[Congressional Record Volume 147, Number 12 (Tuesday, January 30, 2001)]
[Senate]
[Pages S707-S785]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
By Ms. COLLINS (for herself, Mr. Kyl, and Ms. Landrieu):
S. 203. A bill to amend the Internal Revenue Code of 1986 to provide
an above-the-line deduction for qualified professional development
expenses of elementary and secondary school teachers and to allow a
credit against income tax to elementary and secondary school teachers
who provide classroom materials; to the Committee on Finance.
Ms. COLLINS. Mr. President, I rise today with my friend and colleague
from Arizona, Senator Kyl, to introduce the Teacher Support Act of
2001. We are very pleased to be joined by our good friend and
colleague, Senator Landrieu, in proposing this legislation.
Senator Kyl and I crafted this bill to help our teachers when they
pursue professional development or pay for supplies for their
classrooms.
Our legislation has two major provisions.
First, it will allow teachers and teacher aides to take an above-the-
line deduction for their professional development expenses. Thus,
educators who don't itemize their deductions will still be able to
benefit from tax-favored treatment for their professional development.
Second, the legislation will grant educators a tax credit of up to
$100 for books, supplies, and other materials that they purchase for
their classrooms. According to a study by the National Education
Association, the average public school teacher spends more than $400
annually on classroom supplies. This sacrifice, I think, is typical of
the dedication of many of our schoolteachers toward their students.
While our legislation provides some financial assistance to
educators, its ultimate beneficiaries will be their students. Other
than involved parents, a well-qualified teacher is the most important
prerequisite for students' success. Educational researchers have
demonstrated over and over again the close relationship between
qualified educators and successful students. Moreover, educators
themselves understand how important professional development is to
maintaining and extending their level of competence.
Mr. President, when I meet with teachers from my State of Maine, they
repeatedly tell me of their need for more professional development and
the scarcity of financial support for this worthy pursuit. As President
Bush has put it, ``Teachers sometimes lead with their hearts and pay
with their wallets.''
The willingness of Maine's teachers to fund their own professional
development activities has deeply impressed me. For example, an English
teacher, who serves on my education advisory committee, told me of
spending her own money to attend a curriculum conference. She then came
back and shared her new knowledge with all of the teachers in her
department at Bangor High School. She is typical of the many educators
who generously reach into their own pockets to pay for professional
development and to purchase materials to enhance their teaching.
Let me explain how our legislation works in terms of real dollars. In
my home State, the average yearly starting salary of a public school
teacher is about $23,300. Under the current law, even a teacher who is
earning this modest salary cannot deduct the first $466 in professional
development expenses that he or she paid for out-of-pocket. That is
because of the requirement in the current law that sets a floor of 2
percent that has to be reached before the cost of the course or other
professional development is deductible. Moreover, under current law,
professional development expenses above $466 can be deducted only if
the teacher itemizes his or her deductions. Only about one-third of our
Nation's schoolteachers do itemize their tax deductions.
Our legislation would enable all educators, regardless of whether or
not they itemize deductions, to receive tax relief for professional
development expenses.
I greatly admire the many educators who have voluntarily financed
additional education to improve their skills so that they may better
serve their students. I admire those teachers who purchase books,
supplies, equipment, and other materials for their students in order to
enhance their teaching.
I hope this change in our Tax Code will encourage educators to
continue their formal course work in the subject matter they teach and
to attend conferences to give them new ideas for presenting course work
in a challenging manner. This bill will reimburse educators for a small
part of what they invest in our children's future. This money would be
well spent. Investing in education helps us to build one of the most
important assets for our country's future--a well educated population.
We need to ensure that our
[[Page S708]]
public schools have the very best educators possible in order to bring
out the very best in our students.
Last year, Senator Kyl and I offered a similar version of this
legislation as an amendment to the Affordable Education Act of
2000. Our amendment enjoyed overwhelming support and passed the Senate
by a vote of 98-0. Unfortunately, the underlying bill was not taken up
by the House of Representatives.
This year, we are very pleased that President Bush has made the
classroom supplies portion of our bill part of his education platform,
and that our legislation has received the support of the National
Education Association. Our hope is that the bill will become law before
the end of the year. We urge our colleagues to join us in supporting
this legislation.
Mr. President, I ask unanimous consent to print the bill in the
Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
S. 203
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Teacher Support Act of
2001''.
SEC. 2. ABOVE-THE-LINE DEDUCTION FOR QUALIFIED PROFESSIONAL
DEVELOPMENT EXPENSES OF ELEMENTARY AND
SECONDARY SCHOOL TEACHERS.
(a) Deduction Allowed.--Part VII of subchapter B of chapter
1 of the Internal Revenue Code of 1986 (relating to
additional itemized deductions for individuals) is amended by
redesignating section 222 as section 223 and by inserting
after section 221 the following new section:
``SEC. 222. QUALIFIED PROFESSIONAL DEVELOPMENT EXPENSES.
``(a) Allowance of Deduction.--In the case of an eligible
teacher, there shall be allowed as a deduction an amount
equal to the qualified professional development expenses paid
or incurred by the taxpayer during the taxable year.
``(b) Qualified Professional Development Expenses of
Eligible Teachers.--For purposes of this section--
``(1) Qualified professional development expenses.--
``(A) In general.--The term `qualified professional
development expenses' means expenses for tuition, fees,
books, supplies, equipment, and transportation required for
the enrollment or attendance of an individual in a qualified
course of instruction.
``(B) Qualified course of instruction.--The term `qualified
course of instruction' means a course of instruction which--
``(i) is--
``(I) directly related to the curriculum and academic
subjects in which an eligible teacher provides instruction,
or
``(II) designed to enhance the ability of an eligible
teacher to understand and use State standards for the
academic subjects in which such teacher provides instruction,
``(ii) may--
``(I) provide instruction in how to teach children with
different learning styles, particularly children with
disabilities and children with special learning needs
(including children who are gifted and talented), or
``(II) provide instruction in how best to discipline
children in the classroom and identify early and appropriate
interventions to help children described in subclause (I) to
learn,
``(iii) is tied to challenging State or local content
standards and student performance standards,
``(iv) is tied to strategies and programs that demonstrate
effectiveness in increasing student academic achievement and
student performance, or substantially increasing the
knowledge and teaching skills of an eligible teacher,
``(v) is of sufficient intensity and duration to have a
positive and lasting impact on the performance of an eligible
teacher in the classroom (which shall not include 1-day or
short-term workshops and conferences), except that this
clause shall not apply to an activity if such activity is 1
component described in a long-term comprehensive professional
development plan established by an eligible teacher and the
teacher's supervisor based upon an assessment of the needs of
the teacher, the students of the teacher, and the local
educational agency involved, and
``(vi) is part of a program of professional development
which is approved and certified by the appropriate local
educational agency as furthering the goals of the preceding
clauses.
``(C) Local educational agency.--The term `local
educational agency' has the meaning given such term by
section 14101 of the Elementary and Secondary Education Act
of 1965, as in effect on the date of the enactment of this
section.
``(2) Eligible teacher.--
``(A) In general.--The term `eligible teacher' means an
individual who is a kindergarten through grade 12 classroom
teacher or aide in an elementary or secondary school for at
least 720 hours during a school year.
``(B) Elementary or secondary school.--The terms
`elementary school' and `secondary school' have the meanings
given such terms by section 14101 of the Elementary and
Secondary Education Act of 1965 (20 U.S.C. 8801), as so in
effect.
``(c) Denial of Double Benefit.--
``(1) In general.--No other deduction or credit shall be
allowed under this chapter for any amount taken into account
for which a deduction is allowed under this section.
``(2) Coordination with exclusions.--A deduction shall be
allowed under subsection (a) for qualified professional
development expenses only to the extent the amount of such
expenses exceeds the amount excludable under section 135,
529(c)(1), or 530(d)(2) for the taxable year.''.
(b) Deduction Allowed in Computing Adjusted Gross Income.--
Section 62(a) of the Internal Revenue Code of 1986 is amended
by inserting after paragraph (17) the following new
paragraph:
``(18) Qualified professional development expenses.--The
deduction allowed by section 222.''.
(c) Conforming Amendment.--The table of sections for part
VII of subchapter B of chapter 1 of the Internal Revenue Code
of 1986 is amended by striking the item relating to section
222 and inserting the following new items:
``Sec. 222. Qualified professional development expenses.
``Sec. 223. Cross reference.''.
(d) Effective Date.--The amendments made by this section
shall apply to taxable years beginning after December 31,
2000.
SEC. 3. CREDIT TO ELEMENTARY AND SECONDARY SCHOOL TEACHERS
WHO PROVIDE CLASSROOM MATERIALS.
(a) In General.--Subpart B of part IV of subchapter A of
chapter 1 of the Internal Revenue Code of 1986 (relating to
other credits) is amended by adding at the end the following
new section:
``SEC. 30B. CREDIT TO ELEMENTARY AND SECONDARY SCHOOL
TEACHERS WHO PROVIDE CLASSROOM MATERIALS.
``(a) Allowance of Credit.--In the case of an eligible
teacher, there shall be allowed as a credit against the tax
imposed by this chapter for the taxable year an amount equal
to the qualified elementary and secondary education expenses
which are paid or incurred by the taxpayer during such
taxable year.
``(b) Maximum Credit.--The credit allowed by subsection (a)
for any taxable year shall not exceed $100.
``(c) Definitions.--
``(1) Eligible teacher.--The term `eligible teacher' means
an individual who is a kindergarten through grade 12
classroom teacher, instructor, counselor, aide, or principal
in an elementary or secondary school on a full-time basis for
an academic year ending during a taxable year.
``(2) Qualified elementary and secondary education
expenses.--The term `qualified elementary and secondary
education expenses' means expenses for books, supplies (other
than nonathletic supplies for courses of instruction in
health or physical education), computer equipment (including
related software and services) and other equipment, and
supplementary materials used by an eligible teacher in the
classroom.
``(3) Elementary or secondary school.--The term `elementary
or secondary school' means any school which provides
elementary education or secondary education (through grade
12), as determined under State law.
``(d) Special Rules.--
``(1) Denial of double benefit.--No deduction shall be
allowed under this chapter for any expense for which credit
is allowed under this section.
``(2) Application with other credits.--The credit allowable
under subsection (a) for any taxable year shall not exceed
the excess (if any) of--
``(A) the regular tax for the taxable year, reduced by the
sum of the credits allowable under subpart A and the
preceding sections of this subpart, over
``(B) the tentative minimum tax for the taxable year.
``(e) Election To Have Credit Not Apply.--A taxpayer may
elect to have this section not apply for any taxable year.''.
(b) Clerical Amendment.--The table of sections for subpart
B of part IV of subchapter A of chapter 1 is amended by
adding at the end the following new item:
``Sec. 30B. Credit to elementary and secondary school teachers who
provide classroom materials.''.
(c) Effective Date.--The amendments made by this section
shall apply to taxable years beginning after December 31,
2000.
Mr. KYL. Mr. President, I was an original cosponsor of the Teacher
Support Act of 2001. Working together last year, Senator Collins and I,
with invaluable assistance from our departed colleague Paul Coverdell,
persuaded the Senate to pass almost identical legislation by a vote of
98-0.
Like the amendment approved by the Senate last year, the Teacher
Support Act would provide an annual tax credit of up to $100 for
teachers' un-reimbursed classroom expenditures that are qualified under
the Internal Revenue Code. For amounts over $100, teachers would
continue to use the deductions allowed for such expenses under current
law.
We know the need this legislation addresses is real. According to a
recent
[[Page S709]]
study by the NEA, the average K-12 teacher spent $408 every year on
classroom materials needed for education but not supplied by the
schools. These materials include everything from books, workbooks,
erasers, paper, pens, equipment related to classroom instruction, and
professional enrichment programs.
In my discussions with teachers--public and private--I have been
amazed to learn that many use their own money to cover the cost of
classroom materials that are not supplied by their school or school
district.
I have attended intense meetings in which Arizona teachers have
related to me, in confidence, that they have used money from the family
budget, without telling their spouses, for needed classroom supplies,
and that though they feel wracked with guilt, they would do it again
for their students. The Teacher Support Act stands for the idea that
teachers should not feel compelled to make such sacrifices.
Though there is no absolute linkage between personal contributions
for school supplies and the quality of the teaching, there likely is
some correlation, given the degree of commitment evidenced by these
teachers who are spending their own money. To the extent this is true,
the proposal will have the effect of encouraging instruction of the
highest quality.
I am pleased that President Bush campaigned on a similar proposal
last year, and that he has included it in the education package he
announced last week. This legislation, sends a much-needed message to
the hard-working teachers of this country that they have our support,
and that, working together, we can improve education for America's
children.
Ms. LANDRIEU. Mr. President, as you well know, the need for reform in
the American education system is a priority for many members of
Congress, as well as for President Bush and his newly assembled
administration. While there still is some debate over a few remaining
issues such as annual testing and private school vouchers, it is clear
that there is much that we agree must be addressed if our children are
to receive the type of education necessary to be competitive in the
21st century. Almost no one disagrees that focused efforts to recruit
and retain qualified teachers are the key to increasing student
achievement. Today, research is confirming what common sense has
suggested all along. A skilled and knowledgeable teacher can make
enormous difference in how well students learn. One Tennessee study
found that the students who had good teachers three years in a row
scored significantly higher on state tests and made far greater gains
than students with a series of ineffective teachers. Another study
conducted at Stanford found that the strongest indicator of how a
state's students performed on National assessments was the percentage
of well qualified teachers.
The Department of Education estimates that 2,000,000 new teachers
will have to be hired in the next decade. Yet, each year, only 60,000
college graduates enter into teaching. In my home state of Louisiana,
almost one in five of our teachers has not completed the standard
regimen for teaching. One of the main detractors for qualified
professionals to choose to enter the profession of teaching is simply
that the salaries cover little more than life's daily expenses. While
the amount of salary a teacher makes is not determined by the federal
government, that does not preclude us from putting forth innovative
strategies to address the gaps left by these salaries. In fact, I think
it is our responsibility to do all that we can to assist states in
their efforts to bring the best and the brightest teachers into our
nation's classrooms. The federal tax code provides us with several
opportunities to acknowledge and reward teachers for the work that they
do for our children everyday.
I am proud to join Senator Collins in introducing the ``Teacher
Support Act of 2001''. This bill allows educators to receive a tax
credit for some of the costs associated with furthering their
professional development. Specifically, it will allow educators to
deduct professional development expenses, without requiring the
deduction to be subject to the existing two percent floor. In addition,
this legislation creates an above the line deduction, allowing for
teachers who do not itemize their taxes to take advantage of these
helpful benefits. And finally, it allows educators to claim a tax
credit of up to $100 for books, supplies, and equipment that they
purchase for their students.
This is the first of the many steps we as a body must take toward
building a system of supports for our teachers. This small investment
will have an inordinate impact on their ability to provide effective
instruction to our nation's school children. Henry B. Adams once said
``A teacher affects eternity; he can never tell, where his influence
stops.'' With this in mind, I ask you to support this bill and others
like it, so that we can truly affect the future of education in
America.
______
By Mrs. HUTCHISON (for himself, Mr. Durbin, and Mr. Levin):
S. 205. A bill to amend the Internal Revenue Code of 1986 to waive
the income inclusion on a distribution from an individual retirement
account to the extent that the distribution is contributed for
charitable purposes; to the Committee on Finance.
Mrs. HUTCHISON. Mr. President, today I rise to introduce legislation
that will enhance and encourage charitable contributions in the United
States.
As many know, this week, the President is set to unveil a number of
initiatives to promote charitable giving and to expand the role that
charities and faith-based institutions play in attacking social
problems in the United States.
Government alone is incapable of solving society's most vexing
problems. In fact, government programs often fail in their missions.
The old welfare system is a perfect example of what often goes wrong.
Under the old system, we encouraged people to stay on welfare. We
encouraged out-of-wedlock births. We encouraged fathers to live out of
the home. We ended this with our welfare reform bill. Welfare rolls
have now dropped by half across the United States.
The track record of charitable organizations have been far superior
than the government's in tackling social ills. America's top charities
cover a broad range of problems, from the Salvation Army to the YMCA,
and the American Cancer Society to the Red Cross. Each is playing a
role in improving America's health, education and welfare. How
successful can they be? It has been known that mentors in the Big
Brothers/Big Sisters program can cut drug abuse by 50 percent.
Americans appreciate the role of these groups. They are actively
involved in charitable causes. Nearly half of all Americans volunteer
in some capacity on a regular basis.
Nearly 25 percent of all Americans are active in their religion on a
volunteer basis. This is why it is so logical to use faith-based
organizations as means of accomplishing objectives at which the
government has failed. The Chicago Tribune recently noted that
``churches, temples and prayer halls cannot replace the mammoth task of
helping the needy. But, they do a better and more efficient job of
understanding their communities and meeting the need of their
citizens.''
The legislation I am introducing today will make it easier for
charitable contributions to the made and for charitable organizations
to pursue their missions. Under this bill, individuals age 59\1/2\ and
older will be able to move assets penalty-free from an IRA directly to
a charity or into a qualifying deferred charitable gift plan, such as a
charitable remainder trust, pooled income fund or gift annuity. Current
law requires taxpayers to first withdraw the IRA proceeds, pay the
taxes due and then contribute the funds to a charity. Taxes can be
offset by the current charitable deduction, but only to an extent.
Americans currently hold well over $1 trillion in assets in IRAs, and
nearly half of America's families have IRAs. This bill will allow
senior citizens who have provided for their retirement--but find that
they do not need their entire IRA for living expenses--to transfer IRA
funds to charity without dilution. This will cut bureaucratic obstacles
to charitable giving and unlock a substantial amount of new funds that
could flow to America's charitable organizations.
I first introduced this legislation in 1998, and it was folded into
our tax bill
[[Page S710]]
in 1999. Regrettably, it was vetoed by the President. But, given our
new leadership in the White House, this is an idea whose times has
come. In fact, President Bush made this part of his tax plan when it
was unveiled in 1999.
This is also not a partisan proposal. Senator Durbin was an original
co-sponsor of this legislation. I look forward to working with him, and
the White House on this bill. It also has the support of numerous
universities and charitable groups, including the Charitable Accord and
the Council of Foundations, two umbrella organizations representing
more than 2,000 organizations and associations.
Mr. DURBIN. Mr. President, I am pleased to introduce, along with
Senator Kay Bailey Hutchison, the charitable IRA Rollover Act of 2001.
We introduced this legislation in the last Congress. While it was
included in last year's year-end tax bill, our provision was
unfortunately stripped out at the last minute Senator Hutchison and I
sincerely hope that this legislation will become law this year.
The IRA Charitable Rollover Act has the support of numerous
charitable organizations across the United States. The effect of this
bill would be to unlock billions of dollars in savings Americans hold
and make them available to charities. Our legislation will allow
individuals to roll assets from an Individual Retirement Account (IRA)
into a charity or a deferred charitable gift plan without incurring any
income tax consequences. Thus, the donation would be made to charity
without every withdrawing it as income and paying tax on it.
Americans currently hold well over $1 trillion in assets in IRAs.
Nearly half of America's families have IRAs. Recent studies show that
assets of qualified retirement plans comprise a substantial part of the
net worth of many persons. Many of these individuals would like to give
a portion of these assets to charity.
Under our current law, if an IRA is transferred into a charitable
remainder trust, donors are required to recognize that as income.
Therefore, absent the changes called for in the legislation, the donor
will have taxable income in the year the gift is funded. This is a huge
disincentive contained in our complicated and burdensome tax code. This
legislation will unleash a critical source of funding for our nation's
charities. This legislation will provide millions of Americans with a
common sense way to remove obstacles to private charitable giving.
Under the Hutchison-Durbin plan, an individual, upon reaching age
59\1/2\, could move assets penalty-free from an IRA directly to charity
or into a qualifying deferred charitable gift plan--e.g. charitable
remainder trusts, pooled income funds and gift annuities. In the latter
case the donor would be able to receive an income stream from the
retirement plan assets, which would be taxed according to normal rules.
Upon the death of the individual, the remainder would be transferred to
charity.
There are numerous supporters of this legislation including
Georgetown University, the Art Institute of Chicago, the University of
Chicago, the Field Museum, the Catholic Diocese of Peoria, Northwestern
University, the Chicago Symphony Orchestra, and others. There are over
100 groups in Illinois alone that support this sensible legislation.
I hope the Senate will join in this bi-partisan effort to provide a
valuable new source of philanthropy for our nation's charities. I hope
that our colleagues will co-sponsor this important piece of legislation
and that it will be enacted into law this year. I thank the Senator
from Texas, Senator Hutchison, for working with me and my staff in this
effort.
______
By Mr. Shelby (for himself, Mr. Murkowski, Mr. Sarbanes, Mr.
Gramm, Mr. Dodd, Mr. Lott, Mr. Craig, and Mr. Crapo):
S. 206. A bill to repeal the Public Utility Holding Company Act of
1935, to enact the Public Utility Holding Company Act of 2001, and for
other purposes; to the Committee on Banking, Housing, and Urban
Affairs.
Mr. SHELBY. Mr. President, I rise today to introduce the Public
Utility Holding Company Act of 2001. This bipartisan bill is designed
to help America's energy consumers by repealing an antiquated law that
is keeping the benefits of competition from reaching our citizens. I am
pleased to be joined by Senators Gramm and Sarbanes, chairman and
ranking member of the Committee on Banking, Housing, and Urban Affairs,
Senator Murkowski, chairman of the Energy and Natural Resources
Committee, Majority Leader Lott, and Senators Dodd, Craig, and Crapo in
introducing this important legislation. Our bill, which closely tracks
legislation voted out of the Senate Banking Committee with bipartisan
support in the 106th Congress, repeals the Public Utility Holding
Company Act of 1935, PUHCA.
The original PUHCA legislation passed over 60 years ago in 1935. At
that time, a few large holding companies controlled a great majority of
the electric utilities and gas pipelines. However, such a limited
number of providers no longer offer a majority of the utility service.
In fact, over 80 percent of the utility holding companies are currently
exempt from PUHCA.
This legislation implements the recommendations that the Securities
and Exchange Commission, SEC made first in 1981 and then again in 1995
following an extensive study of the effects of this antiquated law on
our energy markets. In the 1995 report entitled. ``The Regulation of
Public-Utility Holding Companies,'' the Division of Investment
Management recommended that Congress conditionally repeal the Act since
``the current regulatory system imposes significant costs, indirect
administrative charges and foregone economies of scale and scope . .
.'' In the end, the report serves to highlight the fact that the
regulatory restraints imposed by PUHCA on our electric and gas
industries are counterproductive in today's competitive environment and
are based on historical assumptions and industry models that are no
longer valid.
In order to ensure that ratepayers are protected, this bill provides
the Federal Energy Regulatory Commission and the States access to the
books and records of holding company systems that are relevant to the
costs incurred by jurisdictional public utility companies. As a result,
the regulatory framework to protect consumers is not only protected in
this bill, but enhanced.
Let me be clear about the effect of PUHCA repeal: it eliminates
redundant and burdensome regulation while enhancing existing consumer
protections.
Mr. President, we are at a time in our nation's history when we are
going to have to make some critical choices regarding our national
energy policy. The fact is, future technological innovation and
economic growth is contingent upon this country's ability to meet its
ever increasing demand for energy. In order to do this, we need to
modernize production systems, increase market competition, and strip
away unnecessary regulations. Achieving these goals is going to be a
difficult and time consuming process. However, repeal of this law would
be the first step in the right direction.
Mr. President, it has been a very long time since it first became
clear that this out dated, Depression-era law had become an unnecessary
constraint on the ability of American gas and electric utilities to
compete. Unfortunately, the many bipartisan efforts to repeal PUHCA
have not been successful. However, strong support still exists for its
elimination. I believe that it is imperative that we achieve this goal
in the 107th Congress.
I ask unanimous consent that the text 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. 206
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Public Utility Holding
Company Act of 2001''.
SEC. 2. FINDINGS AND PURPOSES.
(a) Findings.--Congress finds that--
(1) the Public Utility Holding Company Act of 1935 was
intended to facilitate the work of Federal and State
regulators by placing certain constraints on the activities
of holding company systems;
(2) developments since 1935, including changes in other
regulation and in the electric and gas industries, have
called into question the continued relevance of the model of
regulation established by that Act;
(3) there is a continuing need for State regulation in
order to ensure the rate protection of utility customers; and
[[Page S711]]
(4) limited Federal regulation is necessary to supplement
the work of State commissions for the continued rate
protection of electric and gas utility customers.
(b) Purposes.--The purposes of this Act are--
(1) to eliminate unnecessary regulation, yet continue to
provide for consumer protection by facilitating existing rate
regulatory authority through improved Federal and State
commission access to books and records of all companies in a
holding company system, to the extent that such information
is relevant to rates paid by utility customers, while
affording companies the flexibility required to compete in
the energy markets; and
(2) to address protection of electric and gas utility
customers by providing for Federal and State access to books
and records of all companies in a holding company system that
are relevant to utility rates.
SEC. 3. DEFINITIONS.
For purposes of this Act--
(1) the term ``affiliate'' of a company means any company,
5 percent or more of the outstanding voting securities of
which are owned, controlled, or held with power to vote,
directly or indirectly, by such company;
(2) the term ``associate company'' of a company means any
company in the same holding company system with such company;
(3) the term ``Commission'' means the Federal Energy
Regulatory Commission;
(4) the term ``company'' means a corporation, partnership,
association, joint stock company, business trust, or any
organized group of persons, whether incorporated or not, or a
receiver, trustee, or other liquidating agent of any of the
foregoing;
(5) the term ``electric utility company'' means any company
that owns or operates facilities used for the generation,
transmission, or distribution of electric energy for sale;
(6) the terms ``exempt wholesale generator'' and ``foreign
utility company'' have the same meanings as in sections 32
and 33, respectively, of the Public Utility Holding Company
Act of 1935 (15 U.S.C. 79z-5a, 79z-5b), as those sections
existed on the day before the effective date of this Act;
(7) the term ``gas utility company'' means any company that
owns or operates facilities used for distribution at retail
(other than the distribution only in enclosed portable
containers or distribution to tenants or employees of the
company operating such facilities for their own use and not
for resale) of natural or manufactured gas for heat, light,
or power;
(8) the term ``holding company'' means--
(A) any company that directly or indirectly owns, controls,
or holds, with power to vote, 10 percent or more of the
outstanding voting securities of a public utility company or
of a holding company of any public utility company; and
(B) any person, determined by the Commission, after notice
and opportunity for hearing, to exercise directly or
indirectly (either alone or pursuant to an arrangement or
understanding with one or more persons) such a controlling
influence over the management or policies of any public
utility company or holding company as to make it necessary
or appropriate for the rate protection of utility
customers with respect to rates that such person be
subject to the obligations, duties, and liabilities
imposed by this Act upon holding companies;
(9) the term ``holding company system'' means a holding
company, together with its subsidiary companies;
(10) the term ``jurisdictional rates'' means rates
established by the Commission for the transmission of
electric energy in interstate commerce, the sale of electric
energy at wholesale in interstate commerce, the
transportation of natural gas in interstate commerce, and the
sale in interstate commerce of natural gas for resale for
ultimate public consumption for domestic, commercial,
industrial, or any other use;
(11) the term ``natural gas company'' means a person
engaged in the transportation of natural gas in interstate
commerce or the sale of such gas in interstate commerce for
resale;
(12) the term ``person'' means an individual or company;
(13) the term ``public utility'' means any person who owns
or operates facilities used for transmission of electric
energy in interstate commerce or sales of electric energy at
wholesale in interstate commerce;
(14) the term ``public utility company'' means an electric
utility company or a gas utility company;
(15) the term ``State commission'' means any commission,
board, agency, or officer, by whatever name designated, of a
State, municipality, or other political subdivision of a
State that, under the laws of such State, has jurisdiction to
regulate public utility companies;
(16) the term ``subsidiary company'' of a holding company
means--
(A) any company, 10 percent or more of the outstanding
voting securities of which are directly or indirectly owned,
controlled, or held with power to vote, by such holding
company; and
(B) any person, the management or policies of which the
Commission, after notice and opportunity for hearing,
determines to be subject to a controlling influence, directly
or indirectly, by such holding company (either alone or
pursuant to an arrangement or understanding with one or more
other persons) so as to make it necessary for the rate
protection of utility customers with respect to rates that
such person be subject to the obligations, duties, and
liabilities imposed by this Act upon subsidiary companies of
holding companies; and
(17) the term ``voting security'' means any security
presently entitling the owner or holder thereof to vote in
the direction or management of the affairs of a company.
SEC. 4. REPEAL OF THE PUBLIC UTILITY HOLDING COMPANY ACT OF
1935.
The Public Utility Holding Company Act of 1935 (15 U.S.C.
79 et seq.) is repealed.
SEC. 5. FEDERAL ACCESS TO BOOKS AND RECORDS.
(a) In General.--Each holding company and each associate
company thereof shall maintain, and shall make available to
the Commission, such books, accounts, memoranda, and other
records as the Commission deems to be relevant to costs
incurred by a public utility or natural gas company that is
an associate company of such holding company and necessary or
appropriate for the protection of utility customers with
respect to jurisdictional rates.
(b) Affiliate Companies.--Each affiliate of a holding
company or of any subsidiary company of a holding company
shall maintain, and shall make available to the Commission,
such books, accounts, memoranda, and other records with
respect to any transaction with another affiliate, as the
Commission deems to be relevant to costs incurred by a public
utility or natural gas company that is an associate company
of such holding company and necessary or appropriate for the
protection of utility customers with respect to
jurisdictional rates.
(c) Holding Company Systems.--The Commission may examine
the books, accounts, memoranda, and other records of any
company in a holding company system, or any affiliate
thereof, as the Commission deems to be relevant to costs
incurred by a public utility or natural gas company within
such holding company system and necessary or appropriate for
the protection of utility customers with respect to
jurisdictional rates.
(d) Confidentiality.--No member, officer, or employee of
the Commission shall divulge any fact or information that may
come to his or her knowledge during the course of examination
of books, accounts, memoranda, or other records as provided
in this section, except as may be directed by the Commission
or by a court of competent jurisdiction.
SEC. 6. STATE ACCESS TO BOOKS AND RECORDS.
(a) In General.--Upon the written request of a State
commission having jurisdiction to regulate a public utility
company in a holding company system, the holding company or
any associate company or affiliate thereof, other than such
public utility company, wherever located, shall produce for
inspection books, accounts, memoranda, and other records
that--
(1) have been identified in reasonable detail in a
proceeding before the State commission;
(2) the State commission deems are relevant to costs
incurred by such public utility company; and
(3) are necessary for the effective discharge of the
responsibilities of the State commission with respect to such
proceeding.
(b) Limitation.--Subsection (a) does not apply to any
person that is a holding company solely by reason of
ownership of one or more qualifying facilities under the
Public Utility Regulatory Policies Act of 1978.
(c) Confidentiality of Information.--The production of
books, accounts, memoranda, and other records under
subsection (a) shall be subject to such terms and conditions
as may be necessary and appropriate to safeguard against
unwarranted disclosure to the public of any trade secrets or
sensitive commercial information.
(d) Effect on State Law.--Nothing in this section shall
preempt applicable State law concerning the provision of
books, records, or any other information, or in any way limit
the rights of any State to obtain books, records, or any
other information under any other Federal law, contract, or
otherwise.
(e) Court Jurisdiction.--Any United States district court
located in the State in which the State commission referred
to in subsection (a) is located shall have jurisdiction to
enforce compliance with this section.
SEC. 7. EXEMPTION AUTHORITY.
(a) Rulemaking.--Not later than 90 days after the effective
date of this Act, the Commission shall promulgate a final
rule to exempt from the requirements of section 5 any person
that is a holding company, solely with respect to one or
more--
(1) qualifying facilities under the Public Utility
Regulatory Policies Act of 1978;
(2) exempt wholesale generators; or
(3) foreign utility companies.
(b) Other Authority.--The Commission shall exempt a person
or transaction from the requirements of section 5, if, upon
application or upon the motion of the Commission--
(1) the Commission finds that the books, records, accounts,
memoranda, and other records of any person are not relevant
to the jurisdictional rates of a public utility or natural
gas company; or
(2) the Commission finds that any class of transactions is
not relevant to the jurisdictional rates of a public utility
or natural gas company.
[[Page S712]]
SEC. 8. AFFILIATE TRANSACTIONS.
Nothing in this Act shall preclude the Commission or a
State commission from exercising its jurisdiction under
otherwise applicable law to determine whether a public
utility company, public utility, or natural gas company may
recover in rates any costs of an activity performed by an
associate company, or any costs of goods or services acquired
by such public utility company from an associate company.
SEC. 9. APPLICABILITY.
No provision of this Act shall apply to, or be deemed to
include--
(1) the United States;
(2) a State or any political subdivision of a State;
(3) any foreign governmental authority not operating in the
United States;
(4) any agency, authority, or instrumentality of any entity
referred to in paragraph (1), (2), or (3); or
(5) any officer, agent, or employee of any entity referred
to in paragraph (1), (2), or (3) acting as such in the course
of his or her official duty.
SEC. 10. EFFECT ON OTHER REGULATIONS.
Nothing in this Act precludes the Commission or a State
commission from exercising its jurisdiction under otherwise
applicable law to protect utility customers.
SEC. 11. ENFORCEMENT.
The Commission shall have the same powers as set forth in
sections 306 through 317 of the Federal Power Act (16 U.S.C.
825e-825p) to enforce the provisions of this Act.
SEC. 12. SAVINGS PROVISIONS.
(a) In General.--Nothing in this Act prohibits a person
from engaging in or continuing to engage in activities or
transactions in which it is legally engaged or authorized to
engage on the effective date of this Act.
(b) Effect on Other Commission Authority.--Nothing in this
Act limits the authority of the Commission under the Federal
Power Act (16 U.S.C. 791a et seq.) (including section 301 of
that Act) or the Natural Gas Act (15 U.S.C. 717 et seq.)
(including section 8 of that Act).
SEC. 13. IMPLEMENTATION.
Not later than 18 months after the date of enactment of
this Act, the Commission shall--
(1) promulgate such regulations as may be necessary or
appropriate to implement this Act (other than section 6); and
(2) submit to the Congress detailed recommendations on
technical and conforming amendments to Federal law necessary
to carry out this Act and the amendments made by this Act.
SEC. 14. TRANSFER OF RESOURCES.
All books and records that relate primarily to the
functions transferred to the Commission under this Act shall
be transferred from the Securities and Exchange Commission to
the Commission.
SEC. 15. EFFECTIVE DATE.
This Act shall take effect 18 months after the date of
enactment of this Act.
SEC. 16. AUTHORIZATION OF APPROPRIATIONS.
There are authorized to be appropriated such funds as may
be necessary to carry out this Act.
SEC. 17. CONFORMING AMENDMENT TO THE FEDERAL POWER ACT.
Section 318 of the Federal Power Act (16 U.S.C. 825q) is
repealed.
______
By Mr. FRIST (for himself, Mr. Harkin, Mr. Jeffords, Mr. Kennedy,
Mr. Hutchinson, Ms. Mikulski, Mr. Bingaman, and Mrs. Murray):
S. 208. A bill to reduce health care costs and promote improved
health care by providing supplemental grants for additional preventive
health services for women; to the Committee on Health, Education,
Labor, and Pensions.
Mr. FRIST. Mr. President, although we often think of cardiovascular
disease as a men's health issue, the American Heart Association
estimates that nearly one in two women will die of heart disease or
stroke. However, because of its historically male stereotype, most
women do not realize that they are at such high risk for cardiovascular
disease even though cardiovascular diseases kills nearly 50,000 more
women each year than men. Even more alarming is data reported by the
Society for Women's Health Research which revealed that not all
physicians know that cardiovascular diseases are the leading cause of
death among American women.
Each year nearly half a million women lose their lives as a result of
heart disease and stroke. Fortunately, men have experienced a decline
in deaths due to cardiovascular diseases since 1984; but women have
not, and many of these tragic deaths could have been prevented had
these women known they were at risk. For instance, they could have
taken preventive measures by not smoking, lowering their cholesterol or
blood pressure, or by eating more nutritiously, and perhaps avoided
becoming a victim of heart disease or stroke. For many women,
prevention is truly the only cure, since it has been reported that as
many as two-thirds of women who die from heart attacks have no warning
symptoms of any kind.
Cardiovascular diseases kill more American females each year than the
next 14 causes of death combined, including all forms of cancers. Over
half of all cardiovascular deaths each year are women, and in 1997
alone heart diseases claimed the lives of more than half a million
women. My own home state of Tennessee has the second highest death rate
from heart disease, stroke, and other cardiovascular diseases in the
nation and the 13th highest ranking state in women's heart deaths. In
1997, 10,884 Tennessee women died from these two cardiovascular
diseases alone. Moreover, the Centers for Disease Control and
Prevention (CDC) reports that women in the rural South are more likely
to die of heart disease than those in other parts of the country.
Fortunately, some preventive measures, such as physical activity and
better nutrition, can be taken by women to reduce their risk for
cardiovascular diseases, as well as other preventable diseases, such as
osteoporosis--a disease that affects one out of every two women over 50
and threatens roughly 28 million Americans, 80 percent of whom are
women.
To continue to draw greater awareness to health issues among American
women, particularly cardiovascular diseases, I am very pleased to
reintroduce legislation which I introduced last Congress, the
``WISEWOMAN Expansion Act of 2001,'' with Senator Harkin. Our goal in
expanding this program is to reduce the risk of cardiovascular
diseases, and other preventable diseases, and to increase access to
screening and other preventive measures for low-income and underinsured
women. In addition to making cardiovascular diseases screening
accessible to underserved women, this program will also educate them
about their risk for cardiovascular diseases and how to make lifestyle
changes--thereby giving them the power to prevent these diseases.
The CDC's National Breast and Cervical Cancer Early Detection Program
(NBCCEDP) is an example of a successful program that has provided
critical services to help prevent major diseases affecting American
women. The NBCCEDP has done an outstanding job of reaching out to low-
income underinsured women--women who are generally too young for
Medicare and unable to qualify for Medicaid or other state programs--
and providing them with preventive screenings for breast and cervical
cancers. These women would likely otherwise fall through the cracks in
our health system.
Our bill provides for the expansion of the WISEWOMAN (Well-Integrated
Screening and Evaluation for Women in Massachusetts, Arizona, and North
Carolina) demonstration project, which is run by the CDC in conjunction
with the NBCCEDP, to additional states. The WISEWOMAN program
capitalizes on the highly successful infrastructure of the NBCCEDP to
offer ``one-stop shopping'' screening and preventive services for
uninsured and low-income women. In addition to these very important
breast and cervical cancer screenings, WISEWOMAN screens for
cardiovascular disease risk factors and provides health counseling and
lifestyle interventions to help women reduce behavioral risk factors.
The program addresses risk factors such as elevated cholesterol, high
blood pressure, obesity and smoking and provides important additional
intervention and educational services to women who would not otherwise
have access to cardiovascular disease screening or prevention. This
bill also adds flexibility to the program language that would allow
screenings and other preventive measures for diseases in addition to
cardiovascular diseases, such as osteoporosis, as more preventive
technology is developed.
I would like to thank Judy Womack and Dr. Joy Cox of the Tennessee
Department of Health for their counsel and assistance on this
legislation and for their efforts in helping Tennesseans.
I ask unanimous consent that three letters supporting the WISEWOMAN
Expansion Act of 2001 be printed in the Record.
