Congressional Record, Volume 149 Issue 36 (Thursday, March 6, 2003)

[Congressional Record Volume 149, Number 36 (Thursday, March 6, 2003)]
[Senate]
[Pages S3254-S3333]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

By Ms. SNOWE (for herself, Mr. Bond, Mr. Talent, Mrs. Dole, Mr.
McCain, Mr. Coleman, and Mrs. Hutchison):

[[Page S3255]]

S. 545. A bill to amend title I of the Employee Retirement Income
Security Act of 1974 to improve access and choice for entrepreneurs
with small businesses with respect to medical care for their employees;
to the Committee on Health, Education, Labor, and Pensions.
Ms. SNOWE. Mr. President, today I am introducing a bill that will
provide revolutionary changes to the health insurance choices available
for small businesses. This bill, ``The Small Business Health Fairness
Act of 2003'' will give small businesses the same market-based
advantages and leverage that large employers and unions currently enjoy
to provide health insurance for their employees.
One month ago, I convened my first hearing as Chair of the Committee
on Small Business and Entrepreneurship to explore the crisis small
businesses are currently facing in their attempts to find affordable
health care for their employees. The reason I made this my first
hearing was that whenever I spoke to small businesses this is the
number one issue they wanted to discuss. Small businesses in my State
are literally desperate for more health insurance options; some
business owners even say this is keeping them awake at night.
At the hearing small businesses from my home State of Maine made it
clear that they have only one choice for their health care. Even when
they band together in local purchasing pools, they are unable to
attract any other insurance carriers to provide them with less
expensive and more flexible options. Even though they have cut back on
the coverage and increased the costs to the employees, they are still
finding it almost impossible to provide health insurance to their
employees. And as the costs to the employees increases, many employees
find this too much to absorb, which leaves them uncovered and,
therefore, increase the ranks of the employed but uninsured.
Indeed, the Washington Post reported on February 28 that worries
about rising health care costs registered higher in a poll conducted by
the Kaiser Family Foundation than even concerns over the stock market
or terrorist attacks. Thirty-eight percent of the respondents were
``very worried'' that the cost of their health care or health insurance
would increase compared to 22 percent who were ``very worried'' about
losing their savings in the stock market, or 19 percent who were ``very
worried'' about being a victim of a terrorist attack.

With small businesses creating up to 75 percent of net new jobs in
America and with a shocking 56 percent of the 41.2 million uninsured in
this country already either working a full-time, full-year job or
depending on one who does, we have an obligation to ensure that more of
these individuals can receive insurance through their employers. So
when the Kaiser 2002 Employer Health Benefits Survey reports that only
61 percent of all small businesses are offering health benefits--and
that's down from 67 percent just three years ago--is there any question
that we're headed in exactly the wrong direction?
This is a crisis, and it's even worse in businesses with fewer than
50 employees. Of those, only 47 percent currently provide health
insurance benefits, and the Department of Labor reports that only 24
percent of small businesses that employ ``low-wage'' workers offer
health plans.
The fact is, with more than two-thirds of all Americans relying on
their employer for health insurance, we can't afford to continue the
disturbing trend identified by the Kaiser Family Foundation, where
monthly premiums for employer-sponsored health insurance on average
rose 11 percent from 2000 to 2001, and then 12.7 percent from 2001 to
2002--the second straight year of double digit increases. As a result,
22 percent of all firms increased employee deductibles in 2002, and 32
percent told Kaiser they are likely to do so this year.
The problem is all the more acute for small businesses. For those
with fewer than 10 workers, the employer and employees together pay--on
average--about 8 percent more in premiums than the amount paid by
larger companies. And for all firms under 200 employees, 84 percent
indicated to Kaiser that cost was an important factor in not offering
health care.
The result of all this isn't hard to predict. Businesses can and
clearly are dropping health benefits. Others struggle onward in
providing coverage, but only at the cost of the growth of the business,
or offering packages with higher premiums, or a combination of both.
If we can do something that will help more small businesses provide
health insurance to their employees, then we can significantly reduce
the number of those who are without health insurance in this country.
The Small Business Health Fairness Act of 2003 will improve access to
affordable health care for small businesses by giving them the same
advantages currently enjoyed by large employers and unions. The bill
employs a very basic principle--that volume purchasing of insurance by
small businesses will work as it does for any other commodity and for
any large business or union that purchases health insurance coverage--
it will help reduce the cost. As President Bush has said, ``It makes no
sense in America to isolate small businesses as little health care
islands unto themselves. We must have association health plans.''
The Act will allow small businesses to pool together nationally,
under the auspices of their bona fide associations, and either purchase
their insurance from a provider, or self-insure in the same way that
large employers and unions currently do. These association health
plans, AHPS, would be monitored and regulated by the Department of
Labor's Employee Benefits Security Administration in the same way that
more than 275,000 plans offered by large employers and unions are
currently regulated.

This agency is currently overseeing plans that cover 72 million
people. The Department of Labor released a report last week that
reveals high rates of compliance by group health plans with health care
laws enacted under the Employee Retirement Income Security Act, ERISA.
More importantly, the report and the compliance project that is the
subject of the report, are further evidence of the Labor Department's
commitment and proven success in effectively monitoring health plans.
The report establishes that the Department is prepared to oversee
association health plans.
Studies by the Small Business Administration, the General Accounting
Office, and the Congressional Budget Office have all found that these
types of plans operate with between 13 and 30 percent lower
administrative costs. These lower costs can then be translated into
reducing costs to subscribers or providing more benefits.
Another reason AHPs will be able to offer less expensive plans, and
also greater flexibility, is because they will be exempt from the
myriad State benefit regulations. Associations will be able to design
their plans to meet the needs of their members and their employees. By
administering one national plan, it will further reduce the
administrative costs instead of trying to administer a plan subject to
the mandates of each State.
Even though the benefit mandates will not be in effect, associations
will need to design their plans so that enough members participate in
them to attract the necessary employees to make them work. This means
that they will naturally provide a full range of benefits similar to
what many States currently require. In many cases, the plans offered by
large employers and unions, which are also exempt from the State
benefit mandates, are the most generous plans available. People will
often stay in those jobs specifically to keep their health care
coverage.
The Act would also provide extensive new protections to ensure that
the health care coverage was there when employees need it. Associations
sponsoring these plans would need to be established for at least three
years for purposes other than providing health insurance--this is
intended to prevent the current epidemic of fraud and abuse that is
occurring through sham associations who take money from unsuspecting
small businesses and then cease to exist when some files a claim.
In addition, association health plans would be required to have
sufficient funds in reserve, specific stop-loss insurances,
indemnification insurance, and other funding and certification
requirements to make sure the insurance coverage would be available
when needed. None of these requirements apply

[[Page S3256]]

to any of the plans currently regulated by the Department of Labor,
either the large employer plans under the Employee Retirement Income
Security Act, ERISA, or the union plans under the Taft-Hartley Act.
The approach of this bill is, I believe, a good one--but I also
consider it a starting point. And in that light, I intend to work with
all groups and interested parties that are committed to passing this
bill so that we can improve this bill and finally provide small
businesses with more health insurance options at lower costs. The
current situation is simply unacceptable. Those who oppose this bill
and believe the status quo only needs to be modified slightly are not
paying attention--they are not listening to the millions of small
businesses who are desperate for more choices, or the small employers
who are unable to get health insurance at any cost.
The time for stalling on providing relief for small businesses unable
to get affordable health insurance is over. We must act now, and we
must pass the Small Business Health Fairness Act of 2003 to bring small
businesses more choices and use the power of competition to bring them
better options.
I ask unanimous consent that the text of The Small Business Health
Fairness Act of 2003 and an explanation of its provisions be printed in
the Record.
There being no objection, the bill and additional material was
ordered to be printed in the Record, as follows:

S. 545

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. SHORT TITLE AND TABLE OF CONTENTS.

(a) Short Title.--This Act may be cited as the ``Small
Business Health Fairness Act of 2003''.
(b) Table of Contents.--The table of contents is as
follows:

Sec. 1. Short title and table of contents.
Sec. 2. Rules governing association health plans.

``Part 8--Rules Governing Association Health Plans

``Sec. 801. Association health plans.
``Sec. 802. Certification of association health plans.
``Sec. 803. Requirements relating to sponsors and boards of trustees.
``Sec. 804. Participation and coverage requirements.
``Sec. 805. Other requirements relating to plan documents, contribution
rates, and benefit options.
``Sec. 806. Maintenance of reserves and provisions for solvency for
plans providing health benefits in addition to health
insurance coverage.
``Sec. 807. Requirements for application and related requirements.
``Sec. 808. Notice requirements for voluntary termination.
``Sec. 809. Corrective actions and mandatory termination.
``Sec. 810. Trusteeship by the Secretary of insolvent association
health plans providing health benefits in addition to
health insurance coverage.
``Sec. 811. State assessment authority.
``Sec. 812. Definitions and rules of construction.

Sec. 3. Clarification of treatment of single employer arrangements.
Sec. 4. Clarification of treatment of certain collectively bargained
arrangements.
Sec. 5. Enforcement provisions relating to association health plans.
Sec. 6. Cooperation between Federal and State authorities.
Sec. 7. Effective date and transitional and other rules.

SEC. 2. RULES GOVERNING ASSOCIATION HEALTH PLANS.

(a) In General.--Subtitle B of title I of the Employee
Retirement Income Security Act of 1974 is amended by adding
after part 7 the following new part:

``Part 8--Rules Governing Association Health Plans

``SEC. 801. ASSOCIATION HEALTH PLANS.

``(a) In General.--For purposes of this part, the term
`association health plan' means a group health plan whose
sponsor is (or is deemed under this part to be) described in
subsection (b).
``(b) Sponsorship.--The sponsor of a group health plan is
described in this subsection if such sponsor--
``(1) is organized and maintained in good faith, with a
constitution and bylaws specifically stating its purpose and
providing for periodic meetings on at least an annual basis,
as a bona fide trade association, a bona fide industry
association (including a rural electric cooperative
association or a rural telephone cooperative association), a
bona fide professional association, or a bona fide chamber of
commerce (or similar bona fide business association,
including a corporation or similar organization that operates
on a cooperative basis (within the meaning of section 1381 of
the Internal Revenue Code of 1986)), for substantial purposes
other than that of obtaining or providing medical care;
``(2) is established as a permanent entity which receives
the active support of its members and requires for membership
payment on a periodic basis of dues or payments necessary to
maintain eligibility for membership in the sponsor; and
``(3) does not condition membership, such dues or payments,
or coverage under the plan on the basis of health status-
related factors with respect to the employees of its members
(or affiliated members), or the dependents of such employees,
and does not condition such dues or payments on the basis of
group health plan participation.

Any sponsor consisting of an association of entities which
meet the requirements of paragraphs (1), (2), and (3) shall
be deemed to be a sponsor described in this subsection.

``SEC. 802. CERTIFICATION OF ASSOCIATION HEALTH PLANS.

``(a) In General.--The applicable authority shall prescribe
by regulation, through negotiated rulemaking, a procedure
under which, subject to subsection (b), the applicable
authority shall certify association health plans which apply
for certification as meeting the requirements of this part.
``(b) Standards.--Under the procedure prescribed pursuant
to subsection (a), in the case of an association health plan
that provides at least one benefit option which does not
consist of health insurance coverage, the applicable
authority shall certify such plan as meeting the requirements
of this part only if the applicable authority is satisfied
that the applicable requirements of this part are met (or,
upon the date on which the plan is to commence operations,
will be met) with respect to the plan.
``(c) Requirements Applicable to Certified Plans.--An
association health plan with respect to which certification
under this part is in effect shall meet the applicable
requirements of this part, effective on the date of
certification (or, if later, on the date on which the plan is
to commence operations).
``(d) Requirements for Continued Certification.--The
applicable authority may provide by regulation, through
negotiated rulemaking, for continued certification of
association health plans under this part.
``(e) Class Certification for Fully Insured Plans.--The
applicable authority shall establish a class certification
procedure for association health plans under which all
benefits consist of health insurance coverage. Under such
procedure, the applicable authority shall provide for the
granting of certification under this part to the plans in
each class of such association health plans upon appropriate
filing under such procedure in connection with plans in such
class and payment of the prescribed fee under section 807(a).
``(f) Certification of Self-Insured Association Health
Plans.--An association health plan which offers one or more
benefit options which do not consist of health insurance
coverage may be certified under this part only if such plan
consists of any of the following:
``(1) a plan which offered such coverage on the date of the
enactment of the Small Business Health Fairness Act of 2003,
``(2) a plan under which the sponsor does not restrict
membership to one or more trades and businesses or industries
and whose eligible participating employers represent a broad
cross-section of trades and businesses or industries, or
``(3) a plan whose eligible participating employers
represent one or more trades or businesses, or one or more
industries, consisting of any of the following: agriculture;
equipment and automobile dealerships; barbering and
cosmetology; certified public accounting practices; child
care; construction; dance, theatrical and orchestra
productions; disinfecting and pest control; financial
services; fishing; foodservice establishments; hospitals;
labor organizations; logging; manufacturing (metals); mining;
medical and dental practices; medical laboratories;
professional consulting services; sanitary services;
transportation (local and freight); warehousing; wholesaling/
distributing; or any other trade or business or industry
which has been indicated as having average or above-average
risk or health claims experience by reason of State rate
filings, denials of coverage, proposed premium rate levels,
or other means demonstrated by such plan in accordance with
regulations which the Secretary shall prescribe through
negotiated rulemaking.

``SEC. 803. REQUIREMENTS RELATING TO SPONSORS AND BOARDS OF
TRUSTEES.

``(a) Sponsor.--The requirements of this subsection are met
with respect to an association health plan if the sponsor has
met (or is deemed under this part to have met) the
requirements of section 801(b) for a continuous period of not
less than 3 years ending with the date of the application for
certification under this part.
``(b) Board of Trustees.--The requirements of this
subsection are met with respect to an association health plan
if the following requirements are met:
``(1) Fiscal control.--The plan is operated, pursuant to a
trust agreement, by a board of trustees which has complete
fiscal control over the plan and which is responsible for all
operations of the plan.

[[Page S3257]]

``(2) Rules of operation and financial controls.--The board
of trustees has in effect rules of operation and financial
controls, based on a 3-year plan of operation, adequate to
carry out the terms of the plan and to meet all requirements
of this title applicable to the plan.
``(3) Rules governing relationship to participating
employers and to contractors.--
``(A) In general.--Except as provided in subparagraphs (B)
and (C), the members of the board of trustees are individuals
selected from individuals who are the owners, officers,
directors, or employees of the participating employers or who
are partners in the participating employers and actively
participate in the business.
``(B) Limitation.--
``(i) General rule.--Except as provided in clauses (ii) and
(iii), no such member is an owner, officer, director, or
employee of, or partner in, a contract administrator or other
service provider to the plan.
``(ii) Limited exception for providers of services solely
on behalf of the sponsor.--Officers or employees of a sponsor
which is a service provider (other than a contract
administrator) to the plan may be members of the board if
they constitute not more than 25 percent of the membership of
the board and they do not provide services to the plan other
than on behalf of the sponsor.
``(iii) Treatment of providers of medical care.--In the
case of a sponsor which is an association whose membership
consists primarily of providers of medical care, clause (i)
shall not apply in the case of any service provider described
in subparagraph (A) who is a provider of medical care under
the plan.
``(C) Certain plans excluded.--Subparagraph (A) shall not
apply to an association health plan which is in existence on
the date of the enactment of the Small Business Health
Fairness Act of 2003.
``(D) Sole authority.--The board has sole authority under
the plan to approve applications for participation in the
plan and to contract with a service provider to administer
the day-to-day affairs of the plan.
``(c) Treatment of Franchise Networks.--In the case of a
group health plan which is established and maintained by a
franchiser for a franchise network consisting of its
franchisees--
``(1) the requirements of subsection (a) and section
801(a)(1) shall be deemed met if such requirements would
otherwise be met if the franchiser were deemed to be the
sponsor referred to in section 801(b), such network were
deemed to be an association described in section 801(b), and
each franchisee were deemed to be a member (of the
association and the sponsor) referred to in section 801(b);
and
``(2) the requirements of section 804(a)(1) shall be deemed
met.

The Secretary may by regulation, through negotiated
rulemaking, define for purposes of this subsection the terms
`franchiser', `franchise network', and `franchisee'.
``(d) Certain Collectively Bargained Plans.--
``(1) In general.--In the case of a group health plan
described in paragraph (2)--
``(A) the requirements of subsection (a) and section
801(a)(1) shall be deemed met;
``(B) the joint board of trustees shall be deemed a board
of trustees with respect to which the requirements of
subsection (b) are met; and
``(C) the requirements of section 804 shall be deemed met.

``(2) Requirements.--A group health plan is described in
this paragraph if--
``(A) the plan is a multiemployer plan; or
``(B) the plan is in existence on April 1, 2003, and would
be described in section 3(40)(A)(i) but solely for the
failure to meet the requirements of section 3(40)(C)(ii).
``(3) Construction.--A group health plan described in
paragraph (2) shall only be treated as an association health
plan under this part if the sponsor of the plan applies for,
and obtains, certification of the plan as an association
health plan under this part.

``SEC. 804. PARTICIPATION AND COVERAGE REQUIREMENTS.

``(a) Covered Employers and Individuals.--The requirements
of this subsection are met with respect to an association
health plan if, under the terms of the plan--
``(1) each participating employer must be--
``(A) a member of the sponsor,
``(B) the sponsor, or
``(C) an affiliated member of the sponsor with respect to
which the requirements of subsection (b) are met,
except that, in the case of a sponsor which is a professional
association or other individual-based association, if at
least one of the officers, directors, or employees of an
employer, or at least one of the individuals who are partners
in an employer and who actively participates in the business,
is a member or such an affiliated member of the sponsor,
participating employers may also include such employer; and
``(2) all individuals commencing coverage under the plan
after certification under this part must be--
``(A) active or retired owners (including self-employed
individuals), officers, directors, or employees of, or
partners in, participating employers; or
``(B) the beneficiaries of individuals described in
subparagraph (A).
``(b) Coverage of Previously Uninsured Employees.--In the
case of an association health plan in existence on the date
of the enactment of the Small Business Health Fairness Act of
2003, an affiliated member of the sponsor of the plan may be
offered coverage under the plan as a participating employer
only if--
``(1) the affiliated member was an affiliated member on the
date of certification under this part; or
``(2) during the 12-month period preceding the date of the
offering of such coverage, the affiliated member has not
maintained or contributed to a group health plan with respect
to any of its employees who would otherwise be eligible to
participate in such association health plan.
``(c) Individual Market Unaffected.--The requirements of
this subsection are met with respect to an association health
plan if, under the terms of the plan, no participating
employer may provide health insurance coverage in the
individual market for any employee not covered under the plan
which is similar to the coverage contemporaneously provided
to employees of the employer under the plan, if such
exclusion of the employee from coverage under the plan is
based on a health status-related factor with respect to the
employee and such employee would, but for such exclusion on
such basis, be eligible for coverage under the plan.
``(d) Prohibition of Discrimination Against Employers and
Employees Eligible To Participate.--The requirements of this
subsection are met with respect to an association health plan
if--
``(1) under the terms of the plan, all employers meeting
the preceding requirements of this section are eligible to
qualify as participating employers for all geographically
available coverage options, unless, in the case of any such
employer, participation or contribution requirements of the
type referred to in section 2711 of the Public Health Service
Act are not met;
``(2) upon request, any employer eligible to participate is
furnished information regarding all coverage options
available under the plan; and
``(3) the applicable requirements of sections 701, 702, and
703 are met with respect to the plan.

``SEC. 805. OTHER REQUIREMENTS RELATING TO PLAN DOCUMENTS,
CONTRIBUTION RATES, AND BENEFIT OPTIONS.

``(a) In General.--The requirements of this section are met
with respect to an association health plan if the following
requirements are met:
``(1) Contents of governing instruments.--The instruments
governing the plan include a written instrument, meeting the
requirements of an instrument required under section
402(a)(1), which--
``(A) provides that the board of trustees serves as the
named fiduciary required for plans under section 402(a)(1)
and serves in the capacity of a plan administrator (referred
to in section 3(16)(A));
``(B) provides that the sponsor of the plan is to serve as
plan sponsor (referred to in section 3(16)(B)); and
``(C) incorporates the requirements of section 806.
``(2) Contribution rates must be nondiscriminatory.--
``(A) The contribution rates for any participating small
employer do not vary on the basis of any health status-
related factor in relation to employees of such employer or
their beneficiaries and do not vary on the basis of the type
of business or industry in which such employer is engaged.
``(B) Nothing in this title or any other provision of law
shall be construed to preclude an association health plan, or
a health insurance issuer offering health insurance coverage
in connection with an association health plan, from--
``(i) setting contribution rates based on the claims
experience of the plan; or
``(ii) varying contribution rates for small employers in a
State to the extent that such rates could vary using the same
methodology employed in such State for regulating premium
rates in the small group market with respect to health
insurance coverage offered in connection with bona fide
associations (within the meaning of section 2791(d)(3) of the
Public Health Service Act),
subject to the requirements of section 702(b) relating to
contribution rates.
``(3) Floor for number of covered individuals with respect
to certain plans.--If any benefit option under the plan does
not consist of health insurance coverage, the plan has as of
the beginning of the plan year not fewer than 1,000
participants and beneficiaries.
``(4) Marketing requirements.--
``(A) In general.--If a benefit option which consists of
health insurance coverage is offered under the plan, State-
licensed insurance agents shall be used to distribute to
small employers coverage which does not consist of health
insurance coverage in a manner comparable to the manner in
which such agents are used to distribute health insurance
coverage.
``(B) State-licensed insurance agents.--For purposes of
subparagraph (A), the term `State-licensed insurance agents'
means one or more agents who are licensed in a State and are
subject to the laws of such State relating to licensure,
qualification, testing, examination, and continuing education
of persons authorized to offer, sell, or solicit health
insurance coverage in such State.
``(5) Regulatory requirements.--Such other requirements as
the applicable authority determines are necessary to carry
out the purposes of this part, which shall be prescribed by
the applicable authority by regulation through negotiated
rulemaking.

[[Page S3258]]

``(b) Ability of Association Health Plans To Design Benefit
Options.--Subject to section 514(d), nothing in this part or
any provision of State law (as defined in section 514(c)(1))
shall be construed to preclude an association health plan, or
a health insurance issuer offering health insurance coverage
in connection with an association health plan, from
exercising its sole discretion in selecting the specific
items and services consisting of medical care to be included
as benefits under such plan or coverage, except (subject to
section 514) in the case of any law to the extent that it (1)
prohibits an exclusion of a specific disease from such
coverage, or (2) is not preempted under section 731(a)(1)
with respect to matters governed by section 711 or 712.

``SEC. 806. MAINTENANCE OF RESERVES AND PROVISIONS FOR
SOLVENCY FOR PLANS PROVIDING HEALTH BENEFITS IN
ADDITION TO HEALTH INSURANCE COVERAGE.

``(a) In General.--The requirements of this section are met
with respect to an association health plan if--
``(1) the benefits under the plan consist solely of health
insurance coverage; or
``(2) if the plan provides any additional benefit options
which do not consist of health insurance coverage, the plan--
``(A) establishes and maintains reserves with respect to
such additional benefit options, in amounts recommended by
the qualified actuary, consisting of--
``(i) a reserve sufficient for unearned contributions;
``(ii) a reserve sufficient for benefit liabilities which
have been incurred, which have not been satisfied, and for
which risk of loss has not yet been transferred, and for
expected administrative costs with respect to such benefit
liabilities;
``(iii) a reserve sufficient for any other obligations of
the plan; and
``(iv) a reserve sufficient for a margin of error and other
fluctuations, taking into account the specific circumstances
of the plan; and
``(B) establishes and maintains aggregate and specific
excess /stop loss insurance and solvency indemnification,
with respect to such additional benefit options for which
risk of loss has not yet been transferred, as follows:
``(i) The plan shall secure aggregate excess /stop loss
insurance for the plan with an attachment point which is not
greater than 125 percent of expected gross annual claims. The
applicable authority may by regulation, through negotiated
rulemaking, provide for upward adjustments in the amount of
such percentage in specified circumstances in which the plan
specifically provides for and maintains reserves in excess of
the amounts required under subparagraph (A).
``(ii) The plan shall secure specific excess /stop loss
insurance for the plan with an attachment point which is at
least equal to an amount recommended by the plan's qualified
actuary. The applicable authority may by regulation, through
negotiated rulemaking, provide for adjustments in the amount
of such insurance in specified circumstances in which the
plan specifically provides for and maintains reserves in
excess of the amounts required under subparagraph (A).
``(iii) The plan shall secure indemnification insurance for
any claims which the plan is unable to satisfy by reason of a
plan termination.

Any regulations prescribed by the applicable authority
pursuant to clause (i) or (ii) of subparagraph (B) may allow
for such adjustments in the required levels of excess /stop
loss insurance as the qualified actuary may recommend, taking
into account the specific circumstances of the plan.
``(b) Minimum Surplus in Addition to Claims Reserves.--In
the case of any association health plan described in
subsection (a)(2), the requirements of this subsection are
met if the plan establishes and maintains surplus in an
amount at least equal to--
``(1) $500,000, or
``(2) such greater amount (but not greater than $2,000,000)
as may be set forth in regulations prescribed by the
applicable authority through negotiated rulemaking, based on
the level of aggregate and specific excess /stop loss
insurance provided with respect to such plan.
``(c) Additional Requirements.--In the case of any
association health plan described in subsection (a)(2), the
applicable authority may provide such additional requirements
relating to reserves and excess /stop loss insurance as the
applicable authority considers appropriate. Such requirements
may be provided by regulation, through negotiated rulemaking,
with respect to any such plan or any class of such plans.
``(d) Adjustments for Excess /Stop Loss Insurance.--The
applicable authority may provide for adjustments to the
levels of reserves otherwise required under subsections (a)
and (b) with respect to any plan or class of plans to take
into account excess /stop loss insurance provided with
respect to such plan or plans.
``(e) Alternative Means of Compliance.--The applicable
authority may permit an association health plan described in
subsection (a)(2) to substitute, for all or part of the
requirements of this section (except subsection
(a)(2)(B)(iii)), such security, guarantee, hold-harmless
arrangement, or other financial arrangement as the applicable
authority determines to be adequate to enable the plan to
fully meet all its financial obligations on a timely basis
and is otherwise no less protective of the interests of
participants and beneficiaries than the requirements for
which it is substituted. The applicable authority may take
into account, for purposes of this subsection, evidence
provided by the plan or sponsor which demonstrates an
assumption of liability with respect to the plan. Such
evidence may be in the form of a contract of indemnification,
lien, bonding, insurance, letter of credit, recourse under
applicable terms of the plan in the form of assessments of
participating employers, security, or other financial
arrangement.
``(f) Measures To Ensure Continued Payment of Benefits by
Certain Plans in Distress.--
``(1) Payments by certain plans to association health plan
fund.--
``(A) In general.--In the case of an association health
plan described in subsection (a)(2), the requirements of this
subsection are met if the plan makes payments into the
Association Health Plan Fund under this subparagraph when
they are due. Such payments shall consist of annual payments
in the amount of $5,000, and, in addition to such annual
payments, such supplemental payments as the Secretary may
determine to be necessary under paragraph (2). Payments under
this paragraph are payable to the Fund at the time determined
by the Secretary. Initial payments are due in advance of
certification under this part. Payments shall continue to
accrue until a plan's assets are distributed pursuant to a
termination procedure.
``(B) Penalties for failure to make payments.--If any
payment is not made by a plan when it is due, a late payment
charge of not more than 100 percent of the payment which was
not timely paid shall be payable by the plan to the Fund.
``(C) Continued duty of the secretary.--The Secretary shall
not cease to carry out the provisions of paragraph (2) on
account of the failure of a plan to pay any payment when due.
``(2) Payments by secretary to continue excess /stop loss
insurance coverage and indemnification insurance coverage for
certain plans.--In any case in which the applicable authority
determines that there is, or that there is reason to believe
that there will be: (A) a failure to take necessary
corrective actions under section 809(a) with respect to an
association health plan described in subsection (a)(2); or
(B) a termination of such a plan under section 809(b) or
810(b)(8) (and, if the applicable authority is not the
Secretary, certifies such determination to the Secretary),
the Secretary shall determine the amounts necessary to make
payments to an insurer (designated by the Secretary) to
maintain in force excess /stop loss insurance coverage or
indemnification insurance coverage for such plan, if the
Secretary determines that there is a reasonable expectation
that, without such payments, claims would not be satisfied by
reason of termination of such coverage. The Secretary shall,
to the extent provided in advance in appropriation Acts, pay
such amounts so determined to the insurer designated by the
Secretary.
``(3) Association health plan fund.--
``(A) In general.--There is established on the books of the
Treasury a fund to be known as the `Association Health Plan
Fund'. The Fund shall be available for making payments
pursuant to paragraph (2). The Fund shall be credited with
payments received pursuant to paragraph (1)(A), penalties
received pursuant to paragraph (1)(B); and earnings on
investments of amounts of the Fund under subparagraph (B).
``(B) Investment.--Whenever the Secretary determines that
the moneys of the fund are in excess of current needs, the
Secretary may request the investment of such amounts as the
Secretary determines advisable by the Secretary of the
Treasury in obligations issued or guaranteed by the United
States.
``(g) Excess /Stop Loss Insurance.--For purposes of this
section--
``(1) Aggregate excess /stop loss insurance.--The term
`aggregate excess /stop loss insurance' means, in connection
with an association health plan, a contract--
``(A) under which an insurer (meeting such minimum
standards as the applicable authority may prescribe by
regulation through negotiated rulemaking) provides for
payment to the plan with respect to aggregate claims under
the plan in excess of an amount or amounts specified in such
contract;
``(B) which is guaranteed renewable; and
``(C) which allows for payment of premiums by any third
party on behalf of the insured plan.
``(2) Specific excess /stop loss insurance.--The term
`specific excess /stop loss insurance' means, in connection
with an association health plan, a contract--
``(A) under which an insurer (meeting such minimum
standards as the applicable authority may prescribe by
regulation through negotiated rulemaking) provides for
payment to the plan with respect to claims under the plan in
connection with a covered individual in excess of an amount
or amounts specified in such contract in connection with such
covered individual;
``(B) which is guaranteed renewable; and
``(C) which allows for payment of premiums by any third
party on behalf of the insured plan.
``(h) Indemnification Insurance.--For purposes of this
section, the term `indemnification insurance' means, in
connection with an association health plan, a contract--
``(1) under which an insurer (meeting such minimum
standards as the applicable authority may prescribe through
negotiated

[[Page S3259]]

rulemaking) provides for payment to the plan with respect to
claims under the plan which the plan is unable to satisfy by
reason of a termination pursuant to section 809(b) (relating
to mandatory termination);
``(2) which is guaranteed renewable and noncancellable for
any reason (except as the applicable authority may prescribe
by regulation through negotiated rulemaking); and
``(3) which allows for payment of premiums by any third
party on behalf of the insured plan.
``(i) Reserves.--For purposes of this section, the term
`reserves' means, in connection with an association health
plan, plan assets which meet the fiduciary standards under
part 4 and such additional requirements regarding liquidity
as the applicable authority may prescribe through negotiated
rulemaking.
``(j) Solvency Standards Working Group.--
``(1) In general.--Within 90 days after the date of the
enactment of the Small Business Health Fairness Act of 2003,
the applicable authority shall establish a Solvency Standards
Working Group. In prescribing the initial regulations under
this section, the applicable authority shall take into
account the recommendations of such Working Group.
``(2) Membership.--The Working Group shall consist of not
more than 15 members appointed by the applicable authority.
The applicable authority shall include among persons invited
to membership on the Working Group at least one of each of
the following:
``(A) a representative of the National Association of
Insurance Commissioners;
``(B) a representative of the American Academy of
Actuaries;
``(C) a representative of the State governments, or their
interests;
``(D) a representative of existing self-insured
arrangements, or their interests;
``(E) a representative of associations of the type referred
to in section 801(b)(1), or their interests; and
``(F) a representative of multiemployer plans that are
group health plans, or their interests.

``SEC. 807. REQUIREMENTS FOR APPLICATION AND RELATED
REQUIREMENTS.

``(a) Filing Fee.--Under the procedure prescribed pursuant
to section 802(a), an association health plan shall pay to
the applicable authority at the time of filing an application
for certification under this part a filing fee in the amount
of $5,000, which shall be available in the case of the
Secretary, to the extent provided in appropriation Acts, for
the sole purpose of administering the certification
procedures applicable with respect to association health
plans.
``(b) Information To Be Included in Application for
Certification.--An application for certification under this
part meets the requirements of this section only if it
includes, in a manner and form which shall be prescribed by
the applicable authority through negotiated rulemaking, at
least the following information:
``(1) Identifying information.--The names and addresses
of--
``(A) the sponsor; and
``(B) the members of the board of trustees of the plan.
``(2) States in which plan intends to do business.--The
States in which participants and beneficiaries under the plan
are to be located and the number of them expected to be
located in each such State.
``(3) Bonding requirements.--Evidence provided by the board
of trustees that the bonding requirements of section 412 will
be met as of the date of the application or (if later)
commencement of operations.
``(4) Plan documents.--A copy of the documents governing
the plan (including any bylaws and trust agreements), the
summary plan description, and other material describing the
benefits that will be provided to participants and
beneficiaries under the plan.
``(5) Agreements with service providers.--A copy of any
agreements between the plan and contract administrators and
other service providers.
``(6) Funding report.--In the case of association health
plans providing benefits options in addition to health
insurance coverage, a report setting forth information with
respect to such additional benefit options determined as of a
date within the 120-day period ending with the date of the
application, including the following:
``(A) Reserves.--A statement, certified by the board of
trustees of the plan, and a statement of actuarial opinion,
signed by a qualified actuary, that all applicable
requirements of section 806 are or will be met in accordance
with regulations which the applicable authority shall
prescribe through negotiated rulemaking.
``(B) Adequacy of contribution rates.--A statement of
actuarial opinion, signed by a qualified actuary, which sets
forth a description of the extent to which contribution rates
are adequate to provide for the payment of all obligations
and the maintenance of required reserves under the plan for
the 12-month period beginning with such date within such 120-
day period, taking into account the expected coverage and
experience of the plan. If the contribution rates are not
fully adequate, the statement of actuarial opinion shall
indicate the extent to which the rates are inadequate and the
changes needed to ensure adequacy.
``(C) Current and projected value of assets and
liabilities.--A statement of actuarial opinion signed by a
qualified actuary, which sets forth the current value of the
assets and liabilities accumulated under the plan and a
projection of the assets, liabilities, income, and expenses
of the plan for the 12-month period referred to in
subparagraph (B). The income statement shall identify
separately the plan's administrative expenses and claims.
``(D) Costs of coverage to be charged and other expenses.--
A statement of the costs of coverage to be charged, including
an itemization of amounts for administration, reserves, and
other expenses associated with the operation of the plan.
``(E) Other information.--Any other information as may be
determined by the applicable authority, by regulation through
negotiated rulemaking, as necessary to carry out the purposes
of this part.
``(c) Filing Notice of Certification With States.--A
certification granted under this part to an association
health plan shall not be effective unless written notice of
such certification is filed with the applicable State
authority of each State in which at least 25 percent of the
participants and beneficiaries under the plan are located.
For purposes of this subsection, an individual shall be
considered to be located in the State in which a known
address of such individual is located or in which such
individual is employed.
``(d) Notice of Material Changes.--In the case of any
association health plan certified under this part,
descriptions of material changes in any information which was
required to be submitted with the application for the
certification under this part shall be filed in such form and
manner as shall be prescribed by the applicable authority by
regulation through negotiated rulemaking. The applicable
authority may require by regulation, through negotiated
rulemaking, prior notice of material changes with respect to
specified matters which might serve as the basis for
suspension or revocation of the certification.
``(e) Reporting Requirements for Certain Association Health
Plans.--An association health plan certified under this part
which provides benefit options in addition to health
insurance coverage for such plan year shall meet the
requirements of section 503B by filing an annual report under
such section which shall include information described in
subsection (b)(6) with respect to the plan year and,
notwithstanding section 503C(a)(1)(A), shall be filed with
the applicable authority not later than 90 days after the
close of the plan year (or on such later date as may be
prescribed by the applicable authority). The applicable
authority may require by regulation through negotiated
rulemaking such interim reports as it considers appropriate.
``(f) Engagement of Qualified Actuary.--The board of
trustees of each association health plan which provides
benefits options in addition to health insurance coverage and
which is applying for certification under this part or is
certified under this part shall engage, on behalf of all
participants and beneficiaries, a qualified actuary who shall
be responsible for the preparation of the materials
comprising information necessary to be submitted by a
qualified actuary under this part. The qualified actuary
shall utilize such assumptions and techniques as are
necessary to enable such actuary to form an opinion as to
whether the contents of the matters reported under this
part--
``(1) are in the aggregate reasonably related to the
experience of the plan and to reasonable expectations; and
``(2) represent such actuary's best estimate of anticipated
experience under the plan.
The opinion by the qualified actuary shall be made with
respect to, and shall be made a part of, the annual report.

``SEC. 808. NOTICE REQUIREMENTS FOR VOLUNTARY TERMINATION.

``Except as provided in section 809(b), an association
health plan which is or has been certified under this part
may terminate (upon or at any time after cessation of
accruals in benefit liabilities) only if the board of
trustees--
``(1) not less than 60 days before the proposed termination
date, provides to the participants and beneficiaries a
written notice of intent to terminate stating that such
termination is intended and the proposed termination date;
``(2) develops a plan for winding up the affairs of the
plan in connection with such termination in a manner which
will result in timely payment of all benefits for which the
plan is obligated; and
``(3) submits such plan in writing to the applicable
authority.

Actions required under this section shall be taken in such
form and manner as may be prescribed by the applicable
authority by regulation through negotiated rulemaking.

``SEC. 809. CORRECTIVE ACTIONS AND MANDATORY TERMINATION.

``(a) Actions To Avoid Depletion of Reserves.--An
association health plan which is certified under this part
and which provides benefits other than health insurance
coverage shall continue to meet the requirements of section
806, irrespective of whether such certification continues in
effect. The board of trustees of such plan shall determine
quarterly whether the requirements of section 806 are met. In
any case in which the board determines that there is reason
to believe that there is or will be a failure to meet such
requirements, or the applicable authority makes such a
determination and so notifies the board, the board shall
immediately

[[Page S3260]]

notify the qualified actuary engaged by the plan, and such
actuary shall, not later than the end of the next following
month, make such recommendations to the board for corrective
action as the actuary determines necessary to ensure
compliance with section 806. Not later than 30 days after
receiving from the actuary recommendations for corrective
actions, the board shall notify the applicable authority (in
such form and manner as the applicable authority may
prescribe by regulation through negotiated rulemaking) of
such recommendations of the actuary for corrective action,
together with a description of the actions (if any) that the
board has taken or plans to take in response to such
recommendations. The board shall thereafter report to the
applicable authority, in such form and frequency as the
applicable authority may specify to the board, regarding
corrective action taken by the board until the requirements
of section 806 are met.
``(b) Mandatory Termination.--In any case in which--
``(1) the applicable authority has been notified under
subsection (a) of a failure of an association health plan
which is or has been certified under this part and is
described in section 806(a)(2) to meet the requirements of
section 806 and has not been notified by the board of
trustees of the plan that corrective action has restored
compliance with such requirements; and
``(2) the applicable authority determines that there is a
reasonable expectation that the plan will continue to fail to
meet the requirements of section 806,

the board of trustees of the plan shall, at the direction of
the applicable authority, terminate the plan and, in the
course of the termination, take such actions as the
applicable authority may require, including satisfying any
claims referred to in section 806(a)(2)(B)(iii) and
recovering for the plan any liability under subsection
(a)(2)(B)(iii) or (e) of section 806, as necessary to ensure
that the affairs of the plan will be, to the maximum extent
possible, wound up in a manner which will result in timely
provision of all benefits for which the plan is obligated.

``SEC. 810. TRUSTEESHIP BY THE SECRETARY OF INSOLVENT
ASSOCIATION HEALTH PLANS PROVIDING HEALTH
BENEFITS IN ADDITION TO HEALTH INSURANCE
COVERAGE.

``(a) Appointment of Secretary as Trustee for Insolvent
Plans.--Whenever the Secretary determines that an association
health plan which is or has been certified under this part
and which is described in section 806(a)(2) will be unable to
provide benefits when due or is otherwise in a financially
hazardous condition, as shall be defined by the Secretary by
regulation through negotiated rulemaking, the Secretary
shall, upon notice to the plan, apply to the appropriate
United States district court for appointment of the Secretary
as trustee to administer the plan for the duration of the
insolvency. The plan may appear as a party and other
interested persons may intervene in the proceedings at the
discretion of the court. The court shall appoint such
Secretary trustee if the court determines that the
trusteeship is necessary to protect the interests of the
participants and beneficiaries or providers of medical care
or to avoid any unreasonable deterioration of the financial
condition of the plan. The trusteeship of such Secretary
shall continue until the conditions described in the first
sentence of this subsection are remedied or the plan is
terminated.
``(b) Powers as Trustee.--The Secretary, upon appointment
as trustee under subsection (a), shall have the power--
``(1) to do any act authorized by the plan, this title, or
other applicable provisions of law to be done by the plan
administrator or any trustee of the plan;
``(2) to require the transfer of all (or any part) of the
assets and records of the plan to the Secretary as trustee;
``(3) to invest any assets of the plan which the Secretary
holds in accordance with the provisions of the plan,
regulations prescribed by the Secretary through negotiated
rulemaking, and applicable provisions of law;
``(4) to require the sponsor, the plan administrator, any
participating employer, and any employee organization
representing plan participants to furnish any information
with respect to the plan which the Secretary as trustee may
reasonably need in order to administer the plan;
``(5) to collect for the plan any amounts due the plan and
to recover reasonable expenses of the trusteeship;
``(6) to commence, prosecute, or defend on behalf of the
plan any suit or proceeding involving the plan;
``(7) to issue, publish, or file such notices, statements,
and reports as may be required by the Secretary by regulation
through negotiated rulemaking or required by any order of the
court;
``(8) to terminate the plan (or provide for its termination
in accordance with section 809(b)) and liquidate the plan
assets, to restore the plan to the responsibility of the
sponsor, or to continue the trusteeship;
``(9) to provide for the enrollment of plan participants
and beneficiaries under appropriate coverage options; and
``(10) to do such other acts as may be necessary to comply
with this title or any order of the court and to protect the
interests of plan participants and beneficiaries and
providers of medical care.
``(c) Notice of Appointment.--As soon as practicable after
the Secretary's appointment as trustee, the Secretary shall
give notice of such appointment to--
``(1) the sponsor and plan administrator;
``(2) each participant;
``(3) each participating employer; and
``(4) if applicable, each employee organization which, for
purposes of collective bargaining, represents plan
participants.
``(d) Additional Duties.--Except to the extent inconsistent
with the provisions of this title, or as may be otherwise
ordered by the court, the Secretary, upon appointment as
trustee under this section, shall be subject to the same
duties as those of a trustee under section 704 of title 11,
United States Code, and shall have the duties of a fiduciary
for purposes of this title.
``(e) Other Proceedings.--An application by the Secretary
under this subsection may be filed notwithstanding the
pendency in the same or any other court of any bankruptcy,
mortgage foreclosure, or equity receivership proceeding, or
any proceeding to reorganize, conserve, or liquidate such
plan or its property, or any proceeding to enforce a lien
against property of the plan.
``(f) Jurisdiction of Court.--
``(1) In general.--Upon the filing of an application for
the appointment as trustee or the issuance of a decree under
this section, the court to which the application is made
shall have exclusive jurisdiction of the plan involved and
its property wherever located with the powers, to the extent
consistent with the purposes of this section, of a court of
the United States having jurisdiction over cases under
chapter 11 of title 11, United States Code. Pending an
adjudication under this section such court shall stay, and
upon appointment by it of the Secretary as trustee, such
court shall continue the stay of, any pending mortgage
foreclosure, equity receivership, or other proceeding to
reorganize, conserve, or liquidate the plan, the sponsor, or
property of such plan or sponsor, and any other suit against
any receiver, conservator, or trustee of the plan, the
sponsor, or property of the plan or sponsor. Pending such
adjudication and upon the appointment by it of the Secretary
as trustee, the court may stay any proceeding to enforce a
lien against property of the plan or the sponsor or any other
suit against the plan or the sponsor.
``(2) Venue.--An action under this section may be brought
in the judicial district where the sponsor or the plan
administrator resides or does business or where any asset of
the plan is situated. A district court in which such action
is brought may issue process with respect to such action in
any other judicial district.
``(g) Personnel.--In accordance with regulations which
shall be prescribed by the Secretary through negotiated
rulemaking, the Secretary shall appoint, retain, and
compensate accountants, actuaries, and other professional
service personnel as may be necessary in connection with the
Secretary's service as trustee under this section.

