[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1369 Introduced in House (IH)]
<DOC>
115th CONGRESS
1st Session
H. R. 1369
To amend the Indian Health Care Improvement Act to revise and extend
that Act, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 6, 2017
Mr. Cole introduced the following bill; which was referred to the
Committee on Natural Resources, and in addition to the Committees on
Energy and Commerce, Ways and Means, and the Budget, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To amend the Indian Health Care Improvement Act to revise and extend
that Act, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Indian Healthcare
Improvement Act of 2017''.
(b) Table of Contents.--The table of contents for 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. 124. Other authority for provision of services; shared services
for long-term care.
Sec. 125. Reimbursement from certain third parties of costs of health
services.
Sec. 126. Crediting of reimbursements.
Sec. 127. Behavioral health training and community education programs.
Sec. 128. Cancer screenings.
Sec. 129. Patient travel costs.
Sec. 130. Epidemiology centers.
Sec. 131. Indian youth grant program.
Sec. 132. American Indians Into Psychology Program.
Sec. 133. Prevention, control, and elimination of communicable and
infectious diseases.
Sec. 134. Methods to increase clinician recruitment and retention
issues.
Sec. 135. Liability for payment.
Sec. 136. Offices of Indian Men's Health and Indian Women's Health.
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. 143. Indian health care delivery demonstration projects.
Sec. 144. Tribal management of federally owned quarters.
Sec. 145. Other funding, equipment, and supplies for facilities.
Sec. 146. Indian country modular component facilities demonstration
program.
Sec. 147. 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. 163. Requirement to confer with urban Indian organizations.
Sec. 164. Expanded program authority for urban Indian organizations.
Sec. 165. 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.
Subtitle H--Miscellaneous
Sec. 191. Confidentiality of medical quality assurance records;
qualified immunity for participants.
Sec. 192. Limitation on use of funds appropraited to the Indian Health
Service.
Sec. 193. Arizona, North Dakota, and South Dakota as contract health
service delivery areas; eligibility of
California Indians.
Sec. 194. Methods to increase access to professionals of certain corps.
Sec. 195. Health services for ineligible persons.
Sec. 196. Annual budget submission.
Sec. 197. Prescription drug monitoring.
Sec. 198. Tribal health program option for cost sharing.
Sec. 199. Disease and injury prevention report.
Sec. 200. Other GAO reports.
Sec. 201. Traditional health care practices.
Sec. 202. Director of HIV/AIDS Prevention and Treatment.
TITLE II--AMENDMENTS TO OTHER ACTS AND MISCELLANEOUS PROVISIONS
Sec. 201. Elimination of sunset for reimbursement for all Medicare part
B services furnished by certain indian
hospitals and clinics.
Sec. 202. Including costs incurred by aids drug assistance programs and
indian health service in providing
prescription drugs toward the annual out-
of-pocket threshold under part D.
Sec. 203. Prohibition of use of Federal funds for abortion.
Sec. 204. Reauthorization of Native Hawaiian health care programs.
TITLE I--INDIAN HEALTH CARE IMPROVEMENT ACT REAUTHORIZATION AND
AMENDMENTS
SEC. 101. REAUTHORIZATION.
(a) In General.--Section 825 of the Indian Health Care Improvement
Act (25 U.S.C. 1680o) is amended to read as follows:
``SEC. 825. AUTHORIZATION OF APPROPRIATIONS.
``There are authorized to be appropriated such sums as are
necessary to carry out this Act for fiscal year 2017 and each fiscal
year thereafter, to remain available until expended.''.
(b) Repeals.--The following provisions of the Indian Health Care
Improvement Act are repealed:
(1) Section 123 (25 U.S.C. 1616p).
(2) Paragraph (6) of section 209(m) (25 U.S.C. 1621h(m)).
(3) Subsection (g) of section 211 (25 U.S.C. 1621j).
(4) Subsection (e) of section 216 (25 U.S.C. 1621o).
(5) Section 224 (25 U.S.C. 1621w).
(6) Section 309 (25 U.S.C. 1638a).
(7) Section 407 (25 U.S.C. 1647).
(8) Subsection (c) of section 512 (25 U.S.C. 1660b).
(9) Section 514 (25 U.S.C. 1660d).
(10) Section 603 (25 U.S.C. 1663).
(11) Section 805 (25 U.S.C. 1675).
(c) Conforming Amendments.--
(1) Section 204(c)(1) of the Indian Health Care Improvement
Act (25 U.S.C. 1621c(c)(1)) is amended by striking ``through
fiscal year 2000''.
(2) Section 213 of the Indian Health Care Improvement Act
(25 U.S.C. 1621l) is amended by striking ``(a) The Secretary''
and inserting ``The Secretary''.
(3) Section 310 of the Indian Health Care Improvement Act
(25 U.S.C. 1638b) is amended by striking ``funds provided
pursuant to the authorization contained in section 309'' each
place it appears and inserting ``funds made available to carry
out this title''.
SEC. 102. FINDINGS.
Section 2 of the Indian Health Care Improvement Act (25 U.S.C.
1601) is amended--
(1) by redesignating subsections (a), (b), (c), and (d) as
paragraphs (1), (3), (4), and (5), respectively, and indenting
the paragraphs appropriately; and
(2) by inserting after paragraph (1) (as so redesignated)
the following:
``(2) A major national goal of the United States is to
provide the resources, processes, and structure that will
enable Indian tribes and tribal members to obtain the quantity
and quality of health care services and opportunities that will
eradicate the health disparities between Indians and the
general population of the United States.''.
SEC. 103. DECLARATION OF NATIONAL INDIAN HEALTH POLICY.
Section 3 of the Indian Health Care Improvement Act (25 U.S.C.
1602) is amended to read as follows:
``SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POLICY.
``Congress declares that it is the policy of this Nation, in
fulfillment of its special trust responsibilities and legal obligations
to Indians--
``(1) to ensure the highest possible health status for
Indians and urban Indians and to provide all resources
necessary to effect that policy;
``(2) to raise the health status of Indians and urban
Indians to at least the levels set forth in the goals contained
within the Healthy People 2010 initiative or successor
objectives;
``(3) to ensure maximum Indian participation in the
direction of health care services so as to render the persons
administering such services and the services themselves more
responsive to the needs and desires of Indian communities;
``(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 that all actions under this Act shall be
carried out with active and meaningful consultation with Indian
tribes and tribal organizations, and conference with urban
Indian organizations, to implement this Act and the national
policy of Indian self-determination;
``(6) to ensure that the United States and Indian tribes
work in a government-to-government relationship to ensure
quality health care for all tribal members; and
``(7) to provide funding for programs and facilities
operated by Indian tribes and tribal organizations in amounts
that are not less than the amounts provided to programs and
facilities operated directly by the Service.''.
SEC. 104. DEFINITIONS.
Section 4 of the Indian Health Care Improvement Act (25 U.S.C.
1603) is amended--
(1) by striking the matter preceding subsection (a) and
inserting ``In this Act:'';
(2) in each of subsections (c), (j), (k), and (l), by
redesignating the paragraphs contained in the subsections as
subparagraphs and indenting the subparagraphs appropriately;
(3) by redesignating subsections (a) through (q) as
paragraphs (17), (18), (13), (14), (26), (28), (27), (29), (1),
(20), (11), (7), (19), (10), (21), (8), and (9), respectively,
indenting the paragraphs appropriately, and moving the
paragraphs so as to appear in numerical order;
(4) in each paragraph (as so redesignated), by inserting a
heading the text of which is comprised of the term defined in
the paragraph;
(5) by inserting ``The term'' after each paragraph heading;
(6) by inserting after paragraph (1) (as redesignated by
paragraph (3)) the following:
``(2) Behavioral health.--
``(A) In general.--The term `behavioral health'
means the blending of substance (alcohol, drugs,
inhalants, and tobacco) abuse and mental health
disorders prevention and treatment for the purpose of
providing comprehensive services.
``(B) Inclusions.--The term `behavioral health'
includes the joint development of substance abuse and
mental health treatment planning and coordinated case
management using a multidisciplinary approach.
``(3) California indian.--The term `California Indian'
means any Indian who is eligible for health services provided
by the Service pursuant to section 809.
``(4) Community college.--The term `community college'
means--
``(A) a tribal college or university; or
``(B) a junior or community college.
``(5) Contract health service.--The term `contract health
service' means any health service that is--
``(A) delivered based on a referral by, or at the
expense of, an Indian health program; and
``(B) provided by a public or private medical
provider or hospital that is not a provider or hospital
of the Indian health program.
``(6) Department.--The term `Department', unless otherwise
designated, means the Department of Health and Human
Services.'';
(7) by striking paragraph (7) (as redesignated by paragraph
(3)) and inserting the following:
``(7) Disease prevention.--
``(A) In general.--The term `disease prevention'
means any activity for--
``(i) the reduction, limitation, and
prevention of--
``(I) disease; and
``(II) complications of disease;
and
``(ii) the reduction of consequences of
disease.
``(B) Inclusions.--The term `disease prevention'
includes an activity for--
``(i) controlling--
``(I) the development of diabetes;
``(II) high blood pressure;
``(III) infectious agents;
``(IV) injuries;
``(V) occupational hazards and
disabilities;
``(VI) sexually transmittable
diseases; or
``(VII) toxic agents; or
``(ii) providing--
``(I) fluoridation of water; or
``(II) immunizations.'';
(8) by striking paragraph (9) (as redesignated by paragraph
(3)) and inserting the following:
``(9) FAS.--The term `fetal alcohol syndrome' or `FAS'
means a syndrome in which, with a history of maternal alcohol
consumption during pregnancy, the following criteria are met:
``(A) Central nervous system involvement such as
mental retardation, developmental delay, intellectual
deficit, microencephaly, or neurologic abnormalities.
``(B) Craniofacial abnormalities with at least 2 of
the following: microophthalmia, short palpebral
fissures, poorly developed philtrum, thin upper lip,
flat nasal bridge, and short upturned nose.
``(C) Prenatal or postnatal growth delay.'';
(9) by striking paragraphs (11) and (12) (as redesignated
by paragraph (3)) and inserting the following:
``(11) Health promotion.--The term `health promotion' means
any activity for--
``(A) fostering social, economic, environmental,
and personal factors conducive to health, including
raising public awareness regarding health matters and
enabling individuals to cope with health problems by
increasing knowledge and providing valid information;
``(B) encouraging adequate and appropriate diet,
exercise, and sleep;
``(C) promoting education and work in accordance
with physical and mental capacity;
``(D) making available safe water and sanitary
facilities;
``(E) improving the physical, economic, cultural,
psychological, and social environment;
``(F) promoting culturally competent care; and
``(G) providing adequate and appropriate programs,
including programs for--
``(i) abuse prevention (mental and
physical);
``(ii) community health;
``(iii) community safety;
``(iv) consumer health education;
``(v) diet and nutrition;
``(vi) immunization and other methods of
prevention of communicable diseases, including
HIV/AIDS;
``(vii) environmental health;
``(viii) exercise and physical fitness;
``(ix) avoidance of fetal alcohol spectrum
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) healthy work environments;
``(xxii) elimination, reduction, and
prevention of contaminants that create
unhealthy household conditions (including mold
and other allergens);
``(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 referred
to in section 3(2).
``(12) Indian health program.--The term `Indian health
program' means--
``(A) any health program administered directly by
the Service;
``(B) any tribal health program; and
``(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').'';
(10) by inserting after paragraph (14) (as redesignated by
paragraph (3)) the following:
``(15) Junior or community college.--The term `junior or
community college' has the meaning given the term in section
312(e) of the Higher Education Act of 1965 (20 U.S.C. 1058(e)).
``(16) Reservation.--
``(A) In general.--The term `reservation' means a
reservation, Pueblo, or colony of any Indian tribe.
``(B) Inclusions.--The term `reservation'
includes--
``(i) former reservations in Oklahoma;
``(ii) Indian allotments; and
``(iii) Alaska Native Regions established
pursuant to the Alaska Native Claims Settlement
Act (43 U.S.C. 1601 et seq.).'';
(11) by striking paragraph (20) (as redesignated by
paragraph (3)) and inserting the following:
``(20) Service unit.--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.'';
(12) by inserting after paragraph (21) (as redesignated by
paragraph (3)) the following:
``(22) Telehealth.--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)).
``(23) Telemedicine.--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.
``(24) Tribal college or university.--The term `tribal
college or university' has the meaning given the term in
section 316(b) of the Higher Education Act of 1965 (20 U.S.C.
1059c(b)).
``(25) Tribal health program.--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.).''; and
(13) by striking paragraph (26) (as redesignated by
paragraph (3)) and inserting the following:
``(26) Tribal organization.--The term `tribal organization'
has the meaning given the term in section 4 of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450b).''.
Subtitle A--Indian Health Manpower
SEC. 111. COMMUNITY HEALTH AIDE PROGRAM.
Section 119 of the Indian Health Care Improvement Act (25 U.S.C.
1616l) is amended to read as follows:
``SEC. 119. COMMUNITY HEALTH AIDE PROGRAM.
``(a) General Purposes of Program.--Pursuant to the Act of November
2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'), the
Secretary, acting through the Service, shall develop and operate a
Community Health Aide Program in the State of Alaska under which the
Service--
``(1) provides for the training of Alaska Natives as health
aides or community health practitioners;
``(2) uses those aides or practitioners in the provision of
health care, health promotion, and disease prevention services
to Alaska Natives living in villages in rural Alaska; and
``(3) provides for the establishment of teleconferencing
capacity in health clinics located in or near those villages
for use by community health aides or community health
practitioners.
``(b) Specific Program Requirements.--The Secretary, acting through
the Community Health Aide Program of the Service, shall--
``(1) using trainers accredited by the Program, provide a
high standard of training to community health aides and
community health practitioners to ensure that those aides and
practitioners provide quality health care, health promotion,
and disease prevention services to the villages served by the
Program;
``(2) in order to provide such training, develop a
curriculum that--
``(A) combines education regarding the theory of
health care with supervised practical experience in the
provision of health care;
``(B) provides instruction and practical experience
in the provision of acute care, emergency care, health
promotion, disease prevention, and the efficient and
effective management of clinic pharmacies, supplies,
equipment, and facilities; and
``(C) promotes the achievement of the health status
objectives specified in section 3(2);
``(3) establish and maintain a Community Health Aide
Certification Board to certify as community health aides or
community health practitioners individuals who have
successfully completed the training described in paragraph (1)
or can demonstrate equivalent experience;
``(4) develop and maintain a system that identifies the
needs of community health aides and community health
practitioners for continuing education in the provision of
health care, including the areas described in paragraph (2)(B),
and develop programs that meet the needs for such continuing
education;
``(5) develop and maintain a system that provides close
supervision of community health aides and community health
practitioners;
``(6) develop a system under which the work of community
health aides and community health practitioners is reviewed and
evaluated to ensure the provision of quality health care,
health promotion, and disease prevention services; and
``(7) ensure that--
``(A) pulpal therapy (not including pulpotomies on
deciduous teeth) or extraction of adult teeth can be
performed by a dental health aide therapist only after
consultation with a licensed dentist who determines
that the procedure is a medical emergency that cannot
be resolved with palliative treatment; and
``(B) dental health aide therapists are strictly
prohibited from performing all other oral or jaw
surgeries, subject to the condition that uncomplicated
extractions shall not be considered oral surgery under
this section.
``(c) Program Review.--
``(1) Neutral panel.--
``(A) Establishment.--The Secretary, acting through
the Service, shall establish a neutral panel to carry
out the study under paragraph (2).
``(B) Membership.--Members of the neutral panel
shall be appointed by the Secretary from among
clinicians, economists, community practitioners, oral
epidemiologists, and Alaska Natives.
``(2) Study.--
``(A) In general.--The neutral panel established
under paragraph (1) shall conduct a study of the dental
health aide therapist services provided by the
Community Health Aide Program under this section to
ensure that the quality of care provided through those
services is adequate and appropriate.
``(B) Parameters of study.--The Secretary, in
consultation with interested parties, including
professional dental organizations, shall develop the
parameters of the study.
``(C) Inclusions.--The study shall include a
determination by the neutral panel with respect to--
``(i) the ability of the dental health aide
therapist services under this section to
address the dental care needs of Alaska
Natives;
``(ii) the quality of care provided through
those services, including any training,
improvement, or additional oversight required
to improve the quality of care; and
``(iii) whether safer and less costly
alternatives to the dental health aide
therapist services exist.
``(D) Consultation.--In carrying out the study
under this paragraph, the neutral panel shall consult
with Alaska tribal organizations with respect to the
adequacy and accuracy of the study.
``(3) Report.--The neutral panel shall submit to the
Secretary, the Committee on Indian Affairs of the Senate, and
the Committee on Natural Resources of the House of
Representatives a report describing the results of the study
under paragraph (2), including a description of--
``(A) any determination of the neutral panel under
paragraph (2)(C); and
``(B) any comments received from Alaska tribal
organizations under paragraph (2)(D).
``(d) Nationalization of Program.--
``(1) In general.--Except as provided in paragraph (2), the
Secretary, acting through the Service, may establish a national
Community Health Aide Program in accordance with the program
under this section, as the Secretary determines to be
appropriate.
``(2) Requirement; exclusion.--Subject to paragraphs (3)
and (4), in establishing a national program under paragraph
(1), the Secretary--
``(A) shall not reduce the amounts provided for the
Community Health Aide Program described in subsections
(a) and (b); and
``(B) shall exclude dental health aide therapist
services from services covered under the program.
``(3) Election of indian tribe or tribal organization.--
``(A) In general.--Subparagraph (B) of paragraph
(2) shall not apply in the case of an election made by
an Indian tribe or tribal organization located in a
State (other than Alaska) in which the use of dental
health aide therapist services or midlevel dental
health provider services is authorized under State law
to supply such services in accordance with State law.
``(B) Action by secretary.--On an election by an
Indian tribe or tribal organization under subparagraph
(A), the Secretary, acting through the Service, shall
facilitate implementation of the services elected.
``(4) Vacancies.--The Secretary shall not fill any vacancy
for a certified dentist in a program operated by the Service
with a dental health aide therapist.
``(e) Effect of Section.--Nothing in this section shall restrict
the ability of the Service, an Indian tribe, or a tribal organization
to participate in any program or to provide any service authorized by
any other Federal law.''.
SEC. 112. HEALTH PROFESSIONAL CHRONIC SHORTAGE DEMONSTRATION PROGRAMS.
Title I of the Indian Health Care Improvement Act (25 U.S.C. 1611
et seq.) (as amended by section 101(b)) is amended by adding at the end
the following:
``SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE DEMONSTRATION
PROGRAMS.
``(a) Demonstration Programs.--The Secretary, acting through the
Service, may fund demonstration programs for Indian health programs to
address the chronic shortages of health professionals.
``(b) Purposes of Programs.--The purposes of demonstration programs
under subsection (a) shall be--
``(1) to provide direct clinical and practical experience
within an Indian health program to health profession students
and residents from medical schools;
``(2) to improve the quality of health care for Indians by
ensuring access to qualified health professionals;
``(3) to provide academic and scholarly opportunities for
health professionals serving Indians by identifying all
academic and scholarly resources of the region; and
``(4) to provide training and support for alternative
provider types, such as community health representatives, and
community health aides.
``(c) Advisory Board.--The demonstration programs established
pursuant to subsection (a) shall incorporate a program advisory board,
which may be composed of representatives of tribal governments, Indian
health programs, and Indian communities in the areas to be served by
the demonstration programs.''.
SEC. 113. EXEMPTION FROM PAYMENT OF CERTAIN FEES.
Title I of the Indian Health Care Improvement Act (25 U.S.C. 1611
et seq.) (as amended by section 112) is amended by adding at the end
the following:
``SEC. 124. EXEMPTION FROM PAYMENT OF CERTAIN FEES.
``Employees of a tribal health program or urban Indian organization
shall be exempt from payment of licensing, registration, and any other
fees imposed by a Federal agency to the same extent that officers of
the commissioned corps of the Public Health Service and other employees
of the Service are exempt from those fees.''.
Subtitle B--Health Services
SEC. 121. INDIAN HEALTH CARE IMPROVEMENT FUND.
Section 201 of the Indian Health Care Improvement Act (25 U.S.C.
1621) is amended to read as follows:
``SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND.
``(a) Use of Funds.--The Secretary, acting through the Service, is
authorized to expend funds, directly or under the authority of the
Indian Self-Determination and Education Assistance Act (25 U.S.C. 450
et seq.), which are appropriated under the authority of this section,
for the purposes of--
``(1) eliminating the deficiencies in health status and
health resources of all Indian tribes;
``(2) eliminating backlogs in the provision of health care
services to Indians;
``(3) meeting the health needs of Indians in an efficient
and equitable manner, including the use of telehealth and
telemedicine when appropriate;
``(4) eliminating inequities in funding for both direct
care and contract health service programs; and
``(5) augmenting the ability of the Service to meet the
following health service responsibilities with respect to those
Indian tribes with the highest levels of health status
deficiencies and resource deficiencies:
``(A) Clinical care, including inpatient care,
outpatient care (including audiology, clinical eye, and
vision care), primary care, secondary and tertiary
care, and long-term care.
``(B) Preventive health, including mammography and
other cancer screening.
``(C) Dental care.
``(D) Mental health, including community mental
health services, inpatient mental health services,
dormitory mental health services, therapeutic and
residential treatment centers, and training of
traditional health care practitioners.
``(E) Emergency medical services.
``(F) Treatment and control of, and rehabilitative
care related to, alcoholism and drug abuse (including
fetal alcohol syndrome) among Indians.
``(G) Injury prevention programs, including data
collection and evaluation, demonstration projects,
training, and capacity building.
``(H) Home health care.
``(I) Community health representatives.
``(J) Maintenance and improvement.
``(b) No Offset or Limitation.--Any funds appropriated under the
authority of this section shall not be used to offset or limit any
other appropriations made to the Service under this Act or the Act of
November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'),
or any other provision of law.
``(c) Allocation; Use.--
``(1) In general.--Funds appropriated under the authority
of this section shall be allocated to Service units, Indian
tribes, or tribal organizations. The funds allocated to each
Indian tribe, tribal organization, or Service unit under this
paragraph shall be used by the Indian tribe, tribal
organization, or Service unit under this paragraph to improve
the health status and reduce the resource deficiency of each
Indian tribe served by such Service unit, Indian tribe, or
tribal organization.
``(2) Apportionment of allocated funds.--The apportionment
of funds allocated to a Service unit, Indian tribe, or tribal
organization under paragraph (1) among the health service
responsibilities described in subsection (a)(5) shall be
determined by the Service in consultation with, and with the
active participation of, the affected Indian tribes and tribal
organizations.
``(d) Provisions Relating to Health Status and Resource
Deficiencies.--For the purposes of this section, the following
definitions apply:
``(1) Definition.--The term `health status and resource
deficiency' means the extent to which--
``(A) the health status objectives set forth in
sections 3(1) and 3(2) are not being achieved; and
``(B) the Indian tribe or tribal organization does
not have available to it the health resources it needs,
taking into account the actual cost of providing health
care services given local geographic, climatic, rural,
or other circumstances.
``(2) Available resources.--The health resources available
to an Indian tribe or tribal organization include health
resources provided by the Service as well as health resources
used by the Indian tribe or tribal organization, including
services and financing systems provided by any Federal
programs, private insurance, and programs of State or local
governments.