[[Page S713]]
There being no objection, the letters were ordered to be printed in
the Record, as follows:
American Heart Association,
Office of Public Advocacy,
Washington, DC, January 26, 2001.
Hon. Bill Frist, M.D.,
Hon. Tom Harkin,
United States Senate,
Washington, DC.
Dear Senators Frist and Harkin: Heart attack, stroke and
other cardiovascular diseases remain the leading cause of
death of women in the United States. Heart disease, alone, is
the number one killer of American women and stroke is the
number three killer. In fact, low-income women are at an even
higher risk of heart disease and stroke than other women, and
they have a higher prevalence of risk factors contributing to
these diseases. The American Heart Association is very
grateful for the support you and other members of the United
States Congress have given to the WISEWOMAN demonstration
program which uses the National Breast and Cervical Cancer
Early Detection Program network to provide heart disease and
stroke screening services, as well as diet and physical
activity interventions and appropriate referrals.
The American Heart Association applauds the WISEWOMAN
program and we are anticipating even greater results in the
battle against heart disease and stroke as the program
expands to serve more women throughout the United States. The
Frist-Harkin ``WISEWOMAN Expansion Act of 2001'' will expand
WISEWOMAN's heart disease and stroke screenings beyond its
current limit, which we believe will have a tremendous
positive impact to the cardiovascular health of women who
live in states served by the program.
The American Heart Association recommends increased funding
and expansion of the WISEWOMAN program during fiscal year
2002. Also, because of the solid scientific evidence that
cardiovascular screenings can help prevent heart disease and
stroke in women, we believe cardiovascular screenings
provided by WISEWOMAN should be expanded before using the
demonstration program to provide screenings for other
diseases affecting women.
We thank you for your commitment to fighting heart disease
and stroke, and look forward to your continued support in the
future.
Sincerely,
Rose Marie Robertson, M.D.,
President.
____
Society for
Women's Health Research,
Washington, DC, January 25, 2001.
Hon. Bill Frist,
Chair, Subcommittee on Public Health, Committee on Health,
Education, Labor, and Pensions, Dirksen Senate Office
Building, Washington, DC.
Hon. Tom Harkin,
Ranking Member, Subcommittee on Public Health, Committee on
Health, Education, Labor, and Pensions, Dirksen Senate
Office Building, Washington, DC.
Dear Senators Frist and Harkin: On behalf of the Society
for Women's Health Research, we express our appreciation for
your leadership on the introduction of the ``WISEWOMAN
Expansion Act of 2001.'' In addition to a strong national
research program, disease prevention is vital to our nation's
health. Chronic diseases, such as heart disease, cancer,
diabetes, and osteoporosis are among the most prevalent,
costly, and preventable of all health problems.
As you know, women tend to live longer but not necessarily
better than men. They have more chronic health conditions and
are more economically insecure. Safety net programs often are
the difference between life and death. The WISEWOMAN
Expansion Act is building on a foundation that has provided
positive feedback and will allow additional states to provide
prevention services to those women in need. We applaud the
flexibility of the legislation. With the passage of time, as
new technologies develop, as disease burdens shift, and as
lifestyles change, the program can address women's most
critical health needs.
We thank you for your commitment to improving the nation's
health through prevention. By focusing on the health of
women, you ultimately will be improving the health of the
nation's families.
Sincerely,
Phyliss Greenberger,
President and CEO.
Roberta Biegel,
Director of Government Relations.
____
National Osteoporosis Foundation,
January 29, 2001.
Hon. Tom Harkin,
Hon. Bill Frist,
U.S. Senate, Washington, DC.
Dear Senators Harkin and Frist: On behalf of the National
Osteoporosis Foundation (NOF), I commend you on the
introduction of the bipartisan WISEWOMAN Expansion Act of
2001 that supports your effort to provide additional
preventive health services, including osteoporosis screening,
to low-income and uninsured women.
As you know, osteoporosis is a major health threat for more
than 28 million Americans, 80 percent of whom are women. In
the United States today, 10 million individuals already have
the disease and 18 million more have low bone mass, placing
them at increased risk for osteoporosis. Also, one out of
every two women over 50 will have an osteoporosis-related
fracture in their lifetime. It is estimated that the direct
hospital and nursing home costs of osteoporosis are over
$13.8 billion annually, with much of that attributed to the
more than 1.5 million osteoporosis-related fractures that
occur annually.
The health care services included in the WISEWOMAN program
have provided positive results for many women who have
participated and ultimately cost-savings for the states that
have participated. Expansion of the WISEWOMAN model to
additional states and for additional preventive services,
such as screening for osteoporosis, should enhance positive
results for both the women and states participating in the
program.
The National Osteoporosis Foundation is most appreciative
of your efforts to promote improved both health and endorse
the WISEWOMAN Expansion Act of 2001.
Sincerely,
Sandra C. Raymond,
Executive Director.
Mr. HARKIN. Mr. President, I am pleased to join Senator Frist today
to introduce the ``WISEWOMAN Expansion Act.'' This bill will help
thousands of women have access to basic preventive health care they may
otherwise not receive. The legislation builds on a successful
demonstration program and expands screening services and preventive
care for uninsured and low-income women across the nation.
Beginning in 1990, I worked as Chairman of the Labor, Health and
Human Services and Education Appropriation Subcommittee to provide the
funding for the National Breast and Cervical Cancer Early Detection
Program, NBCCEDP, run through the Centers for Disease Control and
Prevention. In Iowa alone, the program has successfully served close to
9000 women through 618 provider-based breast and cervical cancer
screening sites.
Today, the Centers for Disease Control and Prevention currently run
the WISEWOMAN program through the NBCCEDP as a demonstration project.
The program has successfully built upon the framework of the NBCCEDP to
target other chronic diseases among women, including heart disease, the
leading cause of death among women, and osteoporosis. The programs
address risk factors such as elevated cholesterol, high blood pressure,
obesity and smoking and provide important intervention services.
This demonstration project has been successful. It is now time to
expand the program to additional states, and eventually make it
nationwide. As the brother of two sisters lost to breast cancer and the
father of two daughters, I know first hand the importance of making
women's health initiatives a top priority. The first step to fighting a
chronic disease like cancer, heart disease or osteoporosis is early
detection. All women deserve to benefit from the early detection and
prevention made possible by the latest advances in medicine. This bill
ensures a place for lower income woman at the health care table.
The majority of Americans associate cardiovascular disease with men,
but the American Heart Association estimates that nearly one in two
women will die of heart disease or stroke. In fact, cardiovascular
diseases kills nearly 50,000 more women each year than men. In my own
state of Iowa, cardiovascular disease accounts for 44 percent of all
deaths in Iowa. Close to 7,000 women die annually in Iowa from
cardiovascular disease. Each year, nearly half a million women lose
their lives as a result of heart disease and stroke. Sadly, with
appropriate screening and interventions, many of these deaths could
have been prevented.
Osteoporosis is also a preventable disease and affects one out of
every two women over the age of 50. Fortunately, some of the preventive
measures women can take to reduce their risk for cardiovascular
diseases, such as eating more nutritious foods and exercising, can also
reduce their risk for osteoporosis.
Our bill would do the following:
Expand the current WISEWOMAN demonstration project to additional
states;
Add flexibility to program language that would allow screenings and
other preventive measures for diseases in addition to cardiovascular
diseases;
Allow flexibility for the WISEWOMAN program to grow and adapt with
the changing needs of individual states and our better understanding of
new preventive strategies; and
[[Page S714]]
Ensure continued full collaboration of the WISEWOMAN program with the
NBCCEDP; Authorize the CDC to make competitive grants to states to
carry out additional preventive health services to the breast and
cervical cancer screenings at NBCCEDP programs, such as: screenings for
blood pressure, cholesterol, and osteoporosis; health education and
counseling; lifestyle interventions to change behavioral risk factors
such as smoking, lack of exercise, poor nutrition, and sedentary
lifestyle; and appropriate referrals for medical treatment and follow-
up services.
In order to be eligible for this program, states are required to
already participate in the NBCCEDP and to agree to operate their
WISEWOMAN program in collaboration with the NBCCEDP.
This bipartisan legislation has the support of the National
Osteoporosis Foundation, the American Heart Association, the American
Cancer Society and the Komen Foundation, among others. I urge my
colleagues to join us in supporting this critical legislation.
______
By Mr. CAMPBELL (for himself and Mr. Inouye):
S. 210. A bill to authorize the integration and consolidation of
alcohol and substance abuse programs and services provided by Indian
tribal governments, and for other purposes; to the Committee on Indian
Affairs.
Mr. CAMPBELL. Mr. President, I am pleased to be joined today by the
Vice Chairman of the Committee on Indian Affairs Senator Daniel K.
Inouye in introducing the Native American Alcohol and Substance Abuse
Program Consolidation Act of 2001. This important legislation will
authorize Indian Tribes to consolidate and integrate alcohol, substance
abuse prevention and treatment and mental health programs to provide
more comprehensive treatment and services to Native Americans across
the country.
More often than not, individuals with alcohol and substance abuse
problems are also hobbled with mental health problems, and this bill
authorizes tribes to make mental health services available as well.
Native Americans have higher rates of alcohol and drug use than any
other racial or ethnic group in the United States. Despite previous
treatment and preventive efforts, alcoholism and substance abuse
continue to be prevalent among Native youth: 82 percent of Native
adolescents admitted to having used alcohol, compared with 66 percent
of non-Native youth.
Alcohol continues to be an important risk factor associated with the
top three killers of Native youngsters--accidents, suicide, and
homicide.
Based on 1993 data, the rate of mortality due to alcoholism among
Native youth ages 15 to 24 was 5.2 per 100,000, which is 17 times the
rate for whites in the same age group.
In a 1994 school-based study, 39 percent of Native high school
seniors reported having ``gotten drunk'' and 39 percent of Native kids
admitted to using marijuana.
Alcohol and substance abuse also contribute to other social problems
including sexually transmitted diseases, child and spousal abuse, poor
school achievement and dropout, unemployment, drunk-driving and
vehicular deaths, mental health problems, hopelessness and suicide.
Alcohol, substance abuse, and mental health program funds are
available to tribes from virtually every agency in the federal
government including the Departments of Education, Health and Human
Services, Housing and Urban Development, Interior, Justice, and
Transportation.
To help Tribes slice through the bureaucracy, this bill authorizes
Tribal governments and inter-Tribal organizations to: 1, consolidate
these programs through a single federal office in the Department of
Health and Human Services--Indian Health Services, IHS; and 2, use a
single plan to reduce the administrative and bureaucratic processes,
resulting in better services to Native Americans.
This bill tries to replicate the success of the widely-hailed ``477
model'' that Tribes have used to effectively coordinate employment
training and related services through the Indian Employment Training
and Related Services Demonstration Act of 1992, Pub. Law 102-477.
Under the ``477 model,'' and applicant Tribe files a single plan to
draw and coordinate resources from the spectrum of federal agencies and
administer them through one office. I am hopeful that armed with this
creative tool, Tribes can begin to bring an end to the devastation of
alcohol and drug abuse in their communities.
Mr. President, I ask unanimous consent that a copy of the legislation
be printed in the Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 210
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Native American Alcohol and
Substance Abuse Program Consolidation Act of 2001''.
SEC. 2. STATEMENT OF PURPOSE.
The purposes of this Act are--
(1) to enable Indian tribes to consolidate and integrate
alcohol and other substance abuse prevention, diagnosis and
treatment programs, and mental health and related programs,
to provide unified and more effective and efficient services
to Native Americans afflicted with alcohol and other
substance abuse problems; and
(2) to recognize that Indian tribes can best determine the
goals and methods for establishing and implementing
prevention, diagnosis and treatment programs for their
communities, consistent with the policy of self-
determination.
SEC. 3. DEFINITIONS.
(a) In General.--In this Act:
(1) Federal agency.--The term ``Federal agency'' has the
meaning given the term ``agency'' in section 551(1) of title
5, United States Code.
(2) Indian.--The term ``Indian'' has the meaning given that
term in section 4(d) of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450b(d)).
(3) Indian tribe.--The terms ``Indian tribe'' and ``tribe''
have the meaning given the term ``Indian tribe'' in section
4(e) of the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450b(e)) and shall include entities
as provided for in subsection (b)(2).
(4) Secretary.--Except where otherwise provided, the term
``Secretary'' means the Secretary of Health and Human
Services.
(5) Substance abuse.--The term ``substance abuse'' includes
the illegal use or abuse of a drug, the abuse of an inhalant,
or the abuse of tobacco or related products.
(b) Indian Tribe.--
(1) In general.--In any case in which an Indian tribe has
authorized another Indian tribe, an inter-tribal consortium,
or a tribal organization to plan for or carry out programs,
services, functions, or activities (or portions thereof) on
its behalf under this Act, the authorized Indian tribe,
inter-tribal consortium, or tribal organization shall have
the rights and responsibilities of the authorizing Indian
tribe (except as otherwise provided in the authorizing
resolution or in this Act).
(2) Inclusion of other entities.--In a case described in
paragraph (1), the term ``Indian tribe'', as defined in
subsection (a)(2), shall include the additional authorized
Indian tribe, inter-tribal consortium, or tribal
organization.
SEC. 4. INTEGRATION OF SERVICES AUTHORIZED.
The Secretary, in cooperation with the Secretary of Labor,
the Secretary of the Interior, the Secretary of Education,
the Secretary of Housing and Urban Development, the United
States Attorney General, and the Secretary of Transportation,
as appropriate, shall, upon the receipt of a plan acceptable
to the Secretary that is submitted by an Indian tribe,
authorize the tribe to coordinate, in accordance with such
plan, its federally funded alcohol and substance abuse and
mental health programs in a manner that integrates the
program services involved into a single, coordinated,
comprehensive program and reduces administrative costs by
consolidating administrative functions.
SEC. 5. PROGRAMS AFFECTED.
The programs that may be integrated in a demonstration
project under any plan referred to in section 4 shall
include--
(1) any program under which an Indian tribe is eligible for
the receipt of funds under a statutory or administrative
formula for the purposes of prevention, diagnosis, or
treatment of alcohol and other substance abuse problems and
disorders, or mental health problems and disorders, or any
program designed to enhance the ability to treat, diagnose,
or prevent alcohol and other substance abuse and related
problems and disorders, or mental health problems or
disorders;
(2) any program under which an Indian tribe is eligible for
receipt of funds though a competitive or other grant program
for the purposes of prevention, diagnosis, or treatment of
alcohol and other substance abuse problems and disorders, or
mental health problems and disorders, or treatment,
diagnosis, or prevention of related problems and disorders,
or any program designed to enhance the ability to treat,
diagnose, or prevent alcohol and other substance abuse and
related problems and disorders, or mental health problems or
disorders, if--
[[Page S715]]
(A) the Indian tribe has provided notice to the appropriate
agency regarding the intentions of the tribe to include the
grant program in the plan it submits to the Secretary, and
the affected agency has consented to the inclusion of the
grant in the plan; or
(B) the Indian tribe has elected to include the grant
program in its plan, and the administrative requirements
contained in the plan are essentially the same as the
administrative requirements under the grant program; and
(3) any program under which an Indian tribe is eligible for
receipt of funds under any other funding scheme for the
purposes of prevention, diagnosis, or treatment of alcohol
and other substance abuse problems and disorders, or mental
health problems and disorders, or treatment, diagnosis, or
prevention of related problems and disorders, or any program
designed to enhance the ability to treat, diagnose, or
prevent alcohol and other substance abuse and related
problems and disorders, or mental health problems or
disorders.
SEC. 6. PLAN REQUIREMENTS.
For a plan to be acceptable under section 4, the plan
shall--
(1) identify the programs to be integrated;
(2) be consistent with the purposes of this Act authorizing
the services to be integrated into the project;
(3) describe a comprehensive strategy that identifies the
full range of existing and potential alcohol and substance
abuse and mental health treatment and prevention programs
available on and near the tribe's service area;
(4) describe the manner in which services are to be
integrated and delivered and the results expected under the
plan;
(5) identify the projected expenditures under the plan in a
single budget;
(6) identify the agency or agencies in the tribe to be
involved in the delivery of the services integrated under the
plan;
(7) identify any statutory provisions, regulations,
policies, or procedures that the tribe believes need to be
waived in order to implement its plan; and
(8) be approved by the governing body of the tribe.
SEC. 7. PLAN REVIEW.
(a) Consultation.--Upon receipt of a plan from an Indian
tribe under section 4, the Secretary shall consult with the
head of each Federal agency providing funds to be used to
implement the plan, and with the tribe submitting the plan.
(b) Identification of Waivers.--The parties consulting on
the implementation of the plan under subsection (a) shall
identify any waivers of statutory requirements or of Federal
agency regulations, policies, or procedures necessary to
enable the tribal government to implement its plan.
(c) Waivers.--Notwithstanding any other provision of law,
the head of the affected Federal agency shall have the
authority to waive any statutory requirement, regulation,
policy, or procedure promulgated by the Federal agency that
has been identified by the tribe or the Federal agency under
subsection (b) unless the head of the affected Federal agency
determines that such a waiver is inconsistent with the
purposes of this Act or with those provisions of the Act that
authorizes the program involved which are specifically
applicable to Indian programs.
SEC. 8. PLAN APPROVAL.
(a) In General.--Not later than 90 days after the receipt
by the Secretary of a tribe's plan under section 4, the
Secretary shall inform the tribe, in writing, of the
Secretary's approval or disapproval of the plan, including
any request for a waiver that is made as part of the plan.
(b) Disapproval.--If a plan is disapproved under subsection
(a), the Secretary shall inform the tribal government, in
writing, of the reasons for the disapproval and shall give
the tribe an opportunity to amend its plan or to petition the
Secretary to reconsider such disapproval, including
reconsidering the disapproval of any waiver requested by the
Indian tribe.
SEC. 9. FEDERAL RESPONSIBILITIES.
(a) Responsibilities of the Indian Health Service.--
(1) Memorandum of understanding.--Not later than 180 days
after the date of enactment of this Act, the Secretary, the
Secretary of the Interior, the Secretary of Labor, the
Secretary of Education, the Secretary of Housing and Urban
Development, the United States Attorney General, and the
Secretary of Transportation shall enter into an
interdepartmental memorandum of agreement providing for the
implementation of the plans authorized under this Act.
(2) Lead agency.--The lead agency under this Act shall be
the Indian Health Service.
(3) Responsibilities.--The responsibilities of the lead
agency under this Act shall include--
(A) the development of a single reporting format related to
the plan for the individual project which shall be used by a
tribe to report on the activities carried out under the plan;
(B) the development of a single reporting format related to
the projected expenditures for the individual plan which
shall be used by a tribe to report on all plan expenditures;
(C) the development of a single system of Federal oversight
for the plan, which shall be implemented by the lead agency;
(D) the provision of technical assistance to a tribe
appropriate to the plan, delivered under an arrangement
subject to the approval of the tribe participating in the
project, except that a tribe shall have the authority to
accept or reject the plan for providing the technical
assistance and the technical assistance provider; and
(E) the convening by an appropriate official of the lead
agency (whose appointment is subject to the confirmation of
the Senate) and a representative of the Indian tribes that
carry out projects under this Act, in consultation with each
of the Indian tribes that participate in projects under this
Act, of a meeting not less than 2 times during each fiscal
year for the purpose of providing an opportunity for all
Indian tribes that carry out projects under this Act to
discuss issues relating to the implementation of this Act
with officials of each agency specified in paragraph (1).
(b) Report Requirements.--The single reporting format shall
be developed by the Secretary under subsection (a)(3),
consistent with the requirements of this Act. Such reporting
format, together with records maintained on the consolidated
program at the tribal level shall contain such information as
will--
(1) allow a determination that the tribe has complied with
the requirements incorporated in its approved plan; and
(2) provide assurances to the Secretary that the tribe has
complied with all directly applicable statutory requirements
and with those directly applicable regulatory requirements
which have not been waived.
SEC. 10. NO REDUCTION IN AMOUNTS.
In no case shall the amount of Federal funds available to a
participating tribe involved in any project be reduced as a
result of the enactment of this Act.
SEC. 11. INTERAGENCY FUND TRANSFERS AUTHORIZED.
The Secretary, the Secretary of the Interior, the Secretary
of Labor, the Secretary of Education, the Secretary of
Housing and Urban Development, the United States Attorney
General, or the Secretary of Transportation, as appropriate,
is authorized to take such action as may be necessary to
provide for the interagency transfer of funds otherwise
available to a tribe in order to further the purposes of this
Act.
SEC. 12. ADMINISTRATION OF FUNDS AND OVERAGE.
(a) Administration of Funds.--
(1) In general.--Program funds shall be administered under
this Act in such a manner as to allow for a determination
that funds from specific programs (or an amount equal to the
amount utilized from each program) are expended on activities
authorized under such program.
(2) Separate records not required.--Nothing in this section
shall be construed as requiring a tribe to maintain separate
records tracing any services or activities conducted under
its approved plan under section 4 to the individual programs
under which funds were authorized, nor shall the tribe be
required to allocate expenditures among individual programs.
(b) Overage.--All administrative costs under a plan under
this Act may be commingled, and participating Indian tribes
shall be entitled to the full amount of such costs (under
each program or department's regulations), and no overage
shall be counted for Federal audit purposes so long as the
overage is used for the purposes provided for under this Act.
SEC. 13. FISCAL ACCOUNTABILITY.
Nothing in this Act shall be construed to interfere with
the ability of the Secretary or the lead agency to fulfill
the responsibilities for the safeguarding of Federal funds
pursuant to chapter 75 of title 31, United States Code.
SEC. 14. REPORT ON STATUTORY AND OTHER BARRIERS TO
INTEGRATION.
(a) Preliminary Report.--Not later than 2 years after the
date of enactment of this Act, the Secretary shall submit a
report to the Committee on Indian Affairs of the Senate and
the Committee on Resources of the House of Representatives on
the implementation of the program authorized under this Act.
(b) Final Report.--Not later than 5 years after the date of
the enactment of this Act, the Secretary shall submit a
report to the Committee on Indian Affairs of the Senate and
the Committee on Resources of the House of Representatives on
the results of the implementation of the program authorized
under this Act. The report shall identify statutory barriers
to the ability of tribes to integrate more effectively their
alcohol and substance abuse services in a manner consistent
with the purposes of this Act.
SEC. 15. ASSIGNMENT OF FEDERAL PERSONNEL TO STATE INDIAN
ALCOHOL AND DRUG TREATMENT OR MENTAL HEALTH
PROGRAMS.
Any State with an alcohol and substance abuse or mental
health program targeted to Indian tribes shall be eligible to
receive, at no cost to the State, such Federal personnel
assignments as the Secretary, in accordance with the
applicable provisions of subchapter IV of chapter 33 of title
5, United States Code, may deem appropriate to help insure
the success of such program.
______
By Mr. CAMPBELL (for himself and Mr. Inouye):
S. 211. A bill to amend the Education Amendments of 1978 and the
Tribally Controlled Schools Act of 1988 to improve education for
Indians, Native Hawaiians, and Alaskan Natives; to the Committee on
Indian Affairs.
[[Page S716]]
Mr. CAMPBELL. Mr. President, I am pleased today to be joined by the
Vice Chairman of the Committee on Indian Affairs, Senator Daniel K.
Inouye, in introducing legislation to improve the education delivery
systems in Indian schools so that the President's goal that ``no child
be left behind'' is as true for Native youngsters as for all Americans.
Grounded in the Constitution, treaties, federal statutes and court
decisions, the United States has a unique role in the education of
Native people. This is especially true for the Bureau of Indian Affairs
school system for schools on or near reservations built and designed by
the federal government. The only other school system in which the
federal role is so significant is with Department of Defense schools
for the children of those serving our nation in the armed forces.
As a youngster from a troubled background and a former teacher
myself, I firmly believe that more than ever a quality education holds
the key to a brighter and more hopeful future. I also know that the
life-blood of Native people and the best chance they have for improving
the lives of all their members lies in a well-educated community. In
short, I believe community development starts with individual
development and education is the key.
Like President Bush, I believe that education reform stands at the
top of our national agenda. Education reform in Indian country is
critical if this nation's Native people are to make the kind of
advancement that is so clearly needed.
The geography of much of Indian country is difficult: from wintry
Alaska, to the windswept Plains, to the searing heat of the Southwest,
the terrain often makes it hard to get to school, let alone do well in
school. I believe this reality must be acknowledged as we work to
improve Native school systems.
Members of the Committee on Indian Affairs know all too well that the
conditions in many, if not most, Indian schools is appalling: crumbling
facilities, asbestos and PCBs, lead paint, lack of heat and other
problems combine to make the schools nearly uninhabitable. Most
members, indeed most Americans, would probably pull their children from
school if they were subjected to these conditions.
We made a solid start at facilities replacement and repair with the
Fiscal Year 2001 Interior appropriations bill which provided nearly
$300 million in funds for these purposes.
Nevertheless, the backlog in school construction needs is still in
the $800 to 900 million range.
I am very encouraged by President Bush's plan to establish an Indian
tribal school capital improvement fund of more than $900 million to
rectify the facilities crisis.
The bill I am introducing today, the Native American Educational
Improvement Act of 2001, will improve education for Native people in a
variety of ways.
Title I of the bill will amend the Education Amendments of 1978 in
several respects. This legislation was enacted to provide a
comprehensive structure for the BIA funded schools system including
grant, contract and BIA operated schools.
The bill addresses most aspects of the BIA school system including
standards and accreditation, facilities and various funding issues. It
also provides guidance for how funding should be allocated by
establishing a formula to effect a more equitable distribution of
funds. The formula is based on weighted student units with extra weight
given for such things as disabilities of gifted and talented abilities.
In keeping with the policy of Indian Self Determination, the bill
carves out a key role for Indian Tribes by requiring that actions
undertaken pursuant to the Act be done in consultation with the Tribes.
This emphasis on maximizing local, Indian involvement is witnessed in
the bill in several respects including the use of negotiated rule-
making in proposing and developing regulations to carry out the Act.
There is no single federal policy more successful than the
contracting and compacting opportunities provided by the Indian Self
Determination and Education Assistance Act of 1975, as amended.
Tribes and Tribal consortia have demonstrated that when they are
provided the resources and flexibility to design and implement programs
and services formerly provided by the Federal government, good things
happen: 1, the quality of those services is refined; 2, the Tribe or
consortium enhances its administrative and managerial abilities; and 3,
federal resources are used more efficiently and effectively.
In keeping with this pattern, the bill authorizes Tribal contractors
to perform all functions that are not inherently federal.
The bill will unshackle local authorities from the constraints of
centralized management by authorizing Tribes to waive BIA school
standards and design and implement standards that will better meet the
needs of that Tribe's students.
Standards, flexibility and accreditation are important aspects of any
good school system, but so is a sufficient pool of resources.
This bill will help evaluate whether funding levels for BIA schools
are sufficient and seeks a review by the General Accounting Office to
that effect.
While the core purpose of the Act is to provide a blueprint for the
BIA school system, the bill I introduce today incorporates Tribal
departments of education as well as early childhood development
programs that provide services to meet the needs of parents and
children under age six.
Title II of the bill amends the Tribally Controlled Schools Act of
1988, TCSA, by expanding the opportunities for Tribal operation of
schools that would otherwise be run by the BIA.
Passage of the TCSA in 1988 grew out of dissatisfaction with the
method of contracting educational services under the Indian Self
Determination and Education Assistance Act, P.L. 93-638, ISDEAA.
While many services were being successfully contracted by Tribes
under ISDEAA, education continued to be plagued with problems and
Tribes were looking for an alternative to contracts.
The bill I am introducing today is grounded in the concept of ``lump-
sum'' financing to Indian Tribes. This approach is intended to address
some of the problems faced by ISDEAA contractors. That is, if a Tribe
wants to operate a school pursuant to contract, it would be forced to
negotiate a separate contract for each of the various school functions.
A separate contract was required for transportation, for programs, for
operations and maintenance, and other functions. This bill will
consolidate these and other functions into one contract.
The grant schools operated by Tribes are provided considerable
latitude in managing their finances provided that four specific
requirements are met: As long as a grant school 1, submits an annual
program report; 2, submits an evaluation report; 3, is accredited; and
4, adheres to the federal Single Audit Act, then that school may
continue to enjoy the flexibility afforded it under P.L. 100-297.
Last, to ensure that Tribal initiative and creativity are not
thwarted unnecessarily, this bill prohibits regulations from being
established unless specifically authorized.
I have highlighted but a few of the major provisions included in this
bill and I urge my colleagues to join me in supporting this important
initiative. I ask unanimous consent that a copy of the legislation be
printed in the Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 211
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Native American Education
Improvement Act of 2001''.
TITLE I--AMENDMENTS TO THE EDUCATION AMENDMENTS OF 1978
SEC. 101. AMENDMENTS TO THE EDUCATION AMENDMENTS OF 1978.
Part B of title XI of the Education Amendments of 1978 (25
U.S.C. 2001 et seq.) is amended to read as follows:
``PART B--BUREAU OF INDIAN AFFAIRS PROGRAMS
``SEC. 1120. FINDING AND POLICY.
``(a) Finding.--Congress finds and recognizes that--
``(1) the Federal Government's unique and continuing trust
relationship with and responsibility to the Indian people
includes the education of Indian children; and
[[Page S717]]
``(2) the Federal Government has the responsibility for the
operation and financial support of the Bureau of Indian
Affairs funded school system that the Federal Government has
established on or near reservations and Indian trust lands
throughout the Nation for Indian children.
``(b) Policy.--It is the policy of the United States to
work in full cooperation with tribes toward the goal of
assuring that the programs of the Bureau of Indian Affairs
funded school system are of the highest quality and provide
for the basic elementary and secondary educational needs of
Indian children, including meeting the unique educational and
cultural needs of these children.
``SEC. 1121. ACCREDITATION AND STANDARDS FOR THE BASIC
EDUCATION OF INDIAN CHILDREN IN BUREAU OF
INDIAN AFFAIRS SCHOOLS.
``(a) Purpose; Declarations of Purpose.--
``(1) Purpose.--The purpose of the standards implemented
under this section shall be to ensure that Indian students
being served by a school funded by the Bureau of Indian
Affairs are provided with educational opportunities that
equal or exceed those for all other students in the United
States.
``(2) Declarations of purpose.--
``(A) In general.--Local school boards for schools operated
by the Bureau of Indian Affairs, in cooperation and
consultation with the appropriate tribal governing bodies and
their communities, are encouraged to adopt declarations of
purpose for education for their communities, taking into
account the implications of such declarations on education in
their communities and for their schools. In adopting such
declarations of purpose, the school boards shall consider the
effect the declarations may have on the motivation of
students and faculties.
``(B) Contents.--A declaration of purpose for a community
shall--
``(i) represent the aspirations of the community for the
kinds of people the community would like the community's
children to become; and
``(ii) contain an expression of the community's desires
that all students in the community shall--
``(I) become accomplished in things and ways important to
the students and respected by their parents and community;
``(II) shape worthwhile and satisfying lives for
themselves;
``(III) exemplify the best values of the community and
humankind; and
``(IV) become increasingly effective in shaping the
character and quality of the world all students share.
``(C) Standards.--The declarations of purpose shall
influence the standards for accreditation to be accepted by
the schools.
``(b) Studies and Surveys Relating to Standards.--Not later
than 1 year after the date of enactment of the Native
American Education Improvement Act of 2001, the Secretary, in
consultation with the Secretary of Education, consortia of
education organizations, and Indian organizations and tribes,
and making the fullest use possible of other existing
studies, surveys, and plans, shall carry out, by contract
with an Indian organization, studies and surveys to establish
and revise standards for the basic education of Indian
children attending Bureau funded schools. Such studies and
surveys shall take into account factors such as academic
needs, local cultural differences, type and level of language
skills, geographic isolation, and appropriate teacher-student
ratios for such children, and shall be directed toward the
attainment of equal educational opportunity for such
children.
``(c) Revision of Minimum Academic Standards.--
``(1) In general.--Not later than 2 years after the date of
enactment of the Native American Education Improvement Act of
2001, the Secretary shall--
``(A) propose revisions to the minimum academic standards
contained in part 36 of title 25, Code of Federal Regulations
(on the date of enactment of the Native American Education
Improvement Act of 2001) for the basic education of Indian
children attending Bureau funded schools, in accordance with
the purpose described in subsection (a) and the findings of
the studies and surveys carried out under subsection (b);
``(B) publish such proposed revisions to such standards in
the Federal Register for the purpose of receiving comments
from the tribes, local school boards, Bureau funded schools,
and other interested parties; and
``(C) consistent with the provisions of this section and
section 1130, take such actions as are necessary to
coordinate standards implemented under this section with--
``(i) the Comprehensive School Reform Plan developed by the
Bureau; and
``(ii)(I) the standards of the State in which any Bureau
funded school is located; or
``(II) in a case where schools operated by the Bureau are
within the boundaries of the reservation land of 1 tribe but
within the boundaries of more than 1 State, the standards of
the State selected by the tribe.
``(2) Final standards.--Not later than 6 months after the
close of the comment period for comments described in
paragraph (1)(B), the Secretary shall establish final
standards under this subsection, distribute such standards to
all tribes, and publish such standards in the Federal
Register.
``(3) Further revisions.--The Secretary shall revise
standards under this subsection periodically as necessary.
Prior to making any revisions of such standards, the
Secretary shall distribute proposed revisions of the
standards to all the tribes, and publish such proposed
revisions in the Federal Register, for the purpose of
receiving comments from the tribes and other interested
parties.
``(4) Applicability of standards.--Except as provided in
subsection (e), the final standards published under this
subsection shall apply to all Bureau funded schools not
accredited under subsection (f), and may also serve as model
standards for educational programs for Indian children in
public schools.
``(5) Considerations when establishing and revising
standards.--In establishing and revising standards under this
subsection, the Secretary shall take into account the unique
needs of Indian students and support and reinforce the
specific cultural heritage of each tribe.
``(d) Alternative or Modified Standards.--With respect to a
school that is located in a State or region with standards
that are in conflict with the standards established under
subsection (c), the Secretary shall provide alternative or
modified standards in lieu of the standards established under
such subsection so that the programs of such school are in
compliance with the minimum accreditation standards required
for schools in the State or region where the school is
located.
``(e) Waiver of Standards; Alternative Standards.--
``(1) Waiver.--A tribal governing body, or the local school
board so designated by the tribal governing body, shall have
the local authority to waive, in part or in whole, the
standards established under subsection (c) and (d) if such
standards are determined by such body or board to be
inappropriate for the needs of students from that tribe.
``(2) Alternative standards.--The tribal governing body or
school board involved shall, not later than 60 days after
providing a waiver under paragraph (1) for a school, submit
to the Director a proposal for alternative standards that
take into account the specific needs of the tribe's children.
Such alternative standards shall be established by the
Director for the school involved unless specifically rejected
by the Director for good cause and in writing provided to the
affected tribes or local school board.
``(f) Accreditation and Implementation of Standards.--
``(1) Deadline.--Not later than the second academic year
after publication of final standards established under
subsection (c) or (d), or after the approval of alternative
standards under subsection (e), to the extent necessary
funding is provided, each Bureau funded school to which such
standards would apply shall meet the applicable standards or
be accredited--
``(A) by a tribal accrediting body that has been accepted
by formal action of the appropriate tribal governing body;
``(B) by a regional accreditation agency;
``(C) in accordance with State accreditation standards for
the State in which the school is located; or
``(D) in the case of a school that is located on a
reservation that is located in more than 1 State, in
accordance with the State accreditation standards of 1 State
as selected by the tribal government.
``(2) Determination of standards to be applied.--The
accreditation type or standards applied for each school shall
be determined by the school board of the school, in
consultation with the Administrator of the school, provided
that in the case where the School Board and the Administrator
fail to agree on the type of accreditation and standards to
apply, the decision of the school board with the approval of
the tribal governing body shall be final.
``(3) Assistance to school boards.--The Secretary, through
contracts and grants, shall assist school boards of contract
or grant schools in implementing standards established under
subsections (c), (d), and (e), if the school boards request
that such standards, in part or in whole, be implemented.
``(4) Fiscal control and fund accounting standards.--The
Bureau shall, either directly or through a contract with an
Indian organization, establish a consistent system of
reporting standards for fiscal control and fund accounting
for all contract and grant schools. Such standards shall
yield data results comparable to the data provided by Bureau
schools.
``(g) Annual Plan for Meeting of Standards.--
``(1) In general.--Except as provided in subsections (e)
and (f), the Secretary shall begin to implement the standards
established under this section on the date of their
establishment.
``(2) Plan.--On an annual basis, the Secretary shall submit
to the appropriate committees of Congress, all Bureau funded
schools, and the tribal governing bodies of such schools a
detailed plan to bring all Bureau funded schools up to the
level required by the applicable standards established under
this section. Such plan shall include detailed information on
the status of each school's educational program in relation
to the applicable standards established under this section,
specific cost estimates for meeting such standards at each
school, and specific timelines for bringing each school up to
the level required by such standards.
``(h) Closure or Consolidation of Schools.--
``(1) In general.--Except as specifically required by law,
no Bureau funded school or dormitory operated on or after
January 1, 1992, may be closed, consolidated, or transferred
to another authority and no program of such a school may be
substantially curtailed except in accordance with the
requirements of this subsection.
[[Page S718]]
``(2) Exceptions.--This subsection (other than this
paragraph) shall not apply--
``(A) in those cases in which the tribal governing body for
a school, or the local school board concerned (if designated
by the tribal governing body to act under this paragraph),
requests the closure, consolidation, or substantial
curtailment; or
``(B) if a temporary closure, consolidation, or substantial
curtailment is required by facility conditions that
constitute an immediate hazard to health and safety.
``(3) Regulations.--The Secretary shall, by regulation,
promulgate standards and procedures for the closure, transfer
to another authority, consolidation, or substantial
curtailment of school programs of Bureau schools, in
accordance with the requirements of this subsection.
``(4) Notification.--
``(A) Consideration.--Whenever closure, transfer to another
authority, consolidation, or substantial curtailment of a
school program of a Bureau school is under active
consideration or review by any division of the Bureau or the
Department of the Interior, the head of the division or the
Secretary shall ensure that the affected tribe, tribal
governing body, and local school board, are notified (in
writing) immediately, kept fully and currently informed, and
afforded an opportunity to comment with respect to such
consideration or review.
``(B) Formal decision.--When the head of any division of
the Bureau or the Secretary makes a formal decision to close,
transfer to another authority, consolidate, or substantially
curtail a school program of a Bureau school, the head of the
division or the Secretary shall notify (in writing) the
affected tribes, tribal governing body, and local school
board at least 6 months prior to the end of the academic year
preceding the date of the proposed action.
``(C) Copies of notifications and information.--The
Secretary shall transmit copies of the notifications
described in this paragraph promptly to the appropriate
committees of Congress and publish such notifications copies
in the Federal Register.
``(5) Report.--
``(A) In general.--The Secretary shall submit a report to
the appropriate committees of Congress, the affected tribal
governing body and the designated local school board,
describing the process of the active consideration or review
referred to in paragraph (4).
``(B) Contents.--The report shall include the results of a
study of the impact of the action under consideration or
review on the student population of the school involved,
identify those students at the school with particular
educational and social needs, and ensure that alternative
services are available to such students. Such report shall
include a description of consultation conducted between the
potential service provider and current service provider of
such services, parents, tribal representatives, the tribe
involved, and the Director of the Office regarding such
students.
