Congressional Record, Volume 151 Issue 65 (Tuesday, May 17, 2005)

[Congressional Record Volume 151, Number 65 (Tuesday, May 17, 2005)]
[Senate]
[Pages S5302-S5367]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

By Mr. FRIST (for himself, Mr. Bingaman, Mr. Lugar, Ms. Cantwell,
Mr. Santorum, Ms. Collins, Mr. Cochran, Mrs. Murray, and Mrs.
Feinstein):
S. 1049. A bill to amend title XXI of the Social Security Act to
provide grants to promote innovative outreach and enrollment under the
medicaid and State children's health insurance programs, and for other
purposes; to the Committee on Finance.
Mr. FRIST. Mr. President, today, Senator Bingaman and I introduced
the ``Covering Kids Act of 2005.'' This legislation provides $100
million in funding to a host of entities including the States, local
communities, schools, faith-based organizations, Indian tribes, safety
net providers. The goal is to increase enrollment of eligible children
in Medicaid and the State Children's Health Insurance Program (SCHIP).
I believe that all Americans should have the security of lifelong,
affordable access to health care, especially America's children.
Programs like SCHIP help provide a critical safety net.
But, unfortunately, there are still too many families who are not
aware of the coverage available to them, or face barriers to
enrollment. In fact, over 5.6 million kids are eligible for Medicaid
and SCHIP, but are not enrolled. The Covering Kids Act will help close
that gap.
The legislation will fund innovative outreach and enrollment efforts
to expand coverage among minority and underserved children, and to
those living in rural areas. It will also give states additional
flexibility to streamline enrollment in these programs, reducing
administrative costs for the government and eliminating paperwork and
hassles for families.
Covering children is the right thing to do. And by ensuring that
children have access to preventive care, it is also one of the best
ways of reducing long-term strain on America's health care system.
Since arriving in the Senate in 1995, I have advanced worked hard to
expand

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coverage to uninsured Americans and improve health care for those in
need. I have sponsored numerous pieces of bipartisan legislation
including: the ``Closing the Health Care Gap Act of 2004,'' the
``Pediatric Research Equity Act of 2003,'' the ``Birth Defects and
Developmental Disabilities Prevention Act of 2003,'' and the
``Children's Health Act of 2000.'' Last Congress, we took a critical
step forward in expanding affordable health coverage to millions more
Americans by authorizing tax-free, portable Health Savings Accounts as
part of the Medicare Modernization Act of 2003.
Today, we build on that record of progress.
I first proposed expanding outreach efforts to help lower income
children in July of last year. Today, I join with Senator Jeff Bingaman
and other cosponsors in taking a critical step toward fulfilling that
goal.
I also want to applaud the President for his leadership on this
issue. President Bush has made the expansion of Medicaid and SCHIP
coverage a cornerstone of his agenda. I am confident that with his
leadership, and the efforts of my colleagues on the other side of the
aisle, we can help millions of kids who need coverage by passing this
common sense legislation. All of our children should have access to the
affordable quality health care.
I'm proud to introduce this bipartisan legislation with Senators
Bingaman, Lugar, Cantwell, Santorum, Collins, Cochran, and Murray. I
look forward to working with them, and with all of my colleagues, to
strengthen our Nation's health care system and expand affordable health
coverage.
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. 1049

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 ``Covering Kids Act of 2005''.

SEC. 2. GRANTS TO PROMOTE INNOVATIVE OUTREACH AND ENROLLMENT
UNDER MEDICAID AND SCHIP.

(a) Grants for Expanded Outreach Activities.--Title XXI of
the Social Security Act (42 U.S.C. 1397aa et seq.) is amended
by adding at the end the following:

``SEC. 2111. EXPANDED OUTREACH ACTIVITIES.

``(a) Grants To Conduct Innovative Outreach and Enrollment
Efforts.--
``(1) In general.--The Secretary shall award grants to
eligible entities to--
``(A) conduct innovative outreach and enrollment efforts
that are designed to increase the enrollment and
participation of eligible children under this title and title
XIX; and
``(B) promote understanding of the importance of health
insurance coverage for prenatal care and children.
``(2) Performance bonuses.--The Secretary may reserve a
portion of the funds appropriated under subsection (g) for a
fiscal year for the purpose of awarding performance bonuses
during the succeeding fiscal year to eligible entities that
meet enrollment goals or other criteria established by the
Secretary.
``(b) Priority for Award of Grants.--
``(1) In general.--In making grants under subsection
(a)(1), the Secretary shall give priority to--
``(A) eligible entities that propose to target geographic
areas with high rates of--
``(i) eligible but unenrolled children, including such
children who reside in rural areas; or
``(ii) racial and ethnic minorities and health disparity
populations, including those proposals that address cultural
and linguistic barriers to enrollment; and
``(B) eligible entities that plan to engage in outreach
efforts with respect to individuals described in subparagraph
(A) and that are--
``(i) Federal health safety net organizations; or
``(ii) faith-based organizations or consortia.
``(2) 10 percent set aside for outreach to indian
children.--An amount equal to 10 percent of the funds
appropriated under subsection (g) for a fiscal year shall be
used by the Secretary to award grants to Indian Health
Service providers and urban Indian organizations receiving
funds under title V of the Indian Health Care Improvement Act
(25 U.S.C. 1651 et seq.) for outreach to, and enrollment of,
children who are Indians.
``(c) Application.--An eligible entity that desires to
receive a grant under subsection (a)(1) shall submit an
application to the Secretary in such form and manner, and
containing such information, as the Secretary may decide.
Such application shall include--
``(1) quality and outcomes performance measures to evaluate
the effectiveness of activities funded by a grant awarded
under this section to ensure that the activities are meeting
their goals; and
``(2) an assurance that the entity shall--
``(A) conduct an assessment of the effectiveness of such
activities against such performance measures; and
``(B) cooperate with the collection and reporting of
enrollment data and other information determined as a result
of conducting such assessments to the Secretary, in such form
and manner as the Secretary shall require.
``(d) Dissemination of Enrollment Data and Information
Determined From Effectiveness Assessments; Annual Report.--
The Secretary shall--
``(1) disseminate to eligible entities and make publicly
available the enrollment data and information collected and
reported in accordance with subsection (c)(2)(B); and
``(2) submit an annual report to Congress on the outreach
activities funded by grants awarded under this section.
``(e) Supplement, Not Supplant.--Federal funds awarded
under this section shall be used to supplement, not supplant,
non-Federal funds that are otherwise available for activities
funded under this section.
``(f) Definitions.--In this section:
``(1) Eligible entity.--The term `eligible entity' means
any of the following:
``(A) A State or local government.
``(B) A Federal health safety net organization.
``(C) A national, local, or community-based public or
nonprofit private organization.
``(D) A faith-based organization or consortia, to the
extent that a grant awarded to such an entity is consistent
with the requirements of section 1955 of the Public Health
Service Act (42 U.S.C. 300x-65) relating to a grant award to
non-governmental entities.
``(E) An elementary or secondary school.
``(2) Federal health safety net organization.--The term
`Federal health safety net organization' means--
``(A) an Indian tribe, tribal organization, or an urban
Indian organization receiving funds under title V of the
Indian Health Care Improvement Act (25 U.S.C. 1651 et seq.),
or an Indian Health Service provider;
``(B) a Federally-qualified health center (as defined in
section 1905(l)(2)(B));
``(C) a hospital defined as a disproportionate share
hospital for purposes of section 1923;
``(D) a covered entity described in section 340B(a)(4) of
the Public Health Service Act (42 U.S.C. 256b(a)(4)); and
``(E) any other entity or a consortium that serves children
under a federally-funded program, including the special
supplemental nutrition program for women, infants, and
children (WIC) established under section 17 of the Child
Nutrition Act of 1966 (42 U.S.C. 1786), the head start and
early head start programs under the Head Start Act (42 U.S.C.
9801 et seq.), the school lunch program established under the
Richard B. Russell National School Lunch Act, and an
elementary or secondary school.
``(3) Indians; indian tribe; tribal organization; urban
indian organization.--The terms `Indian', `Indian tribe',
`tribal organization', and `urban Indian organization' have
the meanings given such terms in section 4 of the Indian
Health Care Improvement Act (25 U.S.C. 1603).
``(g) Appropriation.--There is appropriated, out of any
money in the Treasury not otherwise appropriated, $50,000,000
for each of fiscal years 2006 and 2007 for the purpose of
awarding grants under this section. Amounts appropriated and
paid under the authority of this section shall be in addition
to amounts appropriated under section 2104 and paid to States
in accordance with section 2105, including with respect to
expenditures for outreach activities in accordance with
subsection (a)(1)(D)(iii) of that section.''.
(b) Extending Use of Outstationed Workers To Accept Title
XXI Applications.--Section 1902(a)(55) of the Social Security
Act (42 U.S.C. 1396a(a)(55)) is amended by striking ``or
(a)(10)(A)(ii)(IX)'' and inserting ``(a)(10)(A)(ii)(IX), or
(a)(10)(A)(ii)(XIV), and applications for child health
assistance under title XXI''.

SEC. 3. STATE OPTION TO PROVIDE FOR SIMPLIFIED DETERMINATIONS
OF A CHILD'S FINANCIAL ELIGIBILITY FOR MEDICAL
ASSISTANCE UNDER MEDICAID OR CHILD HEALTH
ASSISTANCE UNDER SCHIP.