``(3) Process for review of determinations.--The Secretary
shall establish procedures which allow any Indian tribe or
tribal organization to petition the Secretary for a review of
any determination of the extent of the health status and
resource deficiency of such Indian tribe or tribal
organization.
``(e) Eligibility for Funds.--Tribal health programs shall be
eligible for funds appropriated under the authority of this section on
an equal basis with programs that are administered directly by the
Service.
``(f) Report.--By no later than the date that is 3 years after the
date of enactment of the Indian Healthcare Improvement Act of 2017, the
Secretary shall submit to Congress the current health status and
resource deficiency report of the Service for each Service unit,
including newly recognized or acknowledged Indian tribes. Such report
shall set out--
``(1) the methodology then in use by the Service for
determining tribal health status and resource deficiencies, as
well as the most recent application of that methodology;
``(2) the extent of the health status and resource
deficiency of each Indian tribe served by the Service or a
tribal health program;
``(3) the amount of funds necessary to eliminate the health
status and resource deficiencies of all Indian tribes served by
the Service or a tribal health program; and
``(4) an estimate of--
``(A) the amount of health service funds
appropriated under the authority of this Act, or any
other Act, including the amount of any funds
transferred to the Service for the preceding fiscal
year which is allocated to each Service unit, Indian
tribe, or tribal organization;
``(B) the number of Indians eligible for health
services in each Service unit or Indian tribe or tribal
organization; and
``(C) the number of Indians using the Service
resources made available to each Service unit, Indian
tribe or tribal organization, and, to the extent
available, information on the waiting lists and number
of Indians turned away for services due to lack of
resources.
``(g) Inclusion in Base Budget.--Funds appropriated under this
section for any fiscal year shall be included in the base budget of the
Service for the purpose of determining appropriations under this
section in subsequent fiscal years.
``(h) Clarification.--Nothing in this section is intended to
diminish the primary responsibility of the Service to eliminate
existing backlogs in unmet health care needs, nor are the provisions of
this section intended to discourage the Service from undertaking
additional efforts to achieve equity among Indian tribes and tribal
organizations.
``(i) Funding Designation.--Any funds appropriated under the
authority of this section shall be designated as the `Indian Health
Care Improvement Fund'.''.
SEC. 122. CATASTROPHIC HEALTH EMERGENCY FUND.
Section 202 of the Indian Health Care Improvement Act (25 U.S.C.
1621a) is amended to read as follows:
``SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND.
``(a) Establishment.--There is established an Indian Catastrophic
Health Emergency Fund (hereafter in this section referred to as the
`CHEF') consisting of--
``(1) the amounts deposited under subsection (f); and
``(2) the amounts appropriated to CHEF under this section.
``(b) Administration.--CHEF shall be administered by the Secretary,
acting through the headquarters of the Service, solely for the purpose
of meeting the extraordinary medical costs associated with the
treatment of victims of disasters or catastrophic illnesses who are
within the responsibility of the Service.
``(c) Conditions on Use of Fund.--No part of CHEF or its
administration shall be subject to contract or grant under any law,
including the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450 et seq.), nor shall CHEF funds be allocated,
apportioned, or delegated on an Area Office, Service Unit, or other
similar basis.
``(d) Regulations.--The Secretary shall promulgate regulations
consistent with the provisions of this section to--
``(1) establish a definition of disasters and catastrophic
illnesses for which the cost of the treatment provided under
contract would qualify for payment from CHEF;
``(2) provide that a Service Unit shall not be eligible for
reimbursement for the cost of treatment from CHEF until its
cost of treating any victim of such catastrophic illness or
disaster has reached a certain threshold cost which the
Secretary shall establish at--
``(A) the 2000 level of $19,000; and
``(B) for any subsequent year, not less than the
threshold cost of the previous year increased by the
percentage increase in the medical care expenditure
category of the consumer price index for all urban
consumers (United States city average) for the 12-month
period ending with December of the previous year;
``(3) establish a procedure for the reimbursement of the
portion of the costs that exceeds such threshold cost incurred
by--
``(A) Service Units; or
``(B) whenever otherwise authorized by the Service,
non-Service facilities or providers;
``(4) establish a procedure for payment from CHEF in cases
in which the exigencies of the medical circumstances warrant
treatment prior to the authorization of such treatment by the
Service; and
``(5) establish a procedure that will ensure that no
payment shall be made from CHEF to any provider of treatment to
the extent that such provider is eligible to receive payment
for the treatment from any other Federal, State, local, or
private source of reimbursement for which the patient is
eligible.
``(e) No Offset or Limitation.--Amounts appropriated to CHEF under
this section shall not be used to offset or limit appropriations made
to the Service under the authority of the Act of November 2, 1921 (25
U.S.C. 13) (commonly known as the `Snyder Act'), or any other law.
``(f) Deposit of Reimbursement Funds.--There shall be deposited
into CHEF all reimbursements to which the Service is entitled from any
Federal, State, local, or private source (including third party
insurance) by reason of treatment rendered to any victim of a disaster
or catastrophic illness the cost of which was paid from CHEF.''.
SEC. 123. DIABETES PREVENTION, TREATMENT, AND CONTROL.
Section 204 of the Indian Health Care Improvement Act (25 U.S.C.
1621c) is amended to read as follows:
``SEC. 204. DIABETES PREVENTION, TREATMENT, AND CONTROL.
``(a) Determinations Regarding Diabetes.--The Secretary, acting
through the Service, and in consultation with Indian tribes and tribal
organizations, shall determine--
``(1) by Indian tribe and by Service unit, the incidence
of, and the types of complications resulting from, diabetes
among Indians; and
``(2) based on the determinations made pursuant to
paragraph (1), the measures (including patient education and
effective ongoing monitoring of disease indicators) each
Service unit should take to reduce the incidence of, and
prevent, treat, and control the complications resulting from,
diabetes among Indian tribes within that Service unit.
``(b) Diabetes Screening.--To the extent medically indicated and
with informed consent, the Secretary shall screen each Indian who
receives services from the Service for diabetes and for conditions
which indicate a high risk that the individual will become diabetic and
establish a cost-effective approach to ensure ongoing monitoring of
disease indicators. Such screening and monitoring may be conducted by a
tribal health program and may be conducted through appropriate
Internet-based health care management programs.
``(c) Diabetes Projects.--The Secretary shall continue to maintain
each model diabetes project in existence on the date of enactment of
the Indian Healthcare Improvement Act of 2017, any such other diabetes
programs operated by the Service or tribal health programs, and any
additional diabetes projects, such as the Medical Vanguard program
provided for in title IV of Public Law 108-87, as implemented to serve
Indian tribes. tribal health programs shall receive recurring funding
for the diabetes projects that they operate pursuant to this section,
both at the date of enactment of the Indian Healthcare Improvement Act
of 2017 and for projects which are added and funded thereafter.
``(d) Dialysis Programs.--The Secretary is authorized to provide,
through the Service, Indian tribes, and tribal organizations, dialysis
programs, including the purchase of dialysis equipment and the
provision of necessary staffing.
``(e) Other Duties of the Secretary.--
``(1) In general.--The Secretary shall, to the extent
funding is available--
``(A) in each area office, consult with Indian
tribes and tribal organizations regarding programs for
the prevention, treatment, and control of diabetes;
``(B) establish in each area office a registry of
patients with diabetes to track the incidence of
diabetes and the complications from diabetes in that
area; and
``(C) ensure that data collected in each area
office regarding diabetes and related complications
among Indians are disseminated to all other area
offices, subject to applicable patient privacy laws.
``(2) Diabetes control officers.--
``(A) In general.--The Secretary may establish and
maintain in each area office a position of diabetes
control officer to coordinate and manage any activity
of that area office relating to the prevention,
treatment, or control of diabetes to assist the
Secretary in carrying out a program under this section
or section 330C of the Public Health Service Act (42
U.S.C. 254c-3).
``(B) Certain activities.--Any activity carried out
by a diabetes control officer under subparagraph (A)
that is the subject of a contract or compact under the
Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450 et seq.), and any funds made available
to carry out such an activity, shall not be divisible
for purposes of that Act.''.
SEC. 124. OTHER AUTHORITY FOR PROVISION OF SERVICES; SHARED SERVICES
FOR LONG-TERM CARE.
(a) Other Authority for Provision of Services.--
(1) In general.--Section 205 of the Indian Health Care
Improvement Act (25 U.S.C. 1621d) is amended to read as
follows:
``SEC. 205. OTHER AUTHORITY FOR PROVISION OF SERVICES.
``(a) Definitions.--In this section:
``(1) Assisted living service.--The term `assisted living
service' means any service provided by an assisted living
facility (as defined in section 232(b) of the National Housing
Act (12 U.S.C. 1715w(b))), except that such an assisted living
facility--
``(A) shall not be required to obtain a license;
but
``(B) shall meet all applicable standards for
licensure.
``(2) Home- and community-based service.--The term `home-
and community-based service' means 1 or more of the services
specified in paragraphs (1) through (9) of section 1929(a) of
the Social Security Act (42 U.S.C. 1396t(a)) (whether provided
by the Service or by an Indian tribe or tribal organization
pursuant to the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.)) that are or will be
provided in accordance with applicable standards.
``(3) Hospice care.--The term `hospice care' means--
``(A) the items and services specified in
subparagraphs (A) through (H) of section 1861(dd)(1) of
the Social Security Act (42 U.S.C. 1395x(dd)(1)); and
``(B) such other services as an Indian tribe or
tribal organization determines are necessary and
appropriate to provide in furtherance of that care.
``(4) Long-term care services.--The term `long-term care
services' has the meaning given the term `qualified long-term
care services' in section 7702B(c) of the Internal Revenue Code
of 1986.
``(b) Funding Authorized.--The Secretary, acting through the
Service, Indian tribes, and tribal organizations, may provide funding
under this Act to meet the objectives set forth in section 3 through
health care-related services and programs not otherwise described in
this Act for the following services:
``(1) Hospice care.
``(2) Assisted living services.
``(3) Long-term care services.
``(4) Home- and community-based services.
``(c) Eligibility.--The following individuals shall be eligible to
receive long-term care services under this section:
``(1) Individuals who are unable to perform a certain
number of activities of daily living without assistance.
``(2) Individuals with a mental impairment, such as
dementia, Alzheimer's disease, or another disabling mental
illness, who may be able to perform activities of daily living
under supervision.
``(3) Such other individuals as an applicable tribal health
program determines to be appropriate.
``(d) Authorization of Convenient Care Services.--The Secretary,
acting through the Service, Indian tribes, and tribal organizations,
may also provide funding under this Act to meet the objectives set
forth in section 3 for convenient care services programs pursuant to
section 307(c)(2)(A).''.
(2) Repeal.--Section 821 of the Indian Health Care
Improvement Act (25 U.S.C. 1680k) is repealed.
(b) Shared Services for Long-Term Care.--Section 822 of the Indian
Health Care Improvement Act (25 U.S.C. 1680l) is amended to read as
follows:
``SEC. 822. SHARED SERVICES FOR LONG-TERM CARE.
``(a) Long-Term Care.--
``(1) In general.--Notwithstanding any other provision of
law, the Secretary, acting through the Service, is authorized
to provide directly, or enter into contracts or compacts under
the Indian Self-Determination and Education Assistance Act (25
U.S.C. 450 et seq.) with Indian tribes or tribal organizations
for, the delivery of long-term care (including health care
services associated with long-term care) provided in a facility
to Indians.
``(2) Inclusions.--Each agreement under paragraph (1) shall
provide for the sharing of staff or other services between the
Service or a tribal health program and a long-term care or
related facility owned and operated (directly or through a
contract or compact under the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.)) by the Indian
tribe or tribal organization.
``(b) Contents of Agreements.--An agreement entered into pursuant
to subsection (a)--
``(1) may, at the request of the Indian tribe or tribal
organization, delegate to the Indian tribe or tribal
organization such powers of supervision and control over
Service employees as the Secretary determines to be necessary
to carry out the purposes of this section;
``(2) shall provide that expenses (including salaries)
relating to services that are shared between the Service and
the tribal health program be allocated proportionately between
the Service and the Indian tribe or tribal organization; and
``(3) may authorize the Indian tribe or tribal organization
to construct, renovate, or expand a long-term care or other
similar facility (including the construction of a facility
attached to a Service facility).
``(c) Minimum Requirement.--Any nursing facility provided for under
this section shall meet the requirements for nursing facilities under
section 1919 of the Social Security Act (42 U.S.C. 1396r).
``(d) Other Assistance.--The Secretary shall provide such technical
and other assistance as may be necessary to enable applicants to comply
with this section.
``(e) Use of Existing or Underused Facilities.--The Secretary shall
encourage the use of existing facilities that are underused, or allow
the use of swing beds, for long-term or similar care.''.
SEC. 125. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS OF HEALTH
SERVICES.
Section 206 of the Indian Health Care Improvement Act (25 U.S.C.
1621e) is amended to read as follows:
``SEC. 206. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS OF HEALTH
SERVICES.
``(a) Right of Recovery.--Except as provided in subsection (f), the
United States, an Indian tribe, or tribal organization shall have the
right to recover from an insurance company, health maintenance
organization, employee benefit plan, third-party tortfeasor, or any
other responsible or liable third party (including a political
subdivision or local governmental entity of a State) the reasonable
charges billed by the Secretary, an Indian tribe, or tribal
organization in providing health services through the Service, an
Indian tribe, or tribal organization, or, if higher, the highest amount
the third party would pay for care and services furnished by providers
other than governmental entities, to any individual to the same extent
that such individual, or any nongovernmental provider of such services,
would be eligible to receive damages, reimbursement, or indemnification
for such charges or expenses if--
``(1) such services had been provided by a nongovernmental
provider; and
``(2) such individual had been required to pay such charges
or expenses and did pay such charges or expenses.
``(b) Limitations on Recoveries From States.--Subsection (a) shall
provide a right of recovery against any State, only if the injury,
illness, or disability for which health services were provided is
covered under--
``(1) workers' compensation laws; or
``(2) a no-fault automobile accident insurance plan or
program.
``(c) Nonapplicability of Other Laws.--No law of any State, or of
any political subdivision of a State and no provision of any contract,
insurance or health maintenance organization policy, employee benefit
plan, self-insurance plan, managed care plan, or other health care plan
or program entered into or renewed after the date of enactment of the
Indian Health Care Amendments of 1988, shall prevent or hinder the
right of recovery of the United States, an Indian tribe, or tribal
organization under subsection (a).
``(d) No Effect on Private Rights of Action.--No action taken by
the United States, an Indian tribe, or tribal organization to enforce
the right of recovery provided under this section shall operate to deny
to the injured person the recovery for that portion of the person's
damage not covered hereunder.
``(e) Enforcement.--
``(1) In general.--The United States, an Indian tribe, or
tribal organization may enforce the right of recovery provided
under subsection (a) by--
``(A) intervening or joining in any civil action or
proceeding brought--
``(i) by the individual for whom health
services were provided by the Secretary, an
Indian tribe, or tribal organization; or
``(ii) by any representative or heirs of
such individual, or
``(B) instituting a separate civil action,
including a civil action for injunctive relief and
other relief and including, with respect to a political
subdivision or local governmental entity of a State,
such an action against an official thereof.
``(2) Notice.--All reasonable efforts shall be made to
provide notice of action instituted under paragraph (1)(B) to
the individual to whom health services were provided, either
before or during the pendency of such action.
``(3) Recovery from tortfeasors.--
``(A) In general.--In any case in which an Indian
tribe or tribal organization that is authorized or
required under a compact or contract issued pursuant to
the Indian Self-Determination and Education Assistance
Act (25 U.S.C. 450 et seq.) to furnish or pay for
health services to a person who is injured or suffers a
disease on or after the date of enactment of the Indian
Healthcare Improvement Act of 2017 under circumstances
that establish grounds for a claim of liability against
the tortfeasor with respect to the injury or disease,
the Indian tribe or tribal organization shall have a
right to recover from the tortfeasor (or an insurer of
the tortfeasor) the reasonable value of the health
services so furnished, paid for, or to be paid for, in
accordance with the Federal Medical Care Recovery Act
(42 U.S.C. 2651 et seq.), to the same extent and under
the same circumstances as the United States may recover
under that Act.
``(B) Treatment.--The right of an Indian tribe or
tribal organization to recover under subparagraph (A)
shall be independent of the rights of the injured or
diseased person served by the Indian tribe or tribal
organization.
``(f) Limitation.--Absent specific written authorization by the
governing body of an Indian tribe for the period of such authorization
(which may not be for a period of more than 1 year and which may be
revoked at any time upon written notice by the governing body to the
Service), the United States shall not have a right of recovery under
this section if the injury, illness, or disability for which health
services were provided is covered under a self-insurance plan funded by
an Indian tribe, tribal organization, or urban Indian organization.
Where such authorization is provided, the Service may receive and
expend such amounts for the provision of additional health services
consistent with such authorization.
``(g) Costs and Attorney's Fees.--In any action brought to enforce
the provisions of this section, a prevailing plaintiff shall be awarded
its reasonable attorney's fees and costs of litigation.
``(h) Nonapplicability of Claims Filing Requirements.--An insurance
company, health maintenance organization, self-insurance plan, managed
care plan, or other health care plan or program (under the Social
Security Act or otherwise) may not deny a claim for benefits submitted
by the Service or by an Indian tribe or tribal organization based on
the format in which the claim is submitted if such format complies with
the format required for submission of claims under title XVIII of the
Social Security Act or recognized under section 1175 of such Act.
``(i) Application to Urban Indian Organizations.--The previous
provisions of this section shall apply to urban Indian organizations
with respect to populations served by such Organizations in the same
manner they apply to Indian tribes and tribal organizations with
respect to populations served by such Indian tribes and tribal
organizations.
``(j) Statute of Limitations.--The provisions of section 2415 of
title 28, United States Code, shall apply to all actions commenced
under this section, and the references therein to the United States are
deemed to include Indian tribes, tribal organizations, and urban Indian
organizations.
``(k) Savings.--Nothing in this section shall be construed to limit
any right of recovery available to the United States, an Indian tribe,
or tribal organization under the provisions of any applicable, Federal,
State, or tribal law, including medical lien laws.''.
SEC. 126. CREDITING OF REIMBURSEMENTS.
Section 207 of the Indian Health Care Improvement Act (25 U.S.C.
1621f) is amended to read as follows:
``SEC. 207. CREDITING OF REIMBURSEMENTS.
``(a) Use of Amounts.--
``(1) Retention by program.--Except as provided in sections
202(a)(2) and 813, all reimbursements received or recovered
under any of the programs described in paragraph (2), including
under section 813, by reason of the provision of health
services by the Service, by an Indian tribe or tribal
organization, or by an urban Indian organization, shall be
credited to the Service, such Indian tribe or tribal
organization, or such urban Indian organization, respectively,
and may be used as provided in section 401. In the case of such
a service provided by or through a Service Unit, such amounts
shall be credited to such unit and used for such purposes.
``(2) Programs covered.--The programs referred to in
paragraph (1) are the following:
``(A) Titles XVIII, XIX, and XXI of the Social
Security Act.
``(B) This Act, including section 813.
``(C) Public Law 87-693.
``(D) Any other provision of law.
``(b) No Offset of Amounts.--The Service may not offset or limit
any amount obligated to any Service Unit or entity receiving funding
from the Service because of the receipt of reimbursements under
subsection (a).''.
SEC. 127. BEHAVIORAL HEALTH TRAINING AND COMMUNITY EDUCATION PROGRAMS.
Section 209 of the Indian Health Care Improvement Act (25 U.S.C.
1621h) is amended by striking subsection (d) and inserting the
following:
``(d) Behavioral Health Training and Community Education
Programs.--
``(1) Study; list.--The Secretary, acting through the
Service, and the Secretary of the Interior, in consultation
with Indian tribes and tribal organizations, shall conduct a
study and compile a list of the types of staff positions
specified in paragraph (2) whose qualifications include, or
should include, training in the identification, prevention,
education, referral, or treatment of mental illness, or
dysfunctional and self destructive behavior.
``(2) Positions.--The positions referred to in paragraph
(1) are--
``(A) staff positions within the Bureau of Indian
Affairs, including existing positions, in the fields
of--
``(i) elementary and secondary education;
``(ii) social services and family and child
welfare;
``(iii) law enforcement and judicial
services; and
``(iv) alcohol and substance abuse;
``(B) staff positions within the Service; and
``(C) staff positions similar to those identified
in subparagraphs (A) and (B) established and maintained
by Indian tribes and tribal organizations (without
regard to the funding source).
``(3) Training criteria.--
``(A) In general.--The appropriate Secretary shall
provide training criteria appropriate to each type of
position identified in paragraphs (2)(A) and (2)(B) 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 paragraph (2)(C), the respective
Secretaries shall provide appropriate training to, or
provide funds to, an Indian tribe or tribal
organization for training of appropriate individuals.
In the case of positions funded under a contract or
compact under the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.), the
appropriate Secretary shall ensure that such training
costs are included in the contract or compact, as the
Secretary determines necessary.
``(B) Position specific training criteria.--
Position specific training criteria shall be culturally
relevant to Indians and Indian tribes and shall ensure
that appropriate information regarding traditional
health care practices is provided.
``(4) Community education on mental illness.--The Service
shall develop and implement, on request of an Indian tribe,
tribal organization, or urban Indian organization, or assist
the Indian tribe, tribal organization, or urban Indian
organization to develop and implement, a program of community
education on mental illness. In carrying out this paragraph,
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.
``(5) Plan.--Not later than 90 days after the date of
enactment of the Indian Healthcare Improvement Act of 2017, 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 that Act, with at least 200 of such
positions devoted to child, adolescent, and family services.
The plan developed under this paragraph shall be implemented
under the Act of November 2, 1921 (25 U.S.C. 13) (commonly
known as the `Snyder Act').''.
SEC. 128. CANCER SCREENINGS.
Section 212 of the Indian Health Care Improvement Act (25 U.S.C.
1621k) is amended by inserting ``and other cancer screenings'' before
the period at the end.
SEC. 129. PATIENT TRAVEL COSTS.
Section 213 of the Indian Health Care Improvement Act (25 U.S.C.
1621l) is amended to read as follows:
``SEC. 213. PATIENT TRAVEL COSTS.
``(a) Definition of Qualified Escort.--In this section, the term
`qualified escort' means--
``(1) an adult escort (including a parent, guardian, or
other family member) who is required because of the physical or
mental condition, or age, of the applicable patient;
``(2) a health professional for the purpose of providing
necessary medical care during travel by the applicable patient;
or
``(3) other escorts, as the Secretary or applicable Indian
Health Program determines to be appropriate.
``(b) Provision of Funds.--The Secretary, acting through the
Service and Tribal Health Programs, is authorized to provide funds for
the following patient travel costs, including qualified escorts,
associated with receiving health care services provided (either through
direct or contract care or through a contract or compact under the
Indian Self-Determination and Education Assistance Act (25 U.S.C. 450
et seq.)) under this Act--
``(1) emergency air transportation and non-emergency air
transportation where ground transportation is infeasible;
``(2) transportation by private vehicle (where no other
means of transportation is available), specially equipped
vehicle, and ambulance; and
``(3) transportation by such other means as may be
available and required when air or motor vehicle transportation
is not available.''.
SEC. 130. EPIDEMIOLOGY CENTERS.
Section 214 of the Indian Health Care Improvement Act (25 U.S.C.
1621m) is amended to read as follows:
``SEC. 214. EPIDEMIOLOGY CENTERS.
