II Calendar No. 233 111th CONGRESS 1st Session S. 1790 IN THE SENATE OF THE UNITED STATES October 15, 2009 Mr. Dorgan (for himself, Mr. Reid, Ms. Murkowski, Mr. Udall of New Mexico, Mr. Whitehouse, Mr. Johnson, Mr. Tester, Mr. Akaka, Mr. Conrad, Mr. Begich, Mr. Franken, Mr. Burris, Mr. Inouye, Ms. Stabenow, Mr. Udall of Colorado, Ms. Klobuchar, Mr. Bennet, Mr. Crapo, Mrs. Murray, Ms. Cantwell, Mr. Merkley, and Mr. Dodd) introduced the following bill; which was read twice and referred to the Committee on Indian Affairs December 16, 2009 Reported by Mr. Dorgan, with amendments Omit the part struck through and insert the part printed in italic A BILL To amend the Indian Health Care Improvement Act to revise and extend that Act, and for other purposes.

1.

Short title; table of contents

(a)

Short title

This Act may be cited as the Indian Health Care Improvement Reauthorization and Extension Act of 2009. (b)

Table of contents

The table of contents of this Act is as follows: Sec. 1. Short title; table of contents. TITLE I—Indian Health Care Improvement Act reauthorization and amendments Sec. 101. Reauthorization. Sec. 102. Findings. Sec. 103. Declaration of national Indian health policy. Sec. 104. Definitions. Subtitle A—Indian health manpower Sec. 111. Community Health Aide Program. Sec. 112. Health professional chronic shortage demonstration programs. Sec. 113. Exemption from payment of certain fees. Subtitle B—Health services Sec. 121. Indian Health Care Improvement Fund. Sec. 122. Catastrophic Health Emergency Fund. Sec. 123. Diabetes prevention, treatment, and control. Sec. 121124. Other authority for provision of services; shared services for long-term care. Sec. 122125. Reimbursement from certain third parties of costs of health services. Sec. 123126. Crediting of reimbursements. Sec. 124127. Behavioral health training and community education programs. Sec. 125. Mammography and other cancer screening. Sec. 128. Cancer screenings. Sec. 126129. Patient travel costs. Sec. 127130. Epidemiology centers. Sec. 131. Indian youth grant program. Sec. 132. American Indians Into Psychology Program. Sec. 128133. Prevention, control, and elimination of communicable and infectious diseases. Sec. 129134. Methods to increase clinician recruitment and retention issues. Sec. 135. Liability for payment. Sec. 130136. Offices of Indian Men’s Health and Indian Women’s Health. Sec. 131. Contract health service disbursement formula. Sec. 137. Contract health service administration and disbursement formula. Subtitle C—Health facilities Sec. 141. Health care facility priority system. Sec. 142. Priority of certain projects protected. Sec. 141. Indian health care delivery demonstration projects. Sec. 143. Indian health care delivery demonstration projects. Sec. 142144. Tribal management of federally owned quarters. Sec. 143145. Other funding, equipment, and supplies for facilities. Sec. 144146. Indian country modular component facilities demonstration program. Sec. 145147. Mobile health stations demonstration program. Subtitle D—Access to health services Sec. 151. Treatment of payments under Social Security Act health benefits programs. Sec. 152. Purchasing health care coverage. Sec. 153. Grants to and contracts with the Service, Indian tribes, tribal organizations, and urban Indian organizations to facilitate outreach, enrollment, and coverage of Indians under Social Security Act health benefit programs and other health benefits programs. Sec. 154. Sharing arrangements with Federal agencies. Sec. 155. Eligible Indian veteran services. Sec. 156. Nondiscrimination under Federal health care programs in qualifications for reimbursement for services. Sec. 157. Access to Federal insurance. Sec. 158. General exceptions. Sec. 159. Navajo Nation Medicaid Agency feasibility study. Subtitle E—Health services for urban Indians Sec. 161. Facilities renovation. Sec. 162. Treatment of certain demonstration projects. Sec. 161163. Requirement to confer with urban Indian organizations. Sec. 162164. Expanded program authority for urban Indian organizations. Sec. 163165. Community health representatives. Sec. 166. Use of Federal Government facilities and sources of supply; health information technology. Subtitle F—Organizational improvements Sec. 171. Establishment of the Indian Health Service as an agency of the Public Health Service. Sec. 172. Office of Direct Service Tribes. Sec. 173. Nevada area office. Subtitle G—Behavioral health programs Sec. 181. Behavioral health programs. TITLE VII—Behavioral health programs Subtitle A—General programs Sec. 701. Definitions. Sec. 702. Behavioral health prevention and treatment services. Sec. 703. Memoranda of agreement with the Department of Interior. Sec. 704. Comprehensive behavioral health prevention and treatment program. Sec. 705. Mental health technician program. Sec. 706. Licensing requirement for mental health care workers. Sec. 707. Indian women treatment programs. Sec. 708. Indian youth program. 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 spectrum disorders programs. Sec. 713. Child sexual abuse and prevention treatment programs. Sec. 713. Child sexual abuse prevention and treatment programs. Sec. 714. Domestic and sexual violence prevention and treatment. Sec. 715. Behavioral health research. Subtitle B—Indian youth suicide prevention Sec. 721. Findings and purpose. Sec. 722. Definitions. Sec. 723. Indian youth telemental health demonstration project. Sec. 724. Substance Abuse and Mental Health Services Administration grants. Sec. 725. Use of predoctoral psychology and psychiatry interns. Sec. 726. Indian youth life skills development demonstration program. Subtitle H—Miscellaneous Sec. 191. Confidentiality of medical quality assurance records; qualified immunity for participants. Sec. 192. Arizona, North Dakota, and South Dakota as contract health service delivery areas; eligibility of California Indians. Sec. 193. Methods to increase access to professionals of certain corps. Sec. 194. Health services for ineligible persons. Sec. 195. Annual budget submission. Sec. 196. Prescription drug monitoring. Sec. 197. Tribal health program option for cost sharing. Sec. 198. Disease and injury prevention report. Sec. 199. Other GAO reports. Sec. 199A. Traditional health care practices. Sec. 199B. Director of HIV/AIDS Prevention and Treatment. TITLE II—Amendments to other Acts Sec. 201. Solicitation of proposals for safe harbors under the Social Security Act for facilities of Indian health programs and urban Indian organizations. Sec. 202. Annual report regarding Indians served by health benefits programs under Social Security Act. Sec. 203. Including costs incurred by Service, a federally qualified health center, an AIDS drug assistance program, certain hospitals, or a pharmaceutical manufacturer patient assistance program in providing prescription drugs toward the annual out of pocket threshold under part D. Sec. 204201. Medicare amendments. Sec. 205. Expansion of payments under Medicare, Medicaid, and CHIP for all covered services furnished by Indian health programs. Sec. 206202. Reauthorization of Native Hawaiian health care programs.