(a) Medicaid.--Section 1902(e) of the Social Security Act
(42 U.S.C. 1396a(e)) is amended by adding at the end the
following:
``(13)(A) At the option of the State, the plan may provide
that financial eligibility requirements for medical
assistance are met for a child who is under an age specified
by the State (not to exceed 21 years of age) by using a
determination made within a reasonable period (as determined
by the State) before its use for this purpose, of the child's
family or household income, or if applicable for purposes of
determining eligibility under this title or title XXI, assets
or resources, by a Federal or State agency, or a public or
private entity making such determination on behalf of such
agency, specified by the plan, including (but not limited to)
an agency administering the State program funded under part A
of title IV, the Food Stamp Act of 1977, the Richard B.
Russell National School Lunch Act, or the Child Nutrition Act
of 1966, notwithstanding any differences in budget unit,
disregard, deeming, or other methodology, but only if--

[[Page S5304]]

``(i) the agency has fiscal liabilities or responsibilities
affected or potentially affected by such determination; and
``(ii) any information furnished by the agency pursuant to
this subparagraph is used solely for purposes of determining
financial eligibility for medical assistance under this title
or for child health assistance under title XXI.
``(B) Nothing in subparagraph (A) shall be construed--
``(i) to authorize the denial of medical assistance under
this title or of child health assistance under title XXI to a
child who, without the application of this paragraph, would
qualify for such assistance;
``(ii) to relieve a State of the obligation under
subsection (a)(8) to furnish medical assistance with
reasonable promptness after the submission of an initial
application that is evaluated or for which evaluation is
requested pursuant to this paragraph;
``(iii) to relieve a State of the obligation to determine
eligibility for medical assistance under this title or for
child health assistance under title XXI on a basis other than
family or household income (or, if applicable, assets or
resources) if a child is determined ineligible for such
assistance on the basis of information furnished pursuant to
this paragraph; or
``(iv) as affecting the applicability of any non-financial
requirements for eligibility for medical assistance under
this title or child health assistance under title XXI.''.
(b) SCHIP.--Section 2107(e)(1) of the Social Security Act
(42 U.S.C. 1397gg(e)(1)) is amended by adding at the end the
following:
``(E) Section 1902(e)(13) (relating to the State option to
base a determination of child's financial eligibility for
assistance on financial determinations made by a program
providing nutrition or other public assistance).''.
(c) Effective Date.--The amendments made by this section
take effect on October 1, 2005.

There are nearly 10 million children in the United States without
health insurance coverage. Over half of these children live in families
with incomes below 200 percent of the Federal poverty level and are
eligible for coverage under either the State Children's Health
Insurance Program (S-CHIP) or Medicaid, but are not enrolled in those
safety net programs. Studies have shown that the families of many
eligible children are not familiar with the availability of safety net
coverage or face other barriers that prevent enrollment.
One Tuesday, May 17, Senate Majority Leader Bill Frist and Senator
Jeff Bingaman will introduce bipartisan legislation to help close this
coverage gap. The ``Covering Kids Act of 2005'' seeks to increase
health coverage among uninsured, low-income children by providing
grants to States, faith-based organizations, safety net providers,
schools, and other community and non-profit organizations to conduct
innovative Medicaid and SCHIP outreach and enrollment efforts. Grants
may also be used to promote the understanding of the important role
that health insurance coverage plays in ensuring quality health care
for pregnant women and children.
The legislation appropriates $50 million dollars in fiscal year 2006
and an additional $50 million in fiscal year 2007 in addition to
already appropriated SCHIP funds for these additional outreach and
enrollment efforts. Ten percent of grant funding would be set aside for
grants to the Indian Health Service, tribal organizations, and urban
Indian programs for outreach and enrollment to Native American
children. Outreach funds may be carried over into subsequent fiscal
years until the entire $100 million is awarded to grantees.
In making grants, the Secretary of Health and Human Services, HHS,
must give priority to grantees that propose to target geographic areas
with high numbers of children who are eligible but not enrolled in
Medicaid and SCHIP, including those who live in rural areas and those
areas with large numbers of racial and ethnic minorities and other
health disparity populations.
The Secretary is required to disseminate to eligible grantees as well
as to the public enrollment data and other measurements of the
effectiveness of these outreach programs. The Secretary also is
required to submit an annual report to Congress describing the impact
of these efforts on expanding access to uninsured children.
Further, the legislation also allows States additional flexibility to
streamline Medicaid and SCHIP enrollment processes. Because two-thirds
of uninsured children live in families that receive benefits through
other federal programs, the legislation gives states the option of
using income and resource eligibility determinations made under other
government programs to fast-track enrollment under Medicaid and SCHIP.
This reform would simplify state administrative processes, reduce
paperwork burdens for families and the government, help increase
insurance coverage, and potentially reduce costs across a number of
federal programs.
Mr. BINGAMAN. Mr. President, I am pleased to be introducing
bipartisan legislation today with Senators Frist, Cantwell, Lugar,
Santorum, Collins, Cochran, Murray, and Feinstein named the ``Covering
Kids Act of 2005.'' This legislation is intended to improve outreach
and enrollment efforts targeted toward children and pregnant women and
is very similar to language included in legislation I introduced in the
107th Congress entitled the ``Children's Health Coverage Improvement
Act'' and earlier this year with Senator Lugar entitled ``Children's
Express Lane to Health Coverage Act.''
The legislation provides $100 million in grants over the next two
years to community and faith-based organizations, safety net
organizations such as community health centers, disproportionate share
hospitals, tribal providers or organizations, schools, or State or
local governments for the purposes of conducting innovative outreach
and enrollment efforts.
The bill includes language from legislation introduced by Senator
Lugar and me that would promote what is called ``Express Lane
Eligibility.'' This approach uses two strategies to find and enroll
eligible but uninsured children by: 1. targeting large numbers of
eligible children in other public benefit programs like school lunch
and food stamps; 2. expediting their enrollment in health coverage by
using income-eligibility information already submitted by parents when
they enrolled their children in these other public programs.
In combination, these two common-sense ideas could have a dramatic
impact on reducing the uninsured rate among our Nation's children,
which we must do.
According to the American College of Physicians, uninsured children,
when compared to insured children, are: up to 6 times more likely to
have gone without needed medical, dental, or other health care; 2 times
more likely to have gone without a physician visit during the previous
year; up to 4 times more likely to have delayed seeking medical care;
up to 10 times less likely to have a regular source of medical care;
1.7 times less likely to receive medical treatment for asthma; and, up
to 30 percent less likely to receive medical attention for any injury.
Another study estimated that the 15 percent rise in the number of
children eligible for Medicaid between 1984 and 1992 decreased child
mortality by 5 percent. I would add that the expansion period occurred
during the Reagan and George H.W. Bush administrations with strong
Democratic congressional support, so this is clearly a bipartisan issue
that deserves further bipartisan action once again.
In fact, during the last presidential campaign, President Bush made
very few promises when it came to reducing the number of uninsured in
this country. However, he did make the promise to reduce the number of
uninsured by conducting additional efforts in outreach and enrollment.
As he said in a speech in Pennsylvania on October 21, 2004, ``We'll
keep our commitment to America's children by helping them get a healthy
start in life. I'll work with governors and community leaders and
religious leaders to make sure every eligible child is enrolled in our
government's low-income health insurance program. We will not allow a
lack of attention, or information, to stand between millions of
children and the health care they need.''
I agree and hope that with the support of the Administration and the
Majority Leader in his introduction of this bipartisan legislation
today that we can secure passage of it this year.
Despite the passage of the State Children's Health Insurance Program,
or SCHIP, which has, in combination with Medicaid, caused a reduction
in the rate of uninsured children in recent years, it is estimated that
5-6 million of the remaining 9.2 million uninsured children are
eligible for but unenrolled in either Medicaid or SCHIP. In New Mexico,
there are an estimated 80,000,

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or 15.2 percent, of the children in my State without health insurance
despite the fact that Medicaid and SCHIP cover children all the way up
to 235 percent of the poverty level.
Thus, ineligibility for coverage is no longer a barrier for the vast
majority of uninsured children. As the Urban Institute has said, ``A
major challenge today is how to reach and enroll the millions of
children who are eligible but who remain uninsured.''
The biggest problems are knowledge gaps, confusion about program
rules, and problems created by bureaucratic barriers to coverage. The
State of California has taken some important strides to eliminate some
of these barriers through what they call their Express Lane
Eligibility, or ELE, initiative, which allowed the sharing of income-
eligibility information across public programs. Unfortunately, Down
Horner, Beth Marrow, and Wendy Lazarus of the Children's Partnership in
California found in their report entitled ``Building an On-Ramp to
Children's Health Coverage: A Report on California's Express Lane
Eligibility Program": ``A clear lesson from California's experience is
that there is only so far a state can go in putting an ELE system in
place. In the end, existing Federal rules tend to thwart efforts to
create a truly efficient process. In California, instead of allowing
Medi-Cal to use a school lunch program's income determination, both
school lunch and Medi-Cal have to recount a family's income based on
their own rules.''
If we can engage in innovative enrollment and outreach activities and
promote ELE types of activities in the states, it clearly could have a
profound impact on reducing the uninsured rate among our nation's
children.
I would like to express my thanks to the Majority Leader and his
staff for working through a number of issues with me prior to the
introduction of this legislation. I think the bill is stronger, as a
result, and look forward to working with him on trying to get the bill
enacted in this Congress.
______