``(a) Establishment of Centers.--
``(1) In general.--The Secretary shall establish an
epidemiology center in each Service area to carry out the
functions described in subsection (b).
``(2) New centers.--
``(A) In general.--Subject to subparagraph (B), any
new center established after the date of enactment of
the Indian Healthcare Improvement Act of 2017 may be
operated under a grant authorized by subsection (d).
``(B) Requirement.--Funding provided in a grant
described in subparagraph (A) shall not be divisible.
``(3) Funds not divisible.--An epidemiology center
established under this subsection shall be subject to the
Indian Self-Determination and Education Assistance Act (25
U.S.C. 450 et seq.), but the funds for the center shall not be
divisible.
``(b) Functions of Centers.--In consultation with and on the
request of Indian tribes, tribal organizations, and urban Indian
organizations, each Service area epidemiology center established under
this section shall, with respect to the applicable Service area--
``(1) collect data relating to, and monitor progress made
toward meeting, each of the health status objectives of the
Service, the Indian tribes, tribal organizations, and urban
Indian organizations in the Service area;
``(2) evaluate existing delivery systems, data systems, and
other systems that impact the improvement of Indian health;
``(3) assist Indian tribes, tribal organizations, and urban
Indian organizations in identifying highest-priority health
status objectives and the services needed to achieve those
objectives, based on epidemiological data;
``(4) make recommendations for the targeting of services
needed by the populations served;
``(5) make recommendations to improve health care delivery
systems for Indians and urban Indians;
``(6) provide requested technical assistance to Indian
tribes, tribal organizations, and urban Indian organizations in
the development of local health service priorities and
incidence and prevalence rates of disease and other illness in
the community; and
``(7) provide disease surveillance and assist Indian
tribes, tribal organizations, and urban Indian communities to
promote public health.
``(c) Technical Assistance.--The Director of the Centers for
Disease Control and Prevention shall provide technical assistance to
the centers in carrying out this section.
``(d) Grants for Studies.--
``(1) In general.--The Secretary may make grants to Indian
tribes, tribal organizations, Indian organizations, and
eligible intertribal consortia to conduct epidemiological
studies of Indian communities.
``(2) Eligible intertribal consortia.--An intertribal
consortium or Indian organization shall be eligible to receive
a grant under this subsection if the intertribal consortium
is--
``(A) incorporated for the primary purpose of
improving Indian health; and
``(B) representative of the Indian tribes or urban
Indian communities residing in the area in which the
intertribal consortium is located.
``(3) Applications.--An application for a grant under this
subsection shall be submitted in such manner and at such time
as the Secretary shall prescribe.
``(4) Requirements.--An applicant for a grant under this
subsection shall--
``(A) demonstrate the technical, administrative,
and financial expertise necessary to carry out the
functions described in paragraph (5);
``(B) consult and cooperate with providers of
related health and social services in order to avoid
duplication of existing services; and
``(C) demonstrate cooperation from Indian tribes or
urban Indian organizations in the area to be served.
``(5) Use of funds.--A grant provided under paragraph (1)
may be used--
``(A) to carry out the functions described in
subsection (b);
``(B) to provide information to, and consult with,
tribal leaders, urban Indian community leaders, and
related health staff regarding health care and health
service management issues; and
``(C) in collaboration with Indian tribes, tribal
organizations, and urban Indian organizations, to
provide to the Service information regarding ways to
improve the health status of Indians.
``(e) Access to Information.--
``(1) In general.--An epidemiology center operated by a
grantee pursuant to a grant awarded under subsection (d) shall
be treated as a public health authority (as defined in section
164.501 of title 45, Code of Federal Regulations (or a
successor regulation)) for purposes of the Health Insurance
Portability and Accountability Act of 1996 (Public Law 104-191;
110 Stat. 1936).
``(2) Access to information.--The Secretary shall grant to
each epidemiology center described in paragraph (1) access to
use of the data, data sets, monitoring systems, delivery
systems, and other protected health information in the
possession of the Secretary.
``(3) Requirement.--The activities of an epidemiology
center described in paragraph (1) shall be for the purposes of
research and for preventing and controlling disease, injury, or
disability (as those activities are described in section
164.512 of title 45, Code of Federal Regulations (or a
successor regulation)), for purposes of the Health Insurance
Portability and Accountability Act of 1996 (Public Law104-191;
110 Stat. 1936).''.
SEC. 131. INDIAN YOUTH GRANT PROGRAM.
Section 216(b)(2) of the Indian Health Care Improvement Act (25
U.S.C. 1621o(b)(2)) is amended by striking ``section 209(m)'' and
inserting ``section 708(c)''.
SEC. 132. AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM.
Section 217 of the Indian Health Care Improvement Act (25 U.S.C.
1621p) is amended to read as follows:
``SEC. 217. AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM.
``(a) Grants Authorized.--The Secretary, acting through the
Service, shall make grants of not more than $300,000 to each of 9
colleges and universities for the purpose of developing and maintaining
Indian psychology career recruitment programs as a means of encouraging
Indians to enter the behavioral health field. These programs shall be
located at various locations throughout the country to maximize their
availability to Indian students and new programs shall be established
in different locations from time to time.
``(b) Quentin N. Burdick Program Grant.--The Secretary shall
provide a grant authorized under subsection (a) to develop and maintain
a program at the University of North Dakota to be known as the `Quentin
N. Burdick American Indians Into Psychology Program'. Such program
shall, to the maximum extent feasible, coordinate with the Quentin N.
Burdick Indian health programs authorized under section 117(b), the
Quentin N. Burdick American Indians Into Nursing Program authorized
under section 115(e), and existing university research and
communications networks.
``(c) Regulations.--The Secretary shall issue regulations pursuant
to this Act for the competitive awarding of grants provided under this
section.
``(d) Conditions of Grant.--Applicants under this section shall
agree to provide a program which, at a minimum--
``(1) provides outreach and recruitment for health
professions to Indian communities including elementary,
secondary, and accredited and accessible community colleges
that will be served by the program;
``(2) incorporates a program advisory board comprised of
representatives from the tribes and communities that will be
served by the program;
``(3) provides summer enrichment programs to expose Indian
students to the various fields of psychology through research,
clinical, and experimental activities;
``(4) provides stipends to undergraduate and graduate
students to pursue a career in psychology;
``(5) develops affiliation agreements with tribal colleges
and universities, the Service, university affiliated programs,
and other appropriate accredited and accessible entities to
enhance the education of Indian students;
``(6) to the maximum extent feasible, uses existing
university tutoring, counseling, and student support services;
and
``(7) to the maximum extent feasible, employs qualified
Indians in the program.
``(e) Active Duty Service Requirement.--The active duty service
obligation prescribed under section 338C of the Public Health Service
Act (42 U.S.C. 254m) shall be met by each graduate who receives a
stipend described in subsection (d)(4) that is funded under this
section. Such obligation shall be met by service--
``(1) in an Indian health program;
``(2) in a program assisted under title V; or
``(3) in the private practice of psychology if, as
determined by the Secretary, in accordance with guidelines
promulgated by the Secretary, such practice is situated in a
physician or other health professional shortage area and
addresses the health care needs of a substantial number of
Indians.
``(f) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $2,700,000 for fiscal year 2017
and each fiscal year thereafter.''.
SEC. 133. PREVENTION, CONTROL, AND ELIMINATION OF COMMUNICABLE AND
INFECTIOUS DISEASES.
Section 218 of the Indian Health Care Improvement Act (25 U.S.C.
1621q) is amended to read as follows:
``SEC. 218. PREVENTION, CONTROL, AND ELIMINATION OF COMMUNICABLE AND
INFECTIOUS DISEASES.
``(a) Grants Authorized.--The Secretary, acting through the
Service, and after consultation with the Centers for Disease Control
and Prevention, may make grants available to Indian tribes and tribal
organizations for the following:
``(1) Projects for the prevention, control, and elimination
of communicable and infectious diseases, including
tuberculosis, hepatitis, HIV, respiratory syncytial virus,
hanta virus, sexually transmitted diseases, and H. pylori.
``(2) Public information and education programs for the
prevention, control, and elimination of communicable and
infectious diseases.
``(3) Education, training, and clinical skills improvement
activities in the prevention, control, and elimination of
communicable and infectious diseases for health professionals,
including allied health professionals.
``(4) Demonstration projects for the screening, treatment,
and prevention of hepatitis C virus (HCV).
``(b) Application Required.--The Secretary may provide funding
under subsection (a) only if an application or proposal for funding is
submitted to the Secretary.
``(c) Coordination With Health Agencies.--Indian tribes and tribal
organizations receiving funding under this section are encouraged to
coordinate their activities with the Centers for Disease Control and
Prevention and State and local health agencies.
``(d) Technical Assistance; Report.--In carrying out this section,
the Secretary--
``(1) may, at the request of an Indian tribe or tribal
organization, provide technical assistance; and
``(2) shall prepare and submit a report to Congress
biennially on the use of funds under this section and on the
progress made toward the prevention, control, and elimination
of communicable and infectious diseases among Indians and urban
Indians.''.
SEC. 134. METHODS TO INCREASE CLINICIAN RECRUITMENT AND RETENTION
ISSUES.
(a) Licensing.--Section 221 of the Indian Health Care Improvement
Act (25 U.S.C. 1621t) is amended to read as follows:
``SEC. 221. LICENSING.
``Licensed health professionals employed by a tribal health program
shall be exempt, if licensed in any State, from the licensing
requirements of the State in which the tribal health program performs
the services described in the contract or compact of the tribal health
program under the Indian Self-Determination and Education Assistance
Act (25 U.S.C. 450 et seq.).''.
(b) Continuing Education Allowances.--Section 106 of the Indian
Health Care Improvement Act (25 U.S.C. 1615) is amended to read as
follows:
``SEC. 106. CONTINUING EDUCATION ALLOWANCES.
``In order to encourage scholarship and stipend recipients under
sections 104, 105, and 115 and health professionals, including
community health representatives and emergency medical technicians, to
join or continue in an Indian health program and to provide services in
the rural and remote areas in which a significant portion of Indians
reside, the Secretary, acting through the Service, may--
``(1) provide programs or allowances to transition into an
Indian health program, including licensing, board or
certification examination assistance, and technical assistance
in fulfilling service obligations under sections 104, 105, and
115; and
``(2) provide programs or allowances to health
professionals employed in an Indian health program to enable
those professionals, for a period of time each year prescribed
by regulation of the Secretary, to take leave of the duty
stations of the professionals for professional consultation,
management, leadership, and refresher training courses.''.
SEC. 135. LIABILITY FOR PAYMENT.
Section 222 of the Indian Health Care Improvement Act (25 U.S.C.
1621u) is amended to read as follows:
``SEC. 222. LIABILITY FOR PAYMENT.
``(a) No Patient Liability.--A patient who receives contract health
care services that are authorized by the Service shall not be liable
for the payment of any charges or costs associated with the provision
of such services.
``(b) Notification.--The Secretary shall notify a contract care
provider and any patient who receives contract health care services
authorized by the Service that such patient is not liable for the
payment of any charges or costs associated with the provision of such
services not later than 5 business days after receipt of a notification
of a claim by a provider of contract care services.
``(c) No Recourse.--Following receipt of the notice provided under
subsection (b), or, if a claim has been deemed accepted under section
220(b), the provider shall have no further recourse against the patient
who received the services.''.
SEC. 136. OFFICES OF INDIAN MEN'S HEALTH AND INDIAN WOMEN'S HEALTH.
Section 223 of the Indian Health Care Improvement Act (25 U.S.C.
1621v) is amended--
(1) by striking the section designation and heading and all
that follows through ``oversee efforts of the Service to'' and
inserting the following:
``SEC. 223. OFFICES OF INDIAN MEN'S HEALTH AND INDIAN WOMEN'S HEALTH.
``(a) Office of Indian Men's Health.--
``(1) Establishment.--The Secretary may establish within
the Service an office, to be known as the `Office of Indian
Men's Health'.
``(2) Director.--
``(A) In general.--The Office of Indian Men's
Health shall be headed by a director, to be appointed
by the Secretary.
``(B) Duties.--The director shall coordinate and
promote the health status of Indian men in the United
States.
``(3) Report.--Not later than 2 years after the date of
enactment of theIndian Healthcare Improvement Act of 2017, the
Secretary, acting through the Service, shall submit to Congress
a report describing--
``(A) any activity carried out by the director as
of the date on which the report is prepared; and
``(B) any finding of the director with respect to
the health of Indian men.
``(b) Office of Indian Women's Health.--The Secretary, acting
through the Service, shall establish an office, to be known as the
`Office of Indian Women's Health', to''; and
(2) in subsection (b) (as so redesignated) by inserting
``(including urban Indian women)'' before ``of all ages''.
SEC. 137. CONTRACT HEALTH SERVICE ADMINISTRATION AND DISBURSEMENT
FORMULA.
Title II of the Indian Health Care Improvement Act (25 U.S.C. 1621
et seq.) is amended by adding at the end the following:
``SEC. 226. CONTRACT HEALTH SERVICE ADMINISTRATION AND DISBURSEMENT
FORMULA.
``(a) Submission of Report.--As soon as practicable after the date
of enactment of the Indian Healthcare Improvement Act of 2017, the
Comptroller General of the United States shall submit to the Secretary,
the Committee on Indian Affairs of the Senate, and the Committee on
Natural Resources of the House of Representatives, and make available
to each Indian tribe, a report describing the results of the study of
the Comptroller General regarding the funding of the contract health
service program (including historic funding levels and a recommendation
of the funding level needed for the program) and the administration of
the contract health service program (including the distribution of
funds pursuant to the program), as requested by Congress in March 2009,
or pursuant to section 830.
``(b) Consultation With Tribes.--On receipt of the report under
subsection (a), the Secretary shall consult with Indian tribes
regarding the contract health service program, including the
distribution of funds pursuant to the program--
``(1) to determine whether the current distribution formula
would require modification if the contract health service
program were funded at the level recommended by the Comptroller
General;
``(2) to identify any inequities in the current
distribution formula under the current funding level or
inequitable results for any Indian tribe under the funding
level recommended by the Comptroller General;
``(3) to identify any areas of program administration that
may result in the inefficient or ineffective management of the
program; and
``(4) to identify any other issues and recommendations to
improve the administration of the contract health services
program and correct any unfair results or funding disparities
identified under paragraph (2).
``(c) Subsequent Action by Secretary.--If, after consultation with
Indian tribes under subsection (b), the Secretary determines that any
issue described in subsection (b)(2) exists, the Secretary may initiate
procedures under subchapter III of chapter 5 of title 5, United States
Code, to negotiate or promulgate regulations to establish a
disbursement formula for the contract health service program
funding.''.
Subtitle C--Health Facilities
SEC. 141. HEALTH CARE FACILITY PRIORITY SYSTEM.
Section 301 of the Indian Health Care Improvement Act (25 U.S.C.
1631) is amended--
(1) by redesignating subsection (d) as subsection (h); and
(2) by striking subsection (c) and inserting the following:
``(c) Health Care Facility Priority System.--
``(1) In general.--
``(A) Priority system.--The Secretary, acting
through the Service, shall maintain a health care
facility priority system, which--
``(i) shall be developed in consultation
with Indian tribes and tribal organizations;
``(ii) shall give Indian tribes' needs the
highest priority;
``(iii)(I) may include the lists required
in paragraph (2)(B)(ii); and
``(II) shall include the methodology
required in paragraph (2)(B)(v); and
``(III) may include such health care
facilities, and such renovation or expansion
needs of any health care facility, as the
Service may identify; and
``(iv) shall provide an opportunity for the
nomination of planning, design, and
construction projects by the Service, Indian
tribes, and tribal organizations for
consideration under the priority system at
least once every 3 years, or more frequently as
the Secretary determines to be appropriate.
``(B) Needs of facilities under isdeaa
agreements.--The Secretary shall ensure that the
planning, design, construction, renovation, and
expansion needs of Service and non-Service facilities
operated under contracts or compacts in accordance with
the Indian Self-Determination and Education Assistance
Act (25 U.S.C. 450 et seq.) are fully and equitably
integrated into the health care facility priority
system.
``(C) Criteria for evaluating needs.--For purposes
of this subsection, the Secretary, in evaluating the
needs of facilities operated under a contract or
compact under the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.), shall
use the criteria used by the Secretary in evaluating
the needs of facilities operated directly by the
Service.
``(D) Priority of certain projects protected.--The
priority of any project established under the
construction priority system in effect on the date of
enactment of the Indian Healthcare Improvement Act of
2017 shall not be affected by any change in the
construction priority system taking place after that
date if the project--
``(i) was identified in the fiscal year
2008 Service budget justification as--
``(I) 1 of the 10 top-priority
inpatient projects;
``(II) 1 of the 10 top-priority
outpatient projects;
``(III) 1 of the 10 top-priority
staff quarters developments; or
``(IV) 1 of the 10 top-priority
Youth Regional Treatment Centers;
``(ii) had completed both Phase I and Phase
II of the construction priority system in
effect on the date of enactment of such Act; or
``(iii) is not included in clause (i) or
(ii) and is selected, as determined by the
Secretary--
``(I) on the initiative of the
Secretary; or
``(II) pursuant to a request of an
Indian tribe or tribal organization.
``(2) Report; contents.--
``(A) Initial comprehensive report.--
``(i) Definitions.--In this subparagraph:
``(I) Facilities appropriation
advisory board.--The term `Facilities
Appropriation Advisory Board' means the
advisory board, comprised of 12 members
representing Indian tribes and 2
members representing the Service,
established at the discretion of the
Director--
``(aa) to provide advice
and recommendations for
policies and procedures of the
programs funded pursuant to
facilities appropriations; and
``(bb) to address other
facilities issues.
``(II) Facilities needs assessment
workgroup.--The term `Facilities Needs
Assessment Workgroup' means the
workgroup established at the discretion
of the Director--
``(aa) to review the health
care facilities construction
priority system; and
``(bb) to make
recommendations to the
Facilities Appropriation
Advisory Board for revising the
priority system.
``(ii) Initial report.--
``(I) In general.--Not later than 1
year after the date of enactment of the
Indian Healthcare Improvement Act of
2017, 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
the comprehensive, national, ranked
list of all health care facilities
needs for the Service, Indian tribes,
and tribal organizations (including
inpatient health care facilities,
outpatient health care facilities,
specialized health care facilities
(such as for long-term care and alcohol
and drug abuse treatment), wellness
centers, and staff quarters, and the
renovation and expansion needs, if any,
of such facilities) developed by the
Service, Indian tribes, and tribal
organizations for the Facilities Needs
Assessment Workgroup and the Facilities
Appropriation Advisory Board.
``(II) Inclusions.--The initial
report shall include--
``(aa) the methodology and
criteria used by the Service in
determining the needs and
establishing the ranking of the
facilities needs; and
``(bb) such other
information as the Secretary
determines to be appropriate.
``(iii) Updates of report.--Beginning in
calendar year 2017, the Secretary shall--
``(I) update the report under
clause (ii) not less frequently that
once every 5 years; and
``(II) include the updated report
in the appropriate annual report under
subparagraph (B) for submission to
Congress under section 801.
``(B) Annual reports.--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:
``(i) A description of the health care
facility priority system of the Service
established under paragraph (1).
``(ii) Health care facilities lists, which
may include--
``(I) the 10 top-priority inpatient
health care facilities;
``(II) the 10 top-priority
outpatient health care facilities;
``(III) the 10 top-priority
specialized health care facilities
(such as long-term care and alcohol and
drug abuse treatment); and
``(IV) the 10 top-priority staff
quarters developments associated with
health care facilities.
``(iii) The justification for such order of
priority.
``(iv) The projected cost of such projects.
``(v) The methodology adopted by the
Service in establishing priorities under its
health care facility priority system.
``(3) Requirements for preparation of reports.--In
preparing the report required under paragraph (2), the
Secretary shall--
``(A) consult with and obtain information on all
health care facilities needs from Indian tribes and
tribal organizations; and
``(B) review the total unmet needs of all Indian
tribes and tribal organizations for health care
facilities (including staff quarters), including needs
for renovation and expansion of existing facilities.
``(d) Review of Methodology Used for Health Facilities Construction
Priority System.--
``(1) In general.--Not later than 1 year after the
establishment of the priority system under subsection
(c)(1)(A), the Comptroller General of the United States shall
prepare and finalize a report reviewing the methodologies
applied, and the processes followed, by the Service in making
each assessment of needs for the list under subsection
(c)(2)(A)(ii) and developing the priority system under
subsection (c)(1), including a review of--
``(A) the recommendations of the Facilities
Appropriation Advisory Board and the Facilities Needs
Assessment Workgroup (as those terms are defined in
subsection (c)(2)(A)(i)); and
``(B) the relevant criteria used in ranking or
prioritizing facilities other than hospitals or
clinics.
``(2) Submission to congress.--The Comptroller General of
the United States shall submit the report under paragraph (1)
to--
``(A) the Committees on Indian Affairs and
Appropriations of the Senate;
``(B) the Committees on Natural Resources and
Appropriations of the House of Representatives; and
``(C) the Secretary.
``(e) Funding Condition.--All funds appropriated under the Act of
November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'),
for the planning, design, construction, or renovation of health
facilities for the benefit of 1 or more Indian Tribes shall be subject
to the provisions of section 102 of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450f) or sections 504 and 505 of
that Act (25 U.S.C. 458aaa-3, 458aaa-4).
``(f) Development of Innovative Approaches.--The Secretary shall
consult and cooperate with Indian tribes and tribal organizations, and
confer with urban Indian organizations, in developing innovative
approaches to address all or part of the total unmet need for
construction of health facilities, that may include--
``(1) the establishment of an area distribution fund in
which a portion of health facility construction funding could
be devoted to all Service areas;
``(2) approaches provided for in other provisions of this
title; and
``(3) other approaches, as the Secretary determines to be
appropriate.''.
SEC. 142. PRIORITY OF CERTAIN PROJECTS PROTECTED.
Section 301 of the Indian Health Care Improvement Act (25 U.S.C.
1631) (as amended by section 141) is amended by adding at the end the
following:
``(g) Priority of Certain Projects Protected.--The priority of any
project established under the construction priority system in effect on
the date of enactment of this Indian Healthcare Improvement Act of 2017
shall not be affected by any change in the construction priority system
taking place after that date if the project--
``(1) was identified in the fiscal year 2008 Service budget
justification as--
``(A) 1 of the 10 top-priority inpatient projects;
``(B) 1 of the 10 top-priority outpatient projects;
``(C) 1 of the 10 top-priority staff quarters
developments; or
``(D) 1 of the 10 top-priority Youth Regional
Treatment Centers;
``(2) had completed both Phase I and Phase II of the
construction priority system in effect on the date of enactment
of such Act; or
``(3) is not included in clause (i) or (ii) and is
selected, as determined by the Secretary--
``(A) on the initiative of the Secretary; or
``(B) pursuant to a request of an Indian tribe or
tribal organization.''.
SEC. 143. INDIAN HEALTH CARE DELIVERY DEMONSTRATION PROJECTS.
Section 307 of the Indian Health Care Improvement Act (25 U.S.C.
1637) is amended to read as follows:
``SEC. 307. INDIAN HEALTH CARE DELIVERY DEMONSTRATION PROJECTS.