. H

Miscellaneous

191.

Confidentiality of medical quality assurance records; qualified immunity for participants

Title VIII of the Indian Health Care Improvement Act (as amended by section 101(b)) is amended by inserting after section 804 (25 U.S.C. 1674) the following:

805.

Confidentiality of medical quality assurance records; qualified immunity for participants

(a)

Definitions

In this section: (1)

Health care provider

The term health care provider means any health care professional, including community health aides and practitioners certified under section 119, who is— (A)granted clinical practice privileges or employed to provide health care services at— (i)an Indian health program; or (ii)a health program of an urban Indian organization; and (B)licensed or certified to perform health care services by a governmental board or agency or professional health care society or organization. (2)

Medical quality assurance program

The term medical quality assurance program means any activity carried out before, on, or after the date of enactment of the Indian Health Care Improvement Reauthorization and Extension Act of 2009 by or for any Indian health program or urban Indian organization to assess the quality of medical care, including activities conducted by or on behalf of individuals, Indian health program or urban Indian organization medical or dental treatment review committees, or other review bodies responsible for quality assurance, credentials, infection control, patient safety, patient care assessment (including treatment procedures, blood, drugs, and therapeutics), medical records, health resources management review, and identification and prevention of medical or dental incidents and risks. (3)

Medical quality assurance record

The term medical quality assurance record means the proceedings, records, minutes, and reports that— (A)emanate from quality assurance program activities described in paragraph (2); and (B)are produced or compiled by or for an Indian health program or urban Indian organization as part of a medical quality assurance program. (b)

Confidentiality of records

Medical quality assurance records created by or for any Indian health program or a health program of an urban Indian organization as part of a medical quality assurance program are confidential and privileged. Such records may not be disclosed to any person or entity, except as provided in subsection (d). (c)