``SEC. 811. STATE ASSESSMENT AUTHORITY.

``(a) In General.--Notwithstanding section 514, a State may
impose by law a contribution tax on an association health
plan described in section 806(a)(2), if the plan commenced
operations in such State after the date of the enactment of
the Small Business Health Fairness Act of 2003.
``(b) Contribution Tax.--For purposes of this section, the
term `contribution tax' imposed by a State on an association
health plan means any tax imposed by such State if--
``(1) such tax is computed by applying a rate to the amount
of premiums or contributions, with respect to individuals
covered under the plan who are residents of such State, which
are received by the plan from participating employers located
in such State or from such individuals;
``(2) the rate of such tax does not exceed the rate of any
tax imposed by such State on premiums or contributions
received by insurers or health maintenance organizations for
health insurance coverage offered in such State in connection
with a group health plan;
``(3) such tax is otherwise nondiscriminatory; and
``(4) the amount of any such tax assessed on the plan is
reduced by the amount of any tax or assessment otherwise
imposed by the State on premiums, contributions, or both
received by insurers or health maintenance organizations for
health insurance coverage, aggregate excess /stop loss
insurance (as defined in section 806(g)(1)), specific excess
/stop loss insurance (as defined in section 806(g)(2)), other
insurance related to the provision of medical care under the
plan, or any combination thereof provided by such insurers or
health maintenance organizations in such State in connection
with such plan.

``SEC. 812. DEFINITIONS AND RULES OF CONSTRUCTION.

``(a) Definitions.--For purposes of this part--
``(1) Group health plan.--The term `group health plan' has
the meaning provided in section 733(a)(1) (after applying
subsection (b) of this section).
``(2) Medical care.--The term `medical care' has the
meaning provided in section 733(a)(2).
``(3) Health insurance coverage.--The term `health
insurance coverage' has the meaning provided in section
733(b)(1).
``(4) Health insurance issuer.--The term `health insurance
issuer' has the meaning provided in section 733(b)(2).
``(5) Applicable authority.--

[[Page S3261]]

``(A) In general.--Except as provided in subparagraph (B),
the term `applicable authority' means, in connection with an
association health plan--
``(i) the State recognized pursuant to subsection (c) of
section 506 as the State to which authority has been
delegated in connection with such plan; or
``(ii) if there if no State referred to in clause (i), the
Secretary.
``(B) Exceptions.--
``(i) Joint authorities.--Where such term appears in
section 808(3), section 807(e) (in the first instance),
section 809(a) (in the second instance), section 809(a) (in
the fourth instance), and section 809(b)(1), such term means,
in connection with an association health plan, the Secretary
and the State referred to in subparagraph (A)(i) (if any) in
connection with such plan.
``(ii) Regulatory authorities.--Where such term appears in
section 802(a) (in the first instance), section 802(d),
section 802(e), section 803(d), section 805(a)(5), section
806(a)(2), section 806(b), section 806(c), section 806(d),
paragraphs (1)(A) and (2)(A) of section 806(g), section
806(h), section 806(i), section 806(j), section 807(a) (in
the second instance), section 807(b), section 807(d), section
807(e) (in the second instance), section 808 (in the matter
after paragraph (3)), and section 809(a) (in the third
instance), such term means, in connection with an association
health plan, the Secretary.
``(6) Health status-related factor.--The term `health
status-related factor' has the meaning provided in section
733(d)(2).
``(7) Individual market.--
``(A) In general.--The term `individual market' means the
market for health insurance coverage offered to individuals
other than in connection with a group health plan.
``(B) Treatment of very small groups.--
``(i) In general.--Subject to clause (ii), such term
includes coverage offered in connection with a group health
plan that has fewer than 2 participants as current employees
or participants described in section 732(d)(3) on the first
day of the plan year.
``(ii) State exception.--Clause (i) shall not apply in the
case of health insurance coverage offered in a State if such
State regulates the coverage described in such clause in the
same manner and to the same extent as coverage in the small
group market (as defined in section 2791(e)(5) of the Public
Health Service Act) is regulated by such State.
``(8) Participating employer.--The term `participating
employer' means, in connection with an association health
plan, any employer, if any individual who is an employee of
such employer, a partner in such employer, or a self-employed
individual who is such employer (or any dependent, as defined
under the terms of the plan, of such individual) is or was
covered under such plan in connection with the status of such
individual as such an employee, partner, or self-employed
individual in relation to the plan.
``(9) Applicable state authority.--The term `applicable
State authority' means, with respect to a health insurance
issuer in a State, the State insurance commissioner or
official or officials designated by the State to enforce the
requirements of title XXVII of the Public Health Service Act
for the State involved with respect to such issuer.
``(10) Qualified actuary.--The term `qualified actuary'
means an individual who is a member of the American Academy
of Actuaries or meets such reasonable standards and
qualifications as the Secretary may provide by regulation
through negotiated rulemaking.
``(11) Affiliated member.--The term `affiliated member'
means, in connection with a sponsor--
``(A) a person who is otherwise eligible to be a member of
the sponsor but who elects an affiliated status with the
sponsor,
``(B) in the case of a sponsor with members which consist
of associations, a person who is a member of any such
association and elects an affiliated status with the sponsor,
or
``(C) in the case of an association health plan in
existence on the date of the enactment of the Small Business
Health Fairness Act of 2003, a person eligible to be a member
of the sponsor or one of its member associations.
``(12) Large employer.--The term `large employer' means, in
connection with a group health plan with respect to a plan
year, an employer who employed an average of at least 51
employees on business days during the preceding calendar year
and who employs at least 2 employees on the first day of the
plan year.
``(13) Small employer.--The term `small employer' means, in
connection with a group health plan with respect to a plan
year, an employer who is not a large employer.
``(b) Rules of Construction.--
``(1) Employers and employees.--For purposes of determining
whether a plan, fund, or program is an employee welfare
benefit plan which is an association health plan, and for
purposes of applying this title in connection with such plan,
fund, or program so determined to be such an employee welfare
benefit plan--
``(A) in the case of a partnership, the term `employer' (as
defined in section 3(5)) includes the partnership in relation
to the partners, and the term `employee' (as defined in
section 3(6)) includes any partner in relation to the
partnership; and
``(B) in the case of a self-employed individual, the term
`employer' (as defined in section 3(5)) and the term
`employee' (as defined in section 3(6)) shall include such
individual.
``(2) Plans, funds, and programs treated as employee
welfare benefit plans.--In the case of any plan, fund, or
program which was established or is maintained for the
purpose of providing medical care (through the purchase of
insurance or otherwise) for employees (or their dependents)
covered thereunder and which demonstrates to the Secretary
that all requirements for certification under this part would
be met with respect to such plan, fund, or program if such
plan, fund, or program were a group health plan, such plan,
fund, or program shall be treated for purposes of this title
as an employee welfare benefit plan on and after the date of
such demonstration.''.
(b) Conforming Amendments to Preemption Rules.--
(1) Section 514(b)(6) of such Act (29 U.S.C. 1144(b)(6)) is
amended by adding at the end the following new subparagraph:
``(E) The preceding subparagraphs of this paragraph do not
apply with respect to any State law in the case of an
association health plan which is certified under part 8.''.
(2) Section 514 of such Act (29 U.S.C. 1144) is amended--
(A) in subsection (b)(4), by striking ``Subsection (a)''
and inserting ``Subsections (a) and (e)'';
(B) in subsection (b)(5), by striking ``subsection (a)'' in
subparagraph (A) and inserting ``subsection (a) of this
section and subsections (a)(2)(B) and (b) of section 805'',
and by striking ``subsection (a)'' in subparagraph (B) and
inserting ``subsection (a) of this section or subsection
(a)(2)(B) or (b) of section 805'';
(C) by redesignating subsection (d) as subsection (e); and
(D) by inserting after subsection (c) the following new
subsection:
``(d)(1) Except as provided in subsection (b)(4), the
provisions of this title shall supersede any and all State
laws insofar as they may now or hereafter preclude, or have
the effect of precluding, a health insurance issuer from
offering health insurance coverage in connection with an
association health plan which is certified under part 8.
``(2) Except as provided in paragraphs (4) and (5) of
subsection (b) of this section--
``(A) In any case in which health insurance coverage of any
policy type is offered under an association health plan
certified under part 8 to a participating employer operating
in such State, the provisions of this title shall supersede
any and all laws of such State insofar as they may preclude a
health insurance issuer from offering health insurance
coverage of the same policy type to other employers operating
in the State which are eligible for coverage under such
association health plan, whether or not such other employers
are participating employers in such plan.
``(B) In any case in which health insurance coverage of any
policy type is offered under an association health plan in a
State and the filing, with the applicable State authority, of
the policy form in connection with such policy type is
approved by such State authority, the provisions of this
title shall supersede any and all laws of any other State in
which health insurance coverage of such type is offered,
insofar as they may preclude, upon the filing in the same
form and manner of such policy form with the applicable State
authority in such other State, the approval of the filing in
such other State.
``(3) For additional provisions relating to association
health plans, see subsections (a)(2)(B) and (b) of section
805.
``(4) For purposes of this subsection, the term
`association health plan' has the meaning provided in section
801(a), and the terms `health insurance coverage',
`participating employer', and `health insurance issuer' have
the meanings provided such terms in section 811,
respectively.''.
(3) Section 514(b)(6)(A) of such Act (29 U.S.C.
1144(b)(6)(A)) is amended--
(A) in clause (i)(II), by striking ``and'' at the end;
(B) in clause (ii), by inserting ``and which does not
provide medical care (within the meaning of section
733(a)(2)),'' after ``arrangement,'', and by striking
``title.'' and inserting ``title, and''; and
(C) by adding at the end the following new clause:
``(iii) subject to subparagraph (E), in the case of any
other employee welfare benefit plan which is a multiple
employer welfare arrangement and which provides medical care
(within the meaning of section 733(a)(2)), any law of any
State which regulates insurance may apply.''.
(4) Section 514(e) of such Act (as redesignated by
paragraph (2)(C)) is amended--
(A) by striking ``Nothing'' and inserting ``(1) Except as
provided in paragraph (2), nothing''; and
(B) by adding at the end the following new paragraph:
``(2) Nothing in any other provision of law enacted on or
after the date of the enactment of the Small Business Health
Fairness Act of 2003 shall be construed to alter, amend,
modify, invalidate, impair, or supersede any provision of
this title, except by specific cross-reference to the
affected section.''.
(c) Plan Sponsor.--Section 3(16)(B) of such Act (29 U.S.C.
102(16)(B)) is amended by adding at the end the following new
sentence:

[[Page S3262]]

``Such term also includes a person serving as the sponsor of
an association health plan under part 8.''.
(d) Disclosure of Solvency Protections Related to Self-
Insured and Fully Insured Options Under Association Health
Plans.--Section 102(b) of such Act (29 U.S.C. 102(b)) is
amended by adding at the end the following: ``An association
health plan shall include in its summary plan description, in
connection with each benefit option, a description of the
form of solvency or guarantee fund protection secured
pursuant to this Act or applicable State law, if any.''.
(e) Savings Clause.--Section 731(c) of such Act is amended
by inserting ``or part 8'' after ``this part''.
(f) Report to the Congress Regarding Certification of Self-
Insured Association Health Plans.--Not later than January 1,
2008, the Secretary of Labor shall report to the Committee on
Education and the Workforce of the House of Representatives
and the Committee on Health, Education, Labor, and Pensions
of the Senate the effect association health plans have had,
if any, on reducing the number of uninsured individuals.
(g) Clerical Amendment.--The table of contents in section 1
of the Employee Retirement Income Security Act of 1974 is
amended by inserting after the item relating to section 734
the following new items:

``Part 8--Rules Governing Association Health Plans

SEC. 3. CLARIFICATION OF TREATMENT OF SINGLE EMPLOYER
ARRANGEMENTS.

Section 3(40)(B) of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1002(40)(B)) is amended--
(1) in clause (i), by inserting ``for any plan year of any
such plan, or any fiscal year of any such other
arrangement;'' after ``single employer'', and by inserting
``during such year or at any time during the preceding 1-year
period'' after ``control group'';
(2) in clause (iii)--
(A) by striking ``common control shall not be based on an
interest of less than 25 percent'' and inserting ``an
interest of greater than 25 percent may not be required as
the minimum interest necessary for common control''; and
(B) by striking ``similar to'' and inserting ``consistent
and coextensive with'';
(3) by redesignating clauses (iv) and (v) as clauses (v)
and (vi), respectively; and
(4) by inserting after clause (iii) the following new
clause:
``(iv) in determining, after the application of clause (i),
whether benefits are provided to employees of two or more
employers, the arrangement shall be treated as having only
one participating employer if, after the application of
clause (i), the number of individuals who are employees and
former employees of any one participating employer and who
are covered under the arrangement is greater than 75 percent
of the aggregate number of all individuals who are employees
or former employees of participating employers and who are
covered under the arrangement;''.

SEC. 4. CLARIFICATION OF TREATMENT OF CERTAIN COLLECTIVELY
BARGAINED ARRANGEMENTS.

(a) In General.--Section 3(40)(A)(i) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C.
1002(40)(A)(i)) is amended to read as follows:
``(i)(I) under or pursuant to one or more collective
bargaining agreements which are reached pursuant to
collective bargaining described in section 8(d) of the
National Labor Relations Act (29 U.S.C. 158(d)) or paragraph
Fourth of section 2 of the Railway Labor Act (45 U.S.C. 152,
paragraph Fourth) or which are reached pursuant to labor-
management negotiations under similar provisions of State
public employee relations laws, and (II) in accordance with
subparagraphs (C), (D), and (E);''.
(b) Limitations.--Section 3(40) of such Act (29 U.S.C.
1002(40)) is amended by adding at the end the following new
subparagraphs:
``(C) For purposes of subparagraph (A)(i)(II), a plan or
other arrangement shall be treated as established or
maintained in accordance with this subparagraph only if the
following requirements are met:
``(i) The plan or other arrangement, and the employee
organization or any other entity sponsoring the plan or other
arrangement, do not--
``(I) utilize the services of any licensed insurance agent
or broker for soliciting or enrolling employers or
individuals as participating employers or covered individuals
under the plan or other arrangement; or
``(II) pay any type of compensation to a person, other than
a full time employee of the employee organization (or a
member of the organization to the extent provided in
regulations prescribed by the Secretary through negotiated
rulemaking), that is related either to the volume or number
of employers or individuals solicited or enrolled as
participating employers or covered individuals under the plan
or other arrangement, or to the dollar amount or size of the
contributions made by participating employers or covered
individuals to the plan or other arrangement;

except to the extent that the services used by the plan,
arrangement, organization, or other entity consist solely of
preparation of documents necessary for compliance with the
reporting and disclosure requirements of part 1 or
administrative, investment, or consulting services unrelated
to solicitation or enrollment of covered individuals.
``(ii) As of the end of the preceding plan year, the number
of covered individuals under the plan or other arrangement
who are neither--
``(I) employed within a bargaining unit covered by any of
the collective bargaining agreements with a participating
employer (nor covered on the basis of an individual's
employment in such a bargaining unit); nor
``(II) present employees (or former employees who were
covered while employed) of the sponsoring employee
organization, of an employer who is or was a party to any of
the collective bargaining agreements, or of the plan or other
arrangement or a related plan or arrangement (nor covered on
the basis of such present or former employment),

does not exceed 15 percent of the total number of individuals
who are covered under the plan or arrangement and who are
present or former employees who are or were covered under the
plan or arrangement pursuant to a collective bargaining
agreement with a participating employer. The requirements of
the preceding provisions of this clause shall be treated as
satisfied if, as of the end of the preceding plan year, such
covered individuals are comprised solely of individuals who
were covered individuals under the plan or other arrangement
as of the date of the enactment of the Small Business Health
Fairness Act of 2003 and, as of the end of the preceding plan
year, the number of such covered individuals does not exceed
25 percent of the total number of present and former
employees enrolled under the plan or other arrangement.
``(iii) The employee organization or other entity
sponsoring the plan or other arrangement certifies to the
Secretary each year, in a form and manner which shall be
prescribed by the Secretary through negotiated rulemaking
that the plan or other arrangement meets the requirements of
clauses (i) and (ii).
``(D) For purposes of subparagraph (A)(i)(II), a plan or
arrangement shall be treated as established or maintained in
accordance with this subparagraph only if--
``(i) all of the benefits provided under the plan or
arrangement consist of health insurance coverage; or
``(ii)(I) the plan or arrangement is a multiemployer plan;
and
``(II) the requirements of clause (B) of the proviso to
clause (5) of section 302(c) of the Labor Management
Relations Act, 1947 (29 U.S.C. 186(c)) are met with respect
to such plan or other arrangement.
``(E) For purposes of subparagraph (A)(i)(II), a plan or
arrangement shall be treated as established or maintained in
accordance with this subparagraph only if--
``(i) the plan or arrangement is in effect as of the date
of the enactment of the Small Business Health Fairness Act of
2003; or
``(ii) the employee organization or other entity sponsoring
the plan or arrangement--
``(I) has been in existence for at least 3 years; or
``(II) demonstrates to the satisfaction of the Secretary
that the requirements of subparagraphs (C) and (D) are met
with respect to the plan or other arrangement.''.
(c) Conforming Amendments to Definitions of Participant and
Beneficiary.--Section 3(7) of such Act (29 U.S.C. 1002(7)) is
amended by adding at the end the following new sentence:
``Such term includes an individual who is a covered
individual described in paragraph (40)(C)(ii).''.

SEC. 5. ENFORCEMENT PROVISIONS RELATING TO ASSOCIATION HEALTH
PLANS.

(a) Criminal Penalties for Certain Willful
Misrepresentations.--Section 501 of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1131) is amended--
(1) by inserting ``(a)'' after ``Sec. 501.''; and
(2) by adding at the end the following new subsection:
``(b) Any person who willfully falsely represents, to any
employee, any employee's beneficiary, any employer, the
Secretary, or any State, a plan or other arrangement
established or maintained for the purpose of offering or
providing any benefit described in section 3(1) to employees
or their beneficiaries as--
``(1) being an association health plan which has been
certified under part 8;
``(2) having been established or maintained under or
pursuant to one or more collective

[[Page S3263]]

bargaining agreements which are reached pursuant to
collective bargaining described in section 8(d) of the
National Labor Relations Act (29 U.S.C. 158(d)) or paragraph
Fourth of section 2 of the Railway Labor Act (45 U.S.C. 152,
paragraph Fourth) or which are reached pursuant to labor-
management negotiations under similar provisions of State
public employee relations laws; or
``(3) being a plan or arrangement with respect to which the
requirements of subparagraph (C), (D), or (E) of section
3(40) are met,

shall, upon conviction, be imprisoned not more than 5 years,
be fined under title 18, United States Code, or both.''.
(b) Cease Activities Orders.--Section 502 of such Act (29
U.S.C. 1132), as amended by sections 141 and 143, is further
amended by adding at the end the following new subsection:
``(p) Association Health Plan Cease and Desist Orders.--
``(1) In general.--Subject to paragraph (2), upon
application by the Secretary showing the operation,
promotion, or marketing of an association health plan (or
similar arrangement providing benefits consisting of medical
care (as defined in section 733(a)(2))) that--
``(A) is not certified under part 8, is subject under
section 514(b)(6) to the insurance laws of any State in which
the plan or arrangement offers or provides benefits, and is
not licensed, registered, or otherwise approved under the
insurance laws of such State; or
``(B) is an association health plan certified under part 8
and is not operating in accordance with the requirements
under part 8 for such certification,

a district court of the United States shall enter an order
requiring that the plan or arrangement cease activities.
``(2) Exception.--Paragraph (1) shall not apply in the case
of an association health plan or other arrangement if the
plan or arrangement shows that--
``(A) all benefits under it referred to in paragraph (1)
consist of health insurance coverage; and
``(B) with respect to each State in which the plan or
arrangement offers or provides benefits, the plan or
arrangement is operating in accordance with applicable State
laws that are not superseded under section 514.
``(3) Additional equitable relief.--The court may grant
such additional equitable relief, including any relief
available under this title, as it deems necessary to protect
the interests of the public and of persons having claims for
benefits against the plan.''.
(c) Responsibility for Claims Procedure.--Section 503 of
such Act (29 U.S.C. 1133), as amended by section 301(b), is
amended by adding at the end the following new subsection:
``(c) Association Health Plans.--The terms of each
association health plan which is or has been certified under
part 8 shall require the board of trustees or the named
fiduciary (as applicable) to ensure that the requirements of
this section are met in connection with claims filed under
the plan.''.

SEC. 6. COOPERATION BETWEEN FEDERAL AND STATE AUTHORITIES.

Section 506 of the Employee Retirement Income Security Act
of 1974 (29 U.S.C. 1136) is amended by adding at the end the
following new subsection:
``(c) Consultation With States With Respect to Association
Health Plans.--
``(1) Agreements with states.--The Secretary shall consult
with the State recognized under paragraph (2) with respect to
an association health plan regarding the exercise of--
``(A) the Secretary's authority under sections 502 and 504
to enforce the requirements for certification under part 8;
and
``(B) the Secretary's authority to certify association
health plans under part 8 in accordance with regulations of
the Secretary applicable to certification under part 8.
``(2) Recognition of primary domicile state.--In carrying
out paragraph (1), the Secretary shall ensure that only one
State will be recognized, with respect to any particular
association health plan, as the State to with which
consultation is required. In carrying out this paragraph, the
Secretary shall take into account the places of residence of
the participants and beneficiaries under the plan and the
State in which the trust is maintained.''.

SEC. 7. EFFECTIVE DATE AND TRANSITIONAL AND OTHER RULES.

(a) Effective Date.--The amendments made by sections 2, 5,
and 6 shall take effect one year from the date of the
enactment. The amendments made by sections 3 and 4 shall take
effect on the date of the enactment of this Act. The
Secretary of Labor shall first issue all regulations
necessary to carry out the amendments made by this subtitle
within one year from the date of the enactment. Such
regulations shall be issued through negotiated rulemaking.
(b) Exception.--Section 801(a)(2) of the Employee
Retirement Income Security Act of 1974 (added by section 2)
does not apply in connection with an association health plan
(certified under part 8 of subtitle B of title I of such Act)
existing on the date of the enactment of this Act, if no
benefits provided thereunder as of the date of the enactment
of this Act consist of health insurance coverage (as defined
in section 733(b)(1) of such Act).
(c) Treatment of Certain Existing Health Benefits
Programs.--
(1) In general.--In any case in which, as of the date of
the enactment of this Act, an arrangement is maintained in a
State for the purpose of providing benefits consisting of
medical care for the employees and beneficiaries of its
participating employers, at least 200 participating employers
make contributions to such arrangement, such arrangement has
been in existence for at least 10 years, and such arrangement
is licensed under the laws of one or more States to provide
such benefits to its participating employers, upon the filing
with the applicable authority (as defined in section
812(a)(5) of the Employee Retirement Income Security Act of
1974 (as amended by this subtitle)) by the arrangement of an
application for certification of the arrangement under part 8
of subtitle B of title I of such Act--
(A) such arrangement shall be deemed to be a group health
plan for purposes of title I of such Act;
(B) the requirements of sections 801(a)(1) and 803(a)(1) of
the Employee Retirement Income Security Act of 1974 shall be
deemed met with respect to such arrangement;
(C) the requirements of section 803(b) of such Act shall be
deemed met, if the arrangement is operated by a board of
directors which--
(i) is elected by the participating employers, with each
employer having one vote; and
(ii) has complete fiscal control over the arrangement and
which is responsible for all operations of the arrangement;
(D) the requirements of section 804(a) of such Act shall be
deemed met with respect to such arrangement; and
(E) the arrangement may be certified by any applicable
authority with respect to its operations in any State only if
it operates in such State on the date of certification.

The provisions of this subsection shall cease to apply with
respect to any such arrangement at such time after the date
of the enactment of this Act as the applicable requirements
of this subsection are not met with respect to such
arrangement.
(2) Definitions.--For purposes of this subsection, the
terms ``group health plan'', ``medical care'', and
``participating employer'' shall have the meanings provided
in section 812 of the Employee Retirement Income Security Act
of 1974, except that the reference in paragraph (7) of such
section to an ``association health plan'' shall be deemed a
reference to an arrangement referred to in this subsection.
____

The Small Business Health Fairness Act of 2003

SEC. 421. RULES GOVERNING ASSOCIATION HEALTH PLANS

Subsection (a). Rules Governing Regulation of Association Health Plans.

This subsection adds a new Part 8 (Rules Governing
Regulation of Association Health Plans) to Title I, Subtitle
B of ERISA, as follows:

SEC. 801. ASSOCIATION HEALTH PLANS.

(a) The term ``association health plan'' means a ``group
health plan'' (which is defined in ERISA as added by the
Health Insurance Portability and Accountability Act or HIPAA;
under HIPAA such group health plans are subject to all of the
portability, preexisting condition, nondiscriminating,
special enrollment, renewability and other provisions of
ERISA Part 7)--
(b) The sponsor of an Association Health Plan (AHP) must
be:
(1) Organized and maintained in good faith, with a
constitution and bylaws specifically stating its purpose and
providing for at least annual meetings, as a trade
association, and industry association (including a rural
electric or rural telephone cooperative), a professional
association, or a chamber of commerce (or similar business
group, include a similar organization that operates on a
cooperative basis within the meaning of section 1381 of the
Internal Revenue Code), for substantial purposes other than
that of obtaining or providing medical care.
(2) Is established as a permanent entity which receives the
active support of its members, and collects dues from its
members on a periodic basis;
(3) Does not condition membership, dues or coverage under
the health plan on the basis of health status-related factors
with respect to employees of members, and does not condition
such dues on the basis of the member's participation in the
group health plan.
In addition to the associations described above, certain
other entities are eligible to seek certification as AHPs.
These include (1) franchise networks (section 803(c)), and
(2) multiemployer plans and certain existing collectively
bargained arrangements which fail to meet the statutory
exemption criteria (section 803(d)).

SEC. 802. CERTIFICATION OF ASSOCIATION HEALTH PLANS.

This section establishes a procedure for the certification
of Association Health Plans as prescribed by the Secretary of
Labor or other applicable authority (applicable authority).
In the case of an association health plan that provides at
least one benefit option that does not consist of health
insurance coverage, the applicable authority shall grant
certification only if the applicable requirements are met
(or, upon the date on which the plan is to commence
operations, will be met). Such self-insured association
health plans may only be certified if they also (1) offered
such coverage on the date of enactment of this Act; (2) the
sponsor does not restrict membership to one or more trades or
businesses or industries and whose

[[Page S3264]]

eligible participating employers represent a broad cross-
section of trades or businesses or industries; and (3) the
plan's eligible participating employers represent one or more
trades or businesses, or one or more industries, which have
been indicated as having average or above-average health
insurance risk or health claims experience by reason of state
rate filings, denials of coverage, or proposed premium rate
levels, or other means demonstrated by such plan in accord
with regulations prescribed through negotiated rulemaking by
the applicable authority.
The applicable authority may provide by regulation for
continued certification of association health plans. A
``class certification'' procedure is established to speed the
approval of plans that offer only fully-insured health
insurance coverage.
In essence, this procedure has the same effect as requiring
the Secretary to implement authority under current law to
issue exemptions for association health plans (see ERISA
section 514(b)(6)(B)). An AHP that is certified must also
meet the applicable requirements of Part 8 as described
below.

SEC. 803. REQUIREMENTS RELATING TO SPONSORS AND BOARDS OF
TRUSTEES.

This section establishes additional eligibility
requirements for AHPs. Applicants must demonstrate that the
arrangement's sponsor has been in existence for a continuous
period of at least three years for substantial purposes other
than providing coverage under a group health plan.
Subsection (b) also requires that the plan be operated,
pursuant to trust agreement, by a ``board of trustees'' which
has complete fiscal control and which is responsible for all
operations of the plan. The board of trustees must develop
rules of operation and financial control based on a three-
year plan of operation which is adequate to carry out the
terms of the plan and to meet all applicable requirements of
the certification and Title I of ERISA. The board of trustees
must consist of individuals who are owners, officers,
directors or employees of the employers who participate in
the plan.
In addition to the association described in section 801,
certain other entities are made eligible to seek
certification as AHPs. These include (1) franchise networks
(section 803(c)) and (2) multiemployer plans and certain
existing collectively bargained arrangements which fail to
meet the statutory exemption criteria (section 803(d)).

SEC. 804. PARTICIPATION AND COVERAGE REQUIREMENTS.

This section prohibits discrimination against eligible
employers and employees by requiring that all employers who
are association members be eligible for participation under
the terms of the plan, that eligible employers be informed of
all benefit options available, and that eligible individuals
of such participating employers not be excluded from
enrolling in the plan because of health status. Plans may
include minimum participation, contribution, and size
requirements to the extent that they meet the
nondiscrimination and other rules under sections 701, 702,
and 703. Affiliated members of the plan sponsor may be
offered overage if they are affiliated at the time of
certification or if they were previously uninsured for 12
months prior to being covered. The legislation will not
affect the individual health insurance market adversely
inasmuch as the bill requires that no participating employer
may exclude an employee from enrollment under an AHP by
purchasing an individual policy of health insurance coverage
for such person based on his or her health status.

SEC. 805. OTHER REQUIREMENTS RELATING TO PLAN DOCUMENTS,
CONTRIBUTION RATES, AND BENEFIT OPTIONS.

Section 805 requires an association health plan to meet the
following requirements: (1) its governing instruments must
provide that the board of trustees serves as the named
fiduciary and plan administrator, that the sponsor serves as
plan sponsor, and that the reserve requirements of section
806 are met; (2) the contribution rates for any particular
employer must be nondiscriminatory--they can not vary only on
the claims experience of the particular employer or on the
type of business or industry in which the employer is
engaged, regardless of how much such claims may be above or
below average claims experience, (3) the plan has at least
1,000 participants and beneficiaries if the plan does not
consist solely of fully-insured health insurance coverage,
(4) utilizes State-licensed insurance agents in the marketing
of health insurance benefits under the plan; and (5) the plan
meets such other requirements as may be set forth in
regulations by the applicable authority.
The rules also stipulate that association health plans must
be allowed to design benefit options. Specifically, no
provision of state law shall preclude an AHP or health
insurance issuer from exercising its discretion in designing
the items and services of medical care to be included as
health insurance converge under the plan, except to the
extent that such law (1) prohibits a specific disease from
such coverage, or (2) is not preempted under section
731(a)(1) with respect to the matters governed by section 711
(relating to maternal and newborn hospitalization) and
section 712 (relating to mental health coverage). In
addition, no provision of law shall be construed to preclude
an AHP or health insurance issuer from setting contribution
rates based on the experience under the plan to the extent
such rates are nondiscriminatory as described above.

SEC. 806. MAINTENANCE OF RESERVES AND PROVISIONS FOR SOLVENCY
FOR PLANS PROVIDING HEALTH BENEFITS IN ADDITION
TO HEALTH INSURANCE COVERAGE.

Section 806 requires AHPs offering benefit options that do
not consist solely of fully-insured health insurance coverage
to establish and maintain reserves sufficient for unearned
contributions, benefit liabilities incurred but not yet
satisfied and for which risk of loss has not been
transferred, expected administrative costs, any other
obligations and a margin for error recommended by the plan's
qualified actuary. In addition, the AHP must maintain minimum
surplus reserves of $500,000 or such greater amount (up to
$2,000,000) as the applicable authority may prescribe. Also,
each plan must secure coverage from an insurer consisting of
(1) aggregate stop-loss insurance with an attachment point
not greater than 125 percent of expected gross claims; (2)
specific stop-loss insurance with an attachment point which
is at least equal to an amount recommended by the plan's
qualified actuary; and (3) to prevent insolvency,
indemnification for any claims which a plan is unable to
satisfy by reason of a mandatory termination described under
section 809(b). The applicable authority may provide
additional requirements relating to reserves and excess/stop
loss insurance and may provide adjustments to the levels of
reserves otherwise required to take into account the level of
excess/stop loss insurance or other financial arrangements.
the bill also establishes an ``Association Health Plan
Fund'' which is to be managed by the Department of Labor for
the purpose of making payments to cover any outstanding
benefit claims which are not fulfilled in accord with the
solvency standards described above. All certified AHPs will
pay $5,000 into the fund annually, and this amount may be
altered according to need by the Secretary.
The bill also establishes a ``Solvency Standards Working
Group'' for the purpose of providing input to the applicable
authority with respect to solvency requirements for AHPs
certified under the Act. The Working Group shall consist of
not more than 15 members appointed by the applicable
authority, and shall include: (1) a representative of the
NAIC, (2) a representative of the American Academy of
Actuaries; (3) a representative of the State governments; (4)
a representative of existing self-insured health plans; (5) a
representative bona fide associations eligible to sponsor an
AHP under the Act; and (6) a representative of multiemployer
group health plans.

SEC. 807. REQUIREMENTS FOR APPLICATION AND RELATED
REQUIREMENTS.

This section sets forth additional criteria which
association health plans must meet to qualify for
certification. The Secretary shall grant certification to a
plan only if: (1) a complete application has been filed,
accompanied by the filing fee of $5,000; and (2) all other
terms of the certification are met (including financial,
actuarial, reporting, participation, and such other
requirements as may be specified as a condition of the
certification).
The application must include the following: (1) identifying
information about the arrangement and the states in which it
will operate: (2) evidence that ERISA's bonding requirements
will be met; (3) copies of all plan documents and agreements
with service providers; (4) a funding report indicating that
the reserve requirements of section 806 will be met, that
contribution rates will be adequate to cover obligations, and
that a qualified actuary (a member in good standing of the
American Academy of Actuaries or an actuary meeting such
other standards that the Secretary considers adequate) has
issued an opinion with respect to the arrangement's assets,
liabilities, and projected costs; and (5) any other
information prescribed by the applicable authority. Certified
association health plans must notify by the applicable
authority of any material changes in this information at any
time, must file annual reports with the applicable authority,
and must engage a qualified actuary.
AHPs are also required to file their certification with the
applicable state authority of each state in which at least 25
percent of the participants and beneficiaries under the plan
are located.

SEC. 808. NOTICE REQUIREMENTS FOR VOLUNTARY TERMINATION.

Section 808 requires that, except as provided in section
809, and AHP may terminate only if the board of trustees
provides 60 days advance written notice to participants and
beneficiaries and submits to the applicable authority a plan
providing for timely payment of all benefit obligations.

SEC. 809. CORRECTIVE ACTIONS AND MANDATORY TERMINATION.

Section 809 requires an AHP which offers benefit options
which are not fully-insured to continue to meet the reserve
requirements under section 806 even if its exemption is no
longer in effect. The board of trustees of such an AHP must
quarterly determine whether the reserve requirements of
section 806 are being met and, if they are not, must, in
consultation with the qualified actuary, develop a plan to
ensure compliance and report such information to the
applicable authority. In any case where an AHP notifies the
applicable authority that it has failed to meet the reserve
requirements and corrective action has not restored
compliance, and

[[Page S3265]]

the applicable authority determines that there is a
reasonable expectation that the plan will continue to fail to
meet the requirements applicable to such AHPs, the applicable
authority may direct the board to terminate the arrangement.

SEC. 810 TRUSTEESHIP BY THE SECRETARY OF INSOLVENT
ASSOCIATION HEALTH PLANS PROVIDING HEALTH
BENEFITS IN ADDITION TO HEALTH INSURANCE
COVERAGE.

Whenever the Secretary determines an AHP won't be able to
provide benefits, or is otherwise in financial distress, the
Secretary shall apply for appointment as trustee to
administer the winding down of the plan.

SEC. 811. STATE ASSESSMENT AUTHORITY.

This section allows a state to assess newly certified AHPs
a contribution tax to the same extent they tax health
insurance plan. This is intended to enable states to maintain
the revenue source for funding high-risk insurance pools.

SEC. 812. DEFINITIONS.

This section defines the following terms: group health
plan, medical care, health insurance coverage, health
insurance issuer, applicable authority, health status-related
factor, individual market, treatment of very small groups,
participating employer, applicable state authority, qualified
actuary, affiliated member, large employer, and small
employer. The terms are consistent with those added to ERISA
by HIPAA. In addition, the terms ``employer'' and
``employee'' include self-employed individuals and partners
for purposes of the application of Part 8 and the provisions
of Title I as applicable to association health plans.

Subsection (b). Conforming Amendments.

This subsection contains (1) conforming changes to the
definition of ``plan sponsor'' to include the sponsor of an
AHP; (2) conforming changes to the Title I exception for
church plans electing association health plan status; and (3)
as described below, conforming changes to section 514
preemption rules to reflect the policy changes under Part 8
with respect to association health plans. First, paragraph
(6) of section 514(b) is made inapplicable with respect to
any state law in the case of a certified AHP. Second, a new
subsection 514(d) (current subsection (d) is redesignated as
(e)) clarifies the ability of health insurance issuers to
offer health insurance coverage under AHPs and clarifies the
ability of any health insurance issuer to offer health
insurance coverage of the same policy type as offered in
connection with a particular AHP to eligible employers,
regardless of whether such employers choose or do not choose
to become members of the particular association. Health
insurance coverage policy forms filed and approved in a
particular state in connection with an insurer's offering
under an association health plan are deemed to be approved in
any other state in which such coverage is offered when the
insurer provides a complete filing in the same form and
manner to the authority in the other state. Also, this
section removes the current restriction on state
regulation of self-insured multiple employer welfare
arrangements providing medical care (which do not elect to
meet the certification requirements for AHPs) under
section 514(b)(6)(a)(ii) by eliminating the requirement
that such state laws otherwise ``be consistent with the
provisions of ERISA Title I.'' Section 514 is also amended
to include a cross-reference to section 805(b) (relating
to the ability of AHPs and health insurance issuers to
design association health insurance options) and to
section 805(a)(2)(B) (relating to the ability of AHPs and
health insurance issuers to base contribution rates on the
experience of such plans).

SEC. 422. CLARIFICATION OF TREATMENT OF SINGLE EMPLOYER
ARRANGEMENT.

This section modifies the treatment of certain single
employer arrangements under the section of ERISA that defines
a multiple employer welfare arrangement (section 3(40). The
treatment of a single employer plan as being excluded from
the definition of such an arrangement (and thus from state
law) is clarified by defining the minimum interest required
for two or more entities to be in ``common control'' as a
percentage which can not be required to be greater than 25
percent. Also, a plan would be considered a single employer
plan if less than 25 percent of the covered employees are
employed by other participating employers.

SEC. 423. CLARIFICATION OF TREATMENT OF CERTAIN COLLECTIVELY
BARGAINED ARRANGEMENTS.

This section clarified the conditions under which
multiemployer and other collectively bargained arrangements
are exempted from the definition of a multiple employer
welfare arrangement, and thus exempt from state law. This is
intended to address the problem of ``bogus unions'' and other
illegitimate health insurance operators. The provision amends
the definition of such an arrangement to exclude a plan or
arrangement which is established or maintained under or
pursuant to a collective bargaining arrangement (as described
in the National Labor Relations Act, the Railway Labor Act,
and similar state public employee relation laws). Current law
requires the Secretary to ``find'' that a collective
bargaining agreement exists, but no such finding has ever
been issued. It then specifies additional conditions which
must be met for such a plan to be a statutorily excluded
collectively bargained arrangement, and thus not a multiple
employer welfare arrangement. These include:
(1) The plan can not utilize the services of any licensed
insurance agent or broker to solicit or enroll employers or
pay a commission or other form of compensation to certain
persons that is related to the volume or number of employers
or individuals solicited or enrolled in the plan.
(2) A maximum 15 percent rule applies to the number of
covered individuals in the plan who are not employees (or
their beneficiaries) within a bargaining unit covered by any
of the collective bargaining agreements with a participating
employer or who are not present or former employees (or their
beneficiaries) of sponsoring employee organizations or
employers who are or were a party to any of the collective
bargaining agreements.
(3) The employee organization or other entity sponsoring
the plan or arrangement must certify annually to the
Secretary the plan has met the previous requirements.
(4) If the plan or arrangement is not fully insured, it
must be a multiemployer plan meeting specific requirements of
the Labor Management Relations Act (i.e., the requirement for
joint labor-management trusteeship under section
302(c)(5)(B)).
(5) If the plan or arrangement is not in effect as of the
date of enactment, the employee organization or other entity
sponsoring the plan or arrangement must have existed for at
least three years or have been affiliated with another
employee organization in existence for at least three years,
or demonstrate to the Secretary that certain of the above
requirements have been met.

SEC. 424. ENFORCEMENT PROVISIONS RELATING TO ASSOCIATION
HEALTH PLANS.

This section amends ERISA to establish enforcement
provisions relating to association health plans and multiple
employer welfare arrangements: (1) willful misrepresentation
that an entity is an exempted AHP or collectively-bargained
arrangement may result in criminal penalties: (2) the section
provides for cease activity orders for arrangements found to
be neither licensed, registered, or otherwise approved under
State insurance law, or operating in accordance with the
terms of the certification granted by the Secretary under
Part 8; and (3) the section provides for the responsibility
of the named fiduciary or board of trustees of an AHP to
comply with the required claims procedure under ERISA.

SEC. 425. COOPERATION BETWEEN FEDERAL AND STATE AUTHORITIES

This section amends section 506 of ERISA (relating to
coordination and responsibility of agencies enforcing ERISA
and related laws) to require the Secretary of Labor to
consult with state insurance departments with regard to the
Secretary's authority under section 502 and 504 to enforce
provisions applicable to certified AHPs.

SEC. 426. EFFECTIVE DATE; TRANSITIONAL RULES.

In general, the amendments made by Section 421, 424, and
425 of the Act are effective one year after enactment of the
Act. Sections 422 and 423 are effective upon date of
enactment. In addition, the Secretary is required to issue
all regulations needed to carry out the amendments within one
year after enactment of the Act.
The provisions of section 805(a)(2) relating to health
insurance coverage do not apply to group health plans
existing on the date of enactment if they do not provide
health insurance coverage, but later qualify for
certification.
AHPs not in existence on the date of enactment and desiring
to offer benefits which do not consist of health insurance
must demonstrate to the Secretary that their risk is at least
average or above average. The Secretary shall report to
Congress the affect on reducing the number of uninsured after
five years.
______

By Mr. AKAKA (for himself, Mr. Baucus, Mr. Campbell, Mr. Durbin,
Mrs. Feinstein, Mr. Roberts, and Mr. Leahy):
S. 546. A bill to provide for the protection of paleontological
resources on Federal lands, and for other purposes; to the Committee on
Energy and Natural Resources.
Mr. AKAKA. Mr. President, I rise today to introduce The
Paleontological Resources Preservation Act to protect and preserve the
Nation's important fossil record for the benefit of our citizens. I am
pleased to have Senators Baucus, Campbell, Durbin, Feinstein, Leahy,
and Roberts join me as original cosponsors on this significant
legislation.
This bill was reported favorably by the Energy and Natural Resources
Committee, and approved by unanimous consent during the 107th Congress.
I plan to work closely with my colleagues to enact this bill during the
108th Congress.
In 1999, Congress requested that the Secretary of the Interior review
and report on the Federal policy concerning paleontological resources
on Federal lands. In its request, Congress noted that no unified
Federal policy existed regarding the treatment of fossils by Federal
land management agencies, and emphasized Congress's concerns that lack
of appropriate standards

[[Page S3266]]

would lead to the deterioration or loss of fossils, which are valuable
scientific resources.
In response, seven Federal agencies and the Smithsonian Institution
released a report in May 2000 entitled ``Assessment of Fossil
Management on Federal and Indian Lands.'' This assessment outlined
governing principles for the management of fossils on Federal lands.
The report recommended that penalties for fossil theft be strengthened
and that Federal fossil collections be preserved and available for
research and public education. The interagency group also stated that
fossils on Federal lands are rare and a part of America's heritage and
that effective stewardship requires accurate information and
inventories.
The Paleontological Resources Preservation Act embodies these
principles, and provides the paleontological equivalent of protections
found in the Archeological Resources Preservation Act. The bill finds
that fossil resources on Federal lands are an irreplaceable part of the
heritage of the United States. It affirms that reasonable access to
fossil resources should be provided for scientific, educational, and
recreational purposes. The bill acknowledges the value of amateur
collecting, but protects vertebrate fossils found on Federal lands
under a system of permits.
I would like to emphasize that this bill in no way affects
archaeological or cultural resources under the Archaeological Resources
Protection Act of 1979 or the Native American Graves Protection and
Rehabilitation Act. They are exempted. This bill covers paleontological
remains--fossils on Federal lands only.
As we look toward the future, public access to fossil resources will
take on a new meaning as digital images of fossils become available
worldwide. The National Museum of Natural History, one of the premier
Smithsonian museums, already has an online catalogue of 9 million
specimens, some of which include digital images. Museums will be able
to provide global access for researchers, collectors, and educators to
study fossil collections through online catalogs and images. Many
scientists in developing countries currently lack vital information
about fossils because they cannot afford travel costs to museums. This
digital advance will truly make fossils a global resource for the
public.
Discoveries in paleontology are made more frequently than we realize.
They shape how we learn about the world around us. In January of this
year, Nature reported that Chinese scientists at Beijing's Institute of
Vertebrate Paleontology and Paleoanthropology discovered several four-
winged dinosaur fossils. This discovery is providing us with critical
insight into the phenomenon of flight. The Paleontological Resources
Preservation Act would create a legacy of scientific knowledge for
future generations.
The protections offered in this Act are not new. Federal land
management agencies have individual regulations prohibiting theft of
government property. However, the reality is that U.S. Attorneys are
reluctant to prosecute cases involving fossil theft because they are
difficult. Congress has not provided a clear statute stating the value
of paleontological resources to our Nation, as has been provided for
archeological resources. Fossils are too valuable to be left within the
general theft provisions that are difficult to prosecute, and they are
too valuable to the education of our children not to ensure public
access. We need to work together to make sure that we fulfill our
responsibility as stewards of public lands, and as protectors of our
Nation's natural resources.
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. 546

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 ``Paleontological Resources
Preservation Act''.