``(6) Limitation on certain actions.--No irreversible
action may be taken to further any proposed school closure,
transfer to another authority, consolidation, or substantial
curtailment described in this subsection concerning a school
(including any action that would prejudice the personnel or
programs of such school) prior to the end of the first full
academic year after the report described in paragraph (5) is
submitted.
``(7) Tribal governing body approval required for certain
actions.--The Secretary may terminate, contract, transfer to
any other authority, consolidate, or substantially curtail
the operation or facilities of--
``(A) any Bureau funded school that is operated on or after
January 1, 1999;
``(B) any program of such a school that is operated on or
after January 1, 1999; or
``(C) any school board of a school operated under a grant
under the Tribally Controlled Schools Act of 1988,
only if the tribal governing body for the school involved
approves such action.
``(i) Application for Contracts or Grants for Non-Bureau
Funded Schools or Expansion of Bureau Funded Schools.--
``(1) In general.--
``(A) Applications.--
``(i) Tribes; school boards.--The Secretary shall only
consider the factors described in subparagraph (B) in
reviewing--
``(I) applications from any tribe for the awarding of a
contract or grant for a school that is not a Bureau funded
school; and
``(II) applications from any tribe or school board
associated with any Bureau funded school for the awarding of
a contract or grant for the expansion of a Bureau funded
school that would increase the amount of funds received by
the tribe or school board under section 1126.
``(ii) Limitation.--With respect to applications described
in this subparagraph, the Secretary shall give consideration
to all the factors described in subparagraph (B), but no such
application shall be denied based primarily upon the
geographic proximity of comparable public education.
``(B) Factors.--With respect to applications described in
subparagraph (A) the Secretary shall consider the following
factors relating to the program and services that are the
subject of the application:
``(i) The adequacy of existing facilities to support the
proposed program and services or the applicant's ability to
obtain or provide adequate facilities.
``(ii) Geographic and demographic factors in the affected
areas.
``(iii) The adequacy of the applicant's program plans or,
in the case of a Bureau funded school, of a projected needs
analysis conducted either by the tribe or the Bureau.
``(iv) Geographic proximity of comparable public education.
``(v) The stated needs of all affected parties, including
students, families, tribal governing bodies at both the
central and local levels, and school organizations.
``(vi) Adequacy and comparability of programs and services
already available.
``(vii) Consistency of the proposed program and services
with tribal educational codes or tribal legislation on
education.
``(viii) The history and success of these services for the
proposed population to be served, as determined from all
factors, including standardized examination performance.
``(2) Determination on application.--
``(A) Period.--The Secretary shall make a determination
concerning whether to approve any application described in
paragraph (1)(A) not later than 180 days after the date such
application is submitted to the Secretary.
``(B) Failure to make determination.--If the Secretary
fails to make the determination with respect to an
application by the date described in subparagraph (A), the
application shall be treated as having been approved by the
Secretary.
``(3) Requirements for applications.--
``(A) Approval.--Notwithstanding paragraph (2)(B), an
application described in paragraph (1)(A) may be approved by
the Secretary only if--
``(i) the application has been approved by the tribal
governing body of the students served by (or to be served by)
the school or program that is the subject of the application;
and
``(ii) the tribe or designated school board involved
submits written evidence of such approval with the
application.
``(B) Information.--Each application described in paragraph
(1)(A) shall contain information discussing each of the
factors described in paragraph (1)(B).
``(4) Denial of applications.--If the Secretary denies an
application described in paragraph (1)(A), the Secretary
shall--
``(A) state the objections to the application in writing to
the applicant not later than 180 days after the date the
application is submitted to the Secretary;
``(B) provide assistance to the applicant to overcome the
stated objections;
``(C) provide to the applicant a hearing on the record
regarding the denial, under the same rules and regulations as
apply under the Indian Self-Determination and Education
Assistance Act; and
``(D) provide to the applicant a notice of the applicant's
appeals rights and an opportunity to appeal the decision
resulting from the hearing under subparagraph (D).
``(5) Effective date of a subject application.--
``(A) In general.--Except as otherwise provided in this
paragraph, the action that is the subject of any application
described in paragraph (1)(A) that is approved by the
Secretary shall become effective--
``(i) on the first day of the academic year following the
fiscal year in which the application is approved; or
``(ii) on an earlier date determined by the Secretary.
``(B) Application treated as approved.--If an application
is treated as having been approved by the Secretary under
paragraph (2)(B), the action that is the subject of the
application shall become effective?--
``(i) on the date that is 18 months after the date on which
the application is submitted to the Secretary; or
``(ii) on an earlier date determined by the Secretary.
``(6) Statutory construction.--Nothing in this section
shall be construed to preclude the expansion of grades and
related facilities at a Bureau funded school, if such
expansion is paid for with non-Bureau funds.
``(j) Joint Administration.--Funds received by Bureau
funded schools from the Bureau of Indian Affairs and under
any program from the Department of Education or any other
Federal agency for the purpose of providing education or
related services, and other funds received for such education
and related services from non-Federally funded programs, may
apportion joint administrative, transportation, and program
costs between such programs and the funds shall be retained
at the school.
``(k) General Use of Funds.--Funds received by Bureau
funded schools from the Bureau of Indian Affairs and under
any program from the Department of Education or any other
Federal agency for the purpose of providing education or
related services may be used for schoolwide projects to
improve the educational program of the schools for all Indian
students.
``(l) Study on Adequacy of Funds and Formulas.--
``(1) Study.--The Comptroller General of the United States
shall conduct a study, in consultation with tribes and local
school boards, to determine the adequacy of funding, and
formulas used by the Bureau to determine funding, for
programs operated by Bureau funded schools, taking into
account unique circumstances applicable to Bureau funded
schools, including isolation, limited English proficiency of
Indian students, the costs of educating disabled Indian
students in isolated settings, and other factors that may
disproportionately increase per-pupil
[[Page S719]]
costs, as well as expenditures for comparable purposes in
public schools nationally.
``(2) Findings.--On completion of the study under paragraph
(1), the Secretary shall take such action as may be necessary
to ensure distribution of the findings of the study to the
appropriate authorizing and appropriating committees of
Congress, all affected tribes, local school boards, and
associations of local school boards.
``SEC. 1122. NATIONAL STANDARDS FOR HOME LIVING SITUATIONS.
``(a) In General.--The Secretary, in accordance with
section 1137, shall revise the national standards for home-
living (dormitory) situations to include such factors as
heating, lighting, cooling, adult-child ratios, need for
counselors (including special needs related to off-
reservation home-living (dormitory) situations), therapeutic
programs, space, and privacy. Such standards shall be
implemented in Bureau schools. Any subsequent revisions shall
also be in accordance with such section 1137.
``(b) Implementation.--The Secretary shall implement the
revised standards established under this section immediately
upon their issuance.
``(c) Plan.--
``(1) In general.--Upon the submission of each annual
budget request for Bureau educational services (as contained
in the President's annual budget request under section 1105
of title 31, United States Code), the Secretary shall submit
to the appropriate committees of Congress, the tribes, and
the affected schools, and publish in the Federal Register, a
detailed plan to bring all Bureau funded schools that have
dormitories or provide home-living (dormitory) situations
into compliance with the standards established under this
section.
``(2) Contents.--Each plan under paragraph (1) shall
include--
``(A) a statement of the relative needs of each of the
home-living schools and projected future needs of each of the
home-living schools;
``(B) detailed information on the status of each of the
schools in relation to the standards established under this
section;
``(C) specific cost estimates for meeting each standard for
each such school;
``(D) aggregate cost estimates for bringing all such
schools into compliance with the standards established under
this section; and
``(E) specific timelines for bringing each school into
compliance with such standards.
``(d) Waiver.--A tribal governing body or local school
board may, in accordance with section 1121(e), waive the
standards established under this section for a school
described in subsection (a) in the same manner as the
governing body or school board may waive the standards
provided under section 1121(c) for a Bureau funded school.
``(e) Closure for Failure To Meet Standards Prohibited.--No
school in operation on or before July 1, 1999 (regardless of
compliance or noncompliance with the standards established
under this section), may be closed, transferred to another
authority, or consolidated, and no program of such a school
may be substantially curtailed, because the school failed to
meet such standards.
``SEC. 1123. SCHOOL BOUNDARIES.
``(a) Establishment by Secretary.--Except as described in
subsection (b), the Secretary shall establish, by regulation,
separate geographical attendance areas for each Bureau funded
school.
``(b) Establishment by Tribal Body.--In any case in which
there is more than 1 Bureau funded school located on a
reservation of a tribe, at the direction of the tribal
governing body, the relevant school boards of the Bureau
funded schools on the reservation may, by mutual consent,
establish the boundaries of the relevant geographical
attendance areas for such schools, subject to the approval of
the tribal governing body. Any such boundaries so established
shall be accepted by the Secretary.
``(c) Boundary Revisions.--
``(1) In general.--Effective on July 1, 1999, the Secretary
may not establish or revise boundaries of a geographical
attendance area with respect to any Bureau funded school
unless the tribal governing body concerned or the school
board concerned (if designated by the tribal governing body
to act under this paragraph) has been afforded--
``(A) at least 6 months notice of the intention of the
Secretary to establish or revise such boundaries; and
``(B) the opportunity to propose alternative boundaries.
``(2) Petitions.--Any tribe may submit a petition to the
Secretary requesting a revision of the geographical
attendance area boundaries referred to in paragraph (1).
``(3) Boundaries.--The Secretary shall accept proposed
alternative boundaries described in paragraph (1)(B) or
revised boundaries described in a petition submitted under
paragraph (2) unless the Secretary finds, after consultation
with the affected tribe, that such alternative or revised
boundaries do not reflect the needs of the Indian students to
be served or do not provide adequate stability to all of the
affected programs. On accepting the boundaries, the Secretary
shall publish information describing the boundaries in the
Federal Register.
``(4) Tribal resolution determination.--Nothing in this
section shall be interpreted as denying a tribal governing
body the authority, on a continuing basis, to adopt a tribal
resolution allowing parents a choice of the Bureau funded
school their child may attend, regardless of the geographical
attendance area boundaries established under this section.
``(d) Funding Restrictions.--The Secretary shall not deny
funding to a Bureau funded school for any eligible Indian
student attending the school solely because that student's
home or domicile is outside of the boundaries of the
geographical attendance area established for that school
under this section. No funding shall be made available for
transportation without tribal authorization to enable the
school to provide transportation for any student to or from
the school and a location outside the approved attendance
area of the school.
``(e) Reservation as Boundary.--In any case in which there
is only 1 Bureau funded school located on a reservation, the
boundaries of the geographical attendance area for the school
shall be the boundaries (as established by treaty, agreement,
legislation, court decision, or executive decision and as
accepted by the tribe involved) of the reservation served,
and those students residing near the reservation shall also
receive services from such school.
``(f) Off-Reservation Home-Living Schools.--Notwithstanding
the boundaries of the geographical attendance areas
established under this section, each Bureau funded school
that is an off-reservation home-living school shall implement
special emphasis programs and permit the attendance of
students requiring the programs. The programs provided for
such students shall be coordinated among education line
officers, the families of the students, the schools, and the
entities operating programs that referred the students to the
schools.
``SEC. 1124. FACILITIES CONSTRUCTION.
``(a) National Survey of Facilities Conditions.--
``(1) In general.--Not later than 12 months after the date
of enactment of the Native American Education Improvement Act
of 2001, the General Accounting Office shall compile,
collect, and secure the data that is needed to prepare a
national survey of the physical conditions of all Bureau
funded school facilities.
``(2) Data and methodologies.--In preparing the national
survey required under paragraph (1), the General Accounting
Office shall use the following data and methodologies:
``(A) The existing Department of Defense formula for
determining the condition and adequacy of Department of
Defense facilities.
``(B) Data related to conditions of Bureau funded schools
that has previously been compiled, collected, or secured from
whatever source derived so long as the data is relevant,
timely, and necessary to the survey.
``(C) The methodologies of the American Institute of
Architects, or other accredited and reputable architecture or
engineering associations.
``(3) Consultations.--
``(A) In general.--In carrying out the survey required
under paragraph (1), the General Accounting Office shall, to
the maximum extent practicable, consult (and if necessary
contract) with national, regional, and tribal Indian
education organizations to ensure that a complete and
accurate national survey is achieved.
``(B) Requests for information.--All Bureau funded schools
shall comply with reasonable requests for information by the
General Accounting Office and shall respond to such requests
in a timely fashion.
``(4) Submission to congress.--Not later than 24 months
after the date of enactment of the Native American Education
Improvement Act of 2001, the General Accounting Office shall
submit the results of the national survey conducted under
paragraph (1) to the Committee on Indian Affairs and
Committee on Appropriations of the Senate, and the Committee
on Resources and Committee on Appropriations of the House.
``(5) Negotiated rulemaking committee.--
``(A) In general.--Not later than 6 months after the date
on which the submission is made under paragraph (4), the
Secretary shall establish a negotiated rule making committee
pursuant to section 1137(c). The negotiated rulemaking
committee shall prepare and submit to the Secretary the
following:
``(i) A catalogue of the condition of school facilities at
all Bureau funded schools that--
``(I) rates such facilities with respect to the rate of
deterioration and useful life structures and major systems;
``(II) establishes a routine maintenance schedule for each
facility; and
``(III) makes projections on the amount of funds needed to
keep each school viable, consistent with the standards of
this Act.
``(ii) A school replacement and new construction report
that determines replacement and new construction need, and a
formula for the equitable distribution of funds to address
such need, for Bureau funded schools. Such formula shall
utilize necessary factors in determining an equitable
distribution of funds, including--
``(I) the size of school;
``(II) school enrollment;
``(III) the age of the school;
``(IV) the condition of the school;
``(V) environmental factors at the school; and
``(VI) school isolation.
``(iii) A renovation repairs report that determines
renovation need (major and minor), and a formula for the
equitable distribution of funds to address such need, for
Bureau
[[Page S720]]
funded schools. Such report shall identify needed repairs or
renovations with respect to a facility, or a part of a
facility, or the grounds of the facility, to remedy a need
based on disabilities access or health and safety changes to
a facility. The formula developed shall utilize necessary
factors in determining an equitable distribution of funds,
including the factors described in subparagraph (B).
``(B) Not later 24 months after the negotiated rulemaking
committee is established under subparagraph (A), the reports
described in clauses (ii) and (iii) of subparagraph (A) shall
be submitted to the committees of Congress referred to in
paragraph (4), the national and regional Indian education
organizations, and to all Indian tribes.
``(6) Facilities information systems support database.--The
Secretary shall develop a Facilities Information Systems
Support Database to maintain and update the information
contained in the reports under clauses (ii) and (iii) of
paragraph (5)(A) and the information contained in the survey
conducted under paragraph (1). The system shall be updated
every 3 years by the Bureau of Indian Affairs and monitored
by General Accounting Office, and shall be made available to
Indian tribes, Bureau funded schools, and Congress.
``(b) Compliance With Health and Safety Standards.--The
Secretary shall immediately begin to bring all schools,
dormitories, and other Indian education-related facilities
operated by the Bureau or under contract or grant with the
Bureau into compliance with all applicable tribal, Federal,
or State health and safety standards, whichever provides
greater protection (except that the tribal standards to be
applied shall be no greater than any otherwise applicable
Federal or State standards), with section 504 of the
Rehabilitation Act of 1973, and with the Americans with
Disabilities Act of 1990. Nothing in this section shall
require termination of the operations of any facility which
does not comply with such provisions and which is in use on
the date of the enactment of the Native American Education
Improvement Act of 2001.
``(c) Compliance Plan.--At the time that the annual budget
request for Bureau educational services is presented, the
Secretary shall submit to the appropriate committees of
Congress a detailed plan to bring all facilities covered
under subsection (b) of this section into compliance with the
standards referred to in subsection (b). Such plan shall
include detailed information on the status of each facility's
compliance with such standards, specific cost estimates for
meeting such standards at each school, and specific timelines
for bringing each school into compliance with such standards.
``(d) Construction Priorities.--
``(1) System to establish priorities.--The Secretary shall
annually prepare and submit to the appropriate committees of
Congress, and publish in the Federal Register, information
describing the system used by the Secretary to establish
priorities for replacement and construction projects for
Bureau funded schools and home-living schools, including
boarding schools, and dormitories. On making each budget
request described in subsection (c), the Secretary shall
publish in the Federal Register and submit with the budget
request a list of all of the Bureau funded school
construction priorities, as described in paragraph (2).
``(2) Long-term construction and replacement list.--In
addition to submitting the plan described in subsection (c),
the Secretary shall--
``(A) not later than 18 months after the date of enactment
of the Native American Education Improvement Act of 2001,
establish a long-term construction and replacement priority
list for all Bureau funded schools;
``(B) using the list prepared under subparagraph (A),
propose a list for the orderly replacement of all Bureau
funded education-related facilities over a period of 40 years
to facilitate planning and scheduling of budget requests;
``(C) publish the list prepared under subparagraph (B) in
the Federal Register and allow a period of not less than 120
days for public comment;
``(D) make such revisions to the list prepared under
subparagraph (B) as are appropriate based on the comments
received; and
``(E) publish a final list in the Federal Register.
``(3) Effect on other list.--Nothing in this section shall
be construed as interfering with or changing in any way the
construction and replacement priority list established by the
Secretary, as the list exists on the date of enactment of the
Native American Education Improvement Act of 2001.
``(e) Hazardous Condition at Bureau Funded School.--
``(1) Closure, consolidation, or curtailment.--
``(A) In general.--A Bureau funded school may be closed or
consolidated, and the programs of a Bureau funded school may
be substantially curtailed by reason of facility conditions
that constitute an immediate hazard to health and safety only
if a health and safety officer of the Bureau and an
individual designated by the tribe involved under
subparagraph (B), determine that such conditions exist at a
facility of the Bureau funded school.
``(B) Designation of individual by tribe.--To be designated
by a tribe for purposes of subparagraph (A), an individual
shall--
``(i) be a licensed or certified facilities safety
inspector;
``(ii) have demonstrated experience in the inspection of
facilities for health and safety purposes with respect to
occupancy; or
``(iii) have a significant educational background in the
health and safety of facilities with respect to occupancy.
``(C) Inspection.--In making a determination described in
subparagraph (A), the Bureau health and safety officer and
the individual designated by the tribe shall conduct an
inspection of the conditions of such facility in order to
determine whether conditions at such facility constitute an
immediate hazard to health and safety.
``(D) Failure to concur.--If the Bureau health and safety
officer, and the individual designated by the tribe,
conducting the inspection of a facility required under
subparagraph (A) do not concur that conditions at the
facility constitute an immediate hazard to health and safety,
such officer and individual shall immediately notify the
tribal governing body and provide written information related
to their determinations.
``(E) Consideration by tribal governing body.--Not later
than 10 days after a tribal governing body received notice
under subparagraph (D), the tribal governing body shall
consider all information related to the determinations of the
Bureau health and safety officer and the individual
designated by the tribe and make a determination regarding
the closure, consolidation, or curtailment involved.
``(F) Cessation of closure, consolidation, or
curtailment.--If the Bureau health and safety officer, and
the individual designated by the tribe, conducting the
inspection of a facility required under subparagraph (A),
concur that conditions at the facility constitute an
immediate hazard to health and safety, or if the tribal
governing body makes such a determination under subparagraph
(E) the facility involved shall be closed immediately.
``(G) General closure report.--If a Bureau funded school is
temporarily closed or consolidated or the programs of a
Bureau funded school are temporarily substantially curtailed
under this subsection and the Secretary determines that the
closure, consolidation, or curtailment will exceed 1 year,
the Secretary shall submit to the appropriate committees of
Congress, the affected tribe, and the local school board, not
later than 3 months after the date on which the closure,
consolidation, or curtailment was initiated, a report that
specifies--
``(i) the reasons for such temporary action;
``(ii) the actions the Secretary is taking to eliminate the
conditions that constitute the hazard;
``(iii) an estimated date by which the actions described in
clause (ii) will be concluded; and
``(iv) a plan for providing alternate education services
for students enrolled at the school that is to be closed.
``(2) Nonapplication of certain standards for temporary
facility use.--
``(A) Classroom activities.--The Secretary shall permit the
local school board to temporarily utilize facilities adjacent
to the school, or satellite facilities, if such facilities
are suitable for conducting classroom activities. In
permitting the use of facilities under the preceding
sentence, the Secretary may waive applicable minor standards
under section 1121 relating to such facilities (such as the
required number of exit lights or configuration of restrooms)
so long as such waivers do not result in the creation of an
environment that constitutes an immediate and substantial
threat to the health, safety, and life of students and staff.
``(B) Administrative activities.--The provisions of
subparagraph (A) shall apply with respect to administrative
personnel if the facilities involved are suitable for
activities performed by such personnel.
``(C) Temporary.--In this paragraph, the term `temporary'
means--
``(i) with respect to a school that is to be closed for not
more than 1 year, 3 months or less; and
``(ii) with respect to a school that is to be closed for
not less than 1 year, a time period determined appropriate by
the Bureau.
``(3) Treatment of closure.--Any closure of a Bureau funded
school under this subsection for a period that exceeds 1
month but is less than 1 year, shall be treated by the Bureau
as an emergency facility improvement and repair project.
``(4) Use of funds.--With respect to a Bureau funded school
that is closed under this subsection, the tribal governing
body, or the designated local school board of each Bureau
funded school, involved may authorize the use of school
operations funds, which have otherwise been allocated for
such school, to abate the hazardous conditions without
further action by Congress.
``(f) Funding Requirement.--
``(1) Distribution of funds.--Beginning with the first
fiscal year following the date of enactment of the Native
American Education Improvement Act of 2001, all funds
appropriated to the budget accounts for the operations and
maintenance of Bureau funded schools shall be distributed by
formula to the schools. No funds from these accounts may be
retained or segregated by the Bureau to pay for
administrative or other costs of any facilities branch or
office, at any level of the Bureau.
``(2) Requirements for certain uses.--
``(A) Agreement.--The Secretary shall not withhold funds
that would be distributed under paragraph (1) to any grant or
contract
[[Page S721]]
school, in order to use the funds for maintenance or any
other facilities or road-related purposes, unless such
school--
``(i) has consented to the withholding of such funds,
including the amount of the funds, the purpose for which the
funds will be used, and the timeline for the services to be
provided with the funds; and
``(ii) has provided the consent by entering into an
agreement that is--
``(I) a modification to the contract; and
``(II) in writing (in the case of a school that receives a
grant).
``(B) Cancellation.--The school may, at the end of any
fiscal year, cancel an agreement entered into under this
paragraph, on giving the Bureau 30 days notice of the intent
of the school to cancel the agreement.
``(g) No Reduction in Federal Funding.--Nothing in this
section shall be construed to reduce any Federal funding for
a school because the school received funding for facilities
improvement or construction from a State or any other source.
``SEC. 1125. BUREAU OF INDIAN AFFAIRS EDUCATION FUNCTIONS.
``(a) Formulation and Establishment of Policy and
Procedure; Supervision of Programs and Expenditures.--The
Secretary shall vest in the Assistant Secretary for Indian
Affairs all functions with respect to formulation and
establishment of policy and procedure, and supervision of
programs and expenditures of Federal funds for the purpose of
Indian education administered by the Bureau. The Assistant
Secretary shall carry out such functions through the Director
of the Office of Indian Education Programs.
``(b) Direction and Supervision of Personnel Operations.--
``(1) In general.--Not later than 6 months after the date
of the enactment of the Native American Education Improvement
Act of 2001, the Director of the Office shall direct and
supervise the operations of all personnel directly and
substantially involved in the provision of education services
by the Bureau, including school or institution custodial or
maintenance personnel, and facilities management,
contracting, procurement, and finance personnel.
``(2) Transfers.--The Assistant Secretary for Indian
Affairs shall coordinate the transfer of functions relating
to procurements for, contracts of, operation of, and
maintenance of schools and other support functions to the
Director.
``(c) Inherent Federal Function.--For purposes of this Act,
all functions relating to education that are located at the
Area or Agency level and performed by an education line
officer shall be subject to contract under the Indian Self-
Determination and Education Assistance Act, unless determined
by the Secretary to be inherently Federal functions.
``(d) Evaluation of Programs; Services and Support
Functions; Technical and Coordination Assistance.--Education
personnel who are under the direction and supervision of the
Director of the Office in accordance with subsection (b)(1)
shall--
``(1) monitor and evaluate Bureau education programs;
``(2) provide all services and support functions for
education programs with respect to personnel matters
involving staffing actions and functions; and
``(3) provide technical and coordination assistance in
areas such as procurement, contracting, budgeting, personnel,
curricula, and operation and maintenance of school
facilities.
``(e) Construction, Improvement, Operation, and Maintenance
of Facilities.--
``(1) Plan for construction.--The Assistant Secretary for
Indian Affairs shall submit as part of the annual budget
request for educational services (as contained in the
President's annual budget request under section 1105 of title
31, United States Code) a plan--
``(A) for the construction of school facilities in
accordance with section 1124(d);
``(B) for the improvement and repair of education
facilities and for establishing priorities among the
improvement and repair projects involved, which together
shall form the basis for the distribution of appropriated
funds; and
``(C) for capital improvements to education facilities to
be made over the 5 years succeeding the year covered by the
plan.
``(2) Program for operation and maintenance.--
``(A) In general.--
``(i) Program.--The Assistant Secretary shall establish a
program, including a program for the distribution of funds
appropriated under this part, for the operation and
maintenance of education facilities. Such program shall
include--
``(I) a method of computing the amount necessary for the
operation and maintenance of each education facility;
``(II) a requirement of similar treatment of all Bureau
funded schools;
``(III) a notice of an allocation of the appropriated funds
from the Director of the Office directly to the appropriate
education line officers and school officials;
``(IV) a method for determining the need for, and priority
of, facilities improvement and repair projects, both major
and minor; and
``(V) a system for conducting routine preventive
maintenance.
``(ii) Meetings.--In making the determination referred to
in clause (i)(IV), the Assistant Secretary shall cause a
series of meetings to be conducted at the area and agency
level with representatives of the Bureau funded schools in
the corresponding areas and served by corresponding agencies,
to receive comment on the projects described in clause
(i)(IV) and prioritization of such projects.
``(B) Maintenance.--The appropriate education line officers
shall make arrangements for the maintenance of the education
facilities with the local supervisors of the Bureau
maintenance personnel. The local supervisors of Bureau
maintenance personnel shall take appropriate action to
implement the decisions made by the appropriate education
line officers. No funds made available under this part may be
authorized for expenditure for maintenance of such an
education facility unless the appropriate education line
officer is assured that the necessary maintenance has been,
or will be, provided in a reasonable manner.
``(3) Implementation.--The requirements of this subsection
shall be implemented as soon as practicable after the date of
enactment of the Native American Education Improvement Act of
2001.
``(f) Acceptance of Gifts and Bequests.--
``(1) Guidelines.--Notwithstanding any other provision of
law, the Director of the Office shall promulgate guidelines
for the establishment and administration of mechanisms for
the acceptance of gifts and bequests for the use and benefit
of particular schools or designated Bureau operated education
programs, including, in appropriate cases, the establishment
and administration of trust funds.
``(2) Monitoring and reports.--Except as provided in
paragraph (3), in a case in which a Bureau operated education
program is the beneficiary of such a gift or bequest, the
Director shall--
``(A) make provisions for monitoring use of the gift or
bequest; and
``(B) submit a report to the appropriate committees of
Congress that describes the amount and terms of such gift or
bequest, the manner in which such gift or bequest shall be
used, and any results achieved by such use.
``(3) Exception.--The requirements of paragraph (2) shall
not apply in the case of a gift or bequest that is valued at
$5,000 or less.
``(g) Functions Clarified.--In this section, the term
`functions' includes powers and duties.
``SEC. 1126. ALLOTMENT FORMULA.
``(a) Factors Considered; Revision To Reflect Standards.--
``(1) Formula.--The Secretary shall establish, by
regulation adopted in accordance with section 1137, a formula
for determining the minimum annual amount of funds necessary
to operate each Bureau funded school. In establishing such
formula, the Secretary shall consider--
``(A) the number of eligible Indian students served by the
school and the total student population of the school;
``(B) special cost factors, such as--
``(i) the isolation of the school;
``(ii) the need for special staffing, transportation, or
educational programs;
``(iii) food and housing costs;
``(iv) maintenance and repair costs associated with the
physical condition of the educational facilities;
``(v) special transportation and other costs of an isolated
or small school;
``(vi) the costs of home-living (dormitory) arrangements,
where determined necessary by a tribal governing body or
designated school board;
``(vii) costs associated with greater lengths of service by
education personnel;
``(viii) the costs of therapeutic programs for students
requiring such programs; and
``(ix) special costs for gifted and talented students;
``(C) the costs of providing academic services that are at
least equivalent to the services provided by public schools
in the State in which the school is located;
``(D) whether the available funding will enable the school
involved to comply with the accreditation standards
applicable to the school under section 1121; and
``(E) such other relevant factors as the Secretary
determines are appropriate.
``(2) Revision of formula.--On the establishment of the
standards required in sections 1121 and 1122, the Secretary
shall--
``(A) revise the formula established under paragraph (1) to
reflect the cost of compliance with such standards; and
``(B)(i) by not later than January 1, 2002, review the
formula established under paragraph (1) and take such action
as may be necessary to increase the availability of
counseling and therapeutic programs for students in off-
reservation home-living schools and other Bureau operated
residential facilities; and
``(ii) concurrently with any actions taken under clause
(i), review the standards established under section 1121 to
be certain that the standards adequately provide for parental
notification regarding, and consent for, such counseling and
therapeutic programs.
``(b) Pro Rata Allotment.--Notwithstanding any other
provision of law, Federal funds appropriated for the general
local operation of Bureau funded schools shall be allotted on
a pro rata basis in accordance with the formula established
under subsection (a).
``(c) Annual Adjustment; Reservation of Amount for School
Board Activities.--
``(1) Annual adjustment.--
``(A) In general.--For fiscal year 2002, and for each
subsequent fiscal year, the Secretary shall adjust the
formula established under subsection (a) to--
``(i) use a weighted factor of 1.2 for each eligible Indian
student enrolled in the seventh
[[Page S722]]
and eighth grades of the school in considering the number of
eligible Indian students served by the school;
``(ii) consider a school with an enrollment of fewer than
50 eligible Indian students as having an average daily
attendance of 50 eligible Indian students for purposes of
implementing the adjustment factor for small schools;
``(iii) take into account the provision of residential
services on less than a 9-month basis at a school in a case
in which the school board and supervisor of the school
determine that the school will provide the services for fewer
than 9 months for the academic year involved;
``(iv) use a weighted factor of 2.0 for each eligible
Indian student that--
``(I) is gifted and talented; and
``(II) is enrolled in the school on a full-time basis,
in considering the number of eligible Indian students served
by the school; and
``(v) use a weighted factor of 0.25 for each eligible
Indian student who is enrolled in a year long credit course
in an Indian or Native language as part of the regular
curriculum of a school, in considering the number of eligible
Indian students served by such school.
``(B) Timing.--The Secretary shall make the adjustment
required under subparagraph (A)(v) for such school after--
``(i) the school board of such school provides a
certification of the Indian or Native language curriculum of
the school to the Secretary, together with an estimate of the
number of full-time students expected to be enrolled in the
curriculum in the second academic year after the academic
year for which the certification is made; and
``(ii) the funds appropriated for allotments under this
section are designated, in the appropriations Act
appropriating such funds, as the funds necessary to implement
such adjustment at such school without reducing an allotment
made under this section to any school by virtue of such
adjustment.
``(2) Reservation of amount.--
``(A) In general.--From the funds allotted in accordance
with the formula established under subsection (a) for each
Bureau school, the local school board of such school may
reserve an amount which does not exceed the greater of--
``(i) $8,000; or
``(ii) the lesser of--
``(I) $15,000; or
``(II) 1 percent of such allotted funds,
for school board activities for such school, including
(notwithstanding any other provision of law) meeting expenses
and the cost of membership in, and support of, organizations
engaged in activities on behalf of Indian education.
``(B) Training.--Each local school board, and any agency
school board that serves as a local school board for any
grant or contract school, shall ensure that each individual
who is a new member of the school board receives, within 12
months after the individual becomes a member of the school
board, 40 hours of training relevant to that individual's
service on the board. Such training may include training
concerning legal issues pertaining to Bureau funded schools,
legal issues pertaining to school boards, ethics, and other
topics determined to be appropriate by the school board.
``(d) Reservation of Amount for Emergencies.--
``(1) In general.--The Secretary shall reserve from the
funds available for allotment for each fiscal year under this
section an amount that, in the aggregate, equals 1 percent of
the funds available for allotment for that fiscal year.
``(2) Use of funds.--Amounts reserved under paragraph (1)
shall be used, at the discretion of the Director of the
Office, to meet emergencies and unforeseen contingencies
affecting the education programs funded under this section.
Funds reserved under this subsection may only be expended for
education services or programs, including emergency repairs
of education facilities, at a school site (as defined in
section 5204(c)(2) of the Tribally Controlled Schools Act of
1988).
``(3) Funds remaining available.--Funds reserved under this
subsection shall remain available without fiscal year
limitation until expended. The aggregate amount of such
funds, from all fiscal years, that is available for
expenditure in a fiscal year may not exceed an amount equal
to 1 percent of the funds available for allotment under this
section for that fiscal year.
``(4) Reports.--If the Secretary makes funds available
under this subsection, the Secretary shall submit a report
describing such action to the appropriate committees of
Congress as part of the President's next annual budget
request under section 1105 of title 31, United States Code).
``(e) Supplemental Appropriations.--Any funds provided in a
supplemental appropriations Act to meet increased pay costs
attributable to school level personnel of Bureau funded
schools shall be allotted under this section.
``(f) Eligible Indian Student Defined.--In this section,
the term `eligible Indian student' means a student who--
``(1) is a member of, or is at least \1/4\ degree Indian
blood descendant of a member of, a tribe that is eligible for
the special programs and services provided by the United
States through the Bureau to Indians because of their status
as Indians;
``(2) resides on or near a reservation or meets the
criteria for attendance at a Bureau off-reservation home-
living school; and
``(3) is enrolled in a Bureau funded school.
``(g) Tuition.--
``(1) In general.--A Bureau school or contract or grant
school may not charge an eligible Indian student tuition for
attendance at the school. A Bureau school may not charge a
student attending the school under the circumstances
described in paragraph (2)(C) tuition for attendance at the
school.
``(2) Attendance of non-indian students at bureau
schools.--The Secretary may permit the attendance at a Bureau
school of a student who is not an eligible Indian student
if--
``(A)(i) the Secretary determines that the student's
attendance will not adversely affect the school's program for
eligible Indian students because of cost, overcrowding, or
violation of standards or accreditation requirements; and
``(ii) the local school board consents; and
``(B)(i) the student is a dependent of a Bureau, Indian
Health Service, or tribal government employee who lives on or
near the school site; or
``(ii) tuition is paid for the student in an amount that is
not more than the amount of tuition charged by the nearest
public school district for out-of-district students, and is
paid in addition to the school's allotment under this
section.
``(3) Attendance of non-indian students at contract and
grant schools.--The school board of a contract or grant
school may permit students who are not eligible Indian
students to attend the contract or grant school. Any tuition
collected for those students shall be in addition to the
amount the school received under this section.
``(h) Funds Available Without Fiscal Year Limitation.--
Notwithstanding any other provision of law, at the election
of the local school board of a Bureau school made at any time
during a fiscal year, a portion equal to not more than 15
percent of the funds allotted for the school under this
section for the fiscal year shall remain available to the
school for expenditure without fiscal year limitation. The
Assistant Secretary for Indian Affairs shall take such steps
as may be necessary to implement this subsection.
``(i) Students at Richfield Dormitory, Richfield, Utah.--
Tuition for the instruction of each out-of-State Indian
student in a home-living situation at the Richfield dormitory
in Richfield, Utah, who attends Sevier County high schools in
Richfield, Utah, for an academic year, shall be paid from
Indian school equalization program funds authorized in this
section and section 1129, at a rate not to exceed the
weighted amount provided for under subsection (b) for a
student for that year. No additional administrative cost
funds shall be provided under this part to pay for
administrative costs relating to the instruction of the
students.
``SEC. 1127. ADMINISTRATIVE COST GRANTS.
``(a) Definitions.--In this section:
``(1) Administrative cost.--
``(A) In general.--The term `administrative cost' means the
cost of necessary administrative functions which--
``(i) the tribe or tribal organization incurs as a result
of operating a tribal elementary or secondary educational
program;
``(ii) are not customarily paid by comparable Bureau
operated programs out of direct program funds; and
``(iii) are either--
``(I) normally provided for comparable Bureau programs by
Federal officials using resources other than Bureau direct
program funds; or
``(II) are otherwise required of tribal self-determination
program operators by law or prudent management practice.
``(B) Inclusions.--The term `administrative cost' may
include--
``(i) contract or grant (or other agreement)
administration;
``(ii) executive, policy, and corporate leadership and
decisionmaking;
``(iii) program planning, development, and management;
``(iv) fiscal, personnel, property, and procurement
management;
``(v) related office services and record keeping; and
``(vi) costs of necessary insurance, auditing, legal,
safety and security services.
``(2) Bureau elementary and secondary functions.--The term
`Bureau elementary and secondary functions' means--
``(A) all functions funded at Bureau schools by the Office;
``(B) all programs--
``(i) funds for which are appropriated to other agencies of
the Federal Government; and
``(ii) which are administered for the benefit of Indians
through Bureau schools; and
``(C) all operation, maintenance, and repair funds for
facilities and government quarters used in the operation or
support of elementary and secondary education functions for
the benefit of Indians, from whatever source derived.
``(3) Direct cost base.--
``(A) In general.--Except as otherwise provided in
subparagraph (B), the direct cost base of a tribe or tribal
organization for the fiscal year is the aggregate direct cost
program funding for all tribal elementary or secondary
educational programs operated by the tribe or tribal
organization during--
``(i) the second fiscal year preceding such fiscal year; or
[[Page S723]]
``(ii) if such programs have not been operated by the tribe
or tribal organization during the two preceding fiscal years,
the first fiscal year preceding such fiscal year.
``(B) Functions not previously operated.--In the case of
Bureau elementary or secondary education functions which have
not previously been operated by a tribe or tribal
organization under contract, grant, or agreement with the
Bureau, the direct cost base for the initial year shall be
the projected aggregate direct cost program funding for all
Bureau elementary and secondary functions to be operated by
the tribe or tribal organization during that fiscal year.
``(4) Maximum base rate.--The term `maximum base rate'
means 50 percent.
``(5) Minimum base rate.--The term `minimum base rate'
means 11 percent.
``(6) Standard direct cost base.--The term `standard direct
cost base' means $600,000.
``(7) Tribal elementary or secondary educational
programs.--The term `tribal elementary or secondary
educational programs' means all Bureau elementary and
secondary functions, together with any other Bureau programs
or portions of programs (excluding funds for social services
that are appropriated to agencies other than the Bureau and
are expended through the Bureau, funds for major
subcontracts, construction, and other major capital
expenditures, and unexpended funds carried over from prior
years) which share common administrative cost functions, that
are operated directly by a tribe or tribal organization under
a contract, grant, or agreement with the Bureau.
