[Congressional Record Volume 146, Number 56 (Tuesday, May 9, 2000)]
[Senate]
[Pages S3692-S3736]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. VOINOVICH (for himself, Mr. Reid, Mr. DeWine, Mr. Kennedy, 
        Mr. Bryan, Mr. McConnell, Mr. Harkin, Mr. Thompson. Mr. Frist, 
        and Mr. Bunning):
  S. 2519. A bill to authorize compensation and other benefits for 
employees of the Department of Energy, its contractors, subcontractors, 
and certain vendors who sustain illness or death related to exposure to 
beryllium, ionizing radiation, silica, or hazardous substances in the 
performance of their duties, and for other purposes; to the Committee 
on Health, Education, Labor, and Pension.


     ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION ACT OF 2000

  Mr. VOINOVICH. Mr. President, over the last half century, and at 
facilities all across America, tens of thousands of dedicated men and 
women in our civilian federal workforce helped keep our military fully 
supplied and our nation fully prepared to meet any potential threat. 
Their success is measured in part with the end of the Cold War and the 
collapse of the Soviet Union. However, for many of these workers, their 
success came at a high price; the sacrifice of their health, and even 
their lives, for our liberty. I believe we have a federal obligation to 
live up to our responsibilities with these Cold War veterans.

  The bill I am introducing today, along with Senators Reid, DeWine, 
Kennedy, McConnell, Bryan, Harkin, Thompson, Frist, and Bunning is 
titled the ``Energy Employees Occupational Illness Compensation Act of 
2000.'' This bill will provide financial compensation to Department of 
Energy workers whose impaired health has been caused by exposure to 
beryllium, radiation or other hazardous substances while working for 
the defense of the United States. The bill will also provide 
compensation to survivors of workers who have died while suffering from 
an illness resulting from exposure to these substances.
  Many will express concern that it will be hard to prove if someone 
was made chronically ill by their work environment, however, such 
concerns can be refuted. For example, beryllium disease is a 
``fingerprint'' disease, in that it leaves no doubt as to what caused 
the illness of the sufferer. Additionally, the only processing of the 
materials that cause Chronic Beryllium Disease is unique to our nuclear 
weapons facilities. Skepticism is understandable in many cases of 
radiation exposure at DoE facilities because the records may not 
generally reflect employee exposure to radioactive materials. However, 
concerns have been raised that the DoE destroyed or altered workers' 
records. Additionally, dosimeter badges, which record radiation 
exposure, were not always required to be worn by workers. When they 
were required to be worn, they were not always done so properly or 
consistently. DoE plant management would even ``zero'' dose badges. 
Therefore, many records do not exist, and where they do exist, there is 
adequate reason to doubt their accuracy. That is why this bill places 
the burden of proof on the government to prove that an employee's 
illness was not caused by workplace hazards.
  As one who believes we should rely on sound science, I would 
certainly support a method for compensation based on this principle if 
it was available. Unfortunately in this case, sound science either does 
not exist in DoE facility records, or it cannot be relied upon for 
accuracy. That's precisely what happened in my state of Ohio.
  In a series of newspaper articles from the Columbus Dispatch, it was 
shown that for decades, some workers at the Portsmouth Gaseous 
Diffusion Plant in Piketon, Ohio--a plant which processes high-quality 
nuclear material--did not know they had been exposed to dangerous 
levels of radioactive material. That's because until recently, proper 
safety precautions were rarely taken to adequately protect workers' 
safety. Even when precautions were taken, the application of protective 
standards was inconsistent. In addition, workers at the Piketon plant 
have stated that plant management not only did not keep adequate 
dosimetry records, in some cases, they changed the dosimetry records to 
show lower levels of radiation exposure. If consistent, reliable and 
factual data is not available, then it will be quite difficult to 
utilize sound science.
  Similar occurrences have been reported at the Fernald Feed Materials 
Production Center in Fernald, Ohio and the Mound Facility in 
Miamisburg, Ohio as well as other facilities nationwide.
  The DoE has admitted that at some facilities, workers were not told 
the nature of the substances with which they were working, nor the 
ramifications that these materials may have on their future health and 
quality of life. It is unconscionable that DoE managers and other 
individuals in positions of responsibility could be so insensitive and 
uncaring about their fellow man.
  Last year, the Toledo Blade published an award-winning series of 
articles outlining the plight of workers suffering from Chronic 
Beryllium Disease (CBD). While government standards were met in 
protecting the workers from exposure to the beryllium dust, many 
workers still were diagnosed with CBD. The stories of these workers who 
are suffering from this often debilitating disease are heart-wrenching. 
It is estimated that 1,200 people have contracted CBD, and hundreds 
have died from it, making CBD the number one disease directly caused by 
our Cold War effort.
  Title one of this bill provides compensation to individuals suffering 
from Chronic Beryllium Disease (CBD). Beryllium, which is a toxic 
substance, can cause major health problems if proper precautions are 
not taken while it is being handled. Individuals who suffer from 
Chronic Beryllium Disease experience a loss of lung function, and in 
many cases face a painful death. While there is a blood test that can 
detect CBD, and there are treatments for it, there is no cure. Under 
this bill, if the disease is confirmed, it is presumed work-related and 
workers compensation at benefit levels established under

[[Page S3693]]

the Federal Employees Compensation Act (FECA) is paid--roughly two-
thirds of six years worth of wages and health care coverage. 
Alternatively, a claimant can elect a one-time lump sum payment of 
$200,000 (with healthcare benefits related to their disease) in lieu of 
wage replacement payments. Employees at DoE sites and DoE beryllium 
vendors would be covered under the bill.
  Title two of this bill covers illnesses related to radiation and 
other hazardous substances. The first part of this title covers workers 
at all DoE sites who contract cancer that has been potentially caused 
by exposure to radiation (radiogenic cancer), worked at the site for at 
least one year and wore a radiation dosimeter badge or should have worn 
one. Causation is presumed if the covered cancer is a primary cancer. 
Again, benefits are paid at FECA levels, or in the alternative, a 
claimant can elect a one-time lump sum payment of $200,000 (with 
healthcare benefits) in lieu of wage replacement payments. The 
presumption is modeled after the Radiation Exposure Compensation Act. 
This proposal incorporates all DoE sites across the nation, plus four 
vendor facilities.
  The second part of this title covers workers at DoE sites for 
illness, impairment, disease or death, using a FECA level of benefits. 
The Secretary of Health and Human Services is required to create a 
panel of occupational doctors to review the claims for the Department 
of Labor, and the threshold for eligibility is whether exposure was a 
significant contributing factor to a worker's illness. The bill allows 
claimants to seek a second medical opinion. Further, the bill directs 
the HHS to empanel occupational physicians to develop additional 
presumptions for use in guiding future HHS and Labor Department 
decisions.
  To obtain restitution under the bill, claimants would file with the 
Department of Labor's Office of Worker Compensation Programs under a 
FECA-like program but not FECA itself. The claims reviewer, after 
obtaining all the necessary information, would have 120 days to render 
a decision. If a denial is issued, the claimant can appeal to an 
administrative law judge (ALJ). The ALJ has 180 days to render an 
opinion. If an opinion is not rendered, the appeal can be brought to 
the federal Benefits Review Board (BRB). The BRB has 240 days to render 
an opinion, after which appeals can be brought to the U.S. Court of 
Appeals. Failure to meet deadlines by the DoL results in a default in 
favor of the claimant. This approach is intended to remedy the major 
defects in FECA, which excludes any rights to the Courts and results in 
years of delay in many cases.
  Mr. President, there may be some who will say that this bill costs 
too much, or we can't afford it so we shouldn't do it. I strongly 
disagree.
  Congress appropriates billions of dollars annually on things that are 
not the responsibility of the federal government. And here we have a 
clear instance where our federal government is responsible for the 
actions it has taken and the negligence it has shown against its own 
people. This is an issue where peoples' health has been compromised and 
lives have been lost. In many instances, these workers didn't even know 
that their health and safety was in jeopardy. It is not only a 
responsibility of this government to provide for these individuals, it 
is a moral obligation.
  Mr. President, it is unfortunate that a bill establishing this type 
of compensation program is necessary; it is little consolation for the 
pain, health problems and diminished quality of life that these 
individuals have suffered. These men and women who won the Cold War 
have only asked that the United States government--the government of 
the nation that they spent their lives defending--acknowledge that they 
were made ill in the course of doing their job and recognize that the 
government must take care of them.
  Sadly, because of the government's stonewalling and denial of 
responsibility, the only way many of these employees believe they will 
ever receive proper restitution for what the government has done is to 
file a lawsuit against the Department of Energy or its contractors. 
That should not have to happen and it is my hope that this legislation 
will preclude any perceived need for such lawsuits.
  I believe that all those who have served our nation fighting the Cold 
War deserve to know if the federal government was responsible for 
causing them illness or harm, and if so, to provide them the care that 
they need. I encourage my colleagues to join us in cosponsoring this 
legislation and I urge the Senate to consider this bill during this 
session of Congress.
                                 ______
                                 
      By Mr. JEFFORDS (for himself, Mr. Wellstone, Ms. Snowe, and Ms. 
        Collins):
  S. 2520. A bill to amend the Federal Food, Drug, and Cosmetic Act to 
allow for the importation of certain covered products, and for other 
purposes; to the Committee on Health, Education, Labor, and Pensions.


              MEDICINE EQUITY AND DRUG SAFETY ACT OF 2000

  Mr. JEFFORDS. Mr. President, as we work to address the problems of 
health care in the new millennium, we are blessed and we are cursed: 
blessed with the promise of new research capabilities and the knowledge 
gleaned from the human genome, and cursed with the high costs of all 
medicines, new and old. Today, I come to the floor to introduce a bill 
that will help address the curse of out-of-control drug prices, the 
Medicine Equity and Drug Safety Act of 2000, or MEDS Act.
  There is no question that prescription drugs cost too much in this 
nation.
  During a time when we are experiencing unprecedented economic growth, 
it is not uncommon to hear of patients who cut pills in half, or skip 
dosages in order to make prescriptions last longer, because they can't 
afford the refill. The question that we should ask is, can we put 
politics aside and work in a bipartisan manner to deal with this 
national crisis? I say we must. And I am hopeful we can.
  Prescription medicines have revolutionized the treatment of certain 
diseases, but they are only effective if patients have access to the 
medicines that their doctors prescribe.
  The best medicines in the world will not help a person who cannot 
afford them. And they can actually do more harm than good if taken with 
the improper dosage.
  Mr. President, it is well documented that the average price of 
prescription medicines is much lower in Canada than in the United 
States, with the price of some drugs in Vermont being twice that of the 
same drug available only a few miles away in a Canadian pharmacy. This 
is true even though many of the drugs sold in Canada are actually 
manufactured, packed, and distributed by American companies that sell 
the same FDA-approved products in both markets, but at drastically 
different prices.
  This pricing disparity unfairly places the heaviest burden on the 
most vulnerable Americans--hardworking, but uninsured Americans who 
make too much money to qualify for Medicaid, yet still cannot afford 
the high cost of lifesaving drugs.
  The legislation I am introducing today will allow pharmacists and 
wholesalers to get the same FDA-approved drugs sold at lower prices in 
other countries, and pass the savings on to consumers in the U.S.
  This bipartisan proposal builds on legislation I introduced last 
year, S. 1462, that would allow imports from Canada for personal use, 
and borrows from another bill cosponsored by Senator Wellstone, S. 
1191, that would allow reimportation of prescription drugs that were 
made in U.S. facilities.
  The most important aspect of this bill, Mr. President, is safety. We 
all want to find ways to bring drug costs down for all Americans, but 
the concept of reimportation has been criticized as compromising the 
Food and Drug Administration's (FDA) world-renowned gold standard for 
safety by opening the American market to foreign counterfeiters who 
will attempt to flood the market with fake drugs.
  This bill is simple in its approach. It would empower pharmacists and 
wholesalers to purchase FDA-approved medicines in Canada and pass the 
discounts along to American patients, and would let the experts at 
Health and Human Services (HHS) determine the best mechanism for 
allowing such imports while preserving the gold standard for safety.
  The discretionary authority granted to the Secretary of HHS would be 
subject to a few important requirements,

[[Page S3694]]

such as identification of the importer and the product, but would 
require the Secretary to promulgate regulations setting up a safe 
system for allowing the reimportation of prescription drugs as long as 
the importer has demonstrated, to the satisfaction of HHS, that the 
product being reimported is safe, and is the same product that is being 
sold in the United States at a higher price.
  Mr. President, I have said before and I will say again, this is not 
the only solution, and it may not be the best solution to this problem.
  I strongly believe we need to enact a broad prescription drug 
benefit, and I believe we need to find ways to encourage more insurance 
coverage for more Americans that covers the cost of drugs. But this is 
a positive, bipartisan measure that we can implement now that will 
bring prescription drug prices down for all Americans, and I encourage 
your support.
  Mr. WELLSTONE. Mr. President, I am very pleased to join Senator 
Jeffords, Senator Collins, and Senator Snowe as a cosponsor of the 
Medicine Equity and Drug Safety Act of 2000. As this bill demonstrates, 
concern about the high price of prescription drugs in this country is a 
bipartisan issue. Republicans, Democrats, and independents alike suffer 
from the unconscionable behavior of American drug companies who 
overcharge American consumers day in and day out, compared to prices 
they charge in every other country of the world. Americans regardless 
of party have a fundamental belief in fairness--and know a rip-off when 
they see one. This bill aims to end the rip-off, to end the choke hold 
that the pharmaceutical industry has on America's seniors.
  The Jeffords-Wellstone Medicine Equity and Drug Safety Act will make 
prescription drugs affordable for millions of Americans by applying the 
principles of free trade and competition to the prescription drug 
industry--without sacrificing safety. Senator Jeffords, Senator Snowe, 
Senator Collins and I have heard the first-hand stories from our 
constituents--in Minnesota, in Maine and in Vermont--constituents who 
are justifiably frustrated and discouraged when they can't afford to 
buy prescription drugs that are made in the United States--unless they 
go across the border to Canada where those same drugs, manufactured in 
the same facilities here in the U.S. are available for about half the 
price.
  This legislation provides relief from the price gouging of American 
consumers by our own pharmaceutical industry. This price gouging 
affects all Americans, but especially our senior citizens who feel the 
brunt of this problem more than any other age group because of the 
increasing number of prescription drugs we all will take as the years 
pass. Senior citizens have lost their patience in waiting for answers--
-and so have I. That is why I have joined Senator Jeffords in this 
bipartisan effort to allow all Americans to have access to prescription 
drugs at prices they can afford.
  While we can be proud of both American scientific research that 
produces new miracle cures and the high standards of safety and 
efficacy that we expect to be followed at the FDA, it is shameful that 
America's most vulnerable citizens--the chronically ill and the 
elderly--are being asked to pay the highest prices in the world here in 
the U.S. for the exact same medications manufactured here but sold more 
cheaply overseas.
  Pharmacists could sell prescription drugs for less here in the United 
States, if they could buy and import these same drugs from Canada or 
Europe. Now, however, Federal law allows only the manufacturer of a 
drug to import it into the U.S. Thus American pharmacists and 
wholesalers must pay the exorbitant prices charged by the 
pharmaceutical industry in the U.S. market and pass along those high 
prices to consumers.
  The legislative solution is simple. The bipartisan Medicine Equity 
and Drug Safety Act does two things: first, it allows Americans to 
legally import prescription drugs for personal use (which currently is 
allowed by FDA discretion), and more importantly, in the long run, it 
allows American pharmacists and wholesalers to import FDA approved 
prescription drugs into the United States for resale. Only drugs which 
have already been approved by the FDA for use in the United States 
could be imported for resale. Thus, the existing strict safety 
standards of the FDA will be maintained.
  Pharmacists and wholesalers will be able to purchase drugs at lower 
prices and then pass the savings along to American consumers. To assure 
safety, the bill requires the FDA to develop regulations to precisely 
track imported drugs and to issue any other safety requirements the FDA 
deems necessary. It is time to tell the pharmaceutical industry: 
Enough! It is an industry that controls competition to keep prices so 
high that prescription drugs become unaffordable for the average 
American. It is an industry that puts profits first and leaves patients 
to fend for themselves.
  What this bill does is to address the absurd situation by which 
American consumers are paying substantially higher prices for their 
prescription drugs than are the citizens of Canada, Mexico, and other 
countries. This bill does not create any new federal programs. Instead 
it uses principles of free trade and competition to help make it 
possible for American consumers to purchase the prescription drugs they 
need.
  In summary, this bill brings competition into the price of 
pharmaceuticals and extends the promise of America's medical and 
pharmaceutical research to every American. It deserves bipartisan 
support, and I am glad to say it has it.
  Ms. SNOWE. Mr. President, I am pleased to join Senators Jeffords, 
Wellstone, and Collins today as an original cosponsor of the Medicine 
Equity and Drug Safety Act of 2000.
  There is no doubt that providing access to affordable prescription 
drugs for American consumers is a very important policy issue. It seems 
that everywhere we turn--from ``60 Minutes'' to Newsweek--we are 
hearing stories that our nation's patients face dramatically higher 
prices for their prescription medication than do our neighbors to the 
North.
  In my view, a solution to the pressing problem of prescription drug 
coverage can't come soon enough. In 1998, drug costs grew more than any 
other category of health care--skyrocketing by 15.4 percent in a single 
year. And that's a special burden for seniors, who pay half the cost 
associated with their prescriptions as opposed to those under 65 who 
pay just a third.
  Seniors are reeling from the burden of their prescription drug 
expenses. The March/April 2000 edition of Health Affairs reports that 
the average senior now spends $1,100 every year on medications. And 
with the latest HCFA estimates putting the number of seniors without 
drug coverage at around 31 percent of all Medicare beneficiaries--or 
about 13 out of nearly 40 million Americans--it's not hard to see why 
we can no longer wait to provide a solution. In fact, nearly 86 percent 
of Medicare beneficiaries must use at least one prescription drug every 
day.
  Who are these seniors who don't have prescription drug coverage? Who 
are the ones traveling by the busload to Canada to buy their 
prescription drugs? They are people caught in the middle--most of whom 
are neither wealthy enough to afford their own coverage nor poor enough 
to qualify for Medicaid. In fact, we know that seniors between 100 
percent and 200 percent of the federal poverty have the lowest levels 
of prescription drug coverage. And these seniors who are just over the 
poverty level are the least likely to have access to either employer-
based coverage or Medicaid.
  But even Medicaid is not the answer. According to the Urban 
Institute, in 1996, 63 percent of beneficiaries eligible for QMB 
(Qualified Medicare Beneficiary) protections--that is, those under the 
federal poverty level--actually receive those protections, while only 
10 percent of those between 100 and 120 percent of the poverty level--
those eligible for SLMB (Specified Low-Income Medicare Beneficiary) 
protections--are receiving that coverage. And only 16 states--including 
my home state of Maine--have their own drug assistance programs.
  The high cost of prescription medications in the United States is 
forcing many of our nation's seniors to make unthinkable decisions that 
are harmful to their health and well-being. It is simply unacceptable 
that any person should have to choose between filling a prescription or 
buying groceries.

[[Page S3695]]

  It is fundamentally unfair that a senior in Maine, Vermont, or 
Minnesota must drive across the Canadian border to be able to afford to 
buy his or her prescription medications. And while it is illegal for 
Americans to go to Canada and purchase drugs to be brought back to the 
United States, we know that this happens on a daily basis.
  Mr. President, we are in a time of unparalleled prosperity. Almost 
daily, it seems, we learn of astounding new breakthroughs in biomedical 
research and in new prescription medications. And there is no question 
in anyone's mind that we have the best--the very best--health care in 
the entire world. But yet what does it say when our seniors are forced 
to go to Canada to purchase their prescription medications?
  Mr. President, the legislation introduced today by Senator Jeffords 
will allow Americans to legally purchase in Canada a limited amount of 
their medication for personal use. This will enable American patients 
to purchase their medications at the lower prices. In addition, 
pharmacists and wholesalers will be allowed to reimport prescription 
drugs that were made in the U.S. or in FDA-approved facilities.
  Mr. President, I support this bill and believe that Senator Jeffords 
has written a sound piece of legislation. But the fact of the matter is 
that addressing the issue of seniors crossing the border to purchase 
drugs is really only an interim approach--the real issue for America's 
seniors is the lack of comprehensive prescription drug coverage for 
Medicare beneficiaries.
  This is why last August I introduced the Seniors Prescription 
Insurance Coverage Equity (SPICE) Act, S. 1480, with Senator Ron Wyden 
of Oregon. Our plan will give seniors coverage options similar to those 
enjoyed by Members of Congress and other federal employees, through a 
choice of competing comprehensive drug plans. SPICE will prescribe 
prescription drug coverage for all Medicare-eligible seniors, with the 
federal government covering all or part of the premiums on a sliding 
scale.
  SPICE has the advantage of working with or without Medicare reform--
something I've heard time and again is important to seniors, because it 
means that they don't have to wait for meaningful prescription drug 
coverage. The SPICE gives us the best of all possible worlds--a system 
that can exist outside of Medicare reform, co-exist with a new Medicare 
regime when it comes, and actually serve as a downpayment on 
comprehensive reform.
  Mr. President, I am pleased to join Senator Jeffords as an original 
cosponsor of this bill. He has written a bill with the needs of 
American consumers in mind, and he is ensuring that Americans will have 
access to safe and affordable prescription medications while Congress 
works to devise a long-term solution to this very serious problem.
  Thank you, I yield the floor.
                                 ______
                                 
      By Ms. SNOWE:
  S. 2524. A bill to amend title XVIII of the Social Security Act to 
expand coverage of bone mass measurements under part B of the Medicare 
Program to all individuals at clinical risk for osteoporosis; to the 
Committee on Finance.


             MEDICARE OSTEOPOROSIS MEASUREMENT ACT OF 2000

 Ms. SNOWE. Mr. President, I rise today to introduce the 
Medicare Osteoporosis Measurement Act.
  Three years ago Congress passed the Balanced Budget Act of 1997. In 
doing so, we dramatically expanded coverage of osteoporosis screening 
through bone mass measurements for Medicare beneficiaries. Since we 
passed this law, we have learned that under the current Medicare law, 
it is very difficult for a man to be reimbursed for a bone mass 
measurement test. The bill I am introducing today, the Medicare 
Osteoporosis Measurement Act, would help all individuals enrolled in 
Medicare to receive the necessary tests if they are at risk for 
osteoporosis.
  Currently, Medicare guidelines allow for testing in five categories 
of individuals--and most ``at risk'' men do not fall into any of them. 
The first category in the guidelines is for ``an estrogen-deficient 
woman at clinical risk for osteoporosis.'' The bill I am introducing 
today changes this guideline to say that ``an individual, including an 
estrogen-deficient woman, at clinical risk for osteoporosis'' will be 
eligible for bone mass measurement. This change--of just a few words--
will vastly increase the opportunities for men to be covered for the 
important test.
  Osteoporosis is a major public health problem affecting 28 million 
Americans, who either have the disease or are at risk due to low bone 
mass. Today, two million American men have osteoporosis, and another 
three million are at risk of this disease. Osteoporosis causes 1.5 
million fractures annually at a cost of $13.8 billion--$38 million per 
day--in direct medical expenses. In their lifetime, one in two women 
and one in eight men over the age of 50 will fracture a bone due to 
osteoporosis. Each year, men suffer one-third of all the hip fractures 
that occur, and one-third of these men will not survive more than a 
year. In addition to hip fracture, men also experience painful and 
debilitating fractures of the spine, wrist, and other bones due to 
osteoporosis.
  Osteoporosis is largely preventable and thousands of fractures could 
be avoided if low bone mass were detected early and treated. Though we 
now have drugs that promise to reduce fractures by 50 percent and new 
drugs have been proven to actually rebuild bone mass, a bone mass 
measurement is needed to diagnose osteoporosis and determine one's risk 
for future fractures. And we have learned that there are some prominent 
risk facts: age, gender, race, a family history of bone fractures, 
early menopause, risky health behaviors such as smoking and excessive 
alcohol consumption, and some medications all have been identified as 
contributing factors to bone loss. But identification of risk factors 
alone cannot predict how much bone a person has and how strong bone is.
  Mr. President, we know that osteoporosis is highly preventable, but 
only if it is discovered in time. There is simply no substitute for 
early detection. My legislation will ensure that all Medicare 
beneficiaries at risk for osteoporosis will be able to be tested for 
osteoporosis.
                                 ______
                                 
      By Mrs. FEINSTEIN (for herself, Mr. Lautenberg, Mrs. Boxer, and 
        Mr. Schumer):
  S. 2525. A bill to provide for the implementation of a system of 
licensing for purchasers of certain firearms and for a record of sale 
system for those firearms, and for other purposes; to the Committee on 
the Judiciary.


            firearm licensing and record of sale act of 2000

 Mrs. FEINSTEIN. Mr. President, on any given day in the United 
States 80 people are killed by gun violence, 12 of them children. 
Seeking to bring an end to this senseless violence, supporters of 
sensible gun laws are coming together this Mothers' Day from all over 
the country to participate in the Million Mom March and say to 
Congress: ``Enough is Enough.''
  We share a common purpose: The passage of sensible gun laws that will 
hopefully help save lives.
  This common goal includes moving forward with the four, common-sense 
gun measures passed by this body almost a full year ago--trigger locks, 
closing the gun show loophole, banning the importation of large 
capacity ammunition magazines, and banning juvenile possession of 
assault weapons.
  And beyond those four common sense measures, the mothers flooding 
into Washington are calling for legislation to license gun owners and 
keep track of guns.
  Earlier today, I stood with some of those moms, with Donna Dees-
Thomases, the head of the Million Mom March, with Chief Ramsey of the 
District of Columbia Police Department, with representatives of Handgun 
Control and the Coalition to Stop Gun Violence, and with several of my 
colleagues to announce the introduction of a bill to take the next step 
in the fight to keep guns out of the hands of criminals and juveniles.
  And so I now rise to introduce the ``Firearm Licensing and Record of 
Sale Act of 2000,'' which I believe represents a common-sense approach 
to guns and gun violence in America.
  I am pleased to be joined in this effort by Senators Frank 
Lautenberg, Barbara Boxer and Charles Schumer. And I am pleased that 
Representative Marty Meehan from Massachusetts will soon be introducing 
this legislation in the House. I know that this will be an uphill 
battle, and I don't expect this bill to pass overnight. But it is my

[[Page S3696]]

hope that in the coming months, more of our colleagues in both Houses 
will join us and help us to move this bill forward until we succeed.
  Mr. President, in this country, when you want to hunt, you get a 
hunting license; when you want to fish, you get a fishing license. But 
when you want to buy a gun, no license is necessary. That makes no 
sense.
  We register cars and license drivers. We register pesticides and 
license exterminators. We register animal carriers and researchers, we 
register gambling devices. And we register a whole host of other goods 
and activities--even ``international expositions,'' believe it or not, 
must be registered with the Bureau of International Expositions!
  But when it comes to guns and gun owners--no license and no 
registration, despite the loss of more than 32,000 lives a year from 
gun violence.
  To this end, I have worked with law enforcement officials and other 
experts in drafting the bill we are introducing today.
  Upon enactment of this legislation, anyone purchasing a handgun or 
semi-automatic weapon that takes detachable ammunition magazines will 
be required to have a license. Shotguns and a large number of common 
hunting guns are not covered by the requirements of this bill.
  Current owners of these weapons will have up to 10 years to obtain a 
license.
  The bill sets up a federal system, but allows states to opt out if 
they adopt a system at least as effective as the federal program.
  Under this bill, anyone wishing to obtain a firearm license will need 
to go to a federally licensed firearms dealer. There are currently more 
than 100,000 such dealers across the country--to put that in some 
perspective, there are four times more gun dealers in America than 
there are McDonald's restaurants in the entire world. Operating the 
federal licensing system through these licensed dealers will minimize 
the burden on those wishing to obtain a license.
  If a state opts-out of the federal program, an individual will go to 
a State-designated entity, like a local sheriff, local police 
department, or even Department of Motor Vehicles. It will all depend on 
where the state feels is best.
  Either way, the purchaser will then need to:
  Provide information as to date and place of birth and name and 
address;
  Submit a thumb print;
  Submit a current photograph;
  Sign, under penalty of perjury, that all of the submitted information 
is true and that the applicant is qualified under federal law to 
possess a firearm; Pass a written firearms safety test, requiring 
knowledge of the safe storage and handling of firearms, the legal 
responsibilities of firearm ownership, and other factors as determined 
by the state or federal authority;
  Sign a pledge to keep any firearm safely stored and out of the hands 
of juveniles (this pledge will be backed up by criminal penalties of up 
to three years in jail for anyone failing to do so);

  Undergo state and federal background checks.
  Licenses will be renewable every five years, and can be revoked at 
any time if the licensee becomes disqualified under federal law from 
owning or possessing a gun.
  And the fee for a license cannot exceed $25.
  Once the bill takes effect, all future sales and transfers of 
firearms falling within the scope of the bill will have to be recorded 
through a federally licensed firearms dealer, with an accompanying NICS 
background check. That way, law enforcement agencies will have easier 
access to information leading to the arrest of persons who use guns in 
crime.
  The bill covers both handguns and other guns that are semi-automatic 
and can accept detachable magazines.
  The legislation covers handguns because statistically, these guns are 
used in more crimes than any other. In fact, approximately 85 percent 
of all firearm homicides involve a handgun.
  And the legislation also covers semi-automatic firearms that can 
accept detachable magazines, because these are the kind of assault 
weapons that have the potential to destroy the largest number of lives 
in the shortest period of time.
  A gun that can take a detachable magazine can also take a large 
capacity magazine. Combine that with semi-automatic, rapid fire, and 
you have a deadly combination--as we have seen time and again in recent 
years.
  Put simply, this legislation will cover those firearms that represent 
the greatest threat to the safety of innocent men, women and children 
in this nation.
  Common hunting rifles, shotguns and other firearms that cannot accept 
detachable magazines will remain exempt.
  This represents a compromise between those who would rather not have 
this bill at all, and those of us who believe that universal coverage 
of all firearms would be appropriate.
  Penalties will vary depending on the severity of the violation. But 
in no case will gun owners face jail time simply because they forgot to 
get a license:
  Those who fail to get a license will face fines of between $500 (for 
a first offense) and $5,000 for subsequent offenses.
  Failing to report a change of address or the loss of a firearm will 
also result in penalties between $500 and $5,000, because this system 
works best for law enforcement when the perpetrators of gun crime can 
be quickly traced and arrested;
  Dealers who fail to maintain adequate records will face up to 2 years 
in prison--dealers know their responsibilities, and this will give law 
enforcement the tools necessary to root out bad dealers and prevent the 
straw purchases and other violations of law that allow criminals easy 
access to a continuing flow of guns;
  And adults who recklessly or knowingly allow a child access to a 
firearm face up to three years in prison if the child uses the gun to 
kill or seriously injure another person. In this way, the bill truly 
puts a new sense of responsibility onto gun owners in America.
  Mr. President, law enforcement in California tells me that a 
licensing and record of sale system like the one I am introducing today 
will help law enforcement, upon recovery of a firearm used in crime, to 
track the gun down to the person who sold it, and then to the person 
who bought it.

  And this legislation also sets in place a method through which we can 
better attempt to ensure that gun owners are responsible and trained in 
the use and care of their dangerous possessions.
  We have tried to minimize the burden of this bill at every turn:

       The licensing process will take place through federally 
     licensed firearms dealers--as I mentioned earlier, there are 
     currently more than 100,000 in this country;
       The fee for a license will be only $25;
       Current gun owners will have ten years to get a license, 
     and guns now in homes will not have to be registered.
       Future gun transfers will simply be recorded by licensed 
     dealers--as they are now--and a system will be put in place 
     to allow the quick tracing of guns used in crime. Gun owners 
     themselves will not have to register their old guns or send 
     any paperwork to the government.
  Mr. President, this nation is awash in guns--there are more than 200 
million of them in the United States. The problem of gun violence is 
not going away, and accidental deaths from firearms rob us of countless 
innocents each year.
  Too many lives are lost every year simply because gun owners do not 
know how to use or store their firearms--particularly around children. 
In fact, according to a study released early last year, in 1996 alone 
there were more than 1,100 unintentional shooting deaths and more than 
18,000 firearm suicides--many of which might have been prevented if the 
person intent on suicide did not have easy access to a gun owned by 
somebody else. It is my hope that the provisions of this bill, 
particularly with regard to child access prevention, will begin the 
process of making it harder for children and others to gain easy access 
to firearms.
  I know that this bill will not pass overnight. We have a long process 
of education ahead of us. But the American people are with us. The 
facts are with us. And common sense is with us.
  I thank the Senate for its consideration of this measure, and I look 
forward to working with each of my colleagues to move this bill forward 
in the coming months.
                                 ______
                                 
      By Mr. CAMPBELL (for himself and Mr. Inouye):

[[Page S3697]]

  S. 2526. A bill to amend the Indian Health Care Improvement Act to 
revise and extend such Act; to the Committee on Indian Affairs.


       INDIAN HEALTH CARE IMPROVEMENT ACT REAUTHORIZATION OF 2000

  Mr. CAMPBELL. Mr. President, I am pleased to be joined by Senator 
Inouye today in introducing a bill to reauthorize the Indian Health 
Care Improvement Act (the ``IHCIA'' or the ``Act'').
  The United States first began to provide health services to Indians 
in 1824 as part of the War Department's handling of Indian affairs. In 
1849 this responsibility went to the newly-created Interior Department 
where it rested until 1955 when it was transferred to the Public Health 
Service's Indian Health Agency.
  In 1970, President Nixon issued his now-famous ``Special Message to 
Congress on Indian Affairs'' laying out the rationale for a more 
enlightened Indian Policy--Indian Self Determination.
  The Indian Self-Determination and Education Assistance Act of 1975, 
the Indian Health Care Improvement Act of 1976, and the amendments to 
each over the years can be traced directly to the fundamental change 
proposed in 1970.
  I am happy to say that legislation I proposed earlier this session, 
the Indian Self Governance Amendments of 1999, have passed the House 
and the Senate and awaits final action.
  With the introduction of this bill, we re-affirm the core principles 
that were part of the 1976 legislation: (1) that federal health 
services are consistent with the unique federal-tribal relationship; 
(2) that a goal of the U.S. is to provide the quantity and quality of 
services to raise the health status of Indians; and (3) that Indian 
participation in the planning and management of health services should 
be maximized.
  First enacted in 1976, this IHCIA provides the authorization for 
programs run by the Indian Health Service and is the legislation most 
responsible for raising the health status of Indian people to a level 
that, while still alarming, is not nearly as serious as it was just 
twenty-five years ago.
  Before the passage of the Act in 1976 the mortality rate for Indian 
infants was 25% higher than that of non-Indian babies. The death rates 
for mothers was 82% higher and the mortality rates from infectious 
disease caused diarrhea and dehydration was 138% greater.
  Today we can see marked improvements. Infant mortality rates have 
been reduced by 54%, maternal mortality rates have been reduced by 65%, 
tuberculosis mortality by 80% and overall mortality rates have been 
reduced by 42%.
  While encouraging, these statistics mask the fact that the health 
status of Native people in America is still poor and below that of all 
other groups.
  There are 3 issues in particular that need to be raised: urban 
Indians; Indian health facilities construction needs; and the booming 
problem of diabetes.
  As past censuses have shown, the 2000 decennial census is likely to 
show that more than one-half of the 2.3 million American Indians and 
Alaska Natives reside off-reservation and are what commonly called 
``urban Indians.'' Though the health services framework that now exists 
has slowly begun to acknowledge this trend, I am concerned that urban 
Indian health care needs require a more focused approach.
  An ongoing problem that continues to confront the tribes, the IHS, 
and the Congress is the growing backlog in health care facilities 
construction. Recent estimates show that these needs top $900 million 
and federal appropriations simply will not satisfy these needs. I 
strongly believe that innovative proposals need to be made, refined and 
perfected in order to accomplish our common goal. I am heartened by the 
success of the Joint Venture Program and want to explore other 
proposals to get these facilities built.
  Ailments of affluence continue to seep into native communities and 
erode the quality of life and very social fabric that holds these 
communities together. Alcohol and substance abuse continue to take a 
heavy toll and diabetes rates are reaching alarmingly high rates. Most 
troubling is the increasing obesity and diabetes that is showing up 
with alarming frequency in Native youngsters.
  It is now time to take that extra step an to look at the positive 
things we have accomplished and build upon them.
  This bill is a step in the right direction. It is the product of 
months-long consultations by a group of very dedicated individuals 
consisting of Indian tribal leaders, legal professionals and 
representatives of the private and public health care sectors.
  The group reviewed existing law and has proposed changes to improve 
the current system by stressing local flexibility and choice, and 
making it more responsive to the health needs of Indian people.
  The Committee on Indian Affairs has already had one hearing on the 
bill and will continue to review it in the months ahead.
  I ask unanimous consent that a copy of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2526

       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 
     Health Care Improvement Act Reauthorization of 2000''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title.

   TITLE I--REAUTHORIZATION AND REVISIONS OF THE INDIAN HEALTH CARE 
                            IMPROVEMENT ACT

Sec. 101. Amendment to the Indian Health Care Improvement Act.

       TITLE II--CONFORMING AMENDMENTS TO THE SOCIAL SECURITY ACT

                          Subtitle A--Medicare

Sec. 201. Limitations on charges.
Sec. 202. Indian health programs.
Sec. 203. Qualified Indian health program.

                          Subtitle B--Medicaid

Sec. 211. Payments to Federally-qualified health centers.
Sec. 212. State consultation with Indian health programs.
Sec. 213. Fmap for services provided by Indian health programs.
Sec. 214. Indian Health Service programs.

         Subtitle C--State Children's Health Insurance Program

Sec. 221. Enhanced fmap for State children's health insurance program.
Sec. 222. Direct funding of State children's health insurance program.
``Sec. 2111. Direct funding of Indian health programs.

              Subtitle D--Authorization of Appropriations

Sec. 231. Authorization of appropriations.

                  TITLE III--MISCELLANEOUS PROVISIONS

Sec. 301. Repeals.
Sec. 302. Severability provisions.

   TITLE I--REAUTHORIZATION AND REVISIONS OF THE INDIAN HEALTH CARE 
                            IMPROVEMENT ACT

     SEC. 101. AMENDMENT TO THE INDIAN HEALTH CARE IMPROVEMENT 
                   ACT.

       The Indian Health Care Improvement Act (25 U.S.C. 1601 et 
     seq.) is amended to read as follows:

     ``SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       ``(a) Short Title.--This Act may be cited as the `Indian 
     Health Care Improvement Act'.
       ``(b) Table of Contents.--The table of contents for this 
     Act is as follows:

``Sec. 1. Short title; table of contents.
``Sec. 2. Findings.
``Sec. 3. Declaration of health objectives.
``Sec. 4. Definitions.

       ``TITLE I--INDIAN HEALTH, HUMAN RESOURCES AND DEVELOPMENT

``Sec. 101. Purpose.
``Sec. 102. General requirements.
``Sec. 103. Health professions recruitment program for Indians.
``Sec. 104. Health professions preparatory scholarship program for 
              Indians.
``Sec. 105. Indian health professions scholarships.
``Sec. 106. American Indians into psychology program.
``Sec. 107. Indian Health Service extern programs.
``Sec. 108. Continuing education allowances.
``Sec. 109. Community health representative program.
``Sec. 110. Indian Health Service loan repayment program.
``Sec. 111. Scholarship and loan repayment recovery fund.
``Sec. 112. Recruitment activities.
``Sec. 113. Tribal recruitment and retention program.
``Sec. 114. Advanced training and research.
``Sec. 115. Nursing programs; Quentin N. Burdick American Indians into 
              Nursing Program.
``Sec. 116. Tribal culture and history.
``Sec. 117. INMED program.
``Sec. 118. Health training programs of community colleges.
``Sec. 119. Retention bonus.
``Sec. 120. Nursing residency program.
``Sec. 121. Community health aide program for Alaska.

[[Page S3698]]

``Sec. 122. Tribal health program administration.
``Sec. 123. Health professional chronic shortage demonstration project.
``Sec. 124. Scholarships.
``Sec. 125. National Health Service Corps.
``Sec. 126. Substance abuse counselor education demonstration project.
``Sec. 127. Mental health training and community education.
``Sec. 128. Authorization of appropriations.

                      ``TITLE II--HEALTH SERVICES

``Sec. 201. Indian Health Care Improvement Fund.
``Sec. 202. Catastrophic Health Emergency Fund.
``Sec. 203. Health promotion and disease prevention services.
``Sec. 204. Diabetes prevention, treatment, and control.
``Sec. 205. Shared services.
``Sec. 206. Health services research.
``Sec. 207. Mammography and other cancer screening.
``Sec. 208. Patient travel costs.
``Sec. 209. Epidemiology centers.
``Sec. 210. Comprehensive school health education programs.
``Sec. 211. Indian youth program.
``Sec. 212. Prevention, control, and elimination of communicable and 
              infectious diseases.
``Sec. 213. Authority for provision of other services.
``Sec. 214. Indian women's health care.
``Sec. 215. Environmental and nuclear health hazards.
``Sec. 216. Arizona as a contract health service delivery area.
``Sec. 217. California contract health services demonstration program.
``Sec. 218. California as a contract health service delivery area.
``Sec. 219. Contract health services for the Trenton service area.
``Sec. 220. Programs operated by Indian tribes and tribal 
              organizations.
``Sec. 221.-licensing.
``Sec. 222. Authorization for emergency contract health services.
``Sec. 223. Prompt action on payment of claims.
``Sec. 224. Liability for payment.
``Sec. 225. Authorization of appropriations.

                        ``TITLE III--FACILITIES

``Sec. 301. Consultation, construction and renovation of facilities; 
              reports.
``Sec. 302. Safe water and sanitary waste disposal facilities.
``Sec. 303. Preference to Indians and Indian firms.
``Sec. 304. Soboba sanitation facilities.
``Sec. 305. Expenditure of nonservice funds for renovation.
``Sec. 306. Funding for the construction, expansion, and modernization 
              of small ambulatory care facilities.
``Sec. 307. Indian health care delivery demonstration project.
``Sec. 308. Land transfer.
``Sec. 309. Leases.
``Sec. 310. Loans, loan guarantees and loan repayment.
``Sec. 311. Tribal leasing.
``Sec. 312. Indian Health Service/tribal facilities joint venture 
              program.
``Sec. 313. Location of facilities.
``Sec. 314. Maintenance and improvement of health care facilities.
``Sec. 315. Tribal management of Federally-owned quarters.
``Sec. 316. Applicability of buy American requirement.
``Sec. 317. Other funding for facilities.
``Sec. 318. Authorization of appropriations.

                 ``TITLE IV--ACCESS TO HEALTH SERVICES

``Sec. 401. Treatment of payments under medicare program.
``Sec. 402.-Treatment of payments under medicaid program.
``Sec. 403. Report.
``Sec. 404. Grants to and funding agreements with the service, Indian 
              tribes or tribal organizations, and urban Indian 
              organizations.
``Sec. 405. Direct billing and reimbursement of medicare, medicaid, and 
              other third party payors.
``Sec. 406. Reimbursement from certain third parties of costs of health 
              services.
``Sec. 407. Crediting of reimbursements.
``Sec. 408. Purchasing health care coverage.
``Sec. 409. Indian Health Service, Department of Veteran's Affairs, and 
              other Federal agency health facilities and services 
              sharing.
``Sec. 410. Payor of last resort.
``Sec. 411. Right to recover from Federal health care programs .
``Sec. 412. Tuba city demonstration project.
``Sec. 413. Access to Federal insurance.
``Sec. 414. Consultation and rulemaking.
``Sec. 415. Limitations on charges.
``Sec. 416. Limitation on Secretary's waiver authority.
``Sec. 417. Waiver of medicare and medicaid sanctions.
``Sec. 418. Meaning of `remuneration' for purposes of safe harbor 
              provisions; antitrust immunity.
``Sec. 419. Co-insurance, co-payments, deductibles and premiums.
``Sec. 420. Inclusion of income and resources for purposes of medically 
              needy medicaid eligibility.
``Sec. 421. Estate recovery provisions.
``Sec. 422. Medical child support.
``Sec. 423. Provisions relating to managed care.
``Sec. 424. Navajo Nation medicaid agency.
``Sec. 425. Indian advisory committees.
``Sec. 426. Authorization of appropriations.