SEC. 2. FINDINGS.

The Congress finds the following:
(1) Paleontological resources are nonrenewable. Such
resources on Federal lands are an accessible and
irreplaceable part of the heritage of the United States and
offer significant educational opportunities to all citizens.
(2) Existing Federal laws, statutes, and other provisions
that manage paleontological resources are not articulated in
a unified national policy for Federal land management
agencies and the public. Such a policy is needed to improve
scientific understanding, to promote responsible stewardship,
and to facilitate the enhancement of responsible
paleontological collecting activities on Federal lands.
(3) Consistent with the statutory provisions applicable to
each Federal land management system, reasonable access to
paleontological resources on Federal lands should be provided
for scientific, educational, and recreational purposes.

SEC. 3. PURPOSE.

The purpose of this Act is to establish a comprehensive
national policy for preserving and managing paleontological
resources on Federal lands.

SEC. 4. DEFINITIONS.

As used in this Act:
(1) Casual collecting.--The term ``casual collecting''
means the collecting of a reasonable amount of common
invertebrate and plant paleontological resources for personal
(scientific, educational, or recreational) use, either by
surface collection or using non-powered hand tools resulting
in only negligible disturbance to the Earth's surface and
other resources.
(2) Secretary.--The term ``Secretary'' means the Secretary
of the Interior with respect to lands administered by the
Secretary of the Interior or the Secretary of Agriculture
with respect to National Forest System Lands administered by
the Secretary of Agriculture.
(3) Federal lands.--The term ``Federal lands'' means lands
administered by the Secretary of the Interior, except Indian
lands, or National Forest System Lands administered by the
Secretary of Agriculture.
(4) Indian lands.--The term ``Indian Lands'' means lands of
Indian tribes, or Indian individuals, which are either held
in trust by the United States or subject to a restriction
against alienation imposed by the United States.
(5) State.--The term ``State'' means the fifty States, the
District of Columbia, the Commonwealth of Puerto Rico, and
any other territory or possession of the United States.
(6) Paleontological resource.--The term ``paleontological
resource'' means any fossilized remains, traces, or imprints
of organisms, preserved in or on the earth's crust, that are
of paleontological interest and that provide information
about the history of life on earth, except that the term does
not include--
(A) any materials associated with an archaeological
resource (as defined in section 3(1) of the Archaeological
Resources Protection Act of 1979 (16 U.S.C. 470bb(1)); or
(B) any cultural item (as defined in section 2 of the
Native American Graves Protection and Rehabilitation Act (25
U.S.C. 3001)).

SEC. 5. MANAGEMENT.

(a) In General.--The Secretary shall manage and protect
paleontological resources on Federal lands using scientific
principles and expertise. The Secretary shall develop
appropriate plans for inventory, monitoring, and the
scientific and educational use of paleontological resources,
in accordance with applicable agency laws, regulations, and
policies. These plans shall emphasize interagency
coordination and collaborative efforts where possible with
non-Federal partners, the scientific community, and the
general public.
(b) Coordination of Implementation.--To the extent
possible, the Secretary of the Interior and the Secretary of
Agriculture shall coordinate in the implementation of this
Act.

SEC. 6. PUBLIC AWARENESS AND EDUCATION PROGRAM.

The Secretary shall establish a program to increase public
awareness about the significance of paleontological
resources.

SEC. 7. COLLECTION OF PALEONTOLOGICAL RESOURCES.

(a) Permit Requirement.--
(1) In general.--Except as provided in this Act, a
paleontological resource may not be collected from Federal
lands without a permit issued under this Act by the
Secretary.
(2) Casual collecting exception.--The Secretary may allow
casual collecting without a permit on Federal lands
administered by the Bureau of Land Management, the Bureau of
Reclamation, and the U.S. Forest Service, where such
collection is not inconsistent with the laws governing the
management of those Federal lands and this Act.
(3) Previous permit exception.--Nothing in this section
shall affect a valid permit issued prior to the date of
enactment of this Act.
(b) Criteria for Issuance of a Permit.--The Secretary may
issue a permit for the collection of a paleontological
resource pursuant to an application if the Secretary
determines that--
(1) the applicant is qualified to carry out the permitted
activity;
(2) the permitted activity is undertaken for the purpose of
furthering paleontological knowledge or for public education;
(3) the permitted activity is consistent with any
management plan applicable to the Federal lands concerned;
and
(4) the proposed methods of collecting will not threaten
significant natural or cultural resources.

[[Page S3267]]

(c) Permit Specifications.--A permit for the collection of
a paleontological resource issued under this section shall
contain such terms and conditions as the Secretary deems
necessary to carry out the purposes of this Act. Every permit
shall include requirements that--
(1) the paleontological resource that is collected from
Federal lands under the permit will remain the property of
the United States;
(2) the paleontological resource and copies of associated
records will be preserved for the public in an approved
repository, to be made available for scientific research and
public education; and
(3) specific locality data will not be released by the
permittee or repository without the written permission of the
Secretary.
(d) Modification, Suspension, and Revocation of Permits.--
(1) The Secretary may modify, suspend, or revoke a permit
issued under this section--
(A) for resource, safety, or other management
considerations; or
(B) when there is a violation of term or condition of a
permit issued pursuant to this section.
(2) The permit shall be revoked if any person working under
the authority of the permit is convicted under section 9 or
is assessed a civil penalty under section 10.
(e) Area Closures.--In order to protect paleontological or
other resources and to provide for public safety, the
Secretary may restrict access to or close areas under the
Secretary's jurisdiction to the collection of paleontological
resources.

SEC. 8. CURATION OF RESOURCES.

Any paleontological resource, and any data and records
associated with the resource, collected under a permit, shall
be deposited in an approved repository. The Secretary may
enter into agreements with non-Federal repositories regarding
the curation of these resources, data, and records.

SEC. 9. PROHIBITED ACTS; PENALTIES.

(a) In General.--A person may not--
(1) excavate, remove, damage, or otherwise alter or deface
or attempt to excavate, remove, damage, or otherwise alter or
deface any paleontological resources located on Federal lands
unless such activity is conducted in accordance with this
Act;
(2) exchange, transport, export, receive, or offer to
exchange, transport, export, or receive any paleontological
resource if, in the exercise of due care, the person knew or
should have known such resource to have been excavated,
removed, exchanged, transported, or received from Federal
lands in violation of any provisions, rule, regulation, law,
ordinance, or permit in effect under Federal law, including
this Act; or
(3) sell or purchase or offer to sell or purchase any
paleontological resource if, in the exercise of due care, the
person knew or should have known such resource to have been
excavated, removed, sold, purchased, exchanged, transported,
or received from Federal lands.
(b) False Labeling Offenses.--A person may not make or
submit any false record, account, or label for, or any false
identification of, any paleontological resource excavated or
removed from Federal lands.
(c) Penalities.--
(1) In general.--Except as provided in paragraphs (2) and
(3), a person who knowingly violates or counsels, procures,
solicits, or employs another person to violate subsection (a)
or (b) shall, upon conviction, be guilty of a class A
misdemeanor.
(2) Damage over $1,000.--If the sum of the scientific or
fair market value of the paleontological resources involved
and the cost of restoration and repair of such resources
exceeds the sum of $1,000, such person shall, upon
conviction, be guilty of a class E felony.
(3) Multiple offenses.--In the case of a second or
subsequent such violation, such person shall, upon
conviction, be guilty of a class D felony.
(d) General Exception.--Nothing in subsection (a) shall
apply to any person with respect to any palentological
resource which was in the lawful possession of such person
prior to the date of the enactment of this Act.

SEC. 10. CIVIL PENALTIES FOR VIOLATIONS OF REGULATIONS OR
PERMIT CONDITIONS.

(a) In General.--
(1) Hearing.--A person who violates any prohibition
contained in an applicable regulation or permit issued under
this Act may be assessed a penalty by the Secretary after the
person is given notice and opportunity for a hearing with
respect to the violation. Each violation shall be considered
a separate offense for purposes of this section.
(2) Amount of penalty.--The amount of such penalty assessed
under paragraph (1) shall be determined under regulations
promulgated pursuant to this Act, taking into account the
following factors:
(A) The scientific or fair market value, whichever is
greater, of the paleontological resource involved.
(B) The cost of response, restoration, and repair of the
resource and the paleontolgical site involved.
(C) Any other factors considered relevant by the Secretary
assessing the penalty.
(3) Multiple offenses.--In the case of a second or
subsequent violation by the same person, the amount of a
penalty assessed under paragraph (2) may be doubled.
(4) Limitation.--The amount of any penalty assessed under
this subsection for any one violation shall not exceed an
amount equal to double the cost of response, restoration, and
repair of resources and paleontological site damage plus
double the scientific or fair market value of resources
destroyed or not recovered.
(b) Petition for Judicial Review; Collection of Unpaid
Assessments.--Any person against whom an order is issued
assessing a penalty under subsection (a) may file a petition
for judicial review of the order with an appropriate Federal
district court within the 30-day period beginning on the date
the order making the assessment was issued. The court shall
hear the action on the record made before the Secretary and
shall sustain the action if it is supported by substantial
evidence on the record considered as a whole.
(c) Hearings.--Hearings held during proceedings instituted
under subsection (a) shall be conducted in accordance with
section 554 of title 5, United States Code.
(d) Use of Recovered Amounts.--Penalties collected under
this section shall be available to the Secretary and without
further appropriation may be used only as follows:
(1) To protect, restore, or repair the paleontological
resources and sites which were the subject of the action, or
to acquire sites with equivalent resources, and to protect,
monitor, and study the resources and sites. Any acquisition
shall be subject to any limitations contained in the organic
legislation for such Federal lands.
(2) To provide educational materials to the public about
palenotological resources and sites.
(3) To provide for the payment of Rewards as provided in
section 11.

SEC. 11. REWARDS FORFEITURE.

(a) Rewards.--The Secretary may pay from penalties
collected under section 9 or 10 of this Act an amount equal
to the lesser of one-half of the penalty or $500, to any
person who furnishes information which leads to the finding
of a civil violation, or the conviction of criminal
violation, with respect to which the penalty was paid. If
several persons provided the information, the amount shall be
divided among the persons. No officer or employee of the
United States or of any State or local government who
furnishes information or renders service in the performance
of his official duties shall be eligible for payment under
this subsection.
(b) Forfeiture.--All paleontological resources with respect
to which a violation under section 9 or 10 occurred and which
are in the possession of any person, and all vehicles and
equipment of any person that were used in connection with
the violation, may be subject to forfeiture to the United
States upon--
(1) the person's conviction of the violation under section
9;
(2) assessment of a civil penalty against any person under
section 10 with respect to the violation; or
(3) a determination by any court that the paleontological
resources, vehicles, or equipment were involved in the
violation.

SEC. 12. CONFIDENTIALITY.

Information concerning the nature and specific location of
a paleontological resource the collection of which requires a
permit under this Act or under any other provision of Federal
law shall be withheld from the public under subchapter II of
chapter 5 of title 5, United States Code, or under any other
provision of law unless the responsible Secretary determines
that disclosure would--
(1) further the purposes of this Act;
(2) not create risk of harm to or theft or destruction of
the resource or the site containing the resource; and
(3) be in accordance with other applicable laws.

SEC. 13. REGULATIONS.

As soon as practical after the date of the enactment of
this Act, the Secretary shall issue such regulations as are
appropriate to carry out this Act, providing opportunities
for public notice and comment.

SEC. 14. SAVINGS PROVISIONS.

Nothing in this Act shall be construed to--
(1) invalidate, modify, or impose any additional
restrictions or permitting requirements on any activities
permitted at any time under the general mining laws, the
mineral or geothermal leasing laws, laws providing for
minerals materials disposal, or laws providing for the
management or regulation of the activities authorized by the
aforementioned laws including but not limited to the Federal
Land Policy Management Act (43 U.S.C. 1701-1784), the Mining
in the Parks Act, the Surface Mining Control and Reclamation
Act of 1977 (30 U.S.C. 1201-1358), and the Organic
Administration Act (16 U.S.C. 478, 482, 551);
(2) invalidate, modify, or impose any additional
restrictions or permitting requirements on any activities
permitted at any time existing laws and authorities relating
to reclamation and multiple uses of the public lands;
(3) apply to, or require a permit for, amateur collecting
of a rock, mineral, or invertebrate or plant fossil that is
not protected under this Act;
(4) affect any lands other than Federal lands or affect the
lawful recovery, collection, or sale of paleontological
resources from lands other than Federal lands;
(5) alter or diminish the authority of a Federal agency
under any other law to provide protection for paleontolgical
resources on Federal lands in addition to the protection
provided under this Act; or

[[Page S3268]]

(6) create any right, privilege, benefit, or entitlement
for any person who is not an officer or employee of the
United States acting in that capacity. No person who is not
an officer or employee of the United States acting in that
capacity shall have standing to file any civil action in a
court of the United States to enforce any provision or
amendment made by this Act.

SEC. 15. AUTHORIZATION OF APPROPRIATIONS.

There is authorized to be appropriated such sums as may be
necessary to carry out this Act.

______

By Mr. DURBIN (for himself and Ms. Collins):
S. 547. A bill to encourage energy conservation through bicycling; to
the Committee on Commerce, Science, and Transportation.
Mr. DURBIN. Mr. President, I rise today to introduce the Conserve by
Bike Act to promote energy conservation and improve public health. I am
pleased to be joined by my colleagues from Maine, Senator Susan
Collins, in introducing this measure. This legislation addresses one
part of our Nation's energy challenges. Although there is no single
solution, every possible approach must be considered in order to solve
our energy problems.
Our Nation would realize several benefits from the increased use of
bicycle transportation, including lessened dependence on foreign oil
and prevention of harmful air emissions. Currently, less than one trip
in one hundred, .88 percent, is by bicycle. If we can raise our level
of cycling to one and a half trips per hundred, which is less than one
bike trip every two weeks for the average person, we will save more
than 462 million gallons of gasoline in a year, worth more than $721
million. That is the equivalent of one day a year we will not need to
import any foreign oil.
In addition to fostering greater independence from foreign oil
supplies, this bill will help mitigate air quality challenges, which
can be harmful to public health and the environment. Unlike automotive
transportation, bicycling is emissions-free.
The Conserve by Bike Act encourages bicycling through two key
components: a pilot program and a research project. The Conserve by
Bike Pilot Program established by this legislation would be implemented
by the U.S. Department of Transportation. The Department would fund up
to ten pilots throughout the country that would utilize education and
marketing tools to encourage people to convert some of their car trips
to bike trips. Each of these pilot projects must: 1. document project
results and energy conserved; 2. facilitate partnerships among
stakeholders in two or more of the following fields: transportation,
law enforcement, education, public health, and the environment; 3.
maximize current bicycle facility investments; 4. demonstrate methods
that can be replicated in other locations; and 5. produce ongoing
programs that are sustained by local resources.
This legislation also directs the Transportation Research Board of
the National Academy of Sciences to conduct a research project on
converting car trips to bike trips. The study will consider: 1. what
car trips Americans can reasonably be expected to make by bike, given
such factors as weather, land use, and traffic patterns, carrying
capacity of bicycles, and bicycle infrastructure; 2. what energy
savings would result, or how much energy could be conserved, if these
trips were converted from car to bike; 3. the cost-benefit analysis of
bicycle infrastructure investments; and 4. what factors could encourage
more car trips to be replaced with bike trips. The study also will
identify lessons we can learn from the documented results of the pilot
programs.
The Conserve by Bike Program is a small investment that has the
potential to produce significant returns: greater independence from
foreign oil and a healthier environment and population. The Conserve by
Bike Act authorizes a total of $6.2 million to carry out the pilot
programs and research. A total of $5,150,000 will be used to implement
the pilot projects; $300,000 will be used by the Department of
Transportation to coordinate, publicize, and disseminate the results of
the program; and $750,000 will be utilized for the research study.
The provisions in this bill enjoy strong, bipartisan support and
passed as an amendment to last year's Senate energy bill. The measure
is endorsed by the League of American Bicyclists, which has over
300,000 affiliates, as well as the Association of Pedestrian and
Bicycle Professionals, Rails to Trails Conservancy, Thunderhead
Alliance, Bikes Belong Coalition, Adventure Cycling, International
Mountain Bicycling Association, Chicagoland Bicycle Federation, and the
League of Illinois Bicyclists.
By enacting the Conserve by Bike Act, we can reduce our energy
dependence, reduce harmful air emissions, and improve public health. I
urge my colleagues to cosponsor the Conserve by Bike Act and join me in
making a responsible investment in cleaner, healthier and more energy
efficient future.
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. 547

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. CONSERVE BY BICYCLING PROGRAM.

(a) Definitions.--In this section:
(1) Program.--The term ``program'' means the Conserve by
Bicycling Program established by subsection (b).
(2) Secretary.--The term ``Secretary'' means the Secretary
of Transportation.
(b) Establishment.--There is established within the
Department of Transportation a program to be known as the
``Conserve by Bicycling Program''.
(c) Projects.--
(1) In general.--In carrying out the program, the Secretary
shall establish not more than 10 pilot projects that are--
(A) dispersed geographically throughout the United States;
and
(B) designed to conserve energy resources by encouraging
the use of bicycles in place of motor vehicles.
(2) Requirements.--A pilot project described in paragraph
(1) shall--
(A) use education and marketing to convert motor vehicle
trips to bicycle trips;
(B) document project results and energy savings (in
estimated units of energy conserved);
(C) facilitate partnerships among interested parties in at
least 2 of the fields of--
(i) transportation;
(ii) law enforcement;
(iii) education;
(iv) public health;
(v) environment; and
(vi) energy;
(D) maximize bicycle facility investments;
(E) demonstrate methods that may be used in other regions
of the United States; and
(F) facilitate the continuation of ongoing programs that
are sustained by local resources.
(3) Cost sharing.--At least 20 percent of the cost of each
pilot project described in paragraph (1) shall be provided
from State or local sources.
(d) Energy and Bicycling Research Study.--
(1) In general.--Not later than 2 years after the date of
enactment of this Act, the Secretary shall enter into a
contract with the National Academy of Sciences for, and the
National Academy of Sciences shall conduct and submit to
Congress a report on, a study on the feasibility of
converting motor vehicle trips to bicycle trips.
(2) Components.--The study shall--
(A) document the results or progress of the pilot projects
under subsection (b);
(B) determine the type and duration of motor vehicle trips
that people in the United States may feasibly make by
bicycle, taking into consideration factors such as--
(i) weather;
(ii) land use and traffic patterns;
(iii) the carrying capacity of bicycles; and
(iv) bicycle infrastructure;
(C) determine any energy savings that would result from the
conversion of motor vehicle trips to bicycle trips;
(D) include a cost-benefit analysis of bicycle
infrastructure investments; and
(E) include a description of any factors that would
encourage more motor vehicle trips to be replaced with
bicycle trips.
(f) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section $6,200,000, to
remain available until expended, of which--
(1) $5,150,000 shall be used to carry out pilot projects
described in subsection (c);
(2) $300,000 shall be used by the Secretary to coordinate,
publicize, and disseminate the results of the program; and
(3) $750,000 shall be used to carry out subsection (e).

Ms. COLLINS. Mr. President, I am pleased to join my colleague from
Illinois in reintroducing this legislation to recognize and promote
bicycling's important impact on energy savings and public health.
With America becoming more and more dependent on foreign oil, it is
vital that we look to the contribution that bike travel can make toward
solving our Nation's energy challenges.

[[Page S3269]]

This legislation would establish a Conserve by Bike pilot program that
would oversee pilot projects throughout the country designed to
conserve energy resources by providing education and marketing tools to
convert car trips to bike trips. Right now, fewer than one trip in one
hundred is by bicycle. If we could increase this statistic to one and a
half trips per hundred, we would save over 462 million gallons of
gasoline in a year, worth over $721 million.
While more bike trips would benefit our energy conservation efforts,
that would also help improve the public's health. According to the U.S.
Surgeon General, fewer than one-third of Americans meet Federal
recommendations to engage in at least 30 minutes of moderate physical
activity at least 5 days a week. Even more disturbing is the fact that
approximately 300,000 U.S. death a year are associated with being obese
or overweight. By promoting biking, we are working to ensue that
Americans will increase their physical activity.
The Conserve by Bike Act has received widespread support on the
national, state, and local level, and I urge my colleagues to support
this legislation.
______

By Mr. ROCKEFELLER:
S. 548. A bill to improve mental health programs for veterans, and
for other purposes; to the Committee on Veterans' Affairs.
Mr. ROCKEFELLER. Mr. President, as a senior member of the Senate
Committee on Veterans' Affairs, I am proud to reintroduce legislation
today intended to strengthen mental health programs within the
Department of Veterans Affairs a key element of caring for those who
have served on the battlefield.
Historically, as many as one-third of all veterans seeking care at VA
have received mental health treatment, and research suggests that
serious mental illnesses affect at least one-fifth of the veterans who
use the VA health care system. About 450,000 of the approximately 2.3
million veterans who receive compensation from VA have service-
connected psychiatric and neurological disorders.
I remain concerned about the viability of some of the programs
developed to care for veterans with mental health needs. I have heard
testimony about a number of these programs endangered by budget
constraints and a shift in focus from inpatient care to outpatient
clinics. Specialized programs particularly for substance use disorders
and PTSD shut down, reduced in size, or understaffed--offering little
or no care to veterans suffering from these seriously debilitating
disorders.
Congress previously enacted a provision to designate $15 million in
VA funding specifically to assist medical facilities in their efforts
to improve care for veterans with substance use disorders and PTSD.
This additional funding has enabled VA to develop better outpatient
substance abuse and PTSD treatment programs, outpatient dual-diagnosis
programs, more PTSD community clinical teams, and more residential
substance abuse disorder rehabilitation programs.
The funds for these mental health programs, mandated by the
Millennium Benefits and Health Care Act of 1999, will soon revert to a
general fund. The bill I am introducing today ensures that this funding
will remain ``protected'' for three more years and increases the total
amount of funding identified specifically for treatment of substance
use disorders and PTSD from $15 million to $25 million.
Another provision of the legislation I am introducing today concerns
VA's Mental Illness Research, Education, and Clinical Centers, called
``MIRECCs. In 1996, Congress authorized VA to establish five of these
centers dedicated to mental illness research, education, and clinical
activities. This provision will allow VA to establish up to ten more
MIRECCs to study and treat mental illnesses. MIRECCs have encouraged
research, given VA caregivers more and better tools to treat patients
with mental disorders, and increased our fundamental understanding of
mental illnesses. Much more can be done in this area if the program is
expanded.
Another critical area of VA care involves counseling and treatment
for veterans who were victims of sexual harassment or sexual assault
during active military service. In 1992, Congress authorized VA to
provide counseling to women who experienced sexual trauma during active
military service. Two years later, recognizing that sexual trauma is
not limited to women, Congress expanded VA's mandate to offer
counseling and treatment regardless of gender. The Veterans Millennium
Health Care and Benefits Act of 1999 broadened VA's responsibilities
toward victims of sexual trauma even further, strengthening outreach
efforts and extending the programs through December 2004. The
legislation I am reintroducing today would provide permanent authority
to VA for counseling and treatment of veterans who have experienced
military sexual trauma, so that veterans and health care professionals
can depend upon these critical services.
I hope my colleagues will join me in supporting the expansion of
these enormously important mental health programs with the Department
of Veterans Affairs. We owe our service men and women no less.
I ask unanimous consent that the text of this bill be printed in the
Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:

S. 548

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. PERMANENT AUTHORITY FOR COUNSELING AND TREATMENT
OF VETERANS FOR SEXUAL TRAUMA.

Section 1720D of title 38, United States Code, is amended--
(1) in subsection (a)--
(A) in paragraph (1), by striking ``During the period
through December 31, 2004, the Secretary'' and inserting
``The Secretary''; and
(B) in paragraph (2), by striking ``, during the period
through December 31, 2004,''; and
(2) in subsection (b)--
(A) in paragraph (1), by striking ``establishment and'';
and
(B) in paragraph (2), by striking ``establishing a
program'' and inserting ``operating a program''.

SEC. 2. AUTHORITY TO OPERATE ADDITIONAL DEPARTMENT OF
VETERANS AFFAIRS CENTERS FOR MENTAL ILLNESS
RESEARCH, EDUCATION, AND CLINICAL ACTIVITIES.

Section 7320(b)(3) of title 38, United States Code, is
amended by striking ``five centers'' and inserting ``15
centers''.

SEC. 3. IMPROVEMENT OF PROGRAM FOR PROVISION OF SPECIALIZED
MENTAL HEALTH SERVICES TO VETERANS.

(a) Increase in Funding.--Subsection (c) of section 116 of
the Veterans Millennium Health Care and Benefits Act (Public
Law 106-117; 113 Stat. 1559; 38 U.S.C. 1712A note) is
amended--
(1) in paragraph (1), by striking ``$15,000,000'' and
inserting ``$25,000,000 in each of fiscal years 2004, 2005,
and 2006'';
(2) in paragraph (2), by striking ``$15,000,000'' and
inserting ``$25,000,000''; and
(3) in paragraph (3)--
(A) by inserting ``(A)'' after ``(3)''; and
(B) by adding at the end the following new subparagraph:
``(B) For purposes of this paragraph, in fiscal years 2004,
2005, and 2006, the fiscal year utilized to determine the
baseline amount shall be fiscal year 2003.''.
(b) Allocation of Funds.--Subsection (d) of that section is
amended--
(1) by striking ``The Secretary'' and inserting ``(1) In
each of fiscal years 2004, 2005, and 2006, the Secretary'';
and
(2) by adding at the end the following new paragraphs:
``(2) In allocating funds to facilities in a fiscal year
under paragraph (1), the Secretary shall ensure that--
``(A) not less than $10,000,000 is allocated by direct
grants to programs that are identified by the Mental Health
Strategic Health Care Group and the Committee on Care of
Severely Chronically Mentally Ill Veterans;
``(B) not less than $5,000,000 is allocated for programs on
post-traumatic stress disorder; and
``(C) not less than $5,000,000 is allocated for programs on
substance abuse disorder.
``(3) The Secretary shall provide that the funds to be
allocated under this section during each of fiscal years
2004, 2005, and 2006 are funds for a special purpose program
for which funds are not allocated through the Veterans
Equitable Resource Allocation system.''.
______

By Mr. CAMPBELL (for himself, Mr. Inouye, and Mr. Thomas):
S. 550. A bill to amend the Indian Land Consolidation Act to improve
provisions relating to probate of trust and restricted land, and for
other purposes; to the Committee on Indian Affairs.
Mr. CAMPBELL. Mr. President, I am pleased to be joined by Senators
Inouye and Thomas in introducing key legislation to help stop Indian
land fractionation.

[[Page S3270]]

One of the most enduring and damaging legacies of late-19th century
Federal Indian policy is the continuing fractionation of Indian trust
lands.
The results of this ever-growing problem make it nearly impossible
for affected Indian tribes to devise economic development strategies.
By attempting to ``break up the tribal landmass'' and turning Indians
into yeoman farmers, the Dawes Act of 1887 resulted in millions of
acres of land transferred out of Indian ownership.
By virtue of Indian heirship and probate rules and the steady march
of time, millions more acres have passed from their original Indian
allottees to thousands of descendants with undivided interests in
parcels of land.
In strict economic terms, these interests are practically worthless.
Congressional efforts to counter this problem have focused on the
Indian Land Consolidation Act and amendments made to the Act.
Key escheat sections designed to return individual-owned fractionated
lands to tribal ownership have been held unconstitutional by the U.S.
Supreme Court in 1987, Hodel v. Irving, and in 1997, Babbitt v. Youpee.
Congress and the Administration have also sought to return these
interests to tribal ownership through voluntary purchase.
The ``Indian Land Consolidation Program'' was enacted as part of the
Fiscal Year 1999 Omnibus Appropriation and has proven a success.
In 1999 I introduced amendments to the ILCA to limit disposition of
Indian lands to Indian heirs, life estates to non-Indian heirs, or the
tribe with jurisdiction over the lands.
The bill I am re-introducing today was considered by the Committee on
Indian Affairs and passed by the Senate last session. In light of this,
it is my intention to expedite consideration of the measure.
I urge my colleagues to join me in supporting this important bill.
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. 550

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 ``American Indian Probate
Reform Act of 2003''.

SEC. 2. FINDINGS.

Congress finds that--
(1) the Act of February 8, 1887 (commonly known as the
``Indian General Allotment Act'') (25 U.S.C. 331 et seq.),
which authorized the allotment of Indian reservations, did
not permit Indian allotment owners to provide for the
testamentary disposition of the land that was allotted to
them;
(2) that Act provided that allotments would descend
according to State law of intestate succession based on the
location of the allotment;
(3) the reliance of the Federal Government on the State law
of intestate succession with respect to the descent of
allotments has resulted in numerous problems affecting Indian
tribes, members of Indian tribes, and the Federal Government,
including--
(A) the increasingly fractionated ownership of trust and
restricted land as that land is inherited by successive
generations of owners as tenants in common;
(B) the application of different rules of intestate
succession to each interest of a decedent in or to trust or
restricted land if that land is located within the boundaries
of more than 1 State, which application--
(i) makes probate planning unnecessarily difficult; and
(ii) impedes efforts to provide probate planning assistance
or advice;
(C) the absence of a uniform general probate code for trust
and restricted land, which makes it difficult for Indian
tribes to work cooperatively to develop tribal probate codes;
and
(D) the failure of Federal law to address or provide for
many of the essential elements of general probate law, either
directly or by reference, which--
(i) is unfair to the owners of trust and restricted land
(and heirs and devisees of owners); and
(ii) makes probate planning more difficult; and
(4) a uniform Federal probate code would likely--
(A) reduce the number of fractionated interests in trust or
restricted land;
(B) facilitate efforts to provide probate planning
assistance and advice;
(C) facilitate intertribal efforts to produce tribal
probate codes in accordance with section 206 of the Indian
Land Consolidation Act (25 U.S.C. 2205); and
(D) provide essential elements of general probate law that
are not applicable on the date of enactment of this Act to
interests in trust or restricted land.

SEC. 3. INDIAN PROBATE REFORM.

(a) Testamentary Disposition.--Section 207 of the Indian
Land Consolidation Act (25 U.S.C. 2206) is amended by
striking subsection (a) and inserting the following:
``(a) Testamentary Disposition.--
``(1) General devise of an interest in trust or restricted
land.--
``(A) In general.--Subject to any applicable Federal law
relating to the devise or descent of trust or restricted
land, or a tribal probate code enacted in accordance with
section 206, the owner of an interest in trust or restricted
land may devise such an interest to--
``(i) an Indian tribe with jurisdiction over the land; or
``(ii) any Indian in trust or restricted status (or as a
passive trust interest as provided for in section 207A).
``(B) Status.--The devise of an interest in trust or
restricted land to an Indian under subparagraph (A)(ii) shall
not alter the status of such an interest as a trust or
restricted interest unless the testator provides that the
interest is to be held as a passive trust interest.
``(2) Devise of trust or restricted land in passive trust
or fee.--
``(A) In general.--Except as provided under any applicable
Federal law, any interest in trust or restricted land that is
not devised in accordance with paragraph (1) may be devised
only--
``(i) as a life estate to any non-Indian person, with the
remainder being devised only in accordance with clause (ii),
subparagraph (C), or paragraph (1)(A);
``(ii) to the lineal descendant or heir of the first or
second degree of the testator or, if the testator does not
have an heir of the first or second degree or a lineal
descendant, to any lineal descendant of an Indian grandparent
of the testator, as a passive trust interest (referred to in
this section as an `eligible passive trust devisee'); or
``(iii) in fee in accordance with subparagraph (C).
``(B) Presumed devise of passive trust interest.--Any
devise to an eligible passive trust devisee, or any devise of
a remainder interest from the devise of a life estate under
subparagraph (A)(ii), that does not indicate whether the
interest is devised as a passive trust interest or a fee
interest shall be considered to devise a passive trust
interest.
``(C) Devise of a fee interest.--Subject to subparagraph
(D), any interest in trust or restricted land that is not
devised in accordance with paragraph (1), or devised to an
eligible passive trust devisee in accordance with
subparagraph (A), may be devised to a non-Indian in fee.
``(D) Limitation.--Any interest in trust or restricted land
that is subject to section 4 of the Act of June 18, 1934 (25
U.S.C. 464), may be devised only in accordance with--
``(i) that section;
``(ii) subparagraph (A); or
``(iii) paragraph (1).
``(3) Devise of a passive trust interest.--
``(A) In general.--The holder of an interest in trust or
restricted land that is held as a passive trust interest may
devise the interest as a passive trust interest only to--
``(i)(I) any Indian; or
``(II) the Indian tribe that exercises jurisdiction over
the interest;
``(ii) the lineal descendants, or heirs of the first or
second degree, of the holder;
``(iii) any living descendant of the decedent from whom the
holder acquired the interest by devise or descent; or
``(iv) any person that owns a preexisting interest or a
passive trust interest in the same parcel of land, if the
preexisting interest is held in trust or restricted status or
in passive trust status.
``(B) Ineligible devisees and intestate succession.--A
passive trust interest that is devised to a person that is
not eligible under subparagraph (A) or that is not disposed
of by a valid will shall pass in accordance with the
applicable law of intestate succession as provided for in
subsection (b).''.
(b) Nontestamentary Disposition.--Section 207 of the Indian
Land Consolidation Act (25 U.S.C. 2206) is amended by
striking subsection (b) and inserting the following:
``(b) Nontestamentary Disposition.--
``(1) Rules of descent.--Subject to any applicable Federal
law relating to the devise or descent of trust or restricted
property, any interest in trust or restricted land that is
not disposed of by a valid will--
``(A) shall descend according to a tribal probate code that
is approved in accordance with section 206; or
``(B) in the case of an interest in trust or restricted
land to which such a code does not apply, shall descend in
accordance with--
``(i) paragraphs (2) through (7);
``(ii) section 207A; and
``(iii) other applicable Federal law.
``(2) No applicable code.--An intestate interest to which a
code described in paragraph (1) does not apply--
``(A) shall include--
``(i) an interest acquired by a decedent through devise or
inheritance (referred to in this subsection as a `devise or
inheritance interest'); or
``(ii) an interest acquired by a decedent by any means
other than devise or inheritance (referred to in this
subsection as an `acquired interest'), if--

``(I) the decedent--

``(aa) acquired additional undivided interest in the same
parcel in which the interest

[[Page S3271]]

is held, by a means other than devise or inheritance; or
``(bb) acquired land adjoining the parcel of land in which
the interest is held; or

``(II) the parcel of land in which the interest is held
includes the residence of the spouse of the decedent; and

``(B) shall descend as follows:
``(i) Surviving indian spouse.--

``(I) In general.--If a decedent is survived by an Indian
spouse, and the estate of the decedent includes 1 or more
acquired interests, the spouse of the decedent shall receive
all of the acquired interests.
``(II) Devise or inheritance interests.--If a decedent is
survived by an Indian spouse, and the estate of the decedent
includes 1 or more devise or inheritance interests--

``(aa) if the decedent is not survived by an Indian heir of
the first or second degree, the spouse of the decedent shall
receive all of the devise or inheritance interests; and
``(bb) if the decedent is survived by an Indian heir of the
first or second degree, the devise or inheritance interest of
the decedent shall descend in accordance with paragraph
(3)(A).
``(ii) Surviving non-indian spouse.--

``(I) In general.--If a decedent is survived by a non-
Indian spouse, and the estate of the decedent includes 1 or
more acquired interests--

``(aa) the spouse of the decedent shall receive a life
estate in each acquired interest; and
``(aa)(AA) if the decedent is survived by an Indian heir of
the first or second degree, the remainder interests shall
descend in accordance with paragraph (3)(A); and
``(BB) if the decedent is not survived by an Indian heir of
the first or second degree, the remainder interest shall
descend in accordance with paragraph (3)(C).

``(II) Devise or inheritance interests.--If the estate of a
decedent described in subclause (I) includes 1 or more devise
or inheritance interests--

``(aa) if the decedent is survived by an Indian heir of the
first or second degree, the devise or inheritance interests
shall descend in accordance with paragraph (3)(A); and
``(bb) if the decedent is not survived by an Indian heir of
the first or second degree, the devise or inheritance
interests shall descend in accordance with paragraph (3)(C).
``(iii) No surviving spouse.--If a decedent is not survived
by a spouse, and the estate of the decedent includes 1 or
more acquired interests or 1 or more devise or inheritance
interests--

``(I) if the decedent is survived by an Indian heir of the
first or second degree, the acquired interests or devise or
inheritance interests shall descend in accordance with
paragraph (3)(A); and
``(II) if the decedent is not survived by an Indian heir of
the first or second degree, the acquired interests or devise
or inheritance interests shall descend in accordance with
paragraph (3)(C).

``(3) Rules governing descent of estate.--
``(A) Indian heirs.--For the purpose of this section, an
Indian heir of the first or second degree shall inherit in
the following order:
``(i) To the Indian children of the decedent (or if 1 or
more of those Indian children do not survive the decedent,
the Indian children of the deceased child of the decedent, by
right of representation) shall inherit in equal shares.
``(ii) If the decedent has no Indian children (or
grandchildren that inherit by right of representation under
clause (i)), to the Indian brothers and sisters of the
decedent, in equal shares.
``(iii) If the decedent has no Indian brothers or sisters,
to the Indian parent or parents of the decedent.
``(B) Right of representation.--In any case involving the
determination of a right of representation--
``(i) each interest in trust land shall be equally divided
into a number of shares that equals the sum obtained by
adding--

``(I) the number of surviving heirs in the nearest degree
of kinship; and
``(II) the number of deceased individuals in that same
degree, if any, who left issue who survive the decedent;

``(ii) each surviving heir described in clause (i)(I) shall
receive 1 share; and
``(iii)(I) each deceased individual described in clause
(i)(II) shall receive 1 share; and
``(II) that share shall be divided equally among the
surviving issue of the deceased person.
``(C) No indian heirs.--
``(i) Definition of collateral heir.--In this subparagraph,
the term `collateral heir' means an aunt, uncle, niece,
nephew, or first cousin of a decedent.
``(ii) No heirs.--If a decedent does not have an Indian
heir of the first or second degree, an interest shall descend
to any Indian collateral heir who is a co-owner of an
interest owned by the decedent.
``(iii) Multiple collateral heirs.--If--

``(I) an Indian collateral heir owns an interest to which
clause (ii) applies that is larger than the interest held by
any other such collateral heir, the interest shall descend to
the collateral heir that owns the largest undivided interest
in the parcel; or
``(II) 2 or more collateral heirs own equal shares in an
interest to which clause (ii) applies, the interest shall be
divided equally among those collateral heirs.

``(iv) No ownership.--If none of the Indian collateral
heirs of a decedent owns an interest to which clause (ii)
applies, subject to clause (v), the interest shall descend to
the Indian tribe that exercises jurisdiction over the parcel
of trust or restricted land involved.
``(v) Acquisition of interest.--

``(I) In general.--Notwithstanding clause (iv), an Indian
co-owner of a parcel of trust or restricted land may acquire
an interest that would otherwise descend under that clause by
paying into the estate of the decedent, before the close of
the probate of the estate, the fair market value of the
interest in or to the land.
``(II) Multiple co-owners.--If more than 1 Indian co-owner
(including the Indian tribe referred to in clause (iv))
offers to pay for an interest described in subclause (I), the
highest bidder shall acquire the interest.

``(4) Special rule relating to survival.--In the case of
intestate succession under this section, if an individual who
fails to survive a decedent by at least 120 hours, as
established by clear and convincing evidence--
``(A) the individual shall be deemed to have predeceased
the decedent for the purpose of intestate succession; and
``(B) the heirs of the decedent shall be determined in
accordance with this section.
``(5) Pretermitted spouses and children.--
``(A) Spouses.--
``(i) In general.--Except as provided in clause (ii), if
the surviving spouse of a testator married the testator after
the testator executed the will of the testator, the surviving
spouse shall receive the intestate share in trust or
restricted land that the spouse would have received if the
testator had died intestate.
``(ii) Exception.--Clause (i) shall not apply to an
interest in trust or restricted land in a case in which--

``(I) the will of a testator is executed before the date of
enactment of this subparagraph;
``(II)(aa) the spouse of a testator is a non-Indian; and
``(bb) the testator devised the interests in trust or
restricted land of the testator to 1 or more Indians;
``(III) it appears, based on an examination of the will or
other evidence, that the will was made in contemplation of
the marriage of the testator to the surviving spouse;
``(IV) the will expresses the intention that the will is to
be effective notwithstanding any subsequent marriage; or
``(V)(aa) the testator provided for the spouse by a
transfer of funds or property outside the will; and
``(bb) an intent that the transfer be in lieu of a
testamentary provision is demonstrated by statements of the
testator or through a reasonable inference based on the
amount of the transfer or other evidence.

``(B) Children.--
``(i) In general.--If a testator executed the will of the
testator before the birth or adoption of 1 or more children
of the testator, and the omission of the children from the
will is a product of inadvertence rather than an intentional
omission, the children shall share in the intestate interests
of the decedent in trust or restricted land as if the
decedent had died intestate.
``(ii) Adopted heirs.--Any person recognized as an heir by
virtue of adoption under the Act of July 8, 1940 (25 U.S.C.
372a), shall be treated as the child of a decedent under this
subsection.
``(6) Divorce.--
``(A) Surviving spouse.--
``(i) In general.--An individual who is divorced from a
decedent, or whose marriage to the decedent has been
annulled, shall not be considered to be a surviving spouse
unless, by virtue of a subsequent marriage, the individual is
married to the decedent at the time of death of the decedent.
``(ii) Separation.--A decree of separation that does not
dissolve a marriage, and terminate the status of husband and
wife, shall not be considered a divorce for the purpose of
this subsection.
``(iii) No effect on adjudications.--Nothing in clause (i)
prevents an entity responsible for adjudicating an interest
in trust or restricted land from giving effect to a property
right settlement if 1 of the parties to the settlement dies
before the issuance of a final decree dissolving the marriage
of the parties to the property settlement.
``(B) Effect of subsequent divorce on a will or devise.--
``(i) In general.--If, after executing a will, a testator
is divorced or the marriage of the testator is annulled, on
the effective date of the divorce or annulment, any
disposition of interests in trust or restricted land made by
the will to the former spouse of the testator shall be
considered to be revoked unless the will expressly provides
otherwise.
``(ii) Property.--Property that is prevented from passing
to a former spouse of a decedent under clause (i) shall pass
as if the former spouse failed to survive the decedent.
``(iii) Provisions of wills.--Any provision of a will that
is considered to be revoked solely by operation of this
subparagraph shall be revived by the remarriage of a testator
to the former spouse of the testator.
``(7) Notice.--
``(A) In general.--To the maximum extent practicable, the
Secretary shall notify each owner of trust and restricted
land of the provisions of this Act.
``(B) Combined notices.--The notice under subparagraph (A)
may, at the discretion of the Secretary, be provided with the
notice required under section 207(g).''.