``(b) Grants; Effect Upon Appropriated Amounts.--
``(1) Grants.--
``(A) In general.--Subject to the availability of
appropriated funds, the Secretary shall provide a grant to
each tribe or tribal organization operating a contract or
grant school, in an amount determined under this section, for
the purpose of paying the administrative and indirect costs
incurred in operating the contract or grant school, in order
to--
``(i) enable the tribe or tribal organization operating the
school, without reducing direct program services to the
beneficiaries of the program, to provide all related
administrative overhead services and operations necessary to
meet the requirements of law and prudent management practice;
and
``(ii) carry out other necessary support functions that
would otherwise be provided by the Secretary or other Federal
officers or employees, from resources other than direct
program funds, in support of comparable Bureau operated
programs.
``(B) Amount.--No school operated as a stand-alone
institution shall receive less than $200,000 per year under
this paragraph.
``(2) Effect upon appropriated amounts.--Amounts
appropriated to fund the grants provided for under this
section shall be in addition to, and shall not reduce, the
amounts appropriated for the program being administered by
the contract or grant school.
``(c) Determination of Grant Amount.--
``(1) In general.--The amount of the grant provided to each
tribe or tribal organization under this section for each
fiscal year shall be determined by applying the
administrative cost percentage rate determined under
subsection (d) of the tribe or tribal organization to the
aggregate cost of the Bureau elementary and secondary
functions operated by the tribe or tribal organization for
which funds are received from or through the Bureau. The
administrative cost percentage rate does not apply to
programs not relating to such functions that are operated by
the tribe or tribal organization.
``(2) Direct cost base funds.--The Secretary shall--
``(A) reduce the amount of the grant determined under
paragraph (1) to the extent that payments for administrative
costs are actually received by a tribe or tribal organization
under any Federal education program that is included in the
direct cost base of the tribe or tribal organization; and
``(B) take such actions as may be necessary to be
reimbursed by any other department or agency of the Federal
Government (other than the Department of the Interior) for
the portion of grants made under this section for the costs
of administering any program for Indians that is funded by
appropriations made to such other department or agency.
``(3) Reductions.--If the total amount of funds necessary
to provide grants to tribes and tribal organizations in the
amounts determined under paragraph (1) and (2) for a fiscal
year exceeds the amount of funds appropriated to carry out
this section for such fiscal year, the Secretary shall reduce
the amount of each grant determined under this subsection for
such fiscal year by an amount that bears the same
relationship to such excess as the amount of such grants
determined under this subsection bears to the total of all
grants determined under this subsection for all tribes and
tribal organizations for such fiscal year.
``(d) Administrative Cost Percentage Rate.--
``(1) In general.--For purposes of this section, the
administrative cost percentage rate for a contract or grant
school for a fiscal year is equal to the percentage
determined by dividing--
``(A) the sum of--
``(i) the amount equal to--
``(I) the direct cost base of the tribe or tribal
organization for the fiscal year; multiplied by
``(II) the minimum base rate; plus
``(ii) the amount equal to--
``(I) the standard direct cost base; multiplied by
``(II) the maximum base rate; by
``(B) the sum of--
``(i) the direct cost base of the tribe or tribal
organization for the fiscal year; and
``(ii) the standard direct cost base.
``(2) Rounding.--The administrative cost percentage rate
shall be determined to \1/100\ of a percent.
``(e) Combining Funds.--
``(1) In general.--Funds received by a tribe, tribal
organization, or contract or grant school through grants made
under this section for tribal elementary or secondary
educational programs may be combined by the tribe, tribal
organization, or contract or grant school and placed into a
single administrative cost account without the necessity of
maintaining separate funding source accounting.
``(2) Indirect cost funds.--Indirect cost funds for
programs at the school that share common administrative
services with the tribal elementary or secondary educational
programs may be included in the administrative cost account
described in paragraph (1).
``(f) Availability of Funds.--Funds received through a
grant made under this section with respect to tribal
elementary or secondary educational programs at a contract or
grant school shall remain available to the contract or grant
school--
``(1) without fiscal year limitation; and
``(2) without reducing the amount of any grants otherwise
payable to the school under this section for any fiscal year
after the fiscal year for which the grant is provided.
``(g) Treatment of Funds.--Funds received through a grant
made under this section for Bureau funded programs operated
by a tribe or tribal organization under a contract or grant
shall not be taken into consideration for purposes of
indirect cost underrecovery and overrecovery determinations
by any Federal agency for any other funds, from whatever
source derived.
``(h) Treatment of Entity Operating Other Programs.--In
applying this section and section 106 of the Indian Self-
Determination and Education Assistance Act with respect to an
Indian tribe or tribal organization that--
``(1) receives funds under this section for administrative
costs incurred in operating a contract or grant school or a
school operated under the Tribally Controlled Schools Act of
1988; and
``(2) operates one or more other programs under a contract
or grant provided under the Indian Self-Determination and
Education Assistance Act,
the Secretary shall ensure that the Indian tribe or tribal
organization is provided with the full amount of the
administrative costs that are associated with operating the
contract or grant school, and of the indirect costs, that are
associated with all of such other programs, except that funds
appropriated for implementation of this section shall be used
only to supply the amount of the grant required to be
provided by this section.
``(i) Applicability to Schools Operating Under Tribally
Controlled Schools Act of 1988.--The provisions of this
section that apply to contract or grant schools shall also
apply to those schools receiving assistance under the
Tribally Controlled Schools Act of 1988.
``(j) Authorization of Appropriations.--There are
authorized to be appropriated such sums as may be necessary
to carry out this section.
``SEC. 1128. DIVISION OF BUDGET ANALYSIS.
``(a) Establishment.--Not later than 12 months after the
date of enactment of the Native American Education
Improvement Act of 2001, the Secretary shall establish within
the Office of Indian Education Programs a Division of Budget
Analysis (referred to in this section as the `Division').
Such Division shall be under the direct supervision and
control of the Director of the Office.
``(b) Functions.--In consultation with the tribal governing
bodies and local school boards the Director of the Office,
through the head of the Division, shall conduct studies,
surveys, or other activities to gather demographic
information on Bureau funded schools and project the amounts
necessary to provide to Indian students in such schools the
educational program set forth in this part.
``(c) Annual Reports.--Not later than the date that the
Assistant Secretary for Indian Affairs submits the annual
budget request as part of the President's annual budget
request under section 1105 of title 31, United States Code
for each fiscal year after the date of enactment of the
Native American Education Improvement Act of 2001, the
Director of the Office shall submit to the appropriate
committees of Congress (including the Committee on
Appropriations of the House of Representatives and the
Committee on Appropriations of the Senate), all Bureau funded
schools, and the tribal governing bodies relating to such
schools, a report that shall contain--
``(1) projections, based on the information gathered
pursuant to subsection (b) and any other relevant
information, of amounts necessary to provide to Indian
students in Bureau funded schools the educational program set
forth in this part;
``(2) a description of the methods and formulas used to
calculate the amounts projected pursuant to paragraph (1);
and
[[Page S724]]
``(3) such other information as the Director of the Office
considers to be appropriate.
``(d) Use of Reports.--The Director of the Office and the
Assistant Secretary for Indian Affairs shall use the
information contained in the annual report required by
subsection (c) in preparing their annual budget requests.
``SEC. 1129. UNIFORM DIRECT FUNDING AND SUPPORT.
``(a) Establishment of System and Forward Funding.--
``(1) In general.--The Secretary shall establish, by
regulation adopted in accordance with section 1137, a system
for the direct funding and support of all Bureau funded
schools. Such system shall allot funds in accordance with
section 1126. All amounts appropriated for distribution in
accordance with this section may be made available in
accordance with paragraph (2).
``(2) Timing for use of funds.--
``(A) Availability.--With regard to funds for affected
schools under this part that become available for obligation
on October 1 of the fiscal year for which such funds are
appropriated, the Secretary shall make payments to such
affected schools not later than December 1 of the fiscal
year, except that operations and maintenance funds shall be
forward funded and shall be available for obligation not
later than July 15 and December 1 of each fiscal year, and
shall remain available for obligation through the succeeding
fiscal year.
``(B) Publications.--The Secretary shall, on the basis of
the amounts appropriated as described in this paragraph--
``(i) publish, not later than July 1 of the fiscal year for
which the amounts are appropriated, information indicating
the amount of the allotments to be made to each affected
school under section 1126, of 85 percent of such appropriated
amounts; and
``(ii) publish, not later than September 30 of such fiscal
year, information indicating the amount of the allotments to
be made under section 1126, from the remaining 15 percent of
such appropriated amounts, adjusted to reflect the actual
student attendance.
``(3) Limitation.--
``(A) Expenditures.--Notwithstanding any other provision of
law (including a regulation), the supervisor of a Bureau
school may expend an aggregate of not more than $50,000 of
the amount allotted to the school under section 1126 to
acquire materials, supplies, equipment, operation services,
maintenance services, and other services for the school, and
amounts received as operations and maintenance funds, funds
received from the Department of Education, or funds received
from other Federal sources, without competitive bidding if--
``(i) the cost for any single item acquired does not exceed
$15,000;
``(ii) the school board approves the acquisition;
``(iii) the supervisor certifies that the cost is fair and
reasonable;
``(iv) the documents relating to the acquisition executed
by the supervisor of the school or other school staff cite
this paragraph as authority for the acquisition; and
``(v) the acquisition transaction is documented in a
journal maintained at the school that clearly identifies when
the transaction occurred, the item that was acquired and from
whom, the price paid, the quantities acquired, and any other
information the supervisor or the school board considers to
be relevant.
``(B) Notice.--Not later than 6 months after the date of
enactment of the Native American Education Improvement Act of
2001, the Secretary shall send notice of the provisions of
this paragraph to each supervisor of a Bureau school and
associated school board chairperson, the education line
officer of each agency and area, and the Bureau division in
charge of procurement, at both the local and national levels.
``(C) Application and guidelines.--The Director of the
Office shall be responsible for--
``(i) determining the application of this paragraph,
including the authorization of specific individuals to carry
out this paragraph;
``(ii) ensuring that there is at least 1 such individual at
each Bureau facility; and
``(iii) the provision of guidelines on the use of this
paragraph and adequate training on such guidelines.
``(b) Local Financial Plans for Expenditure of Funds.--
``(1) Plan required.--
``(A) In general.--Each Bureau school that receives an
allotment under section 1126 shall prepare a local financial
plan that specifies the manner in which the school will
expend the funds made available under the allotment and
ensures that the school will meet the accreditation
requirements or standards for the school established pursuant
to section 1121.
``(B) Requirement.--A local financial plan under
subparagraph (A) shall comply with all applicable Federal and
tribal laws.
``(C) Preparation and revision.--The financial plan for a
school under subparagraph (A) shall be prepared by the
supervisor of the school in active consultation with the
local school board for the school. The local school board for
each school shall have the authority to ratify, reject, or
amend such financial plan and, at the initiative of the local
school board or in response to the supervisor of the school,
to revise such financial plan to meet needs not foreseen at
the time of preparation of the financial plan.
``(D) Role of supervisor.--The supervisor of the school--
``(i) shall put into effect the decisions of the school
board relating to the financial plan under subparagraph (A);
and
``(ii) shall provide the appropriate local union
representative of the education employees of the school with
copies of proposed financial plans relating to the school and
all modifications and proposed modifications to the plans,
and at the same time submit such copies to the local school
board.
``(iii) may appeal any such action of the local school
board to the appropriate education line officer of the Bureau
agency by filing a written statement describing the action
and the reasons the supervisor believes such action should be
overturned.
A copy of statement under clause (iii) shall be submitted to
the local school board and such board shall be afforded an
opportunity to respond, in writing, to such appeal. After
reviewing such written appeal and response, the appropriate
education line officer may, for good cause, overturn the
action of the local school board. The appropriate education
line officer shall transmit the determination of such appeal
in the form of a written opinion to such board and to such
supervisor identifying the reasons for overturning such
action.
``(2) Requirement.--A Bureau school shall expend amounts
received under an allotment under section 1126 in accordance
with the local financial plan prepared under paragraph (1).
``(c) Tribal Division of Education, Self-Determination
Grant and Contract Funds.--The Secretary may approve
applications for funding tribal divisions of education and
developing tribal codes of education, from funds made
available pursuant to section 103(a) of the Indian Self-
Determination and Education Assistance Act.
``(d) Technical Assistance and Training.--A local school
board may, in the exercise of the authority of the school
board under this section, request technical assistance and
training from the Secretary. The Secretary shall, to the
greatest extent possible, provide such assistance and
training, and make appropriate provision in the budget of the
Office for such assistance and training.
``(e) Summer Program of Academic and Support Services.--
``(1) In general.--A financial plan prepared under
subsection (b) for a school may include, at the discretion of
the supervisor and the local school board of such school, a
provision for funding a summer program of academic and
support services for students of the school. Any such program
may include activities related to the prevention of alcohol
and substance abuse. The Assistant Secretary for Indian
Affairs shall provide for the utilization of facilities of
the school for such program during any summer in which such
utilization is requested.
``(2) Use of other funds.--Notwithstanding any other
provision of law, funds authorized under the Act of April 16,
1934 (commonly known as the `Johnson-O'Malley Act'; 48 Stat.
596, chapter 147) and this Act may be used to augment the
services provided in each summer program referred to in
paragraph (1) at the option of the tribe or school receiving
such funds. The augmented services shall be under the control
of the tribe or school.
``(3) Technical assistance and program coordination.--The
Assistant Secretary for Indian Affairs, acting through the
Director of the Office, shall provide technical assistance
and coordination of activities for any program described in
paragraph (1) and shall, to the extent possible, encourage
the coordination of such programs with any other summer
programs that might benefit Indian youth, regardless of the
funding source or administrative entity of such programs.
``(f) Cooperative Agreements.--
``(1) In general.--From funds allotted to a Bureau school
under section 1126, the Secretary shall, if specifically
requested by the appropriate tribal governing body, implement
a cooperative agreement that is entered into between the
tribe, the Bureau, the local school board, and a local public
school district that meets the requirements of paragraph (2)
and involves the school. The tribe, the Bureau, the school
board, and the local public school district shall determine
the terms of the agreement.
``(2) Coordination provisions.--An agreement under
paragraph (1) may, with respect to the Bureau school and
schools in the school district involved, encompass
coordination of all or any part of the following:
``(A) The academic program and curriculum, unless the
Bureau school is accredited by a State or regional
accrediting entity and would not continue to be so accredited
if the agreement encompassed the program and curriculum.
``(B) Support services, including procurement and
facilities maintenance.
``(C) Transportation.
``(3) Equal benefit and burden.--
``(A) In general.--Each agreement entered into pursuant to
the authority provided in paragraph (1) shall confer a
benefit upon the Bureau school commensurate with the burden
assumed by the school.
``(B) Limitation.--Subparagraph (A) shall not be construed
to require equal expenditures, or an exchange of similar
services, by the Bureau school and schools in the school
district.
``(g) Product or Result of Student Projects.--
Notwithstanding any other provision of law, where there is
agreement on
[[Page S725]]
action between the superintendent and the school board of a
Bureau funded school, the product or result of a project
conducted in whole or in major part by a student may be given
to that student upon the completion of such project.
``(h) Matching Fund Requirements.--
``(1) Not considered federal funds.--Notwithstanding any
other provision of law, funds received by a Bureau funded
school under this title for education-related activities (not
including funds for construction, maintenance and facilities,
improvement or repair) shall not be considered to be Federal
funds for the purposes of meeting a matching funds
requirement for any Federal program.
``(2) Nonapplication of requirements.--
``(A) In general.--Notwithstanding any other provision of
law, no requirement relating to the provision of matching
funds or the provision of services or in-kind activity as a
condition of participation in a program or project or receipt
of a grant, shall apply to a Bureau funded school unless the
provision of law authorizing such requirement specifies that
such requirement applies to such a school.
``(B) Limitation.--In considering an application from a
Bureau funded school for participation in a program or
project that has a requirement described in subparagraph (A),
the entity administering such program or project or receiving
such grant shall not give positive or negative weight to such
application based solely on the provisions of this paragraph.
Such an application shall be considered as if it fully met
any matching requirement.
``SEC. 1130. POLICY FOR INDIAN CONTROL OF INDIAN EDUCATION.
``(a) Facilitation of Indian Control.--It shall be the
policy of the Secretary and the Bureau, in carrying out the
functions of the Bureau, to facilitate Indian control of
Indian affairs in all matters relating to education.
``(b) Consultation With Tribes.--
``(1) In general.--All actions under this Act shall be done
with active consultation with tribes. The Bureau and tribes
shall work in a government-to-government relationship to
ensure quality education for all tribal members.
``(2) Requirements.--The consultation required under
paragraph (1) means a process involving the open discussion
and joint deliberation of all options with respect to
potential issues or changes between the Bureau and all
interested parties. During such discussions and joint
deliberations, interested parties (including tribes and
school officials) shall be given an opportunity to present
issues including proposals regarding changes in current
practices or programs which will be considered for future
action by the Bureau. All interested parties shall be given
an opportunity to participate and discuss the options
presented or to present alternatives, with the views and
concerns of the interested parties given effect unless the
Secretary determines, from information available from or
presented by the interested parties during one or more of the
discussions and deliberations, that there is a substantial
reason for another course of action. The Secretary shall
submit to any Member of Congress, within 18 days of the
receipt of a written request by such Member, a written
explanation of any decision made by the Secretary which is
not consistent with the views of the interested parties.
``SEC. 1131. INDIAN EDUCATION PERSONNEL.
``(a) Definitions.--In this section:
``(1) Education position.--The term `education position'
means a position in the Bureau the duties and
responsibilities of which--
``(A) are performed on a school-year basis principally in a
Bureau school and involve--
``(i) classroom or other instruction or the supervision or
direction of classroom or other instruction;
``(ii) any activity (other than teaching) that requires
academic credits in educational theory and practice equal to
the academic credits in educational theory and practice
required for a bachelor's degree in education from an
accredited institution of higher education;
``(iii) any activity in or related to the field of
education, whether or not academic credits in educational
theory and practice are a formal requirement for the conduct
of such activity; or
``(iv) provision of support services at, or associated
with, the site of the school; or
``(B) are performed at the agency level of the Bureau and
involve the implementation of education-related programs,
other than the position of agency superintendent for
education.
``(2) Educator.--The term `educator' means an individual
whose services are required, or who is employed, in an
education position.
``(b) Civil Service Authorities Inapplicable.--Chapter 51,
subchapter III of chapter 53, and chapter 63 of title 5,
United States Code, relating to classification, pay, and
leave, respectively, and the sections of such title relating
to the appointment, promotion, hours of work, and removal of
civil service employees, shall not apply to educators or to
education positions.
``(c) Regulations.--Not later than 60 days after the date
of enactment of the Native American Education Improvement Act
of 2001, the Secretary shall prescribe regulations to carry
out this section. Such regulations shall include provisions
relating to--
``(1) the establishment of education positions;
``(2) the establishment of qualifications for educators and
education personnel;
``(3) the fixing of basic compensation for educators and
education positions;
``(4) the appointment of educators;
``(5) the discharge of educators;
``(6) the entitlement of educators to compensation;
``(7) the payment of compensation to educators;
``(8) the conditions of employment of educators;
``(9) the leave system for educators;
``(10) the length of the school year applicable to
education positions described in subsection (a)(1)(A); and
``(11) such matters as may be appropriate.
``(d) Qualifications of Educators.--
``(1) Requirements.--In prescribing regulations to govern
the qualifications of educators, the Secretary shall
require--
``(A) that lists of qualified and interviewed applicants
for education positions be maintained in the appropriate
agency or area office of the Bureau or, in the case of
individuals applying at the national level, the Office;
``(B)(i) that a local school board have the authority to
waive, on a case-by-case basis, any formal education or
degree qualification established by regulation, in order for
a tribal member to be hired in an education position to teach
courses on tribal culture and language; and
``(ii) that a determination by a local school board that
such a tribal member be hired shall be instituted by the
supervisor of the school involved; and
``(C) that it shall not be a prerequisite to the employment
of an individual in an education position at the local
level--
``(i) that such individual's name appear on a list
maintained pursuant to subparagraph (A); or
``(ii) that such individual have applied at the national
level for an education position.
``(2) Exception for certain temporary employment.--The
Secretary may authorize the temporary employment in an
education position of an individual who has not met the
certification standards established pursuant to regulations,
if the Secretary determines that failure to authorize the
employment would result in that position remaining vacant.
``(e) Hiring of Educators.--
``(1) Requirements.--In prescribing regulations to govern
the appointment of educators, the Secretary shall require--
``(A)(i)(I) that educators employed in a Bureau school
(other than the supervisor of the school) shall be hired by
the supervisor of the school; and
``(II) that, in a case in which there are no qualified
applicants available to fill a vacancy at a Bureau school,
the supervisor may consult a list maintained pursuant to
subsection (d)(1)(A);
``(ii) each supervisor of a Bureau school shall be hired by
the education line officer of the agency office of the Bureau
for the jurisdiction in which the school is located;
``(iii) each educator employed in an agency office of the
Bureau shall be hired by the superintendent for education of
the agency office; and
``(iv) each education line officer and educator employed in
the office of the Director of the Office shall be hired by
the Director;
``(B)(i) that, before an individual is employed in an
education position in a Bureau school by the supervisor of
the school (or, with respect to the position of supervisor,
by the appropriate agency education line officer), the local
school board for the school shall be consulted; and
``(ii) that a determination by such school board, as
evidenced by school board records, that such individual
should or should not be so employed shall be instituted by
the supervisor (or with respect to the position of
supervisor, by the superintendent for education of the agency
office);
``(C)(i) that, before an individual is employed in an
education position in an agency office of the Bureau, the
appropriate agency school board shall be consulted; and
``(ii) that a determination by such school board, as
evidenced by school board records, that such individual
should or should not be employed shall be instituted by the
superintendent for education of the agency office;
``(D) that before an individual is employed in an education
position (as described in subsection (a)(1)(B)) in the office
of the Director of the Office (other than the position of
Director), the school boards representing all Bureau schools
shall be consulted; and
``(E) that all employment decisions or actions be in
compliance with all applicable Federal, State and tribal
laws.
``(2) Information regarding application at national
level.--
``(A) In general.--Any individual who applies at the local
level for an education position shall state on such
individual's application whether or not such individual has
applied at the national level for an education position.
``(B) Effect of inaccurate statement.--If an individual
described in subparagraph (A) is employed at the local level,
such individual's name shall be immediately forwarded to the
Secretary by the local employer. The Secretary shall, as soon
as practicable but in no event later than 30 days after the
receipt of the name, ascertain the accuracy of the statement
made by such individual pursuant
[[Page S726]]
to subparagraph (A). Notwithstanding subsection (g), if the
Secretary finds that the individual's statement was false,
such individual, at the Secretary's discretion, may be
disciplined or discharged.
``(C) Effect of application at national level.--If an
individual described in subparagraph (A) has applied at the
national level for an education position, the appointment of
such individual at the local level shall be conditional for a
period of 90 days. During that period, the Secretary may
appoint a more qualified individual (as determined by the
Secretary) from a list maintained pursuant to subsection
(e)(1)(A) to the position to which such individual was
appointed.
``(3) Statutory construction.--Except as expressly
provided, nothing in this section shall be construed as
conferring upon local school boards authority over, or
control of, educators at Bureau funded schools or the
authority to issue management decisions.
``(4) Appeals.--
``(A) By supervisor.--The supervisor of a school may appeal
to the appropriate agency education line officer any
determination by the local school board for the school that
an individual be employed, or not be employed, in an
education position in the school (other than that of
supervisor) by filing a written statement describing the
determination and the reasons the supervisor believes such
determination should be overturned. A copy of such statement
shall be submitted to the local school board and such board
shall be afforded an opportunity to respond, in writing, to
such appeal. After reviewing such written appeal and
response, the education line officer may, for good cause,
overturn the determination of the local school board. The
education line officer shall transmit the determination of
such appeal in the form of a written opinion to such board
and to such supervisor identifying the reasons for
overturning such determination.
``(B) By education line officer.--The education line
officer of an agency office of the Bureau may appeal to the
Director of the Office any determination by the local school
board for the school that an individual be employed, or not
be employed, as the supervisor of a school by filing a
written statement describing the determination and the
reasons the supervisor believes such determination should be
overturned. A copy of such statement shall be submitted to
the local school board and such board shall be afforded. an
opportunity to respond, in writing, to such appeal. After
reviewing such written appeal and response, the Director may,
for good cause, overturn the determination of the local
school board. The Director shall transmit the determination
of such appeal in the form of a written opinion to such board
and to such education line officer identifying the reasons
for overturning such determination.
``(5) Other appeals.--The education line officer of an
agency office of the Bureau may appeal to the Director of the
Office any determination by the agency school board that an
individual be employed, or not be employed, in an education
position in such agency office by filing a written statement
describing the determination and the reasons the supervisor
believes such determination should be overturned. A copy of
such statement shall be submitted to the agency school board
and such board shall be afforded an opportunity to respond,
in writing, to such appeal. After reviewing such written
appeal and response, the Director may, for good cause,
overturn the determination of the agency school board. The
Director shall transmit the determination of such appeal in
the form of a written opinion to such board and to such
education line officer identifying the reasons for
overturning such determination.
``(f) Discharge and Conditions of Employment of
Educators.--
``(1) Regulations.--In prescribing regulations to govern
the discharge and conditions of employment of educators, the
Secretary shall require--
``(A) that procedures shall be established for the rapid
and equitable resolution of grievances of educators;
``(B) that no educator may be discharged without notice of
the reasons for the discharge and an opportunity for a
hearing under procedures that comport with the requirements
of due process; and
``(C) that each educator employed in a Bureau school shall
be notified 30 days prior to the end of an academic year
whether the employment contract of the individual will be
renewed for the following year.
``(2) Procedures for discharge.--
``(A) Determinations.--The supervisor of a Bureau school
may discharge (subject to procedures established under
paragraph (1)(B)) for cause (as determined under regulations
prescribed by the Secretary) any educator employed in such
school. On giving notice to an educator of the supervisor's
intention to discharge the educator, the supervisor shall
immediately notify the local school board of the proposed
discharge. A determination by the local school board that
such educator shall not be discharged shall be followed by
the supervisor.
``(B) Appeals.--The supervisor shall have the right to
appeal a determination by a local school board under
subparagraph (A), as evidenced by school board records, not
to discharge an educator to the education line officer of the
appropriate agency office of the Bureau. Upon hearing such an
appeal, the agency education line officer may, for good
cause, issue a decision overturning the determination of the
local school board with respect to the employment of such
individual. The education line officer shall make the
decision in writing and submit the decision to the local
school board.
``(3) Recommendations of school boards for discharge.--Each
local school board for a Bureau school shall have the right--
``(A) to recommend to the supervisor that an educator
employed in the school be discharged; and
``(B) to recommend to the education line officer of the
appropriate agency office of the Bureau and to the Director
of the Office, that the supervisor of the school be
discharged.
``(g) Applicability of Indian Preference Laws.--
``(1) In general.--Notwithstanding any provision of the
Indian preference laws, such laws shall not apply in the case
of any personnel action carried out under this section with
respect to an applicant or employee not entitled to an Indian
preference if each tribal organization concerned grants a
written waiver of the application of such laws with respect
to such personnel action and states that such waiver is
necessary. This paragraph shall not be construed to relieve
the Bureau's responsibility to issue timely and adequate
announcements and advertisements concerning any such
personnel action if such action is intended to fill a vacancy
(no matter how such vacancy is created).
``(2) Definitions.--In this subsection:
``(A) Indian preference laws.--The term `Indian preference
laws' means section 12 of the Act of June 18, 1934 (48 Stat.
986, chapter 576) or any other provision of law granting a
preference to Indians in promotions and other personnel
actions. Such term shall not include section 7(b) of the
Indian Self-Determination and Education Assistance Act.
``(B) Tribal organization.--The term `tribal organization'
means--
``(i) the recognized governing body of any Indian tribe,
band, nation, pueblo, or other organized community, including
a Native village (as defined in section 3(c) of the Alaska
Native Claims Settlement Act); or
``(ii) in connection with any personnel action referred to
in this subsection, any local school board to which the
governing body has delegated the authority to grant a waiver
under this subsection with respect to a personnel action.
``(h) Compensation or Annual Salary.--
``(1) In general.--
``(A) Compensation for educators and education positions.--
Except as otherwise provided in this section, the Secretary
shall fix the basic compensation for educators and education
positions--
``(i) at rates in effect under the General Schedule for
individuals with comparable qualifications, and holding
comparable positions, to whom chapter 51 of title 5, United
States Code, is applicable; or
``(ii) on the basis of the Federal Wage System schedule in
effect for the locality involved, and for the comparable
positions, at the rates of compensation in effect for the
senior executive service.
``(B) Compensation or salary for teachers and counselors.--
The Secretary shall establish the rate of basic compensation,
or annual salary rate, for the positions of teachers and
counselors (including dormitory counselors and home-living
counselors) at the rate of basic compensation applicable (on
the date of enactment of the Native American Education
Improvement Act of 2001 and thereafter) for comparable
positions in the overseas schools under the Defense
Department Overseas Teachers Pay and Personnel Practices Act.
The Secretary shall allow the local school boards involved
authority to implement only the aspects of the Defense
Department Overseas Teachers Pay and Personnel Practices Act
pay provisions that are considered essential for recruitment
and retention of teachers and counselors. Implementation of
such provisions shall not be construed to require the
implementation of that entire Act.
``(C) Rates for new hires.--
``(i) In general.--Beginning with the first fiscal year
following the date of enactment of the Native American
Education Improvement Act of 2001, each local school board of
a Bureau school may establish a rate of compensation or
annual salary rate described in clause (ii) for teachers and
counselors (including academic counselors) who are new hires
at the school and who had not worked at the school, as of the
first day of such fiscal year.
``(ii) Consistent rates.--The rates established under
clause (i) shall be consistent with the rates paid for
individuals in the same positions, with the same tenure and
training, as the teachers and counselors, in any other school
within whose boundaries the Bureau school is located.
``(iii) Decreases.--In an instance in which the
establishment of rates under clause (i) causes a reduction in
compensation at a school from the rate of compensation that
was in effect for the first fiscal year following the date of
enactment of the Native American Education Improvement Act of
2001, the new rates of compensation may be applied to the
compensation of employees of the school who worked at the
school as of such date of enactment by applying those rates
at each contract renewal for the employees so that the
reduction takes effect in 3 equal installments.
``(iv) Increases.--In an instance in which the
establishment of such rates at a school causes an increase in
compensation from the
[[Page S727]]
rate of compensation that was in effect for the first fiscal
year following the date of enactment of the Native American
Education Improvement Act of 2001, the school board may apply
the new rates at the next contract renewal so that either--
``(I) the entire increase occurs on 1 date; or
``(II) the increase takes effect in 3 equal installments.
``(D) Established regulations, procedures, and
arrangements.--
``(i) Promotions and advancements.--The establishment of
rates of basic compensation and annual salary rates under
subparagraphs (B) and (C) shall not preclude the use of
regulations and procedures used by the Bureau prior to April
28, 1988, in making determinations regarding promotions and
advancements through levels of pay that are based on the
merit, education, experience, or tenure of an educator.
``(ii) Continued employment or compensation.--The
establishment of rates of basic compensation and annual
salary rates under subparagraphs (B) and (C) shall not affect
the continued employment or compensation of an educator who
was employed in an education position on October 31, 1979,
and who did not make an election under subsection (o), as in
effect on January 1, 1990.
``(2) Post differential rates.--
``(A) In general.--The Secretary may pay a post
differential rate not to exceed 25 percent of the rate of
basic compensation, for educators or education positions, on
the basis of conditions of environment or work that warrant
additional pay, as a recruitment and retention incentive.
``(B) Supervisor's authority.--
``(i) In general.--Except as provided in clause (ii) on the
request of the supervisor and the local school board of a
Bureau school, the Secretary shall grant the supervisor of
the school authorization to provide 1 or more post
differential rates under subparagraph (A).
``(ii) Exception.--The Secretary shall disapprove, or
approve with a modification, a request for authorization to
provide a post differential rate if the Secretary determines
for clear and convincing reasons (and advises the board in
writing of those reasons) that the rate should be disapproved
or decreased because the disparity of compensation between
the appropriate educators or positions in the Bureau school,
and the comparable educators or positions at the nearest
public school, is--
``(I)(aa) at least 5 percent; or
``(bb) less than 5 percent; and
``(II) does not affect the recruitment or retention of
employees at the school.
``(iii) Approval of requests.--A request made under clause
(i) shall be considered to be approved at the end of the 60th
day after the request is received in the Central Office of
the Bureau unless before that time the request is approved,
approved with a modification, or disapproved by the
Secretary.
``(iv) Discontinuation of or decrease in rates.--The
Secretary or the supervisor of a Bureau school may
discontinue or decrease a post differential rate provided for
under this paragraph at the beginning of an academic year
if--
``(I) the local school board requests that such
differential be discontinued or decreased; or
``(II) the Secretary or the supervisor, respectively,
determines for clear and convincing reasons (and advises the
board in writing of those reasons) that there is no disparity
of compensation that would affect the recruitment or
retention of employees at the school after the differential
is discontinued or decreased.
``(v) Reports.--On or before February 1 of each year, the
Secretary shall submit to Congress a report describing the
requests and approvals of authorization made under this
paragraph during the previous year and listing the positions
receiving post differential rates under contracts entered
into under those authorizations.
``(i) Liquidation of Remaining Leave Upon Termination.--
Upon termination of employment with the Bureau, any annual
leave remaining to the credit of an individual within the
purview of this section shall be liquidated in accordance
with sections 5551(a) and 6306 of title 5, United States
Code, except that leave earned or accrued under regulations
prescribed pursuant to subsection (c)(9) shall not be so
liquidated.
``(j) Transfer of Remaining Leave Upon Transfer, Promotion,
or Reemployment.--In the case of any educator who--
``(1) is transferred, promoted, or reappointed, without a
break in service, to a position in the Federal Government
under a different leave system than the system for leave
described in subsection (c)(9); and
``(2) earned or was credited with leave under the
regulations prescribed under subsection (c)(9) and has such
leave remaining to the credit of such educator;
such leave shall be transferred to such educator's credit in
the employing agency for the position on an adjusted basis in
accordance with regulations that shall be prescribed by the
Director of the Office of Personnel Management.
``(k) Ineligibility for Employment of Voluntarily
Terminated Educators.--An educator who voluntarily terminates
employment under an employment contract with the Bureau
before the expiration of the employment contract shall not be
eligible to be employed in another education position in the
Bureau during the remainder of the term of such contract.
``(l) Dual Compensation.--In the case of any educator
employed in an education position described in subsection
(a)(1)(A) who--
``(1) is employed at the end of an academic year;
``(2) agrees in writing to serve in such position for the
next academic year; and
``(3) is employed in another position during the recess
period immediately preceding such next academic year, or
during such recess period receives additional compensation
referred to in section 5533 of title 5, United States Code,
relating to dual compensation;
such section 5533 shall not apply to such educator by reason
of any such employment during the recess period with respect
to any receipt of additional compensation.
``(m) Voluntary Services.--Notwithstanding section 1342 of
title 31, United States Code, the Secretary may, subject to
the approval of the local school boards concerned, accept
voluntary services on behalf of Bureau schools. Nothing in
this part shall be construed to require Federal employees to
work without compensation or to allow the use of volunteer
services to displace or replace Federal employees. An
individual providing volunteer services under this section
shall be considered to be a Federal employee only for
purposes of chapter 81 of title 5, United States Code, and
chapter 171 of title 28, United States Code.
``(n) Proration of Pay.--
``(1) Election of employee.--Notwithstanding any other
provision of law, including laws relating to dual
compensation, the Secretary, at the election of an educator,
shall prorate the salary of the educator for an academic year
over a 12-month period. Each educator employed for the
academic year shall annually elect to be paid on a 12-month
basis or for those months while school is in session. No
educator shall suffer a loss of pay or benefits, including
benefits under unemployment or other Federal or federally
assisted programs, because of such election.
``(2) Change of election.--During the course of such
academic year, the employee may change the election made
under paragraph (1) once.
``(3) Lump-sum payment.--That portion of the employee's pay
that would be paid between academic years may be paid in a
lump sum at the election of the employee.
``(4) Application.--This subsection applies to educators,
whether employed under this section or title 5, United States
Code.
``(o) Extracurricular Activities.--
``(1) Stipend.--Notwithstanding any other provision of law,
the Secretary may provide, for Bureau employees in each
Bureau area, a stipend in lieu of overtime premium pay or
compensatory time off for overtime work. Any employee of the
Bureau who performs overtime work that consists of additional
activities to provide services to students or otherwise
support the school's academic and social programs may elect
to be compensated for all such work on the basis of the
stipend. Such stipend shall be paid as a supplement to the
employee's base pay.
``(2) Election not to receive stipend.--If an employee
elects not to be compensated through the stipend established
by this subsection, the appropriate provisions of title 5,
United States Code, shall apply with respect to the work
involved.
``(3) Application.--This subsection applies to Bureau
employees, whether employed under this section or title 5,
United States Code.
``(p) Covered Individuals; Election.--This section shall
apply with respect to any educator hired after November 1,
1979 (and to any educator who elected to be covered under
this section or a corresponding provision after November 1,
1979) and to the position in which such educator is employed.
The enactment of this section shall not affect the continued
employment of an individual employed on October 31, 1979 in
an education position, or such person's right to receive the
compensation attached to such position.
``(q) Furlough Without Consent.--
``(1) In general.--An educator who was employed in an
education position on October 31, 1979, who was eligible to
make an election under subsection (p) at that time, and who
did not make the election under paragraph such subsection,
may not be placed on furlough (within the meaning of section
7511(a)(5) of title 5, United States Code, without the
consent of such educator for an aggregate of more than 4
weeks within the same calendar year, unless--
``(A) the supervisor, with the approval of the local school
board (or of the education line officer upon appeal under
paragraph (2)), of the Bureau school at which such educator
provides services determines that a longer period of furlough
is necessary due to an insufficient amount of funds available
for personnel compensation at such school, as determined
under the financial plan process as determined under section
1129(b); and
``(B) all educators (other than principals and clerical
employees) providing services at such Bureau school are
placed on furloughs of equal length, except that the
supervisor, with the approval of the local school board (or
of the agency education line officer upon appeal under
paragraph (2)), may continue 1 or more educators in pay
status if--
``(i) such educators are needed to operate summer programs,
attend summer training sessions, or participate in special
activities including curriculum development committees; and
``(ii) such educators are selected based upon such
educator's qualifications after public notice of the minimum
qualifications
[[Page S728]]
reasonably necessary and without discrimination as to
supervisory, nonsupervisory, or other status of the educators
who apply.
``(2) Appeals.--The supervisor of a Bureau school may
appeal to the appropriate agency education line officer any
refusal by the local school board to approve any
determination of the supervisor that is described in
paragraph (1)(A) by filing a written statement describing the
determination and the reasons the supervisor believes such
determination should be approved. A copy of such statement
shall be submitted to the local school board and such board
shall be afforded an opportunity to respond, in writing, to
such appeal. After reviewing such written appeal and
response, the education line officer may, for good cause,
approve the determination of the supervisor. The educational
line officer shall transmit the determination of such appeal
in the form of a written opinion to such local school board
and to the supervisor identifying the reasons for approving
such determination.
``SEC. 1132. COMPUTERIZED MANAGEMENT INFORMATION SYSTEM.