``(a) Purpose and General Authority.--
``(1) Purpose.--The purpose of this section is to encourage
the establishment of demonstration projects that meet the
applicable criteria of this section to be carried out by the
Secretary, acting through the Service, or Indian tribes or
tribal organizations acting pursuant to contracts or compacts
under the Indian Self Determination and Education Assistance
Act (25 U.S.C. 450 et seq.)--
``(A) to test alternative means of delivering
health care and services to Indians through facilities;
or
``(B) to use alternative or innovative methods or
models of delivering health care services to Indians
(including primary care services, contract health
services, or any other program or service authorized by
this Act) through convenient care services (as defined
in subsection (c)), community health centers, or
cooperative agreements or arrangements with other
health care providers that share or coordinate the use
of facilities, funding, or other resources, or
otherwise coordinate or improve the coordination of
activities of the Service, Indian tribes, or tribal
organizations, with those of the other health care
providers.
``(2) Authority.--The Secretary, acting through the
Service, is authorized to carry out, or to enter into contracts
or compacts under the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.) with Indian tribes or
tribal organizations to carry out, health care delivery
demonstration projects that--
``(A) test alternative means of delivering health
care and services to Indians through facilities; or
``(B) otherwise carry out the purposes of this
section.
``(b) Use of Funds.--The Secretary, in approving projects pursuant
to this section--
``(1) may authorize such contracts for the construction and
renovation of hospitals, health centers, health stations, and
other facilities to deliver health care services; and
``(2) is authorized--
``(A) to waive any leasing prohibition;
``(B) to permit use and carryover of funds
appropriated for the provision of health care services
under this Act (including for the purchase of health
benefits coverage, as authorized by section 402(a));
``(C) to permit the use of other available funds,
including other Federal funds, funds from third-party
collections in accordance with sections 206, 207, and
401, and non-Federal funds contributed by State or
local governmental agencies or facilities or private
health care providers pursuant to cooperative or other
agreements with the Service, 1 or more Indian tribes,
or tribal organizations;
``(D) to permit the use of funds or property
donated or otherwise provided from any source for
project purposes;
``(E) to provide for the reversion of donated real
or personal property to the donor; and
``(F) to permit the use of Service funds to match
other funds, including Federal funds.
``(c) Health Care Demonstration Projects.--
``(1) Definition of convenient care service.--In this
subsection, the term `convenient care service' means any
primary health care service, such as urgent care services,
nonemergent care services, prevention services and screenings,
and any service authorized by section 203 or 205(d), that is
offered--
``(A) at an alternative setting; or
``(B) during hours other than regular working
hours.
``(2) General projects.--
``(A) Criteria.--The Secretary may approve under
this section demonstration projects that meet the
following criteria:
``(i) There is a need for a new facility or
program, such as a program for convenient care
services, or an improvement in, increased
efficiency at, or reorientation of an existing
facility or program.
``(ii) A significant number of Indians,
including Indians with low health status, will
be served by the project.
``(iii) The project has the potential to
deliver services in an efficient and effective
manner.
``(iv) The project is economically viable.
``(v) For projects carried out by an Indian
tribe or tribal organization, the Indian tribe
or tribal organization has the administrative
and financial capability to administer the
project.
``(vi) The project is integrated with
providers of related health or social services
(including State and local health care agencies
or other health care providers) and is
coordinated with, and avoids duplication of,
existing services in order to expand the
availability of services.
``(B) Priority.--In approving demonstration
projects under this paragraph, the Secretary shall give
priority to demonstration projects, to the extent the
projects meet the criteria described in subparagraph
(A), located in any of the following Service units:
``(i) Cass Lake, Minnesota.
``(ii) Mescalero, New Mexico.
``(iii) Owyhee and Elko, Nevada.
``(iv) Schurz, Nevada.
``(v) Ft. Yuma, California.
``(3) Innovative health services delivery demonstration
project.--
``(A) Application or request.--On receipt of an
application or request from an Indian tribe, a
consortium of Indian tribes, or a tribal organization
within a Service area, the Secretary shall take into
consideration alternative or innovated methods to
deliver health care services within the Service area
(or a portion of, or facility within, the Service area)
as described in the application or request, including
medical, dental, pharmaceutical, nursing, clinical
laboratory, contract health services, convenient care
services, community health centers, or any other health
care services delivery models designed to improve
access to, or efficiency or quality of, the health
care, health promotion, or disease prevention services
and programs under this Act.
``(B) Approval.--In addition to projects described
in paragraph (2), in any fiscal year, the Secretary is
authorized under this paragraph to approve not more
than 10 applications for health care delivery
demonstration projects that meet the criteria described
in subparagraph (C).
``(C) Criteria.--The Secretary shall approve under
subparagraph (B) demonstration projects that meet all
of the following criteria:
``(i) The criteria set forth in paragraph
(2)(A).
``(ii) There is a lack of access to health
care services at existing health care
facilities, which may be due to limited hours
of operation at those facilities or other
factors.
``(iii) The project--
``(I) expands the availability of
services; or
``(II) reduces--
``(aa) the burden on
Contract Health Services; or
``(bb) the need for
emergency room visits.
``(d) Technical Assistance.--On receipt of an application or
request from an Indian tribe, a consortium of Indian tribes, or a
tribal organization, the Secretary shall provide such technical and
other assistance as may be necessary to enable applicants to comply
with this section, including information regarding the Service unit
budget and available funding for carrying out the proposed
demonstration project.
``(e) Service to Ineligible Persons.--Subject to section 813, 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 813, may be included, subject to
the terms of that section, in any demonstration project approved
pursuant to this section.
``(f) Equitable Treatment.--For purposes of subsection (c), the
Secretary, in evaluating facilities operated under any contract or
compact under the Indian Self-Determination and Education Assistance
Act (25 U.S.C. 450 et seq.), shall use the same criteria that the
Secretary uses in evaluating facilities operated directly by the
Service.
``(g) Equitable Integration of Facilities.--The Secretary shall
ensure that the planning, design, construction, renovation, and
expansion needs of Service and non-Service facilities that are the
subject of a contract or compact under the Indian Self-Determination
and Education Assistance Act (25 U.S.C. 450 et seq.) for health
services are fully and equitably integrated into the implementation of
the health care delivery demonstration projects under this section.''.
SEC. 144. TRIBAL MANAGEMENT OF FEDERALLY OWNED QUARTERS.
Title III of the Indian Health Care Improvement Act (as amended by
section 101(b)) is amended by inserting after section 308 (25 U.S.C.
1638) the following:
``SEC. 309. TRIBAL MANAGEMENT OF FEDERALLY OWNED QUARTERS.
``(a) Rental Rates.--
``(1) Establishment.--Notwithstanding any other provision
of law, a tribal health program that operates a hospital or
other health facility and the federally owned quarters
associated with such a facility pursuant to a contract or
compact under the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.) may establish the rental
rates charged to the occupants of those quarters, on providing
notice to the Secretary.
``(2) Objectives.--In establishing rental rates under this
subsection, a tribal health program shall attempt--
``(A) to base the rental rates on the reasonable
value of the quarters to the occupants of the quarters;
and
``(B) to generate sufficient funds to prudently
provide for the operation and maintenance of the
quarters, and at the discretion of the tribal health
program, to supply reserve funds for capital repairs
and replacement of the quarters.
``(3) Equitable funding.--A federally owned quarters the
rental rates for which are established by a tribal health
program under this subsection shall remain eligible to receive
improvement and repair funds to the same extent that all
federally owned quarters used to house personnel in programs of
the Service are eligible to receive those funds.
``(4) Notice of rate change.--A tribal health program that
establishes a rental rate under this subsection shall provide
occupants of the federally owned quarters a notice of any
change in the rental rate by not later than the date that is 60
days notice before the effective date of the change.
``(5) Rates in alaska.--A rental rate established by a
tribal health program under this section for a federally owned
quarters in the State of Alaska 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.
``(b) Direct Collection of Rent.--
``(1) In general.--Notwithstanding any other provision of
law, and subject to paragraph (2), a tribal health program may
collect rent directly from Federal employees who occupy
federally owned quarters if the tribal health program submits
to the Secretary and the employees a notice of the election of
the tribal health program to collect rents directly from the
employees.
``(2) Action by employees.--On receipt of a notice
described in paragraph (1)--
``(A) the affected Federal employees shall pay rent
for occupancy of a federally owned quarters directly to
the applicable tribal health program; and
``(B) the Secretary shall not have the authority to
collect rent from the employees through payroll
deduction or otherwise.
``(3) Use of payments.--The rent payments under this
subsection--
``(A) shall be retained by the applicable tribal
health program in 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, as the tribal health program
determines to be appropriate; and
``(B) shall not be made payable to, or otherwise be
deposited with, the United States.
``(4) Retrocession of authority.--If a tribal health
program that elected to collect rent directly under paragraph
(1) requests retrocession of the authority of the tribal health
program to collect that rent, the retrocession shall take
effect on the earlier of--
``(A) the first day of the month that begins not
less than 180 days after the tribal health program
submits the request; and
``(B) such other date as may be mutually agreed on
by the Secretary and the tribal health program.''.
SEC. 145. OTHER FUNDING, EQUIPMENT, AND SUPPLIES FOR FACILITIES.
Title III of the Indian Health Care Improvement Act (25 U.S.C. 1631
et seq.) is amended by adding at the end the following:
``SEC. 311. OTHER FUNDING, EQUIPMENT, AND SUPPLIES FOR FACILITIES.
``(a) Authorization.--
``(1) Authority to transfer funds.--The head of any Federal
agency to which funds, equipment, or other supplies are made
available for the planning, design, construction, or operation
of a health care or sanitation facility may transfer the funds,
equipment, or supplies to the Secretary for the planning,
design, construction, or operation of a health care or
sanitation facility to achieve--
``(A) the purposes of this Act; and
``(B) the purposes for which the funds, equipment,
or supplies were made available to the Federal agency.
``(2) Authority to accept funds.--The Secretary may--
``(A) accept from any source, including Federal and
State agencies, funds, equipment, or supplies that are
available for the construction or operation of health
care or sanitation facilities; and
``(B) use those funds, equipment, and supplies to
plan, design, construct, and operate health care or
sanitation facilities for Indians, including pursuant
to a contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C.
450 et seq.).
``(3) Effect of receipt.--Receipt of funds by the Secretary
under this subsection shall not affect any priority established
under section 301.
``(b) Interagency Agreements.--The Secretary may enter into
interagency agreements with Federal or State agencies and other
entities, and accept funds, equipment, or other supplies from those
entities, to provide for the planning, design, construction, and
operation of health care or sanitation facilities to be administered by
Indian health programs to achieve--
``(1) the purposes of this Act; and
``(2) the purposes for which the funds were appropriated or
otherwise provided.
``(c) Establishment of Standards.--
``(1) In general.--The Secretary, acting through the
Service, shall establish, by regulation, standards for the
planning, design, construction, and operation of health care or
sanitation facilities serving Indians under this Act.
``(2) Other regulations.--Notwithstanding any other
provision of law, any other applicable regulations of the
Department shall apply in carrying out projects using funds
transferred under this section.
``(d) Definition of Sanitation Facility.--In this section, the term
`sanitation facility' means a safe and adequate water supply system,
sanitary sewage disposal system, or sanitary solid waste system
(including all related equipment and support infrastructure).''.
SEC. 146. INDIAN COUNTRY MODULAR COMPONENT FACILITIES DEMONSTRATION
PROGRAM.
Title III of the Indian Health Care Improvement Act (25 U.S.C. 1631
et seq.) (as amended by section 145) is amended by adding at the end
the following:
``SEC. 312. INDIAN COUNTRY MODULAR COMPONENT FACILITIES DEMONSTRATION
PROGRAM.
``(a) Definition of Modular Component Health Care Facility.--In
this section, the term `modular component health care facility' means a
health care facility that is constructed--
``(1) off-site using prefabricated component units for
subsequent transport to the destination location; and
``(2) represents a more economical method for provision of
health care facility than a traditionally constructed health
care building.
``(b) Establishment.--The Secretary, acting through the Service,
shall establish a demonstration program under which the Secretary shall
award no less than 3 grants for purchase, installation and maintenance
of modular component health care facilities in Indian communities for
provision of health care services.
``(c) Selection of Locations.--
``(1) Petitions.--
``(A) Solicitation.--The Secretary shall solicit
from Indian tribes petitions for location of the
modular component health care facilities in the Service
areas of the petitioning Indian tribes.
``(B) Petition.--To be eligible to receive a grant
under this section, an Indian tribe or tribal
organization must submit to the Secretary a petition to
construct a modular component health care facility in
the Indian community of the Indian tribe, at such time,
in such manner, and containing such information as the
Secretary may require.
``(2) Selection.--In selecting the location of each modular
component health care facility to be provided under the
demonstration program, the Secretary shall give priority to
projects already on the Indian Health Service facilities
construction priority list and petitions which demonstrate that
erection of a modular component health facility--
``(A) is more economical than construction of a
traditionally constructed health care facility;
``(B) can be constructed and erected on the
selected location in less time than traditional
construction; and
``(C) can adequately house the health care services
needed by the Indian population to be served.
``(3) Effect of selection.--A modular component health care
facility project selected for participation in the
demonstration program shall not be eligible for entry on the
facilities construction priorities list entitled `IHS Health
Care Facilities FY 2011 Planned Construction Budget' and dated
May 7, 2009 (or any successor list).
``(d) Eligibility.--
``(1) In general.--An Indian tribe may submit a petition
under subsection (c)(1)(B) regardless of whether the Indian
tribe is a party to any contract or compact under the Indian
Self-Determination and Education Assistance Act (25 U.S.C. 450
et seq.).
``(2) Administration.--At the election of an Indian tribe
or tribal organization selected for participation in the
demonstration program, the funds provided for the project shall
be subject to the provisions of the Indian Self-Determination
and Education Assistance Act.
``(e) Reports.--Not later than 1 year after the date on which funds
are made available for the demonstration program and annually
thereafter, the Secretary shall submit to Congress a report
describing--
``(1) each activity carried out under the demonstration
program, including an evaluation of the success of the
activity; and
``(2) the potential benefits of increased use of modular
component health care facilities in other Indian communities.
``(f) Authorization of Appropriations.--There are authorized to be
appropriated $50,000,000 to carry out the demonstration program under
this section for the first 5 fiscal years, and such sums as may be
necessary to carry out the program in subsequent fiscal years.''.
SEC. 147. MOBILE HEALTH STATIONS DEMONSTRATION PROGRAM.
Title III of the Indian Health Care Improvement Act (25 U.S.C. 1631
et seq.) (as amended by section 146) is amended by adding at the end
the following:
``SEC. 313. MOBILE HEALTH STATIONS DEMONSTRATION PROGRAM.
``(a) Definitions.--In this section:
``(1) Eligible tribal consortium.--The term `eligible
tribal consortium' means a consortium composed of 2 or more
Service units between which a mobile health station can be
transported by road in up to 8 hours. A Service unit operated
by the Service or by an Indian tribe or tribal organization
shall be equally eligible for participation in such consortium.
``(2) Mobile health station.--The term `mobile health
station' means a health care unit that--
``(A) is constructed, maintained, and capable of
being transported within a semi-trailer truck or
similar vehicle;
``(B) is equipped for the provision of 1 or more
specialty health care services; and
``(C) can be equipped to be docked to a stationary
health care facility when appropriate.
``(3) Specialty health care service.--
``(A) In general.--The term `specialty health care
service' means a health care service which requires the
services of a health care professional with specialized
knowledge or experience.
``(B) Inclusions.--The term `specialty health care
service' includes any service relating to--
``(i) dialysis;
``(ii) surgery;
``(iii) mammography;
``(iv) dentistry; or
``(v) any other specialty health care
service.
``(b) Establishment.--The Secretary, acting through the Service,
shall establish a demonstration program under which the Secretary shall
provide at least 3 mobile health station projects.
``(c) Petition.--To be eligible to receive a mobile health station
under the demonstration program, an eligible tribal consortium shall
submit to the Secretary, a petition at such time, in such manner, and
containing--
``(1) a description of the Indian population to be served;
``(2) a description of the specialty service or services
for which the mobile health station is requested and the extent
to which such service or services are currently available to
the Indian population to be served; and
``(3) such other information as the Secretary may require.
``(d) Use of Funds.--The Secretary shall use amounts made available
to carry out the demonstration program under this section--
``(1)(A) to establish, purchase, lease, or maintain mobile
health stations for the eligible tribal consortia selected for
projects; and
``(B) to provide, through the mobile health station, such
specialty health care services as the affected eligible tribal
consortium determines to be necessary for the Indian population
served;
``(2) to employ an existing mobile health station
(regardless of whether the mobile health station is owned or
rented and operated by the Service) to provide specialty health
care services to an eligible tribal consortium; and
``(3) to establish, purchase, or maintain docking equipment
for a mobile health station, including the establishment or
maintenance of such equipment at a modular component health
care facility (as defined in section 312(a)), if applicable.
``(e) Reports.--Not later than 1 year after the date on which the
demonstration program is established under subsection (b) and annually
thereafter, the Secretary, acting through the Service, shall submit to
Congress a report describing--
``(1) each activity carried out under the demonstration
program including an evaluation of the success of the activity;
and
``(2) the potential benefits of increased use of mobile
health stations to provide specialty health care services for
Indian communities.
``(f) Authorization of Appropriations.--There are authorized to be
appropriated $5,000,000 per year to carry out the demonstration program
under this section for the first 5 fiscal years, and such sums as may
be needed to carry out the program in subsequent fiscal years.''.
Subtitle D--Access to Health Services
SEC. 151. TREATMENT OF PAYMENTS UNDER SOCIAL SECURITY ACT HEALTH
BENEFITS PROGRAMS.
Section 401 of the Indian Health Care Improvement Act (25 U.S.C.
1641) is amended to read as follows:
``SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SECURITY ACT HEALTH
BENEFITS PROGRAMS.
``(a) Disregard of Medicare, Medicaid, and CHIP Payments in
Determining Appropriations.--Any payments received by an Indian health
program or by an urban Indian organization under title XVIII, XIX, or
XXI of the Social Security Act for services provided to Indians
eligible for benefits under such respective titles shall not be
considered in determining appropriations for the provision of health
care and services to Indians.
``(b) Nonpreferential Treatment.--Nothing in this Act authorizes
the Secretary to provide services to an Indian with coverage under
title XVIII, XIX, or XI of the Social Security Act in preference to an
Indian without such coverage.
``(c) Use of Funds.--
``(1) Special fund.--
``(A) 100 percent pass-through of payments due to
facilities.--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 title XVIII or XIX of the Social Security
Act shall be placed in a special fund to be held by the
Secretary. 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 either such title.
``(B) Use of funds.--Amounts received by a facility
of the Service under subparagraph (A) by reason of a
provision of title XVIII or XIX of the Social Security
Act shall first be 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 operated by or through such facility which
may be necessary to achieve or maintain compliance with
the applicable conditions and requirements of such
respective title. Any amounts so received that are in
excess of the amount necessary to achieve or maintain
such conditions and requirements shall, subject to
consultation with the Indian tribes being served by the
Service unit, be used for reducing the health resource
deficiencies (as determined in section 201(c)) of such
Indian tribes, including the provision of services
pursuant to section 205.
``(2) Direct payment option.--Paragraph (1) shall not apply
to a tribal health program upon the election of such 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 by
such program during the period of such election.
``(d) Direct Billing.--
``(1) In general.--Subject to complying with the
requirements of paragraph (2), a tribal health program may
elect to directly bill for, and receive payment for, health
care items and services provided by such program for which
payment is made under title XVIII, XIX, or XXI of the Social
Security Act or from any other third party payor.
``(2) Direct reimbursement.--
``(A) Use of funds.--Each tribal health program
making the election described in paragraph (1) with
respect to a program under a title of the Social
Security Act shall be reimbursed directly by that
program for items and services furnished without regard
to subsection (c)(1), except that all amounts so
reimbursed shall be used by the tribal health program
for the purpose of making any improvements in
facilities of the tribal health program 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
(including coverage for a service or service within a
contract health service delivery area or any portion of
a contract health service delivery area that would
otherwise be provided as a contract health service), or
otherwise to achieve the objectives provided in section
3 of this Act.
``(B) Audits.--The amounts paid to a tribal health
program making the election described in paragraph (1)
with respect to a program under title XVIII, XIX, or
XXI of the Social Security Act shall be subject to all
auditing requirements applicable to the program under
such title, as well as all auditing requirements
applicable to programs administered by an Indian health
program. Nothing in the preceding sentence shall be
construed as limiting the application of auditing
requirements applicable to amounts paid under title
XVIII, XIX, or XXI of the Social Security Act.
``(C) Identification of source of payments.--Any
tribal health program that receives reimbursements or
payments under title XVIII, XIX, or XXI of the Social
Security Act shall provide to the Service a list of
each provider enrollment number (or other identifier)
under which such program receives such reimbursements
or payments.
``(3) Examination and implementation of changes.--
``(A) In general.--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 title XIX or XXI of the Social Security
Act.
``(B) Coordination of information.--The Service
shall provide the Administrator of the Centers for
Medicare & Medicaid Services with copies of the lists
submitted to the Service under paragraph (2)(C),
enrollment data regarding patients served by the
Service (and by tribal health programs, to the extent
such data is available to the Service), and such other
information as the Administrator may require for
purposes of administering title XVIII, XIX, or XXI of
the Social Security Act.
``(4) Withdrawal from program.--A tribal health program
that bills directly under the program established under this
subsection may withdraw from participation in the same manner
and under the same conditions that an Indian tribe or tribal
organization may retrocede a contracted program to the
Secretary under the authority of the Indian Self-Determination
and Education Assistance Act (25 U.S.C. 450 et seq.). All cost
accounting and billing authority under the program established
under this subsection shall be returned to the Secretary upon
the Secretary's acceptance of the withdrawal of participation
in this program.
``(5) Termination for failure to comply with
requirements.--The Secretary may terminate the participation of
a tribal health program or in the direct billing program
established under this subsection if the Secretary determines
that the program has failed to comply with the requirements of
paragraph (2). The Secretary shall provide a tribal health
program with notice of a determination that the program has
failed to comply with any such requirement and a reasonable
opportunity to correct such noncompliance prior to terminating
the program's participation in the direct billing program
established under this subsection.
``(e) Related Provisions Under the Social Security Act.--For
provisions related to subsections (c) and (d), see sections 1880, 1911,
and 2107(e)(1)(D) of the Social Security Act.''.
SEC. 152. PURCHASING HEALTH CARE COVERAGE.
Section 402 of the Indian Health Care Improvement Act (25 U.S.C.
1642) is amended to read as follows:
``SEC. 402. PURCHASING HEALTH CARE COVERAGE.
``(a) In General.--Insofar as amounts are made available under law
(including a provision of the Social Security Act, the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et seq.), or
other law, other than under section 404) 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 (including coverage for a service, or service within a
contract health service delivery area, or any portion of a contract
health service delivery area that would otherwise be provided as a
contract health service) for such beneficiaries in any manner,
including through--
``(1) a tribally owned and operated health care plan;
``(2) a State or locally authorized or licensed health care
plan;
``(3) a health insurance provider or managed care
organization;
``(4) a self-insured plan; or
``(5) a high deductible or health savings account plan.
``(b) Financial Need.--The purchase of coverage under subsection
(a) by an Indian tribe, tribal organization, or urban Indian
organization may be based on the financial needs of such beneficiaries
(as determined by the 1 or more Indian tribes being served based on a
schedule of income levels developed or implemented by such 1 or more
Indian tribes).
