[Congressional Record Volume 142, Number 136 (Friday, September 27, 1996)]
[House]
[Pages H11416-H11418]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    INDIAN HEALTH CARE IMPROVEMENT TECHNICAL CORRECTIONS ACT OF 1996

  Mr. YOUNG of Alaska. Mr. Speaker, I move to suspend the rules and 
agree to the resolution (H. Res. 544) providing for the concurrence by 
the House with an amendment in the amendment of the Senate to H.R. 
3378.
  The Clerk read as follows:

                              H. Res. 544

       Resolved, That upon adoption of this resolution 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, with the 
     Senate amendment thereto, shall be considered to have been 
     taken from the Speaker's table to the end that the Senate 
     amendment thereto be, and the same are hereby, agreed to with 
     an amendment as follows:
       In lieu of the matter proposed to be inserted by the Senate 
     to the text of the bill, insert the following:

     SECTION 1. SHORT TITLE; REFERENCE.

       (a) Short Title.--Tthis 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 204(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. 254l) 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); and
       (iii) by striking the period at the end of clause (iv) and 
     inserting ``; or'';
       (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 received 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 Service 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''.
       (3) 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''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Alaska [Mr. Young] and the gentleman from American Samoa [Mr. 
Faleomavaega] each will control 20 minutes.
  The Chair recognizes the gentleman from Alaska [Mr. Young].
  Mr. YOUNG of Alaska. Mr. Speaker, I yield myself such time as I may 
consume.
  (Mr. YOUNG of Alaska asked and was given permission to revise and 
extend his remarks and include extraneous material.)
  Mr. YOUNG of Alaska. Mr. Speaker, H.R. 3378 was passed by the House 
earlier this year, sent to the other body, amended by the other body 
and sent

[[Page H11417]]

back to us for further action. The other body amended the bill to make 
technical amendments to certain provisions in the Health Care 
Improvement Act and authorized several Indian Health care demonstration 
programs, the year 2000.
  Mr. Speaker, I include for the Record a letter dated September 25 
from Chairman Thomas J. Bliley, Jr. This letter explains the support of 
the gentleman from Virginia [Mr. Bliley] for 3378, as amended.
  The letter referred to follows:

                                         House of Representatives,


                                        Committee on Commerce,

                               Washington, DC, September 25, 1996.
     Hon. Don Young,
     Chairman, Committee on Resources,
     U.S. House of Representatives,
     Washington, DC.
       Dear Mr. Chairman: The Senate recently passed an amended 
     version of H.R. 3378, a bill to amend the Indian Health Care 
     Improvement Act to extend the demonstration program for 
     direct billing of Medicare, Medicaid, and other third party 
     payors. I remain concerned about the implications of passing 
     this measure, but appreciate your interest in having it move 
     forward, since the projects would otherwise expire September 
     30, 1996.
       It is my understanding that the Committee on Resources 
     would like to bring the measure up for Floor consideration, 
     with an amendment negotiated among the House Committee on 
     Commerce, the House Committee on Resources, and the Senate 
     Committee on Indian Affairs. Based on our agreement to drop 
     section 2(b)(1)(A)(iv), and to include in the record of the 
     debate the statement regarding scholarship paybacks, the 
     Committee on Commerce will not object to Floor consideration 
     of H.R. 3378.
       By participating in this process of expending consideration 
     of H.R. 3378, this Committee does not waive its 
     jurisdictional interest in the matter. Although I understand 
     a conference of this measure is unlikely, I reserve the right 
     to seek conferees on issues within the jurisdiction of the 
     Commerce Committee during any House-Senate conference that 
     may be convened.
       I want to thank you and your staff for your cooperation in 
     this process. I would appreciate your including this letter 
     as part of the record during consideration of this bill by 
     the House.
           Sincerely,
                                  Thomas J. Bliley, Jr., Chairman.

