italic"><enum>(1)</enum><header>Application</header><text>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—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID31F66563630F4B47AE18087B34D9A406" reported-display-style="italic"><enum>(A)</enum><text>adequate financial
support will be available for the provision of services at such
facility;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDD8CD7613A049455793CDD6E3B63A501B" reported-display-style="italic"><enum>(B)</enum><text>such facility will be
available to eligible Indians without regard to ability to pay or source of
payment; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDF5E5668753BE40ED90DEFB4D152B6568" reported-display-style="italic"><enum>(C)</enum><text>such facility will, as
feasible without diminishing the quality or quantity of services provided to
eligible Indians, serve noneligible persons on a cost basis.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDA8E13EF0D8B74A70AA482059B7FDD39D" reported-display-style="italic"><enum>(2)</enum><header>Priority</header><text>In
awarding grants under this section, the Secretary shall give priority to Indian
Tribes and Tribal Organizations that demonstrate—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID898E169DF21F420F954913AE16E38734" reported-display-style="italic"><enum>(A)</enum><text>a need for increased
ambulatory care services; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID342393D113794495B4A7E50CC4BD0324" reported-display-style="italic"><enum>(B)</enum><text>insufficient capacity to
deliver such services.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDAD60CDF4D69749B6B799C5006C7CFE11" reported-display-style="italic"><enum>(3)</enum><header>Peer review
panels</header><text>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).</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDF745DE441C5045BBB540ED0B324E3944" reported-display-style="italic"><enum>(d)</enum><header>Reversion of
Facilities</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID5CF759F0C1694D06A733F10C56FF9D9F" reported-display-style="italic"><enum>(e)</enum><header>Funding
Nonrecurring</header><text>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 <act-name parsable-cite="ISDA">Indian Self-Determination and Education Assistance Act (25
U.S.C. 450 et seq.)</act-name> or for reallocation or redesign
thereunder.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID9B9B8C85D93D4749869BE7B0B23EC586" reported-display-style="italic"><enum>306.</enum><header>Indian Health care
delivery demonstration project</header>
<subsection changed="added" committee-id="SLIA00" id="ID5F1FA18D8DB84650BD32D26537C9286A" reported-display-style="italic"><enum>(a)</enum><header>Health Care
Demonstration Projects</header><text>The Secretary, acting through the Service,
and in consultation with Indian Tribes and Tribal Organizations, is authorized
to enter into construction agreements under the <act-name parsable-cite="ISDA">Indian Self-Determination and Education Assistance
Act</act-name> (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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID463ECD3AE6AE4F1D964246B26397830A" reported-display-style="italic"><enum>(b)</enum><header>Use of
Funds</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID8AFF8F493FAF46B3914C0F94112B9CB5" reported-display-style="italic"><enum>(1)</enum><text>waive any leasing
prohibition;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID0694CB851128469EA6116D4D934D4F8C" reported-display-style="italic"><enum>(2)</enum><text>permit carryover of funds
appropriated for the provision of health care services;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDE12BAA8185DD4E7C9D70B424E035176E" reported-display-style="italic"><enum>(3)</enum><text>permit the use of other
available funds;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID99D7A8E2043C42A68BCA712682FA5F1E" reported-display-style="italic"><enum>(4)</enum><text>permit the use of funds
or property donated from any source for project purposes;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDE9F6C1461DF945489B654E3E186DC76D" reported-display-style="italic"><enum>(5)</enum><text>provide for the reversion
of donated real or personal property to the donor; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID0CA0AF21E9CB45BF93D973EB98AF7AEE" reported-display-style="italic"><enum>(6)</enum><text>permit the use of Service
funds to match other funds, including Federal funds.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDF6F2A0DA3EEC48C0B58795F285F10C3A" reported-display-style="italic"><enum>(c)</enum><header>Regulations</header><text>The
Secretary shall develop and promulgate regulations not later than 1 year after
the date of enactment of the <act-name parsable-cite="IHCIA">Indian Health Care
Improvement Act</act-name> 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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDF8DC37D9E16C40308AAFA875CE08165E" reported-display-style="italic"><enum>(d)</enum><header>Criteria</header><text>The
Secretary may approve projects that meet the following criteria:</text>
<paragraph changed="added" committee-id="SLIA00" id="ID04CD5A39610C48E99D464C86A9B57A87" reported-display-style="italic"><enum>(1)</enum><text>There is a need for a new
facility or program or the reorientation of an existing facility or
program.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID445F55DD54964C6A9434976B3F916D0B" reported-display-style="italic"><enum>(2)</enum><text>A significant number of
Indians, including those with low health status, will be served by the
project.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID1AE2827D0DFA4E0CA8D6260E41CD0864" reported-display-style="italic"><enum>(3)</enum><text>The project has the
potential to deliver services in an efficient and effective manner.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID9BE915C5B8034733826BE73E998C7154" reported-display-style="italic"><enum>(4)</enum><text>The project is
economically viable.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID29E1A24B39804D95AC80309FF2E026BC" reported-display-style="italic"><enum>(5)</enum><text>The Indian Tribe or
Tribal Organization has the administrative and financial capability to
administer the project.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID48A31FDE683147B6AD1F1AFAA7D42664" reported-display-style="italic"><enum>(6)</enum><text>The project is integrated
with providers of related health and social services and is coordinated with,
and avoids duplication of, existing services.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID92922A4E33BC4AC6A558DFEB3D8CB4FF" reported-display-style="italic"><enum>(e)</enum><header>Peer Review
Panels</header><text>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).</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDADF794FA158D49BB89F0A11E96EFCA16" reported-display-style="italic"><enum>(f)</enum><header>Priority</header><text>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):</text>
<paragraph changed="added" committee-id="SLIA00" id="ID3D844B4997B04C14B640CD8654609998" reported-display-style="italic"><enum>(1)</enum><text>Cass Lake,
Minnesota.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID3DEF25C38F7643F2BF7F023BADF1773B" reported-display-style="italic"><enum>(2)</enum><text>Clinton, Oklahoma.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDE789D167F81046E3A69F257FBA4EB7A7" reported-display-style="italic"><enum>(3)</enum><text>Harlem, Montana.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDD0B3EA9B97ED42BD9829E44E8458F2F2" reported-display-style="italic"><enum>(4)</enum><text>Mescalero, New
Mexico.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID8BABC417DD394B0197D8A3FC0CA7D73E" reported-display-style="italic"><enum>(5)</enum><text>Owyhee, Nevada.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDE200AEE3830A4F4B830416B99D10C28F" reported-display-style="italic"><enum>(6)</enum><text>Parker, Arizona.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDC49636CC88B0462DB29F191441B693D6" reported-display-style="italic"><enum>(7)</enum><text>Schurz, Nevada.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID8FE92C7D980640BB8CB45E028AE3CD67" reported-display-style="italic"><enum>(8)</enum><text>Winnebago,
Nebraska.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDC87DE08571CC4CA59E4DFB945044879A" reported-display-style="italic"><enum>(9)</enum><text>Ft. Yuma,
California.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID2F1896D6B80C4B5EBCF0AC98EA1919FD" reported-display-style="italic"><enum>(g)</enum><header>Technical
Assistance</header><text>The Secretary shall provide such technical and other
assistance as may be necessary to enable applicants to comply with the
provisions of this section.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID3AFCB7C45F0846D3A1B0F4FD960AB5E8" reported-display-style="italic"><enum>(h)</enum><header>Service to Ineligible
Persons</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID8351CBC0F77A4171987077A78F2A20AD" reported-display-style="italic"><enum>(i)</enum><header>Equitable
Treatment</header><text>For purposes of subsection (d)(1), the Secretary shall,
in evaluating facilities operated under any contract or compact under the
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (25 U.S.C. 450 et seq.), use the same criteria that
the Secretary uses in evaluating facilities operated directly by the
Service.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID526B291953474CA7A3A6D3F85E27F658" reported-display-style="italic"><enum>(j)</enum><header>Equitable Integration
of Facilities</header><text>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
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID12071B7628314A899B024D6DD5078CB8" reported-display-style="italic"><enum>307.</enum><header>Land
transfer</header><text display-inline="no-display-inline">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.</text>
</section><section changed="added" committee-id="SLIA00" id="IDD109C8702E0043DE89BE9D798550861C" reported-display-style="italic"><enum>308.</enum><header>Leases, contracts, and
other agreements</header><text display-inline="no-display-inline">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(<added-phrase>l</added-phrase>) of the
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450j(l))</act-name> and regulations
thereunder.</text>
</section><section changed="added" committee-id="SLIA00" id="IDA22E31645D914394A60F2B05F2EA1CE8" reported-display-style="italic"><enum>309.</enum><header>Study on loans, loan
guarantees, and loan repayment</header>
<subsection changed="added" committee-id="SLIA00" id="ID78903CA80BCB4BF9B77179FBC9BC2F3D" reported-display-style="italic"><enum>(a)</enum><header>In
General</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDE222027A31B3442A950592FD435093CA" reported-display-style="italic"><enum>(1)</enum><text>inpatient
facilities;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID0032E88AB9EC47DC8A8202C28DD12048" reported-display-style="italic"><enum>(2)</enum><text>outpatient
facilities;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDAC86F5C04AAF4294BDB0B6F19C92E329" reported-display-style="italic"><enum>(3)</enum><text>staff quarters;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDD80A3685BF3C4FA8BD9D2C7C294A8E13" reported-display-style="italic"><enum>(4)</enum><text>hostels; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID40F2FFA0122F44508D387C4E98E41F64" reported-display-style="italic"><enum>(5)</enum><text>specialized care
facilities, such as behavioral health and elder care facilities.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDE79D61970531413499209E4B4B236D7C" reported-display-style="italic"><enum>(b)</enum><header>Determinations</header><text>In
carrying out the study under subsection (a), the Secretary shall
determine—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID904A25B08C564685AB6234C6812402DD" reported-display-style="italic"><enum>(1)</enum><text>the maximum principal
amount of a loan or loan guarantee that should be offered to a recipient from
the loan fund;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID1FEB69EBD39A4CC0BD9ED895C7B49C17" reported-display-style="italic"><enum>(2)</enum><text>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));</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID92840270FA4547CBB5BE8DC53689241D" reported-display-style="italic"><enum>(3)</enum><text>the cumulative total of
the principal of direct loans and loan guarantees, respectively, that may be
outstanding at any 1 time;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID132E0702508C4D00A4283925BF538660" reported-display-style="italic"><enum>(4)</enum><text>the maximum term of a
loan or loan guarantee that may be made for a facility from the loan
fund;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID17E092C3B30E4E2FA73FE3FC3D2181BD" reported-display-style="italic"><enum>(5)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID3EE408E072A546B98B0A2B0B37D96B85" reported-display-style="italic"><enum>(6)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDA9E9A0E928DD4BEABFBDCE990D2B59D6" reported-display-style="italic"><enum>(7)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID112031EF629F487BBC1A242B50FEA497" reported-display-style="italic"><enum>(8)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID4B25E376D3DB4793A62551A145415BE1" reported-display-style="italic"><enum>(9)</enum><text>the appropriateness of,
and best methods for, coordinating the loan fund with the health care priority
system of the Service under section 301; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID3766DFD2F5494C37991D8A22CF78FCFB" reported-display-style="italic"><enum>(10)</enum><text>any legislative or
regulatory changes required to implement recommendations of the Secretary based
on results of the study.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID47198DC5835749918DB9DA0C0F817986" reported-display-style="italic"><enum>(c)</enum><header>Report</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDA35984C332004F518A3C98EBBCC66007" reported-display-style="italic"><enum>(1)</enum><text>the manner of
consultation made as required by subsection (a); and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID8FBA8E065A3B46CAB55368273C441051" reported-display-style="italic"><enum>(2)</enum><text>the results of the study,
including any recommendations of the Secretary based on results of the
study.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="IDFAB2A6009BC14F4A8B2744FCDCE7C032" reported-display-style="italic"><enum>310.</enum><header>Tribal
leasing</header><text display-inline="no-display-inline">A Tribal Health
Program may lease permanent structures for the purpose of providing health care
services without obtaining advance approval in appropriation Acts.</text>
</section><section changed="added" committee-id="SLIA00" id="IDFF093796F4FA437082045645ADADF8BC" reported-display-style="italic"><enum>311.</enum><header>Indian Health
Service/tribal facilities joint venture Program</header>
<subsection changed="added" committee-id="SLIA00" id="ID45AD9DB9FE6147039143C844FF49DBB7" reported-display-style="italic"><enum>(a)</enum><header>In
General</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDBE7E00A8BEA44B478F13BDF3A5F0C255" reported-display-style="italic"><enum>(1)</enum><text>has begun but not
completed the process of acquisition or construction of a health facility to be
used in the joint venture project; or</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID70ED2369618B454DB11F3A16E6B54ABC" reported-display-style="italic"><enum>(2)</enum><text>has not begun the process
of acquisition or construction of a health facility for use in the joint
venture project.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID9382C706F8A745B4AC2C5C61900E7D6F" reported-display-style="italic"><enum>(b)</enum><header>Requirements</header><text>The
Secretary shall make such an arrangement with an Indian Tribe or Tribal
Organization only if—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID236C9516FBF94D169026C686136D5B63" reported-display-style="italic"><enum>(1)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID4B10AAFA7D054443BF252560B22587DB" reported-display-style="italic"><enum>(2)</enum><text>the Indian Tribe or
Tribal Organization meets the need criteria which shall be developed through
the negotiated rulemaking process provided for under section 802.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID2C49618059BC49C281289EB1D2EF1AD3" reported-display-style="italic"><enum>(c)</enum><header>Continued
Operation</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID660EC14A7D5147829F2BA395078C2E02" reported-display-style="italic"><enum>(d)</enum><header>Breach of
Agreement</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID714B621CF3274C4C8DE834D920928428" reported-display-style="italic"><enum>(e)</enum><header>Recovery for
Nonuse</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID2DA0C1FB9152430B9B420AFB5A0F11F5" reported-display-style="italic"><enum>(f)</enum><header>Definition</header><text>For
the purposes of this section, the term <term>health facility</term> or
<term>health facilities</term> includes quarters needed to provide housing for
staff of the relevant Tribal Health Program.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="IDCB89F52B8B5F46A0918571F8CD4B18E0" reported-display-style="italic"><enum>312.</enum><header>Location of
facilities</header>
<subsection changed="added" committee-id="SLIA00" id="ID961BB9F6C7ED4AF9B0149D67D390B0B0" reported-display-style="italic"><enum>(a)</enum><header>In
General</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID5359DD5B68654772BA85FA478F4CAE46" reported-display-style="italic"><enum>(b)</enum><header>Definition</header><text>For
purposes of this section, the term <term>Indian lands</term> means—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDA2CFCC39B5AA4601B94A5EF9347760F5" reported-display-style="italic"><enum>(1)</enum><text>all lands within the
exterior boundaries of any reservation; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID533E4F9F17DA48138159D3FF4F850ABE" reported-display-style="italic"><enum>(2)</enum><text>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.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="IDD854C474E64444E793451EE29C95F604" reported-display-style="italic"><enum>313.</enum><header>Maintenance and
improvement of Health care facilities</header>
<subsection changed="added" committee-id="SLIA00" id="ID44058E42860B465587C63541745ED3A9" reported-display-style="italic"><enum>(a)</enum><header>Report</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDAAC85E27CD3143C2B96AC2FD920C69A5" reported-display-style="italic"><enum>(b)</enum><header>Maintenance of Newly
Constructed Space</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDE3932E8B672143568DD7C451C804C2A8" reported-display-style="italic"><enum>(c)</enum><header>Replacement
Facilities</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="IDB8EC6B8BD4B64AECACE498C068D976B1" reported-display-style="italic"><enum>314.</enum><header>Tribal management of
Federally owned quarters</header>
<subsection changed="added" committee-id="SLIA00" id="ID702039D25EB14A3C920516D407B46432" reported-display-style="italic"><enum>(a)</enum><header>Rental Rates</header>
<paragraph changed="added" committee-id="SLIA00" id="IDC83071E9F9B74DF3B7AFC6F61A7FF7CD" reported-display-style="italic"><enum>(1)</enum><header>Establishment</header><text>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 <act-name parsable-cite="ISDA">Indian Self-Determination and Education Assistance
Act</act-name> (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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID83019090A83147FCBAB049D79D8B0620" reported-display-style="italic"><enum>(2)</enum><header>Objectives</header><text>In
establishing rental rates pursuant to authority of this subsection, a Tribal
Health Program shall endeavor to achieve the following objectives:</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID62E567DEF70043E4928E51DF4999F6CD" reported-display-style="italic"><enum>(A)</enum><text>To base such rental rates
on the reasonable value of the quarters to the occupants thereof.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID268A308FF4BD4D989032CC95406349A3" reported-display-style="italic"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID3CFEC83E8F4143A38035FB1364F985BF" reported-display-style="italic"><enum>(3)</enum><header>Equitable
funding</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDEFEE9642772C42A9979CA10A1A20EC38" reported-display-style="italic"><enum>(4)</enum><header>Notice of rate
change</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDF64AEF64CF1140A0A65EF8BD547E2EEF" reported-display-style="italic"><enum>(b)</enum><header>Direct Collection of
Rent</header>
<paragraph changed="added" committee-id="SLIA00" id="IDF154855D8E7E4187AAEC557F5ABABA35" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>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:</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID07489D38037E4F58B91A63B781F5D8EA" reported-display-style="italic"><enum>(A)</enum><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDB5EAB97E139F4B41B2BB8ECE4568BB7D" reported-display-style="italic"><enum>(B)</enum><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID7D6698A455CD40A0B27E5537E135B019" reported-display-style="italic"><enum>(C)</enum><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID4652E8AFE5A445FD933425961B36DDFF" reported-display-style="italic"><enum>(D)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID1578B3879BD24BECB132CED6BFCFF373" reported-display-style="italic"><enum>(2)</enum><header>Retrocession of
authority</header><text>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—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDC5061BAB83674487AF562FB2E1DA3B87" reported-display-style="italic"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDF93FCCC5684B4CF49D13294DAD1C5033" reported-display-style="italic"><enum>(B)</enum><text>such other date as may be
mutually agreed by the Secretary and the Tribal Health Program.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDCD05A93CDBB041FDBDBCC60400B8BA69" reported-display-style="italic"><enum>(c)</enum><header>Rates in
Alaska</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID6665BD0C8A034B539A22D26DC07B19A8" reported-display-style="italic"><enum>315.</enum><header>Applicability of
<act-name parsable-cite="BAA">Buy American Act</act-name> requirement</header>
<subsection changed="added" committee-id="SLIA00" id="IDA020B73F9B5646BFADD7ECD0A619D3D8" reported-display-style="italic"><enum>(a)</enum><header>Applicability</header><text>The
Secretary shall ensure that the requirements of the
<act-name parsable-cite="BAA">Buy American Act</act-name> apply to all
procurements made with funds provided pursuant to section 317. Indian Tribes
and Tribal Organizations shall be exempt from these requirements.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID2EC6621B1385477A9DF796105703A65C" reported-display-style="italic"><enum>(b)</enum><header>Effect of
Violation</header><text>If it has been finally determined by a court or Federal
agency that any person intentionally affixed a label bearing a <quote>Made in
America</quote> 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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDE041DF7B660F4708B845E37F6E170A47" reported-display-style="italic"><enum>(c)</enum><header>Definitions</header><text>For
purposes of this section, the term <term><act-name parsable-cite="BAA">Buy
American Act</act-name></term> means title III of the Act entitled <quote>An
Act making appropriations for the Treasury and Post Office Departments for the
fiscal year ending June 30, 1934, and for other purposes</quote>, approved
March 3, 1933 (41 U.S.C. 10a et seq.).</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID62F5E23A25F94093ABF470D81FD25B0C" reported-display-style="italic"><enum>316.</enum><header>Other funding for
facilities</header>
<subsection changed="added" committee-id="SLIA00" id="ID6D58C2DCDBD642B496D10A61B9ADE096" reported-display-style="italic"><enum>(a)</enum><header>Authority To Accept
Funds</header><text>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 <act-name parsable-cite="ISDA">Indian
Self-Determination and Education Assistance Act</act-name> (25 U.S.C. 450 et
seq.). Receipt of such funds shall have no effect on the priorities established
pursuant to section 301.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID9BBD9AE633D04C4AA57871370C2F96E5" reported-display-style="italic"><enum>(b)</enum><header>Interagency
Agreements</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDB6F4D6743A4F401882CD14AF0D77F2FB" reported-display-style="italic"><enum>(c)</enum><header>Transferred
Funds</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID4E19CDF63A1145C9B109148DF94BA167" reported-display-style="italic"><enum>(d)</enum><header>Establishment of
Standards</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="IDE4B577705028434885F6397DB93850AD" reported-display-style="italic"><enum>317.</enum><header>Authorization of
appropriations</header><text display-inline="no-display-inline">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.</text>
</section><enum>IV</enum><header>ACCESS TO HEALTH
SERVICES</header>
<section changed="added" committee-id="SLIA00" id="ID23CDDFD1365E4CA9BD953B1EEF8C6F85" reported-display-style="italic"><enum>401.</enum><header>Treatment of payments
under <act-name parsable-cite="SSA">Social Security Act</act-name> Health care
Programs</header>
<subsection changed="added" committee-id="SLIA00" id="ID92E5AE17D7204B1BAE45C2389D922B1B" reported-display-style="italic"><enum>(a)</enum><header>Disregard of Medicare,
Medicaid, and SCHIP Payments in Determining Appropriations</header><text>Any
payments received by an Indian Health Program or by an Urban Indian
Organization made under title XVIII, XIX, or XXI of the
<act-name parsable-cite="SSA">Social Security Act</act-name> 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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID997D0952B80542C28C74746A0D41746F" reported-display-style="italic"><enum>(b)</enum><header>Nonpreferential
Treatment</header><text>Nothing in this Act authorizes the Secretary to provide
services to an Indian with coverage under title XVIII, XIX, or XXI of the
<act-name parsable-cite="SSA">Social Security Act</act-name> in preference to
an Indian without such coverage.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID55C107816A3644AFB22B5D26111865E5" reported-display-style="italic"><enum>(c)</enum><header>Use of Funds</header>
<paragraph changed="added" committee-id="SLIA00" id="ID7308C0B46A1A49B4B53F99A7E9430C77" reported-display-style="italic"><enum>(1)</enum><header>Special
fund</header><text>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 <act-name parsable-cite="SSA">Social Security
Act</act-name> 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
<act-name parsable-cite="SSA">Social Security Act</act-name>. 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
<act-name parsable-cite="SSA">Social Security Act</act-name>.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID20F24B4D2BDE4C1EA886D52E52E341C3" reported-display-style="italic"><enum>(2)</enum><header>Direct payment
option</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID545E71B139604623850B0A43E873D6FF" reported-display-style="italic"><enum>(d)</enum><header>Direct Billing</header>
<paragraph changed="added" committee-id="SLIA00" id="ID7431EA2509674BB5BF641D8514CDF1AB" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>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 <act-name parsable-cite="SSA">Social Security Act</act-name> or
from any other third party payor.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDB14D0FF1CE0042D3913B70B1F8D30C6D" reported-display-style="italic"><enum>(2)</enum><header>Direct
reimbursement</header>