``(c) Expenses for Self-Insured Plan.--In the case of a self-
insured plan under subsection (a)(4), the amounts may be used for
expenses of operating the plan, including administration and insurance
to limit the financial risks to the entity offering the plan.
``(d) Construction.--Nothing in this section shall be construed as
affecting the use of any amounts not referred to in subsection (a).''.
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.
Section 404 of the Indian Health Care Improvement Act (25 U.S.C.
1644) is amended to read as follows:
``SEC. 404. 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.
``(a) Indian Tribes and Tribal Organizations.--The Secretary,
acting through the Service, shall make grants to or enter into
contracts with Indian tribes and tribal organizations to assist such
tribes and tribal organizations in establishing and administering
programs on or near reservations and trust lands, including programs to
provide outreach and enrollment through video, electronic delivery
methods, or telecommunication devices that allow real-time or time-
delayed communication between individual Indians and the benefit
program, to assist individual Indians--
``(1) to enroll for benefits under a program established
under title XVIII, XIX, or XXI of the Social Security Act and
other health benefits programs; and
``(2) with respect to such programs for which the charging
of premiums and cost sharing is not prohibited under such
programs, to pay premiums or cost sharing for coverage for such
benefits, which may be based on financial need (as determined
by the Indian tribe or tribes or tribal organizations being
served based on a schedule of income levels developed or
implemented by such tribe, tribes, or tribal organizations).
``(b) Conditions.--The Secretary, acting through the Service, shall
place conditions as deemed necessary to effect the purpose of this
section in any grant or contract which the Secretary makes with any
Indian tribe or tribal organization pursuant to this section. Such
conditions shall include requirements that the Indian tribe or tribal
organization successfully undertake--
``(1) to determine the population of Indians eligible for
the benefits described in subsection (a);
``(2) to educate Indians with respect to the benefits
available under the respective programs;
``(3) to provide transportation for such individual Indians
to the appropriate offices for enrollment or applications for
such benefits; and
``(4) to develop and implement methods of improving the
participation of Indians in receiving benefits under such
programs.
``(c) Application to Urban Indian Organizations.--
``(1) In general.--The provisions of subsection (a) shall
apply with respect to grants and other funding to urban Indian
organizations with respect to populations served by such
organizations in the same manner they apply to grants and
contracts with Indian tribes and tribal organizations with
respect to programs on or near reservations.
``(2) Requirements.--The Secretary shall include in the
grants or contracts made or provided under paragraph (1)
requirements that are--
``(A) consistent with the requirements imposed by
the Secretary under subsection (b);
``(B) appropriate to urban Indian organizations and
urban Indians; and
``(C) necessary to effect the purposes of this
section.
``(d) Facilitating Cooperation.--The Secretary, acting through the
Centers for Medicare & Medicaid Services, shall develop and disseminate
best practices that will serve to facilitate cooperation with, and
agreements between, States and the Service, Indian tribes, tribal
organizations, or urban Indian organizations with respect to the
provision of health care items and services to Indians under the
programs established under title XVIII, XIX, or XXI of the Social
Security Act.
``(e) Agreements Relating to Improving Enrollment of Indians Under
Social Security Act Health Benefits Programs.--For provisions relating
to agreements of the Secretary, acting through the Service, for the
collection, preparation, and submission of applications by Indians for
assistance under the Medicaid and children's health insurance programs
established under titles XIX and XXI of the Social Security Act, and
benefits under the Medicare program established under title XVIII of
such Act, see subsections (a) and (b) of section 1139 of the Social
Security Act.
``(f) Definition of Premiums and Cost Sharing.--In this section:
``(1) Premium.--The term `premium' includes any enrollment
fee or similar charge.
``(2) Cost sharing.--The term `cost sharing' includes any
deduction, deductible, copayment, coinsurance, or similar
charge.''.
SEC. 154. SHARING ARRANGEMENTS WITH FEDERAL AGENCIES.
Section 405 of the Indian Health Care Improvement Act (25 U.S.C.
1645) is amended to read as follows:
``SEC. 405. SHARING ARRANGEMENTS WITH FEDERAL AGENCIES.
``(a) Authority.--
``(1) In general.--The Secretary may enter into (or expand)
arrangements for the sharing of medical facilities and services
between the Service, Indian tribes, and tribal organizations
and the Department of Veterans Affairs and the Department of
Defense.
``(2) Consultation by secretary required.--The Secretary
may not finalize any arrangement between the Service and a
Department described in paragraph (1) without first consulting
with the Indian tribes which will be significantly affected by
the arrangement.
``(b) Limitations.--The Secretary shall not take any action under
this section or under subchapter IV of chapter 81 of title 38, United
States Code, which would impair--
``(1) the priority access of any Indian to health care
services provided through the Service and the eligibility of
any Indian to receive health services through the Service;
``(2) the quality of health care services provided to any
Indian through the Service;
``(3) the priority access of any veteran to health care
services provided by the Department of Veterans Affairs;
``(4) the quality of health care services provided by the
Department of Veterans Affairs or the Department of Defense; or
``(5) the eligibility of any Indian who is a veteran to
receive health services through the Department of Veterans
Affairs.
``(c) Reimbursement.--The Service, Indian tribe, or tribal
organization shall be reimbursed by the Department of Veterans Affairs
or the Department of Defense (as the case may be) where services are
provided through the Service, an Indian tribe, or a tribal organization
to beneficiaries eligible for services from either such Department,
notwithstanding any other provision of law.
``(d) Construction.--Nothing in this section may be construed as
creating any right of a non-Indian veteran to obtain health services
from the Service.''.
SEC. 155. ELIGIBLE INDIAN VETERAN SERVICES.
Title IV of the Indian Health Care Improvement Act (25 U.S.C. 1641
et seq.) (as amended by section 101(b)) is amended by adding at the end
the following:
``SEC. 407. ELIGIBLE INDIAN VETERAN SERVICES.
``(a) Findings; Purpose.--
``(1) Findings.--Congress finds that--
``(A) collaborations between the Secretary and the
Secretary of Veterans Affairs regarding the treatment
of Indian veterans at facilities of the Service should
be encouraged to the maximum extent practicable; and
``(B) increased enrollment for services of the
Department of Veterans Affairs by veterans who are
members of Indian tribes should be encouraged to the
maximum extent practicable.
``(2) Purpose.--The purpose of this section is to reaffirm
the goals stated in the document entitled `Memorandum of
Understanding Between the VA/Veterans Health Administration And
HHS/Indian Health Service' and dated February 25, 2003
(relating to cooperation and resource sharing between the
Veterans Health Administration and Service).
``(b) Definitions.--In this section:
``(1) Eligible indian veteran.--The term `eligible Indian
veteran' means an Indian or Alaska Native veteran who receives
any medical service that is--
``(A) authorized under the laws administered by the
Secretary of Veterans Affairs; and
``(B) administered at a facility of the Service
(including a facility operated by an Indian tribe or
tribal organization through a contract or compact with
the Service under the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.))
pursuant to a local memorandum of understanding.
``(2) Local memorandum of understanding.--The term `local
memorandum of understanding' means a memorandum of
understanding between the Secretary (or a designee, including
the director of any area office of the Service) and the
Secretary of Veterans Affairs (or a designee) to implement the
document entitled `Memorandum of Understanding Between the VA/
Veterans Health Administration And HHS/Indian Health Service'
and dated February 25, 2003 (relating to cooperation and
resource sharing between the Veterans Health Administration and
Indian Health Service).
``(c) Eligible Indian Veterans Expenses.--
``(1) In general.--Notwithstanding any other provision of
law, the Secretary shall provide for veteran-related expenses
incurred by eligible Indian veterans as described in subsection
(b)(1)(B).
``(2) Method of payment.--The Secretary shall establish
such guidelines as the Secretary determines to be appropriate
regarding the method of payments to the Secretary of Veterans
Affairs under paragraph (1).
``(d) Tribal Approval of Memoranda.--In negotiating a local
memorandum of understanding with the Secretary of Veterans Affairs
regarding the provision of services to eligible Indian veterans, the
Secretary shall consult with each Indian tribe that would be affected
by the local memorandum of understanding.
``(e) Funding.--
``(1) Treatment.--Expenses incurred by the Secretary in
carrying out subsection (c)(1) shall not be considered to be
Contract Health Service expenses.
``(2) Use of funds.--Of funds made available to the
Secretary in appropriations Acts for the Service (excluding
funds made available for facilities, Contract Health Services,
or contract support costs), the Secretary shall use such sums
as are necessary to carry out this section.''.
SEC. 156. NONDISCRIMINATION UNDER FEDERAL HEALTH CARE PROGRAMS IN
QUALIFICATIONS FOR REIMBURSEMENT FOR SERVICES.
Title IV of the Indian Health Care Improvement Act (25 U.S.C. 1641
et seq.) (as amended by section 155) is amended by adding at the end
the following:
``SEC. 408. NONDISCRIMINATION UNDER FEDERAL HEALTH CARE PROGRAMS IN
QUALIFICATIONS FOR REIMBURSEMENT FOR SERVICES.
``(a) Requirement To Satisfy Generally Applicable Participation
Requirements.--
``(1) In general.--A Federal health care program must
accept an entity that is operated by the Service, an Indian
tribe, tribal organization, or urban Indian organization as a
provider eligible to receive payment under the program for
health care services furnished to an Indian on the same basis
as any other provider qualified to participate as a provider of
health care services under the program if the entity meets
generally applicable State or other requirements for
participation as a provider of health care services under the
program.
``(2) Satisfaction of state or local licensure or
recognition requirements.--Any requirement for participation as
a provider of health care services under a Federal health care
program that an entity be licensed or recognized under the
State or local law where the entity is located to furnish
health care services shall be deemed to have been met in the
case of an entity operated by the Service, an Indian tribe,
tribal organization, or urban Indian organization if the entity
meets all the applicable standards for such licensure or
recognition, regardless of whether the entity obtains a license
or other documentation under such State or local law. In
accordance with section 221, the absence of the licensure of a
health professional employed by such an entity under the State
or local law where the entity is located shall not be taken
into account for purposes of determining whether the entity
meets such standards, if the professional is licensed in
another State.
``(b) Application of Exclusion From Participation in Federal Health
Care Programs.--
``(1) Excluded entities.--No entity operated by the
Service, an Indian tribe, tribal organization, or urban Indian
organization that has been excluded from participation in any
Federal health care program or for which a license is under
suspension or has been revoked by the State where the entity is
located shall be eligible to receive payment or reimbursement
under any such program for health care services furnished to an
Indian.
``(2) Excluded individuals.--No individual who has been
excluded from participation in any Federal health care program
or whose State license is under suspension shall be eligible to
receive payment or reimbursement under any such program for
health care services furnished by that individual, directly or
through an entity that is otherwise eligible to receive payment
for health care services, to an Indian.
``(3) Federal health care program defined.--In this
subsection, the term, `Federal health care program' has the
meaning given that term in section 1128B(f) of the Social
Security Act (42 U.S.C. 1320a-7b(f)), except that, for purposes
of this subsection, such term shall include the health
insurance program under chapter 89 of title 5, United States
Code.
``(c) Related Provisions.--For provisions related to
nondiscrimination against providers operated by the Service, an Indian
tribe, tribal organization, or urban Indian organization, see section
1139(c) of the Social Security Act (42 U.S.C. 1320b-9(c)).''.
SEC. 157. ACCESS TO FEDERAL INSURANCE.
Title IV of the Indian Health Care Improvement Act (25 U.S.C. 1641
et seq.) (as amended by section 156) is amended by adding at the end
the following:
``SEC. 409. ACCESS TO FEDERAL INSURANCE.
``Notwithstanding the provisions of title 5, United States Code,
Executive order, or administrative regulation, an Indian tribe or
tribal organization carrying out programs under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et seq.) or
an urban Indian organization carrying out programs under title V of
this Act shall be entitled to purchase coverage, rights, and benefits
for the employees of such Indian tribe or tribal organization, or urban
Indian organization, under chapter 89 of title 5, United States Code,
and chapter 87 of such title if necessary employee deductions and
agency contributions in payment for the coverage, rights, and benefits
for the period of employment with such Indian tribe or tribal
organization, or urban Indian organization, are currently deposited in
the applicable Employee's Fund under such title.''.
SEC. 158. GENERAL EXCEPTIONS.
Title IV of the Indian Health Care Improvement Act (25 U.S.C. 1641
et seq.) (as amended by section 157) is amended by adding at the end
the following:
``SEC. 410. GENERAL EXCEPTIONS.
``The requirements of this title shall not apply to any excepted
benefits described in paragraph (1)(A) or (3) of section 2791(c) of the
Public Health Service Act (42 U.S.C. 300gg-91).''.
SEC. 159. NAVAJO NATION MEDICAID AGENCY FEASIBILITY STUDY.
Title IV of the Indian Health Care Improvement Act (25 U.S.C. 1641
et seq.) (as amended by section 158) is amended by adding at the end
the following:
``SEC. 411. NAVAJO NATION MEDICAID AGENCY FEASIBILITY STUDY.
``(a) Study.--The Secretary shall conduct a study to determine the
feasibility of treating the Navajo Nation as a State for the purposes
of title XIX of the Social Security Act, to provide services to Indians
living within the boundaries of the Navajo Nation through an entity
established having the same authority and performing the same functions
as single-State medicaid agencies responsible for the administration of
the State plan under title XIX of the Social Security Act.
``(b) Considerations.--In conducting the study, the Secretary shall
consider the feasibility of--
``(1) assigning and paying all expenditures for the
provision of services and related administration funds, under
title XIX of the Social Security Act, to Indians living within
the boundaries of the Navajo Nation that are currently paid to
or would otherwise be paid to the State of Arizona, New Mexico,
or Utah;
``(2) providing assistance to the Navajo Nation in the
development and implementation of such entity for the
administration, eligibility, payment, and delivery of medical
assistance under title XIX of the Social Security Act;
``(3) providing an appropriate level of matching funds for
Federal medical assistance with respect to amounts such entity
expends for medical assistance for services and related
administrative costs; and
``(4) authorizing the Secretary, at the option of the
Navajo Nation, to treat the Navajo Nation as a State for the
purposes of title XIX of the Social Security Act (relating to
the State children's health insurance program) under terms
equivalent to those described in paragraphs (2) through (4).
``(c) Report.--Not later then 3 years after the date of enactment
of the Indian Healthcare Improvement Act of 2017, the Secretary shall
submit to the Committee on Indian Affairs and Committee on Finance of
the Senate and the Committee on Natural Resources and Committee on
Energy and Commerce of the House of Representatives a report that
includes--
``(1) the results of the study under this section;
``(2) a summary of any consultation that occurred between
the Secretary and the Navajo Nation, other Indian Tribes, the
States of Arizona, New Mexico, and Utah, counties which include
Navajo Lands, and other interested parties, in conducting this
study;
``(3) projected costs or savings associated with
establishment of such entity, and any estimated impact on
services provided as described in this section in relation to
probable costs or savings; and
``(4) legislative actions that would be required to
authorize the establishment of such entity if such entity is
determined by the Secretary to be feasible.''.
Subtitle E--Health Services for Urban Indians
SEC. 161. FACILITIES RENOVATION.
Section 509 of the Indian Health Care Improvement Act (25 U.S.C.
1659) is amended by inserting ``or construction or expansion of
facilities'' after ``renovations to facilities''.
SEC. 162. TREATMENT OF CERTAIN DEMONSTRATION PROJECTS.
Section 512 of the Indian Health Care Improvement Act (25 U.S.C.
1660b) is amended to read as follows:
``SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION PROJECTS.
``Notwithstanding any other provision of law, the Tulsa Clinic and
Oklahoma City Clinic demonstration projects shall--
``(1) be permanent programs within the Service's direct
care program;
``(2) continue to be treated as Service units and operating
units in the allocation of resources and coordination of care;
and
``(3) continue to meet the requirements and definitions of
an urban Indian organization in this Act, and shall not be
subject to the provisions of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.).''.
SEC. 163. REQUIREMENT TO CONFER WITH URBAN INDIAN ORGANIZATIONS.
(a) Conferring With Urban Indian Organizations.--Title V of the
Indian Health Care Improvement Act (25 U.S.C. 1651 et seq.) (as amended
by section 101(b)) is amended by adding at the end the following:
``SEC. 514. CONFERRING WITH URBAN INDIAN ORGANIZATIONS.
``(a) Definition of Confer.--In this section, the term `confer'
means to engage in an open and free exchange of information and
opinions that--
``(1) leads to mutual understanding and comprehension; and
``(2) emphasizes trust, respect, and shared responsibility.
``(b) Requirement.--The Secretary shall ensure that the Service
confers, to the maximum extent practicable, with urban Indian
organizations in carrying out this Act.''.
(b) Contracts With, and Grants to, Urban Indian Organizations.--
Section 502 of the Indian Health Care Improvement Act (25 U.S.C. 1652)
is amended to read as follows:
``SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN INDIAN ORGANIZATIONS.
``(a) In General.--Pursuant to the Act of November 2, 1921 (25
U.S.C. 13) (commonly known as the `Snyder Act'), the Secretary, acting
through the Service, shall enter into contracts with, or make grants
to, urban Indian organizations to assist the urban Indian organizations
in the establishment and administration, within urban centers, of
programs that meet the requirements of this title.
``(b) Conditions.--Subject to section 506, the Secretary, acting
through the Service, shall include such conditions as the Secretary
considers necessary to effect the purpose of this title in any contract
into which the Secretary enters with, or in any grant the Secretary
makes to, any urban Indian organization pursuant to this title.''.
SEC. 164. EXPANDED PROGRAM AUTHORITY FOR URBAN INDIAN ORGANIZATIONS.
Title V of the Indian Health Care Improvement Act (25 U.S.C. 1651
et seq.) (as amended by section 163(a)) is amended by adding at the end
the following:
``SEC. 515. EXPANDED PROGRAM AUTHORITY FOR URBAN INDIAN ORGANIZATIONS.
``Notwithstanding any other provision of this Act, the Secretary,
acting through the Service, is authorized to establish programs,
including programs for awarding grants, for urban Indian organizations
that are identical to any programs established pursuant to sections
218, 702, and 708(g).''.
SEC. 165. COMMUNITY HEALTH REPRESENTATIVES.
Title V of the Indian Health Care Improvement Act (25 U.S.C. 1651
et seq.) (as amended by section 164) is amended by adding at the end
the following:
``SEC. 516. COMMUNITY HEALTH REPRESENTATIVES.
``The Secretary, acting through the Service, may enter into
contracts with, and make grants to, urban Indian organizations for the
employment of Indians trained as health service providers through the
Community Health Representative Program under section 107 in the
provision of health care, health promotion, and disease prevention
services to urban Indians.''.
SEC. 166. USE OF FEDERAL GOVERNMENT FACILITIES AND SOURCES OF SUPPLY;
HEALTH INFORMATION TECHNOLOGY.
Title V of the Indian Health Care Improvement Act (25 U.S.C. 1651
et seq.) (as amended by section 165) is amended by adding at the end
the following:
``SEC. 517. USE OF FEDERAL GOVERNMENT FACILITIES AND SOURCES OF SUPPLY.
``(a) In General.--The Secretary may permit an urban Indian
organization that has entered into a contract or received a grant
pursuant to this title, in carrying out the contract or grant, to use,
in accordance with such terms and conditions for use and maintenance as
are agreed on by the Secretary and the urban Indian organizations--
``(1) any existing facility under the jurisdiction of the
Secretary;
``(2) all equipment contained in or pertaining to such an
existing facility; and
``(3) any other personal property of the Federal Government
under the jurisdiction of the Secretary.
``(b) Donations.--Subject to subsection (d), the Secretary may
donate to an urban Indian organization that has entered into a contract
or received a grant pursuant to this title any personal or real
property determined to be excess to the needs of the Service or the
General Services Administration for the purposes of carrying out the
contract or grant.
``(c) Acquisition of Property.--The Secretary may acquire excess or
surplus personal or real property of the Federal Government 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 purposes of the contract or
grant.
``(d) Priority.--If the Secretary receives from an urban Indian
organization or an Indian tribe or tribal organization a request for a
specific item of personal or real property described in subsection (b)
or (c), the Secretary shall give priority to the request for donation
to the Indian tribe or tribal organization, if the Secretary receives
the request from the Indian tribe or tribal organization before the
earlier of--
``(1) the date on which the Secretary transfers title to
the property to the urban Indian organization; and
``(2) the date on which the Secretary transfers the
property physically to the urban Indian organization.
``(e) Executive Agency Status.--For purposes of section 501(a) of
title 40, United States Code, an urban Indian organization that has
entered into a contract or received a grant pursuant to this title may
be considered to be an Executive agency in carrying out the contract or
grant.
``SEC. 518. HEALTH INFORMATION TECHNOLOGY.
``The Secretary, acting through the Service, may make grants to
urban Indian organizations under this title for the development,
adoption, and implementation of health information technology (as
defined in section 3000 of the Public Health Service Act (42 U.S.C.
300jj)), telemedicine services development, and related
infrastructure.''.
Subtitle F--Organizational Improvements
SEC. 171. ESTABLISHMENT OF THE INDIAN HEALTH SERVICE AS AN AGENCY OF
THE PUBLIC HEALTH SERVICE.
Section 601 of the Indian Health Care Improvement Act (25 U.S.C.
1661) is amended to read as follows:
``SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERVICE AS AN AGENCY OF
THE PUBLIC HEALTH SERVICE.
``(a) Establishment.--
``(1) In general.--In order to more effectively and
efficiently carry out the responsibilities, authorities, and
functions of the United States to provide health care services
to Indians and Indian tribes, as are or may be hereafter
provided by Federal statute or treaties, there is established
within the Public Health Service of the Department the Indian
Health Service.
``(2) Director.--The Service shall be administered by a
Director, who shall be appointed by the President, by and with
the advice and consent of the Senate. The Director 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, 2008, the term of service of
the Director shall be 4 years. A Director may serve more than 1
term.
``(3) Incumbent.--The individual serving in the position of
Director of the Service on the day before the date of enactment
of the Indian Healthcare Improvement Act of 2017 shall serve as
Director.
``(4) Advocacy and consultation.--The position of Director
is established to, in a manner consistent with the government-
to-government relationship between the United States and Indian
Tribes--
``(A) facilitate advocacy for the development of
appropriate Indian health policy; and
``(B) promote consultation on matters relating to
Indian health.
``(b) Agency.--The Service shall be an agency within the Public
Health Service of the Department, and shall not be an office,
component, or unit of any other agency of the Department.
``(c) Duties.--The Director shall--
``(1) perform all functions that were, on the day before
the date of enactment of the Indian Healthcare Improvement Act
of 2017, carried out by or under the direction of the
individual serving as Director of the Service on that day;
``(2) perform all functions of the Secretary relating to
the maintenance and operation of hospital and health facilities
for Indians and the planning for, and provision and utilization
of, health services for Indians, including by ensuring that all
agency directors, managers, and chief executive officers have
appropriate and adequate training, experience, skill levels,
knowledge, abilities, and education (including continuing
training requirements) to competently fulfill the duties of the
positions and the mission of the Service;
``(3) administer all health programs under which health
care is provided to Indians based upon their status as Indians
which are administered by the Secretary, including programs
under--
``(A) this Act;
``(B) the Act of November 2, 1921 (25 U.S.C. 13);
``(C) the Act of August 5, 1954 (42 U.S.C. 2001 et
seq.);
``(D) the Act of August 16, 1957 (42 U.S.C. 2005 et
seq.); and
``(E) the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.);
``(4) administer all scholarship and loan functions carried
out under title I;
``(5) directly advise the Secretary concerning the
development of all policy- and budget-related matters affecting
Indian health;
``(6) collaborate with the Assistant Secretary for Health
concerning appropriate matters of Indian health that affect the
agencies of the Public Health Service;
``(7) advise each Assistant Secretary of the Department
concerning matters of Indian health with respect to which that
Assistant Secretary has authority and responsibility;
``(8) advise the heads of other agencies and programs of
the Department concerning matters of Indian health with respect
to which those heads have authority and responsibility;
``(9) coordinate the activities of the Department
concerning matters of Indian health; and
``(10) perform such other functions as the Secretary may
designate.