By Mr. DODD (for himself and Mr. Bond):
S. 1051. A bill to amend the Public Health Service Act to reauthorize
and extend certain programs to provide coordinated services and
research with respect to children and families with HIV/AIDS; to the
Committee on Health, Education, Labor, and Pensions.
Mr. DODD. Mr. President, I rise today to introduce the Children and
Family HIV/AIDS Research and Care Act of 2005. This bipartisan
legislation is similar to a bill that was introduced last year. This
legislation will address the special needs of children and youth with
HIV/AIDS--needs that are too often overlooked, both domestically and
internationally. It recognizes the, simple fact that when it comes to
HIV prevention, research, care, and treatment, children and youth are
not just small adults. To give them a chance for a healthy future, we
must ensure that their unique needs are met. I want to thank my good
friend Senator Bond of Missouri for joining me in introducing this
important legislation. I am very pleased to work with him to move this
bill forward.
Children's growing bodies are especially susceptible to the rapid
advancement of HIV infection. Because their immune systems are still
immature, the disease typically progresses more rapidly and differently
in children than in adults. For example, children with HIV infection
are more prone to neurological abnormalities and certain opportunistic
infections than adults. In addition, because children's bodies are
growing and developing, HIV/AIDS can have profound effects on
children's physical growth and ability to reach developmental
milestones such as crawling, walking and learning to talk.
While research has definitively shown that initiating drug treatment
in children in a timely manner promotes normal growth and development,
and prolongs life, treating children with HIV/AIDS presents particular
challenges. Appropriately formulated and dosed HIV/AIDS drugs are
urgently needed to ensure that children receive optimal care.
Currently, liquid formulations that young children can swallow are not
always readily available. In addition, pediatric dosing and safety
information for these powerful drugs is often lacking, particularly for
younger children. This lack of information puts children at risk; too
much medication can be toxic and too little will not effectively
suppress the virus. Over time, under-dosing can lead to drug
resistance, a particularly serious concern for children who will need
to use these medications for years, if not decades.
Appropriate HIV/AIDS care and treatment for children and youth also
requires that special attention be paid to their social development
needs. Children and youth have unique concerns regarding disclosure and
stigma that may be exacerbated by frequent absences from school and
social activities, and the onset of sexual maturity. Working with
schools and other social and community institutions is imperative to
promoting a sense of normalcy. Because children are not typically
medical decision-makers, developing long-term care partnerships with
parents and other caregivers is also crucial to successful care and
treatment. At the same time, maximizing each child's own ability to
take active participation in different aspects of his or her own care
can increase a child's sense of ownership over treatment, improving
adherence and overall health.
By reauthorizing and expanding Title IV of the Ryan White CARE Act
this legislation will help to ensure that the unique care and treatment
needs of children are addressed. This program is a lifeline for more
than 53,000 women, children, and youth affected by HIV/AIDS served
annually by Title IV-funded projects. Through 91 grants in 35 states,
the District of Columbia, Puerto Rico and the Virgin Islands, Title IV
projects provide medical care, case management, support services,
mental health, transportation, child care, and other crucial services
to families affected by HIV/AIDS. Title IV is the smallest of the four
main titles of the Ryan White CARE Act, yet reaches the highest
proportion of minorities.
Key to the success of Title IV projects is the model of ``family-
centered care.'' This model of care treats the whole family as the
client, whether several family members are infected by HIV, or just a
parent or child. The family-centered care model is crucial to
developing strong partnerships between consumers and providers, leading
to better health outcomes for women, children, and youth. By allowing
affected family members to receive services, as well as the infected
individuals, Title IV projects promote health at the family level,
thereby prolonging life, improving quality of life, and saving money by
keeping people out of the hospital.
I would like to take a moment to recognize the work done by the
Children, Youth and Family AIDS Network of Connecticut, which provides
Title IV services to more than 500 children, youth, women, and families
affected by HIV/AIDS in my home state. Just earlier today, I had an
opportunity to meet with some of these individuals. They made it clear
just how important these services are to their quality of life.
While recommitting the Health Resources and Services Administration
(HRSA) to family-centered care and the unique work of Title IV, this
legislation will also expand the innovative strategies Title IV
projects have used to prevent mother-to-child HIV transmission. Since
1994, when the administration of preventive drug interventions was
shown to significantly reduce perinatal HIV transmission, the number of
newborns infected with HIV has decreased dramatically. Yet mother-to-
children transmission does continue to occur, largely due to missed
opportunities for identifying HIV-positive pregnant women and providing
the supportive services needed to ensure adherence to recommended
treatment regimens. We propose to fund demonstration grants to assess
the effectiveness of two strategies in reducing mother-to-children
transmission: (1) increasing routine, voluntary HIV testing of pregnant
women and (2) increasing access to prenatal care, intensive case
management, and supportive services for HIV-positive pregnant women.
In addition, this bill will encourage research into key care and
treatment questions affecting the pediatric populations. These include:
the long-term health effects of preventive drug regimens on HIV-exposed
children; the

[[Page S5306]]

long-term health, psycho-social, and prevention needs for children and
adolescents perinatally HIV-infected; the transition to adulthood for
HIV-infected children; and safer and more effective treatment options
for infants, children, and adolescents with HIV disease.
Since history suggests that a vaccine may prove to be the most
effective, affordable, long-term approach to stopping the spread of
HIV, this legislation will also ensure that children are not an
afterthought when it comes to the development of an HIV vaccine.
Currently, some of the populations hardest hit by the pandemic--infants
and youth--are at risk of being left behind in the search for an
effective vaccine. Because we cannot assume that a vaccine tested in
adults will also be safe and effective when used in pediatric
populations, it will be important to ensure that promising vaccines are
tested in infants and youth as early as is medically and ethically
appropriate. Failure to begin planning for the inclusion of these
groups in clinical trials could mean significant delays in the
availability of a pediatric HIV vaccine, at the cost of countless
thousands of lives. This legislation will ensure that we begin now to
address the logistical, regulatory, medical, and ethical issues
presented by pediatric testing of HIV vaccines so that children can
share in the benefits of any advances in vaccines research.
I want to thank several organizations for lending their expertise to
the development of this legislation, in particular the Elizabeth Glaser
Pediatric AIDS Foundation, the AIDS Alliance for Children, Youth and
Families, and the American Academy of Pediatrics, all of whom endorse
this bill.
HIV/AIDS is the single greatest health care catastrophe facing the
world today. We need to do much more to seek effective treatments and,
eventually, a cure for this horrible illness. This legislation is by no
means sufficient to reach that goal, but it is a step towards ensuring
that children are not left behind as we make progress, and then when we
do finally eradicate HIV/AIDS once and for all, children and youth are
able to benefit immediately. I urge all of my colleagues to join us in
support of this legislation.
Mr. BOND. Mr. President, currently, more than 3,700 children and
youth under the age of 13 are living with HIV or AIDS in the United
States and of the more than 40,000 Americans newly infected with HIV
each year, half are young people under the age of 25 years old. When we
think about this devastating virus we do not often associate it with
children, especially infants or newborn babies, but the fact is this
disease does not discriminate on the basis of age. It affects children
in very specific and very different ways than adults.
For instance, the medical experience of children with HIV/AIDS can
differ significantly from that of adults. Because children's immune
systems are still immature, the disease typically progresses more
rapidly in children than in adults and can have different
manifestations. For example, the majorities of children with HIV have
neurological abnormalities and are more susceptible to certain
opportunistic infections than adults. In addition, because children's
bodies are growing and developing, HIV/AIDS can have profound effects
on children's physical growth and ability to reach developmental
milestones such as crawling, walking and learning to walk.
Medication for young children living with HIV/AIDS can also be very
different than that of an adult living with HIV/AIDS. For example,
children of certain ages cannot swallow pills and require liquid
formulations of life-saving HIV/AIDS drugs that are not always readily
available. In addition, dosing and safety information for these
powerful drugs are often strikingly different for children and adults,
and for younger children, this information is typically completely
missing. This lack of information puts children at risk by requiring
health care providers to estimate correct dosing. Too much medication
can be toxic, and too little will not effectively suppress the virus.
Over time, underdosing can lead to drug resistance.
Children are not just small adults and their growing bodies are
especially susceptible to the rapid advancement of HIV infection. Early
awareness that a child has HIV infection, combined with good care and
support, can enhance survival and quality of life, which is why I am
introducing, with my colleague Senator Dodd, The Children and Family
HIV/AIDS Research and Care Act.
This legislation will address those needs of children and adolescents
living with HIV/AIDS by reauthorizing Title IV of the Ryan White CARE
Act and expanding its focus on reaching and caring for adolescents with
HIV/AIDS. Moreover, this legislation will continue to work to reduce
mother-to-child transmission of HIV, by promoting routine, voluntary
prenatal HIV testing and intensive care management for HIV-positive
pregnant women. In addition, because children are at risk of being left
behind in the search for an effective HIV vaccine, the bill will
require federal agencies funding and regulating HIV vaccine research to
develop plans and guidelines for including pediatric populations in
clinical trials as quickly as is medically and ethically appropriate.
This legislation will also encourage research on key remaining
pediatric research questions, including how to provide safer and more
effective treatment options for children with HIV/AIDS.
For a young person living with HIV or AIDS there is no cure and there
is no remission. It is with them at home, on the playground, in the
classroom, and at a Friday night sleepover. It will be with them as
they enter high school, go to college and get their first job. For a
person born with this virus it is a permanent part of their life. This
bill will help to ensure that the needs of infants, children, and
adolescents living with HIV/AIDS are not overlooked.
______