<subparagraph changed="added" committee-id="SLIA00" id="ID74DA72AFDF2648248029B05A613CD6DC" reported-display-style="italic"><enum>(A)</enum><header>Use of
funds</header><text>Each Tribal Health Program exercising the option described
in paragraph (1) with respect to a program under a title of the
<act-name parsable-cite="SSA">Social Security Act</act-name> 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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID397226AF3D5542CCA21F8BF3C613066C" reported-display-style="italic"><enum>(B)</enum><header>Audits</header><text>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
<act-name parsable-cite="SSA">Social Security Act</act-name> shall be subject
to all auditing requirements applicable to programs administered by an Indian
Health Program.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID34E8313639B4472C9DD53243984E0E62" reported-display-style="italic"><enum>(C)</enum><header>Identification of
source of payments</header><text>If an Indian Tribe or Tribal Organization
receives funding from the Service under the <act-name parsable-cite="ISDA">Indian Self-Determination and Education Assistance Act (25
U.S.C. 450 et seq.)</act-name> 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 <act-name parsable-cite="SSA">Social Security Act</act-name>, 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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID053A338F980D4C618094E4C0FFAFCE9C" reported-display-style="italic"><enum>(3)</enum><header>Examination and
implementation of changes</header><text>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
<act-name parsable-cite="SSA">Social Security Act</act-name>.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID4F54310723364E3A973583BEE08C1770" reported-display-style="italic"><enum>(4)</enum><header>Withdrawal from
program</header><text>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 <act-name parsable-cite="ISDA">Indian Self-Determination and
Education Assistance Act</act-name> (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.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="ID67953B5FB96248D097DFF5FEDAD1D395" reported-display-style="italic"><enum>402.</enum><header>Grants to and
contracts with the Service, Indian Tribes, Tribal Organizations, and Urban
Indian Organizations</header>
<subsection changed="added" committee-id="SLIA00" id="ID2831E74454A64375B415313A0711C019" reported-display-style="italic"><enum>(a)</enum><header>Indian Tribes and
Tribal Organizations</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID57C336D162334344B06EA14BB3788243" reported-display-style="italic"><enum>(1)</enum><text>to enroll for benefits
under title XVIII, XIX, or XXI of the <act-name parsable-cite="SSA">Social
Security Act</act-name> and other health benefits programs; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID11B284F865534B61BB27E2AE3ADDC86C" reported-display-style="italic"><enum>(2)</enum><text>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).</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID10C8AC546B454C058592CA860612FBAA" reported-display-style="italic"><enum>(b)</enum><header>Conditions</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDE591482CF245419A97E213528A3A4B9F" reported-display-style="italic"><enum>(1)</enum><text>to determine the
population of Indians eligible for the benefits described in subsection
(a);</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDB2C00DCE092C4759B91D03A602BA6268" reported-display-style="italic"><enum>(2)</enum><text>to educate Indians with
respect to the benefits available under the respective programs;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID0DA41130B4F44E2B843C8C9A67AD20F1" reported-display-style="italic"><enum>(3)</enum><text>to provide transportation
for such individual Indians to the appropriate offices for enrollment or
applications for such benefits; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID6E9B7ABE3BDB49E892A6F841CF02EBBC" reported-display-style="italic"><enum>(4)</enum><text>to develop and implement
methods of improving the participation of Indians in receiving the benefits
provided under titles XVIII, XIX, and XXI of the <act-name parsable-cite="SSA">Social Security Act</act-name>.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID3171BE7B7E2D404EA406FEBCD9BF5539" reported-display-style="italic"><enum>(c)</enum><header>Agreements Relating to
Improving Enrollment of Indians Under <act-name parsable-cite="SSA">Social
Security Act</act-name> Programs</header>
<paragraph changed="added" committee-id="SLIA00" id="IDB30F0CADD0374F828A0213CE41D563D5" reported-display-style="italic"><enum>(1)</enum><header>Agreements with
secretary to improve receipt and processing of applications</header>
<subparagraph changed="added" committee-id="SLIA00" id="ID3154BCCDAB9D4081A53ECF241CB69A81" reported-display-style="italic"><enum>(A)</enum><header>Authorization</header><text>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 <act-name parsable-cite="SSA">Social Security
Act</act-name>, and benefits under title XVIII of such Act, by an Indian Health
Program or Urban Indian Organization.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDFCCD738BF6C84AB489DB401326FA8CF3" reported-display-style="italic"><enum>(B)</enum><header>Reimbursement of
costs</header><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID863054B03AE54075872146C6A84F7718" reported-display-style="italic"><enum>(C)</enum><header>Processing
clarified</header><text>In this paragraph, the term <term>processing</term>
does not include a final determination of eligibility.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID0387765797B3490294664639DA393AB9" reported-display-style="italic"><enum>(2)</enum><header>Agreements with states
for outreach on or near reservation</header>
<subparagraph changed="added" committee-id="SLIA00" id="IDDBDF604B58994E6DBFB9830129B818B7" reported-display-style="italic"><enum>(A)</enum><header>In
general</header><text>In order to improve the access of Indians residing on or
near a reservation to obtain benefits under title XIX or XXI of the
<act-name parsable-cite="SSA">Social Security Act</act-name>, 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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID95753AF28151453897A6CFFBD5489392" reported-display-style="italic"><enum>(B)</enum><header>Construction</header><text>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.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDEEFE78A752A64D0A950065190544A7EF" reported-display-style="italic"><enum>(d)</enum><header>Facilitating
Cooperation</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID23E27901A17E4C64B85B4FF4558523E6" reported-display-style="italic"><enum>(e)</enum><header>Application to Urban
Indian Organizations</header>
<paragraph changed="added" committee-id="SLIA00" id="IDBC0D580FCEE64D6BBC6ADD5208284349" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID05FC5EABAF204A569BE5838B84A1846C" reported-display-style="italic"><enum>(2)</enum><header>Requirements</header><text>The
Secretary shall include in the grants or contracts made or provided under
paragraph (1) requirements that are—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDB3F1CD93F5C04E79A015AB9B8571475E" reported-display-style="italic"><enum>(A)</enum><text>consistent with the
requirements imposed by the Secretary under subsection (b);</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID7A55B53FF0714F01A77D5B89ECF1EBEF" reported-display-style="italic"><enum>(B)</enum><text>appropriate to Urban
Indian Organizations and Urban Indians; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDCDD808B2A20C49ABBCE1E7547C194EBE" reported-display-style="italic"><enum>(C)</enum><text>necessary to effect the
purposes of this section.</text>
</subparagraph></paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="ID925C1417AEC842C4A00908F2A349AEB2" reported-display-style="italic"><enum>403.</enum><header>Reimbursement from
certain third parties of costs of Health Services</header>
<subsection changed="added" committee-id="SLIA00" id="IDE5A39878C31042FC82F36610D90B24FC" reported-display-style="italic"><enum>(a)</enum><header>Right of
Recovery</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDD311BD0C94A24FFAA69BA1A4592AB073" reported-display-style="italic"><enum>(1)</enum><text>such services had been
provided by a nongovernmental provider; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID844C12321D8642739F7033129CECB295" reported-display-style="italic"><enum>(2)</enum><text>such individual had been
required to pay such charges or expenses and did pay such charges or
expenses.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDC8A4A8220FFE4B3A9A724784DDB924E4" reported-display-style="italic"><enum>(b)</enum><header>Limitations on
Recoveries From States</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID824C3D0FFBB3455DB2FDCF6DEF6FD8F8" reported-display-style="italic"><enum>(1)</enum><text>workers’ compensation
laws; or</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID3D9733B7E3384964A928AB11C13C2C95" reported-display-style="italic"><enum>(2)</enum><text>a no-fault automobile
accident insurance plan or program.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID199EE0021ECA4C59BD286B87E889EBC5" reported-display-style="italic"><enum>(c)</enum><header>Nonapplication of Other
Laws</header><text>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).</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID2B2CE3B580F643619ACE74719E1DC7F4" reported-display-style="italic"><enum>(d)</enum><header>No Effect on Private
Rights of Action</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDBA31539258F144F7BFA94E4BD4707B1F" reported-display-style="italic"><enum>(e)</enum><header>Enforcement</header>
<paragraph changed="added" committee-id="SLIA00" id="IDA93AAC3A55E748EFAF5C1E16FF47FA6A" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>The United States, an Indian Tribe, or Tribal
Organization may enforce the right of recovery provided under subsection (a)
by—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID793C944F24294ECDAF18F66CBAA42216" reported-display-style="italic"><enum>(A)</enum><text>intervening or joining in
any civil action or proceeding brought—</text>
<clause changed="added" committee-id="SLIA00" id="IDAF20A603954C45789CEA4D340F010A60" reported-display-style="italic"><enum>(i)</enum><text>by the individual for
whom health services were provided by the Secretary, an Indian Tribe, or Tribal
Organization; or</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID04970FE159EF42BFA4B1A6137E34FB3A" reported-display-style="italic"><enum>(ii)</enum><text>by any representative or
heirs of such individual, or</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID6EAB58B1A51A45F6A035E7BFCFB917A9" reported-display-style="italic"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDAD097E84871947FAA2D4E60E7D7FC5DC" reported-display-style="italic"><enum>(2)</enum><header>Notice</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDFC217AF59708463CA2D2E76AA387267E" reported-display-style="italic"><enum>(f)</enum><header>Limitation</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDEBB884A4F44D48FE8D2443DDB8910722" reported-display-style="italic"><enum>(g)</enum><header>Costs and Attorneys’
Fees</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID6FC33E455DF14C75BE0C2C63B8631503" reported-display-style="italic"><enum>(h)</enum><header>Nonapplication of
Claims Filing Requirements</header><text>An insurance company, health
maintenance organization, self-insurance plan, managed care plan, or other
health care plan or program (under the <act-name parsable-cite="SSA">Social
Security Act</act-name> 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
<act-name parsable-cite="SSA">Social Security Act</act-name> or recognized
under section 1175 of such Act.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID085BCF59BBF74C64A3669F661F2AE1A3" reported-display-style="italic"><enum>(i)</enum><header>Application to Urban
Indian Organizations</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDE3B6F2887EAA4DE48C7D2A49D7C93CF6" reported-display-style="italic"><enum>(j)</enum><header>Statute of
Limitations</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID74012062031C457E8605A9F8A5297DE4" reported-display-style="italic"><enum>(k)</enum><header>Savings</header><text>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.).</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID9201B1B79F9E45D78C9B80A6D5881A5F" reported-display-style="italic"><enum>404.</enum><header>Crediting of
reimbursements</header>
<subsection changed="added" committee-id="SLIA00" id="ID09A41FE02D8C42A1AEE80BF842AF9E0F" reported-display-style="italic"><enum>(a)</enum><header>Use of Amounts</header>
<paragraph changed="added" committee-id="SLIA00" id="IDA71D71B9C0874C5EBE8DF21AD86F97D3" reported-display-style="italic"><enum>(1)</enum><header>Retention by
program</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDCFC305537DBE41EC8601FE2ED01C497C" reported-display-style="italic"><enum>(2)</enum><header>Programs
covered</header><text>The programs referred to in paragraph (1) are the
following:</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID8B40195892CC461CBE75C113C516DE2E" reported-display-style="italic"><enum>(A)</enum><text>Titles XVIII, XIX, and
XXI of the <act-name parsable-cite="SSA">Social Security Act</act-name>.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDC65507CF015A40EA8229560C3C629341" reported-display-style="italic"><enum>(B)</enum><text>This Act, including
section 807.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID3AB45AA63CAB45359C2EC6FF135AF987" reported-display-style="italic"><enum>(C)</enum><text>Public Law 87–693.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID724498ADBE4E479D9EEDE5C7DF1AC75C" reported-display-style="italic"><enum>(D)</enum><text>Any other provision of
law.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID9640B6FE89834EB1A60446FF56B534BA" reported-display-style="italic"><enum>(b)</enum><header>No Offset of
Amounts</header><text>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).</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="IDA4945860544249EC92D74384C66A2E9F" reported-display-style="italic"><enum>405.</enum><header>Purchasing Health care
coverage</header>
<subsection changed="added" committee-id="SLIA00" id="IDBE720D9E3C794493BAD1498EC98A1F79" reported-display-style="italic"><enum>(a)</enum><header>In
General</header><text>Insofar as amounts are made available under law
(including a provision of the <act-name parsable-cite="SSA">Social Security
Act</act-name>, the <act-name parsable-cite="ISDA">Indian Self-Determination
and Education Assistance Act (25 U.S.C. 450 et seq.)</act-name>, 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—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID36BAF5C81F944F57AC0780C49D5AE860" reported-display-style="italic"><enum>(1)</enum><text>a tribally owned and
operated health care plan;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDAD53FBDA778648FF9AC402567050B0B4" reported-display-style="italic"><enum>(2)</enum><text>a State or locally
authorized or licensed health care plan;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID2121C5D2C4F84AB2B369C4611B4ADEE9" reported-display-style="italic"><enum>(3)</enum><text>a health insurance
provider or managed care organization; or</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDD5CE1EAEDE99420797B1E44428D1F12E" reported-display-style="italic"><enum>(4)</enum><text>a self-insured
plan.</text>
</paragraph><continuation-text changed="added" committee-id="SLIA00" continuation-text-level="subsection" reported-display-style="italic">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).</continuation-text></subsection><subsection changed="added" committee-id="SLIA00" id="ID032F89B44D5F43979AE28EEE1AD25272" reported-display-style="italic"><enum>(b)</enum><header>Expenses for
Self-Insured Plan</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID503024D03F7C46C59A58F44A27F02659" reported-display-style="italic"><enum>(c)</enum><header>Construction</header><text>Nothing
in this section shall be construed as affecting the use of any amounts not
referred to in subsection (a).</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID4BCEB4A8D831436DA803F5E2B262B6CA" reported-display-style="italic"><enum>406.</enum><header>Sharing arrangements
with Federal agencies</header>
<subsection changed="added" committee-id="SLIA00" id="ID4AFAD50AA89D48078AAAF1211D51FC0E" reported-display-style="italic"><enum>(a)</enum><header>Authority</header>
<paragraph changed="added" committee-id="SLIA00" id="ID01549FBD9AD542A0A0B0EE5152984EAC" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDFDB4715695A54658965AE56D5C7736B0" reported-display-style="italic"><enum>(2)</enum><header>Consultation by
secretary required</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDC0CAD67EEE9640E2BAD7E214FB111F1C" reported-display-style="italic"><enum>(b)</enum><header>Limitations</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID203889E488DB44A0A7D62B37C0CEF7AD" reported-display-style="italic"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDD3E83EF5C87E43E2864C9228401F4E09" reported-display-style="italic"><enum>(2)</enum><text>the quality of health
care services provided to any Indian through the Service;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID6DBF7EBECFE1463CA82957705B32E709" reported-display-style="italic"><enum>(3)</enum><text>the priority access of
any veteran to health care services provided by the Department of Veterans
Affairs;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDEC57AEE0AFCF4F26BD609498C6F7ECAC" reported-display-style="italic"><enum>(4)</enum><text>the quality of health
care services provided by the Department of Veterans Affairs or the Department
of Defense; or</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID26DB06AEDDE44204BF59974DA95FD562" reported-display-style="italic"><enum>(5)</enum><text>the eligibility of any
Indian who is a veteran to receive health services through the Department of
Veterans Affairs.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID8F652F8EF334460793BC68E316B85469" reported-display-style="italic"><enum>(c)</enum><header>Reimbursement</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDEFED7E3A448642698F0D3966CF63A595" reported-display-style="italic"><enum>(d)</enum><header>Construction</header><text>Nothing
in this section may be construed as creating any right of a non-Indian veteran
to obtain health services from the Service.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID93D329AC014B44179EDFA0CD5AADA883" reported-display-style="italic"><enum>407.</enum><header>Payor of last
resort</header><text display-inline="no-display-inline">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.</text>
</section><section changed="added" committee-id="SLIA00" id="ID2C688AC3A46C4E3A8A06AA972D094D41" reported-display-style="italic"><enum>408.</enum><header>Nondiscrimination in
qualifications for reimbursement for Services</header><text display-inline="no-display-inline">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.</text>
</section><section changed="added" committee-id="SLIA00" id="ID17A798F6CB84451084441A56A1E40F64" reported-display-style="italic"><enum>409.</enum><header>Consultation</header>
<subsection changed="added" committee-id="SLIA00" id="IDA80551609DD34359B066240798677EF5" reported-display-style="italic"><enum>(a)</enum><header>Tribal Technical
Advisory Group (TTAG)</header><text>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)).</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID7A99AA1729984DD495800C5679545632" reported-display-style="italic"><enum>(b)</enum><header>Solicitation of
Medicaid Advice</header>
<paragraph changed="added" committee-id="SLIA00" id="IDDE5B3E78BBDA4EAD91E83E4BA675FECD" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>As part of its plan under title XIX of the
<act-name parsable-cite="SSA">Social Security Act</act-name>, 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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID72DC199344484DBFA31318379F3BAB16" reported-display-style="italic"><enum>(2)</enum><header>Manner of
advice</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID1CC6C5ABCD5942DE9E3C926C091384BB" reported-display-style="italic"><enum>(3)</enum><header>Payment of
expenses</header><text>The reasonable expenses of carrying out this subsection
shall be eligible for reimbursement under section 1903(a) of the
<act-name parsable-cite="SSA">Social Security Act</act-name>.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID58557855BDA54D3F8AA66511286EFD91" reported-display-style="italic"><enum>(c)</enum><header>Construction</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID032F7F0DDB2E430D8DC0580D6DBE0177" reported-display-style="italic"><enum>410.</enum><header>State children’s
Health insurance Program (schip)</header>
<subsection changed="added" committee-id="SLIA00" id="IDB38D721EB5C74042BD5589E41F991089" reported-display-style="italic"><enum>(a)</enum><header>Optional Use of Funds
for Indian Health Program Payments</header><text>Subject to the succeeding
provisions of this section, a State may provide under its State child health
plan under title XXI of the <act-name parsable-cite="SSA">Social Security
Act</act-name> (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
<act-name parsable-cite="SSA">Social Security Act</act-name> as expenditures
described in section 2105(a)(1)(A) of such Act.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID0F6F3779D337434E893B9B81AC570716" reported-display-style="italic"><enum>(b)</enum><header>Use of
Funds</header><text>Payments under this section may be used only for
expenditures described in clauses (i) through (iii) of section 2105(a)(1)(D) of
the <act-name parsable-cite="SSA">Social Security Act</act-name> for targeted
low-income children or other low-income children (as defined in 2110 of such
Act) who are—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID9E909AA10373413C97A525BB125EC6BD" reported-display-style="italic"><enum>(1)</enum><text>Indians; or</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDF87952B1DE6844BBBDBB94A8102F8FF7" reported-display-style="italic"><enum>(2)</enum><text>otherwise eligible for
health services from the Indian Health Program involved.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID3C4703FAC3174DE7AA22B90BA6D7A4D8" reported-display-style="italic"><enum>(c)</enum><header>Special
Restrictions</header><text>The following conditions apply to a State electing
to provide payments under this section:</text>
<paragraph changed="added" committee-id="SLIA00" id="ID7D6641C0DB844FE6868273FAD4DA104E" reported-display-style="italic"><enum>(1)</enum><header>No limitation on other
schip participation of, or provider payments to, indian health
programs</header><text>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 <act-name parsable-cite="SSA">Social Security
Act</act-name> 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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDA936BC56F73B44A3B50E8AA7E8E3492E" reported-display-style="italic"><enum>(2)</enum><header>No limitation on other
schip eligibility of indians</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID4D70A06B2DD14B39B6B008FF4E79EBD3" reported-display-style="italic"><enum>(3)</enum><header>Limitation on
acceptance of contributions</header>
<subparagraph changed="added" committee-id="SLIA00" id="IDCFE4AD73492648FF99BCA5C0E5B9711F" reported-display-style="italic"><enum>(A)</enum><header>In
general</header><text>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 <act-name parsable-cite="SSA">Social Security Act</act-name>.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDEA99A3CE3A06487DA7E1258FBED63131" reported-display-style="italic"><enum>(B)</enum><header>Contribution
defined</header><text>For purposes of subparagraph (A), the term
<term>contribution</term> includes any tax, donation, fee, or other payment
made, whether made voluntarily or involuntarily.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID730C10BA9BC04207A7FCFDEFF166F6E5" reported-display-style="italic"><enum>(d)</enum><header>Application of Separate
10 Percent Limitation</header><text>Payment may be made under section 2105(a)
of the <act-name parsable-cite="SSA">Social Security Act</act-name> 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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID8F7550133E7444D7A04EEBDE2BDAD28A" reported-display-style="italic"><enum>(e)</enum><header>General
Terms</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="IDE0829B1F70354956AB642BE7F0631873" reported-display-style="italic"><enum>411.</enum><header><act-name parsable-cite="SSA">Social Security Act</act-name> sanctions</header>
<subsection changed="added" committee-id="SLIA00" id="ID11A5807954DD435A805BE6497D517AEB" reported-display-style="italic"><enum>(a)</enum><header>Requests for Waiver of
Sanctions</header>
<paragraph changed="added" committee-id="SLIA00" id="IDE31AE70E00504EDEA001CA7D0BB8939D" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>For purposes of applying any authority under a provision
of title XI, XVIII, XIX, or XXI of the <act-name parsable-cite="SSA">Social
Security Act</act-name> 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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID6DBCD6884E664C719512958A3557B7D1" reported-display-style="italic"><enum>(2)</enum><header>Procedure</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID0F1C5EA453244A9FBD9F531E04CB379D" reported-display-style="italic"><enum>(b)</enum><header>Safe Harbor for
Transactions Between and Among Indian Health Care Programs</header><text>For
purposes of applying section 1128B(b) of the <act-name parsable-cite="SSA">Social Security Act</act-name>, 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:</text>
<paragraph changed="added" committee-id="SLIA00" id="ID9E92D48D5DA145B0A79722EC9A7C0734" reported-display-style="italic"><enum>(1)</enum><text>An exchange between or
among the following:</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID93D9C8EE85DF4C839A13ED217EC96243" reported-display-style="italic"><enum>(A)</enum><text>Any Indian Health
Program.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID7F9478243B684ABE91191DFCF72D3659" reported-display-style="italic"><enum>(B)</enum><text>Any Urban Indian
Organization.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID508BE9CA31F24D46AE296579713179AF" reported-display-style="italic"><enum>(2)</enum><text>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—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDAF975E1E882448DAAFBB512977ADEEDF" reported-display-style="italic"><enum>(A)</enum><text>is for the purpose of
transporting the patient for the provision of health care items or
services;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID3BACC8F082D345F49BBA65667D1FF930" reported-display-style="italic"><enum>(B)</enum><text>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;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID4CA12F09F5EF44A8AA6B15A1BA26F898" reported-display-style="italic"><enum>(C)</enum><text>is for the purpose of
paying premiums, copayments, deductibles, or other cost-sharing on behalf of
patients; or</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID4C672D274DEA47B0B701915E05FC53DD" reported-display-style="italic"><enum>(D)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID7E9BC8D394334BAC90E8AF6BB89E0D9E" reported-display-style="italic"><enum>(3)</enum><text>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.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="ID6F3B746CB08049ECBD5F2B3F1B063CB4" reported-display-style="italic"><enum>412.</enum><header>Cost sharing</header>
<subsection changed="added" committee-id="SLIA00" id="IDE47690DB19C74D8FABD94FAB8232DD57" reported-display-style="italic"><enum>(a)</enum><header>Coinsurance,
Copayments, and Deductibles</header><text>Notwithstanding any other provision