              ``TITLE V--HEALTH SERVICES FOR URBAN INDIANS

``Sec. 501. Purpose.
``Sec. 502. Contracts with, and grants to, urban Indian organizations.
``Sec. 503. Contracts and grants for the provision of health care and 
              referral services.
``Sec. 504. Contracts and grants for the determination of unmet health 
              care needs.
``Sec. 505. Evaluations; renewals.
``Sec. 506. Other contract and grant requirements.
``Sec. 507. Reports and records.
``Sec. 508. Limitation on contract authority.
``Sec. 509. Facilities.
``Sec. 510. Office of Urban Indian Health.
``Sec. 511. Grants for alcohol and substance abuse related services.
``Sec. 512. Treatment of certain demonstration projects.
``Sec. 513. Urban NIAAA transferred programs.
``Sec. 514. Consultation with urban Indian organizations.
``Sec. 515. Federal Tort Claims Act coverage.
``Sec. 516. Urban youth treatment center demonstration.
``Sec. 517. Use of Federal government facilities and sources of supply.
``Sec. 518. Grants for diabetes prevention, treatment and control.
``Sec. 519. Community health representatives.
``Sec. 520. Regulations.
``Sec. 521. Authorization of appropriations.

                ``TITLE VI--ORGANIZATIONAL IMPROVEMENTS

``Sec. 601. Establishment of the Indian Health Service as an agency of 
              the Public Health Service.
``Sec. 602. Automated management information system.
``Sec. 603. Authorization of appropriations.

                ``TITLE VII--BEHAVIORAL HEALTH PROGRAMS

``Sec. 701. Behavioral health prevention and treatment services.
``Sec. 702. Memorandum of agreement with the Department of the 
              Interior.
``Sec. 703. Comprehensive behavioral health prevention and treatment 
              program.
``Sec. 704. Mental health technician program.
``Sec. 705. Licensing requirement for mental health care workers.
``Sec. 706. Indian women treatment programs.
``Sec. 707. Indian youth program.
``Sec. 708. Inpatient and community-based mental health facilities 
              design, construction and staffing assessment. --
``Sec. 709. Training and community education.
``Sec. 710. Behavioral health program.
``Sec. 711. Fetal alcohol disorder funding.
``Sec. 712. Child sexual abuse and prevention treatment programs.
``Sec. 713. Behavioral mental health research.
``Sec. 714. Definitions.
``Sec. 715. Authorization of appropriations.

                      ``TITLE VIII--MISCELLANEOUS

``Sec. 801. Reports.
``Sec. 802. Regulations.
``Sec. 803. Plan of implementation.
``Sec. 804. Availability of funds.
``Sec. 805. Limitation on use of funds appropriated to the Indian 
              Health Service.
``Sec. 806. Eligibility of California Indians.
``Sec. 807. Health services for ineligible persons.
``Sec. 808. Reallocation of base resources.
``Sec. 809. Results of demonstration projects.
``Sec. 810. Provision of services in Montana.
``Sec. 811. Moratorium.
``Sec. 812. Tribal employment.
``Sec. 813. Prime vendor.
``Sec. 814. National Bi-Partisan Commission on Indian Health Care 
              Entitlement.
``Sec. 815. Appropriations; availability.
``Sec. 816. Authorization of appropriations.

     ``SEC. 2. FINDINGS.

       ``Congress makes the following findings:
       ``(1) Federal delivery of health services and funding of 
     tribal and urban Indian health

[[Page S3699]]

     programs to maintain and improve the health of the Indians 
     are consonant with and required by the Federal Government's 
     historical and unique legal relationship with the American 
     Indian people, as reflected in the Constitution, treaties, 
     Federal laws, and the course of dealings of the United States 
     with Indian Tribes, and the United States' resulting 
     government to government and trust responsibility and 
     obligations to the American Indian people.
       ``(2) From the time of European occupation and colonization 
     through the 20th century, the policies and practices of the 
     United States caused or contributed to the severe health 
     conditions of Indians.
       ``(3) Indian Tribes have, through the cession of over 
     400,000,000 acres of land to the United States in exchange 
     for promises, often reflected in treaties, of health care 
     secured a de facto contract that entitles Indians to health 
     care in perpetuity, based on the moral, legal, and historic 
     obligation of the United States.
       ``(4) The population growth of the Indian people that began 
     in the later part of the 20th century increases the need for 
     Federal health care services.
       ``(5) A major national goal of the United States is to 
     provide the quantity and quality of health services which 
     will permit the health status of Indians, regardless of where 
     they live, to be raised to the highest possible level, a 
     level that is not less than that of the general population, 
     and to provide for the maximum participation of Indian 
     Tribes, tribal organizations, and urban Indian organizations 
     in the planning, delivery, and management of those services.
       ``(6) Federal health services to Indians have resulted in a 
     reduction in the prevalence and incidence of illnesses among, 
     and unnecessary and premature deaths of, Indians.
       ``(7) Despite such services, the unmet health needs of the 
     American Indian people remain alarmingly severe, and even 
     continue to increase, and the health status of the Indians is 
     far below the health status of the general population of the 
     United States.
       ``(8) The disparity in health status that is to be 
     addresses is formidable. In death rates for example, Indian 
     people suffer a death rate for diabetes mellitus that is 249 
     percent higher than the death rate for all races in the 
     United States, a pneumonia and influenza death rate that is 
     71 percent higher, a tuberculosis death rate that is 533 
     percent higher, and a death rate from alcoholism that is 627 
     percent higher.

     ``SEC. 3. DECLARATION OF HEALTH OBJECTIVES.

       ``Congress hereby declares that it is the policy of the 
     United States, in fulfillment of its special trust 
     responsibilities and legal obligations to the American Indian 
     people--
       ``(1) to assure the highest possible health status for 
     Indians and to provide all resources necessary to effect that 
     policy;
       ``(2) to raise the health status of Indians by the year 
     2010 to at least the levels set forth in the goals contained 
     within the Healthy People 2000, or any successor standards 
     thereto;
       ``(3) in order to raise the health status of Indian people 
     to at least the levels set forth in the goals contained 
     within the Healthy People 2000, or any successor standards 
     thereto, to permit Indian Tribes and tribal organizations to 
     set their own health care priorities and establish goals that 
     reflect their unmet needs;
       ``(4) to increase the proportion of all degrees in the 
     health professions and allied and associated health 
     professions awarded to Indians so that the proportion of 
     Indian health professionals in each geographic service area 
     is raised to at least the level of that of the general 
     population;
       ``(5) to require meaningful, active consultation with 
     Indian Tribes, Indian organizations, and urban Indian 
     organizations to implement this Act and the national policy 
     of Indian self-determination; and
       ``(6) that funds for health care programs and facilities 
     operated by Tribes and tribal organizations be provided in 
     amounts that are not less than the funds that are provided to 
     programs and facilities operated directly by the Service.

     ``SEC. 4. DEFINITIONS.

       ``In this Act:
       ``(1) Accredited and accessible.--The term `accredited and 
     accessible', with respect to an entity, means a community 
     college or other appropriate entity that is on or near a 
     reservation and accredited by a national or regional 
     organization with accrediting authority.
       ``(2) Area office.--The term `area office' mean an 
     administrative entity including a program office, within the 
     Indian Health Service through which services and funds are 
     provided to the service units within a defined geographic 
     area.
       ``(3) Assistant secretary.--The term `Assistant Secretary' 
     means the Assistant Secretary of the Indian Health as 
     established under section 601.
       ``(4) Contract health service.--The term `contract health 
     service' means a health service that is provided at the 
     expense of the Service, Indian Tribe, or tribal organization 
     by a public or private medical provider or hospital, other 
     than a service funded under the Indian Self-Determination and 
     Education Assistance Act or under this Act.
       ``(5) Department.--The term `Department', unless 
     specifically provided otherwise, means the Department of 
     Health and Human Services.
       ``(6) Fund.--The terms `fund' or `funding' mean the 
     transfer of monies from the Department to any eligible entity 
     or individual under this Act by any legal means, including 
     funding agreements, contracts, memoranda of understanding, 
     Buy Indian Act contracts, or otherwise.
       ``(7) Funding agreement.--The term `funding agreement' 
     means any agreement to transfer funds for the planning, 
     conduct, and administration of programs, functions, services 
     and activities to Tribes and tribal organizations from the 
     Secretary under the authority of the Indian Self-
     Determination and Education Assistance Act.
       ``(8) Health profession.--The term `health profession' 
     means allopathic medicine, family medicine, internal 
     medicine, pediatrics, geriatric medicine, obstetrics and 
     gynecology, podiatric medicine, nursing, public health 
     nursing, dentistry, psychiatry, osteopathy, optometry, 
     pharmacy, psychology, public health, social work, marriage 
     and family therapy, chiropractic medicine, environmental 
     health and engineering, and allied health professions, or any 
     other health profession.
       ``(9) Health promotion; disease prevention.--The terms 
     `health promotion' and `disease prevention' shall have the 
     meanings given such terms in paragraphs (1) and (2) of 
     section 203(c).
       ``(10) Indian.--The term `Indian' and `Indians' shall have 
     meanings given such terms for purposes of the Indian Self-
     Determination and Education Assistance Act.
       ``(11) Indian health program.--The term `Indian health 
     program' shall have the meaning given such term in section 
     110(a)(2)(A).
       ``(12) Indian tribe.--The term `Indian tribe' shall have 
     the meaning given such term in section 4(e) of the Indian 
     Self Determination and Education Assistance Act.
       ``(13) Reservation.--The term `reservation' means any 
     Federally recognized Indian tribe's reservation, Pueblo or 
     colony, including former reservations in Oklahoma, Alaska 
     Native Regions established pursuant to the Alaska Native 
     Claims Settlement Act, and Indian allotments.
       ``(14) Secretary.--The term `Secretary', unless 
     specifically provided otherwise, means the Secretary of 
     Health and Human Services.
       ``(15) Service.--The term `Service' means the Indian Health 
     Service.
       ``(16) Service area.--The term `service area' means the 
     geographical area served by each area office.
       ``(17) Service unit.--The term `service unit' means--
       ``(A) an administrative entity within the Indian Health 
     Service; or
       ``(B) a tribe or tribal organization operating health care 
     programs or facilities with funds from the Service under the 
     Indian Self-Determination and Education Assistance Act, 
     through which services are provided, directly or by contract, 
     to the eligible Indian population within a defined geographic 
     area.
       ``(18) Traditional health care practices.--The term 
     `traditional health care practices' means the application by 
     Native healing practitioners of the Native healing sciences 
     (as opposed or in contradistinction to western healing 
     sciences) which embodies the influences or forces of innate 
     tribal discovery, history, description, explanation and 
     knowledge of the states of wellness and illness and which 
     calls upon these influences or forces, including physical, 
     mental, and spiritual forces in the promotion, restoration, 
     preservation and maintenance of health, well-being, and 
     life's harmony.
       ``(19) Tribal organization.--The term `tribal organization' 
     shall have the meaning given such term in section 4(l) of the 
     Indian Self Determination and Education Assistance Act.
       ``(20) Tribally controlled community college.--The term 
     `tribally controlled community college' shall have the 
     meaning given such term in section 126 (g)(2).
       ``(21) Urban center.--The term `urban center' means any 
     community that has a sufficient urban Indian population with 
     unmet health needs to warrant assistance under title V, as 
     determined by the Secretary.
       ``(22) Urban indian.--The term `urban Indian' means any 
     individual who resides in an urban center and who--
       ``(A) regardless of whether such individual lives on or 
     near a reservation, is a member of a tribe, band or other 
     organized group of Indians, including those tribes, bands or 
     groups terminated since 1940;
       ``(B) is an Eskimo or Aleut or other Alaskan Native;
       ``(C) is considered by the Secretary of the Interior to be 
     an Indian for any purpose; or
       ``(D) is determined to be an Indian under regulations 
     promulgated by the Secretary.
       ``(23) Urban indian organization.--The term `urban Indian 
     organization' means a nonprofit corporate body situated in an 
     urban center, governed by an urban Indian controlled board of 
     directors, and providing for the participation of all 
     interested Indian groups and individuals, and which is 
     capable of legally cooperating with other public and private 
     entities for the purpose of performing the activities 
     described in section 503(a).

       ``TITLE I--INDIAN HEALTH, HUMAN RESOURCES AND DEVELOPMENT

     ``SEC. 101. PURPOSE.

       ``The purpose of this title is to increase, to the maximum 
     extent feasible, the number of Indians entering the health 
     professions and providing health services, and to assure an 
     optimum supply of health professionals to

[[Page S3700]]

     the Service, Indian tribes, tribal organizations, and urban 
     Indian organizations involved in the provision of health 
     services to Indian people.

     ``SEC. 102. GENERAL REQUIREMENTS.

       ``(a) Service Area Priorities.--Unless specifically 
     provided otherwise, amounts appropriated for each fiscal year 
     to carry out each program authorized under this title shall 
     be allocated by the Secretary to the area office of each 
     service area using a formula--
       ``(1) to be developed in consultation with Indian Tribes, 
     tribal organizations and urban Indian organizations; and
       ``(2) that takes into account the human resource and 
     development needs in each such service area.
       ``(b) Consultation.--Each area office receiving funds under 
     this title shall actively and continuously consult with 
     representatives of Indian tribes, tribal organizations, and 
     urban Indian organizations to prioritize the utilization of 
     funds provided under this title within the service area.
       ``(c) Reallocation.--Unless specifically prohibited, an 
     area office may reallocate funds provided to the office under 
     this title among the programs authorized by this title, 
     except that scholarship and loan repayment funds shall not be 
     used for administrative functions or expenses.
       ``(d) Limitation.--This section shall not apply with 
     respect to individual recipients of scholarships, loans or 
     other funds provided under this title (as this title existed 
     1 day prior to the date of enactment of this Act) until such 
     time as the individual completes the course of study that is 
     supported through the use of such funds.

     ``SEC. 103. HEALTH PROFESSIONS RECRUITMENT PROGRAM FOR 
                   INDIANS.

       ``(a) In General.--The Secretary, acting through the 
     Service, shall make funds available through the area office 
     to public or nonprofit private health entities, or Indian 
     tribes or tribal organizations to assist such entities in 
     meeting the costs of--
       ``(1) identifying Indians with a potential for education or 
     training in the health professions and encouraging and 
     assisting them--
       ``(A) to enroll in courses of study in such health 
     professions; or
       ``(B) if they are not qualified to enroll in any such 
     courses of study, to undertake such postsecondary education 
     or training as may be required to qualify them for 
     enrollment;
       ``(2) publicizing existing sources of financial aid 
     available to Indians enrolled in any course of study referred 
     to in paragraph (1) or who are undertaking training necessary 
     to qualify them to enroll in any such course of study; or
       ``(3) establishing other programs which the area office 
     determines will enhance and facilitate the enrollment of 
     Indians in, and the subsequent pursuit and completion by them 
     of, courses of study referred to in paragraph (1).
       ``(b) Administrative Provisions.--
       ``(1) Application.--To be eligible to receive funds under 
     this section an entity described in subsection (a) shall 
     submit to the Secretary, through the appropriate area office, 
     and have approved, an application in such form, submitted in 
     such manner, and containing such information as the Secretary 
     shall by regulation prescribe.
       ``(2) Preference.--In awarding funds under this section, 
     the area office shall give a preference to applications 
     submitted by Indian tribes, tribal organizations, or urban 
     Indian organizations.
       ``(3) Amount.--The amount of funds to be provided to an 
     eligible entity under this section shall be determined by the 
     area office. Payments under this section may be made in 
     advance or by way of reimbursement, and at such intervals and 
     on such conditions as provided for in regulations promulgated 
     pursuant to this Act.
       ``(4) Terms.--A funding commitment under this section 
     shall, to the extent not otherwise prohibited by law, be for 
     a term of 3 years, as provided for in regulations promulgated 
     pursuant to this Act.
       ``(c) Definition.--For purposes of this section and 
     sections 104 and 105, the terms `Indian' and `Indians' shall, 
     in addition to the definition provided for in section 4, mean 
     any individual who--
       ``(1) irrespective of whether such individual lives on or 
     near a reservation, is a member of a tribe, band, or other 
     organized group of Indians, including those Tribes, bands, or 
     groups terminated since 1940;
       ``(2) is an Eskimo or Aleut or other Alaska Native;
       ``(3) is considered by the Secretary of the Interior to be 
     an Indian for any purpose; or
       ``(4) is determined to be an Indian under regulations 
     promulgated by the Secretary.

     ``SEC. 104. HEALTH PROFESSIONS PREPARATORY SCHOLARSHIP 
                   PROGRAM FOR INDIANS.

       ``(a) In General.--The Secretary, acting through the 
     Service, shall provide scholarships through the area offices 
     to Indians who--
       ``(1) have successfully completed their high school 
     education or high school equivalency; and
       ``(2) have demonstrated the capability to successfully 
     complete courses of study in the health professions.
       ``(b) Purpose.--Scholarships provided under this section 
     shall be for the following purposes:
       ``(1) Compensatory preprofessional education of any 
     recipient. Such scholarship shall not exceed 2 years on a 
     full-time basis (or the part-time equivalent thereof, as 
     determined by the area office pursuant to regulations 
     promulgated under this Act).
       ``(2) Pregraduate education of any recipient leading to a 
     baccalaureate degree in an approved course of study 
     preparatory to a field of study in a health profession, such 
     scholarship not to exceed 4 years (or the part-time 
     equivalent thereof, as determined by the area office pursuant 
     to regulations promulgated under this Act) except that an 
     extension of up to 2 years may be approved by the Secretary.
       ``(c) Use of Scholarship.--Scholarships made under this 
     section may be used to cover costs of tuition, books, 
     transportation, board, and other necessary related expenses 
     of a recipient while attending school.
       ``(d) Limitations.--Scholarship assistance to an eligible 
     applicant under this section shall not be denied solely on 
     the basis of--
       ``(1) the applicant's scholastic achievement if such 
     applicant has been admitted to, or maintained good standing 
     at, an accredited institution; or
       ``(2) the applicant's eligibility for assistance or 
     benefits under any other Federal program.

     ``SEC. 105. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.

       ``(a) Scholarships.--
       ``(1) In general.--In order to meet the needs of Indians, 
     Indian tribes, tribal organizations, and urban Indian 
     organizations for health professionals, the Secretary, acting 
     through the Service and in accordance with this section, 
     shall provide scholarships through the area offices to 
     Indians who are enrolled full or part time in accredited 
     schools and pursuing courses of study in the health 
     professions. Such scholarships shall be designated Indian 
     Health Scholarships and shall, except as provided in 
     subsection (b), be made in accordance with section 338A of 
     the Public Health Service Act (42 U.S.C. 254l).
       ``(2) No delegation.--The Director of the Service shall 
     administer this section and shall not delegate any 
     administrative functions under a funding agreement pursuant 
     to the Indian Self-Determination and Education Assistance 
     Act.
       ``(b) Eligibility.--
       ``(1) Enrollment.--An Indian shall be eligible for a 
     scholarship under subsection (a) in any year in which such 
     individual is enrolled full or part time in a course of study 
     referred to in subsection (a)(1).
       ``(2) Service obligation.--
       ``(A) Public health service act.--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 Indian has entered into under that section 
     shall, if that individual is a recipient of an Indian Health 
     Scholarship, be met in full-time practice on an equivalent 
     year for year obligation, by service--
       ``(i) in the Indian Health Service;
       ``(ii) in a program conducted under a funding agreement 
     entered into under the Indian Self-Determination and 
     Education Assistance Act;
       ``(iii) in a program assisted under title V; or
       ``(iv) in the private practice of the applicable profession 
     if, as determined by the Secretary, in accordance with 
     guidelines promulgated by the Secretary, such practice is 
     situated in a physician or other health professional shortage 
     area and addresses the health care needs of a substantial 
     number of Indians.
       ``(B) Deferring active service.--At the request of any 
     Indian 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 (iv) of subparagraph (A).
       ``(C) New scholarship recipients.--A recipient of an Indian 
     Health Scholarship that is awarded after December 31, 2001, 
     shall meet the active duty service obligation under such 
     scholarship by providing service within the service area from 
     which the scholarship was awarded. In placing the recipient 
     for active duty the area office shall give priority to the 
     program that funded the recipient, except that in cases of 
     special circumstances, a recipient may be placed in a 
     different service area pursuant to an agreement between the 
     areas or programs involved.
       ``(D) Priority in assignment.--Subject to subparagraph (C), 
     the area office, in making assignments of Indian Health 
     Scholarship recipients required to meet the active duty 
     service obligation described in subparagraph (A), shall give 
     priority to assigning individuals to service in those 
     programs specified in

[[Page S3701]]

     subparagraph (A) that have a need for health professionals to 
     provide health care services as a result of individuals 
     having breached contracts entered into under this section.
       ``(3) Part time enrollment.--In the case of an Indian 
     receiving a scholarship under this section who is enrolled 
     part time in an approved course of study--
       ``(A) such scholarship shall be for a period of years not 
     to exceed the part-time equivalent of 4 years, as determined 
     by the appropriate area office;
       ``(B) the period of obligated service described in 
     paragraph (2)(A) shall be equal to the greater of--
       ``(i) the part-time equivalent of 1 year for each year for 
     which the individual was provided a scholarship (as 
     determined by the area office); or
       ``(ii) two years; and
       ``(C) the amount of the monthly stipend specified in 
     section 338A(g)(1)(B) of the Public Health Service Act (42 
     U.S.C. 254l(g)(1)(B)) shall be reduced pro rata (as 
     determined by the Secretary) based on the number of hours 
     such student is enrolled.
       ``(4) Breach of contract.--
       ``(A) In general.--An Indian who has, on or after the date 
     of the enactment of this paragraph, entered into a written 
     contract with the area office pursuant to a scholarship under 
     this section and who--
       ``(i) fails to maintain an acceptable level of academic 
     standing in the educational institution in which he or she is 
     enrolled (such level determined by the educational 
     institution under regulations of the Secretary);
       ``(ii) is dismissed from such educational institution for 
     disciplinary reasons;
       ``(iii) voluntarily terminates the training in such an 
     educational institution for which he or she is provided a 
     scholarship under such contract before the completion of such 
     training; or
       ``(iv) fails to accept payment, or instructs the 
     educational institution in which he or she is enrolled not to 
     accept payment, in whole or in part, of a scholarship under 
     such contract;
     in lieu of any service obligation arising under such 
     contract, shall be liable to the United States for the amount 
     which has been paid to him or her, or on his or her behalf, 
     under the contract.
       ``(B) Failure to perform service obligation.--If for any 
     reason not specified in subparagraph (A) an individual 
     breaches his or her written contract by failing either to 
     begin such individual's service obligation under this section 
     or to complete such service obligation, the United States 
     shall be entitled to recover from the individual an amount 
     determined in accordance with the formula specified in 
     subsection (l) of section 110 in the manner provided for in 
     such subsection.
       ``(C) Death.--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) Waiver.--The Secretary shall provide for the partial 
     or total waiver or suspension of any obligation of service or 
     payment of a recipient of an Indian Health Scholarship if the 
     Secretary, in consultation with the appropriate area office, 
     Indian tribe, tribal organization, and urban Indian 
     organization, 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) Hardship or good cause.--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) Bankruptcy.--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) Funding for Tribes for Scholarship Programs.--
       ``(1) Provision of funds.--
       ``(A) in general.--The Secretary shall make funds 
     available, through area offices, to Indian Tribes and tribal 
     organizations for the purpose of assisting such Tribes and 
     tribal organizations in educating Indians to serve as health 
     professionals in Indian communities.
       ``(B) Limitation.--The Secretary shall ensure that amounts 
     available for grants under subparagraph (A) for any fiscal 
     year shall not exceed an amount equal to 5 percent of the 
     amount available for each fiscal year for Indian Health 
     Scholarships under this section.
       ``(C) Application.--An application for funds under 
     subparagraph (A) shall be in such form and contain such 
     agreements, assurances and information as consistent with 
     this section.
       ``(2) Requirements.--
       ``(A) In general.--An Indian Tribe or tribal organization 
     receiving funds under paragraph (1) shall agree to provide 
     scholarships to Indians in accordance with the requirements 
     of this subsection.
       ``(B) Matching requirement.--With respect to the costs of 
     providing any scholarship pursuant to subparagraph (A)--
       ``(i) 80 percent of the costs of the scholarship shall be 
     paid from the funds provided under paragraph (1) to the 
     Indian Tribe or tribal organization; and
       ``(ii) 20 percent of such costs shall be paid from any 
     other source of funds.
       ``(3) Eligibility.--An Indian Tribe or tribal organization 
     shall provide scholarships under this subsection only to 
     Indians who are enrolled or accepted for enrollment in a 
     course of study (approved by the Secretary) in one of the 
     health professions described in this Act.
       ``(4) Contracts.--In providing scholarships under paragraph 
     (1), the Secretary and the Indian Tribe or tribal 
     organization shall enter into a written contract with each 
     recipient of such scholarship. Such contract shall--
       ``(A) obligate such recipient to provide service in an 
     Indian health program (as defined in section 110(a)(2)(A)) in 
     the same service area where the Indian Tribe or tribal 
     organization providing the scholarship is located, for--
       ``(i) a number of years equal to the number of years for 
     which the scholarship is provided (or the part-time 
     equivalent thereof, as determined by the Secretary), or for a 
     period of 2 years, whichever period is greater; or
       ``(ii) such greater period of time as the recipient and the 
     Indian Tribe or tribal organization may agree;
       ``(B) provide that the scholarship--
       ``(i) may only be expended for--

       ``(I) tuition expenses, other reasonable educational 
     expenses, and reasonable living expenses incurred in 
     attendance at the educational institution; and
       ``(II) payment to the recipient of a monthly stipend of not 
     more than the amount authorized by section 338(g)(1)(B) of 
     the Public Health Service Act (42 U.S.C. 254m(g)(1)(B), such 
     amount to be reduced pro rata (as determined by the 
     Secretary) based on the number of hours such student is 
     enrolled, and may not exceed, for any year of attendance 
     which the scholarship is provided, the total amount required 
     for the year for the purposes authorized in this clause; and

       ``(ii) may not exceed, for any year of attendance which the 
     scholarship is provided, the total amount required for the 
     year for the purposes authorized in clause (i);
       ``(C) require the recipient of such scholarship to maintain 
     an acceptable level of academic standing as determined by the 
     educational institution in accordance with regulations issued 
     pursuant to this Act; and
       ``(D) require the recipient of such scholarship to meet the 
     educational and licensure requirements appropriate to the 
     health profession involved.
       ``(5) Breach of contract.--
       ``(A) In general.--An individual who has entered into a 
     written contract with the Secretary and an Indian Tribe or 
     tribal organization under this subsection and who--
       ``(i) fails to maintain an acceptable level of academic 
     standing in the education institution in which he or she is 
     enrolled (such level determined by the educational 
     institution under regulations of the Secretary);
       ``(ii) is dismissed from such education for disciplinary 
     reasons;
       ``(iii) voluntarily terminates the training in such an 
     educational institution for which he or she has been provided 
     a scholarship under such contract before the completion of 
     such training; or
       ``(iv) fails to accept payment, or instructs the 
     educational institution in which he or she is enrolled not to 
     accept payment, in whole or in part, of a scholarship under 
     such contract, in lieu of any service obligation arising 
     under such contract;
     shall be liable to the United States for the Federal share of 
     the amount which has been paid to him or her, or on his or 
     her behalf, under the contract.
       ``(B) Failure to perform service obligation.--If for any 
     reason not specified in subparagraph (A), an individual 
     breaches his or her written contract by failing to either 
     begin such individual's service obligation required under 
     such contract or to complete such service obligation, the 
     United States shall be entitled to recover from the 
     individual an amount determined in accordance with the 
     formula specified in subsection (l) of section 110 in the 
     manner provided for in such subsection.
       ``(C) Information.--The Secretary may carry out this 
     subsection on the basis of information received from Indian 
     Tribes or tribal organizations involved, or on the basis of 
     information collected through such other means as the 
     Secretary deems appropriate.
       ``(6) Required agreements.--The recipient of a scholarship 
     under paragraph (1) shall agree, in providing health care 
     pursuant to the requirements of this subsection--
       ``(A) not to discriminate against an individual seeking 
     care on the basis of the ability of the individual to pay for 
     such care or on the basis that payment for such care will be 
     made pursuant to the program established in title XVIII of 
     the Social Security Act or pursuant to the programs 
     established in title XIX of such Act; and
       ``(B) to accept assignment under section 1842(b)(3)(B)(ii) 
     of the Social Security Act for all services for which payment 
     may be made under part B of title XVIII of such Act, and to 
     enter into an appropriate agreement with the State agency 
     that administers the State plan for medical assistance under 
     title XIX

[[Page S3702]]

     of such Act to provide service to individuals entitled to 
     medical assistance under the plan.
       ``(7) Payments.--The Secretary, through the area office, 
     shall make payments under this subsection to an Indian Tribe 
     or tribal organization for any fiscal year subsequent to the 
     first fiscal year of such payments unless the Secretary or 
     area office determines that, for the immediately preceding 
     fiscal year, the Indian Tribe or tribal organization has not 
     complied with the requirements of this subsection.

     ``SEC. 106. AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM.

       ``(a) In General.--Notwithstanding section 102, the 
     Secretary shall provide funds to at least 3 colleges and 
     universities for the purpose of developing and maintaining 
     American Indian psychology career recruitment programs as a 
     means of encouraging Indians to enter the mental health 
     field. These programs shall be located at various colleges 
     and universities 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 American Indians Into Psychology 
     Program.--The Secretary shall provide funds 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 American Indians Into Nursing Program authorized 
     under section 115, the Quentin N. Burdick Indians into Health 
     Program authorized under section 117, and existing university 
     research and communications networks.
       ``(c) Requirements.--
       ``(1) Regulations.--The Secretary shall promulgate 
     regulations pursuant to this Act for the competitive awarding 
     of funds under this section.
       ``(2) Program.--Applicants for funds under this section 
     shall agree to provide a program which, at a minimum--
       ``(A) 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;
       ``(B) incorporates a program advisory board comprised of 
     representatives from the Tribes and communities that will be 
     served by the program;
       ``(C) provides summer enrichment programs to expose Indian 
     students to the various fields of psychology through 
     research, clinical, and experimental activities;
       ``(D) provides stipends to undergraduate and graduate 
     students to pursue a career in psychology;
       ``(E) develops affiliation agreements with tribal community 
     colleges, the Service, university affiliated programs, and 
     other appropriate accredited and accessible entities to 
     enhance the education of Indian students;
       ``(F) utilizes, to the maximum extent feasible, existing 
     university tutoring, counseling and student support services; 
     and
       ``(G) employs, to the maximum extent feasible, qualified 
     Indians in the program.
       ``(d) Active Duty Obligation.--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 (c)(2)(C) that 
     is funded under this section. Such obligation shall be met by 
     service--
       ``(1) in the Indian Health Service;
       ``(2) in a program conducted under a funding agreement 
     contract entered into under the Indian Self-Determination and 
     Education Assistance Act;
       ``(3) in a program assisted under title V; or
       ``(4) 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.

     ``SEC. 107. INDIAN HEALTH SERVICE EXTERN PROGRAMS.

       ``(a) In General.--Any individual who receives a 
     scholarship pursuant to section 105 shall be entitled to 
     employment in the Service, or may be employed by a program of 
     an Indian tribe, tribal organization, or urban Indian 
     organization, or other agency of the Department as may be 
     appropriate and available, during any nonacademic period of 
     the year. Periods of employment pursuant to this subsection 
     shall not be counted in determining the fulfillment of the 
     service obligation incurred as a condition of the 
     scholarship.
       ``(b) Enrollees in Course of Study.--Any individual who is 
     enrolled in a course of study in the health professions may 
     be employed by the Service or by an Indian tribe, tribal 
     organization, or urban Indian organization, during any 
     nonacademic period of the year. Any such employment shall not 
     exceed 120 days during any calendar year.
       ``(c) High School Programs.--Any individual who is in a 
     high school program authorized under section 103(a) may be 
     employed by the Service, or by a Indian Tribe, tribal 
     organization, or urban Indian organization, during any 
     nonacademic period of the year. Any such employment shall not 
     exceed 120 days during any calendar year.
       ``(d) Administrative Provisions.--Any employment pursuant 
     to this section shall be made without regard to any 
     competitive personnel system or agency personnel limitation 
     and to a position which will enable the individual so 
     employed to receive practical experience in the health 
     profession in which he or she is engaged in study. Any 
     individual so employed shall receive payment for his or her 
     services comparable to the salary he or she would receive if 
     he or she were employed in the competitive system. Any 
     individual so employed shall not be counted against any 
     employment ceiling affecting the Service or the Department.

     ``SEC. 108. CONTINUING EDUCATION ALLOWANCES.

       ``In order to encourage health professionals, including for 
     purposes of this section, community health representatives 
     and emergency medical technicians, to join or continue in the 
     Service or in any program of an Indian tribe, tribal 
     organization, or urban Indian organization and to provide 
     their services in the rural and remote areas where a 
     significant portion of the Indian people reside, the 
     Secretary, acting through the area offices, may provide 
     allowances to health professionals employed in the Service or 
     such a program to enable such professionals to take leave of 
     their duty stations for a period of time each year (as 
     prescribed by regulations of the Secretary) for professional 
     consultation and refresher training courses.

     ``SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PROGRAM.

       ``(a) In General.--Under the authority of the Act of 
     November 2, 1921 (25 U.S.C. 13) (commonly known as the Snyder 
     Act), the Secretary shall maintain a Community Health 
     Representative Program under which the Service, Indian tribes 
     and tribal organizations--
       ``(1) provide for the training of Indians as community 
     health representatives; and
       ``(2) use such community health representatives in the 
     provision of health care, health promotion, and disease 
     prevention services to Indian communities.
       ``(b) Activities.--The Secretary, acting through the 
     Community Health Representative Program, shall--
       ``(1) provide a high standard of training for community 
     health representatives to ensure that the community health 
     representatives provide quality health care, health 
     promotion, and disease prevention services to the Indian 
     communities served by such Program;
       ``(2) in order to provide such training, develop and 
     maintain a curriculum that--
       ``(A) combines education in the theory of health care with 
     supervised practical experience in the provision of health 
     care; and
       ``(B) provides instruction and practical experience in 
     health promotion and disease prevention activities, with 
     appropriate consideration given to lifestyle factors that 
     have an impact on Indian health status, such as alcoholism, 
     family dysfunction, and poverty;
       ``(3) maintain a system which identifies the needs of 
     community health representatives for continuing education in 
     health care, health promotion, and disease prevention and 
     maintain programs that meet the needs for such continuing 
     education;
       ``(4) maintain a system that provides close supervision of 
     community health representatives;
       ``(5) maintain a system under which the work of community 
     health representatives is reviewed and evaluated; and
       ``(6) promote traditional health care practices of the 
     Indian tribes served consistent with the Service standards 
     for the provision of health care, health promotion, and 
     disease prevention.

     ``SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT PROGRAM.

       ``(a) Establishment.--
       ``(1) In general.--The Secretary, acting through the 
     Service, shall establish a program to be known as the Indian 
     Health Service Loan Repayment Program (referred to in this 
     Act as the `Loan Repayment Program') in order to assure an 
     adequate supply of trained health professionals necessary to 
     maintain accreditation of, and provide health care services 
     to Indians through, Indian health programs.
       ``(2) Definitions.--In this section:
       ``(A) Indian health program.--The term `Indian health 
     program' means any health program or facility funded, in 
     whole or part, by the Service for the benefit of Indians and 
     administered--
       ``(i) directly by the Service;
       ``(ii) by any Indian tribe or tribal or Indian organization 
     pursuant to a funding agreement under--

       ``(I) the Indian Self-Determination and Educational 
     Assistance Act; or
       ``(II) section 23 of the Act of April 30, 1908 (25 U.S.C. 
     47) (commonly known as the `Buy-Indian Act'); or

       ``(iii) by an urban Indian organization pursuant to title 
     V.
       ``(B) State.--The term `State' has the same meaning given 
     such term in section 331(i)(4) of the Public Health Service 
     Act.
       ``(b) Eligibility.--To be eligible to participate in the 
     Loan Repayment Program, an individual must--
       ``(1)(A) be enrolled--
       ``(i) in a course of study or program in an accredited 
     institution, as determined by the Secretary, within any State 
     and be scheduled to complete such course of study in the same 
     year such individual applies to participate in such program; 
     or
       ``(ii) in an approved graduate training program in a health 
     profession; or
       ``(B) have--
       ``(i) a degree in a health profession; and
       ``(ii) a license to practice a health profession in a 
     State;

[[Page S3703]]

       ``(2)(A) be eligible for, or hold, an appointment as a 
     commissioned officer in the Regular or Reserve Corps of the 
     Public Health Service;
       ``(B) be eligible for selection for civilian service in the 
     Regular or Reserve Corps of the Public Health Service;
       ``(C) meet the professional standards for civil service 
     employment in the Indian Health Service; or
       ``(D) be employed in an Indian health program without a 
     service obligation; and
       ``(3) submit to the Secretary an application for a contract 
     described in subsection (f).
       ``(c) Forms.--
       ``(1) In general.--In disseminating application forms and 
     contract forms to individuals desiring to participate in the 
     Loan Repayment Program, the Secretary shall include with such 
     forms a fair summary of the rights and liabilities of an 
     individual whose application is approved (and whose contract 
     is accepted) by the Secretary, including in the summary a 
     clear explanation of the damages to which the United States 
     is entitled under subsection (l) in the case of the 
     individual's breach of the contract. The Secretary shall 
     provide such individuals with sufficient information 
     regarding the advantages and disadvantages of service as a 
     commissioned officer in the Regular or Reserve Corps of the 
     Public Health Service or a civilian employee of the Indian 
     Health Service to enable the individual to make a decision on 
     an informed basis.
       ``(2) Forms to be understandable.--The application form, 
     contract form, and all other information furnished by the 
     Secretary under this section shall be written in a manner 
     calculated to be understood by the average individual 
     applying to participate in the Loan Repayment Program.
       ``(3) Availability.--The Secretary shall make such 
     application forms, contract forms, and other information 
     available to individuals desiring to participate in the Loan 
     Repayment Program on a date sufficiently early to ensure that 
     such individuals have adequate time to carefully review and 
     evaluate such forms and information.
       ``(d) Priority.--
       ``(1) Annual determinations.--The Secretary, acting through 
     the Service and in accordance with subsection (k), shall 
     annually--
       ``(A) identify the positions in each Indian health program 
     for which there is a need or a vacancy; and
       ``(B) rank those positions in order of priority.
       ``(2) Priority in approval.--Consistent with the priority 
     determined under paragraph (1), the Secretary, in determining 
     which applications under the Loan Repayment Program to 
     approve (and which contracts to accept), shall give priority 
     to applications made by--
       ``(A) Indians; and
       ``(B) individuals recruited through the efforts an Indian 
     tribe, tribal organization, or urban Indian organization.
       ``(e) Contracts.--
       ``(1) In general.--An individual becomes a participant in 
     the Loan Repayment Program only upon the Secretary and the 
     individual entering into a written contract described in 
     subsection (f).
       ``(2) Notice.--Not later than 21 days after considering an 
     individual for participation in the Loan Repayment Program 
     under paragraph (1), the Secretary shall provide written 
     notice to the individual of--
       ``(A) the Secretary's approving of the individual's 
     participation in the Loan Repayment Program, including 
     extensions resulting in an aggregate period of obligated 
     service in excess of 4 years; or
       ``(B) the Secretary's disapproving an individual's 
     participation in such Program.
       ``(f) Written Contract.--The written contract referred to 
     in this section between the Secretary and an individual shall 
     contain--
       ``(1) an agreement under which--
       ``(A) subject to paragraph (3), the Secretary agrees--
       ``(i) to pay loans on behalf of the individual in 
     accordance with the provisions of this section; and
       ``(ii) to accept (subject to the availability of 
     appropriated funds for carrying out this section) the 
     individual into the Service or place the individual with a 
     tribe, tribal organization, or urban Indian organization as 
     provided in subparagraph (B)(iii); and
       ``(B) subject to paragraph (3), the individual agrees--
       ``(i) to accept loan payments on behalf of the individual;
       ``(ii) in the case of an individual described in subsection 
     (b)(1)--

       ``(I) to maintain enrollment in a course of study or 
     training described in subsection (b)(1)(A) until the 
     individual completes the course of study or training; and
       ``(II) while enrolled in such course of study or training, 
     to maintain an acceptable level of academic standing (as 
     determined under regulations of the Secretary by the 
     educational institution offering such course of study or 
     training);

       ``(iii) to serve for a time period (referred to in this 
     section as the `period of obligated service') equal to 2 
     years or such longer period as the individual may agree to 
     serve in the full-time clinical practice of such individual's 
     profession in an Indian health program to which the 
     individual may be assigned by the Secretary;
       ``(2) a provision permitting the Secretary to extend for 
     such longer additional periods, as the individual may agree 
     to, the period of obligated service agreed to by the 
     individual under paragraph (1)(B)(iii);
       ``(3) a provision that any financial obligation of the 
     United States arising out of a contract entered into under 
     this section and any obligation of the individual which is 
     conditioned thereon is contingent upon funds being 
     appropriated for loan repayments under this section;
       ``(4) a statement of the damages to which the United States 
     is entitled under subsection (l) for the individual's breach 
     of the contract; and
       ``(5) such other statements of the rights and liabilities 
     of the Secretary and of the individual, not inconsistent with 
     this section.
       ``(g) Loan Repayments.--
       ``(1) In general.--A loan repayment provided for an 
     individual under a written contract under the Loan Repayment 
     Program shall consist of payment, in accordance with 
     paragraph (2), on behalf of the individual of the principal, 
     interest, and related expenses on government and commercial 
     loans received by the individual regarding the undergraduate 
     or graduate education of the individual (or both), which 
     loans were made for--
       ``(A) tuition expenses;
       ``(B) all other reasonable educational expenses, including 
     fees, books, and laboratory expenses, incurred by the 
     individual; and
       ``(C) reasonable living expenses as determined by the 
     Secretary.
       ``(2) Amount of payment.--
       ``(A) In general.--For each year of obligated service that 
     an individual contracts to serve under subsection (f) the 
     Secretary may pay up to $35,000 (or an amount equal to the 
     amount specified in section 338B(g)(2)(A) of the Public 
     Health Service Act) on behalf of the individual for loans 
     described in paragraph (1). In making a determination of the 
     amount to pay for a year of such service by an individual, 
     the Secretary shall consider the extent to which each such 
     determination--
       ``(i) affects the ability of the Secretary to maximize the 
     number of contracts that can be provided under the Loan 
     Repayment Program from the amounts appropriated for such 
     contracts;
       ``(ii) provides an incentive to serve in Indian health 
     programs with the greatest shortages of health professionals; 
     and
       ``(iii) provides an incentive with respect to the health 
     professional involved remaining in an Indian health program 
     with such a health professional shortage, and continuing to 
     provide primary health services, after the completion of the 
     period of obligated service under the Loan Repayment Program.
       ``(B) Time for payment.--Any arrangement made by the 
     Secretary for the making of loan repayments in accordance 
     with this subsection shall provide that any repayments for a 
     year of obligated service shall be made not later than the 
     end of the fiscal year in which the individual completes such 
     year of service.
       ``(3) Schedule for payments.--The Secretary may enter into 
     an agreement with the holder of any loan for which payments 
     are made under the Loan Repayment Program to establish a 
     schedule for the making of such payments.
       ``(h) Counting of Individuals.--Notwithstanding any other 
     provision of law, individuals who have entered into written 
     contracts with the Secretary under this section, while 
     undergoing academic training, shall not be counted against 
     any employment ceiling affecting the Department.
       ``(i) Recruiting Programs.--The Secretary shall conduct 
     recruiting programs for the Loan Repayment Program and other 
     health professional programs of the Service at educational 
     institutions training health professionals or specialists 
     identified in subsection (a).
       ``(j) Nonapplication of Certain Provision.--Section 214 of 
     the Public Health Service Act (42 U.S.C. 215) shall not apply 
     to individuals during their period of obligated service under 
     the Loan Repayment Program.
       ``(k) Assignment of Individuals.--The Secretary, in 
     assigning individuals to serve in Indian health programs 
     pursuant to contracts entered into under this section, 
     shall--
       ``(1) ensure that the staffing needs of Indian health 
     programs administered by an Indian tribe or tribal or health 
     organization receive consideration on an equal basis with 
     programs that are administered directly by the Service; and
       ``(2) give priority to assigning individuals to Indian 
     health programs that have a need for health professionals to 
     provide health care services as a result of individuals 
     having breached contracts entered into under this section.
       ``(l) Breach of Contract.--
       ``(1) In general.--An individual who has entered into a 
     written contract with the Secretary under this section and 
     who--
       ``(A) is enrolled in the final year of a course of study 
     and who--
       ``(i) fails to maintain an acceptable level of academic 
     standing in the educational institution in which he is 
     enrolled (such level determined by the educational 
     institution under regulations of the Secretary);
       ``(ii) voluntarily terminates such enrollment; or
       ``(iii) is dismissed from such educational institution 
     before completion of such course of study; or
       ``(B) is enrolled in a graduate training program, and who 
     fails to complete such training program, and does not receive 
     a waiver from the Secretary under subsection (b)(1)(B)(ii),

[[Page S3704]]

     shall be liable, in lieu of any service obligation arising 
     under such contract, to the United States for the amount 
     which has been paid on such individual's behalf under the 
     contract.
       ``(2) Amount of recovery.--If, for any reason not specified 
     in paragraph (1), an individual breaches his written contract 
     under this section by failing either to begin, or complete, 
     such individual's period of obligated service in accordance 
     with subsection (f), the United States shall be entitled to 
     recover from such individual an amount to be determined in 
     accordance with the following formula:

                              A=3Z(t-s/t)

     in which--
       ``(A) `A' is the amount the United States is entitled to 
     recover;
       ``(B) `Z' is the sum of the amounts paid under this section 
     to, or on behalf of, the individual and the interest on such 
     amounts which would be payable if, at the time the amounts 
     were paid, they were loans bearing interest at the maximum 
     legal prevailing rate, as determined by the Treasurer of the 
     United States;
       ``(C) `t' is the total number of months in the individual's 
     period of obligated service in accordance with subsection 
     (f); and
       ``(D) `s' is the number of months of such period served by 
     such individual in accordance with this section.
     Amounts not paid within such period shall be subject to 
     collection through deductions in Medicare payments pursuant 
     to section 1892 of the Social Security Act.
       ``(3) Damages.--
       ``(A) Time for payment.--Any amount of damages which the 
     United States is entitled to recover under this subsection 
     shall be paid to the United States within the 1-year period 
     beginning on the date of the breach of contract or such 
     longer period beginning on such date as shall be specified by 
     the Secretary.
       ``(B) Delinquencies.--If damages described in subparagraph 
     (A) are delinquent for 3 months, the Secretary shall, for the 
     purpose of recovering such damages--
       ``(i) utilize collection agencies contracted with by the 
     Administrator of the General Services Administration; or
       ``(ii) enter into contracts for the recovery of such 
     damages with collection agencies selected by the Secretary.
       ``(C) Contracts for recovery of damages.--Each contract for 
     recovering damages pursuant to this subsection shall provide 
     that the contractor will, not less than once each 6 months, 
     submit to the Secretary a status report on the success of the 
     contractor in collecting such damages. Section 3718 of title 
     31, United States Code, shall apply to any such contract to 
     the extent not inconsistent with this subsection.
       ``(m) Cancellation, Waiver or Release.--
       ``(1) Cancellation.--Any obligation of an individual under 
     the Loan Repayment Program for service or payment of damages 
     shall be canceled upon the death of the individual.
       ``(2) Waiver of service obligation.--The Secretary shall by 
     regulation provide for the partial or total waiver or 
     suspension of any obligation of service or payment by an 
     individual under the Loan Repayment Program whenever 
     compliance by the individual is impossible or would involve 
     extreme hardship to the individual and if enforcement of such 
     obligation with respect to any individual would be 
     unconscionable.
       ``(3) Waiver of rights of united states.--The Secretary may 
     waive, in whole or in part, the rights of the United States 
     to recover amounts under this section in any case of extreme 
     hardship or other good cause shown, as determined by the 
     Secretary.
       ``(4) Release.--Any obligation of an individual under the 
     Loan Repayment Program for payment of damages may be released 
     by a discharge in bankruptcy under title 11 of the United 
     States Code only if such discharge is granted after the 
     expiration of the 5-year period beginning on the first date 
     that payment of such damages is required, and only if the 
     bankruptcy court finds that nondischarge of the obligation 
     would be unconscionable.
       ``(n) Report.--The Secretary shall submit to the President, 
     for inclusion in each report required to be submitted to the 
     Congress under section 801, a report concerning the previous 
     fiscal year which sets forth--
       ``(1) the health professional positions maintained by the 
     Service or by tribal or Indian organizations for which 
     recruitment or retention is difficult;
       ``(2) the number of Loan Repayment Program applications 
     filed with respect to each type of health profession;
       ``(3) the number of contracts described in subsection (f) 
     that are entered into with respect to each health profession;
       ``(4) the amount of loan payments made under this section, 
     in total and by health profession;
       ``(5) the number of scholarship grants that are provided 
     under section 105 with respect to each health profession;
       ``(6) the amount of scholarship grants provided under 
     section 105, in total and by health profession;
       ``(7) the number of providers of health care that will be 
     needed by Indian health programs, by location and profession, 
     during the 3 fiscal years beginning after the date the report 
     is filed; and
       ``(8) the measures the Secretary plans to take to fill the 
     health professional positions maintained by the Service or by 
     tribes, tribal organizations, or urban Indian organizations 
     for which recruitment or retention is difficult.