Prohibition on disclosure and testimony

(1)

In general

No part of any medical quality assurance record described in subsection (b) may be subject to discovery or admitted into evidence in any judicial or administrative proceeding, except as provided in subsection (d). (2)

Testimony

An individual who reviews or creates medical quality assurance records for any Indian health program or urban Indian organization who participates in any proceeding that reviews or creates such records may not be permitted or required to testify in any judicial or administrative proceeding with respect to such records or with respect to any finding, recommendation, evaluation, opinion, or action taken by such person or body in connection with such records except as provided in this section. (d)

Authorized disclosure and testimony

(1)

In general

Subject to paragraph (2), a medical quality assurance record described in subsection (b) may be disclosed, and an individual referred to in subsection (c) may give testimony in connection with such a record, only as follows: (A)To a Federal agency or private organization, if such medical quality assurance record or testimony is needed by such agency or organization to perform licensing or accreditation functions related to any Indian health program or to a health program of an urban Indian organization to perform monitoring, required by law, of such program or organization. (B)To an administrative or judicial proceeding commenced by a present or former Indian health program or urban Indian organization provider concerning the termination, suspension, or limitation of clinical privileges of such health care provider. (C)To a governmental board or agency or to a professional health care society or organization, if such medical quality assurance record or testimony is needed by such board, agency, society, or organization to perform licensing, credentialing, or the monitoring of professional standards with respect to any health care provider who is or was an employee of any Indian health program or urban Indian organization. (D)To a hospital, medical center, or other institution that provides health care services, if such medical quality assurance record or testimony is needed by such institution to assess the professional qualifications of any health care provider who is or was an employee of any Indian health program or urban Indian organization and who has applied for or been granted authority or employment to provide health care services in or on behalf of such program or organization. (E)To an officer, employee, or contractor of the Indian health program or urban Indian organization that created the records or for which the records were created. If that officer, employee, or contractor has a need for such record or testimony to perform official duties. (F)To a criminal or civil law enforcement agency or instrumentality charged under applicable law with the protection of the public health or safety, if a qualified representative of such agency or instrumentality makes a written request that such record or testimony be provided for a purpose authorized by law. (G)In an administrative or judicial proceeding commenced by a criminal or civil law enforcement agency or instrumentality referred to in subparagraph (F), but only with respect to the subject of such proceeding. (2)

Identity of participants

With the exception of the subject of a quality assurance action, the identity of any person receiving health care services from any Indian health program or urban Indian organization or the identity of any other person associated with such program or organization for purposes of a medical quality assurance program that is disclosed in a medical quality assurance record described in subsection (b) shall be deleted from that record or document before any disclosure of such record is made outside such program or organization. (e)

Disclosure for certain purposes

(1)

In general

Nothing in this section shall be construed as authorizing or requiring the withholding from any person or entity aggregate statistical information regarding the results of any Indian health program or urban Indian organization’s medical quality assurance programs. (2)

Withholding from Congress

Nothing in this section shall be construed as authority to withhold any medical quality assurance record from a committee of either House of Congress, any joint committee of Congress, or the Government Accountability Office if such record pertains to any matter within their respective jurisdictions. (f)

Prohibition on disclosure of record or testimony

An individual or entity having possession of or access to a record or testimony described by this section may not disclose the contents of such record or testimony in any manner or for any purpose except as provided in this section. (g)

Exemption from Freedom of Information Act

Medical quality assurance records described in subsection (b) may not be made available to any person under section 552 of title 5, United States Code. (h)

Limitation on civil liability

An individual who participates in or provides information to a person or body that reviews or creates medical quality assurance records described in subsection (b) shall not be civilly liable for such participation or for providing such information if the participation or provision of information was in good faith based on prevailing professional standards at the time the medical quality assurance program activity took place. (i)

Application to information in certain other records

Nothing in this section shall be construed as limiting access to the information in a record created and maintained outside a medical quality assurance program, including a patient’s medical records, on the grounds that the information was presented during meetings of a review body that are part of a medical quality assurance program. (j)

Regulations

The Secretary, acting through the Service, shall promulgate regulations pursuant to section 802. (k)

Continued protection

Disclosure under subsection (d) does not permit redisclosure except to the extent such further disclosure is authorized under subsection (d) or is otherwise authorized to be disclosed under this section. (l)

Inconsistencies

To the extent that the protections under part C of title IX of the Public Health Service Act (42 U.S.C. 229b–21 et seq.) (as amended by the Patient Safety and Quality Improvement Act of 2005 (Public Law 109–41; 119 Stat. 424)) and this section are inconsistent, the provisions of whichever is more protective shall control. (m)

Relationship to other law

This section shall continue in force and effect, except as otherwise specifically provided in any Federal law enacted after the date of enactment of the Indian Health Care Improvement Reauthorization and Extension Act of 2009.