of Federal or State law—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDEEC48C63CE5F4BF29D207432EF981DBB" reported-display-style="italic"><enum>(1)</enum><header>Protection for eligible
indians under social security act health programs</header><text>No Indian who
is furnished an item or service for which payment may be made under title XIX
or XXI of the <act-name parsable-cite="SSA">Social Security Act</act-name> may
be charged a deductible, copayment, or coinsurance.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDBF301DAF981E4826AAA9234EB2175747" reported-display-style="italic"><enum>(2)</enum><header>Protection for
indians</header><text>No Indian who is furnished an item or service by the
Service may be charged a deductible, copayment, or coinsurance.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID91F983CB022C48D1A65241CBBEB9FD8D" reported-display-style="italic"><enum>(3)</enum><header>No reduction in amount
of payment to indian health providers</header><text>The payment or
reimbursement due to the Service, Indian Tribe, Tribal Organization, or Urban
Indian Organization under title XIX or XXI of the <act-name parsable-cite="SSA">Social Security Act</act-name> 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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDC297F5EAAF894890B4A330384A61D69A" reported-display-style="italic"><enum>(b)</enum><header>Exemption From Medicaid
and SCHIP Premiums</header><text>Notwithstanding any other provision of Federal
or State law, no Indian who is otherwise eligible for services under title XIX
of the <act-name parsable-cite="SSA">Social Security Act</act-name> (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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID7B9F5E1D2FD34B14BCC9916401961A25" reported-display-style="italic"><enum>(c)</enum><header>Treatment of Certain
Property for Medicaid Eligibility</header><text>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
<act-name parsable-cite="SSA">Social Security Act</act-name>:</text>
<paragraph changed="added" committee-id="SLIA00" id="IDB8F13B34478F41A190A101CD6C68D422" reported-display-style="italic"><enum>(1)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID410E0AF773844692B99842DDC173668A" reported-display-style="italic"><enum>(2)</enum><text>For any federally
recognized Tribe not described in paragraph (1), property located within the
most recent boundaries of a prior Federal reservation.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDC1849696B20E4BE49EC4AD5F56DA5E7A" reported-display-style="italic"><enum>(3)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID3F626A99F4624720B9D095A6C2F04761" reported-display-style="italic"><enum>(4)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID8602530CE28A4519AB17CD067ED8DE74" reported-display-style="italic"><enum>(d)</enum><header>Continuation of Current
Law Protections of Certain Indian Property From Medicaid Estate
Recovery</header><text>Income, resources, and property that are exempt from
medicaid estate recovery under title XIX of the <act-name parsable-cite="SSA">Social Security Act</act-name> 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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="IDD9E565A075664D15935A13C2FE716C1B" reported-display-style="italic"><enum>413.</enum><header>Treatment under
Medicaid managed care</header>
<subsection changed="added" committee-id="SLIA00" id="ID780CCD663B054112814449B5D87C71DC" reported-display-style="italic"><enum>(a)</enum><header>Provision of Services,
to Enrollees With Non-Indian Medicaid Managed Care Entities, by Indian Health
Programs and Urban Indian Organizations</header>
<paragraph changed="added" committee-id="SLIA00" id="ID71D15AA427B74D4C9F02FF8ABF910403" reported-display-style="italic"><enum>(1)</enum><header>Payment rules</header>
<subparagraph changed="added" committee-id="SLIA00" id="ID7829FA76ABE0475CA2693BAD5DD26CA6" reported-display-style="italic"><enum>(A)</enum><header>In
general</header><text>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:</text>
<clause changed="added" committee-id="SLIA00" id="ID156A0D89A8644C08992D268EB307A31E" reported-display-style="italic"><enum>(i)</enum><header>Direct
payment</header><text>The entity shall make prompt payment (in accordance with
rules applicable to medicaid managed care entities under title XIX of the
<act-name parsable-cite="SSA">Social Security Act</act-name>) 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.</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID9289B9E64B114DDD8E69CF689B198523" reported-display-style="italic"><enum>(ii)</enum><header>Payment through
state</header><text>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.</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID4E0F0DCCD68148EAB5218AA9D9FFEFC3" reported-display-style="italic"><enum>(B)</enum><header>Compliance with
generally applicable requirements</header>
<clause changed="added" committee-id="SLIA00" id="ID90BB1C97E7D042C6927085260F96B147" reported-display-style="italic"><enum>(i)</enum><header>In
general</header><text>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
<act-name parsable-cite="SSA">Social Security Act</act-name> with respect to
covered services.</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID026C7EFDD43E409E9ED5648D155CA0C5" reported-display-style="italic"><enum>(ii)</enum><header>Satisfaction of claim
requirement</header><text>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).</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDE74088FA333E464BB39EDC644BDC1435" reported-display-style="italic"><enum>(C)</enum><header>Construction</header><text>Nothing
in this subsection shall be construed as waiving the application of section
1902(a)(30)(A) of the <act-name parsable-cite="SSA">Social Security
Act</act-name> (relating to application of standards to assure that payments
are consistent with efficiency, economy, and quality of care).</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID2AE413367C154C92AC61E6D089F7D88A" reported-display-style="italic"><enum>(2)</enum><header>Enrollee option to
select an indian health program or Urban Indian Organization as primary care
provider</header><text>In the case of a non-Indian medicaid managed care entity
that—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDDB5F19B684A1480CB2670CCE63FAFF7E" reported-display-style="italic"><enum>(A)</enum><text>has an Indian enrolled
with the entity; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID2EF41551CEA94641A0011CDB860780E8" reported-display-style="italic"><enum>(B)</enum><text>has an Indian Health
Program or Urban Indian Organization that is participating as a primary care
provider within the network of the entity,</text>
</subparagraph><continuation-text changed="added" committee-id="SLIA00" continuation-text-level="paragraph" reported-display-style="italic">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.</continuation-text></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID965720A1C1074327872FB8570F233058" reported-display-style="italic"><enum>(b)</enum><header>Offering of Managed
Care Through Indian Medicaid Managed Care Entities</header><text>If—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDD1DDD2C3A73D41A4A583EBC2E2ADF6B5" reported-display-style="italic"><enum>(1)</enum><text>a State elects to provide
services through medicaid managed care entities under its medicaid managed care
program; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID7EB87C91E0314258A608B72FCE192247" reported-display-style="italic"><enum>(2)</enum><text>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,</text>
</paragraph><continuation-text changed="added" committee-id="SLIA00" continuation-text-level="subsection" reported-display-style="italic">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.</continuation-text></subsection><subsection changed="added" committee-id="SLIA00" id="ID43CCB43AC4F34BCCA65416A1B610141C" reported-display-style="italic"><enum>(c)</enum><header>Special Rules for
Indian Managed Care Entities</header><text>The following are special rules
regarding the application of a medicaid managed care program to Indian medicaid
managed care entities:</text>
<paragraph changed="added" committee-id="SLIA00" id="ID4671794304634A969EBC2246F66970A4" reported-display-style="italic"><enum>(1)</enum><header>Enrollment</header>
<subparagraph changed="added" committee-id="SLIA00" id="ID25E18869E35D48F392A1185BD45CD936" reported-display-style="italic"><enum>(A)</enum><header>Limitation to
indians</header><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID6E20B9D14D0D4B938A1C2CB7544BD4AC" reported-display-style="italic"><enum>(B)</enum><header>No less choice of
plans</header><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDE6E47E37EF3D40B1B2CAB5BFBC1A40B3" reported-display-style="italic"><enum>(C)</enum><header>Default
enrollment</header>
<clause changed="added" committee-id="SLIA00" id="ID4399FA3C10494BC88697C00A31A302B6" reported-display-style="italic"><enum>(i)</enum><header>In
general</header><text>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.</text>
</clause><clause changed="added" committee-id="SLIA00" id="IDBDFB96543DA94C2DABB3B2AE7EFD46C7" reported-display-style="italic"><enum>(ii)</enum><header>Indian
described</header><text>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).</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDFC51015A6C8848AD8937A8757AFE237E" reported-display-style="italic"><enum>(D)</enum><header>Exception to state
lock-in</header><text>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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID9415A248DB5C4CC2B4F30A4FACF1A4DB" reported-display-style="italic"><enum>(2)</enum><header>Flexibility in
application of solvency</header><text>In applying section 1903(m)(1) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> to an Indian
medicaid managed care entity—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID2C046C944F1F4CD8893C1037D812C9B5" reported-display-style="italic"><enum>(A)</enum><text>any reference to a
<quote>State</quote> in subparagraph (A)(ii) of that section shall be deemed to
be a reference to the <quote>Secretary</quote>; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDFEA2EAB2E36244CE8A3FD491B77CB812" reported-display-style="italic"><enum>(B)</enum><text>the entity shall be
deemed to be a public entity described in subparagraph (C)(ii) of that
section.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDF58C9D86A8A844DD932C3A71F9A352E1" reported-display-style="italic"><enum>(3)</enum><header>Exceptions to advance
directives</header><text>The Secretary may modify or waive the requirements of
section 1902(w) of the <act-name parsable-cite="SSA">Social Security
Act</act-name> (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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID14FC5843456945EE9250C9EA71C00FC1" reported-display-style="italic"><enum>(4)</enum><header>Flexibility in
information and marketing</header>
<subparagraph changed="added" committee-id="SLIA00" id="IDC64EFC9F74D543A09424735AC8AD9605" reported-display-style="italic"><enum>(A)</enum><header>Materials</header><text>The
Secretary may modify requirements under section 1932(a)(5) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> 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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDBEDE86DC3FE74FE3B01185E33BA049E7" reported-display-style="italic"><enum>(B)</enum><header>Distribution of
marketing materials</header><text>The provisions of section 1932(d)(2)(B) of
the <act-name parsable-cite="SSA">Social Security Act</act-name> 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.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDB79E5AB318B84DB197CCD143D909BA08" reported-display-style="italic"><enum>(d)</enum><header>Malpractice
Insurance</header><text>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
<act-name parsable-cite="SSA">Social Security Act</act-name>, that is covered
under the Federal Tort Claims Act (28 U.S.C. 1346(b), 2671 et seq.) is deemed
to satisfy such requirement.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDAB28321B73664248BDA6F630D04096D2" reported-display-style="italic"><enum>(e)</enum><header>Definitions</header><text>For
purposes of this section:</text>
<paragraph changed="added" committee-id="SLIA00" id="ID14D68A8006FD4890B6DC00A59DCEDE11" reported-display-style="italic"><enum>(1)</enum><header>Medicaid managed care
entity</header><text>The term <term>medicaid managed care entity</term> means a
managed care entity (whether a managed care organization or a primary care case
manager) under title XIX of the <act-name parsable-cite="SSA">Social Security
Act</act-name>, 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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDD625CC0FDF8948FCB8734EE2C2F67252" reported-display-style="italic"><enum>(2)</enum><header>Indian medicaid managed
care entity</header><text>The term <term>Indian medicaid managed care
entity</term> means a managed care entity that is controlled (within the
meaning of the last sentence of section 1903(m)(1)(C) of the
<act-name parsable-cite="SSA">Social Security Act</act-name>) 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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDE69F4E731C7844B488CCB763736B625C" reported-display-style="italic"><enum>(3)</enum><header>Non-Indian medicaid
managed care entity</header><text>The term <term>non-Indian medicaid managed
care entity</term> means a medicaid managed care entity that is not an Indian
medicaid managed care entity.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID4EE09A0F4AF241FFA425CCE272E60134" reported-display-style="italic"><enum>(4)</enum><header>Covered medicaid
managed care services</header><text>The term <term>covered medicaid managed
care services</term> 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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID3750FD996ECF4EDF8D744C7D8817D2FC" reported-display-style="italic"><enum>(5)</enum><header>Medicaid managed care
program</header><text>The term <term>medicaid managed care program</term> means
a program under sections 1903(m) and 1932 of the <act-name parsable-cite="SSA">Social Security Act</act-name> and includes a managed care
program operating under a waiver under section 1915(b) or 1115 of such Act or
otherwise.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="ID00B27C9977D84BFBB56DBE88E359D5EF" reported-display-style="italic"><enum>414.</enum><header>Navajo Nation Medicaid
Agency feasibility study</header>
<subsection changed="added" committee-id="SLIA00" id="ID1FC366BA334E4AFCA1BEB76F272A634A" reported-display-style="italic"><enum>(a)</enum><header>Study</header><text>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
<act-name parsable-cite="SSA">Social Security Act</act-name>, 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 <act-name parsable-cite="SSA">Social
Security Act</act-name>.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDD58CE4BFF68D4C50A0E83E7713455C7C" reported-display-style="italic"><enum>(b)</enum><header>Considerations</header><text>In
conducting the study, the Secretary shall consider the feasibility of—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDF4A4B32E066B44E7865C2BAE832A2260" reported-display-style="italic"><enum>(1)</enum><text>assigning and paying all
expenditures for the provision of services and related administration funds,
under title XIX of the <act-name parsable-cite="SSA">Social Security
Act</act-name>, 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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID3B99633FC6054B76965CEC55B23D1268" reported-display-style="italic"><enum>(2)</enum><text>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 <act-name parsable-cite="SSA">Social Security
Act</act-name>;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDA9F827D80E4F471A91348C9B511EDB14" reported-display-style="italic"><enum>(3)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDDF0134D89CB540A1BC27099CCB1923ED" reported-display-style="italic"><enum>(4)</enum><text>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 <act-name parsable-cite="SSA">Social
Security Act</act-name> (relating to the State children’s health insurance
program) under terms equivalent to those described in paragraphs (2) through
(4).</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDE10E5C480AB44BF8B2A87AD0A44CAE6C" reported-display-style="italic"><enum>(c)</enum><header>Report</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID3D858D9CC4444C93B70A2FB4F3A684A3" reported-display-style="italic"><enum>(1)</enum><text>the results of the study
under this section;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDE609CA4C7CA64F6D9409FDF5DC9FA7C7" reported-display-style="italic"><enum>(2)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID3E8AD251C4CB4DCE958C4FADDB59FCAF" reported-display-style="italic"><enum>(3)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID7263BA034F5C41ABB928EA0ECC5CC7A8" reported-display-style="italic"><enum>(4)</enum><text>legislative actions that
would be required to authorize the establishment of such entity if such entity
is determined by the Secretary to be feasible.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="IDA3787B9A7A4D4C11B897BB7E4BB5FCE4" reported-display-style="italic"><enum>415.</enum><header>Authorization of
appropriations</header><text display-inline="no-display-inline">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.</text>
</section><enum>V</enum><header>HEALTH SERVICES FOR URBAN
INDIANS</header>
<section changed="added" committee-id="SLIA00" id="ID90CF42F06054456A881367816CC47345" reported-display-style="italic"><enum>501.</enum><header>Purpose</header><text display-inline="no-display-inline">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.</text>
</section><section changed="added" committee-id="SLIA00" id="ID035BD186EFB841FD8E2377131F00C4B2" reported-display-style="italic"><enum>502.</enum><header>Contracts with, and
Grants to, Urban Indian Organizations</header><text display-inline="no-display-inline">Under authority of the Act of November 2,
1921 (25 U.S.C. 13) (commonly known as the <quote>Snyder Act</quote>), 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.</text>
</section><section changed="added" committee-id="SLIA00" id="IDEA6E680EC2CB4AA1863AA8D6A07FED99" reported-display-style="italic"><enum>503.</enum><header>Contracts and grants
for the provision of Health care and referral Services</header>
<subsection changed="added" committee-id="SLIA00" id="ID2F1985622DAB46389BB28B925D4F663B" reported-display-style="italic"><enum>(a)</enum><header>Requirements for Grants
and Contracts</header><text>Under authority of the Act of November 2, 1921 (25
U.S.C. 13) (commonly known as the <quote>Snyder Act</quote>), 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—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID408479EACDFC4B38A944E1D72F680F1F" reported-display-style="italic"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID3C8B4EBFAC6045E2BB54A8A007B63B38" reported-display-style="italic"><enum>(2)</enum><text>estimate the current
health status of Urban Indians residing in such Urban Center or centers;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID9AD8603C9C5A4D4C9EA4F81E8634EF5D" reported-display-style="italic"><enum>(3)</enum><text>estimate the current
health care needs of Urban Indians residing in such Urban Center or
centers;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDD051D3892F7D44FDB39C3AC9A258A248" reported-display-style="italic"><enum>(4)</enum><text>provide basic health
education, including health promotion and disease prevention education, to
Urban Indians;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDB5690C58655A4A1FA8F44A9D66A7FA75" reported-display-style="italic"><enum>(5)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID260FE231B1C74B2ABCB064DB7A81210E" reported-display-style="italic"><enum>(6)</enum><text>where necessary, provide,
or enter into contracts for the provision of, health care services for Urban
Indians.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID7CA4AE17B0A347C5B2ACC9575DC5D265" reported-display-style="italic"><enum>(b)</enum><header>Criteria</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID0C39677CD5FF4B30BCBA52CF7FDE7D68" reported-display-style="italic"><enum>(1)</enum><text>the extent of unmet
health care needs of Urban Indians in the Urban Center or centers
involved;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID5E4AFE0CFBE645F8BC8A30C3FB39F5E8" reported-display-style="italic"><enum>(2)</enum><text>the size of the Urban
Indian population in the Urban Center or centers involved;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDAB0466C348684ED3B66A4C73BBAE17AB" reported-display-style="italic"><enum>(3)</enum><text>the extent, if any, to
which the activities set forth in subsection (a) would duplicate any project
funded under this title;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID486E485602574EF89C08EB50E96AE013" reported-display-style="italic"><enum>(4)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDECA8FB87100F421E9F4575AD152ADCE1" reported-display-style="italic"><enum>(5)</enum><text>the satisfactory
performance and successful completion by an Urban Indian Organization of other
contracts with the Secretary under this title;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDB3C8D49DC7014C45982ABF5D40EF20B0" reported-display-style="italic"><enum>(6)</enum><text>the appropriateness and
likely effectiveness of conducting the activities set forth in subsection (a)
in an Urban Center or centers; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID457731E1C5F041618AAE11E6BD2C05D4" reported-display-style="italic"><enum>(7)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID6C4B3F4FFE6C492486C73B5C1A40C8AE" reported-display-style="italic"><enum>(c)</enum><header>Access to Health
Promotion and Disease Prevention Programs</header><text>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).</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID9D4027362FE5499A8BC8445482521B58" reported-display-style="italic"><enum>(d)</enum><header>Immunization
Services</header>
<paragraph changed="added" committee-id="SLIA00" id="ID9F59CBE0F36546EAB04458677F91DBEC" reported-display-style="italic"><enum>(1)</enum><header>Access or services
provided</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID446AB98AC0984B18B573E42DBE2A6087" reported-display-style="italic"><enum>(2)</enum><header>Definition</header><text>For
purposes of this subsection, the term <term>immunization services</term> means
services to provide without charge immunizations against vaccine-preventable
diseases.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID4685E842FD3D4645B0F6C21541F24E85" reported-display-style="italic"><enum>(e)</enum><header>Behavioral Health
Services</header>
<paragraph changed="added" committee-id="SLIA00" id="ID70E3E5CDACDE4B38AE38B045343C2F5D" reported-display-style="italic"><enum>(1)</enum><header>Access or services
provided</header><text>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).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID75A581920ADB491A9907A1DA3EF49A7E" reported-display-style="italic"><enum>(2)</enum><header>Assessment
required</header><text>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:</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDD14AE8091D7541F7A75A1828F80F30CE" reported-display-style="italic"><enum>(A)</enum><text>The behavioral health
needs of the Urban Indian population concerned.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID523E2D753BF247FA8403F02A530DAB2A" reported-display-style="italic"><enum>(B)</enum><text>The behavioral health
services and other related resources available to that population.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDD3BD2C3E36A24936A8946C072CEE8F58" reported-display-style="italic"><enum>(C)</enum><text>The barriers to obtaining
those services and resources.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDEC3C827589AB4518A93B253BDBE38EA5" reported-display-style="italic"><enum>(D)</enum><text>The needs that are unmet
by such services and resources.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID4D0B8E6BABB244D790B583DC83B5BBD0" reported-display-style="italic"><enum>(3)</enum><header>Purposes of
grants</header><text>Grants may be made under this subsection for the
following:</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDD58766E3AF294C6CBA0B135336D67FE1" reported-display-style="italic"><enum>(A)</enum><text>To prepare assessments
required under paragraph (2).</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDC4754FEF38974FD09A816791CED92646" reported-display-style="italic"><enum>(B)</enum><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID9AE3292615D840C1823F376CDF7B9C21" reported-display-style="italic"><enum>(C)</enum><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDCF3D741FF8A6444B8F7EF7E6BCDD5DE0" reported-display-style="italic"><enum>(D)</enum><text>To develop innovative
behavioral health service delivery models which incorporate Indian cultural
support systems and resources.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID3B01E6D626724ADA9974C91AB3BEEDE8" reported-display-style="italic"><enum>(f)</enum><header>Prevention of Child
Abuse</header>
<paragraph changed="added" committee-id="SLIA00" id="ID3BB123F54A8B4788B76EC29CFE5CC398" reported-display-style="italic"><enum>(1)</enum><header>Access or services
provided</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID6D96CA6B95CD409F99F6DD3037B4D5DA" reported-display-style="italic"><enum>(2)</enum><header>Evaluation
required</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDD01509739654459B9934D39AFC016B3A" reported-display-style="italic"><enum>(3)</enum><header>Purposes of
grants</header><text>Grants may be made under this subsection for the
following:</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID5411742367034927AEFFCF757EEA2B91" reported-display-style="italic"><enum>(A)</enum><text>To prepare assessments
required under paragraph (2).</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID87C498BAF7764170B7A2DE9F79410309" reported-display-style="italic"><enum>(B)</enum><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID6274420E287F4577A8D3A716532425AC" reported-display-style="italic"><enum>(C)</enum><text>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).</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID1E7B72AE7A0349BEB6875ED5CFE26692" reported-display-style="italic"><enum>(4)</enum><header>Considerations when
making grants</header><text>In making grants to carry out this subsection, the
Secretary shall take into consideration—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID031E1A493E334EC7B5F7E6F1E0DD4D49" reported-display-style="italic"><enum>(A)</enum><text>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;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID27FD6D7DA16C421D87EE1C4546F0F221" reported-display-style="italic"><enum>(B)</enum><text>the capability and
expertise demonstrated by the Urban Indian Organization to address the complex
problem of child sexual abuse in the community; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDC4613BF3AEA24F35B31F67642984F309" reported-display-style="italic"><enum>(C)</enum><text>the assessment required
under paragraph (2).</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID0C67BD3C715541A69143D13E71150B34" reported-display-style="italic"><enum>(g)</enum><header>Other
Grants</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="IDE8A97F9D9AEA4E188C357C28C98B5EB3" reported-display-style="italic"><enum>504.</enum><header>Contracts and grants
for the determination of unmet Health care needs</header>
<subsection changed="added" committee-id="SLIA00" id="ID194F6F12D27349BD9AA4F16D57F4E5C6" reported-display-style="italic"><enum>(a)</enum><header>Grants and Contracts
Authorized</header><text>Under authority of the Act of November 2, 1921 (25