[[Page S3272]]

(c) Rule of Construction.--Section 207 of the Indian Land
Consolidation Act (25 U.S.C. 2206) is amended by adding at
the end the following:
``(h) Applicable Federal Law.--
``(1) In general.--For purpose of subsections (a) and (b),
any reference to applicable Federal law includes--
``(A) Public Law 91-627 (84 Stat. 1874);
``(B) Public Law 92-377 (86 Stat. 530);
``(C) Public Law 92-443 (86 Stat. 744);
``(D) Public Law 96-274 (94 Stat. 537); and
``(E) Public Law 98-513 (98 Stat. 2411).
``(2) No effect on laws.--Nothing in this section amends or
otherwise affects any law described in paragraph (1), or any
other Federal law, that provides for the devise and descent
of any trust or restricted land located on a specific Indian
reservation.''.
(d) Passive Trust Interest Status for Trust or Restricted
Land.--The Indian Land Consolidation Act is amended by
inserting after section 207 (25 U.S.C. 2206) the following:

``SEC. 207A. PASSIVE TRUST INTEREST STATUS FOR TRUST OR
RESTRICTED LAND.

``(a) Passive Trust Interest Status.--
``(1) In general.--The owner of an interest in trust or
restricted land may submit to the Secretary an application
requesting that the interest be held in passive trust
interest status.
``(2) Authority.--An application under paragraph (1) may
authorize the Secretary to amend any existing lease or
agreement with respect to the interest that is the subject of
the application.
``(b) Approval.--On the approval of an application by the
Secretary under subsection (a), an interest in trust or
restricted land covered by the application shall be held as a
passive trust interest in accordance with this section.
``(c) Requirements.--Except as provided in this section, an
interest in trust or restricted land that is held as a
passive trust interest under this section--
``(1) shall continue to be covered under any applicable
tax-exempt status, and continue to be subject to any
restrictions on alienation, until the interest is patented in
fee;
``(2) may, without the approval of the Secretary, be--
``(A) leased for a period of not to exceed 25 years;
``(B) mortgaged in accordance with the Act of March 29,
1956 (25 U.S.C. 483a); or
``(C) sold or conveyed to--
``(i) an Indian;
``(ii) the Indian tribe that exercises jurisdiction over
the interest; or
``(iii) a co-owner of an interest in the parcel of land in
which the interest is held, if the co-owner owns a pre-
existing trust, restricted interest, or a passive trust
interest in the parcel; and
``(3) may be subject to an ordinance or resolution enacted
under subsection (d).
``(d) Ordinance or Resolution for Removal of Status.--
``(1) In general.--The governing body of the Indian tribe
that exercises jurisdiction over an interest in trust or
restricted land that is held as a passive trust interest in
accordance with this section may enact an ordinance or
resolution to permit the owner of the interest to apply to
the Secretary for the removal of the trust or restricted
status of any portion of the land that is subject to the
jurisdiction of the Indian tribe.
``(2) Review by secretary.--The Secretary shall review, and
may approve, an ordinance or resolution enacted by an Indian
tribe in accordance with paragraph (1) if the Secretary
determines that the ordinance or resolution--
``(A) is consistent with this Act; and
``(B) would not increase fractionated ownership of Indian
land.
``(e) Revenues or Royalties.--
``(1) In general.--Except as provided in paragraph (2), the
Secretary shall not be responsible for the collection of or
accounting for any lease revenues or royalties accruing to an
interest held as a passive trust interest by any person under
this section.
``(2) Exception.--Paragraph (1) shall not apply to an
interest described in that paragraph if the Secretary
approves an application to take the interest into active
trust status on behalf of an Indian or an Indian tribe in
accordance with regulations promulgated by the Secretary.
``(3) Authority of secretary.--Nothing in this subsection
alters any authority or responsibility of the Secretary with
respect to an interest in trust or restricted land held in
active trust status (including an undivided interest included
in the same parcel of land as an undivided passive trust
interest).
``(f) Jurisdiction Over Passive Trust Interest.--With
respect to an interest in trust or restricted land that is
devised or held as a passive trust interest under this
section--
``(1) an Indian tribe that exercises jurisdiction over such
an interest shall continue to exercise jurisdiction over the
land that is held as a passive trust interest; and
``(2) any person holding, leasing, or otherwise using the
land shall be considered to consent to the jurisdiction of
the Indian tribe with respect to the use of the land
(including any effects associated with any use of the land).
``(g) Probate of Passive Trust Interests.--
``(1) In general.--An interest in trust or restricted land
that is held as a passive trust interest under this section
shall be subject to--
``(A) probate by the Secretary in accordance with this Act;
and
``(B) all other laws applicable to the probate of trust or
restricted land.
``(2) Commencement of probate.--Any interested party may
file an application to commence the probate of an interest in
trust or restricted land held as a passive trust interest.
``(h) Regulations.--The Secretary shall promulgate such
regulations as are necessary to carry out this section.''.

SEC. 4. PARTITION OF INDIAN LAND.

Section 205 of the Indian Land Consolidation Act (25 U.S.C.
2204) is amended by adding at the end the following:
``(c) Partition.--
``(1) Definitions.--In this subsection:
``(A) Eligible indian tribe.--The term `eligible Indian
tribe' means an Indian tribe that--
``(i) owns eligible land; and
``(ii) consents to partition of the eligible land.
``(B) Eligible land.--The term `eligible land' means an
undivided parcel of land that--
``(i) is located within the reservation of an Indian tribe;
or
``(ii) is otherwise under the jurisdiction of an Indian
tribe.
``(2) Requirements.--Notwithstanding any other provision of
law, in accordance with this subsection and subject to
paragraphs (3), (4), and (5)--
``(A) an eligible Indian tribe may apply to the Secretary
for the partition of a parcel of eligible land; and
``(B) the Secretary may commence a process for partitioning
the eligible land under this subsection if--
``(i) the eligible Indian tribe meets the applicable
ownership requirement under subparagraph (A) or (B) of
paragraph (3); or
``(ii) the Secretary determines that it is reasonable to
believe that the partition of the eligible land owned would
be in accordance with paragraph (3)(C).
``(3) Tribal ownership.--A parcel of eligible land may be
partitioned under this subsection if, with respect to the
eligible Indian tribe involved--
``(A) the eligible Indian tribe owns 50 percent or more of
the undivided interest in the parcel;
``(B) the eligible Indian tribe is the owner of the largest
quantity of undivided interest in the parcel; or
``(C) the owners of undivided interests equal to at least
50 percent of the undivided interest in the parcel (including
any undivided interest owned by the eligible Indian tribe)
consent or do not object to the partition.
``(4) Tribal consent.--A parcel of land that is located
within the reservation of an Indian tribe or otherwise under
the jurisdiction of an Indian tribe shall be partitioned
under this subsection only if the Indian tribe does not
object to the partition.
``(5) Applicability.--This subsection shall not apply to
any parcel of land that is the bona fide residence of any
person unless the person consents to the partition in
writing.
``(6) Partition in kind.--
``(A) In general.--The Secretary shall commence the
partition process described in subparagraph (B) if--
``(i) an eligible Indian tribe applies to partition
eligible land under this paragraph; and
``(ii)(I) the Secretary determines that the eligible Indian
tribe meets the applicable ownership requirements of
subparagraph (A) or (B) of paragraph (3); or
``(II) the Secretary determines that it is reasonable to
believe that the partition would be in accordance with
paragraph (3)(C).
``(B) Partition Process.--In carrying out any partition
under this paragraph, the Secretary shall--
``(i) provide, to each owner of any undivided interest in
eligible land to be partitioned, through publication or other
appropriate means, notice of the proposed partition;
``(ii) make available to any interested party a copy of any
proposed partition plan submitted by an eligible Indian tribe
or proposed by the Secretary; and
``(iii) review--

``(I) any proposed partition plan submitted by any owner of
an undivided interest in the eligible land; and
``(II) any comments or objections concerning a partition,
or any proposed plan of partition, submitted by any owner or
any other interested party.

``(C) Determination not to partition.--If the Secretary
determines that a parcel of eligible land cannot be
partitioned in a manner that is fair and equitable to the
owners of the eligible land, the Secretary shall inform each
owner of the eligible land of--
``(i) the determination of the Secretary; and
``(ii) the right of the owner to appeal the determination.
``(D) Partition with consent of eligible indian tribe.--If
the Secretary determines that a parcel of eligible land may
be partitioned in a manner that is fair and equitable to the
owners of the eligible land, and the applicable eligible
Indian tribe meets the applicable ownership requirements
under subparagraph (A) or (B) of paragraph (3), the Secretary
shall--
``(i) approve a plan of partition;
``(ii) provide notice to the owners of the eligible land of
the determination of the Secretary;
``(iii) make a copy of the plan of partition available to
each owner of the eligible land; and

[[Page S3273]]

``(iv) inform each owner of the right to appeal the
determination of the Secretary to partition the eligible land
in accordance with the plan.
``(E) Partition with consent; implied consent.--If the
Secretary determines that a parcel of eligible land may be
partitioned in a manner that is fair and equitable to the
owners of the eligible land, but the eligible Indian tribe
involved does not meet the applicable ownership requirements
under subparagraph (A) or (B) of paragraph (3), the Secretary
shall--
``(i)(I) make a plan of partition available to the owners
of the parcel; and
``(II) inform the owners that the eligible land will be
partitioned in accordance with the plan if the owners of 50
percent or more of undivided ownership interest in the
eligible land--

``(aa) consent to the partition; or
``(bb) do not object to the partition by such date as may
be established by the Secretary; and

``(ii)(I) if the owners of 50 percent or more of undivided
ownership interest in the eligible land consent to the
partition or do not object by a date established by the
Secretary under clause (i)(II)(bb), inform the owners of the
eligible land that--
``(aa) the plan for partition is final; and
``(bb) the owners have the right to appeal the
determination of the Secretary to partition the eligible
land; or
``(II) if the owners of 50 percent or more of the undivided
ownership interest in the eligible land object to the
partition, inform the eligible Indian tribe of the objection.
``(F) Successive partition plans.--In carrying out
subparagraph (E) in accordance with paragraph (3)(C), the
Secretary may, in accordance with subparagraph (E)--
``(i) approve 1 or more successive plans of partition; and
``(ii) make those plans available to the owners of the
eligible land to be partitioned.
``(G) Plan of partition.--A plan of partition approved by
the Secretary in accordance with subparagraph (D) or (E)--
``(i) may determine that 1 or more of the undivided
interests in a parcel of eligible land are not susceptible to
a partition in kind;
``(ii) may provide for the sale or exchange of those
undivided interests to--

``(I) 1 or more of the owners of undivided interests in the
eligible land; or
``(II) the Secretary in accordance with section 213; and

``(iii) shall provide that the sale of any undivided
interest referred to in clause (ii) shall be for not less
than the fair market value of the interest.
``(7) Partition by sale.--
``(A) In general.--The Secretary shall commence the
partition process described in subparagraph (B) if--
``(i) an eligible Indian tribe applies to partition a
parcel of eligible land under this subsection; and
``(ii)(I) the Secretary determines that the Indian tribe
meets the applicable ownership requirements of subparagraph
(A) or (B) of paragraph (3); or
``(II) the Secretary determines that it is reasonable to
believe that the partition would be in accordance with
paragraph (3)(C).
``(B) Partition process.--In carrying out any partition of
eligible land under this paragraph, the Secretary--
``(i) shall conduct a preliminary appraisal of the eligible
land;
``(ii) shall provide to the owners of the eligible land,
through publication or other appropriate means--

``(I) notice of the application of the eligible Indian
tribe to partition the eligible land; and
``(II) access to the preliminary appraisal conducted in
accordance with clause (i);

``(iii) shall inform each owner of the eligible land of the
right to submit to the Secretary comments relating to the
preliminary appraisal;
``(iv) may, based on comments received under clause (iii),
modify the preliminary appraisal or provide for the conduct
of a new appraisal; and
``(v) shall--

``(I) issue a final appraisal for the eligible land;
``(II) provide to the owners of the eligible land and the
appropriate Indian tribes access to the final appraisal; and
``(III) inform the Indian tribes of the right to appeal the
final appraisal.

``(C) Purchase by eligible indian tribe.--If an eligible
Indian tribe enters into an agreement with the Secretary to
pay fair market value for eligible land partitioned under
this subsection, as determined by the final appraisal of the
eligible land issued under subparagraph (B)(v)(I) (including
any appraisal issued by the Secretary after an appeal by the
Indian tribe under subparagraph (B)(v)(III)), and the
eligible Indian tribe meets the applicable ownership
requirements of subparagraph (A) or (B) of paragraph (3), the
Secretary shall--
``(i) provide to each owner of the eligible land notice of
the agreement; and
``(ii) inform the owners of the right to appeal the
decision of the Secretary to enter into the agreement
(including the right to appeal any final appraisal of the
parcel referred to in subparagraph (B)(v)(III)).
``(D) Partition with consent; implied consent.--
``(i) In general.--If an eligible Indian tribe agrees to
pay fair market value for eligible land partitioned under
this subsection, as determined by the final appraisal of the
eligible land issued under subparagraph (B)(v)(I) (including
any appraisal issued by the Secretary after an appeal by the
Indian tribe under subparagraph (B)(v)(III)), but does not
meet the applicable ownership requirements of subparagraph
(A) or (B) of paragraph (3), the Secretary shall--

``(I) provide to each owner of the undivided interest in
the eligible land notice that the Indian tribe did not meet
the requirements; and
``(II) inform the owners that the eligible land will be
partitioned by sale unless the partition is opposed by the
owners of 50 percent or more of the undivided ownership
interest in the eligible land.

``(ii) Failure to object to partition.--If the owners of 50
percent or more of undivided ownership interest in or to a
parcel of eligible land consent to the partition of the
eligible land, or do not object to the partition by such date
as may be established by the Secretary, the Secretary shall
inform the owners of the eligible land of the right to appeal
the determination of the Secretary to partition the eligible
land (including the results of the final appraisal issued
under subparagraph (B)(v)(I)).
``(iii) Objection to partition.--If the owners of 50
percent or more of the undivided ownership interest in a
parcel of eligible land object to the partition of the
eligible land--

``(I) the Secretary shall notify the eligible Indian tribe
of the objection; and
``(II) the eligible Indian tribe and the Secretary may
agree to increase the amount offered to purchase the
undivided ownership interests in the eligible land.

``(8) Enforcement.--
``(A) In general.--If, with respect to a parcel of eligible
land, a partition in kind is approved under subparagraph (D)
or (E) of paragraph (6), or a partition by sale is approved
under paragraph (7)(C), and the owner of an interest in or to
the eligible land fails to convey the interest to the Indian
tribe, the Indian tribe or the United States may--
``(i) bring a civil action in the United States district
court for the district in which the eligible land is located;
and
``(ii) request the court to issue an appropriate order for
the partition in kind, or partition by sale to the Indian
tribe, of the eligible land.
``(B) Federal role.--With respect to any civil action
brought under subparagraph (A)--
``(i) the United States--

``(I) shall receive notice of the civil action; and
``(II) may be a party to the civil action; and

``(ii) the civil action shall not be dismissed, and no
relief requested shall be denied, on the ground that the
civil action is against the United States or that the United
States is an indispensable party.''.

SEC. 5. ADDITIONAL AMENDMENTS.

(a) In General.--The Indian Land Consolidation Act (25
U.S.C. 2201 et seq.) is amended--
(1) in the second sentence of section 205(a) (25 U.S.C.
2204(a)), by striking ``over 50 per centum of the undivided
interests'' and inserting ``undivided interests equal to at
least 50 percent of the undivided interest'';
(2) in section 206 (25 U.S.C. 2205)--
(A) in subsection (a), by striking paragraph (3) and
inserting the following:
``(3) Tribal probate codes.--Except as provided in any
applicable Federal law, the Secretary shall not approve a
tribal probate code, or an amendment to such a code, that
prevents the devise of an interest in trust or restricted
land to--
``(A) an Indian lineal descendant of the original allottee;
or
``(B) an Indian who is not a member of the Indian tribe
that exercises jurisdiction over such an interest, unless the
code provides for--
``(i) the renouncing of interests to eligible devisees in
accordance with the code;
``(ii) the opportunity for a devisee who is the spouse or
lineal descendant of a testator to reserve a life estate; and
``(iii) payment of fair market value in the manner
prescribed under subsection (c)(2).''; and
(B) in subsection (c)--
(i) in paragraph (1)--

(I) by striking the paragraph heading and inserting the
following:

``(1) Authority.--
``(A) In general.--'';

(II) in the first sentence of subparagraph (A) (as
designated by clause (i)), by striking ``section 207(a)(6)(A)
of this title'' and inserting ``section 207(a)(2)(A)(ii),
207(a)(2)(C), or 207(a)(3)''; and
(III) by striking the last sentence and inserting the
following:

``(B) Transfer.--The Secretary shall transfer payments
received under subparagraph (A) to any person or persons who
would have received an interest in land if the interest had
not been acquired by the Indian tribe in accordance with this
paragraph.''; and
(ii) in paragraph (2)--

(I) in subparagraph (A)--

(aa) by striking the subparagraph heading and all that
follows through ``Paragraph (1) shall apply'' and inserting
the following:
``(A) Nonapplicability to certain interests.--

[[Page S3274]]

``(i) In general.--Paragraph (1) shall not apply'';
(bb) in clause (i) (as designated by item (a)), by striking
``if, while'' and inserting the following: ``if--

``(I) while'';

(cc) by striking the period at the end and inserting ``;
or''; and
(dd) by adding at the end the following:

``(II)(aa) the interest is part of a family farm that is
devised to a member of the family of the decedent; and
``(bb) the devisee agrees that the Indian tribe that
exercises jurisdiction over the land will have the
opportunity to acquire the interest for fair market value if
the interest is offered for sale to an entity that is not a
member of the family of the owner of the land.

``(ii) Recording of interest.--On request by an Indian
tribe described in clause (i)(II)(bb), a restriction relating
to the acquisition by the Indian tribe of an interest in a
family farm involved shall be recorded as part of the deed
relating to the interest involved.
``(iii) Mortgage and foreclosure.--Nothing in clause
(i)(II) prevents or limits the ability of an owner of land to
which that clause applies to mortgage the land or limit the
right of the entity holding such a mortgage to foreclose or
otherwise enforce such a mortgage agreement in accordance
with applicable law.
``(iv) Definition of member of the family.--In this
paragraph, the term `member of the family', with respect to a
decedent or landowner, means--

``(I) a lineal descendant of a decedent or landowner;
``(II) a lineal descendant of the grandparent of a decedent
or landowner;
``(III) the spouse of a descendant or landowner described
in subclause (I) or (II); and
``(IV) the spouse of a decedent or landowner.''; and
(II) in subparagraph (B), by striking ``subparagraph (A)''
and all that follows through ``207(a)(6)(B) of this title''
and inserting ``paragraph (1)'';

(3) in section 207 (25 U.S.C. 2206)--
(A) in subsection (c)--
(i) by redesignating paragraph (3) as paragraph (4); and
(ii) by inserting after paragraph (2) the following:
``(3) Alienation of joint tenancy interests.--
``(A) In general.--With respect to any interest held in
joint tenancy in accordance with this subsection--
``(i) nothing in this subsection alters the ability of an
owner of such an interest to convey a life estate in the
undivided joint tenancy interest of the owner; and
``(ii) only the last remaining owner of such an interest
may devise or convey more than a life estate in the interest.
``(B) Application of provision.--This paragraph shall not
apply--
``(i) to any conveyance, sale, or transfer that is part of
an agreement referred to in subsection (e); or
``(ii) to a co-owner of a joint tenancy interest.''; and
(B) in subsection (g)(5), by striking ``this section'' and
inserting ``subsections (a) and (b)'';
(4) in section 213 (25 U.S.C. 2212)--
(A) in subsection (a)(2), by striking ``(A) In general.--''
and all that follows through ``the Secretary shall submit''
and inserting ``The Secretary shall submit'';
(B) in subsection (b), by striking paragraph (4) and
inserting the following:
``(4) shall minimize the administrative costs associated
with the land acquisition program through the use of policies
and procedures designed to accommodate the voluntary sale of
interests under the pilot program under this section,
notwithstanding the existence of any otherwise applicable
policy, procedure, or regulation, through the elimination of
duplicate--
``(A) conveyance documents;
``(B) administrative proceedings; and
``(C) transactions.''; and
(C) in subsection (c)--
(i) in paragraph (1)--

(I) in subparagraph (A), by striking ``landowner upon
payment'' and all that follows and inserting the following:
``landowner--

``(i) on payment by the Indian landowner of the amount paid
for the interest by the Secretary; or
``(ii) if--

``(I) the Indian referred to in this subparagraph provides
assurances that the purchase price will be paid by pledging
revenue from any source, including trust resources; and
``(II) the Secretary determines that the purchase price
will be paid in a timely and efficient manner.''; and
(II) in subparagraph (B), by inserting before the period at
the end the following: ``unless the interest is subject to a
foreclosure of a mortgage in accordance with the Act of March
29, 1956 (25 U.S.C. 483a)''; and

(ii) in paragraph (3), by striking ``10 percent of more of
the undivided interests'' and inserting ``an undivided
interest'';
(5) in section 214 (25 U.S.C. 2213), by striking subsection
(b) and inserting the following:
``(b) Application of Revenue From Acquired Interests to
Land Consolidation Pilot Program.--
``(1) In general.--The Secretary shall have a lien on any
revenue accruing to an interest described in subsection (a)
until the Secretary provides for the removal of the lien
under paragraph (3) or (4).
``(2) Requirements.--
``(A) In general.--Until the Secretary removes a lien from
an interest in land under paragraph (1)--
``(i) any lease, resource sale contract, right-of-way, or
other document evidencing a transaction affecting the
interest shall contain a clause providing that all revenue
derived from the interest shall be paid to the Secretary; and
``(ii) any revenue derived from any interest acquired by
the Secretary in accordance with section 213 shall be
deposited in the fund created under section 216.
``(B) Approval of transactions.--Notwithstanding section 16
of the Act of June 18, 1934 (commonly known as the `Indian
Reorganization Act') (25 U.S.C. 476), or any other provision
of law, until the Secretary removes a lien from an interest
in land under paragraph (1), the Secretary may approve a
transaction covered under this section on behalf of an Indian
tribe.
``(3) Removal of lien after findings.--The Secretary may
remove a lien referred to in paragraph (1) if the Secretary
makes a finding that--
``(A) the costs of administering the interest from which
revenue accrues under the lien will equal or exceed the
projected revenues for the parcel of land involved;
``(B) in the discretion of the Secretary, it will take an
unreasonable period of time for the parcel of land to
generate revenue that equals the purchase price paid for the
interest; or
``(C) a subsequent decrease in the value of land or
commodities associated with the parcel of land make it likely
that the interest will be unable to generate revenue that
equals the purchase price paid for the interest in a
reasonable time.
``(4) Other removal of lien.--In accordance with
regulations to be promulgated by the Secretary, and in
consultation with tribal governments and other entities
described in section 213(b)(3), the Secretary shall
periodically remove liens referred to in paragraph (1) from
interests in land acquired by the Secretary.'';
(6) in section 216 (25 U.S.C. 2215)--
(A) in subsection (a), by striking paragraph (2) and
inserting the following:
``(2) collect all revenues received from the lease, permit,
or sale of resources from interests acquired under section
213 or paid by Indian landowners under section 213.''; and
(B) in subsection (b)--
(i) in paragraph (1)--

(I) in the matter preceding subparagraph (A), by striking
``Subject to paragraph (2), all'' and inserting ``All'';
(II) in subparagraph (A), by striking ``and'' at the end;
(III) in subparagraph (B), by striking the period at the
end and inserting ``; and''; and
(IV) by adding at the end the following:

``(C) be used to acquire undivided interests on the
reservation from which the income was derived.''; and
(ii) by striking paragraph (2) and inserting the following:
``(2) Use of funds.--The Secretary may use the revenue
deposited in the Acquisition Fund under paragraph (1) to
acquire some or all of the undivided interests in any parcels
of land in accordance with section 205.'';
(7) in section 217 (25 U.S.C. 2216)--
(A) in subsection (e)(3), by striking ``prospective
applicants for the leasing, use, or consolidation of'' and
insert ``any person that is leasing, using, or consolidating,
or is applying to lease, use, or consolidate,''; and
(B) by striking subsection (f) and inserting the following:
``(f) Purchase of Land by Indian Tribe.--
``(1) In general.--Except as provided in paragraph (2),
before the Secretary approves an application to terminate the
trust status or remove the restrictions on alienation from a
parcel of trust or restricted land, the Indian tribe that
exercises jurisdiction over the parcel shall have the
opportunity--
``(A) to match any offer contained in the application; or
``(B) in a case in which there is no purchase price
offered, to acquire the interest in the parcel by paying the
fair market value of the interest.
``(2) Exception for family farms.--
``(A) In general.--Paragraph (1) shall not apply to a
parcel of trust or restricted land that is part of a family
farm that is conveyed to a member of the family of a
landowner (as defined in section 206(c)(2)(A)(iv)) if--
``(i) the interest is offered for sale to an entity that is
not a member of the family of the landowner; and
``(ii) the Indian tribe that exercises jurisdiction over
the land is afforded the opportunity to purchase the
interest.
``(B) Applicability.--Section 206(c)(2)(A) shall apply with
respect to the recording and mortgaging of any trust or
restricted land referred to in subparagraph (A).''; and
(8) in section 219(b)(1)(A) (25 U.S.C. 2218(b)(1)(A)), by
striking ``100'' and inserting ``90''.
(b) Definition.--
(1) In general.--Section 202 of the Indian Land
Consolidation Act (25 U.S.C. 2201) is amended by striking
paragraph (2) and inserting the following:
``(2) Indian.--
``(A) In general.--The term `Indian' means--
``(i) any person that is a member of any Indian tribe or is
eligible to become a member of any Indian tribe;

[[Page S3275]]

``(ii) subject to subparagraph (B), any person that has
been found to meet the definition of `Indian' under any
Federal law; and
``(iii) with respect to the ownership, devise, or descent
of trust or restricted land in the State of California, any
person that meets the definition of `Indians of California'
contained in the first section of the Act of May 18, 1928 (25
U.S.C. 651), until otherwise provided by Congress in
accordance with section 809(b) of the Indian Health Care
Improvement Act (25 U.S.C. 1679(b));''.
``(B) Exclusions.--The term `Indian' does not include any
person excluded from a definition described in subparagraph
(A)(ii) by a regulation promulgated by the Secretary in a
case in which the Secretary determines that the definition is
not consistent with the purposes of this Act, unless the
definition described in subparagraph (A)(ii) is contained in
a law relating to--
``(i) agriculture;
``(ii) cultural resources;
``(iii) economic development;
``(iv) grazing;
``(v) housing;
``(vi) Indian schools;
``(vii) natural resources;
``(viii) any other program with benefits intended to run to
Indian landowners; or
``(ix) any land-related program that takes effect after the
date of enactment of this subparagraph.''.
(2) Applicability.--Any exclusion referred to in the
amendment made by paragraph (1) shall apply only to a
decedent who dies after the date on which the Secretary of
the Interior promulgates a regulation providing for the
exclusion.
(c) Mortgages and Deeds of Trust.--The Act of March 29,
1956 (25 U.S.C. 483a), is amended in the first sentence of
subsection (a) by inserting after ``any land'' the following:
``(including land owned by any person in passive trust status
in accordance with section 207A of the Indian Land
Consolidation Act)''.
(d) Issuance of Patents.--Section 5 of the Act of February
8, 1887 (25 U.S.C. 348), is amended by striking the second
proviso and inserting the following: ``Provided, That the
rules of intestate succession under the Indian Land
Consolidation Act (25 U.S.C. 2201 et seq.) (including a
tribal probate code approved under that Act or regulations
promulgated under that Act) shall apply to that land for
which patents have been executed and delivered:''.
(e) Transfers of Restricted Indian Land.--Section 4 of the
Act of June 18, 1934 (25 U.S.C. 464), is amended in the first
proviso by striking ``, in accordance with'' and all that
follows through the colon and inserting ``in accordance with
the Indian Land Consolidation Act (25 U.S.C. 2201 et seq.)
(including a tribal probate code approved under that Act or
regulations promulgated under that Act):''.

SEC. 6. INHERITANCE OF CERTAIN TRUST OR RESTRICTED LAND.

(a) In General.--Section 5 of Public Law 98-513 (98 Stat.
2413) is amended to read as follows:

``SEC. 5. INHERITANCE OF CERTAIN TRUST OR RESTRICTED LAND.

``(a) In General.--Notwithstanding any other provision of
this Act--
``(1) the owner of an interest in trust or restricted land
within the reservation may not devise an interest (including
a life estate under section 4) in the land that is less than
2.5 acres to more than 1 tribal member unless each tribal
member already holds an interest in that land; and
``(2) any interest in trust or restricted land within the
reservation that is less than 2.5 acres that would otherwise
pass by intestate succession (including a life estate in the
land under section 4), or that is devised to more than 1
tribal member that is not described in paragraph (1), shall
revert to the Indian tribe, to be held in the name of the
United States in trust for the Indian tribe.
``(b) Notice.--
``(1) In general.--Not later than 180 days after the date
of enactment of the Indian Probate Reform Act of 2003, the
Secretary shall provide notice to owners of trust or
restricted land within the Lake Traverse Reservation of the
provisions of this section by--
``(A) direct mail;
``(B) publication in the Federal Register; or
``(C) publication in local newspapers.
``(2) Certification.--After providing notice under
paragraph (1), the Secretary shall--
``(A) certify that the requirements of this subsection have
been met; and
``(B) shall publish notice of that certification in the
Federal Register.''.
(b) Applicability.--This section and the amendment made by
this section shall not apply with respect to the estate of
any person who dies before the date that is 1 year after the
date on which the Secretary makes the required certification
under section 5(b) of Public Law 98-513 (98 Stat. 2413) (as
amended by subsection (a)).

SEC. 7. EFFECTIVE DATE.

The amendments made by this Act shall not apply to the
estate of an individual who dies before the later of--
(1) the date that is 1 year after the date of enactment of
this Act; or
(2) the date specified in section 207(g)(5) of the Indian
Land Consolidation Act (25 U.S.C. 2206(g)(5)).
______

By Mr. CAMPBELL:
S. 551. A bill to provide for the implementation of air quality
programs developed in accordance with an Intergovernmental Agreement
between the Southern Ute Indian Tribe and the State of Colorado
concerning Air Quality Control on the Southern Ute Indian Reservation,
and for other purposes; to the Committee on Environment and Public
Works.
Mr. CAMPBELL. Mr. President, today I am re-introducing a bill that is
important to the State of Colorado, the Southern Ute Indian Tribe and
all Coloradans that live in the southwest corner of our beautiful
State.
More than thirty years of experience with environmental laws shows us
that local design and implementation of such laws almost always trumps
the ``one size fits all'' approach advocated by many in Washington,
D.C.
The Federal Clean Air Act authorizes States and Indian tribes to
accept responsibility for air quality plans and standards, and
implement many of the regulatory programs needed to maintain or improve
air quality.
In 1984 Congress ratified a jurisdiction and boundary agreement
between the Tribe and the State that spared both sides litigation costs
and a fight over the jurisdictional status of each square inch on the
reservation. The 1984 pact permits the Tribe and the State to work out
jurisdictional issues for themselves.
Some uncertainty remains with respect to environmental issues and
rather than placing the Environmental Protection Agency in the middle
of a controversy about whether it is authorized to delegate Clean Air
Act programs within the Ute Reservation, the Tribe and the State signed
an agreement to eliminate any ambiguities.
First, consistent with Congress' mandate in the Clean Air Act, the
Tribe will be the entity responsible for administering Clean Air Act
programs within the reservation.
Second, an equal number of Tribal and State representatives will sit
on the Commission established to hear and make decisions, and will set
the pace for Tribal applications for delegations of authority. Finally,
Federal court review is available to hear challenges to decisions by
the Commission.
In closing, let me again commend the efforts of both the Tribe and
the State in negotiating and signing this historic agreement.
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. 551

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 ``Southern Ute and Colorado
Intergovernmental Agreement Implementation Act of 2003''.

SEC. 2. FINDINGS AND PURPOSE.

(a) Findings.--Congress, after review and in recognition of
the purposes and uniqueness of the Intergovernmental
Agreement between the Southern Ute Indian Tribe and the State
of Colorado, finds that--
(1) the Intergovernmental Agreement is consistent with the
special legal relationship between Federal Government and the
Tribe; and
(2) air quality programs developed in accordance with the
Intergovernmental Agreement and submitted by the Tribe for
approval by the Administrator may be implemented in a manner
that is consistent with the Clean Air Act (42 U.S.C. 7401 et
seq.).
(b) Purpose.--The purpose of this Act is to provide for the
implementation and enforcement of air quality control
programs under the Clean Air Act (42 U.S.C. 7401 et seq.) and
other air quality programs developed in accordance with the
Intergovernmental Agreement that provide for--
(1) the regulation of air quality within the exterior
boundaries of the Reservation; and
(2) the establishment of a Southern Ute Indian Tribe/State
of Colorado Environmental Commission.

SEC. 3. DEFINITIONS.

In this Act:
(1) Administrator.--The term ``Administrator'' means the
Administrator of the Environmental Protection Agency.
(2) Commission.--The term ``Commission'' means the Southern
Ute Indian Tribe/State of Colorado Environmental Commission
established by the State and the Tribe in accordance with the
Intergovernmental Agreement.
(3) Intergovernmental agreement.--The term
``Intergovernmental Agreement'' means the agreement entered
into by the Tribe and the State on December 13, 1999.
(4) Reservation.--The term ``Reservation'' means the
Southern Ute Indian Reservation.
(5) State.--The term ``State'' means the State of Colorado.

[[Page S3276]]

(6) Tribe.--The term ``Tribe'' means the Southern Ute
Indian Tribe.

SEC. 4. TRIBAL AUTHORITY.

(a) Air Program Applications.--
(1) In general.--The Administrator is authorized to treat
the Tribe as a State for the purpose of any air program
applications submitted to the Administrator by the Tribe
under section 301(d) of the Clean Air Act (42 U.S.C. 7601(d))
to carry out, in a manner consistent with the Clean Air Act
(42 U.S.C. 7401 et seq.), the Intergovernmental Agreement.
(2) Applicability.--If the Administrator approves an air
program application of the Tribe, the approved program shall
be applicable to all air resources within the exterior
boundaries of the Reservation.
(b) Termination.--If the Tribe or the State terminates the
Intergovernmental Agreement, the Administrator shall promptly
take appropriate administrative action to withdraw treatment
of the Tribe as a State for the purpose described in
subsection (a)(1).

SEC. 5. CIVIL ENFORCEMENT.

If any person fails to comply with a final civil order of
the Tribe or the Commission made in accordance with a program
under the Clean Air Act (42 U.S.C. 7401 et seq.) or any other
air quality program established under the Intergovernmental
Agreement, the Tribe or the Commission, as appropriate, may
bring a civil action for declaratory or injunctive relief, or
for other orders in aid of enforcement, in the United States
District Court for the District of Colorado.

SEC. 6. JUDICIAL REVIEW.

Any decision by the Commission that would be subject to
appellate review if it were made by the Administrator--
(1) shall be subject to appellate review by the United
States Court of Appeals for the Tenth Circuit; and
(2) may be reviewed by the Court of Appeals applying the
same standard that would be applicable to a decision of the
Administrator.

SEC. 7. DISCLAIMER.

Nothing in this Act--
(1) modifies any provision of--
(A) the Clean Air Act (42 U.S.C. 7401 et seq.);
(B) Public Law 98-290 (25 U.S.C. 668 note); or
(C) any lawful administrative rule promulgated in
accordance with those statutes; or
(2) affects or influences in any manner any past or
prospective judicial interpretation or application of those
statutes by the United States, the Tribe, the State, or any
Federal, tribal, or State court.
______

By Mr. GRASSLEY (for himself, Mr. Schumer, Mr. DeWine, Mr. Allen,
Mr. Craig, Mr. Graham of South Carolina, Mr. Allard, and Mr.
Talent):
S. 554. A bill to allow media coverage of court proceedings; to the
Committee on the Judiciary.
Mr. GRASSLEY. Mr. President, I rise today to introduce the Sunshine
in the Courtroom Act of 2003, a bill to allow media coverage of court
proceedings. This legislation will provide Federal judges with the
statutory authority to exercise their discretion to allow the
photographing, electronic recording, broadcasting and televising of
federal court proceedings.
During the 107th Congress, the Judiciary Committee reported identical
legislation favorably, by a vote of 12 to 7. It's my hope that the full
Senate will have the opportunity to act on this bill as early as
possible in the 108th Congress.
Sunshine bill will help the American people to become better informed
about the judicial process. Moreover, this bill will help to produce a
better judiciary. Increased public awareness and scrutiny will bring
about greater accountability and help judges to do a better job.
Allowing cameras in the Federal courts is consistent with the intent
of our Nation's Founders that trials should be held in front of as many
people as choose to attend them. In my view, the First Amendment to the
Constitution requires that court proceedings must be open to the public
and, by extension, to the news media. As the Supreme Court has said,
``what transpires in the courtroom is public property.''
Clearly, the basic American values of openness and education are
served by allowing electronic media access to Federal courtrooms. There
are many beneficial and no substantial detrimental effects to allowing
greater public access to the inner workings of our federal courts.
Fifteen States have conducted studies aimed specifically at the
educational benefits that are derived from camera access to courtrooms.
They all determined that camera coverage contributes to greater public
understanding of the judicial system.
Moroever, the experience of the States with electronic media access
to judicial proceedings demonstrate that still and video cameras can be
used without any problems, and that procedural discipline is preserved.
According to the National Center for State Courts, all fifty States
allow at least some degree of camera access to judicial proceedings
under a wide variety of rules and conditions. My own State of Iowa, for
example, has operated successfully in this open manner for more than 20
years.
Furthermore, at the Federal level, the Federal Judicial Center
conducted a pilot program in 1994 that studied the effects of allowing
camera access to courtrooms. The study found ``small or no effects of
camera presence on participants in judicial proceedings, courtroom
decorum, or the administration of justice.''
Based on the experience of the States, as well as state and Federal
studies, Senator Schumer and I are introducing this bill with a well-
founded confidence that it represents sound public policy.
Nevertheless, in order to provide a mechanism for Congress to study the
effects of this legislation on our judiciary before making this change
permanent, we have included a three-year sunset provision in our bill.
The Supreme Court of the United States has recognized that there is a
strong public interest in electronic media access to important court
cases. At my urging and that of Senator Schumer, Chief Justice
Rehnquist permitted the delayed audio broadcasting of the oral
arguments before the Supreme Court in the historic 2000 presidential
election dispute. The Supreme Court's response to our request was a
major step in the right direction.
It is important to emphasize, that this bill does not require any
Federal judge in any Federal court to allow camera access to judicial
proceedings. Rather, it simply gives Federal judges the discretion to
allow cameras or other electronic media access if they see fit. The
bill also protects the privacy and safety of non-party witnesses by
giving them the right to have their faces and voices obscured.
This piece of sunshine legislation will bring greater openness and
accountability to the Nation's Federal courts. The best way to maintain
confidence in our Federal judiciary, which has tremendous power, is to
let the sun shine in by allowing judges to exercise their discretion in
opening Federal courtrooms to public view through the broadcasting and
televising of judicial proceedings. I urge my colleagues to join me in
co-sponsoring the Sunshine in the Courtroom Act.
I ask unanimous consent that the text of bill be printed in the
Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. DEFINITIONS.

In this Act:
(1) Presiding judge.--The term ``presiding judge'' means
the judge presiding over the court proceeding concerned. In
proceedings in which more than 1 judge participates, the
presiding judge shall be the senior active judge so
participating or, in the case of a circuit court of appeals,
the senior active circuit judge so participating, except
that--
(A) in en banc sittings of any United States circuit court
of appeals, the presiding judge shall be the chief judge of
the circuit whenever the chief judge participates; and
(B) in en banc sittings of the Supreme Court of the United
States, the presiding judge shall be the Chief Justice
whenever the Chief Justice participates.
(2) Appellate court of the united states.--The term
``appellate court of the United States'' means any United
States circuit court of appeals and the Supreme Court of the
United States.

SEC. 2. AUTHORITY OF PRESIDING JUDGE TO ALLOW MEDIA COVERAGE
OF COURT PROCEEDINGS.

(a) Authority of Appellate Courts.--Notwithstanding any
other provision of law, the presiding judge of an appellate
court of the United States may, in the discretion of that
judge, permit the photographing, electronic recording,
broadcasting, or televising to the public of court
proceedings over which that judge presides.
(b) Authority of District Courts.--
(1) In general.--Notwithstanding any other provision of
law, any presiding judge of a district court of the United
States may, in the discretion of that judge, permit the
photographing, electronic recording, broadcasting, or
televising to the public of court proceedings over which that
judge presides.
(2) Obscuring of witnesses.--
(A) In general.--Upon the request of any witness in a trial
proceeding other than a party, the court shall order the face
and

[[Page S3277]]

voice of the witness to be disguised or otherwise obscured in
such manner as to render the witness unrecognizable to the
broadcast audience of the trial proceeding.
(B) Notification to witnesses.--The presiding judge in a
trial proceeding shall inform each witness who is not a party
that the witness has the right to request that the image and
voice of that witness be obscured during the witness'
testimony.
(c) Advisory Guidelines.--The Judicial Conference of the
United States may promulgate advisory guidelines to which a
presiding judge, in the discretion of that judge, may refer
in making decisions with respect to the management and
administration of photographing, recording, broadcasting, or
televising described under subsections (a) and (b).

SEC. 3. SUNSET.

The authority under section 2(b) shall terminate 3 years
after the date of the enactment of this Act.
______

By Mr. CAMPBELL (for himself and Mr. Inouye):
S. 555. A bill to establish the Native American Health and Wellness
Foundation, and for other purposes; to the Committee on Indian Affairs.
______

By Mr. CAMPBELL (for himself, Mr. Inouye, and Mr. McCain):
S. 556. A bill to amend the Indian Health Care Improvement Act to
revise and extend that Act; to the Committee on Indian Affairs.
Mr. CAMPBELL. Mr. President today I am pleased to be joined by
Senators Inouye and McCain in introducing two bills vitally important
to the health of Native Americans: the ``Indian Health Care Improvement
Act Reauthorization of 2003''.
It is an unfortunate fact that the health status of Native people in
the United States is poor. In fact, in the western hemisphere only the
people of Haiti are in worse shape.
Alcohol, drug abuse, and mental illness, tuberculosis, cancer,
obesity and diabetes, heart disease, infant mortality, and a host of
related pathologies plague Native people.
Last fall's reauthorization of the Special Indian Diabetes Program
showed the Federal commitment to ending the scourge of diabetes in
Native communities.
The ``Indian Health Care Improvement Act Reauthorization of 2003''
will reauthorize the programs administered by the Indian Health Service
and will increase the direct management of health care services by
tribes, Native Alaskans and Urban Indian health centers.
This bill is the product of intense consultation between tribes,
Native Alaskan health providers, and Urban Indian health centers, and
relevant Federal agencies and representatives of the public and private
health care sectors.
The efforts of the IHS and Native health providers have been
successful in improving the health status of Native people. Just in the
last 10 years, infant and maternal mortality rates have declined by 30
percent and 40 percent, respectively. Similarly, tuberculosis mortality
rates have also been reduced 53 percent. Other indicia of Native health
status have also shown marked improvement.
Even with modest increases in recent spending bills, funding for
Native health care continues to lag far behind the level of need.
To help close this gap, we must be creative and tap other sources of
funds for Native health including the private, tribal and non-profit
sectors of our economy.
The second bill I am introducing will do just that and will
facilitate the contribution of funds for purposes of Native health care
by establishing a non-profit, charitable foundation to receive funds
and in-kind contributions for such purposes.
This is not a radical step as similar foundations have been
established for other purposes. In recent years Congress has created
both the American Indian Education Foundation and the Fish and Wildlife
Foundation, which have proven to be very successful in achieving their
purposes.
I urge my colleagues to join me in supporting these important bills.
I ask unanimous consent that copies of the bills be printed in the
Record.
There being no objection, the bills were ordered to be printed in the
Record, as follows:

S. 555

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 Health and
Wellness Foundation Act of 2003''.

SEC. 2. NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION.

(a) In General.--The Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.) is amended
by adding at the end the following:

``TITLE VIII--NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION

``SEC. 801. DEFINITIONS.