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192.

Arizona, North Dakota, and South Dakota as contract health service delivery areas; eligibility of California Indians

Title VIII of the Indian Health Care Improvement Act is amended— (1)by striking section 808 (25 U.S.C. 1678) and inserting the following:

808.

Arizona as contract health service delivery area

(a)

In general

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 Indian tribes in the State of Arizona. (b)

Maintenance of services

The Service shall not curtail any health care services provided to Indians residing on reservations in the State of Arizona if the curtailment is due to the provision of contract services in that State pursuant to the designation of the State as a contract health service delivery area by subsection (a).

; (2)by inserting after section 808 (25 U.S.C. 1678) the following:

808A.

North Dakota and South Dakota as contract health service delivery area

(a)

In general

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 Indian tribes in the States of North Dakota and South Dakota. (b)

Maintenance of services

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 the curtailment is due to the provision of contract services in those States pursuant to the designation of the States as a contract health service delivery area by subsection (a).

; and (3)by striking section 809 (25 U.S.C. 1679) and inserting the following:

809.

Eligibility of California Indians

(a)

In general

The following California Indians shall be eligible for health services provided by the Service: (1)Any member of a federally recognized Indian tribe. (2)Any descendant of an Indian who was residing in California on June 1, 1852, if such descendant— (A)is a member of the Indian community served by a local program of the Service; and (B)is regarded as an Indian by the community in which such descendant lives. (3)Any Indian who holds trust interests in public domain, national forest, or reservation allotments in California. (4)Any Indian in Californiaof California who is listed on the plans for distribution of the assets of rancherias and reservations located within the State of California under the Act of August 18, 1958 (72 Stat. 619), and any descendant of such an Indian. (b)

Clarification

Nothing in this section may be construed as expanding the eligibility of California Indians for health services provided by the Service beyond the scope of eligibility for such health services that applied on May 1, 1986.

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193.

Methods to increase access to professionals of certain corps

Section 812 of the Indian Health Care Improvement Act (25 U.S.C. 1680b) is amended to read as follows:

812.

National Health Service Corps

(a)

No reduction in services

The Secretary shall not remove a member of the National Health Service Corps from an Indian health program or urban Indian organization or withdraw funding used to support such a member, unless the Secretary, acting through the Service, has ensured that the Indians receiving services from the member will experience no reduction in services. (b)

Treatment of Indian health programs

At the request of an Indian health program, the services of a member of the National Health Service Corps assigned to the Indian health program may be limited to the individuals who are eligible for services from that Indian health program.

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194.

Health services for ineligible persons

Section 813 of the Indian Health Care Improvement Act (25 U.S.C. 1680c) is amended to read as follows:

813.

Health services for ineligible persons

(a)

Children

Any individual who— (1)has not attained 19 years of age; (2)is the natural or adopted child, stepchild, foster child, legal ward, or orphan of an eligible Indian; and (3)is not otherwise eligible for health services provided by the Service, shall be eligible for all health services provided by the Service on the same basis and subject to the same rules that apply to eligible Indians until such individual attains 19 years of age. The existing and potential health needs of all such individuals shall be taken into consideration by the Service in determining the need for, or the allocation of, the health resources of the Service. If such an individual has been determined to be legally incompetent prior to attaining 19 years of age, such individual shall remain eligible for such services until 1 year after the date of a determination of competency.(b)

Spouses

Any spouse of an eligible Indian who is not an Indian, or who is of Indian descent but is not otherwise eligible for the health services provided by the Service, shall be eligible for such health services if all such spouses or spouses who are married to members of each Indian tribe being served are made eligible, as a class, by an appropriate resolution of the governing body of the Indian tribe or tribal organization providing such services. The health needs of persons made eligible under this paragraph shall not be taken into consideration by the Service in determining the need for, or allocation of, its health resources. (c)

