[Congressional Record Volume 149, Number 85 (Wednesday, June 11, 2003)]
[Extensions of Remarks]
[Pages E1215-E1217]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




INTRODUCTION OF THE INDIAN HEALTH CARE IMPROVEMENT ACT REAUTHORIZATION 
                               IN FY 2003

                                 ______
                                 

                             HON. DON YOUNG

                               of alaska

                    in the house of representatives

                        Wednesday, June 11, 2003

  Mr. YOUNG of Alaska. Mr. Speaker, I rise today to introduce 
amendments to the Indian Health Care Improvement Act. I am pleased to 
be joined in the co-sponsorship of this measure by both Republican and 
Democratic members of the U.S. House of Representatives.
  The Indian Health Care Improvement Act (IHCIA) became Public Law 94-
437 in the 94th Congress (September 30, 1976), and was amended by:
  P.L. 96-537--December 17, 1980;
  P.L. 100-579--October 31, 1988;
  P.L. 100-690--November 18, 1988;
  P.L. 100-713--November 23, 1988;
  P.L. 101-630--November 28, 1990;
  P.L. 102-573--October 29, 1992; and
  P.L. 104-313--October 19, 1996.
  The purpose of the Act is to implement the Federal responsibility for 
the care and education of the Indian people by improving the services 
and facilities of Federal Indian health programs and encouraging the 
maximum participation of American Indians and Alaska Natives in such 
programs, and other purposes.
  The IHCIA provides for health care delivery to over 2 million 
American Indians and Alaska Natives. Congress enacted a one-year 
extension to extend the life of the Act through FY 2001 but efforts at 
further extensions were interrupted due to 9/11/01 events. 
Appropriations for Indian health have continued through authorization 
of the Snyder Act, a permanent law authorizing expenditures of funds 
for a variety of Indian programs, including health. For FY 2003, 
Congress appropriated $2.9 billion to help provide health care services 
to American Indians and Alaska Natives. The IHCIA requires 
Reauthorization this year.
  Since 1998, the Indian Health Service (IHS) started the 
reauthorization process under the IHS's Tribal Consultation Policy by 
conveying

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a Roundtable to begin the discussion of the reauthorization and to give 
guidance to the consultation process which included all stakeholders, 
I/T/U (Indian Health Service/Tribes/Urban).
  Coordinators from the 12 IHS areas formed workgroups of I/T/U and 
National Indian Health Board (NIHB) representatives. These meetings 
were to inform the I/T/U's about the reauthorization process, and 
provide opportunities to discuss and reach consensus on recommendations 
for the Act.
  Four regional consultation meetings were held to provide further 
opportunities for I/T/U's to provide input, share recommendations from 
the 12 IHS Areas, and build consensus among participants for a unified 
position. The final report entitled ``Speaking with One Voice'' 
identified areas of consensus and differences.

  The IHS Director convened a National Steering Committee (NSC) to be 
responsible for the final drafting of the report on the IHCIA 
recommendations. The NSC is composed of one elected and one alternative 
tribal representative from each of the 12 IHS Areas, a representative 
from the National Indian Health Board, National Council of Urban Indian 
Health, and the Self-Governance Advisory Committee. During the course 
of the 4 meetings, this group's responsibility evolved from compiling a 
final report of recommendations to the drafting of the actual IHCIA 
reauthorization bill language.
  During the last year and a half, House Resources Committee, Office of 
Native American and Insular Affairs Committee staff, Cynthia A. 
Ahwinona, has traveled to ``American Indian and Alaska Natives 
country'' to observe the work of the NSC of the tribal leaders 
comprised to propose IHCIA reauthorization revisions to Congress. The 
draft bill was drafted by dozens of tribal attorneys and had technical, 
legal citation errors and, in some instances, was drafted very poorly 
and did not accomplish what was intended by the NSC.
  As consensus was arrived, House Resources Committee and several 
members of the NSC met with House Legislative Counsel, Lisa Daly, 
Edward Grossman and Pierre Poisson in person and via teleconference to 
start the redrafting of the bill. Invited participants included both 
the Republican and Democratic health staff of the House Resources 
Committee and the Senate Committee on Indian Affairs, a representative 
from the National Indian Health Board, representatives of the IHS, and 
tribal attorneys from the NSC.
  I want to personally thank Lisa Daly, Edward Grossman and Pierre 
Poisson of the House Legislative Counsel, Myra Munson of Sonosky, 
Chambers, Sachse, Endrieson and Perry, LLP. and Carol Barbero of Hobbs, 
Straus, Dean and Walker for all their efforts in the drafting of this 
bill. Thank you all, you have done a wonderful job. Attached is brief 
summary of each Title of the Indian Health Care Improvement Act 
Reauthorization of FY 03.