``In this title:
``(1) Board.--The term `Board' means the Board of Directors
of the Foundation.
``(2) Foundation.--The term `Foundation' means the Native
American Health and Wellness Foundation established under
section 802.
``(3) Secretary.--The term `Secretary' means the Secretary
of Health and Human Services.
``(4) Service.--The term `Service' means the Indian Health
Service of the Department of Health and Human Services.

``SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION.

``(a) In General.--As soon as practicable after the date of
enactment of this title, the Secretary shall establish, under
the laws of the District of Columbia and in accordance with
this title, the Native American Health and Wellness
Foundation.
``(b) Perpetual Existence.--The Foundation shall have
perpetual existence.
``(c) Nature of Corporation.--The Foundation--
``(1) shall be a charitable and nonprofit federally
chartered corporation; and
``(2) shall not be an agency or instrumentality of the
United States.
``(d) Place of Incorporation and Domicile.--The Foundation
shall be incorporated and domiciled in the District of
Columbia.
``(e) Purposes.--The purposes of the Foundation shall be--
``(1) to encourage, accept, and administer private gifts of
real and personal property, and any income from or interest
in such gifts, for the benefit of, or in support of, the
mission of the Service;
``(2) to undertake and conduct such other activities as
will further the health and wellness activities and
opportunities of Native Americans; and
``(3) to participate with and assist Federal, State, and
tribal governments, agencies, entities, and individuals in
undertaking and conducting activities that will further the
health and wellness activities and opportunities of Native
Americans.
``(f) Board of Directors.--
``(1) In general.--The Board of Directors shall be the
governing body of the Foundation.
``(2) Powers.--The Board may exercise, or provide for the
exercise of, the powers of the Foundation.
``(3) Selection.--
``(A) In general.--Subject to subparagraph (B), the number
of members of the Board, the manner of selection of the
members (including the filling of vacancies), and the terms
of office of the members shall be as provided in the
constitution and bylaws of the Foundation.
``(B) Requirements.--
``(i) Number of members.--The Board shall have at least 11
members, 2 of whom shall be the Secretary and the Director of
the Indian Health Service, who shall serve as nonvoting
members.
``(ii) Initial voting members.--The initial voting members
of the Board--

``(I) shall be appointed by the Secretary not later than
180 days after the date on which the Foundation is
established; and
``(II) shall have staggered terms (as determined by the
Secretary).

``(iii) Qualification.--The members of the Board shall be
United States citizens who are knowledgeable or experienced
in Native American health care and related matters.
``(C) Compensation.--A member of the Board shall not
receive compensation for service as a member, but shall be
reimbursed for actual and necessary travel and subsistence
expenses incurred in the performance of the duties of the
Foundation.
``(g) Officers.--
``(1) In general.--The officers of the Foundation shall
be--
``(A) a secretary, elected from among the members of the
Board; and
``(B) any other officers provided for in the constitution
and bylaws of the Foundation.
``(2) Secretary.--The secretary of the Foundation shall
serve, at the direction of the Board, as the chief operating
officer of the Foundation.
``(3) Election.--The manner of election, term of office,
and duties of the officers of the Foundation shall be as
provided in the constitution and bylaws of the Foundation.
``(h) Powers.--The Foundation--
``(1) shall adopt a constitution and bylaws for the
management of the property of the Foundation and the
regulation of the affairs of the Foundation;
``(2) may adopt and alter a corporate seal;
``(3) may enter into contracts;
``(4) may acquire (through a gift or otherwise), own,
lease, encumber, and transfer real or personal property as
necessary or convenient to carry out the purposes of the
Foundation;
``(5) may sue and be sued; and
``(6) may perform any other act necessary and proper to
carry out the purposes of the Foundation.
``(i) Principal Office.--

[[Page S3278]]

``(1) In General.--The principal office of the Foundation
shall be in the District of Columbia.
``(2) Activities; offices.--The activities of the
Foundation may be conducted, and offices may be maintained,
throughout the United States in accordance with the
constitution and bylaws of the Foundation.
``(j) Service of Process.--The Foundation shall comply with
the law on service of process of each State in which the
Foundation is incorporated and of each State in which the
Foundation carries on activities.
``(k) Liability of Officers, Employees, and Agents.--
``(1) In general.--The Foundation shall be liable for the
acts of the officers, employees, and agents of the Foundation
acting within the scope of their authority.
``(2) Personal liability.--A member of the Board shall be
personally liable only for gross negligence in the
performance of the duties of the member.
``(l) Restrictions.--
``(1) Limitation on spending.--Beginning with the fiscal
year following the first full fiscal year during which the
Foundation is in operation, the administrative costs of the
Foundation shall not exceed 10 percent of the sum of--
``(A) the amounts transferred to the Foundation under
subsection (m) during the preceding fiscal year; and
``(B) donations received from private sources during the
preceding fiscal year.
``(2) Appointment and hiring.--The appointment of officers
and employees of the Foundation shall be subject to the
availability of funds.
``(3) Status.--A member of the Board or officer, employee,
or agent of the Foundation shall not by reason of association
with the Foundation be considered to be an officer, employee,
or agent of the United States.
``(m) Transfer of Donated Funds.--The Secretary may
transfer to the Foundation funds held by the Department of
Health and Human Services under the Act of August 5, 1954 (42
U.S.C. 2001 et seq.) if the transfer or use of the funds is
not prohibited by any term under which the funds were
donated.
``(n) Audits.--The Foundation shall comply with section
10101 of title 36, United States Code, as if the Foundation
were a corporation under part B of subtitle II of that title.

``SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT.

``(a) Provision of Support by Secretary.--Subject to
subsection (b), during the 5-year period beginning on the
date on which the Foundation is established, the Secretary--
``(1) may provide personnel, facilities, and other
administrative support services to the Foundation;
``(2) may provide funds to reimburse the travel expenses of
the members of the Board; and
``(3) shall require and accept reimbursements from the
Foundation for--
``(A) services provided under paragraph (1); and
``(B) funds provided under paragraph (2).
``(b) Reimbursement.--Reimbursements accepted under
subsection (a)(3)--
``(1) shall be deposited in the Treasury of the United
States to the credit of the applicable appropriations
account; and
``(2) shall be chargeable for the cost of providing
services described in subsection (a)(1) and travel expenses
described in subsection (a)(2).
``(c) Continuation of Certain Services.--The Secretary may
continue to provide facilities and necessary support services
to the Foundation after the termination of the 5-year period
specified in subsection (a) if the facilities and services--
``(1) are available; and
``(2) are provided on reimbursable cost basis.''.
(b) Technical Amendments.--The Indian Self-Determination
and Education Assistance Act is amended--
(1) by redesignating title V (as added by section 1302 of
the American Indian Education Foundation Act of 2000) (25
U.S.C. 458bbb et seq.)) as title VII;
(2) by redesignating sections 501, 502, and 503 (as added
by section 1302 of the American Indian Education Foundation
Act of 2000) as sections 701, 702, and 703, respectively; and
(3) in subsection (a)(2) of section 702 and paragraph (2)
of section 703 (as redesignated by paragraph (2)), by
striking ``section 501'' and inserting ``section 701''.
____

S. 556

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title.--This Act may be cited as the ``Indian
Health Care Improvement Act Reauthorization of 2003''.
(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.

[[Page S3279]]

``Sec. 220. Programs operated by Indian tribes and tribal
organizations.
``Sec. 221. Licensing.
``Sec. 222. Authorization for emergency contract health services.
``Sec. 223. Prompt action on payment of claims.
``Sec. 224. Liability for payment.
``Sec. 225. Authorization of appropriations.

``TITLE III--FACILITIES

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

``TITLE IV--ACCESS TO HEALTH SERVICES

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

``TITLE V--HEALTH SERVICES FOR URBAN INDIANS

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

``TITLE VI--ORGANIZATIONAL IMPROVEMENTS

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

``TITLE VII--BEHAVIORAL HEALTH PROGRAMS

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

``TITLE VIII--MISCELLANEOUS

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

``SEC. 2. FINDINGS.

``Congress makes the following findings:
``(1) Federal delivery of health services and funding of
tribal and urban Indian health 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
addressed is formidable. In death rates

[[Page S3280]]

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

[[Page S3281]]

the course of study that is supported through the use of such
funds.

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

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

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

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

``SEC. 105. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.

``(a) Scholarships.--
``(1) In general.--In order to meet the needs of Indians,
Indian tribes, tribal organizations, and urban Indian
organizations for health professionals, the Secretary, acting
through the Service and in accordance with this section,
shall provide scholarships through the area offices to
Indians who are enrolled full or part time in accredited
schools and pursuing courses of study in the health
professions. Such scholarships shall be designated Indian
Health Scholarships and shall, except as provided in
subsection (b), be made in accordance with section 338A of
the Public Health Service Act (42 U.S.C. 254l).
``(2) No delegation.--The Director of the Service shall
administer this section and shall not delegate any
administrative functions under a funding agreement pursuant
to the Indian Self-Determination and Education Assistance
Act.
``(b) Eligibility.--
``(1) Enrollment.--An Indian shall be eligible for a
scholarship under subsection (a) in any year in which such
individual is enrolled full or part time in a course of study
referred to in subsection (a)(1).
``(2) Service obligation.--
``(A) Public health service act.--The active duty service
obligation under a written contract with the Secretary under
section 338A of the Public Health Service Act (42 U.S.C.
254l) that an Indian has entered into under that section
shall, if that individual is a recipient of an Indian Health
Scholarship, be met in full-time practice on an equivalent
year for year obligation, by service--
``(i) in the Indian Health Service;
``(ii) in a program conducted under a funding agreement
entered into under the Indian Self-Determination and
Education Assistance Act;
``(iii) in a program assisted under title V; or
``(iv) in the private practice of the applicable profession
if, as determined by the Secretary, in accordance with
guidelines promulgated by the Secretary, such practice is
situated in a physician or other health professional shortage
area and addresses the health care needs of a substantial
number of Indians.
``(B) Deferring active service.--At the request of any
Indian who has entered into a contract referred to in
subparagraph (A) and who receives a degree in medicine
(including osteopathic or allopathic medicine), dentistry,
optometry, podiatry, or pharmacy, the Secretary shall defer
the active duty service obligation of that individual under
that contract, in order that such individual may complete any
internship, residency, or other advanced clinical training
that is required for the practice of that health profession,
for an appropriate period (in years, as determined by the
Secretary), subject to the following conditions:
``(i) No period of internship, residency, or other advanced
clinical training shall be counted as satisfying any period
of obligated service that is required under this section.
``(ii) The active duty service obligation of that
individual shall commence not later than 90 days after the
completion of that advanced clinical training (or by a date
specified by the Secretary).
``(iii) The active duty service obligation will be served
in the health profession of that individual, in a manner
consistent with clauses (i) through (iv) of subparagraph (A).
``(C) New scholarship recipients.--A recipient of an Indian
Health Scholarship that is awarded after December 31, 2003,
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);

[[Page S3282]]

``(ii) is dismissed from such educational institution for
disciplinary reasons;
``(iii) voluntarily terminates the training in such an
educational institution for which he or she is provided a
scholarship under such contract before the completion of such
training; or
``(iv) fails to accept payment, or instructs the
educational institution in which he or she is enrolled not to
accept payment, in whole or in part, of a scholarship under
such contract;
in lieu of any service obligation arising under such
contract, shall be liable to the United States for the amount
which has been paid to him or her, or on his or her behalf,
under the contract.
``(B) Failure to perform service obligation.--If for any
reason not specified in subparagraph (A) an individual
breaches his or her written contract by failing either to
begin such individual's service obligation under this section
or to complete such service obligation, the United States
shall be entitled to recover from the individual an amount
determined in accordance with the formula specified in
subsection (l) of section 110 in the manner provided for in
such subsection.
``(C) Death.--Upon the death of an individual who receives
an Indian Health Scholarship, any obligation of that
individual for service or payment that relates to that
scholarship shall be canceled.
``(D) Waiver.--The Secretary shall provide for the partial
or total waiver or suspension of any obligation of service or
payment of a recipient of an Indian Health Scholarship if the
Secretary, in consultation with the appropriate area office,
Indian tribe, tribal organization, and urban Indian
organization, determines that--
``(i) it is not possible for the recipient to meet that
obligation or make that payment;
``(ii) requiring that recipient to meet that obligation or
make that payment would result in extreme hardship to the
recipient; or
``(iii) the enforcement of the requirement to meet the
obligation or make the payment would be unconscionable.
``(E) Hardship or good cause.--Notwithstanding any other
provision of law, in any case of extreme hardship or for
other good cause shown, the Secretary may waive, in whole or
in part, the right of the United States to recover funds made
available under this section.
``(F) Bankruptcy.--Notwithstanding any other provision of
law, with respect to a recipient of an Indian Health
Scholarship, no obligation for payment may be released by a
discharge in bankruptcy under title 11, United States Code,
unless that discharge is granted after the expiration of the
5-year period beginning on the initial date on which that
payment is due, and only if the bankruptcy court finds that
the nondischarge of the obligation would be unconscionable.
``(c) Funding for Tribes for Scholarship Programs.--
``(1) Provision of funds.--
``(A) In general.--The Secretary shall make funds
available, through area offices, to Indian Tribes and tribal
organizations for the purpose of assisting such Tribes and
tribal organizations in educating Indians to serve as health
professionals in Indian communities.
``(B) Limitation.--The Secretary shall ensure that amounts
available for grants under subparagraph (A) for any fiscal
year shall not exceed an amount equal to 5 percent of the
amount available for each fiscal year for Indian Health
Scholarships under this section.
``(C) Application.--An application for funds under
subparagraph (A) shall be in such form and contain such
agreements, assurances and information as consistent with
this section.
``(2) Requirements.--
``(A) In general.--An Indian Tribe or tribal organization
receiving funds under paragraph (1) shall agree to provide
scholarships to Indians in accordance with the requirements
of this subsection.
``(B) Matching requirement.--With respect to the costs of
providing any scholarship pursuant to subparagraph (A)--
``(i) 80 percent of the costs of the scholarship shall be
paid from the funds provided under paragraph (1) to the
Indian Tribe or tribal organization; and
``(ii) 20 percent of such costs shall be paid from any
other source of funds.
``(3) Eligibility.--An Indian Tribe or tribal organization
shall provide scholarships under this subsection only to
Indians who are enrolled or accepted for enrollment in a
course of study (approved by the Secretary) in one of the
health professions described in this Act.
``(4) Contracts.--In providing scholarships under paragraph
(1), the Secretary and the Indian Tribe or tribal
organization shall enter into a written contract with each
recipient of such scholarship. Such contract shall--
``(A) obligate such recipient to provide service in an
Indian health program (as defined in section 110(a)(2)(A)) in
the same service area where the Indian Tribe or tribal
organization providing the scholarship is located, for--
``(i) a number of years equal to the number of years for
which the scholarship is provided (or the part-time
equivalent thereof, as determined by the Secretary), or for a
period of 2 years, whichever period is greater; or
``(ii) such greater period of time as the recipient and the
Indian Tribe or tribal organization may agree;
``(B) provide that the scholarship--
``(i) may only be expended for--

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

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

[[Page S3283]]

into Health Program authorized under section 117, and
existing university research and communications networks.
``(c) Requirements.--
``(1) Regulations.--The Secretary shall promulgate
regulations pursuant to this Act for the competitive awarding
of funds under this section.
``(2) Program.--Applicants for funds under this section
shall agree to provide a program which, at a minimum--
``(A) provides outreach and recruitment for health
professions to Indian communities including elementary,
secondary and accredited and accessible community colleges
that will be served by the program;
``(B) incorporates a program advisory board comprised of
representatives from the Tribes and communities that will be
served by the program;
``(C) provides summer enrichment programs to expose Indian
students to the various fields of psychology through
research, clinical, and experimental activities;
``(D) provides stipends to undergraduate and graduate
students to pursue a career in psychology;
``(E) develops affiliation agreements with tribal community
colleges, the Service, university affiliated programs, and
other appropriate accredited and accessible entities to
enhance the education of Indian students;
``(F) utilizes, to the maximum extent feasible, existing
university tutoring, counseling and student support services;
and
``(G) employs, to the maximum extent feasible, qualified
Indians in the program.
``(d) Active Duty Obligation.--The active duty service
obligation prescribed under section 338C of the Public Health
Service Act (42 U.S.C. 254m) shall be met by each graduate
who receives a stipend described in subsection (c)(2)(C) that
is funded under this section. Such obligation shall be met by
service--
``(1) in the Indian Health Service;
``(2) in a program conducted under a funding agreement
contract entered into under the Indian Self-Determination and
Education Assistance Act;
``(3) in a program assisted under title V; or
``(4) in the private practice of psychology if, as
determined by the Secretary, in accordance with guidelines
promulgated by the Secretary, such practice is situated in a
physician or other health professional shortage area and
addresses the health care needs of a substantial number of
Indians.

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

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

``SEC. 108. CONTINUING EDUCATION ALLOWANCES.

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

``SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PROGRAM.

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

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

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

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

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

[[Page S3284]]

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
individual 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;
``(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.

[[Page S3285]]

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

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

``(a) Establishment.--Notwithstanding section 102, there is
established in the Treasury of the United States a fund to be
known as the Indian Health Scholarship and Loan Repayment
Recovery Fund (referred to in this section as the `LRRF').
The LRRF Fund shall consist of--
``(1) such amounts as may be collected from individuals
under subparagraphs (A) and (B) of section 105(b)(4) and
section 110(l) for breach of contract;
``(2) such funds as may be appropriated to the LRRF;
``(3) such interest earned on amounts in the LRRF; and
``(4) such additional amounts as may be collected,
appropriated, or earned relative to the LRRF.

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

``SEC. 112. RECRUITMENT ACTIVITIES.

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

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

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

``SEC. 114. ADVANCED TRAINING AND RESEARCH.

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

[[Page S3286]]

``(1) recruit individuals for programs which train
individuals to be nurses, nurse midwives, or advanced
practice nurses;
``(2) provide scholarships to Indian individuals enrolled
in such programs that may be used to pay the tuition charged
for such program and for other expenses incurred in
connection with such program, including books, fees, room and
board, and stipends for living expenses;
``(3) provide a program that encourages nurses, nurse
midwives, and advanced practice nurses to provide, or
continue to provide, health care services to Indians;
``(4) provide a program that increases the skills of, and
provides continuing education to, nurses, nurse midwives, and
advanced practice nurses; or
``(5) provide any program that is designed to achieve the
purpose described in subsection (a).
``(c) Applications.--Each application for funds under
subsection (a) shall include such information as the
Secretary may require to establish the connection between the
program of the applicant and a health care facility that
primarily serves Indians.
``(d) Preferences.--In providing funds under subsection
(a), the Secretary shall extend a preference to--
``(1) programs that provide a preference to Indians;
``(2) programs that train nurse midwives or advanced
practice nurses;
``(3) programs that are interdisciplinary; and
``(4) programs that are conducted in cooperation with a
center for gifted and talented Indian students established
under section 5324(a) of the Indian Education Act of 1988.
``(e) Quentin N. Burdick American Indians Into Nursing
Program.--The Secretary shall ensure that a portion of the
funds authorized under subsection (a) is made available to
establish and maintain a program at the University of North
Dakota to be known as the `Quentin N. Burdick American
Indians Into Nursing Program'. Such program shall, to the
maximum extent feasible, coordinate with the Quentin N.
Burdick American Indians Into Psychology Program established
under section 106(b) and the Quentin N. Burdick Indian Health
Programs established under section 117(b).
``(f) Service Obligation.--The active duty service
obligation prescribed under section 338C of the Public Health
Service Act (42 U.S.C. 254m) shall be met by each individual
who receives training or assistance described in paragraph
(1) or (2) of subsection (b) that is funded under subsection
(a). Such obligation shall be met by service--
``(1) in the Indian Health Service;
``(2) in a program conducted under a contract entered into
under the Indian Self-Determination and Education assistance
Act;
``(3) in a program assisted under title V; or
``(4) in the private practice of nursing if, as determined
by the Secretary, in accordance with guidelines promulgated
by the Secretary, such practice is situated in a physician or
other health professional shortage area and addresses the
health care needs of a substantial number of Indians.

``SEC. 116. TRIBAL CULTURE AND HISTORY.

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

``SEC. 117. INMED PROGRAM.

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

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

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

Such courses of study may be offered in conjunction with the
college or university with which the community college has
entered 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--

[[Page S3287]]

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

``SEC. 120. NURSING RESIDENCY PROGRAM.

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

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

``(a) In General.--Under the authority of the Act of
November 2, 1921 (25 U.S.C. 13; commonly known as the Snyder
Act), the Secretary shall maintain a Community Health Aide
Program in Alaska under which the Service--
``(1) provides for the training of Alaska Natives as health
aides or community health practitioners;
``(2) uses such aides or practitioners in the provision of
health care, health promotion, and disease prevention
services to Alaska Natives living in villages in rural
Alaska; and
``(3) provides for the establishment of teleconferencing
capacity in health clinics located in or near such villages
for use by community health aides or community health
practitioners.
``(b) Activities.--The Secretary, acting through the
Community Health Aide Program under subsection (a), shall--
``(1) using trainers accredited by the Program, provide a
high standard of training to community health aides and
community health practitioners to ensure that such aides and
practitioners provide quality health care, health promotion,
and disease prevention services to the villages served by the
Program;
``(2) in order to provide such training, develop a
curriculum that--
``(A) combines education in the theory of health care with
supervised practical experience in the provision of health
care;
``(B) provides instruction and practical experience in the
provision of acute care, emergency care, health promotion,
disease prevention, and the efficient and effective
management of clinic pharmacies, supplies, equipment, and
facilities; and
``(C) promotes the achievement of the health status
objective specified in section 3(b);
``(3) establish and maintain a Community Health Aide
Certification Board to certify as community health aides or
community health practitioners individuals who have
successfully completed the training described in paragraph
(1) or who can demonstrate equivalent experience;
``(4) develop and maintain a system which identifies the
needs of community health aides and community health
practitioners for continuing education in the provision of
health care, including the areas described in paragraph
(2)(B), and develop programs that meet the needs for such
continuing education;
``(5) develop and maintain a system that provides close
supervision of community health aides and community health
practitioners; and
``(6) develop a system under which the work of community
health aides and community health practitioners is reviewed
and evaluated to assure the provision of quality health care,
health promotion, and disease prevention services.

``SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION.

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

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

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

``SEC. 124. SCHOLARSHIPS.

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

``SEC. 125. NATIONAL HEALTH SERVICE CORPS.

``(a) Limitations.--The Secretary shall not--
``(1) remove a member of the National Health Services Corps
from a health program operated by Indian Health Service or by
a tribe or tribal organization under a funding agreement with
the Service under the Indian Self-Determination and Education
Assistance Act, or by urban Indian organizations; or
``(2) withdraw the funding used to support such a member;

unless the Secretary, acting through the Service, tribes or
tribal organization, has ensured that the Indians receiving
services from such member will experience no reduction in
services.
``(b) Designation of Service Areas as Health Professional
Shortage Areas.--All service areas served by programs
operated by the Service or by a tribe or tribal organization
under 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.

[[Page S3288]]

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

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

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

``SEC. 128. AUTHORIZATION OF APPROPRIATIONS.

``There are authorized to be appropriated such sums as may
be necessary for each fiscal year through fiscal year 2015 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

[[Page S3289]]

under the authority of the Indian Self-Determination and
Education Assistance Act shall be eligible for funds
appropriated under the authority of this section on an equal
basis with programs that are administered directly by the
Service.
``(e) Report.--Not later than the date that is 3 years
after the date of enactment of this Act, the Secretary shall
submit to the Congress the current health status and resource
deficiency report of the Service for each Indian tribe or
service unit, including newly recognized or acknowledged
tribes. Such report shall set out--
``(1) the methodology then in use by the Service for
determining tribal health status and resource deficiencies,
as well as the most recent application of that methodology;
``(2) the extent of the health status and resource
deficiency of each Indian tribe served by the Service;
``(3) the amount of funds necessary to eliminate the health
status and resource deficiencies of all Indian tribes served
by the Service; and
``(4) an estimate of--
``(A) the amount of health service funds appropriated under
the authority of this Act, or any other Act, including the
amount of any funds transferred to the Service, for the
preceding fiscal year which is allocated to each service
unit, Indian tribe, or comparable entity;
``(B) the number of Indians eligible for health services in
each service unit or Indian tribe or tribal organization; and
``(C) the number of Indians using the Service resources
made available to each service unit or Indian tribe or tribal
organization, and, to the extent available, information on
the waiting lists and number of Indians turned away for
services due to lack of resources.
``(f) Budgetary Rule.--Funds appropriated under the
authority of this section for any fiscal year shall be
included in the base budget of the Service for the purpose of
determining appropriations under this section in
subsequent fiscal years.
``(g) Rule of Construction.--Nothing in this section shall
be construed to diminish the primary responsibility of the
Service to eliminate existing backlogs in unmet health care
needs or to discourage the Service from undertaking
additional efforts to achieve equity among Indian tribes and
tribal organizations.
``(h) Designation.--Any funds appropriated under the
authority of this section shall be designated as the `Indian
Health Care Improvement Fund'.

``SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND.

``(a) Establishment.--
``(1) In general.--There is hereby established an Indian
Catastrophic Health Emergency Fund (referred to in this
section as the `CHEF') consisting of--
``(A) the amounts deposited under subsection (d); and
``(B) any amounts appropriated to the CHEF under this Act.
``(2) Administration.--The CHEF shall be administered by
the Secretary solely for the purpose of meeting the
extraordinary medical costs associated with the treatment of
victims of disasters or catastrophic illnesses who are within
the responsibility of the Service.
``(3) Equitable allocation.--The CHEF shall be equitably
allocated, apportioned or delegated on a service unit or area
office basis, based upon a formula to be developed by the
Secretary in consultation with the Indian tribes and tribal
organizations through negotiated rulemaking under title VIII.
Such formula shall take into account the added needs of
service areas which are contract health service dependent.
``(4) Not subject to contract or grant.--No part of the
CHEF or its administration shall be subject to contract or
grant under any law, including the Indian Self-Determination
and Education Assistance Act.
``(5) Administration.--Amounts provided from the CHEF shall
be administered by the area offices based upon priorities
determined by the Indian tribes and tribal organizations
within each service area, including a consideration of the
needs of Indian tribes and tribal organizations which are
contract health service-dependent.
``(b) Requirements.--The Secretary shall, through the
negotiated rulemaking process under title VIII, promulgate
regulations consistent with the provisions of this section--
``(1) establish a definition of disasters and catastrophic
illnesses for which the cost of treatment provided under
contract would qualify for payment from the CHEF;
``(2) provide that a service unit, Indian tribe, or tribal
organization shall not be eligible for reimbursement for the
cost of treatment from the CHEF until its cost of treatment
for any victim of such a catastrophic illness or disaster has
reached a certain threshold cost which the Secretary shall
establish at--
``(A) for 1999, not less than $19,000; and
``(B) for any subsequent year, not less than the threshold
cost of the previous year increased by the percentage
increase in the medical care expenditure category of the
consumer price index for all urban consumers (United States
city average) for the 12-month period ending with December of
the previous year;
``(3) establish a procedure for the reimbursement of the
portion of the costs incurred by--
``(A) service units, Indian tribes, or tribal
organizations, or facilities of the Service; or
``(B) non-Service facilities or providers whenever
otherwise authorized by the Service;

in rendering treatment that exceeds threshold cost described
in paragraph (2);
``(4) establish a procedure for payment from the CHEF in
cases in which the exigencies of the medical circumstances
warrant treatment prior to the authorization of such
treatment by the Service; and
``(5) establish a procedure that will ensure that no
payment shall be made from the CHEF to any provider of
treatment to the extent that such provider is eligible to
receive payment for the treatment from any other Federal,
State, local, or private source of reimbursement for which
the patient is eligible.
``(c) Limitation.--Amounts appropriated to the CHEF under
this section shall not be used to offset or limit
appropriations made to the Service under the authority of the
Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the
Snyder Act) or any other law.
``(d) Deposits.--There shall be deposited into the CHEF all
reimbursements to which the Service is entitled from any
Federal, State, local, or private source (including third
party insurance) by reason of treatment rendered to any
victim of a disaster or catastrophic illness the cost of
which was paid from the CHEF.

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

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

[[Page S3290]]

``(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 2015, each effective model diabetes
project in existence on the date of the enactment of this Act
and such other diabetes programs operated by the Secretary or
by Indian tribes and tribal organizations and any additional
programs added to meet existing diabetes needs. Indian tribes
and tribal organizations shall receive recurring funding for
the diabetes programs which they operate pursuant to this
section. Model diabetes projects shall consult, on a regular
basis, with tribes and tribal organizations in their regions
regarding diabetes needs and provide technical expertise as
needed.
``(d) Dialysis Programs.--The Secretary shall provide
funding through the Service, Indian tribes and tribal
organizations to establish dialysis programs, including funds
to purchase dialysis equipment and provide necessary
staffing.
``(e) Other Activities.--The Secretary shall, to the extent
funding is available--
``(1) in each area office of the Service, consult with
Indian tribes and tribal organizations regarding programs for
the prevention, treatment, and control of diabetes;
``(2) establish in each area office of the Service a
registry of patients with diabetes to track the prevalence of
diabetes and the complications from diabetes in that area;
and
``(3) ensure that data collected in each area office
regarding diabetes and related complications among Indians is
disseminated to tribes, tribal organizations, and all other
area offices.

``SEC. 205. SHARED SERVICES.

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

``SEC. 206. HEALTH SERVICES RESEARCH.

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

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

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

``SEC. 208. PATIENT TRAVEL COSTS.

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

``SEC. 209. EPIDEMIOLOGY CENTERS.

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

[[Page S3291]]

``(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 organizations and urban Indian organizations in the
development of comprehensive health education plans, and the
dissemination of comprehensive health education materials and
information on existing health programs and resources.
``(d) Criteria.--The Secretary, in consultation with Indian
tribes, tribal organizations, and urban Indian organizations
shall establish criteria for the review and approval of
applications for funding under this section.
``(e) Comprehensive School Health Education Program.--
``(1) Development.--The Secretary of the Interior, acting
through the Bureau of Indian Affairs and in cooperation with
the Secretary and affected Indian tribes and tribal
organizations, shall develop a comprehensive school health
education program for children from preschool through grade
12 for use in schools operated by the Bureau of Indian
Affairs.
``(2) Requirements.--The program developed under paragraph
(1) shall include--
``(A) school programs on nutrition education, personal
health, oral health, and fitness;
``(B) mental health wellness programs;
``(C) chronic disease prevention programs;
``(D) substance abuse prevention programs;
``(E) injury prevention and safety education programs; and
``(F) activities for the prevention and control of
communicable diseases.
``(3) Training and coordination.--The Secretary of the
Interior shall--
``(A) provide training to teachers in comprehensive school
health education curricula;
``(B) ensure the integration and coordination of school-
based programs with existing services and health programs
available in the community; and
``(C) encourage healthy, tobacco-free school environments.

``SEC. 211. INDIAN YOUTH PROGRAM.

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

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

``(a) In General.--The Secretary, acting through the
Service after consultation with Indian tribes, tribal
organizations, urban Indian organizations, and the Centers
for Disease Control and Prevention, may make funding
available to Indian tribes and tribal organizations for--
``(1) projects for the prevention, control, and elimination
of communicable and infectious diseases, including
tuberculosis, hepatitis, HIV, respiratory syncitial virus,
hanta virus, sexually transmitted diseases, and H. Pylori,
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--

[[Page S3292]]

``(1) an evaluation of the nature and extent of health
problems caused by environmental hazards currently exhibited
among Indians and the causes of such health problems;
``(2) an analysis of the potential effect of ongoing and
future environmental resource development on or near Indian
reservations and communities including the cumulative effect
of such development over time on health;
``(3) an evaluation of the types and nature of activities,
practices, and conditions causing or affecting such health
problems including uranium mining and milling, uranium mine
tailing deposits, nuclear power plant operation and
construction, and nuclear waste disposal, oil and gas
production or transportation on or near Indian reservations
or communities, and other development that could affect the
health of Indians and their water supply and food chain;
``(4) a summary of any findings or recommendations provided
in Federal and State studies, reports, investigations, and
inspections during the 5 years prior to the date of the
enactment of this Act that directly or indirectly relate to
the activities, practices, and conditions affecting the
health or safety of such Indians; and
``(5) a description of the efforts that have been made by
Federal and State agencies and resource and economic
development companies to effectively carry out an education
program for such Indians regarding the health and safety
hazards of such development.
``(b) Development of Health Care Plans.--Upon the
completion of the study under subsection (a), the Secretary
and the Service shall take into account the results of such
study and, in consultation with Indian tribes and tribal
organizations, develop a health care plan to address the
health problems that were the subject of such study. The
plans shall include--
``(1) methods for diagnosing and treating Indians currently
exhibiting such health problems;
``(2) preventive care and testing for Indians who may be
exposed to such health hazards, including the monitoring of
the health of individuals who have or may have been exposed
to excessive amounts of radiation, or affected by other
activities that have had or could have a serious impact upon
the health of such individuals; and
``(3) a program of education for Indians who, by reason of
their work or geographic proximity to such nuclear or other
development activities, may experience health problems.
``(c) Submission to Congress.--
``(1) General report.--Not later than 18 months after the
date of enactment of this Act, the Secretary and the Service
shall submit to Congress a report concerning the study
conducted under subsection (a).
``(2) Health care plan report.--Not later than 1 year after
the date on which the report under paragraph (1) is submitted
to Congress, the Secretary and the Service shall submit to
Congress the health care plan prepared under subsection (b).
Such plan shall include recommended activities for the
implementation of the plan, as well as an evaluation of any
activities previously undertaken by the Service to address
the health problems involved.
``(d) Task Force.--
``(1) Established.--There is hereby established an
Intergovernmental Task Force (referred to in this section as
the `task force') that shall be composed of the following
individuals (or their designees):
``(A) The Secretary of Energy.
``(B) The Administrator of the Environmental Protection
Agency.
``(C) The Director of the Bureau of Mines.
``(D) The Assistant Secretary for Occupational Safety and
Health.
``(E) The Secretary of the Interior.
``(2) Duties.--The Task Force shall identify existing and
potential operations related to nuclear resource development
or other environmental hazards that affect or may affect the
health of Indians on or near an Indian reservation or in an
Indian community, and enter into activities to correct
existing health hazards and ensure that current and future
health problems resulting from nuclear resource or other
development activities are minimized or reduced.
``(3) Administrative provisions.--The Secretary shall serve
as the chairperson of the Task Force. The Task Force shall
meet at least twice each year. Each member of the Task Force
shall furnish necessary assistance to the Task Force.
``(e) Provision of Appropriate Medical Care.--In the case
of any Indian who--
``(1) as a result of employment in or near a uranium mine
or mill or near any other environmental hazard, suffers from
a work related illness or condition;
``(2) is eligible to receive diagnosis and treatment
services from a Service facility; and
``(3) by reason of such Indian's employment, is entitled to
medical care at the expense of such mine or mill operator or
entity responsible for the environmental hazard;

the Service shall, at the request of such Indian, render
appropriate medical care to such Indian for such illness or
condition and may recover the costs of any medical care so
rendered to which such Indian is entitled at the expense of
such operator or entity from such operator or entity. Nothing
in this subsection shall affect the rights of such Indian to
recover damages other than such costs paid to the Service
from the employer for such illness or condition.

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

``(a) In General.--For fiscal years beginning with the
fiscal year ending September 30, 1983, and ending with the
fiscal year ending September 30, 2015, 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, 2003, and ending with the
fiscal year ending September 30, 2015, 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, 2003, and ending with the
fiscal year ending September 30, 2015, 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.

[[Page S3293]]

``(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 2015 to
carry out this title.

``TITLE III--FACILITIES

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

``(a) Consultation.--Prior to the expenditure of, or the
making of any firm commitment to expend, any funds
appropriated for the planning, design, construction, or
renovation of facilities pursuant to the Act of November 2,
1921 (25 U.S.C. 13) (commonly known as the Snyder Act), the
Secretary, acting through the Service, shall--
``(1) consult with any Indian tribe that would be
significantly affected by such expenditure for the purpose of
determining and, whenever practicable, honoring tribal
preferences concerning size, location, type, and other
characteristics of any facility on which such expenditure is
to be made; and
``(2) ensure, whenever practicable, that such facility
meets the construction standards of any nationally recognized
accrediting body by not later than 1 year after the date on
which the construction or renovation of such facility is
completed.
``(b) Closure of Facilities.--
``(1) In general.--Notwithstanding any provision of law
other than this subsection, no Service hospital or outpatient
health care facility or any inpatient service or special care
facility operated by the Service, may be closed if the
Secretary has not submitted to the Congress at least 1 year
prior to the date such proposed closure an evaluation of the
impact of such proposed closure which specifies, in addition
to other considerations--
``(A) the accessibility of alternative health care
resources for the population served by such hospital or
facility;
``(B) the cost effectiveness of such closure;
``(C) the quality of health care to be provided to the
population served by such hospital or facility after such
closure;
``(D) the availability of contract health care funds to
maintain existing levels of service;
``(E) the views of the Indian tribes served by such
hospital or facility concerning such closure;
``(F) the level of utilization of such hospital or facility
by all eligible Indians; and
``(G) the distance between such hospital or facility and
the nearest operating Service hospital.
``(2) Temporary closure.--Paragraph (1) shall not apply to
any temporary closure of a facility or of any portion of a
facility if such closure is necessary for medical,
environmental, or safety reasons.
``(c) Priority System.--
``(1) Establishment.--The Secretary shall establish a
health care facility priority system, that shall--
``(A) be developed with Indian tribes and tribal
organizations through negotiated rulemaking under section
802;
``(B) give the needs of Indian tribes the highest priority,
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 2003, 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 2004, 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.

[[Page S3294]]

``(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 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--

[[Page S3295]]

``(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, 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.

[[Page S3296]]

``(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.
``(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

[[Page S3297]]

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.--
``(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

[[Page S3298]]

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 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 2015 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.

[[Page S3299]]

``(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 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

[[Page S3300]]

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 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

[[Page S3301]]

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,
2003, 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 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 2003);
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.

[[Page S3302]]

``(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 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

[[Page S3303]]

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 2004 through 2015 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;
``(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.
``(2) 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

[[Page S3304]]

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 or 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 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;

[[Page S3305]]

``(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 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, 2004, 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

[[Page S3306]]

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 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 2015 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 2015 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,

[[Page S3307]]

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;
``(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

[[Page S3308]]

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.
``(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

[[Page S3309]]

traditional health care practices, cultural values, and
community and family involvement.
``(c) Criteria.--The Secretary, in consultation with Indian
tribes and tribal organizations, shall establish criteria for
the review and approval of applications and proposals for
funding under this section.
``(d) Earmark of Certain Funds.--Twenty percent of the
amounts appropriated to carry out this section shall be used
to make grants to urban Indian organizations funded under
title V.

``SEC. 707. INDIAN YOUTH PROGRAM.

``(a) Detoxification and Rehabilitation.--The Secretary
shall, consistent with section 701, develop and implement a
program for acute detoxification and treatment for Indian
youth that includes behavioral health services. The program
shall include regional treatment centers designed to include
detoxification and rehabilitation for both sexes on a
referral basis and programs developed and implemented by
Indian tribes or tribal organizations at the local level
under the Indian Self-Determination and Education Assistance
Act. Regional centers shall be integrated with the intake and
rehabilitation programs based in the referring Indian
community.
``(b) Alcohol and Substance Abuse Treatment Centers or
Facilities.--
``(1) Establishment.--
``(A) In general.--The Secretary, acting through the
Service, Indian tribes, or tribal organizations, shall
construct, renovate, or, as necessary, purchase, and
appropriately staff and operate, at least 1 youth regional
treatment center or treatment network in each area under the
jurisdiction of an area office.
``(B) Area office in california.--For purposes of this
subsection, the area office in California shall be considered
to be 2 area offices, 1 office whose jurisdiction shall be
considered to encompass the northern area of the State of
California, and 1 office whose jurisdiction shall be
considered to encompass the remainder of the State of
California for the purpose of implementing California
treatment networks.
``(2) Funding.--For the purpose of staffing and operating
centers or facilities under this subsection, funding shall be
made available pursuant to the Act of November 2, 1921 (25
U.S.C. 13) (commonly known as the Snyder Act).
``(3) Location.--A youth treatment center constructed or
purchased under this subsection shall be constructed or
purchased at a location within the area described in
paragraph (1) that is agreed upon (by appropriate tribal
resolution) by a majority of the tribes to be served by such
center.
``(4) Specific provision of funds.--
``(A) In general.--Notwithstanding any other provision of
this title, the Secretary may, from amounts authorized to be
appropriated for the purposes of carrying out this section,
make funds available to--
``(i) the Tanana Chiefs Conference, Incorporated, for the
purpose of leasing, constructing, renovating, operating and
maintaining a residential youth treatment facility in
Fairbanks, Alaska;
``(ii) the Southeast Alaska Regional Health Corporation to
staff and operate a residential youth treatment facility
without regard to the proviso set forth in section 4(l) of
the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450b(l));
``(iii) the Southern Indian Health Council, for the purpose
of staffing, operating, and maintaining a residential youth
treatment facility in San Diego County, California; and
``(iv) the Navajo Nation, for the staffing, operation, and
maintenance of the Four Corners Regional Adolescent Treatment
Center, a residential youth treatment facility in New Mexico.
``(B) Provision of services to eligible youth.--Until
additional residential youth treatment facilities are
established in Alaska pursuant to this section, the
facilities specified in subparagraph (A) shall make every
effort to provide services to all eligible Indian youth
residing in such State.
``(c) Intermediate Adolescent Behavioral Health Services.--
``(1) In general.--The Secretary, acting through the
Service, Indian Tribes and tribal 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

[[Page S3310]]

the communities receiving services for prevention,
intervention, treatment and aftercare).
``(b) Training.--The Secretary shall, either directly or
through Indian tribes or tribal organization, provide
instruction in the area of behavioral health issues,
including instruction in crisis intervention and family
relations in the context of alcohol and substance abuse,
child sexual abuse, youth alcohol and substance abuse, and
the causes and effects of fetal alcohol disorders, to
appropriate employees of the Bureau of Indian Affairs and the
Service, and to personnel in schools or programs operated
under any contract with the Bureau of Indian Affairs or the
Service, including supervisors of emergency shelters and
halfway houses described in section 4213 of the Indian
Alcohol and Substance Abuse Prevention and Treatment Act of
1986 (25 U.S.C. 2433).
``(c) Community-Based Training Models.--In carrying out the
education and training programs required by this section, the
Secretary, acting through the Service and in consultation
with Indian tribes, tribal organizations, Indian behavioral
health experts, and Indian alcohol and substance abuse
prevention experts, shall develop and provide community-based
training models. Such models shall address--
``(1) the elevated risk of alcohol and behavioral health
problems faced by children of alcoholics;
``(2) the cultural, spiritual, and multigenerational
aspects of behavioral health problem prevention and recovery;
and
``(3) community-based and multidisciplinary strategies for
preventing and treating behavioral health problems.

``SEC. 710. BEHAVIORAL HEALTH PROGRAM.

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

``SEC. 711. FETAL ALCOHOL DISORDER FUNDING.

``(a) Establishment of Program.--
``(1) In general.--The Secretary, consistent with Section
701, acting through Indian tribes, tribal organizations, and
urban Indian organizations, shall establish and operate fetal
alcohol disorders programs as provided for in this section
for the purposes of meeting the health status objective
specified in section 3(b).
``(2) Use of funds.--Funding provided pursuant to this
section shall be used to--
``(A) develop and provide community and in-school training,
education, and prevention programs relating to fetal alcohol
disorders;
``(B) identify and provide behavioral health treatment to
high-risk women;
``(C) identify and provide appropriate educational and
vocational support, counseling, advocacy, and information to
fetal alcohol disorder affected persons and their families or
caretakers;
``(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 neurodevelopmental disorders.--The
term `alcohol related neurodevelopmental disorders' or `ARND'
with respect to an individual means the individual has a
history of maternal alcohol consumption during pregnancy,
central nervous system involvement such as developmental
delay, intellectual deficit, or neurologic abnormalities,
that behaviorally, there may be problems with irritability,
and failure to thrive as infants, and

[[Page S3311]]

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 2015 to
carry out this title.

``TITLE VIII--MISCELLANEOUS

``SEC. 801. REPORTS.

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

[[Page S3312]]

``(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, 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 and, as such, may
act

[[Page S3313]]

as an ordering agent of the Service and the employees of the
tribe or tribal organization may order supplies on behalf
thereof on the same basis as employees of the Service.