Health facilities providing health services

(1)

In general

The Secretary is authorized to provide health services under this subsection through health facilities operated directly by the Service to individuals who reside within the Service unit and who are not otherwise eligible for such health services if— (A)the Indian tribes served by such Service unit requests such provision of health services to such individuals, and (B)the Secretary and the served Indian tribes have jointly determined that the provision of such health services will not result in a denial or diminution of health services to eligible Indians. (2)

ISDEAA programs

In the case of health facilities operated under a contract or compact entered into under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), the governing body of the Indian tribe or tribal organization providing health services under such contract or compact is authorized to determine whether health services should be provided under such contract or compact to individuals who are not eligible for such health services under any other subsection of this section or under any other provision of law. In making such determinations, the governing body of the Indian tribe or tribal organization shall take into account the consideration described in paragraph (1)(B). Any services provided by the Indian tribe or tribal organization pursuant to a determination made under this subparagraph shall be deemed to be provided under the agreement entered into by the Indian tribe or tribal organization under the Indian Self-Determination and Education Assistance Act. The provisions of section 314 of Public Law 101–512 (104 Stat. 1959), as amended by section 308 of Public Law 103–138 (107 Stat. 1416), shall apply to any services provided by the Indian tribe or tribal organization pursuant to a determination made under this subparagraph. (3)

Payment for services

(A)

In general

Persons receiving health services provided by the Service under this subsection shall be liable for payment of such health services under a schedule of charges prescribed by the Secretary which, in the judgment of the Secretary, results in reimbursement in an amount not less than the actual cost of providing the health services. Notwithstanding section 207 of this Act or any other provision of law, amounts collected under this subsection, including Medicare, Medicaid, or children’s health insurance program reimbursements under titles XVIII, XIX, and XXI of the Social Security Act (42 U.S.C. 1395 et seq.), shall be credited to the account of the program providing the service and shall be used for the purposes listed in section 401(d)(2) and amounts collected under this subsection shall be available for expenditure within such program. (B)

Indigent people

Health services may be provided by the Secretary through the Service under this subsection to an indigent individual who would not be otherwise eligible for such health services but for the provisions of paragraph (1) only if an agreement has been entered into with a State or local government under which the State or local government agrees to reimburse the Service for the expenses incurred by the Service in providing such health services to such indigent individual. (4)

Revocation of consent for services

(A)

Single tribe service area

In the case of a Service Area which serves only 1 Indian tribe, the authority of the Secretary to provide health services under paragraph (1) shall terminate at the end of the fiscal year succeeding the fiscal year in which the governing body of the Indian tribe revokes its concurrence to the provision of such health services. (B)

Multitribal service area

In the case of a multitribal Service Area, the authority of the Secretary to provide health services under paragraph (1) shall terminate at the end of the fiscal year succeeding the fiscal year in which at least 51 percent of the number of Indian tribes in the Service Area revoke their concurrence to the provisions of such health services. (d)

Other services

The Service may provide health services under this subsection to individuals who are not eligible for health services provided by the Service under any other provision of law in order to— (1)achieve stability in a medical emergency; (2)prevent the spread of a communicable disease or otherwise deal with a public health hazard; (3)provide care to non-Indian women pregnant with an eligible Indian's child for the duration of the pregnancy through postpartum; or (4)provide care to immediate family members of an eligible individual if such care is directly related to the treatment of the eligible individual. (e)

Hospital privileges for practitioners

(1)

In general

Hospital privileges in health facilities operated and maintained by the Service or operated under a contract or compact pursuant to the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) may be extended to non-Service health care practitioners who provide services to individuals described in subsection (a), (b), (c), or (d). Such non-Service health care practitioners may, as part of the privileging process, be designated as employees of the Federal Government for purposes of section 1346(b) and chapter 171 of title 28, United States Code (relating to Federal tort claims) only with respect to acts or omissions which occur in the course of providing services to eligible individuals as a part of the conditions under which such hospital privileges are extended. (2)

Definition

For purposes of this subsection, the term non-Service health care practitioner means a practitioner who is not— (A)an employee of the Service; or (B)an employee of an Indian tribe or tribal organization operating a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) or an individual who provides health care services pursuant to a personal services contract with such Indian tribe or tribal organization. (f)

Eligible Indian

For purposes of this section, the term eligible Indian means any Indian who is eligible for health services provided by the Service without regard to the provisions of this section.