``(a) Establishment of System.--Not later than July 1,
2002, the Secretary shall establish within the Office a
computerized management information system, which shall
provide processing and information to the Office. The
information provided shall include information regarding--
``(1) student enrollment;
``(2) curricula;
``(3) staffing;
``(4) facilities;
``(5) community demographics;
``(6) student assessment information;
``(7) information on the administrative and program costs
attributable to each Bureau program, divided into discrete
elements;
``(8) relevant reports;
``(9) personnel records;
``(10) finance and payroll; and
``(11) such other items as the Secretary determines to be
appropriate.
``(b) Implementation of System.--Not later than July 1,
2003, the Secretary shall complete implementation of such a
system at each Bureau field office and Bureau funded school.
``SEC. 1133. UNIFORM EDUCATION PROCEDURES AND PRACTICES.
``Not later than 90 days after the date of enactment of the
Native American Education Improvement Act of 2001, the
Secretary shall cause the various divisions of the Bureau to
formulate uniform procedures and practices with respect to
such concerns of those divisions as relate to education, and
shall submit a report on the procedures and practices to
Congress.
``SEC. 1134. RECRUITMENT OF INDIAN EDUCATORS.
``The Secretary shall institute a policy for the
recruitment of qualified Indian educators and a detailed plan
to promote employees from within the Bureau. Such plan shall
include provisions for opportunities for acquiring work
experience prior to receiving an actual work assignment.
``SEC. 1135. ANNUAL REPORT; AUDITS.
``(a) Annual Reports.--The Secretary shall submit to each
appropriate committee of Congress, all Bureau funded schools,
and the tribal governing bodies of such schools, a detailed
annual report on the state of education within the Bureau and
any problems encountered in Indian education during the
period covered by the report. Such report shall contain
suggestions for the improvement of the Bureau educational
system and for increasing tribal or local Indian control of
such system. Such report shall also include information on
the status of tribally controlled community colleges.
``(b) Budget Request.--The annual budget request for the
Bureau's education programs, as submitted as part of the
President's next annual budget request under section 1105 of
title 31, United States Code) shall include the plans
required by sections 1121(g), 1122(c), and 1124(c).
``(c) Financial and Compliance Audits.--The Inspector
General of the Department of the Interior shall establish a
system to ensure that financial and compliance audits are
conducted for each Bureau school at least once in every 3
years. Such an audit of a Bureau school shall examine the
extent to which such school has complied with the local
financial plan prepared by the school under section 1129(b).
``(d) Administrative Evaluation of Schools.--The Director
shall, at least once every 3 to 5 years, conduct a
comprehensive evaluation of Bureau operated schools. Such
evaluation shall be in addition to any other program review
or evaluation that may be required under Federal law.
``SEC. 1136. RIGHTS OF INDIAN STUDENTS.
``The Secretary shall prescribe such rules and regulations
as may be necessary to ensure the protection of the
constitutional and civil rights of Indian students attending
Bureau funded schools, including such students' right to
privacy under the laws of the United States, such students'
right to freedom of religion and expression, and such
students' right to due process in connection with
disciplinary actions, suspensions, and expulsions.
``SEC. 1137. REGULATIONS.
``(a) In General.--The Secretary may issue only such
regulations as may be necessary to ensure compliance with the
specific provisions of this part. In issuing the regulations,
the Secretary shall publish proposed regulations in the
Federal Register, and shall provide a period of not less than
120 days for public comment and consultation on the
regulations. The regulations shall contain, immediately
following each regulatory section, a citation to any
statutory provision providing authority to issue such
regulatory section.
``(b) Regional Meetings.--Prior to publishing any proposed
regulations under subsection (a) and prior to establishing
the negotiated rulemaking committee under subsection (c), the
Secretary shall convene regional meetings to consult with
personnel of the Office of Indian Education Programs,
educators at Bureau schools, representatives of Bureau
employees, and tribal officials, parents, teachers and school
board members of tribes served by Bureau funded schools to
provide guidance to the Secretary on the content of
regulations authorized to be issued under this part and the
Tribally Controlled Schools Act of 1988.
``(c) Negotiated Rulemaking.--
``(1) In general.--Notwithstanding sections 563(a) and
565(a) of title 5, United States Code, the Secretary shall
promulgate regulations authorized under subsection (a) and
under the Tribally Controlled Schools Act of 1988, in
accordance with the negotiated rulemaking procedures provided
for under subchapter III of chapter 5 of title 5, United
States Code, and shall publish final regulations in the
Federal Register.
``(2) Expiration of authority.--The authority of the
Secretary to promulgate regulations under this part and under
the Tribally Controlled Schools Act of 1988, shall expire on
the date than is 18 months after the date of enactment of
this part. If the Secretary determines that an extension of
the deadline under this paragraph is appropriate, the
Secretary may submit proposed legislation to Congress for an
extension of such deadline.
``(3) Rulemaking committee.--The Secretary shall establish
a negotiated rulemaking committee to carry out this
subsection. In establishing such committee, the Secretary
shall--
``(A) apply the procedures provided for under subchapter
III of chapter 5 of title 5, United States Code, in a manner
that reflects the unique government-to-government
relationship between Indian tribes and the United States;
``(B) ensure that the membership of the committee includes
only representatives of the Federal Government and of tribes
served by Bureau-funded schools;
``(C) select the tribal representatives of the committee
from among individuals nominated by the representatives of
the tribal and tribally-operated schools;
``(D) ensure, to the maximum extent possible, that the
tribal representative membership on the committee reflects
the proportionate share of students from tribes served by the
Bureau funded school system; and
``(E) comply with the Federal Advisory Committee Act (5
U.S.C. App. 2).
``(4) Authorization of appropriations.--There is authorized
to be appropriated such sums as necessary to carry out the
negotiated rulemaking provided for under this section. In the
absence of a specific appropriation to carry out this
subsection, the Secretary shall pay the costs of the
negotiated rulemaking proceedings from the general
administrative funds of the Department of the Interior.
``(d) Application of Section.--
``(1) Supremacy of provisions.--The provisions of this
section shall supersede any conflicting provisions of law
(including any conflicting regulations) in effect on the day
before the date of enactment of this part, and the Secretary
may repeal any regulation that is inconsistent with the
provisions of this part.
``(2) Modifications.--The Secretary may modify regulations
promulgated under this section or the Tribally Controlled
Schools Act of 1988, only in accordance with this section.
``SEC. 1138. EARLY CHILDHOOD DEVELOPMENT PROGRAM.
``(a) Grants.--The Secretary shall make grants to tribes,
tribal organizations, and consortia of tribes and tribal
organizations to fund early childhood development programs
that are operated by such tribes, organizations, or
consortia.
``(b) Amount of Grants.--
``(1) In general.--The amount of the grant made under
subsection (a) to each eligible tribe, tribal organization,
or consortium of tribes or tribal organizations for each
fiscal year shall be equal to the amount that bears the same
relationship to the total amount appropriated under
subsection (g) for such fiscal year (other than amounts
reserved under subsection (f)) as--
``(A) the total number of children under age 6 who are
members of--
``(i) such tribe;
``(ii) the tribe that authorized such tribal organization;
or
``(iii) any tribe that--
``(I) is a member of such consortium; or
``(II) so authorizes any tribal organization that is a
member of such consortium; bears to
``(B) the total number of all children under age 6 who are
members of any tribe that--
``(i) is eligible to receive funds under subsection (a);
``(ii) is a member of a consortium that is eligible to
receive such funds; or
``(iii) is authorized by any tribal organization that is
eligible to receive such funds.
``(2) Limitation.--No grant may be made under subsection
(a)--
[[Page S729]]
``(A) to any tribe that has fewer than 500 members;
``(B) to any tribal organization that is authorized to
act--
``(i) on behalf of only 1 tribe that has fewer than 500
members; or
``(ii) on behalf of 1 or more tribes that have a combined
total membership of fewer than 500 members; or
``(C) to any consortium composed of tribes, or tribal
organizations authorized by tribes to act on behalf of the
tribes, that have a combined total tribal membership of fewer
than 500 members.
``(c) Applications.--
``(1) In general.--To be eligible to receive a grant under
subsection (a), a tribe, tribal organization, or consortium
shall submit to the Secretary an application for the grant at
such time, in such manner, and containing such information as
the Secretary shall prescribe.
``(2) Contents.--An application submitted under paragraph
(1) shall describe the early childhood development program
that the applicant desires to operate.
``(d) Requirement of Programs Funded.--In operating an
early childhood development program that is funded through a
grant made under subsection (a), a tribe, tribal
organization, or consortium--
``(1) shall coordinate the program with other childhood
development programs and may provide services that meet
identified needs of parents, and children under age 6, that
are not being met by the programs, including needs for--
``(A) prenatal care;
``(B) nutrition education;
``(C) health education and screening;
``(D) family literacy services;
``(E) educational testing; and
``(F) other educational services;
``(2) may include, in the early childhood development
program funded through the grant, instruction in the
language, art, and culture of the tribe served by the
program; and
``(3) shall provide for periodic assessments of the
program.
``(e) Coordination of Family Literacy Programs.--An entity
that operates a family literacy program under this section or
another similar program funded by the Bureau shall coordinate
the program involved with family literacy programs for Indian
children carried out under part B of title I of the
Elementary and Secondary Education Act of 1965 in order to
avoid duplication and to encourage the dissemination of
information on quality family literacy programs serving
Indians.
``(f) Administrative Costs.--The Secretary shall reserve
funds appropriated under subsection (g) to include in each
grant made under subsection (a) an amount for administrative
costs incurred by the tribe, tribal organization, or
consortium involved in establishing and maintaining the early
childhood development program.
``(g) Authorization of Appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated such sums as may be necessary for each of fiscal
years 2002, 2003, 2004, 2005, and 2006.
``SEC. 1139. TRIBAL DEPARTMENTS OR DIVISIONS OF EDUCATION.
``(a) In General.--Subject to the availability of
appropriations, the Secretary shall make grants and provide
technical assistance to tribes for the development and
operation of tribal departments or divisions of education for
the purpose of planning and coordinating all educational
programs of the tribe.
``(b) Applications.--For a tribe to be eligible to receive
a grant under this section, the governing body of the tribe
shall submit an application to the Secretary at such time, in
such manner, and containing such information as the Secretary
may require.
``(c) Diversity.--The Secretary shall award grants under
this section in a manner that fosters geographic and
population diversity.
``(d) Use.--Tribes that receive grants under this section
shall use the funds made available through the grants--
``(1) to facilitate tribal control in all matters relating
to the education of Indian children on reservations (and on
former Indian reservations in Oklahoma);
``(2) to provide for the development of coordinated
educational programs (including all preschool, elementary,
secondary, and higher or vocational educational programs
funded by tribal, Federal, or other sources) on reservations
(and on former Indian reservations in Oklahoma) by
encouraging tribal administrative support of all Bureau
funded educational programs as well as encouraging tribal
cooperation and coordination with entities carrying out all
educational programs receiving financial support from other
Federal agencies, State agencies, or private entities; and
``(3) to provide for the development and enforcement of
tribal educational codes, including tribal educational
policies and tribal standards applicable to curriculum,
personnel, students, facilities, and support programs.
``(e) Priorities.--In making grants under this section, the
Secretary shall give priority to any application that--
``(1) includes--
``(A) assurances that the applicant serves 3 or more
separate Bureau funded schools; and
``(B) assurances from the applicant that the tribal
department of education to be funded under this section will
provide coordinating services and technical assistance to all
of such schools; and
``(2) includes assurances that all education programs for
which funds are provided by such a contract or grant will be
monitored and audited, by or through the tribal department of
education, to ensure that the programs meet the requirements
of law; and
``(3) provides a plan and schedule that--
``(A) provides for--
``(i) the assumption, by the tribal department of
education, of all assets and functions of the Bureau agency
office associated with the tribe, to the extent the assets
and functions relate to education; and
``(ii) the termination by the Bureau of such functions and
office at the time of such assumption; and
``(B) provides that the assumption shall occur over the
term of the grant made under this section, except that, when
mutually agreeable to the tribal governing body and the
Assistant Secretary, the period in which such assumption is
to occur may be modified, reduced, or extended after the
initial year of the grant.
``(e) Time Period of Grant.--Subject to the availability of
appropriated funds, a grant provided under this section shall
be provided for a period of 3 years. If the performance of
the grant recipient is satisfactory to the Secretary, the
grant may be renewed for additional 3-year terms.
``(f) Terms, Conditions, or Requirements.--A tribe that
receives a grant under this section shall comply with
regulations relating to grants made under section 103(a) of
the Indian Self-Determination and Education Assistance Act
that are in effect on the date that the tribal governing body
submits the application for the grant under subsection (c).
The Secretary shall not impose any terms, conditions, or
requirements on the provision of grants under this section
that are not specified in this section.
``(g) Authorization of Appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated $2,000,000 for fiscal year 2002 and such sums as
may be necessary for each of fiscal years 2003, 2004, 2005,
and 2006.
``SEC. 1140. DEFINITIONS.
``In this part, unless otherwise specified:
``(1) Agency school board.--
``(A) In general.--Except as provided in subparagraph (B),
the term `agency school board' means a body, for which--
``(i) the members are appointed by all of the school boards
of the schools located within an agency, including schools
operated under contracts or grants; and
``(ii) the number of such members shall be determined by
the Secretary in consultation with the affected tribes.
``(B) Exceptions.--In the case of an agency serving a
single school, the school board of such school shall be
considered to be the agency school board. In the case of an
agency serving a school or schools operated under a contract
or grant, at least 1 member of the body described in
subparagraph (A) shall be from such a school.
``(2) Bureau.--The term `Bureau' means the Bureau of Indian
Affairs of the Department of the Interior.
``(3) Bureau funded school.--The term `Bureau funded
school' means--
``(A) a Bureau school;
``(B) a contract or grant school; or
``(C) a school for which assistance is provided under the
Tribally Controlled Schools Act of 1988.
``(4) Bureau school.--The term `Bureau school' means--
``(A) a Bureau operated elementary school or secondary
school that is a day or boarding school; or
``(B) a Bureau operated dormitory for students attending a
school other than a Bureau school.
``(5) Contract or grant school.--The term `contract or
grant school' means an elementary school, secondary school,
or dormitory that receives financial assistance for its
operation under a contract, grant, or agreement with the
Bureau under section 102, 103(a), or 208 of the Indian Self-
Determination and Education Assistance Act, or under the
Tribally Controlled Schools Act of 1988.
``(6) Education line officer.--The term `education line
officer' means a member of the education personnel under the
supervision of the Director of the Office, whether located in
a central, area, or agency office.
``(7) Financial plan.--The term `financial plan' means a
plan of services provided by each Bureau school.
``(8) Indian organization.--The term `Indian organization'
means any group, association, partnership, corporation, or
other legal entity owned or controlled by a federally
recognized Indian tribe or tribes, or a majority of whose
members are members of federally recognized tribes.
``(9) Inherently federal functions.--The term `inherently
Federal functions' means functions and responsibilities
which, under section 1125(c), are non-contractible,
including--
``(A) the allocation and obligation of Federal funds and
determinations as to the amounts of expenditures;
``(B) the administration of Federal personnel laws for
Federal employees;
``(C) the administration of Federal contracting and grant
laws, including the monitoring and auditing of contracts and
grants in order to maintain the continuing trust,
programmatic, and fiscal responsibilities of the Secretary;
``(D) the conducting of administrative hearings and
deciding of administrative appeals;
[[Page S730]]
``(E) the determination of the Secretary's views and
recommendations concerning administrative appeals or
litigation and the representation of the Secretary in
administrative appeals and litigation;
``(F) the issuance of Federal regulations and policies as
well as any documents published in the Federal Register;
``(G) reporting to Congress and the President;
``(H) the formulation of the Secretary's and the
President's policies and their budgetary and legislative
recommendations and views; and
``(I) the non-delegable statutory duties of the Secretary
relating to trust resources.
``(10) Local educational agency.--The term `local
educational agency' means a board of education or other
legally constituted local school authority having
administrative control and direction of free public education
in a county, township, or independent or other school
district located within a State, and includes any State
agency that directly operates and maintains facilities for
providing free public education.
``(11) Local school board.--The term `local school board',
when used with respect to a Bureau school, means a body
chosen in accordance with the laws of the tribe to be served
or, in the absence of such laws, elected by the parents of
the Indian children attending the school, except that, for a
school serving a substantial number of students from
different tribes--
``(A) the members of the body shall be appointed by the
tribal governing bodies of the tribes affected; and
``(B) the number of such members shall be determined by the
Secretary in consultation with the affected tribes.
``(12) Office.--The term `Office' means the Office of
Indian Education Programs within the Bureau.
``(13) Secretary.--The term `Secretary' means the Secretary
of the Interior.
``(14) Supervisor.--The term `supervisor' means the
individual in the position of ultimate authority at a Bureau
school.
``(15) Tribal governing body.--The term `tribal governing
body' means, with respect to any school, the tribal governing
body, or tribal governing bodies, that represent at least 90
percent of the students served by such school.
``(16) Tribe.--The term `tribe' means any Indian tribe,
band, nation, or other organized group or community,
including an Alaska Native Regional Corporation or Village
Corporation (as defined in or established pursuant to the
Alaska Native Claims Settlement Act), which is recognized as
eligible for the special programs and services provided by
the United States to Indians because of their status as
Indians.''.
TITLE II--TRIBALLY CONTROLLED SCHOOLS ACT OF 1988
SEC. 201. TRIBALLY CONTROLLED SCHOOLS.
Sections 5202 through 5213 of the Tribally Controlled
Schools Act of 1988 (25 U.S.C. 2501 et seq.) are amended to
read as follows:
``SEC. 5202. FINDINGS.
``Congress, after careful review of the Federal
Government's historical and special legal relationship with,
and resulting responsibilities to, Indians, finds that--
``(1) the Indian Self-Determination and Education
Assistance Act, which was a product of the legitimate
aspirations and a recognition of the inherent authority of
Indian nations, was and is a crucial positive step towards
tribal and community control;
``(2) because of the Bureau of Indian Affairs'
administration and domination of the contracting process
under such Act, Indians have not been provided with the full
opportunity to develop leadership skills crucial to the
realization of self-government and have been denied an
effective voice in the planning and implementation of
programs for the benefit of Indians that are responsive to
the true needs of Indian communities;
``(3) Indians will never surrender their desire to control
their relationships both among themselves and with non-Indian
governments, organizations, and persons;
``(4) true self-determination in any society of people is
dependent upon an educational process that will ensure the
development of qualified people to fulfill meaningful
leadership roles;
``(5) the Federal administration of education for Indian
children have not effected the desired level of educational
achievement or created the diverse opportunities and personal
satisfaction that education can and should provide;
``(6) true local control requires the least possible
Federal interference; and
``(7) the time has come to enhance the concepts made
manifest in the Indian Self-Determination and Education
Assistance Act.
``SEC. 5203. DECLARATION OF POLICY.
``(a) Recognition.--Congress recognizes the obligation of
the United States to respond to the strong expression of the
Indian people for self-determination by assuring maximum
Indian participation in the direction of educational services
so as to render the persons administering such services and
the services themselves more responsive to the needs and
desires of Indian communities.
``(b) Commitment.--Congress declares its commitment to the
maintenance of the Federal Government's unique and continuing
trust relationship with and responsibility to the Indian
people through the establishment of a meaningful Indian self-
determination policy for education that will deter further
perpetuation of Federal bureaucratic domination of programs.
``(c) National Goal.--Congress declares that a major
national goal of the United States is to provide the
resources, processes, and structure that will enable tribes
and local communities to obtain the quantity and quality of
educational services and opportunities that will permit
Indian children--
``(1) to compete and excel in the life areas of their
choice; and
``(2) to achieve the measure of self-determination
essential to their social and economic well-being.
``(d) Educational Needs.--Congress affirms--
``(1) the reality of the special and unique educational
needs of Indian people, including the need for programs to
meet the linguistic and cultural aspirations of Indian tribes
and communities; and
``(2) that the needs may best be met through a grant
process.
``(e) Federal Relations.--Congress declares a commitment to
the policies described in this section and support, to the
full extent of congressional responsibility, for Federal
relations with the Indian nations.
``(f) Termination.--Congress repudiates and rejects House
Concurrent Resolution 108 of the 83d Congress and any policy
of unilateral termination of Federal relations with any
Indian Nation.
``SEC. 5204. GRANTS AUTHORIZED.
``(a) In General.--
``(1) Eligibility.--The Secretary shall provide grants to
Indian tribes and tribal organizations that--
``(A) operate contract schools under title XI of the
Education Amendments of 1978 and notify the Secretary of
their election to operate the schools with assistance under
this part rather than continuing to operate such schools as
contract schools under such title;
``(B) operate other tribally controlled schools eligible
for assistance under this part and submit applications (which
are approved by their tribal governing bodies) to the
Secretary for such grants; or
``(C) elect to assume operation of Bureau funded schools
with the assistance provided under this part and submit
applications (which are approved by their tribal governing
bodies) to the Secretary for such grants.
``(2) Deposit of funds.--Funds made available through a
grant provided under this part shall be deposited into the
general operating fund of the tribally controlled school with
respect to which the grant is made.
``(3) Use of funds.--
``(A) Education related activities.--Except as otherwise
provided in this paragraph, funds made available through a
grant provided under this part shall be used to defray, at
the discretion of the school board of the tribally controlled
school with respect to which the grant is provided, any
expenditures for education related activities for which the
grant may be used under the laws described in section
5205(a), or any similar activities, including expenditures
for--
``(i) school operations, and academic, educational,
residential, guidance and counseling, and administrative
purposes; and
``(ii) support services for the school, including
transportation.
``(B) Operations and maintenance expenditures.--Funds made
available through a grant provided under this part may, at
the discretion of the school board of the tribally controlled
school with respect to which such grant is provided, be used
to defray operations and maintenance expenditures for the
school if any funds for the operation and maintenance of the
school are allocated to the school under the provisions of
any of the laws described in section 5205(a).
``(4) Waiver of federal tort claims act.--Notwithstanding
section 314 of the Department of Interior and Related
Agencies Appropriations Act, 1991 (Public Law 101-512), the
Federal Tort Claims Act shall not apply to a program operated
by a tribally controlled school if the program is not funded
by the Federal agency. Nothing in the preceding sentence
shall be construed to apply to--
``(A) the employees of the school involved; and
``(B) any entity that enters into a contract with a grantee
under this section.
``(b) Limitations.--
``(1) 1 grant per tribe or organization per fiscal year.--
Not more than 1 grant may be provided under this part with
respect to any Indian tribe or tribal organization for any
fiscal year.
``(2) Nonsectarian use.--Funds made available through any
grant provided under this part may not be used in connection
with religious worship or sectarian instruction.
``(3) Administrative costs limitation.--Funds made
available through any grant provided under this part may not
be expended for administrative cost (as defined in section
1127(a) of the Education Amendments of 1978) in excess of the
amount generated for such cost under section 1127 of such
Act.
``(c) Limitation on Transfer of Funds Among School Sites.--
``(1) In general.--In the case of a recipient of a grant
under this part that operates schools at more than 1 school
site, the grant recipient may expend not more than the lesser
of--
``(A) 10 percent of the funds allocated for such school
site, under section 1127 of the Education Amendments of 1978;
or
``(B) $400,000 of such funds;
at any other school site.
[[Page S731]]
``(2) Definition of school site.--In this subsection, the
term `school site' means the physical location and the
facilities of an elementary or secondary educational or
residential program operated by, or under contract or grant
with, the Bureau for which a discrete student count is
identified under the funding formula established under
section 1126 of the Education Amendments of 1978.
``(d) No Requirement To Accept Grants.--Nothing in this
part may be construed--
``(1) to require a tribe or tribal organization to apply
for or accept; or
``(2) to allow any person to coerce any tribe or tribal
organization to apply for, or accept,
a grant under this part to plan, conduct, and administer all
of, or any portion of, any Bureau program. The submission of
such applications and the timing of such applications shall
be strictly voluntary. Nothing in this part may be construed
as allowing or requiring the grant recipient to make any
grant under this part to any other entity.
``(e) No Effect on Federal Responsibility.--Grants provided
under this part shall not terminate, modify, suspend, or
reduce the responsibility of the Federal Government to
provide an educational program.
``(f) Retrocession.--
``(1) In general.--Whenever a tribal governing body
requests retrocession of any program for which assistance is
provided under this part, such retrocession shall become
effective on a date specified by the Secretary that is not
later than 120 days after the date on which the tribal
governing body requests the retrocession. A later date may be
specified if mutually agreed upon by the Secretary and the
tribal governing body. If such a program is retroceded, the
Secretary shall provide to any Indian tribe served by such
program at least the same quantity and quality of services
that would have been provided under such program at the level
of funding provided under this part prior to the
retrocession.
``(2) Status after retrocession.--The tribe requesting
retrocession shall specify whether the retrocession relates
to status as a Bureau operated school or as a school operated
under a contract under the Indian Self-Determination Act.
``(3) Transfer of equipment and materials.--Except as
otherwise determined by the Secretary, the tribe or tribal
organization operating the program to be retroceded shall
transfer to the Secretary (or to the tribe or tribal
organization that will operate the program as a contract
school) the existing equipment and materials that were
acquired--
``(A) with assistance under this part; or
``(B) upon assumption of operation of the program under
this part if the school was a Bureau funded school under
title XI of the Education Amendments of 1978 before receiving
assistance under this part.
``(g) Prohibition of Termination for Administrative
Convenience.--Grants provided under this part may not be
terminated, modified, suspended, or reduced solely for the
convenience of the administering agency.
``SEC. 5205. COMPOSITION OF GRANTS.
``(a) In General.--The funds made available through a grant
provided under this part to an Indian tribe or tribal
organization for any fiscal year shall consist of--
``(1) the total amount of funds allocated for such fiscal
year under sections 1126 and 1127 of the Education Amendments
of 1978 with respect to the tribally controlled school
eligible for assistance under this part that is operated by
such Indian tribe or tribal organization, including funds
provided under such sections, or under any other provision of
law, for transportation costs for such school;
``(2) to the extent requested by such Indian tribe or
tribal organization, the total amount of funds provided from
operations and maintenance accounts and, notwithstanding
section 105 of the Indian Self-Determination and Education
Assistance Act or any other provision of law, other
facilities accounts for such school for such fiscal year
(including accounts for facilities referred to in section
1125(d) of the Education Amendments of 1978 or any other
law); and
``(3) the total amount of funds that are allocated to such
school for such fiscal year under--
``(A) title I of the Elementary and Secondary Education Act
of 1965;
``(B) the Individuals with Disabilities Education Act; and
``(C) any other Federal education law.
``(b) Special Rules.--
``(1) In general.--
``(A) Applicable provisions.--Funds allocated to a tribally
controlled school by reason of paragraph (1) or (2) of
subsection (a) shall be subject to the provisions of this
part and shall not be subject to any additional restriction,
priority, or limitation that is imposed by the Bureau with
respect to funds provided under--
``(i) title I of the Elementary and Secondary Education Act
of 1965;
``(ii) the Individuals with Disabilities Education Act; or
``(iii) any Federal education law other than title XI of
the Education Amendments of 1978.
``(B) Other bureau requirements.--Indian tribes and tribal
organizations to which grants are provided under this part,
and tribally controlled schools for which such grants are
provided, shall not be subject to any requirements,
obligations, restrictions, or limitations imposed by the
Bureau that would otherwise apply solely by reason of the
receipt of funds provided under any law referred to in clause
(i), (ii) or (iii) of subparagraph (A).
``(2) Schools considered contract schools.--Tribally
controlled schools for which grants are provided under this
part shall be treated as contract schools for the purposes of
allocation of funds under sections 1125(d), 1126, and 1127 of
the Education Amendments of 1978.
``(3) Schools considered bureau schools.--Tribally
controlled schools for which grants are provided under this
part shall be treated as Bureau schools for the purposes of
allocation of funds provided under--
``(A) title I of the Elementary and Secondary Education Act
of 1965;
``(B) the Individuals with Disabilities Education Act; and
``(C) any other Federal education law, that are distributed
through the Bureau.
``(4) Accounts; use of certain funds.--
``(A) Separate account.--Notwithstanding section
5204(a)(2), with respect to funds from facilities improvement
and repair, alteration and renovation (major or minor),
health and safety, or new construction accounts included in
the grant provided under section 5204(a), the grant recipient
shall maintain a separate account for such funds. At the end
of the period designated for the work covered by the funds
received, the grant recipient shall submit to the Secretary a
separate accounting of the work done and the funds expended.
Funds received from those accounts may only be used for the
purpose for which the funds were appropriated and for the
work encompassed by the application or submission for which
the funds were received.
``(B) Requirements for projects.--
``(i) Regulatory requirements.--With respect to a grant to
a tribally controlled school under this part for new
construction or facilities improvements and repair in excess
of $100,000, such grant shall be subject to the
Administrative and Audit Requirements and Cost Principles for
Assistance Programs contained in part 12 of title 43, Code of
Federal Regulations.
``(ii) Exception.--Notwithstanding clause (i), grants
described in such clause shall not be subject to section
12.61 of title 43, Code of Federal Regulations. The Secretary
and the grantee shall negotiate and determine a schedule of
payments for the work to be performed.
``(iii) Applications.--In considering applications for a
grant described in clause (i), the Secretary shall consider
whether the Indian tribe or tribal organization involved
would be deficient in assuring that the construction projects
under the proposed grant conform to applicable building
standards and codes and Federal, tribal, or State health and
safety standards as required under section 1124 of the
Education Amendments of 1978 (25 U.S.C. 2005(a)) with respect
to organizational and financial management capabilities.
``(iv) Disputes.--Any disputes between the Secretary and
any grantee concerning a grant described in clause (i) shall
be subject to the dispute provisions contained in section
5209(e).
``(C) New construction.--Notwithstanding subparagraph (A),
a school receiving a grant under this part for facilities
improvement and repair may use such grant funds for new
construction if the tribal governing body or tribal
organization that submits the application for the grant
provides funding for the new construction equal to at least
25 percent of the total cost of such new construction.
``(D) Period.--Where the appropriations measure under which
the funds described in subparagraph (A) are made available or
the application submitted for the funds does not stipulate a
period for the work covered by the funds, the Secretary and
the grant recipient shall consult and determine such a period
prior to the transfer of the funds. A period so determined
may be extended upon mutual agreement of the Secretary and
the grant recipient.
``(5) Enforcement of request to include funds.--
``(A) In general.--If the Secretary fails to carry out a
request filed by an Indian tribe or tribal organization to
include in such tribe or organization's grant under this part
the funds described in subsection (a)(2) within 180 days
after the filing of the request, the Secretary shall--
``(i) be deemed to have approved such request; and
``(ii) immediately upon the expiration of such 180-day
period amend the grant accordingly.
``(B) Rights.--A tribe or organization described in
subparagraph (A) may enforce its rights under subsection
(a)(2) and this paragraph, including rights relating to any
denial or failure to act on such tribe's or organization's
request, pursuant to the dispute authority described in
section 5209(e).
``SEC. 5206. ELIGIBILITY FOR GRANTS.
``(a) Rules.--
``(1) In general.--A tribally controlled school is eligible
for assistance under this part if the school--
``(A) on April 28, 1988, was a contract school under title
XI of the Education Amendments of 1978 and the tribe or
tribal organization operating the school submits to the
Secretary a written notice of election to receive a grant
under this part;
``(B) was a Bureau operated school under title XI of the
Education Amendments of 1978 and has met the requirements of
subsection (b);
[[Page S732]]
``(C) is not a Bureau funded school, but has met the
requirements of subsection (c); or
``(D) is a school with respect to which an election has
been made under paragraph (2) and that has met the
requirements of subsection (b).
``(2) New schools.--Notwithstanding paragraph (1), for
purposes of determining eligibility for assistance under this
part, any application that has been submitted under the
Indian Self-Determination and Education Assistance Act by an
Indian tribe or tribal organization for a school that is not
in operation on the date of enactment of the Native American
Education Improvement Act of 2001 shall be reviewed under the
guidelines and regulations for applications submitted under
the Indian Self-Determination and Education Assistance Act
that were in effect at the time the application was
submitted, unless the Indian tribe or tribal organization
elects to have the application reviewed under the provisions
of subsection (b).
``(b) Additional Requirements for Bureau Funded Schools and
Certain Electing Schools.--
``(1) Bureau funded schools.--A school that was a Bureau
funded school under title XI of the Education Amendments of
1978 on the date of enactment of the Native American
Education Improvement Act of 2001, and any school with
respect to which an election is made under subsection (a)(2),
meets the requirements of this subsection if--
``(A) the Indian tribe or tribal organization that
operates, or desires to operate, the school submits to the
Secretary an application requesting that the Secretary--
``(i) transfer operation of the school to the Indian tribe
or tribal organization, if the Indian tribe or tribal
organization is not already operating the school; and
``(ii) make a determination as to whether the school is
eligible for assistance under this part; and
``(B) the Secretary makes a determination that the school
is eligible for assistance under this part.
``(2) Certain electing schools.--
``(A) Determination.--By not later than 120 days after the
date on which an application is submitted to the Secretary
under paragraph (1)(A), the Secretary shall determine--
``(i) in the case of a school that is not being operated by
the Indian tribe or tribal organization, whether to transfer
operation of the school to the Indian tribe or tribal
organization; and
``(ii) whether the school is eligible for assistance under
this part.
``(B) Consideration; transfers and eligibility.--In
considering applications submitted under paragraph (1)(A),
the Secretary--
``(i) shall transfer operation of the school to the Indian
tribe or tribal organization, if the tribe or tribal
organization is not already operating the school; and
``(ii) shall determine that the school is eligible for
assistance under this part, unless the Secretary finds by
clear and convincing evidence that the services to be
provided by the Indian tribe or tribal organization will be
deleterious to the welfare of the Indians served by the
school and will not carry out the purposes of this Act.
``(C) Consideration; possible deficiencies.--In considering
applications submitted under paragraph (1)(A), the Secretary
shall only consider whether the Indian tribe or tribal
organization would be deficient in operating the school with
respect to--
``(i) equipment;
``(ii) bookkeeping and accounting procedures;
``(iii) ability to adequately manage a school; or
``(iv) adequately trained personnel.
``(c) Additional Requirements for a School That Is Not a
Bureau Funded School.--
``(1) In general.--A school that is not a Bureau funded
school under title XI of the Education Amendments of 1978
meets the requirements of this subsection if--
``(A) the Indian tribe or tribal organization that
operates, or desires to operate, the school submits to the
Secretary an application requesting a determination by the
Secretary as to whether the school is eligible for assistance
under this part; and
``(B) the Secretary makes a determination that the school
is eligible for assistance under this part.
``(2) Deadline for determination by secretary.--
``(A) Determination.--By not later than 180 days after the
date on which an application is submitted to the Secretary
under paragraph (1)(A), the Secretary shall determine whether
the school is eligible for assistance under this part.
``(B) Factors.--In making the determination under
subparagraph (A), the Secretary shall give equal
consideration to each of the following factors:
``(i) With respect to the applicant's proposal--
``(I) the adequacy of facilities or the potential to obtain
or provide adequate facilities;
``(II) geographic and demographic factors in the affected
areas;
``(III) adequacy of the applicant's program plans;
``(IV) geographic proximity of comparable public education;
and
``(V) the needs to be met by the school, as expressed by
all affected parties, including but not limited to students,
families, tribal governments at both the central and local
levels, and school organizations.
``(ii) With respect to all education services already
available--
``(I) geographic and demographic factors in the affected
areas;
``(II) adequacy and comparability of programs already
available;
``(III) consistency of available programs with tribal
education codes or tribal legislation on education; and
``(IV) the history and success of those services for the
proposed population to be served, as determined from all
factors including, if relevant, standardized examination
performance.
``(C) Exception regarding proximity.--The Secretary may not
make a determination under this paragraph that is primarily
based upon the geographic proximity of comparable public
education.
``(D) Information on factors.--An application submitted
under paragraph (1)(A) shall include information on the
factors described in subparagraph (B)(i), but the applicant
may also provide the Secretary such information relative to
the factors described in subparagraph (B)(ii) as the
applicant considers to be appropriate.
``(E) Treatment of lack of determination.--If the Secretary
fails to make a determination under subparagraph (A) with
respect to an application within 180 days after the date on
which the Secretary received the application--
``(i) the Secretary shall be deemed to have made a
determination that the tribally controlled school is eligible
for assistance under this part; and
``(ii) the grant shall become effective 18 months after the
date on which the Secretary received the application, or on
an earlier date, at the Secretary's discretion.
``(d) Filing of Applications and Reports.--
``(1) In general.--Each application or report submitted to
the Secretary under this part, and any amendment to such
application or report, shall be filed with the education line
officer designated by the Director of the Office of Indian
Education Programs of the Bureau of Indian Affairs. The date
on which the filing occurs shall, for purposes of this part,
be treated as the date on which the application, report, or
amendment was submitted to the Secretary.
``(2) Supporting documentation.--
``(A) In general.--Any application that is submitted under
this part shall be accompanied by a document indicating the
action taken by the appropriate tribal governing body
concerning authorizing such application.
``(B) Authorization action.--The Secretary shall administer
the requirement of subparagraph (A) in a manner so as to
ensure that the tribe involved, through the official action
of the tribal governing body, has approved of the application
for the grant.
``(C) Rule of construction.--Nothing in this paragraph
shall be construed as making a tribal governing body (or
tribe) that takes an action described in subparagraph (A) a
party to the grant (unless the tribal governing body or the
tribe is the grantee) or as making the tribal governing body
or tribe financially or programmatically responsible for the
actions of the grantee.
``(3) Rules of construction.--Nothing in this subsection
shall be construed as making a tribe act as a surety for the
performance of a grantee under a grant under this part.
``(4) Clarification.--The provisions of paragraphs (2) and
(3) shall be construed as a clarification of policy in
existence on the date of enactment of the Native American
Education Improvement Act of 2001 with respect to grants
under this part and shall not be construed as altering such
policy or as a new policy.
``(e) Effective Date for Approved Applications.--Except as
provided in subsection (c)(2)(E), a grant provided under this
part shall be made, and any transfer of the operation of a
Bureau school made under subsection (b) shall become
effective, beginning on the first day of the academic year
succeeding the fiscal year in which the application for the
grant or transfer is made, or on an earlier date determined
by the Secretary.
``(f) Denial of Applications.--
``(1) In general.--If the Secretary disapproves a grant
under this part, disapproves the transfer of operations of a
Bureau school under subsection (b), or determines that a
school is not eligible for assistance under this part, the
Secretary shall--
``(A) state the objections in writing to the tribe or
tribal organization involved within the allotted time;
``(B) provide assistance to the tribe or tribal
organization to cure all stated objections;
``(C) at the request of the tribe or tribal organization,
provide to the tribe or tribal organization a hearing on the
record regarding the refusal or determination involved, under
the same rules and regulations as apply under the Indian
Self-Determination and Education Assistance Act; and
``(D) provide to the tribe or tribal organization an
opportunity to appeal the decision resulting from the
hearing.
``(2) Timeline for reconsideration of amended
applications.--The Secretary shall reconsider any amended
application submitted under this part within 60 days after
the amended application is submitted to the Secretary and
shall submit the determinations of the Secretary with respect
to such reconsideration to the tribe or the tribal
organization.
``(g) Report.--The Bureau shall prepare and submit to
Congress an annual report on
[[Page S733]]
all applications received, and actions taken (including the
costs associated with such actions), under this section on
the same date as the date on which the President is required
to submit to Congress a budget of the United States
Government under section 1105 of title 31, United States
Code.
``SEC. 5207. DURATION OF ELIGIBILITY DETERMINATION.