U.S.C. 13) (commonly known as the <quote>Snyder Act</quote>), 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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDD63C9B8E36B14E14973A09528E228796" reported-display-style="italic"><enum>(b)</enum><header>Purpose</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID406D0371F1ED442391AB123D65062D57" reported-display-style="italic"><enum>(c)</enum><header>Grant and Contract
Requirements</header><text>Any contract entered into, or grant made, by the
Secretary under this section shall include requirements that—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID5901574EABC6446581DA7C2703105265" reported-display-style="italic"><enum>(1)</enum><text>the Urban Indian
Organization successfully undertakes to—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID80693426A01447548BFAFF3487A03D36" reported-display-style="italic"><enum>(A)</enum><text>document the health care
status and unmet health care needs of Urban Indians in the Urban Center
involved; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID3B3C23CB128447CCA04FAD92ABFDDE14" reported-display-style="italic"><enum>(B)</enum><text>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</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDFB12FC409926433A8ED03D37DDEA7D48" reported-display-style="italic"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID661AD7256BCD4283991072D21BCE31EA" reported-display-style="italic"><enum>(d)</enum><header>No
Renewals</header><text>The Secretary may not renew any contract entered into or
grant made under this section.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID3B303DEC56FB42F8965967BB304B8742" reported-display-style="italic"><enum>505.</enum><header>Evaluations;
renewals</header>
<subsection changed="added" committee-id="SLIA00" id="ID9633B9A7C76B4FB3924A04BFC0B02C9B" reported-display-style="italic"><enum>(a)</enum><header>Procedures for
Evaluations</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID2F34DC35A9FD484CB0530BD8896AA518" reported-display-style="italic"><enum>(b)</enum><header>Evaluations</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID5FCEFC9508FB4E2EB0CADB0704FC0F31" reported-display-style="italic"><enum>(1)</enum><text>acting through the
Service, conduct an annual onsite evaluation of the organization; or</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDC82B0A6119D3444E8E98CD7345694805" reported-display-style="italic"><enum>(2)</enum><text>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 <act-name parsable-cite="SSA">Social
Security Act</act-name>.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID75B9807E5BE8497DB09CE9B46C5266A8" reported-display-style="italic"><enum>(c)</enum><header>Noncompliance;
Unsatisfactory Performance</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID18A3976542134C18B567F580C76AED81" reported-display-style="italic"><enum>(d)</enum><header>Considerations for
Renewals</header><text>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).</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID2C49EF63DB634006AD5F1AB220750249" reported-display-style="italic"><enum>506.</enum><header>Other contract and
grant requirements</header>
<subsection changed="added" committee-id="SLIA00" id="IDD8A21569C62F4875B5395725D5E34A6B" reported-display-style="italic"><enum>(a)</enum><header>Procurement</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID40DE3208326F498AAA565FEA6234FBDB" reported-display-style="italic"><enum>(b)</enum><header>Payments Under
Contracts or Grants</header><text>Payments under any contracts or grants
pursuant to this title shall, notwithstanding any term or condition of such
contract or grant—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDE0BD33F18D0E4E3590CF110FB680D4EB" reported-display-style="italic"><enum>(1)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDD16891749E2A40A486403027CA995489" reported-display-style="italic"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDB47D727029A740D5B468F3C99237FE3E" reported-display-style="italic"><enum>(c)</enum><header>Revision or Amendment
of Contracts</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID074F2AAE7BF244E69CB3A1C6CFA99449" reported-display-style="italic"><enum>(d)</enum><header>Fair and Uniform
Services and Assistance</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="IDD60E4A4A4BF54B378A91524904982137" reported-display-style="italic"><enum>507.</enum><header>Reports and
records</header>
<subsection changed="added" committee-id="SLIA00" id="IDAE140A2B297D4CE7B241328672A895AA" reported-display-style="italic"><enum>(a)</enum><header>Reports</header><text>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:</text>
<paragraph changed="added" committee-id="SLIA00" id="ID091559F66AB34995949CEEAAF9ED8B63" reported-display-style="italic"><enum>(1)</enum><text>In the case of a contract
or grant under section 503, recommendations pursuant to section
503(a)(5).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID29B37FD540F7420C9D6C7D5D1F48F1B0" reported-display-style="italic"><enum>(2)</enum><text>Information on activities
conducted by the organization pursuant to the contract or grant.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID4AF9ABD1ED994C9F8186AD54A3E65C9A" reported-display-style="italic"><enum>(3)</enum><text>An accounting of the
amounts and purpose for which Federal funds were expended.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDEBFEB83DF0864D48925F63309F17DD08" reported-display-style="italic"><enum>(4)</enum><text>A minimum set of data,
using uniformly defined elements, as specified by the Secretary after
consultation with Urban Indian Organizations.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID2285956B5F784A40A43B548BEE2C49A4" reported-display-style="italic"><enum>(b)</enum><header>Audit</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID3459E02F066D4068AD8BA03EA67878D1" reported-display-style="italic"><enum>(c)</enum><header>Costs of
Audits</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID226BBB902B034303B2227B9B01047B4B" reported-display-style="italic"><enum>(1)</enum><text>a certified public
accountant; or</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDFC4D3AACCE64408DAFFB51FD49689F4F" reported-display-style="italic"><enum>(2)</enum><text>a certified public
accounting firm qualified to conduct Federal compliance audits.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="ID6AB5EBE73ECC4951917DC598405C4514" reported-display-style="italic"><enum>508.</enum><header>Limitation on contract
authority</header><text display-inline="no-display-inline">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.</text>
</section><section changed="added" committee-id="SLIA00" id="ID30AAE4177E4940F1877A5F0E7E336F1E" reported-display-style="italic"><enum>509.</enum><header>Facilities</header>
<subsection changed="added" committee-id="SLIA00" id="IDC9ED4BEC35E549AF8805B1F9DF2AC38E" reported-display-style="italic"><enum>(a)</enum><header>Grants</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID1BCC34D4FBC2476D88C2F4ABDEA0E7EE" reported-display-style="italic"><enum>(b)</enum><header>Loan Fund
Study</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="IDA0C9CDD6EF9F43BFAD32CD76C7EB7840" reported-display-style="italic"><enum>510.</enum><header>Division of Urban
Indian Health</header><text display-inline="no-display-inline">There is
established within the Service a Division of Urban Indian Health, which shall
be responsible for—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID4DDCCE3C633A4B8FB97BD85F935B9813" reported-display-style="italic"><enum>(1)</enum><text>carrying out the
provisions of this title;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID4C45B33C3FB24708B8C024B66E6ABBCC" reported-display-style="italic"><enum>(2)</enum><text>providing central
oversight of the programs and services authorized under this title; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDD639DC8F4E134D3FB59EB7B23E017D4C" reported-display-style="italic"><enum>(3)</enum><text>providing technical
assistance to Urban Indian Organizations.</text>
</paragraph></section><section changed="added" committee-id="SLIA00" id="IDA6B66B9AB1654FC7BEAF3B9219575CAD" reported-display-style="italic"><enum>511.</enum><header>Grants for alcohol and
substance abuse-related Services</header>
<subsection changed="added" committee-id="SLIA00" id="ID5F03391FCDE0483B80AA642F15384801" reported-display-style="italic"><enum>(a)</enum><header>Grants
Authorized</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID41149BAC7BFB445C99FCB3CA9406C07C" reported-display-style="italic"><enum>(b)</enum><header>Goals</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDC9C17C74CE5240F7A18ED3AFB9D6B9AF" reported-display-style="italic"><enum>(c)</enum><header>Criteria</header><text>The
Secretary shall establish criteria for the grants made under subsection (a),
including criteria relating to the following:</text>
<paragraph changed="added" committee-id="SLIA00" id="IDA32E0F8066D04863A9EA1F087E5A7BC2" reported-display-style="italic"><enum>(1)</enum><text>The size of the Urban
Indian population.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID0441D8E80D834B1DB2E6CF5A67FF3431" reported-display-style="italic"><enum>(2)</enum><text>Capability of the
organization to adequately perform the activities required under the
grant.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID31DB4EC85BE844C582D774ED9541A832" reported-display-style="italic"><enum>(3)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDE3A49A5788CF43278F34FA19DBCB266A" reported-display-style="italic"><enum>(4)</enum><text>Identification of the
need for services.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDF3BF4077E30D4CCA8D378C4E73009D06" reported-display-style="italic"><enum>(d)</enum><header>Allocation of
Grants</header><text>The Secretary shall develop a methodology for allocating
grants made pursuant to this section based on the criteria established pursuant
to subsection (c).</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDE47C1CCEAEF4496AA1A74D58564E47A8" reported-display-style="italic"><enum>(e)</enum><header>Grants Subject to
Criteria</header><text>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).</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="IDAEFAAD3B5DDC48CF95CF842CFF841319" reported-display-style="italic"><enum>512.</enum><header>Treatment of certain
demonstration projects</header><text display-inline="no-display-inline">Notwithstanding any other provision of law,
the Tulsa Clinic and Oklahoma City Clinic demonstration projects shall—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID2E263909DD1F451B84961CB70DC37E2E" reported-display-style="italic"><enum>(1)</enum><text>be permanent programs
within the Service’s direct care program;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID8CC5EEB59B5A4E91A58C841484FA03B2" reported-display-style="italic"><enum>(2)</enum><text>continue to be treated as
Service Units in the allocation of resources and coordination of care;
and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDE23EE2475D104D98B27A87458C632D9B" reported-display-style="italic"><enum>(3)</enum><text>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 <act-name parsable-cite="ISDA">Indian Self-Determination and Education Assistance Act (25
U.S.C. 450 et seq.)</act-name>.</text>
</paragraph></section><section changed="added" committee-id="SLIA00" id="IDDDADE93C2E714A71B766D294777D65F5" reported-display-style="italic"><enum>513.</enum><header>Urban NIAAA
transferred Programs</header>
<subsection changed="added" committee-id="SLIA00" id="ID6555BEFA1CDD4204B0B5623F48917B03" reported-display-style="italic"><enum>(a)</enum><header>Grants and
Contracts</header><text>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 <quote>NIAAA</quote>) and transferred
to the Service.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDFA7560BECDE2440AAF30E6E33212E084" reported-display-style="italic"><enum>(b)</enum><header>Use of
Funds</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID5AA46B59D7C74210BCD712B416B9E7F6" reported-display-style="italic"><enum>(c)</enum><header>Eligibility</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDD3AEBBF18A17456BA346BC6F8B7C5D6B" reported-display-style="italic"><enum>(d)</enum><header>Report</header><text>The
Secretary shall evaluate and report to Congress on the activities of programs
funded under this section not less than every 5 years.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID5CD568A14B6A41839F6FB5629261643A" reported-display-style="italic"><enum>514.</enum><header>Consultation with
Urban Indian Organizations</header>
<subsection changed="added" committee-id="SLIA00" id="ID476BC95E074149C481AE0EDC67C0BB62" reported-display-style="italic"><enum>(a)</enum><header>In
General</header><text>The Secretary shall ensure that the Service consults, to
the greatest extent practicable, with Urban Indian Organizations.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID00B2647C94B44C62ACEC94A7CC9495A5" reported-display-style="italic"><enum>(b)</enum><header>Definition of
Consultation</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="IDED63BAD57F714E5B87D532A6C486E5A9" reported-display-style="italic"><enum>515.</enum><header>Federal Tort Claim Act
coverage</header>
<subsection changed="added" committee-id="SLIA00" id="IDFCED0B3CFC8F4B4E874C3C93513B0249" reported-display-style="italic"><enum>(a)</enum><header>In
General</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDD8FF1589406F430D813710D65AB5F55C" reported-display-style="italic"><enum>(b)</enum><header>Claims Resulting From
Performance of Contract or Grant</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="IDE83139A063C845A39D9E920933E6719D" reported-display-style="italic"><enum>516.</enum><header>Urban youth treatment
center demonstration</header>
<subsection changed="added" committee-id="SLIA00" id="IDD3352A54F3BE45ED9CD5FDCEBC7448A2" reported-display-style="italic"><enum>(a)</enum><header>Construction and
Operation</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID195228AC32024372A62B15B835B571F7" reported-display-style="italic"><enum>(b)</enum><header>Definition of
State</header><text>A State described in this subsection is a State in
which—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDBBFB145115934997B7729C14A5C40DC4" reported-display-style="italic"><enum>(1)</enum><text>there resides Urban
Indian youth with need for alcohol and substance abuse treatment services in a
residential setting; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID405AD41B09CE4AEE8DDC6E88ABCA1BD1" reported-display-style="italic"><enum>(2)</enum><text>there is a significant
shortage of culturally competent residential treatment services for Urban
Indian youth.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="IDF01AD2381E5C4179A425E8CF619CC5E9" reported-display-style="italic"><enum>517.</enum><header>Use of Federal
Government facilities and sources of supply</header>
<subsection changed="added" committee-id="SLIA00" id="ID6AE1D3DDF8B846C88743CB7E508442D1" reported-display-style="italic"><enum>(a)</enum><header>Authorization for
Use</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDBEA5951286A0485D8492A35374595905" reported-display-style="italic"><enum>(b)</enum><header>Donations</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDC08FA59331DA46E7AA20097AD958E0F5" reported-display-style="italic"><enum>(c)</enum><header>Acquisition of Property
for Donation</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID7AC5C561E0814C6FBAB362E4533097DA" reported-display-style="italic"><enum>(d)</enum><header>Priority</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID12C30CB92048465090484880FEE6BE1B" reported-display-style="italic"><enum>(e)</enum><header>Urban Indian
Organizations Deemed Executive Agency for Certain Purposes</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID7074DEA6AA8C41DE8217386363F8F8D3" reported-display-style="italic"><enum>518.</enum><header>Grants for diabetes
prevention, treatment, and control</header>
<subsection changed="added" committee-id="SLIA00" id="IDEAAF25B0613F40A890B64C630D23C21A" reported-display-style="italic"><enum>(a)</enum><header>Grants
Authorized</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID9C21A2F1D10C4F92A434EAB2CFD3466C" reported-display-style="italic"><enum>(b)</enum><header>Goals</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDC7A3BCD50A764E66ABF91A716F9EA345" reported-display-style="italic"><enum>(c)</enum><header>Establishment of
Criteria</header><text>The Secretary shall establish criteria for the grants
made under subsection (a) relating to—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDB3D6F849E0D64F1E8638A499924C3DE2" reported-display-style="italic"><enum>(1)</enum><text>the size and location of
the Urban Indian population to be served;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDB35F426258E746AC8F421B8B4A6A64F1" reported-display-style="italic"><enum>(2)</enum><text>the need for prevention
of and treatment of, and control of the complications resulting from, diabetes
among the Urban Indian population to be served;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID01046E0A6337490CB64740AED4AC69C6" reported-display-style="italic"><enum>(3)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID95462ECFD8F54C9E9DF7189874BCC120" reported-display-style="italic"><enum>(4)</enum><text>the capability of the
organization to adequately perform the activities required under the grant;
and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID5A2BEA5523434FB98D91CE8579B167D3" reported-display-style="italic"><enum>(5)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID962AA8915E8342859CDC9CC4303CF1A8" reported-display-style="italic"><enum>(d)</enum><header>Funds Subject to
Criteria</header><text>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).</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID038661874EFF4B7EA1711CB651CB9178" reported-display-style="italic"><enum>519.</enum><header>Community Health
Representatives</header><text display-inline="no-display-inline">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.</text>
</section><section changed="added" committee-id="SLIA00" id="ID4D334A50BDEC4129A05D81ECB6BF3A94" reported-display-style="italic"><enum>520.</enum><header>Effective
date</header><text display-inline="no-display-inline">The amendments made by
the <act-name parsable-cite="IHCIA">Indian Health Care Improvement
Act</act-name> 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.</text>
</section><section changed="added" committee-id="SLIA00" id="ID93FADC622D804C50AB1003ED88041488" reported-display-style="italic"><enum>521.</enum><header>Eligibility for
Services</header><text display-inline="no-display-inline">Urban Indians shall
be eligible and the ultimate beneficiaries for health care or referral services
provided pursuant to this title.</text>
</section><section changed="added" committee-id="SLIA00" id="IDCE0977E7F8FC440E95A7B1339764639B" reported-display-style="italic"><enum>522.</enum><header>Authorization of
appropriations</header><text display-inline="no-display-inline">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.</text>
</section><enum>VI</enum><header>ORGANIZATIONAL
IMPROVEMENTS</header>
<section changed="added" committee-id="SLIA00" id="ID31212F8E31784CA3B5E7EE28B59B8802" reported-display-style="italic"><enum>601.</enum><header>Establishment of the
Indian Health Service as an agency of the public Health Service</header>
<subsection changed="added" committee-id="SLIA00" id="IDA8DA383BAF074D59841E886728E222E8" reported-display-style="italic"><enum>(a)</enum><header>Establishment</header>
<paragraph changed="added" committee-id="SLIA00" id="ID752F618E50EC4CD6A5335DC806B1BEA5" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDD3F9C3B73008431C83BFC0250B7880FC" reported-display-style="italic"><enum>(2)</enum><header>Assistant secretary of
indian health</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDC5129945AFB54182B971994D95E1630A" reported-display-style="italic"><enum>(3)</enum><header>Incumbent</header><text>The
individual serving in the position of Director of the Indian Health Service on
the day before the date of enactment of the <act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name> Amendments
of 2005 shall serve as Assistant Secretary.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID1EA7AE49C89440F0B81F66DF11A10F1D" reported-display-style="italic"><enum>(4)</enum><header>Advocacy and
consultation</header><text>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—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDDFA2835938A3412BACEB09AB8D426BDA" reported-display-style="italic"><enum>(A)</enum><text>facilitate advocacy for
the development of appropriate Indian health policy; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID7884952967DC437C852E71DD90D5E89C" reported-display-style="italic"><enum>(B)</enum><text>promote consultation on
matters relating to Indian health.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID091651F51A114BC182FF41B618FC7233" reported-display-style="italic"><enum>(b)</enum><header>Agency</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDD0013022E9154B95AA9D80E917850D58" reported-display-style="italic"><enum>(c)</enum><header>Duties</header><text>The
Assistant Secretary of Indian Health shall—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDA3B0A6FCF5F945D9AAF776CC83EF8607" reported-display-style="italic"><enum>(1)</enum><text>perform all functions
that were, on the day before the date of enactment of the
<act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name>
Amendments of 2005, carried out by or under the direction of the individual
serving as Director of the Service on that day;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID622577C010074620BADFF5B6968EB130" reported-display-style="italic"><enum>(2)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID23D7F4D127B14C99B087FC3CD4660BB0" reported-display-style="italic"><enum>(3)</enum><text>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—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID1BD171E8B1C44717B06F09EC8B538D0C" reported-display-style="italic"><enum>(A)</enum><text>this Act;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID76A206C4C27B46CBA6D87483069C8397" reported-display-style="italic"><enum>(B)</enum><text>the Act of November 2,
1921 (25 U.S.C. 13);</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDFD7BCBAF218A41F69167A91BF5BB9388" reported-display-style="italic"><enum>(C)</enum><text>the Act of August 5, 1954
(42 U.S.C. 2001 et seq.);</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID1029B6B3626D49259B8D0E36EDCA1B6A" reported-display-style="italic"><enum>(D)</enum><text>the Act of August 16,
1957 (42 U.S.C. 2005 et seq.); and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID50A6AEBCE0804CB58ABEF27A2FB6C918" reported-display-style="italic"><enum>(E)</enum><text>the
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (25 U.S.C. 450 et seq.);</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID91C5064B7E1D4BDC89CD3E3D296EF4F1" reported-display-style="italic"><enum>(4)</enum><text>administer all
scholarship and loan functions carried out under title I;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDAE058CCDC5A1411A9BEF6552A09FBD56" reported-display-style="italic"><enum>(5)</enum><text>report directly to the
Secretary concerning all policy- and budget-related matters affecting Indian
health;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID1C1C1500436E4AC0BE9940CC73DCB4EC" reported-display-style="italic"><enum>(6)</enum><text>collaborate with the
Assistant Secretary for Health concerning appropriate matters of Indian health
that affect the agencies of the Public Health Service;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID1FE5942F417844B1AF8045E6BF308F1C" reported-display-style="italic"><enum>(7)</enum><text>advise each Assistant
Secretary of the Department concerning matters of Indian health with respect to
which that Assistant Secretary has authority and responsibility;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID2787315ED52E45FF83003AADD7156219" reported-display-style="italic"><enum>(8)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID83DEE68CE5F3472AAEA5612F03BB7028" reported-display-style="italic"><enum>(9)</enum><text>coordinate the activities
of the Department concerning matters of Indian health; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDA6D5C537745A4558B55F854928BD4EE8" reported-display-style="italic"><enum>(10)</enum><text>perform such other
functions as the Secretary may designate.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDAEC0E415942C448EBC3CDA55E42B3508" reported-display-style="italic"><enum>(d)</enum><header>Authority</header>
<paragraph changed="added" committee-id="SLIA00" id="IDBFFFE441D3C74E19880FE70C73DE15DA" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>The Secretary, acting through the Assistant Secretary,
shall have the authority—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID50CC500EE5E04F86B917A23FBE6F74D7" reported-display-style="italic"><enum>(A)</enum><text>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;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID30CBF169F7FC48D88F18825B09F4A013" reported-display-style="italic"><enum>(B)</enum><text>to enter into contracts
for the procurement of goods and services to carry out the functions of the
Service; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID30FC1D4B75DE45A4A2322553FDE9C8DF" reported-display-style="italic"><enum>(C)</enum><text>to manage, expend, and
obligate all funds appropriated for the Service.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDDF28E1BB7A7247A3BD73AEF6CC510168" reported-display-style="italic"><enum>(2)</enum><header>Personnel
actions</header><text>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).</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID8DA2017E44394ED6ABD229D41A17CB6E" reported-display-style="italic"><enum>(e)</enum><header>References</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID2B12A326B1B748E9AB99E0643F09B579" reported-display-style="italic"><enum>602.</enum><header>Automated management
information system</header>
<subsection changed="added" committee-id="SLIA00" id="ID2253B475E1B84000B1F047B2E2AF3FF6" reported-display-style="italic"><enum>(a)</enum><header>Establishment</header>
<paragraph changed="added" committee-id="SLIA00" id="ID3E77CC1EEA4A43B1A519C538E20F685C" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>The Secretary shall establish an automated management
information system for the Service.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID0969F564C9C2471F807DD3638A804F5A" reported-display-style="italic"><enum>(2)</enum><header>Requirements of
system</header><text>The information system established under paragraph (1)
shall include—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID45AA0B2400214AA291EB25D6DAC996C4" reported-display-style="italic"><enum>(A)</enum><text>a financial management
system;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID044597619E1A4384A9755CDBE702BF3D" reported-display-style="italic"><enum>(B)</enum><text>a patient care
information system for each area served by the Service;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID45B189BF3E1F423CA0A9837631F9B34D" reported-display-style="italic"><enum>(C)</enum><text>a privacy component that
protects the privacy of patient information held by, or on behalf of, the
Service;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID401A80B80B2F4CF49F8B20811CDDCE26" reported-display-style="italic"><enum>(D)</enum><text>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;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID86807662212C471E9904F73BBA7BA190" reported-display-style="italic"><enum>(E)</enum><text>an interface mechanism
for patient billing and accounts receivable system; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID1146AA62D3274EE08045456B6EC48215" reported-display-style="italic"><enum>(F)</enum><text>a training