      Indian Health Care Improvement Act Reauthorization of FY 03

       Section 1. Short Title.
       Section 2. Findings. Sets forth the national goal of the 
     U.S. in providing the quantity and quality of health services 
     to bring the health status of Indians to the highest possible 
     level.
       Section 3. Declaration of Health Objectives. Sets forth 6 
     Health Status Objectives to be reached by the year 2010.
       Section 4. Definitions. States the definitions of terms 
     used throughout the Act.


                    title i. indian health manpower

       The purpose of this title is to increase, to the maximum 
     extent feasible, the number of American Indians and Alaska 
     natives entering the health professions. It also seeks to 
     assure an adequate supply of health professionals to the 
     Service, Indian tribes, tribal organizations, and urban 
     Indian organizations involved in the delivery of health care 
     to American Indians and Alaska natives. This title covers 
     recruitment, scholarships, extern programs, continuing 
     education, community health representatives, loan repayment, 
     advanced training and research, nursing, tribal cultural and 
     history, inmed, health training, incentives, residency, 
     community health aide for Alaska, and a University of South 
     Dakota pilot project.


                       title ii. health services

       The purpose of this title is to establish programs that 
     respond to the health needs of American Indians and Alaska 
     natives. For example, American Indians and Alaska natives 
     have a disproportionately high rate of diabetes (death rate 
     for this disease is more than 300% of the rate for the U.S. 
     population generally), so this title has a specific diabetes 
     provision. It also includes the Indian Health Care 
     Improvement Fund through which the Appropriation Acts supply 
     funds to eliminate health deficiencies and disparities in 
     resources made available to American Indians and Alaska 
     Native tribes and communities. This title contains 
     catastrophic health emergency fund; health promotion and 
     disease prevention services; diabetes prevention, treatment 
     and control; hospice feasibility; research; mental health; 
     managed care feasibility; Arizona, North Dakota, South 
     Dakota, Trenton and California contract health services 
     programs; mammography; patient travel; epidemiology; school 
     health education; Indian youth; psychology; tuberculosis; 
     environmental and nuclear health hazards and women's health.


                         title iii. facilities

       The purpose of this title relates to the construction of 
     health facilities, including hospitals, clinics, and health 
     stations including necessary staff quarters, and of 
     sanitation facilities for Indian communities and homes. It 
     also would require the IHS to annually report on Indian 
     Health Service/Tribes/Urban (ITU's) needs for inpatient, 
     outpatient and specialized care facilities, including 
     renovation of existing facilities. It also would require 
     newly-constructed/renovated facilities, whenever practicable, 
     to meet the construction standards of any nationally 
     recognized accrediting bodies. There is also a provision to 
     waive the Davis-Bacon when a tribe has its own wage law and 
     performs the construction project instead of IHS.


                  title iv. access to health services

       The purpose of this title is to address payments to the IHS 
     and tribes for services covered by Social Security Act Health 
     Care programs, and to enable Indian health programs to access 
     reimbursements from third party collections. This title 
     states that any payments received by a hospital or skilled 
     nursing facility of the IHS for services provided to American 
     Indians and Alaska Natives eligible for benefits under the 
     Social Security Act Health Care programs will not be 
     considered in determining appropriations for health care of 
     American Indians or Alaska Natives.
       Requires the Secretary to enter into agreements with 
     tribes, tribal organizations and urban Indian organizations 
     to assist them in enrolling qualified Indians in Medicare, 
     Medicaid and SCHIP (State children's health insurance 
     program), and to enable tribes to pay premiums for coverage. 
     Authorizes the Secretary to enter into agreements with I/T/
     U's for receipt/processing of Medicaid/Medicare/SCHIP 
     applications. Condition continuing approval of State Medicaid 
     plan on taking steps to provide for Medicaid enrollment on 
     reservations, and to obtain input from tribes in the State on 
     matters relating to impact of changes in the State plan on 
     Indian health programs. If tribe/tribal organizations 
     performs outreach, the agreement may provide for 100% 
     reimbursement of costs and assures that 100% FMAP (Federal 
     Medical Assistance Payment) continues to apply to Medicaid 
     and SCHIP services provided by tribes/tribal organizations 
     who directly bill for the services they provide. Ensures that 
     insurance companies must reimburse I/T/U's for the services 
     they provide. Ensure that managed care plans must reimburse 
     I/T/U's for the services they provide.
       Authorize IHS and tribal programs to receive reimbursement 
     for all Medicare Part B services and eliminates ambiguity 
     about Medicaid coverage. Authorizes Federal/State/tribal 
     agreements for tribal operation of Indian SCHIP programs; 
     places a Medicare-like rate ceiling on hospital services 
     purchased under the IHS's Contract Health Service program; 
     directs the Secretary of HHS to study the Medicare and 
     Medicaid payment methodology for Indian health programs and 
     report to Congress; and directs the Secretary to establish a 
     National Indian Technical Advisory Group to assist the 
     Secretary in identifying and addressing issues regarding the 
     health care programs under the Social Security Act (including 
     medicare, medicaid and SCHIP) that have implications for 
     Indian Health Programs or Urban Indian Organizations.