``(a) In General.--If the Secretary determines that a
tribally controlled school is eligible for assistance under
this part, the eligibility determination shall remain in
effect until the determination is revoked by the Secretary,
and the requirements of subsection (b) or (c) of section
5206, if applicable, shall be considered to have been met
with respect to such school until the eligibility
determination is revoked by the Secretary.
``(b) Annual Reports.--
``(1) In general.--Each recipient of a grant provided under
this part for a school shall prepare an annual report
concerning the school involved, the contents of which shall
be limited to--
``(A) an annual financial statement reporting revenue and
expenditures as defined by the cost accounting standards
established by the grant recipient;
``(B) a biannual financial audit conducted pursuant to the
standards of chapter 71 of title 31, United States Code;
``(C) a biannual compliance audit of the procurement of
personal property during the period for which the report is
being prepared that shall be in compliance with written
procurement standards that are developed by the local school
board;
``(D) an annual submission to the Secretary containing
information on the number of students served and a brief
description of programs offered through the grant; and
``(E) a program evaluation conducted by an impartial
evaluation review team, to be based on the standards
established for purposes of subsection (c)(1)(A)(ii).
``(2) Evaluation review teams.--In appropriate cases,
representatives of other tribally controlled schools and
representatives of tribally controlled community colleges
shall be members of the evaluation review teams.
``(3) Evaluations.--In the case of a school that is
accredited, the evaluations required under this subsection
shall be conducted at intervals under the terms of the
accreditation.
``(4) Submission of report.--
``(A) To tribal governing body.--Upon completion of the
annual report required under paragraph (1), the recipient of
the grant shall send (via first class mail, return receipt
requested) a copy of such annual report to the tribal
governing body.
``(B) To secretary.--Not later than 30 days after receiving
written confirmation that the tribal governing body has
received the report sent pursuant to subparagraph (A), the
recipient of the grant shall send a copy of the report to the
Secretary.
``(c) Revocation of Eligibility.--
``(1) In general.--
``(A) Nonrevocation conditions.--The Secretary shall not
revoke a determination that a school is eligible for
assistance under this part if--
``(i) the Indian tribe or tribal organization submits the
reports required under subsection (b) with respect to the
school; and
``(ii) at least 1 of the following conditions applies with
respect to the school:
``(I) The school is certified or accredited by a State
certification or regional accrediting association or is a
candidate in good standing for such certification or
accreditation under the rules of the State certification or
regional accrediting association, showing that credits
achieved by the students within the education programs of the
school are, or will be, accepted at grade level by a State
certified or regionally accredited institution.
``(II) The Secretary determines that there is a reasonable
expectation that the certification or accreditation described
in subclause (I), or candidacy in good standing for such
certification or accreditation, will be achieved by the
school within 3 years and that the program offered by the
school is beneficial to Indian students.
``(III) The school is accredited by a tribal department of
education if such accreditation is accepted by a generally
recognized State certification or regional accrediting
agency.
``(IV) The school accepts the standards issued under
section 1121 of the Education Amendments of 1978 and an
impartial evaluator chosen by the grant recipient conducts a
program evaluation for the school under this section in
conformance with the regulations pertaining to Bureau
operated schools, but no grant recipient shall be required to
comply with the standards to a greater degree than a
comparable Bureau operated school.
``(V)(aa) Every 3 years, an impartial evaluator agreed upon
by the Secretary and the grant recipient conducts evaluations
of the school, and the school receives a positive assessment
under such evaluations. The evaluations are conducted under
standards adopted by a contractor under a contract for the
school entered into under the Indian Self-Determination and
Education Assistance Act (or revisions of such standards
agreed to by the Secretary and the grant recipient) prior to
the date of enactment of the Native American Education
Improvement Act of 2001.
``(bb) If the Secretary and a grant recipient other than a
tribal governing body fail to agree on such an evaluator, the
tribal governing body shall choose the evaluator or perform
the evaluation. If the Secretary and a grant recipient that
is a tribal governing body fail to agree on such an
evaluator, item (aa) shall not apply.
``(B) Standards.--The choice of standards employed for the
purposes of subparagraph (A)(ii) shall be consistent with
section 1121(e) of the Education Amendments of 1978.
``(2) Notice requirements for revocation.--The Secretary
shall not revoke a determination that a school is eligible
for assistance under this part, or reassume control of a
school that was a Bureau school prior to approval of an
application submitted under section 5206(b)(1)(A), until the
Secretary--
``(A) provides notice, to the tribally controlled school
involved and the appropriate tribal governing body (within
the meaning of section 1140 of the Education Amendments of
1978) for the tribally controlled school, which states--
``(i) the specific deficiencies that led to the revocation
or reassumption determination; and
``(ii) the actions that are needed to remedy such
deficiencies; and
``(B) affords such school and governing body an opportunity
to carry out the remedial actions.
``(3) Technical assistance.--The Secretary shall provide
such technical assistance to enable the school and governing
body to carry out such remedial actions.
``(4) Hearing and appeal.--In addition to notice and
technical assistance under this subsection, the Secretary
shall provide to the school and governing body--
``(A) at the request of the school or governing body, a
hearing on the record regarding the revocation or
reassumption determination, to be conducted under the rules
and regulations described in section 5206(f)(1)(C); and
``(B) an opportunity to appeal the decision resulting from
the hearing.
``(d) Applicability of Section Pursuant to Election Under
Section 5209(b).--With respect to a tribally controlled
school that receives assistance under this part pursuant to
an election made under section 5209(b)--
``(1) subsection (b) shall apply; and
``(2) the Secretary may not revoke eligibility for
assistance under this part except in conformance with
subsection (c).
``SEC. 5208. PAYMENT OF GRANTS; INVESTMENT OF FUNDS; STATE
PAYMENTS TO SCHOOLS.
``(a) Payments.--
``(1) Manner of payments.--
``(A) In general.--Except as otherwise provided in this
subsection, the Secretary shall make payments to grant
recipients under this part in 2 payments, of which--
``(i) the first payment shall be made not later than July
15 of each year in an amount equal to 80 percent of the
amount that the grant recipient was entitled to receive
during the preceding academic year; and
``(ii) the second payment, consisting of the remainder to
which the grant recipient was entitled for the academic year,
shall be made not later than December 1 of each year.
``(B) Excess funding.--In a case in which the amount
provided to a grant recipient under subparagraph (A)(i) is in
excess of the amount that the recipient is entitled to
receive for the academic year involved, the recipient shall
return to the Secretary such excess amount. The amount
returned to the Secretary under this subparagraph shall be
distributed equally to all schools in the system.
``(2) Newly funded schools.--For any school for which no
payment under this part was made from Bureau funds in the
academic year preceding the year for which the payments are
being made, full payment of the amount computed for the
school for the first academic year of eligibility under this
part shall be made not later than December 1 of the academic
year.
``(3) Late funding.--With regard to funds for grant
recipients under this part that become available for
obligation on October 1 of the fiscal year for which such
funds are appropriated, the Secretary shall make payments to
the grant recipients not later than December 1 of the fiscal
year, except that operations and maintenance funds shall be
forward funded and shall be available for obligation not
later than July 15 and December 1 of each fiscal year.
``(4) Applicability of certain title 31 provisions.--The
provisions of chapter 39 of title 31, United States Code,
shall apply to the payments required to be made under
paragraphs (1), (2), and (3).
``(5) Restrictions.--Payments made under paragraphs (1),
(2), and (3) shall be subject to any restriction on amounts
of payments under this part that is imposed by a continuing
resolution or other Act appropriating the funds involved.
``(b) Investment of Funds.--
``(1) Treatment of interest and investment income.--
Notwithstanding any other provision of law, any interest or
investment income that accrues on or is derived from any
funds provided under this part for a school after such funds
are paid to an Indian tribe or tribal organization and before
such funds are expended for the purpose for which such funds
were provided under this part shall be the property of the
Indian tribe or tribal organization. The interest or income
shall not be taken into account by any officer or employee of
the Federal Government in determining whether to provide
assistance, or the amount of assistance to be provided, under
any provision of Federal law.
[[Page S734]]
``(2) Permissible investments.--Funds provided under this
part may be invested by an Indian tribe or tribal
organization, as approved by the grantee, before such funds
are expended for the objectives of this part if such funds
are--
``(A) invested by the Indian tribe or tribal organization
only--
``(i) in obligations of the United States;
``(ii) in obligations or securities that are guaranteed or
insured by the United States; or
``(iii) in mutual (or other) funds that are registered with
the Securities and Exchange Commission and that only invest
in obligations of the United States, or securities that are
guaranteed or insured by the United States; or
``(B) deposited only into accounts that are insured by an
agency or instrumentality of the United States, or are fully
supported by collateral to ensure protection of the funds,
even in the event of a bank failure.
``(c) Recoveries.--Funds received under this part shall not
be taken into consideration by any Federal agency for the
purposes of making underrecovery and overrecovery
determinations for any other funds, from whatever source
derived.
``(d) Payments by States.--
``(1) In general.--With respect to a school that receives
assistance under this part, a State shall not--
``(A) take into account the amount of such assistance in
determining the amount of funds that such school is eligible
to receive under applicable State law; or
``(B) reduce any State payments that such school is
eligible to receive under applicable State law because of the
assistance received by the school under this part.
``(2) Violations.--
``(A) In general.--Upon receipt of any information from any
source that a State is in violation of paragraph (1), the
Secretary shall immediately, but in no case later than 90
days after the receipt of such information, conduct an
investigation and make a determination of whether such
violation has occurred.
``(B) Determination.--If the Secretary makes a
determination under subparagraph (A) that a State has
violated paragraph (1), the Secretary shall inform the
Secretary of Education of such determination and the basis
for the determination. The Secretary of Education shall, in
an expedient manner, pursue penalties under paragraph (3)
with respect to the State.
``(3) Penalties.--A State determined to have violated
paragraph (1) shall be subject to penalties similar to the
penalties described in section 8809(e) of the Elementary and
Secondary Education Act of 1965 for a violation of title VIII
of such Act.
``SEC. 5209. APPLICATION WITH RESPECT TO INDIAN SELF-
DETERMINATION AND EDUCATION ASSISTANCE ACT.
``(a) Certain Provisions To Apply to Grants.--The following
provisions of the Indian Self-Determination and Education
Assistance Act (and any subsequent revisions thereto or
renumbering thereof), shall apply to grants provided under
this part and the schools funded under such grants:
``(1) Section 5(f) (relating to single agency audits).
``(2) Section 6 (relating to criminal activities;
penalties).
``(3) Section 7 (relating to wage and labor standards).
``(4) Section 104 (relating to retention of Federal
employee coverage).
``(5) Section 105(f) (relating to Federal property).
``(6) Section 105(k) (relating to access to Federal sources
of supply).
``(7) Section 105(l) (relating to lease of facility used
for administration and delivery of services).
``(8) Section 106(e) (relating to limitation on remedies
relating to cost allowances).
``(9) Section 106(i) (relating to use of funds for matching
or cost participation requirements).
``(10) Section 106(j) (relating to allowable uses of
funds).
``(11) The portions of section 108(c) that consist of model
agreements provisions 1(b)(5) (relating to limitations of
costs), 1(b)(7) (relating to records and monitoring), 1(b)(8)
(relating to property), and 1(b)(9) (relating to availability
of funds).
``(12) Section 109 (relating to reassumption).
``(13) Section 111 (relating to sovereign immunity and
trusteeship rights unaffected).
``(b) Election for Grant in Lieu of Contract.--
``(1) In general.--A contractor that carries out an
activity to which this part applies and who has entered into
a contract under the Indian Self-Determination and Education
Assistance Act that is in effect on the date of enactment of
the Native American Education Improvement Act of 2001 may, by
giving notice to the Secretary, elect to receive a grant
under this part in lieu of such contract and to have the
provisions of this part apply to such activity.
``(2) Effective date of election.--Any election made under
paragraph (1) shall take effect on the first day of July
immediately following the date of such election.
``(3) Exception.--In any case in which the first day of
July immediately following the date of an election under
paragraph (1) is less than 60 days after such election, such
election shall not take effect until the first day of July of
year following the year in which the election is made.
``(c) No Duplication.--No funds may be provided under any
contract entered into under the Indian Self-Determination and
Education Assistance Act to pay any expenses incurred in
providing any program or services if a grant has been made
under this part to pay such expenses.
``(d) Transfers and Carryovers.--
``(1) Buildings, equipment, supplies, materials.--A tribe
or tribal organization assuming the operation of--
``(A) a Bureau school with assistance under this part shall
be entitled to the transfer or use of buildings, equipment,
supplies, and materials to the same extent as if the tribe or
tribal organization were contracting under the Indian Self-
Determination and Education Assistance Act; or
``(B) a contract school with assistance under this part
shall be entitled to funding for improvements, alterations,
replacement and code compliance in facilities where programs
approved under this part were used in the operation of the
contract school to the same extent as if it were contracting
under the Indian Self-Determination and Education Assistance
Act and to the transfer or use of buildings, equipment,
supplies, and materials that were used in the operation of
the contract school to the same extent as if the tribe or
tribal organization were contracting under such Act.
``(2) Funds.--Any tribe or tribal organization that assumes
operation of a Bureau school with assistance under this part
and any tribe or tribal organization that elects to operate a
school with assistance under this part rather than to
continue to operate the school as a contract school shall be
entitled to any funds that would remain available from the
previous fiscal year if such school remained a Bureau school
or was operated as a contract school, respectively.
``(e) Exceptions, Problems, and Disputes.--
``(1) In general.--Any exception or problem cited in an
audit conducted pursuant to section 5207(b)(1)(B), any
dispute regarding a grant authorized to be made pursuant to
this part or any modification of such grant, and any dispute
involving an administrative cost grant under section 1127 of
the Education Amendments of 1978, shall be administered under
the provisions governing such exceptions, problems, or
disputes described in this paragraph in the case of contracts
under the Indian Self-Determination and Education Assistance
Act.
``(2) Administrative appeals.--The Equal Access to Justice
Act (as amended) and the amendments made by such Act shall
apply to an administrative appeal filed after September 8,
1988, by a grant recipient regarding a grant provided under
this part, including an administrative cost grant.
``SEC. 5210. ROLE OF THE DIRECTOR.
``Applications for grants under this part, and all
modifications to the applications, shall be reviewed and
approved by personnel under the direction and control of the
Director of the Office of Indian Education Programs. Reports
required under this part shall be submitted to education
personnel under the direction and control of the Director of
such Office.
``SEC. 5211. REGULATIONS.
``The Secretary is authorized to issue regulations relating
to the discharge of duties specifically assigned to the
Secretary in this part. For all other matters relating to the
details of planning, developing, implementing, and evaluating
grants under this part, the Secretary shall not issue
regulations. Regulations issued pursuant to this part shall
not have the standing of a Federal statute for purposes of
judicial review.
``SEC. 5212. THE TRIBALLY CONTROLLED GRANT SCHOOL ENDOWMENT
PROGRAM.
``(a) In General.--
``(1) Establishment.--Each school receiving a grant under
this part may establish, at a federally insured financial
institution, a trust fund for the purposes of this section.
``(2) Deposits and use.--The school may provide--
``(A) for deposit into the trust fund, only funds from non-
Federal sources, except that the interest on funds received
from grants provided under this part may be used for that
purpose;
``(B) for deposit into the trust fund, any earnings on
funds deposited in the fund; and
``(C) for the sole use of the school any noncash, in-kind
contributions of real or personal property, which may at any
time be used, sold, or otherwise disposed of.
``(b) Interest.--Interest from the fund established under
subsection (a) may periodically be withdrawn and used, at the
discretion of the school, to defray any expenses associated
with the operation of the school consistent with the purposes
of this Act.
``SEC. 5213. DEFINITIONS.
``In this part:
``(1) Bureau.--The term `Bureau' means the Bureau of Indian
Affairs of the Department of the Interior.
``(2) Eligible indian student.--The term `eligible Indian
student' has the meaning given such term in section 1126(a)
of the Education Amendments of 1978.
``(3) Indian.--The term `Indian' means a member of an
Indian tribe, and includes individuals who are eligible for
membership in a tribe, and the child or grandchild of such an
individual.
``(4) Indian tribe.--The term `Indian tribe' means any
Indian tribe, band, nation, or other organized group or
community, including an Alaska Native Village Corporation or
[[Page S735]]
Regional Corporation (as defined in or established pursuant
to the Alaskan Native Claims Settlement Act), which is
recognized as eligible for the special programs and services
provided by the United States to Indians because of their
status as Indians.
``(5) Local educational agency.--The term `local
educational agency' means a public board of education or
other public authority legally constituted within a State for
either administrative control or direction of, or to perform
a service function for, public elementary schools or
secondary schools in a city, county, township, school
district, or other political subdivision of a State or such
combination of school districts or counties as are recognized
in a State as an administrative agency for the State's public
elementary schools or secondary schools. Such term includes
any other public institution or agency having administrative
control and direction of a public elementary school or
secondary school.
``(6) Secretary.--The term `Secretary' means the Secretary
of the Interior.
``(7) Tribal governing body.--The term `tribal governing
body' means, with respect to any school that receives
assistance under this Act, the recognized governing body of
the Indian tribe involved.
``(8) Tribal organization.--
``(A) In general.--The term `tribal organization' means--
``(i) the recognized governing body of any Indian tribe; or
``(ii) any legally established organization of Indians
that--
``(I) is controlled, sanctioned, or chartered by such
governing body or is democratically elected by the adult
members of the Indian community to be served by such
organization; and
``(II) includes the maximum participation of Indians in all
phases of the organization's activities.
``(B) Authorization.--In any case in which a grant is
provided under this part to an organization to provide
services through a tribally controlled school benefiting more
than 1 Indian tribe, the approval of the governing bodies of
Indian tribes representing 80 percent of the students
attending the tribally controlled school shall be considered
a sufficient tribal authorization for such grant.
``(9) Tribally controlled school.--The term `tribally
controlled school' means a school that--
``(A) is operated by an Indian tribe or a tribal
organization, enrolling students in kindergarten through
grade 12, including a preschool;
``(B) is not a local educational agency; and
``(C) is not directly administered by the Bureau of Indian
Affairs.''.
______
By Mr. CAMPBELL (for himself, Mr. Inouye, and Mr. McCain):
S. 212. A bill to amend the Indian Health Care Improvement Act to
revise and extend such Act; to the Committee on Indian Affairs.
Mr. CAMPBELL. Mr. President, I am pleased to be joined today by the
Vice Chairman of the Committee on Indian Affairs, Senator Daniel K.
Inouye, and former Chairman, Senator John McCain in introducing
important legislation to reauthorize the Indian Health Care Improvement
Act of 1976, the ``IHCIA'' or the ``Act''.
The United States first provided 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 Department of the
Interior where it rested until 1955 when it was transferred to the
Public Health Service's Indian Health Agency.
The evolution of the Indian Health Service from an ad hoc service
provided to Indians by the BIA to a specialized agency within the
Department of Health and Human Services was completed with the passage
of the Indian Health Care Improvement Act of 1976.
In 1970, President Nixon issued his now-famous ``Special Message to
Congress on Indian Affairs'' laying out the rationale for a more
enlightened Federal Indian Policy: Indian Self-Determination.
Self-Determination is the core principle embodied in the IHCIA the
main purposes of which are to improve the health status of Indian
people and to increase the number of Indians involved in the health
professions.
The Indian Self-Determination and Education Assistance Act of 1975,
the IHCIA, and the amendments to each over the years can all be traced
directly to the fundamental changes first proposed in 1970.
I am proud to say that legislation I proposed in the 106th Congress,
the Indian Tribal Self-Governance Amendments of 2000, were enacted into
law as Public Law 106-260. The bill we introduce today builds on this
new law in important respects.
By introducing the IHCIA reauthorization bill, we re-affirm Indian
Self-Determination and the principles of the IHCIA (1) that the
provision of Federal health services is consistent with the 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;
(3) that Indian participation in the planning and management of health
services should be maximized; and (4) that the numbers of American
Indians and Alaska Natives trained in health professions be maximized.
Before the passage of the Act in 1976 the mortality rate for Indian
infants was 25 percent higher than that of non-Indian babies. The death
rates for mothers was 82 percent higher and the mortality rates from
infectious disease-causing diarrhea and dehydration was 138 percent
greater.
Today we can see marked improvements. Infant mortality rates have
been reduced by 54 percent, maternal mortality rates have been reduced
by 65 percent, tuberculosis mortality by 80 percent and overall
mortality rates have been reduced by 42 percent.
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 racial and ethnic groups.
While we will continue to push forward on all fronts in seeking to
improve Indian health services, I believe that there are three emergent
issues that we need to address; urban Indian health care; Indian health
facilities construction needs; and the booming problem of diabetes.
Undoubtedly the 2000 decennial census will likely show what past
counts have shown--that more than one-half of the 2.3 million American
Indians and Alaska Natives reside off-reservation and are referred to
as ``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 and vigorous
approach.
Another problem that must be addressed is the growing backlog in
health care facilities construction. Recent estimates show that there
is some $900 million in unmet facilities needs. The dogged approach to
eliminating this backlog by relying on federal appropriations will not
work, and 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 cooperative federal-tribal efforts in making
the Joint Venture Program a success and look forward to building on
this success in the coming years.
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 is reaching alarmingly high rates. Most
troubling is the increasing obesity and diabetes that is occurring with
alarming frequency in Native youngsters.
It is now time to make the extra effort to look at the positive
things we have accomplished and build upon them.
This bill is a step in the right direction on these and other health
matters. The bill we introduced last year was the product of months-
long consultations by a group of very dedicated individuals consisting
of Indian Tribal leaders, health and 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.
I am hopeful that in moving forward this year we can draw from the
hearing record built after no fewer than five hearings on the bill that
was introduced in the 106th Congress, S. 2526.
I urge my colleagues to join me in supporting this key measure. 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. 212
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
[[Page S736]]
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Indian
Health Care Improvement Act Reauthorization of 2001''.
(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. Qualified Indian health program.
Subtitle B--Medicaid
Sec. 211. State consultation with Indian health programs.
Sec. 212. Fmap for services provided by Indian health programs.
Sec. 213. 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.
Subtitle D--Authorization of Appropriations
Sec. 231. Authorization of appropriations.
TITLE III--MISCELLANEOUS PROVISIONS
Sec. 301. Repeals.
Sec. 302. Severability provisions.
Sec. 303. Effective date.
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.
``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. 216A. North Dakota as a contract health service delivery area.
``Sec. 216B. South Dakota 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.
[[Page S737]]
``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 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 2010, 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 2010, 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).
[[Page S738]]
``(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) for purposes of title V and 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
and those tribes, bands or groups that are recognized by the
States in which they reside, or who is a descendant in the
first or second degree of any such member;
``(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 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;
``(2) that takes into account the human resource and
development needs in each such service area; and
``(3) that weighs the allocation of amounts appropriated in
favor of those service areas where the health status of
Indians within the area, as measured by life expectancy based
upon the most recent data available, is significantly lower
than the average health status for Indians in all service
areas, except that amounts allocated to each such area using
such a weighted allocation formula shall not be less than the
amounts allocated to each such area in the previous fiscal
year.
``(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.
[[Page S739]]
``(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 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)
[[Page S740]]
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 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
[[Page S741]]
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;
``(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.--Notwithstanding 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--
``(A) give first priority to applications made by
individuals Indians; and
``(B) after making determinations on all applications
submitted by individual Indians as required under
subparagraph (A), give priority to--
``(i) individuals recruited through the efforts an Indian
tribe, tribal organization, or urban Indian organization; and
``(ii) other individuals based on the priority rankings
under paragraph (1).
``(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;
[[Page S742]]
``(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),
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.
[[Page S743]]
``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.
``(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
[[Page S744]]
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 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
[[Page S745]]
``(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 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
[[Page S746]]
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 2013 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. Such allocation
shall weigh the amounts appropriated in favor of those
service areas where the health status of Indians within the
area, as measured by life expectancy based upon the most
recent data available, is significantly lower than the
average health status for Indians for all service areas,
except that amounts allocated to each such area using such a
weighted allocation formula shall not be less than the
amounts allocated to each such area in the previous fiscal
year.
``(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
``(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.
[[Page S747]]
``(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;
``(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 2013, 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
[[Page S748]]
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.
``(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.
[[Page S749]]
``(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,
which projects may include screening, testing and treatment
for HCV and other infectious and communicable diseases;
``(2) public information and education programs for the
prevention, control, and elimination of communicable and
infectious diseases;
``(3) education, training, and clinical skills improvement
activities in the prevention, control, and elimination of
communicable and infectious diseases for health
professionals, including allied health professionals; and
``(4) a demonstration project that studies the
seroprevalence of the Hepatitis C virus among a random sample
of American Indian and Alaskan Native populations and
identifies prevalence rates among a variety of tribes and
geographic regions.
``(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 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.
[[Page S750]]
``(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, 2013, 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. 216A. NORTH DAKOTA AS A CONTRACT HEALTH SERVICE
DELIVERY AREA.
``(a) In General.--For fiscal years beginning with the
fiscal year ending September 30, 2001, and ending with the
fiscal year ending September 30, 2013, the State of North
Dakota shall be designated as a contract health service
delivery area by the Service for the purpose of providing
contract health care services to members of federally
recognized Indian Tribes of North Dakota.
``(b) Limitation.--The Service shall not curtail any health
care services provided to Indians residing on Federal
reservations in the State of North Dakota 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. 216B. SOUTH DAKOTA AS A CONTRACT HEALTH SERVICE
DELIVERY AREA.
``(a) In General.--For fiscal years beginning with the
fiscal year ending September 30, 2001, and ending with the
fiscal year ending September 30, 2013, the State of South
Dakota shall be designated as a contract health service
delivery area by the Service for the purpose of providing
contract health care services to members of federally
recognized Indian Tribes of South Dakota.
``(b) Limitation.--The Service shall not curtail any health
care services provided to Indians residing on Federal
reservations in the State of South Dakota 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, 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 2013 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.
[[Page S751]]
``(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, with additional priority being given to those
service areas where the health status of Indians within the
area, as measured by life expectancy based upon the most
recent data available, is significantly lower than the
average health status for Indians in all service areas; 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 2001, 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 2002, 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 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
[[Page S752]]
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.
``(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,
[[Page S753]]
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) 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.
[[Page S754]]
``(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.--
``(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.--
[[Page S755]]
``(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.
``(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
[[Page S756]]
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 2013 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, 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
[[Page S757]]
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) Establishment of Direct Billing Program.--
``(1) In general.--The Secretary shall establish a program
under which Indian tribes, tribal organizations, and Alaska
Native health organizations that contract or compact for the
operation of a hospital or clinic of the Service under the
Indian Self-Determination and Education Assistance Act may
elect to directly bill for, and receive payment for, health
care services provided by such hospital or clinic for which
payment is made under the medicare program established under
title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.), under the medicaid program established under title XIX
of the Social Security Act (42 U.S.C. 1396 et seq.), 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 (42 U.S.C.
1396d(b)) shall apply for purposes of reimbursement under
title XIX of the Social Security Act for health care services
directly billed under the program established under this
section.
``(b) Direct Reimbursement.--
``(1) Use of funds.--Each hospital or clinic participating
in the program described in subsection (a) of this section
shall be reimbursed directly under titles XVIII and XIX of
the Social Security Act for services furnished, without
regard to the provisions of section 1880(c) of the Social
Security Act (42 U.S.C. 1395qq(c)) and sections 402(a) and
807(b)(2)(A), but all funds so reimbursed shall first be used
by the hospital or clinic for the purpose of making any
improvements in the hospital or clinic that may be necessary
to achieve or maintain compliance with the conditions and
requirements applicable generally to facilities of such type
under title XVIII or XIX of the Social Security Act. Any
funds so reimbursed which are in excess of the amount
necessary to achieve or maintain such conditions shall be
used--
``(A) solely for improving the health resources deficiency
level of the Indian tribe; and
``(B) in accordance with the regulations of the Service
applicable to funds provided by the Service under any
contract entered into under the Indian Self-Determination Act
(25 U.S.C. 450f et seq.).
``(2) Audits.--The amounts paid to the hospitals and
clinics participating in the program established under this
section shall be subject to all auditing requirements
applicable to programs administered directly by the Service
and to facilities participating in the medicare and medicaid
programs under titles XVIII and XIX of the Social Security
Act.
``(3) Secretarial oversight.--The Secretary shall monitor
the performance of hospitals and clinics participating in the
program established under this section, and shall require
such hospitals and clinics to submit reports on the program
to the Secretary on an annual basis.
``(4) No payments from special funds.--Notwithstanding
section 1880(c) of the Social Security Act (42 U.S.C.
1395qq(c)) or section 402(a), no payment may be made out of
the special funds described in such sections for the benefit
of any hospital or clinic during the period that the hospital
or clinic participates in the program established under this
section.
``(c) Requirements for Participation.--
``(1) Application.--Except as provided in paragraph (2)(B),
in order to be eligible for participation in the program
established under this section, an Indian tribe, tribal
organization, or Alaska Native health organization shall
submit an application to the Secretary that establishes to
the satisfaction of the Secretary that--
``(A) the Indian tribe, tribal organization, or Alaska
Native health organization contracts or compacts for the
operation of a facility of the Service;
``(B) the facility is eligible to participate in the
medicare or medicaid programs under section 1880 or 1911 of
the Social Security Act (42 U.S.C. 1395qq; 1396j);
``(C) the facility meets the requirements that apply to
programs operated directly by the Service; and
``(D) the facility--
``(i) is accredited by an accrediting body as eligible for
reimbursement under the medicare or medicaid programs; or
``(ii) has submitted a plan, which has been approved by the
Secretary, for achieving such accreditation.
``(2) Approval.--
``(A) In general.--The Secretary shall review and approve a
qualified application not later than 90 days after the date
the application is submitted to the Secretary unless the
Secretary determines that any of the criteria set forth in
paragraph (1) are not met.
``(B) Grandfather of demonstration program participants.--
Any participant in the demonstration program authorized under
this section as in effect on the day before the date of
enactment of the Alaska Native and American Indian Direct
Reimbursement Act of 2000 shall be deemed approved for
participation in the program established under this section
and shall not be required to submit an application in order
to participate in the program.
``(C) Duration.--An approval by the Secretary of a
qualified application under subparagraph (A), or a deemed
approval of a demonstration program under subparagraph (B),
shall continue in effect as long as the approved applicant or
the deemed approved demonstration program meets the
requirements of this section.
``(d) Examination and Implementation of Changes.--
``(1) In general.--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--
``(A) 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 title XIX of the Social Security Act; and
``(B) any changes that may be necessary to enable
participants in the program established under this section to
provide to the Service medical records information on
patients served under the program that is consistent with the
medical records information system of the Service.
``(2) Accounting information.--The accounting information
that a participant in the program established under this
section shall be required to report shall be the same as the
information required to be reported by participants in the
demonstration program authorized under this section as in
effect on the day before the date of enactment of the Alaska
Native and American Indian Direct Reimbursement Act of 2000.
The Secretary may from time to time, after consultation with
the program participants, change the accounting information
submission requirements.
``(e) 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 a tribe or tribal organization may retrocede
a contracted program to the Secretary under authority of the
Indian Self-Determination Act (25 U.S.C. 450 et seq.). 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.
``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, only if the injury, illness, or disability for
[[Page S758]]
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,
2001, 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 tribal organization carrying out programs
under the Indian Self-Determination and
[[Page S759]]
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 2001);
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 upon or interpreted to deny or
reduce payments otherwise due under subsection (a), except to
the extent the Service, an Indian
[[Page S760]]
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 2002 through 2013 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;
``(2) the size of the urban Indian population in the urban
center or centers involved;
[[Page S761]]
``(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
under section 503 which has completed performance of a
contract or grant under section 504, the Secretary shall
review the
[[Page S762]]
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) Tulsa and Oklahoma City Clinics.--Notwithstanding any
other provision of law, the Tulsa and Oklahoma City Clinic
demonstration projects shall become permanent programs within
the Service's direct care program and continue to be treated
as service units 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.
``(b) Report.--The Secretary shall submit to the President,
for inclusion in the report required to be submitted to the
Congress
[[Page S763]]
under section 801 for fiscal year 1999, a report on the
findings and conclusions derived from the demonstration
projects specified in subsection (a).
``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, 2002, 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.
``(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
[[Page S764]]
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 2013 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 2013 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.
``(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;
[[Page S765]]
``(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;
``(I) traditional health care practices; and
``(J) diagnostic services, including the utilization of
neurological assessment technology; 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 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;
``(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.
[[Page S766]]
``(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 systems of care and 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;
``(E) specialized residential treatment programs for high
risk populations including pregnant and post partum women and
their children;
``(F) diagnostic services utilizing, when appropriate,
neuropsychiatric assessments which include the use of the
most advances technology available; and
``(G) a telepsychiatry program that uses experts in the
field of pediatric psychiatry, and that incorporates
assessment, diagnosis and treatment for children, including
those children with concurrent neurological disorders.
``(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.
[[Page S767]]
``(c) Intermediate Adolescent Behavioral Health Services.--
``(1) In general.--The Secretary, acting through the
Service, Indian Tribes and tribal 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) to provide intensive home- and community-based
services, including collaborative systems of care.
``(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,
[[Page S768]]
advocacy, and information to fetal alcohol disorder affected
persons and their families or caretakers;
``(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-dependence 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 neurodevelop-mental disorders.--The
term `alcohol related neurodevelop-mental 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 2013 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
[[Page S769]]
general population, including specific comparisons of
appropriations provided and those required for such parity;
``(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 of the Social Security Act,
section 402(a) of this Act,
[[Page S770]]
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 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
[[Page S771]]
models for providing and funding health services for all
Indian beneficiaries including those who live outside of a
reservation, temporarily or permanently;
``(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 2013 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 striking ``and'' 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. 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--
[[Page S772]]
``(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;
or
``(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 qualified
Indian 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 decrease 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 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
section 330 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 pneumococcal 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. 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 (64), by striking ``and'' at the end:
(2) in paragraph (65), by striking the period and inserting
``; and''; and
(3) by inserting after paragraph (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. 212. 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. 213. 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, an
Indian tribe or tribal organization, or an urban Indian
organization
[[Page S773]]
(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 by such
entities if and for so long as the 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, or 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 2002 through 2013 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.
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.
SEC. 303. EFFECTIVE DATE.
This Act and the amendments made by this Act take effect on
October 1, 2001.
______
By Mr. HATCH (for himself and Mr. Bennett):
S. 213. A bill to amend the National Trails System Act to update the
feasibility and suitability studies of 4 national historic trails and
provide for possible additions to such trails; to the Committee on
Energy and Natural Resources.
Mr. HATCH. Mr. President, I rise today to introduce an amendment to
the National Trails System Act which would update the feasibility and
suitability studies of four national historic trails and allow possible
additions to them. The trails in question are the Oregon, the Mormon,
the Pony Express and the California National Historic Trails.
In 1978, the Oregon and Mormon trails were established by the
National Trails System Act. At that time the language of the bill
defined these trails as ``point to point,'' limiting them to one
beginning point and one destination. The Mormon Pioneer National
Historic Trail at that time was defined as the route Brigham Young took
in 1846 through Iowa and then to the Salt Lake Valley in 1847. The
Oregon Trail was defined narrowly as the route taken by settlers from
Independence, Missouri, to Oregon City from 1841 to 1848. It, too, was
limited to a single trail with only three variants.
Later, in 1992, Congress passed an amendment for the establishment of
the California and Pony Express National Historic Trails. This
amendment broadened the possibility of trail variants for the
California Trail and provided a more accurate depiction of the original
trail. However, the legislation I am introducing today will provide
additional authority for variations to these trails.
To those of us in the West, these trails are the highways of our
history. With this legislation, I hope to capture the stories made
along the side roads, as well. In many cases, our most interesting and
telling history was made along the variations of the main trails. Since
the enactment of the National Trails System Act in 1978, there has been
a great deal of support to broaden the Act to include these side roads
to history.
Not every pioneer company embarked on their journey from Omaha,
Nebraska or Independence, Missouri. Tens of thousands of settlers began
from other starting points. These trail variations and alternate routes
show the ingenuity and adaptability of the poineers as they were forced
to contend with inclement weather, lack of water, difficult terrain,
and hostile Native American tribes. The variant routes taken by the
pioneers tell important stories that would otherwise slip through the
cracks under a strict interpretation of the National Trails System Act.
The Act requires that comprehensive management and use plans be
prepared for all historic trails. In 1981, such plans were completed
for the Mormon and Oregon trails. Since that time, however, endless
hours of research by the Park Service and trails organizations have
produced a more complete picture of the westward expansion. The
National Park Service has determined, however, that legislation is
required to update the trails with this newfound history.
That is why I am introducing this legislation today. This bill would
authorize the study of further important additions to the California,
Mormon Pioneer, Oregon, and Pony Express National Historic Trails and
allow for a more complete story to be told of our history in the West.
I thank the Senate for the opportunity to address this issue today,
and I urge my colleagues to support this legislation.
[[Page S774]]
______
By Mr. McCAIN (for himself, Mr. Inouye, Mr. Conrad, Mr. Daschle,
and Mr. Campbell):
S. 214. A bill to elevate the position of Director of the Indian
Health Service within the Department of Health and Human Services to
Assistant Secretary for Indian Health, and for other purposes; to
Committee on Indian Affairs.
Mr. McCAIN. Mr. President, I rise to introduce legislation to
designate the Director of the Indian Health Service as an Assistant
Secretary for Indian Health within the Department of Health and Human
Services. My colleagues, Senators Inouye, Conrad, Daschle and Campbell
are joining me in this effort as original co-sponsors. I am pleased to
note that Congressman Nethercutt from Washington will introduce
companion legislation on the House side.
The purpose of this legislation is simple. It will redesignate the
current Director of the Indian Health Service, IHS, as a new Assistant
Secretary within the Department of Health and Human Services to be
responsible for Indian health policy and budgetary matters.
As the primary health care delivery system, the Indian Health Service
is the principal advocate for Indian health care needs, both on the
reservation level and for urban populations. More than 1.5 million
Indian people are served every year by the IHS. At its current
capacity, the IHS estimates that it can only meet about 60 percent of
tribal health care needs. The IHS will continue to be challenged by a
growing Indian population as well as an increasing disparity between
the health status of Indian people as compared to other Americans.
Thousands of Indian people continue to suffer from the worst imaginable
health care conditions in Indian country--from diabetes to cancer to
infant mortality. In nearly every category, the health status of Native
Americans falls far below the national standard.
The purpose of this bill is to respond to the desire by Indian people
for a stronger leadership and policy role within the primary health
care agency, the Department of Health and Human Services. The Assistant
Secretary for Indian Health will ensure that critical policy and
budgetary decisions will be made with the full involvement and
consultation of not only the Indian Health Service, but also the direct
involvement of the Tribal governments.
This legislation is long overdue in bringing focus and national
attention to the health care status of Indian people and fulfilling the
federal trust responsibility toward Indian tribes. Implementation of
this bill is intended to support the long-standing policies of Indian
self-determination and tribal self-governance and assist Indian tribes
who are making positive strides in providing direct health care to
their own communities.
Tribal communities are in dire need of a senior policy official who
is knowledgeable about the programs administered by the IHS and who can
provide the leadership for the health care needs of American Indians
and Alaska Natives. We continue to pursue passage of this legislation
as many believe that the priority of Indian health issues within the
Department should be raised to the highest levels within our federal
government.