By Mr. STEVENS (for himself, Mr. Inouye, Mr. Rockefeller, Mr.
Dorgan, Ms. Snowe, Mrs. Boxer, Ms. Cantwell, Mr. Lautenberg,
Mr. Pryor, Mrs. Clinton, and Mr. Schumer):
S. 1052. A bill to improve transportation security, and for other
purposes; to the Committee on Commerce, Science, and Transportation.
Mr. STEVENS. Mr. President, I am pleased to join my good friend,
Senator Inouye, Co-Chairman of the Commerce Committee, and several of
our colleagues, today in introducing the ``Transportation Security
Improvement Act of 2005.'' The Commerce Committee is committed to
fulfilling its oversight responsibilities with respect to the security
of all major modes of transportation.
It has been four years since Congress enacted landmark aviation and
maritime transportation security laws after the September 11 attacks.
We must remain diligent in carrying out our responsibility to secure
the Nation's domestic transportation system so as to ensure consumer
trust and the uninterrupted flow of commerce. Recent reorganizations
and budgetary decisions affecting the Transportation Security
Administration (TSA) have effectively marginalized maritime and surface
transportation security, suggested re-privatization of aviation
security, and offered inadequate funding for the security of all modes.
The bill that we introduce today recognizes transportation security
as a national security function and an economic necessity. The
legislation would address security vulnerabilities that exist within
our aviation, maritime, rail, and surface transportation systems. More
specifically, the bill would, among other things: make notable changes
to aviation security policy, including prohibiting the Administration
from increasing passenger fees without the approval of Congress;
eliminate the existing cap of 45,000 full time equivalent aviation
security screening employees; enhance maritime cargo security by
improving the examination of shipments before they reach U.S. shores;
require TSA to conduct a railroad sector threat assessment and submit
prioritized recommended solutions for improving rail security; make
improvements to bus and motor carrier security by subjecting foreign
commercial drivers transporting hazardous materials into the U.S. to
submit to security background checks; and encourage the deployment of
rail car tracking equipment for high-hazard materials rail shipments.
This is an important first step toward bolstering our nation's
security with respect to transportation and I

[[Page S5307]]

look forward to working with Senator Inouye, as well as the Department
of Homeland Security, DOT, and private industry, on this legislation in
committee and on the Senate floor.
Mr. INOUYE. Mr. President, I rise as a leading co-sponsor of the
Transportation Security Improvement Act of 2005 introduced today by my
colleague and Chairman, Ted Stevens, along with Senators Jay
Rockefeller, Olympia Snowe, Frank Lautenberg, Byron Dorgan, Barbara
Boxer, Maria Cantwell, Mark Pryor, Hillary Clinton, and Chuck Schumer.
Nearly 4 years after the enactment of landmark aviation and maritime
security laws, it is time to build upon that foundation, make needed
improvements and enhancements to our transportation security efforts
across all modes, and reestablish the requisite funding levels. Most
importantly, we must restore the sense of urgency that is essential if
we are to keep our transportation systems, and our economy, strong,
vibrant, and secure. We have worked hard to develop this legislation,
and we will continue to improve it with the assistance of committee
members and the Department of Homeland Security as we move forward
through the legislative process.
Over the past 3\1/2\ years, the administration and Congress have
slowly lost the sense of immediacy that once allowed us to recognize
that transportation security is a matter of national security. The
administration's budget and priorities indicate that they are
overlooking glaring security vulnerabilities, disregarding the
continuing threats and risks that are reported almost daily, and
underestimating the economic consequences that would undoubtedly result
from another attack on our transportation systems. I am hopeful that
the new leadership will reinvigorate transportation security.
The economic importance of those systems can hardly be overstated: 95
percent of the Nation's cargo comes through the ports; our rail system
and our motor carriers move all of those goods from our coasts and
borders throughout the interior U.S. to retail outlets and
manufacturers that rely on on-time delivery; our aviation system
carried 629.7 million domestic passengers during 2004 and averaged 1.5
million enplanements per day in January this year; approximately 24
million passengers ride Amtrak annually, and there are nearly 3.4
billion passenger and commuter rail trips in this country each year.
The loss of our aviation system for just 4 days after the September
11th attacks sent shockwaves through the economy that are still being
felt today. The al Qaida attack on the passenger trains in Madrid,
Spain, killing nearly 200 people and injuring 1,800, unfortunately
proved that railroads are vulnerable targets for terrorists. If there
is an incident at any one seaport, the whole system for moving cargo
into and out of the country would screech to a halt, as we scramble to
ensure security at other ports. In addition to the horrible loss of
life, the resulting economic damage would be widespread, catastrophic
and possibly irreversible. We cannot afford to risk this kind of damage
due to a lack of preparedness and forethought.
The terrorists that seek to do us harm are cunning, dynamic, and most
of all, patient. While they have not successfully struck our homeland
since September 11, 2001, it does not mean that they are not preparing
to do so. They work 24 hours a day, studying what we do and how we do
it. It is imperative that we stay ahead of them. That means we must
constantly anticipate, innovate, and plan. We must continually research
and implement the most effective technologies. We must recruit, train
and deploy the most skilled security force. Simply put, our entire
economy relies on a well-functioning, secure, transportation system. It
is in our greatest economic interest to ensure that this system, and
the passengers and cargo that use it, are well protected. And, in
keeping with transportation security's impact on the nation's physical
and economic security, it is the responsibility of the federal
government to properly finance that protection.
Following passage of our new aviation security laws, the
Transportation Security Administration, TSA, was assembled quickly,
presented with an enormous task, and expected to produce immediate
results. It has performed admirably, despite the administration's near-
constant reorganization of the agency with little to no input from
Congress. While we take seriously recent reports about financial
mismanagement and the limits of the human capacity to detect security
breaches, we cannot and must not use these inadequacies as
justification to cast aside the critical work of this agency. There are
some in Congress that have never been comfortable with the new Federal
role in transportation security, and they look to every negative report
to help usher in a return to private security screening companies. We
contend, however, that transportation security must not be judged only
by the bottom-line commercial pressures of the private sector.
Transportation security is a unique national security function and an
economic necessity, and like our national defense, it must remain a
primary responsibility of the federal government.
The need for Congressional action to secure all forms of
transportation infrastructure across the country remains essential, and
I, along with many of my colleagues on the Senate Commerce Committee,
have expressed great reservations about the direction our Nation is now
headed on matters of transportation security.
As I noted during the Senate's consideration of the nomination of
Michael Chertoff to be the Secretary of the Department of Homeland
Security, the administration's budget demonstrates the lost sense of
urgency. It shifts critical work away from the TSA. It erodes the
Agency's limited focus and accountability. It undermines the
effectiveness of our maritime and land security efforts. It underfunds
efforts across all modes, but particularly port and rail.
The legislation we are introducing today renews the importance and
commitment transportation security deserves. It identifies the
numerous, lingering shortcomings that currently exist, re-dedicates our
efforts on maritime and surface transportation security, and provides
the guidance necessary to adequately defend the nation's
infrastructure.
The TSA should not focus almost exclusively on aviation, nor should
it be transformed into a glorified, security screener training and
placement agency. The TSA is essential, and it possesses critical
expertise that must be cultivated and put to proper use. We believe
that the TSA, as outlined by our bill, can and will be the difference
between a flourishing economy fueled by smooth-running
transportation systems and an economy crippled by transportation
systems that could fall victim to terrorist attacks.

As such, the Transportation Security Improvement Act of 2005 will
authorize the TSA for the next 3 fiscal years and re-dedicate the
agency to its mission of providing specialized security for all modes
of transportation. It provides further direction to the agency's cargo
security functions, strengthens aviation, maritime, rail, hazardous
materials, and pipeline security efforts, and enhances interagency
cooperation. While the proposal incorporates several Commerce Committee
and Senate-passed bills or initiatives from the prior Congress, it also
puts forth new ideas to enhance transportation security across all
modes.
We recognize that Secretary Chertoff has had only a short time to
make changes and that his comprehensive review is pending. Our
legislation provides the flexibility necessary to address his findings
and prerogatives. However, it is incumbent upon Congress to provide
guidance and clarify the expectations.
On the matter of port security, our legislation seeks to improve
interagency cooperation with the further development of joint operation
command centers. It clarifies the roles and responsibilities for cargo
security programs, while establishing criteria for contingency response
plans to resume the flow of commerce in the event of a seaport attack.
By setting a minimum floor for research and development funding related
to maritime and land security, the bill further encourages the
development of effective technologies that detect terrorist threats.
Conversely, the administration has