component.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID99A8ACD9C9304D2DB8D186499D191605" reported-display-style="italic"><enum>(b)</enum><header>Provision of Systems to
Tribes and Organizations</header><text>The Secretary shall provide each Tribal
Health Program automated management information systems which—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDE81439D786174944A462F7920DA053BB" reported-display-style="italic"><enum>(1)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDF8D5222395154DDF8E4A467799D7B951" reported-display-style="italic"><enum>(2)</enum><text>meet the management
information needs of the Service.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID43C9ACF26C2D4987AE1E27A124D5C67F" reported-display-style="italic"><enum>(c)</enum><header>Access to
Records</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID67DAF625E31644DBBE786E07A083DDAA" reported-display-style="italic"><enum>(d)</enum><header>Authority To Enhance
Information Technology</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID3D90523496DE4927835FFBB421449506" reported-display-style="italic"><enum>603.</enum><header>Authorization of
appropriations</header><text display-inline="no-display-inline">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.</text>
</section><enum>VII</enum><header>BEHAVIORAL HEALTH
PROGRAMS</header>
<section changed="added" committee-id="SLIA00" id="IDFC1384DE22804A8ABDAAB4BFB00F993E" reported-display-style="italic"><enum>701.</enum><header>Behavioral Health
prevention and treatment Services</header>
<subsection changed="added" committee-id="SLIA00" id="IDA584B4148D6F4073B5D1D6F573A45019" reported-display-style="italic"><enum>(a)</enum><header>Purposes</header><text>The
purposes of this section are as follows:</text>
<paragraph changed="added" committee-id="SLIA00" id="ID75E3CC545D5B4ACE86B84C414884CAF1" reported-display-style="italic"><enum>(1)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID771B22451137414584882A1E493DFD86" reported-display-style="italic"><enum>(2)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDA74EF046C9F74AD68C6EA897CA60634E" reported-display-style="italic"><enum>(3)</enum><text>To assist Indian Tribes
to identify services and resources available to address mental illness and
dysfunctional and self-destructive behavior.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID5123AF42967F452C8C28FA7E11D87DDA" reported-display-style="italic"><enum>(4)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDDC310BA272484815973C0ACEB940C68C" reported-display-style="italic"><enum>(5)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDF4A174A3699244899423500396BBFE12" reported-display-style="italic"><enum>(6)</enum><text>To modify or supplement
existing programs and authorities in the areas identified in paragraph
(2).</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID9590921C56394EFDADCABBD2E1761DA7" reported-display-style="italic"><enum>(b)</enum><header>Plans</header>
<paragraph changed="added" committee-id="SLIA00" id="IDF57C97D4708847AEA037FD979D6388AB" reported-display-style="italic"><enum>(1)</enum><header>Development</header><text>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:</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID4BCB502EFC3044F7897BEA8809EC6B36" reported-display-style="italic"><enum>(A)</enum><text>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—</text>
<clause changed="added" committee-id="SLIA00" id="ID267B1DC15F1144DC880380B83AC6C3C9" reported-display-style="italic"><enum>(i)</enum><text>the number of Indians
served who are directly or indirectly affected by such illness or behavior;
or</text>
</clause><clause changed="added" committee-id="SLIA00" id="IDD7C2A525025443609DDBDE795B47F82F" reported-display-style="italic"><enum>(ii)</enum><text>an estimate of the
financial and human cost attributable to such illness or behavior.</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID917839B954244B08AC8A82ED6FBC7E20" reported-display-style="italic"><enum>(B)</enum><text>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).</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID4311684AD3A247A685E8DDA4D1075C10" reported-display-style="italic"><enum>(C)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID189D9AF06D324639B53B31A48812D8A4" reported-display-style="italic"><enum>(2)</enum><header>National
clearinghouse</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDB05FE32A6E3D4C4BA439D412ECBD0286" reported-display-style="italic"><enum>(3)</enum><header>Technical
assistance</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID332BE17757A54BB8A6A2CB5BEE3ED48C" reported-display-style="italic"><enum>(c)</enum><header>Programs</header><text>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:</text>
<paragraph changed="added" committee-id="SLIA00" id="ID32BB38478A4F4AF6A3003635B73AA417" reported-display-style="italic"><enum>(1)</enum><header>Comprehensive
care</header><text>A comprehensive continuum of behavioral health care which
provides—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDFB5C5DC1A1F440D5BEB64775BC91AFE9" reported-display-style="italic"><enum>(A)</enum><text>community-based
prevention, intervention, outpatient, and behavioral health aftercare;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID80696AF26DFC43D3BC98EA7CC9A2DA86" reported-display-style="italic"><enum>(B)</enum><text>detoxification (social
and medical);</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID2ABBAEBAC0934CE1B7F52B254AEB0C86" reported-display-style="italic"><enum>(C)</enum><text>acute
hospitalization;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID00F9584169A545D2809932D72B41481D" reported-display-style="italic"><enum>(D)</enum><text>intensive outpatient/day
treatment;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID06E4AC421D934D1181BA4A78F04E8C1E" reported-display-style="italic"><enum>(E)</enum><text>residential
treatment;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDBBC1CEE4C0F7481DB154DA55E987EC9A" reported-display-style="italic"><enum>(F)</enum><text>transitional living for
those needing a temporary, stable living environment that is supportive of
treatment and recovery goals;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID62CF91365B084BE6A104A7FE7D3F30D4" reported-display-style="italic"><enum>(G)</enum><text>emergency shelter;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID63712470D7DF4EFCAF07AA86938079A4" reported-display-style="italic"><enum>(H)</enum><text>intensive case
management;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID94300BCC741E41EC828564A4C273E34C" reported-display-style="italic"><enum>(I)</enum><text>Traditional Health Care
Practices; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID84BFB8343F2C446B9663F4980848C189" reported-display-style="italic"><enum>(J)</enum><text>diagnostic
services.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID7FF7F3B74A394499B11DDD1C18CEDA66" reported-display-style="italic"><enum>(2)</enum><header>Child
care</header><text>Behavioral health services for Indians from birth through
age 17, including—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDF5B1B8AEEEAA480BA374D6D9CD44C94F" reported-display-style="italic"><enum>(A)</enum><text>preschool and school age
fetal alcohol disorder services, including assessment and behavioral
intervention;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDC052848337C34971957CB02C94132A2E" reported-display-style="italic"><enum>(B)</enum><text>mental health and
substance abuse services (emotional, organic, alcohol, drug, inhalant, and
tobacco);</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID268AA7B960364239A5F5C26FE9331153" reported-display-style="italic"><enum>(C)</enum><text>identification and
treatment of co-occurring disorders and comorbidity;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDF5E7FA010F1A48659A44AB50539484C8" reported-display-style="italic"><enum>(D)</enum><text>prevention of alcohol,
drug, inhalant, and tobacco use;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDEBFA6DC6A7A74B70BDEB5ADDAD70613F" reported-display-style="italic"><enum>(E)</enum><text>early intervention,
treatment, and aftercare;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID01B8EEBD6639443F9F4316AC26F01B67" reported-display-style="italic"><enum>(F)</enum><text>promotion of healthy
approaches to risk and safety issues; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID2623975BE6D342B8B12183A9EC511617" reported-display-style="italic"><enum>(G)</enum><text>identification and
treatment of neglect and physical, mental, and sexual abuse.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID6AB38AF2A02A4ED8BC10B7D1B0E9D483" reported-display-style="italic"><enum>(3)</enum><header>Adult
care</header><text>Behavioral health services for Indians from age 18 through
55, including—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDD9EAEFA0E9C54B22972A8970C099A9FD" reported-display-style="italic"><enum>(A)</enum><text>early intervention,
treatment, and aftercare;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID9565E64118F24F468C4B59724278E24B" reported-display-style="italic"><enum>(B)</enum><text>mental health and
substance abuse services (emotional, alcohol, drug, inhalant, and tobacco),
including sex specific services;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDF05747F70B014574970B94B434AC7C4C" reported-display-style="italic"><enum>(C)</enum><text>identification and
treatment of co-occurring disorders (dual diagnosis) and comorbidity;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDC2367295002D463B987B48C98C5D4FE9" reported-display-style="italic"><enum>(D)</enum><text>promotion of healthy
approaches for risk-related behavior;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDEF04CA7146B94C368E17B7A88510CBFC" reported-display-style="italic"><enum>(E)</enum><text>treatment services for
women at risk of giving birth to a child with a fetal alcohol disorder;
and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID49AE144F2A63447DB49F47F3BF891742" reported-display-style="italic"><enum>(F)</enum><text>sex specific treatment
for sexual assault and domestic violence.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDC31D3031FBE0447CB4ACFA6A0661026A" reported-display-style="italic"><enum>(4)</enum><header>Family
care</header><text>Behavioral health services for families, including—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDA781C2F9D5824662B3A268ABA4829AF1" reported-display-style="italic"><enum>(A)</enum><text>early intervention,
treatment, and aftercare for affected families;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID3AB02C08099C44D285CB15E83CC11AD5" reported-display-style="italic"><enum>(B)</enum><text>treatment for sexual
assault and domestic violence; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID856E4E9C59564140B5E54491D5F98C58" reported-display-style="italic"><enum>(C)</enum><text>promotion of healthy
approaches relating to parenting, domestic violence, and other abuse
issues.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDC4AD79CA5B8D4551882BB091D407F1D5" reported-display-style="italic"><enum>(5)</enum><header>Elder
care</header><text>Behavioral health services for Indians 56 years of age and
older, including—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDB9D3649EC7DB49A98543CEBEDA54920C" reported-display-style="italic"><enum>(A)</enum><text>early intervention,
treatment, and aftercare;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDE3741083394148DDA902118659BC89BF" reported-display-style="italic"><enum>(B)</enum><text>mental health and
substance abuse services (emotional, alcohol, drug, inhalant, and tobacco),
including sex specific services;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID6E9DB10201454DA19057DC6EFFE8CF02" reported-display-style="italic"><enum>(C)</enum><text>identification and
treatment of co-occurring disorders (dual diagnosis) and comorbidity;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDA2D734020C5448C3931BC089A0329A9B" reported-display-style="italic"><enum>(D)</enum><text>promotion of healthy
approaches to managing conditions related to aging;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID670A30198047446993BEBB6372D97165" reported-display-style="italic"><enum>(E)</enum><text>sex specific treatment
for sexual assault, domestic violence, neglect, physical and mental abuse and
exploitation; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID98C2DF003EDA4610AFF0A9E55030FB41" reported-display-style="italic"><enum>(F)</enum><text>identification and
treatment of dementias regardless of cause.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDB2317AE98B5145DD91ED87E429F8B796" reported-display-style="italic"><enum>(d)</enum><header>Community Behavioral
Health Plan</header>
<paragraph changed="added" committee-id="SLIA00" id="ID77EBA8615929495B819E3AEB4079C708" reported-display-style="italic"><enum>(1)</enum><header>Establishment</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID7E55936FA3DF4992BEE9B5B9F782FFA3" reported-display-style="italic"><enum>(2)</enum><header>Technical
assistance</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDD182AE5D92AB4B6C884580531B82C3E7" reported-display-style="italic"><enum>(3)</enum><header>Funding</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID0BE2E3B6BFDE4FACA18D25CE29490699" reported-display-style="italic"><enum>(e)</enum><header>Coordination for
Availability of Services</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDCE32D3D1CED147D58F386BA7D06B0977" reported-display-style="italic"><enum>(f)</enum><header>Mental Health Care Need
Assessment</header><text>Not later than 1 year after the date of enactment of
the <act-name parsable-cite="IHCIA">Indian Health Care Improvement
Act</act-name> 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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID787917F362D541C8A0F770CB7856E972" reported-display-style="italic"><enum>702.</enum><header>Memoranda of agreement
with the Department of the Interior</header>
<subsection changed="added" committee-id="SLIA00" id="ID511277FF96774EA5B62D2EBC1FDBF7E9" reported-display-style="italic"><enum>(a)</enum><header>Contents</header><text>Not
later than 12 months after the date of enactment of the
<act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name>
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:</text>
<paragraph changed="added" committee-id="SLIA00" id="ID3ECA561248D347DBBD18384B073CF2FF" reported-display-style="italic"><enum>(1)</enum><text>The scope and nature of
mental illness and dysfunctional and self-destructive behavior, including child
abuse and family violence, among Indians.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID93E44D20C7CD47C3B34FF0EFE5ACFAEF" reported-display-style="italic"><enum>(2)</enum><text>The existing Federal,
tribal, State, local, and private services, resources, and programs available
to provide behavioral health services for Indians.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDEA82BA29EA334493A11A30BE90A8940A" reported-display-style="italic"><enum>(3)</enum><text>The unmet need for
additional services, resources, and programs necessary to meet the needs
identified pursuant to paragraph (1).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDD2487AD7CB3E468B9C62F21B300CA6ED" reported-display-style="italic"><enum>(4)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="ID0B5404EAEB584D849AE2D3FBFFD85DD1"><enum>(A)</enum><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID226A1B3FB8B94891B23A32A6FD08D617" indent="up1" reported-display-style="italic"><enum>(B)</enum><text>The right of Indians to
participate in, and receive the benefit of, such services.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID17F345C7AC244D9083A470DDDF9466F4" indent="up1" reported-display-style="italic"><enum>(C)</enum><text>The actions necessary to
protect the exercise of such right.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID84DC8F776B834469958F5E415889F6D6" reported-display-style="italic"><enum>(5)</enum><text>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).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDC9EC5C9A4E314810B7EBE48387EA2472" reported-display-style="italic"><enum>(6)</enum><text>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—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID6F5973780E8C451596FFFA6F498D8AF9" reported-display-style="italic"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID2C863D92FAA54BE5924850E984902D4A" reported-display-style="italic"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID54971DC79C964970AD9C4DDCA503D99D" reported-display-style="italic"><enum>(7)</enum><text>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).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID9F09ED4B5EA243D19064D490181947FC" reported-display-style="italic"><enum>(8)</enum><text>Providing for an annual
review of such agreement by the Secretaries which shall be provided to Congress
and Indian Tribes and Tribal Organizations.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDD0B16C1185594511BAC6F588D591D0A3" reported-display-style="italic"><enum>(b)</enum><header>Specific Provisions
Required</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDD9BCE62DA7D44C798964737E7FD6AB5A" reported-display-style="italic"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDA9DC0D964DA944FF87F1DFF9C10639CC" reported-display-style="italic"><enum>(2)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDD42610DB64514176BFB74FDFFCD19A70" reported-display-style="italic"><enum>(3)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDD54E4106FDC24E59BD623A873BBFA94B" reported-display-style="italic"><enum>(c)</enum><header>Consultation</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID6C7FF601FC7A45CC9EB8103A7FC3544D" reported-display-style="italic"><enum>(1)</enum><text>Indian Tribes and Tribal
Organizations;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDCA1541BFEBD542B19903193FCC70CF77" reported-display-style="italic"><enum>(2)</enum><text>Indians;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID08DAC80982EC4917AE60578D8422F184" reported-display-style="italic"><enum>(3)</enum><text>Urban Indian
Organizations and other Indian organizations; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDCF0E15157A464A8B8BD345BF88A1B4C0" reported-display-style="italic"><enum>(4)</enum><text>behavioral health service
providers.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDEE64C462A8FD42E29A5FF585FEB3D2C2" reported-display-style="italic"><enum>(d)</enum><header>Publication</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="IDE822C771893744A7BF8F7EA47A39CEAB" reported-display-style="italic"><enum>703.</enum><header>Comprehensive
behavioral Health prevention and treatment Program</header>
<subsection changed="added" committee-id="SLIA00" id="ID440F6B270FB04560872E89D2024951D8" reported-display-style="italic"><enum>(a)</enum><header>Establishment</header>
<paragraph changed="added" committee-id="SLIA00" id="IDC19F405DAB7D484F98312644A1E05A96" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>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—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDDFDEABC90884415CB62E58DD2A7F88A3" reported-display-style="italic"><enum>(A)</enum><text>prevention, through
educational intervention, in Indian communities;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID2507CF1D645F45CAA26C6EFCB0C75DDC" reported-display-style="italic"><enum>(B)</enum><text>acute detoxification,
psychiatric hospitalization, residential, and intensive outpatient
treatment;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDC4A23871952444FE9533B489829E7347" reported-display-style="italic"><enum>(C)</enum><text>community-based
rehabilitation and aftercare;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDD32213E22EDB4F92A66AF7CAAF74D22B" reported-display-style="italic"><enum>(D)</enum><text>community education and
involvement, including extensive training of health care, educational, and
community-based personnel;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDC6C7A17C3D09467A8C1918BA2385FEF1" reported-display-style="italic"><enum>(E)</enum><text>specialized residential
treatment programs for high-risk populations, including pregnant and postpartum
women and their children; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID128839D6394E4423AA1B077343BFAAAD" reported-display-style="italic"><enum>(F)</enum><text>diagnostic
services.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID2865EC67A56344FF955F5C68EC8F0322" reported-display-style="italic"><enum>(2)</enum><header>Target
populations</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID4311DFD1C1C74D0A8A4F089104CAB7CA" reported-display-style="italic"><enum>(b)</enum><header>Contract Health
Services</header>
<paragraph changed="added" committee-id="SLIA00" id="IDE298F78C0B5341FFA5F88CC2BA911985" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>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).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID3975911AB2F7452B9CAF4AB2260979AB" reported-display-style="italic"><enum>(2)</enum><header>Provision of
assistance</header><text>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.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="IDE1B417E32D594E7AB665A9EA7B843AA6" reported-display-style="italic"><enum>704.</enum><header>Mental Health
technician Program</header>
<subsection changed="added" committee-id="SLIA00" id="ID76C040EB02734469ADD93BA6BFC0400E" reported-display-style="italic"><enum>(a)</enum><header>In
General</header><text>Under the authority of the Act of November 2, 1921 (25
U.S.C. 13) (commonly known as the <quote>Snyder Act</quote>), the Secretary
shall establish and maintain a mental health technician program within the
Service which—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID9AC00BA5A7AA4FC3BAAFD48D9755BB64" reported-display-style="italic"><enum>(1)</enum><text>provides for the training
of Indians as mental health technicians; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDB58B55C0658645E480CF453D4B34FD45" reported-display-style="italic"><enum>(2)</enum><text>employs such technicians
in the provision of community-based mental health care that includes
identification, prevention, education, referral, and treatment services.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID3FC07BEC3B0A44AC8B71865A3B5B9833" reported-display-style="italic"><enum>(b)</enum><header>Paraprofessional
Training</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID9668D779465D4688A1537C8798E338B8" reported-display-style="italic"><enum>(c)</enum><header>Supervision and
Evaluation of Technicians</header><text>The Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, shall supervise and evaluate
the mental health technicians in the training program.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID57133115B6C445CBB17A00A72601903B" reported-display-style="italic"><enum>(d)</enum><header>Traditional Health Care
Practices</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID77BFA8A42684469EAAFE8ED1FDD6039D" reported-display-style="italic"><enum>705.</enum><header>Licensing requirement
for mental Health care workers</header><text display-inline="no-display-inline">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.</text>
</section><section changed="added" committee-id="SLIA00" id="ID64CAFE2B48B74129B0A5D69594D476ED" reported-display-style="italic"><enum>706.</enum><header>Indian women treatment
Programs</header>
<subsection changed="added" committee-id="SLIA00" id="ID1B22005E45124F67A615C7FC22C0B03C" reported-display-style="italic"><enum>(a)</enum><header>Grants</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDCF721546A2BF4AB6B32128303902A7FF" reported-display-style="italic"><enum>(b)</enum><header>Use of grant
funds</header><text>A grant made pursuant to this section may be used
to—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID95D413F437804E79962BDDF5D25DB81C" reported-display-style="italic"><enum>(1)</enum><text>develop and provide
community training, education, and prevention programs for Indian women
relating to behavioral health issues, including fetal alcohol disorders;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDEE4BFCC9F44247FB8736558BA3E9C4EB" reported-display-style="italic"><enum>(2)</enum><text>identify and provide
psychological services, counseling, advocacy, support, and relapse prevention
to Indian women and their families; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID4D39F4F2F32D4C4283E7D459B383833B" reported-display-style="italic"><enum>(3)</enum><text>develop prevention and
intervention models for Indian women which incorporate Traditional Health Care
Practices, cultural values, and community and family involvement.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID2C85B7A9F6E14C1C9065E33F47E075FE" reported-display-style="italic"><enum>(c)</enum><header>Criteria</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID8D18BD63E37B42B99FD997D555F82AB8" reported-display-style="italic"><enum>(d)</enum><header>Earmark of Certain
Funds</header><text>Twenty percent of the funds appropriated pursuant to this
section shall be used to make grants to Urban Indian Organizations.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID5880852DB640450A8F00C912B68E9C6E" reported-display-style="italic"><enum>707.</enum><header>Indian youth
Program</header>
<subsection changed="added" committee-id="SLIA00" id="ID6B952BB2D6294049992A184637471F9D" reported-display-style="italic"><enum>(a)</enum><header>Detoxification and
Rehabilitation</header><text>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 <act-name parsable-cite="ISDA">Indian
Self-Determination and Education Assistance Act (25 U.S.C. 450 et
seq.)</act-name>. Regional centers shall be integrated with the intake and
rehabilitation programs based in the referring Indian community.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID37A8D538283047C0895CB568531F739C" reported-display-style="italic"><enum>(b)</enum><header>Alcohol and Substance
Abuse Treatment Centers or Facilities</header>
<paragraph changed="added" committee-id="SLIA00" id="ID87914F317785405080B14E458D3D0AEE" reported-display-style="italic"><enum>(1)</enum><header>Establishment</header>
<subparagraph changed="added" committee-id="SLIA00" id="ID7A6DD6C22A494ADEA8779FD804DA3BD9" reported-display-style="italic"><enum>(A)</enum><header>In
general</header><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID63A55F84CD2A4A6C9BCD0015B8B80564" reported-display-style="italic"><enum>(B)</enum><header>Area office in
california</header><text>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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDEB64A07B443046B7B1E433C5B9FBB21C" reported-display-style="italic"><enum>(2)</enum><header>Funding</header><text>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).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID0717649DF5684C01BBA524C6ADC9D1DF" reported-display-style="italic"><enum>(3)</enum><header>Location</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID2A573E85745A48B5A5B2D8F31390E10F" reported-display-style="italic"><enum>(4)</enum><header>Specific provision of
funds</header>
<subparagraph changed="added" committee-id="SLIA00" id="IDC77CEAD8655D4B54B178F2B82E3B819B" reported-display-style="italic"><enum>(A)</enum><header>In
general</header><text>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—</text>
<clause changed="added" committee-id="SLIA00" id="ID20EE95752CEF463DB69302C579217140" reported-display-style="italic"><enum>(i)</enum><text>the Tanana Chiefs
Conference, Incorporated, for the purpose of leasing, constructing, renovating,
operating, and maintaining a residential youth treatment facility in Fairbanks,
Alaska; and</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID5062037A70F049CAA97DEF6531015641" reported-display-style="italic"><enum>(ii)</enum><text>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(<added-phrase>l</added-phrase>) of the <act-name parsable-cite="ISDA">Indian
Self-Determination and Education Assistance Act</act-name> (25 U.S.C.