  Mr. Speaker, in conclusion I note that the managers have amended the 
other body's amendment to delete certain language which we feel is 
unnecessary.
  Mr. Speaker, H.R. 3378 is an important piece of legislation which has 
been admitted and then readmitted. It is a good bill, and I urge my 
colleagues to give it full support.
  Mr. Speaker, H.R. 3378 was passed by this House earlier this year, 
sent to the other body, amended by the other body, and sent back to us 
for further action.
  The other body amended the bill to make technical amendments to 
certain provisions of the Indian Health Care Improvement Act and to 
reauthorize several Indian health care demonstration programs through 
the year 2000.
  Among the technical amendments to the Indian Health Care Improvement 
Act made by the other body was legislation which clarifies that the 
Secretary may waive or modify the service obligation requirements, 
under the Indian health scholarship program, in a case of extreme 
hardship or for other good cause.
  In the past, the Secretary has granted a small number of such 
waivers, in accord with National Health Service Corps regulations. This 
change clarifies that this authority may be exercised specifically for 
the Indian health service scholarship program.
  Other than for severe hardship circumstances, such waivers have been 
considered in particular in cases where service has been performed by 
Indian health scholarship awardees in certain recruitment and training 
programs in academic institutions. In these cases, an individual 
scholarship awardee has served in a significant capacity in a program, 
funded by the Indian Health Service, designed to attract and retain 
American Indian and Alaska Native students in health professions 
training.
  In recognition of the enormous need for such recruitment and 
retention activities, it has been decided in a small number of cases 
that such service can be substituted, in whole or in part, for direct 
provision of health care.
  The managers emphasize that the primary purpose for the Indian health 
scholarship program is to increase the number of individuals providing 
direct health care to American Indian and Alaska Native people in areas 
and at facilities where access to health care is difficult or limited. 
Thus, service in such a capacity should remain the principal way that 
scholarship payback obligations are fulfilled.
  However, the managers recognize the importance of stronger, more 
targeted, and more aggressive recruitment and retention of American 
Indian and Alaska Native students into health care training, and that 
such efforts may be enhanced by having an Indian health scholarship 
recipient serve in such a program.
  When the major duties and responsibilities of an individual, who 
already has received training through an Indian health scholarship, are 
the recruitment and training of Indian health professionals, that 
individual may be contributing to the purpose of the scholarship 
program through increasing the number of available health care 
providers, even though that individual is not providing health care 
personally.
  Thus, there may be a small number of cases where such service is a 
good cause to waive or offset the scholarship service obligation.
  It has come to the attention of the managers that both the Indian 
Health Service and a number of tribal organizations have identified the 
need for greater flexibility in assessing payback obligations to best 
serve the health care needs of Indian people.
  The managers emphasize, in granting this additional flexibility to 
the Secretary, that they expect this avenue of fulfilling scholarship 
obligations to be limited.
  Most Indian health scholarship recipients will fulfill their service 
obligations by providing direct health care, and the Secretary is 
expected to exercise significant caution and considerable judgment is 
using this new authority.
  It must not be forgotten that direct health care service to Indian 
people, in addition to successfully having completed a health 
professions program, is a key component contributing to any 
individual's ability to recruit students.
  In conclusion, I note that the managers have amended the other body's 
amendment to delete certain language which we feel is unnecessary.
  Mr. Speaker, H.R. 3378 is an important piece of legislation which has 
been amended and then reamended. It is a good bill and I urge my 
colleagues to give it their full support.
  Mr. Speaker, I reserve the balance of my time.
  Mr. FALEOMAVAEGA. Mr. Speaker, I yield myself such time as I may 
consume.
  (Mr. FALEOMAVAEGA asked and was given permission to revise and extend 
his remarks.)
  Mr. FALEOMAVAEGA. Mr. Speaker, H.R. 3378, under suspension of the 
rules last month, was properly discharged by the Committee on Commerce, 
and of course it was passed by this committee. We are again amending 
the provisions of H.R. 3378 in the process of sending it back to the 
Senate.
  Mr. Speaker, H.R. 3378 extends for 2 years a demonstration project 
authorized in section 405 of the Indian Health Care Improvement Act 
that allows four Indian hospitals to bill HCFA directly for Medicaid 
reimbursement rather than go through the Indian Health Service, which 
will save them time and money.
  The Senate renamed our bill the Indian Health Care Improvement Act 
Technical Corrections Act of 1996 and added six new provisions. Five 
were noncontroversial, and one of these provisions Mr. Speaker, 
includes alleopathic medicine within the act's definition of health 
professions; the second amendment also extended the California Contract 
Health Services Demonstration Project through the year 2000. Another 
amendment also extends the funding through the year 2000 and authorizes 
the appropriation of such sums as necessary to fund the Gallup Alcohol 
and Substance Abuse Treatment Center. Furthermore, Mr. Speaker, the 
amendments also extend funding through the year 2000 for the Substance 
Abuse Counselor Education Program; another amendment continues funding 
for the year 2000 for the home and community-based care demonstration 
program.
  The sixth amendment, Mr. Speaker, alters the requirements of the 
Indian Health Care Service Professional Scholarship Program. The 
amendment allows scholarship recipients to meet their service 
obligations by serving as an academic institution where the recipient's 
primary responsibility is the recruitment of other Indian medical 
students. The amendment also allows the Secretary to waive obligations 
for extreme hardships or for other good cause. The amendment also 
allows for release of a recipient's obligation for bankruptcy and 
cancels a recipient's obligation upon death.

[[Page H11418]]

  Mr. Speaker, we in the Committee on Commerce had a problem with the 
portion of the amendment that allows scholarship recipients to pay back 
their debt by working in an academic setting where their primary 
responsibility is the recruitment of more Indians. The problem is that 
Indians do not have enough medical care on their reservations, and this 
amendment offers somewhat of a loophole for scholarship recipients to 
avoid working on reservations by living and working at universities.
  Mr. Speaker, after reviewing these hardship cases of health 
professionals who thought that they were getting credit for doing 
recruitment, we agree those cases were better dealt with on a case-by-
case basis under a Secretarial waiver authority rather than by a large 
loophole. The amendments grant the Secretary waiver authority for 
hardship and good cause, so we all agreed to strike the academic 
recruitment language from the bill, and the managers state their 
concerns on the floor.
  Mr. Speaker, with the above concerns discussed earlier relative to 
the legislation, I support the amendments that we have now agreed to 
with the other side, and I ask my colleagues to support this 
legislation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. YOUNG of Alaska. Mr. Speaker, I yield myself such time as I may 
consume.
  I will compliment the gentleman on the statement. He and I worked 
very closely on these issues in committee, and he is a great friend of 
Alaska natives and most people involved in American native group.
  Mr. Speaker, I have no further requests for time, and I yield back 
the balance of my time.
  Mr. FALEOMAVAEGA. Mr. Speaker, I have no additional speakers at this 
time. I urge the adoption of this measure, and I yield back the balance 
of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Alaska [Mr. Young] that the House suspend the rules and 
agree to the resolution, House Resolution 544.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the resolution was agreed to.
  A motion to reconsider was laid on the table.

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