I look forward to working with my colleagues on both sides of the
aisle and the new Administration to ensure prompt passage of this
legislation. I ask unanimous consent that the full text of this bill be
included in the Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 214
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. OFFICE OF ASSISTANT SECRETARY FOR INDIAN HEALTH.
(a) Establishment.--There is established within the
Department of Health and Human Services the Office of the
Assistant Secretary for Indian Health in order to, in a
manner consistent with the government-to-government
relationship between the United States and Indian tribes--
(1) facilitate advocacy for the development of appropriate
Indian health policy; and
(2) promote consultation on matters related to Indian
health.
(b) Assistant Secretary for Indian Health.--In addition to
the functions performed on the date of enactment of this Act
by the Director of the Indian Health Service, the Assistant
Secretary for Indian Health shall perform such functions as
the Secretary of Health and Human Services (referred to in
this section as the ``Secretary'') may designate. The
Assistant Secretary for Indian Health shall--
(1) report directly to the Secretary concerning all policy-
and budget-related matters affecting Indian health;
(2) collaborate with the Assistant Secretary for Health
concerning appropriate matters of Indian health that affect
the agencies of the Public Health Service;
(3) advise each Assistant Secretary of the Department of
Health and Human Services concerning matters of Indian health
with respect to which that Assistant Secretary has authority
and responsibility;
(4) advise the heads of other agencies and programs of the
Department of Health and Human Services concerning matters of
Indian health with respect to which those heads have
authority and responsibility; and
(5) coordinate the activities of the Department of Health
and Human Services concerning matters of Indian health.
(c) References.--Reference in any other Federal law,
Executive order, rule, regulation, or delegation of
authority, or any document of or relating to the Director of
the Indian Health Service shall be deemed to refer to the
Assistant Secretary for Indian Health.
(d) Rate of Pay.--
(1) Positions at level iv.--Section 5315 of title 5, United
States Code, is amended--
(A) by striking the following:
``Assistant Secretaries of Health and Human Services
(6).''; and
(B) by inserting the following:
``Assistant Secretaries of Health and Human Services
(7).''.
(2) Positions at level v.--Section 5316 of title 5, United
States Code, is amended by striking the following:
``Director, Indian Health Service, Department of Health and
Human Services.''.
(e) Duties of Assistant Secretary for Indian Health.--
Section 601(a) of the Indian Health Care Improvement Act (25
U.S.C. 1661(a)) is amended--
(1) by inserting ``(1)'' after ``(a)'';
(2) in the second sentence of paragraph (1), as so
designated, by striking ``a Director,'' and inserting ``the
Assistant Secretary for Indian Health,''; and
(3) by striking the third sentence of paragraph (1) and all
that follows through the end of the subsection and inserting
the following: ``The Assistant Secretary for Indian Health
shall carry out the duties specified in paragraph (2).
``(2) The Assistant Secretary for Indian Health shall--
``(A) report directly to the Secretary concerning all
policy- and budget-related matters affecting Indian health;
``(B) collaborate with the Assistant Secretary for Health
concerning appropriate matters of Indian health that affect
the agencies of the Public Health Service;
``(C) advise each Assistant Secretary of the Department of
Health and Human Services concerning matters of Indian health
with respect to which that Assistant Secretary has authority
and responsibility;
``(D) advise the heads of other agencies and programs of
the Department of Health and Human Services concerning
matters of Indian health with respect to which those heads
have authority and responsibility; and
``(E) coordinate the activities of the Department of Health
and Human Services concerning matters of Indian health.''.
(f) Continued Service by Incumbent.--The individual serving
in the position of Director of the Indian Health Service on
the date preceding the date of enactment of this Act may
serve as Assistant Secretary for Indian Health, at the
pleasure of the President after the date of enactment of this
Act.
(g) Conforming Amendments.--
(1) Amendments to indian health care improvement act.--The
Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.)
is amended--
(A) in section 601--
(i) in subsection (c), by striking ``Director of the Indian
Health Service'' both places it appears and inserting
``Assistant Secretary for Indian Health''; and
(ii) in subsection (d), by striking ``Director of the
Indian Health Service'' and inserting ``Assistant Secretary
for Indian Health''; and
(B) in section 816(c)(1), by striking ``Director of the
Indian Health Service'' and inserting ``Assistant Secretary
for Indian Health''.
(2) Amendments to other provisions of law.--The following
provisions are each amended by striking ``Director of the
Indian Health Service'' each place it appears and inserting
``Assistant Secretary for Indian Health'':
(A) Section 203(a)(1) of the Rehabilitation Act of 1973 (29
U.S.C. 761b(a)(1)).
(B) Subsections (b) and (e) of section 518 of the Federal
Water Pollution Control Act (33 U.S.C. 1377 (b) and (e)).
(C) Section 803B(d)(1) of the Native American Programs Act
of 1974 (42 U.S.C. 2991b-2(d)(1)).
______
By Ms. STABENOW:
S. 215. A bill to amend the Federal Food, Drug, and Cosmetic Act to
permit importation in personal baggage and by mail of certain covered
products for personal use from certain foreign countries and to correct
impediments in implementation of the Medicine Equity and Drug Safety
Act of 2000; to the
[[Page S775]]
Committee on Health, Education, Labor, and Pensions.
Ms. STABENOW. Mr. President, today I rise to introduce my first bill
in the Senate, the Medication Equity and Drug Savings Act, or the MEDS
Act.
On January 22, a little over a week ago, I had the privilege of
addressing my colleagues in my first speech on the Senate floor. The
topic of the speech was health care, specifically the need to pass a
strong Patients' Bill of Rights. I pledged my commitment to making
health care a priority during my tenure in this esteemed body.
Today, I am pleased to share with my colleagues that I am taking the
next step in keeping my promise by introducing a bill that addresses
another priority health care issue: the price of prescription drugs. We
all know that providing prescription drugs for seniors has become a
very important issue for the American public. In fact, this was a key
issue in many campaigns throughout the country, including my own.
On a fundamental level, I believe everyone should have access to
affordable prescription drugs, especially senior citizens enrolled in
Medicare and the disabled. It is an outrage that not only must those
seniors, who rely solely on Medicare for their health insurance, pay
for all of their medications out of their own pockets, but that in many
instances they pay more for the same drug than their counterparts with
other insurance.
So we have situations where those without insurance, and most often
this falls on our seniors--but anyone without insurance is most often
walking into the pharmacy and paying more. We did a study in my State
that showed, on average, they paid twice as much as someone with
insurance for the very same medications.
I have conducted several prescription drug price studies in Michigan,
and I have learned that, in fact, there is a genuine problem that
touches the lives of so many people whom I represent. My concerns have
been confirmed by literally thousands of letters and e-mails and phone
calls from seniors and families who cannot afford to buy their
medications.
I have been saddened by the sheer number of seniors who confided in
me that the cost of their drugs is so high that they are often forced
to give up their meals or are not able to heat their homes. In Michigan
that can be very serious in the wintertime. This is in order to buy
their medications.
These are not new stories. I know my colleagues have heard these
stories as well, but they are real. They are not just stories. They are
affecting people today. As we speak, there are seniors somewhere
deciding whether or not they are going to skip their meals to get their
medicine, or whether they are going to eat and not have the medications
they need.
I also know from hearing from doctors in my district who are worried
about seniors, who decided to do their own self-regulation. They cannot
afford all their pills, so they will skip a couple of pills, or they
will take them every other day, or cut them in half. Oftentimes they
have been placed in serious jeopardy as to their health because they
have not been able to afford their medications and they have taken them
inappropriately.
The bottom line is that Medicare should include a defined, voluntary
prescription drug benefit to help cover the costs of prescription drugs
for seniors and the disabled. I am committed to working with my
colleagues across the aisle, and the administration, to finish what we
started last year and create this new component of Medicare that is
absolutely critical. Without it, we are not fulfilling the promise of
universal health care for those over the age of 65, or the disabled. If
we do not cover medications, we are not providing health care in the
truest sense for those individuals.
In fact, one of the very first bills I cosponsored this year was S.
10, a bill that would create this important benefit in the Medicare
program. I am ready to work with my colleagues to make sure that we do
whatever it takes to update Medicare and create a defined benefit that
will make such an incredible difference in the lives of seniors and
their families in my great State of Michigan and all across the
country. As we work on this complex issue, there are other approaches
we can take in a more immediate sense to cut the costs of prescription
drugs.
Last year, Congress passed and the President signed into law an
important new Act that would permit U.S. manufactured, FDA approved
drugs to be reimported back into the United States by wholesalers. I
firmly believe that implementing this Act could substantially reduce
the cost of drugs, not just for seniors, but for everyone.
Many of my colleagues may remember that during my campaign I
organized several bus trips to Canada. As you know, Canada is just a
short trip over a bridge or through a tunnel for many residents of
Michigan. What I discovered on my bus trips was almost unbelievable.
With just a short drive across the border, U.S. citizens can
substantially reduce the cost of their medications by purchasing them
in Canadian pharmacies. The difference in price for medications was
absolutely shocking. A price study I conducted, comparing the price of
several drugs purchased in the U.S. to the Canadian prices, conformed
what we saw happening on our bus trips--the price of the same drug
purchased in Canada is substantially lower than the average U.S. price.
I have brought a chart to the floor to show my colleagues some of the
incredible differences between the average price in Canada and the
average price in Michigan. I would like to point those out today.
Zocor, a drug to reduce cholesterol, costs $109.73 in Michigan for
50, 5 milligram tablets. The same drug costs only $46.17 in Canada.
That is a 138 percent difference in price.
Prilosec, a drug to treat ulcers $115.37 in Michigan for 20, 20
milligram capsules. The same drug costs only $55.10 in Canada. That is
a 109 percent difference in price.
Procardia XL, a drug to treat heart problems, costs $133.36 for 100,
30 milligram tablets in Michigan. The same drug costs only $74.25 in
Canada. That is an 80 percent difference in price.
Norvasc, a drug to treat high blood pressure, costs $116.79 for 90, 5
milligram tablets. The same drug costs only $89.91 in Canada. That is a
30 percent difference in price.
Tamoxifen, a drug to treat breast cancer, costs $136.50 in Michigan
for a one month supply. The same drug costs only $15.92 in Canada. That
is an 88 percent savings in price.
Zoloft, a drug to treat depression, costs $220.64 for 100, 50
milligram tablets in Michigan. The same drug costs $129.05 in Canada.
That is a 30 percent difference in price.
These are all drugs that have been manufactured in the United States
and have met all FDA manufacturing, safety and purity requirements.
Furthermore, because these are U.S. drugs, the companies developing and
manufacturing them have all benefited from substantial assistance from
the U.S. government, including NIH supported research and the Research
and Development tax credit. Furthermore, a great deal of this research
is conducted in state universities.
I believe that U.S. citizens should have access to these U.S. drugs
that are sold at lower prices in other countries. Competition is key to
ensuring prices that consumers are willing to pay. Keeping the Canadian
border, as well as other borders, closed is an obstacle to competition
and is serving to maintain artificially high prices for drugs in the
United States. I believe that permitting U.S. wholesalers, such as
pharmacies, to bring lower priced drugs back into this country could
reduce the price of drugs for every American.
As my colleagues know, the Secretary of Health and Human Services was
given broad discretion in implementing the wholesale reimportation
provision of the Act. The former Secretary expressed concerns that the
provision may not provide cost savings and could pose risks to the
public health and opted not to promulgate rules. I understand that my
colleagues are urging the new Secretary to reconsider this decision and
to begin the implementation process. I am hopeful this may happen and
would like to work with my colleagues to forward this effort.
Nonetheless, I recognize that there are some concerns with the law
enacted last year. My bill addresses these concerns by correcting these
impediments that may delay the Secretary from promulgating regulations
and
[[Page S776]]
permitting reimportation. Furthermore, my bill directs the Secretary to
dispense with the delay and instructs him to begin the rulemaking
process within 30 days of enactment of the bill.
The first of the concerns about wholesale reimportation addressed by
my bill is the sunset provision. My bill would lift the 5 year sunset
imposed in the Act. Critics argued that sunsetting the provision would
be a disincentive for distributors to develop ways to comply with the
reimportation requirements when there was the possibility that
reimportation could be prohibited again in the near future.
Careful thought was put into the requirements to ensure consumers
would be protected. I believe reimporters should be given every
opportunity to meet these requirement and that removing the sunset will
give these distributors what they need.
Further, I believe consumers should always have access to U.S.
manufactured drugs as long as they comply with FDA safety requirements
and there is no need for a sunset. If Congress or the administration
identifies safety concerns in the future, they should be addressed by
revising the reimportation safety requirements, not sunsetting the
entire provision of the law.
The act also did not specify that reimorters could use the
manufacturers' FDA-approved labels. These labels are required by law if
the products are to be sold in the United States. My bill would make
those labels available to the reimporters from the manufacturers for a
small fee.
Finally, while the act prohibited manufacturers from entering into
agreements with distributors that would interfere with reimportation of
drugs, critics argue this provision was not strong enough to work. My
legislation tightens up this section by prohibiting manufacturers from
discriminating against wholesalers simply because they intend to
reimport the product.
The bill also has stronger language prohibiting price fixing.
Wholesale reimportation of prescription drugs is only half the story.
While I think it is critical that wholesalers be permitted to bring
U.S.-manufactured drugs back into the country to reduce the price for
consumers, I also believe individuals should be able to cross the
border and purchase medication for themselves.
The act we passed last year did not change the current law which
prohibits individuals from bringing medications across the border for
their own use. That is why my bill also makes personal reimportation
legal. I believe individuals should be able to cross the border and
purchase prescription drugs at a lower price for their own use.
The FDA currently has an enforcement policy that permits individuals
who meet specific requirements to bring a 90-day supply of medication
with them into the United States from another country, and my
legislation would codify the current enforcement policy into law. It
requires essentially the same safety precautions currently expected of
individuals who bring medication over the border under the FDA's
enforcement policy.
The bill also recognizes that some individuals may be too ill to
cross the borders themselves and permits them to designate a proxy to
bring the medication back for them as long as they provide a letter
from their doctor indicating that the trip to another country would
endanger their health.
The bill also provides opportunities for individuals to order
medication over the Internet--there are other new sites being
developed--and other means--hotlines, et cetera--in order to also have
prescription drugs delivered by mail.
I am committed to this issue of making prescription drugs more
affordable for everyone. This is a matter of fairness. This bill is a
matter of fairness to Americans, young and old, who need to have access
to affordable prescription drugs. We as Americans ought not to be
underwriting the research and at the same time, after the medications,
as great as they are, are developed, manufactured, and sold, have
Americans paying on average twice as much as those in other countries.
That makes no sense to me.
I am committed to working with my colleagues on both sides of the
aisle. I appreciate the time I have been given today. This is a
critical issue. I cannot think of a more serious issue affecting
particularly older people today than the issue of access to
medications. I think it is shameful that we have even one senior who is
having to choose today, tomorrow, or next week between eating or taking
their medicine. We can fix that. One way is to start with this
legislation which opens our borders and allows real competition for the
best price for American citizens.
I ask unanimous consent that the text 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. 215
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act maybe cited as the ``Medication Equity and Drug
Savings Act''.
SEC. 2. IMPORTATION OF COVERED PRODUCTS FOR PERSONAL USE.
(a) In General.--Chapter VIII of the Federal Food, Drug,
and Cosmetic Act (21 U.S.C. 381 et seq.) is amended by adding
at the end the following:
``SEC. 805. IMPORTATION OF COVERED PRODUCTS FOR PERSONAL USE.
``(a) Definitions.--In this section:
``(1) Covered product.--The term `covered product' means a
prescription drug described in section 503(b)(1).
``(2) Foreign country.--The term `foreign country' means--
``(A) Australia, Canada, Israel, Japan, New Zealand,
Switzerland, and South Africa; and
``(B) any other country, union, or economic area that the
Secretary designates for the purposes of this section,
subject to such limitations as the Secretary determines to be
appropriate to protect the public health.
``(3) Market value.--The term `market value' means--
``(A) the price paid for a covered product in foreign
country; or
``(B) in the case of a gift, the price at which the covered
product is being sold in the foreign country from which the
covered product is imported.
``(b) Importation in Person.--
``(1) Regulations.--Notwithstanding subsections (d) and (t)
of section 301 and section 801(a), the Secretary shall
promulgate regulations permitting individuals to import into
the United States from a foreign country, in personal
baggage, a covered product that meets--
``(A) the conditions specified in paragraph (2); and
``(B) such additional criteria as the Secretary specifies
to ensure the safety of patients in the United States.
``(2) Conditions.--A covered product may be imported under
the regulations if--
``(A) the intended use of the covered product is
appropriately identified;
``(B) the covered product is not considered to represent a
significant health risk (as determined by the Secretary
without any consideration given to the cost or availability
of such a product in the United States); and
``(C) the individual seeking to import the covered
product--
``(i) states in writing that the covered product is for the
personal use of the individual;
``(ii) seeks to import a quantity of the covered product
appropriate for personal use, such as a 90-day supply;
``(iii) provides the name and address of a health
professional licensed to prescribe drugs in the United States
that is responsible for treatment with the covered product or
provides evidence that the covered product is for the
continuation of a treatment begun in a foreign country;
``(iv) provides a detailed description of the covered
product being imported, including the name, quantity, and
market value of the covered product;
``(v) provides the time when and the place where the
covered product is purchased;
``(vi) provides the port of entry through which the covered
product is imported;
``(vii) provides the name, address, and telephone number of
the individual who is importing the covered product; and
``(viii) provides any other information that the Secretary
determines to be necessary, including such information as the
Secretary determines to be appropriate to identify the
facility in which the covered product was manufactured.
``(3) Importation by an individual other than the
patient.--The regulations shall permit an individual who
seeks to import a covered product under this subsection to
designate another individual to effectuate the importation if
the individual submits to the Secretary a certification by a
health professional licensed to prescribe drugs in the United
States that travelling to a foreign country to effectuate the
importation would pose a significant risk to the health of
the individual.
``(4) Consultation.--In promulgating regulations under
paragraph (1), the Secretary shall consult with the United
States Trade Representative and the Commissioner of Customs.
``(c) Importation by Mail.--
``(1) Regulations.--Notwithstanding subsections (d) and (t)
of section 301 and section 801(a), the Secretary shall
promulgate regulations permitting individuals to import into
the United States by mail a covered product
[[Page S777]]
that meets such criteria as the Secretary specifies to ensure
the safety of patients in the United States.
``(2) Criteria.--In promulgating regulations under
paragraph (1), the Secretary shall impose the conditions
specified in subsection (b)(2) to the maximum extent
practicable.
``(3) Consultation.--In promulgating regulations under
paragraph (1), the Secretary shall consult with the United
States Trade Representative and the Commissioner of Customs.
``(d) Records.--Any information documenting the importation
of a covered product under subsections (b) and (c) shall be
gathered and maintained by the Secretary for such period as
the Secretary determines to be appropriate.
``(e) Study and Report.--
``(1) Study.--The Secretary shall conduct a study on the
imports permitted under this section, taking into
consideration the information received under subsections (b)
and (c).
``(2) Evaluations.--In conducting the study, the Secretary
shall evaluate--
``(A) the safety and purity of the covered products
imported; and
``(B) patent, trade, and other issues that may have an
effect on the safety or availability of the covered products.
``(3) Report.--Not later than 5 years after the date of
enactment of this section, the Secretary shall submit to
Congress a report describing the results of the study.
``(f) No Effect on Other Authority.--Nothing in this
section limits the statutory, regulatory, or enforcement
authority of the Secretary relating to importation of covered
products, other than the importation described in subsections
(b) and (c).
``(g) Limitation.--Information collected under this section
shall be subject to section 522a of title 5, United States
Code.''.
(b) Conforming Amendment.--Section 801(d)(1) of the Federal
Food, Drug, and Cosmetic Act (21 U.S.C. 381(d)(1)) is amended
by striking ``section 804'' and inserting ``sections 804 and
805''.
SEC. 3. CORRECTION OF IMPEDIMENTS IN IMPLEMENTATION OF
MEDICINE EQUITY AND DRUG SAFETY ACT OF 2000.
(a) Access to Labeling to Permit Importation.--Section 804
of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 384)
is amended--
(1) in subsection (b)--
(A) in paragraph (2), by striking ``and'' at the end;
(B) in paragraph (3), by striking the period at the end and
inserting ``; and''; and
(C) by adding at the end the following paragraph:
``(4) specify a fair and reasonable fee that a manufacturer
may charge an importer for printing and shipping labels for a
covered product for use by the importer.'';
(2) in subsection (e)(2), by inserting after ``used only
for purposes of testing'' the following: ``or the labeling of
covered products''; and
(3) in subsection (h)--
(A) by striking ``No manufacturer'' and inserting the
following:
``(1) In general.--No manufacturer''; and
(B) by adding at the end the following:
``(2) No conditions for labeling.--No manufacturer of a
covered product may impose any condition for the privilege of
an importer in using labeling for a covered product, except a
requirement that the importer pay a fee for such use
established by regulation under subsection (b)(4).''.
(b) Prohibition of Pricing Conditions.--Paragraph (1) of
section 804(h) of the Federal Food, Drug, and Cosmetic Act
(21 U.S.C. 384(h)) (as designated by subsection (a)(3)(A)) is
amended by inserting before the period at the end the
following: ``that--
``(A) imposes a condition regarding the price at which an
importer may resell a covered product; or
``(B) discriminates against a person on the basis of--
``(i) importation by the person of a covered product
imported under subsection (a); or
``(ii) sale or distribution by the person of such covered
products''.
(c) Conditions for Taking Effect.--Section 804 of the
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 384) is
amended by striking subsection (l) and inserting the
following:
``(l) Conditions for Taking Effect.--
``(1) In general.--Except as provided in paragraph (2),
this section shall become effective only if the Secretary
certifies to Congress that there is no reasonable likelihood
that the implementation of this section would pose any
appreciable additional risk to the public health or safety.
``(2) Regulations.--Notwithstanding the failure of the
Secretary to make a certification under paragraph (1), the
Secretary, not later than 30 days after the date of enactment
of this paragraph, shall commence a rulemaking for the
purpose of formulating regulations to enable the Secretary to
implement this section immediately upon making such a
certification.''.
(d) Repeal of Sunset Provision.--Section 804 of the Federal
Food, Drug, and Cosmetic Act (21 U.S.C. 384) is amended by
striking subsection (m).
(e) Authorization of Appropriations.--Section 804 of the
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 384) (as
amended by subsection (d)) is amended by adding at the end
the following:
``(m) Authorization of Appropriations.--There are
authorized to be appropriated for fiscal year 2002 and each
subsequent fiscal year such sums as are necessary to carry
out this section.''.
______
By Mr. SPECTER (for himself, Mr. Harkin, Mr. Biden, and Mr.
Jeffords):
S. 216. A bill to establish a Commission for the comprehensive study
of voting procedures in Federal, State, and local elections, and for
other purposes; to the Committee on Rules and Administration.
Mr. SPECTER. Mr. President, I have sought recognition to introduce
legislation which seeks to modernize Federal election voting procedures
throughout the United States. The 2000 election saga is now over and,
in the words of President John F. Kennedy, ``Our task now is not to fix
the blame for the past, but to fix the course for the future.''
I believe that had we studied our country's voting and monitoring
procedures after President Kennedy's election, we would have in place
today a uniform Federal election system that would have avoided the
very problem presented in Florida. The presidential election of the
year 2000 has drawn attention to several issues relating to current
voting technologies. The central question is, how can we ensure fair,
reliable, prompt and secure voting procedures?
In this electronic age--in a nation that has put a man on the moon
and an ATM machine on every corner --we have no excuse not to ensure
that we have an accurate voting system in which every person's vote
counts. Thousands of my Pennsylvania constituents raise similar
questions relating to the paradox of the ``Internet age'' and
antiquated voting procedures. In order to move the voting process to
the point we expect in the 21st century, we must establish a system
that will improve the integrity of elections and facilitate faster,
more accurate results and overcome the weaknesses of older election
technology.
It is not really practical for someone to layout an entire bill with
the precise procedures to implement these objectives, but it seems to
me that it will be useful to establish a Commission which would take up
the question of how to reform our Federal election procedures. On
November 14, 2000, the first legislative day following the presidential
election, I introduced legislation addressing the issue of modernizing
our voting procedures. Today, I am reintroducing essentially the same
bill with my distinguished colleague, Senator Harkin, as the lead
cosponsor. This bill would establish a Commission for the Comprehensive
Study of Voting Procedures which would take up the very question of the
best methods to ensure accurate, electronic, and timely reporting of
vote counts. The Commission would then submit a report to the President
and Congress which would include recommendations to reform or augment
current voting procedures for Federal elections. Further, this bill
would authorize matching grants for States and localities to implement
the Commission's recommendations in relation to Federal elections.
Congress should address this issue as least as to Federal elections,
leaving the matters of State and local elections to State officials
under Federalist concepts.
Specifically, my bill would create a 6 member Commission with the
President, Senate Majority Leader, Senate Minority Leader, Speaker of
the House, and House Minority Leader each appointing one member; and
the Director of the Office of Election Administration of the Federal
Election Commission serving as a advisory, non-voting member. The
Commission would conduct a thorough study of all issues relating to
voting procedures in Federal, State, and local elections, including the
following: (1) Voting procedures in Federal, State, and local
government elections; (2) Current voting procedures which represent the
best practices in Federal, State, and local government elections; (3)
Current legislation and regulatory efforts which affect voting
procedures; (4) Implementing standardized voting procedures, including
technology, for Federal, State, and local government elections; (5)
Speed and timeliness of reporting vote counts in Federal, State, and
local government elections; (6) Accuracy of vote counts in Federal,
State, and local government elections; (7) Security of voting
procedures in Federal, State, and local
[[Page S778]]
government elections; (8) Accessibility of voting procedures for
individuals with disabilities and the elderly; and (9) Level of
matching grant funding necessary to enable States and localities to
implement the recommendations of the Commission for the modernization
of State and local voting procedures. The details of this bill are
incorporated in the attached section-by-section analysis.
Studies have shown that more than half of the nation's registered
voters are currently using outdated voting systems. A recent USA Today
article noted that most voters across our country still punch paper
ballots, even though experts say that system is more vulnerable to
voter error than any other. In addition, approximately 20% of voters
use mechanical-lever machines that are no longer manufactured, while
more than 25% of voters fill in a circle, square, or arrow next to
their choice of candidates on a ballot.
My bill is necessary to prevent a recurrence of the problems that
threatened the 2000 presidential election whose problems could have
been avoided if we had modernized voting and monitoring procedures.
Voting is the fundamental safeguard of our democracy and we have the
technological power to ensure that every person's vote does count. The
time is now to repair the problems of our patchwork system in order to
restore the faith of American voters in our Federal election process.
Mr. President, I ask that the full text of the bill and a section by
section analysis be printed in the Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 216
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Commission on the
Comprehensive Study of Voting Procedures Act of 2001''.
SEC. 2. FINDINGS.
Congress finds that--
(1) Americans are increasingly concerned about current
voting procedures;
(2) Americans are increasingly concerned about the speed
and timeliness of vote counts;
(3) Americans are increasingly concerned about the accuracy
of vote counts;
(4) Americans are increasingly concerned about the security
of voting procedures;
(5) the shift in the United States is to the increasing use
of technology which calls for a reassessment of the use of
standardized technology for Federal elections; and
(6) there is a need for Congress to establish a method for
standardizing voting procedures in order to ensure the
integrity of Federal elections.
SEC. 3. ESTABLISHMENT OF COMMISSION.
There is established the Commission on the Comprehensive
Study of Voting Procedures (in this Act referred to as the
``Commission'').
SEC. 4. DUTIES OF THE COMMISSION; MATCHING GRANT PROGRAM.
(a) Study.--Not later than 1 year after the date on which
all of the members of the Commission have been appointed
under section 5, the Commission shall complete a thorough
study of all issues relating to voting procedures in Federal,
State, and local elections, including the following:
(1) Voting procedures in Federal, State, and local
government elections.
(2) Voting procedures that represent the best practices in
Federal, State, and local government elections.
(3) Legislation and regulatory efforts that affect voting
procedures issues.
(4) The implementation of standardized voting procedures,
including standardized technology, for Federal, State, and
local government elections.
(5) The speed and timeliness of vote counts in Federal,
State and local elections.
(6) The accuracy of vote counts in Federal, State and local
elections.
(7) The security of voting procedures in Federal, State and
local elections.
(8) The accessibility of voting procedures for individuals
with disabilities and the elderly.
(9) The level of matching grant funding necessary to enable
States and localities to implement the recommendations made
by the Commission under subsection (b) for the modernization
of State and local voting procedures.
(b) Recommendations.--The Commission shall develop
recommendations with respect to Federal elections matters.
(c) Reports.--
(1) Final report.--Not later than 180 days after the
expiration of the period referred to in subsection (a), the
Commission shall submit a report, that has been approved by a
majority of the members of the Commission, to the President
and Congress which shall contain a detailed statement of the
findings and conclusions of the Commission, together with its
recommendations for such legislation and administrative
actions as it considers appropriate.
(2) Interim reports.--The Commission may submit to the
President and Congress any interim reports that are approved
by a majority of the members of the Commission.
(3) Additional reports.--The Commission may, together with
the report submitted under paragraph (1), submit additional
reports that contain any dissenting or minority opinions of
the members of the Commission.
(d) Matching Grant Program.--
(1) Authority.--After the submission of the final report
under subsection (c)(1), the Attorney General, acting through
the Assistant Attorney General for the Office of Justice
Programs, shall award grants to State and local governments
to enable such governments to implement the recommendations
made by the Commission under subsection (b).
(2) Application.--To be eligible to receive a grant under
paragraph (1), a State or local government shall prepare and
submit to the Attorney General an application at such time,
in such manner, and containing such information as the
Attorney General may require including an assurance that the
applicant will comply with the requirements of paragraph (3).
(3) Matching funds.--The Attorney General may not award a
grant to a State or local government under this subsection
unless the government agrees to makes available (directly or
through donations from public or private entities) non-
Federal contributions toward the activities to be conducted
under the grant in an amount equal to not less than $1 for
each $1 of Federal funds provided under the grant.
(4) Amount of grant.--The Attorney General shall determine
the amount of each grant under this subsection based on the
recommendations made by the Commission under subsection (b).
(5) Authorization of appropriations.--There is authorized
to be appropriated to carry out this subsection, the amounts
recommended for each fiscal year by the Commission under
subsection (b) as being necessary for the modernization of
State and local voting procedures with respect to Federal
elections.
SEC. 5. MEMBERSHIP.
(a) Number and Appointment.--The Commission shall be
composed of--
(1) five voting members of whom--
(A) one shall be appointed by the President;
(B) one shall be appointed by the majority leader of the
Senate;
(C) one shall be appointed by the minority leader of the
Senate;
(D) one shall be appointed by the Speaker of the House of
Representatives; and
(E) one shall be appointed by the minority leader of the
House of Representatives; and
(2) the Director of the Office of Election Administration
of the Federal Election Commission who shall be an advisory,
nonvoting member.
(b) Date of Appointment.--The appointments of the members
of the Commission shall be made not later than 30 days after
the date of enactment of this Act.
(c) Terms.--Each member of the Commission shall be
appointed for the life of the Commission.
(d) Vacancies.--A vacancy in the Commission shall not
affect its powers, but shall be filled in the same manner in
which the original appointment was made.
(e) Meetings.--
(1) In general.--The Commission shall meet at the call of
the Chairperson or a majority if its members.
(2) Initial meeting.--Not later than 30 days after the date
on which all members of the Commission have been appointed,
the Commission shall hold its first meeting.
(f) Quorum.--A majority of the members of the Commission
shall constitute a quorum, but a lesser number of members may
hold hearings.
(g) Chairperson and Vice Chairperson.--The Commission shall
select a Chairperson and Vice Chairperson from among its
members.
SEC. 6. POWERS OF THE COMMISSION.
(a) Hearings and Sessions.--The Commission may hold such
hearings for the purpose of carrying out this Act, sit and
act at such times and places, take such testimony, and
receive such evidence as the Commission considers advisable
to carry out this Act. The Commission may administer oaths
and affirmations to witnesses appearing before the
Commission.
(b) Information From Federal Agencies.--The Commission may
secure directly from any Federal department or agency such
information as the Commission considers necessary to carry
out this Act. Upon request of the Chairperson of the
Commission, the head of such department or agency shall
furnish such information to the Commission.
(c) Website.--For purposes of conducting the study under
section 4(a), the Commission shall establish a website to
facilitate public comment and participation.
(d) Postal Services.--The Commission may use the United
States mails in the same manner and under the same conditions
as other departments and agencies of the Federal Government.
(e) Administrative Support Services.--Upon the request of
the Chairperson of the Commission, the Administrator of the
General Services Administration shall provide to the
Commission, on a reimbursable basis, the
[[Page S779]]
administrative support services that are necessary to enable
the Commission to carry out its duties under this Act.
(f) Contracts.--The Commission may contract with and
compensate persons and Federal agencies for supplies and
services without regard to section 3709 of the Revised
Statutes (42 U.S.C. 5).
(g) Gifts and Donations.--The Commission may accept, use,
and dispose of gifts or donations of services or property to
carry out this Act.
SEC. 7. COMMISSION PERSONNEL MATTERS.
(a) Compensation of Members.--Each member of the Commission
who is not an officer or employee of the Federal Government
shall be compensated at a rate equal to the daily equivalent
of the annual rate of basic pay prescribed for level IV of
the Executive Schedule under section 5315 of title 5, United
States Code, for each day (including travel time) during
which such member is engaged in the performance of the duties
of the Commission. All members of the Commission who are
officers or employees of the United States shall serve
without compensation in addition to that received for their
services as officers or employees of the United States.
(b) Travel Expenses.--The members of the Commission shall
be allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for employees of agencies
under subchapter I of chapter 57 of title 5, United States
Code, while away from their homes or regular places of
business in the performance of services for the Commission.
(c) Staff.--
(1) In general.--The Chairperson of the Commission may,
without regard to the civil service laws and regulations,
appoint and terminate an executive director and such other
additional personnel as may be necessary to enable the
Commission to perform its duties. The employment of an
executive director shall be subject to confirmation by the
Commission.
(2) Compensation.--The Chairperson of the Commission may
fix the compensation of the executive director and other
personnel without regard to chapter 51 and subchapter III of
chapter 53 of title 5, United States Code, relating to
classification of positions and General Schedule pay rates,
except that the rate of pay for the executive director and
other personnel may not exceed the rate payable for level V
of the Executive Schedule under section 5316 of such title.
(d) Detail of Government Employees.--Any Federal Government
employee may be detailed to the Commission without
reimbursement, and such detail shall be without interruption
or loss of civil service status or privilege.
(e) Procurement of Temporary and Intermittent Services.--
The Chairperson of the Commission may procure temporary and
intermittent services under section 3109(b) of title 5,
United States Code, at rates for individuals which do not
exceed the daily equivalent of the annual rate of basic pay
prescribed for level V of the Executive Schedule under
section 5316 of such title.
SEC. 8. LIMITATION ON CONTRACTING AUTHORITY.
Any new contracting authority provided for in this Act
shall be effective only to the extent, or in the amounts,
provided for in advance in appropriations Acts.
SEC. 9. TERMINATION OF THE COMMISSION.
The Commission shall terminate 30 days after the date on
which the Commission submits its report under section 4.
SEC. 10. RULE OF CONSTRUCTION.
Nothing in this Act shall be construed to prohibit the
enactment of an Act with respect to voting procedures during
the period in which the Commission is carrying out its duties
under this Act.
SEC. 11. AUTHORIZATION OF APPROPRIATIONS.
(a) In General.--There are authorized to be appropriated
such sums as may be necessary to the Commission to carry out
this Act.
(b) Availability.--Any sums appropriated under the
authorization contained in this section shall remain
available, without fiscal year limitation, until expended.
____
Section-by-Section Analysis--The Commission for the Comprehensive Study
of Voting Procedures Act of 2001
Sections 1-2. Denotes the title of the bill and enumerates
the findings, which include increasing concern over voting
procedures; increasing concern over the speed, timeliness,
and accuracy of voting counts; increasing use of technology
by American citizens; and increasing need for standardized
voting technology and standardized voting procedures in
Federal elections.
Section 3. Establishes the Commission for the Comprehensive
Study of Voting Procedures.
Section 4. Directs the Commission to conduct a study of
issues relating to voting procedures, which should take no
more than one year from the appointment of the full
Commission and should include the following:
Monitoring voting procedures in Federal, State, and local
government elections;
Current voting procedures which represent the best
practices in Federal, State, and local government elections;
Current legislation and regulatory efforts which affect
voting procedures issues;
Implementing standardized voting procedures, including
standardized technology, for Federal, State, and local
government elections;
Speed and timeliness of reporting vote counts in Federal,
State, and local government elections;
Accuracy of vote counts in Federal, State, and local
government elections;
Security of voting procedures in Federal, State, and local
government elections;
Accessibility of voting procedures for individuals with
disabilities and the elderly;
Level of matching grant funding necessary to enable States
and localities to implement the recommendations of the
Commission for the modernization of State and local voting
procedures.
Requires the Commission to submit a report to Congress on
its findings, including any recommendations for legislation
to reform or augment current voting procedures, within 180
days of completing their study.
Establishes a matching grant program for States and
localities under the Assistant Attorney General for the
Office of Justice Programs, following the submissions of the
Commission's final report. Also, authorizes an amount to be
appropriated as the Commission finds necessary for States and
localities to implement the recommendations of the Commission
with respect to Federal elections.
Section 5. Specifies the membership of the Commission.
Stipulates that the Commission consist of 6 members appointed
as follows:
1 by the President
1 by the Senate Majority Leader
1 by the Senate Minority Leader
1 by the Speaker of the House
1 by the House Minority Leader
the Director of the Office of Election Administration of
the Federal Election Commission.
Sections 6-7. Authorizes powers to the Commission,
establishes a Web site to facilitate public participation and
comment, and provides for the hiring of a Director and staff.
Section 8-9. Limits the contracting authority of the
Commission to those provided under appropriations and
specifies that the Commission terminate 30 days after the
final report is submitted.
Section 10-11. Specifies the caveat that the Act will not
prohibit the enactment of legislation on voting procedure
issues during the existence of the Commission and authorizes
appropriations.
Mr. HARKIN. Mr. President, I am pleased to join with Senator Specter
on the introduction of the Commission on the Comprehensive Study of
Voting Procedures Act of 2001. This measure is very similar to the one
we introduced soon after last year's election. I think that we can all
agree that this year's Presidential election has exposed a number of
serious flaws in Florida's voting system, as well as in those of many
states around the country.
First, thousands of ballots were not counted due to voter error. Some
people voted for two candidates. Some voted for no candidate. And
thousands who voted for just one candidate did so in such a way that
their ballots could not be accurately read by vote-counting machines.
Second, the systems we traditionally use to decide elections--systems
that can determine the results of an election that is won by one
percent or two percent or five percent of the vote--simply aren't
accurate enough to decide an election based on a margin of just
hundredths of one percent. For example, ask any election expert in the
country, and they'll tell you that punch card machines just aren't up
to such a task. The press late last year was filled with reports and
analysis showing that punch card systems have a far greater proportion
of undercounted votes than other systems.
We also now know that butterfly ballots were not the wisest idea. And
it's not just a matter of avoiding that particular design. We've also
got to develop a mechanism to ensure that ballots are designed in ways
that voter error is minimized. In addition, we learned that some
Floridians thought they were registered to vote. However, when they
arrived at the polls, they found that their names were not listed on
the registration roles. These citizens were not allowed to vote in
Florida.