450b(<added-phrase>l</added-phrase>)).</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDF85C473F207D47E1A688C50018987084" reported-display-style="italic"><enum>(B)</enum><header>Provision of services
to eligible youths</header><text>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.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDBD0C8F6F0DD644019D53046C3E431486" reported-display-style="italic"><enum>(c)</enum><header>Intermediate Adolescent
Behavioral Health Services</header>
<paragraph changed="added" committee-id="SLIA00" id="IDFB4CB02645AC4465B71B74E63E057829" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>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—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDB0EC5D9CC3DA4CFA822F60CE4FDB8360" reported-display-style="italic"><enum>(A)</enum><text>pretreatment
assistance;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDCACC3DC958434D2688E43908DF10CE30" reported-display-style="italic"><enum>(B)</enum><text>inpatient, outpatient,
and aftercare services;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID1C3EDF0E653640098142FF6DF51DAE2E" reported-display-style="italic"><enum>(C)</enum><text>emergency care;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDF16E5F29767345739485DB04CC16DE18" reported-display-style="italic"><enum>(D)</enum><text>suicide prevention and
crisis intervention; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID0FE013C3EFFF4F8484D6624FE1735F72" reported-display-style="italic"><enum>(E)</enum><text>prevention and treatment
of mental illness and dysfunctional and self-destructive behavior, including
child abuse and family violence.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDA690D21785E44B66A1A440EC0123AEC6" reported-display-style="italic"><enum>(2)</enum><header>Use of
funds</header><text>Funds provided under this subsection may be used—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID52AB15E1531C47408D9E4ED2EBE20584" reported-display-style="italic"><enum>(A)</enum><text>to construct or renovate
an existing health facility to provide intermediate behavioral health
services;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID9255643E6ED243169914779C29ACC619" reported-display-style="italic"><enum>(B)</enum><text>to hire behavioral health
professionals;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDF585E69CCC43406490DB26635AFB2383" reported-display-style="italic"><enum>(C)</enum><text>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;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID889FD40AF4924D07A14075C76DB35E5A" reported-display-style="italic"><enum>(D)</enum><text>to make renovations and
hire appropriate staff to convert existing hospital beds into adolescent
psychiatric units; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID297D73E057C54A65B71D751E4D5AB4C1" reported-display-style="italic"><enum>(E)</enum><text>for intensive home- and
community-based services.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID653BB032D84C4DF982ABBB8D541BA56D" reported-display-style="italic"><enum>(3)</enum><header>Criteria</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID954A34AFB365414ABFA88F96A6FE29A1" reported-display-style="italic"><enum>(d)</enum><header>Federally Owned
Structures</header>
<paragraph changed="added" committee-id="SLIA00" id="ID7021B1C8E20B469F9C752E65678ABA80" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>The Secretary, in consultation with Indian Tribes and
Tribal Organizations, shall—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDF3CBE05AE76247B2B8FE43AB3F7E6D3A" reported-display-style="italic"><enum>(A)</enum><text>identify and use, where
appropriate, federally owned structures suitable for local residential or
regional behavioral health treatment for Indian youths; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID6869AB83E92844D3BE556D110ADB1182" reported-display-style="italic"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDD23E0D90D28141A7BF7AC440EFA75924" reported-display-style="italic"><enum>(2)</enum><header>Terms and conditions
for use of structure</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDFD34AC371BEB465D96244A197E1B7831" reported-display-style="italic"><enum>(e)</enum><header>Rehabilitation and
Aftercare Services</header>
<paragraph changed="added" committee-id="SLIA00" id="IDF93B460918DE40FEAEBEF1F350BA6874" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID88612314F8A146D38968BCA9204A12AD" reported-display-style="italic"><enum>(2)</enum><header>Administration</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDB7D0A5E34AC542E597A4C9FC61E94545" reported-display-style="italic"><enum>(f)</enum><header>Inclusion of Family in
Youth Treatment Program</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID421533E6DA144E00BC114C544B9FB383" reported-display-style="italic"><enum>(g)</enum><header>Multidrug Abuse
Program</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="id88A78B2A156944279C33563475786709" reported-display-style="italic"><enum>(h)</enum><header>Indian youth mental
health</header><text>The Secretary, acting through the Service, shall collect
data for the report under section 801 with respect to—</text>
<paragraph changed="added" committee-id="SLIA00" id="id9F237D0C58CC4671817B78F3749F7FE0" reported-display-style="italic"><enum>(1)</enum><text>the number of Indian
youth who are being provided mental health services through the Service and
Tribal Health Programs;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID31c3b93edadb40a0a06ee2dd0cee8f7e" reported-display-style="italic"><enum>(2)</enum><text>a description of, and
costs associated with, the mental health services provided for Indian youth
through the Service and Tribal Health Programs;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID106ded3d93514ea0bc68bf211418fd8f" reported-display-style="italic"><enum>(3)</enum><text>the number of youth
referred to the Service or Tribal Health Programs for mental health
services;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID211e877effd94ec1aff095e45a100bec" reported-display-style="italic"><enum>(4)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="idCD32EADCE47741028432D26683DC3663" reported-display-style="italic"><enum>(5)</enum><text>the costs of the services
described in paragraph (4).</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="idBA8A95A9CAE6424A968BE184B959DBD4" reported-display-style="italic"><enum>708.</enum><header>Indian youth
telemental health demonstration project</header>
<subsection changed="added" committee-id="SLIA00" id="ID386382cdb34a4042b661b1e1530f5ab7" reported-display-style="italic"><enum>(a)</enum><header>Purpose</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID01fdb734aabf4e298a6d82114cb05d6e" reported-display-style="italic"><enum>(1)</enum><text>the use of psychotherapy,
psychiatric assessments, diagnostic interviews, therapies for mental health
conditions predisposing to suicide, and alcohol and substance abuse
treatment;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID705896258f354726aaf0b7f76e6524c3" reported-display-style="italic"><enum>(2)</enum><text>the provision of clinical
expertise to, consultation services with, and medical advice and training for
frontline health care providers working with Indian youth;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID1ffc00c558a1457a8225660ba90780a9" reported-display-style="italic"><enum>(3)</enum><text>training and related
support for community leaders, family members and health and education workers
who work with Indian youth;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID530c76d22a304468a3b07733f8cd60bd" reported-display-style="italic"><enum>(4)</enum><text>the development of
culturally-relevant educational materials on suicide; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDaf6dd78cdeb0406bbaba397cac6659c4" reported-display-style="italic"><enum>(5)</enum><text>data collection and
reporting.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID7c105b045504472ebcbd533f368bce79" reported-display-style="italic"><enum>(b)</enum><header>Definitions</header><text>For
the purpose of this section, the following definitions shall apply:</text>
<paragraph changed="added" committee-id="SLIA00" id="IDa7a289b4a3194ed2abf6bdfde126cdd0" reported-display-style="italic"><enum>(1)</enum><header>Demonstration
project</header><text>The term <term>demonstration project</term> means the
Indian youth telemental health demonstration project authorized under
subsection (c).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDacd620ad8ef945b0acefcac5e6281491" reported-display-style="italic"><enum>(2)</enum><header>Telemental
health</header><text>The term <term>telemental health</term> 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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDc3967adaa788478c93c19227db9ba4e9" reported-display-style="italic"><enum>(c)</enum><header>Authorization</header>
<paragraph changed="added" committee-id="SLIA00" id="ID3f5824a008c7416ca085a59da5af757d" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>The Secretary is authorized to award grants under the
demonstration project for the provision of telemental health services to Indian
youth who—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID4a791617cfb240028cbd1bdd5d75fab3" reported-display-style="italic"><enum>(A)</enum><text>have expressed suicidal
ideas;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID3cd8f99fd11e4cef849942376a401415" reported-display-style="italic"><enum>(B)</enum><text>have attempted suicide;
or</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID0b70a96da79b410885a25888a334439b" reported-display-style="italic"><enum>(C)</enum><text>have mental health
conditions that increase or could increase the risk of suicide.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDe4b9ac0eee9c44bbb5fa7daabe72cd8c" reported-display-style="italic"><enum>(2)</enum><header>Eligibility for
grants</header><text>Such grants shall be awarded to Indian Tribes, Tribal
Organizations, and Urban Indian Organizations that operate 1 or more
facilities—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDc49c0d7f3c5a46a0a0f693c9fcc74812" reported-display-style="italic"><enum>(A)</enum><text>located in Alaska and
part of the Alaska Federal Health Care Access Network;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID65f6a3549cf347bfa908775949ea33c5" reported-display-style="italic"><enum>(B)</enum><text>reporting active clinical
telehealth capabilities; or</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID810edc0992674ae2be4a9c29f757df20" reported-display-style="italic"><enum>(C)</enum><text>offering school-based
telemental health services relating to psychiatry to Indian youth.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDb687d38f227b46a4bbcd91c1281e549e" reported-display-style="italic"><enum>(3)</enum><header>Grant
period</header><text>The Secretary shall award grants under this section for a
period of up to 4 years.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDf4ac5156948649e6a403b7c596b9b00b" reported-display-style="italic"><enum>(4)</enum><header>Awarding of
grants</header><text>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—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID81f6787247b9457299175f91eb84225b" reported-display-style="italic"><enum>(A)</enum><text>serve a particular
community or geographic area where there is a demonstrated need to address
Indian youth suicide;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID74f412ca4cc74faca808678cf5f6106e" reported-display-style="italic"><enum>(B)</enum><text>enter in to collaborative
partnerships with Indian Health Service or other Tribal Health Programs or
facilities to provide services under this demonstration project;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDb8a557ca3133478699c9183fd1961aa0" reported-display-style="italic"><enum>(C)</enum><text>serve an isolated
community or geographic area which has limited or no access to behavioral
health services; or</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDcb4e1cb57c6846b994e4db0aa665572e" reported-display-style="italic"><enum>(D)</enum><text>operate a detention
facility at which youth are detained.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID7d5bf22866124ab98a9cdb2fe8a5399d" reported-display-style="italic"><enum>(d)</enum><header>Use of
funds</header><text>An Indian Tribe, Tribal Organization, or Urban Indian
Organization shall use a grant received under subsection (c) for the following
purposes:</text>
<paragraph changed="added" committee-id="SLIA00" id="IDa2278bca09844bab932f81b7dbd5239a" reported-display-style="italic"><enum>(1)</enum><text>To provide telemental
health services to Indian youth, including the provision of—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID6e7f025018c14554a71632f59b6857be" reported-display-style="italic"><enum>(A)</enum><text>psychotherapy;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID3037eea03e924c2db68ebc2bbfa8f725" reported-display-style="italic"><enum>(B)</enum><text>psychiatric assessments
and diagnostic interviews, therapies for mental health conditions predisposing
to suicide, and treatment; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID5ae565c3bbd749d181b0c21164bea017" reported-display-style="italic"><enum>(C)</enum><text>alcohol and substance
abuse treatment.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID19e4f38695564c46b09aec3ae75ce98b" reported-display-style="italic"><enum>(2)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDc316c3d8b871474b863c5290436313aa" reported-display-style="italic"><enum>(3)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID8c8d96e0128942dfa1e75febbfeb1104" reported-display-style="italic"><enum>(4)</enum><text>To develop and distribute
culturally appropriate community educational materials on—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID9e722318921f4e4c840a5084b3674a2a" reported-display-style="italic"><enum>(A)</enum><text>suicide
prevention;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID530e3688658b4d1f9842a9a6658ff92f" reported-display-style="italic"><enum>(B)</enum><text>suicide education;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID5de38f35cbd347d9acab88d1db4171c7" reported-display-style="italic"><enum>(C)</enum><text>suicide screening;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID36c0341530874e83af3a261cb1a36297" reported-display-style="italic"><enum>(D)</enum><text>suicide intervention;
and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID8adb6d93102c4764b7594e05d0cb00eb" reported-display-style="italic"><enum>(E)</enum><text>ways to mobilize
communities with respect to the identification of risk factors for
suicide.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDc536c4edb8d142c5b6c683bbdd0719d1" reported-display-style="italic"><enum>(5)</enum><text>For data collection and
reporting related to Indian youth suicide prevention efforts.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID0cfbd915bc4e4a7e8312101b606941a9" reported-display-style="italic"><enum>(e)</enum><header>Applications</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDf5fd7257abed477b8a9d552714c9eb04" reported-display-style="italic"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID806dd6e1317c45d5bb87adf7f82c0e47" reported-display-style="italic"><enum>(2)</enum><text>a description of the
manner in which the project funded under the grant would—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDaa6ca7443b1f481ca9442508bf1bc115" reported-display-style="italic"><enum>(A)</enum><text>meet the telemental
health care needs of the Indian youth population to be served by the project;
or</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID39998dc81bee4fd5bf5097eb659e2098" reported-display-style="italic"><enum>(B)</enum><text>improve the access of the
Indian youth population to be served to suicide prevention and treatment
services;</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDc89c306417594d96a02b4d26a384d6f2" reported-display-style="italic"><enum>(3)</enum><text>evidence of support for
the project from the local community to be served by the project;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID46366b0848ea41c6909c4e8781979ad4" reported-display-style="italic"><enum>(4)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID2d4f22c8efd34032a5c6a2ba896edb8b" reported-display-style="italic"><enum>(5)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDa7d9aa54e69c4fafa2fa0ca8d8bae1b2" reported-display-style="italic"><enum>(6)</enum><text>a plan for sustaining the
project after Federal assistance for the demonstration project has
terminated.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDb4cddf2dc31e433286dec446775a4b73" reported-display-style="italic"><enum>(f)</enum><header>Traditional health care
practices</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID6a2478c8b7b64f30822ca5fae12bac87" reported-display-style="italic"><enum>(g)</enum><header>Collaboration;
reporting to national clearinghouse</header>
<paragraph changed="added" committee-id="SLIA00" id="ID866fdcc451ca432baee70407bc6df80f" reported-display-style="italic"><enum>(1)</enum><header>Collaboration</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID6614207cb8b34889afe991be3d357f52" reported-display-style="italic"><enum>(2)</enum><header>Reporting to national
clearinghouse</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID2b297f8cad074c6f898679c4738cb3f0" reported-display-style="italic"><enum>(h)</enum><header>Annual
report</header><text>Each grant recipient shall submit to the Secretary an
annual report that—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDdd025c3b176b4ba1abc6452b963a7c49" reported-display-style="italic"><enum>(1)</enum><text>describes the number of
telemental health services provided; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDf61163f840de4a9c846e57fb510998bc" reported-display-style="italic"><enum>(2)</enum><text>includes any other
information that the Secretary may require.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID1cde80e371fa454fb78b24e4558e7e0f" reported-display-style="italic"><enum>(i)</enum><header>Report to
Congress</header><text display-inline="yes-display-inline">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—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDced242da178e476db821fa0e7ae2fcdd" reported-display-style="italic"><enum>(1)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID71e37889225749339e2d480ad0e5a307" reported-display-style="italic"><enum>(2)</enum><text>evaluates the impact of
the telemental health services funded by the grants in reducing the number of
completed suicides among Indian youth.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDcdf569e07ee448dd8724c3f753c74c3f" reported-display-style="italic"><enum>(j)</enum><header>Authorization of
appropriations</header><text>There is authorized to be appropriated to carry
out this section $1,500,000 for each of fiscal years 2006 through 2009.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="IDAADCEFA175F34F5E81D28D9CE59F5871" reported-display-style="italic"><enum>709.</enum><header>Inpatient and
community-based mental Health facilities design, construction, and
staffing</header><text display-inline="no-display-inline">Not later than 1 year
after the date of enactment of the <act-name parsable-cite="IHCIA">Indian
Health Care Improvement Act</act-name> 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.</text>
</section><section changed="added" committee-id="SLIA00" id="IDA7A2B97469624C158A4E199CAE32E07C" reported-display-style="italic"><enum>710.</enum><header>Training and community
education</header>
<subsection changed="added" committee-id="SLIA00" id="ID64C7D59CCFAC48A9A19C4572169C1125" reported-display-style="italic"><enum>(a)</enum><header>Program</header><text>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).</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID6018477BD9AD403DA41F09397D1CBC9C" reported-display-style="italic"><enum>(b)</enum><header>Instruction</header><text>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).</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID800E1D32B53241ACB69BAFD9A9D8DCCF" reported-display-style="italic"><enum>(c)</enum><header>Training
Models</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID81BCD005170140238D984C9CE681CEDA" reported-display-style="italic"><enum>(1)</enum><text>the elevated risk of
alcohol and behavioral health problems faced by children of alcoholics;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDDA85B9F9E5C64C6D8F076F48A6632B4C" reported-display-style="italic"><enum>(2)</enum><text>the cultural, spiritual,
and multigenerational aspects of behavioral health problem prevention and
recovery; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDAAACEB64B59E4AF8B70A3F148AB5E208" reported-display-style="italic"><enum>(3)</enum><text>community-based and
multidisciplinary strategies for preventing and treating behavioral health
problems.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="ID6418E077AD9E473B8CEC095D7DB600B5" reported-display-style="italic"><enum>711.</enum><header>Behavioral Health
Program</header>
<subsection changed="added" committee-id="SLIA00" id="ID87B78722CA6C4882B1272C6657A9A4B4" reported-display-style="italic"><enum>(a)</enum><header>Innovative
Programs</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID70B75C30730546528D1B519F839651BD" reported-display-style="italic"><enum>(b)</enum><header>Funding;
Criteria</header><text>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:</text>
<paragraph changed="added" committee-id="SLIA00" id="IDFEB292C452FB4012AAD48BA559F1F284" reported-display-style="italic"><enum>(1)</enum><text>The project will address
significant unmet behavioral health needs among Indians.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID0DF179B752F04FDCB99D9D3A7EA40D75" reported-display-style="italic"><enum>(2)</enum><text>The project will serve a
significant number of Indians.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDA0AECE26FAA1464898285A896A9FDED3" reported-display-style="italic"><enum>(3)</enum><text>The project has the
potential to deliver services in an efficient and effective manner.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID907E762FBAA84AF69855CD11CE975AF2" reported-display-style="italic"><enum>(4)</enum><text>The Indian Tribe or
Tribal Organization has the administrative and financial capability to
administer the project.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID7A9BA5EC6E0A4F8AAC2EA07FBB3504D7" reported-display-style="italic"><enum>(5)</enum><text>The project may deliver
services in a manner consistent with Traditional Health Care Practices.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDADEF27C9D90949438B45A17232F70784" reported-display-style="italic"><enum>(6)</enum><text>The project is
coordinated with, and avoids duplication of, existing services.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID7EE213AF301343218591263600ED2720" reported-display-style="italic"><enum>(c)</enum><header>Equitable
Treatment</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID1D667665CE1B4153A2FD54A631E171A4" reported-display-style="italic"><enum>712.</enum><header>Fetal alcohol disorder
programs</header>
<subsection changed="added" committee-id="SLIA00" id="IDC39016E7407A457091D57CE65DAD023F" reported-display-style="italic"><enum>(a)</enum><header>Programs</header>
<paragraph changed="added" committee-id="SLIA00" id="ID7FC7050D4B3548639565CEFA03AD42B4" reported-display-style="italic"><enum>(1)</enum><header>Establishment</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDBE02F7EE3F8A4DDE81CDB8609EBAC266" reported-display-style="italic"><enum>(2)</enum><header>Use of
funds</header><text>Funding provided pursuant to this section shall be used for
the following:</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDB798D3ABA95743938A96A2046F63D3F4" reported-display-style="italic"><enum>(A)</enum><text>To develop and provide
for Indians community and in school training, education, and prevention
programs relating to fetal alcohol disorders.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID1E6C33053B6548BA9F0437363E8D50D1" reported-display-style="italic"><enum>(B)</enum><text>To identify and provide
behavioral health treatment to high-risk Indian women and high-risk women
pregnant with an Indian’s child.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID361B2BF6E14D48BAAC49D8A9C873A506" reported-display-style="italic"><enum>(C)</enum><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDA0D41013228E40989527A54C56B0563E" reported-display-style="italic"><enum>(D)</enum><text>To develop and implement
counseling and support programs in schools for fetal alcohol disorder affected
Indian children.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID5F6BCE2A09484BE59D63EFA33B28DB07" reported-display-style="italic"><enum>(E)</enum><text>To develop prevention and
intervention models which incorporate practitioners of Traditional Health Care
Practices, cultural and spiritual values, and community involvement.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID8283362558264CE39FA39594DB12C23C" reported-display-style="italic"><enum>(F)</enum><text>To develop, print, and
disseminate education and prevention materials on fetal alcohol
disorder.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDC97A1C8B388E4FEA8473A0319071C1A8" reported-display-style="italic"><enum>(G)</enum><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID3A8AFAE12966407AA57A216CBA92637F" reported-display-style="italic"><enum>(H)</enum><text>To develop early
childhood intervention projects from birth on to mitigate the effects of fetal
alcohol disorder among Indians.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID5C96A14C8D224EBABFCE0FB9440AD795" reported-display-style="italic"><enum>(I)</enum><text>To develop—</text>
<clause changed="added" committee-id="SLIA00" id="idCFE4BB46D0D2497F944F73CD3012B875" reported-display-style="italic"><enum>(i)</enum><text>community-based support
services for Indians and women pregnant with Indian children; and</text>
</clause><clause changed="added" committee-id="SLIA00" id="id1BE3C9391666493A8D918D28DB14CB47" reported-display-style="italic"><enum>(ii)</enum><text>to the extent funding is
available, community-based housing for adult Indians with fetal alcohol
disorder.</text>
</clause></subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID1519AA07BF884AC6ACD994FF20517503" reported-display-style="italic"><enum>(3)</enum><header>Criteria for
applications</header><text>The Secretary shall establish criteria for the
review and approval of applications for funding under this section.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID1287486E0F624526B2580FDC7DA270F9" reported-display-style="italic"><enum>(b)</enum><header>Services</header><text>The
Secretary, acting through the Service and Indian Tribes, Tribal Organizations,
and Urban Indian Organizations, shall—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID5CBC5CA3878C405A98590D9475BC0F9A" reported-display-style="italic"><enum>(1)</enum><text>develop and provide
services for the prevention, intervention, treatment, and aftercare for those
affected by fetal alcohol disorder in Indian communities; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID8D14FB877D384CAC81BBCEAABF4B75BF" reported-display-style="italic"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID029EA917F88F4DA4936986194FA6A9ED" reported-display-style="italic"><enum>(c)</enum><header>Task
Force</header><text>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:</text>
<paragraph changed="added" committee-id="SLIA00" id="ID59377510DEAB4E4E9DE6F1AE5F98784A" reported-display-style="italic"><enum>(1)</enum><text>The National Institute on
Drug Abuse.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID46CCCE4364B84F539F1E55EB9C7D00DC" reported-display-style="italic"><enum>(2)</enum><text>The National Institute on
Alcohol and Alcoholism.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID62BF84A6AF8D41509AA35BEA29B08A66" reported-display-style="italic"><enum>(3)</enum><text>The Office of Substance
Abuse Prevention.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID45829ED7C0454A25BE045599B004E424" reported-display-style="italic"><enum>(4)</enum><text>The National Institute of
Mental Health.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDD78631B59C264035AEAD914D48B76C7B" reported-display-style="italic"><enum>(5)</enum><text>The Service.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID337421075626424FA5FA8D588C59D45E" reported-display-style="italic"><enum>(6)</enum><text>The Office of Minority
Health of the Department of Health and Human Services.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDCDB79CF10099477DAC1B2DB833E7C63A" reported-display-style="italic"><enum>(7)</enum><text>The Administration for
Native Americans.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID2EF4607472214B22BF29E936F0456B4B" reported-display-style="italic"><enum>(8)</enum><text>The National Institute of
Child Health and Human Development (NICHD).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDD3676AEFEC624CCA9427203FF4C160D7" reported-display-style="italic"><enum>(9)</enum><text>The Centers for Disease
Control and Prevention.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID5C344FE4E1C2407CB407821B29F0FB77" reported-display-style="italic"><enum>(10)</enum><text>The Bureau of Indian
Affairs.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID780891D65F154F379EF137D049C954AE" reported-display-style="italic"><enum>(11)</enum><text>Indian Tribes.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID6AF2062BB22846D3B2426510040AD89C" reported-display-style="italic"><enum>(12)</enum><text>Tribal
Organizations.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID30C2538106064A298E658C573B447C81" reported-display-style="italic"><enum>(13)</enum><text>Urban Indian
Organizations.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID2C6EB887763241F39B431968F599C3DE" reported-display-style="italic"><enum>(14)</enum><text>Indian fetal alcohol
disorder experts.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDD1AB4700BB3E4CFAACD803D76F4B35AB" reported-display-style="italic"><enum>(d)</enum><header>Applied Research
Projects</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID104C8293888A41D7B46D222B0120B910" reported-display-style="italic"><enum>(e)</enum><header>Funding for Urban
Indian Organizations</header><text>Ten percent of the funds appropriated
pursuant to this section shall be used to make grants to Urban Indian
Organizations funded under title V.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="IDC19A3C848DF444CDA0E57B2EE0CC77BB" reported-display-style="italic"><enum>713.</enum><header>Child sexual abuse and
prevention treatment Programs</header>
<subsection changed="added" committee-id="SLIA00" id="ID8A6C91DFFA18472F95C903AF384F60B1" reported-display-style="italic"><enum>(a)</enum><header>Establishment</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID2AEB9B7222B34B6BB0648F6279B4DF5E" reported-display-style="italic"><enum>(1)</enum><text>victims of sexual abuse
who are Indian children or children in an Indian household; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID02D40921F29C4258A63499805C1582FE" reported-display-style="italic"><enum>(2)</enum><text>perpetrators of child
sexual abuse who are Indian or members of an Indian household.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID74859A4919124FFAA5F26AB4E42E8E84" reported-display-style="italic"><enum>(b)</enum><header>Use of
Funds</header><text>Funding provided pursuant to this section shall be used for
the following:</text>
<paragraph changed="added" committee-id="SLIA00" id="IDED197BA53E914D319D1E157ABB5EA87A" reported-display-style="italic"><enum>(1)</enum><text>To develop and provide
community education and prevention programs related to sexual abuse of Indian
children or children in an Indian household.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID2CA8E5BC28A9465C892D7422C0C6EC10" reported-display-style="italic"><enum>(2)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID522A41AEE0784EE089B1A89809902E2D" reported-display-style="italic"><enum>(3)</enum><text>To develop prevention and
intervention models which incorporate Traditional Health Care Practices,
cultural and spiritual values, and community involvement.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID73AEB2A0C6A14B259A50FF41061B84B6" reported-display-style="italic"><enum>(4)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID6451EEF4C51E466BAA1ADEB8578C840F" reported-display-style="italic"><enum>(5)</enum><text>To identify and provide
behavioral health treatment to Indian perpetrators and perpetrators who are
members of an Indian household—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID081AE3E3150A4BE5A8624B789C385F2C" reported-display-style="italic"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDA9A8AD28BFB648CF84362291475948D7" reported-display-style="italic"><enum>(B)</enum><text>providing treatment after
the perpetrator is released, until it is determined that the perpetrator is not
a threat to children.</text>
</subparagraph></paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="ID49FD899C3AB2426097A9D01FFED4FC2E" reported-display-style="italic"><enum>714.</enum><header>Behavioral Health
research</header><text display-inline="no-display-inline">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—</text>
<paragraph id="id9DDFCF7D9A55486FA5DECD3B9699FFFF"><enum>(1)</enum><text>the
multifactorial causes of Indian youth suicide, including—</text>
<subparagraph id="id8E6206BAC6524C7A852A66F09D111094"><enum>(A)</enum><text>protective and
risk factors and scientific data that identifies those factors; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id4D90E42122584B698F381E65565363B8"><enum>(B)</enum><text display-inline="yes-display-inline">the effects of loss of cultural identity