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

``(a) Establishment.--There is hereby established the
National Bi-Partisan Indian Health Care Entitlement
Commission (referred to in this Act as the `Commission').
``(b) Membership.--The Commission shall be composed of 25
members, to be appointed as follows:
``(1) Ten members of Congress, of which--
``(A) three members shall be from the House of
Representatives and shall be appointed by the majority
leader;
``(B) three members shall be from the House of
Representatives and shall be appointed by the minority
leader;
``(C) two members shall be from the Senate and shall be
appointed by the majority leader; and
``(D) two members shall be from the Senate and shall be
appointed by the minority leader;

who shall each be members of the committees of Congress that
consider legislation affecting the provision of health care
to Indians and who shall elect the chairperson and vice-
chairperson of the Commission.
``(2) Twelve individuals to be appointed by the members of
the Commission appointed under paragraph (1), of which at
least 1 shall be from each service area as currently
designated by the Director of the Service, to be chosen from
among 3 nominees from each such area as selected by the
Indian tribes within the area, with due regard being given to
the experience and expertise of the nominees in the provision
of health care to Indians and with due regard being given to
a reasonable representation on the Commission of members who
are familiar with various health care delivery modes and who
represent tribes of various size populations.
``(3) Three individuals shall be appointed by the Director
of the Service from among individual who are knowledgeable
about the provision of health care to Indians, at least 1 of
whom shall be appointed from among 3 nominees from each
program that is funded in whole or in part by the Service
primarily or exclusively for the benefit of urban Indians.

All those persons appointed under paragraphs (2) and (3)
shall be members of Federally recognized Indian Tribes.
``(c) Terms.--
``(1) In general.--Members of the Commission shall serve
for the life of the Commission.
``(2) Appointment of members.--Members of the Commission
shall be appointed under subsection (b)(1) not later than 90
days after the date of enactment of this Act, and the
remaining members of the Commission shall be appointed not
later than 60 days after the date on which the members are
appointed under such subsection.
``(3) Vacancy.--A vacancy in the membership of the
Commission shall be filled in the manner in which the
original appointment was made.
``(d) Duties of the Commission.--The Commission shall carry
out the following duties and functions:
``(1) Review and analyze the recommendations of the report
of the study committee established under paragraph (3) to the
Commission.
``(2) Make recommendations to Congress for providing health
services for Indian persons as an entitlement, giving due
regard to the effects of such a programs on existing health
care delivery systems for Indian persons and the effect of
such programs on the sovereign status of Indian Tribes;
``(3) Establish a study committee to be composed of those
members of the Commission appointed by the Director of the
Service and at least 4 additional members of Congress from
among the members of the Commission which shall--
``(A) to the extent necessary to carry out its duties,
collect and compile data necessary to understand the extent
of Indian needs with regard to the provision of health
services, regardless of the location of Indians, including
holding hearings and soliciting the views of Indians, Indian
tribes, tribal organizations and urban Indian organizations,
and which may include authorizing and funding feasibility
studies of various models for providing and funding health
services for all Indian beneficiaries including those who
live outside of a reservation, temporarily or permanently;
``(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 provided, 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

[[Page S3314]]

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 2015 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--
``(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

[[Page S3315]]

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 (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 2004 through 2015 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, 2003.
______

By Ms. COLLINS (for herself, Mr. Grassley, Mr. Bingaman, Mr.
Cochran, Mr. Daschle, Mr. Sarbanes, and Mr. Smith):
S. 557. A bill to amend the Internal Revenue Code of 1986 to exclude
from

[[Page S3316]]

gross income amounts received on account of claims based on certain
unlawful discrimination and to allow income averaging for backpay and
frontpay awards received on account of such claims, and for other
purposes; to the Committee on Finance.
Ms. COLLINS. Mr. President, I rise to introduce the Civil Rights Tax
Relief Act of 2003, a bill designed to promote the fair and equitable
settlement of civil rights claims. I am very pleased to be joined today
by Senators Grassley, Daschle, Bingaman, Cochran, and Sarbanes.
The primary purpose of this bill is to remedy an unintended
consequence of the Small Business Job Protection Act of 1996, which
made damage awards that are not based on ``physical injuries or
physical sickness'' part of a plaintiff's taxable income. Because most
acts of employment discrimination and civil rights violations do not
cause physical injuries, this provision has had a direct and negative
impact on plaintiffs who successfully prove that they have been
subjected to intentional employment discrimination or other intentional
violations of their civil rights.
The problem is compounded by the fact that plaintiffs are now taxed
on the entirety of their settlements or damage awards in civil rights
cases, despite the fact that a portion of a settlement or award must be
paid to the plaintiff's attorney, who in turn is taxed on the same
funds. This double taxation of attorneys' fees awards penalizes
Americans who win their civil rights cases.
I would like to share one example of how individuals can be harmed by
the current taxation scheme, and even discouraged from challenging
workplace discrimination. The example was brought to my attention by
David Webbert, an attorney who practices in Augusta, ME--my State's
capital. In one of his cases, David represented a person who
successfully challenged a business' policy of discriminating against
persons with a particular type of disability. As a result of the case,
the discriminatory policy was declared illegal and was ended. Although
the plaintiff did not receive any monetary damages in the case, the law
did provide for payment of attorney's fees, which were paid by the
defendant's insurance company. Because of the current law's double
taxation of attorney's fees, they were taxable to the plaintiff in this
case, despite the fact that they were also taxable to the attorney. In
short, plaintiffs in civil rights cases like this could have to pay
taxes even though they receive no monetary award. Or, in other words,
under current law, a plaintiff can actually be penalized financially
for bringing a meritorious case against a company's discriminatory
policies.
Our bill would eliminate the unfair taxation of civil rights victims'
settlements and court awards--taxation that adds insult to a civil
rights victim's injury and serves as a barrier to the just settlement
of civil rights claims.
Our bill would change the taxation of awards received by individuals
that result from judgments in or settlements of employment
discrimination cases. First, the bill excludes from gross income
amounts awarded other than for punitive damages and compensation
attributable to services that were to be performed, known as
``backpay,'' or that would have been performed but for a claimed
violation of law by the employer, known as ``frontpay.'' Second, award
amounts for frontpay or backpay would be included in income, but would
be eligible for income averaging according to the time period covered
by the award. This correction would allow individuals to pay taxes at
the same marginal rates that would have applied to them had they not
suffered discrimination. Third, the bill would change the tax code so
that people who bring civil rights cases are not taxed on the portion
of any award paid as fees to their attorney. This provision would
eliminate the double-taxation of such fees, which would still be
taxable income to the attorney.
The Civil Rights Tax Relief Act would encourage the fair settlement
of costly and protracted litigation of employment discrimination
claims. Our legislation would allow both plaintiffs and defendants to
settle claims based on the damages suffered, not on the excessive taxes
that are now levied.
Our bill has been endorsed by the U.S. Chamber of Commerce, AARP, the
National Employment Lawyers Association, the No FEAR Coalition, the
Religious Action Committee for Reform Judaism, the Society for Human
Resource Management, and others. This bill is a ``win-win'' for civil
rights plaintiffs and defendant businesses. I invite my colleagues to
join in support of this common sense legislation.
______

By Mr. McCAIN (for himself, Mr. Bingaman, Mr. Campbell, Mrs.
Murray, Mr. Johnson, and Mr. Domenici):
S. 558. A bill to elevate the position 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 the 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. I'm pleased that my colleagues, Senators Bingaman, Campbell,
Murray, Johnson, and Domenici are joining me in this effort as original
co-sponsors.
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.
The Indian Health Service is the primary health care delivery system
and principal advocate for Indian health care needs, both on the
reservation level and for urban populations. More than 1.6 million
Indian people are served every year by the IHS, yet the agency has not
had the necessary resources to fully meet 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 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 Administration to ensure prompt passage of this
legislation. I ask unanimous consent that the text of this bill be
printed in the Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:

S. 558

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) Definitions.--In this section:
(1) Assistant secretary.--The term ``Assistant Secretary''
means the Assistant Secretary for Indian Health appointed
under subsection (b)(2)(A).

[[Page S3317]]

(2) Department.--The term ``Department'' means the
Department of Health and Human Services.
(3) Office.--The term ``Office'' means the Office of the
Assistant Secretary for Indian Health established by
subsection (b)(1).
(4) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(b) Establishment.--
(1) In general.--There is established within the Department
the Office of the Assistant Secretary for Indian Health.
(2) Assistant secretary.--
(A) In general.--Except as provided in subparagraph (B),
the Office shall be headed by an Assistant Secretary for
Indian Health, to be appointed by the President, by and with
the advice and consent of the Senate.
(B) Continued service by incumbent.--The individual serving
in the position of Director of the Indian Health Service on
the day before the date of enactment of this Act may serve as
Assistant Secretary at the pleasure of the President after
the date of enactment of this Act.
(3) Duties.--The position of Assistant Secretary is
established to, in a manner consistent with the government-
to-government relationship between the United States and
Indian tribes--
(A) facilitate advocacy for the development of appropriate
Indian health policy; and
(B) promote consultation on matters relating to Indian
health.
(c) Assistant Secretary for Indian Health.--In addition to
the functions performed as of the date of enactment of this
Act by the Director of the Indian Health Service, the
Assistant Secretary 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
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 concerning matters of Indian health with respect
to which those heads have authority and responsibility;
(5) coordinate the activities of the Department concerning
matters of Indian health; and
(6) perform such other functions as the Secretary may
designate.
(d) Rate of Pay.--
(1) Positions at level iv.--Section 5315 of title 5, United
States Code, is amended by striking ``Assistant Secretaries
of Health and Human Services (6).'' and inserting ``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 ``Director, Indian Health
Service, Department of Health and Human Services.''.
(e) Duties of Assistant Secretary for Indian Health.--
Section 601 of the Indian Health Care Improvement Act (25
U.S.C. 1661) is amended by striking the section heading and
all that follows through subsection (a) and inserting the
following:

``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, there is established
within the Public Health Service of the Department of Health
and Human Services the Indian Health Service.
``(2) Administration.--The Indian Health Service shall be
administered by the Assistant Secretary for Indian Health.
``(3) Duties.--In carrying out paragraph (2), the Assistant
Secretary 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;
``(E) coordinate the activities of the Department of Health
and Human Services concerning matters of Indian health; and
``(F) perform such other functions as the Secretary may
designate.''.
(f) Conforming Amendments.--
(1) Amendments to indian health care improvement act.--The
Indian Health Care Improvement Act is amended--
(A) in section 601 (25 U.S.C. 1661)--
(i) in subsection (c), by striking ``Director of the Indian
Health Service'' each place it appears and inserting
``Assistant Secretary for Indian Health''; and
(ii) in subsection (d)(1), by striking ``Director of the
Indian Health Service'' and inserting ``Assistant Secretary
for Indian Health''; and
(B) in section 816(c)(1) (25 U.S.C. 1680f(c)(1)), by
striking ``Director of the Indian Health Service'' and
inserting ``Assistant Secretary for Indian Health''.
(2) Amendments to other provisions of law.--
(A) Section 3307(b)(1)(C) of the Children's Health Act of
2000 (25 U.S.C. 1671 note; Public Law 106-310) is amended by
striking ``Director of the Indian Health Service'' and
inserting ``Assistant Secretary for Indian Health''.
(B) The Indian Lands Open Dump Cleanup Act of 1994 is
amended--
(i) in section 3 (25 U.S.C. 3902)--

(I) by striking paragraph (2);
(II) by redesignating paragraphs (1), (3), (4), (5), and
(6) as paragraphs (4), (5), (2), (6), and (1), respectively,
and moving those paragraphs so as to appear in numerical
order; and
(III) by inserting before paragraph (4) (as redesignated by
subclause (II)) the following:

``(3) Assistant secretary.--The term `Assistant Secretary'
means the Assistant Secretary for Indian Health.'';
(ii) in section 5 (25 U.S.C. 3904), by striking the section
heading and inserting the following:

``SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR INDIAN
HEALTH.'';

(iii) in section 6(a) (25 U.S.C. 3905(a)), in the
subsection heading, by striking ``Director'' and inserting
``Assistant Secretary'';
(iv) in section 9(a) (25 U.S.C. 3908(a)), in the subsection
heading, by striking ``Director'' and inserting ``Assistant
Secretary''; and
(v) by striking ``Director'' each place it appears and
inserting ``Assistant Secretary''.
(C) Section 5504(d)(2) of the Augustus F. Hawkins-Robert T.
Stafford Elementary and Secondary School Improvement
Amendments of 1988 (25 U.S.C. 2001 note; Public Law 100-297)
is amended by striking ``Director of the Indian Health
Service'' and inserting ``Assistant Secretary for Indian
Health''.
(D) Section 203(a)(1) of the Rehabilitation Act of 1973 (29
U.S.C. 763(a)(1)) is amended by striking ``Director of the
Indian Health Service'' and inserting ``Assistant Secretary
for Indian Health''.
(E) Subsections (b) and (e) of section 518 of the Federal
Water Pollution Control Act (33 U.S.C. 1377) are amended by
striking ``Director of the Indian Health Service'' each place
it appears and inserting ``Assistant Secretary for Indian
Health''.
(F) Section 317M(b) of the Public Health Service Act (42
U.S.C. 247b-14(b)) is amended--
(i) by striking ``Director of the Indian Health Service''
each place it appears and inserting ``Assistant Secretary for
Indian Health''; and
(ii) in paragraph (2)(A), by striking ``the Directors
referred to in such paragraph'' and inserting ``the Director
of the Centers for Disease Control and Prevention and the
Assistant Secretary for Indian Health''.
(G) Section 417C(b) of the Public Health Service Act (42
U.S.C. 285-9(b)) is amended by striking ``Director of the
Indian Health Service'' and inserting ``Assistant Secretary
for Indian Health''.
(H) Section 1452(i) of the Safe Drinking Water Act (42
U.S.C. 300j-12(i)) is amended by striking ``Director of the
Indian Health Service'' each place it appears and inserting
``Assistant Secretary for Indian Health''.
(I) Section 803B(d)(1) of the Native American Programs Act
of 1974 (42 U.S.C. 2991b-2(d)(1)) is amended in the last
sentence by striking ``Director of the Indian Health
Service'' and inserting ``Assistant Secretary for Indian
Health''.
(J) Section 203(b) of the Michigan Indian Land Claims
Settlement Act (Public Law 105-143; 111 Stat. 2666) is
amended by striking ``Director of the Indian Health Service''
and inserting ``Assistant Secretary for Indian Health''.
(g) References.--Any reference to the Director of the
Indian Health Service in any other Federal law, Executive
order, rule, regulation, or delegation of authority, or in
any document of or relating to the Director of the Indian
Health Service, shall be deemed to refer to the Assistant
Secretary.
______

By Mr. CAMPBELL:
S. 559. A bill to amend title 49, United States Code, to permit an
individual to operate a commercial motor vehicle solely within the
borders of a State if the individual meets certain minimum standards
prescribed by the State, and for other purposes; to the Committee on
Commerce, Science, and Transportation.
Mr. CAMPBELL. Mr. President, today I am introducing the Commercial
Driver's License Devolution Act of 2003. This bill is identical to that
which I introduced in the 107th Congress as a companion bill to
language originally brought to the floor of the House of
Representatives by my friend from North Carolina, Representative Howard
Coble.
I believe it is no secret to my colleagues here in the Senate, that I
support small business and returning power to the States. The
traditional, one-size-fits-all approach to governing has done more harm
than good, and this bill is an attempt to remedy some of that.

[[Page S3318]]

This legislation will give States the option to establish their own
commercial driver's license, CDL, requirements for intrastate drivers.
It will return power to the States by giving them the option to license
intrastate drivers of commercial motor vehicles based upon testing
standards determined by the individual States. And I stress, it will be
an ``option.''
I want to emphasize that this legislation is not a Federal mandate
imposed on States. States that choose not to participate would remain
under Federal guidelines. A State that chooses to exercise this option
would in no way diminish the role of the CDL in the long-haul trucking
industry. Additionally, this legislation effectively precludes two or
more States from using this option as the basis for an interstate
compact.
As I am sure my colleagues are aware, the Commercial Motor Vehicle
Safety Act of 1986, CMVSA, required States to establish a new and
uniform program of testing and licensure for all operators of
commercial vehicles both intra and interstate. The principal objectives
of the Act have been met, and would not be harmed by this legislation
I'm introducing here today.
I have no issue with the CMVSA. It is a good law, and at the time the
provisions it contained were necessary and timely for improving the
standards of performance for long-haul truck drivers in this country.
However, I, like my counterpart in the House, believe the CMVSA was
imposed upon intrastate commerce where the operation of trucks may be a
small but necessary part of an individual's job. Therefore, the reality
was that Washington imposed its will on thousands of small businesses
across this country who aren't involved in long-haul trucking and we
expected them to adjust to any circumstance that might arise. That's
unfair and not what government is supposed to be about.
When you have conditions such as these, I believe it should be within
a State's discretion to determine what kind of commercial vehicle
licensure and testing is required for commerce taking place solely
within its borders.
This legislation is important to our nation's small businesses,
especially those dependent upon commercial truck travel, which means
it's important to the consumers. I urge my colleagues in the Senate to
support it.
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. 559

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 ``Commercial Driver's License
Devolution Act of 2003''.

SEC. 2. INTRASTATE OPERATION OF COMMERCIAL MOTOR VEHICLES.

(a) In General.--Paragraph (1) of section 31305(b) of title
49, United States Code, is amended--
(1) by striking ``paragraph (2)'' and inserting
``paragraphs (2) and (3)''; and
(2) by adding at the end the following:
``(3) An individual may operate a commercial motor vehicle
solely within the borders of a State if the individual--
``(A) meets the minimum standards prescribed under the laws
of that State for ensuring the fitness of an individual to
operate a commercial motor vehicle; and
``(B) has passed written and driving tests to operate a
commercial motor vehicle that meet the minimum standards
prescribed under the laws of that State.''.
(b) Requirements for State Participation.--Section 31311(a)
of such title is amended--
(1) in paragraph (1)--
(A) by striking ``with'' and inserting ``with either''; and
(B) by striking ``under section 31305(a)'' and inserting
``or by the State under section 31305''; and
(2) in paragraph (2), by striking ``the minimum standards''
and inserting ``either the minimum standards prescribed by
the Secretary of Transportation or by the State under section
31305 of this title''.
______

By Mr. CRAIG (for himself, Mr. Dayton, Mr. Coleman, Mr. Leahy,
Mr. Bond, Mr. Bingaman, Ms. Snowe, Mrs. Lincoln, Mr. Shelby,
Mr. Jeffords, Mr. Domenici, Mr. Levin, Ms. Collins, Mr.
Johnson, Mr. Specter, Mr. Feingold, and Mr. Kohl):
S. 560. A bill to impose tariff-rate quotas on certain casein and
milk protein concentrates; to the Committee on Finance.
Mr. FEINGOLD. Mr. President, I am pleased today to show my support
for the Milk Import Tariff Equity Act of 2003 by being an original
cosponsor of Senator Craig's bill. This legislation will prevent
foreign dairy products from continuing to circumvent U.S. trade laws.
Currently, milk protein concentrate, MPC, is not subject to the same
quotas required of other dairy products. Foreign dairy producers have
begun exploiting this loophole by blending previously processed dairy
proteins with nonfat dry milk to boost its protein content so that it
qualifies as milk protein concentrate. This allows the milk protein
concentrate to circumvent any laws that would subject the imports to
tariff rate quotas.
The result has been a flood of foreign dairy blends being imported in
the U.S. market, displacing sales of domestic dairy products and
lowering prices for American dairy farmers.
As milk prices are at historic lows, down about 38 percent from
prices last year, this flood of foreign dairy products has put a strain
on many of the dairy farmers in my State of Wisconsin.
Since many of the blended products imported into this country are
heavily subsidized, American farmers are forced to compete on an unfair
playing field. This loophole in our tariff schedule allows certain
heavily subsidized foreign dairy products nearly unfettered access to
our dairy markets, hurting the American dairy farmers.
As I travel across Wisconsin, I have heard from any dairy farmers who
are struggling to stay in business. Many of these farmers are concerned
about the flood of unfair imports that are hurting our American dairy
markets.
In March of 2001, the General Accounting Office, GAO, released a
report that highlighted the increase of milk protein concentrates
coming into this country under outdated trade laws. The report pointed
to a loophole in our trade laws that has resulted in increased imports
of blended dairy proteins. The importing of blended dairy proteins is
being done solely for the purpose of avoiding the U.S. tariff rate
quota for nonfat dry milk.
The GAO study determined that MPC imports surged by more than 600
percent in the six years before the report was released. MPC imports
lower prices for U.S. dairy farmers by displacing sales of domestic
dairy products.
Since I have received the results from the General Accounting Office
study that reported this loophole in U.S. trade laws, I have
participated in a bipartisan effort to amend this loophole, so that we
may protect our dairy farmers from unfair trade practices and help them
in the struggle to farm on such an unfair playing field.
This bill would close this loophole by regulating milk protein
concentrate imports in the same manner all other dairy import products
are regulated. It would correct a loophole that exists in U.S. trade
law that is contributing to such low dairy prices experienced in my
state of Wisconsin and across the Nation.
This loophole depresses the price of milk for farmers, costs U.S.
taxpayers money, and gives foreign dairy producers an unfair advantage
over our own dairy farmers. It is time for this Congress to stand
behind our farmers and that is why I support the Milk Import Tariff
Equity Act of 2003.
Mr. LEAHY. Mr. President, I am pleased to join my colleagues Senator
Mark Dayton and Senator Larry Craig in introducing the bipartisan Milk
Import Tariff Equity Act. Our bill will prevent importers of dairy
products from circumventing U.S. trade laws.
Although I opposed it at the time, during the Uruguay Round
multilateral trade negotiations, the United States agreed to allow a
substantial increase in dairy product imports into this country. Tariff
rate quotas were established to allow imports of most dairy products to
rise from an average of 2 percent of domestic consumption to as much as
five percent. At least initially, these controls appeared to be
effective. But foreign competitors have found ways to circumvent these
quotas by adjusting the protein content of nonfat dry milk so that it
is classified

[[Page S3319]]

by the U.S. Customs Service as milk protein concentrate, MPC. While
nonfat dry milk imports are strictly regulated, there are no quotas on
MPCs and duties are low.
A recent GAO study requested by Congress determined that MPC imports
surged by more than 600 percent over a six year period. MPC imports
lower prices for U.S. dairy farmers by displacing sales of nonfat dry
milk. According to the GAO study, some exporters are blending
previously processed dairy proteins, such as casein, whey and nonfat
dry milk into MPC solely for the purpose of avoiding the U.S. tariff
rate quota for nonfat dry milk. This practice, specifically cited in
the GAO report, circumvents statutory U.S. trade provisions designed to
regulate imports of nonfat dry milk powder.
It is time to close this loophole. Under our bill, MPCs would be
regulated in the same manner as all other dairy products: by imposing
tariff-rate quotas on MPC imports. This legislation also closes a
similar loophole that exists for casein used in the production of food
or feed, while continuing to allow unrestricted access for imports of
casein used in the manufacture of glues and for other industrial
purposes.
Most Americans probably don't realize it, because retail fluid milk
prices have hardly changed, but dairy farmers in Vermont and across
this Nation are really struggling. Farm-gate milk prices have fallen
more than 30 percent over the past 18 months and are now at the lowest
levels in 25 years. Even the most efficient producers are unable to
make a profit at these prices. Prices are low in part due to these
imports. Others will argue that MPC imports represent just a small
fraction of U.S. milk production. But when you are dealing with a
perishable commodity like milk, even a slight increase in supply can
have a dramatic effect on prices.
Closing the MPC loophole is one of the most important steps we can
take to help our nation's dairy farmers. I commend Senators Dayton and
Craig for their leadership on this issue, and I urge my colleagues to
join me in cosponsoring this important legislation.
______

By Mr. CRAPO (for himself, Mr. Enzi, Mr. Craig, Mr. Domenici, Mr.
Burns, and Mr. Smith):
S. 561. A bill to preserve the authority of States over water within
their boundaries, to delegate to States the authority of Congress to
regulate water, and for other purposes; to the Committee on the
Judiciary.
Mr. CRAPO. Mr. President, I rise to introduce the State Water
Sovereignty Protection Act, a bill to preserve the authority of the
States over waters within their boundaries, to delegate the authority
of the Congress to the States to regulate water, and for other
purposes.
Since 1866, Congress has recognized and deferred to the States the
authority to allocate and administer water within their borders. The
Supreme Court has confirmed that this is an appropriate role for the
States. Additionally, in 1952, the Congress passed the McCarran
amendment which provides for the adjudication of State and Federal
Water claims in State water courts.
However, despite both judicial and legislative edicts, I am deeply
concerned that the administration, Federal agencies, and some in the
Congress are setting the stage for ignoring long established statutory
provisions concerning State water rights and State water contracts. The
Endangered Species Act, the Clean Water Act, the Federal Land Policy
Management Act, and wilderness designations have all been vehicles used
to erode State sovereignty over its water.
It is imperative that States maintain sovereignty over management and
control of their water and river systems. All rights to water or
reservations of rights for any purposes in States should be subject to
the substantive and procedural laws of that State, not the Federal
Government. To protect State water rights, I am introducing the State
Water Sovereignty Protection Act.
The State Water Sovereignty Protection Act provides that whenever the
United States seeks to appropriate water or acquire a water right, it
will be subject to State procedural and substantive water law. The Act
further holds that States control the water within their boundaries and
that the Federal Government may exercise management or control over
water only in compliance with State law. Finally, in any administrative
or judicial proceeding in which the United States participates pursuant
to the McCarran Amendment, the United States is subject to all costs
and fees to the same extent as costs and fees may be imposed on a
private party.
______

By Ms. MURKOWSKI (for herself, Mr. Stevens, Mr. Burns, Mr. Craig,
Mr. Crapo, Mr. Inhofe, and Mr. Smith):
S. 562. A bill to amend chapter 3 of title 28, United States Code, to
divide the Ninth Judicial Circuit of the United States into 2 circuits,
and for other purposes; to the Committee on the Judiciary.
Ms. MURKOWSKI. Mr. President, earlier this week, the Senate, in a 94-
0 vote, went on record expressing its unanimous opposition to last
week's decision by the Ninth Circuit Court of Appeals refusing to
review a three-judge panel ruling that bars children in public schools
from voluntarily reciting the Pledge of Allegiance.
The Pledge decision rendered by the court is not an aberration. It is
symptomatic of a court that has become dysfunctional and out-of-touch
with American jurisprudence, common sense, and constitutional values.
Unfortunately, citizens in the states that are within the Ninth
Circuit's jurisdiction have had to contend with the court's
idiosyncratic jurisprudence for decades.
One should not be surprised that the full Ninth Circuit refused to
reconsider this ill-conceived decision. The recent history of the court
suggests a judicial activism that is close to the fringe of legal
reasoning. And it is for that reason that the Ninth Circuit has, by
far, the highest reversal rate in the country. During the 1990s, almost
90 percent of cases from the Ninth Circuit reviewed by the Supreme
Court were reversed. In 1997, a startling 27 of the 28 cases brought
before the Supreme Court were reversed--two-thirds by a unanimous vote.
Over the last three years, one-third of all cases reversed by the
Supreme Court came from the 9th Circuit. That's three times the number
of reversals for the next nearest circuit. And 33 times higher than the
reversal rate for the 10th Circuit
Last November, on a single day, the Supreme Court summarily and
unanimously reversed three Ninth Circuit decisions. In one of those
three cases, the Supreme Court ruled that the circuit had overreached
its authority and stated that the Court ``exceed[ed] the limits imposed
on federal habeas review substitut[ing] its own judgment for that of
the state court.''
One of the reasons the Ninth Circuit is reversed so often is because
the circuit has become too large and unwieldy. The Circuit serves a
population of more than 54 million people, almost 60 percent more than
are served by the next largest circuit. By 2010, the Census Bureau
estimates that the Ninth Circuit's population will be more than 63
million.
According to the Administrative Office of the U.S. Courts, the Ninth
Circuit alone accounts for more than 60 percent of all appeals pending
for more than a year. And with its huge caseload, the judges on the
Court just do not have the opportunity to keep up with decisions within
the circuit, let alone decisions from other circuits
Another problem unique to the Ninth Circuit is that it never speaks
with one voice. All other circuits sit as one entity to hear full-
court, en banc, cases. The Ninth Circuit sits in panels of 11. Clearly,
such a procedure injects unnecessary randomness into decisions. If an
en banc case is decided 6 to 5, there is no reason to think it
represents the views of the majority of the court's 24 active members.
In fact, some commentators believe a majority of the 24 members of
the court may have disagreed with the Pledge decision, but were
concerned that a random pick of 11 members of the Court to hear the
case, en banc, might have resulted in the decision being affirmed.
It is inconceivable to me that a circuit court could render a
decision based on its concern about the potential makeup of an en banc
panel. What

[[Page S3320]]

kind of jurisprudence is that? Citizens in no other circuit face that
type of coin-flip justice. That is fundamentally unfair to every single
one of the 54 million people who live within the jurisdiction of the
Ninth Circuit and is reason alone to restructure the circuit.
It is time that Congress finally faces the fact that the Ninth
Circuit is no longer a viable and functioning circuit. It is for that
reason that I am today introducing the Ninth Circuit Court of Appeals
Reorganization Act of 2003. I am pleased to be joined in this effort by
Senators, Stevens, Burns, Craig, Crapo, Inhofe, and Smith.
The bill we are introducing today would divide the Ninth Circuit into
two independent circuits. The restructured Ninth Circuit would contain
California, and Nevada. A new Twelfth Circuit would be composed of
Alaska, Hawaii, Arizona, Idaho, Montana, Oregon, Washington, Guam, and
the Northern Mariana Islands.
Earlier I indicated a number of reasons why I believe the Circuit
needs to be reorganized. Let us not forget the scope of this circuit
and the 54 million people who live within it. The Ninth Circuit extends
from the Arctic Circle to the Mexican border, spans the tropics of
Hawaii and across the International Dateline to Guam and the Mariana
Islands. Encompassing some 14 million square miles, the Ninth Circuit,
by any means of measure, is the largest of all U.S. Circuit Courts of
Appeal. It is larger than the First, Second, Third, Fourth, Fifth,
Sixth, Seventh and Eleventh Circuits combined!
Moreover, because of the sheer magnitude of cases brought before the
Court, citizens within the court's jurisdiction face unprecedented
delays in getting their cases heard. Whereas the national average time
to get a final disposition of an appellate case is nearly 11 months, an
appeal in the Ninth Circuit takes nearly 50 percent longer--almost one
year and four months.
This is not the first time that Congress has recognized that the
Ninth Circuit needs restructuring. Numerous proposals to divide the
Ninth Circuit were debated in Congress even before World War II.
In 1973, the Congressional Commission on the Revision of the Federal
Court of Appellate System Commission, commonly known as the Hruska
Commission, recommended that the Ninth Circuit be divided. Also that
year, the American Bar Association adopted a resolution in support of
dividing the Ninth Circuit.
In 1995, a bill was reported from the Senate Judiciary Committee in
which Chairman Orrin Hatch of Utah declared in his Committee's report
that the time for a split had arrived: ``The legislative history, in
conjunction with available statistics and research concerning the Ninth
Circuit, provides an ample record for an informed decision at this
point as to whether to divide the Ninth Circuit . . . Upon careful
consideration the time has indeed come.''

In 1997, Congress commissioned a report on structural alternatives
for the Federal courts of appeals. The Commission, chaired by former
Supreme Court Justice Byron R. White, found numerous faults within the
Ninth Circuit and recommended major reforms and a fundamental
reorganization of the Circuit.
On the day my legislation is enacted into law, the concerns of the
White Commission will be addressed. A more cohesive, efficient, and
predictable judiciary will emerge.
Many who oppose legislation to reorganize the Ninth Circuit, contend
that all the Circuit needs is the appropriation of more Federal dollars
for more Federal judges. However, I do not believe more money will
solve the inherent problems that exist in a circuit of such magnitude.
As former Senator and Alabama Supreme Court Chief Justice, Howell
Heflin, a Democrat from Alabama, remarked after Congress divided the
former Fifth Circuit: ``congress recognized that a point is reached
where the addition of judges decreases the effectiveness of the court,
complicates the administration of uniform law, and potentially
diminishes the quality of justice within a Circuit.'' in the case of
the Ninth Circuit, there can be little doubt that we are at that point
in time that former Senator Heflin cited.
Former Oregon Senator Bob Packwood believed that a Ninth Circuit
split would enable judges to achieve a greater mastery of applicable,
but unique, State law and State issues. He believed such mastery was
necessary because ``burgeoning conflicts in the area of natural
resources and the continuing expansion of international trade efforts
will all expand the demand for judicial excellence . . . By reforming
our courts now, they will be better able to dispense justice in a fair
and expeditious manner.''
I agree with the former Senator. The uniqueness of the Northwest, and
in particular, Alaska, cannot be overstated. An effective appellate
process demands mastery of State law and State issues relative to the
geographic land mass, population and native cultures that are unique to
the relevant region. Presently, California is responsible for almost 50
percent of the appellate court's filings, which means that California
judges and California judicial philosophy dominate judicial decisions
on issues that are fundamentally unique to the Pacific Northwest. This
need for greater regional representation is demonstrated by the fact
that the East Coast is comprised of five Federal circuits. A division
of the Ninth Circuit will enable judges, lawyers and parties to master
a more manageable and predictable universe of relevant case law.
Further, a division of the Ninth Circuit would honor Congress'
original intent in establishing appellate court boundaries that respect
and reflect a regional identity. In spite of efforts to modernize the
administration of the Ninth Circuit, its size works against the
original purpose of its creation: the uniform, coherent and efficient
development and application of Federal law in the region. Establishing
a circuit comprised solely of States in the Northwest region would
adhere to Congressional intent. And the State of Hawaii should
rightfully be included in this circuit, for like Alaska, there are
unique issues that are faced by the two States that are not part of the
contiguous lower 48.
A new Twelfth Circuit, comprised of states of the Pacific Northwest,
would respect the economic, historical, cultural and legal ties which
philosophically unite this region.
No single Court can effectively exercise its power in an area that
extends from the Arctic Circle to the tropics. Legislation dividing the
Ninth Circuit will create a regional commonality that will lead to
greater uniformity and consistency in the development of federal law,
and will ultimately strengthen the constitutional guarantee of equal
justice for all.
It is my hope that this Congress will finally approve this necessary
reorganization. It is long overdue.
I ask unanimous consent that the text of my bill be printed in the
Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:

S. 562

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 ``Ninth Circuit Court of
Appeals Reorganization Act of 2003''.

SEC. 2. DEFINITIONS.

In this Act:
(1) Former ninth circuit.--The term ``former ninth
circuit'' means the ninth judicial circuit of the United
States as in existence on the day before the effective date
of this Act.
(2) New ninth circuit.--The term ``new ninth circuit''
means the ninth judicial circuit of the United States
established by the amendment made by section 3(2)(A).
(3) Twelfth circuit.--The term ``twelfth circuit'' means
the twelfth judicial circuit of the United States established
by the amendment made by section 3(2)(C).

SEC. 3. NUMBER AND COMPOSITION OF CIRCUITS.

Section 41 of title 28, United States Code, is amended--
(1) in the matter before the table, by striking
``thirteen'' and inserting ``fourteen''; and
(2) in the table--
(A) by striking the item relating to the ninth circuit and
inserting the following:

``Ninth........................... California, Nevada.'';

(B) by inserting between the last 2 items the following:

``Twelfth......................... Alaska, Arizona, Guam, Hawaii,
Idaho, Montana, Northern
Mariana Islands, Oregon,
Washington.''.

[[Page S3321]]

SEC. 4. NUMBER OF CIRCUIT JUDGES.

The table in section 44(a) of title 28, United States Code,
is amended--
(1) by striking the item relating to the ninth circuit and
inserting the following:

``Ninth.....................................................25'';....

(2) by inserting between the last 2 items the following:

``Twelfth...................................................13.''....

SEC. 5. PLACES OF CIRCUIT COURT.

The table in section 48(a) of title 28, United States Code,
is amended--
(1) by striking the item relating to the ninth circuit and
inserting the following:

``Ninth........................... San Francisco, Los Angeles.'';

and
(2) by inserting between the last 2 items at the end the
following:

``Twelfth......................... Portland, Seattle.''.

SEC. 6. ELECTION OF ASSIGNMENT BY CIRCUIT JUDGES.

(a) In General.--Except as provided in subsection (b) and
notwithstanding section 44(c) of title 28, United States
Code, each circuit judge who is in regular active service,
and each judge who is a senior judge, of the former ninth
circuit on the day before the effective date of this Act may
elect to be assigned to the new ninth circuit or to the
twelfth circuit and shall notify the Director of the
Administrative Office of the United States Courts of such
election.

SEC. 7. SENIORITY OF JUDGES.

The seniority of each judge who elects to be assigned under
section 6 shall run from the date of commission of such judge
as a judge of the former ninth circuit.

SEC. 8. APPLICATION TO CASES.

(a) In General.--The provisions of the following paragraphs
of this subsection apply to any case in which, on the day
before the effective date of this Act, an appeal or other
proceeding has been filed with the former ninth circuit:
(1) If the matter has been submitted for decision, further
proceedings in respect of the matter shall be had in the same
manner and with the same effect as if this Act had not been
enacted.
(2) If the matter has not been submitted for decision, the
appeal or proceeding, together with the original papers,
printed records, and record entries duly certified, shall, by
appropriate orders, be transferred to the court to which the
matter would have been submitted had this Act been in full
force and effect at the time such appeal was taken or other
proceeding commenced, and further proceedings in respect of
the case shall be had in the same manner and with the same
effect as if the appeal or other proceeding had been filed in
such court.
(3) A petition for rehearing or a petition for re-hearing
en banc in a matter decided before the effective date of this
Act, or submitted before the effective date of this Act and
decided on or after the effective date as provided in
paragraph (1), shall be treated in the same manner and with
the same effect as though this Act had not been enacted. If a
petition for rehearing en banc is granted, the matter shall
be reheard by a court comprised as though this Act had not
been enacted.

SEC. 9. ADMINISTRATION.

(a) Actions.--The former ninth circuit as constituted on
the day before the effective date of this Act may take such
administrative actions as may be required to carry out this
Act and the amendments made by this Act.
(b) Termination.--The former ninth circuit shall cease to
exist for administrative purposes on July 1, 2005.
(c) Meetings.--During the 10 years following the date of
enactment of this Act, the new ninth circuit and the twelfth
circuit may meet in either circuit's jurisdiction.

SEC. 10. EFFECTIVE DATE.

This Act and the amendments made by this Act shall become
effective on October 1, 2003.
______

By Ms. LANDRIEU (for herself, Mr. Sununu, Mr. Burns, Mr. Dodd,
Mr. Gregg, Mrs. Hutchison, Mr. Inouye, Mr. Jeffords, Mr. Leahy,
Mr. Lieberman, Mr. Lott, Ms. Mikulski, Mr. Kennedy, Mr. Miller,
Mr. Dorgan, and Mr. Kerry):
S. 564. A bill to facilitate the deployment of wireless
telecommunications networks I order to further the availability of the
Emergency Alert System, and for other purposes; to the Committee on
Commerce, Science, and Transportation.
Ms. LANDRIEU. Mr. President, today I rise to introduce the Emergency
Communications and Competition Act, ECCA, along with my colleague from
New Hampshire, Senator Sununu. We are joined by twelve of our
colleagues, led by Senator Burns, the distinguished chairman of the
Commerce Communications Subcommittee, as well as Senators Dodd, Gregg,
Hutchison, Inouye, Jeffords, Lott, Kennedy, Leahy, Lieberman, Mikulski,
and Miller.
The bill we introduce today is identical to S. 2922, the measure
which Senator Burns and I co-authored in the 107th Congress. I was very
pleased and grateful for the tremendous support this legislation
received from local television broadcasters and a wide range of public
interest groups that speak for consumers, minority groups, rural
Americans, health care, public safety, and property rights.
This bill will ensure that consumers will soon be able to avail
themselves of an innovative new wireless technology that has been
approved by the Federal Communications Commission. It is called the
Multichannel Video Distribution and Data Service, MVDDS, a title which
accurately describes what this new service will provide consumers:
cable competition and high speed access to the Internet.
As I indicated in my introductory remarks to S. 2922 last September,
unless Congress enacts this legislation, it may be years before MVDDS
is actually deployed to the public. That would be a lost opportunity
for consumers. We need to improve our communications infrastructure,
not only for greater access to cable and the Internet, but also for
public safety purposes. MVDDS technology can address all of these
needs, and we should remove unnecessary and counterproductive
regulatory obstacles that prevent its swift deployment.
The Consumers Union, like many, has supported ECCA because it will
help ensure that competition rapidly emerges for video programming as
well as high speed Internet services. Earlier this year, the Consumers
Union issued a report, ``Cable Mergers, Monopoly Power and Price
Increases,'' which documents the most recent steep rate increases
imposed by cable operators. The report noted, for instance, that cable
rates in Baton Rouge soared 7 percent last November. This was typical
of rate increases throughout the country.
According to the most recent data from the Bureau of Labor
Statistics, cable rates rose 11.4 percent in just the last two years.
This compares to a 3.8 percent increase in the Consumer Price Index
over the same period. According to the FCC, just one percent of cable
communities enjoy ``effective competition.'' I submit that this
startling lack of competition, more than anything else, explains why
local cable rates have increased at three times the inflation rate.
If MVDDS can go head-to-head with incumbent cable systems in all
parts of the country, I believe that this good old fashioned
competition will result in lower prices and better service for
consumers--even for those who don't choose to subscribe to MVDDS.
Rural organizations recognize the extraordinary opportunity this new
wireless technology can offer rural Americans. They understand that the
FCC's Order, which authorized MVDDS, will likely fail to ensure this
new technology will indeed adequately serve rural America.
Local television broadcasters support this measure because it will
ensure consumers in their markets can view all local television
stations. Today, satellite operators DirecTV and EchoStar do not carry
over 1,000 local TV channels--and no stations from ten States: Alaska,
Arkansas, Idaho, Maine, Montana, Mississippi, North and South Dakota,
West Virginia, and Wyoming. As you know, the satellite operators sought
to merge so that they would have sufficient capacity to carry all local
TV stations, but federal regulators rejected the merger on
anticompetitive grounds.
The Emergency Communications and Competition Act, which we are re-
introducing today, will restore fairness in the FCC licensing process,
and in so doing, speed the deployment of MVDDS to applicants that are
ready to launch service to the public now.
The bill provides that MVDDS applicants will be licensed in the same
manner as satellite companies who applied on the same day to share the
same spectrum. Currently, the FCC plans to subject only MVDDS
applicants to an auction process. This would impose a discriminatory
tax on an innovative new technology. Unfortunately, this is more of the
same burdensome regulation that I believe has contributed to the
collapse of the telecommunications sector. Government regulation is
necessary, certainly, but we must be smart in how we regulate business.
We must ensure that our laws and regulations are technologically
neutral so

[[Page S3322]]

that government policies don't replace the role of the marketplace in
determining the fate of consumer products and services.
In an Order released last month, the FCC recognized the need to
prevent disparity in licensing when it authorized certain satellite
spectrum to be re-used for mobile terrestrial service without requiring
a spectrum auction. Similarly, the ECCA would prohibit the FCC from
conducting an auction for licenses that re-use satellite spectrum for
fixed terrrestrial operations.
Furthermore, an action would drastically delay the introduction of
service to the public. Mr. President, this is quite the opposite of
what spectrum auctions are supposed to do. In this case, industry
incumbents can abuse the auction process to block the introduction of
new competition. A company with vast resources available could easily
trounce a small startup in an auction--and then, under the terms of the
FCC's Order, it would not have to deploy service for 10 years.
Consumers cannot and should not have to wait while this spectrum is
``shelved'' for an entire decade.
The ECCA solves this problem by ensuring that only qualified
applicants will be licensed. That is, within six months of enactment,
the FCC would issue licenses to any applicant that can demonstrate
through independent testing that it will employ a technology that won't
cause harmful interference to DBS operators with whom they would share
spectrum. Then, to be sure that service is in fact deployed, the ECCA
requires licensees to provide service to consumers within five rather
than ten years.