     ``SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOVERY FUND.

       ``(a) Establishment.--Notwithstanding section 102, there is 
     established in the Treasury of the United States a fund to be 
     known as the Indian Health Scholarship and Loan Repayment 
     Recovery Fund (referred to in this section as the `LRRF'). 
     The LRRF Fund shall consist of--
       ``(1) such amounts as may be collected from individuals 
     under subparagraphs (A) and (B) of section 105(b)(4) and 
     section 110(l) for breach of contract;
       ``(2) such funds as may be appropriated to the LRRF;
       ``(3) such interest earned on amounts in the LRRF; and
       ``(4) such additional amounts as may be collected, 
     appropriated, or earned relative to the LRRF.
      Amounts appropriated to the LRRF shall remain available 
     until expended.
       ``(b) Use of LRRF.--
       ``(1) In general.--Amounts in the LRRF may be expended by 
     the Secretary, subject to section 102, acting through the 
     Service, to make payments to the Service or to an Indian 
     tribe or tribal organization administering a health care 
     program pursuant to a funding agreement entered into under 
     the Indian Self-Determination and Education Assistance Act--
       ``(A) to which a scholarship recipient under section 105 or 
     a loan repayment program participant under section 110 has 
     been assigned to meet the obligated service requirements 
     pursuant to sections; and
       ``(B) that has a need for a health professional to provide 
     health care services as a result of such recipient or 
     participant having breached the contract entered into under 
     section 105 or section 110.
       ``(2) Scholarships and recruiting.--An Indian tribe or 
     tribal organization receiving payments pursuant to paragraph 
     (1) may expend the payments to provide scholarships or to 
     recruit and employ, directly or by contract, health 
     professionals to provide health care services.
       ``(c) Investing of Fund.--
       ``(1) In general.--The Secretary of the Treasury shall 
     invest such amounts of the LRRF as the Secretary determines 
     are not required to meet current withdrawals from the LRRF. 
     Such investments may be made only in interest-bearing 
     obligations of the United States. For such purpose, such 
     obligations may be acquired on original issue at the issue 
     price, or by purchase of outstanding obligations at the 
     market price.
       ``(2) Sale price.--Any obligation acquired by the LRRF may 
     be sold by the Secretary of the Treasury at the market price.

     ``SEC. 112. RECRUITMENT ACTIVITIES.

       ``(a) Reimbursement of Expenses.--The Secretary may 
     reimburse health professionals seeking positions in the 
     Service, Indian tribes, tribal organizations, or urban Indian 
     organizations, including unpaid student volunteers and 
     individuals considering entering into a contract under 
     section 110, and their spouses, for actual and reasonable 
     expenses incurred in traveling to and from their places of 
     residence to an area in which they may be assigned for the 
     purpose of evaluating such area with respect to such 
     assignment.
       (b) Assignment of Personnel.--The Secretary, acting through 
     the Service, shall assign one individual in each area office 
     to be responsible on a full-time basis for recruitment 
     activities.

     ``SEC. 113. TRIBAL RECRUITMENT AND RETENTION PROGRAM.

       ``(a) Funding of Projects.--The Secretary, acting through 
     the Service, shall fund innovative projects for a period not 
     to exceed 3 years to enable Indian tribes, tribal 
     organizations, and urban Indian organizations to recruit, 
     place, and retain health professionals to meet the staffing 
     needs of Indian health programs (as defined in section 
     110(a)(2)(A)).
       ``(b) Eligibility.--Any Indian tribe, tribal organization, 
     or urban Indian organization may submit an application for 
     funding of a project pursuant to this section.

     ``SEC. 114. ADVANCED TRAINING AND RESEARCH.

       ``(a) Demonstration Project.--The Secretary, acting through 
     the Service, shall establish a demonstration project to 
     enable health professionals who have worked in an Indian 
     health program (as defined in section 110) for a substantial 
     period of time to pursue advanced training or research in 
     areas of study for which the Secretary determines a need 
     exists.
       ``(b) Service Obligation.--
       ``(1) In general.--An individual who participates in the 
     project under subsection (a), where the educational costs are 
     borne by the Service, shall incur an obligation to serve in 
     an Indian health program for a period of obligated service 
     equal to at least the period of time during which the 
     individual participates in such project.
       ``(2) Failure to complete service.--In the event that an 
     individual fails to complete a period of obligated service 
     under paragraph (1), the individual shall be liable to the 
     United States for the period of service remaining. In such 
     event, with respect to individuals entering the project after 
     the date of the enactment of this Act, the United States 
     shall be entitled to recover from such individual an amount 
     to be determined in accordance with the formula specified in 
     subsection (l) of section 110 in the manner provided for in 
     such subsection.

[[Page S3705]]

       ``(c) Opportunity to Participate.--Health professionals 
     from Indian tribes, tribal organizations, and urban Indian 
     organizations under the authority of the Indian Self-
     Determination and Education Assistance Act shall be given an 
     equal opportunity to participate in the program under 
     subsection (a).

     ``SEC. 115. NURSING PROGRAMS; QUENTIN N. BURDICK AMERICAN 
                   INDIANS INTO NURSING PROGRAM.

       ``(a) Grants.--Notwithstanding section 102, the Secretary, 
     acting through the Service, shall provide funds to--
       ``(1) public or private schools of nursing;
       ``(2) tribally controlled community colleges and tribally 
     controlled postsecondary vocational institutions (as defined 
     in section 390(2) of the Tribally Controlled Vocational 
     Institutions Support Act of 1990 (20 U.S.C. 2397h(2)); and
       ``(3) nurse midwife programs, and advance practice nurse 
     programs, that are provided by any tribal college accredited 
     nursing program, or in the absence of such, any other public 
     or private institution,
     for the purpose of increasing the number of nurses, nurse 
     midwives, and nurse practitioners who deliver health care 
     services to Indians.
       ``(b) Use of Grants.--Funds provided under subsection (a) 
     may be used to--
       ``(1) recruit individuals for programs which train 
     individuals to be nurses, nurse midwives, or advanced 
     practice nurses;
       ``(2) provide scholarships to Indian individuals enrolled 
     in such programs that may be used to pay the tuition charged 
     for such program and for other expenses incurred in 
     connection with such program, including books, fees, room and 
     board, and stipends for living expenses;
       ``(3) provide a program that encourages nurses, nurse 
     midwives, and advanced practice nurses to provide, or 
     continue to provide, health care services to Indians;
       ``(4) provide a program that increases the skills of, and 
     provides continuing education to, nurses, nurse midwives, and 
     advanced practice nurses; or
       ``(5) provide any program that is designed to achieve the 
     purpose described in subsection (a).
       ``(c) Applications.--Each application for funds under 
     subsection (a) shall include such information as the 
     Secretary may require to establish the connection between the 
     program of the applicant and a health care facility that 
     primarily serves Indians.
       ``(d) Preferences.--In providing funds under subsection 
     (a), the Secretary shall extend a preference to--
       ``(1) programs that provide a preference to Indians;
       ``(2) programs that train nurse midwives or advanced 
     practice nurses;
       ``(3) programs that are interdisciplinary; and
       ``(4) programs that are conducted in cooperation with a 
     center for gifted and talented Indian students established 
     under section 5324(a) of the Indian Education Act of 1988.
       ``(e) Quentin N. Burdick American Indians Into Nursing 
     Program.--The Secretary shall ensure that a portion of the 
     funds authorized under subsection (a) is made available to 
     establish and maintain a program at the University of North 
     Dakota to be known as the `Quentin N. Burdick American 
     Indians Into Nursing Program'. Such program shall, to the 
     maximum extent feasible, coordinate with the Quentin N. 
     Burdick American Indians Into Psychology Program established 
     under section 106(b) and the Quentin N. Burdick Indian Health 
     Programs established under section 117(b).
       ``(f) Service Obligation.--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 individual 
     who receives training or assistance described in paragraph 
     (1) or (2) of subsection (b) that is funded under subsection 
     (a). Such obligation shall be met by service--
       ``(1) in the Indian Health Service;
       ``(2) in a program conducted under a contract entered into 
     under the Indian Self-Determination and Education assistance 
     Act;
       ``(3) in a program assisted under title V; or
       ``(4) in the private practice of nursing if, as determined 
     by the Secretary, in accordance with guidelines promulgated 
     by the Secretary, such practice is situated in a physician or 
     other health professional shortage area and addresses the 
     health care needs of a substantial number of Indians.

     ``SEC. 116. TRIBAL CULTURE AND HISTORY.

       ``(a) In General.--The Secretary, acting through the 
     Service, shall require that appropriate employees of the 
     Service who serve Indian tribes in each service area receive 
     educational instruction in the history and culture of such 
     tribes and their relationship to the Service.
       ``(b) Requirements.--To the extent feasible, the 
     educational instruction to be provided under subsection (a) 
     shall--
       ``(1) be provided in consultation with the affected tribal 
     governments, tribal organizations, and urban Indian 
     organizations;
       ``(2) be provided through tribally-controlled community 
     colleges (within the meaning of section 2(4) of the Tribally 
     Controlled Community College Assistance Act of 1978) and 
     tribally controlled postsecondary vocational institutions (as 
     defined in section 390(2) of the Tribally Controlled 
     Vocational Institutions Support Act of 1990 (20 U.S.C. 
     2397h(2)); and
       ``(3) include instruction in Native American studies.

     ``SEC. 117. INMED PROGRAM.

       ``(a) Grants.--The Secretary may provide grants to 3 
     colleges and universities for the purpose of maintaining and 
     expanding the Native American health careers recruitment 
     program known as the `Indians into Medicine Program' 
     (referred to in this section as `INMED') as a means of 
     encouraging Indians to enter the health professions.
       ``(b) Quentin N. Burdick Indian Health Program.--The 
     Secretary shall provide 1 of the grants under subsection (a) 
     to maintain the INMED program at the University of North 
     Dakota, to be known as the `Quentin N. Burdick Indian Health 
     Program', unless the Secretary makes a determination, based 
     upon program reviews, that the program is not meeting the 
     purposes of this section. Such program shall, to the maximum 
     extent feasible, coordinate with the Quentin N. Burdick 
     American Indians Into Psychology Program established under 
     section 106(b) and the Quentin N. Burdick American Indians 
     Into Nursing Program established under section 115.
       ``(c) Requirements.--
       ``(1) In general.--The Secretary shall develop regulations 
     to govern grants under to this section.
       ``(2) Program requirements.--Applicants for grants provided 
     under this section shall agree to provide a program that--
       ``(A) provides outreach and recruitment for health 
     professions to Indian communities including elementary, 
     secondary and community colleges located on Indian 
     reservations which will be served by the program;
       ``(B) incorporates a program advisory board comprised of 
     representatives from the tribes and communities which will be 
     served by the program;
       ``(C) provides summer preparatory programs for Indian 
     students who need enrichment in the subjects of math and 
     science in order to pursue training in the health 
     professions;
       ``(D) provides tutoring, counseling and support to students 
     who are enrolled in a health career program of study at the 
     respective college or university; and
       ``(E) to the maximum extent feasible, employs qualified 
     Indians in the program.

     ``SEC. 118. HEALTH TRAINING PROGRAMS OF COMMUNITY COLLEGES.

       ``(a) Establishment Grants.--
       ``(1) In general.--The Secretary, acting through the 
     Service, shall award grants to accredited and accessible 
     community colleges for the purpose of assisting such colleges 
     in the establishment of programs which provide education in a 
     health profession leading to a degree or diploma in a health 
     profession for individuals who desire to practice such 
     profession on an Indian reservation, in the Service, or in a 
     tribal health program.
       ``(2) Amount.--The amount of any grant awarded to a 
     community college under paragraph (1) for the first year in 
     which such a grant is provided to the community college shall 
     not exceed $100,000.
       ``(b) Continuation Grants.--
       ``(1) In general.--The Secretary, acting through the 
     Service, shall award grants to accredited and accessible 
     community colleges that have established a program described 
     in subsection (a)(1) for the purpose of maintaining the 
     program and recruiting students for the program.
       ``(2) Eligibility.--Grants may only be made under this 
     subsection to a community college that--
       ``(A) is accredited;
       ``(B) has a relationship with a hospital facility, Service 
     facility, or hospital that could provide training of nurses 
     or health professionals;
       ``(C) has entered into an agreement with an accredited 
     college or university medical school, the terms of which--
       ``(i) provide a program that enhances the transition and 
     recruitment of students into advanced baccalaureate or 
     graduate programs which train health professionals; and
       ``(ii) stipulate certifications necessary to approve 
     internship and field placement opportunities at health 
     programs of the Service or at tribal health programs;
       ``(D) has a qualified staff which has the appropriate 
     certifications;
       ``(E) is capable of obtaining State or regional 
     accreditation of the program described in subsection (a)(1); 
     and
       ``(F) agrees to provide for Indian preference for 
     applicants for programs under this section.
       ``(c) Service Personnel and Technical Assistance.--The 
     Secretary shall encourage community colleges described in 
     subsection (b)(2) to establish and maintain programs 
     described in subsection (a)(1) by--
       ``(1) entering into agreements with such colleges for the 
     provision of qualified personnel of the Service to teach 
     courses of study in such programs, and
       ``(2) providing technical assistance and support to such 
     colleges.
       ``(d) Specified Courses of Study.--Any program receiving 
     assistance under this section that is conducted with respect 
     to a health profession shall also offer courses of study 
     which provide advanced training for any health professional 
     who--
       ``(1) has already received a degree or diploma in such 
     health profession; and
       ``(2) provides clinical services on an Indian reservation, 
     at a Service facility, or at a tribal clinic.
     Such courses of study may be offered in conjunction with the 
     college or university with which the community college has 
     entered

[[Page S3706]]

     into the agreement required under subsection (b)(2)(C).
       ``(e) Priority.--Priority shall be provided under this 
     section to tribally controlled colleges in service areas that 
     meet the requirements of subsection (b).
       ``(f) Definitions.--In this section:
       ``(1) Community college.--The term `community college' 
     means--
       ``(A) a tribally controlled community college; or
       ``(B) a junior or community college.
       ``(2) Junior or community college.--The term `junior or 
     community college'' has the meaning given such term by 
     section 312(e) of the Higher Education Act of 1965 (20 U.S.C. 
     1058(e)).
       ``(3) Tribally controlled college.--The term `tribally 
     controlled college' has the meaning given the term `tribally 
     controlled community college' by section 2(4) of the Tribally 
     Controlled Community College Assistance Act of 1978.

     ``SEC. 119. RETENTION BONUS.

       ``(a) In General.--The Secretary may pay a retention bonus 
     to any health professional employed by, or assigned to, and 
     serving in, the Service, an Indian tribe, a tribal 
     organization, or an urban Indian organization either as a 
     civilian employee or as a commissioned officer in the Regular 
     or Reserve Corps of the Public Health Service who--
       ``(1) is assigned to, and serving in, a position for which 
     recruitment or retention of personnel is difficult;
       ``(2) the Secretary determines is needed by the Service, 
     tribe, tribal organization, or urban organization;
       ``(3) has--
       ``(A) completed 3 years of employment with the Service; 
     tribe, tribal organization, or urban organization; or
       ``(B) completed any service obligations incurred as a 
     requirement of--
       ``(i) any Federal scholarship program; or
       ``(ii) any Federal education loan repayment program; and
       ``(4) enters into an agreement with the Service, Indian 
     tribe, tribal organization, or urban Indian organization for 
     continued employment for a period of not less than 1 year.
       ``(b) Rates.--The Secretary may establish rates for the 
     retention bonus which shall provide for a higher annual rate 
     for multiyear agreements than for single year agreements 
     referred to in subsection (a)(4), but in no event shall the 
     annual rate be more than $25,000 per annum.
       ``(c) Failure to Complete Term of Service.--Any health 
     professional failing to complete the agreed upon term of 
     service, except where such failure is through no fault of the 
     individual, shall be obligated to refund to the Government 
     the full amount of the retention bonus for the period covered 
     by the agreement, plus interest as determined by the 
     Secretary in accordance with section 110(l)(2)(B).
       ``(d) Funding Agreement.--The Secretary may pay a retention 
     bonus to any health professional employed by an organization 
     providing health care services to Indians pursuant to a 
     funding agreement under the Indian Self-Determination and 
     Education Assistance Act if such health professional is 
     serving in a position which the Secretary determines is--
       ``(1) a position for which recruitment or retention is 
     difficult; and
       ``(2) necessary for providing health care services to 
     Indians.

     ``SEC. 120. NURSING RESIDENCY PROGRAM.

       ``(a) Establishment.--The Secretary, acting through the 
     Service, shall establish a program to enable Indians who are 
     licensed practical nurses, licensed vocational nurses, and 
     registered nurses who are working in an Indian health program 
     (as defined in section 110(a)(2)(A)), and have done so for a 
     period of not less than 1 year, to pursue advanced training.
       ``(b) Requirement.--The program established under 
     subsection (a) shall include a combination of education and 
     work study in an Indian health program (as defined in section 
     110(a)(2)(A)) leading to an associate or bachelor's degree 
     (in the case of a licensed practical nurse or licensed 
     vocational nurse) or a bachelor's degree (in the case of a 
     registered nurse) or an advanced degrees in nursing and 
     public health.
       ``(c) Service Obligation.--An individual who participates 
     in a program under subsection (a), where the educational 
     costs are paid by the Service, shall incur an obligation to 
     serve in an Indian health program for a period of obligated 
     service equal to the amount of time during which the 
     individual participates in such program. In the event that 
     the individual fails to complete such obligated service, the 
     United States shall be entitled to recover from such 
     individual an amount determined in accordance with the 
     formula specified in subsection (l) of section 110 in the 
     manner provided for in such subsection.

     ``SEC. 121. COMMUNITY HEALTH AIDE PROGRAM FOR ALASKA.

       ``(a) In General.--Under the authority of the Act of 
     November 2, 1921 (25 U.S.C. 13; commonly known as the Snyder 
     Act), the Secretary shall maintain a Community Health Aide 
     Program in Alaska under which the Service--
       ``(1) provides for the training of Alaska Natives as health 
     aides or community health practitioners;
       ``(2) uses such aides or practitioners in the provision of 
     health care, health promotion, and disease prevention 
     services to Alaska Natives living in villages in rural 
     Alaska; and
       ``(3) provides for the establishment of teleconferencing 
     capacity in health clinics located in or near such villages 
     for use by community health aides or community health 
     practitioners.
       ``(b) Activities.--The Secretary, acting through the 
     Community Health Aide Program under subsection (a), 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 such 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 in 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 
     objective specified in section 3(b);
       ``(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 who can demonstrate equivalent experience;
       ``(4) develop and maintain a system which identifies the 
     needs of community health aides and community health 
     practitioners for continuing education in the provision of 
     health care, including the areas described in paragraph 
     (2)(B), and develop programs that meet the needs for such 
     continuing education;
       ``(5) develop and maintain a system that provides close 
     supervision of community health aides and community health 
     practitioners; and
       ``(6) develop a system under which the work of community 
     health aides and community health practitioners is reviewed 
     and evaluated to assure the provision of quality health care, 
     health promotion, and disease prevention services.

     ``SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION.

       ``Subject to Section 102, the Secretary, acting through the 
     Service, shall, through a funding agreement or otherwise, 
     provide training for Indians in the administration and 
     planning of tribal health programs.

     ``SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE 
                   DEMONSTRATION PROJECT.

       ``(a) Pilot Programs.--The Secretary may, through area 
     offices, fund pilot programs for tribes and tribal 
     organizations to address chronic shortages of health 
     professionals.
       ``(b) Purpose.--It is the purpose of the health professions 
     demonstration project under this section to--
       ``(1) provide direct clinical and practical experience in a 
     service area to health professions students and residents 
     from medical schools;
       ``(2) improve the quality of health care for Indians by 
     assuring access to qualified health care professionals; and
       ``(3) provide academic and scholarly opportunities for 
     health professionals serving Indian people by identifying and 
     utilizing all academic and scholarly resources of the region.
       ``(c) Advisory Board.--A pilot program established under 
     subsection (a) shall incorporate a program advisory board 
     that shall be composed of representatives from the tribes and 
     communities in the service area that will be served by the 
     program.

     ``SEC. 124. SCHOLARSHIPS.

       ``Scholarships and loan reimbursements provided to 
     individuals pursuant to this title shall be treated as 
     `qualified scholarships' for purposes of section 117 of the 
     Internal Revenue Code of 1986.

     ``SEC. 125. NATIONAL HEALTH SERVICE CORPS.

       ``(a) Limitations.--The Secretary shall not--
       ``(1) remove a member of the National Health Services Corps 
     from a health program operated by Indian Health Service or by 
     a tribe or tribal organization under a funding agreement with 
     the Service under the Indian Self-Determination and Education 
     Assistance Act, or by urban Indian organizations; or
       ``(2) withdraw the funding used to support such a member;
     unless the Secretary, acting through the Service, tribes or 
     tribal organization, has ensured that the Indians receiving 
     services from such member will experience no reduction in 
     services.
       ``(b) Designation of Service Areas as Health Professional 
     Shortage Areas.--All service areas served by programs 
     operated by the Service or by a tribe or tribal organization 
     sunder the Indian Self-Determination and Education Assistance 
     Act, or by an urban Indian organization, shall be designated 
     under section 332 of the Public Health Service Act (42 U.S.C. 
     254e) as Health Professional Shortage Areas.
       ``(c) Full Time Equivalent.--National Health Service Corps 
     scholars that qualify for the commissioned corps in the 
     Public Health Service shall be exempt from the full time 
     equivalent limitations of the National

[[Page S3707]]

     Health Service Corps and the Service when such scholars serve 
     as commissioned corps officers in a health program operated 
     by an Indian tribe or tribal organization under the Indian 
     Self-Determination and Education Assistance Act or by an 
     urban Indian organization.

     ``SEC. 126. SUBSTANCE ABUSE COUNSELOR EDUCATION DEMONSTRATION 
                   PROJECT.

       ``(a) Demonstration Projects.--The Secretary, acting 
     through the Service, may enter into contracts with, or make 
     grants to, accredited tribally controlled community colleges, 
     tribally controlled postsecondary vocational institutions, 
     and eligible accredited and accessible community colleges to 
     establish demonstration projects to develop educational 
     curricula for substance abuse counseling.
       ``(b) Use of Funds.--Funds provided under this section 
     shall be used only for developing and providing educational 
     curricula for substance abuse counseling (including paying 
     salaries for instructors). Such curricula may be provided 
     through satellite campus programs.
       ``(c) Term of Grant.--A contract entered into or a grant 
     provided under this section shall be for a period of 1 year. 
     Such contract or grant may be renewed for an additional 1 
     year period upon the approval of the Secretary.
       ``(d) Review of Applications.--Not later than 180 days 
     after the date of the enactment of this Act, the Secretary, 
     after consultation with Indian tribes and administrators of 
     accredited tribally controlled community colleges, tribally 
     controlled postsecondary vocational institutions, and 
     eligible accredited and accessible community colleges, shall 
     develop and issue criteria for the review and approval of 
     applications for funding (including applications for renewals 
     of funding) under this section. Such criteria shall ensure 
     that demonstration projects established under this section 
     promote the development of the capacity of such entities to 
     educate substance abuse counselors.
       ``(e) Technical Assistance.--The Secretary shall provide 
     such technical and other assistance as may be necessary to 
     enable grant recipients to comply with the provisions of this 
     section.
       ``(f) Report.--The Secretary shall submit to the President, 
     for inclusion in the report required to be submitted under 
     section 801 for fiscal year 1999, a report on the findings 
     and conclusions derived from the demonstration projects 
     conducted under this section.
       ``(g) Definitions.--In this section:
       ``(1) Educational curriculum.--The term `educational 
     curriculum' means 1 or more of the following:
       ``(A) Classroom education.
       ``(B) Clinical work experience.
       ``(C) Continuing education workshops.
       ``(2) Tribally controlled community college.--The term 
     `tribally controlled community college' has the meaning given 
     such term in section 2(a)(4) of the Tribally Controlled 
     Community College Assistance Act of 1978 (25 U.S.C. 
     1801(a)(4)).
       ``(3) Tribally controlled postsecondary vocational 
     institution.--The term `tribally controlled postsecondary 
     vocational institution' has the meaning given such term in 
     section 390(2) of the Tribally Controlled Vocational 
     Institutions Support Act of 1990 (20 U.S.C. 2397h(2)).

     ``SEC. 127. MENTAL HEALTH TRAINING AND COMMUNITY EDUCATION.

       ``(a) Study and List.--
       ``(1) In general.--The Secretary and the Secretary of the 
     Interior in consultation with Indian tribes and tribal 
     organizations shall conduct a study and compile a list of the 
     types of staff positions specified in subsection (b) whose 
     qualifications include or should include, training in the 
     identification, prevention, education, referral or treatment 
     of mental illness, dysfunctional or 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, 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 specified in 
     subsection (b) and established and maintained by Indian 
     tribes, tribal organizations, and urban Indian organizations, 
     including positions established pursuant to funding 
     agreements under the Indian Self-determination and Education 
     Assistance Act, and this Act.
       ``(3) Training criteria.--
       ``(A) In general.--The appropriate Secretary shall provide 
     training criteria appropriate to each type of position 
     specified in subsection (b)(1) and ensure that appropriate 
     training has been or will be provided to any individual in 
     any such position.
       ``(B) Training.--With respect to any such individual in a 
     position specified pursuant to subsection (b)(3), the 
     respective Secretaries shall provide appropriate training or 
     provide funds to an Indian tribe, tribal organization, or 
     urban Indian organization for the training of appropriate 
     individuals. In the case of a funding agreement, the 
     appropriate Secretary shall ensure that such training costs 
     are included in the funding agreement, if necessary.
       ``(4) Cultural relevancy.--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.
       ``(5) Community education.--
       ``(A) Development.--The Service shall develop and 
     implement, or on request of an Indian tribe or tribal 
     organization, assist an Indian tribe or tribal organization, 
     in developing and implementing a program of community 
     education on mental illness.
       ``(B) Technical assistance.--In carrying out this 
     paragraph, the Service shall, upon the request of an Indian 
     tribe or tribal organization, provide technical assistance to 
     the Indian tribe or tribal organization to obtain and develop 
     community educational materials on the identification, 
     prevention, referral and treatment of mental illness, 
     dysfunctional and self-destructive behavior.
       ``(b) Staffing.--
       ``(1) In general.--Not later than 90 days after the date of 
     enactment of the Act, the Director of the Service shall 
     develop a plan under which the Service will increase the 
     number of health care staff that are providing mental health 
     services by at least 500 positions within 5 years after such 
     date of enactment, with at least 200 of such positions 
     devoted to child, adolescent, and family services. The 
     allocation of such positions shall be subject to the 
     provisions of section 102(a).
       ``(2) Implementation.--The plan developed under paragraph 
     (1) shall be implemented under the Act of November 2, 1921 
     (25 U.S.C. 13) (commonly know as the `Snyder Act').

     ``SEC. 128. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2012 to 
     carry out this title.

                      ``TITLE II--HEALTH SERVICES

     ``SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND.

       ``(a) In General.--The Secretary may expend funds, directly 
     or under the authority of the Indian Self-Determination and 
     Education Assistance Act, that are appropriated under the 
     authority of this section, for the purposes of--
       ``(1) eliminating the deficiencies in the health status and 
     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;
       ``(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 
     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 in accordance with section 207;
       ``(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) accident prevention programs;
       ``(H) home health care;
       ``(I) community health representatives;
       ``(J) maintenance and repair; and
       ``(K) traditional health care practices.
       ``(b) Use of Funds.--
       ``(1) 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, the Act of November 2, 1921 (25 U.S.C. 13) (commonly 
     known as the `Snyder Act'), or any other provision of law.
       ``(2) Allocation.--
       ``(A) In general.--Funds appropriated under the authority 
     of this section shall be allocated to service units or Indian 
     tribes or tribal organizations. The funds allocated to each 
     tribe, tribal organization, or service unit under this 
     subparagraph shall be used to improve the health status and 
     reduce the resource deficiency of each tribe served by such 
     service unit, tribe or tribal organization.
       ``(B) Apportionment.--The apportionment of funds allocated 
     to a service unit, tribe or tribal organization under 
     subparagraph (A) among the health service responsibilities 
     described in subsection (a)(4) shall be determined by the 
     Service in consultation with, and with the active 
     participation of, the affected Indian tribes in accordance 
     with this section and such rules as may be established under 
     title VIII.
       ``(c) Health Status and Resource Deficiency.--In this 
     section:
       ``(1) Definition.--The term `health status and resource 
     deficiency' means the extent to which--
       ``(A) the health status objective set forth in section 3(2) 
     is not being achieved; and

[[Page S3708]]

       ``(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) Resources.--The health resources available to an 
     Indian tribe or tribal organization shall 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) Review of determination.--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 tribe or tribal organization.
       ``(d) Eligibility.--Programs administered by any Indian 
     tribe or tribal organization under the authority of the 
     Indian Self-Determination and Education Assistance Act 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.
       ``(e) Report.--Not later than the date that is 3 years 
     after the date of enactment of this Act, the Secretary shall 
     submit to the Congress the current health status and resource 
     deficiency report of the Service for each Indian tribe or 
     service unit, including newly recognized or acknowledged 
     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;
       ``(3) the amount of funds necessary to eliminate the health 
     status and resource deficiencies of all Indian tribes served 
     by the Service; 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 comparable entity;
       ``(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 or 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.
       ``(f) Budgetary Rule.--Funds appropriated under the 
     authority of 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.
       ``(g) Rule of Construction.--Nothing in this section shall 
     be construed to diminish the primary responsibility of the 
     Service to eliminate existing backlogs in unmet health care 
     needs or to discourage the Service from undertaking 
     additional efforts to achieve equity among Indian tribes and 
     tribal organizations.
       ``(h) Designation.--Any funds appropriated under the 
     authority of this section shall be designated as the `Indian 
     Health Care Improvement Fund'.

     ``SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND.

       ``(a) Establishment.--
       ``(1) In general.--There is hereby established an Indian 
     Catastrophic Health Emergency Fund (referred to in this 
     section as the `CHEF') consisting of--
       ``(A) the amounts deposited under subsection (d); and
       ``(B) any amounts appropriated to the CHEF under this Act.
       ``(2) Administration.--The CHEF shall be administered by 
     the Secretary 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.
       ``(3) Equitable allocation.--The CHEF shall be equitably 
     allocated, apportioned or delegated on a service unit or area 
     office basis, based upon a formula to be developed by the 
     Secretary in consultation with the Indian tribes and tribal 
     organizations through negotiated rulemaking under title VIII. 
     Such formula shall take into account the added needs of 
     service areas which are contract health service dependent.
       ``(4) Not subject to contract or grant.--No part of the 
     CHEF or its administration shall be subject to contract or 
     grant under any law, including the Indian Self-Determination 
     and Education Assistance Act.
       ``(5) Administration.--Amounts provided from the CHEF shall 
     be administered by the area offices based upon priorities 
     determined by the Indian tribes and tribal organizations 
     within each service area, including a consideration of the 
     needs of Indian tribes and tribal organizations which are 
     contract health service-dependent.
       ``(b) Requirements.--The Secretary shall, through the 
     negotiated rulemaking process under title VIII, promulgate 
     regulations consistent with the provisions of this section--
       ``(1) establish a definition of disasters and catastrophic 
     illnesses for which the cost of treatment provided under 
     contract would qualify for payment from the CHEF;
       ``(2) provide that a service unit, Indian tribe, or tribal 
     organization shall not be eligible for reimbursement for the 
     cost of treatment from the CHEF until its cost of treatment 
     for any victim of such a catastrophic illness or disaster has 
     reached a certain threshold cost which the Secretary shall 
     establish at--
       ``(A) for 1999, not less than $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 incurred by--
       ``(A) service units, Indian tribes, or tribal 
     organizations, or facilities of the Service; or
       ``(B) non-Service facilities or providers whenever 
     otherwise authorized by the Service;
     in rendering treatment that exceeds threshold cost described 
     in paragraph (2);
       ``(4) establish a procedure for payment from the 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 the 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.
       ``(c) Limitation.--Amounts appropriated to the 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.
       ``(d) Deposits.--There shall be deposited into the 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 the CHEF.

     ``SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION SERVICES.

       ``(a) Findings.--Congress finds that health promotion and 
     disease prevention activities will---
       ``(1) improve the health and well-being of Indians; and
       ``(2) reduce the expenses for health care of Indians.
       ``(b) Provision of Services.--The Secretary, acting through 
     the Service and through Indian tribes and tribal 
     organizations, shall provide health promotion and disease 
     prevention services to Indians so as to achieve the health 
     status objective set forth in section 3(b).
       ``(c) Disease Prevention and Health Promotion.--In this 
     section:
       ``(1) Disease prevention.--The term `disease prevention' 
     means the reduction, limitation, and prevention of disease 
     and its complications, and the reduction in the consequences 
     of such diseases, including--
       ``(A) controlling--
       ``(i) diabetes;
       ``(ii) high blood pressure;
       ``(iii) infectious agents;
       ``(iv) injuries;
       ``(v) occupational hazards and disabilities;
       ``(vi) sexually transmittable diseases; and
       ``(vii) toxic agents; and
       ``(B) providing--
       ``(i) for the fluoridation of water; and
       ``(ii) immunizations.
       ``(2) Health promotion.--The term `health promotion' means 
     fostering social, economic, environmental, and personal 
     factors conducive to health, including--
       ``(A) raising people's awareness about health matters and 
     enabling them to cope with health problems by increasing 
     their knowledge and providing them with valid information;
       ``(B) encouraging adequate and appropriate diet, exercise, 
     and sleep;
       ``(C) promoting education and work in conformity with 
     physical and mental capacity;
       ``(E) making available suitable housing, safe water, and 
     sanitary facilities;
       ``(F) improving the physical economic, cultural, 
     psychological, and social environment;
       ``(G) promoting adequate opportunity for spiritual, 
     religious, and traditional practices; and
       ``(H) adequate and appropriate programs including--
       ``(i) abuse prevention (mental and physical);
       ``(iii) community health;
       ``(iv) community safety;
       ``(v) consumer health education;
       ``(vi) diet and nutrition;
       ``(vii) disease prevention (communicable, immunizations, 
     HIV/AIDS);
       ``(viii) environmental health;
       ``(ix) exercise and physical fitness;
       ``(x) fetal alcohol disorders;
       ``(xi) first aid and CPR education;
       ``(xii) human growth and development;
       ``(xiii) injury prevention and personal safety;
       ``(xiv) mental health (emotional, self-worth);
       ``(xv) personal health and wellness practices;
       ``(xvi) personal capacity building;

[[Page S3709]]

       ``(xvii) prenatal, pregnancy, and infant care;
       ``(xviii) psychological well being;
       ``(xix) reproductive health (family planning);
       ``(xx) safe and adequate water;
       ``(xxi) safe housing;
       ``(xxii) safe work environments;
       ``(xxiii) stress control;
       ``(xxiv) substance abuse;
       ``(xxv) sanitary facilities;
       ``(xxvi) tobacco use cessation and reduction;
       ``(xxvii) violence prevention; and
       ``(xxviii) such other activities identified by the Service, 
     an Indian tribe or tribal organization, to promote the 
     achievement of the objective described in section 3(b).
       ``(d) Evaluation.--The Secretary, after obtaining input 
     from affected Indian tribes and tribal organizations, shall 
     submit to the President for inclusion in each statement which 
     is required to be submitted to Congress under section 801 an 
     evaluation of--
       ``(1) the health promotion and disease prevention needs of 
     Indians;
       ``(2) the health promotion and disease prevention 
     activities which would best meet such needs;
       ``(3) the internal capacity of the Service to meet such 
     needs; and
       ``(4) the resources which would be required to enable the 
     Service to undertake the health promotion and disease 
     prevention activities necessary to meet such needs.

     ``SEC. 204. DIABETES PREVENTION, TREATMENT, AND CONTROL.

       ``(a) Determination.--The Secretary, in consultation with 
     Indian tribes and tribal organizations, shall determine--
       ``(1) by tribe, tribal organization, and service unit of 
     the Service, the prevalence of, and the types of 
     complications resulting from, diabetes among Indians; and
       ``(2) based on paragraph (1), the measures (including 
     patient education) each service unit should take to reduce 
     the prevalence of, and prevent, treat, and control the 
     complications resulting from, diabetes among Indian tribes 
     within that service unit.
       ``(b) Screening.--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. Such screening may be done by an Indian 
     tribe or tribal organization operating health care programs 
     or facilities with funds from the Service under the Indian 
     Self-Determination and Education Assistance Act.
       ``(c) Continued Funding.--The Secretary shall continue to 
     fund, through fiscal year 2012, each effective model diabetes 
     project in existence on the date of the enactment of this Act 
     and such other diabetes programs operated by the Secretary or 
     by Indian tribes and tribal organizations and any additional 
     programs added to meet existing diabetes needs. Indian tribes 
     and tribal organizations shall receive recurring funding for 
     the diabetes programs which they operate pursuant to this 
     section. Model diabetes projects shall consult, on a regular 
     basis, with tribes and tribal organizations in their regions 
     regarding diabetes needs and provide technical expertise as 
     needed.
       ``(d) Dialysis Programs.--The Secretary shall provide 
     funding through the Service, Indian tribes and tribal 
     organizations to establish dialysis programs, including funds 
     to purchase dialysis equipment and provide necessary 
     staffing.
       ``(e) Other Activities.--The Secretary shall, to the extent 
     funding is available--
       ``(1) in each area office of the Service, consult with 
     Indian tribes and tribal organizations regarding programs for 
     the prevention, treatment, and control of diabetes;
       ``(2) establish in each area office of the Service a 
     registry of patients with diabetes to track the prevalence of 
     diabetes and the complications from diabetes in that area; 
     and
       ``(3) ensure that data collected in each area office 
     regarding diabetes and related complications among Indians is 
     disseminated to tribes, tribal organizations, and all other 
     area offices.

     ``SEC. 205. SHARED SERVICES.

       ``(a) In General.--The Secretary, acting through the 
     Service and notwithstanding any other provision of law, is 
     authorized to enter into funding agreements or other 
     arrangements with Indian tribes or tribal organizations for 
     the delivery of long-term care and similar services to 
     Indians. Such projects shall provide for the sharing of staff 
     or other services between a Service or tribal facility and a 
     long-term care or other similar facility owned and operated 
     (directly or through a funding agreement) by such Indian 
     tribe or tribal organization.
       ``(b) Requirements.--A funding agreement or other 
     arrangement entered into pursuant to subsection (a)--
       ``(1) may, at the request of the Indian tribe or tribal 
     organization, delegate to such tribe or tribal organization 
     such powers of supervision and control over Service employees 
     as the Secretary deems necessary to carry out the purposes of 
     this section;
       ``(2) shall provide that expenses (including salaries) 
     relating to services that are shared between the Service and 
     the tribal facility be allocated proportionately between the 
     Service and the tribe or tribal organization; and
       ``(3) may authorize such 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) Technical Assistance.--The Secretary shall provide 
     such technical and other assistance as may be necessary to 
     enable applicants to comply with the provisions of this 
     section.
       ``(d) Use of Existing Facilities.--The Secretary shall 
     encourage the use for long-term or similar care of existing 
     facilities that are under-utilized or allow the use of swing 
     beds for such purposes.

     ``SEC. 206. HEALTH SERVICES RESEARCH.

       ``(a) Funding.--The Secretary shall make funding available 
     for research to further the performance of the health service 
     responsibilities of the Service, Indian tribes, and tribal 
     organizations and shall coordinate the activities of other 
     Agencies within the Department to address these research 
     needs.
       ``(b) Allocation.--Funding under subsection (a) shall be 
     allocated equitably among the area offices. Each area office 
     shall award such funds competitively within that area.
       ``(c) Eligibility for Funds.--Indian tribes and tribal 
     organizations receiving funding from the Service under the 
     authority of the Indian Self-Determination and Education 
     Assistance Act shall be given an equal opportunity to compete 
     for, and receive, research funds under this section.
       ``(d) Use.--Funds received under this section may be used 
     for both clinical and non-clinical research by Indian tribes 
     and tribal organizations and shall be distributed to the area 
     offices. Such area offices may make grants using such funds 
     within each area.