and the development of scientific data on those effects;</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID22DF85068B1B4187918DE64262124A66" reported-display-style="italic"><enum>(2)</enum><text>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</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID86CDE4D214F94C549757599C866AF8C3" reported-display-style="italic"><enum>(3)</enum><text>the development of models
of prevention techniques.</text>
</paragraph><continuation-text changed="added" committee-id="SLIA00" continuation-text-level="section" reported-display-style="italic">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.</continuation-text></section><section changed="added" committee-id="SLIA00" id="IDAB238C6CAD7C47719457FA77E6CB0E4A" reported-display-style="italic"><enum>715.</enum><header>Definitions</header><text display-inline="no-display-inline">For the purpose of this title, the following
definitions shall apply:</text>
<paragraph changed="added" committee-id="SLIA00" id="ID7A3BC7D1A90946D39E23C464C0337D19" reported-display-style="italic"><enum>(1)</enum><header>Assessment</header><text>The
term <term>assessment</term> means the systematic collection, analysis, and
dissemination of information on health status, health needs, and health
problems.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDA4108F42621A427D8BE0C89306551710" reported-display-style="italic"><enum>(2)</enum><header>Alcohol-related
neurodevelopmental disorders or arnd</header><text>The term
<term>alcohol-related neurodevelopmental disorders</term> or <term>ARND</term>
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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID5ED989CCBC3A4C598729EA8929B7399E" reported-display-style="italic"><enum>(3)</enum><header>Behavioral health
aftercare</header><text>The term <term>behavioral health aftercare</term>
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.)</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID38B7DABDBD8446D6A75B3717E85E1CDE" reported-display-style="italic"><enum>(4)</enum><header>Dual
diagnosis</header><text>The term <term>dual diagnosis</term> means coexisting
substance abuse and mental illness conditions or diagnosis. Such clients are
sometimes referred to as mentally ill chemical abusers (MICAs).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID5573E87B341B45A6B5ECFAA9BB0E1AD0" reported-display-style="italic"><enum>(5)</enum><header>Fetal alcohol
disorders</header><text>The term <term>fetal alcohol disorders</term> means
fetal alcohol syndrome, partial fetal alcohol syndrome and alcohol related
neurodevelopmental disorder (ARND).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDAF47E0CB4A704428B8F310D859E6C5FB" reported-display-style="italic"><enum>(6)</enum><header>Fetal alcohol syndrome
or fas</header><text>The term <term>fetal alcohol syndrome</term> or
<term>FAS</term> means a syndrome in which, with a history of maternal alcohol
consumption during pregnancy, the following criteria are met:</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID4CE55AED74774B6A8DC5D71D2AA0E427" reported-display-style="italic"><enum>(A)</enum><text>Central nervous system
involvement such as developmental delay, intellectual deficit, microencephaly,
or neurologic abnormalities.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDCC2071AACF494E7E8BED84342063A3CD" reported-display-style="italic"><enum>(B)</enum><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID92DAC36853B64EDF845CC7EA8476BBAB" reported-display-style="italic"><enum>(C)</enum><text>Prenatal or postnatal
growth delay.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID8DACF9E88A9B4E3BAFC0991E0CBFFD43" reported-display-style="italic"><enum>(7)</enum><header>Partial
fas</header><text>The term <term>partial FAS</term> 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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID3DE2ADE51E944B23B73E9127E6301429" reported-display-style="italic"><enum>(8)</enum><header>Rehabilitation</header><text>The
term <term>rehabilitation</term> means to restore the ability or capacity to
engage in usual and customary life activities through education and
therapy.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID715A7B0A55454FA0B6E47DB4E68BAA81" reported-display-style="italic"><enum>(9)</enum><header>Substance
abuse</header><text>The term <term>substance abuse</term> includes inhalant
abuse.</text>
</paragraph></section><section changed="added" committee-id="SLIA00" id="ID7716D914ADFF468EB0F8F857D8C48DC7" reported-display-style="italic"><enum>716.</enum><header>Authorization of
appropriations</header><text display-inline="no-display-inline">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.</text>
</section><enum>VIII</enum><header>MISCELLANEOUS</header>
<section changed="added" committee-id="SLIA00" id="IDEF6B95DFA35B4422AE16A245A1FDEBE1" reported-display-style="italic"><enum>801.</enum><header>Reports</header><text display-inline="no-display-inline">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:</text>
<paragraph changed="added" committee-id="SLIA00" id="ID61543C2B20F140C4B3B285B7984CED25" reported-display-style="italic"><enum>(1)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDD2B3A893095641E7A8511F64DF1FD1D6" reported-display-style="italic"><enum>(2)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID6F00594B232F43D4993DEBE9E839A2DE" reported-display-style="italic"><enum>(3)</enum><text>A report on the use of
health services by Indians—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID1E51EA1872054720B519BB0E2D60FE7D" reported-display-style="italic"><enum>(A)</enum><text>on a national and area or
other relevant geographical basis;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID148D301A3A5E4737A0A58FA597BED976" reported-display-style="italic"><enum>(B)</enum><text>by gender and age;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDC68DC1FAC15A4B7AACB21447F0AA0363" reported-display-style="italic"><enum>(C)</enum><text>by source of payment and
type of service;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID910C59BDED874D0FB96B8847D497394A" reported-display-style="italic"><enum>(D)</enum><text>comparing such rates of
use with rates of use among comparable non-Indian populations; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDCB50934383184EACAB6817E32C6A9549" reported-display-style="italic"><enum>(E)</enum><text>provided under
contracts.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDDE120A19881540FE88D28DB920C80896" reported-display-style="italic"><enum>(4)</enum><text>A report of contractors
to the Secretary on Health Care Educational Loan Repayments every 6 months
required by section 110.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID08942531BE7A4E8BBA08C18971BD9610" reported-display-style="italic"><enum>(5)</enum><text>A general audit report of
the Secretary on the Health Care Educational Loan Repayment Program as required
by section 110(n).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDFEFBAB76CE7544F09237F0F7B8753B57" reported-display-style="italic"><enum>(6)</enum><text>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).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID9DB6A291762C473999115BF1590D559F" reported-display-style="italic"><enum>(7)</enum><text>A separate statement
which specifies the amount of funds requested to carry out the provisions of
section 201.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID522A0F3D958F4F1BBF6A7810F1C7A799" reported-display-style="italic"><enum>(8)</enum><text>A report of the
evaluations of health promotion and disease prevention as required in section
203(c).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID2F3842B8A5184D0B8574E58DDDF0D749" reported-display-style="italic"><enum>(9)</enum><text>A biennial report to
Congress on infectious diseases as required by section 212.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID85C07F428A5340058E14193D7B4F0FB3" reported-display-style="italic"><enum>(10)</enum><text>A report on
environmental and nuclear health hazards as required by section 215.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID773DC2E6A9054F58B040A19DA36F5967" reported-display-style="italic"><enum>(11)</enum><text>An annual report on the
status of all health care facilities needs as required by section 301(c)(2) and
301(d).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID8192C14E5073452E869F38DA3469BFEA" reported-display-style="italic"><enum>(12)</enum><text>Reports on safe water
and sanitary waste disposal facilities as required by section 302(h).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDB0343A439DDF4F79996B301B80279F2D" reported-display-style="italic"><enum>(13)</enum><text>An annual report on the
expenditure of nonservice funds for renovation as required by sections
304(b)(2).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDAD2F050B355D4A739920DF5CE8D57FA2" reported-display-style="italic"><enum>(14)</enum><text>A report identifying the
backlog of maintenance and repair required at Service and tribal facilities
required by section 313(a).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID866F5C92CE474E5FBC3B9C26E918C037" reported-display-style="italic"><enum>(15)</enum><text>A report providing an
accounting of reimbursement funds made available to the Secretary under titles
XVIII, XIX, and XXI of the <act-name parsable-cite="SSA">Social Security
Act</act-name>.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID31A5FEA9C3EC46D89CF73E8B763E6C58" reported-display-style="italic"><enum>(16)</enum><text>A report on any
arrangements for the sharing of medical facilities or services, as authorized
by section 406.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID76411F553FAA4D20837DDC856702E9FE" reported-display-style="italic"><enum>(17)</enum><text>A report on evaluation
and renewal of Urban Indian programs under section 505.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID90A6AE7076274401BC4FF3C5DF202FD1" reported-display-style="italic"><enum>(18)</enum><text>A report on the
evaluation of programs as required by section 513(d).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDA1EAB29B7C2342F7AD052728680ADC8C" reported-display-style="italic"><enum>(19)</enum><text>A report on alcohol and
substance abuse as required by section 701(f).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="id5FA8946B371C43DC874CF22016F95D6E" reported-display-style="italic"><enum>(20)</enum><text>A report on Indian youth
mental health services as required by section 707(h).</text>
</paragraph></section><section changed="added" committee-id="SLIA00" id="ID3B79D411C9DE4AFF8D591833EF438AC0" reported-display-style="italic"><enum>802.</enum><header>Regulations</header>
<subsection changed="added" committee-id="SLIA00" id="ID278FAB7EB7D24962AD0A831C6E7C9727" reported-display-style="italic"><enum>(a)</enum><header>Deadlines</header>
<paragraph changed="added" committee-id="SLIA00" id="ID66E6C6D60B6F490BA7391B77ADCC2415" reported-display-style="italic"><enum>(1)</enum><header>Procedures</header><text>Not
later than 90 days after the date of enactment of the
<act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name>
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 <quote>Administrative Procedure Act</quote>). The
Secretary shall issue no regulations to carry out titles VI and VIII.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDEA0D03D1C31347DDB90CB4EF13C8C291" reported-display-style="italic"><enum>(2)</enum><header>Proposed
regulations</header><text>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 <act-name parsable-cite="IHCIA">Indian Health Care
Improvement Act</act-name> Amendments of 2005 and shall have no less than a
120-day comment period.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDE7C773B7B8F741608A3093A718115A41" reported-display-style="italic"><enum>(3)</enum><header>Expiration of
authority</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID8926429002FA4A57887C323B81AC3F54" reported-display-style="italic"><enum>(b)</enum><header>Committee</header><text>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)).</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID13D0A769DB274D6C9F254D5BB761D1BF" reported-display-style="italic"><enum>(c)</enum><header>Adaptation of
Procedures</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDB52156EEC449440CA88C401988783F56" reported-display-style="italic"><enum>(d)</enum><header>Lack of
Regulations</header><text>The lack of promulgated regulations shall not limit
the effect of this Act.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID1A917FC536D647A99024485CF6503F4B" reported-display-style="italic"><enum>(e)</enum><header>Inconsistent
Regulations</header><text>The provisions of this Act shall supersede any
conflicting provisions of law in effect on the day before the date of enactment
of the <act-name parsable-cite="IHCIA">Indian Health Care Improvement
Act</act-name> Amendments of 2005, and the Secretary is authorized to repeal
any regulation inconsistent with the provisions of this Act.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="IDA2692BC2706C41499E26A3AB5005CC64" reported-display-style="italic"><enum>803.</enum><header>Plan of
implementation</header><text display-inline="no-display-inline">Not later than
9 months after the date of enactment of the <act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name> 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.</text>
</section><section changed="added" committee-id="SLIA00" id="ID4511EF87330C4A6EB893EE8C487F8CDB" reported-display-style="italic"><enum>804.</enum><header>Availability of
funds</header><text display-inline="no-display-inline">The funds appropriated
pursuant to this Act shall remain available until expended.</text>
</section><section changed="added" committee-id="SLIA00" id="ID94E291C5BE9F403B9E3ECAC62182585C" reported-display-style="italic"><enum>805.</enum><header>Limitation on use of
funds appropriated to the Indian Health Service</header><text display-inline="no-display-inline">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.</text>
</section><section changed="added" committee-id="SLIA00" id="ID3558CD449A934A809AC6CBBB29722028" reported-display-style="italic"><enum>806.</enum><header>Eligibility of
California Indians</header>
<subsection changed="added" committee-id="SLIA00" id="ID93E1BF719D63408C86CD5366277A8BDE" reported-display-style="italic"><enum>(a)</enum><header>In
General</header><text>The following California Indians shall be eligible for
health services provided by the Service:</text>
<paragraph changed="added" committee-id="SLIA00" id="IDD61C9EA54F89405A8291065352A19ECF" reported-display-style="italic"><enum>(1)</enum><text>Any member of a federally
recognized Indian Tribe.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID0C19BC45BDCF4A2FB1A81928E5F6A9AF" reported-display-style="italic"><enum>(2)</enum><text>Any descendant of an
Indian who was residing in California on June 1, 1852, if such
descendant—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID85BED67739F54625932D14041E52A07D" reported-display-style="italic"><enum>(A)</enum><text>is a member of the Indian
community served by a local program of the Service; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDF79D950683E640D89B80D507721A2107" reported-display-style="italic"><enum>(B)</enum><text>is regarded as an Indian
by the community in which such descendant lives.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDE745B4D56637433B8FD36C0E78620EAA" reported-display-style="italic"><enum>(3)</enum><text>Any Indian who holds
trust interests in public domain, national forest, or reservation allotments in
California.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID9FD325336F024785BD267425319AFC64" reported-display-style="italic"><enum>(4)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDF77B3E1C3F3E4B8B9A4D4D44E97759DA" reported-display-style="italic"><enum>(b)</enum><header>Clarification</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID1D731C3C67134F5992870F598A2A81D0" reported-display-style="italic"><enum>807.</enum><header>Health Services for
ineligible persons</header>
<subsection changed="added" committee-id="SLIA00" id="ID9E7CC2AAC8A844E686E9F4306FDCC9ED" reported-display-style="italic"><enum>(a)</enum><header>Children</header><text>Any
individual who—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDDAA0F85C8A3B4CC4A395BE9AAE1E3CAD" reported-display-style="italic"><enum>(1)</enum><text>has not attained 19 years
of age;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID0736F159CA5F433194CA90BE2D4A7D81" reported-display-style="italic"><enum>(2)</enum><text>is the natural or adopted
child, stepchild, foster child, legal ward, or orphan of an eligible Indian;
and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID26079D5EB09C4C83811F2C644857C498" reported-display-style="italic"><enum>(3)</enum><text>is not otherwise eligible
for health services provided by the Service,</text>
</paragraph><continuation-text changed="added" committee-id="SLIA00" continuation-text-level="subsection" reported-display-style="italic">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.</continuation-text></subsection><subsection changed="added" committee-id="SLIA00" id="ID95AB991BB20841289A793454BE609787" reported-display-style="italic"><enum>(b)</enum><header>Spouses</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID664143BF6A614572A8CF2C94CCBA1520" reported-display-style="italic"><enum>(c)</enum><header>Provision of Services
to Other Individuals</header>
<paragraph changed="added" committee-id="SLIA00" id="IDFEBA255366E44DAC81B897C8A9054DC0" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>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—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID3B288DE2C3164BF88DBFFC741CC5AAD7" reported-display-style="italic"><enum>(A)</enum><text>the Indian Tribes served
by such Service Unit request such provision of health services to such
individuals; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID3566192622034E358CBDE077CEBCF427" reported-display-style="italic"><enum>(B)</enum><text>the Secretary and the
served Indian Tribes have jointly determined that—</text>
<clause changed="added" committee-id="SLIA00" id="ID68EB0E672EA54C689F4BF54047793A12" reported-display-style="italic"><enum>(i)</enum><text>the provision of such
health services will not result in a denial or diminution of health services to
eligible Indians; and</text>
</clause><clause changed="added" committee-id="SLIA00" id="IDDE535FF58D5C4E9899E916C02CE42549" reported-display-style="italic"><enum>(ii)</enum><text>there is no reasonable
alternative health facilities or services, within or without the Service Unit,
available to meet the health needs of such individuals.</text>
</clause></subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID22FE1A11C59944D0B1815B93AC83CAF0" reported-display-style="italic"><enum>(2)</enum><header>ISDEAA
programs</header><text>In the case of health programs and facilities operated
under a contract or compact entered into under the
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (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).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID80C9AFC094AE4FF6B1890042F946169A" reported-display-style="italic"><enum>(3)</enum><header>Payment for
services</header>
<subparagraph changed="added" committee-id="SLIA00" id="IDD122EF51B2184A5CBEB3E2F2BC05A1B3" reported-display-style="italic"><enum>(A)</enum><header>In
general</header><text>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 <act-name parsable-cite="SSA">Social Security Act</act-name>, 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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID25811AE52B7E476292CFF2E8D2E9E1C2" reported-display-style="italic"><enum>(B)</enum><header>Indigent
people</header><text>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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="IDC92370C192A84A3DB89A5CC1E44617B0" reported-display-style="italic"><enum>(4)</enum><header>Revocation of consent
for services</header>
<subparagraph changed="added" committee-id="SLIA00" id="ID115FAC017CA84DEA9064A5E1C3AF8C35" reported-display-style="italic"><enum>(A)</enum><header>Single tribe service
area</header><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID0DCF1A07140147F9BA2E7D31BD5BD1A6" reported-display-style="italic"><enum>(B)</enum><header>Multitribal service
area</header><text>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.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDD5283A14AA4345C5AE362DD20D24BB30" reported-display-style="italic"><enum>(d)</enum><header>Other
Services</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID65C7DCC242DE457C8D8937751E564FE5" reported-display-style="italic"><enum>(1)</enum><text>achieve stability in a
medical emergency;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDAF85808FDC4147AD8E9E413469780BA3" reported-display-style="italic"><enum>(2)</enum><text>prevent the spread of a
communicable disease or otherwise deal with a public health hazard;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDEC44700340E4439A9D9DBE8AF12CD92A" reported-display-style="italic"><enum>(3)</enum><text>provide care to
non-Indian women pregnant with an eligible Indian’s child for the duration of
the pregnancy through postpartum; or</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID6F40AB4532DB44AFB12BB478C60586BD" reported-display-style="italic"><enum>(4)</enum><text>provide care to immediate
family members of an eligible individual if such care is directly related to
the treatment of the eligible individual.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID530B75DB503A40DE96EB614CF5C6E2C4" reported-display-style="italic"><enum>(e)</enum><header>Hospital Privileges for
Practitioners</header><text>Hospital privileges in health facilities operated
and maintained by the Service or operated under a contract or compact pursuant
to the <act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID9564B9AE364449BF8DC87A32C9BFEBEF" reported-display-style="italic"><enum>(f)</enum><header>Eligible
Indian</header><text>For purposes of this section, the term <term>eligible
Indian</term> means any Indian who is eligible for health services provided by
the Service without regard to the provisions of this section.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="ID676EE1B7306E48F1BFF2BE11413DA48D" reported-display-style="italic"><enum>808.</enum><header>Reallocation of base
resources</header>
<subsection changed="added" committee-id="SLIA00" id="ID786219C6D9D84C92A230463F1382F33F" reported-display-style="italic"><enum>(a)</enum><header>Report
Required</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID7610D18217F14C649415DF9DF7591EF4" reported-display-style="italic"><enum>(b)</enum><header>Exception</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="IDC30AC07DE8BE438D8B74AD8610133722" reported-display-style="italic"><enum>809.</enum><header>Results of
demonstration projects</header><text display-inline="no-display-inline">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.</text>
</section><section changed="added" committee-id="SLIA00" id="ID019FF65A420F41958F072B4C3D4E278B" reported-display-style="italic"><enum>810.</enum><header>Provision of Services
in Montana</header>
<subsection changed="added" committee-id="SLIA00" id="ID3B130B8D5AE94B359B9C67915E4886C6" reported-display-style="italic"><enum>(a)</enum><header>Consistent With Court
Decision</header><text>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).</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID3D4AB50C4E164E7B98477B4348BD90C9" reported-display-style="italic"><enum>(b)</enum><header>Clarification</header><text>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.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="IDBD9906DFDEC445FEA019837F677955E1" reported-display-style="italic"><enum>811.</enum><header>Moratorium</header><text display-inline="no-display-inline">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.</text>
</section><section changed="added" committee-id="SLIA00" id="IDADEB1D293B504068BE2DE575F7FC0A00" reported-display-style="italic"><enum>812.</enum><header>Tribal
employment</header><text display-inline="no-display-inline">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
<act-name parsable-cite="ISDA">Indian Self-Determination and Education
Assistance Act</act-name> (25 U.S.C. 450 et seq.) shall not be considered an
<quote>employer</quote>.</text>
</section><section changed="added" committee-id="SLIA00" id="ID085DF207B2BA4EBDAEB4A51D662D2573" reported-display-style="italic"><enum>813.</enum><header>Severability
provisions</header><text display-inline="no-display-inline">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.</text>
</section><section changed="added" committee-id="SLIA00" id="IDA92801912B70435DB41078E622E1A895" reported-display-style="italic"><enum>814.</enum><header>Establishment of
National Bipartisan Commission on Indian Health Care</header>
<subsection changed="added" committee-id="SLIA00" id="IDEED18EA2B068494EA9AD792BC2832F29" reported-display-style="italic"><enum>(a)</enum><header>Establishment</header><text>There
is established the National Bipartisan Indian Health Care Commission (the
<quote>Commission</quote>).</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID5CF1A39630E24001817D2E7A89E8AC49" reported-display-style="italic"><enum>(b)</enum><header>Duties of
Commission</header><text>The duties of the Commission are the following:</text>
<paragraph changed="added" committee-id="SLIA00" id="ID903D0C629A2F4C59BDF5DE52FD8C35A3" reported-display-style="italic"><enum>(1)</enum><text>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:</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID647D9B98FD7140CD9DC4FEED4A91169E" reported-display-style="italic"><enum>(A)</enum><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID6377C2E9B813483D8B88A528B81BC0A3" reported-display-style="italic"><enum>(B)</enum><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID1D75EEB1B4DE4EA585E4E23ADDF216CF" reported-display-style="italic"><enum>(C)</enum><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID12596C52DB9F432C8873D4F32C7C3A0E" reported-display-style="italic"><enum>(D)</enum><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDA548795ECC0E43A5B56C6901E329EBC8" reported-display-style="italic"><enum>(E)</enum><text>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.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID518DCB7233A348738F9D925E77EC1BD4" reported-display-style="italic"><enum>(2)</enum><text>To review and analyze the
recommendations of the report of the study committee.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID506B1CD0A582463DA2D99C7CF79C65AE" reported-display-style="italic"><enum>(3)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID7428900E13694580B2F931733EEF9832" reported-display-style="italic"><enum>(4)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID3305AC56FA9547388210B4B77C5A415B" reported-display-style="italic"><enum>(c)</enum><header>Members</header>
<paragraph changed="added" committee-id="SLIA00" id="IDC7C01BDBE850402293C6E95A35647E27" reported-display-style="italic"><enum>(1)</enum><header>Appointment</header><text>The
Commission shall be composed of 25 members, appointed as follows:</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID0A87967B17C442B8A4FD34230E0D78AA" reported-display-style="italic"><enum>(A)</enum><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID8868AEC6F2494A3487BA8661A49788CE" reported-display-style="italic"><enum>(B)</enum><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID3EC7BCD3D013449AB22DBAB7265CC0E1" reported-display-style="italic"><enum>(C)</enum><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID4341B8E9391F44398C60B0A12C8337D5" reported-display-style="italic"><enum>(D)</enum><text>All those persons chosen
by the congressional members of the Commission and by the Director shall be
members of federally recognized Indian Tribes.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID7C0F651C82F8459881CD4B66468F7BA6" reported-display-style="italic"><enum>(2)</enum><header>Chair; vice
chair</header><text>The Chair and Vice Chair of the Commission shall be
selected by the congressional members of the Commission.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID157E8A2B03C04E04B400AB7AC3ADF6D4" reported-display-style="italic"><enum>(3)</enum><header>Terms</header><text>The
terms of members of the Commission shall be for the life of the
Commission.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID33A709994698473A84AC0131E62044E3" reported-display-style="italic"><enum>(4)</enum><header>Deadline for
appointments</header><text>Congressional members of the Commission shall be
appointed not later than 180 days after the date of enactment of the
<act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name>
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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID4786BFD806174F8FA25627C188676DF3" reported-display-style="italic"><enum>(5)</enum><header>Vacancy</header><text>A
vacancy in the Commission shall be filled in the manner in which the original
appointment was made.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID3AADAF19C7F2480796D35639524DC5AD" reported-display-style="italic"><enum>(d)</enum><header>Compensation</header>
<paragraph changed="added" committee-id="SLIA00" id="ID3557467872714890947D4F73AA9C0278" reported-display-style="italic"><enum>(1)</enum><header>Congressional
members</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID95C963483ECB47DCAE11D59C07A6009D" reported-display-style="italic"><enum>(2)</enum><header>Other
members</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDF7754FAE57CB4FA2A5A7A6EBA471B81F" reported-display-style="italic"><enum>(e)</enum><header>Meetings</header><text>The
Commission shall meet at the call of the Chair.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDF721DDF7DDEA46DF8D3C5EBB384559CB" reported-display-style="italic"><enum>(f)</enum><header>Quorum</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDAC489F3984004BDDB588BA0E3BA20D83" reported-display-style="italic"><enum>(g)</enum><header>Executive Director;
Staff; Facilities</header>
<paragraph changed="added" committee-id="SLIA00" id="ID85B772451397486F91A31FAA52FC1A12" reported-display-style="italic"><enum>(1)</enum><header>Appointment;
pay</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID5C1E27795DBB43C6B11926B469FCB608" reported-display-style="italic"><enum>(2)</enum><header>Staff
appointment</header><text>With the approval of the Commission, the executive
director may appoint such personnel as the executive director deems
appropriate.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDC5D654C759864A98A70F5CCB591EB21E" reported-display-style="italic"><enum>(3)</enum><header>Staff
pay</header><text>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).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDF22A7863E84049B18A692B3283F47EE4" reported-display-style="italic"><enum>(4)</enum><header>Temporary
services</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID94167580E99340FC8BA2B74686B80E95" reported-display-style="italic"><enum>(5)</enum><header>Facilities</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDBF91674AFC20432BB372739E47E09E47" reported-display-style="italic"><enum>(h)</enum><header>Hearings</header><paragraph commented="no" display-inline="yes-display-inline" id="ID6E6FEA3621E1458EA500B9F237DE67CA"><enum>(1)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDC627BE5822614EB3A34A3CE3E639F337" indent="up1" reported-display-style="italic"><enum>(2)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID61B81B65AC8A4866A834DB130885D8CE" indent="up1" reported-display-style="italic"><enum>(3)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="ID17C5BB8F5F164458AA857BAB21BC6D2B"><enum>(A)</enum><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID0FC7064FB7814266A6867AC51AD20F65" indent="up1" reported-display-style="italic"><enum>(B)</enum><text>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).</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID847891E9CBBA42F987E47EB444E61215" indent="up1" reported-display-style="italic"><enum>(4)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID68DE1257E7A7418AA223D36A0F651868" indent="up1" reported-display-style="italic"><enum>(5)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID845FE58D6300415CAF1B6607807BD742" indent="up1" reported-display-style="italic"><enum>(6)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID7F02ED7750704F4987014BB0115B585F" indent="up1" reported-display-style="italic"><enum>(7)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID407FB285DAB54935ADEB4E15D232A8D8" indent="up1" reported-display-style="italic"><enum>(8)</enum><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDEDAD4E6A1984430294D8D34966E90A71" indent="up1" reported-display-style="italic"><enum>(9)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDC03BC4A9D8CE432699A170D6130A86E3" reported-display-style="italic"><enum>(i)</enum><header>Authorization of
Appropriations</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDB9B65263D4C6484E8B2F4CC2C8A729CD" reported-display-style="italic"><enum>(j)</enum><header>FACA</header><text>The
<act-name parsable-cite="FACA">Federal Advisory Committee Act</act-name> (5
U.S.C. App.) shall not apply to the Commission.</text>
</subsection></section><section changed="added" committee-id="SLIA00" id="IDEEBAA71662B54406A44D2460CD2A8151" reported-display-style="italic"><enum>815.</enum><header>Appropriations;
availability</header><text display-inline="no-display-inline">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.</text>
</section><section changed="added" committee-id="SLIA00" id="IDA2CD5C1D595242AFA11BB2314690A0B0" reported-display-style="italic"><enum>816.</enum><header>Authorization of
appropriations</header>
<subsection changed="added" committee-id="SLIA00" id="ID65A6F58BAEBA4171AD9973881D37631C" reported-display-style="italic"><enum>(a)</enum><header>In
General</header><text>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.</text>
</subsection></section>.