               title v. health services for urban indians

       The purpose of this title is to establish programs in urban 
     centers to make health services more accessible to Indians 
     who live in urban areas rather than on reservations or Alaska 
     Native villages. The Secretary through the IHS is authorized 
     to enter into contracts or grants to urban Indian 
     organizations to help these agencies with establishing and 
     administering health programs which meet the requirements of 
     the IHCIA and will require evaluations renewals. Authorizes 
     the establishment of an Office of Urban Indian Health which 
     shall be responsible for carrying out the provisions of this 
     title, providing central oversight of the programs and 
     services authorized under this title and, providing technical 
     assistance to Urban Indian Organizations. The bill would also 
     extend FTCA (Federal Tort Claims Act) coverage to urban 
     Indian organizations (Federal law already extends FTCA 
     coverage to tribally-operated health programs).


                 title vi. organizational improvements

       This title addresses the establishment of the IHS as an 
     agency of the PHS(Public Health Service). It covers the 
     appointment of the Director of IHS by the President and 
     confirmed by the Senate. This title also authorizes the 
     Secretary through the Director of IHS to establish an 
     automated management information system as well as other 
     duties as assigned by the Secretary for the IHS. Authorizes 
     appropriations to carry out this title.


                 title vii. behavioral health programs

       This title is revised from current law (which only 
     addresses substance abuse programs) in order to focus on 
     behavioral health. It combines all substance abuse, mental 
     health and social service programs in one title and 
     integrates these programs to enhance performance and 
     efficiency. The title addresses the responsibilities of the 
     IHS as outlined by the Memorandum of Agreement pursuant to 
     the section 402 of the Indian Alcohol and Substance Abuse 
     Prevention and Treatment Act of 1986. The IHS will

[[Page E1217]]

     determine the scope of the alcohol and substance abuse among 
     Indian people; they must assess the existing and needed 
     resources for prevention of alcohol and substance abuse and 
     the treatment of Indians affected. Finally, IHS must estimate 
     the funding necessary to adequately support a program of 
     prevention of alcohol and substance abuse and treatment of 
     Indians affected. The IHS will also provide a comprehensive 
     alcohol and substance abuse prevention and treatment 
     programs, a rehabilitation and aftercare services, IHS youth 
     program, and training and community education. In this 
     section demonstration projects are outlined as well as grants 
     focusing of Fetal Alcohol Syndrome and Fetal Alcohol effect. 
     It also expands the authorization to establish inpatient 
     mental health facilities in each Area. Authorizes funding for 
     development of innovative community-based behavioral health 
     services. The requirement of matching funds has been 
     eliminated here. Allows the Fetal Alcohol Disorder programs 
     to be funded under the ISDEAA (Indian Self-Determination and 
     Education Assistance Act). Provides for a program to treat 
     both the victims and the perpetrator of child sexual abuse. 
     And, has been expanded to allow Indian Tribes and Tribal 
     Organizations to obtain funding for behavioral health 
     research.


                        title vii. miscellaneous

       The purpose of this title is to address various topics 
     including the President's reporting of the progress made in 
     meeting the objectives of this Act to Congress at the time of 
     submitting the budget. It also applies the Negotiated 
     Rulemaking Act to the development of IHCIA regulations. Other 
     provisions require the Secretary to develop a plan of 
     implementation to submit to Congress; describe the 
     eligibility of California Indians for IHS services and sets 
     out the conditions for the issue of Indian health funding as 
     an entitlement.


                 amendments to the social security act

       Amendments to the Social Security Act appear at the end of 
     the bill. These provisions are necessary to reflect a number 
     of the objectives described above in the Title IV summary.

                          ____________________