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195.

Annual budget submission

Title VIII of the Indian Health Care Improvement Act (25 U.S.C. 1671 et seq.) is amended by adding at the end the following:

826.

Annual budget submission

Effective beginning with the submission of the annual budget request to Congress for fiscal year 2011, the President shall include, in the amount requested and the budget justification, amounts that reflect any changes in— (1)the cost of health care services, as indexed for United States dollar inflation (as measured by the Consumer Price Index); and (2)the size of the population served by the Service.

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196.

Prescription drug monitoring

Title VIII of the Indian Health Care Improvement Act (25 U.S.C. 1671 et seq.) (as amended by section 195) is amended by adding at the end the following:

827.

Prescription drug monitoring

(a)

Monitoring

(1)

Establishment

The Secretary, in coordination with the Secretary of the Interior and the Attorney General, shall establish a prescription drug monitoring program, to be carried out at health care facilities of the Service, tribal health care facilities, and urban Indian health care facilities. (2)

Report

Not later than 18 months after the date of enactment of the Indian Health Care Improvement Reauthorization and Extension Act of 2009, the Secretary shall submit to the Committee on Indian Affairs of the Senate and the Committee on Natural Resources of the House of Representatives a report that describes— (A)the needs of the Service, tribal health care facilities, and urban Indian health care facilities with respect to the prescription drug monitoring program under paragraph (1); (B)the planned development of that program, including any relevant statutory or administrative limitations; and (C)the means by which the program could be carried out in coordination with any State prescription drug monitoring program. (b)

Abuse

(1)

In general

The Attorney General, in conjunction with the Secretary and the Secretary of the Interior, shall conduct— (A)an assessment of the capacity of, and support required by, relevant Federal and tribal agencies— (i)to carry out data collection and analysis regarding incidents of prescription drug abuse in Indian communities; and (ii)to exchange among those agencies and Indian health programs information relating to prescription drug abuse in Indian communities, including statutory and administrative requirements and limitations relating to that abuse; and (B)training for Indian health care providers, tribal leaders, law enforcement officers, and school officials regarding awareness and prevention of prescription drug abuse and strategies for improving agency responses to addressing prescription drug abuse in Indian communities. (2)

Report

Not later than 18 months after the date of enactment of the Indian Health Care Improvement Reauthorization and Extension Act of 2009, the Attorney General shall submit to the Committee on Indian Affairs of the Senate and the Committee on Natural Resources of the House of Representatives a report that describes— (A)the capacity of Federal and tribal agencies to carry out data collection and analysis and information exchanges as described in paragraph (1)(A); (B)the training conducted pursuant to paragraph (1)(B); (C)infrastructure enhancements required to carry out the activities described in paragraph (1), if any; and (D)any statutory or administrative barriers to carrying out those activities.

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197.

Tribal health program option for cost sharing

Title VIII of the Indian Health Care Improvement Act (25 U.S.C. 1671 et seq.) (as amended by section 196) is amended by adding at the end the following:

828.

Tribal health program option for cost sharing

(a)

In general

Nothing in this Act limits the ability of a tribal health program operating any health program, service, function, activity, or facility funded, in whole or part, by the Service through, or provided for in, a compact with the Service pursuant to title V of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 458aaa et seq.) to charge an Indian for services provided by the tribal health program. (b)

Service

Nothing in this Act authorizes the Service— (1)to charge an Indian for services; or (2)to require any tribal health program to charge an Indian for services.

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198.

Disease and injury prevention report

Title VIII of the Indian Health Care Improvement Act (25 U.S.C. 1671 et seq.) (as amended by section 197) is amended by adding at the end the following:

829.

Disease and injury prevention report

Not later than 18 months after the date of enactment of the Indian Health Care Improvement Reauthorization and Extension Act of 2009, the Secretary shall submit to the Committee on Indian Affairs of the Senate and the Committees on Natural Resources and Energy and Commerce of the House of Representatives describing— (1)all disease and injury prevention activities conducted by the Service, independently or in conjunction with other Federal departments and agencies and Indian tribes; and (2)the effectiveness of those activities, including the reductions of injury or disease conditions achieved by the activities.

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199.

Other GAO reports

Title VIII of the Indian Health Care Improvement Act (25 U.S.C. 1671 et seq.) (as amended by section 198) is amended by adding at the end the following:

830.

