[Congressional Record Volume 142, Number 130 (Thursday, September 19, 1996)]
[Senate]
[Pages S11041-S11042]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




      THE INDIAN HEALTH CARE IMPROVEMENT ACT AMENDMENT ACT OF 1996

                                 ______
                                 

                       McCAIN AMENDMENT NO. 5392

  Mr. STEVENS (for Mr. McCain) proposed an amendment to the bill (H.R. 
3378) to amend the Indian Health Care Improvement Act to extend the 
demonstration program for direct billing of Medicare, Medicaid, and 
other third party payors; as follows:

       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. SHORT TITLE; REFERENCES.

       (a) Short Title.--This Act may be cited as the ``Indian 
     Health Care Improvement Technical Corrections Act of 1996''.
       (b) References.--Whenever in this Act an amendment or 
     repeal is expressed in terms of an amendment to or repeal of 
     a section or other provision, the reference shall be 
     considered to be made to a section or other provision of the 
     Indian Health Care Improvement Act.

     SEC. 2. TECHNICAL CORRECTIONS IN THE INDIAN HEALTH CARE 
                   IMPROVEMENT ACT.

       (a) Definition of Health Profession.--Section 4(n) (25 
     U.S.C. 1603(n)) is amended--
       (1) by inserting ``allopathic medicine,'' before ``family 
     medicine''; and
       (2) by striking ``and allied health professions'' and 
     inserting ``an allied health profession, or any other health 
     profession''.
       (b) Indian Health Professions Scholarships.--Section 104(b) 
     of the Indian Health Care Improvement Act (25 U.S.C. 
     1613a(b)) is amended--
       (1) in paragraph (3)--
       (A) in subparagraph (A)--
       (i) by striking the matter preceding clause (i) and 
     inserting the following:
       ``(3)(A) The active duty service obligation under a written 
     contract with the Secretary under section 338A of the Public 
     Health Service Act (42 U.S.C. 2541) that an individual has 
     entered into under that section shall, if that individual is 
     a recipient of an Indian Health Scholarship, be met in full-
     time practice, by service--'';
       (ii) by striking ``or'' at the end of clause (iii);
       (iii) by striking the period at the end of clause (iv) and 
     inserting ``; or''; and
       (iv) by adding at the end the following new clause:
       ``(v) in an academic setting (including a program that 
     receives funding under section 102, 112, or 114, or any other 
     academic setting that the Secretary, acting through the 
     Service, determines to be appropriate for the purposes of 
     this clause) in which the major duties and responsibilities 
     of the recipient are the recruitment and training of Indian 
     health professionals in the discipline of that recipient in a 
     manner consistent with the purpose of this title, as 
     specified in section 101.'';

[[Page S11042]]

       (B) by redesignating subparagraphs (B) and (C) as 
     subparagraphs (C) and (D), respectively;
       (C) by inserting after subparagraph (A) the following new 
     subparagraph:
       ``(B) At the request of any individual who has entered into 
     a contract referred to in subparagraph (A) and who receives a 
     degree in medicine (including osteopathic or allopathic 
     medicine), dentistry, optometry, podiatry, or pharmacy, the 
     Secretary shall defer the active duty service obligation of 
     that individual under that contract, in order that such 
     individual may complete any internship, residency, or other 
     advanced clinical training that is required for the practice 
     of that health profession, for an appropriate period (in 
     years, as determined by the Secretary), subject to the 
     following conditions:
       ``(i) No period of internship, residency, or other advanced 
     clinical training shall be counted as satisfying any period 
     of obligated service that is required under this section.
       ``(ii) The active duty service obligation of that 
     individual shall commence not later than 90 days after the 
     completion of that advanced clinical training (or by a date 
     specified by the Secretary).
       ``(iii) The active duty service obligation will be served 
     in the health profession of that individual, in a manner 
     consistent with clauses (i) through (v) of subparagraph 
     (A).'';
       (D) in subparagraph (C), as so redesignated, by striking 
     ``prescribed under section 338C of the Public Health Service 
     Act (42 U.S.C. 254m) by service in a program specified in 
     subparagraph (A)'' and inserting ``described in subparagraph 
     (A) by service in a program specified in that 
     subparagraph''; and
       (E) in subparagraph (D), as so redesignated--
       (i) by striking ``Subject to subparagraph (B),'' and 
     inserting ``Subject to subparagraph (C),''; and
       (ii) by striking ``prescribed under section 338C of the 
     Public Health Service Act (42 U.S.C. 254m)'' and inserting 
     ``described in subparagraph (A)'';
       (2) in paragraph (4)--
       (A) in subparagraph (B), by striking the matter preceding 
     clause (i) and inserting the following:
       ``(B) the period of obligated service described in 
     paragraph (3)(A) shall be equal to the greater of--''; and
       (B) in subparagraph (C), by striking ``(42 U.S.C. 
     254m(g)(1)(B))'' and inserting ``(42 U.S.C. 254l(g)(1)(B))''; 
     and
       (3) in paragraph (5), by adding at the end the following 
     new subparagraphs:
       ``(C) Upon the death of an individual who receives an 
     Indian Health Scholarship, any obligation of that individual 
     for service or payment that relates to that scholarship shall 
     be canceled.
       ``(D) The Secretary shall provide for the partial or total 
     waiver or suspension of any obligation of service or payment 
     of a recipient of an Indian Health Scholarship if the 
     Secretary determines that--
       ``(i) it is not possible for the recipient to meet that 
     obligation or make that payment;
       ``(ii) requiring that recipient to meet that obligation or 
     make that payment would result in extreme hardship to the 
     recipient; or
       ``(iii) the enforcement of the requirement to meet the 
     obligation or make the payment would be unconscionable.
       ``(E) Notwithstanding any other provision of law, in any 
     case of extreme hardship or for other good cause shown, the 
     Secretary may waive, in whole or in part, the right of the 
     United States to recover funds made available under this 
     section.
       ``(F) Notwithstanding any other provision of law, with 
     respect to a recipient of an Indian Health Scholarship, no 
     obligation for payment may be released by a discharge in 
     bankruptcy under title 11, United States Code, unless that 
     discharge is granted after the expiration of the 5-year 
     period beginning on the initial date on which that payment is 
     due, and only if the bankruptcy court finds that the 
     nondischarge of the obligation would be unconscionable.''.
       (c) California Contract Health Services Demonstration 
     Program.--Section 211(g) (25 U.S.C. 1621j(g)) is amended by 
     striking ``1993, 1994, 1995, 1996, and 1997'' and inserting 
     ``1996 through 2000''.
       (d) Extension of Certain Demonstration Program.--Section 
     405(c)(2) (25 U.S.C. 1645(c)(2)) is amended by striking 
     ``September 30, 1996'' and inserting ``September 30, 1998''.
       (e) Gallup Alcohol and Substance Abuse Treatment Center.--
     Section 706(d) (25 U.S.C. 1665e(d)) is amended to read as 
     follows:
       ``(d) Authorization of Appropriations.--There are 
     authorized to be appropriated, for each of fiscal years 1996 
     through 2000, such sums as may be necessary to carry out 
     subsection (b).''.
       (f) Substance Abuse Counselor Education Demonstration 
     Program.--Section 711(h) (25 U.S.C. 1665j(h)) is amended by 
     striking ``1993, 1994, 1995, 1996, and 1997'' and inserting 
     ``1996 through 2000''.
       (g) Home and Community-Based Care Demonstration Program.--
     Section 821(i) (25 U.S.C. 1680k(i)) is amended by striking 
     ``1993, 1994, 1995, 1996, and 1997'' and inserting ``1996 
     through 2000''.

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