(b)
(1)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)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)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:
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
.
3.Soboba sanitation
facilitiesThe Act of December
17, 1970 (84 Stat. 1465), is amended by adding at the end the following new
section:
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).
.
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 servicesSection 1911 of the
Social Security Act (42 U.S.C. 1396j)
is amended—
(A)by amending the heading
to read as follows:
;
and
(B)by amending subsection
(a) to read as follows:
(a)Eligibility for
Reimbursement for Medical AssistanceThe 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 provisionSuch section is amended by striking
subsection (b).
(3)Revision of authority
to enter into agreementsSubsection (c) of such section is
redesignated as subsection (b) and is amended to read as follows:
(b)Authority To Enter Into
AgreementsThe 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)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)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
EntitiesA 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)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
OrganizationsSection 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
paymentsFor 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
.
5.Native American Health
and Wellness Foundation
(a)The Indian
Self-Determination and Education Assistance Act (25 U.S.C. 450 et
seq.) is amended by adding at the end the following:
<enum>VIII</enum><header>NATIVE AMERICAN HEALTH
AND WELLNESS FOUNDATION</header>
<section changed="added" committee-id="SLIA00" id="ID6BE819DE4ED84C89BA5B7AB26059182C" reported-display-style="italic"><enum>801.</enum><header>Definitions</header><text display-inline="no-display-inline">In this title:</text>
<paragraph changed="added" committee-id="SLIA00" id="ID519248FD8F684F10B5174F5C7B1901D6" reported-display-style="italic"><enum>(1)</enum><header>Board</header><text>The
term <term>Board</term> means the Board of Directors of the Foundation.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDB1874FB23BC14C539F27896F361EF457" reported-display-style="italic"><enum>(2)</enum><header>Committee</header><text>The
term <term>Committee</term> means the Committee for the Establishment of Native
American Health and Wellness Foundation established under section
802(f).</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID35FFF22A654B4696A83BA79C6381B519" reported-display-style="italic"><enum>(3)</enum><header>Foundation</header><text>The
term <term>Foundation</term> means the Native American Health and Wellness
Foundation established under section 802.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID4D601FE226374F7781A7590410E146DD" reported-display-style="italic"><enum>(4)</enum><header>Secretary</header><text>The
term <term>Secretary</term> means the Secretary of Health and Human
Services.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID8468BCB1FF594D14961E918A2182B380" reported-display-style="italic"><enum>(5)</enum><header>Service</header><text>The
term <term>Service</term> means the Indian Health Service of the Department of
Health and Human Services.</text>
</paragraph></section><section changed="added" committee-id="SLIA00" id="ID50DE622214BB44B88112D2AFFF1876D3" reported-display-style="italic"><enum>802.</enum><header>Native American Health
and Wellness Foundation</header>
<subsection changed="added" committee-id="SLIA00" id="IDE02A4968133547F38AD70FF1D4C7B167" reported-display-style="italic"><enum>(a)</enum><header>Establishment</header>
<paragraph changed="added" committee-id="SLIA00" id="id22D2C5CE76A4424299B0C20515015C9F" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="id630B682A18244643B54824DC90746098" reported-display-style="italic"><enum>(2)</enum><header>Funding
determinations</header><text>No funds, gift, property, or other item of value
(including any interest accrued on such an item) acquired by the Foundation
shall—</text>
<subparagraph changed="added" committee-id="SLIA00" id="id4B7CBB1AEC4544FE8650D913EBEBA37F" reported-display-style="italic"><enum>(A)</enum><text>be taken into
consideration for purposes of determining Federal appropriations relating to
the provision of health care and services to Indians; or</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="id34628C01AD354A3B936A093F8C831ECA" reported-display-style="italic"><enum>(B)</enum><text>otherwise limit,
diminish, or affect the Federal responsibility for the provision of health care
and services to Indians.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDD846B90F07D34EF6AE92AEDA2DF8773C" reported-display-style="italic"><enum>(b)</enum><header>Perpetual
Existence</header><text>The Foundation shall have perpetual existence.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID03020E0FC32C44D6BFA47E4D9F30438C" reported-display-style="italic"><enum>(c)</enum><header>Nature of
Corporation</header><text>The Foundation—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDBE28FC763F9E496A81FA3A0A90600241" reported-display-style="italic"><enum>(1)</enum><text>shall be a charitable and
nonprofit federally chartered corporation; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID584926BEEF3E461BB6A94251204E8620" reported-display-style="italic"><enum>(2)</enum><text>shall not be an agency or
instrumentality of the United States.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDD279B7C1654F40DD9468DBB7D62396E7" reported-display-style="italic"><enum>(d)</enum><header>Place of Incorporation
and Domicile</header><text>The Foundation shall be incorporated and domiciled
in the District of Columbia.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="IDA90B97F0F72E4CEFB71FA3B682F102F1" reported-display-style="italic"><enum>(e)</enum><header>Duties</header><text>The
Foundation shall—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDA3C9579F3E4B4A20B4EA32413F650675" reported-display-style="italic"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDF413E57812BA490093836CEC5C7314C4" reported-display-style="italic"><enum>(2)</enum><text>undertake and conduct
such other activities as will further the health and wellness activities and
opportunities of Native Americans; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID99AF831B665246B1AC2EC039EF86AD4C" reported-display-style="italic"><enum>(3)</enum><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID06633C9B893646D8BE2669CBEAF6AAB8" reported-display-style="italic"><enum>(f)</enum><header>Committee for the
Establishment of Native American Health and Wellness Foundation</header>
<paragraph changed="added" committee-id="SLIA00" id="ID32DC01D9D64742859833D0414FF19B84" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>The Secretary shall establish the Committee for the
Establishment of Native American Health and Wellness Foundation to assist the
Secretary in establishing the Foundation.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID42DC0BEAC74E4E87A72F9AAB2988B975" reported-display-style="italic"><enum>(2)</enum><header>Duties</header><text>Not
later than 180 days after the date of enactment of this section, the Committee
shall—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID28185ED2782A419FAB34BF7501C52AD0" reported-display-style="italic"><enum>(A)</enum><text>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;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDDDE97CC9DE9F4179B1B2AF31806DF997" reported-display-style="italic"><enum>(B)</enum><text>ensure that the
Foundation qualifies for and maintains the status required to carry out this
section, until the Board is established;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID5ED4D1DC36244D1694C96263C81B1D49" reported-display-style="italic"><enum>(C)</enum><text>establish the
constitution and initial bylaws of the Foundation;</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID404FD1172010439C876FFA84821C60BA" reported-display-style="italic"><enum>(D)</enum><text>provide for the initial
operation of the Foundation, including providing for temporary or interim
quarters, equipment, and staff; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID93862780457C464B96AE6230E5B8F6BE" reported-display-style="italic"><enum>(E)</enum><text>appoint the initial
members of the Board in accordance with the constitution and initial bylaws of
the Foundation.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDC34C014ADFAD466DA7BE9506AAA07A6C" reported-display-style="italic"><enum>(g)</enum><header>Board of
Directors</header>
<paragraph changed="added" committee-id="SLIA00" id="IDDBE84D84255E46CD91B5AB1A6E34D7FD" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>The Board of Directors shall be the governing body of the
Foundation.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDA58B0D8C25A74BA7A847E59852A46C59" reported-display-style="italic"><enum>(2)</enum><header>Powers</header><text>The
Board may exercise, or provide for the exercise of, the powers of the
Foundation.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID820D3ECE1ADE4F689A740ED219C5EBC2" reported-display-style="italic"><enum>(3)</enum><header>Selection</header>
<subparagraph changed="added" committee-id="SLIA00" id="IDB52775BEBC6C4AD483C529F7275325BD" reported-display-style="italic"><enum>(A)</enum><header>In
general</header><text>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.</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID91906152CEC741619EBDC8A7327DFAC5" reported-display-style="italic"><enum>(B)</enum><header>Requirements</header>
<clause changed="added" committee-id="SLIA00" id="IDDCB11D612B0E4CC0820CC85D7E5FA825" reported-display-style="italic"><enum>(i)</enum><header>Number of
members</header><text>The Board shall have at least 11 members, who shall have
staggered terms.</text>
</clause><clause changed="added" committee-id="SLIA00" id="ID3A0FAC9CD296464B8AC27FAA81E43F64" reported-display-style="italic"><enum>(ii)</enum><header>Initial voting
members</header><text>The initial voting members of the Board—</text>
<subclause changed="added" committee-id="SLIA00" id="ID59F5813EC9DE43748928B5B6451FB321" reported-display-style="italic"><enum>(I)</enum><text>shall be appointed by the
Committee not later than 180 days after the date on which the Foundation is
established; and</text>
</subclause><subclause changed="added" committee-id="SLIA00" id="ID88639EEDF2EE4772A5C3568571ADACD6" reported-display-style="italic"><enum>(II)</enum><text>shall have staggered
terms.</text>
</subclause></clause><clause changed="added" committee-id="SLIA00" id="ID2261FAB67FF5406E8AF96E21A9C4858A" reported-display-style="italic"><enum>(iii)</enum><header>Qualification</header><text>The
members of the Board shall be United States citizens who are knowledgeable or
experienced in Native American health care and related matters.</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID16D3AA05A86D46BB9DBEC9C84072DDFC" reported-display-style="italic"><enum>(C)</enum><header>Compensation</header><text>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.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID8F674263144E41ED9A29509232B2E2B5" reported-display-style="italic"><enum>(h)</enum><header>Officers</header>
<paragraph changed="added" committee-id="SLIA00" id="ID40CD9A7440F043EB8392DB5D2A9FF78D" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>The officers of the Foundation shall be—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID8C7B4918553A49B58AFE1E8047793246" reported-display-style="italic"><enum>(A)</enum><text>a secretary, elected from
among the members of the Board; and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="IDA7454648BC9440298C05F793888A9C34" reported-display-style="italic"><enum>(B)</enum><text>any other officers
provided for in the constitution and bylaws of the Foundation.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID82A1DC140F8B471EAC914573A6F6AC7B" reported-display-style="italic"><enum>(2)</enum><header>Secretary</header><text>The
secretary of the Foundation shall serve, at the direction of the Board, as the
chief operating officer of the Foundation.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID56DD3CF50E974543BFD3A2B79F40E0DE" reported-display-style="italic"><enum>(3)</enum><header>Election</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID439A99505B4E4AE086572C4BD70D21CF" reported-display-style="italic"><enum>(i)</enum><header>Powers</header><text>The
Foundation—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDC4F2932129074ADC92A0BD2F3FE77ECB" reported-display-style="italic"><enum>(1)</enum><text>shall adopt a
constitution and bylaws for the management of the property of the Foundation
and the regulation of the affairs of the Foundation;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID914680B29FF44A6D975A5741FDCD228F" reported-display-style="italic"><enum>(2)</enum><text>may adopt and alter a
corporate seal;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID3B5E058379A54F848B80A1A4AFC6F697" reported-display-style="italic"><enum>(3)</enum><text>may enter into
contracts;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID0742916F426A459F8DB973CBAB167426" reported-display-style="italic"><enum>(4)</enum><text>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;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID6BA6D0B581984702A03C3E49C527753A" reported-display-style="italic"><enum>(5)</enum><text>may sue and be sued;
and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDB5481E7C52764A3CBCF270CCAF54754E" reported-display-style="italic"><enum>(6)</enum><text>may perform any other act
necessary and proper to carry out the purposes of the Foundation.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="IDA03185AD36E6451A8F7913DB1F5E970E" reported-display-style="italic"><enum>(j)</enum><header>Principal
Office</header>
<paragraph changed="added" committee-id="SLIA00" id="IDB93EF3D41B2D4074B8AD3FFF3B5A8ABE" reported-display-style="italic"><enum>(1)</enum><header>In
General</header><text>The principal office of the Foundation shall be in the
District of Columbia.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID94C66D1C86D94F6C9E8183EAC64B793B" reported-display-style="italic"><enum>(2)</enum><header>Activities;
offices</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID9471C587D749413EB41F103A33B30060" reported-display-style="italic"><enum>(k)</enum><header>Service of
Process</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID6F036F0DD5824BF0A66D23737DF8468C" reported-display-style="italic"><enum>(l)</enum><header>Liability of Officers,
Employees, and Agents</header>
<paragraph changed="added" committee-id="SLIA00" id="IDDF884706F2C742BEBAEA98E3A4EE1AA5" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>The Foundation shall be liable for the acts of the
officers, employees, and agents of the Foundation acting within the scope of
their authority.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID3B216F5B88CA4DF48B012353C4443B1D" reported-display-style="italic"><enum>(2)</enum><header>Personal
liability</header><text>A member of the Board shall be personally liable only
for gross negligence in the performance of the duties of the member.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID415120C358EC471DB88C6DE0151B1DD2" reported-display-style="italic"><enum>(m)</enum><header>Restrictions</header>
<paragraph changed="added" committee-id="SLIA00" id="IDB06CD83C01C24CE3AE5072EC1C893949" reported-display-style="italic"><enum>(1)</enum><header>Limitation on
spending</header><text>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—</text>
<subparagraph changed="added" committee-id="SLIA00" id="IDB5DDB78F060349C0B739B465FDCC7F20" reported-display-style="italic"><enum>(A)</enum><text>the amounts transferred
to the Foundation under subsection (o) during the preceding fiscal year;
and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID1858D42774A6483C8D2116BE5803F602" reported-display-style="italic"><enum>(B)</enum><text>donations received from
private sources during the preceding fiscal year.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SLIA00" id="ID14A0ECF91A1B4D898EACA2CFFEB4907E" reported-display-style="italic"><enum>(2)</enum><header>Appointment and
hiring</header><text>The appointment of officers and employees of the
Foundation shall be subject to the availability of funds.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID9B7A5223B4A34FB8A06DCAAE03605437" reported-display-style="italic"><enum>(3)</enum><header>Status</header><text>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.</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID0896EAFDDA544BF5A6A5D80FFD2BBDC4" reported-display-style="italic"><enum>(n)</enum><header>Audits</header><text>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.</text>
</subsection><subsection changed="added" committee-id="SLIA00" id="ID8728FDC73DDA4B61B4A2E7142D221118" reported-display-style="italic"><enum>(o)</enum><header>Funding</header>
<paragraph changed="added" committee-id="SLIA00" id="IDEBA0484D7FC84E5F8C3E011F33615C50" reported-display-style="italic"><enum>(1)</enum><header>Authorization of
appropriations</header><text>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.</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID067CA9B23E0E4CB0967528F110010B9B" reported-display-style="italic"><enum>(2)</enum><header>Transfer of donated
funds</header><text>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.</text>
</paragraph></subsection></section><section changed="added" committee-id="SLIA00" id="ID2A8FEBE8092F478C9C95D91A8F4200E8" reported-display-style="italic"><enum>803.</enum><header>Administrative
Services and support</header>
<subsection changed="added" committee-id="SLIA00" id="ID6E7EB8377B77453793094E27D92F8156" reported-display-style="italic"><enum>(a)</enum><header>Provision of Support by
Secretary</header><text>Subject to subsection (b), during the 5-year period
beginning on the date on which the Foundation is established, the
Secretary—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID59841FA83B20497DB232F1428FE21AD0" reported-display-style="italic"><enum>(1)</enum><text>may provide personnel,
facilities, and other administrative support services to the Foundation;</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID4A962DDBD94149C7A8CF2BE49F60E342" reported-display-style="italic"><enum>(2)</enum><text>may provide funds for
initial operating costs and to reimburse the travel expenses of the members of
the Board; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDAADA228A23D146B1B9E2994211897CC5" reported-display-style="italic"><enum>(3)</enum><text>shall require and accept
reimbursements from the Foundation for—</text>
<subparagraph changed="added" committee-id="SLIA00" id="ID30C3D33EDAEB498697F0DDE5852804F5" reported-display-style="italic"><enum>(A)</enum><text>services provided under
paragraph (1); and</text>
</subparagraph><subparagraph changed="added" committee-id="SLIA00" id="ID553F337D4B1A4ED99918EA82423C2AFE" reported-display-style="italic"><enum>(B)</enum><text>funds provided under
paragraph (2).</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID261C6D8CA7C2412D9D4A08C2AC51CEFD" reported-display-style="italic"><enum>(b)</enum><header>Reimbursement</header><text>Reimbursements
accepted under subsection (a)(3)—</text>
<paragraph changed="added" committee-id="SLIA00" id="IDCAC5AD544ACD40999F1B12ABB258355D" reported-display-style="italic"><enum>(1)</enum><text>shall be deposited in the
Treasury of the United States to the credit of the applicable appropriations
account; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="ID8B9058941AB84810A543B4619F6783C3" reported-display-style="italic"><enum>(2)</enum><text>shall be chargeable for
the cost of providing services described in subsection (a)(1) and travel
expenses described in subsection (a)(2).</text>
</paragraph></subsection><subsection changed="added" committee-id="SLIA00" id="ID79E87C674BB04D1FB9598C935688F8D7" reported-display-style="italic"><enum>(c)</enum><header>Continuation of Certain
Services</header><text>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—</text>
<paragraph changed="added" committee-id="SLIA00" id="ID7CB17BCF99E04D70B10D634723C42B5A" reported-display-style="italic"><enum>(1)</enum><text>are available; and</text>
</paragraph><paragraph changed="added" committee-id="SLIA00" id="IDD3F7631640754FF4B049FE077CB81FB0" reported-display-style="italic"><enum>(2)</enum><text>are provided on
reimbursable cost
basis.</text>
</paragraph></subsection></section>.
(b)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
.
March 16 (legislative
day, March 15), 2006
Reported with an amendment