     ``SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREENING.

       ``The Secretary, through the Service or through Indian 
     tribes or tribal organizations, shall provide for the 
     following screening:
       ``(1) Mammography (as defined in section 1861(jj) of the 
     Social Security Act) for Indian women at a frequency 
     appropriate to such women under national standards, and under 
     such terms and conditions as are consistent with standards 
     established by the Secretary to assure the safety and 
     accuracy of screening mammography under part B of title XVIII 
     of the Social Security Act.
       ``(2) Other cancer screening meeting national standards.

     ``SEC. 208. PATIENT TRAVEL COSTS.

       ``The Secretary, acting through the Service, Indian tribes 
     and tribal organizations shall provide funds for the 
     following patient travel costs, including appropriate and 
     necessary qualified escorts, associated with receiving health 
     care services provided (either through direct or contract 
     care or through funding agreements entered into pursuant to 
     the Indian Self-Determination and Education Assistance Act) 
     under this Act:
       ``(1) Emergency air transportation and nonemergency air 
     transportation where ground transportation is infeasible.
       ``(2) Transportation by private vehicle, specially equipped 
     vehicle and ambulance.
       ``(3) Transportation by such other means as may be 
     available and required when air or motor vehicle 
     transportation is not available.

     ``SEC. 209. EPIDEMIOLOGY CENTERS.

       ``(a) Establishment.--
       ``(1) In general.--In addition to those centers operating 1 
     day prior to the date of enactment of this Act, (including 
     those centers for which funding is currently being provided 
     through funding agreements under the Indian Self-
     Determination and Education Assistance Act), the Secretary 
     shall, not later than 180 days after such date of enactment, 
     establish and fund an epidemiology center in each service 
     area which does not have such a center to carry out the 
     functions described in paragraph (2). Any centers established 
     under the preceding sentence may be operated by Indian tribes 
     or tribal organizations pursuant to funding agreements under 
     the Indian Self-Determination and Education Assistance Act, 
     but funding under such agreements may not be divisible.
       ``(2) Functions.--In consultation with and upon the request 
     of Indian tribes, tribal organizations and urban Indian 
     organizations, each area epidemiology center established 
     under this subsection shall, with respect to such area 
     shall--
       ``(A) collect data related to the health status objective 
     described in section 3(b), and monitor the progress that the 
     Service, Indian tribes, tribal organizations, and urban 
     Indian organizations have made in meeting such health status 
     objective;
       ``(B) evaluate existing delivery systems, data systems, and 
     other systems that impact the improvement of Indian health;
       ``(C) assist Indian tribes, tribal organizations, and urban 
     Indian organizations in identifying their highest priority 
     health status objectives and the services needed to achieve 
     such objectives, based on epidemiological data;
       ``(D) make recommendations for the targeting of services 
     needed by tribal, urban, and other Indian communities;
       ``(E) make recommendations to improve health care delivery 
     systems for Indians and urban Indians;
       ``(F) provide requested technical assistance to Indian 
     Tribes 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
       ``(G) provide disease surveillance and assist Indian 
     tribes, tribal organizations, and urban Indian organizations 
     to promote public health.

[[Page S3710]]

       ``(3) Technical assistance.--The director of the Centers 
     for Disease Control and Prevention shall provide technical 
     assistance to the centers in carrying out the requirements of 
     this subsection.
       ``(b) Funding.--The Secretary may make funding available to 
     Indian tribes, tribal organizations, and eligible intertribal 
     consortia or urban Indian organizations to conduct 
     epidemiological studies of Indian communities.

     ``SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION PROGRAMS.

       ``(a) In General.--The Secretary, acting through the 
     Service, shall provide funding to Indian tribes, tribal 
     organizations, and urban Indian organizations to develop 
     comprehensive school health education programs for children 
     from preschool through grade 12 in schools for the benefit of 
     Indian and urban Indian children.
       ``(b) Use of Funds.--Funds awarded under this section may 
     be used to--
       ``(1) develop and implement health education curricula both 
     for regular school programs and after school programs;
       ``(2) train teachers in comprehensive school health 
     education curricula;
       ``(3) integrate school-based, community-based, and other 
     public and private health promotion efforts;
       ``(4) encourage healthy, tobacco-free school environments;
       ``(5) coordinate school-based health programs with existing 
     services and programs available in the community;
       ``(6) develop school programs on nutrition education, 
     personal health, oral health, and fitness;
       ``(7) develop mental health wellness programs;
       ``(8) develop chronic disease prevention programs;
       ``(9) develop substance abuse prevention programs;
       ``(10) develop injury prevention and safety education 
     programs;
       ``(11) develop activities for the prevention and control of 
     communicable diseases;
       ``(12) develop community and environmental health education 
     programs that include traditional health care practitioners;
       ``(13) carry out violence prevention activities; and
       ``(14) carry out activities relating to such other health 
     issues as are appropriate.
       ``(c) Technical Assistance.--The Secretary shall, upon 
     request, provide technical assistance to Indian tribes, 
     tribal organization and urban Indian organizations in the 
     development of comprehensive health education plans, and the 
     dissemination of comprehensive health education materials and 
     information on existing health programs and resources.
       ``(d) Criteria.--The Secretary, in consultation with Indian 
     tribes tribal organizations, and urban Indian organizations 
     shall establish criteria for the review and approval of 
     applications for funding under this section.
       ``(e) Comprehensive School Health Education Program.--
       ``(1) Development.--The Secretary of the Interior, acting 
     through the Bureau of Indian Affairs and in cooperation with 
     the Secretary and affected Indian tribes and tribal 
     organizations, shall develop a comprehensive school health 
     education program for children from preschool through grade 
     12 for use in schools operated by the Bureau of Indian 
     Affairs.
       ``(2) Requirements.--The program developed under paragraph 
     (1) shall include--
       ``(A) school programs on nutrition education, personal 
     health, oral health, and fitness;
       ``(B) mental health wellness programs;
       ``(C) chronic disease prevention programs;
       ``(D) substance abuse prevention programs;
       ``(E) injury prevention and safety education programs; and
       ``(F) activities for the prevention and control of 
     communicable diseases.
       ``(3) Training and coordination.--The Secretary of the 
     Interior shall--
       ``(A) provide training to teachers in comprehensive school 
     health education curricula;
       ``(B) ensure the integration and coordination of school-
     based programs with existing services and health programs 
     available in the community; and
       ``(C) encourage healthy, tobacco-free school environments.

     ``SEC. 211. INDIAN YOUTH PROGRAM.

       ``(a) In General.--The Secretary, acting through the 
     Service, is authorized to provide funding to Indian tribes, 
     tribal organizations, and urban Indian organizations for 
     innovative mental and physical disease prevention and health 
     promotion and treatment programs for Indian and urban Indian 
     preadolescent and adolescent youths.
       ``(b) Use of Funds.--
       ``(1) in general.--Funds made available under this section 
     may be used to--
       ``(A) develop prevention and treatment programs for Indian 
     youth which promote mental and physical health and 
     incorporate cultural values, community and family 
     involvement, and traditional health care practitioners; and
       ``(B) develop and provide community training and education.
       ``(2) Limitation.--Funds made available under this section 
     may not be used to provide services described in section 
     707(c).
       ``(c) Requirements.--The Secretary shall--
       ``(1) disseminate to Indian tribes, tribal organizations, 
     and urban Indian organizations information regarding models 
     for the delivery of comprehensive health care services to 
     Indian and urban Indian adolescents;
       ``(2) encourage the implementation of such models; and
       ``(3) at the request of an Indian tribe, tribal 
     organization, or urban Indian organization, provide technical 
     assistance in the implementation of such models.
       ``(d) Criteria.--The Secretary, in consultation with Indian 
     tribes, tribal organization, and urban Indian organizations, 
     shall establish criteria for the review and approval of 
     applications under this section.

     ``SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF 
                   COMMUNICABLE AND INFECTIOUS DISEASES.

       ``(a) In General.--The Secretary, acting through the 
     Service after consultation with Indian tribes, tribal 
     organizations, urban Indian organizations, and the Centers 
     for Disease Control and Prevention, may make funding 
     available to Indian tribes and tribal organizations for--
       ``(1) projects for the prevention, control, and elimination 
     of communicable and infectious diseases, including 
     tuberculosis, hepatitis, HIV, respiratory syncitial virus, 
     hanta virus, sexually transmitted diseases, and H. Pylori;
       ``(2) public information and education programs for the 
     prevention, control, and elimination of communicable and 
     infectious diseases; and
       ``(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.
       ``(b) Requirement of Application.--The Secretary may 
     provide funds under subsection (a) only if an application or 
     proposal for such funds is submitted.
       ``(c) Technical Assistance and 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, biennially, a report to 
     Congress 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. 213. AUTHORITY FOR PROVISION OF OTHER SERVICES.

       ``(a) In General.--The Secretary, acting through the 
     Service, Indian tribes, and tribal organizations, may provide 
     funding under this Act to meet the objective set forth in 
     section 3 through health care related services and programs 
     not otherwise described in this Act. Such services and 
     programs shall include services and programs related to--
       ``(1) hospice care and assisted living;
       ``(2) long-term health care;
       ``(3) home- and community-based services;
       ``(4) public health functions; and
       ``(5) traditional health care practices.
       ``(b) Availability of Services for Certain Individuals.--At 
     the discretion of the Service, Indian tribe, or tribal 
     organization, services hospice care, home health care (under 
     section 201), home- and community- based care, assisted 
     living, and long term care may be provided (on a cost basis) 
     to individuals otherwise ineligible for the health care 
     benefits of the Service. Any funds received under this 
     subsection shall not be used to offset or limit the funding 
     allocated to a tribe or tribal organization.
       ``(c) Definitions.--In this section:
       ``(1) Home- and community-based services.--The term `home- 
     and community-based services' means 1 or more of the 
     following:
       ``(A) Homemaker/home health aide services.
       ``(B) Chore services.
       ``(C) Personal care services.
       ``(D) Nursing care services provided outside of a nursing 
     facility by, or under the supervision of, a registered nurse.
       ``(E) Training for family members.
       ``(F) Adult day care.
       ``(G) Such other home- and community-based services as the 
     Secretary or a tribe or tribal organization may approve.
       ``(2) Hospice care.--The term `hospice care' means 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 such other services which an Indian tribe 
     or tribal organization determines are necessary and 
     appropriate to provide in furtherance of such care.
       ``(3) Public health functions.--The term `public health 
     functions' means public health related programs, functions, 
     and services including assessments, assurances, and policy 
     development that Indian tribes and tribal organizations are 
     authorized and encouraged, in those circumstances where it 
     meets their needs, to carry out by forming collaborative 
     relationships with all levels of local, State, and Federal 
     governments.

     ``SEC. 214. INDIAN WOMEN'S HEALTH CARE.

       ``The Secretary acting through the Service, Indian tribes, 
     tribal organizations, and urban Indian organizations shall 
     provide funding to monitor and improve the quality of health 
     care for Indian women of all ages through the planning and 
     delivery of programs administered by the Service, in order to 
     improve and enhance the treatment models of care for Indian 
     women.

     ``SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH HAZARDS.

       ``(a) Study and Monitoring Programs.--The Secretary and the 
     Service shall, in conjunction with other appropriate Federal 
     agencies and in consultation with concerned

[[Page S3711]]

     Indian tribes and tribal organizations, conduct a study and 
     carry out ongoing monitoring programs to determine the trends 
     that exist in the health hazards posed to Indian miners and 
     to Indians on or near Indian reservations and in Indian 
     communities as a result of environmental hazards that may 
     result in chronic or life-threatening health problems. Such 
     hazards include nuclear resource development, petroleum 
     contamination, and contamination of the water source or of 
     the food chain. Such study (and any reports with respect to 
     such study) shall include--
       ``(1) an evaluation of the nature and extent of health 
     problems caused by environmental hazards currently exhibited 
     among Indians and the causes of such health problems;
       ``(2) an analysis of the potential effect of ongoing and 
     future environmental resource development on or near Indian 
     reservations and communities including the cumulative effect 
     of such development over time on health;
       ``(3) an evaluation of the types and nature of activities, 
     practices, and conditions causing or affecting such health 
     problems including uranium mining and milling, uranium mine 
     tailing deposits, nuclear power plant operation and 
     construction, and nuclear waste disposal, oil and gas 
     production or transportation on or near Indian reservations 
     or communities, and other development that could affect the 
     health of Indians and their water supply and food chain;
       ``(4) a summary of any findings or recommendations provided 
     in Federal and State studies, reports, investigations, and 
     inspections during the 5 years prior to the date of the 
     enactment of this Act that directly or indirectly relate to 
     the activities, practices, and conditions affecting the 
     health or safety of such Indians; and
       ``(5) a description of the efforts that have been made by 
     Federal and State agencies and resource and economic 
     development companies to effectively carry out an education 
     program for such Indians regarding the health and safety 
     hazards of such development.
       ``(b) Development of Health Care Plans.--Upon the 
     completion of the study under subsection (a), the Secretary 
     and the Service shall take into account the results of such 
     study and, in consultation with Indian tribes and tribal 
     organizations, develop a health care plan to address the 
     health problems that were the subject of such study. The 
     plans shall include--
       ``(1) methods for diagnosing and treating Indians currently 
     exhibiting such health problems;
       ``(2) preventive care and testing for Indians who may be 
     exposed to such health hazards, including the monitoring of 
     the health of individuals who have or may have been exposed 
     to excessive amounts of radiation, or affected by other 
     activities that have had or could have a serious impact upon 
     the health of such individuals; and
       ``(3) a program of education for Indians who, by reason of 
     their work or geographic proximity to such nuclear or other 
     development activities, may experience health problems.
       ``(c) Submission to Congress.--
       ``(1) General report.--Not later than 18 months after the 
     date of enactment of this Act, the Secretary and the Service 
     shall submit to Congress a report concerning the study 
     conducted under subsection (a).
       ``(2) Health care plan report.--Not later than 1 year after 
     the date on which the report under paragraph (1) is submitted 
     to Congress, the Secretary and the Service shall submit to 
     Congress the health care plan prepared under subsection (b). 
     Such plan shall include recommended activities for the 
     implementation of the plan, as well as an evaluation of any 
     activities previously undertaken by the Service to address 
     the health problems involved.
       ``(d) Task Force.--
       ``(1) Established.--There is hereby established an 
     Intergovernmental Task Force (referred to in this section as 
     the `task force') that shall be composed of the following 
     individuals (or their designees):
       ``(A) The Secretary of Energy.
       ``(B) The Administrator of the Environmental Protection 
     Agency.
       ``(C) The Director of the Bureau of Mines.
       ``(D) The Assistant Secretary for Occupational Safety and 
     Health.
       ``(E) The Secretary of the Interior.
       ``(2) Duties.--The Task Force shall identify existing and 
     potential operations related to nuclear resource development 
     or other environmental hazards that affect or may affect the 
     health of Indians on or near an Indian reservation or in an 
     Indian community, and enter into activities to correct 
     existing health hazards and ensure that current and future 
     health problems resulting from nuclear resource or other 
     development activities are minimized or reduced.
       ``(3) Administrative provisions.--The Secretary shall serve 
     as the chairperson of the Task Force. The Task Force shall 
     meet at least twice each year. Each member of the Task Force 
     shall furnish necessary assistance to the Task Force.
       ``(e) Provision of Appropriate Medical Care.--In the case 
     of any Indian who--
       ``(1) as a result of employment in or near a uranium mine 
     or mill or near any other environmental hazard, suffers from 
     a work related illness or condition;
       ``(2) is eligible to receive diagnosis and treatment 
     services from a Service facility; and
       ``(3) by reason of such Indian's employment, is entitled to 
     medical care at the expense of such mine or mill operator or 
     entity responsible for the environmental hazard;
     the Service shall, at the request of such Indian, render 
     appropriate medical care to such Indian for such illness or 
     condition and may recover the costs of any medical care so 
     rendered to which such Indian is entitled at the expense of 
     such operator or entity from such operator or entity. Nothing 
     in this subsection shall affect the rights of such Indian to 
     recover damages other than such costs paid to the Service 
     from the employer for such illness or condition.

     ``SEC. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DELIVERY 
                   AREA.

       ``(a) In General.--For fiscal years beginning with the 
     fiscal year ending September 30, 1983, and ending with the 
     fiscal year ending September 30, 2012, the State of Arizona 
     shall be designated as a contract health service delivery 
     area by the Service for the purpose of providing contract 
     health care services to members of federally recognized 
     Indian Tribes of Arizona.
       ``(b) Limitation.--The Service shall not curtail any health 
     care services provided to Indians residing on Federal 
     reservations in the State of Arizona if such curtailment is 
     due to the provision of contract services in such State 
     pursuant to the designation of such State as a contract 
     health service delivery area pursuant to subsection (a).

     ``SEC. 217. CALIFORNIA CONTRACT HEALTH SERVICES DEMONSTRATION 
                   PROGRAM.

       ``(a) In General.--The Secretary may fund a program that 
     utilizes the California Rural Indian Health Board as a 
     contract care intermediary to improve the accessibility of 
     health services to California Indians.
       ``(b) Reimbursement of Board.--
       ``(1) Agreement.--The Secretary shall enter into an 
     agreement with the California Rural Indian Health Board to 
     reimburse the Board for costs (including reasonable 
     administrative costs) incurred pursuant to this section in 
     providing medical treatment under contract to California 
     Indians described in section 809(b) throughout the California 
     contract health services delivery area described in section 
     218 with respect to high-cost contract care cases.
       ``(2) Administration.--Not more than 5 percent of the 
     amounts provided to the Board under this section for any 
     fiscal year may be used for reimbursement for administrative 
     expenses incurred by the Board during such fiscal year.
       ``(3) Limitation.--No payment may be made for treatment 
     provided under this section to the extent that payment may be 
     made for such treatment under the Catastrophic Health 
     Emergency Fund described in section 202 or from amounts 
     appropriated or otherwise made available to the California 
     contract health service delivery area for a fiscal year.
       ``(c) Advisory Board.--There is hereby established an 
     advisory board that shall advise the California Rural Indian 
     Health Board in carrying out this section. The advisory board 
     shall be composed of representatives, selected by the 
     California Rural Indian Health Board, from not less than 8 
     tribal health programs serving California Indians covered 
     under this section, at least 50 percent of whom are not 
     affiliated with the California Rural Indian Health Board.

     ``SEC. 218. CALIFORNIA AS A CONTRACT HEALTH SERVICE DELIVERY 
                   AREA.

       ``The State of California, excluding the counties of 
     Alameda, Contra Costa, Los Angeles, Marin, Orange, 
     Sacramento, San Francisco, San Mateo, Santa Clara, Kern, 
     Merced, Monterey, Napa, San Benito, San Joaquin, San Luis 
     Obispo, Santa Cruz, Solano, Stanislaus, and Ventura shall be 
     designated as a contract health service delivery area by the 
     Service for the purpose of providing contract health services 
     to Indians in such State, except that any of the counties 
     described in this section may be included in the contract 
     health services delivery area if funding is specifically 
     provided by the Service for such services in those counties.

     ``SEC. 219. CONTRACT HEALTH SERVICES FOR THE TRENTON SERVICE 
                   AREA.

       ``(a) In General.--The Secretary, acting through the 
     Service, shall provide contract health services to members of 
     the Turtle Mountain Band of Chippewa Indians that reside in 
     the Trenton Service Area of Divide, McKenzie, and Williams 
     counties in the State of North Dakota and the adjoining 
     counties of Richland, Roosevelt, and Sheridan in the State of 
     Montana.
       ``(b) Rule of Construction.--Nothing in this section shall 
     be construed as expanding the eligibility of members of the 
     Turtle Mountain Band of Chippewa Indians for health services 
     provided by the Service beyond the scope of eligibility for 
     such health services that applied on May 1, 1986.

     ``SEC. 220. PROGRAMS OPERATED BY INDIAN TRIBES AND TRIBAL 
                   ORGANIZATIONS.

       ``The Service shall provide funds for health care programs 
     and facilities operated by Indian tribes and tribal 
     organizations under funding agreements with the Service 
     entered into under the Indian Self-Determination and 
     Education Assistance Act on the same basis as such funds are 
     provided to programs and facilities operated directly by the 
     Service.

     ``SEC. 221.-LICENSING.

       ``Health care professionals employed by Indian Tribes and 
     tribal organizations to carry out agreements under the Indian 
     Self-Determination and Education Assistance Act,

[[Page S3712]]

     shall, if licensed in any State, be exempt from the licensing 
     requirements of the State in which the agreement is 
     performed.

     ``SEC. 222. AUTHORIZATION FOR EMERGENCY CONTRACT HEALTH 
                   SERVICES.

       ``With respect to an elderly Indian or an Indian with a 
     disability receiving emergency medical care or services from 
     a non-Service provider or in a non-Service facility under the 
     authority of this Act, the time limitation (as a condition of 
     payment) for notifying the Service of such treatment or 
     admission shall be 30 days.

     ``SEC. 223. PROMPT ACTION ON PAYMENT OF CLAIMS.

       ``(a) Requirement.--The Service shall respond to a 
     notification of a claim by a provider of a contract care 
     service with either an individual purchase order or a denial 
     of the claim within 5 working days after the receipt of such 
     notification.
       ``(b) Failure to Respond.--If the Service fails to respond 
     to a notification of a claim in accordance with subsection 
     (a), the Service shall accept as valid the claim submitted by 
     the provider of a contract care service.
       ``(c) Payment.--The Service shall pay a valid contract care 
     service claim within 30 days after the completion of the 
     claim.

     ``SEC. 224. LIABILITY FOR PAYMENT.

       ``(a) No 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.
       ``(c) Limitation.--Following receipt of the notice provided 
     under subsection (b), or, if a claim has been deemed accepted 
     under section 223(b), the provider shall have no further 
     recourse against the patient who received the services 
     involved.

     ``SEC. 225. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2012 to 
     carry out this title.

                        ``TITLE III--FACILITIES

     ``SEC. 301. CONSULTATION, CONSTRUCTION AND RENOVATION OF 
                   FACILITIES; REPORTS.

       ``(a) Consultation.--Prior to the expenditure of, or the 
     making of any firm commitment to expend, any funds 
     appropriated for the planning, design, construction, or 
     renovation of facilities pursuant to the Act of November 2, 
     1921 (25 U.S.C. 13) (commonly known as the Snyder Act), the 
     Secretary, acting through the Service, shall--
       ``(1) consult with any Indian tribe that would be 
     significantly affected by such expenditure for the purpose of 
     determining and, whenever practicable, honoring tribal 
     preferences concerning size, location, type, and other 
     characteristics of any facility on which such expenditure is 
     to be made; and
       ``(2) ensure, whenever practicable, that such facility 
     meets the construction standards of any nationally recognized 
     accrediting body by not later than 1 year after the date on 
     which the construction or renovation of such facility is 
     completed.
       ``(b) Closure of Facilities.--
       ``(1) in general.--Notwithstanding any provision of law 
     other than this subsection, no Service hospital or outpatient 
     health care facility or any inpatient service or special care 
     facility operated by the Service, may be closed if the 
     Secretary has not submitted to the Congress at least 1 year 
     prior to the date such proposed closure an evaluation of the 
     impact of such proposed closure which specifies, in addition 
     to other considerations--
       ``(A) the accessibility of alternative health care 
     resources for the population served by such hospital or 
     facility;
       ``(B) the cost effectiveness of such closure;
       ``(C) the quality of health care to be provided to the 
     population served by such hospital or facility after such 
     closure;
       ``(D) the availability of contract health care funds to 
     maintain existing levels of service;
       ``(E) the views of the Indian tribes served by such 
     hospital or facility concerning such closure;
       ``(F) the level of utilization of such hospital or facility 
     by all eligible Indians; and
       ``(G) the distance between such hospital or facility and 
     the nearest operating Service hospital.
       ``(2) Temporary closure.--Paragraph (1) shall not apply to 
     any temporary closure of a facility or of any portion of a 
     facility if such closure is necessary for medical, 
     environmental, or safety reasons.
       ``(c) Priority System.--
       ``(1) Establishment.--The Secretary shall establish a 
     health care facility priority system, that shall--
       ``(A) be developed with Indian tribes and tribal 
     organizations through negotiated rulemaking under section 
     802;
       ``(B) give the needs of Indian tribes' the highest 
     priority; and
       ``(C) at a minimum, include the lists required in paragraph 
     (2)(B) and the methodology required in paragraph (2)(E);
     except that the priority of any project established under the 
     construction priority system in effect on the date of this 
     Act shall not be affected by any change in the construction 
     priority system taking place thereafter if the project was 
     identified as one of the top 10 priority inpatient projects 
     or one of the top 10 outpatient projects in the Indian Health 
     Service budget justification for fiscal year 2000, or if the 
     project had completed both Phase I and Phase II of the 
     construction priority system in effect on the date of this 
     Act.
       ``(2) Report.--The Secretary shall submit to the President, 
     for inclusion in each report required to be transmitted to 
     the Congress under section 801, a report that includes--
       ``(A) a description of the health care facility priority 
     system of the Service, as established under paragraph (1);
       ``(B) health care facility lists, including--
       ``(i) the total health care facility planning, design, 
     construction and renovation needs for Indians;
       ``(ii) the 10 top-priority inpatient care facilities;
       ``(iii) the 10 top-priority outpatient care facilities;
       ``(iv) the 10 top-priority specialized care facilities 
     (such as long-term care and alcohol and drug abuse 
     treatment); and
       ``(v) any staff quarters associated with such prioritized 
     facilities;
       ``(C) the justification for the order of priority among 
     facilities;
       ``(D) the projected cost of the projects involved; and
       ``(E) the methodology adopted by the Service in 
     establishing priorities under its health care facility 
     priority system.
       ``(3) Consultation.--In preparing each report required 
     under paragraph (2) (other than the initial report) the 
     Secretary shall annually--
       ``(A) consult with, and obtain information on all health 
     care facilities needs from, Indian tribes and tribal 
     organizations including those tribes or tribal organizations 
     operating health programs or facilities under any funding 
     agreement entered into with the Service under the Indian 
     Self-Determination and Education Assistance Act; and
       ``(B) review the total unmet needs of all tribes and tribal 
     organizations for health care facilities (including staff 
     quarters), including needs for renovation and expansion of 
     existing facilities.
       ``(4) Criteria.--For purposes of this subsection, the 
     Secretary shall, in evaluating the needs of facilities 
     operated under any funding agreement entered into with the 
     Service under the Indian Self-Determination and Education 
     Assistance Act, use the same criteria that the Secretary uses 
     in evaluating the needs of facilities operated directly by 
     the Service.
       ``(5) Equitable integration.--The Secretary shall ensure 
     that the planning, design, construction, and renovation needs 
     of Service and non-Service facilities, operated under funding 
     agreements in accordance with the Indian Self-Determination 
     and Education Assistance Act are fully and equitably 
     integrated into the health care facility priority system.
       ``(d) Review of Need for Facilities.--
       ``(1) Report.--Beginning in 2001, the Secretary shall 
     annually submit to the President, for inclusion in the report 
     required to be transmitted to Congress under section 801 of 
     this Act, a report which sets forth the needs of the Service 
     and all Indian tribes and tribal organizations, including 
     urban Indian organizations, for inpatient, outpatient and 
     specialized care facilities, including the needs for 
     renovation and expansion of existing facilities .
       ``(2) Consultation.--In preparing each report required 
     under paragraph (1) (other than the initial report), the 
     Secretary shall consult with Indian tribes and tribal 
     organizations including those tribes or tribal organizations 
     operating health programs or facilities under any funding 
     agreement entered into with the Service under the Indian 
     Self-Determination and Education Assistance Act, and with 
     urban Indian organizations.
       ``(3) Criteria.--For purposes of this subsection, the 
     Secretary shall, in evaluating the needs of facilities 
     operated under any funding agreement entered into with the 
     Service under the Indian Self-Determination and Education 
     Assistance Act, use the same criteria that the Secretary uses 
     in evaluating the needs of facilities operated directly by 
     the Service.
       ``(4) Equitable integration.--The Secretary shall ensure 
     that the planning, design, construction, and renovation needs 
     of facilities operated under funding agreements, in 
     accordance with the Indian Self-Determination and Education 
     Assistance Act, are fully and equitably integrated into the 
     development of the health facility priority system.-
       ``(5) Annual nominations.--Each year the Secretary shall 
     provide an opportunity for the nomination of planning, 
     design, and construction projects by the Service and all 
     Indian tribes and tribal organizations for consideration 
     under the health care facility priority system.
       ``(e) Inclusion of Certain Programs.--All funds 
     appropriated under the Act of November 2, 1921 (25 U.S.C. 
     13), for the planning, design, construction, or renovation of 
     health facilities for the benefit of an Indian tribe or 
     tribes shall be subject to the provisions of section 102 of 
     the Indian Self-Determination and Education Assistance Act.
       ``(f) Innovative Approaches.--The Secretary shall consult 
     and cooperate with Indian tribes, tribal organizations and 
     urban Indian organizations in developing innovative 
     approaches to address all or part of the total unmet need for 
     construction of health facilities, including those provided 
     for in

[[Page S3713]]

     other sections of this title and other approaches.

     ``SEC. 302. SAFE WATER AND SANITARY WASTE DISPOSAL 
                   FACILITIES.

       ``(a) Findings.--Congress finds and declares that--
       ``(1) the provision of safe water supply facilities and 
     sanitary sewage and solid waste disposal facilities is 
     primarily a health consideration and function;
       ``(2) Indian people suffer an inordinately high incidence 
     of disease, injury, and illness directly attributable to the 
     absence or inadequacy of such facilities;
       ``(3) the long-term cost to the United States of treating 
     and curing such disease, injury, and illness is substantially 
     greater than the short-term cost of providing such facilities 
     and other preventive health measures;
       ``(4) many Indian homes and communities still lack safe 
     water supply facilities and sanitary sewage and solid waste 
     disposal facilities; and
       ``(5) it is in the interest of the United States, and it is 
     the policy of the United States, that all Indian communities 
     and Indian homes, new and existing, be provided with safe and 
     adequate water supply facilities and sanitary sewage waste 
     disposal facilities as soon as possible.
       ``(b) Provision of Facilities and Services.--
       ``(1) In general.--In furtherance of the findings and 
     declarations made in subsection (a), Congress reaffirms the 
     primary responsibility and authority of the Service to 
     provide the necessary sanitation facilities and services as 
     provided in section 7 of the Act of August 5, 1954 (42 U.S.C. 
     2004a).
       ``(2) Assistance.--The Secretary, acting through the 
     Service, is authorized to provide under section 7 of the Act 
     of August 5, 1954 (42 U.S.C. 2004a)--
       ``(A) financial and technical assistance to Indian tribes, 
     tribal organizations and Indian communities in the 
     establishment, training, and equipping of utility 
     organizations to operate and maintain Indian sanitation 
     facilities, including the provision of existing plans, 
     standard details, and specifications available in the 
     Department, to be used at the option of the tribe or tribal 
     organization;
       ``(B) ongoing technical assistance and training in the 
     management of utility organizations which operate and 
     maintain sanitation facilities; and
       ``(C) priority funding for the operation, and maintenance 
     assistance for, and emergency repairs to, tribal sanitation 
     facilities when necessary to avoid an imminent health threat 
     or to protect the investment in sanitation facilities and the 
     investment in the health benefits gained through the 
     provision of sanitation facilities.
       ``(3) Provisions relating to funding.--Notwithstanding any 
     other provision of law--
       ``(A) the Secretary of Housing and Urban Development is 
     authorized to transfer funds appropriated under the Native 
     American Housing Assistance and Self-Determination Act of 
     1996 to the Secretary of Health and Human Services;
       ``(B) the Secretary of Health and Human Services is 
     authorized to accept and use such funds for the purpose of 
     providing sanitation facilities and services for Indians 
     under section 7 of the Act of August 5, 1954 (42 U.S.C. 
     2004a);
       ``(C) unless specifically authorized when funds are 
     appropriated, the Secretary of Health and Human Services 
     shall not use funds appropriated under section 7 of the Act 
     of August 5, 1954 (42 U.S.C. 2004a) to provide sanitation 
     facilities to new homes constructed using funds provided by 
     the Department of Housing and Urban Development;
       ``(D) the Secretary of Health and Human Services is 
     authorized to accept all Federal funds that are available for 
     the purpose of providing sanitation facilities and related 
     services and place those funds into funding agreements, 
     authorized under the Indian Self Determination and Education 
     Assistance Act, between the Secretary and Indian tribes and 
     tribal organizations;
       ``(E) the Secretary may permit funds appropriated under the 
     authority of section 4 of the Act of August 5, 1954 (42 
     U.S.C. 2004) to be used to fund up to 100 percent of the 
     amount of a tribe's loan obtained under any Federal program 
     for new projects to construct eligible sanitation facilities 
     to serve Indian homes;
       ``(F) the Secretary may permit funds appropriated under the 
     authority of section 4 of the Act of August 5, 1954 (42 
     U.S.C. 2004) to be used to meet matching or cost 
     participation requirements under other Federal and non-
     Federal programs for new projects to construct eligible 
     sanitation facilities;
       ``(G) all Federal agencies are authorized to transfer to 
     the Secretary funds identified, granted, loaned or 
     appropriated and thereafter the Department's applicable 
     policies, rules, regulations shall apply in the 
     implementation of such projects;
       ``(H) the Secretary of Health and Human Services shall 
     enter into inter-agency agreements with the Bureau of Indian 
     Affairs, the Department of Housing and Urban Development, the 
     Department of Agriculture, the Environmental Protection 
     Agency and other appropriate Federal agencies, for the 
     purpose of providing financial assistance for safe water 
     supply and sanitary sewage disposal facilities under this 
     Act; and
       ``(I) the Secretary of Health and Human Services shall, by 
     regulation developed through rulemaking under section 802, 
     establish standards applicable to the planning, design and 
     construction of water supply and sanitary sewage and solid 
     waste disposal facilities funded under this Act.
       ``(c) 10-Year Funding Plan.--The Secretary, acting through 
     the Service and in consultation with Indian tribes and tribal 
     organizations, shall develop and implement a 10-year funding 
     plan to provide safe water supply and sanitary sewage and 
     solid waste disposal facilities serving existing Indian homes 
     and communities, and to new and renovated Indian homes.
       ``(d) Capability of Tribe or Community.--The financial and 
     technical capability of an Indian tribe or community to 
     safely operate and maintain a sanitation facility shall not 
     be a prerequisite to the provision or construction of 
     sanitation facilities by the Secretary.
       ``(e) Financial Assistance.--The Secretary may provide 
     financial assistance to Indian tribes, tribal organizations 
     and communities for the operation, management, and 
     maintenance of their sanitation facilities.
       ``(f) Responsibility for Fees for Operation and 
     Maintenance.--The Indian family, community or tribe involved 
     shall have the primary responsibility to establish, collect, 
     and use reasonable user fees, or otherwise set aside funding, 
     for the purpose of operating and maintaining sanitation 
     facilities. If a community facility is threatened with 
     imminent failure and there is a lack of tribal capacity to 
     maintain the integrity or the health benefit of the facility, 
     the Secretary may assist the Tribe in the resolution of the 
     problem on a short term basis through cooperation with the 
     emergency coordinator or by providing operation and 
     maintenance service.
       ``(g) Eligibility of Certain Tribes or Organizations.--
     Programs administered by Indian tribes or tribal 
     organizations under the authority of the Indian Self-
     Determination and Education Assistance Act shall be eligible 
     for--
       ``(1) any funds appropriated pursuant to this section; and
       ``(2) any funds appropriated for the purpose of providing 
     water supply, sewage disposal, or solid waste facilities;
     on an equal basis with programs that are administered 
     directly by the Service.
       ``(h) Report.--
       ``(1) In general.--The Secretary shall submit to the 
     President, for inclusion in each report required to be 
     transmitted to the Congress under section 801, a report which 
     sets forth--
       ``(A) the current Indian sanitation facility priority 
     system of the Service;
       ``(B) the methodology for determining sanitation 
     deficiencies;
       ``(C) the level of initial and final sanitation deficiency 
     for each type sanitation facility for each project of each 
     Indian tribe or community; and
       ``(D) the amount of funds necessary to reduce the 
     identified sanitation deficiency levels of all Indian tribes 
     and communities to a level I sanitation deficiency as 
     described in paragraph (4)(A).
       ``(2) Consultation.--In preparing each report required 
     under paragraph (1), the Secretary shall consult with Indian 
     tribes and tribal organizations (including those tribes or 
     tribal organizations operating health care programs or 
     facilities under any funding agreements entered into with the 
     Service under the Indian Self-Determination and Education 
     Assistance Act) to determine the sanitation needs of each 
     tribe and in developing the criteria on which the needs will 
     be evaluated through a process of negotiated rulemaking.
       ``(3) Methodology.--The methodology used by the Secretary 
     in determining, preparing cost estimates for and reporting 
     sanitation deficiencies for purposes of paragraph (1) shall 
     be applied uniformly to all Indian tribes and communities.
       ``(4) Sanitation deficiency levels.--For purposes of this 
     subsection, the sanitation deficiency levels for an 
     individual or community sanitation facility serving Indian 
     homes are as follows:
       ``(A) A level I deficiency is a sanitation facility serving 
     and individual or community--
       ``(i) which complies with all applicable water supply, 
     pollution control and solid waste disposal laws; and
       ``(ii) in which the deficiencies relate to routine 
     replacement, repair, or maintenance needs.
       ``(B) A level II deficiency is a sanitation facility 
     serving and individual or community--
       ``(i) which substantially or recently complied with all 
     applicable water supply, pollution control and solid waste 
     laws, in which the deficiencies relate to small or minor 
     capital improvements needed to bring the facility back into 
     compliance;
       ``(ii) in which the deficiencies relate to capital 
     improvements that are necessary to enlarge or improve the 
     facilities in order to meet the current needs for domestic 
     sanitation facilities; or
       ``(iii) in which the deficiencies relate to the lack of 
     equipment or training by an Indian Tribe or community to 
     properly operate and maintain the sanitation facilities.
       ``(C) A level III deficiency is an individual or community 
     facility with water or sewer service in the home, piped 
     services or a haul system with holding tanks and interior 
     plumbing, or where major significant interruptions to water 
     supply or sewage disposal occur frequently, requiring major 
     capital improvements to correct the deficiencies. There is no 
     access to or no approved or permitted solid waste facility 
     available.

[[Page S3714]]

       ``(D) A level IV deficiency is an individual or community 
     facility where there are no piped water or sewer facilities 
     in the home or the facility has become inoperable due to 
     major component failure or where only a washeteria or central 
     facility exists.
       ``(E) A level V deficiency is the absence of a sanitation 
     facility, where individual homes do not have access to safe 
     drinking water or adequate wastewater disposal.
       ``(i) Definitions.--In this section:
       ``(1) Facility.--The terms `facility' or `facilities' shall 
     have the same meaning as the terms `system' or `systems' 
     unless the context requires otherwise.
       ``(2) Indian community.--The term `Indian community' means 
     a geographic area, a significant proportion of whose 
     inhabitants are Indians and which is served by or capable of 
     being served by a facility described in this section.

     ``SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS.

       ``(a) In General.--The Secretary, acting through the 
     Service, may utilize the negotiating authority of the Act of 
     June 25, 1910 (25 U.S.C. 47), to give preference to any 
     Indian or any enterprise, partnership, corporation, or other 
     type of business organization owned and controlled by an 
     Indian or Indians including former or currently federally 
     recognized Indian tribes in the State of New York 
     (hereinafter referred to as an `Indian firm') in the 
     construction and renovation of Service facilities pursuant to 
     section 301 and in the construction of safe water and 
     sanitary waste disposal facilities pursuant to section 302. 
     Such preference may be accorded by the Secretary unless the 
     Secretary finds, pursuant to rules and regulations 
     promulgated by the Secretary, that the project or function to 
     be contracted for will not be satisfactory or such project or 
     function cannot be properly completed or maintained under the 
     proposed contract. The Secretary, in arriving at such 
     finding, shall consider whether the Indian or Indian firm 
     will be deficient with respect to--
       ``(1) ownership and control by Indians;
       ``(2) equipment;
       ``(3) bookkeeping and accounting procedures;
       ``(4) substantive knowledge of the project or function to 
     be contracted for;
       ``(5) adequately trained personnel; or
       ``(6) other necessary components of contract performance.
       ``(b) Exemption from Davis-Bacon.--For the purpose of 
     implementing the provisions of this title, construction or 
     renovation of facilities constructed or renovated in whole or 
     in part by funds made available pursuant to this title are 
     exempt from the Act of March 3, 1931 (40 U.S.C. 276a--276a-5, 
     known as the Davis-Bacon Act). For all health facilities, 
     staff quarters and sanitation facilities, construction and 
     renovation subcontractors shall be paid wages at rates that 
     are not less than the prevailing wage rates for similar 
     construction in the locality involved, as determined by the 
     Indian tribe, Tribes, or tribal organizations served by such 
     facilities.

     ``SEC. 304. SOBOBA SANITATION FACILITIES.

       ``Nothing in the Act of December 17, 1970 (84 Stat. 1465) 
     shall be construed to preclude the Soboba Band of Mission 
     Indians and the Soboba Indian Reservation from being provided 
     with sanitation facilities and services under the authority 
     of section 7 of the Act of August 5, 1954 (68 Stat 674), as 
     amended by the Act of July 31, 1959 (73 Stat. 267).

     ``SEC. 305. EXPENDITURE OF NONSERVICE FUNDS FOR RENOVATION.

       ``(a) Permissibility.--
       ``(1) In general.--Notwithstanding any other provision of 
     law, the Secretary is authorized to accept any major 
     expansion, renovation or modernization by any Indian tribe of 
     any Service facility, or of any other Indian health facility 
     operated pursuant to a funding agreement entered into under 
     the Indian Self-Determination and Education Assistance Act, 
     including--
       ``(A) any plans or designs for such expansion, renovation 
     or modernization; and
       ``(B) any expansion, renovation or modernization for which 
     funds appropriated under any Federal law were lawfully 
     expended;
     but only if the requirements of subsection (b) are met.
       ``(2) Priority list.--The Secretary shall maintain a 
     separate priority list to address the need for increased 
     operating expenses, personnel or equipment for such 
     facilities described in paragraph (1). The methodology for 
     establishing priorities shall be developed by negotiated 
     rulemaking under section 802. The list of priority facilities 
     will be revised annually in consultation with Indian tribes 
     and tribal organizations.
       ``(3) Report.--The Secretary shall submit to the President, 
     for inclusion in each report required to be transmitted to 
     the Congress under section 801, the priority list maintained 
     pursuant to paragraph (2).
       ``(b) Requirements.--The requirements of this subsection 
     are met with respect to any expansion, renovation or 
     modernization if--
       ``(1) the tribe or tribal organization--
       ``(A) provides notice to the Secretary of its intent to 
     expand, renovate or modernize; and
       ``(B) applies to the Secretary to be placed on a separate 
     priority list to address the needs of such new facilities for 
     increased operating expenses, personnel or equipment; and
       ``(2) the expansion renovation or modernization--
       ``(A) is approved by the appropriate area director of the 
     Service for Federal facilities; and
       ``(B) is administered by the Indian tribe or tribal 
     organization in accordance with any applicable regulations 
     prescribed by the Secretary with respect to construction or 
     renovation of Service facilities.
       ``(c) Right of Tribe in Case of Failure of Facility to be 
     Used as a Service Facility.--If any Service facility which 
     has been expanded, renovated or modernized by an Indian tribe 
     under this section ceases to be used as a Service facility 
     during the 20-year period beginning on the date such 
     expansion, renovation or modernization is completed, such 
     Indian tribe shall be entitled to recover from the United 
     States an amount which bears the same ratio to the value of 
     such facility at the time of such cessation as the value of 
     such expansion, renovation or modernization (less the total 
     amount of any funds provided specifically for such facility 
     under any Federal program that were expended for such 
     expansion, renovation or modernization) bore to the value of 
     such facility at the time of the completion of such 
     expansion, renovation or modernization.

     ``SEC. 306. FUNDING FOR THE CONSTRUCTION, EXPANSION, AND 
                   MODERNIZATION OF SMALL AMBULATORY CARE 
                   FACILITIES.