Other GAO reports

(a)

Coordination of services

(1)

Study and evaluation

The Comptroller General of the United States shall conduct a study, and evaluate the effectiveness, of coordination of health care services provided to Indians— (A)through Medicare, Medicaid, or SCHIP; (B)by the Service; or (C)using funds provided by— (i)State or local governments; or (ii)Indian tribes. (2)

Report

Not later than 18 months after the date of enactment of the Indian Health Care Improvement Reauthorization and Extension Act of 2009, the Comptroller General shall submit to Congress a report— (A)describing the results of the evaluation under paragraph (1); and (B)containing recommendations of the Comptroller General regarding measures to support and increase coordination of the provision of health care services to Indians as described in paragraph (1). (b)

Payments for contract health services

(1)

In general

The Comptroller General shall conduct a study on the use of health care furnished by health care providers under the contract health services program funded by the Service and operated by the Service, an Indian tribe, or a tribal organization. (2)

Analysis

The study conducted under paragraph (1) shall include an analysis of— (A)the amounts reimbursed under the contract health services program described in paragraph (1) for health care furnished by entities, individual providers, and suppliers, including a comparison of reimbursement for that health care through other public programs and in the private sector; (B)barriers to accessing care under such contract health services program, including barriers relating to travel distances, cultural differences, and public and private sector reluctance to furnish care to patients under the program; (C)the adequacy of existing Federal funding for health care under the contract health services program; (D)the administration of the contract health service program, including the distribution of funds to Indian health programs pursuant to the program; and (E)any other items determined appropriate by the Comptroller General. (3)

Report

Not later than 18 months after the date of enactment of the Indian Health Care Improvement Reauthorization and Extension Act of 2009, the Comptroller General shall submit to Congress a report on the study conducted under paragraph (1), together with recommendations regarding— (A)the appropriate level of Federal funding that should be established for health care under the contract health services program described in paragraph (1); (B)how to most efficiently use that funding; and (C)the identification of any inequities in the current distribution formula or inequitable results for any Indian tribe under the funding level, and any recommendations for addressing any inequities or inequitable results identified. (4)

Consultation

In conducting the study under paragraph (1) and preparing the report under paragraph (3), the Comptroller General shall consult with the Service, Indian tribes, and tribal organizations.

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199A.

Traditional health care practices

Title VIII of the Indian Health Care Improvement Act (25 U.S.C. 1671 et seq.) (as amended by section 199) is amended by adding at the end the following:

831.

Traditional health care practices

Although the Secretary may promote traditional health care practices, consistent with the Service standards for the provision of health care, health promotion, and disease prevention under this Act, the United States is not liable for any provision of traditional health care practices pursuant to this Act that results in damage, injury, or death to a patient. Nothing in this subsection shall be construed to alter any liability or other obligation that the United States may otherwise have under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) or this Act.

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199B.

Director of HIV/AIDS Prevention and Treatment

Title VIII of the Indian Health Care Improvement Act (25 U.S.C. 1671 et seq.) (as amended by section 199A) is amended by adding at the end the following:

832.

Director of HIV/AIDS Prevention and Treatment

(a)

Establishment

The Secretary, acting through the Service, shall establish within the Service the position of the Director of HIV/AIDS Prevention and Treatment (referred to in this section as the Director). (b)

Duties

The Director shall— (1)coordinate and promote HIV/AIDS prevention and treatment activities specific to Indians; (2)provide technical assistance to Indian tribes, tribal organizations, and urban Indian organizations regarding existing HIV/AIDS prevention and treatment programs; and (3)ensure interagency coordination to facilitate the inclusion of Indians in Federal HIV/AIDS research and grant opportunities, with emphasis on the programs operated under the Ryan White Comprehensive Aids Resources Emergency Act of 1990 (Public Law 101–381; 104 Stat. 576) and the amendments made by that Act. (c)

Report

Not later than 2 years after the date of enactment of the Indian Health Care Improvement Reauthorization and Extension Act of 2009, and not less frequently than once every 2 years thereafter, the Director shall submit to Congress a report describing, with respect to the preceding 2-year period— (1)each activity carried out under this section; and (2)any findings of the Director with respect to HIV/AIDS prevention and treatment activities specific to Indians.

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December 16, 2009 Reported with amendments