[[Page S5308]]

continued to consolidate critical infrastructure grant programs, which
we believe will effectively decrease funding for port security and
eliminate the appropriate expertise necessary to review grant proposals
and distribute the funds accordingly.
In addressing aviation security, we continue to be concerned that
current budget proposals diminish the TSA's authority and squander its
expertise. Airport directors are still struggling to receive the
technological and capital improvements that would increase the
efficiency and effectiveness of the current security system and lower
costs considerably. Instead of addressing these shortcomings with
aggressive support, the administration has chosen to place a greater
burden on the airlines through increased security fees at the same
moment that the carriers are facing the most difficult financial period
in their history. Not only has the industry lost more than $30 billion
cumulatively since 2000, the Federal government has had to bail out the
carriers twice. Increasing the carriers' financial burden is ill
conceived and counterproductive.
Quietly but consistently, we also hear of some of our colleagues'
desire to return to the same privatized security apparatus that proved
disastrously inadequate on September 11, 2001. These efforts are short-
sighted, defy our experience, and will reverse much of the progress we
have made since September 11. Those seeking to return to the old
system, at times, claim that the system is no better than pre-September
11. We all know that is not the case. We also know that with new
technology, we can improve screener performance. There is no doubt that
human factors limit the capabilities of screeners, but as we fund and
deploy new equipment, the security system will continue to improve. Our
bill seeks to enhance the current screener workforce by directing a
more appropriate use of the TSA's resources and through improved
training. It would also stimulate efforts to streamline and improve
collections of existing airline and passenger security fees to promote
a more efficient and healthy aviation industry.
On rail security, our legislation will incorporate an updated version
of the Rail Security Act of 2004, which the Senate passed by unanimous
consent last year. It features new efforts to ensure the security of
hazardous materials that are shipped by rail and improves security
training and awareness for our railroad workers and the public. The
tragic events in Madrid, Spain, demonstrated to all of us the clear
threats to our rail system. We have already been warned publicly twice
by the FBI that al Qaida may be directly targeting U.S. passenger
trains and that their operatives may try to destroy key rail bridges
and sections of track to cause derailments. The rail threat assessment
required by our legislation and the grant programs and other measures
designed to respond to those threats will strengthen our ability to
address them. Until we pass a rail security package, this body is
failing its responsibility to try to secure our national transportation
system. We owe it to the American people to strengthen the security of
our passenger and freight railroads.
To address the security needs of our other surface transportation
modes, the proposal will include funding to improve intercity bus
security, strengthen hazardous material transportation security
efforts, establish new security guidelines for truck rental and leasing
operations, and develop pipeline security incident recovery plans. Such
action is long overdue as the administration has consistently failed to
develop dedicated programs, much less financial support, for rail and
other surface transportation security efforts.
We have reached a critical juncture for transportation security in
the United States and the steps that we take in the coming months will
impact our safety, security and one of our most essential freedoms--
movement--for years to come. We must commit ourselves to ensuring that
our transportation security remains a priority and is as strong and
effective as possible. I believe the Transportation Security
Improvement Act of 2005 will continue to move us in that direction.
Mr. ROCKEFELLER. Mr. President, it is my honor today to join the
distinguished cochairmen of the Senate Commerce, Science, and
Transportation Committee, Senators Ted Stevens and Daniel Inouye, along
with our colleagues Senators Byron Dorgan, Frank Lautenberg, Mark
Pryor, Barbara Boxer, Maria Cantwell, Hillary Clinton, and Chuck
Schumer, to introduce the Transportation Security Improvements Act of
2005. This is a vitally important contribution to the security of all
Americans, and I commend it to my colleagues for their consideration.
The Transportation Security Improvements Act will increase
authorizations for the Transportation Security Administration, TSA, by
more than $19 billion through fiscal year 2008, and will forthrightly
address continuing vulnerabilities in the security of our various
transportation modes that Congress and the administration have as yet
virtually ignored.
Americans were shocked to learn just how lax our aviation security
was on September 11. Even those terrorists on official Government watch
lists, who should have been barred from entering the United States,
were able to board planes that they then turned into weapons without
any significant interference from airport security staffs. As a wounded
Nation tried to overcome the horrors of that day, Congress immediately
went about fixing what was so obviously wrong with our aviation
security.
Now, as we approach the fourth anniversary of that fateful day,
Americans are regaining their confidence about aviation security. There
is still work to be done, and my colleagues and I endeavor in this bill
to further secure air travel. Still, we have done much to improve
domestic aviation security by improving the security procedures we
demand of airlines and airport personnel both here and abroad. We need
to remain vigilant and avoid the inexcusable error of believing we have
done all that needs to be done. We must act with the knowledge that our
enemies will continue to probe the system they so successfully breached
in 2001 to find new and additional opportunities to kill and terrorize
Americans.
What my colleagues and I also have realized for some time is that in
devoting our energy and resources to aviation security we have been, in
a manner of speaking, ``fighting the last war.'' While the aviation
sector is prepared for today's threats, congressional action regarding
the level of security of our other transportation modes is not much
changed from the blissfully naive standards of September 10.
To be fair, industries in the other transportation modes have worked
hard to improve the security of their respective sectors. The
relatively little money Congress and the administration have dedicated
to improving transportation security has been put to good use. Industry
and Government working together, even given the overwhelming scope of
the threat, have improved transportation security and protected the
lives and property of Americans. We just have not done enough.
The Transportation Security Improvements Act seeks to make overdue
improvements to the overall security of this Nation's vast
transportation infrastructure. Our bill addresses the security
practices and requirements of our Nation's freight and passenger rail
network, as well as those of our ocean-going and inland ports, the
trucking industry, intercity buses, and the special risks of hazardous
materials transportation, regardless of the mode of transportation. It
makes the TSA responsible for coordinating international and domestic
cargo security. It calls on TSA to work cooperatively with stakeholders
in the various transportation modes on preparedness and incident
response, and establishes new maritime and land security command
procedures. Perhaps most importantly, we acknowledge the need of TSA
management to deploy such human resources as it sees fit to protect
Americans' lives and property, and it removes the current statutory cap
on the agency of 45,000 full-time employees.
To continue the TSA's efforts to improve aviation security, our bill
authorizes $15.75 billion over the next 3 fiscal years to fully fund
key security programs to defend our Nation's air transportation system.
In lieu of recent reports regarding the performance of the airport
screening workforce, our bill could not be more timely. We have

[[Page S5309]]

included provisions to provide TSA greater flexibility in meeting the
staffing needs of screening checkpoints through elimination of an
arbitrary staffing cap that was put in place shortly after the agency
was created, while also requiring TSA to review the adequacy of
recurrent training for these employees. With the difficult economic
environment currently faced by the airline industry, the bill takes
steps to relieve the carriers of some of the burden that they face
through collection of these fees. We would prohibit increasing aviation
security fees without Congressional review and approval, while
requiring TSA to consider alternative means of collecting such fees.
Finally, the bill prohibits the certification of any foreign repair
stations until TSA and FAA strengthen the oversight of such facilities
by reviewing, auditing and developing regulations to ensure an adequate
level of safety and security.
To dramatically improve maritime and land security, we increase
funding by $1.099 billion to develop and implement cargo screening and
inspection standards, with special attention given to high-risk
cargoes. We authorize 10 additional Joint Operation Command Centers to
supplement the current positive interagency and public-private
cooperation at our ports. We streamline procedures for foreign vessels
and those with Coast Guard-certified security plans, require funding
for port security technology improvements, and impose a January 2006
deadline for development of a comprehensive Transportation Worker
Identification Credentialing Program.
We assist our railroads and hazardous materials shippers in
maintaining and improving security along the Nation's nearly 150,000
miles of freight and passenger rail infrastructure. We increase rail
security funding by nearly $800 million over 3 years, and with those
funds require the TSA to conduct a comprehensive security threat
assessment that I first advocated in October 2001. We authorize grants
to Amtrak and our freight railroads for overall security improvements,
and establish a revamped security training program for railroad
employees. Our legislation would allow Amtrak to make specific and
long-overdue security improvements along its well-traveled Northeast
corridor, and it authorizes development of baggage, passenger, and
cargo screening programs, as well as reviews of procedures used by
foreign railroads and research into additional improvements.
We seek in this legislation to improve the security of the highway
system that is the envy of the world. Our bill makes it a priority to
better protect and address the unique security vulnerabilities of
intercity buses and their passengers. This is a topic first brought to
the attention of Congress by our former colleague Max Cleland, and
which I hope we can now see enacted into law as a rightful part of his
legacy of service to this country. We further seek to improve highway
security by imposing the same level of background checks on foreign
drivers transporting hazardous materials as we already require of
American drivers. We require vehicles carrying hazardous materials to
be equipped with wireless communications equipment, and that their
drivers have established plans for the use of alternate routes. We
provide funding for the TSA to conduct security inspections of our
pipeline network, to develop a pipeline incident response plan, and to
analyze the security plans in place for hazmat carriers. We create a
public sector response center, and provide for the distribution of
emergency wireless communications equipment to first responders, hazmat
carriers, and TSA personnel.
Our constituents have sent us here, first and foremost, to protect
them. The ruthless attacks of September 11, 2001, exposed inexcusable
gaps in our efforts in that regard. At a time when the air in this city
is acrid with accusation and acrimony, I ask my colleagues to consider
this legislation a priority for quick passage, and an example of the
good work this institution can do when we remember why Americans
elected us. I ask my colleagues to join us in this effort, and I ask
the majority leader to find time on the Senate Calendar for its
expeditious consideration by the full Senate.
There being no objection, the bill was ordered to be printed in the
Record, as follows:

S. 1052

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
``Transportation Security Improvement Act of 2005''.
(b) Table of Contents.--The table of contents for this Act
is as follows:

Title I--Authorizations

Sec. 101. Transportation Security Administration authorization.
Sec. 102. Department of Transportation authorization.
Sec. 103. Certain personnel limitations not to apply.
Sec. 104. Intermodal regional security managers.
Sec. 105. Security threat assessment coordination policy.
Sec. 106. Reorganizations.