       ``(a) Availability of Funding.--
       ``(1) In general.--The Secretary, acting through the 
     Service and in consultation with Indian tribes and tribal 
     organization, shall make funding available to tribes and 
     tribal organizations for the construction, expansion, or 
     modernization of facilities for the provision of ambulatory 
     care services to eligible Indians (and noneligible persons as 
     provided for in subsections (b)(2) and (c)(1)(C)). Funding 
     under this section may cover up to 100 percent of the costs 
     of such construction, expansion, or modernization. For the 
     purposes of this section, the term `construction' includes 
     the replacement of an existing facility.
       ``(2) Requirement.--Funding under paragraph (1) may only be 
     made available to an Indian tribe or tribal organization 
     operating an Indian health facility (other than a facility 
     owned or constructed by the Service, including a facility 
     originally owned or constructed by the Service and 
     transferred to an Indian tribe or tribal organization) 
     pursuant to a funding agreement entered into under the Indian 
     Self-Determination and Education Assistance Act.
       ``(b) Use of Funds.--
       ``(1) In general.--Funds provided under this section may be 
     used only for the construction, expansion, or modernization 
     (including the planning and design of such construction, 
     expansion, or modernization) of an ambulatory care facility--
       ``(A) located apart from a hospital;
       ``(B) not funded under section 301 or section 307; and
       ``(C) which, upon completion of such construction, 
     expansion, or modernization will--
       ``(i) have a total capacity appropriate to its projected 
     service population;
       ``(ii) provide annually not less than 500 patient visits by 
     eligible Indians and other users who are eligible for 
     services in such facility in accordance with section 
     807(b)(1)(B); and
       ``(iii) provide ambulatory care in a service area 
     (specified in the funding agreement entered into under the 
     Indian Self-Determination and Education Assistance Act) with 
     a population of not less than 1,500 eligible Indians and 
     other users who are eligible for services in such facility in 
     accordance with section 807(b)(1)(B).
       ``(2) Limitation.--Funding provided under this section may 
     be used only for the cost of that portion of a construction, 
     expansion or modernization project that benefits the service 
     population described in clauses (ii) and (iii) of paragraph 
     (1)(C). The requirements of such clauses (ii) and (iii) shall 
     not apply to a tribe or tribal organization applying for 
     funding under this section whose principal office for health 
     care administration is located on an island or where such 
     office is not located on a road system providing direct 
     access to an inpatient hospital where care is available to 
     the service population.
       ``(c) Application and Priority.--
       ``(1) Application.--No funding may be made available under 
     this section unless an application for such funding has been 
     submitted to and approved by the Secretary. An application or 
     proposal for funding under this section shall be submitted in 
     accordance with applicable regulations and shall set forth 
     reasonable assurance by the applicant that, at all times 
     after the construction, expansion, or modernization of a 
     facility carried out pursuant to funding received under this 
     section--
       ``(A) adequate financial support will be available for the 
     provision of services at such facility;
       ``(B) such facility will be available to eligible Indians 
     without regard to ability to pay or source of payment; and
       ``(C) such facility will, as feasible without diminishing 
     the quality or quantity of services provided to eligible 
     Indians, serve noneligible persons on a cost basis.
       ``(2) Priority.--In awarding funds under this section, the 
     Secretary shall give priority to tribes and tribal 
     organizations that demonstrate--
       ``A) a need for increased ambulatory care services; and
       ``(B) insufficient capacity to deliver such services.
       ``(d) Failure to Use Facility as Health Facility.--If any 
     facility (or portion thereof)

[[Page S3715]]

     with respect to which funds have been paid under this 
     section, ceases, within 5 years after completion of the 
     construction, expansion, or modernization carried out with 
     such funds, to be utilized for the purposes of providing 
     health care services to eligible Indians, all of the right, 
     title, and interest in and to such facility (or portion 
     thereof) shall transfer to the United States unless otherwise 
     negotiated by the Service and the Indian tribe or tribal 
     organization.
       ``(e) No Inclusion in Tribal Share.--Funding provided to 
     Indian tribes and tribal organizations under this section 
     shall be non-recurring and shall not be available for 
     inclusion in any individual tribe's tribal share for an award 
     under the Indian Self-Determination and Education Assistance 
     Act or for reallocation or redesign thereunder.

     ``SEC. 307. INDIAN HEALTH CARE DELIVERY DEMONSTRATION 
                   PROJECT.

       ``(a) Health Care Delivery Demonstration Projects.--The 
     Secretary, acting through the Service and in consultation 
     with Indian tribes and tribal organizations, may enter into 
     funding agreements with, or make grants or loan guarantees 
     to, Indian tribes or tribal organizations for the purpose of 
     carrying out a health care delivery demonstration project to 
     test alternative means of delivering health care and services 
     through health facilities, including hospice, traditional 
     Indian health and child care facilities, to Indians.
       ``(b) Use of Funds.--The Secretary, in approving projects 
     pursuant to this section, may authorize funding for the 
     construction and renovation of hospitals, health centers, 
     health stations, and other facilities to deliver health care 
     services and is authorized to--
       ``(1) waive any leasing prohibition;
       ``(2) permit carryover of funds appropriated for the 
     provision of health care services;
       ``(3) permit the use of other available funds;
       ``(4) permit the use of funds or property donated from any 
     source for project purposes;
       ``(5) provide for the reversion of donated real or personal 
     property to the donor; and
       ``(6) permit the use of Service funds to match other funds, 
     including Federal funds.
       ``(c) Criteria.--
       ``(1) In general.--The Secretary shall develop and publish 
     regulations through rulemaking under section 802 for the 
     review and approval of applications submitted under this 
     section. The Secretary may enter into a contract, funding 
     agreement or award a grant under this section for projects 
     which meet the following criteria:
       ``(A) There is a need for a new facility or program or the 
     reorientation of an existing facility or program.
       ``(B) A significant number of Indians, including those with 
     low health status, will be served by the project.
       ``(C) The project has the potential to address the health 
     needs of Indians in an innovative manner.
       ``(D) The project has the potential to deliver services in 
     an efficient and effective manner.
       ``(E) The project is economically viable.
       ``(F) The Indian tribe or tribal organization has the 
     administrative and financial capability to administer the 
     project.
       ``(G) The project is integrated with providers of related 
     health and social services and is coordinated with, and 
     avoids duplication of, existing services.
       ``(2) Peer review panels.--The Secretary may provide for 
     the establishment of peer review panels, as necessary, to 
     review and evaluate applications and to advise the Secretary 
     regarding such applications using the criteria developed 
     pursuant to paragraph (1).
       ``(3) Priority.--The Secretary shall give priority to 
     applications for demonstration projects under this section in 
     each of the following service units to the extent that such 
     applications are filed in a timely manner and otherwise meet 
     the criteria specified in paragraph (1):
       ``(A) Cass Lake, Minnesota.
       ``(B) Clinton, Oklahoma.
       ``(C) Harlem, Montana.
       ``(D) Mescalero, New Mexico.
       ``(E) Owyhee, Nevada.
       ``(F) Parker, Arizona.
       ``(G) Schurz, Nevada.
       ``(H) Winnebago, Nebraska.
       ``(I) Ft. Yuma, California
       ``(d) Technical Assistance.--The Secretary shall provide 
     such technical and other assistance as may be necessary to 
     enable applicants to comply with the provisions of this 
     section.
       ``(e) Service to Ineligible Persons.--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 care practitioners as provided in section 807 
     may be included, subject to the terms of such section, in any 
     demonstration project approved pursuant to this section.
       ``(f) Equitable Treatment.--For purposes of subsection 
     (c)(1)(A), the Secretary shall, in evaluating facilities 
     operated under any funding agreement entered into with the 
     Service under the Indian Self-Determination and Education 
     Assistance Act, 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 which are the subject of a funding agreement for 
     health services entered into with the Service under the 
     Indian Self-Determination and Education Assistance Act, are 
     fully and equitably integrated into the implementation of the 
     health care delivery demonstration projects under this 
     section.

     ``SEC. 308. LAND TRANSFER.

       ``(a) General Authority for Transfers.--Notwithstanding any 
     other provision of law, the Bureau of Indian Affairs and all 
     other agencies and departments of the United States are 
     authorized to transfer, at no cost, land and improvements to 
     the Service for the provision of health care services. The 
     Secretary is authorized to accept such land and improvements 
     for such purposes.
       ``(b) Chemawa Indian School.--The Bureau of Indian Affairs 
     is authorized to transfer, at no cost, up to 5 acres of land 
     at the Chemawa Indian School, Salem, Oregon, to the Service 
     for the provision of health care services. The land 
     authorized to be transferred by this section is that land 
     adjacent to land under the jurisdiction of the Service and 
     occupied by the Chemawa Indian Health Center.

     ``SEC. 309. LEASES.

       ``(a) In General.--Notwithstanding any other provision of 
     law, the Secretary is authorized, in carrying out the 
     purposes of this Act, to enter into leases with Indian tribes 
     and tribal organizations for periods not in excess of 20 
     years. Property leased by the Secretary from an Indian tribe 
     or tribal organization may be reconstructed or renovated by 
     the Secretary pursuant to an agreement with such Indian tribe 
     or tribal organization.
       ``(b) Facilities for the Administration and Delivery of 
     Health Services.--The Secretary may enter into leases, 
     contracts, and other legal agreements with Indian tribes or 
     tribal organizations which hold--
       ``(1) title to;
       ``(2) a leasehold interest in; or
       ``(3) a beneficial interest in (where title is held by the 
     United States in trust for the benefit of a tribe);
     facilities used for the administration and delivery of health 
     services by the Service or by programs operated by Indian 
     tribes or tribal organizations to compensate such Indian 
     tribes or tribal organizations for costs associated with the 
     use of such facilities for such purposes, and such leases 
     shall be considered as operating leases for the purposes of 
     scoring under the Budget Enforcement Act, notwithstanding any 
     other provision of law. Such costs include rent, depreciation 
     based on the useful life of the building, principal and 
     interest paid or accrued, operation and maintenance expenses, 
     and other expenses determined by regulation to be allowable 
     pursuant to regulations under section 105(l) of the Indian 
     Self-Determination and Education Assistance Act.

     ``SEC. 310. LOANS, LOAN GUARANTEES AND LOAN REPAYMENT.

       ``(a) Health Care Facilities Loan Fund.--There is 
     established in the Treasury of the United States a fund to be 
     known as the `Health Care Facilities Loan Fund' (referred to 
     in this Act as the `HCFLF') to provide to Indian Tribes and 
     tribal organizations direct loans, or guarantees for loans, 
     for the construction of health care facilities (including 
     inpatient facilities, outpatient facilities, associated staff 
     quarters and specialized care facilities such as behavioral 
     health and elder care facilities).
       ``(b) Standards and Procedures.--The Secretary may 
     promulgate regulations, developed through rulemaking as 
     provided for in section 802, to establish standards and 
     procedures for governing loans and loan guarantees under this 
     section, subject to the following conditions:
       ``(1) The principal amount of a loan or loan guarantee may 
     cover up to 100 percent of eligible costs, including costs 
     for the planning, design, financing, site land development, 
     construction, rehabilitation, renovation, conversion, 
     improvements, medical equipment and furnishings, other 
     facility related costs and capital purchase (but excluding 
     staffing).
       ``(2) The cumulative total of the principal of direct loans 
     and loan guarantees, respectively, outstanding at any one 
     time shall not exceed such limitations as may be specified in 
     appropriation Acts.
       ``(3) In the discretion of the Secretary, the program under 
     this section may be administered by the Service or the Health 
     Resources and Services Administration (which shall be 
     specified by regulation).
       ``(4) The Secretary may make or guarantee a loan with a 
     term of the useful estimated life of the facility, or 25 
     years, whichever is less.
       ``(5) The Secretary may allocate up to 100 percent of the 
     funds available for loans or loan guarantees in any year for 
     the purpose of planning and applying for a loan or loan 
     guarantee.
       ``(6) The Secretary may accept an assignment of the revenue 
     of an Indian tribe or tribal organization as security for any 
     direct loan or loan guarantee under this section.
       ``(7) In the planning and design of health facilities under 
     this section, users eligible under section 807(b) may be 
     included in any projection of patient population.
       ``(8) The Secretary shall not collect loan application, 
     processing or other similar fees from Indian tribes or tribal 
     organizations applying for direct loans or loan guarantees 
     under this section.
       ``(9) Service funds authorized under loans or loan 
     guarantees under this section may be used in matching other 
     Federal funds.
       ``(c) Funding.--

[[Page S3716]]

       ``(1) In general.--The HCFLF shall consist of--
       ``(A) such sums as may be initially appropriated to the 
     HCFLF and as may be subsequently appropriated under paragraph 
     (2);
       ``(B) such amounts as may be collected from borrowers; and
       ``(C) all interest earned on amounts in the HCFLF.
       ``(2) Authorization of appropriations.--There is authorized 
     to be appropriated such sums as may be necessary to initiate 
     the HCFLF. For each fiscal year after the initial year in 
     which funds are appropriated to the HCFLF, there is 
     authorized to be appropriated an amount equal to the sum of 
     the amount collected by the HCFLF during the preceding fiscal 
     year, and all accrued interest on such amounts.
       ``(3) Availability of funds.--Amounts appropriated, 
     collected or earned relative to the HCFLF shall remain 
     available until expended.
       ``(d) Funding Agreements.--Amounts in the HCFLF and 
     available pursuant to appropriation Acts may be expended by 
     the Secretary, acting through the Service, to make loans 
     under this section to an Indian tribe or tribal organization 
     pursuant to a funding agreement entered into under the Indian 
     Self-Determination and Education Assistance Act.
       ``(e) Investments.--The Secretary of the Treasury shall 
     invest such amounts of the HCFLF as such Secretary determines 
     are not required to meet current withdrawals from the HCFLF. 
     Such investments may be made only in interest-bearing 
     obligations of the United States. For such purpose, such 
     obligations may be acquired on original issue at the issue 
     price, or by purchase of outstanding obligations at the 
     market price. Any obligation acquired by the fund may be sold 
     by the Secretary of the Treasury at the market price.
       ``(f) Grants.--The Secretary is authorized to establish a 
     program to provide grants to Indian tribes and tribal 
     organizations for the purpose of repaying all or part of any 
     loan obtained by an Indian tribe or tribal organization for 
     construction and renovation of health care facilities 
     (including inpatient facilities, outpatient facilities, 
     associated staff quarters and specialized care facilities). 
     Loans eligible for such repayment grants shall include loans 
     that have been obtained under this section or otherwise.

     ``SEC. 311. TRIBAL LEASING.

       ``Indian Tribes and tribal organizations providing health 
     care services pursuant to a funding agreement contract 
     entered into under the Indian Self- Determination and 
     Education Assistance Act may lease permanent structures for 
     the purpose of providing such health care services without 
     obtaining advance approval in appropriation Acts.

     ``SEC. 312. INDIAN HEALTH SERVICE/TRIBAL FACILITIES JOINT 
                   VENTURE PROGRAM.

       ``(a) Authority.--
       ``(1) In general.--The Secretary, acting through the 
     Service, shall make arrangements with Indian tribes and 
     tribal organizations to establish joint venture demonstration 
     projects under which an Indian tribe or tribal organization 
     shall expend tribal, private, or other available funds, for 
     the acquisition or construction of a health facility for a 
     minimum of 10 years, under a no-cost lease, in exchange for 
     agreement by the Service to provide the equipment, supplies, 
     and staffing for the operation and maintenance of such a 
     health facility.
       ``(2) Use of resources.--A tribe or tribal organization may 
     utilize tribal funds, private sector, or other available 
     resources, including loan guarantees, to fulfill its 
     commitment under this subsection.
       ``(3) Eligibility of certain entities.--A tribe that has 
     begun and substantially completed the process of acquisition 
     or construction of a health facility shall be eligible to 
     establish a joint venture project with the Service using such 
     health facility.
       ``(b) Requirements.--
       ``(1) In general.--The Secretary shall enter into an 
     arrangement under subsection (a)(1) with an Indian tribe or 
     tribal organization only if--
       ``(A) the Secretary first determines that the Indian tribe 
     or tribal organization has the administrative and financial 
     capabilities necessary to complete the timely acquisition or 
     construction of the health facility described in subsection 
     (a)(1); and
       ``(B) the Indian tribe or tribal organization meets the 
     needs criteria that shall be developed through the negotiated 
     rulemaking process provided for under section 802.
       ``(2) Continued operation of facility.--The Secretary shall 
     negotiate an agreement with the Indian tribe or tribal 
     organization regarding the continued operation of a facility 
     under this section at the end of the initial 10 year no-cost 
     lease period.
       ``(3) Breach or termination of agreement.--An Indian tribe 
     or tribal organization that has entered into a written 
     agreement with the Secretary under this section, and that 
     breaches or terminates without cause such agreement, shall be 
     liable to the United States for the amount that has been paid 
     to the tribe or tribal organization, or paid to a third party 
     on the tribe's or tribal organization's behalf, under the 
     agreement. The Secretary has the right to recover tangible 
     property (including supplies), and equipment, less 
     depreciation, and any funds expended for operations and 
     maintenance under this section. The preceding sentence shall 
     not apply to any funds expended for the delivery of health 
     care services, or for personnel or staffing.
       ``(d) Recovery for Non-Use.--An Indian tribe or tribal 
     organization that has entered into a written agreement with 
     the Secretary under this section shall be entitled to recover 
     from the United States an amount that is proportional to the 
     value of such facility should at any time within 10 years the 
     Service ceases to use the facility or otherwise breaches the 
     agreement.
       ``(e) Definition.--In this section, the terms `health 
     facility' or `health facilities' include staff quarters 
     needed to provide housing for the staff of the tribal health 
     program.

     ``SEC. 313. LOCATION OF FACILITIES.

       ``(a) Priority.--The Bureau of Indian Affairs and the 
     Service shall, in all matters involving the reorganization or 
     development of Service facilities, or in the establishment of 
     related employment projects to address unemployment 
     conditions in economically depressed areas, give priority to 
     locating such facilities and projects on Indian lands if 
     requested by the Indian owner and the Indian tribe with 
     jurisdiction over such lands or other lands owned or leased 
     by the Indian tribe or tribal organization so long as 
     priority is given to Indian land owned by an Indian tribe or 
     tribes.
       ``(b) Definition.--In this section, the term `Indian lands' 
     means--
       ``(1) all lands within the exterior boundaries of any 
     Indian reservation;
       ``(2) any lands title to which is held in trust by the 
     United States for the benefit of any Indian tribe or 
     individual Indian, or held by any Indian tribe or individual 
     Indian subject to restriction by the United States against 
     alienation and over which an Indian tribe exercises 
     governmental power; and
       ``(3) all lands in Alaska owned by any Alaska Native 
     village, or any village or regional corporation under the 
     Alaska Native Claims Settlement Act, or any land allotted to 
     any Alaska Native.

     ``SEC. 314. MAINTENANCE AND IMPROVEMENT OF HEALTH CARE 
                   FACILITIES.

       ``(a) Report.--The Secretary shall submit to the President, 
     for inclusion in the report required to be transmitted to 
     Congress under section 801, a report that identifies the 
     backlog of maintenance and repair work required at both 
     Service and tribal facilities, including new facilities 
     expected to be in operation in the fiscal year after the year 
     for which the report is being prepared. The report shall 
     identify the need for renovation and expansion of existing 
     facilities to support the growth of health care programs.
       ``(b) Maintenance of Newly Constructed Space.--
       ``(1) In general.--The Secretary may expend maintenance and 
     improvement funds to support the maintenance of newly 
     constructed space only if such space falls within the 
     approved supportable space allocation for the Indian tribe or 
     tribal organization.
       ``(2) Definition.--For purposes of paragraph (1), the term 
     `supportable space allocation' shall be defined through the 
     negotiated rulemaking process provided for under section 802.
       ``(c) Construction of Replacement Facilities.--
       ``(1) In general.--In addition to using maintenance and 
     improvement funds for the maintenance of facilities under 
     subsection (b)(1), an Indian tribe or tribal organization may 
     use such funds for the construction of a replacement facility 
     if the costs of the renovation of such facility would exceed 
     a maximum renovation cost threshold.
       ``(2) Definition.--For purposes of paragraph (1), the term 
     `maximum renovation cost threshold' shall be defined through 
     the negotiated rulemaking process provided for under section 
     802.

     ``SEC. 315. TRIBAL MANAGEMENT OF FEDERALLY-OWNED QUARTERS.

       ``(a) Establishment of Rental Rates.--
       ``(1) In general.--Notwithstanding any other provision of 
     law, an Indian tribe or tribal organization which operates a 
     hospital or other health facility and the Federally-owned 
     quarters associated therewith, pursuant to a funding 
     agreement under the Indian Self-Determination and Education 
     Assistance Act, may establish the rental rates charged to the 
     occupants of such quarters by providing notice to the 
     Secretary of its election to exercise such authority.
       ``(2) Objectives.--In establishing rental rates under 
     paragraph (1), an Indian tribe or tribal organization shall 
     attempt to achieve the following objectives:
       ``(A) The rental rates should be based on the reasonable 
     value of the quarters to the occupants thereof.
       ``(B) The rental rates should generate sufficient funds to 
     prudently provide for the operation and maintenance of the 
     quarters, and, subject to the discretion of the Indian tribe 
     or tribal organization, to supply reserve funds for capital 
     repairs and replacement of the quarters.
       ``(3) Eligibility for quarters improvement and repair.--Any 
     quarters whose rental rates are established by an Indian 
     tribe or tribal organization under this subsection shall 
     continue to be eligible for quarters improvement and repair 
     funds to the same extent as other Federally-owned quarters 
     that are used to house personnel in Service-supported 
     programs.
       ``(4) Notice of change in rates.--An Indian tribe or tribal 
     organization that exercises the authority provided under this 
     subsection shall provide occupants with not less than 60 days 
     notice of any change in rental rates.

[[Page S3717]]

       ``(b) Collection of Rents.--
       ``(1) In general.--Notwithstanding any other provision of 
     law, and subject to paragraph (2), an Indian tribe or a 
     tribal organization that operates Federally-owned quarters 
     pursuant to a funding agreement under the Indian Self-
     Determination and Education Assistance Act shall have the 
     authority to collect rents directly from Federal employees 
     who occupy such quarters in accordance with the following:
       ``(A) The Indian tribe or tribal organization shall notify 
     the Secretary and the Federal employees involved of its 
     election to exercise its authority to collect rents directly 
     from such Federal employees.
       ``(B) Upon the receipt of a notice described in 
     subparagraph (A), the Federal employees involved shall pay 
     rents for the occupancy of such quarters directly to the 
     Indian tribe or tribal organization and the Secretary shall 
     have no further authority to collect rents from such 
     employees through payroll deduction or otherwise.
       ``(C) Such rent payments shall be retained by the Indian 
     tribe or tribal organization and shall not be made payable to 
     or otherwise be deposited with the United States.
       ``(D) Such rent payments shall be deposited into a separate 
     account which shall be used by the Indian tribe or tribal 
     organization for the maintenance (including capital repairs 
     and replacement expenses) and operation of the quarters and 
     facilities as the Indian tribe or tribal organization shall 
     determine appropriate.
       ``(2) Retrocession.--If an Indian tribe or tribal 
     organization which has made an election under paragraph (1) 
     requests retrocession of its authority to directly collect 
     rents from Federal employees occupying Federally-owned 
     quarters, such retrocession shall become effective on the 
     earlier of--
       ``(A) the first day of the month that begins not less than 
     180 days after the Indian tribe or tribal organization 
     notifies the Secretary of its desire to retrocede; or
       ``(B) such other date as may be mutually agreed upon by the 
     Secretary and the Indian tribe or tribal organization.
       ``(c) Rates.--To the extent that an Indian tribe or tribal 
     organization, pursuant to authority granted in subsection 
     (a), establishes rental rates for Federally-owned quarters 
     provided to a Federal employee in Alaska, such rents may be 
     based on the cost of comparable private rental housing in the 
     nearest established community with a year-round population of 
     1,500 or more individuals.-

     ``SEC. 316. APPLICABILITY OF BUY AMERICAN REQUIREMENT.

       ``(a) In General.--The Secretary shall ensure that the 
     requirements of the Buy American Act apply to all 
     procurements made with funds provided pursuant to the 
     authorization contained in section 318, except that Indian 
     tribes and tribal organizations shall be exempt from such 
     requirements.
       ``(b) False or Misleading Labeling.--If it has been finally 
     determined by a court or Federal agency that any person 
     intentionally affixed a label bearing a `Made in America' 
     inscription, or any inscription with the same meaning, to any 
     product sold in or shipped to the United States that is not 
     made in the United States, such person shall be ineligible to 
     receive any contract or subcontract made with funds provided 
     pursuant to the authorization contained in section 318, 
     pursuant to the debarment, suspension, and ineligibility 
     procedures described in sections 9.400 through 9.409 of title 
     48, Code of Federal Regulations.
       (c) Definition.--In this section, the term `Buy American 
     Act' means title III of the Act entitled `An Act making 
     appropriations for the Treasury and Post Office Departments 
     for the fiscal year ending June 30, 1934, and for other 
     purposes', approved March 3, 1933 (41 U.S.C. 10a et seq.).

     ``SEC. 317. OTHER FUNDING FOR FACILITIES.

       ``Notwithstanding any other provision of law--
       ``(1) the Secretary may accept from any source, including 
     Federal and State agencies, funds that are available for the 
     construction of health care facilities and use such funds to 
     plan, design and construct health care facilities for Indians 
     and to place such funds into funding agreements authorized 
     under the Indian Self-Determination and Education Assistance 
     Act (25 U.S.C. 450f et seq.) between the Secretary and an 
     Indian tribe or tribal organization, except that the receipt 
     of such funds shall not have an effect on the priorities 
     established pursuant to section 301;
       ``(2) the Secretary may enter into interagency agreements 
     with other Federal or State agencies and other entities and 
     to accept funds from such Federal or State agencies or other 
     entities to provide for the planning, design and construction 
     of health care facilities to be administered by the Service 
     or by Indian tribes or tribal organizations under the Indian 
     Self-Determination and Education Assistance Act in order to 
     carry out the purposes of this Act, together with the 
     purposes for which such funds are appropriated to such other 
     Federal or State agency or for which the funds were otherwise 
     provided;
       ``(3) any Federal agency to which funds for the 
     construction of health care facilities are appropriated is 
     authorized to transfer such funds to the Secretary for the 
     construction of health care facilities to carry out the 
     purposes of this Act as well as the purposes for which such 
     funds are appropriated to such other Federal agency; and
       ``(4) the Secretary, acting through the Service, shall 
     establish standards under regulations developed through 
     rulemaking under section 802, for the planning, design and 
     construction of health care facilities serving Indians under 
     this Act.

     ``SEC. 318. AUTHORIZATION OF APPROPRIATIONS.

       ``There is authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2012 to 
     carry out this title.

                 ``TITLE IV--ACCESS TO HEALTH SERVICES

     ``SEC. 401. TREATMENT OF PAYMENTS UNDER MEDICARE PROGRAM.

       ``(a) In General.--Any payments received by the Service, by 
     an Indian tribe or tribal organization pursuant to a funding 
     agreement under the Indian Self-Determination and Education 
     Assistance Act, or by an urban Indian organization pursuant 
     to title V of this Act for services provided to Indians 
     eligible for benefits under title XVIII of the Social 
     Security Act shall not be considered in determining 
     appropriations for health care and services to Indians.
       ``(b) Equal Treatment.--Nothing in this Act authorizes the 
     Secretary to provide services to an Indian beneficiary with 
     coverage under title XVIII of the Social Security Act in 
     preference to an Indian beneficiary without such coverage.
       ``(c) Special Fund.--
       ``(1) Use of funds.--Notwithstanding any other provision of 
     this title or of title XVIII of the Social Security Act, 
     payments to which any facility of the Service is entitled by 
     reason of this section shall be placed in a special fund to 
     be held by the Secretary and first used (to such extent or in 
     such amounts as are provided in appropriation Acts) for the 
     purpose of making any improvements in the programs of the 
     Service which may be necessary to achieve or maintain 
     compliance with the applicable conditions and requirements of 
     this title and of title XVIII of the Social Security Act. Any 
     funds to be reimbursed which are in excess of the amount 
     necessary to achieve or maintain such conditions and 
     requirements shall, subject to the consultation with tribes 
     being served by the service unit, be used for reducing the 
     health resource deficiencies of the Indian tribes.
       ``(2) Nonapplication in case of election for direct 
     billing.--Paragraph (1) shall not apply upon the election of 
     an Indian tribe or tribal organization under section 405 to 
     receive direct payments for services provided to Indians 
     eligible for benefits under title XVIII of the Social 
     Security Act.

     ``SEC. 402. TREATMENT OF PAYMENTS UNDER MEDICAID PROGRAM.

       ``(a) Special Fund.--
       ``(1) Use of funds.--Notwithstanding any other provision of 
     law, payments to which any facility of the Service (including 
     a hospital, nursing facility, intermediate care facility for 
     the mentally retarded, or any other type of facility which 
     provides services for which payment is available under title 
     XIX of the Social Security Act) is entitled under a State 
     plan by reason of section 1911 of such Act shall be placed in 
     a special fund to be held by the Secretary and first used (to 
     such extent or in such amounts as are provided in 
     appropriation Acts) for the purpose of making any 
     improvements in the facilities of such Service which may be 
     necessary to achieve or maintain compliance with the 
     applicable conditions and requirements of such title. Any 
     payments which are in excess of the amount necessary to 
     achieve or maintain such conditions and requirements shall, 
     subject to the consultation with tribes being served by the 
     service unit, be used for reducing the health resource 
     deficiencies of the Indian tribes. In making payments from 
     such fund, the Secretary shall ensure that each service unit 
     of the Service receives 100 percent of the amounts to which 
     the facilities of the Service, for which such service unit 
     makes collections, are entitled by reason of section 1911 of 
     the Social Security Act.
       ``(2) Nonapplication in case of election for direct 
     billing.--Paragraph (1) shall not apply upon the election of 
     an Indian tribe or tribal organization under section 405 to 
     receive direct payments for services provided to Indians 
     eligible for medical assistance under title XIX of the Social 
     Security Act.
       ``(b) Payments Disregarded for Appropriations.--Any 
     payments received under section 1911 of the Social Security 
     Act for services provided to Indians eligible for benefits 
     under title XIX of the Social Security Act shall not be 
     considered in determining appropriations for the provision of 
     health care and services to Indians.
       ``(c) Direct Billing.--For provisions relating to the 
     authority of certain Indian tribes and tribal organizations 
     to elect to directly bill for, and receive payment for, 
     health care services provided by a hospital or clinic of such 
     tribes or tribal organizations and for which payment may be 
     made under this title, see section 405.

     ``SEC. 403. REPORT.

       ``(a) Inclusion in Annual Report.--The Secretary shall 
     submit to the President, for inclusion in the report required 
     to be transmitted to the Congress under section 801, an 
     accounting on the amount and use of funds made available to 
     the Service pursuant to this title as a result of 
     reimbursements under titles XVIII and XIX of the Social 
     Security Act.
       ``(b) Identification of Source of Payments.--If an Indian 
     tribe or tribal organization receives funding from the 
     Service under the Indian Self-Determination and Education 
     Assistance Act or an urban Indian organization receives 
     funding from the Service under Title V of this Act and 
     receives reimbursements or payments under title XVIII,

[[Page S3718]]

     XIX, or XXI of the Social Security Act, such Indian tribe or 
     tribal organization, or urban Indian organization, shall 
     provide to the Service a list of each provider enrollment 
     number (or other identifier) under which it receives such 
     reimbursements or payments.

     ``SEC. 404. GRANTS TO AND FUNDING AGREEMENTS WITH THE 
                   SERVICE, INDIAN TRIBES OR TRIBAL ORGANIZATIONS, 
                   AND URBAN INDIAN ORGANIZATIONS.

       ``(a) In General.--The Secretary shall make grants to or 
     enter into funding agreements with Indian tribes and tribal 
     organizations to assist such organizations in establishing 
     and administering programs on or near Federal Indian 
     reservations and trust areas and in or near Alaska Native 
     villages to assist individual Indians to--
       ``(1) enroll under sections 1818, 1836, and 1837 of the 
     Social Security Act;
       ``(2) pay premiums for health insurance coverage; and
       ``(3) apply for medical assistance provided pursuant to 
     titles XIX and XXI of the Social Security Act.
       ``(b) Conditions.--The Secretary shall place conditions as 
     deemed necessary to effect the purpose of this section in any 
     funding agreement or grant which the Secretary makes with any 
     Indian tribe or tribal organization pursuant to this section. 
     Such conditions shall include, but are not limited to, 
     requirements that the organization successfully undertake 
     to--
       ``(1) determine the population of Indians to be served that 
     are or could be recipients of benefits or assistance under 
     titles XVIII, XIX, and XXI of the Social Security Act;
       ``(2) assist individual Indians in becoming familiar with 
     and utilizing such benefits and assistance;
       ``(3) provide transportation to such individual Indians to 
     the appropriate offices for enrollment or applications for 
     such benefits and assistance;
       ``(4) develop and implement--
       ``(A) a schedule of income levels to determine the extent 
     of payments of premiums by such organizations for health 
     insurance coverage of needy individuals; and
       ``(B) methods of improving the participation of Indians in 
     receiving the benefits and assistance provided under titles 
     XVIII, XIX, and XXI of the Social Security Act.
       ``(c) Agreements For Receipt and Processing of 
     Applications.--The Secretary may enter into an agreement with 
     an Indian tribe or tribal organization, or an urban Indian 
     organization, which provides for the receipt and processing 
     of applications for medical assistance under title XIX of the 
     Social Security Act, child health assistance under title XXI 
     of such Act and benefits under title XVIII of such Act by a 
     Service facility or a health care program administered by 
     such Indian tribe or tribal organization, or urban Indian 
     organization, pursuant to a funding agreement under the 
     Indian Self-Determination and Education Assistance Act or a 
     grant or contract entered into with an urban Indian 
     organization under title V of this Act. Notwithstanding any 
     other provision of law, such agreements shall provide for 
     reimbursement of the cost of outreach, education regarding 
     eligibility and benefits, and translation when such services 
     are provided. The reimbursement may be included in an 
     encounter rate or be made on a fee-for-service basis as 
     appropriate for the provider. When necessary to carry out the 
     terms of this section, the Secretary, acting through the 
     Health Care Financing Administration or the Service, may 
     enter into agreements with a State (or political subdivision 
     thereof) to facilitate cooperation between the State and the 
     Service, an Indian tribe or tribal organization, and an urban 
     Indian organization.
       ``(d) Grants.--
       ``(1) In general.--The Secretary shall make grants or enter 
     into contracts with urban Indian organizations to assist such 
     organizations in establishing and administering programs to 
     assist individual urban Indians to--
       ``(A) enroll under sections 1818, 1836, and 1837 of the 
     Social Security Act;
       ``(B) pay premiums on behalf of such individuals for 
     coverage under title XVIII of such Act; and
       ``(C) apply for medical assistance provided under title XIX 
     of such Act and for child health assistance under title XXI 
     of such Act.
       ``(2) Requirements.--The Secretary shall include in the 
     grants or contracts made or entered into under paragraph (1) 
     requirements that are--
       ``(A) consistent with the conditions imposed by the 
     Secretary under subsection (b);
       ``(B) appropriate to urban Indian organizations and urban 
     Indians; and
       ``(C) necessary to carry out the purposes of this section.

     ``SEC. 405. DIRECT BILLING AND REIMBURSEMENT OF MEDICARE, 
                   MEDICAID, AND OTHER THIRD PARTY PAYORS.

       ``(a) Direct Billing.--
       ``(1) In general.--An Indian tribe or tribal organization 
     may directly bill for, and receive payment for, health care 
     services provided by such tribe or organization for which 
     payment is made under title XVIII of the Social Security Act, 
     under a State plan for medical assistance approved under 
     title XIX of such Act, under a State child health plan 
     approved under title XXI of such Act, or from any other third 
     party payor.
       ``(2) Application of 100 percent fmap.--The third sentence 
     of section 1905(b) of the Social Security Act and section 
     2101(c) of such Act shall apply for purposes of reimbursement 
     under the medicaid or State children's health insurance 
     program for health care services directly billed under the 
     program established under this section.
       ``(b) Direct Reimbursement.--
       ``(1) Use of Funds.--Each Indian tribe or tribal 
     organization exercising the option described in subsection 
     (a) of this section shall be reimbursed directly under the 
     medicare, medicaid, and State children's health insurance 
     programs for services furnished, without regard to the 
     provisions of sections 1880(c) of the Social Security Act and 
     section 402(a) of this Act, but all funds so reimbursed shall 
     first be used by the health program for the purpose of making 
     any improvements in the facility or health programs that may 
     be necessary to achieve or maintain compliance with the 
     conditions and requirements applicable generally to such 
     health services under the medicare, medicaid, or State 
     children's health insurance program. Any funds so reimbursed 
     which are in excess of the amount necessary to achieve or 
     maintain such conditions or requirements shall be used to 
     provide additional health services, improvements in its 
     health care facilities, or otherwise to achieve the health 
     objectives provided for under section 3 of this Act.
       ``(2) Audits.--The amounts paid to the health programs 
     exercising the option described in subsection (a) shall be 
     subject to all auditing requirements applicable to programs 
     administered directly by the Service and to facilities 
     participating in the medicare, medicaid, and State children's 
     health insurance programs.
       ``(3) No Payments from Special Funds.--Notwithstanding 
     section 401(c) or section 402(a), no payment may be made out 
     of the special fund described in section 401(c) or 402(a), 
     for the benefit of any health program exercising the option 
     described in subsection (a) of this section during the period 
     of such participation.
       ``(c) Examination and Implementation of Changes.--The 
     Secretary, acting through the Service, and with the 
     assistance of the Administrator of the Health Care Financing 
     Administration, 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 section, including any agreements with 
     States that may be necessary to provide for direct billing 
     under the medicaid or State children's health insurance 
     program.
       ``(d) Withdrawal From Program.--A participant in the 
     program established under this section 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 
     authority of the Indian Self-Determination and Education 
     Assistance Act. All cost accounting and billing authority 
     under the program established under this section shall be 
     returned to the Secretary upon the Secretary's acceptance of 
     the withdrawal of participation in this program.
       ``(e) Limitation.--Notwithstanding this section, 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), neither the United States through the 
     Service, nor an Indian tribe or tribal organization under a 
     funding agreement pursuant to the Indian Self-Determination 
     and Education Assistance Act, nor an urban Indian 
     organization funded under title V, shall 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 or 
     tribal organization, or urban Indian organization. Where such 
     tribal authorization is provided, the Service may receive and 
     expend such funds for the provision of additional health 
     services.

     ``SEC. 406. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS 
                   OF HEALTH SERVICES.

       ``(a) Right of Recovery.--Except as provided in subsection 
     (g), the United States, an Indian tribe or tribal 
     organization shall have the right to recover the reasonable 
     charges billed or expenses incurred by the Secretary or an 
     Indian tribe or tribal organization in providing health 
     services, through the Service or an Indian tribe or tribal 
     organization to any individual to the same extent that such 
     individual, or any nongovernmental provider of such services, 
     would be eligible to receive 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 expenses.
       ``(b) Urban Indian Organizations.--Except as provided in 
     subsection (g), an urban Indian organization shall have the 
     right to recover the reasonable charges billed or expenses 
     incurred by the organization in providing health services to 
     any individual to the same extent that such individual, or 
     any other nongovernmental provider of such services, would be 
     eligible to receive reimbursement or indemnification for such 
     charges or expenses if such individual had been required to 
     pay such charges or expenses and did pay such charges or 
     expenses.
       ``(c) Limitations on Recoveries from States.--Subsections 
     (a) and (b) shall provide a right of recovery against any 
     State,

[[Page S3719]]

     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.
       ``(d) Nonapplication of Other Laws.--No law of any State, 
     or of any political subdivision of a State and no provision 
     of any contract 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 
     or an Indian tribe or tribal organization under subsection 
     (a), or an urban Indian organization under subsection (b).
       ``(e) No Effect On Private Rights of Action.--No action 
     taken by the United States or an Indian tribe or tribal 
     organization to enforce the right of recovery provided under 
     subsection (a), or by an urban Indian organization to enforce 
     the right of recovery provided under subsection (b), shall 
     affect the right of any person to any damages (other than 
     damages for the cost of health services provided by the 
     Secretary through the Service).
       ``(f) Methods of Enforcement.--
       ``(1) In general.--The United States or an Indian tribe or 
     tribal organization may enforce the right of recovery 
     provided under subsection (a), and an urban Indian 
     organization may enforce the right of recovery provided under 
     subsection (b), 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 urban Indian organization; or
       ``(ii) by any representative or heirs of such individual; 
     or
       ``(B) instituting a civil action.
       ``(2) Notice.--All reasonable efforts shall be made to 
     provide notice of an action instituted in accordance with 
     paragraph (1)(B) to the individual to whom health services 
     were provided, either before or during the pendency of such 
     action.
       ``(g) Limitation.--Notwithstanding this section, 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), neither the United States through the 
     Service, nor an Indian tribe or tribal organization under a 
     funding agreement pursuant to the Indian Self-Determination 
     and Education Assistance Act, nor an urban Indian 
     organization funded under title V, shall 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 or 
     tribal organization, or urban Indian organization. Where such 
     tribal authorization is provided, the Service may receive and 
     expend such funds for the provision of additional health 
     services.
       ``(h) Costs and Attorneys' Fees.--In any action brought to 
     enforce the provisions of this section, a prevailing 
     plaintiff shall be awarded reasonable attorneys' fees and 
     costs of litigation.
       ``(i) Right of Action Against Insurers and Employee Benefit 
     Plans.--
       ``(1) In general.--Where an insurance company or employee 
     benefit plan fails or refuses to pay the amount due under 
     subsection (a) for services provided to an individual who is 
     a beneficiary, participant, or insured of such company or 
     plan, the United States or an Indian tribe or tribal 
     organization shall have a right to assert and pursue all the 
     claims and remedies against such company or plan, and against 
     the fiduciaries of such company or plan, that the individual 
     could assert or pursue under applicable Federal, State or 
     tribal law.
       ``(2) Urban indian organizations.--Where an insurance 
     company or employee benefit plan fails or refuses to pay the 
     amounts due under subsection (b) for health services provided 
     to an individual who is a beneficiary, participant, or 
     insured of such company or plan, the urban Indian 
     organization shall have a right to assert and pursue all the 
     claims and remedies against such company or plan, and against 
     the fiduciaries of such company or plan, that the individual 
     could assert or pursue under applicable Federal or State law.
       ``(j) Nonapplication of Claims Filing Requirements.--
     Notwithstanding any other provision in law, the Service, an 
     Indian tribe or tribal organization, or an urban Indian 
     organization shall have a right of recovery for any otherwise 
     reimbursable claim filed on a current HCFA-1500 or UB-92 
     form, or the current NSF electronic format, or their 
     successors. No health plan shall deny payment because a claim 
     has not been submitted in a unique format that differs from 
     such forms.

     ``SEC. 407. CREDITING OF REIMBURSEMENTS.

       ``(a) Retention of Funds.--Except as provided in section 
     202(d), this title, and section 807, all reimbursements 
     received or recovered under the authority of this Act, Public 
     Law 87-693, or any other provision of law, by reason of the 
     provision of health services by the Service or by an Indian 
     tribe or tribal organization under a funding agreement 
     pursuant to the Indian Self-Determination and Education 
     Assistance Act, or by an urban Indian organization funded 
     under title V, shall be retained by the Service or that tribe 
     or tribal organization and shall be available for the 
     facilities, and to carry out the programs, of the Service or 
     that tribe or tribal organization to provide health care 
     services to Indians.
       ``(b) No Offset of Funds.--The Service may not offset or 
     limit the amount of funds obligated to any service unit or 
     entity receiving funding from the Service because of the 
     receipt of reimbursements under subsection (a).

     ``SEC. 408. PURCHASING HEALTH CARE COVERAGE.

       ``An Indian tribe or tribal organization, and an urban 
     Indian organization may utilize funding from the Secretary 
     under this Act to purchase managed care coverage for Service 
     beneficiaries (including insurance to limit the financial 
     risks of managed care entities) from--
       ``(1) a tribally owned and operated managed care plan;
       ``(2) a State or locally-authorized or licensed managed 
     care plan; or
       ``(3) a health insurance provider.

     ``SEC. 409. INDIAN HEALTH SERVICE, DEPARTMENT OF VETERAN'S 
                   AFFAIRS, AND OTHER FEDERAL AGENCY HEALTH 
                   FACILITIES AND SERVICES SHARING.