Clearly, our voting system has flaws. However there's nothing wrong
with our voting system that can't be fixed by what's right with it. For
example, in Iowa, we have a law that allows any potential voter who is
not found on the registration roles to cast a ``challenged ballot.''
This challenged ballot is like an absentee ballot. It's put in an
envelope, and election officials spend the days immediately after the
election rechecking registration roles for clerical errors.
If an error was made, and a person was indeed registered to vote,
then his or her challenged ballot is counted. This isn't a perfect
solution, but it ensures that fewer people fall through the
[[Page S780]]
cracks. And there are more creative answers like this just waiting to
be discovered in innovative, forward-thinking counties throughout
America. That's why Senator Specter and I have introduced a bill
designed to revamp our election systems to make them as clear,
accessible and accurate as possible.
The Specter-Harkin bill establishes a bipartisan commission which
would spend one year examining election practices throughout America.
The Commission would seek to discover the strengths and weaknesses in
our election system in order to determine the best course of action for
the future.
The Commission would specifically be responsible for studying the
following:
(1) Voting procedures in Federal, State, and local government
elections.
(2) Voting procedures that represent the best practices in Federal,
State, and local government elections.
(3) Legislation and regulatory efforts that affect voting procedures
issues.
(4) The implementation of standardized voting procedures, including
standardized technology for Federal, State, and local government
elections.
(5) The speed and timeliness of vote counts in Federal, State and
local elections.
(6) The accuracy of vote counts in Federal, State and local
elections.
(7) The security of voting procedures in Federal, State and local
elections.
(8) The accessibility of voting procedures for individuals with
disabilities and the elderly.
(9) The level of matching grant funding necessary to implement the
Commission's recommendations.
Lastly, the bill authorizes a one-to-one matching grant program
subject to the appropriation of the funds.
The commission would seek to answer questions like the following:
What are the latest innovations in voting technology? What are the best
failsafe systems we can install to alert voters that they've voted for
too many candidates or too few? Are we doing everything we can to make
our voting system accessible to the elderly, people with disabilities,
and others with special needs?
The next Presidential election is less than four years away. By
allotting 12 full months for the Commission to study our voting
systems, we'll leave time for the Commission to finish a report and
submit it to Congress for review and passage, and to allow Federal,
State and local governments to pass and implement new voting
legislation. But the timeline is tight, and we must move forward
quickly.
Clearly, when it comes to voting, local officials should have
discretion in their precincts. But at the very least, we must establish
minimum standards for accessibility and accuracy in order to ensure a
full, fair and precise count. We also need clear guidelines regarding
the recounting of votes in very close elections. Each vote is an
expression of one American's will, and we cannot deny anyone that
fundamental right to shape our democracy.
There will always be conflicting views about what happened in
Florida. And we'll probably never come to complete agreement on the
results. But let us move forward and work together to minimize voting
inaccuracies in the future and ensure every American's right to be
heard.
______
By Mr. SCHUMER (for himself, Mr. Warner, Mr. Durbin, Mr.
Santorum, Mr. Sarbanes, Mr. Chafee, Mr. Voinovich, Mr. Kerry,
Mr. Dodd, and Ms. Mikulski):
S. 217. A bill to amend the Internal Revenue Code of 1986 to provide
a uniform dollar limitation for all types of transportation fringe
benefits excludable from gross income, and for other purposes; to the
Committee on Finance.
Mr. SCHUMER. Mr. President, I am proud to join my colleagues--
Senators Warner, Durbin, Chafee, Sarbanes, Santorum, Dodd, Kerry,
Voinovich, and Mikulski today to introduce the Commuter Benefits Equity
Act of 2001. This bill corrects an inequity in the tax code and has the
potential to draw hundreds of thousands of commuters out of their cars
and onto our nation's transit and commuter rail systems.
The inequity I am speaking about is the largely ignored difference in
the amount of ``pretax'' compensation that current law permits
employers to give employees to cover parking and transit costs. At
present, a company may provide a worker with $175 per month to cover
parking expenses. That limit is set at $65 per employee for mass
transit expenses.
At a time when our nation's highways and bridges are under
unprecedented strain, it is hard to believe that federal law provides a
greater incentive for workers to drive to work than to leave their cars
at home.
The Commuter Benefits Equity Act of 2001 would raise the monthly cap
to $175 for transit and provide ``cost of living'' increases for both
benefits in the future. I would note that the parking benefit just
received a $5 COLA.
It is often said that people love their cars and simply will not ride
mass transit to work. Many times this view is asserted as if it were an
incontrovertible fact. I don't believe it at all, and recent ridership
increases show how untrue such statements are.
According to the American Public Transportation Association,
Americans took over 9.4 billion trips on public transportation last
year--a 320 million ride increase over 1999. This figure marks the
highest ridership number in more than forty years. It also signifies a
20 percent increase over the last five years.
Clearly, Americans are willing to use mass transportation. I suspect
that if the federal government were to remove barriers like the current
disparity in the parking and transit benefits, even more would abandon
their cars.
It certainly is a goal worth pursuing.
According to the Texas Transportation Institute, between 1982 and
1997 the average delays faced by commuters in our metropolitan areas
increased by alarming percentages. Over that fifteen-year period,
commuters in New York endured a 158-percent increase in the amount of
time they spent stuck in traffic. And that, comparatively speaking, is
low. The figure for Detroit commuters was 182 percent. In Dallas it was
300 percent. Denver commuters faced a grim 337-percent increase.
The monthly cap on the federal transit benefit must be raised because
it is far below the average costs incurred by the suburban commuters
who use mass transportation. For instance, it costs a Westchester, New
York commuter over $170 per month to take MetroNorth into the City. In
Chicago, the average cost is approximately $148. In suburban Seattle
that cost can exceed $200. Many commuters who would prefer to ride a
train into work versus sitting in traffic probably can't afford to do
so. This is because the choice between paying the majority of their own
mass transportation costs or sitting in traffic and getting heavily
subsidized parking is one they cannot justify economically.
My colleagues and I believe that by creating a more level playing
field between the transit and parking benefits, mass transportation use
in this country will rise more rapidly. We also anticipate that our
nation's urban highways will operate more efficiently. This view is
shared by groups such as the Sierra Club, Environmental Defense, and
the U.S. Conference of Mayors, who have endorsed the Commuter Benefits
Equity Act of 2001.
Mr. President, I ask unanimous consent that any comments relating to
this bill appear in the Record following my remarks as well as the text
of the Commuter Benefits Equity Act of 2001.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 217
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Commuter Benefits Equity Act
of 2001''.
SEC. 2. UNIFORM DOLLAR LIMITATION FOR ALL TYPES OF
TRANSPORTATION FRINGE BENEFITS.
(a) In General.--Subparagraph (A) of section 132(f)(2) of
the Internal Revenue Code of 1986 (relating to limitation on
exclusion) is amended by striking ``$65'' and inserting
``$175''.
(b) Conforming Amendment.--Section 9010 of the
Transportation Equity Act for the 21st Century is amended by
striking subsection (c).
(c) Effective Date.--The amendments made by this section
shall apply to taxable years beginning after December 31,
2001.
SEC. 3. CLARIFICATION OF FEDERAL EMPLOYEE BENEFITS.
Section 7905 of title 5, United States Code, is amended--
[[Page S781]]
(1) in subsection (a)--
(A) in paragraph (2)(C) by inserting ``and'' after the
semicolon;
(B) in paragraph (3) by striking ``; and'' and inserting a
period; and
(C) by striking paragraph (4); and
(2) in subsection (b)(2)(A) by amending subparagraph (A) to
read as follows:
``(A) a qualified transportation fringe as defined in
section 132(f)(1) of the Internal Revenue Code of 1986;''.
Mr. WARNER. Mr. President, I am pleased today to join with my
distinguished colleague from New York, Senator Schumer, to introduce
the Commuter Benefits Equity Act of 2001.
Transportation gridlock in the metropolitan Washington region is
dramatic and well documented. The average commuter spends about 76
hours a year idling on our area roads. The average speed on the Capital
Beltway has decreased from 47 miles per hour to 23 miles per hour
today. This wasted time in cars results in lost work productivity, lost
time with families and degraded air quality. The quality of life for
commuters is significantly reduced all across the country. I firmly
believe the strength of our economy will be jeopardized if the growing
rate of congestion in our communities remains unchecked.
Yes, the construction of new roads and the expansion of existing
roads must occur. But, this alone is not the answer to our problems.
Relief from our growing gridlock will not come from any one solution.
It will only come from an integrated policy of options that provide
short-term, immediate solutions, together with long-term planning for
new transportation facilities, both roads and transit.
For these reasons, I have worked over the years to provide commuters
with greater incentives to use mass transit, bus or rail, and to join
vanpools. Increased transit ridership, extension of the Metro system,
the Dulles Rapid Transit System, and expanded telecommuting
opportunities are critical to providing temporary short-term solutions.
Greater transit use and broader telework options are measures we can
implement today that will deliver results tomorrow.
The measure I am introducing today with Senator Schumer will provide
parity in the tax code for those who enjoy employer-provided parking
and those who elect to commute by mass transit.
Today, the tax code provides two benefits for employers to offer
their employees, both Federal employees and those in the private
sector. Employers can offer employees a cash benefit of $65 per month
for commuting expenses, or employers can set aside up to $65 per month
of an employee's pre-tax income to pay for commuting costs. Under the
tax code, however, the employer-provided parking benefit is valued at
$175 per month.
The legislation introduced today will increase the transit/vanpool
benefit to $175 per month to be on par with the value of the parking
benefit.
Last year, I authored a provision in the FY 2001 Department of
Defense Authorization bill requiring the Department of Defense to offer
the cash commuting benefit to all DOD employees working in areas that
do not meet the Federal air quality standards. With a total
metropolitan Washington regional federal workforce of 323,000 persons,
the Department of Defense is, by far, the single largest federal
employer with 65,000 persons.
The implementation of this benefit by the Federal agencies will
improve employee satisfaction and have a positive effect on retention
rates in the Federal workforce. This measure, however, is not limited
to Federal employees. It does extend the benefit to private sector
employees as well.
Equally important are the resulting air quality benefits from
increased transit use. According to the Environmental Protection
Agency, the metropolitan Washington area is an air quality non-
attainment area, categorized as severe, under the Clean Air Act
Amendments of 1990. Mobile sources are responsible for the majority of
our air quality violations.
Mr. President, I commend this legislation to my colleagues for their
attention. It's costs are modest, and the benefits to our society are
significant.
Mr. SARBANES. Mr. President, I am pleased to join with my colleagues
Senators Schumer and Warner in introducing the Commuter Benefits Equity
Act of 2001. This measure is another important step forward in our
efforts to make transit services more accessible and improve the
quality of life for commuters throughout the nation.
All across the nation, congestion and gridlock are taking their toll
in terms of economic loss, environmental impacts, and personal
frustration. According to the Texas Transportation Institute's Annual
Mobility Report, in 1997, Americans in 68 urban areas spent 4.3 billion
hours stuck in traffic, with an estimated cost to the nation of $72
billion in lost time and wasted fuel, and the problem is growing. One
way in which federal, state, and local governments are responding to
this problem is by promoting greater use of transit as a commuting
option. The American Public Transportation Association estimates that
last year, Americans took over 9.4 billion trips on transit, the
highest level in more than 40 years. But we need to do more to
encourage people to get out of their cars and onto public
transportation.
The Internal Revenue Code currently allows employers to provide a
tax-free transit benefit to their employees. Under this ``Commuter
Choice'' program, employers can set aside up to $65 per month of an
employee's pre-tax income to pay for the cost of commuting by public
transportation or vanpool. Alternatively, an employer can choose to
offer the same amount as a tax-free benefit in addition to an
employee's salary. This program is designed to encourage Americans to
leave their cars behind when commuting to work.
By all accounts, this program is working. In the Washington area, for
example, the Washington Metropolitan Area Transit Authority reports
that 168,500 commuters take advantage of transit pass programs offered
by their employers. That means fewer cars on our congested streets and
highways.
Employees of the federal government account for a large percentage of
those benefitting from this program in the Washington area. Under an
Executive Order issued by President Clinton, all federal agencies in
the National Capital Region, which includes Montgomery, Prince
George's, and Frederick Counties, Maryland, as well as several counties
in Northern Virginia, are required to offer this transit benefit to
their employees. The Commuter Choice program is now being used by
115,000 Washington-area federal employees who are choosing to take
transit to work.
However, despite the success of the Commuter Choice program in taking
cars off the road, our tax laws still reflect a bias toward driving.
The Internal Revenue Code allows employers to offer a tax-free parking
benefit to their employees of up to $175 per month. The striking
disparity between the amount allowed for parking--$175 per month--and
the amount allowed for transit--$65 per month--undermines our
commitment to supporting public transportation use.
The Commuter Benefits Equity Act would address this discrepancy by
raising the maximum monthly transit benefit to $175, equal to the
parking benefit. The federal government should not reward those who
drive to work more richly than those who take public transportation.
Indeed, since the passage of the Intermodal Surface Transportation
Efficiency Act of 1991, federal transportation policy has endeavored to
create a level playing field between highways and transit, favoring
neither mode above the other. The Commuter Benefits Equity Act would
ensure that our tax laws reflect this balanced approach.
In addition, the Commuter Benefits Equity Act would remedy another
inconsistency in current law. Private-sector employers can offer their
employees the transit benefit in tandem with the parking benefit, to
help employees pay for the costs of parking at transit facilities,
commuter rail stations, or other locations which serve public
transportation or vanpool commuters. However, under current law,
federal agencies cannot offer a parking benefit to their employees who
use park-and-ride lots or other remote parking locations. The Commuter
Benefits Equity Act would remove this restriction, allowing federal
employees access to the same benefits enjoyed by their private-sector
counterparts.
The Washington Metropolitan Region is home to thousands of federal
employees. It is also one of the nation's most highly congested areas,
with the second longest average commute time
[[Page S782]]
in the country. This area ranks third in the nation in the number of
workers commuting more than 60 minutes to work, and has the highest per
vehicle congestion cost and the second highest per capita congestion
cost in the nation. It is clearly in our interest to support programs
which encourage federal employees to make greater use of public
transportation for their commuting needs.
The simple change made by the Commuter Benefits Equity Act would
provide a significant benefit to those federal employees whose commute
to work includes parking at a transit facility. For example, a commuter
who rides the Metrorail System to work and parks at the Wheaton park-
and-ride lot pays about $50 monthly for parking, on top of the cost of
riding the train. A private-sector employee whose employer provides the
parking benefit in addition to salary could receive $600 a year tax
free to help pay these parking costs. Federal government employees
should be allowed the same benefit.
I support the Commuter Benefits Equity Act because it creates
parity--parity in the tax code between the parking and transit
benefits, and parity for federal employees with their private-sector
counterparts. Both of these improvements will aid our efforts to fight
congestion and pollution by supporting public transportation. I
encourage my colleagues to join me in supporting the Commuter Benefits
Equity Act.
______
By Mr. McCONNELL (for himself, Mr. Torricelli, Mrs. Feinstein,
Mr. Allard, Mr. Smith of Oregon, Ms. Landrieu, Mr. Burns, Mr.
Bennett, Mr. Breaux, Mr. Hutchinson, Mr. Santorum, Mr. Warner,
Mr. Reid, and Mr. Roberts).
S. 218. A bill to establish an Election Administration Commission to
study Federal, State, and local voting procedures and election
administration and provide grants to modernize voting procedures and
election administration, and for other purposes; to the Committee on
Rules and Administration.
Mr. McCONNELL. Mr. President, I rise today to re-introduce along with
Senators Torricelli, Feinstein, Allard, Smith, Breaux, Burns, Reid,
Bennett, Landrie, Santorum, Roberts, Hutchinson, and Warner meaningful,
bipartisan legislation to reform the administration of our nation's
elections. I ask that the entire text of my statement and the text of
the legislation appear in the record.
As we move into the twenty-first century it is inexcusable that the
world's most advanced democracy relies on voting systems designed
shortly after the Second World War. The goal of our legislation is
rather simple: that no American ever again be forced to hear the
phrases dimpled chad, hanging chad or pregnant chad. The Election
Reform Act will ensure that our nation's electoral process is brought
up to twenty-first century standards.
By combining the Federal Election Commission's Election Clearinghouse
and the Department of Defenses' Office of Voting Assistance, which
facilitates voting by American civilians and servicemen overseas, into
the Election Administration Commission, the bill will create one agency
that can bring focuses expertise to bear on the administration of
elections. This Commission will consist of four Commissioners appointed
by the President with the advice and consent of the Senate. It will
continue to carry out the functions of the two entities that are being
combined to create it.
In addition, the new Commission will engage in ongoing study and make
periodic recommendations on the best practices relating to voting
technology and ballot design as well as polling place accessibility for
the disabled. The Commission will also study and recommend ways to
improve voter registration, verification of registration, and the
maintenance and accuracy of voter rolls. This is of special urgency in
view of the allegations surfacing in this election of hundreds of
felons being listed on voting rolls and illegally voting, as reported
in the Miami Herald, while other law abiding citizens who allegedly
registered were not included on the voting rolls and were unable to
vote. Such revelations from this year's elections coupled with the
well-knows report by ``60 Minutes'' of the prevalence of dead people
and pets both registering and voting in past elections make clear the
need for thoughtful study and recommendations to ensure that everyone
who is legally entitled to vote is able to do so and that everyone who
votes is legally entitled to do so--and does so only once.
In addition to its studies and recommendations, the Commission will
provide matching grants to states working to improve election
administration. During the first four years, low-income communities
will get priority for these grants and low-income communities are
permanently exempted from the requirement to provide matching funds.
The legislation also ensure that states comply with the provisions in
the Uniformed Overseas Voting Act designed to facilitate voting by
members of the armed forces stationed overseas.
Finally, I am pleased also to announce that Representative Tom Davis,
along with Representatives Rothman, Dreier, and Hastings are re-
introducing the House companion to our bill today.
______
Mr. DODD (for himself, Mr. McCain, Mr. Hollings, and Mr. Hagel):
S. 219. A bill to suspend for two years the certification procedures
under section 490(b) of the Foreign Assistance Act of 1961 in order to
foster greater multilateral cooperation in international
counternarcotics programs, and for other purposes; to the Committee on
Foreign Relations.
Mr. DODD. Mr. President, today I send to the desk legislation on
behalf of myself, Senators McCain, Hollings and Hagel. The purpose of
the bill we are introducing today is to help the incoming Bush
administration in its efforts to strengthen international cooperation
in combating international drug trafficking and drug-related crimes.
As you know, the issue of how best to construct and implement an
effective international counter narcotics policy has been the subject
of much debate in this Chamber over the years, and I would add much
disagreement. Our intention in introducing this legislation is to try
to see if there is some way to end what has become a stale annual
debate that has not brought us any closer to mounting a credible effort
to eliminate or even contain the international drug mafia. We all can
agree that drugs are a problem--a big problem. We can agree as well
that the international drug trade poses a direct threat to the United
States and to international efforts to promote democracy, economic
stability, human rights, and the rule of law throughout the world, but
most especially in our own hemisphere.
While the international impact is serious and of great concern, of
even greater concern to me personally are effects it is having here at
home. Last year Americans spent more than $60 billion to purchase
illegal drugs. Nearly 15 million Americans (twelve years of age and
older) use illegal drugs, including 1.5 million cocaine users, 208,000
heroin addicts, and more than 11 million smokers of marijuana. This
menace isn't just confined to inner cities or the poor. Illegal drug
use occurs among members of every ethnic and socioeconomic group in the
United States.
The human and economic costs of illegal drug consumption by Americans
are enormous. More than 16,000 people die annual as a result of drug
induced deaths. Drug related illness, death, and crime cost the United
States approximately over $100 billion annually, including costs for
lost productivity, premature death, and incarceration.
This is an enormously lucrative business--drug trafficking generates
estimated revenues of $400 billion annually. The United States has
spent more than $30 billion in foreign interdiction and source country
counter narcotics programs since 1981, and despite impressive seizures
at the border, on the high seas, and in other countries, foreign drugs
are cheaper and more readily available in the United States today than
two decades ago.
We think that for a variety of reasons, that the time is right to
give the incoming Bush administration some flexibility with respect to
the annual certification process, so that it can determine whether this
is the best mechanism for producing the kind of international
cooperation and partnership that is needed to contain this
transnational menace. I believe that
[[Page S783]]
government leaders, particularly in this hemisphere, have come to
recognize that illegal drug production and consumption are increasingly
threats to political stability within their national borders. Clearly
President Pastrana of Colombia has acknowledged that fact and has
sought to work very closely with the United States in implementing Plan
Colombia. Similarly President Vincente Fox of Mexico has made
international counter narcotics cooperation a high priority since
assuming office last December. These leaders also feel strongly,
however, that unilateral efforts by the United States to grade their
governments' performance in this area is a major irritant in the
bilateral relationship and counterproductive to their efforts to
instill a cooperative spirit in their own bureaucracies.
The legislation we are introducing today recognizes that illicit drug
production, distribution and consumption are national security threats
to many governments around the globe, and especially many of those in
our own hemisphere, including Mexico, Colombia, and other countries in
the Andean region. It urges the Administration to develop an enhanced
multilateral strategy for addressing these threats from both the supply
and demand side of the equation. It calls upon the President to
consider convening a conference of heads of state, at an early date, to
review on a country-by-country basis, national strategies for drug
reduction and prevention, and agree upon a time table for action. It
also recommends that the President submit any legislative changes to
existing law which he deems necessary in order to implement this
international program within one year from the enactment of this
legislation.
In order to create the kind of international cooperation and mutual
respect that must be present if the Bush administration's effort is to
produce results, the bill would also suspend the annual drug
certification procedure for a period of 2 years, while efforts are
ongoing to develop and implement this enhanced multilateral strategy. I
believe it is fair to say that while the certification procedure may
have had merit when it was enacted into law in 1986, it has now become
a hurdle to furthering bilateral and multilateral cooperation with
other governments, particularly those in our own hemisphere such as
Mexico and Colombia--governments whose cooperation is critical if we
are to succeed in stemming the flow of drugs across our borders.
Let me make clear however, that while we would not be ``grading''
other governments on whether they have ``cooperated fully'' during the
two year ``suspension'' period, the detailed reporting requirements
currently required by law concerning what each government has done to
cooperate in the areas of eradication, extradition, asset seizure,
money laundering and demand reduction during the previous calendar year
will remain in force. We will be fully informed as to whether
governments are following short of their national and international
obligations. Moreover, if the President determines during the two year
suspension period that the certification process may be useful in order
to elicit more cooperation from a particular government he may go ahead
and issue the annual certification decision with respect to that
country. The annual determination as to which countries are major
producers or transit sources of illegal drugs will also continue to be
required by law.
I believe that we need to reach out to other governments who share
our concerns about the threat that drugs pose to the very fabric of
their societies and our own. It is arrogant to assume we are the only
Nation that cares about such matters. We need to sit down and figure
out what each of us can do better to make it harder for drug
traffickers to ply their trade. It is in that spirit that we urge our
colleagues to give this proposal serious consideration. Together,
working collectively we can defeat the traffickers. But if we expend
our energies playing the blame game, we are certainly not going to
effectively address this threat. We aren't going to stop one additional
teenager from becoming hooked on drugs, or one more citizen from being
mugged outside his home by some drug crazed thief.
During the Clinton Administration, Barry McCaffrey, the Director of
the Office of National Drug Control Policy did a fine job in attempting
to forge more cooperative relations with Colombia, Mexico and other
countries in our own hemisphere. The OAS has also done some important
work over the last several years in putting in place an institutional
framework for dealing with the complexities of compiling national
statistics so that we can better understand what needs to be done. The
United Nations, through its Office for Drug Control and Crime
Prevention has also made some important contributions in furthering
international cooperation in this area. However, still more needs to be
done. We believe that this legislation will build upon that progress. I
would urge my colleagues to give some thought and attention to our
legislative initiative. We believe that if they do, that they will come
to the conclusion that it is worthy of their support.
Mr. President, I ask unanimous consent that the text of this
legislation be printed in the Record at the conclusion of these
remarks.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 219
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. TWO-YEAR SUSPENSION OF DRUG CERTIFICATION
PROCEDURES.
(a) Findings.--Congress makes the following findings:
(1) The international drug trade poses a direct threat to
the United States and to international efforts to promote
democracy, economic stability, human rights, and the rule of
law.
(2) The United States has a vital national interest in
combating the financial and other resources of the
multinational drug cartels, which resources threaten the
integrity of political and financial institutions both in the
United States and abroad.
(3) Illegal drug use occurs among members of every ethnic
and socioeconomic group in the United States.
(4) Worldwide drug trafficking generates revenues estimated
at $400,000,000,000 annually.
(5) The 1961 Single Convention on Narcotic Drugs, the 1971
Convention on Psychotropic Substances, and the 1988
Convention Against Illicit Traffic in Narcotic Drugs and
Psychotropic Substances form the legal framework for
international dung control cooperation.
(6) The United Nations International Drug Control Program,
the International Narcotics Control Board, and the
Organization of American States can play important roles in
facilitating the development and implementation of more
effective multilateral programs to combat both domestic and
international drug trafficking and consumption.
(7) The annual certification process required by section
490 of the Foreign Assistance Act of 1961 (22 U.S.C. 2291j),
which has been in effect since 1986, does not currently
foster effective and consistent bilateral or multilateral
cooperation with United States counternarcotics programs
because its provisions are vague and inconsistently applied
and in many cases have been superseded by subsequent
bilateral and multilateral agreements and because it
alienates the very allies whose cooperation we seek.
(b) Sense of Congress.--It is the sense of Congress that--
(1) many governments are extremely concerned by the
national security threat posed by illicit drug production,
distribution, and consumption, and crimes related thereto,
particularly those in the Western Hemisphere;
(2) an enhanced multilateral strategy should be developed
among drug producing, transit, and consuming nations designed
to improve cooperation with respect to the investigation and
prosecution of drug related crimes, and to make available
information on effective drug education and drug treatment;
(3) the President should at the earliest feasible date in
2001 convene a conference of heads of state of major illicit
drug producing countries, major drug transit countries, and
major money laundering countries to present and review
country by country drug reduction and prevention strategies
relevant to the specific circumstances of each country, and
agree to a program and timetable for implementation of such
strategies; and
(4) not later than one year after the date of the enactment
of this Act, the President should transmit to Congress
legislation to implement a proposed multilateral strategy to
achieve the goals referred to in paragraph (2), including any
amendments to existing law that may be required to implement
that strategy.
(c) Two-Year Suspension of Drug Certification Process.--(1)
Subsections (a) through (g) of section 490 of the Foreign
Assistance Act of 1961 (22 U.S.C. 2291j), relating to annual
certification procedures for assistance for certain drug-
producing countries and drug-transit countries, shall not
apply in the first 2 calendar years beginning after the date
of the enactment of this Act.
[[Page S784]]
(2) Notwithstanding any provision of paragraph (1), section
489 of the Foreign Assistance Act of 1961 (22 U.S.C. 2291h),
relating to the international narcotics control strategy
report, and section 490(h) of that Act (22 U.S.C. 2291j(h)),
relating to determinations of major drug-transit countries
and major illicit drug producing countries, shall continue to
apply in the 2 calendar years referred to in that paragraph.
(3) The President may waive the applicability of paragraph
(1) to one or more countries in one or both of the calendar
years referred to in that paragraph if the President
determines that bilateral counternarcotics cooperation would
be enhanced by the applicability of subsections (a) through
(g) of section 490 of the Foreign Assistance Act of 1961 to
such country or countries in such calendar year.
(d) Applicability.--(1) Except as provided in paragraph
(2), the provisions of subsection (c) shall take effect on
the date of the enactment of this Act and apply with respect
to certifications otherwise required under section 490 of the
Foreign Assistance of 1961 in the first two fiscal years
beginning after that date.
(2) If this Act is enacted on or before February 28, 2001,
the provisions of subsection (c) shall take effect on the
date of the enactment of this Act and apply with respect to
certifications otherwise required under section 490 of the
Foreign Assistance of 1961 in fiscal years 2001 and 2002.
Mr. HOLLINGS. Mr. President, I rise today to join my good friend
Senator Dodd, and our distinguished colleagues Senator Hagel and
Chairman McCain, in cosponsoring an important piece of legislation with
far-reaching effects in our struggle to combat drug trafficking. Our
bill calls for the development of a multilateral strategy among major
illicit drug producing, transit, drug demand, and consuming countries
to improve cooperation with respect to the investigation and
prosecution of drug related crimes. Intelligence reports have shown
that sophisticated cartels operate on a truly global scale. America's
drug demand problems may feed Europe's money laundering problems which
are related to Asia's organized crime problems or street-crime in Latin
America. All the states of the world are under attack from a common,
sophisticated enemy. Our bill encourages the President of the United
States to bring the heads of state together to review individual
country strategies and develop a new multilateral approach. This bill
requires the President to submit to Congress legislation to implement a
multilateral strategy devised through the consultation process
described above.
Drug trafficking becomes harder to fight as the world becomes
increasingly interconnected. I am united with my colleagues to remain
vigilant in fighting the proliferation of drugs on the streets of the
United States. The last time I checked, the United States does not
produce one ounce of cocaine, or one ounce of heroin. This bill
recognizes the essential truth of drug trafficking--it is a
multinational, multifaceted criminal plague that respects no borders.
With this in mind, I rise to support a 2-year moratorium of the
annual U.S. certification procedures which require the President to
certify that other nations qualify as ``partners'' in combating drug
trafficking. This certification is required for the release of certain
U.S. bilateral assistance, as well as for the release of multilateral
development aid from institutions where the United States is a voting
member. This practice stymies multilateral cooperation in combating
drug trafficking and has not yielded any measurable results--unless one
counts the resentment of our neighbors. We need a new approach and new
strategic partners. This legislation will direct President Bush to seek
out new approaches and new partners rather than wasting time and energy
on certification.
Officials from Mexico, our neighbor and close ally, have routinely
appealed to the President of the United States and to Congress to
suspend the drug certification process. They argue it is detrimental to
bilateral cooperation in enforcement and interdiction, it is bad for
the morale of law enforcement, and it serves to absolve the United
States from its responsibility in the proliferation of drug
trafficking. Americans spend an estimated $110 billion a year on
illegal drugs--the equivalent of one-tenth the value of the country's
entire industrial production. Unfortunately, the dedicated and
hardworking efforts of our law enforcement and customs officials to
gain control of drugs entering our country from Mexico are to date
unsuccessful. The Mexican police have been overwhelmed by the sheer
volume of drugs transhipped through their country (The DEA estimated
that, in 1999, 55 percent of the cocaine and 14 percent of the heroin
which enter the United States came from Mexico, as did 3,700 metric
tons of marijuana). The situation is further complicated by the
existing corruption in Mexican police ranks. By way of example, in
December 1999 the Government of Mexico reported that between 1997 and
1999 more than 1,400 federal police officers had been fired for
corruption and that 357 of the officers had been prosecuted. Given the
pervasive scale of the problem, the Federal Preventive Police (FPP) was
created to investigate and root out crooked officers in the federal
police. By the winter of 2000, several agents of the FPP were under
investigation themselves for corruption.
Despite these grim examples there are clear signs of hope. In July
2000 Mexico turned a corner in history and ended seven decades of one-
party rule by sending opposition candidate Vincente Fox to Los Pinos.
Fox cast a wide net in the Mexican mainstream with themes of inclusion
and governmental responsiveness in a historic campaign. ``Democracy is
a starting point--it is the process by which society becomes organized
and gains its own voice'' said Fox. ``Democracy provides the legitimacy
necessary for the country to meet the historic challenges in the areas
of development, social justice, and the reduction of inequality.''
President Fox represents a clean break with the institutionalized
corruption and graft that carried Mexico to the brink of Chaos in 1994
when PRI presidential candidate Donaldo Colosio was assassinated.
President Fox inherited a judicial system and a federal police force
rocked by scandal and largely ineffectual in combating drug
trafficking. Mexico ranked 4th in the World Bank's 2000 list of most
corrupt governments. Backed with a popular mandate for change, Fox put
fighting corruption as the overarching goal in all his policy
initiatives. The task will not be easy. Last Friday, January 19th, for
example, it was reported that convicted drug kingpin Joaquin Guzman
Loera escaped from a maximum security prison in Jalisco. Guzman is a
leader of the Felix Gallardo drug family, which authorities say is
deeply involved in shipping illegal drugs to the United States.
While I am sobered by the accounts of the Guzman escape, it is
encouraging that the Mexican Supreme Court reversed its decision on
extraditions for drug crimes and agreed to turn over drug kingpins
wanted in the United States. We must further these confidence-building
initiatives between the United States and Mexico. One way to do this is
to grant Mexico a two-year moratorium from the drug certification
process to allow President Fox to organize his Administration and to
set his course. We should not evaluate President Fox for the corruption
of his predecessors. We must allow him to address the endemic
corruption that plaques the Mexican state.
This legislation does not cede Congress' role in the so-called drug
war. It call for new energy and a new multilateral approach. It
emphasizes Congress' interest in building real partnerships and looking
for new answers in this difficult struggle. This legislation will give
us a fresh start with our neighbor to the south and build confidence
between our people. President Fox is committed to reforming Mexico and
I intend to urge my colleagues to help this vibrant new leader to
achieve his goal. He has brought the liberating force of democracy to
his people, but his work is not done. President Fox has to use his
power to transform the state. He has an old order to dismantle, a new
one to build, and 6 years to do it. I have confidence in Mr. Fox and
his able cabinet. My colleagues and I are reaching out to the Fox
Administration and the Mexican people; we want to build a partnership
and seek new ways to address common problems.
______
By Mrs. BOXER:
S. 221. A bill to authorize the Secretary of Energy to make loans
through a revolving loan fund for States to construct electricity
generation facilities for use in electricity supply emergencies.
Mrs. BOXER. Mr. President, since last week, I have introduced several
bills to help California deal with the
[[Page S785]]
electricity crisis and to help prevent such emergencies from occurring
in other States in the future. Today, I am introducing another such
bill--the State Electricity Reserve Fund Act.
Current electricity generating capacity is tied to the expected need.
Private generating companies have no incentive to build or maintain
facilities that would generate capacity greater than what is needed to
meet consumer demand. The plants would be idle most of the time. As a
result, electricity shortages can occur.
A lack of rainfall, which means that hydroelectric facilities cannot
be operated as often, as well as unseasonably hot or cold temperatures,
or rapid population increases in a State can all result in a demand for
electricity unexpectedly exceeding supply. But with supply tied to
expected demand, this can result in devastatingly large price increases
for consumers and/or electricity shortages, which in turn could cause
brownouts or blackouts.
This is exactly what has happened in California. In the late 1980's,
the California Public Utilities Commission required utilities to
determine demand for new power generating capacity. At that time, the
state recognized that generation needs could increase. However, the
utilities argued that no new capacity would be needed in California
until 2005. The utilities fought the attempt by the state to make them
build more generating capacity. The utilities argued it was not needed.
It turned out that it was needed. And whether the utilities should
have known is another argument for another day. But the point here is
that we cannot rely on the private sector to create a ``rainy day
fund'' of electricity in the event of emergencies.
So, the State Electricity Reserve Fund Act would create a revolving
loan fund for states to use to help pay for the creation of an
electricity reserve capacity. These loans could be used by states to
build electricity generation facilities that would be controlled by the
state and would be kept in reserve unless the Governor of the State
declares an electricity emergency.
Mr. President, it is not an unusual thing for the federal government
to prepare for energy emergencies. We have the Strategic Petroleum
Reserve in the case of oil shortages, and last year we established the
Home Heating Oil Reserve for the Northeastern States. My bill is based
on the same premise.
True, we cannot store electricity like we can store petroleum and
heating oil. But we can financially help States build a reserve
facility, including a reserve of the fuel that is needed to generate
electricity, to be used in the case of electricity emergencies. If such
a reserve had existed in California, we would not have reached State
III emergencies and rolling blackouts over the past couple of weeks.
Mr. President, I think being prepared for emergencies is always a
good policy. Helping States be prepared for electricity emergencies is
no different.
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. 221
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``State Electricity Reserve
Fund Act of 2001''.
SEC. 2. PURPOSE.
The purpose of this Act is to assist States in creating
electric generating capacity to be used in the event of an
electricity emergency.
SEC. 3. EMERGENCY ELECTRICITY GENERATION FACILITIES.
(a) Revolving Loan Fund.--There is established in the
Treasury of the United States a revolving loan fund to be
known as the ``State Electricity Reserve Loan Fund''
consisting of such amounts as may be appropriated or credited
to such Fund as provided in this section.
(b) Expenditures From Loan Fund.--
(1) In general.--The Secretary of Energy, under such rules
and regulations as the Secretary may prescribe, may make
loans from the State Electricity Reserve Loan Fund, without
further appropriation, to a State.
(2) Purpose.--Loans provided under this section shall be
used for the purpose of designing and constructing 1 or more
facilities in a State with capacity to generate an amount of
electricity sufficient to meet the amount of any intermittent
deficiencies in electricity supply that the State may
reasonably be expected to experience during any period over
the next 10 years.
(3) Use of funds.--A facility designed or constructed with
a loan provided under this section--
(A) shall be owned by the State and operated by the State
directly or through a contract with an electric utility or a
consortium of electric utilities; and
(B) shall be operated to supply electricity to the
electricity transmission grid only during periods of
electricity emergencies declared by the Governor of the
State.
(4) Determinations by secretary.--No loan shall be provided
under this section unless the Secretary determines that--
(A) there is reasonable assurance of repayment of the loan;
and
(B) the amount of the loan, together with other funds
provided by or available to the State, is adequate to assure
completion of the facility or facilities for which the loan
is made.
(5) Loan amount.--The amount of a loan provided under this
section shall not exceed the lesser of--
(A) 40 percent of the costs to be incurred in designing and
constructing the facility or facilities involved; or
(B) $1,000,000,000.
(c) Loan Repayment.--
(1) Length of repayment.--
(A) In general.--Before making a loan under this section,
the Secretary shall determine the period of time within which
a State must repay such loan.
(B) Limitation.--Except as provided in subparagraph (C),
the Secretary shall in no case allow repayment of such loan--
(i) to begin later than the date that is 2 years after the
date on which the loan is made; and
(ii) to be completed later than the date that is 10 years
after the date on which the loan is made.
(C) Moratorium.--The Secretary may grant a temporary
moratorium on the repayment of a loan provided under this
section if, in the determination of the Secretary, continued
repayment of such loan would cause a financial hardship on
the State that received the loan.
(2) Interest.--The Secretary may not impose or collect
interest or other charges on a loan provided under this
section.
(3) Credit to loan fund.--Repayment of amounts loaned under
this section shall be credited to the State Electricity
Reserve Loan Fund and shall be available for the purposes for
which the fund is established.
(d) Administration Expenses.--The Secretary may defray the
expenses of administering the loans provided under this
section.
(e) Appropriations.--Out of any funds in the Treasury not
otherwise appropriated, there are appropriated to the State
Electricity Reserve Loan Fund--
(1) $5,000,000,000 in fiscal year 2002;
(2) $4,000,000,000 in fiscal year 2003;
(3) $3,000,000,000 in fiscal year 2004;
(4) $2,000,000,000 in fiscal year 2005; and
(5) $1,000,000,000 in fiscal year 2006.
____________________