[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
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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,
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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
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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.
____________________