       ``(a) Examination of Feasibility of Arrangements.--
       ``(1) In general.--The Secretary shall examine the 
     feasibility of entering into arrangements or expanding 
     existing arrangements for the sharing of medical facilities 
     and services between the Service and the Veterans' 
     Administration, and other appropriate Federal agencies, 
     including those within the Department, and shall, in 
     accordance with subsection (b), prepare a report on the 
     feasibility of such arrangements.
       ``(2) Submission of report.--Not later than September 30, 
     2000, the Secretary shall submit the report required under 
     paragraph (1) to Congress.
       ``(3) Consultation required.--The Secretary may not 
     finalize any arrangement described in paragraph (1) without 
     first consulting with the affected Indian tribes.
       ``(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;
       ``(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 Veterans' Administration;
       ``(4) the quality of health care services provided to any 
     veteran by the Veteran's Administration;
       ``(5) the eligibility of any Indian to receive health 
     services through the Service; or
       ``(6) the eligibility of any Indian who is a veteran to 
     receive health services through the Veterans' Administration 
     provided, however, the Service or the Indian tribe or tribal 
     organization shall be reimbursed by the Veterans' 
     Administration where services are provided through the 
     Service or Indian tribes or tribal organizations to 
     beneficiaries eligible for services from the Veterans' 
     Administration, notwithstanding any other provision of law.
       ``(c) Agreements For Parity in Services.--The Service may 
     enter into agreements with other Federal agencies to assist 
     in achieving parity in services for Indians. Nothing in this 
     section may be construed as creating any right of a veteran 
     to obtain health services from the Service.

     ``SEC. 410. PAYOR OF LAST RESORT.

       ``The Service, and programs operated by Indian tribes or 
     tribal organizations, or urban Indian organizations shall be 
     the payor of last resort for services provided to individuals 
     eligible for services from the Service and such programs, 
     notwithstanding any Federal, State or local law to the 
     contrary, unless such law explicitly provides otherwise.

     ``SEC. 411. RIGHT TO RECOVER FROM FEDERAL HEALTH CARE 
                   PROGRAMS .

       ``Notwithstanding any other provision of law, the Service, 
     Indian tribes or tribal organizations, and urban Indian 
     organizations (notwithstanding limitations on who is eligible 
     to receive services from such entities) shall be entitled to 
     receive payment or reimbursement for services provided by 
     such entities from any Federally funded health care program, 
     unless there is an explicit prohibition on such payments in 
     the applicable authorizing statute.

     ``SEC. 412. TUBA CITY DEMONSTRATION PROJECT.

       ``(a) In General.--Notwithstanding any other provision of 
     law, including the Anti-Deficiency Act, provided the Indian 
     tribes to be served approve, the Service in the Tuba City 
     Service Unit may--
       ``(1) enter into a demonstration project with the State of 
     Arizona under which the Service would provide certain 
     specified medicaid services to individuals dually eligible 
     for services from the Service and for medical assistance 
     under title XIX of the Social Security Act in return for 
     payment on a capitated basis from the State of Arizona; and
       ``(2) purchase insurance to limit the financial risks under 
     the project.
       ``(b) Extension of Project.--The demonstration project 
     authorized under subsection (a) may be extended to other 
     service units in Arizona, subject to the approval of the 
     Indian tribes to be served in such service units, the 
     Service, and the State of Arizona.

     ``SEC. 413. ACCESS TO FEDERAL INSURANCE.

       ``Notwithstanding the provisions of title 5, United States 
     Code, Executive Order, or administrative regulation, an 
     Indian tribe or

[[Page S3720]]

     tribal organization carrying out programs under the Indian 
     Self-Determination and Education Assistance Act 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. 414. CONSULTATION AND RULEMAKING.

       ``(a) Consultation.--Prior to the adoption of any policy or 
     regulation by the Health Care Financing Administration, the 
     Secretary shall require the Administrator of that 
     Administration to--
       ``(1) identify the impact such policy or regulation may 
     have on the Service, Indian tribes or tribal organizations, 
     and urban Indian organizations;
       ``(2) provide to the Service, Indian tribes or tribal 
     organizations, and urban Indian organizations the information 
     described in paragraph (1);
       ``(3) engage in consultation, consistent with the 
     requirements of Executive Order 13084 of May 14, 1998, with 
     the Service, Indian tribes or tribal organizations, and urban 
     Indian organizations prior to enacting any such policy or 
     regulation.
       ``(b) Rulemaking.--The Administrator of the Health Care 
     Financing Administration shall participate in the negotiated 
     rulemaking provided for under title VIII with regard to any 
     regulations necessary to implement the provisions of this 
     title that relate to the Social Security Act.

     ``SEC. 415. LIMITATIONS ON CHARGES.

       ``No provider of health services that is eligible to 
     receive payments or reimbursements under titles XVIII, XIX, 
     or XXI of the Social Security Act or from any Federally 
     funded (whether in whole or part) health care program may 
     seek to recover payment for services--
       ``(1) that are covered under and furnished to an individual 
     eligible for the contract health services program operated by 
     the Service, by an Indian tribe or tribal organization, or 
     furnished to an urban Indian eligible for health services 
     purchased by an urban Indian organization, in an amount in 
     excess of the lowest amount paid by any other payor for 
     comparable services; or
       ``(2) for examinations or other diagnostic procedures that 
     are not medically necessary if such procedures have already 
     been performed by the referring Indian health program and 
     reported to the provider.

     ``SEC. 416. LIMITATION ON SECRETARY'S WAIVER AUTHORITY.

       ``Notwithstanding any other provision of law, the Secretary 
     may not waive the application of section 1902(a)(13)(D) of 
     the Social Security Act to any State plan under title XIX of 
     the Social Security Act.

     ``SEC. 417. WAIVER OF MEDICARE AND MEDICAID SANCTIONS.

       ``Notwithstanding any other provision of law, the Service 
     or an Indian tribe or tribal organization or an urban Indian 
     organization operating a health program under the Indian 
     Self-Determination and Education Assistance Act shall be 
     entitled to seek a waiver of sanctions imposed under title 
     XVIII, XIX, or XXI of the Social Security Act as if such 
     entity were directly responsible for administering the State 
     health care program.

     ``SEC. 418. MEANING OF `REMUNERATION' FOR PURPOSES OF SAFE 
                   HARBOR PROVISIONS; ANTITRUST IMMUNITY.

       ``(a) Meaning of Remuneration.--Notwithstanding any other 
     provision of law, the term `remuneration' as used in sections 
     1128A and 1128B of the Social Security Act shall not include 
     any exchange of anything of value between or among--
       ``(1) any Indian tribe or tribal organization or an urban 
     Indian organization that administers health programs under 
     the authority of the Indian Self-Determination and Education 
     Assistance Act;
       ``(2) any such Indian tribe or tribal organization or urban 
     Indian organization and the Service;
       ``(3) any such Indian tribe or tribal organization or urban 
     Indian organization and any patient served or eligible for 
     service under such programs, including patients served or 
     eligible for service pursuant to section 813 of this Act (as 
     in effect on the day before the date of enactment of the 
     Indian Health Care Improvement Act Reauthorization of 2000); 
     or
       ``(4) any such Indian tribe or tribal organization or urban 
     Indian organization and any third party required by contract, 
     section 206 or 207 of this Act (as so in effect), or other 
     applicable law, to pay or reimburse the reasonable health 
     care costs incurred by the United States or any such Indian 
     tribe or tribal organization or urban Indian organization;
     provided the exchange arises from or relates to such health 
     programs.
       ``(b) Antitrust Immunity.--An Indian tribe or tribal 
     organization or an urban Indian organization that administers 
     health programs under the authority of the Indian Self-
     Determination and Education Assistance Act or title V shall 
     be deemed to be an agency of the United States and immune 
     from liability under the Acts commonly known as the Sherman 
     Act, the Clayton Act, the Robinson-Patman Anti-Discrimination 
     Act, the Federal Trade Commission Act, and any other Federal, 
     State, or local antitrust laws, with regard to any 
     transaction, agreement, or conduct that relates to such 
     programs.

     ``SEC. 419. CO-INSURANCE, CO-PAYMENTS, DEDUCTIBLES AND 
                   PREMIUMS.

       ``(a) Exemption From Cost-Sharing Requirements.--
     Notwithstanding any other provision of Federal or State law, 
     no Indian who is eligible for services under title XVIII, 
     XIX, or XXI of the Social Security Act, or under any other 
     Federally funded health care programs, may be charged a 
     deductible, co-payment, or co-insurance for any service 
     provided by or through the Service, an Indian tribe or tribal 
     organization or urban Indian organization, nor may the 
     payment or reimbursement due to the Service or an Indian 
     tribe or tribal organization or urban Indian organization be 
     reduced by the amount of the deductible, co-payment, or co-
     insurance that would be due from the Indian but for the 
     operation of this section. For the purposes of this section, 
     the term `through' shall include services provided directly, 
     by referral, or under contracts or other arrangements between 
     the Service, an Indian tribe or tribal organization or an 
     urban Indian organization and another health provider.
       ``(b) Exemption from Premiums.--
       ``(1) Medicaid and state children's health insurance 
     program.--Notwithstanding any other provision of Federal or 
     State law, no Indian who is otherwise eligible for medical 
     assistance under title XIX of the Social Security Act or 
     child health assistance under title XXI of such Act may be 
     charged a premium as a condition of receiving such assistance 
     under title XIX of XXI of such Act.
       ``(2) Medicare enrollment premium penalties.--
     Notwithstanding section 1839(b) of the Social Security Act or 
     any other provision of Federal or State law, no Indian who is 
     eligible for benefits under part B of title XVIII of the 
     Social Security Act, but for the payment of premiums, shall 
     be charged a penalty for enrolling in such part at a time 
     later than the Indian might otherwise have been first 
     eligible to do so. The preceding sentence applies whether an 
     Indian pays for premiums under such part directly or such 
     premiums are paid by another person or entity, including a 
     State, the Service, an Indian Tribe or tribal organization, 
     or an urban Indian organization.

     ``SEC. 420. INCLUSION OF INCOME AND RESOURCES FOR PURPOSES OF 
                   MEDICALLY NEEDY MEDICAID ELIGIBILITY.

       ``For the purpose of determining the eligibility under 
     section 1902(a)(10)(A)(ii)(IV) of the Social Security Act of 
     an Indian for medical assistance under a State plan under 
     title XIX of such Act, the cost of providing services to an 
     Indian in a health program of the Service, an Indian Tribe or 
     tribal organization, or an urban Indian organization shall be 
     deemed to have been an expenditure for health care by the 
     Indian.

     ``SEC. 421. ESTATE RECOVERY PROVISIONS.

       ``Notwithstanding any other provision of Federal or State 
     law, the following property may not be included when 
     determining eligibility for services or implementing estate 
     recovery rights under title XVIII, XIX, or XXI of the Social 
     Security Act, or any other health care programs funded in 
     whole or part with Federal funds:
       ``(1) Income derived from rents, leases, or royalties of 
     property held in trust for individuals by the Federal 
     Government.
       ``(2) Income derived from rents, leases, royalties, or 
     natural resources (including timber and fishing activities) 
     resulting from the exercise of Federally protected rights, 
     whether collected by an individual or a tribal group and 
     distributed to individuals.
       ``(3) Property, including interests in real property 
     currently or formerly held in trust by the Federal Government 
     which is protected under applicable Federal, State or tribal 
     law or custom from recourse, including public domain 
     allotments.
       ``(4) Property that has unique religious or cultural 
     significance or that supports subsistence or traditional life 
     style according to applicable tribal law or custom.

     ``SEC. 422. MEDICAL CHILD SUPPORT.

       ``Notwithstanding any other provision of law, a parent 
     shall not be responsible for reimbursing the Federal 
     Government or a State for the cost of medical services 
     provided to a child by or through the Service, an Indian 
     tribe or tribal organization or an urban Indian organization. 
     For the purposes of this subsection, the term `through' 
     includes services provided directly, by referral, or under 
     contracts or other arrangements between the Service, an 
     Indian Tribe or tribal organization or an urban Indian 
     organization and another health provider.

     ``SEC. 423. PROVISIONS RELATING TO MANAGED CARE.

       ``(a) Recovery From Managed Care Plans.--Notwithstanding 
     any other provision in law, the Service, an Indian Tribe or 
     tribal organization or an urban Indian organization shall 
     have a right of recovery under section 408 from all private 
     and public health plans or programs, including the medicare, 
     medicaid, and State children's health insurance programs 
     under titles XVIII, XIX, and XXI of the Social Security Act, 
     for the reasonable costs of delivering health services to 
     Indians entitled to receive services from the Service, an 
     Indian Tribe or tribal organization or an urban Indian 
     organization.
       ``(b) Limitation.--No provision of law or regulation, or of 
     any contract, may be relied

[[Page S3721]]

     upon or interpreted to deny or reduce payments otherwise due 
     under subsection (a), except to the extent the Service, an 
     Indian tribe or tribal organization, or an urban Indian 
     organization has entered into an agreement with a managed 
     care entity regarding services to be provided to Indians or 
     rates to be paid for such services, provided that such an 
     agreement may not be made a prerequisite for such payments to 
     be made.
       ``(c) Parity.--Payments due under subsection (a) from a 
     managed care entity may not be paid at a rate that is less 
     than the rate paid to a `preferred provider' by the entity 
     or, in the event there is no such rate, the usual and 
     customary fee for equivalent services.
       ``(d) No Claim Requirement.--A managed care entity may not 
     deny payment under subsection (a) because an enrollee with 
     the entity has not submitted a claim.
       ``(e) Direct Billing.--Notwithstanding the preceding 
     subsections of this section, the Service, an Indian tribe or 
     tribal organization, or an urban Indian organization that 
     provides a health service to an Indian entitled to medical 
     assistance under the State plan under title XIX of the Social 
     Security Act or enrolled in a child health plan under title 
     XXI of such Act shall have the right to be paid directly by 
     the State agency administering such plans notwithstanding any 
     agreements the State may have entered into with managed care 
     organizations or providers.
       ``(f) Requirement For Medicaid Managed Care Entities.--A 
     managed care entity (as defined in section 1932(a)(1)(B) of 
     the Social Security Act shall, as a condition of 
     participation in the State plan under title XIX of such Act, 
     offer a contract to health programs administered by the 
     Service, an Indian tribe or tribal organization or an urban 
     Indian organization that provides health services in the 
     geographic area served by the managed care entity and such 
     contract (or other provider participation agreement) shall 
     contain terms and conditions of participation and payment no 
     more restrictive or onerous than those provided for in this 
     section.
       ``(g) Prohibition.--Notwithstanding any other provision of 
     law or any waiver granted by the Secretary no Indian may be 
     assigned automatically or by default under any managed care 
     entity participating in a State plan under title XIX or XXI 
     of the Social Security Act unless the Indian had the option 
     of enrolling in a managed care plan or health program 
     administered by the Service, an Indian tribe or tribal 
     organization, or an urban Indian organization.
       ``(h) Indian Managed Care Plans.--Notwithstanding any other 
     provision of law, any State entering into agreements with one 
     or more managed care organizations to provide services under 
     title XIX or XXI of the Social Security Act shall enter into 
     such an agreement with the Service, an Indian tribe or tribal 
     organization or an urban Indian organization under which such 
     an entity may provide services to Indians who may be eligible 
     or required to enroll with a managed care organization 
     through enrollment in an Indian managed care organization 
     that provides services similar to those offered by other 
     managed care organizations in the State. The Secretary and 
     the State are hereby authorized to waive requirements 
     regarding discrimination, capitalization, and other matters 
     that might otherwise prevent an Indian managed care 
     organization or health program from meeting Federal or State 
     standards applicable to such organizations, provided such 
     Indian managed care organization or health program offers 
     Indian enrollees services of an equivalent quality to that 
     required of other managed care organizations.
       ``(i) Advertising.--A managed care organization entering 
     into a contract to provide services to Indians on or near an 
     Indian reservation shall provide a certificate of coverage or 
     similar type of document that is written in the Indian 
     language of the majority of the Indian population residing on 
     such reservation.

     ``SEC. 424. NAVAJO NATION MEDICAID AGENCY.

       ``(a) In General.--Notwithstanding any other provision of 
     law, the Secretary may treat the Navajo Nation as a State 
     under title XIX of the Social Security Act for purposes of 
     providing medical assistance to Indians living within the 
     boundaries of the Navajo Nation.
       ``(b) Assignment and Payment.--Notwithstanding any other 
     provision of law, the Secretary may assign and pay all 
     expenditures related to the provision of services to Indians 
     living within the boundaries of the Navajo Nation under title 
     XIX of the Social Security Act (including administrative 
     expenditures) that are currently paid to or would otherwise 
     be paid to the States of Arizona, New Mexico, and Utah, to an 
     entity established by the Navajo Nation and approved by the 
     Secretary, which shall be denominated the Navajo Nation 
     Medicaid Agency.
       ``(c) Authority.--The Navajo Nation Medicaid Agency shall 
     serve Indians living within the boundaries of the Navajo 
     Nation and shall have the same authority and perform the same 
     functions as other State agency responsible for the 
     administration of the State plan under title XIX of the 
     Social Security Act.
       ``(d) Technical Assistance.--The Secretary may directly 
     assist the Navajo Nation in the development and 
     implementation of a Navajo Nation Medicaid Agency for the 
     administration, eligibility, payment, and delivery of medical 
     assistance under title XIX of the Social Security Act (which 
     shall, for purposes of reimbursement to such Nation, include 
     Western and traditional Navajo healing services) within the 
     Navajo Nation. Such assistance may include providing funds 
     for demonstration projects conducted with such Nation.
       ``(e) FMAP.--Notwithstanding section 1905(b) of the Social 
     Security Act, the Federal medical assistance percentage shall 
     be 100 per cent with respect to amounts the Navajo Nation 
     Medicaid agency expends for medical assistance and related 
     administrative costs.
       ``(f) Waiver Authority.--The Secretary shall have the 
     authority to waive applicable provisions of Title XIX of the 
     Social Security Act to establish, develop and implement the 
     Navajo Nation Medicaid Agency.
       ``(g) SCHIP.--At the option of the Navajo Nation, the 
     Secretary may treat the Navajo Nation as a State for purposes 
     of title XXI of the Social Security Act under terms 
     equivalent to those described in the preceding subsections of 
     this section.

     ``SEC. 425. INDIAN ADVISORY COMMITTEES.

       ``(a) National Indian Technical Advisory Group.--The 
     Administrator of the Health Care Financing Administration 
     shall establish and fund the expenses of a National Indian 
     Technical Advisory Group which shall have no fewer than 14 
     members, including at least 1 member designated by the Indian 
     tribes and tribal organizations in each service area, 1 urban 
     Indian organization representative, and 1 member representing 
     the Service. The scope of the activities of such group shall 
     be established under section 802 provided that such scope 
     shall include providing comment on and advice regarding the 
     programs funded under titles XVIII, XIX, and XXI of the 
     Social Security Act or regarding any other health care 
     program funded (in whole or part) by the Health Care 
     Financing Administration.
       ``(b) Indian Medicaid Advisory Committees.--The 
     Administrator of the Health Care Financing Administration 
     shall establish and provide funding for a Indian Medicaid 
     Advisory Committee made up of designees of the Service, 
     Indian tribes and tribal organizations and urban Indian 
     organizations in each State in which the Service directly 
     operates a health program or in which there is one or more 
     Indian tribe or tribal organization or urban Indian 
     organization.

     ``SEC. 426. AUTHORIZATION OF APPROPRIATIONS.

       There is authorized to be appropriated such sums as may be 
     necessary for each of fiscal years 2000 through 2012 to carry 
     out this title.''.

              ``TITLE V--HEALTH SERVICES FOR URBAN INDIANS

     ``SEC. 501. PURPOSE.

       ``The purpose of this title is to establish programs in 
     urban centers to make health services more accessible and 
     available to urban Indians.

     ``SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN INDIAN 
                   ORGANIZATIONS.

       ``Under the authority of the Act of November 2, 1921 (25 
     U.S.C. 13)(commonly known as the Snyder Act), the Secretary, 
     through the Service, shall enter into contracts with, or make 
     grants to, urban Indian organizations to assist such 
     organizations in the establishment and administration, within 
     urban centers, of programs which meet the requirements set 
     forth in this title. The Secretary, through the Service, 
     subject to section 506, shall include such conditions as the 
     Secretary considers necessary to effect the purpose of this 
     title in any contract which the Secretary enters into with, 
     or in any grant the Secretary makes to, any urban Indian 
     organization pursuant to this title.

     ``SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION OF HEALTH 
                   CARE AND REFERRAL SERVICES.

       ``(a) Authority.--Under the authority of 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, and make grants to, urban Indian 
     organizations for the provision of health care and referral 
     services for urban Indians. Any such contract or grant shall 
     include requirements that the urban Indian organization 
     successfully undertake to--
       ``(1) estimate the population of urban Indians residing in 
     the urban center or centers that the organization proposes to 
     serve who are or could be recipients of health care or 
     referral services;
       ``(2) estimate the current health status of urban Indians 
     residing in such urban center or centers;
       ``(3) estimate the current health care needs of urban 
     Indians residing in such urban center or centers;
       ``(4) provide basic health education, including health 
     promotion and disease prevention education, to urban Indians;
       ``(5) make recommendations to the Secretary and Federal, 
     State, local, and other resource agencies on methods of 
     improving health service programs to meet the needs of urban 
     Indians; and
       ``(6) where necessary, provide, or enter into contracts for 
     the provision of, health care services for urban Indians.
       ``(b) Criteria.--The Secretary, acting through the Service, 
     shall by regulation adopted pursuant to section 520 prescribe 
     the criteria for selecting urban Indian organizations to 
     enter into contracts or receive grants under this section. 
     Such criteria shall, among other factors, include--
       ``(1) the extent of unmet health care needs of urban 
     Indians in the urban center or centers involved;

[[Page S3722]]

       ``(2) the size of the urban Indian population in the urban 
     center or centers involved;
       ``(3) the extent, if any, to which the activities set forth 
     in subsection (a) would duplicate any project funded under 
     this title;
       ``(4) the capability of an urban Indian organization to 
     perform the activities set forth in subsection (a) and to 
     enter into a contract with the Secretary or to meet the 
     requirements for receiving a grant under this section;
       ``(5) the satisfactory performance and successful 
     completion by an urban Indian organization of other contracts 
     with the Secretary under this title;
       ``(6) the appropriateness and likely effectiveness of 
     conducting the activities set forth in subsection (a) in an 
     urban center or centers; and
       ``(7) the extent of existing or likely future participation 
     in the activities set forth in subsection (a) by appropriate 
     health and health-related Federal, State, local, and other 
     agencies.
       ``(c) Health Promotion and Disease Prevention.--The 
     Secretary, acting through the Service, shall facilitate 
     access to, or provide, health promotion and disease 
     prevention services for urban Indians through grants made to 
     urban Indian organizations administering contracts entered 
     into pursuant to this section or receiving grants under 
     subsection (a).
       ``(d) Immunization Services.--
       ``(1) In general.--The Secretary, acting through the 
     Service, shall facilitate access to, or provide, immunization 
     services for urban Indians through grants made to urban 
     Indian organizations administering contracts entered into, or 
     receiving grants, under this section.
       ``(3) Definition.--In this section, the term `immunization 
     services' means services to provide without charge 
     immunizations against vaccine-preventable diseases.
       ``(e) Mental Health Services.--
       ``(1) In general.--The Secretary, acting through the 
     Service, shall facilitate access to, or provide, mental 
     health services for urban Indians through grants made to 
     urban Indian organizations administering contracts entered 
     into, or receiving grants, under this section.
       ``(2) Assessment.--A grant may not be made under this 
     subsection to an urban Indian organization until that 
     organization has prepared, and the Service has approved, an 
     assessment of the mental health needs of the urban Indian 
     population concerned, the mental health services and other 
     related resources available to that population, the barriers 
     to obtaining those services and resources, and the needs that 
     are unmet by such services and resources.
       ``(3) Use of funds.--Grants may be made under this 
     subsection--
       ``(A) to prepare assessments required under paragraph (2);
       ``(B) to provide outreach, educational, and referral 
     services to urban Indians regarding the availability of 
     direct behavioral health services, to educate urban Indians 
     about behavioral health issues and services, and effect 
     coordination with existing behavioral health providers in 
     order to improve services to urban Indians;
       ``(C) to provide outpatient behavioral health services to 
     urban Indians, including the identification and assessment of 
     illness, therapeutic treatments, case management, support 
     groups, family treatment, and other treatment; and
       ``(D) to develop innovative behavioral health service 
     delivery models which incorporate Indian cultural support 
     systems and resources.
       ``(f) Child Abuse.--
       ``(1) In general.--The Secretary, acting through the 
     Service, shall facilitate access to, or provide, services for 
     urban Indians through grants to urban Indian organizations 
     administering contracts entered into pursuant to this section 
     or receiving grants under subsection (a) to prevent and treat 
     child abuse (including sexual abuse) among urban Indians.
       ``(2) Assessment.--A grant may not be made under this 
     subsection to an urban Indian organization until that 
     organization has prepared, and the Service has approved, an 
     assessment that documents the prevalence of child abuse in 
     the urban Indian population concerned and specifies the 
     services and programs (which may not duplicate existing 
     services and programs) for which the grant is requested.
       ``(3) Use of funds.--Grants may be made under this 
     subsection--
       ``(A) to prepare assessments required under paragraph (2);
       ``(B) for the development of prevention, training, and 
     education programs for urban Indian populations, including 
     child education, parent education, provider training on 
     identification and intervention, education on reporting 
     requirements, prevention campaigns, and establishing service 
     networks of all those involved in Indian child protection; 
     and
       ``(C) to provide direct outpatient treatment services 
     (including individual treatment, family treatment, group 
     therapy, and support groups) to urban Indians who are child 
     victims of abuse (including sexual abuse) or adult survivors 
     of child sexual abuse, to the families of such child victims, 
     and to urban Indian perpetrators of child abuse (including 
     sexual abuse).
       ``(4) Considerations.--In making grants to carry out this 
     subsection, the Secretary shall take into consideration--
       ``(A) the support for the urban Indian organization 
     demonstrated by the child protection authorities in the area, 
     including committees or other services funded under the 
     Indian Child Welfare Act of 1978 (25 U.S.C. 1901 et seq.), if 
     any;
       ``(B) the capability and expertise demonstrated by the 
     urban Indian organization to address the complex problem of 
     child sexual abuse in the community; and
       ``(C) the assessment required under paragraph (2).
       ``(g) Multiple Urban Centers.--The Secretary, acting 
     through the Service, may enter into a contract with, or make 
     grants to, an urban Indian organization that provides or 
     arranges for the provision of health care services (through 
     satellite facilities, provider networks, or otherwise) to 
     urban Indians in more than one urban center.

     ``SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINATION OF 
                   UNMET HEALTH CARE NEEDS.

       ``(a) Authority.--
       ``(1) In general.--Under authority of the Act of November 
     2, 1921 (25 U.S.C. 13) (commonly known as the Snyder Act), 
     the Secretary, acting through the Service, may enter into 
     contracts with, or make grants to, urban Indian organizations 
     situated in urban centers for which contracts have not been 
     entered into, or grants have not been made, under section 
     503.
       ``(2) Purpose.--The purpose of a contract or grant made 
     under this section shall be the determination of the matters 
     described in subsection (b)(1) in order to assist the 
     Secretary in assessing the health status and health care 
     needs of urban Indians in the urban center involved and 
     determining whether the Secretary should enter into a 
     contract or make a grant under section 503 with respect to 
     the urban Indian organization which the Secretary has entered 
     into a contract with, or made a grant to, under this section.
       ``(b) Requirements.--Any contract entered into, or grant 
     made, by the Secretary under this section shall include 
     requirements that--
       ``(1) the urban Indian organization successfully undertake 
     to--
       ``(A) document the health care status and unmet health care 
     needs of urban Indians in the urban center involved; and
       ``(B) with respect to urban Indians in the urban center 
     involved, determine the matters described in paragraphs (2), 
     (3), (4), and (7) of section 503(b); and
       ``(2) the urban Indian organization complete performance of 
     the contract, or carry out the requirements of the grant, 
     within 1 year after the date on which the Secretary and such 
     organization enter into such contract, or within 1 year after 
     such organization receives such grant, whichever is 
     applicable.
       ``(c) Limitation on Renewal.--The Secretary may not renew 
     any contract entered into, or grant made, under this section.

     ``SEC. 505. EVALUATIONS; RENEWALS.

       ``(a) Procedures.--The Secretary, acting through the 
     Service, shall develop procedures to evaluate compliance with 
     grant requirements under this title and compliance with, and 
     performance of contracts entered into by urban Indian 
     organizations under this title. Such procedures shall include 
     provisions for carrying out the requirements of this section.
       ``(b) Compliance with Terms.--The Secretary, acting through 
     the Service, shall evaluate the compliance of each urban 
     Indian organization which has entered into a contract or 
     received a grant under section 503 with the terms of such 
     contract of grant. For purposes of an evaluation under this 
     subsection, the Secretary, in determining the capacity of an 
     urban Indian organization to deliver quality patient care 
     shall, at the option of the organization--
       ``(1) conduct, through the Service, an annual onsite 
     evaluation of the organization; or
       ``(2) accept, in lieu of an onsite evaluation, evidence of 
     the organization's provisional or full accreditation by a 
     private independent entity recognized by the Secretary for 
     purposes of conducting quality reviews of providers 
     participating in the medicare program under Title XVIII of 
     the Social Security Act.
       ``(c) Noncompliance.--
       ``(1) In general.--If, as a result of the evaluations 
     conducted under this section, the Secretary determines that 
     an urban Indian organization has not complied with the 
     requirements of a grant or complied with or satisfactorily 
     performed a contract under section 503, the Secretary shall, 
     prior to renewing such contract or grant, attempt to resolve 
     with such organization the areas of noncompliance or 
     unsatisfactory performance and modify such contract or grant 
     to prevent future occurrences of such noncompliance or 
     unsatisfactory performance.
       ``(2) Nonrenewal.--If the Secretary determines, under an 
     evaluation under this section, that noncompliance or 
     unsatisfactory performance cannot be resolved and prevented 
     in the future, the Secretary shall not renew such contract or 
     grant with such organization and is authorized to enter into 
     a contract or make a grant under section 503 with another 
     urban Indian organization which is situated in the same urban 
     center as the urban Indian organization whose contract or 
     grant is not renewed under this section.
       ``(d) Determination of Renewal.--In determining whether to 
     renew a contract or grant with an urban Indian organization

[[Page S3723]]

     under section 503 which has completed performance of a 
     contract or grant under section 504, the Secretary shall 
     review the records of the urban Indian organization, the 
     reports submitted under section 507, and, in the case of a 
     renewal of a contract or grant under section 503, shall 
     consider the results of the onsite evaluations or 
     accreditation under subsection (b).

     ``SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS.

       ``(a) Application of Federal Law.--Contracts with urban 
     Indian organizations entered into pursuant to this title 
     shall be in accordance with all Federal contracting laws and 
     regulations relating to procurement except that, in the 
     discretion of the Secretary, such contracts may be negotiated 
     without advertising and need not conform to the provisions of 
     the Act of August 24, 1935 (40 U.S.C. 270a, et seq.).
       ``(b) Payments.--Payments under any contracts or grants 
     pursuant to this title shall, notwithstanding any term or 
     condition of such contract or grant--
       ``(1) be made in their entirety by the Secretary to the 
     urban Indian organization by not later than the end of the 
     first 30 days of the funding period with respect to which the 
     payments apply, unless the Secretary determines through an 
     evaluation under section 505 that the organization is not 
     capable of administering such payments in their entirety; and
       ``(2) if unexpended by the urban Indian organization during 
     the funding period with respect to which the payments 
     initially apply, be carried forward for expenditure with 
     respect to allowable or reimbursable costs incurred by the 
     organization during 1 or more subsequent funding periods 
     without additional justification or documentation by the 
     organization as a condition of carrying forward the 
     expenditure of such funds.
       ``(c) Revising or Amending Contract.--Notwithstanding any 
     provision of law to the contrary, the Secretary may, at the 
     request or consent of an urban Indian organization, revise or 
     amend any contract entered into by the Secretary with such 
     organization under this title as necessary to carry out the 
     purposes of this title.
       ``(d) Fair and Uniform Provision of Services.--Contracts 
     with, or grants to, urban Indian organizations and 
     regulations adopted pursuant to this title shall include 
     provisions to assure the fair and uniform provision to urban 
     Indians of services and assistance under such contracts or 
     grants by such organizations.
       ``(e) Eligibility of Urban Indians.--Urban Indians, as 
     defined in section 4(f), shall be eligible for health care or 
     referral services provided pursuant to this title.

     ``SEC. 507. REPORTS AND RECORDS.

       ``(a) Report.--For each fiscal year during which an urban 
     Indian organization receives or expends funds pursuant to a 
     contract entered into, or a grant received, pursuant to this 
     title, such organization shall submit to the Secretary, on a 
     basis no more frequent than every 6 months, a report 
     including--
       ``(1) in the case of a contract or grant under section 503, 
     information gathered pursuant to paragraph (5) of subsection 
     (a) of such section;
       ``(2) information on activities conducted by the 
     organization pursuant to the contract or grant;
       ``(3) an accounting of the amounts and purposes for which 
     Federal funds were expended; and
       ``(4) a minimum set of data, using uniformly defined 
     elements, that is specified by the Secretary, after 
     consultations consistent with section 514, with urban Indian 
     organizations.
       ``(b) Audits.--The reports and records of the urban Indian 
     organization with respect to a contract or grant under this 
     title shall be subject to audit by the Secretary and the 
     Comptroller General of the United States.
       ``(c) Cost of Audit.--The Secretary shall allow as a cost 
     of any contract or grant entered into or awarded under 
     section 502 or 503 the cost of an annual independent 
     financial audit conducted by--
       ``(1) a certified public accountant; or
       ``(2) a certified public accounting firm qualified to 
     conduct Federal compliance audits.

     ``SEC. 508. LIMITATION ON CONTRACT AUTHORITY.

       ``The authority of the Secretary to enter into contracts or 
     to award grants under this title shall be to the extent, and 
     in an amount, provided for in appropriation Acts.

     ``SEC. 509. FACILITIES.

       ``(a) Grants.--The Secretary may make grants to contractors 
     or grant recipients under this title for the lease, purchase, 
     renovation, construction, or expansion of facilities, 
     including leased facilities, in order to assist such 
     contractors or grant recipients in complying with applicable 
     licensure or certification requirements.
       ``(b) Loans or Loan Guarantees.--The Secretary, acting 
     through the Service or through the Health Resources and 
     Services Administration, may provide loans to contractors or 
     grant recipients under this title from the Urban Indian 
     Health Care Facilities Revolving Loan Fund (referred to in 
     this section as the `URLF') described in subsection (c), or 
     guarantees for loans, for the construction, renovation, 
     expansion, or purchase of health care facilities, subject to 
     the following requirements:
       ``(1) The principal amount of a loan or loan guarantee may 
     cover 100 percent of the costs (other than staffing) relating 
     to the facility, including planning, design, financing, site 
     land development, construction, rehabilitation, renovation, 
     conversion, medical equipment, furnishings, and capital 
     purchase.
       ``(2) The total amount of the principal of loans and loan 
     guarantees, respectively, outstanding at any one time shall 
     not exceed such limitations as may be specified in 
     appropriations Acts.
       ``(3) The loan or loan guarantee may have a term of the 
     shorter of the estimated useful life of the facility, or 25 
     years.
       ``(4) An urban Indian organization may assign, and the 
     Secretary may accept assignment of, the revenue of the 
     organization as security for a loan or loan guarantee under 
     this subsection.
       ``(5) The Secretary shall not collect application, 
     processing, or similar fees from urban Indian organizations 
     applying for loans or loan guarantees under this subsection.
       ``(c) Urban Indian Health Care Facilities Revolving Loan 
     Fund.--
       ``(1) Establishment.--There is established in the Treasury 
     of the United States a fund to be known as the Urban Indian 
     Health Care Facilities Revolving Loan Fund. The URLF shall 
     consist of--
       ``(A) such amounts as may be appropriated to the URLF;
       ``(B) amounts received from urban Indian organizations in 
     repayment of loans made to such organizations under paragraph 
     (2); and
       ``(C) interest earned on amounts in the URLF under 
     paragraph (3).
       ``(2) Use of urlf.--Amounts in the URLF may be expended by 
     the Secretary, acting through the Service or the Health 
     Resources and Services Administration, to make loans 
     available to urban Indian organizations receiving grants or 
     contracts under this title for the purposes, and subject to 
     the requirements, described in subsection (b). Amounts 
     appropriated to the URLF, amounts received from urban Indian 
     organizations in repayment of loans, and interest on amounts 
     in the URLF shall remain available until expended.
       ``(3) Investments.--The Secretary of the Treasury shall 
     invest such amounts of the URLF as such Secretary determines 
     are not required to meet current withdrawals from the URLF. 
     Such investments may be made only in interest-bearing 
     obligations of the United States. For such purpose, such 
     obligations may be acquired on original issue at the issue 
     price, or by purchase of outstanding obligations at the 
     market price. Any obligation acquired by the URLF may be sold 
     by the Secretary of the Treasury at the market price.

     ``SEC. 510. OFFICE OF URBAN INDIAN HEALTH.

       ``There is hereby established within the Service an Office 
     of Urban Indian Health which shall be responsible for--
       ``(1) carrying out the provisions of this title;
       ``(2) providing central oversight of the programs and 
     services authorized under this title; and
       ``(3) providing technical assistance to urban Indian 
     organizations.

     ``SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE RELATED 
                   SERVICES.

       ``(a) Grants.--The Secretary may make grants for the 
     provision of health-related services in prevention of, 
     treatment of, rehabilitation of, or school and community-
     based education in, alcohol and substance abuse in urban 
     centers to those urban Indian organizations with whom the 
     Secretary has entered into a contract under this title or 
     under section 201.
       ``(b) Goals of Grant.--Each grant made pursuant to 
     subsection (a) shall set forth the goals to be accomplished 
     pursuant to the grant. The goals shall be specific to each 
     grant as agreed to between the Secretary and the grantee.
       ``(c) Criteria.--The Secretary shall establish criteria for 
     the grants made under subsection (a), including criteria 
     relating to the--
       ``(1) size of the urban Indian population;
       ``(2) capability of the organization to adequately perform 
     the activities required under the grant;
       ``(3) satisfactory performance standards for the 
     organization in meeting the goals set forth in such grant, 
     which standards shall be negotiated and agreed to between the 
     Secretary and the grantee on a grant-by-grant basis; and
       ``(4) identification of need for services.
     The Secretary shall develop a methodology for allocating 
     grants made pursuant to this section based on such criteria.
       ``(d) Treatment of Funds Received by Urban Indian 
     Organizations.--Any funds received by an urban Indian 
     organization under this Act for substance abuse prevention, 
     treatment, and rehabilitation shall be subject to the 
     criteria set forth in subsection (c).

     ``SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION PROJECTS.

       ``(a) Oklahoma City Clinic.--
       ``(1) In general.--Notwithstanding any other provision of 
     law, the Oklahoma City Clinic demonstration project shall be 
     treated as a service unit in the allocation of resources and 
     coordination of care and shall not be subject to the 
     provisions of the Indian Self-Determination and Education 
     Assistance Act for the term of such projects. The Secretary 
     shall provide assistance to such projects in the development 
     of resources and equipment and facility needs.
       ``(2) Report.--The Secretary shall submit to the President, 
     for inclusion in the report

[[Page S3724]]

     required to be submitted to the Congress under section 801 
     for fiscal year 1999, a report on the findings and 
     conclusions derived from the demonstration project specified 
     in paragraph (1).
       ``(b) Tulsa Clinic.--Notwithstanding any other provision of 
     law, the Tulsa Clinic demonstration project shall become a 
     permanent program within the Service's direct care program 
     and continue to be treated as a service unit in the 
     allocation of resources and coordination of care, and shall 
     continue to meet the requirements and definitions of an urban 
     Indian organization in this title, and as such will not be 
     subject to the provisions of the Indian Self-Determination 
     and Education Assistance Act.

     ``SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS.

       ``(a) Grants and Contracts.--The Secretary, acting through 
     the Office of Urban Indian Health of the Service, shall make 
     grants or enter into contracts, effective not later than 
     September 30, 2001, with urban Indian organizations for the 
     administration of urban Indian alcohol programs that were 
     originally established under the National Institute on 
     Alcoholism and Alcohol Abuse (referred to in this section to 
     as `NIAAA') and transferred to the Service.
       ``(b) Use of Funds.--Grants provided or contracts entered 
     into under this section shall be used to provide support for 
     the continuation of alcohol prevention and treatment services 
     for urban Indian populations and such other objectives as are 
     agreed upon between the Service and a recipient of a grant or 
     contract under this section.
       ``(c) Eligibility.--Urban Indian organizations that operate 
     Indian alcohol programs originally funded under NIAAA and 
     subsequently transferred to the Service are eligible for 
     grants or contracts under this section.
       ``(d) Evaluation and Report.--The Secretary shall evaluate 
     and report to the Congress on the activities of programs 
     funded under this section at least every 5 years.

     ``SEC. 514. CONSULTATION WITH URBAN INDIAN ORGANIZATIONS.

       ``(a) In General.--The Secretary shall ensure that the 
     Service, the Health Care Financing Administration, and other 
     operating divisions and staff divisions of the Department 
     consult, to the maximum extent practicable, with urban Indian 
     organizations (as defined in section 4) prior to taking any 
     action, or approving Federal financial assistance for any 
     action of a State, that may affect urban Indians or urban 
     Indian organizations.
       ``(b) Requirement.--In subsection (a), the term 
     `consultation' means the open and free exchange of 
     information and opinion among urban Indian organizations and 
     the operating and staff divisions of the Department which 
     leads to mutual understanding and comprehension and which 
     emphasizes trust, respect, and shared responsibility.

     ``SEC. 515. FEDERAL TORT CLAIMS ACT COVERAGE.

       ``For purposes of section 224 of the Public Health Service 
     Act (42 U.S.C. 233), with respect to claims by any person, 
     initially filed on or after October 1, 1999, whether or not 
     such person is an Indian or Alaska Native or is served on a 
     fee basis or under other circumstances as permitted by 
     Federal law or regulations, for personal injury (including 
     death) resulting from the performance prior to, including, or 
     after October 1, 1999, of medical, surgical, dental, or 
     related functions, including the conduct of clinical studies 
     or investigations, or for purposes of section 2679 of title 
     28, United States Code, with respect to claims by any such 
     person, on or after October 1, 1999, for personal injury 
     (including death) resulting from the operation of an 
     emergency motor vehicle, an urban Indian organization that 
     has entered into a contract or received a grant pursuant to 
     this title is deemed to be part of the Public Health Service 
     while carrying out any such contract or grant and its 
     employees (including those acting on behalf of the 
     organization as provided for in section 2671 of title 28, 
     United States Code, and including an individual who provides 
     health care services pursuant to a personal services contract 
     with an urban Indian organization for the provision of 
     services in any facility owned, operated, or constructed 
     under the jurisdiction of the Indian Health Service) are 
     deemed employees of the Service while acting within the scope 
     of their employment in carrying out the contract or grant, 
     except that such employees shall be deemed to be acting 
     within the scope of their employment in carrying out the 
     contract or grant when they are required, by reason of their 
     employment, to perform medical, surgical, dental or related 
     functions at a facility other than a facility operated by the 
     urban Indian organization pursuant to such contract or grant, 
     but only if such employees are not compensated for the 
     performance of such functions by a person or entity other 
     than the urban Indian organization.

     ``SEC. 516. URBAN YOUTH TREATMENT CENTER DEMONSTRATION.

       ``(a) Construction and Operation.--The Secretary, acting 
     through the Service, shall, through grants or contracts, make 
     payment for the construction and operation of at least 2 
     residential treatment centers in each State described in 
     subsection (b) to demonstrate the provision of alcohol and 
     substance abuse treatment services to urban Indian youth in a 
     culturally competent residential setting.
       ``(b) States.--A State described in this subsection is a 
     State in which--
       ``(1) there reside urban Indian youth with a need for 
     alcohol and substance abuse treatment services in a 
     residential setting; and
       ``(2) there is a significant shortage of culturally 
     competent residential treatment services for urban Indian 
     youth.

     ``SEC. 517. USE OF FEDERAL GOVERNMENT FACILITIES AND SOURCES 
                   OF SUPPLY.