This legislation also requires that parties who apply for licenses
under this provision must assume specific public interest obligations
in exchange for their prompt licensing. The bill requires full must-
carry of local television stations, and an additional set aside of 4
percent of system capacity for other pubic interest purposes such as
telemedicine and distance learning. I can assure my colleagues that
these are issues particularly important in rural areas in states like
Louisiana.
The ECCA will also promote public safety, in two ways. First, it will
require MVDDS licensees to air Emergency Alert System warnings,
including AMBER alerts for missing children. EAS warnings are presently
carried by cable systems and over-the-air broadcasters, but they are
not seen by those who get their programming from DBS unless the viewer
happens to be watching a local channel. Obviously, the need for greater
dissemination of EAS warnings is particularly important for the ten
states in which no local stations are carried via satellite.
Second, this legislation requires MVDDS licensees to make their
transmission systems available to national security and emergency
preparedness personnel on a top-priority basis in times of need. We all
know that when emergencies strike, the need for public safety personnel
to communicate with one another skyrockets. MVDDS wireless networks,
which will be deployed ubiquitously throughout the country, can help
alleviate this thirst for spectrum.
For these reasons, I believe that Congress should act on this matter
as soon as possible. I urge my colleagues to support his bill and vote
for enactment. I as, unanimous consent that the text of this bill be
printed in the Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:

S. 564

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 ``Emergency Communications and
Competition Act of 2003''.

SEC. 2. PURPOSES.

The purposes of this Act are as follows:
(1) To facilitate the deployment of new wireless
telecommunications networks in order to extend the reach of
the Emergency Alert System (EAS) to viewers of multichannel
video programming who may not receive Emergency Alert System
warnings from other communications technologies.
(2) To ensure that emergency personnel have priority access
to communications facilities in times of emergency.
(3) To promote the rapid deployment of low cost multi-
channel video programming and broadband Internet services to
the public, without causing harmful interference to existing
telecommunications services.
(4) To ensure the universal carriage of local television
stations, including any Emergency Alert System warnings, by
multichannel video programming distributors in all markets,
regardless of population.
(5) To advance the public interest by making available new
high speed data and video services to unserved and
underserved populations, including schools, libraries, tribal
lands, community centers, senior centers, and low-income
housing.
(6) To ensure that new technologies capable of fulfilling
the purposes set forth in paragraphs (1) through (5) are
licensed and deployed promptly after such technologies have
been determined to be technologically feasible.

SEC. 3. LICENSING.

(a) Grant of Certain Licenses.--
(1) In general.--The Federal Communications Commission
shall assign licenses in the 12.2-12.7 GHz band for the
provision of fixed terrestrial services using the rules,
policies, and procedures used by the Commission to assign
licenses in the 12.2-12.7 GHz band for the provision of
international or global satellite communications services in
accordance with section 647 of the Open-market Reorganization
for the Betterment of International Telecommunications Act
(47 U.S.C. 765f).
(2) Deadline.--The Commission shall accept for filing and
grant licenses under paragraph (1) to any applicant that is
qualified pursuant to subsection (b) not later than six
months after the date of the enactment of this Act. The
preceding sentence shall not be construed to preclude the
Commission from granting licenses under paragraph (1) after
the deadline specified in that sentence to applicants that
qualify after that deadline.
(b) Qualifications.--
(1) Non-interference with direct broadcast satellite
service.--A license may be granted under this section only if
operations under the license will not cause harmful
interference to direct broadcast satellite service.
(2) Acceptance of applications.--The Commission shall
accept an application for a license to operate a fixed
terrestrial service in the 12.2-12.7 GHz band if the
applicant--
(A) successfully demonstrates the terrestrial technology it
will employ under the license with operational equipment that
it furnishes, or has furnished, for independent testing
pursuant to section 1012 of the Launching Our Communities'
Access to Local Television Act of 2000 (47 U.S.C. 1110); and
(B) certifies in its application that it has authority to
use such terrestrial service technology under the license.
(3) Clarification.--Section 1012(a) of the Launching Our
Communities' Access to Local Television Act of 2000 (47
U.S.C. 1110(a); 114 Stat. 2762A-141) is amended by inserting
``, or files,'' after ``has filed''.
(4) PCS or cellular services.--A license granted under this
section may not be used for the provision of Personal
Communications Service or terrestrial cellular telephony
service.
(c) Prompt Commencement of Service.--In order to facilitate
and ensure the prompt deployment of service to unserved and
underserved areas and to prevent stockpiling or warehousing
of spectrum by licensees, the Commission shall require that
any licensee under this section commence service to consumers
within five years of the grant of the license under this
section.
(d) Expansion of Emergency Alert System.--Each licensee
under this section shall disseminate Federal, State, and
local Emergency Alert System warnings to all subscribers of
the licensee under the license under this section.
(e) Access for Emergency Personnel.--
(1) Requirement.--Each licensee under this section shall
provide immediate access for national security and emergency
preparedness personnel to the terrestrial services covered by
the license under this section as follows:
(A) Whenever the Emergency Alert System is activated.
(B) Otherwise at the request of the Secretary of Homeland
Security.
(2) Nature of access.--Access under paragraph (1) shall
ensure that emergency data is transmitted to the public, or
between emergency personnel, at a higher priority than any
other data transmitted by the service concerned.
(f) Additional Public Interest Obligations.--
(1) Additional obligations.--Each licensee under this
section shall--
(A) adhere to rules governing carriage of local television
station signals and rules concerning obscenity and indecency
consistent with sections 614, 615, 616, 624(d)(2), 639, 640,
and 641 of the Communications Act of 1934 (47 U.S.C. 534,
535, 536, 544(d)(2), 559, 560, and 561);
(B) make its facilities available for candidates for public
office consistent with sections 312(a)(7) and 315 of the
Communications Act of 1934 (47 U.S.C. 312(a)(7) and 315); and
(C) allocate 4 percent of its capacity for services that
promote the public interest, in addition to the capacity
utilized to fulfill the obligations required of subparagraphs
(A) and (B), such as--
(i) telemedicine;
(ii) educational programming, including distance learning;
(iii) high speed Internet access to unserved and
underserved populations; and

[[Page S3323]]

(iv) specialized local data and video services intended to
facilitate public participation in local government and
community life.
(2) License boundaries.--In order to ensure compliance with
paragraph (1), the Commission shall establish boundaries for
licenses under this section that conform to existing
television markets, as determined by the Commission for
purposes of section 652(h)(1)(C)(i) of the Communications Act
of 1934 (47 U.S.C. 534(h)(1)(C)(i)).
(g) Redesignation of Multichannel Video Distribution and
Data Service.--The Commission shall redesignate the
Multichannel Video Distribution and Data Service (MVDDS) as
the Terrestrial Direct Broadcast Service (TDBS).
______

By Mr. EDWARDS:
S. 565. A bill to improve homeland security, prevent tax increases,
support education and health care, and strengthen the economy; to the
Committee on Appropriations.
Mr. EDWARDS. Mr. President, I rise today to introduce the Homeland
Protection and Tax Hike Prevention Act of 2003.
As I speak, State governments face a budget gap of $80 billion in
2004, according to the National Governors Association. My own State of
North Carolina must close a $2 billion deficit this year, the third
year in a row that we have faced a deficit of $1 billion or more. There
is an additional $30 billion deficit in 2003 that, for most States,
must be closed before the fiscal year ends in June. Cities and towns
face a similar budget pinch. The likely result in many States will be
steep tax increases and budget cuts.
Because most States have seen two or three lean years in a row, the
easiest cuts and sources of revenue have already been tapped. States
already closed nearly $50 billion in deficits for 2003. According to
Standard and Poor's, ``With rainy day funds having been depleted
rapidly over the past three years, few options remain other than tough
cuts or revenue increases.''
The State and local budget crisis is a serious threat to our economy.
State spending cuts and tax increases equaling $100 billion would
directly lower GDP growth by one percentage point, according to the
Center on Budget and Policy Priorities. According to the Center, ``The
only way this blow to the economy can be mitigated is through federal
fiscal relief for the states.''
Millions of Americans across the Nation will be directly affected by
State tax increases and budget cuts. For example, Kansas is considering
new taxes on hair stylists, theaters, and doctors. Missouri is now
taxing pharmacies. In fact, policymakers in 15 States are already
calling for tax increases of approximately $14 billion in 2004.
New York budget proposals would raise class sizes and cut 43,000
early education slots in New York City. Florida may take away medical
coverage for 26,000 low-income people. In California, hundreds of
nursing homes are in danger of bankruptcy, according to the Washington
Post. San Diego may close fire stations.
Portland, OR, will likely trim its school year by 24 days. Oregon
State police are laying off 129 troopers and abandoning 24-hour
patrols. The Multnomah county jail will release as many as 500 inmates
early. Medical benefits will be eliminated for 8,000 elderly and
disabled people.
This is wrong. It's wrong for the people being hurt. And it is wrong
for our economy. That's why I am proposing the Homeland Protection and
Tax Hike Prevention Act of 2003. This bill would enacts a State relief
plan I first described last November. It gives States and cities a
total of $50 billion, allowing them to avoid raising taxes and protect
critical priorities in public safety, education, and health care.
First, my legislation would provide $10 billion to states and major
cities to strengthen homeland security. We have a whole range of
homeland security priorities that we ought to be meeting but we
haven't. Although our domestic readiness begins with first responders,
they are not getting the training and equipment they need to respond to
an attack with speed, skill, and strength. Our public health system
isn't fully prepared to respond to biological attacks. We need to
modernize an emergency warning system that is terribly out of date so
we can reach Americans at any time, day or night.
Our infrastructure is exposed. There are 500 large skyscrapers, 250
major arenas and stadiums, and countless train, subway, and automobile
bridges and tunnels. Many of these facilities have vulnerable
ventilation systems, poor emergency exits, and inadequate fire
retardants and blast-resistant materials. Security at nuclear and
chemical plants and over shipments is still too lax. At 123 chemical
plants, a toxic chemical release would endanger a million people or
more.
We need to meet all these priorities, and we can ought to meet them
through a partnership between Washington, states, and local
communities. This bill goes a long way toward doing that by providing
$10 billion for homeland security.
Next, today's bill would provide States $10 billion through higher
Medicaid reimbursements. Higher Medicaid reimbursements can
dramatically help State budgets. It can also address serious inequities
in the way Medicaid funds are distributed today. The legislation is
based on Senator Rockefeller's excellent proposal. It maintains last
year's Medicaid matching rate where rates are declining and provides an
additional modest, temporary increase in the matching rate. This short-
lived relief will help states balance their budgets and protect
children and seniors who rely on Medicaid.
Last but not least, my bill will give States and local governments
$30 billion in general relief. In return for this aid, State and local
governments must agree not to cut K-12 education funding or raise
college tuition faster than inflation for low- and middle-income
families.
Across the Nation, States and cities are struggling with more needs
and less revenue. Washington is not doing its part to help. Instead, we
have created new demands through the No Child Left Behind education
reform law and the Federal special education laws, without delivering
the resources needed to meet those demands. We ought to help States and
localities meet those demands, and this bill will do that.
The Homeland Protection and Tax Hike Protection Act will strengthen
our homeland security and prevent states and cities from raising taxes
and cutting schools and health care. I hope my colleagues will join me
in supporting it.
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. 565

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 ``Homeland Protection and Tax
Hike Prevention Act of 2003''.

SEC. 2. PURPOSES.

The purposes of this Act are--
(1) to ameliorate the hardships faced by millions of
Americans as a result of State and local budget crises,
including tax increases and cuts to education, health care,
and other vital State and local programs;
(2) to avoid the economic damage that would be caused by
tens of billions of dollars in State and local tax increases
and spending cuts that would further weaken the Nation's
economic growth and job creation; and
(3) to improve the Nation's readiness for a terrorist
attack by providing financial assistance to assist States and
cities to--
(A) prepare first responders and emergency personnel;
(B) implement anti-counterfeiting protections;
(C) strengthen security at vulnerable targets, such as
nuclear power plants and public transportation systems; and
(D) address other homeland security priorities.

SEC. 3. DEFINITIONS.

As used in this Act, the following definitions shall apply:
(1) State.--Except as used in section 6, the term ``State''
means each of the several States of the United States, the
District of Columbia, and the Commonwealth of Puerto Rico.
(2) Metropolitan statistical area.--The term ``metropolitan
statistical area'' means a statistical geographic entity
associated with at least 1 urbanized area that has a
population of not less than 50,000, as identified by the
Office of Management and Budget.
(3) Metropolitan city.--The term ``metropolitan city''
means--
(A) a central city within a metropolitan statistical area;
and
(B) any other city within a metropolitan statistical area
that has a population of not less than 50,000.
(4) Unit of general local government.--
(A) In general.--The term ``unit of general local
government'' means--
(i) a county, parish, township, city, or political
subdivision of a county, parish, township, or city, that is a
unit of general local

[[Page S3324]]

government as determined by the Secretary of Commerce for
general statistical purposes; and
(ii) the District of Columbia, the Commonwealth of Puerto
Rico, and the recognized governing body of an Indian tribe or
Alaskan native village that carries out substantial
governmental duties and powers.
(B) Treatment of subsumed areas.--For purposes of
determining a unit of general local government under this
section, the rules under section 6720(c) of title 31, United
States Code, shall apply.

SEC. 4. HOMELAND SECURITY GRANTS.

(a) Grants Authorized.--
(1) In general.--From the amount appropriated under
subsection (d), the Secretary of Homeland Security (referred
to in this section as the ``Secretary'') shall, as soon as
practicable after the date of enactment of this Act, award
grants to States and metropolitan cities, which have
submitted an application in accordance with subsection (c) to
accomplish the objectives described under subsection (b).
(2) Allocations to states.--
(A) Population-based allocations.--The Secretary shall
allocate $2,500,000,000 for grants to the States based on the
relative population of each State.
(B) Risk-based allocations.--Subject to paragraph (4), the
Secretary shall allocate $2,500,000,000 for grants to the
States based on--
(i) the potential risk, as it pertains to chemical
security, of each State;
(ii) the proximity of each State to the nearest operating
nuclear power plant;
(iii) the proximity of each State to the nearest United
States land or water port;
(iv) the proximity of each State to the nearest
international border; and
(v) the proximity of each State to the nearest Disaster
Medical Assistance Team.
(3) Allocations to metropolitan cities.--
(A) Population-based allocations.--The Secretary shall
allocate $2,500,000,000 for grants to units of general local
government within metropolitan cities based on the relative
population of each metropolitan statistical area.
(B) Risk-based allocations.--The Secretary shall allocate
$2,500,000,000 for grants to metropolitan cities within
metropolitan statistical areas based on--
(i) the potential risk, as it pertains to chemical
security, of each metropolitan statistical area;
(ii) the proximity of each metropolitan statistical area to
the nearest operating nuclear power plant;
(iii) the proximity of each metropolitan statistical area
to the nearest United States land or water port;
(iv) the proximity of each metropolitan statistical area to
the nearest international border; and
(v) the proximity of each metropolitan statistical area to
the nearest Disaster Medical Assistance Team.
(C) Metropolitan cities.--The Secretary shall distribute
the allocations under subparagraphs (A) and (B) to
metropolitan cities based on the relative population of each
such city.
(4) Clarification of risk factors.--In allocating funds to
States and metropolitan statistical areas under paragraphs
(2)(B) and (3)(B), the Secretary shall equally weigh each of
the following risk factors:
(A) Potential risk as it pertains to chemical security.--If
a State or metropolitan statistical area is within the
vulnerable zone of a worst-case chemical release, as
specified in the most recent risk management plans filed with
the Environmental Protection Agency or another instrument
developed by the Environmental Protection Agency or the
Homeland Security Department that captures the same
information for the same facilities, the ratio under
paragraphs (2)(B)(i) and (3)(B)(i) shall be 1 divided by the
total number of States or metropolitan statistical areas that
are within such a zone.
(B) Proximity as it pertains to nuclear security.--If a
State or metropolitan statistical area is located within 50
miles of an operating nuclear power plant, as identified by
the Nuclear Regulatory Commission, the ratio under paragraphs
(2)(B)(ii) and (3)(B)(ii) shall be 1 divided by the total
number of States or metropolitan statistical areas that are
located within 50 miles of an operating nuclear power plant.
(C) Proximity as it pertains to port security.--If a State
or metropolitan statistical area is located within 50 miles
of 1 of the 100 largest United States ports, as stated by the
Department of Transportation, Bureau of Transportation
Statistics, United States Port Report by All Land Modes, or
within 50 miles of one of the 30 largest United States water
ports by metric tons and value, as stated by the Department
of Transportation, Maritime Administration, United States
Foreign Waterborne Transportation Statistics, the ratio under
paragraphs (2)(B)(iii) and (3)(B)(iii) shall be 1 divided by
the total number of States or metropolitan statistical areas
that are located within 50 miles of a United States land or
water port.
(D) Proximity to International Borders.--If a State or
metropolitan statistical area is located within 50 miles of
an international border, the ratio under paragraph (2)(B)(iv)
and (3)(B)(iv) shall be 1 divided by the total number of
States or metropolitan statistical areas that are located
within 50 miles of an international border.
(E) Proximity to disaster medical assistance teams.--If a
State or metropolitan statistical area is located within 50
miles of a Disaster Medical Assistance Team, as organized by
the National Disaster Medical System through the Department
of Public Health, the ratio under paragraphs (2)(B)(v) and
(3)(B)(v) shall be 1 divided by the total number of States or
metropolitan statistical areas that are located within 50
miles of a Disaster Medical Assistance Team.
(b) Use of Funds.--Grants awarded pursuant to subsection
(a) may be used to--
(1) support police, fire, health, and other emergency
personnel by--
(A) purchasing or upgrading communications systems,
protective gear, or hazardous materials detection equipment;
(B) providing training for emergency responses; and
(C) providing for expenses related to retention of
personnel and overtime;
(2) improve safeguards against the counterfeiting of
official State documents, including--
(A) the improvement of procedures to obtain proof of
identity before issuance of official identification cards;
and
(B) the implementation of biometric identifiers and
holograms;
(3) improve security at chemical plants by--
(A) strengthening requirements for perimeter security and
assisting in meeting such requirements; and
(B) strengthening requirements for the use and handling of
hazardous materials and assisting in meeting such
requirements;
(4) improve security in train and subway cars and stations,
on bridges, in tunnels, and in arenas by installing and
improving--
(A) fire and blast protections;
(B) ventilation systems;
(C) entrance security;
(D) sensors to detect chemical and biological weapons; and
(E) emergency evacuation systems;
(5) improve security at and around skyscrapers, public
monuments, and other major buildings;
(6) secure food and water supplies, reservoirs, water
treatment plants, and distribution systems;
(7) strengthen protections of other critical networks,
including--
(A) telecommunications;
(B) electrical power plants and grids; and
(C) computer networks and databases;
(8) plan and prepare for a response for chemical or
biological attacks, including--
(A) purchasing, distributing, and storing treatments and
preventive measures;
(B) providing emergency training for health officials; and
(C) developing public health surveillance systems to
identify the disease outbreaks by monitoring ambulance calls,
hospital admittance, and other measures;
(9) establish systems to notify members of the public and
appropriate agencies when a threat has emerged and any
precautions the public should take;
(10) establish programs that offer opportunities for
members of the community to participate in terrorism
preparation and prevention, including neighborhood watch
groups; and
(11) design, review, and improve disaster response systems,
enhancing communities' ability to coordinate efforts and
share information, and devise and implement a homeland
security plan.
(c) Application.--
(1) In general.--Each eligible entity desiring a grant
under this section shall submit an application to the
Secretary at such time, in such manner, and accompanied by
such information as the Secretary may reasonably require.
(2) Contents.--Each application submitted pursuant to
paragraph (1) shall--
(A) describe the activities for which assistance under this
section is sought; and
(B) provide such additional assurances as the Secretary
determines to be necessary to ensure that the grantee will
use the proceeds of the grant in compliance with subsection
(b).
(d) Authorization and Appropriation.--There are authorized
to be appropriated, and are appropriated, $10,000,000,000 for
fiscal year 2003 to carry out this section, which shall
remain available through September 30, 2004.

SEC. 5. BUDGET CRISIS RELIEF GRANTS.

(a) Grants Authorized.--From the amount appropriated under
subsection (c) for fiscal year 2003, the Secretary of the
Treasury (referred to in this section as the ``Secretary'')
shall, as soon as practicable after the date of enactment of
this Act, allocate financial assistance to each of the States
as follows:
(1) Grants to States.--
(A) Allocations based on population.--The Secretary shall
allocate $7,500,000,000 among the States on the basis of the
relative population of each State, as determined by the
Secretary on the basis of the most recent satisfactory data.
(B) Allocations based on unemployment.--The Secretary shall
allocate $7,500,000,000 among the States on the basis of the
relative number of unemployed individuals for calendar year
2002 in each State, as determined by the Secretary on the
basis of the most recent satisfactory data.
(2) Grants to local government.--
(A) Allocations based on population.--The Secretary shall
allocate an additional $7,500,000,000 among units of general
local

[[Page S3325]]

government within each State on the basis of the relative
population of each State and of each such unit within each
State, as determined by the Secretary on the basis of the
most recent satisfactory data.
(B) Allocations based on unemployment.--The Secretary shall
allocate an additional $7,500,000,000 among units of general
local government within each State on the basis of the
relative number of unemployed individuals for calendar year
2002 in each State and in each such unit within each State,
as determined by the Secretary on the basis of the most
recent satisfactory data.
(b) Maintenance of Effort.--A State or unit of general
local government, before receiving the proceeds of a grant
under this section, shall certify that such State or unit of
general local government--
(1) will maintain its expenditures for elementary,
secondary, and higher education at a level equal to not less
than the level of such expenditures maintained by the State
or unit of general local government for the fiscal year
immediately preceding the fiscal year for which the grant is
received; and
(2) will not raise the net tuition, after scholarships and
tuition waivers, at public colleges and universities by more
than the inflation rate.
(c) Authorization and Appropriation.--There are authorized
to be appropriated, and are appropriated, $30,000,000,000 for
fiscal year 2003 to carry out this section.

SEC 6. TEMPORARY STATE FISCAL RELIEF THROUGH INCREASE IN
MEDICAID FMAP.

(a) Definitions.--In this section, the following
definitions shall apply:
(1) FMAP.--The term ``FMAP'' means the Federal medical
assistance percentage, as defined in section 1905(b) of the
Social Security Act (42 U.S.C. 1396d(b)).
(2) State.--The term ``State'' has the meaning given such
term for purposes of title XIX of the Social Security Act (42
U.S.C. 1396 et seq.).
(b) Permitting Maintenance of Fiscal Year 2002 FMAP for
Last 2 Calendar Quarters of Fiscal Year 2003.--
Notwithstanding any other provision of law, but subject to
subsection (f), if the FMAP determined without regard to this
section for a State for fiscal year 2003 is less than the
FMAP as so determined for fiscal year 2002, the FMAP for the
State for fiscal year 2002 shall be substituted for the
State's FMAP for the third and fourth calendar quarters of
fiscal year 2003, before the application of this section.
(c) Permitting Maintenance of Fiscal Year 2003 FMAP for
Fiscal Year 2004.--Notwithstanding any other provision of
law, but subject to subsection (f), if the FMAP determined
without regard to this section for a State for fiscal year
2004 is less than the FMAP as so determined for fiscal year
2003, the FMAP for the State for fiscal year 2003 shall be
substituted for the State's FMAP for each calendar quarter of
fiscal year 2004, before the application of this section.
(d) General 2.45 Percentage Points Increase for Last 2
Calendar Quarters of Fiscal Year 2003 and Fiscal Year 2004.--
Notwithstanding any other provision of law, but subject to
subsections (f) and (g), for each State for the third and
fourth calendar quarters of fiscal year 2003 and each
calendar quarter of fiscal year 2004, the FMAP (taking into
account the application of subsections (b) and (c)) shall be
increased by 2.45 percentage points.
(e) Increase in Cap on Medicaid Payments To Territories.--
Notwithstanding any other provision of law, but subject to
subsection (g), with respect to the third and fourth calendar
quarters of fiscal year 2003 and each calendar quarter of
fiscal year 2004, the amounts otherwise determined for Puerto
Rico, the Virgin Islands, Guam, the Northern Mariana Islands,
and American Samoa under subsections (f) and (g) of section
1108 of the Social Security Act (42 U.S.C. 1308) shall each
be increased by an amount equal to 4.90 percent of such
amounts.
(f) Scope of Application.--The increases in the FMAP for a
State under this section shall apply only for purposes of
title XIX of the Social Security Act and shall not apply with
respect to--
(1) disproportionate share hospital payments described in
section 1923 of such Act (42 U.S.C. 1396r-4); or
(2) payments under title IV or XXI of such Act (42 U.S.C.
601 et seq. and 1397aa et seq.).
(g) State Eligibility.--
(1) In general.--Subject to paragraph (2), a State is
eligible for an increase in its FMAP under subsection (d) or
an increase in a cap amount under subsection (e) only if the
eligibility under its State plan under title XIX of the
Social Security Act (including any waiver under such title or
under section 1115 of such Act (42 U.S.C. 1315)) is no more
restrictive than the eligibility under such plan (or waiver)
as in effect on September 2, 2003.
(2) State reinstatement of eligibility permitted.--A State
that has restricted eligibility under its State plan under
title XIX of the Social Security Act (including any waiver
under such title or under section 1115 of such Act (42 U.S.C.
1315)) after September 2, 2003, but prior to the date of
enactment of this Act is eligible for an increase in its FMAP
under subsection (d) or an increase in a cap amount under
subsection (e) in the first calendar quarter (and subsequent
calendar quarters) in which the State has reinstated
eligibility that is no more restrictive than the eligibility
under such plan (or waiver) as in effect on September 2,
2003.
(3) Rule of construction.--Nothing in paragraph (1) or (2)
shall be construed as affecting a State's flexibility with
respect to benefits offered under the State medicaid program
under title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.) (including any waiver under such title or under section
1115 of such Act (42 U.S.C. 1315)).
(h) Sunset Date.--This section is repealed, effective
October 1, 2004.
______

By Ms. MIKULSKI (for herself, Mr. Bond, Mr. Kennedy, Mrs.
Lincoln, Mr. Breaux, and Mr. Dodd):
S. 566. A bill to amend the Public Health Service Act to provide for
Alzheimer's disease research and demonstration grants; to the Committee
on Health, Education, Labor, and Pensions.
Mr. MIKULSKI. Mr. President, I rise to introduce the Alzheimer's
Disease Research, Prevention, and Care Act of 2003. I am pleased that
Senators Bond, Kennedy, Lincoln, Breaux, and Dodd are joining me as
original cosponsors of this legislation. This bill expands research on
Alzheimer's disease at the National Institute on Aging and reauthorizes
the Alzheimer's Demonstration Grant Program that helps patients and
families get services like respite care and adult day care.
I believe that ``honor thy mother and father'' is not only a good
commandment to live by, it's also a good policy to govern by. That's
why I authored the Alzheimer's Disease Research, Prevention, and Care
Act--to put values into action and get behind our Nation's families.
In 1998, the Federal Government was spending just $323 million on
Alzheimer's disease research, a disease that affects about 4 million
Americans. I fought for more funding for Alzheimer's disease and the
National Institute on Aging. Not just an incremental increase--I fought
to double the funding. I am proud that the National Institute on Aging
was funded at $1 billion this year. That's double what it was 5 years
ago. The Federal Government will spend more than $600 million on
Alzheimer's research this year.
This investment in Alzheimer's disease research is paying off.
Scientists have found evidence that a cholesterol-lowering drug may
prevent Alzheimer's. Researchers are testing a vaccine on mice that may
prevent the disease in humans. Seven clinical trials are currently
underway to find out whether estrogen, vitamin E, gingko biloba, and
aspirin can prevent the disease.
Even with these victories, there is still a lot more to do.
Alzheimer's disease is a devastating illness. Four million Americans
suffer from Alzheimer's, including one in ten people over age 65 and
nearly half of those over age 85. Nineteen million Americans say they
have a family member with the disease. The Medicare program alone spent
$31.9 billion for the care of people with Alzheimer's disease in the
year 2000. Without a cure, the number of Alzheimer's patients will more
than triple in the next 50 years. Fourteen million Americans will
suffer from Alzheimer's by 2050. If science can help delay the onset of
Alzheimer's by even five years, it would improve the lives of millions
of families and save billions of dollars.
This legislation is about more than just statistics--it's about
helping to meet the day-to-day needs of patients with Alzheimer's and
the long range needs of the nation. Last year, I chaired a hearing at
the Gerontology Research Center at the Johns Hopkins Bayview Medical
center in Baltimore. I heard from Peter Savage, a Baltimore man caring
for his wife, Ina. Mrs. Savage was diagnosed with early onset
Alzheimer's disease at just 53 years old. I heard Mr. Savage's pain and
frustration as he told the Subcommittee on Aging about his family's
long struggle: watching his wife's slow decline; trying to care for
Mrs. Savage by himself and with the help of daughters; the difficulty
of finding someone to help them when the caregiving responsibilities
were more than the family alone could bear; and the looming costs of
nursing home care.
The bill I am introducing gets behind families like the Savages and
millions of others struggling with this disease. My bill reauthorizes
and expands the Alzheimer's Demonstration grant Program. This program
helps patients and families get support services like respite care and
home health care. These

[[Page S3326]]

grants connect help states leverage private resources to fill in gaps
in existing services and make sure that programs reach the most
vulnerable families. This important program needs to be renewed this
year. I'm fighting to expand this program to nearly every state, to
keep our promises to America's families.
This bill also helps to meet the long-range needs of our Nation by
increasing the Federal Government's commitment to Alzheimer's disease
research at the National Institutes of Health and the National
Institute on Aging. It puts the Alzheimer's Disease Prevention
Initiative in our Federal law books to speed up the discovery of new
ways to prevent the disease. My bill sets up a cooperative clinical
research program to stretch our Federal research dollars, by making it
easier for researchers across the country to share data and enroll
patients in clinical trials. It also authorizes research on ways to
improve the health of Alzheimer's caregivers--and ease some of their
burden.
This bill gets behind our Nation's families--both in the lab and in
the community. I look forward to working with my colleagues to pass
this important legislation.
______

By Mr. LUGAR (by request):
S. 571. A bill to establish the Millennium Challenge Account and the
Millennium Challenge Corporation in order to reduce global poverty
through increased economic growth by supporting a new compact for
global development; to the Committee on Foreign Relations.
Mr. LUGAR. Mr. President, by request, I introduce for appropriate
reference a bill to establish the Millennium Challenge Account and the
Millennium Challenge Corporation in order to reduce global poverty
through increased economic growth by supporting a new compact for
global development.
This proposed legislation has been requested by the President of the
United States, George W. Bush, and I am introducing it in order that
there may be a specific bill to which Members of the Senate and the
public may direct their attention and comments.
I reserve my right to support or oppose this bill, as well as to make
any suggested amendments to it, as this important initiative of the
President continues to be considered by the Committee on Foreign
Relations.
I ask unanimous consent that the text of the bill be printed in the
Record together with a section-by-section analysis of the bill and the
letter from the President of the United States to the Congress of the
United States dated February 5, 2003.
There being no objection, the material was ordered to be printed in
the Record, as follows:

S. 571

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 ``Millennium Challenge Act of
2003''.

TITLE I--THE MILLENNIUM CHALLENGE ACCOUNT

SEC. 101. STATEMENT OF POLICY.

It is the policy of the United States to reduce global
poverty through increased economic growth by supporting a new
compact for global development in which increased support is
provided by developed countries to those developing countries
that are ruling justly, fostering economic freedom, and
investing in their citizens.

SEC. 102. ELIGIBILITY CRITERIA.

To be eligible for assistance under this Act, a country
(``eligible country'')--
(1) must suffer from significant poverty;
(2) must have a demonstrated commitment to--
(A) Just and democratic governance, including political
pluralism and the rule of law, and respect for human and
civil rights of all citizens, protect private property
rights, encourage transparency and accountability of
governance, and limit corruption;
(B) Economic freedom, including economic policies that
encourage citizens and firms to participate in the global
product and capital markets, promote private sector growth,
and avoid direct government participation in the economy; and
(C) Investing in its own people, including improving the
availability of educational opportunities and health care for
all citizens; and
(3) must have entered into a Millennium Challenge Contract,
as defined in section 103, with the United States.

SEC. 103. MILLENNIUM CHALLENGE CONTRACT.

(a) In General.--A Millennium Challenge Contract, is an
agreement between the United States and an eligible country
that establishes a multi-year plan of partnership for
achieving shared development objectives in furtherance of the
purposes of this Act.
(b) Elements.--The Millennium Challenge Contract shall
contain--
(1) the specific objectives that the eligible country and
the United States expect to achieve;
(2) the responsibilities of the eligible country and the
United States in the achievement of those objectives;
(3) regular benchmarks to measure progress towards
achieving the agreed upon objectives and a description of how
the objectives will be sustained once assistance under this
Millennium Challenge Contract ends;
(4) a plan and a timeframe that describes how and when
those objectives will be met;
(5) the role and contribution of the business community,
private and voluntary organizations, and other members of
civil society in designing that plan and achieving the
objectives;
(6) where appropriate, the contribution of other donors in
the achievement of those objectives; and
(7) a plan to ensure financial accountability of funds used
to achieve those objectives.
(c) Local Input.--The Millennium Challenge Contract should
take into account the perspectives of the rural and urban
poor in an eligible country, and should reflect consultation
with private and voluntary organizations, and the business
community in the country.
(d) Other Donors.--To the maximum extent feasible,
activities undertaken to achieve the objectives of the
Millennium Challenge Contract should be undertaken in
coordination with the assistance activities of other donors.

SEC. 104. MILLENNIUM CHALLENGE ASSISTANCE.

The President is authorized to provide assistance for
eligible countries to support policies and programs that are
in furtherance of the purposes of this Act. The goal of the
Millennium Challenge Account is to reduce poverty by
significantly increasing the economic growth trajectory of
recipient countries. This requires an emphasis on investments
that raise the productive potential of a country's citizens
and firms and help integrate its economy into the global
product and capital markets. Key areas of focus for
Millennium Challenge Assistance will include:
(a) Agricultural development;
(b) Education;
(c) Enterprise and private sector development;
(d) Governance;
(e) Health; and
(f) Trade and investment capability building.

SEC. 105. AUTHORIZATION OF THE MILLENNIUM CHALLENGE ACCOUNT
AND AUTHORITIES.

(a) Authorization of Millennium Challenge Account.
(1) Authorization.--There are authorized to be appropriated
to the President to carry out this Act $1,300,000,000 for
fiscal year 2004, and such sums as may be necessary for
subsequent fiscal years.
(2) Availability--Funds appropriated under paragraph (1)--
(A) may be referred to as the ``Millennium Challenge
Account'';
(B) are authorized to remain available until expended; and
(C) are in addition to funds otherwise available for such
purposes.
(b) Applicability of Provisions of Law.--
(1) Funds made available to carry out the purposes of this
Act may be made available notwithstanding any other provision
of law, except the provisions of the Anti-Deficiency Act.
(2) Notwithstanding paragraph (l), country, including the
government of a country, that is ineligible to receive
assistance under provisions of law that would prohibit
assistance under Part I of the Foreign Assistance Act of 1961
shall not be eligible to receive assistance under this Act.
If the President waives the provisions of Part I of the
Foreign Assistance Act of 1961, such country could receive
assistance under this Act.
(c) Use of Other Funds.--Any funds allocated from funds
appropriated to carry out any other Act may be made
available, if used in conjunction with funds appropriated to
carry out this Act, under the authority and subject to the
limitations applicable to funds made available to carry out
this Act.

SEC. 106. EVALUATION AND ACCOUNT ABILITY.

All concluded Millennium Challenge Contracts and
performance evaluations of activities under these contracts
shall be made available to the public on the Internet, unless
the Board makes a specific finding that a performance
evaluation or contract should not be posted.

SEC. 107. GRADUATION.

The Millennium Challenge Contract will provide funds for
limited purposes, projects, and terms.

TITLE II--THE MILLENNIUM CHALLENGE CORPORATION

SEC. 201. ESTABLISHMENT OF THE MILLENNIUM CHALLENGE
CORPORATION.

(a) Establishment of the Millennium Challenge
Corporation.--There is hereby established in the executive
branch, a corporation to be known as the Millennium Challenge
Corporation (hereinafter in this Act referred to as the
``Corporation'').
(b) Responsibility of the Corporation.--It shall be the
responsibility of the Corporation to implement title I of
this Act, consistent with the direction of the President.

[[Page S3327]]

SEC. 202. MANAGEMENT OF THE CORPORATION.

(a) Board of Directors.--The management of the Corporation
shall be vested in a board of directors (hereafter in this
title referred to as the ``Board'') composed of the Secretary
of State, who shall Chair, the Secretary of the Treasury, and
the Director of the Office of Management and Budget, and may
include individuals serving in such positions in an acting
capacity.
(b) Functions of the Board.--
(1) The Board shall direct the exercise of all the
functions and powers of the Corporation, including the
authority to review and approve the eligibility of countries
for assistance.
(2) The Board may prescribe, amend, and repeal bylaws,
rules, regulations, and procedures governing the manner in
which the business of the Corporation may be conducted and in
which the powers granted to it by law may be exercised and
enjoyed.
(3) Members of the Board shall serve without additional
compensation, but may be reimbursed for travel expenses,
including per diem, in lieu of subsistence, while engaged in
their duties on behalf of the Corporation.
(c) Chief Executive Officer of the Corporation.--
(1) The chief executive officer of the Corporation
(hereafter referred to in this title as the ``CEO'') shall be
appointed by the President, by and with the advice and
consent of the Senate, and shall exercise the functions and
powers vested in the CEO by the President and the Board.
(2) The CEO shall receive compensation at the rate provided
for level II of the Executive Schedule under section 5313 of
title 5, United States Code.
(d) Functions of, and actions by, the Corporation, Board,
CEO, or an officer of the United States under this Act are
vested in their discretion.

SEC. 203. FUNCTIONS OF THE CORPORATION.

In order to carry out programs in furtherance of the
purposes and policies of this Act, and in accordance with the
provisions of Title I of this Act, the Corporation may make
grants for any eligible country, including to any private or
public entity, and including for the purpose of providing
technical assistance to any such country for the development
of the Millennium Challenge Contract and the management,
including financial management, and evaluation of programs
for which assistance is provided pursuant to this Act.

SEC. 204. POWERS OF THE CORPORATION.

(A) Powers.--The Corporation--
(1) shall have perpetual succession unless dissolved by the
Act of Congress;
(2) may adopt, alter, and use a seal, which shall be
judicially noticed;
(3) may prescribe, amend, and repeal such rules,
regulations, and procedures as may be necessary for carrying
out the functions of the Corporation;
(4) may make and perform such contracts, grants, and other
agreements with any individual, corporation, or other private
or public entity however designated and wherever situated, as
may be necessary for carrying out the functions of the
Corporation and all Millennium Challenge Contracts;
(5) may determine and prescribe the manner in which its
obligations shall be incurred and its expenses allowed and
paid, including expenses for representation not exceeding
$95,000 in any fiscal year;
(6) may lease, purchase, or otherwise acquire, improve, and
use such real property wherever situated, as may be necessary
for carrying out the functions of the Corporation;
(7) may accept cash gifts or donations of services or of
property (real, personal, or mixed), tangible or intangible,
in furtherance of the purposes of this Act;
(8) may use the United States mails in the same manner and
on the same conditions as the executive departments of
Government;
(9) may, with the consent of the agency of the United
States, use the information, services, facilities, and
personnel of that agency on a full or partial reimbursement
or on a non-reimbursable basis in carrying out the purposes
of this Act;
(10) may contract with individuals for personal services,
who shall not be considered federal employees for any
provision of law administered by the Office of Personnel
Management;
(11) hire or obtain passenger motor vehicles; and
(12) shall have such other powers as may be necessary and
incident to carrying out this Act;
(b) Principal Office.--
(1) The Corporation shall maintain its principal office in
the metropolitan Washington, D.C. area.
(2) The Corporation may establish other offices in any
place including places outside the United States, in the
Corporation may carry on all or any of its operations and
business.
(c) Positions With Foreign Governments.--When approved by
the Corporation, in furtherance of its purposes, employees of
the Corporation (including individuals detailed to the
Corporation) may accept and hold offices or positions to
which no compensation is attached with governments or
governmental agencies of foreign countries or international
organizations.
(d) Commitment Authority.--Subject to the provisions of the
Anti-Deficiency Act, a contract, grant, or other agreement
which entails commitments for the expenditure of funds
available under this Act may commit with expenditures for
such period of time as it deemed necessary to carrying out
this Act.
(e) Contracting Authority.--In furtherance of the purposes
of this Act, functions and powers authorized by this Act may
be performed without regard to any provision of law
regulating the making, performance, amendment, or
modification of contracts, grants, and other agreements.
(f) Taxation of the Corporation.--The Corporation,
including all its assets and property, shall be exempt from
taxation now or hereafter imposed by the United States, or
any territory or possession thereof, or by any State, county,
municipality, or local taxing authority.

SEC. 205. PERSONNEL AND ADMINISTRATIVE AUTHORITIES.

(a) Personnel Authorities.--Notwithstanding any provision
of title 5, United States Code or of the Foreign Service Act
of 1980, as amended, the CEO of the Millennium Challenge
Corporation may, in regulations prescribed jointly with the
Director of the Office of Personnel Management, establish,
and from time to time adjust, a human resources management
system, including a retirement benefits programs.
(1) Any system established under this subsection shall not
waive, modify, or otherwise affect, with respect to Civil
Service and Foreign Service employees--
(A) the public employment principles of merit and fitness
set forth in section 2301 of title 5, including the
principles of hiring based on merit, fair treatment without
regard to political affiliation or other non-merit
considerations, equal pay for equal work, and protection of
employees against reprisal for whistle blowing,
(B) section 2302 (b) of title 5,
(C) chapters 72 and 73 of title 5,
(D) the conflict of interest provisions in title 18,
chapter 11 of the United States Code.
(2) The CEO of the Corporation may, without regard to the
civil service and foreign service laws and regulations,
appoint and terminate personnel as may be necessary to enable
the Corporation to perform its duties.
(3) The CEO may fix the compensation of the Corporation
personnel without regard to the provisions of chapter 51 and
subchapter III of chapter 53 of title 5, United States Code,
relating to the classification of positions and General
Schedule pay rates, and without regard to the provisions of
chapters 4 and 5 of the Foreign Service Act, relating to the
classification of positions and Foreign Service pay rates.
(4) The Corporation may utilize such authority contained in
the Foreign Service Act of 1980, as amended, as the
Corporation deems appropriate.
(5) The CEO and other personnel who are employees of the
Corporation shall be employees under section 2105 of title 5,
United States Code, for purposes of chapters 63 (relating to
leave), 81 (relating to compensation for work injuries), 85
(relating to unemployment benefits), 87 (relating to life
insurance benefits), 89 (relating to health insurance
benefits), and 90 (relating to long-term care insurance) of
that title. If the CEO chooses not to waive chapters 83 and
84 (relating to retirement benefits) of title 5, or chapter 8
of the Foreign Service Act (relating to Foreign Service
retirement systems), employees of the Corporation shall be
eligible for benefits under those chapters as otherwise
applicable.
(6) No individual, except for the officers of the
Corporation, may be employed by the Corporation for a period
in excess of 5 years: Provided, That the CEO, under special
circumstances, may approve an extension of the length of
employment on an individual basis.
(7) Individuals employed by the Corporation, including
individuals detailed to or contracted by the Corporation,
while performing duties in any country or place outside the
United States, and their families shall, if they are
nationals of or permanently resident in such country or
place, enjoy the privileges and immunities of at least the
administrative and technical staff of the Mission of the
United States to such country and shall be subject to 22
U.S.C. 3927 in the same manner as United States Government
employees.
(8) The CEO 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.
(b) Detail of Personnel to the Corporation.--
(1) Any Federal Government employee may be detailed to the
Corporation on a fully or partially reimbursable or on a
nonreimbursable basis, and such detail shall be without
interruption or loss of civil service or Foreign Service
status or privilege.
(2) Alternatively, an employee serving under a career or
career conditional appointment or the equivalent in an agency
who transfers to or converts to an appointment in the
Corporation with the consent of the head of the agency is
entitled to be returned to the employee's former position or
a position of like seniority, status, and pay without grade
or pay reduction in the agency if the employee--
(A) is being separated from the Corporation for reasons
other than misconduct, neglect of duty, or malfeasance; and
(B) applies for return not later than 30 days before the date
of the termination of the employment in the Corporation.
(3) An employee of a private sector organization assigned
to the Corporation under this section is deemed, during the
period of

[[Page S3328]]

assignment, to be on detail to such agency. Such employee--
(A) may continue to receive pay and benefits from the
private sector organization from which he is assigned;
(B) is deemed to be an employee of the Corporation as
specified in (a)(5) of this section, for the purposes of
chapters 81 and 85 of title 5 U.S.C.;
(C) may not have access to any trade secrets or to any
other non-public information which is of commercial value to
the private sector organization from which he is assigned,
and
(D) is subject to such regulations as the President may
prescribe. Such assignment may be made with or without
reimbursement by the Corporation for the pay, or a part
thereof, of the employee during the period of assignment, or
for any contribution of the private sector organization to
its employee benefit system. A private sector organization
may not charge the Federal Government, as direct or indirect
costs under a Federal contract, the costs of pay or benefits
paid by the organization to an employee assigned to the
Corporation.
(c) Allocation of Funds.--
(1) Transfer or Allocation.--The Corporation may allocate
or transfer to any agency of the United States Government any
part of any funds available for carrying out the purposes of
this Act. Such funds shall be available for obligation and
expenditure for the purposes for which authorized, in
accordance with authority granted in this Act or under
authority governing the activities of the agencies of the
United States Government to which such funds are allocated or
transferred.
(2) Use of Services.--For carrying out the purposes of this
Act, the Corporation may utilize the services and facilities
of, or procure commodities from, any agency of the United
States Government under such terms and conditions as may be
agreed to by the head of such agency and the Corporation.
(d) Other Authorities.--Except where inconsistent with the
provisions of this Act, the Corporation is authorized to use
any of the administrative authorities contained in the State
Department Basic Authorities Act of 1956 and the Foreign
Assistance Act of 1961.
(e) Government Corporation Control Act.--The Corporation
shall be subject to the provisions of the Government
Corporation Control Act, title 31, United States Code.
____

Millennium Challenge Act of 2003

section-by-section analysis

Section 1. Short title
This Act may be cited as the ``Millennium Challenge Act of
2003''.