``(d) Authority.--
``(1) In general.--The Secretary, acting through the
Director, shall have the authority--
``(A) except to the extent provided for in
paragraph (2), to appoint and compensate employees for
the Service in accordance with title 5, United States
Code;
``(B) to enter into contracts for the procurement
of goods and services to carry out the functions of the
Service; and
``(C) to manage, expend, and obligate all funds
appropriated for the Service.
``(2) Personnel actions.--Notwithstanding any other
provision of law, the provisions of section 12 of the Act of
June 18, 1934 (48 Stat. 986; 25 U.S.C. 472), shall apply to all
personnel actions taken with respect to new positions created
within the Service as a result of its establishment under
subsection (a).''.
SEC. 172. OFFICE OF DIRECT SERVICE TRIBES.
Title VI of the Indian Health Care Improvement Act (25 U.S.C. 1661
et seq.) (as amended by section 101(b)) is amended by adding at the end
the following:
``SEC. 603. OFFICE OF DIRECT SERVICE TRIBES.
``(a) Establishment.--There is established within the Service an
office, to be known as the `Office of Direct Service Tribes'.
``(b) Treatment.--The Office of Direct Service Tribes shall be
located in the Office of the Director.
``(c) Duties.--The Office of Direct Service Tribes shall be
responsible for--
``(1) providing Service-wide leadership, guidance and
support for direct service tribes to include strategic planning
and program evaluation;
``(2) ensuring maximum flexibility to tribal health and
related support systems for Indian beneficiaries;
``(3) serving as the focal point for consultation and
participation between direct service tribes and organizations
and the Service in the development of Service policy;
``(4) holding no less than biannual consultations with
direct service tribes in appropriate locations to gather
information and aid in the development of health policy; and
``(5) directing a national program and providing leadership
and advocacy in the development of health policy, program
management, budget formulation, resource allocation, and
delegation support for direct service tribes.''.
SEC. 173. NEVADA AREA OFFICE.
Title VI of the Indian Health Care Improvement Act (25 U.S.C. 1661
et seq.) (as amended by section 172) is amended by adding at the end
the following:
``SEC. 604. NEVADA AREA OFFICE.
``(a) In General.--Not later than 1 year after the date of
enactment of this section, in a manner consistent with the tribal
consultation policy of the Service, the Secretary shall submit to
Congress a plan describing the manner and schedule by which an area
office, separate and distinct from the Phoenix Area Office of the
Service, can be established in the State of Nevada.
``(b) Failure To Submit Plan.--
``(1) Definition of operations funds.--In this subsection,
the term `operations funds' means only the funds used for--
``(A) the administration of services, including
functional expenses such as overtime, personnel
salaries, and associated benefits; or
``(B) related tasks that directly affect the
operations described in subparagraph (A).
``(2) Withholding of funds.--If the Secretary fails to
submit a plan in accordance with subsection (a), the Secretary
shall withhold the operations funds reserved for the Office of
the Director, subject to the condition that the withholding
shall not adversely impact the capacity of the Service to
deliver health care services.
``(3) Restoration.--The operations funds withheld pursuant
to paragraph (2) may be restored, at the discretion of the
Secretary, to the Office of the Director on achievement by that
Office of compliance with this section.''.
Subtitle G--Behavioral Health Programs
SEC. 181. BEHAVIORAL HEALTH PROGRAMS.
Title VII of the Indian Health Care Improvement Act (25 U.S.C. 1665
et seq.) is amended to read as follows:
``TITLE VII--BEHAVIORAL HEALTH PROGRAMS
``Subtitle A--General Programs
``SEC. 701. DEFINITIONS.
``In this subtitle:
``(1) Alcohol-related neurodevelopmental disorders; arnd.--
The term `alcohol-related neurodevelopmental disorders' or
`ARND' means, with a history of maternal alcohol consumption
during pregnancy, central nervous system abnormalities, which
may range from minor intellectual deficits and developmental
delays to mental retardation. ARND children may have behavioral
problems, learning disabilities, problems with executive
functioning, and attention disorders. The neurological defects
of ARND may be as severe as FAS, but facial anomalies and other
physical characteristics are not present in ARND, thus making
diagnosis difficult.
``(2) Assessment.--The term `assessment' means the
systematic collection, analysis, and dissemination of
information on health status, health needs, and health
problems.
``(3) Behavioral health aftercare.--The term `behavioral
health aftercare' includes those activities and resources used
to support recovery following inpatient, residential, intensive
substance abuse, or mental health outpatient or outpatient
treatment. The purpose is to help prevent or deal with relapse
by ensuring that by the time a client or patient is discharged
from a level of care, such as outpatient treatment, an
aftercare plan has been developed with the client. An aftercare
plan may use such resources as a community-based therapeutic
group, transitional living facilities, a 12-step sponsor, a
local 12-step or other related support group, and other
community-based providers.
``(4) Dual diagnosis.--The term `dual diagnosis' means
coexisting substance abuse and mental illness conditions or
diagnosis. Such clients are sometimes referred to as mentally
ill chemical abusers (MICAs).
``(5) Fetal alcohol spectrum disorders.--
``(A) In general.--The term `fetal alcohol spectrum
disorders' includes a range of effects that can occur
in an individual whose mother drank alcohol during
pregnancy, including physical, mental, behavioral, and/
or learning disabilities with possible lifelong
implications.
``(B) Inclusions.--The term `fetal alcohol spectrum
disorders' may include--
``(i) fetal alcohol syndrome (FAS);
``(ii) partial fetal alcohol syndrome
(partial FAS);
``(iii) alcohol-related birth defects
(ARBD); and
``(iv) alcohol-related neurodevelopmental
disorders (ARND).
``(6) FAS or fetal alcohol syndrome.--The term `FAS' or
`fetal alcohol syndrome' means a syndrome in which, with a
history of maternal alcohol consumption during pregnancy, the
following criteria are met:
``(A) Central nervous system involvement, such as
mental retardation, developmental delay, intellectual
deficit, microencephaly, or neurological abnormalities.
``(B) Craniofacial abnormalities with at least 2 of
the following:
``(i) Microophthalmia.
``(ii) Short palpebral fissures.
``(iii) Poorly developed philtrum.
``(iv) Thin upper lip.
``(v) Flat nasal bridge.
``(vi) Short upturned nose.
``(C) Prenatal or postnatal growth delay.
``(7) Rehabilitation.--The term `rehabilitation' means
medical and health care services that--
``(A) are recommended by a physician or licensed
practitioner of the healing arts within the scope of
their practice under applicable law;
``(B) are furnished in a facility, home, or other
setting in accordance with applicable standards; and
``(C) have as their purpose any of the following:
``(i) The maximum attainment of physical,
mental, and developmental functioning.
``(ii) Averting deterioration in physical
or mental functional status.
``(iii) The maintenance of physical or
mental health functional status.
``(8) Substance abuse.--The term `substance abuse' includes
inhalant abuse.
``SEC. 702. BEHAVIORAL HEALTH PREVENTION AND TREATMENT SERVICES.
``(a) Purposes.--The purposes of this section are as follows:
``(1) To authorize and direct the Secretary, acting through
the Service, Indian tribes, and tribal organizations, to
develop a comprehensive behavioral health prevention and
treatment program which emphasizes collaboration among alcohol
and substance abuse, social services, and mental health
programs.
``(2) To provide information, direction, and guidance
relating to mental illness and dysfunction and self-destructive
behavior, including child abuse and family violence, to those
Federal, tribal, State, and local agencies responsible for
programs in Indian communities in areas of health care,
education, social services, child and family welfare, alcohol
and substance abuse, law enforcement, and judicial services.
``(3) To assist Indian tribes to identify services and
resources available to address mental illness and dysfunctional
and self-destructive behavior.
``(4) To provide authority and opportunities for Indian
tribes and tribal organizations to develop, implement, and
coordinate with community-based programs which include
identification, prevention, education, referral, and treatment
services, including through multidisciplinary resource teams.
``(5) To ensure that Indians, as citizens of the United
States and of the States in which they reside, have the same
access to behavioral health services to which all citizens have
access.
``(6) To modify or supplement existing programs and
authorities in the areas identified in paragraph (2).
``(b) Plans.--
``(1) Development.--The Secretary, acting through the
Service, Indian tribes, and tribal organizations, shall
encourage Indian tribes and tribal organizations to develop
tribal plans, and urban Indian organizations to develop local
plans, and for all such groups to participate in developing
areawide plans for Indian Behavioral Health Services. The plans
shall include, to the extent feasible, the following
components:
``(A) An assessment of the scope of alcohol or
other substance abuse, mental illness, and
dysfunctional and self-destructive behavior, including
suicide, child abuse, and family violence, among
Indians, including--
``(i) the number of Indians served who are
directly or indirectly affected by such illness
or behavior; or
``(ii) an estimate of the financial and
human cost attributable to such illness or
behavior.
``(B) An assessment of the existing and additional
resources necessary for the prevention and treatment of
such illness and behavior, including an assessment of
the progress toward achieving the availability of the
full continuum of care described in subsection (c).
``(C) An estimate of the additional funding needed
by the Service, Indian tribes, tribal organizations,
and urban Indian organizations to meet their
responsibilities under the plans.
``(2) National clearinghouse.--The Secretary, acting
through the Service, shall coordinate with existing national
clearinghouses and information centers to include at the
clearinghouses and centers plans and reports on the outcomes of
such plans developed by Indian tribes, tribal organizations,
urban Indian organizations, and Service areas relating to
behavioral health. The Secretary shall ensure access to these
plans and outcomes by any Indian tribe, tribal organization,
urban Indian organization, or the Service.
``(3) Technical assistance.--The Secretary shall provide
technical assistance to Indian tribes, tribal organizations,
and urban Indian organizations in preparation of plans under
this section and in developing standards of care that may be
used and adopted locally.
``(c) Programs.--The Secretary, acting through the Service, shall
provide, to the extent feasible and if funding is available, programs
including the following:
``(1) Comprehensive care.--A comprehensive continuum of
behavioral health care which provides--
``(A) community-based prevention, intervention,
outpatient, and behavioral health aftercare;
``(B) detoxification (social and medical);
``(C) acute hospitalization;
``(D) intensive outpatient/day treatment;
``(E) residential treatment;
``(F) transitional living for those needing a
temporary, stable living environment that is supportive
of treatment and recovery goals;
``(G) emergency shelter;
``(H) intensive case management;
``(I) diagnostic services; and
``(J) promotion of healthy approaches to risk and
safety issues, including injury prevention.
``(2) Child care.--Behavioral health services for Indians
from birth through age 17, including--
``(A) preschool and school age fetal alcohol
spectrum disorder services, including assessment and
behavioral intervention;
``(B) mental health and substance abuse services
(emotional, organic, alcohol, drug, inhalant, and
tobacco);
``(C) identification and treatment of co-occurring
disorders and comorbidity;
``(D) prevention of alcohol, drug, inhalant, and
tobacco use;
``(E) early intervention, treatment, and aftercare;
``(F) promotion of healthy approaches to risk and
safety issues; and
``(G) identification and treatment of neglect and
physical, mental, and sexual abuse.
``(3) Adult care.--Behavioral health services for Indians
from age 18 through 55, including--
``(A) early intervention, treatment, and aftercare;
``(B) mental health and substance abuse services
(emotional, alcohol, drug, inhalant, and tobacco),
including sex specific services;
``(C) identification and treatment of co-occurring
disorders (dual diagnosis) and comorbidity;
``(D) promotion of healthy approaches for risk-
related behavior;
``(E) treatment services for women at risk of
giving birth to a child with a fetal alcohol spectrum
disorder; and
``(F) sex specific treatment for sexual assault and
domestic violence.
``(4) Family care.--Behavioral health services for
families, including--
``(A) early intervention, treatment, and aftercare
for affected families;
``(B) treatment for sexual assault and domestic
violence; and
``(C) promotion of healthy approaches relating to
parenting, domestic violence, and other abuse issues.
``(5) Elder care.--Behavioral health services for Indians
56 years of age and older, including--
``(A) early intervention, treatment, and aftercare;
``(B) mental health and substance abuse services
(emotional, alcohol, drug, inhalant, and tobacco),
including sex specific services;
``(C) identification and treatment of co-occurring
disorders (dual diagnosis) and comorbidity;
``(D) promotion of healthy approaches to managing
conditions related to aging;
``(E) sex specific treatment for sexual assault,
domestic violence, neglect, physical and mental abuse
and exploitation; and
``(F) identification and treatment of dementias
regardless of cause.
``(d) Community Behavioral Health Plan.--
``(1) Establishment.--The governing body of any Indian
tribe, tribal organization, or urban Indian organization may
adopt a resolution for the establishment of a community
behavioral health plan providing for the identification and
coordination of available resources and programs to identify,
prevent, or treat substance abuse, mental illness, or
dysfunctional and self-destructive behavior, including child
abuse and family violence, among its members or its service
population. This plan should include behavioral health
services, social services, intensive outpatient services, and
continuing aftercare.
``(2) Technical assistance.--At the request of an Indian
tribe, tribal organization, or urban Indian organization, the
Bureau of Indian Affairs and the Service shall cooperate with
and provide technical assistance to the Indian tribe, tribal
organization, or urban Indian organization in the development
and implementation of such plan.
``(3) Funding.--The Secretary, acting through the Service,
Indian tribes, and tribal organizations, may make funding
available to Indian tribes and tribal organizations which adopt
a resolution pursuant to paragraph (1) to obtain technical
assistance for the development of a community behavioral health
plan and to provide administrative support in the
implementation of such plan.
``(e) Coordination for Availability of Services.--The Secretary,
acting through the Service, shall coordinate behavioral health
planning, to the extent feasible, with other Federal agencies and with
State agencies, to encourage comprehensive behavioral health services
for Indians regardless of their place of residence.
``(f) Mental Health Care Need Assessment.--Not later than 1 year
after the date of enactment of the Indian Healthcare Improvement Act of
2017, the Secretary, acting through the Service, shall make an
assessment of the need for inpatient mental health care among Indians
and the availability and cost of inpatient mental health facilities
which can meet such need. In making such assessment, the Secretary
shall consider the possible conversion of existing, underused Service
hospital beds into psychiatric units to meet such need.
``SEC. 703. MEMORANDA OF AGREEMENT WITH THE DEPARTMENT OF INTERIOR.
``(a) Contents.--Not later than 1 year after the date of enactment
of the Indian Healthcare Improvement Act of 2017, the Secretary, acting
through the Service, and the Secretary of the Interior shall develop
and enter into a memoranda of agreement, or review and update any
existing memoranda of agreement, as required by section 4205 of the
Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986
(25 U.S.C. 2411) under which the Secretaries address the following:
``(1) The scope and nature of mental illness and
dysfunctional and self-destructive behavior, including child
abuse and family violence, among Indians.
``(2) The existing Federal, tribal, State, local, and
private services, resources, and programs available to provide
behavioral health services for Indians.
``(3) The unmet need for additional services, resources,
and programs necessary to meet the needs identified pursuant to
paragraph (1).
``(4)(A) The right of Indians, as citizens of the United
States and of the States in which they reside, to have access
to behavioral health services to which all citizens have
access.
``(B) The right of Indians to participate in, and receive
the benefit of, such services.
``(C) The actions necessary to protect the exercise of such
right.
``(5) The responsibilities of the Bureau of Indian Affairs
and the Service, including mental illness identification,
prevention, education, referral, and treatment services
(including services through multidisciplinary resource teams),
at the central, area, and agency and Service unit, Service
area, and headquarters levels to address the problems
identified in paragraph (1).
``(6) A strategy for the comprehensive coordination of the
behavioral health services provided by the Bureau of Indian
Affairs and the Service to meet the problems identified
pursuant to paragraph (1), including--
``(A) the coordination of alcohol and substance
abuse programs of the Service, the Bureau of Indian
Affairs, and Indian tribes and tribal organizations
(developed under the Indian Alcohol and Substance Abuse
Prevention and Treatment Act of 1986 (25 U.S.C. 2401 et
seq.)) with behavioral health initiatives pursuant to
this Act, particularly with respect to the referral and
treatment of dually diagnosed individuals requiring
behavioral health and substance abuse treatment; and
``(B) ensuring that the Bureau of Indian Affairs
and Service programs and services (including
multidisciplinary resource teams) addressing child
abuse and family violence are coordinated with such
non-Federal programs and services.
``(7) Directing appropriate officials of the Bureau of
Indian Affairs and the Service, particularly at the agency and
Service unit levels, to cooperate fully with tribal requests
made pursuant to community behavioral health plans adopted
under section 702(c) and section 4206 of the Indian Alcohol and
Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C.
2412).
``(8) Providing for an annual review of such agreement by
the Secretaries which shall be provided to Congress and Indian
tribes and tribal organizations.
``(b) Specific Provisions Required.--The memoranda of agreement
updated or entered into pursuant to subsection (a) shall include
specific provisions pursuant to which the Service shall assume
responsibility for--
``(1) the determination of the scope of the problem of
alcohol and substance abuse among Indians, including the number
of Indians within the jurisdiction of the Service who are
directly or indirectly affected by alcohol and substance abuse
and the financial and human cost;
``(2) an assessment of the existing and needed resources
necessary for the prevention of alcohol and substance abuse and
the treatment of Indians affected by alcohol and substance
abuse; and
``(3) an estimate of the funding necessary to adequately
support a program of prevention of alcohol and substance abuse
and treatment of Indians affected by alcohol and substance
abuse.
``(c) Publication.--Each memorandum of agreement entered into or
renewed (and amendments or modifications thereto) under subsection (a)
shall be published in the Federal Register. At the same time as
publication in the Federal Register, the Secretary shall provide a copy
of such memoranda, amendment, or modification to each Indian tribe,
tribal organization, and urban Indian organization.
``SEC. 704. COMPREHENSIVE BEHAVIORAL HEALTH PREVENTION AND TREATMENT
PROGRAM.
``(a) Establishment.--
``(1) In general.--The Secretary, acting through the
Service, shall provide a program of comprehensive behavioral
health, prevention, treatment, and aftercare, which may
include, if feasible and appropriate, systems of care, and
shall include--
``(A) prevention, through educational intervention,
in Indian communities;
``(B) acute detoxification, psychiatric
hospitalization, residential, and intensive outpatient
treatment;
``(C) community-based rehabilitation and aftercare;
``(D) community education and involvement,
including extensive training of health care,
educational, and community-based personnel;
``(E) specialized residential treatment programs
for high-risk populations, including pregnant and
postpartum women and their children; and
``(F) diagnostic services.
``(2) Target populations.--The target population of such
programs shall be members of Indian tribes. Efforts to train
and educate key members of the Indian community shall also
target employees of health, education, judicial, law
enforcement, legal, and social service programs.
``(b) Contract Health Services.--
``(1) In general.--The Secretary, acting through the
Service, may enter into contracts with public or private
providers of behavioral health treatment services for the
purpose of carrying out the program required under subsection
(a).
``(2) Provision of assistance.--In carrying out this
subsection, the Secretary shall provide assistance to Indian
tribes and tribal organizations to develop criteria for the
certification of behavioral health service providers and
accreditation of service facilities which meet minimum
standards for such services and facilities.
``SEC. 705. MENTAL HEALTH TECHNICIAN PROGRAM.
``(a) In General.--Pursuant to the Act of November 2, 1921 (25
U.S.C. 13) (commonly known as the `Snyder Act'), the Secretary shall
establish and maintain a mental health technician program within the
Service which--
``(1) provides for the training of Indians as mental health
technicians; and
``(2) employs such technicians in the provision of
community-based mental health care that includes
identification, prevention, education, referral, and treatment
services.
``(b) Paraprofessional Training.--In carrying out subsection (a),
the Secretary, acting through the Service, shall provide high-standard
paraprofessional training in mental health care necessary to provide
quality care to the Indian communities to be served. Such training
shall be based upon a curriculum developed or approved by the Secretary
which combines education in the theory of mental health care with
supervised practical experience in the provision of such care.
``(c) Supervision and Evaluation of Technicians.--The Secretary,
acting through the Service, shall supervise and evaluate the mental
health technicians in the training program.
``(d) Traditional Health Care Practices.--The Secretary, acting
through the Service, shall ensure that the program established pursuant
to this section involves the use and promotion of the traditional
health care practices of the Indian tribes to be served.
``SEC. 706. LICENSING REQUIREMENT FOR MENTAL HEALTH CARE WORKERS.
``(a) In General.--Subject to section 221, and except as provided
in subsection (b), any individual 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 psychologist, social worker, or
marriage and family therapist, respectively.
``(b) Trainees.--An individual may be employed as a trainee in
psychology, social work, or marriage and family therapy to provide
mental health care services described in subsection (a) if such
individual--
``(1) works under the direct supervision of a licensed
psychologist, social worker, or marriage and family therapist,
respectively;
``(2) is enrolled in or has completed at least 2 years of
course work at a post-secondary, accredited education program
for psychology, social work, marriage and family therapy, or
counseling; and
``(3) meets such other training, supervision, and quality
review requirements as the Secretary may establish.
``SEC. 707. INDIAN WOMEN TREATMENT PROGRAMS.
``(a) Grants.--The Secretary, consistent with section 702, 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 cultural,
historical, social, and child care needs of Indian women, regardless of
age.
``(b) Use of Grant Funds.--A grant made pursuant to this section
may be used--
``(1) to develop and provide community training, education,
and prevention programs for Indian women relating to behavioral
health issues, including fetal alcohol spectrum disorders;
``(2) to identify and provide psychological services,
counseling, advocacy, support, and relapse prevention to Indian
women and their families; and
``(3) to develop prevention and intervention models for
Indian women which incorporate traditional health care
practices, cultural values, and community and family
involvement.
``(c) Criteria.--The Secretary, in consultation with Indian tribes
and tribal organizations, shall establish criteria for the review and
approval of applications and proposals for funding under this section.
``(d) Allocation of Funds for Urban Indian Organizations.--20
percent of the funds appropriated pursuant to this section shall be
used to make grants to urban Indian organizations.
``SEC. 708. INDIAN YOUTH PROGRAM.
``(a) Detoxification and Rehabilitation.--The Secretary, acting
through the Service, consistent with section 702, shall develop and
implement a program for acute detoxification and treatment for Indian
youths, including behavioral health services. The program shall include
regional treatment centers designed to include detoxification and
rehabilitation for both sexes on a referral basis and programs
developed and implemented by Indian tribes or tribal organizations at
the local level under the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.). Regional centers shall be
integrated with the intake and rehabilitation programs based in the
referring Indian community.
``(b) Alcohol and Substance Abuse Treatment Centers or
Facilities.--
``(1) Establishment.--
``(A) In general.--The Secretary, acting through
the Service, shall construct, renovate, or, as
necessary, purchase, and appropriately staff and
operate, at least 1 youth regional treatment center or
treatment network in each area under the jurisdiction
of an area office.