Title II--Improved Aviation Security

Sec. 201. Post-fiscal year 2006 air carrier security fees.
Sec. 202. Alternative collection methods for passenger security fee.
Sec. 203. Screener training review.
Sec. 204. Employee retention internship program.
Sec. 205. Repair station security.
Sec. 206. Waiver process for certain employment disqualifications.

Title III--Improved Rail Security

Sec. 301. Short title.
Sec. 302. Rail transportation security risk assessment.
Sec. 303. Systemwide Amtrak security upgrades.
Sec. 304. Fire and life-safety improvements.
Sec. 305. Freight and passenger rail security upgrades.
Sec. 306. Rail security research and development.
Sec. 307. Oversight and grant procedures.
Sec. 308. Amtrak plan to assist families of passengers involved in rail
passenger accidents.
Sec. 309. Northern Border rail passenger report.
Sec. 310. Rail worker security training program.
Sec. 311. Whistleblower protection program.
Sec. 312. High hazard material security threat mitigation plans.
Sec. 313. Memorandum of agreement.
Sec. 314. Rail security enhancements.
Sec. 315. Welded rail and tank car safety improvements.
Sec. 316. Report regarding impact on security of train travel in
communities without grade separation.
Sec. 317. Study of foreign rail transport security programs.
Sec. 318. Passenger, baggage, and cargo screening.
Sec. 319. Public awareness.
Sec. 320. Railroad high hazard material tracking.

Title IV--Improved Motor Carrier, Bus, and Hazardous Material Security

Sec. 401. Background checks for drivers hauling hazardous materials.
Sec. 402. Written plans for hazardous materials highway routing.
Sec. 403. Motor carrier high hazard material tracking.
Sec. 404. Truck leasing security training guidelines.
Sec. 405. Hazardous materials security inspections and enforcement.
Sec. 406. Pipeline security and incident recovery plan.
Sec. 407. Pipeline security inspections and enforcement.
Sec. 408. Memorandum of agreement.
Sec. 409. National public sector response system.
Sec. 410. Over-the-road bus security assistance.

Title V--Improved Maritime Security

Sec. 501. Establishment of additional joint operational centers for
port security.
Sec. 502. AMTS plan to include salvage response plan.
Sec. 503. Priority to certain vessels in post-incident resumption of
trade.
Sec. 504. Assistance for foreign ports.
Sec. 505. Improved data used for targeted cargo searches.
Sec. 506. Increase in number of customs inspectors assigned overseas.
Sec. 507. Random inspection of containers.
Sec. 508. Cargo security.
Sec. 509. Secure systems of international intermodal transportation.
Sec. 510. Technology for maritime transportation security.
Sec. 511. Deadline for transportation security cards.
Sec. 512. Evaluation and report.
Sec. 513. Port security grants.
Sec. 514. Work stoppages and employee-employer disputes.
Sec. 515. Appeal of denial of waiver for transportation security card.

TITLE I--AUTHORIZATIONS

SEC. 101. TRANSPORTATION SECURITY ADMINISTRATION
AUTHORIZATION.

Section 114 of title 49, United States Code, is amended by
adding at the end thereof the following:
``(u) Authorization of Appropriations.--There are
authorized to be appropriated to

[[Page S5310]]

the Secretary of Homeland Security, (Transportation Security
Administration)--
``(1) for Aviation Security--
``(A) $5,000,000,000 for fiscal year 2006;
``(B) $5,250,000,000 for fiscal year 2007; and
``(C) $5,500,000,000 for fiscal year 2008;
``(2) for Maritime and Land Security--
``(A) $394,000,000 for fiscal year 2006;
``(B) $354,000,000 for fiscal year 2007; and
``(C) $354,000,000 for fiscal year 2008;
``(3) for Intelligence--
``(A) $30,000,000 for fiscal year 2006;
``(B) $32,000,000 for fiscal year 2007; and
``(C) $34,000,000 for fiscal year 2008;
``(4) for Research and Development--
``(A) $30,000,000 for fiscal year 2006;
``(B) $32,000,000 for fiscal year 2007; and
``(C) $34,000,000 for fiscal year 2008; and
``(5) for Administration--
``(A) $530,000,000 for fiscal year 2006;
``(B) $535,000,000 for fiscal year 2007; and
``(C) $540,000,000 for fiscal year 2008.''.

SEC. 102. DEPARTMENT OF TRANSPORTATION AUTHORIZATION.

There are authorized to be appropriated to the Secretary of
Transportation to carry out title III of this Act and
sections 20118 and 24316 of title 49, United States Code, as
added by title III of this Act--
(1) $261,000,000 for fiscal year 2006;
(2) $258,000,000 for fiscal year 2007; and
(3) $258,000,000 for fiscal year 2008.

SEC. 103. CERTAIN PERSONNEL LIMITATIONS NOT TO APPLY.

(a) In General.--Any statutory limitation on the number of
employees in the Transportation Security Administration of
the Department of Transportation, before or after its
transfer to the Department of Homeland Security, does not
apply to the extent that any such employees are responsible
for implementing the provisions of this Act.
(b) Aviation Security.--Nothwithstanding any provision of
law imposing a limitation on the recruiting or hiring of
personnel into the Transportation Security Administration to
a maximum number of permanent positions, the Secretary of
Homeland Security shall recruit and hire such personnel into
the Administration as may be necessary--
(1) to provide appropriate levels of aviation security; and
(2) to accomplish that goal in such a manner that the
average aviation security-related delay experienced by
airline passengers is reduced.

SEC. 104. INTERMODAL REGIONAL SECURITY MANAGERS.

(a) Establishment, Designation, and Stationing.--The Under
Secretary of Homeland Security for Border and Transportation
Security, acting through the Transportation Security
Administration, is authorized to establish the position of
Intermodal Manager within each of at least 8 regional areas
of the nation, as divided on a geographical basis. The Under
Secretary shall designate individuals as Managers for, and
station those Managers within, those regions.
(b) Duties and Powers.--The regional offices shall--
(1) receive intelligence information related to maritime
and land security within the region;
(2) assist in the development and implementation of
vulnerability, threat, and risk assessments, security plans,
the identification of critical infrastructure for the region
undertaken by the Transportation Security Administration and
the Department of Homeland Security, or other public or
private entity when appropriate;
(3) serve as the regional coordinator of the Assistant
Secretary's response to terrorist incidents and threats to
maritime and land assets, operations and infrastructure
within the region;
(4) coordinate efforts related to maritime and land
security with other Department officials, State and local law
enforcement, and other public and private entities;
(5) coordinate with other regional managers;
(6) assist the Assistant Secretary in prioritizing maritime
and land security improvements, grants, and other efforts
funded by the Transportation Security Administration or the
Department of Homeland Security within the region.
(7) engage in outreach and promote public awareness of
maritime and land security efforts when appropriate.

SEC. 105. SECURITY THREAT ASSESSMENT COORDINATION POLICY.

(a) In General.--The Secretary of Homeland Security shall
transmit to the Senate Committee on Commerce, Science, and
Transportation and the House of Representatives Committee on
Transportation and Infrastructure a copy of the report on
comprehensive terrorist-related screening procedures required
by Homeland Security Presidential Directive 11 issued on
August 27, 2004.
(b) Format.--The Secretary may submit the report in both
classified and redacted formats if the Secretary determines
that such action is appropriate or necessary.

SEC. 106. REORGANIZATIONS.

The Secretary of Homeland Security shall notify the Senate
Committee on Commerce, Science, and Transportation, the
Senate Committee on Homeland Security and Governmental
Affairs, and the House of Representatives Committee on
Homeland Security in writing not less than 15 days before--
(1) reorganizing or renaming offices;
(2) reorganizing programs or activities; or
(3) contracting out or privatizing any functions or
activities presently performed by Federal employees.

TITLE II--IMPROVED AVIATION SECURITY

SEC. 201. POST-FISCAL YEAR 2006 AIR CARRIER SECURITY FEES.

(a) Air Carrier Security Service Fees Subject to
Congressional Review.--Section 44940(a)(2) of title 49,
United States Code, is amended by adding at the end the
following:
``(D) Fiscal years 2007 and later.--The Under Secretary may
not impose a fee under subparagraph (A) after September 30,
2006, unless--
``(i) the fee is imposed by rule promulgated by the Under
Secretary; and
``(ii) the Under Secretary submits the rule to the Senate
Committee on Commerce, Science, and Transportation and the
House of Representatives Committee on Transportation and
Infrastructure not less than 60 days before its proposed
effective date.
``(E) Application of chapter 8 of title 5.--Chapter 8 of
title 5 applies to any rule promulgated by the Under
Secretary imposing a fee under subparagraph (A) after
September 30, 2006.''.
(b) Report on Transportation Security Service Fees.--Each
year, beginning with calendar year 2006, the Secretary of
Homeland Security, shall transmit a report to the Senate
Committee on Commerce, Science, and Transportation and the
House of Representatives Committee on Transportation and
Infrastructure on fees, substantially similar to the fee
imposed under section 44940(a)(2) of title 49, United States
Code, that are imposed under authority of law on competing
modes of regularly-scheduled commercial passenger
transportation by rail, vessel, or over-the-road bus to pay
for the difference between the Transportation Security
Administration's costs of providing transportation security
services in connection with those modes of transportation and
amounts collected from fees imposed under authority of law on
passengers using those modes of transportation, taking into
account costs that are the same as or similar to the costs
described in 44940(a)(1) of that title that are appropriate
to the respective modes of transportation.