       ``(a) In General.--The Secretary shall permit an urban 
     Indian organization that has entered into a contract or 
     received a grant pursuant to this title, in carrying out such 
     contract or grant, to use existing facilities and all 
     equipment therein or pertaining thereto and other personal 
     property owned by the Federal Government within the 
     Secretary's jurisdiction under such terms and conditions as 
     may be agreed upon for their use and maintenance.
       ``(b) Donation of Property.--Subject to subsection (d), the 
     Secretary may donate to an urban Indian organization that has 
     entered into a contract or received a grant pursuant to this 
     title any personal or real property determined to be excess 
     to the needs of the Service or the General Services 
     Administration for purposes of carrying out the contract or 
     grant.
       ``(c) Acquisition of Property.--The Secretary may acquire 
     excess or surplus government personal or real property for 
     donation, subject to subsection (d), to an urban Indian 
     organization that has entered into a contract or received a 
     grant pursuant to this title if the Secretary determines that 
     the property is appropriate for use by the urban Indian 
     organization for a purpose for which a contract or grant is 
     authorized under this title.
       ``(d) Priority.--In the event that the Secretary receives a 
     request for a specific item of personal or real property 
     described in subsections (b) or (c) from an urban Indian 
     organization and from an Indian tribe or tribal organization, 
     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 date on which the Secretary transfers 
     title to the property or, if earlier, the date on which the 
     Secretary transfers the property physically, to the urban 
     Indian organization.
       ``(e) Relation to Federal Sources of Supply.--For purposes 
     of section 201(a) of the Federal Property and Administrative 
     Services Act of 1949 (40 U.S.C. 481(a)) (relating to Federal 
     sources of supply, including lodging providers, airlines, and 
     other transportation providers), an urban Indian organization 
     that has entered into a contract or received a grant pursuant 
     to this title shall be deemed an executive agency when 
     carrying out such contract or grant, and the employees of the 
     urban Indian organization shall be eligible to have access to 
     such sources of supply on the same basis as employees of an 
     executive agency have such access.

     ``SEC. 518. GRANTS FOR DIABETES PREVENTION, TREATMENT AND 
                   CONTROL.

       ``(a) Authority.--The Secretary may make grants to those 
     urban Indian organizations that have entered into a contract 
     or have received a grant under this title for the provision 
     of services for the prevention, treatment, and control of the 
     complications resulting from, diabetes among urban Indians.
       ``(b) Goals.--Each grant made pursuant to subsection (a) 
     shall set forth the goals to be accomplished under the grant. 
     The goals shall be specific to each grant as agreed upon 
     between the Secretary and the grantee.
       ``(c) Criteria.--The Secretary shall establish criteria for 
     the awarding of grants made under subsection (a) relating 
     to--
       ``(1) the size and location of the urban Indian population 
     to be served;
       ``(2) the need for the prevention of, treatment of, and 
     control of the complications resulting from diabetes among 
     the urban Indian population to be served;
       ``(3) performance standards for the urban Indian 
     organization in meeting the goals set forth in such grant 
     that are negotiated and agreed to by the Secretary and the 
     grantee;
       ``(4) the capability of the urban Indian organization to 
     adequately perform the activities required under the grant; 
     and
       ``(5) the willingness of the urban Indian organization to 
     collaborate with the registry, if any, established by the 
     Secretary under section 204(e) in the area office of the 
     Service in which the organization is located.
       ``(d) Application of Criteria.--Any funds received by an 
     urban Indian organization under this Act for the prevention, 
     treatment, and control of diabetes among urban Indians shall 
     be subject to the criteria developed by the Secretary under 
     subsection (c).

     ``SEC. 519. COMMUNITY HEALTH REPRESENTATIVES.

       ``The Secretary, acting through the Service, may enter into 
     contracts with, and make grants to, urban Indian 
     organizations for the use of Indians trained as health 
     service providers through the Community Health 
     Representatives Program under section 107(b) in the provision 
     of health care, health promotion, and disease prevention 
     services to urban Indians.

     ``SEC. 520. REGULATIONS.

       ``(a) Effect of Title.--This title shall be effective on 
     the date of enactment of this Act regardless of whether the 
     Secretary has promulgated regulations implementing this 
     title.
       ``(b) Promulgation.--
       ``(1) In general.--The Secretary may promulgate regulations 
     to implement the provisions of this title.

[[Page S3725]]

       ``(2) Publication.--Proposed regulations to implement this 
     title shall be published by the Secretary in the Federal 
     Register not later than 270 days after the date of enactment 
     of this Act and shall have a comment period of not less than 
     120 days.
       ``(3) Expiration of authority.--The authority to promulgate 
     regulations under this title shall expire on the date that is 
     18 months after the date of enactment of this Act.
       ``(c) Negotiated Rulemaking Committee.--A negotiated 
     rulemaking committee shall be established pursuant to section 
     565 of Title 5, United States Code, to carry out this section 
     and shall, in addition to Federal representatives, have as 
     the majority of its members representatives of urban Indian 
     organizations from each service area.
       ``(d) Adaption of Procedures.--The Secretary shall adapt 
     the negotiated rulemaking procedures to the unique context of 
     this Act.

     ``SEC. 521. AUTHORIZATION OF APPROPRIATIONS.

       ``There is authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2012 to 
     carry out this title.

                ``TITLE VI--ORGANIZATIONAL IMPROVEMENTS

     ``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) Assistant secretary of indian health.--The Service 
     shall be administered by an Assistance Secretary of Indian 
     Health, who shall be appointed by the President, by and with 
     the advice and consent of the Senate. The Assistant Secretary 
     shall report to the Secretary. Effective with respect to an 
     individual appointed by the President, by and with the advice 
     and consent of the Senate, after January 1, 1993, the term of 
     service of the Assistant Secretary shall be 4 years. An 
     Assistant Secretary may serve more than 1 term.
       ``(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) Functions and Duties.--The Secretary shall carry out 
     through the Assistant Secretary of the Service--
       ``(1) all functions which were, on the day before the date 
     of enactment of the Indian Health Care Amendments of 1988, 
     carried out by or under the direction of the individual 
     serving as Director of the Service on such day;
       ``(2) 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;
       ``(3) 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 Act (25 U.S.C. 450f, et 
     seq.); and
       ``(4) all scholarship and loan functions carried out under 
     title I.
       ``(d) Authority.--
       ``(1) in general.--The Secretary, acting through the 
     Assistant Secretary, 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. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM.

       ``(a) Establishment.--
       ``(1) In general.--The Secretary, in consultation with 
     tribes, tribal organizations, and urban Indian organizations, 
     shall establish an automated management information system 
     for the Service.
       ``(2) Requirements of system.--The information system 
     established under paragraph (1) shall include--
       ``(A) a financial management system;
       ``(B) a patient care information system;
       ``(C) a privacy component that protects the privacy of 
     patient information;
       ``(D) a services-based cost accounting component that 
     provides estimates of the costs associated with the provision 
     of specific medical treatments or services in each area 
     office of the Service;
       ``(E) an interface mechanism for patient billing and 
     accounts receivable system; and
       ``(F) a training component.
       ``(b) Provision of Systems to Tribes and Organizations.--
     The Secretary shall provide each Indian tribe and tribal 
     organization that provides health services under a contract 
     entered into with the Service under the Indian Self-
     Determination Act automated management information systems 
     which--
       ``(1) meet the management information needs of such Indian 
     tribe or tribal organization with respect to the treatment by 
     the Indian tribe or tribal organization of patients of the 
     Service; and
       ``(2) meet the management information needs of the Service.
       ``(c) Access to Records.--Notwithstanding any other 
     provision of law, each patient shall have reasonable access 
     to the medical or health records of such patient which are 
     held by, or on behalf of, the Service.
       ``(d) Authority to Enhance Information Technology.--The 
     Secretary, acting through the Assistant Secretary, shall have 
     the authority to enter into contracts, agreements or joint 
     ventures with other Federal agencies, States, private and 
     nonprofit organizations, for the purpose of enhancing 
     information technology in Indian health programs and 
     facilities.

     ``SEC. 603. AUTHORIZATION OF APPROPRIATIONS.

       ``There is authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2012 to 
     carry out this title.

                ``TITLE VII--BEHAVIORAL HEALTH PROGRAMS

     ``SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREATMENT 
                   SERVICES.

       ``(a) Purposes.--It is the purpose of this section to--
       ``(1) authorize and direct the Secretary, acting through 
     the Service, Indian tribes, tribal organizations, and urban 
     Indian organizations to develop a comprehensive behavioral 
     health prevention and treatment program which emphasizes 
     collaboration among alcohol and substance abuse, social 
     services, and mental health programs;
       ``(2) 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) assist Indian tribes to identify services and 
     resources available to address mental illness and 
     dysfunctional and self-destructive behavior;
       ``(4) provide authority and opportunities for Indian tribes 
     to develop and implement, and coordinate with, community-
     based programs which include identification, prevention, 
     education, referral, and treatment services, including 
     through multi-disciplinary resource teams;
       ``(5) 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; and
       ``(6) modify or supplement existing programs and 
     authorities in the areas identified in paragraph (2).
       ``(b) Behavioral Health Planning.--
       ``(1) Area-wide plans.--The Secretary, acting through the 
     Service, Indian tribes, tribal organizations, and urban 
     Indian organizations, shall encourage Indian tribes and 
     tribal organizations to develop tribal plans, encourage urban 
     Indian organizations to develop local plans, and encourage 
     all such groups to participate in developing area-wide plans 
     for Indian Behavioral Health Services. The plans shall, to 
     the extent feasible, include--
       ``(A) an assessment of the scope of the problem of alcohol 
     or other substance abuse, mental illness, 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; and
       ``(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); and
       ``(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 shall 
     establish a national clearinghouse of plans and reports on 
     the outcomes of such plans developed under this section by 
     Indian tribes, tribal organizations and by areas relating to 
     behavioral health. The Secretary shall ensure access to such 
     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 
     utilized and adopted locally.

[[Page S3726]]

       ``(c) Continuum of Care.--The Secretary, acting through the 
     Service, Indian tribes and tribal organizations, shall 
     provide, to the extent feasible and to the extent that 
     funding is available, for the implementation of programs 
     including--
       ``(1) a comprehensive continuum of behavioral health care 
     that provides for--
       ``(A) community based prevention, intervention, outpatient 
     and behavioral health aftercare;
       ``(B) detoxification (social and medical);
       ``(C) acute hospitalization;
       ``(D) intensive outpatient or day treatment;
       ``(E) residential treatment;
       ``(F) transitional living for those needing a temporary 
     stable living environment that is supportive of treatment or 
     recovery goals;
       ``(G) emergency shelter;
       ``(H) intensive case management; and
       ``(I) traditional health care practices; and
       ``(2) behavioral health services for particular 
     populations, including--
       ``(A) for persons from birth through age 17, child 
     behavioral health services, that include--
       ``(i) pre-school and school age fetal alcohol disorder 
     services, including assessment and behavioral intervention);
       ``(ii) mental health or substance abuse services 
     (emotional, organic, alcohol, drug, inhalant and tobacco);
       ``(iii) services for co-occurring disorders (multiple 
     diagnosis);
       ``(iv) prevention services that are focused on individuals 
     ages 5 years through 10 years (alcohol, drug, inhalant and 
     tobacco);
       ``(v) early intervention, treatment and aftercare services 
     that are focused on individuals ages 11 years through 17 
     years;
       ``(vi) healthy choices or life style services (related to 
     STD's, domestic violence, sexual abuse, suicide, teen 
     pregnancy, obesity, and other risk or safety issues);
       ``(vii) co-morbidity services;
       ``(B) for persons ages 18 years through 55 years, adult 
     behavioral health services that include--
       ``(i) early intervention, treatment and aftercare services;
       ``(ii) mental health and substance abuse services 
     (emotional, alcohol, drug, inhalant and tobacco);
       ``(iii) services for co-occurring disorders (dual 
     diagnosis) and co-morbidity;
       ``(iv) healthy choices and life style services (related to 
     parenting, partners, domestic violence, sexual abuse, 
     suicide, obesity, and other risk related behavior);
       ``(v) female specific treatment services for--

       ``(I) women at risk of giving birth to a child with a fetal 
     alcohol disorder;
       ``(II) substance abuse requiring gender specific services;
       ``(III) sexual assault and domestic violence; and
       ``(IV) healthy choices and life style (parenting, partners, 
     obesity, suicide and other related behavioral risk); and

       ``(vi) male specific treatment services for--

       ``(I) substance abuse requiring gender specific services;
       ``(II) sexual assault and domestic violence; and
       ``(III) healthy choices and life style (parenting, 
     partners, obesity, suicide and other risk related behavior);

       ``(C) family behavioral health services, including--
       ``(i) early intervention, treatment and aftercare for 
     affected families;
       ``(ii) treatment for sexual assault and domestic violence; 
     and
       ``(iii) healthy choices and life style (related to 
     parenting, partners, domestic violence and other abuse 
     issues);
       ``(D) for persons age 56 years and older, elder behavioral 
     health services including--
       ``(i) early intervention, treatment and aftercare services 
     that include--

       ``(I) mental health and substance abuse services 
     (emotional, alcohol, drug, inhalant and tobacco);
       ``(II) services for co-occurring disorders (dual diagnosis) 
     and co-morbidity; and
       ``(III) healthy choices and life style services (managing 
     conditions related to aging);

       ``(ii) elder women specific services that include--

       ``(I) treatment for substance abuse requiring gender 
     specific services and
       ``(II) treatment for sexual assault, domestic violence and 
     neglect;

       ``(iii) elder men specific services that include--

       ``(I) treatment for substance abuse requiring gender 
     specific services; and
       ``(II) treatment for sexual assault, domestic violence and 
     neglect; and

       ``(iv) services for dementia regardless of cause.
       ``(d) Community Behavioral Health Plan.--
       ``(1) In general.--The governing body of any Indian tribe 
     or tribal organization or urban Indian organization may, at 
     its discretion, 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 alcohol and other 
     substance abuse, mental illness or dysfunctional and self-
     destructive behavior, including child abuse and family 
     violence, among its members or its service population. Such 
     plan should include behavioral health services, social 
     services, intensive outpatient services, and continuing after 
     care.
       ``(2) Technical assistance.--In furtherance of a plan 
     established pursuant to paragraph (1) and at the request of a 
     tribe, the appropriate agency, service unit, or other 
     officials of the Bureau of Indian Affairs and the Service 
     shall cooperate with, and provide technical assistance to, 
     the Indian tribe or tribal organization in the development of 
     a plan under paragraph (1). Upon the establishment of such a 
     plan and at the request of the Indian tribe or tribal 
     organization, such officials shall cooperate with the Indian 
     tribe or tribal organization in the implementation of such 
     plan.
       ``(3) Funding.--The Secretary, acting through the Service, 
     may make funding available to Indian tribes and tribal 
     organizations adopting 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) Coordinated Planning.--The Secretary, acting through 
     the Service, Indian tribes, tribal organizations, and urban 
     Indian organizations shall coordinate behavioral health 
     planning, to the extent feasible, with other Federal and 
     State agencies, to ensure that comprehensive behavioral 
     health services are available to Indians without regard to 
     their place of residence.
       ``(f) Facilities Assessment.--Not later than 1 year after 
     the date of enactment of this Act, 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, 
     under-utilized service hospital beds into psychiatric units 
     to meet such need.

     ``SEC. 702. MEMORANDUM OF AGREEMENT WITH THE DEPARTMENT OF 
                   THE INTERIOR.

       ``(a) In General.--Not later than 1 year days after the 
     date of enactment of this Act, the Secretary and the 
     Secretary of the Interior shall develop and enter into a 
     memorandum of agreement, or review and update any existing 
     memoranda of agreement as required under section 4205 of the 
     Indian Alcohol and Substance Abuse Prevention and Treatment 
     Act of 1986 (25 U.S.C. 2411), and under which the Secretaries 
     address--
       ``(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 mental 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 mental health services to which all citizens have access;
       ``(B) the right of Indians to participate in, and receive 
     the benefit of, such services; and
       ``(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 health identification, 
     prevention, education, referral, and treatment services 
     (including services through multidisciplinary resource 
     teams), at the central, area, and agency and service unit 
     levels to address the problems identified in paragraph (1);
       ``(6) a strategy for the comprehensive coordination of the 
     mental health services provided by the Bureau of Indian 
     Affairs and the Service to meet the needs identified pursuant 
     to paragraph (1), including--
       ``(A) the coordination of alcohol and substance abuse 
     programs of the Service, the Bureau of Indian Affairs, and 
     the various Indian tribes (developed under the Indian Alcohol 
     and Substance Abuse Prevention and Treatment Act of 1986) 
     with the mental health initiatives pursuant to this Act, 
     particularly with respect to the referral and treatment of 
     dually-diagnosed individuals requiring mental health and 
     substance abuse treatment; and
       ``(B) ensuring that 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) direct appropriate officials of the Bureau of Indian 
     Affairs and the Service, particularly at the agency and 
     service unit levels, to cooperate fully with tribal requests 
     made pursuant to community behavioral health plans adopted 
     under section 701(c) and section 4206 of the Indian Alcohol 
     and Substance Abuse Prevention and Treatment Act of 1986 (25 
     U.S.C. 2412); and
       ``(8) provide for an annual review of such agreement by the 
     2 Secretaries and a report which shall be submitted to 
     Congress and made available to the Indian tribes.
       ``(b) Specific Provisions.--The memorandum 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 Indian people, 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;

[[Page S3727]]

       ``(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) Consultation.--The Secretary and the Secretary of the 
     Interior shall, in developing the memorandum of agreement 
     under subsection (a), consult with and solicit the comments 
     of--
       ``(1) Indian tribes and tribal organizations;
       ``(2) Indian individuals;
       ``(3) urban Indian organizations and other Indian 
     organizations;
       ``(4) behavioral health service providers.
       ``(d) Publication.--The memorandum of agreement under 
     subsection (a) shall be published in the Federal Register. At 
     the same time as the publication of such agreement in the 
     Federal Register, the Secretary shall provide a copy of such 
     memorandum to each Indian tribe, tribal organization, and 
     urban Indian organization.

     ``SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PREVENTION AND 
                   TREATMENT PROGRAM.

       ``(a) Establishment.--
       ``(1) In general.--The Secretary, acting through the 
     Service, Indian tribes and tribal organizations consistent 
     with section 701, shall provide a program of comprehensive 
     behavioral health prevention and treatment and aftercare, 
     including traditional health care practices, which shall 
     include--
       ``(A) prevention, through educational intervention, in 
     Indian communities;
       ``(B) acute detoxification or psychiatric hospitalization 
     and treatment (residential and intensive outpatient);
       ``(C) community-based rehabilitation and aftercare;
       ``(D) community education and involvement, including 
     extensive training of health care, educational, and 
     community-based personnel; and
       ``(E) specialized residential treatment programs for high 
     risk populations including pregnant and post partum women and 
     their children.
       ``(2) Target populations.--The target population of the 
     program under paragraph (1) shall be members of Indian 
     tribes. Efforts to train and educate key members of the 
     Indian community shall 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 (with the consent of the Indian tribe to be served), 
     Indian tribes and tribal organizations, may enter into 
     contracts with public or private providers of behavioral 
     health treatment services for the purpose of carrying out the 
     program required under subsection (a).
       ``(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. 704. MENTAL HEALTH TECHNICIAN PROGRAM.

       ``(a) In General.--Under the authority of 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) Training.--In carrying out subsection (a)(1), the 
     Secretary 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.--The Secretary shall 
     supervise and evaluate the mental health technicians in the 
     training program under this section.
       ``(d) Traditional Care.--The Secretary shall ensure that 
     the program established pursuant to this section involves the 
     utilization and promotion of the traditional Indian health 
     care and treatment practices of the Indian tribes to be 
     served.-

     ``SEC. 705. LICENSING REQUIREMENT FOR MENTAL HEALTH CARE 
                   WORKERS.

       ``Subject to section 220, any person employed as a 
     psychologist, social worker, or marriage and family therapist 
     for the purpose of providing mental health care services to 
     Indians in a clinical setting under the authority of this Act 
     or through a funding agreement pursuant to the Indian Self-
     Determination and Education Assistance Act shall--
       ``(1) in the case of a person employed as a psychologist to 
     provide health care services, be licensed as a clinical or 
     counseling psychologist, or working under the direct 
     supervision of a clinical or counseling psychologist;
       ``(2) in the case of a person employed as a social worker, 
     be licensed as a social worker or working under the direct 
     supervision of a licensed social worker; or
       ``(3) in the case of a person employed as a marriage and 
     family therapist, be licensed as a marriage and family 
     therapist or working under the direct supervision of a 
     licensed marriage and family therapist.

     ``SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.

       ``(a) Funding.--The Secretary, consistent with section 701, 
     shall make funding available to Indian tribes, tribal 
     organizations and urban Indian organization to develop and 
     implement a comprehensive behavioral health program of 
     prevention, intervention, treatment, and relapse prevention 
     services that specifically addresses the spiritual, cultural, 
     historical, social, and child care needs of Indian women, 
     regardless of age.
       ``(b) Use of Funds.--Funding provided pursuant to this 
     section may be used to--
       ``(1) develop and provide community training, education, 
     and prevention programs for Indian women relating to 
     behavioral health issues, including fetal alcohol disorders;
       ``(2) identify and provide psychological services, 
     counseling, advocacy, support, and relapse prevention to 
     Indian women and their families; and
       ``(3) 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) Earmark of Certain Funds.--Twenty percent of the 
     amounts appropriated to carry out this section shall be used 
     to make grants to urban Indian organizations funded under 
     title V.

     ``SEC. 707. INDIAN YOUTH PROGRAM.

       ``(a) Detoxification and Rehabilitation.--The Secretary 
     shall, consistent with section 701, develop and implement a 
     program for acute detoxification and treatment for Indian 
     youth that includes 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. 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, Indian tribes, or tribal organizations, shall 
     construct, renovate, or, as necessary, purchase, and 
     appropriately staff and operate, at least 1 youth regional 
     treatment center or treatment network in each area under the 
     jurisdiction of an area office.
       ``(B) Area office in california.--For 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 
     centers or facilities under this subsection, funding shall be 
     made available pursuant to the Act of November 2, 1921 (25 
     U.S.C. 13) (commonly known as the Snyder Act).
       ``(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) that is agreed upon (by appropriate tribal 
     resolution) by a majority of the 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;
       ``(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));
       ``(iii) the Southern Indian Health Council, for the purpose 
     of staffing, operating, and maintaining a residential youth 
     treatment facility in San Diego County, California; and
       ``(iv) the Navajo Nation, for the staffing, operation, and 
     maintenance of the Four Corners Regional Adolescent Treatment 
     Center, a residential youth treatment facility in New Mexico.
       ``(B) Provision of services to eligible youth.--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 youth 
     residing in such State.
       ``(c) Intermediate Adolescent Behavioral Health Services.--
       ``(1) In general.--The Secretary, acting through the 
     Service, Indian Tribes and tribal

[[Page S3728]]

     organizations, may provide intermediate behavioral health 
     services, which may incorporate traditional health care 
     practices, to Indian children and adolescents, including--
       ``(A) pre-treatment assistance;
       ``(B) inpatient, outpatient, and after-care 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; and
       ``(D) to make renovations and hire appropriate staff to 
     convert existing hospital beds into adolescent psychiatric 
     units; and
       ``(E) intensive home and community based services.
       ``(3) Criteria.--The Secretary 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, acting through the 
     Service, shall, in consultation with Indian tribes and tribal 
     organizations--
       ``(A) identify and use, where appropriate, federally owned 
     structures suitable for local residential or regional 
     behavioral health treatment for Indian youth; and
       ``(B) establish guidelines, in consultation with Indian 
     tribes and tribal organizations, for determining the 
     suitability of any such Federally owned structure to be used 
     for local residential or regional behavioral health treatment 
     for Indian youth.
       ``(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, an Indian tribe or tribal 
     organization, 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 youth who have significant behavioral health 
     problems, and require long-term treatment, community 
     reintegration, and monitoring to support the Indian youth 
     after their return to their home community.
       ``(2) Administration.--Services under paragraph (1) shall 
     be administered within each service unit or tribal program by 
     trained staff within the community who can assist the Indian 
     youth in 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 youth 
     authorized by this section, the Secretary, an Indian tribe or 
     tribal organization shall provide for the inclusion of family 
     members of such youth 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, Indian tribes, tribal organizations and 
     urban Indian organizations, shall provide, consistent with 
     section 701, programs and services to prevent and treat the 
     abuse of multiple forms of substances, including alcohol, 
     drugs, inhalants, and tobacco, among Indian youth residing in 
     Indian communities, on Indian reservations, and in urban 
     areas and provide appropriate mental health services to 
     address the incidence of mental illness among such youth.

     ``SEC. 708. INPATIENT AND COMMUNITY-BASED MENTAL HEALTH 
                   FACILITIES DESIGN, CONSTRUCTION AND STAFFING 
                   ASSESSMENT. --

       ``(a) In General.--Not later than 1 year after the date of 
     enactment of this section, the Secretary, acting through the 
     Service, Indian tribes and tribal organizations, shall 
     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.
       ``(b) Treatment of California.--For purposes of this 
     section, California shall be considered to be 2 areas of the 
     Service, 1 area whose location shall be considered to 
     encompass the northern area of the State of California and 1 
     area whose jurisdiction shall be considered to encompass the 
     remainder of the State of California.
       ``(c) Conversion of Certain Hospital Beds.--The Secretary 
     shall consider the possible conversion of existing, under-
     utilized Service hospital beds into psychiatric units to meet 
     needs under this section.-

     ``SEC. 709. TRAINING AND COMMUNITY EDUCATION.

       ``(a) Community Education.--
       ``(1) In general.--The Secretary, in cooperation with the 
     Secretary of the Interior, shall develop and implement, or 
     provide funding to enable Indian tribes and tribal 
     organization 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.
       ``(2) Education.--A program under paragraph (1) shall 
     include education concerning behavioral health for political 
     leaders, tribal judges, law enforcement personnel, members of 
     tribal health and education boards, and other critical 
     members of each tribal community.
       ``(3) Training.--Community-based training (oriented toward 
     local capacity development) under a program under paragraph 
     (1) shall include tribal community provider training 
     (designed for adult learners from the communities receiving 
     services for prevention, intervention, treatment and 
     aftercare).
       ``(b) Training.--The Secretary shall, either directly or 
     through Indian tribes or tribal organization, provide 
     instruction in the area of behavioral health issues, 
     including instruction in crisis intervention and family 
     relations in the context of alcohol and substance abuse, 
     child sexual abuse, youth alcohol and substance abuse, and 
     the causes and effects of fetal alcohol disorders, to 
     appropriate employees of the Bureau of Indian Affairs and the 
     Service, and to personnel in schools or programs operated 
     under any contract with the Bureau of Indian Affairs or the 
     Service, including supervisors of emergency shelters and 
     halfway houses described in section 4213 of the Indian 
     Alcohol and Substance Abuse Prevention and Treatment Act of 
     1986 (25 U.S.C. 2433).
       ``(c) Community-Based Training Models.--In carrying out the 
     education and training programs required by this section, the 
     Secretary, acting through the Service and 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 and 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. 710. BEHAVIORAL HEALTH PROGRAM.

       ``(a) Programs for Innovative Services.--The Secretary, 
     acting through the Service, Indian Tribes or tribal 
     organizations, consistent with Section 701, may develop, 
     implement, and carry out programs to deliver innovative 
     community-based behavioral health services to Indians.
       ``(b) Criteria.--The Secretary may award funding for a 
     project under subsection (a) to an Indian tribe or tribal 
     organization and may consider the following criteria:
       ``(1) Whether the project will address significant unmet 
     behavioral health needs among Indians.
       ``(2) Whether the project will serve a significant number 
     of Indians.
       ``(3) Whether the project has the potential to deliver 
     services in an efficient and effective manner.
       ``(4) Whether the tribe or tribal organization has the 
     administrative and financial capability to administer the 
     project.
       ``(5) Whether the project will deliver services in a manner 
     consistent with traditional health care.
       ``(6) Whether the project is coordinated with, and avoids 
     duplication of, existing services.
       ``(c) Funding Agreements.--For purposes of this subsection, 
     the Secretary shall, in evaluating applications or proposals 
     for funding for projects to be operated under any funding 
     agreement entered into with the Service under the Indian 
     Self-Determination Act and Education Assistance Act, use the 
     same criteria that the Secretary uses in evaluating any other 
     application or proposal for such funding.

     ``SEC. 711. FETAL ALCOHOL DISORDER FUNDING.

       ``(a) Establishment of Program.--
       ``(1) In general.--The Secretary, consistent with Section 
     701, acting through Indian tribes, tribal organizations, and 
     urban Indian organizations, shall establish and operate fetal 
     alcohol disorders programs as provided for in this section 
     for the purposes of meeting the health status objective 
     specified in section 3(b).
       ``(2) Use of funds.--Funding provided pursuant to this 
     section shall be used to--
       ``(A) develop and provide community and in-school training, 
     education, and prevention programs relating to fetal alcohol 
     disorders;
       ``(B) identify and provide behavioral health treatment to 
     high-risk women;
       ``(C) identify and provide appropriate educational and 
     vocational support, counseling, advocacy, and information to 
     fetal alcohol disorder affected persons and their families or 
     caretakers;

[[Page S3729]]

       ``(D) develop and implement counseling and support programs 
     in schools for fetal alcohol disorder affected children;
       ``(E) develop prevention and intervention models which 
     incorporate traditional practitioners, cultural and spiritual 
     values and community involvement;
       ``(F) develop, print, and disseminate education and 
     prevention materials on fetal alcohol disorders;
       ``(G) develop and implement, through the tribal 
     consultation process, culturally sensitive assessment and 
     diagnostic tools including dysmorphology clinics and 
     multidisciplinary fetal alcohol disorder clinics for use in 
     tribal and urban Indian communities;
       ``(H) develop early childhood intervention projects from 
     birth on to mitigate the effects of fetal alcohol disorders; 
     and
       ``(I) develop and fund community-based adult fetal alcohol 
     disorder housing and support services.
       ``(3) Criteria.--The Secretary shall establish criteria for 
     the review and approval of applications for funding under 
     this section.
       ``(b) Provision of Services.--The Secretary, acting through 
     the Service, Indian tribes, tribal organizations and urban 
     Indian organizations, shall--
       ``(1) develop and provide services for the prevention, 
     intervention, treatment, and aftercare for those affected by 
     fetal alcohol disorders in Indian communities; and
       ``(2) provide supportive services, directly or through an 
     Indian tribe, tribal organization or urban Indian 
     organization, including services to meet the special 
     educational, vocational, school-to-work transition, and 
     independent living needs of adolescent and adult Indians with 
     fetal alcohol disorders.
       ``(c) Task Force.--
       ``(1) In general.--The Secretary shall establish a task 
     force to be known as the Fetal Alcohol Disorders Task Force 
     to advise the Secretary in carrying out subsection (b).
       ``(2) Composition.--The task force under paragraph (1) 
     shall be composed of representatives from the National 
     Institute on Drug Abuse, the National Institute on Alcohol 
     and Alcoholism, the Office of Substance Abuse Prevention, the 
     National Institute of Mental Health, the Service, the Office 
     of Minority Health of the Department of Health and Human 
     Services, the Administration for Native Americans, the 
     National Institute of Child Health & Human Development, the 
     Centers for Disease Control and Prevention, the Bureau of 
     Indian Affairs, Indian tribes, tribal organizations, urban 
     Indian communities, and Indian fetal alcohol disorders 
     experts.
       ``(d) Applied Research.--The Secretary, acting through the 
     Substance Abuse and Mental Health Services Administration, 
     shall make funding available to Indian Tribes, tribal 
     organizations and urban Indian organizations for applied 
     research projects which propose to elevate the understanding 
     of methods to prevent, intervene, treat, or provide 
     rehabilitation and behavioral health aftercare for Indians 
     and urban Indians affected by fetal alcohol disorders.
       ``(e) Urban Indian Organizations.--The Secretary shall 
     ensure that 10 percent of the amounts appropriated to carry 
     out this section shall be used to make grants to urban Indian 
     organizations funded under title V.

     ``SEC. 712. CHILD SEXUAL ABUSE AND PREVENTION TREATMENT 
                   PROGRAMS.

       ``(a) Establishment.--The Secretary and the Secretary of 
     the Interior, acting through the Service, Indian tribes and 
     tribal organizations, shall establish, consistent with 
     section 701, in each service area, programs involving 
     treatment for--
       ``(1) victims of child sexual abuse; and
       ``(2) perpetrators of child sexual abuse.
       ``(b) Use of Funds.--Funds provided under this section 
     shall be used to--
       ``(1) develop and provide community education and 
     prevention programs related to child sexual abuse;
       ``(2) identify and provide behavioral health treatment to 
     children who are victims of sexual abuse and to their 
     families who are affected by sexual abuse;
       ``(3) develop prevention and intervention models which 
     incorporate traditional health care practitioners, cultural 
     and spiritual values, and community involvement;
       ``(4) develop and implement, though the tribal consultation 
     process, culturally sensitive assessment and diagnostic tools 
     for use in tribal and urban Indian communities.
       ``(5) identify and provide behavioral health treatment to 
     perpetrators of child sexual abuse with efforts being made to 
     begin offender and behavioral health treatment while the 
     perpetrator is incarcerated or at the earliest possible date 
     if the perpetrator is not incarcerated, and to provide 
     treatment after release to the community until it is 
     determined that the perpetrator is not a threat to children.

     ``SEC. 713. BEHAVIORAL MENTAL HEALTH RESEARCH.

       ``(a) In General.--The Secretary, acting through the 
     Service and in consultation with appropriate Federal 
     agencies, shall provide funding to Indian Tribes, tribal 
     organizations and urban Indian organizations or, enter into 
     contracts with, or make grants to appropriate institutions, 
     for the conduct of research on the incidence and prevalence 
     of behavioral health problems among Indians served by the 
     Service, Indian Tribes or tribal organizations and among 
     Indians in urban areas. Research priorities under this 
     section shall include--
       ``(1) the inter-relationship and inter-dependance of 
     behavioral health problems with alcoholism and other 
     substance abuse, suicide, homicides, other injuries, and the 
     incidence of family violence; and
       ``(2) the development of models of prevention techniques.
       ``(b) Special Emphasis.--The effect of the inter-
     relationships and interdependencies referred to in subsection 
     (a)(1) on children, and the development of prevention 
     techniques under subsection (a)(2) applicable to children, 
     shall be emphasized.

     ``SEC. 714. DEFINITIONS.

       ``In this title:
       ``(1) Assessment.--The term `assessment' means the 
     systematic collection, analysis and dissemination of 
     information on health status, health needs and health 
     problems.
       ``(2) Alcohol related neurodevelopmental disorders.--The 
     term `alcohol related neurodevelopmental disorders' or `ARND' 
     with respect to an individual means the individual has a 
     history of maternal alcohol consumption during pregnancy, 
     central nervous system involvement such as developmental 
     delay, intellectual deficit, or neurologic abnormalities, 
     that behaviorally, there may be problems with irritability, 
     and failure to thrive as infants, and that as children become 
     older there will likely be hyperactivity, attention deficit, 
     language dysfunction and perceptual and judgment problems.
       ``(3) Behavioral health.--The term `behavioral health' 
     means the blending of substances (alcohol, drugs, inhalants 
     and tobacco) abuse and mental health prevention and 
     treatment, for the purpose of providing comprehensive 
     services. Such term includes the joint development of 
     substance abuse and mental health treatment planning and 
     coordinated case management using a multidisciplinary 
     approach.
       ``(4) Behavioral health aftercare.--
       ``(A) In general.--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, to help prevent or treat relapse, including the 
     development of an aftercare plan.
       ``(B) Aftercare plan.--Prior to the time at which an 
     individual is discharged from a level of care, such as 
     outpatient treatment, an aftercare plan shall have been 
     developed for the individual. Such plan may use such 
     resources as community base therapeutic group care, 
     transitional living, a 12-step sponsor, a local 12-step or 
     other related support group, or other community based 
     providers (such as mental health professionals, traditional 
     health care practitioners, community health aides, community 
     health representatives, mental health technicians, or 
     ministers).
       ``(5) Dual diagnosis.--The term `dual diagnosis' means 
     coexisting substance abuse and mental illness conditions or 
     diagnosis. In individual with a dual diagnosis may be 
     referred to as a mentally ill chemical abuser.-
       ``(6) Fetal alcohol disorders.--The term `fetal alcohol 
     disorders' means fetal alcohol syndrome, partial fetal 
     alcohol syndrome, or alcohol related neural developmental 
     disorder.
       ``(7) Fetal alcohol syndrome.--The term `fetal alcohol 
     syndrome' or `FAS' with respect to an individual means a 
     syndrome in which the individual has a history of maternal 
     alcohol consumption during pregnancy, and with respect to 
     which the following criteria should be met:
       ``(A) Central nervous system involvement such as 
     developmental delay, intellectual deficit, microencephaly, or 
     neurologic abnormalities.
       ``(B) Craniofacial abnormalities with at least 2 of the 
     following: microphthalmia, short palpebral fissures, poorly 
     developed philtrum, thin upper lip, flat nasal bridge, and 
     short upturned nose.
       ``(C) Prenatal or postnatal growth delay.
       ``(8) Partial fas.--The term `partial FAS' with respect to 
     an individual means a history of maternal alcohol consumption 
     during pregnancy having most of the criteria of FAS, though 
     not meeting a minimum of at least 2 of the following: micro-
     ophthalmia, short palpebral fissures, poorly developed 
     philtrum, thin upper lip, flat nasal bridge, short upturned 
     nose.
       ``(9) Rehabilitation.--The term `rehabilitation' means to 
     restore the ability or capacity to engage in usual and 
     customary life activities through education and therapy.-
       ``(10) Substance abuse.--The term `substance abuse' 
     includes inhalant abuse. --

     ``SEC. 715. AUTHORIZATION OF APPROPRIATIONS.

       ``There is authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2012 to 
     carry out this title.

                      ``TITLE VIII--MISCELLANEOUS

     ``SEC. 801. REPORTS.

       ``The President shall, at the time the budget is submitted 
     under section 1105 of title 31, United States Code, for each 
     fiscal year transmit to the Congress a report containing--
       ``(1) a report on the progress made in meeting the 
     objectives of this Act, including a review of programs 
     established or assisted pursuant to this Act and an 
     assessment and recommendations of additional programs or 
     additional assistance necessary to, at a minimum, provide 
     health services to Indians, and ensure a health status for 
     Indians, which are at a parity with the health services 
     available to and the health status of, the general 
     population, including specific comparisons of appropriations 
     provided and those required for such parity;

[[Page S3730]]

       ``(2) a report on whether, and to what extent, new national 
     health care programs, benefits, initiatives, or financing 
     systems have had an impact on the purposes of this Act and 
     any steps that the Secretary may have taken to consult with 
     Indian tribes to address such impact, including a report on 
     proposed changes in the allocation of funding pursuant to 
     section 808;
       ``(3) a report on the use of health services by Indians--
       ``(A) on a national and area or other relevant geographical 
     basis;
       ``(B) by gender and age;
       ``(C) by source of payment and type of service;
       ``(D) comparing such rates of use with rates of use among 
     comparable non-Indian populations; and
       ``(E) on the services provided under funding agreements 
     pursuant to the Indian Self-Determination and Education 
     Assistance Act;
       ``(4) a report of contractors concerning health care 
     educational loan repayments under section 110;
       ``(5) a general audit report on the health care educational 
     loan repayment program as required under section 110(n);
       ``(6) a separate statement that specifies the amount of 
     funds requested to carry out the provisions of section 201;
       ``(7) a report on infectious diseases as required under 
     section 212;
       ``(8) a report on environmental and nuclear health hazards 
     as required under section 214;
       ``(9) a report on the status of all health care facilities 
     needs as required under sections 301(c)(2) and 301(d);
       ``(10) a report on safe water and sanitary waste disposal 
     facilities as required under section 302(h)(1);
       ``(11) a report on the expenditure of non-service funds for 
     renovation as required under sections 305(a)(2) and 
     305(a)(3);
       ``(12) a report identifying the backlog of maintenance and 
     repair required at Service and tribal facilities as required 
     under section 314(a);
       ``(13) a report providing an accounting of reimbursement 
     funds made available to the Secretary under titles XVIII and 
     XIX of the Social Security Act as required under section 
     403(a);
       ``(14) a report on services sharing of the Service, the 
     Department of Veteran's Affairs, and other Federal agency 
     health programs as required under section 412(c)(2);
       ``(15) a report on the evaluation and renewal of urban 
     Indian programs as required under section 505;
       ``(16) a report on the findings and conclusions derived 
     from the demonstration project as required under section 
     512(a)(2);
       ``(17) a report on the evaluation of programs as required 
     under section 513; and
       ``(18) a report on alcohol and substance abuse as required 
     under section 701(f).

     ``SEC. 802. REGULATIONS.

       ``(a) Initiation of Rulemaking Procedures.--
       ``(1) in general.--Not later than 90 days after the date of 
     enactment of this Act, the Secretary shall initiate 
     procedures under subchapter III of chapter 5 of title 5, 
     United States Code, to negotiate and promulgate such 
     regulations or amendments thereto that are necessary to carry 
     out this Act.
       ``(2) Publication.--Proposed regulations to implement this 
     Act shall be published in the Federal Register by the 
     Secretary not later than 270 days after the date of enactment 
     of this Act and shall have not less than a 120 day comment 
     period.
       ``(3) Expiration of authority.--The authority to promulgate 
     regulations under this Act shall expire 18 months from the 
     date of enactment of this Act.
       ``(b) Rulemaking Committee.--A negotiated rulemaking 
     committee established pursuant to section 565 of Title 5, 
     United States Code, to carry out this section shall have as 
     its members only representatives of the Federal Government 
     and representatives of Indian tribes, and tribal 
     organizations, a majority of whom shall be nominated by and 
     be representatives of Indian tribes, tribal organizations, 
     and urban Indian organizations from each service area.
       ``(c) Adaption of Procedures.--The Secretary shall adapt 
     the negotiated rulemaking procedures to the unique context of 
     self-governance and the government-to-government relationship 
     between the United States and Indian Tribes.
       ``(d) Failure To Promulgate Regulations.--The lack of 
     promulgated regulations shall not limit the effect of this 
     Act.
       ``(e) Supremacy of Provisions.--The provisions of this Act 
     shall supersede any conflicting provisions of law (including 
     any conflicting regulations) in effect on the day before the 
     date of enactment of the Indian Self-Determination Contract 
     Reform Act of 1994, and the Secretary is authorized to repeal 
     any regulation that is inconsistent with the provisions of 
     this Act.

     ``SEC. 803. PLAN OF IMPLEMENTATION.

       ``Not later than 240 days after the date of enactment of 
     this Act, the Secretary, in consultation with Indian tribes, 
     tribal organizations, and urban Indian organizations, shall 
     prepare and submit to Congress a plan that shall explain the 
     manner and schedule (including a schedule of appropriate 
     requests), by title and section, by which the Secretary will 
     implement the provisions of this Act.

     ``SEC. 804. AVAILABILITY OF FUNDS.

       ``Amounts appropriated under this Act shall remain 
     available until expended.

     ``SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED TO THE 
                   INDIAN HEALTH SERVICE.

       ``Any limitation on the use of funds contained in an Act 
     providing appropriations for the Department for a period with 
     respect to the performance of abortions shall apply for that 
     period with respect to the performance of abortions using 
     funds contained in an Act providing appropriations for the 
     Service.

     ``SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS.

       ``(a) Eligibility.--
       ``(1) In general.--Until such time as any subsequent law 
     may otherwise provide, 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, but only 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 Indian reservation allotments in 
     California.
       ``(4) Any Indian in California who is listed on the plans 
     for distribution of the assets of California rancherias and 
     reservations under the Act of August 18, 1958 (72 Stat. 619), 
     and any descendant of such an Indian.
       ``(b) Rule of Construction.--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. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS.

       ``(a) Ineligible Persons.--
       ``(1) In general.--Any individual who--
       ``(A) has not attained 19 years of age;
       ``(B) is the natural or adopted child, step-child, foster-
     child, legal ward, or orphan of an eligible Indian; and
       ``(C) is not otherwise eligible for the 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 one year after the date such 
     disability has been removed.
       ``(2) Spouses.--Any spouse of an eligible Indian who is not 
     an Indian, or who is of Indian descent but not otherwise 
     eligible for the health services provided by the Service, 
     shall be eligible for such health services if all of such 
     spouses or spouses who are married to members of the 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.
       ``(b) Programs and Services.--
       ``(1) Programs.--
       ``(A) In general.--The Secretary may provide health 
     services under this subsection through health programs 
     operated directly by the Service to individuals who reside 
     within the service area of a service unit and who are not 
     eligible for such health services under any other subsection 
     of this section or under any other provision of law if--
       ``(i) the Indian tribe (or, in the case of a multi-tribal 
     service area, all the Indian tribes) served by such service 
     unit requests such provision of health services to such 
     individuals; and
       ``(ii) the Secretary and the Indian tribe or tribes have 
     jointly determined that--

       ``(I) the provision of such health services will not result 
     in a denial or diminution of health services to eligible 
     Indians; and
       ``(II) there is no reasonable alternative health program or 
     services, within or without the service area of such service 
     unit, available to meet the health needs of such individuals.