``(B) Area office in california.--For the purposes
of this subsection, the area office in California shall
be considered to be 2 area offices, 1 office whose
jurisdiction shall be considered to encompass the
northern area of the State of California, and 1 office
whose jurisdiction shall be considered to encompass the
remainder of the State of California for the purpose of
implementing California treatment networks.
``(2) Funding.--For the purpose of staffing and operating
such centers or facilities, funding shall be pursuant to the
Act of November 2, 1921 (25 U.S.C. 13).
``(3) Location.--A youth treatment center constructed or
purchased under this subsection shall be constructed or
purchased at a location within the area described in paragraph
(1) agreed upon (by appropriate tribal resolution) by a
majority of the Indian tribes to be served by such center.
``(4) Specific provision of funds.--
``(A) In general.--Notwithstanding any other
provision of this title, the Secretary may, from
amounts authorized to be appropriated for the purposes
of carrying out this section, make funds available to--
``(i) the Tanana Chiefs Conference,
Incorporated, for the purpose of leasing,
constructing, renovating, operating, and
maintaining a residential youth treatment
facility in Fairbanks, Alaska; and
``(ii) the Southeast Alaska Regional Health
Corporation to staff and operate a residential
youth treatment facility without regard to the
proviso set forth in section 4(l) of the Indian
Self-Determination and Education Assistance Act
(25 U.S.C. 450b(l)).
``(B) Provision of services to eligible youths.--
Until additional residential youth treatment facilities
are established in Alaska pursuant to this section, the
facilities specified in subparagraph (A) shall make
every effort to provide services to all eligible Indian
youths residing in Alaska.
``(c) Intermediate Adolescent Behavioral Health Services.--
``(1) In general.--The Secretary, acting through the
Service, may provide intermediate behavioral health services,
which may , if feasible and appropriate, incorporate systems of
care, to Indian children and adolescents, including--
``(A) pretreatment assistance;
``(B) inpatient, outpatient, and aftercare
services;
``(C) emergency care;
``(D) suicide prevention and crisis intervention;
and
``(E) prevention and treatment of mental illness
and dysfunctional and self-destructive behavior,
including child abuse and family violence.
``(2) Use of funds.--Funds provided under this subsection
may be used--
``(A) to construct or renovate an existing health
facility to provide intermediate behavioral health
services;
``(B) to hire behavioral health professionals;
``(C) to staff, operate, and maintain an
intermediate mental health facility, group home, sober
housing, transitional housing or similar facilities, or
youth shelter where intermediate behavioral health
services are being provided;
``(D) to make renovations and hire appropriate
staff to convert existing hospital beds into adolescent
psychiatric units; and
``(E) for intensive home- and community-based
services.
``(3) Criteria.--The Secretary, acting through the Service,
shall, in consultation with Indian tribes and tribal
organizations, establish criteria for the review and approval
of applications or proposals for funding made available
pursuant to this subsection.
``(d) Federally Owned Structures.--
``(1) In general.--The Secretary, in consultation with
Indian tribes and tribal organizations, shall--
``(A) identify and use, where appropriate,
federally owned structures suitable for local
residential or regional behavioral health treatment for
Indian youths; and
``(B) establish guidelines for determining the
suitability of any such federally owned structure to be
used for local residential or regional behavioral
health treatment for Indian youths.
``(2) Terms and conditions for use of structure.--Any
structure described in paragraph (1) may be used under such
terms and conditions as may be agreed upon by the Secretary and
the agency having responsibility for the structure and any
Indian tribe or tribal organization operating the program.
``(e) Rehabilitation and Aftercare Services.--
``(1) In general.--The Secretary, Indian tribes, or tribal
organizations, in cooperation with the Secretary of the
Interior, shall develop and implement within each Service unit,
community-based rehabilitation and follow-up services for
Indian youths who are having significant behavioral health
problems, and require long-term treatment, community
reintegration, and monitoring to support the Indian youths
after their return to their home community.
``(2) Administration.--Services under paragraph (1) shall
be provided by trained staff within the community who can
assist the Indian youths in their continuing development of
self-image, positive problem-solving skills, and nonalcohol or
substance abusing behaviors. Such staff may include alcohol and
substance abuse counselors, mental health professionals, and
other health professionals and paraprofessionals, including
community health representatives.
``(f) Inclusion of Family in Youth Treatment Program.--In providing
the treatment and other services to Indian youths authorized by this
section, the Secretary, acting through the Service, shall provide for
the inclusion of family members of such youths in the treatment
programs or other services as may be appropriate. Not less than 10
percent of the funds appropriated for the purposes of carrying out
subsection (e) shall be used for outpatient care of adult family
members related to the treatment of an Indian youth under that
subsection.
``(g) Multidrug Abuse Program.--The Secretary, acting through the
Service, shall provide, consistent with section 702, programs and
services to prevent and treat the abuse of multiple forms of
substances, including alcohol, drugs, inhalants, and tobacco, among
Indian youths residing in Indian communities, on or near reservations,
and in urban areas and provide appropriate mental health services to
address the incidence of mental illness among such youths.
``(h) Indian Youth Mental Health.--The Secretary, acting through
the Service, shall collect data for the report under section 801 with
respect to--
``(1) the number of Indian youth who are being provided
mental health services through the Service and tribal health
programs;
``(2) a description of, and costs associated with, the
mental health services provided for Indian youth through the
Service and tribal health programs;
``(3) the number of youth referred to the Service or tribal
health programs for mental health services;
``(4) the number of Indian youth provided residential
treatment for mental health and behavioral problems through the
Service and tribal health programs, reported separately for on-
and off-reservation facilities; and
``(5) the costs of the services described in paragraph (4).
``SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL HEALTH FACILITIES
DESIGN, CONSTRUCTION, AND STAFFING.
``Not later than 1 year after the date of enactment of theIndian
Healthcare Improvement Act of 2017, the Secretary, acting through the
Service, may provide, in each area of the Service, not less than 1
inpatient mental health care facility, or the equivalent, for Indians
with behavioral health problems. For the purposes of this subsection,
California shall be considered to be 2 area offices, 1 office whose
location shall be considered to encompass the northern area of the
State of California and 1 office whose jurisdiction shall be considered
to encompass the remainder of the State of California. The Secretary
shall consider the possible conversion of existing, underused Service
hospital beds into psychiatric units to meet such need.
``SEC. 710. TRAINING AND COMMUNITY EDUCATION.
``(a) Program.--The Secretary, in cooperation with the Secretary of
the Interior, shall develop and implement or assist 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.
Such program may also include community-based training to develop local
capacity and tribal community provider training for prevention,
intervention, treatment, and aftercare.
``(b) Instruction.--The Secretary, acting through the Service,
shall 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 spectrum disorders to appropriate employees of the Bureau of
Indian Affairs and the Service, and to personnel in schools or programs
operated under any contract with the Bureau of Indian Affairs or the
Service, including supervisors of emergency shelters and halfway houses
described in section 4213 of the Indian Alcohol and Substance Abuse
Prevention and Treatment Act of 1986 (25 U.S.C. 2433).
``(c) Training Models.--In carrying out the education and training
programs required by this section, the Secretary, in consultation with
Indian tribes, tribal organizations, Indian behavioral health experts,
and Indian alcohol and substance abuse prevention experts, shall
develop and provide community-based training models. Such models shall
address--
``(1) the elevated risk of alcohol abuse and other
behavioral health problems faced by children of alcoholics;
``(2) the cultural, spiritual, and multigenerational
aspects of behavioral health problem prevention and recovery;
and
``(3) community-based and multidisciplinary strategies for
preventing and treating behavioral health problems.
``SEC. 711. BEHAVIORAL HEALTH PROGRAM.
``(a) Innovative Programs.--The Secretary, acting through the
Service, consistent with section 702, may plan, develop, implement, and
carry out programs to deliver innovative community-based behavioral
health services to Indians.
``(b) Awards; Criteria.--The Secretary may award a grant for a
project under subsection (a) to an Indian tribe or tribal organization
and may consider the following criteria:
``(1) The project will address significant unmet behavioral
health needs among Indians.
``(2) The project will serve a significant number of
Indians.
``(3) The project has the potential to deliver services in
an efficient and effective manner.
``(4) The Indian tribe or tribal organization has the
administrative and financial capability to administer the
project.
``(5) The project may deliver services in a manner
consistent with traditional health care practices.
``(6) The project is coordinated with, and avoids
duplication of, existing services.
``(c) Equitable Treatment.--For purposes of this subsection, the
Secretary shall, in evaluating project applications or proposals, use
the same criteria that the Secretary uses in evaluating any other
application or proposal for such funding.
``SEC. 712. FETAL ALCOHOL SPECTRUM DISORDERS PROGRAMS.
``(a) Programs.--
``(1) Establishment.--The Secretary, consistent with
section 702, acting through the Service, Indian Tribes, and
Tribal Organizations, is authorized to establish and operate
fetal alcohol spectrum disorders programs as provided in this
section for the purposes of meeting the health status
objectives specified in section 3.
``(2) Use of funds.--
``(A) In general.--Funding provided pursuant to
this section shall be used for the following:
``(i) To develop and provide for Indians
community and in-school training, education,
and prevention programs relating to fetal
alcohol spectrum disorders.
``(ii) To identify and provide behavioral
health treatment to high-risk Indian women and
high-risk women pregnant with an Indian's
child.
``(iii) To identify and provide appropriate
psychological services, educational and
vocational support, counseling, advocacy, and
information to fetal alcohol spectrum
disorders-affected Indians and their families
or caretakers.
``(iv) To develop and implement counseling
and support programs in schools for fetal
alcohol spectrum disorders-affected Indian
children.
``(v) To develop prevention and
intervention models which incorporate
practitioners of traditional health care
practices, cultural values, and community
involvement.
``(vi) To develop, print, and disseminate
education and prevention materials on fetal
alcohol spectrum disorders.
``(vii) To develop and implement, in
consultation with Indian Tribes and Tribal
Organizations, and in conference with urban
Indian Organizations, culturally sensitive
assessment and diagnostic tools including
dysmorphology clinics and multidisciplinary
fetal alcohol spectrum disorders clinics for
use in Indian communities and urban Centers.
``(viii) To develop and provide training on
fetal alcohol spectrum disorders to
professionals providing services to Indians,
including medical and allied health
practitioners, social service providers,
educators, and law enforcement, court officials
and corrections personnel in the juvenile and
criminal justice systems.
``(B) Additional uses.--In addition to any purpose
under subparagraph (A), funding provided pursuant to
this section may be used for 1 or more of the
following:
``(i) Early childhood intervention projects
from birth on to mitigate the effects of fetal
alcohol spectrum disorders among Indians.
``(ii) Community-based support services for
Indians and women pregnant with Indian
children.
``(iii) Community-based housing for adult
Indians with fetal alcohol spectrum disorders.
``(3) Criteria for applications.--The Secretary shall
establish criteria for the review and approval of applications
for funding under this section.
``(b) Services.--The Secretary, acting through the Service, Indian
Tribes, and Tribal Organizations, shall--
``(1) develop and provide services for the prevention,
intervention, treatment, and aftercare for those affected by
fetal alcohol spectrum disorders in Indian communities; and
``(2) provide supportive services, including services to
meet the special educational, vocational, school-to-work
transition, and independent living needs of adolescent and
adult Indians with fetal alcohol spectrum disorders.
``(c) Applied Research Projects.--The Secretary, acting through the
Substance Abuse and Mental Health Services Administration, shall make
grants to Indian Tribes, Tribal Organizations, and urban Indian
Organizations for applied research projects which propose to elevate
the understanding of methods to prevent, intervene, treat, or provide
rehabilitation and behavioral health aftercare for Indians and urban
Indians affected by fetal alcohol spectrum disorders.
``(d) Funding for Urban Indian Organizations.--Ten percent of the
funds appropriated pursuant to this section shall be used to make
grants to urban Indian Organizations funded under title V.
``SEC. 713. CHILD SEXUAL ABUSE PREVENTION AND TREATMENT PROGRAMS.
``(a) Establishment.--The Secretary, acting through the Service,
shall establish, consistent with section 702, in every Service area,
programs involving treatment for--
``(1) victims of sexual abuse who are Indian children or
children in an Indian household; and
``(2) other members of the household or family of the
victims described in paragraph (1).
``(b) Use of Funds.--Funding provided pursuant to this section
shall be used for the following:
``(1) To develop and provide community education and
prevention programs related to sexual abuse of Indian children
or children in an Indian household.
``(2) To identify and provide behavioral health treatment
to victims of sexual abuse who are Indian children or children
in an Indian household, and to their family members who are
affected by sexual abuse.
``(3) To develop prevention and intervention models which
incorporate traditional health care practices, cultural values,
and community involvement.
``(4) To develop and implement culturally sensitive
assessment and diagnostic tools for use in Indian communities
and urban centers.
``(c) Coordination.--The programs established under subsection (a)
shall be carried out in coordination with programs and services
authorized under the Indian Child Protection and Family Violence
Prevention Act (25 U.S.C. 3201 et seq.).
``SEC. 714. DOMESTIC AND SEXUAL VIOLENCE PREVENTION AND TREATMENT.
``(a) In General.--The Secretary, in accordance with section 702,
is authorized to establish in each Service area programs involving the
prevention and treatment of--
``(1) Indian victims of domestic violence or sexual abuse;
and
``(2) other members of the household or family of the
victims described in paragraph (1).
``(b) Use of Funds.--Funds made available to carry out this section
shall be used--
``(1) to develop and implement prevention programs and
community education programs relating to domestic violence and
sexual abuse;
``(2) to provide behavioral health services, including
victim support services, and medical treatment (including
examinations performed by sexual assault nurse examiners) to
Indian victims of domestic violence or sexual abuse;
``(3) to purchase rape kits; and
``(4) to develop prevention and intervention models, which
may incorporate traditional health care practices.
``(c) Training and Certification.--
``(1) In general.--Not later than 1 year after the date of
enactment of the Indian Healthcare Improvement Act of 2017, the
Secretary shall establish appropriate protocols, policies,
procedures, standards of practice, and, if not available
elsewhere, training curricula and training and certification
requirements for services for victims of domestic violence and
sexual abuse.
``(2) Report.--Not later than 18 months after the date of
enactment of the Indian Healthcare Improvement Act of 2017, 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 the means and extent
to which the Secretary has carried out paragraph (1).
``(d) Coordination.--
``(1) In general.--The Secretary, in coordination with the
Attorney General, Federal and tribal law enforcement agencies,
Indian health programs, and domestic violence or sexual assault
victim organizations, shall develop appropriate victim services
and victim advocate training programs--
``(A) to improve domestic violence or sexual abuse
responses;
``(B) to improve forensic examinations and
collection;
``(C) to identify problems or obstacles in the
prosecution of domestic violence or sexual abuse; and
``(D) to meet other needs or carry out other
activities required to prevent, treat, and improve
prosecutions of domestic violence and sexual abuse.
``(2) Report.--Not later than 2 years after the date of
enactment of the Indian Healthcare Improvement Act of 2017, 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, with respect to the
matters described in paragraph (1), the improvements made and
needed, problems or obstacles identified, and costs necessary
to address the problems or obstacles, and any other
recommendations that the Secretary determines to be
appropriate.
``SEC. 715. BEHAVIORAL HEALTH RESEARCH.
``(a) In General.--The Secretary, in consultation with appropriate
Federal agencies, shall make grants to, or enter into contracts with,
Indian tribes, tribal organizations, and urban Indian organizations or
enter into contracts with, or make grants to appropriate institutions
for, the conduct of research on the incidence and prevalence of
behavioral health problems among Indians served by the Service, Indian
tribes, or tribal organizations and among Indians in urban areas.
Research priorities under this section shall include--
``(1) the multifactorial causes of Indian youth suicide,
including--
``(A) protective and risk factors and scientific
data that identifies those factors; and
``(B) the effects of loss of cultural identity and
the development of scientific data on those effects;
``(2) the interrelationship and interdependence of
behavioral health problems with alcoholism and other substance
abuse, suicide, homicides, other injuries, and the incidence of
family violence; and
``(3) the development of models of prevention techniques.
``(b) Emphasis.--The effect of the interrelationships and
interdependencies referred to in subsection (a)(2) on children, and the
development of prevention techniques under subsection (a)(3) applicable
to children, shall be emphasized.
``Subtitle B--Indian Youth Suicide Prevention
``SEC. 721. FINDINGS AND PURPOSE.
``(a) Findings.--Congress finds that--
``(1)(A) the rate of suicide of American Indians and Alaska
Natives is 1.9 times higher than the national average rate; and
``(B) the rate of suicide of Indian and Alaska Native youth
aged 15 through 24 is--
``(i) 3.5 times the national average rate; and
``(ii) the highest rate of any population group in
the United States;
``(2) many risk behaviors and contributing factors for
suicide are more prevalent in Indian country than in other
areas, including--
``(A) history of previous suicide attempts;
``(B) family history of suicide;
``(C) history of depression or other mental
illness;
``(D) alcohol or drug abuse;
``(E) health disparities;
``(F) stressful life events and losses;
``(G) easy access to lethal methods;
``(H) exposure to the suicidal behavior of others;
``(I) isolation; and
``(J) incarceration;
``(3) according to national data for 2005, suicide was the
second-leading cause of death for Indians and Alaska Natives of
both sexes aged 10 through 34;
``(4)(A) the suicide rates of Indian and Alaska Native
males aged 15 through 24 are--
``(i) as compared to suicide rates of males of any
other racial group, up to 4 times greater; and
``(ii) as compared to suicide rates of females of
any other racial group, up to 11 times greater; and
``(B) data demonstrates that, over their lifetimes, females
attempt suicide 2 to 3 times more often than males;
``(5)(A) Indian tribes, especially Indian tribes located in
the Great Plains, have experienced epidemic levels of suicide,
up to 10 times the national average; and
``(B) suicide clustering in Indian country affects entire
tribal communities;
``(6) death rates for Indians and Alaska Natives are
statistically underestimated because many areas of Indian
country lack the proper resources to identify and monitor the
presence of disease;
``(7)(A) the Indian Health Service experiences health
professional shortages, with physician vacancy rates of
approximately 17 percent, and nursing vacancy rates of
approximately 18 percent, in 2007;
``(B) 90 percent of all teens who die by suicide suffer
from a diagnosable mental illness at time of death;
``(C) more than \1/2\ of teens who die by suicide have
never been seen by a mental health provider; and
``(D) \1/3\ of health needs in Indian country relate to
mental health;
``(8) often, the lack of resources of Indian tribes and the
remote nature of Indian reservations make it difficult to meet
the requirements necessary to access Federal assistance,
including grants;
``(9) the Substance Abuse and Mental Health Services
Administration and the Service have established specific
initiatives to combat youth suicide in Indian country and among
Indians and Alaska Natives throughout the United States,
including the National Suicide Prevention Initiative of the
Service, which has worked with Service, tribal, and urban
Indian health programs since 2003;
``(10) the National Strategy for Suicide Prevention was
established in 2001 through a Department of Health and Human
Services collaboration among--
``(A) the Substance Abuse and Mental Health
Services Administration;
``(B) the Service;
``(C) the Centers for Disease Control and
Prevention;
``(D) the National Institutes of Health; and
``(E) the Health Resources and Services
Administration; and
``(11) the Service and other agencies of the Department of
Health and Human Services use information technology and other
programs to address the suicide prevention and mental health
needs of Indians and Alaska Natives.
``(b) Purposes.--The purposes of this subtitle are--
``(1) 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--
``(A) the use of psychotherapy, psychiatric
assessments, diagnostic interviews, therapies for
mental health conditions predisposing to suicide, and
alcohol and substance abuse treatment;
``(B) the provision of clinical expertise to,
consultation services with, and medical advice and
training for frontline health care providers working
with Indian youth;
``(C) training and related support for community
leaders, family members, and health and education
workers who work with Indian youth;
``(D) the development of culturally relevant
educational materials on suicide; and
``(E) data collection and reporting;
``(2) to encourage Indian tribes, tribal organizations, and
other mental health care providers serving residents of Indian
country to obtain the services of predoctoral psychology and
psychiatry interns; and
``(3) to enhance the provision of mental health care
services to Indian youth through existing grant programs of the
Substance Abuse and Mental Health Services Administration.
``SEC. 722. DEFINITIONS.
``In this subtitle:
``(1) Administration.--The term `Administration' means the
Substance Abuse and Mental Health Services Administration.
``(2) Demonstration project.--The term `demonstration
project' means the Indian youth telemental health demonstration
project authorized under section 723(a).
``(3) Telemental health.--The term `telemental health'
means the use of electronic information and telecommunications
technologies to support long-distance mental health care,
patient and professional-related education, public health, and
health administration.
``SEC. 723. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRATION PROJECT.
``(a) Authorization.--
``(1) In general.--The Secretary, acting through the
Service, is authorized to carry out a demonstration project to
award grants for the provision of telemental health services to
Indian youth who--
``(A) have expressed suicidal ideas;
``(B) have attempted suicide; or
``(C) have behavioral health conditions that
increase or could increase the risk of suicide.
``(2) Eligibility for grants.--Grants under paragraph (1)
shall be awarded to Indian tribes and tribal organizations that
operate 1 or more facilities--
``(A) located in an area with documented
disproportionately high rates of suicide;
``(B) reporting active clinical telehealth
capabilities; or
``(C) offering school-based telemental health
services to Indian youth.
``(3) Grant period.--The Secretary shall award grants under
this section for a period of up to 4 years.
``(4) Maximum number of grants.--Not more than 5 grants
shall be provided under paragraph (1), with priority
consideration given to Indian tribes and tribal organizations
that--
``(A) serve a particular community or geographic
area in which there is a demonstrated need to address
Indian youth suicide;
``(B) enter into collaborative partnerships with
Service or other tribal health programs or facilities
to provide services under this demonstration project;
``(C) serve an isolated community or geographic
area that has limited or no access to behavioral health
services; or
``(D) operate a detention facility at which Indian
youth are detained.
``(5) Consultation with administration.--In developing and
carrying out the demonstration project under this subsection,
the Secretary shall consult with the Administration as the
Federal agency focused on mental health issues, including
suicide.
``(b) Use of Funds.--
``(1) In general.--An Indian tribe or tribal organization
shall use a grant received under subsection (a) for the
following purposes:
``(A) To provide telemental health services to
Indian youth, including the provision of--
``(i) psychotherapy;
``(ii) psychiatric assessments and
diagnostic interviews, therapies for mental
health conditions predisposing to suicide, and
treatment; and
``(iii) alcohol and substance abuse
treatment.
``(B) To provide clinician-interactive medical
advice, guidance and training, assistance in diagnosis
and interpretation, crisis counseling and intervention,
and related assistance to Service or tribal clinicians
and health services providers working with youth being
served under the demonstration project.
``(C) 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 the demonstration project,
including with identification of suicidal tendencies,
crisis intervention and suicide prevention, emergency
skill development, and building and expanding networks
among those individuals and with State and local health
services providers.
``(D) To develop and distribute culturally
appropriate community educational materials regarding--
``(i) suicide prevention;
``(ii) suicide education;
``(iii) suicide screening;
``(iv) suicide intervention; and
``(v) ways to mobilize communities with
respect to the identification of risk factors
for suicide.
``(E) To conduct data collection and reporting
relating to Indian youth suicide prevention efforts.