SEC. 202. ALTERNATIVE COLLECTION METHODS FOR PASSENGER
SECURITY FEE.

(a) In General.--
(1) Study.--The Assistant Secretary of Homeland Security
(Transportation Security Administration) shall study the
feasibility of collecting the passenger security service fee
authorized by section 44940(a) of title 49, United States
Code, directly from passengers at, or before they reach, the
airport through a system developed or approved by the
Assistant Secretary, including the use of vending kiosks,
other automated vending devices, the Internet, or other
remote vending sites.
(2) Solicitation of proposals.--In carrying out this
subsection the Secretary shall solicit proposals for such
alternative collection mechanisms.
(3) Development of alternatives.--Based on the study
conducted under paragraph (1) and an evaluation of proposals
submitted pursuant to the solicitation under paragraph (2),
the Assistant Secretary shall develop such alternative
collection systems as the Assistant Secretary determines to
be feasible, including schedules and methods to ensure the
efficiency of such systems.
(b) Report.--The Secretary shall report the results of the
study, together with any recommendations the Secretary deems
appropriate, to the Congress within 6 months after the date
of enactment of this Act.
(c) Demonstration Projects.--If the Secretary determines
that a system of direct collection of such fees from
passengers at airports is feasible, the Secretary shall
conduct demonstration projects at no fewer than 3 airports
within 1 year after submitting the report required by
subsection (b) to the Congress.

SEC. 203. SCREENER TRAINING REVIEW.

Within 6 months after the date of enactment of this Act,
the Assistant Secretary of Homeland Security (Transportation
Security Administration), shall transmit a report on the
adequacy of training for Transportation Security
Administration screeners to the Congress. In addition to
other issues, the Assistant Secretary shall specifically
address any multi-hour weekly training requirement for such
screeners, including an assessment of the degree to which
such a requirement is observed and whether the requirement is
appropriate, workable, and desirable. The Inspector General
of the Department of Homeland Security shall review the
report submitted under this section.

SEC. 204. EMPLOYEE RETENTION INTERNSHIP PROGRAM.

The Assistant Secretary of Homeland Security
(Transportation Security Administration), shall establish a
pilot program at no fewer than 3 airports for training
students to perform screening of passengers and property
under section 44901 of title 49, United States Code. The
program shall be an internship for pre-employment training of
final-year students from public and private secondary schools
located in nearby communities. Under the program,
participants--
(1) shall be compensated for training and services time
while participating in the program, and
(2) shall be required to agree, as a condition of
participation in the program, to accept employment as a
screener upon successful completion of the internship and
upon graduation from the secondary school.

SEC. 205. REPAIR STATION SECURITY.

(a) Certification of Foreign Repair Stations Suspension.--
If the Under Secretary of Homeland Security for Border and
Transportation Security does not issue the regulations
required by section 44924(e) of title 49,

[[Page S5311]]

United States Code, within 90 days after the date of
enactment of this Act, the Administrator of the Federal
Aviation Administration may not certify any foreign repair
station under part 145 of title 14, Code of Federal
Regulations after such 90th day.
(b) 6-Month Deadline for Security Review and Audit.--
Subsections (a) and (d) of section 44924 of title 49, United
States Code, are each amended by striking ``18 months'' and
inserting ``6 months''.

SEC. 206. WAIVER PROCESS FOR CERTAIN EMPLOYMENT
DISQUALIFICATIONS.

Section 44936 of title 49, United States Code, is amended
by adding at the end the following:
``(f) Waiver Process.--
``(1) In general.--The Under Secretary for Border and
Transportation Security of the Department of Homeland
Security shall establish a process to permit an individual
who was convicted of a crime listed in subsection (b) to
obtain a waiver from the Under Secretary to permit that
individual's employment.
``(2) Factors.--In deciding whether to grant a waiver under
this subsection, the Under Secretary shall give consideration
to the circumstances of the disqualifying crime, restitution
made by the individual, and other factors that would tend to
indicate that the individual does not pose a security or
terrorism risk.
``(3) Appeals process.--The Under Secretary shall establish
a process that includes an opportunity for a hearing for
individuals who are denied waivers under this subsection.
``(4) Restrictions on use and maintenance of information.--
``(A) Information submitted to or obtained by the Attorney
General or the Secretary under this section about an
individual may not be made available to the public, including
the individual's employer.
``(B) Any information submitted to or obtained under this
section shall be maintained confidentially by the Under
Secretary and may be used only for making determinations
under this section. The Under Secretary may share any such
information with other Federal law enforcement agencies. An
individual's employer may only be informed whether or not the
individual has been granted unescorted access under this
section.
``(5) Appeal.--An individual denied a waiver under this
subsection may file a civil action appealing that denial in
any United States District Court and those courts shall have
jurisdiction of the appeal.''.

TITLE III--IMPROVED RAIL SECURITY

SEC. 301. SHORT TITLE.

This title may be cited as the ``Rail Security Act of
2005''.

SEC. 302. RAIL TRANSPORTATION SECURITY RISK ASSESSMENT.

(a) In General.--
(1) Vulnerability and risk assessment.--The Secretary of
Homeland Security shall establish a task force, including the
Transportation Security Administration, the Department of
Transportation, and other appropriate agencies, to complete a
vulnerability and risk assessment of freight and passenger
rail transportation (encompassing railroads, as that term is
defined in section 20102(1) of title 49, United States Code).
The assessment shall include--
(A) identification and evaluation of critical assets and
infrastructures;
(B) identification of vulnerabilities and risks to those
assets and infrastructures;
(C) identification of vulnerabilities and risks that are
specific to the transportation of hazardous materials via
railroad; and
(D) identification of security weaknesses in passenger and
cargo security, transportation infrastructure, protection
systems, procedural policies, communications systems,
employee training, emergency response planning, and any other
area identified by the assessment.
(2) Existing private and public sector efforts.--The
assessment shall take into account actions taken or planned
by both public and private entities to address identified
security issues and assess the effective integration of such
actions.
(3) Recommendations.--Based on the assessment conducted
under paragraph (1), the Secretary, in consultation with the
Secretary of Transportation, shall develop prioritized
recommendations for improving rail security, including any
recommendations the Secretary has for--
(A) improving the security of rail tunnels, rail bridges,
rail switching and car storage areas, other rail
infrastructure and facilities, information systems, and other
areas identified by the Secretary as posing significant rail-
related risks to public safety and the movement of interstate
commerce, taking into account the impact that any proposed
security measure might have on the provision of rail service;
(B) deploying equipment to detect explosives and hazardous
chemical, biological, and radioactive substances, and any
appropriate countermeasures;
(C) training appropriate railroad or railroad shipper
employees in terrorism prevention, passenger evacuation, and
response activities;
(D) conducting public outreach campaigns on passenger
railroads;
(E) deploying surveillance equipment; and
(F) identifying the immediate and long-term costs of
measures that may be required to address those risks.
(4) Plans.--The report required by subsection (c) shall
include--
(A) a plan, developed in consultation with the freight and
intercity passenger railroads, and State and local
governments, for the Federal government to provide increased
security support at high or severe threat levels of alert;
(B) a plan for coordinating existing and planned rail
security initiatives undertaken by the public and private
sectors; and
(C) a contingency plan, developed in conjunction with
freight and intercity and commuter passenger railroads, to
ensure the continued movement of freight and passengers in
the event of an attack affecting the railroad system, which
shall contemplate--
(i) the possibility of rerouting traffic due to the loss of
critical infrastructure, such as a bridge, tunnel, yard, or
station; and
(ii) methods of continuing railroad service in the
Northeast Corridor in the event of a commercial power loss,
or catastrophe affecting a critical bridge, tunnel, yard, or
station.
(b) Consultation; Use of Existing Resources.--In carrying
out the assessment and developing the recommendations and
plans required by subsection (a), the Secretary of Homeland
Security shall consult with rail management, rail labor,
owners or lessors of rail cars used to transport hazardous
materials, first responders, shippers of hazardous materials,
public safety officials, and other relevant parties.
(c) Report.--
(1) Contents.--Within 180 days after the date of enactment
of this Act, the Secretary shall transmit to the Senate
Committee on Commerce, Science, and Transportation and the
House of Representatives Committee on Transportation and
Infrastructure a report containing the assessment,
prioritized recommendations, and plans required by subsection
(a) and an estimate of the cost to implement such
recommendations.
(2) Format.--The Secretary may submit the report in both
classified and redacted formats if the Secretary determines
that such action is appropriate or necessary.
(d) Annual Updates.--The Secretary, in consultation with
the Secretary of Transportation, shall update the assessment
and recommendations each year and transmit a report, which
may be submitted in both classified and redacted formats, to
the Committees named in subsection (c)(1), containing the
updated assessment and recommendations.
(e) Funding.--Out of funds appropriated pursuant to section
114(u)(2) of title 49, United States Code, there shall be
made available to the Secretary of Homeland Security to carry
out this section $5,000,000 for fiscal year 2006.

SEC. 303. SYSTEMWIDE AMTRAK SECURITY UPGRADES.