       ``(B) Funding agreements.--In the case of health programs 
     operated under a funding agreement entered into under the 
     Indian Self-Determination and Educational Assistance Act, the 
     governing body of the Indian tribe or tribal organization 
     providing health services under such funding agreement is 
     authorized to determine whether health services should be 
     provided under such funding agreement 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 considerations described in subparagraph (A)(ii).
       ``(2) Liability for payment.--
       ``(A) In general.--Persons receiving health services 
     provided by the Service by reason of this subsection shall be 
     liable for payment of such health services under a schedule 
     of charges prescribed by the Secretary which, in the judgment 
     of the Secretary, results in reimbursement in an amount not 
     less than the actual cost of providing the health services. 
     Notwithstanding section 1880(c) of the Social Security Act, 
     section 402(a) of this Act, or any other provision of law, 
     amounts collected under this subsection, including medicare 
     or medicaid reimbursements under titles XVIII and XIX of the 
     Social Security

[[Page S3731]]

     Act, shall be credited to the account of the program 
     providing the service and shall be used solely for the 
     provision of health services within that program. Amounts 
     collected under this subsection shall be available for 
     expenditure within such program for not to exceed 1 fiscal 
     year after the fiscal year in which collected.
       ``(B) Services for indigent persons.--Health services may 
     be provided by the Secretary through the Service under this 
     subsection to an indigent person who would not be 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 person.
       ``(3) Service areas.--
       ``(A) Service to only one tribe.--In the case of a service 
     area which serves only one Indian tribe, the authority of the 
     Secretary to provide health services under paragraph (1)(A) 
     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) Multi-tribal areas.--In the case of a multi-tribal 
     service area, the authority of the Secretary to provide 
     health services under paragraph (1)(A) 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 provision of 
     such health services.
       ``(c) Purpose for Providing 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 subsection of this section or 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 post partum; or
       ``(4) provide care to immediate family members of an 
     eligible person if such care is directly related to the 
     treatment of the eligible person.
       ``(d) Hospital Privileges.--Hospital privileges in health 
     facilities operated and maintained by the Service or operated 
     under a contract entered into under the Indian Self-
     Determination Education Assistance Act may be extended to 
     non-Service health care practitioners who provide services to 
     persons described in subsection (a) or (b). Such non-Service 
     health care practitioners may be regarded 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 
     persons as a part of the conditions under which such hospital 
     privileges are extended.
       ``(e) Definition.--In 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. 808. REALLOCATION OF BASE RESOURCES.

       ``(a) Requirement of Report.--Notwithstanding any other 
     provision of law, any allocation of Service funds for a 
     fiscal year that reduces by 5 percent or more from the 
     previous fiscal year the funding for any recurring program, 
     project, or activity of a service unit may be implemented 
     only after the Secretary has submitted to the President, for 
     inclusion in the report required to be transmitted to the 
     Congress under section 801, a report on the proposed change 
     in allocation of funding, including the reasons for the 
     change and its likely effects.
       ``(b) Nonapplication of Section.--Subsection (a) shall not 
     apply if the total amount appropriated to the Service for a 
     fiscal year is less than the amount appropriated to the 
     Service for previous fiscal year.

     ``SEC. 809. RESULTS OF DEMONSTRATION PROJECTS.

       ``The Secretary shall provide for the dissemination to 
     Indian tribes of the findings and results of demonstration 
     projects conducted under this Act.

     ``SEC. 810. PROVISION OF SERVICES IN MONTANA.

       ``(a) In General.--The Secretary, acting through the 
     Service, shall provide services and benefits for Indians in 
     Montana in a manner consistent with the decision of the 
     United States Court of Appeals for the Ninth Circuit in 
     McNabb for McNabb v. Bowen, 829 F.2d 787 (9th Cr. 1987).
       ``(b) Rule of Construction.--The provisions of subsection 
     (a) shall not be construed to be an expression of the sense 
     of the Congress on the application of the decision described 
     in subsection (a) with respect to the provision of services 
     or benefits for Indians living in any State other than 
     Montana.

     ``SEC. 811. MORATORIUM.

       ``During the period of the moratorium imposed by Public Law 
     100-446 on implementation of the final rule published in the 
     Federal Register on September 16, 1987, by the Health 
     Resources and Services Administration, relating to 
     eligibility for the health care services of the Service, the 
     Service shall provide services pursuant to the criteria for 
     eligibility for such services that were in effect on 
     September 15, 1987, subject to the provisions of sections 806 
     and 807 until such time as new criteria governing eligibility 
     for services are developed in accordance with section 802.

     ``SEC. 812. TRIBAL EMPLOYMENT.

       ``For purposes of section 2(2) of the Act of July 5, 1935 
     (49 Stat. 450, Chapter 372), an Indian tribe or tribal 
     organization carrying out a funding agreement under the Self-
     Determination and Education Assistance Act shall not be 
     considered an employer.

     ``SEC. 813. PRIME VENDOR.

       ``For purposes of section 4 of Public Law 102-585 (38 
     U.S.C. 812) Indian tribes and tribal organizations carrying 
     out a grant, cooperative agreement, or funding agreement 
     under the Indian Self-Determination and Education Assistance 
     Act (25 U.S.C. 450 et. seq.) shall be deemed to be an 
     executive agency and part of the Service in the and, as such, 
     may act as an ordering agent of the Service and the employees 
     of the tribe or tribal organization may order supplies on 
     behalf thereof on the same basis as employees of the Service.

     ``SEC. 814. NATIONAL BI-PARTISAN COMMISSION ON INDIAN HEALTH 
                   CARE ENTITLEMENT.

       ``(a) Establishment.--There is hereby established the 
     National Bi-Partisan Indian Health Care Entitlement 
     Commission (referred to in this Act as the `Commission').
       ``(b) Membership.--The Commission shall be composed of 25 
     members, to be appointed as follows:
       ``(1) Ten members of Congress, of which--
       ``(A) three members shall be from the House of 
     Representatives and shall be appointed by the majority 
     leader;
       ``(B) three members shall be from the House of 
     Representatives and shall be appointed by the minority 
     leader;
       ``(C) two members shall be from the Senate and shall be 
     appointed by the majority leader; and
       ``(D) two members shall be from the Senate and shall be 
     appointed by the minority leader;
     who shall each be members of the committees of Congress that 
     consider legislation affecting the provision of health care 
     to Indians and who shall elect the chairperson and vice-
     chairperson of the Commission.
       ``(2) Twelve individuals to be appointed by the members of 
     the Commission appointed under paragraph (1), of which at 
     least 1 shall be from each service area as currently 
     designated by the Director of the Service, to be chosen from 
     among 3 nominees from each such area as selected by the 
     Indian tribes within the area, with due regard being given to 
     the experience and expertise of the nominees in the provision 
     of health care to Indians and with due regard being given to 
     a reasonable representation on the Commission of members who 
     are familiar with various health care delivery modes and who 
     represent tribes of various size populations.
       ``(3) Three individuals shall be appointed by the Director 
     of the Service from among individual who are knowledgeable 
     about the provision of health care to Indians, at least 1 of 
     whom shall be appointed from among 3 nominees from each 
     program that is funded in whole or in part by the Service 
     primarily or exclusively for the benefit of urban Indians.
     All those persons appointed under paragraphs (2) and (3) 
     shall be members of Federally recognized Indian Tribes.
       ``(c) Terms.--
       ``(1) In general.--Members of the Commission shall serve 
     for the life of the Commission.
       ``(2) Appointment of members.--Members of the Commission 
     shall be appointed under subsection (b)(1) not later than 90 
     days after the date of enactment of this Act, and the 
     remaining members of the Commission shall be appointed not 
     later than 60 days after the date on which the members are 
     appointed under such subsection.
       ``(3) Vacancy.--A vacancy in the membership of the 
     Commission shall be filled in the manner in which the 
     original appointment was made.
       ``(d) Duties of the Commission.--The Commission shall carry 
     out the following duties and functions:
       ``(1) Review and analyze the recommendations of the report 
     of the study committee established under paragraph (3) to the 
     Commission.
       ``(2) Make recommendations to Congress for providing health 
     services for Indian persons as an entitlement, giving due 
     regard to the effects of such a programs on existing health 
     care delivery systems for Indian persons and the effect of 
     such programs on the sovereign status of Indian Tribes;
       ``(3) Establish a study committee to be composed of those 
     members of the Commission appointed by the Director of the 
     Service and at least 4 additional members of Congress from 
     among the members of the Commission which shall--
       ``(A) to the extent necessary to carry out its duties, 
     collect and compile data necessary to understand the extent 
     of Indian needs with regard to the provision of health 
     services, regardless of the location of Indians, including 
     holding hearings and soliciting the views of Indians, Indian 
     tribes, tribal organizations and urban Indian organizations, 
     and which may include authorizing and funding feasibility 
     studies of various models for providing and funding health 
     services for all Indian beneficiaries including those who 
     live outside of a reservation, temporarily or permanently;

[[Page S3732]]

       ``(B) make recommendations to the Commission for 
     legislation that will provide for the delivery of health 
     services for Indians as an entitlement, which shall, at a 
     minimum, address issues of eligibility, benefits to be 
     provided, including recommendations regarding from whom such 
     health services are to be provide,d and the cost, including 
     mechanisms for funding of the health services to be provided;
       ``(C) determine the effect of the enactment of such 
     recommendations on the existing system of the delivery of 
     health services for Indians;
       ``(D) determine the effect of a health services entitlement 
     program for Indian persons on the sovereign status of Indian 
     tribes;
       ``(E) not later than 12 months after the appointment of all 
     members of the Commission, make a written report of its 
     findings and recommendations to the Commission, which report 
     shall include a statement of the minority and majority 
     position of the committee and which shall be disseminated, at 
     a minimum, to each Federally recognized Indian tribe, tribal 
     organization and urban Indian organization for comment to the 
     Commission; and
       ``(F) report regularly to the full Commission regarding the 
     findings and recommendations developed by the committee in 
     the course of carrying out its duties under this section.
       ``(4) Not later than 18 months after the date of 
     appointment of all members of the Commission, submit a 
     written report to Congress containing a recommendation of 
     policies and legislation to implement a policy that would 
     establish a health care system for Indians based on the 
     delivery of health services as an entitlement, together with 
     a determination of the implications of such an entitlement 
     system on existing health care delivery systems for Indians 
     and on the sovereign status of Indian tribes.
       ``(e) Administrative Provisions.--
       ``(1) Compensation and expenses.--
       ``(A) Congressional members.--Each member of the Commission 
     appointed under subsection (b)(1) shall receive no additional 
     pay, allowances, or benefits by reason of their service on 
     the Commission and shall receive travel expenses and per diem 
     in lieu of subsistence in accordance with sections 5702 and 
     5703 of title 5, United States Code.
       ``(B) Other members.--The members of the Commission 
     appointed under paragraphs (2) and (3) of subsection (b), 
     while serving on the business of the Commission (including 
     travel time) shall be entitled to receive compensation at the 
     per diem equivalent of the rate provided for level IV of the 
     Executive Schedule under section 5315 of title 5, United 
     States Code, and while so serving away from home and the 
     member's regular place of business, be allowed travel 
     expenses, as authorized by the chairperson of the Commission. 
     For purposes of pay (other than pay of members of the 
     Commission) and employment benefits, rights, and privileges, 
     all personnel of the Commission shall be treated as if they 
     were employees of the United States Senate.
       ``(2) Meetings and quorum.--
       ``(A) Meetings.--The Commission shall meet at the call of 
     the chairperson.
       ``(B) Quorum.--A quorum of the Commission shall consist of 
     not less than 15 members, of which not less than 6 of such 
     members shall be appointees under subsection (b)(1) and not 
     less than 9 of such members shall be Indians.
       ``(3) Director and staff.--
       ``(A) Executive director.--The members of the Commission 
     shall appoint an executive director of the Commission. The 
     executive director shall be paid the rate of basic pay equal 
     to that for level V of the Executive Schedule.
       ``(B) Staff.--With the approval of the Commission, the 
     executive director may appoint such personnel as the 
     executive director deems appropriate.
       ``(C) Applicability of civil service laws.--The staff of 
     the Commission shall be appointed without regard to the 
     provisions of title 5, United States Code, governing 
     appointments in the competitive service, and shall be paid 
     without regard to the provisions of chapter 51 and subchapter 
     III of chapter 53 of such title (relating to classification 
     and General Schedule pay rates).
       ``(D) Experts and consultants.--With the approval of the 
     Commission, the executive director may procure temporary and 
     intermittent services under section 3109(b) of title 5, 
     United States Code.
       ``(E) Facilities.--The Administrator of the General 
     Services Administration shall locate suitable office space 
     for the operation of the Commission. The facilities shall 
     serve as the headquarters of the Commission and shall include 
     all necessary equipment and incidentals required for the 
     proper functioning of the Commission.
       ``(f) Powers.--
       ``(1) Hearings and other activities.--For the purpose of 
     carrying out its duties, the Commission may hold such 
     hearings and undertake such other activities as the 
     Commission determines to be necessary to carry out its 
     duties, except that at least 6 regional hearings shall be 
     held in different areas of the United States in which large 
     numbers of Indians are present. Such hearings shall be held 
     to solicit the views of Indians regarding the delivery of 
     health care services to them. To constitute a hearing under 
     this paragraph, at least 5 members of the Commission, 
     including at least 1 member of Congress, must be present. 
     Hearings held by the study committee established under this 
     section may be counted towards the number of regional 
     hearings required by this paragraph.
       ``(2) Studies by gao.--Upon request of the Commission, the 
     Comptroller General shall conduct such studies or 
     investigations as the Commission determines to be necessary 
     to carry out its duties.
       ``(3) Cost estimates.--
       ``(A) In general.--The Director of the Congressional Budget 
     Office or the Chief Actuary of the Health Care Financing 
     Administration, or both, shall provide to the Commission, 
     upon the request of the Commission, such cost estimates as 
     the Commission determines to be necessary to carry out its 
     duties.
       ``(B) Reimbursements.--The Commission shall reimburse the 
     Director of the Congressional Budget Office for expenses 
     relating to the employment in the office of the Director of 
     such additional staff as may be necessary for the Director to 
     comply with requests by the Commission under subparagraph 
     (A).
       ``(4) Detail of federal employees.--Upon the request of the 
     Commission, the head of any federal Agency is authorized to 
     detail, without reimbursement, any of the personnel of such 
     agency to the Commission to assist the Commission in carrying 
     out its duties. Any such detail shall not interrupt or 
     otherwise affect the civil service status or privileges of 
     the federal employee.
       ``(5) Technical assistance.--Upon the request of the 
     Commission, the head of a Federal Agency shall provide such 
     technical assistance to the Commission as the Commission 
     determines to be necessary to carry out its duties.
       ``(6) use of mails.--The Commission may use the United 
     States mails in the same manner and under the same conditions 
     as Federal Agencies and shall, for purposes of the frank, be 
     considered a commission of Congress as described in section 
     3215 of title 39, United States Code.
       ``(7) Obtaining information.--The Commission may secure 
     directly from the any Federal Agency information necessary to 
     enable it to carry out its duties, if the information may be 
     disclosed under section 552 of title 4, United States Code. 
     Upon request of the chairperson of the Commission, the head 
     of such agency shall furnish such information to the 
     Commission.
       ``(8) Support services.--Upon the request of the 
     Commission, the Administrator of General Services shall 
     provide to the Commission on a reimbursable basis such 
     administrative support services as the Commission may 
     request.
       ``(9) Printing.--For purposes of costs relating to printing 
     and binding, including the cost of personnel detailed from 
     the Government Printing Office, the Commission shall be 
     deemed to be a committee of the Congress.
       ``(g) Authorization of Appropriations.--There is authorized 
     to be appropriated $4,000,000 to carry out this section. The 
     amount appropriated under this subsection shall not be 
     deducted from or affect any other appropriation for health 
     care for Indian persons.

     ``SEC. 815. APPROPRIATIONS; AVAILABILITY.

       ``Any new spending authority (described in subsection 
     (c)(2)(A) or (B) of section 401 of the Congressional Budget 
     Act of 1974) which is provided under this Act shall be 
     effective for any fiscal year only to such extent or in such 
     amounts as are provided in appropriation Acts.

     ``SEC. 816. AUTHORIZATION OF APPROPRIATIONS.

       ``There is authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2012 to 
     carry out this title.''.

       TITLE II--CONFORMING AMENDMENTS TO THE SOCIAL SECURITY ACT

                          Subtitle A--Medicare

     SEC. 201. LIMITATIONS ON CHARGES.

       Section 1866(a)(1) of the Social Security Act (42 U.S.C. 
     1395cc(a)(1)) is amended--
       (1) in subparagraph (R), by adding a semicolon at the end;
       (2) in subparagraph (S), by striking the period and 
     inserting ``; and''; and
       (3) by adding at the end the following:
       ``(T) in the case of hospitals and critical access 
     hospitals which provide inpatient hospital services for which 
     payment may be made under this title, to accept as payment in 
     full for services that are covered under and furnished to an 
     individual eligible for the contract health services program 
     operated by the Indian Health Service, by an Indian tribe or 
     tribal organization, or furnished to an urban Indian eligible 
     for health services purchased by an urban Indian organization 
     (as those terms are defined in section 4 of the Indian Health 
     Care Improvement Act), in accordance with such admission 
     practices and such payment methodology and amounts as are 
     prescribed under regulations issued by the Secretary.''.

     SEC. 202. INDIAN HEALTH PROGRAMS.

       Section 1880 of the Social Security Act (42 U.S.C. 1395qq) 
     is amended to read as follows:


                        ``indian health programs

       ``Sec. 1880. (a) Eligibility for Payments.--The Indian 
     Health Service (referred to in this section as the `Service') 
     and an Indian tribe or tribal organization, or an urban 
     Indian organization (as those terms are defined in section 4 
     of the Indian Health Care Improvement Act), shall be eligible 
     for payments under this title, notwithstanding sections 
     1814(c) and 1835(d), if and for so long as the Service, 
     Indian tribe or tribal organization, or urban Indian 
     organization meets the

[[Page S3733]]

     conditions and requirements for such payments which are 
     applicable generally to the service or provider type for 
     which the Service, Indian tribe or tribal organization, or 
     urban Indian organization seeks payment under this title and 
     for services and provider types provided by a qualified 
     Indian health program under section 1880A.
       ``(b) Period for Billing.--Notwithstanding subsection (a), 
     if the Service, an Indian tribe or tribal organization, or 
     urban Indian organization, does not meet all of the 
     conditions and requirements of this title which are 
     applicable generally to the service or provider type for 
     which payment is sought, but submits to the Secretary within 
     6 months after the date on which such reimbursement is first 
     sought an acceptable plan for achieving compliance with such 
     conditions and requirements, the Service, an Indian tribe or 
     tribal organization, or urban Indian organization shall be 
     deemed to meet such conditions and requirements (and to be 
     eligible for reimbursement under this title), without regard 
     to the extent of actual compliance with such conditions and 
     requirements during the first 12 months after the month in 
     which such plan is submitted.
       ``(c) Direct Billing.--For provisions relating to the 
     authority of certain Indian tribes and tribal organizations 
     to elect to directly bill for, and receive payment for, 
     health care services provided by a hospital or clinic of such 
     tribes or tribal organizations and for which payment may be 
     made under this title, see section 405 of the Indian Health 
     Care Improvement Act.
       ``(d) Community Health Aides.--The Service or an Indian 
     Tribe or tribal organization providing a service otherwise 
     eligible for payment under this section through the use of a 
     community health aide or practitioner certified under the 
     provisions of section 121 of the Indian Health Care 
     Improvement Act shall be paid for such services on the same 
     basis that such services are reimbursed under State plans 
     approved under title XIX.
       ``(e) Treatment of Certain Programs.--Notwithstanding any 
     other provision of law, a health program operated by the 
     Service or an Indian tribe or tribal organization, which 
     collaborates with a hospital operated by the Service or an 
     Indian tribe or tribal organization, shall, at the option of 
     the Indian tribe or tribal organization, be paid for services 
     for which it would otherwise be eligible for under this as if 
     the health program were an outpatient department of the 
     hospital. In situations where the health program is on a 
     separate campus from the hospital, billing as an outpatient 
     department of the hospital shall not subject such a health 
     program to the requirements of section 1867.
       ``(f) Payment for Certain Nursing Services.--The Service or 
     an Indian tribe or tribal organization providing visiting 
     nurse services in a home health agency shortage area shall be 
     paid for such services on the same basis that such services 
     are reimbursed under this title for other primary care 
     providers.
       ``(g) Alternative Methods of Reimbursement.--
     Notwithstanding any other provision of law, the Secretary may 
     identify and implement alternative methods of reimbursing 
     Indian health programs for services reimbursable under this 
     title that are provided to Indians, so long as such methods--
       ``(1) allow an Indian tribe or tribal organization or urban 
     Indian organization to opt to receive reimbursement under 
     reimbursement methodologies applicable to other providers of 
     similar services; and
       ``(2) provide that the amount of reimbursement resulting 
     under any such methodology shall not be less than 100 percent 
     of the reasonable cost of the service to which the 
     methodology applies under section 1861(v).''.

     SEC. 203. QUALIFIED INDIAN HEALTH PROGRAM.

       Title XVIII of the Social Security Act (42 U.S.C. 1395 et 
     seq.) is amended by inserting after section 1880 the 
     following:


                   ``qualified indian health program

       ``Sec. 1880A. (a) Definition of Qualified Indian Health 
     Program.--In this section:
       ``(1) In general.--The term `qualified Indian health 
     program' means a health program operated by-
       ``(A) the Indian Health Service;
       ``(B) an Indian tribe or tribal organization or an urban 
     Indian organization (as those terms are defined in section 4 
     of the Indian Health Care Improvement Act) and which is 
     funded in whole or part by the Indian Health Service under 
     the Indian Self Determination and Education Assistance Act; 
     and
       ``(C) an urban Indian organization (as so defined) and 
     which is funded in whole or in part under title V of the 
     Indian Health Care Improvement Act.
       ``(2) Included programs and entities.--Such term may 
     include 1 or more hospital, nursing home, home health 
     program, clinic, ambulance service or other health program 
     that provides a service for which payments may be made under 
     this title and which is covered in the cost report submitted 
     under this title or title XIX for the qualified Indian health 
     program.
       ``(b) Eligibility for Payments.--A qualified Indian health 
     program shall be eligible for payments under this title, 
     notwithstanding sections 1814(c) and 1835(d), if and for so 
     long as the program meets all the conditions and requirements 
     set forth in this section.
       ``(c) Determination of Payments.--
       ``(1) In general.--Notwithstanding any other provision in 
     the law, a qualified Indian health program shall be entitled 
     to receive payment based on an all-inclusive rate which shall 
     be calculated to provide full cost recovery for the cost of 
     furnishing services provided under this section.
       ``(2) Definition of full cost recovery.--
       ``(A) In general.--Subject to subparagraph (B), in this 
     section, the term `full cost recovery' means the sum of--
       ``(i) the direct costs, which are reasonable, adequate and 
     related to the cost of furnishing such services, taking into 
     account the unique nature, location, and service population 
     of the qualified Indian health program, and which shall 
     include direct program, administrative, and overhead costs, 
     without regard to the customary or other charge or any fee 
     schedule that would otherwise be applicable; and
       ``(ii) indirect costs which, in the case of a qualified 
     Indian health program--

       ``(I) for which an indirect cost rate (as that term is 
     defined in section 4(g) of the Indian Self-Determination and 
     Education Assistance Act) has been established, shall be not 
     less than an amount determined on the basis of the indirect 
     cost rate; or
       ``(II) for which no such rate has been established, shall 
     be not less than the administrative costs specifically 
     associated with the delivery of the services being provided.

       ``(B) Limitation.--Notwithstanding any other provision of 
     law, the amount determined to be payable as full cost 
     recovery may not be reduced for co-insurance, co-payments, or 
     deductibles when the service was provided to an Indian 
     entitled under Federal law to receive the service from the 
     Indian Health Service, an Indian tribe or tribal 
     organization, or an urban Indian organization or because of 
     any limitations on payment provided for in any managed care 
     plan.
       ``(3) Outstationing Costs.--In addition to full cost 
     recovery, a qualified Indian health program shall be entitled 
     to reasonable outstationing costs, which shall include all 
     administrative costs associated with outreach and acceptance 
     of eligibility applications for any Federal or State health 
     program including the programs established under this title, 
     title XIX, and XXI.
       ``(4) Determination of all-inclusive encounter or per diem 
     amount.--
       ``(A) In general.--Costs identified for services addressed 
     in a cost report submitted by a qualified Indian health 
     program shall be used to determine an all-inclusive encounter 
     or per diem payment amount for such services.
       ``(B) No single report requirement.--Not all health 
     programs provided or administered by the Indian Health 
     Service, an Indian tribe or tribal organization, or an urban 
     Indian organization need be combined into a single cost 
     report.
       ``(C) Payment for items not covered by a cost report.--A 
     full cost recovery payment for services not covered by a cost 
     report shall be made on a fee-for-service, encounter, or per 
     diem basis.
       ``(5) Optional determination.--The full cost recovery rate 
     provided for in paragraphs (1) through (3) may be determined, 
     at the election of the qualified Indian health program, by 
     the Health Care Financing Administration or by the State 
     agency responsible for administering the State plan under 
     title XIX and shall be valid for reimbursements made under 
     this title, title XIX, and title XXI. The costs described in 
     paragraph (2)(A) shall be calculated under whatever 
     methodology yields the greatest aggregate payment for the 
     cost reporting period, provided that such methodology shall 
     be adjusted to include adjustments to such payment to take 
     into account for those qualified Indian health programs that 
     include hospitals--
       ``(A) a significant decreases in discharges;
       ``(B) costs for graduate medical education programs;
       ``(C) additional payment as a disproportionate share 
     hospital with a payment adjustment factor of 10; and
       ``(D) payment for outlier cases.
       ``(6) Election of payment.--A qualified Indian health 
     program may elect to receive payment for services provided 
     under this section--
       ``(A) on the full cost recovery basis provided in 
     paragraphs (1) through (5);
       ``(B) on the basis of the inpatient or outpatient encounter 
     rates established for Indian Health Service facilities and 
     published annually in the Federal Register;
       ``(C) on the same basis as other providers are reimbursed 
     under this title, provided that the amounts determined under 
     paragraph (c)(2)(B) shall be added to any such amount;
       ``(D) on the basis of any other rate or methodology 
     applicable to the Indian Health Service or an Indian Tribe or 
     tribal organization; or
       ``(E) on the basis of any rate or methodology negotiated 
     with the agency responsible for making payment.
       ``(d) Election of Reimbursement for Other Services.--
       ``(1) In general.--A qualified Indian health program may 
     elect to be reimbursed for any service the Indian Health 
     Service, an Indian tribe or tribal organization or an urban 
     Indian organization may be reimbursed for under section 1880 
     and section 1911.
       ``(2) Option to include additional services.--An election 
     under paragraph (1) may include, at the election of the 
     qualified Indian health program--
       ``(A) any service when furnished by an employee of the 
     qualified Indian health program who is licensed or certified 
     to perform such a service to the same extent that such 
     service would be reimbursable if performed by a physician and 
     any service or supplies

[[Page S3734]]

     furnished as incident to a physician's service as would 
     otherwise be covered if furnished by a physician or as an 
     incident to a physician's service;
       ``(B) screening, diagnostic, and therapeutic outpatient 
     services including part-time or intermittent screening, 
     diagnostic, and therapeutic skilled nursing care and related 
     medical supplies (other than drugs and biologicals), 
     furnished by an employee of the qualified Indian health 
     program who is licensed or certified to perform such a 
     service for an individual in the individual's home or in a 
     community health setting under a written plan of treatment 
     established and periodically reviewed by a physician, when 
     furnished to an individual as an outpatient of a qualified 
     Indian health program;
       ``(C) preventive primary health services as described under 
     sections 329, 330, and 340 of the Public Health Service Act, 
     when provided by an employee of the qualified Indian health 
     program who is licensed or certified to perform such a 
     service, regardless of the location in which the service is 
     provided;
       ``(D) with respect to services for children, all services 
     specified as part of the State plan under title XIX, the 
     State child health plan under title XXI, and early and 
     periodic screening, diagnostic, and treatment services as 
     described in section 1905(r);
       ``(E) influenza and pneumococccal immunizations;
       ``(F) other immunizations for prevention of communicable 
     diseases when targeted; and
       ``(G) the cost of transportation for providers or patients 
     necessary to facilitate access for patients.''.

                          Subtitle B--Medicaid

     SEC. 211. PAYMENTS TO FEDERALLY-QUALIFIED HEALTH CENTERS.

       Section 1902(a)(13) of the Social Security Act (42 U.S.C. 
     1396a(a)(13)) is amended--
       (1) in subparagraph (B), by striking ``and'' at the end;
       (2) in subparagraph (C), by adding ``and'' at the end; and
       (3) by adding at the end the following:
       ``(D)(i) for payment for services described in section 
     1905(a)(2)(C) under the plan furnished by an Indian tribe or 
     tribal organization or an urban Indian organization (as 
     defined in section 4 of the Indian Health Care Improvement 
     Act) of 100 percent of costs which are reasonable and related 
     to the cost of furnishing such services or based on other 
     tests of reasonableness as the Secretary prescribes in 
     regulations under section 1833(a)(3), or, in the case of 
     services to which those regulations do not apply, the same 
     methodology used under section 1833(a)(3), and
       ``(ii) in the case of such services furnished pursuant to a 
     contract between the a Federally-qualified health center and 
     a medicaid managed care organization under section 1903(m), 
     for payment to the Federally-qualified health center at least 
     quarterly by the State of a supplemental payment equal to the 
     amount (if any) by which the amount determined under clause 
     (i) exceeds the amount of the payments provided under such 
     contract.''.

     SEC. 212. STATE CONSULTATION WITH INDIAN HEALTH PROGRAMS.

       Section 1902(a) of the Social Security Act (42 U.S.C. 
     1396a(a)) is amended--
       (1) in paragraph (65), by striking the period; and
       (2) by inserting after (65), the following:
       ``(66) if the Indian Health Service operates or funds 
     health programs in the State or if there are Indian tribes or 
     tribal organizations or urban Indian organizations (as those 
     terms are defined in Section 4 of the Indian Health Care 
     Improvement Act) present in the State, provide for meaningful 
     consultation with such entities prior to the submission of, 
     and as a precondition of approval of, any proposed amendment, 
     waiver, demonstration project, or other request that would 
     have the effect of changing any aspect of the State's 
     administration of the State plan under this title, so long 
     as--
       ``(A) the term `meaningful consultation' is defined through 
     the negotiated rulemaking process provided for under section 
     802 of the Indian Health Care Improvement Act; and
       ``(B) such consultation is carried out in collaboration 
     with the Indian Medicaid Advisory Committee established under 
     section 415(a)(3) of that Act.''.

     SEC. 213. FMAP FOR SERVICES PROVIDED BY INDIAN HEALTH 
                   PROGRAMS.

       The third sentence of Section 1905(b) of the Social 
     Security Act (42 U.S.C. 1396d(b)) is amended to read as 
     follows:
     ``Notwithstanding the first sentence of this section, the 
     Federal medical assistance percentage shall be 100 per cent 
     with respect to amounts expended as medical assistance for 
     services which are received through 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) under section 1911, whether 
     directly, by referral, or under contracts or other 
     arrangements between the Indian Health Service, Indian tribe 
     or tribal organization, or urban Indian organization and 
     another health provider.''.

     SEC. 214. INDIAN HEALTH SERVICE PROGRAMS.

       Section 1911 of the Social Security Act (42 U.S.C. 1396j) 
     is amended to read as follows:


                    ``indian health service programs

       ``Sec. 1911. (a) In General.--The Indian Health Service and 
     an Indian tribe or tribal organization or an urban Indian 
     organization (as those terms are defined in section 4 of the 
     Indian Health Care Improvement Act), shall be eligible for 
     reimbursement for medical assistance provided under a State 
     plan if and for so long as such Service, Indian tribe or 
     tribal organization, or urban Indian organization provides 
     services or provider types of a type otherwise covered under 
     the State plan and meets the conditions and requirements 
     which are applicable generally to the service for which it 
     seeks reimbursement under this title and for services 
     provided by a qualified Indian health program under section 
     1880A.
       ``(b) Period for Billing.--Notwithstanding subsection (a), 
     if the Indian Health Service, an Indian tribe or tribal 
     organization, or an urban Indian organization which provides 
     services of a type otherwise covered under the State plan 
     does not meet all of the conditions and requirements of this 
     title which are applicable generally to such services submits 
     to the Secretary within 6 months after the date on which such 
     reimbursement is first sought an acceptable plan for 
     achieving compliance with such conditions and requirements, 
     the Service, an Indian tribe or tribal organization, or urban 
     Indian organization shall be deemed to meet such conditions 
     and requirements (and to be eligible for reimbursement under 
     this title), without regard to the extent of actual 
     compliance with such conditions and requirements during the 
     first 12 months after the month in which such plan is 
     submitted.
       ``(c) Authority to Enter Into Agreements.--The Secretary 
     may enter into agreements with the State agency for the 
     purpose of reimbursing such agency for health care and 
     services provided by the Indian Health Service, Indian tribes 
     or tribal organizations and urban Indian organizations, 
     directly, through referral, or under contracts or other 
     arrangements between the Indian Health Service, an Indian 
     tribe or tribal organization, or an urban Indian organization 
     and another health care provider to Indians who are eligible 
     for medical assistance under the State plan.

         Subtitle C--State Children's Health Insurance Program

     SEC. 221. ENHANCED FMAP FOR STATE CHILDREN'S HEALTH INSURANCE 
                   PROGRAM.

       (a) In General.--Section 2105(b) of the Social Security Act 
     (42 U.S.C. 1397ee(b)) is amended--
       (1) by striking ``For purposes'' and inserting the 
     following:
       ``(1) In general.--Subject to paragraph (2), for 
     purposes''; and
       (2) by adding at the end the following:
       ``(2) Services provided by indian programs.--Without regard 
     to which option a State chooses under section 2101(a), the 
     `enhanced FMAP' for a State for a fiscal year shall be 100 
     per cent with respect to expenditures for child health 
     assistance for services provided through a health program 
     operated by the Indian Health Service, an Indian tribe or 
     tribal organization, or an urban Indian organization (as such 
     terms are defined in section 4 of the Indian Health Care 
     Improvement Act).''.
       (b) Conforming Amendment.--Section 2105(c)(6)(B) of such 
     Act (42 U.S.C. 1397ee(c)(6)(B)) is amended by inserting ``an 
     Indian tribe or tribal organization, or an urban Indian 
     organization (as such terms are defined in section 4 of the 
     Indian Health Care Improvement Act)'' after ``Service''.

     SEC. 222. DIRECT FUNDING OF STATE CHILDREN'S HEALTH INSURANCE 
                   PROGRAM.

       Title XXI of Social Security Act (42 U.S.C. 1397aa et seq.) 
     is amended by adding at the end the following:

     ``SEC. 2111. DIRECT FUNDING OF INDIAN HEALTH PROGRAMS.

       ``(a) In General.--The Secretary may enter into agreements 
     directly with the Indian Health Service, an Indian tribe or 
     tribal organization, or an urban Indian organization (as such 
     terms are defined in section 4 of the Indian Health Care 
     Improvement Act) for such entities to provide child health 
     assistance to Indians who reside in a service area on or near 
     an Indian reservation. Such agreements may provide for 
     funding under a block grant or such other mechanism as is 
     agreed upon by the Secretary and the Indian Health Service, 
     Indian tribe or tribal organization, or urban Indian 
     organization. Such agreements may not be made contingent on 
     the approval of the State in which the Indians to be served 
     reside.
       ``(b) Transfer of Funds.--Notwithstanding any other 
     provision of law, a State may transfer funds to which it is, 
     or would otherwise be, entitled to under this title to the 
     Indian Health Service, an Indian tribe or tribal organization 
     or an urban Indian organization--
       ``(1) to be administered by such entity to achieve the 
     purposes and objectives of this title under an agreement 
     between the State and the entity; or
       ``(2) under an agreement entered into under subsection (a) 
     between the entity and the Secretary.''.

              Subtitle D--Authorization of Appropriations

     SEC. 231. AUTHORIZATION OF APPROPRIATIONS.

       There is authorized to be appropriated such sums as may be 
     necessary for each of fiscal years 2000 through 2012 to carry 
     out this title and the amendments by this title.

                  TITLE III--MISCELLANEOUS PROVISIONS

     SEC. 301. REPEALS.

       The following are repealed:
       (1) Section 506 of Public Law 101-630 (25 U.S.C. 1653 note) 
     is repealed.
       (2) Section 712 of the Indian Health Care Amendments of 
     1988 is repealed.

[[Page S3735]]

     SEC. 302. SEVERABILITY PROVISIONS.

       If any provision of this Act, any amendment made by the 
     Act, or the application of such provision or amendment to any 
     person or circumstances is held to be invalid, the remainder 
     of this Act, the remaining amendments made by this Act, and 
     the application of such provisions to persons or 
     circumstances other than those to which it is held invalid, 
     shall not be affected thereby.

  Mr. INOUYE. Mr. President, I rise today to join my Chairman, Senator 
Ben Nighthorse Campbell, in the introduction of a bill to reauthorize 
the Indian Health Care Improvement Act of 1976, Public Law 94-437.
  Mr. President, for the past two years, the leaders of Indian country 
have been engaged in a consultation process with the Indian Health 
Service in an effort to address changes to the Act which would hold the 
potential of improving and enhancing the ability of tribal health 
programs, urban Indian health care programs, and the Indian Health 
Service to provide comprehensive primary health care and public health 
services to all eligible American Indian and Alaska Native patients 
citizens.
  The goal of the consultation process was to build a consensus on the 
best means of addressing the health care challenges that confront 
Native America, so that the reauthorization bill could reflect a 
unified vision of the Indian Health Service, tribal governments and 
urban Indian health care programs. The tribal participants in this 
process appropriately named this comprehensive consultation process 
``Speaking with One Voice''.
  Mr. President, this tribally-developed reauthorization bill is the 
most comprehensive to date. The first step in the consultation process 
was the convening of a roundtable discussion with tribal leaders, urban 
Indian health care providers, Indian Health Service health care 
professionals, national Indian health organizations, researchers, and 
other policy makers. Specific recommendations regarding the manner in 
which tribal consultation meetings would be carried out were developed 
at this Roundtable. From these recommendations, the Roundtable 
participants developed a consultation approach that included the 
pursuit of consensus on what amendments to the Act were necessary and 
the identification of opportunities for change, the identification of 
area and regional differences, the promotion of a partnership 
environment for tribes, urban Indians, and the Indian Health Service, 
and the establishment of a core group to review materials.
  Beginning in the fall of 1998, tribal representatives participated in 
twelve Area meetings to begin discussing concerns and recommendations 
related to the Act. Each of the twelve geographic Areas facilitated a 
consultation process with health care providers in their respective 
Areas, and this process was completed in January 1999.
  Four regional consultation meetings were held across the country from 
January to April, 1999. Regional meetings were intended to provide a 
forum for tribes to provide input, to share the recommendations from 
each Area, and to build consensus among participants for a unified 
position from each regional meeting. From these four meetings, a matrix 
of 135 recommendations for each of the sections in the Indian Health 
Care Improvement Act was developed, as well as proposals for new 
provisions. Over 900 health care providers participated in the four 
regional meetings.
  Upon the completion of the four regional meetings, the Indian Health 
Service convened a National Steering committee composed of elected 
tribal representatives and urban Indian health care program directors. 
Many of the members of the steering committee had participated in the 
Area and regional consultation meetings. The National Steering 
Committee developed a draft consensus bill based on the Area and 
regional consultation meetings. The draft bill was mailed to every 
tribal government and urban Indian health care program in the nation 
with a 30-day period for additional comments. The draft bill was then 
presented at a national meeting in Washington, D.C. in late July of 
last year. Participants in this national meeting included tribal 
government leaders, urban Indian health care providers, members of 
Congress and their staff, as well as several Administration and 
departmental officials.
  The National Steering Committee has completed a monumental task with 
the broad support of Indian Tribes and communities across the United 
States.
  With this in mind, I urge my colleagues to support this legislation.
                                 ______
                                 
      By Mr. GRASSLEY:
  S. 2527. A bill to amend the Public Health Service Act to provide 
grant programs to reduce substance abuse, and for other purposes; to 
the Committee on Health, Education, Labor, and Pensions.


              drug treatment and research enhancement act

  Mr. GRASSLEY. Mr. President, I am sending a bill to the desk to help 
reinforce our national drug control effort. I held a hearing earlier 
today on the domestic consequences of a new wave of heroin use. This is 
a flesh and blood problem that touches all of us. What we see in our 
homes and schools across the nation is the emergence of a new threat to 
our young people. A purer form of heroin is making its presence felt. 
In rich neighborhoods and poor. In our cities and rural areas. In the 
lives of our young people and their families.

  No heroin consumed in this country is made here. Every gram of it is 
grown in some foreign field, processed in a distant, illegal lab, and 
smuggled into this country. Yet, this heroin makes its way here by 
every means possible. It walks, floats, flies, and sneaks across our 
borders.
  While the heroin used here comes from overseas, the consequences of 
its coming are felt in our homes, in our schools, in our neighborhoods. 
It is our young people who die. It is American families who bear the 
burden and pay the price. Heroin is an equal opportunity destroyer. It 
blights inner city streets, suburban neighborhoods, and rural 
communities alike. I fear that the problem is getting worse. And I am 
concerned that our current policies are simply not up to the challenge.
  Somewhere along the way, we lost the clear, consistent message that 
the only proper response to drugs is to say an emphatic ``NO''. We're 
supposed to be more sophisticated. More tolerant. More willing to 
listen to notions of making dangerous drugs more available. What all of 
this ``more'' has meant is that we have more young people using more 
drugs at younger ages. Today's heroin is cheaper and purer and more 
widely available. It is more aggressively marketed and it is presented 
as being safer, as ``user friendly''.
  In the late 1980s and early 1990s, heroin had a bad rap. All drugs 
did. That is less true today. In the last several years, heroin use 
among young people has doubled and attitudes about the dangers of the 
drug have shifted. While it is true that most of our 12 to 20 year olds 
still believe it bad, the new heroin that we see on our streets and in 
our schools is marketed to avoid this stigma. The chief reason that the 
old heroin was seen as bad was because you needed a needle to use it. 
With the new heroin you can get high from smoking or inhaling, at least 
at first. And we now have well-moneyed think tank talking heads who 
preach that the only consequence of heroin addiction is a mild case of 
constipation. That it is our drug laws that are dangerous not the 
drugs. In such an environment, we should not be too surprised that an 
increasing number of young people should be persuaded that heroin is 
okay.
  Communities in Plano, Texas and Orlando, Florida learned this to 
their dismay when dozens of high school kids died from heroin 
overdoses. I can think of no pain greater than that of a parent who 
must bid farewell forever to a child. It is somehow contrary to the 
natural order for a parent to precede a child in death. But the pain of 
addiction is a spreading circle of hurt. The hearing I held today on 
this problem brought this point home in the voices of those most 
affected: addicts and their families.
  The legislation that I offer today will help us address this new 
problem before it gets any worse. I am proposing that we look at the 
means to improve our prevention message to stop drug use before it 
starts. I hope to revitalize community and parent involvement.
  I am also proposing increased resources for addiction research and 
ways to get the best information and best practices into the hands of 
the professionals who must deal with addiction problems.

[[Page S3736]]

  In addition, I am calling for a new initiative to support juvenile 
residential treatment programs that work. Current research shows that 
we need more focused, long-term critical intervention for young addicts 
to break the cycle of addiction today before it becomes a worse problem 
tomorrow. Investment now means better chances for young people and for 
all of us later.
  It's not just a new heroin that plagues us. Designer drugs like 
methamphetamine and now Ecstasy are flooding this country. Along with 
heroin, these are marketed to our young people as safe and friendly. 
Left unanswered, we will see another generation of young lives 
blighted. We will see families torn up by a widening circle of hurt 
from drug use. We saw what a similar wave of drug use did to us and to 
a generaton of young people in the 1960s and 1970s. We cannot afford to 
go through this again. I hope we can begin today to renew our 
commitment to a drug free future for our young people. I ask my 
colleagues to join me in supporting the Drug Treatment and Research 
Enhancement Act.

                          ____________________