TITLE I--THE MILLENNIUM CHALLENGE ACCOUNT

Sec. 101. Statement of policy
Section 101 states the objective of the Millennium
Challenge Account, which is to reduce poverty through
promoting sustained economic growth in developing countries
committed to implementing good policies.
Sec. 102. Eligibility criteria
Section 102 identifies the criteria by which countries will
be eligible to receive Millennium Challenge Account (MCA)
assistance funds. MCA assistance will go to:
Very poor countries. It is currently anticipated that in FY
2004, countries eligible for MCA funds will be those that are
currently eligible to borrow from the International
Development Association (IDA) and which have per capita
incomes below $1,435 (the historical IDA ``cutoff'' for aid).
In FY 2005, all countries with per capita incomes below
$1,435 will be eligible for MCA assistance. In FY 2006, the
list of eligible countries further expands to those with per
capita incomes up to $2,975 (the current World Bank cutoff
for lower middle income countries). The per capita income
levels will be adjusted on an annual basis.
Countries with a demonstrated commitment to ruling justly,
encouraging economic freedom, and investing in their people.
To assess this commitment and identify recipient countries,
the MCA will use clear, concrete, and objective criteria. It
is the Administration's intent that in 2004, countries will
be selected based on 16 indicators chosen because of the
relative quality and objectivity of their data, country
coverage, public availability, and correlation with growth
and poverty reduction. The specific indicators are listed
below with their source noted.
Governing Justly:
Civil Liberties (Freedom House);
Political Rights (Freedom House);
Voice and Accountability (World Bank Institute);
Government Effectiveness (World Bank Institute);
Rule of Law (World Bank Institute); and
Control of Corruption (World Bank Institute).
Investing in People:
Public Primary Education Spending as Percent of Gross
Domestic Product (GDP) (World Bank/national sources);
Primary Education Completion Rate (World Bank/national
sources);
Public Expenditures on Health as Percent of GDP (World
Bank/national sources); and
Immunization Rates: DPT (diphtheria, pertussis, tetanus)
and Measles (World Bank/UN/national sources).
Promoting Economic Freedom:
Country Credit Rating (Institutional Investor Magazine);
Inflation (International Monetary Fund [IMF]);
3-Year Budget Deficit (IMF/national sources);
Trade Policy (Heritage Foundation);
Regulatory Quality (World Bank Institute); and
Days to Start a Business (World Bank).
Countries that have signed a Millennium Challenge Contract
with the United States. The terms of this contract are
defined in Section 103 below.
Sec. 103. Millennium challenge contract
Section 103 specifies the contractual relationship between
recipient nations and the United States. Each MCA country
will negotiate and sign a Millennium Challenge Contract with
the Millennium Challenge Corporation (MCC), established in
Title II. To initiate the negotiation, the selected MCA
countries will submit country proposals for MCA funds which
integrate official interests with those of the private sector
and civil society.
The negotiated Millennium Challenge Contracts will include
a limited number of clear and measurable objectives, regular
benchmarks to measure progress toward achieving the
objectives, a plan and a timeframe describing how and when
the objectives will be met. Each contract will state the
responsibilities of the recipient country and the United
States, and describe the role and contributions of non-
governmental entities including other donors as appropriate.
In addition, all contracts will provide for the financial
accountability of MCA funds.
Sec. 104. Millennium challenge assistance
Section 104 authorizes the President to provide assistance
for activities that contribute to the achievement of the
objectives specified in the contract. These activities will
drive productivity and economic growth in MCA countries.
Areas of focus for the MCA include agricultural development,
education, enterprise and private sector promotion, good
governance, health, and trade and investment capacity
building.
Sec. 105. Authorization of the millennium challenge account
and authorities
Section 105 authorizes appropriations to the President of
$1.3 billion in FY 2004 to carry out the MCA and such sums as
may be necessary for subsequent fiscal years. It is
anticipated that funding for MCA will reach $5 billion by FY
2006. MCA funds will be available until expended (``no-year
funds''). This availability of funds allows the Corporation
to obligate funds in the most productive manner.
Section 105 allows the provision of MCA assistance to
countries notwithstanding any other provision of law with the
exception of prohibiting MCA assistance to countries that are
ineligible to receive assistance under part I of the Foreign
Assistance Act of 1961. This provision restricts or prohibits
assistance to countries that engage in actions prohibited in
part I, including countries that: violate human rights,
support trafficking in narcotics or human beings, and
contribute to terrorist financing. If the President waives
any of these provisions to make a country eligible to receive
assistance under part I of the Foreign Assistance Act, then
that country also would be eligible to receive MCA
assistance. MCA assistance would be subject to the provisions
of the Anti-Deficiency Act.
In addition, section 105 makes the authorities and
limitations that are applicable to MCA assistance applicable,
as well, to any other funds used in conjunction with MCA
funds.
Sec. 106. Evaluation and accountability
Section 106 requires the Millennium Challenge Corporation,
established in Title II, to make all concluded Millennium
Challenge Contracts and their formal performance evaluations
publicly available on the Internet. The public nature of MCA
performance information makes the recipient countries and
implementers of MCA programs directly accountable to the
citizens of MCA countries and United States taxpayers.
Sec. 107. Graduation
Participation in the MCA will be limited according to the
terms of the Millennium Challenge Contracts, which will
define the purposes, activities and timeframe. MCA assistance
will have a clearly defined end date. For example, at the
conclusion of the contract period, MCA assistance will end
unless participant countries submit a new proposal and
renegotiate a new contract with the Corporation. Each
contract will also specify the conditions under which the
contract will be amended or terminated, including for reasons
of poor performance.

TITLE II--THE MILLENNIUM CHALLENGE CORPORATION

Sec. 201. Establishment of the millennium challenge
corporation
Section 201 establishes an independent U.S. Government
Corporation that will implement the MCA according to
provisions of Title I of this Act.
Sec. 202. Management of the corporation
Section 202 establishes a board of directors for the
Corporation that will be chaired by the Secretary of State
and include the Secretary of the Treasury, and the Director
of the Office of Management and Budget. Individuals serving
in these positions in an acting capacity may serve on the
Board. The Board will direct the exercise of all functions
and powers of the Corporation, and shall make the final
decision on the eligibility and selection of MCA countries.

[[Page S3329]]

The position of the CEO of the Corporation will be a
Senate-confirmed Presidential appointment. The CEO's
compensation is fixed at the equivalent of a deputy secretary
of a department of level II of the Executive Schedule.
Sec. 203. Functions of the corporation
Section 203 authorizes the Corporation to make grants to
any private or public entity to carry out the Millennium
Challenge Contracts, to provide technical assistance to
develop or carry out the Contracts, and to provide for the
financial management and evaluation of MCA programs.
Sec. 204. Powers of the corporation
Section 204 provides general powers to the MCC to enable it
to conduct business operations. The principal office of the
MCC is to be established in the Washington, D.C. metropolitan
area. The MCC also has the authority to establish overseas
offices as it sees fit. Employees of the MCC, and individuals
detailed to the MCC, are provided the authority to hold
offices with foreign governments, foreign government
agencies, or international organizations, so long as no
compensation is paid to such employees or individuals by the
foreign entity or international organization. Contracts and
other commitments of funds may make commitments for the
expenditure of funds for such period of time as the MCC deems
necessary. This section also provides discretion to the MCC
with regard to the making, performance, amendment, or
modification of contracts, grants, and other agreements.
Finally, this section provides that the MCC and its assets
and property are to be exempt from taxation by the United
States or by any State or local taxing authority.
Sec. 205. Personnel and administrative authorities
Section 205 authorizes the CEO of the MCC, in coordination
with the Director of the Office of Personnel Management, to
establish a human resources management system for the
Corporation, including a retirement benefits program.
However, provisions of title 5 of the United States Code
related to anti-discrimination, merit systems principles,
whistle blowing, and conflicts of interest, are specifically
made applicable to the MCC. Employees of the MCC are
considered Federal employees for purposes of leave benefits,
workers compensation, unemployment benefits, life insurance,
health insurance, and long-term care insurance.
Section 205 also provides the authorities for detailing
U.S. government employees and private sector staff to the
Corporation. Federal employees have two options for serving
in the Corporation. They may be detailed on a reimbursable or
nonreimburseable basis without interruption of their civil
service status and privileges. Alternatively, they may resign
from their home agency and retain employment rights. Private
sector organizations may also detail staff to the MCC, while
continuing to pay those employees pay and benefits.
The Corporation has the authority to allocate or transfer
money to other agencies; use the services and facilities of
any U.S. agency under agreed upon terms; and use any of the
administrative authorities contained in the State Department
Basic Authorities Act of 1956 and the Foreign Assistance Act
of 1961.
Section 205 also makes the provisions of the Government
Corporation Control act applicable to the MCC.
____

To the Congress of the United States:
I am pleased to transmit a legislative proposal to
establish the Millennium Challenge Account and the Millennium
Challenge Corporation. Also transmitted is a section-by-
section analysis.
The Millennium Challenge Account (MCA) represents a new
approach to providing and delivering development assistance.
This new compact for development breaks with the past by
tying increased assistance to performance and creating new
accountability for all nations. This proposal implements my
commitment to increase current levels of core development
assistance by 50 percent over the next 3 years, thus
providing an annual increase of $5 billion by fiscal; year
2006. To be eligible for this new assistance, countries must
demonstrate commitment to three standards--ruling justly,
investing in their people, and encouraging economic freedom.
Given this commitment, and the link between financial
accountability and development success, special attention
will be given to fighting corruption.
The goal of the Millennium Challenge Account initiative is
to reduce poverty by significantly increasing economic growth
in recipient countries through a variety of targeted
investments. The MCA will be administered by a new, small
Government corporation, called the Millennium Challenge
Corporation, designed to support innovative strategies and to
ensure accountability for measurable results. The Corporation
will be supervised by a Board of Directors chaired by the
Secretary of State and composed of other Cabinet-level
officials. The Corporation will be led by a Chief Executive
Officer appointed by the President, by and with the advice
and consent of the Senate. This proposal provides the
Corporation with flexible authorities to optimize program
implementation, contracting, and personnel selection while
pursuing innovative strategies.
The Millennium Challenge Account initiative recognizes the
need for country ownership, financial oversight, and
accountability for results to ensure effective assistance. We
cannot accept permanent poverty in a world of progress. The
MCA will provide people in developing nations the tools they
need to seize the opportunities of the global economy. I urge
the prompt and favorable consideration of this legislation.
George W. Bush.
The White House February 5, 2003.
______

By Mr. FRIST:
S. 572. A bill to establish a congressional commemorative medal for
organ donors and their families; to the Committee on Banking, Housing,
and Urban Affairs.
______

By Mr. FRIST (for himself, Mr. Dodd, and Mr. Enzi):
S. 573. A bill to amend the Public Health Service Act to promote
organ donation, and for other purposes; to the Committee on Health,
Education, Labor and Pensions.
Mr. FRIST. Mr. President, this year, due to the rapid and tremendous
advancements in our knowledge and in the science of organ
transplantation, thousands of Americans will receive a life-saving
organ transplant. These advances have allowed us to save the lives of
patients who were once not considered candidates for transplantation.
As a heart and lung transplant surgeon, I have had the opportunity to
watch the field develop and grow over the past three decades. I
remember my own experiences--of conducting some of the first
transplants using hearts and lungs--and recognize our tremendous
progress since that time. And I also know the hundreds of my own
patients who live improved lives due to advances in transplantation.
But I have also shared in the grief of patients who died before they
could receive a transplant--a direct result of a large and growing
shortage of organ donors. Medical advances have produced a staggering
increase in the number of eligible transplant candidates, while the
supply of organs fails to keep pace. Today, more than 80,000 patients
await a transplant (a four-fold increase from just over a decade ago).
At the same time, more patients die each year before they can receive
that life-saving organ.
I have also witnessed firsthand how great, lifesaving hope can spring
from great tragedy. Earlier this year, I offered my assistance at the
scene of a horrible automobile accident in Florida. Most of the family
in the accident died--including two young children. While my heart goes
out to his family for their terrible loss, from this tragedy has come
new life. This family agreed to donate the organs of their loved ones.
This gift has saved the life of a boy from the Virgin Islands. We must
honor this family, and all other donor families, by redoubling our
efforts to increasing organ donation.
There is no need for people to die while awaiting a new organ. In my
practice, I carried a card that listed my patients who were waiting on
hearts--always aware that several of them would die before a live-
saving organ would become available. It was this needless loss of life
that was the most painful, most frustrating and most disappointing part
of my work.
In 2000, there were almost 23,000 transplants--a significant increase
over the roughly 13,000 transplant performed in 1988. Between 1990 and
2001, the number of organ donors almost doubled, mainly as a result of
an increase in organs from live donors. In fact, over those ten years,
the number of cadaveric donors increased only 35 percent while the
demand for transplant has more than tripled.
More must be done. There are simply not enough organ donors; public
awareness has not kept up with the rapid advances of transplantation.
It is our duty to do all we can to raise awareness about the gift of
life.
We must do is work to encourage all Americans to share their desire
to be an organ donor with their families.
We must find other ways to improve organ donation--to identify
eligible organs and work with families to help them better understand
the value of donation. This is a new science--one that I have had the
privilege of watching firsthand grow from theories and experiments to
accepted medical practice. My mentor, Dr. Norman Shumway, was one of
the leaders in the field; and the advent of cyclosporin was critical to
its progress. But much remains to be learned, and we must continue to
move forward.
That is why one of my first priorities when I came to the Senate in
1995 was

[[Page S3330]]

to establish the Congressional Task Force on Organ Donation--to promote
awareness of this important issue and encourage a new dialogue seeking
answers.
Recent years have witnessed a new emphasis on highlighting public
awareness of this need. In particular, I commend Secretary Thompson for
making organ donation a top priority at the Department of Health and
Human Services.
There also are a number of complementary legislative approaches that
we should pursue towards this end.
We should provide funding for innovative and bold demonstration
projects to improve donation and recovery rates. As part of this, we
should ensure that the projects' results will be evaluated quickly and
their lessons be disseminated broadly.
We should provide for the placement and evaluation of organ donation
coordinators in hospitals--a model that has worked with success in
other countries.
We should expand the authority of the Agency for Healthcare Research
and Quality to conduct important research on the recovery, preservation
and transportation of organs. The science of organ transplantation has
been improved and refined since its inception. Yet all too often, organ
donation efforts are conducted under the same practices as they were
twenty years ago. We must establish a strong evidence-based approach to
enhancing organ donation and recovery.
We must encourage living organ donation by reducing potential
financial disincentives facing living donors through the reimbursement
of travel and other expenses incurred by living donors and their
families.
We must also seriously evaluate the long-term health effects of
serving as a living donor by asking the Institute of Medicine to report
on this issue and by establishing a living donor registry to track the
health of individuals who have served as living organ donors.
We must seriously examine and improve the role of organ donor
registries. These programs have an important role to play in improving
organ donation rates and have been used with different levels of
success in some states. However, a number of questions surrounding
registries remain unanswered and their effectiveness has not been fully
evaluated.
We must undertake a high-level systematic examination of the
effectiveness of a range of organ donation approaches. Specifically,
the Institute of Medicine should evaluate practices or organ
procurement organizations, States, and other countries. This study
should examine existing barriers to organ donation, as well as best
donation and recovery practices, such as mandated choice and presumed
consent. The study should evaluate consent practices, existing state
routine notification laws, and the impact of requests for consent where
registry listing constitutes express consent under State law. This
review should be timely and include recommendations for action
necessary to replicate the best practices identified and to otherwise
increase organ donation rates.
We must recognize and honor the sacrificial decisions to give consent
and give the gift of life made each year by thousands of donors and
families. We must do this in such a way as to honor those sharing life
through donation and increase public awareness of this issue.
These initiatives are contained within two important pieces of
legislation I am introducing today.
The Organ Donation and Recovery Improvement Act is a bipartisan,
comprehensive bill that seeks to improve the overall process of organ
donation and recovery, enhance our knowledge base in these fields,
encourage novel approaches to this growing problem and increase the
number of organs available for transplants each year. The bill also
seeks to remove potential barriers to donation, while identifying and
focusing on best practices in organ donation. I thank Senator
Christopher Dodd and Senator Mike Enzi for their assistance on this
important bill. I also want to thank the wide range of patient and
organ transplantation organizations who have done good work on this
bill, including the American Society of Transplantation, American
Society of Transplant Surgeons, North American Transplant Coordinators
Organization, Tennessee Donor Services, New Mexico Donor Services, and
Golden State Donor Services.
The Gift of Life Congressional Medal Act will make each donor or
donor family eligible to receive a commemorative Congressional medal.
This legislation, which does not cost taxpayers a penny, will recognize
the thousands of individuals each year who share the gift of life
through organ donation. Moreover, it will encourage potential donors
and enhance public awareness of the importance of organ donation to the
over 80,000 Americans waiting for a transplant. Representative Pete
Stark will soon be introducing the companion bill in the House of
Representatives, and I thank him for his dedication in this area.
Organ donation is one of the most important issues before us today.
Each year, thousands of donors and families make the important decision
to give consent and give the gift of life. We must recognize and honor
their sacrifice, and, in so honoring, work to increase donation rates
and allow more families to receive this gift of life each year.
Hundreds of my own patients are alive today because of this gift. Let
us work together to allow more patients and families to experience this
miracle.
I ask unanimous consent that the text of the bills printed in the
Record.

S. 572

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 ``Gift of Life Congressional
Medal Act of 2003''.

SEC. 2. CONGRESSIONAL MEDAL.

The Secretary of the Treasury shall design and strike a
bronze medal with suitable emblems, devices, and
inscriptions, to be determined by the Secretary of the
Treasury, to commemorate organ donors and their families.

SEC. 3. ELIGIBILITY REQUIREMENTS.

(a) In General.--Any organ donor, or the family or family
member of any organ donor, shall be eligible for a medal
described in section 2.
(b) Documentation.--The Secretary of Health and Human
Services shall direct the entity holding the Organ
Procurement and Transplantation Network (hereafter in this
Act referred to as ``OPTN'') to contract to--
(1) establish an application procedure requiring the
relevant organ procurement organization, as described in
section 371(b)(1) of the Public Health Service Act (42 U.S.C.
273(b)(1)), through which an individual or their family made
an organ donation, to submit to the OPTN contractor
documentation supporting the eligibility of that individual
or their family to receive a medal described in section 2;
and
(2) determine, through the documentation provided, and, if
necessary, independent investigation, whether the individual
or family is eligible to receive a medal described in section
2.

SEC. 4. PRESENTATION.

(a) Delivery to the Secretary of Health and Human
Services.--The Secretary of the Treasury shall deliver medals
struck pursuant to this Act to the Secretary of Health and
Human Services.
(b) Delivery to Eligible Recipients.--The Secretary of
Health and Human Services shall direct the OPTN contractor to
arrange for the presentation to the relevant organ
procurement organization all medals struck pursuant to this
Act to individuals or families that, in accordance with
section 3, the OPTN contractor has determined to be eligible
to receive medals under this Act.
(c) Limitation.--
(1) In general.--Except as provided in paragraph (2), only
1 medal may be presented to a family under subsection (b).
Such medal shall be presented to the donating family member,
or in the case of a deceased donor, the family member who
signed the consent form authorizing, or who otherwise
authorized, the donation of the organ involved.
(2) Exception.--In the case of a family in which more than
1 member is an organ donor, the OPTN contractor may present
an additional medal to each such organ donor or their family.

SEC. 5. DUPLICATE MEDALS.

(a) In General.--The Secretary of Health and Human Services
or the OPTN contractor may provide duplicates of the medal
described in section 2 to any recipient of a medal under
section 4(b), under such regulations as the Secretary of
Health and Human Services may issue.
(b) Limitation.--The price of a duplicate medal shall be
sufficient to cover the cost of such duplicates.

SEC. 6. NATIONAL MEDALS.

The medals struck pursuant to this Act are national medals
for purposes of section 5111 of title 31, United States Code.

SEC. 7. GENERAL WAIVER OF PROCUREMENT REGULATIONS.

No provision of law governing procurement or public
contracts shall be applicable to the procurement of goods or
services necessary for carrying out the provisions of this
Act.

SEC. 8. SOLICITATION OF DONATIONS.

(a) In General.--The Secretary of the Treasury may enter
into an agreement with the OPTN contractor to collect funds
to offset expenditures relating to the issuance of medals
authorized under this Act.

[[Page S3331]]

(b) Payment of Funds.--
(1) In general.--Except as provided in paragraph (2), all
funds received by the Organ Procurement and Transplantation
Network under subsection (a) shall be promptly paid by the
Organ Procurement and Transplantation Network to the
Secretary of the Treasury.
(2) Limitation.--Not more than 5 percent of any funds
received under subsection (a) shall be used to pay
administrative costs incurred by the OPTN contractor as a
result of an agreement established under this section.
(c) Numismatic Public Enterprise Fund.--Notwithstanding any
other provision of law--
(1) all amounts received by the Secretary of the Treasury
under subsection (b)(1) shall be deposited in the Numismatic
Public Enterprise Fund, as described in section 5134 of title
31, United States Code; and
(2) the Secretary of the Treasury shall charge such fund
with all expenditures relating to the issuance of medals
authorized under this Act.
(d) Start-Up Costs.--A 1-time amount not to exceed $55,000
shall be provided to the OPTN contractor to cover initial
start-up costs. The amount will be paid back in full within 3
years of the date of the enactment of this Act from funds
received under subsection (a).
(e) No Net Cost to the Government.--The Secretary of the
Treasury shall take all actions necessary to ensure that the
issuance of medals authorized under section 2 results in no
net cost to the Government.

SEC. 9. DEFINITIONS.

In this Act:
(1) Organ.--The term ``organ'' means the human kidney,
liver, heart, lung, pancreas, and any other human organ
(other than corneas and eyes) specified by regulation of the
Secretary of Health and Human Services or the OPTN
contractor.
(2) Organ procurement and transplantation network.--The
term ``Organ Procurement and Transplantation Network'' means
the Organ Procurement and Transplantation Network established
under section 372 of the Public Health Service Act (42 U.S.C.
274).

SEC. 10. SUNSET PROVISION.

This Act shall be effective during the 5-year period
beginning on the date of the enactment of this Act.

S. 573

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 ``Organ Donation and Recovery
Improvement Act''.

TITLE I--ORGAN DONATION AND RECOVERY

SEC. 101. INTERAGENCY TASK FORCE ON ORGAN DONATION.

Part H of title III of the Public Health Service Act (42
U.S.C. 273 et seq.) is amended--
(1) by redesignating section 378 (42 U.S.C. 274g) as
section 378E; and
(2) by inserting after section 377 (42 U.S.C. 274f) the
following:

``SEC. 378. INTER-AGENCY TASK FORCE ON ORGAN DONATION AND
RESEARCH.

``(a) In General.--The Secretary shall establish an inter-
agency task force on organ donation and research (referred to
in this section as the `task force') to improve the
coordination and evaluation of--
``(1) federally supported or conducted organ donation
efforts and policies; and
``(2) federally supported or conducted basic, clinical and
health services research (including research on preservation
techniques and organ rejection and compatibility).
``(b) Composition.--
``(1) In general.--The task force shall be composed of--
``(A) the Surgeon General, who shall serve as the
chairperson; and
``(B) representatives to be appointed by the Secretary from
relevant agencies within the Department of Health and Human
Services (including the Health Resources and Services
Administration, Centers for Medicare & Medicaid Services,
National Institutes of Health, and Agency for Healthcare
Research and Quality).
``(2) Other ex officio members.--The Secretary shall invite
the following individuals to serve as ex officio members of
the task force:
``(A) A representative from the Department of
Transportation.
``(B) A representative from the Department of Defense.
``(C) A representative from the Department of Veterans
Affairs.
``(D) A representative from the Office of Personnel
Management.
``(E) A physician representatives from the board of
directors of the Organ Procurement and Transplantation
Network.
``(F) Representatives of other Federal agencies or
departments as determined to be appropriate by the Secretary.
``(c) Annual Report.--In addition to activities carried out
under subsection (a), the task force shall support the
development of the annual report under section 378D(c).
``(d) Termination.--The task force may be terminated at the
discretion of the Secretary following the completion of at
least 2 annual reports under section 378D(c). Upon such
termination, the Secretary shall provide for the on-going
coordination of federally supported or conducted organ
donation and research activities.''.

SEC. 102. DEMONSTRATION PROJECTS, EDUCATION, AND PUBLIC
AWARENESS.

Part H of title III of the Public Health Service Act (42
U.S.C 273 et seq.) is amended by inserting after section 378,
as added by section 101, the following:

``SEC. 378A. DEMONSTRATION PROJECTS, EDUCATION, AND PUBLIC
AWARENESS.

``(a) Grants To Increase Donation Rates.--The Secretary
shall award peer-reviewed grants to public and non-profit
private entities, including States, to carry out studies and
demonstration projects to increase organ donation and
recovery rates, including living donation.
``(b) Organ Donation Public Awareness Program.--The
Secretary shall establish a public education program in
cooperation with existing national public awareness campaigns
to increase awareness about organ donation and the need to
provide for an adequate rate of such donations.
``(c) Development of Curricula and Other Education
Activities.--
``(1) In general.--The Secretary, in coordination with the
Organ Procurement and Transplantation Network and other
appropriate organizations, shall support the development and
dissemination of model curricula to train health care
professionals and other appropriate professionals (including
religious leaders in the community, funeral directors, and
law enforcement officials) in issues surrounding organ
donation, including methods to approach patients and their
families, cultural sensitivities, and other relevant issues.
``(2) Health care professionals.--For purposes of
subparagraph (A), the term `health care professionals'
includes--
``(A) medical students, residents and fellows, attending
physicians (through continuing medical education courses and
other methods), nurses, social workers, and other allied
health professionals; and
``(B) hospital- or other health care-facility based
chaplains; and
``(C) emergency medical personnel.
``(d) Limited Demonstration Projects.--
``(1) Reports.--Not later than 1 year after the date of
enactment of this section, the Secretary shall prepare and
submit to the appropriate committees of Congress a report
evaluating the ethical implications of proposals for
demonstration projects to increase cadaveric donation.
``(2) Authority.--Notwithstanding section 301 of the
National Organ Transplant Act (42 U.S.C. 274e), upon the
submission of and consistent with the report by the Secretary
under paragraph (1), the Secretary may conduct up to 3
demonstration projects to increase cadaveric donation.
``(3) Duration.--Each project shall last no more than 3
years, and shall be conducted in a limited number of sites or
areas.
``(4) Review.--The Secretary shall provide for the ongoing
ethical review and evaluation of such projects to ensure that
such projects are administered effectively as possible and in
accordance with the stated purpose of this subsection under
paragraph (2).
``(e) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section, $5,000,000 for
fiscal year 2004, and such sums as may be necessary for each
of the fiscal years 2005 through 2008.

``SEC. 378B. GRANTS REGARDING HOSPITAL ORGAN DONATION
COORDINATORS.

``(a) Authority.--
``(1) In general.--The Secretary may award grants to
qualified organ procurement organizations under section 371
to establish programs coordinating organ donation activities
of eligible hospitals and qualified organ procurement
organizations under section 371. Such activities shall be
coordinated to increase the rate of organ donations for such
hospitals.
``(2) Eligible hospital.--For purposes of this section, an
eligible hospital is a hospital that performs significant
trauma care, or a hospital or consortium of hospitals that
serves a population base of not fewer than 200,000
individuals.
``(b) Administration of Coordination Program.--A condition
for the receipt of a grant under subsection (a) is that the
applicant involved agree that the program under such
subsection will be carried out jointly--
``(1) by representatives from the eligible hospital and the
qualified organ procurement organization with respect to
which the grant is made; and
``(2) by such other entities as the representatives
referred to in paragraph (1) may designate.
``(c) Evaluations.--Within 3 years after the award of
grants under this section, the Secretary shall ensure an
evaluation of programs carried out pursuant to subsection (a)
in order to determine the extent to which the programs have
increased the rate of organ donation for the eligible
hospitals involved. Such evaluation shall include
recommendations on whether the program should be expanded to
include other grantees, such as hospitals.
``(d) Matching Requirement.--The Secretary may not award a
grant to a qualifying organ donation entity under this
section unless such entity agrees that, with respect to costs
to be incurred by the entity in carrying out activities for
which the grant was awarded, the entity shall contribute
(directly or through donations from public or private
entities) non-Federal contributions in cash or in kind, in an
amount equal to not less than 30 percent of the amount of the
grant awarded to such entity.
``(e) Funding.--For the purpose of carrying out this
section, there are authorized to be appropriated $3,000,000
for fiscal year 2004,

[[Page S3332]]

and such sums as may be necessary for each of fiscal years
2005 through 2008.''.

SEC. 103. STUDIES RELATING TO ORGAN DONATION AND THE
RECOVERY, PRESERVATION, AND TRANSPORTATION OF
ORGANS.

Part H of title III of the Public Health Service Act (42
U.S.C 273 et seq.) is amended by inserting after section
378B, as added by section 102, the following:

``SEC. 378C. STUDIES RELATING TO ORGAN DONATION AND THE
RECOVERY, PRESERVATION, AND TRANSPORTATION OF
ORGANS.

``(a) Development of Supportive Information.--The
Secretary, acting through the Administrator of the Health
Resources and Services Administration and the Director of the
Agency for Healthcare Research and Quality shall develop
scientific evidence in support of efforts to increase organ
donation and improve the recovery, preservation, and
transportation of organs.
``(b) Activities.--In carrying out subsection (a), the
Secretary shall--
``(1) conduct or support evaluation research to determine
whether interventions, technologies, or other activities
improve the effectiveness, efficiency, or quality of existing
organ donation practice;
``(2) undertake or support periodic reviews of the
scientific literature to assist efforts of professional
societies to ensure that the clinical practice guidelines
that they develop reflect the latest scientific findings;
``(3) ensure that scientific evidence of the research and
other activities undertaken under this section is readily
accessible by the organ procurement workforce; and
``(4) work in coordination with the appropriate
professional societies as well as the Organ Procurement and
Transplantation Network and other organ procurement and
transplantation organizations to develop evidence and promote
the adoption of such proven practices.
``(c) Research, Demonstrations, and Training.--The
Secretary, acting through the Administrator of the Health
Resources and Services Administration and the Director of the
Agency for Healthcare Research and Quality, as appropriate,
shall provide support for research, demonstrations, and
training as appropriate, to--
``(1) develop a uniform clinical vocabulary for organ
recovery;
``(2) apply information technology and telecommunications
to support the clinical operations of organ procurement
organizations;
``(3) enhance the skill levels of the organ procurement
workforce in undertaking quality improvement activities; and
``(4) assess specific organ recovery, preservation, and
transportation technologies.
``(d) Authorization of Appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated $5,000,000 for fiscal year 2004, and such sums
as may be necessary for each of fiscal years 2005 through
2008.''.

SEC. 104. REPORTS.

Part H of title III of the Public Health Service Act (42
U.S.C. 273 et seq.) is amended by inserting after section
378C, as added by section 103, the following:

``SEC. 378D. REPORTS.

``(a) IOM Report on Best Practices.--
``(1) In general.--The Secretary shall enter into a
contract with the Institute of Medicine to conduct an
evaluation of the organ donation practices of organ
procurement organizations, States, other countries, and other
appropriate organizations.
``(2) Considerations.--In conducting the evaluation under
paragraph (1), the Institute of Medicine shall examine--
``(A) existing barriers to organ donation, including among
minority populations; and
``(B) best donation and recovery practices, including--
``(i) mandated choice and presumed consent;
``(ii) organ procurement organization and provider consent
practices (including consent best practices);
``(iii) the efficacy and reach of existing State routine
notification laws with respect to organ procurement
organizations;
``(iv) the impact of requests for consent in States where
registry registration constitutes express consent under State
law; and
``(v) recommendations with respect to achieving higher
donation rates, including among minority populations.
``(3) Report.--Not later than 18 months after the date of
enactment of this section, the Institute of Medicine shall
submit to the Secretary a report concerning the evaluation
conducted under this subsection. Such report shall include
recommendations for administrative actions and, if necessary,
legislation in order to replicate the best practices
identified in the evaluation and to otherwise increase organ
donation and recovery rates.
``(b) IOM Report on Living Donations.--
``(1) In general.--The Secretary shall enter into a
contract with the Institute of Medicine to conduct an
evaluation of living donation practices and procedures. Such
evaluation shall include, but is not limited to an assessment
of issues relating to informed consent and the health risks
associated with living donation (including possible reduction
of long-term effects).
``(2) Report.--Not later than 18 months after the date of
enactment of this section, the Institute of Medicine shall
submit to the Secretary a report concerning the evaluation
conducted under this subsection.
``(c) Report on Donation and Recovery Activities.--
``(1) In general.--The Secretary as part of the report
specified in 274d shall submit an evaluation concerning
federally supported or conducted organ donation and recovery
activities, including donation and recovery activities
evaluated or conducted under the amendments made by the Organ
Donation and Recovery Improvement Act to increase organ
donation and recovery rates.
``(2) Requirements.--To the extent practicable, each
evaluation submitted under paragraph (1) shall--
``(A) evaluate the effectiveness of activities, identify
best practices, and make recommendations regarding the
adoption of best practices with respect to organ donation and
recovery; and
``(B) assess organ donation and recovery activities that
are recently completed, ongoing, or planned.''.

SEC. 105. TECHNICAL AMENDMENT CONCERNING ORGAN PURCHASES.

Section 301(c)(2) of the National Organ Transplant Act (42
U.S.C. 274e(c)(2)) is amended by adding at the end the
following: ``Such term does not include familial, emotional,
psychological, or physical benefit to an organ donor,
recipient, or any other party to an organ donation event.''.

TITLE II--LIVING DONATION EXPENSES

SEC. 201. REIMBURSEMENT OF TRAVEL AND SUBSISTENCE EXPENSES
INCURRED TOWARD LIVING ORGAN DONATION.

Section 377 of the Public Health Service Act (42 U.S.C.
274f) is amended to read as follows:

``SEC. 377. REIMBURSEMENT OF TRAVEL AND SUBSISTENCE EXPENSES
INCURRED TOWARD LIVING ORGAN DONATION.

``(a) In General.--The Secretary may award grants to
States, transplant centers, qualified organ procurement
organizations under section 371, or other public or private
entities for the purpose of--
``(1) providing for the reimbursement of travel and
subsistence expenses incurred by individuals toward making
living donations of their organs (in this section referred as
`donating individuals'); and
``(2) providing for the reimbursement of such incidental
nonmedical expenses that are so incurred as the Secretary
determines by regulation to be appropriate.
``(b) Preference.--The Secretary shall, in carrying out
subsection (a), give preference to those individuals that the
Secretary determines are more likely to be otherwise unable
to meet such expenses.
``(c) Certain Circumstances.--The Secretary may, in
carrying out subsection (a), consider--
``(1) the term `donating individuals' as including
individuals who in good faith incur qualifying expenses
toward the intended donation of an organ but with respect to
whom, for such reasons as the Secretary determines to be
appropriate, no donation of the organ occurs; and
``(2) the term `qualifying expenses' as including the
expenses of having relatives or other individuals, not to
exceed 2, who accompany or assist the donating individual for
purposes of subsection (a) (subject to making payment for
only such types of expenses as are paid for donating
individual).
``(d) Relationship to Payments Under Other Programs.--An
award may be made under subsection (a) only if the applicant
involved agrees that the award will not be expended to pay
the qualifying expenses of a donating individual to the
extent that payment has been made, or can reasonably be
expected to be made, with respect to such expenses--
``(1) under any State compensation program, under an
insurance policy, or under any Federal or State health
benefits program;
``(2) by an entity that provides health services on a
prepaid basis; or
``(3) by the recipient of the organ.
``(e) Authorization of Appropriations.--For the purpose of
carrying out this section, there is authorized to be
appropriated $5,000,000 for fiscal year 2004, and such sums
as may be necessary for each of fiscal years 2005 through
2008.''.

TITLE III--ORGAN REGISTRIES

SEC. 301. ADVISORY COMMITTEE.

Part H of title III of the Public Health Service Act (42
U.S.C. 273 et seq.) is amended by inserting after section 371
the following:

``SEC. 371A. ADVISORY COMMITTEE.

``(a) In General.--Not later than 6 months after enactment,
the Secretary shall establish an advisory committee to study
existing organ donor registries and make recommendations to
Congress regarding the costs, benefits, and expansion of such
registries.
``(b) Membership.--The committee shall be composed of 10
members of whom--
``(1) at least 1 member shall be a physician with
experience performing transplants;
``(2) at least 1 member shall have experience in organ
recovery;
``(3) at least 1 member shall be representative of an
organization with experience conducting national awareness
campaigns and donor outreach;
``(4) at least 1 member shall be representative of a State
with an existing donor registry;
``(5) at least 1 member shall have experience with national
information systems where coordination occurs with State-
based systems; and

[[Page S3333]]

``(6) at least 1 member shall represent donor families,
transplant recipients, and those awaiting transplantation.
``(c) Initial Meeting.--Not later than 30 days after the
date on which all members of the committee have been
appointed, the committee shall hold its first meeting.
``(d) Meetings.--The committee shall meet at the call of
the Chairman who shall be selected by the Secretary.
``(e) Compensation.--Each member of the committee shall not
receive compensation for services provided under this
section.
``(f) Travel Expenses.--The members of the committee 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 committee.
``(g) Administrative Support.--The Secretary shall ensure
that the committee is provided with administrative support or
any other technical assistance that such committee needs in
carrying out its duties.
``(h) Permanent Committee.--Section 14 of the Federal
Advisory Committee Act shall not apply to the committee
established under this section.
``(i) Report.--Not later than 1 year after the date on
which the committee is established under subsection (a), the
committee shall prepare and submit to Congress a report
regarding the status of organ donor registries, current best
practices, the effect of organ donor registries on organ
donation rates, the merits of expanding organ donor
registries, issues relating to consent, the efficacy of
current privacy protections, potential forms of technical
assistance, and recommendations regarding improving the
effectiveness and establishing formal linkages between organ
donor registries.
``(j) Definition.--In this section, the term `organ donor
registry' means a listing of individuals who have indicated
their desire to donate their organs and tissue upon their
death through driver's license preferences or other formal
mechanisms.''.

SEC. 302. NATIONAL LIVING DONOR REGISTRY.

Part H of title III of the Public Health Service Act (42
U.S.C. 273 et seq.), as amended by section 301, is further
amended by inserting after section 371A the following:

``SEC. 371B. NATIONAL LIVING DONOR REGISTRY.

``The Secretary shall by contract establish and maintain a
registry of individuals who have served as living organ
donors for the purpose of evaluating the long-term health
effects associated with living organ donations.''.

SEC. 303. QUALIFIED ORGAN PROCUREMENT ORGANIZATIONS.

Section 371(a) of the Public Health Service Act (42 U.S.C.
273(a)) is amended by striking paragraph (3).
Mr. DODD. Mr. President, for tragic reasons, organ donation has been
in the spotlight of late. On Saturday, February 23, 2002, 17-year-old
Jessica Santillan died after receiving organs from a donor with an
incompatible blood type. I would like to take this opportunity to
express my heartfelt condolences to Jessica's family and friends.
While it is critical to understand how mistakes led to Jessica's
death, and how they can be avoided in the future, this tragic incident
should not diminish our commitment to organ donation--a procedure that
saves thousand of lives each year, and was in fact Jessica's only
chance for survival. Instead, we should make a commitment to increasing
our donation rates and saving even more lives.
Today, I am pleased to reintroduce legislation with Senator Bill
Frist to do just that. The Organ Donation and Recovery Improvement Act,
which Senator Frist and I originally introduced last Congress, will
bring positive attention to this critical public health issue by
increasing resources and coordinating efforts to improve organ donation
and recovery. I am proud to be working with my friend and colleague,
Senator Frist, whose leadership and professional experience as a heart
and lung transplant surgeon has been critical in making this issue a
priority.
At this very moment, more than 80,000 people are waiting for an organ
transplant, and one person is added to this list every thirteen
minutes. This list has increased from 19,095 people a decade ago.
Unfortunately, the discrepancy between the need and the number of
available organs is growing exponentially. From 1999 to 2000,
transplant waiting lists grew by 10.2 percent, while the total increase
in donations grew by 5.3 percent. Tragically, in 2000, approximately
5,500 wait-listed patients died waiting for an organ.
Undoubtedly, the task before our nation in caring for these patients
seems daunting. However, each person who makes the decision to donate
can save as many as three lives. None of us wants to imagine the
anguish of watching a family member or a friend wait for an organ
transplant hoping that their name reaches the top of the list before
their damaged organ fails or having to bear the emotional, physical, or
financial costs of undergoing a transplant procedure. For those that
do, and for all of those that will, we must improve and strengthen our
systems of organ donation and recovery. The legislation that Senator
Frist and I are introducing today represents a significant step towards
this goal. It would establish a task force to evaluate and improve
federal efforts relating to organ donation and transplantation
research, and would also authorize $3 million in fiscal year 2004 and
such sums as may be necessary in fiscal years 2005 through 2008 for
grants to Organ Procurement Organizations to coordinate donation
activities between hospitals.
A vital part of increasing donations lies in education and public
awareness initiatives. This legislation would authorize $5 million in
fiscal year 2004 and such sums as may be necessary in fiscal years 2005
through 2008 to educate the public about issues surrounding organ
donation, as well as train health care providers and other appropriate
professionals in the best methods to use when approaching possible
donors and their families. This funding could also be used for other
demonstration projects to increase organ donation and recovery rates.
In addition, an equal amount is authorized to expand the Agency for
Health Care Research and Quality's authority to improve organ donation
practices.
We must also work to remove the barriers that stand in a donor's way
as he or she seeks to help another person continue life. Our bill would
seek to expand living donation by authorizing $5 million in fiscal year
2004 and such sums as may be necessary in fiscal years 2005 through
2008 for the reimbursement of related expenses incurred by the donor.
In addition, this legislation requests an Institute of Medicine report
on living donation practices and potential long-term health risks.
Finally, we must work to improve the science of donation and
recovery, and address legal issues relating to donation, including
consent. More than 20 states currently have registries that may prove
indispensable in ensuring that we honor a donor's wishes. This bill
would establish an advisory committee to study the benefits, and
potential shortcomings, of these arrangements and work to create a
national sense of urgency that matches the national need for donors.
I would like to recognize the invaluable support and guidance we
received in drafting this bill from the American Society of
Transplantation, the American Liver Foundation, the Patient Access to
Transplantation Coalition, the North American Transplant Coordinators
Organization, and the National Kidney Foundation. I would be remiss not
to also mention the Association of Organ Procurement Organizations,
whose members nationwide have worked so tirelessly to bridge the gap
between the immense need for and the inadequate supply of donated
organs. In my home state of Connecticut, we are well-served by the
tremendous work of the Northeast Organ Procurement Organization and the
New England Organ Bank.
Finally, I look forward to working with my colleagues, including
Senator Kennedy, Senator Gregg, and Senator Durbin, whose commitment to
this issue has been unparalleled. I urge Congress to take swift action
on this bipartisan legislation aimed at increasing organ donation and
saving lives.

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