``(2) Traditional health care practices.--In carrying out
the purposes described in paragraph (1), an Indian tribe or
tribal organization may use and promote the traditional health
care practices of the Indian tribes of the youth to be served.
``(c) Applications.--
``(1) In general.--Subject to paragraph (2), to be eligible
to receive a grant under subsection (a), an Indian tribe or
tribal 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--
``(A) a description of the project that the Indian
tribe or tribal organization will carry out using the
funds provided under the grant;
``(B) a description of the manner in which the
project funded under the grant would--
``(i) meet the telemental health care needs
of the Indian youth population to be served by
the project; or
``(ii) improve the access of the Indian
youth population to be served to suicide
prevention and treatment services;
``(C) evidence of support for the project from the
local community to be served by the project;
``(D) 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;
``(E) a plan to involve the tribal community of the
youth who are provided services by the project in
planning and evaluating the behavioral health care and
suicide prevention efforts provided, in order to ensure
the integration of community, clinical, environmental,
and cultural components of the treatment; and
``(F) a plan for sustaining the project after
Federal assistance for the demonstration project has
terminated.
``(2) Efficiency of grant application process.--The
Secretary shall carry out such measures as the Secretary
determines to be necessary to maximize the time and workload
efficiency of the process by which Indian tribes and tribal
organizations apply for grants under paragraph (1).
``(d) Collaboration.--The Secretary, acting through the Service,
shall encourage Indian tribes and tribal organizations receiving grants
under this section to collaborate to enable comparisons regarding best
practices across projects.
``(e) Annual Report.--Each grant recipient shall submit to the
Secretary an annual report that--
``(1) describes the number of telemental health services
provided; and
``(2) includes any other information that the Secretary may
require.
``(f) Reports to Congress.--
``(1) Initial report.--
``(A) In general.--Not later than 2 years after the
date on which the first grant is awarded under this
section, the Secretary shall submit to the Committee on
Indian Affairs of the Senate and the Committee on
Natural Resources and the Committee on Energy and
Commerce of the House of Representatives a report
that--
``(i) describes each project funded by a
grant under this section during the preceding
2-year period, including a description of the
level of success achieved by the project; and
``(ii) evaluates whether the demonstration
project should be continued during the period
beginning on the date of termination of funding
for the demonstration project under subsection
(g) and ending on the date on which the final
report is submitted under paragraph (2).
``(B) Continuation of demonstration project.--On a
determination by the Secretary under clause (ii) of
subparagraph (A) that the demonstration project should
be continued, the Secretary may carry out the
demonstration project during the period described in
that clause using such sums otherwise made available to
the Secretary as the Secretary determines to be
appropriate.
``(2) Final report.--Not later than 270 days after the date
of termination of funding for the demonstration project under
subsection (g), the Secretary shall submit to the Committee on
Indian Affairs of the Senate and the Committee on Natural
Resources and the Committee on Energy and Commerce of the House
of Representatives a final report that--
``(A) describes the results of the projects funded
by grants awarded under this section, including any
data available that indicate the number of attempted
suicides;
``(B) evaluates the impact of the telemental health
services funded by the grants in reducing the number of
completed suicides among Indian youth;
``(C) evaluates whether the demonstration project
should be--
``(i) expanded to provide more than 5
grants; and
``(ii) designated as a permanent program;
and
``(D) evaluates the benefits of expanding the
demonstration project to include urban Indian
organizations.
``(g) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $1,500,000 for each of fiscal
years 2017 through 2019.
``SEC. 724. SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
GRANTS.
``(a) Grant Applications.--
``(1) Efficiency of grant application process.--The
Secretary, acting through the Administration, shall carry out
such measures as the Secretary determines to be necessary to
maximize the time and workload efficiency of the process by
which Indian tribes and tribal organizations apply for grants
under any program administered by the Administration, including
by providing methods other than electronic methods of
submitting applications for those grants, if necessary.
``(2) Priority for certain grants.--
``(A) In general.--To fulfill the trust
responsibility of the United States to Indian tribes,
in awarding relevant grants pursuant to a program
described in subparagraph (B), the Secretary shall take
into consideration the needs of Indian tribes or tribal
organizations, as applicable, that serve populations
with documented high suicide rates, regardless of
whether those Indian tribes or tribal organizations
possess adequate personnel or infrastructure to fulfill
all applicable requirements of the relevant program.
``(B) Description of grant programs.--A grant
program referred to in subparagraph (A) is a grant
program--
``(i) administered by the Administration to
fund activities relating to mental health,
suicide prevention, or suicide-related risk
factors; and
``(ii) under which an Indian tribe or
tribal organization is an eligible recipient.
``(3) Clarification regarding indian tribes and tribal
organizations.--Notwithstanding any other provision of law, in
applying for a grant under any program administered by the
Administration, no Indian tribe or tribal organization shall be
required to apply through a State or State agency.
``(4) Requirements for affected states.--
``(A) Definitions.--In this paragraph:
``(i) Affected state.--The term `affected
State' means a State--
``(I) the boundaries of which
include 1 or more Indian tribes; and
``(II) the application for a grant
under any program administered by the
Administration of which includes
statewide data.
``(ii) Indian population.--The term `Indian
population' means the total number of residents
of an affected State who are Indian.
``(B) Requirements.--As a condition of receipt of a
grant under any program administered by the
Administration, each affected State shall--
``(i) describe in the grant application--
``(I) the Indian population of the
affected State; and
``(II) the contribution of that
Indian population to the statewide data
used by the affected State in the
application; and
``(ii) demonstrate to the satisfaction of
the Secretary that--
``(I) of the total amount of the
grant, the affected State will allocate
for use for the Indian population of
the affected State an amount equal to
the proportion that--
``(aa) the Indian
population of the affected
State; bears to
``(bb) the total population
of the affected State; and
``(II) the affected State will take
reasonable efforts to collaborate with
each Indian tribe located within the
affected State to carry out youth
suicide prevention and treatment
measures for members of the Indian
tribe.
``(C) Report.--Not later than 1 year after the date
of receipt of a grant described in subparagraph (B), an
affected State shall submit to the Secretary a report
describing the measures carried out by the affected
State to ensure compliance with the requirements of
subparagraph (B)(ii).
``(b) No Non-Federal Share Requirement.--Notwithstanding any other
provision of law, no Indian tribe or tribal organization shall be
required to provide a non-Federal share of the cost of any project or
activity carried out using a grant provided under any program
administered by the Administration.
``(c) Outreach for Rural and Isolated Indian Tribes.--Due to the
rural, isolated nature of most Indian reservations and communities
(especially those reservations and communities in the Great Plains
region), the Secretary shall conduct outreach activities, with a
particular emphasis on the provision of telemental health services, to
achieve the purposes of this subtitle with respect to Indian tribes
located in rural, isolated areas.
``(d) Provision of Other Assistance.--
``(1) In general.--The Secretary, acting through the
Administration, shall carry out such measures (including
monitoring and the provision of required assistance) as the
Secretary determines to be necessary to ensure the provision of
adequate suicide prevention and mental health services to
Indian tribes described in paragraph (2), regardless of whether
those Indian tribes possess adequate personnel or
infrastructure--
``(A) to submit an application for a grant under
any program administered by the Administration,
including due to problems relating to access to the
Internet or other electronic means that may have
resulted in previous obstacles to submission of a grant
application; or
``(B) to fulfill all applicable requirements of the
relevant program.
``(2) Description of indian tribes.--An Indian tribe
referred to in paragraph (1) is an Indian tribe--
``(A) the members of which experience--
``(i) a high rate of youth suicide;
``(ii) low socioeconomic status; and
``(iii) extreme health disparity;
``(B) that is located in a remote and isolated
area; and
``(C) that lacks technology and communication
infrastructure.
``(3) Authorization of appropriations.--There are
authorized to be appropriated to the Secretary such sums as the
Secretary determines to be necessary to carry out this
subsection.
``(e) Early Intervention and Assessment Services.--
``(1) Definition of affected entity.--In this subsection,
the term `affected entity' means any entity--
``(A) that receives a grant for suicide
intervention, prevention, or treatment under a program
administered by the Administration; and
``(B) the population to be served by which includes
Indian youth.
``(2) Requirement.--The Secretary, acting through the
Administration, shall ensure that each affected entity carrying
out a youth suicide early intervention and prevention strategy
described in section 520E(c)(1) of the Public Health Service
Act (42 U.S.C. 290bb-36(c)(1)), or any other youth suicide-
related early intervention and assessment activity, provides
training or education to individuals who interact frequently
with the Indian youth to be served by the affected entity
(including parents, teachers, coaches, and mentors) on
identifying warning signs of Indian youth who are at risk of
committing suicide.
``SEC. 725. USE OF PREDOCTORAL PSYCHOLOGY AND PSYCHIATRY INTERNS.
``The Secretary shall carry out such activities as the Secretary
determines to be necessary to encourage Indian tribes, tribal
organizations, and other mental health care providers to obtain the
services of predoctoral psychology and psychiatry interns--
``(1) to increase the quantity of patients served by the
Indian tribes, tribal organizations, and other mental health
care providers; and
``(2) for purposes of recruitment and retention.
``SEC. 726. INDIAN YOUTH LIFE SKILLS DEVELOPMENT DEMONSTRATION PROGRAM.
``(a) Purpose.--The purpose of this section is to authorize the
Secretary, acting through the Administration, to carry out a
demonstration program to test the effectiveness of a culturally
compatible, school-based, life skills curriculum for the prevention of
Indian and Alaska Native adolescent suicide, including through--
``(1) the establishment of tribal partnerships to develop
and implement such a curriculum, in cooperation with--
``(A) behavioral health professionals, with a
priority for tribal partnerships cooperating with
mental health professionals employed by the Service;
``(B) tribal or local school agencies; and
``(C) parent and community groups;
``(2) the provision by the Administration or the Service
of--
``(A) technical expertise; and
``(B) clinicians, analysts, and educators, as
appropriate;
``(3) training for teachers, school administrators, and
community members to implement the curriculum;
``(4) the establishment of advisory councils composed of
parents, educators, community members, trained peers, and
others to provide advice regarding the curriculum and other
components of the demonstration program;
``(5) the development of culturally appropriate support
measures to supplement the effectiveness of the curriculum; and
``(6) projects modeled after evidence-based projects, such
as programs evaluated and published in relevant literature.
``(b) Demonstration Grant Program.--
``(1) Definitions.--In this subsection:
``(A) Curriculum.--The term `curriculum' means the
culturally compatible, school-based, life skills
curriculum for the prevention of Indian and Alaska
Native adolescent suicide identified by the Secretary
under paragraph (2)(A).
``(B) Eligible entity.--The term `eligible entity'
means--
``(i) an Indian tribe;
``(ii) a tribal organization;
``(iii) any other tribally authorized
entity; and
``(iv) any partnership composed of 2 or
more entities described in clause (i), (ii), or
(iii).
``(2) Establishment.--The Secretary, acting through the
Administration, may establish and carry out a demonstration
program under which the Secretary shall--
``(A) identify a culturally compatible, school-
based, life skills curriculum for the prevention of
Indian and Alaska Native adolescent suicide;
``(B) identify the Indian tribes that are at
greatest risk for adolescent suicide;
``(C) invite those Indian tribes to participate in
the demonstration program by--
``(i) responding to a comprehensive program
requirement request of the Secretary; or
``(ii) submitting, through an eligible
entity, an application in accordance with
paragraph (4); and
``(D) provide grants to the Indian tribes
identified under subparagraph (B) and eligible entities
to implement the curriculum with respect to Indian and
Alaska Native youths who--
``(i) are between the ages of 10 and 19;
and
``(ii) attend school in a region that is at
risk of high youth suicide rates, as determined
by the Administration.
``(3) Requirements.--
``(A) Term.--The term of a grant provided under the
demonstration program under this section shall be not
less than 4 years.
``(B) Maximum number.--The Secretary may provide
not more than 5 grants under the demonstration program
under this section.
``(C) Amount.--The grants provided under this
section shall be of equal amounts.
``(D) Certain schools.--In selecting eligible
entities to receive grants under this section, the
Secretary shall ensure that not less than 1
demonstration program shall be carried out at each of--
``(i) a school operated by the Bureau of
Indian Education;
``(ii) a Tribal school; and
``(iii) a school receiving payments under
section 8002 or 8003 of the Elementary and
Secondary Education Act of 1965 (20 U.S.C.
7702, 7703).
``(4) Applications.--To be eligible to receive a grant
under the demonstration program, an eligible entity shall
submit to the Secretary an application, at such time, in such
manner, and containing such information as the Secretary may
require, including--
``(A) an assurance that, in implementing the
curriculum, the eligible entity will collaborate with 1
or more local educational agencies, including
elementary schools, middle schools, and high schools;
``(B) an assurance that the eligible entity will
collaborate, for the purpose of curriculum development,
implementation, and training and technical assistance,
with 1 or more--
``(i) nonprofit entities with demonstrated
expertise regarding the development of
culturally sensitive, school-based, youth
suicide prevention and intervention programs;
or
``(ii) institutions of higher education
with demonstrated interest and knowledge
regarding culturally sensitive, school-based,
life skills youth suicide prevention and
intervention programs;
``(C) an assurance that the curriculum will be
carried out in an academic setting in conjunction with
at least 1 classroom teacher not less frequently than
twice each school week for the duration of the academic
year;
``(D) a description of the methods by which
curriculum participants will be--
``(i) screened for mental health at-risk
indicators; and
``(ii) if needed and on a case-by-case
basis, referred to a mental health clinician
for further assessment and treatment and with
crisis response capability; and
``(E) an assurance that supportive services will be
provided to curriculum participants identified as high-
risk participants, including referral, counseling, and
follow-up services for--
``(i) drug or alcohol abuse;
``(ii) sexual or domestic abuse; and
``(iii) depression and other relevant
mental health concerns.
``(5) Use of funds.--An Indian tribe identified under
paragraph (2)(B) or an eligible entity may use a grant provided
under this subsection--
``(A) to develop and implement the curriculum in a
school-based setting;
``(B) to establish an advisory council--
``(i) to advise the Indian tribe or
eligible entity regarding curriculum
development; and
``(ii) to provide support services
identified as necessary by the community being
served by the Indian tribe or eligible entity;
``(C) to appoint and train a school- and community-
based cultural resource liaison, who will act as an
intermediary among the Indian tribe or eligible entity,
the applicable school administrators, and the advisory
council established by the Indian tribe or eligible
entity;
``(D) to establish an on-site, school-based, MA- or
Ph.D.-level mental health practitioner (employed by the
Service, if practicable) to work with tribal educators
and other personnel;
``(E) to provide for the training of peer
counselors to assist in carrying out the curriculum;
``(F) to procure technical and training support
from nonprofit or State entities or institutions of
higher education identified by the community being
served by the Indian tribe or eligible entity as the
best suited to develop and implement the curriculum;
``(G) to train teachers and school administrators
to effectively carry out the curriculum;
``(H) to establish an effective referral procedure
and network;
``(I) to identify and develop culturally compatible
curriculum support measures;
``(J) to obtain educational materials and other
resources from the Administration or other appropriate
entities to ensure the success of the demonstration
program; and
``(K) to evaluate the effectiveness of the
curriculum in preventing Indian and Alaska Native
adolescent suicide.
``(c) Evaluations.--Using such amounts made available pursuant to
subsection (e) as the Secretary determines to be appropriate, the
Secretary shall conduct, directly or through a grant, contract, or
cooperative agreement with an entity that has experience regarding the
development and operation of successful culturally compatible, school-
based, life skills suicide prevention and intervention programs or
evaluations, an annual evaluation of the demonstration program under
this section, including an evaluation of--
``(1) the effectiveness of the curriculum in preventing
Indian and Alaska Native adolescent suicide;
``(2) areas for program improvement; and
``(3) additional development of the goals and objectives of
the demonstration program.
``(d) Report to Congress.--
``(1) In general.--Subject to paragraph (2), not later than
180 days after the date of termination of the demonstration
program, the Secretary shall submit to the Committee on Indian
Affairs and the Committee on Health, Education, Labor, and
Pensions of the Senate and the Committee on Natural Resources
and the Committee on Education and Labor of the House of
Representatives a final report that--
``(A) describes the results of the program of each
Indian tribe or eligible entity under this section;
``(B) evaluates the effectiveness of the curriculum
in preventing Indian and Alaska Native adolescent
suicide;
``(C) makes recommendations regarding--
``(i) the expansion of the demonstration
program under this section to additional
eligible entities;
``(ii) designating the demonstration
program as a permanent program; and
``(iii) identifying and distributing the
curriculum through the Suicide Prevention
Resource Center of the Administration; and
``(D) incorporates any public comments received
under paragraph (2).
``(2) Public comment.--The Secretary shall provide a notice
of the report under paragraph (1) and an opportunity for public
comment on the report for a period of not less than 90 days
before submitting the report to Congress.
``(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $1,000,000 for each of fiscal
years 2017 through 2020.''.
Subtitle H--Miscellaneous
SEC. 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:
``SEC. 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
Healthcare Improvement Act of 2017 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
Healthcare Improvement Act of 2017.''.
SEC. 192. LIMITATION ON USE OF FUNDS APPROPRAITED TO THE INDIAN HEALTH
SERVICE.
Section 806 of the Indian Health Care Improvement Act is amended--
(1) by striking ``Any limitation'' and inserting the
following:
``(a) HHS Appropriations.--Any limitation''; and
(2) by adding at the end the following:
``(b) Limitations Pursuant to Other Federal Law.--Any limitation
pursuant to other Federal laws on the use of Federal funds appropriated
to the Service shall apply with respect to the performance or coverage
of abortions.''.
SEC. 193. 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:
``SEC. 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:
``SEC. 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:
``SEC. 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 of California who is listed on the plans
for distribution of the assets of rancherias and reservations
located within the State of California under the Act of August
18, 1958 (72 Stat. 619), and any descendant of such an Indian.
``(b) Clarification.--Nothing in this section may be construed as
expanding the eligibility of California Indians for health services
provided by the Service beyond the scope of eligibility for such health
services that applied on May 1, 1986.''.
SEC. 194. 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:
``SEC. 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.''.
SEC. 195. 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:
``SEC. 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.''.
SEC. 196. 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:
``SEC. 826. ANNUAL BUDGET SUBMISSION.
``Effective beginning with the submission of the annual budget
request to Congress for fiscal year 2017, 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.''.
SEC. 197. 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:
``SEC. 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 Healthcare Improvement Act of 2017, 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 Healthcare Improvement Act of 2017, 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.''.
SEC. 198. 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:
``SEC. 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.''.
SEC. 199. 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:
``SEC. 829. DISEASE AND INJURY PREVENTION REPORT.
``Not later than 18 months after the date of enactment of the
Indian Healthcare Improvement Act of 2017, 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.''.
SEC. 200. 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:
``SEC. 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 Healthcare Improvement Act of 2017, 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 Healthcare Improvement Act of 2017, 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.''.
SEC. 201. 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:
``SEC. 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.''.
SEC. 202. 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:
``SEC. 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 Healthcare Improvement Act of 2017, 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.''.
TITLE II--AMENDMENTS TO OTHER ACTS AND MISCELLANEOUS PROVISIONS
SEC. 201. ELIMINATION OF SUNSET FOR REIMBURSEMENT FOR ALL MEDICARE PART
B SERVICES FURNISHED BY CERTAIN INDIAN HOSPITALS AND
CLINICS.
(a) Reimbursement for All Medicare Part B Services Furnished by
Certain Indian Hospitals and Clinics.--Section 1880(e)(1)(A) of the
Social Security Act (42 U.S.C. 1395qq(e)(1)(A)) is amended by striking
``during the 5-year period beginning on'' and inserting ``on or
after''.
(b) Effective Date.--The amendments made by this section shall
apply to items or services furnished on or after January 1, 2017.
SEC. 202. INCLUDING COSTS INCURRED BY AIDS DRUG ASSISTANCE PROGRAMS AND
INDIAN HEALTH SERVICE IN PROVIDING PRESCRIPTION DRUGS
TOWARD THE ANNUAL OUT-OF-POCKET THRESHOLD UNDER PART D.
(a) In General.--Section 1860D-2(b)(4)(C) of the Social Security
Act (42 U.S.C. 1395w-102(b)(4)(C)) is amended--
(1) in clause (i), by striking ``and'' at the end;
(2) in clause (ii)--
(A) by striking ``such costs shall be treated as
incurred only if'' and inserting ``subject to clause
(iii), such costs shall be treated as incurred only
if'';
(B) by striking ``, under section 1860D-14, or
under a State Pharmaceutical Assistance Program''; and
(C) by striking the period at the end and inserting
``; and''; and
(3) by inserting after clause (ii) the following new
clause:
``(iii) such costs shall be treated as
incurred and shall not be considered to be
reimbursed under clause (ii) if such costs are
borne or paid--
``(I) under section 1860D-14;
``(II) under a State Pharmaceutical
Assistance Program;
``(III) by the Indian Health
Service, an Indian tribe or tribal
organization, or an urban Indian
organization (as defined in section 4
of the Indian Health Care Improvement
Act); or
``(IV) under an AIDS Drug
Assistance Program under part B of
title XXVI of the Public Health Service
Act.''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to costs incurred on or after January 1, 2017.
SEC. 203. PROHIBITION OF USE OF FEDERAL FUNDS FOR ABORTION.
No funds authorized or appropriated by this Act (or an amendment
made by this Act) may be used to pay for any abortion or to cover any
part of the costs of any health plan that includes coverage of
abortion, except in the case where a woman suffers from a physical
disorder, physical injury, or physical illness that would, as certified
by a physician, place the woman in danger of death unless an abortion
is performed, including a life-endangering physical condition caused by
or arising from the pregnancy itself, or unless the pregnancy is the
result of an act of rape or incest.
SEC. 204. REAUTHORIZATION OF NATIVE HAWAIIAN HEALTH CARE PROGRAMS.
(a) Reauthorization.--The Native Hawaiian Health Care Act of 1988
(42 U.S.C. 11701 et seq.) is amended by striking ``2001'' each place it
appears in sections 6(h)(1), 7(b), and 10(c) (42 U.S.C. 11705(h)(1),
11706(b), 11709(c)) and inserting ``2019''.
(b) Health and Education.--
(1) In general.--Section 6(c) of the Native Hawaiian Health
Care Act of 1988 (42 U.S.C. 11705) is amended by adding at the
end the following:
``(4) Health and education.--In order to enable privately
funded organizations to continue to supplement public efforts
to provide educational programs designed to improve the health,
capability, and well-being of Native Hawaiians and to continue
to provide health services to Native Hawaiians, notwithstanding
any other provision of Federal or State law, it shall be lawful
for the private educational organization identified in section
7202(16) of the Elementary and Secondary Education Act of 1965
(20 U.S.C. 7512(16)) to continue to offer its educational
programs and services to Native Hawaiians (as defined in
section 7207 of that Act (20 U.S.C. 7517)) first and to others
only after the need for such programs and services by Native
Hawaiians has been met.''.
(2) Effective date.--The amendment made by paragraph (1)
takes effect on December 5, 2006.
(c) Definition of Health Promotion.--Section 12(2) of the Native
Hawaiian Health Care Act of 1988 (42 U.S.C. 11711(2)) is amended--
(1) in subparagraph (F), by striking ``and'' at the end;
(2) in subparagraph (G), by striking the period at the end
and inserting ``, and''; and
(3) by adding at the end the following:
``(H) educational programs with the mission of
improving the health, capability, and well-being of
Native Hawaiians.''.
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