(a) In General--Subject to subsection (c) the Secretary of
Homeland Security, in consulation with the Assistant
Secretary of Homeland Security (Transportation Security
Administration), is authorized to make grants to Amtrak--
(1) to secure major tunnel access points and ensure tunnel
integrity in New York, Baltimore, and Washington, DC;
(2) to secure Amtrak trains;
(3) to secure Amtrak stations;
(4) to obtain a watch list identification system approved
by the Secretary;
(5) to obtain train tracking and interoperable
communications systems that are coordinated to the maximum
extent possible;
(6) to hire additional police and security officers,
including canine units; and
(7) to expand emergency preparedness efforts.
(b) Conditions.--The Secretary of Transportation shall
disburse funds to Amtrak provided under subsection (a) for
projects contained in a systemwide security plan approved by
the Secretary of Homeland Security. The plan shall include
appropriate measures to address security awareness, emergency
response, and passenger evacuation training.
(c) Equitable Geographic Allocation.--The Secretary shall
ensure that, subject to meeting the highest security needs on
Amtrak's entire system, stations and facilities located
outside of the Northeast Corridor receive an equitable share
of the security funds authorized by this section.
(d) Availability of Funds.--Out of funds appropriated
pursuant to section 114(u)(2) of title 49, United States
Code, there shall be made available to the Secretary of
Homeland Security and the Assistant Secretary of Homeland
Security (Transportation Security Administration) to carry
out this section--
(1) $63,500,000 for fiscal year 2006;
(2) $30,000,000 for fiscal year 2007; and
(3) $30,000,000 for fiscal year 2008.

Amounts appropriated pursuant to this subsection shall remain
available until expended.

SEC. 304. FIRE AND LIFE-SAFETY IMPROVEMENTS.

(a) Life-safety Needs.--The Secretary of Transportation is
authorized to make grants to Amtrak for the purpose of making
fire and life-safety improvements to Amtrak tunnels on the
Northeast Corridor in New York, NY, Baltimore, MD, and
Washington, DC.
(b) Authorization of Appropriations.--Out of funds
appropriated pursuant to section 102 of this Act, there shall
be made available to the Secretary of Transportation for the
purposes of carrying out subsection (a) the following
amounts:
(1) For the 6 New York tunnels to provide ventilation,
electrical, and fire safety technology upgrades, emergency
communication

[[Page S5312]]

and lighting systems, and emergency access and egress for
passengers--
(A) $190,000,000 for fiscal year 2006;
(B) $190,000,000 for fiscal year 2007;
(C) $190,000,000 for fiscal year 2008;
(2) For the Baltimore & Potomac tunnel and the Union
tunnel, together, to provide adequate drainage, ventilation,
communication, lighting, and passenger egress upgrades--
(A) $19,000,000 for fiscal year 2006;
(B) $19,000,000 for fiscal year 2007;
(C) $19,000,000 for fiscal year 2008;
(3) For the Washington, DC, Union Station tunnels to
improve ventilation, communication, lighting, and passenger
egress upgrades--
(A) $13,333,000 for fiscal year 2006;
(B) $13,333,000 for fiscal year 2007;
(C) $13,333,000 for fiscal year 2008;
(c) Infrastructure Upgrades.--Out of funds appropriated
pursuant to section 102 of this Act, there shall be made
available to the Secretary of Transportation for fiscal year
2006 $3,000,000 for the preliminary design of options for a
new tunnel on a different alignment to augment the capacity
of the existing Baltimore tunnels.
(d) Availability of Appropriated Funds.--Amounts made
available pursuant to this section shall remain available
until expended.
(e) Plans Required.--The Secretary may not make amounts
available to Amtrak for obligation or expenditure under
subsection (a)--
(1) until Amtrak has submitted to the Secretary, and the
Secretary has approved, an engineering and financial plan for
such projects; and
(2) unless, for each project funded pursuant to this
section, the Secretary has approved a project management plan
prepared by Amtrak addressing appropriate project budget,
construction schedule, recipient staff organization, document
control and record keeping, change order procedure, quality
control and assurance, periodic plan updates, and periodic
status reports.
(f) Review of Plans.--The Secretary of Transportation shall
complete the review of the plans required by paragraphs (1)
and (2) of subsection (e) and approve or disapprove the plans
within 45 days after the date on which each such plan is
submitted by Amtrak. If the Secretary determines that a plan
is incomplete or deficient, the Secretary shall notify Amtrak
of the incomplete items or deficiencies and Amtrak shall,
within 30 days after receiving the Secretary's notification,
submit a modified plan for the Secretary's review. Within 15
days after receiving additional information on items
previously included in the plan, and within 45 days after
receiving items newly included in a modified plan, the
Secretary shall either approve the modified plan, or, if the
Secretary finds the plan is still incomplete or deficient,
the Secretary shall identify in writing to the Senate
Committee on Commerce, Science, and Transportation and the
House of Representatives Committee on Transportation and
Infrastructure the portions of the plan the Secretary finds
incomplete or deficient, approve all other portions of the
plan, obligate the funds associated with those other
portions, and execute an agreement with Amtrak within 15 days
thereafter on a process for resolving the remaining portions
of the plan.
(g) Financial Contribution From Other Tunnel Users.--The
Secretary shall, taking into account the need for the timely
completion of all portions of the tunnel projects described
in subsection (a)--
(1) consider the extent to which rail carriers other than
Amtrak use or plan to use the tunnels;
(2) consider the feasibility of seeking a financial
contribution from those other rail carriers toward the costs
of the projects; and
(3) obtain financial contributions or commitments from such
other rail carriers at levels reflecting the extent of their
use or planned use of the tunnels, if feasible.

SEC. 305. FREIGHT AND PASSENGER RAIL SECURITY UPGRADES.

(a) Security Improvement Grants.--The Secretary of Homeland
Security, through the Assistant Secretary of Homeland
Security (Transportation Security Administration) and other
appropriate agencies, is authorized to make grants to freight
railroads, the Alaska Railroad, hazardous materials shippers,
owners of rail cars used in the transportation of hazardous
materials, universities, colleges and research centers, State
and local governments (for rail passenger facilities and
infrastructure not owned by Amtrak), and, through the
Secretary of Transportation, to Amtrak, for full or partial
reimbursement of costs incurred in the conduct of activities
to prevent or respond to acts of terrorism, sabotage, or
other intercity passenger rail and freight rail security
vulnerabilities and risks identified under section 302,
including--
(1) security and redundancy for critical communications,
computer, and train control systems essential for secure rail
operations;
(2) accommodation of cargo or passenger screening equipment
at the United States-Mexico border or the United States-
Canada border;
(3) the security of hazardous material transportation by
rail;
(4) secure intercity passenger rail stations, trains, and
infrastructure;
(5) structural modification or replacement of rail cars
transporting high hazard materials to improve their
resistance to acts of terrorism;
(6) employee security awareness, preparedness, passenger
evacuation, and emergency response training;
(7) public security awareness campaigns for passenger train
operations;
(8) the sharing of intelligence and information about
security threats;
(9) to obtain train tracking and interoperable
communications systems that are coordinated to the maximum
extent possible;
(10) to hire additional police and security officers,
including canine units; and
(11) other improvements recommended by the report required
by section 302, including infrastructure, facilities, and
equipment upgrades.
(b) Accountability.--The Secretary shall adopt necessary
procedures, including audits, to ensure that grants made
under this section are expended in accordance with the
purposes of this Act and the priorities and other criteria
developed by the Secretary.
(c) Allocation.--The Secretary shall distribute the funds
authorized by this section based on risk and vulnerability as
determined under section 302, and shall encourage non-Federal
financial participation in awarding grants. With respect to
grants for passenger rail security, the Secretary shall also
take into account passenger volume and whether a station is
used by commuter rail passengers as well as intercity rail
passengers.
(d) Conditions.--The Secretary of Transportation may not
disburse funds to Amtrak under subsection (a) unless Amtrak
meets the conditions set forth in section 303(b) of this Act.
(e) Allocation Between Railroads and Others.--Unless as a
result of the assessment required by section 302 the
Secretary of Homeland Security determines that critical rail
transportation security needs require reimbursement in
greater amounts to any eligible entity, no grants under this
section may be made--
(1) in excess of $65,000,000 to Amtrak; or
(2) in excess of $100,000,000 for the purposes described in
paragraphs (3) and (5) of subsection (a).
(f) Authorization of Appropriations.--Out of funds
appropriated pursuant to section 114(u)(2) of title 49,
United States Code, there shall be made available to the
Secretary of Homeland Security to carry out this section--
(1) $120,000,000 for fiscal year 2006;
(2) $120,000,000 for fiscal year 2007; and
(3) $120,000,000 for fiscal year 2008.

Amounts made available pursuant to this subsection shall
remain available until expended.
(g) High Hazard Materials Defined.--In this section, the
term ``high hazard materials'' means quantities of poison
inhalation hazard materials, Class 2.3 gases, Class 6.1
materials, and anhydrous ammonia that the Secretary, in
consultation with the Secretary of Transportation, determines
pose a security risk.

SEC. 306. RAIL SECURITY RESEARCH AND DEVELOPMENT.

(a) Establishment of Research and Development Program.--The
Secretary of Transportation, in conjunction with the Under
Secretary of Homeland Security for Science and Technology and
the Assistant Secretary of Homeland Security (Transportation
Security Administration), shall carry out a research and
development program for the purpose of improving freight and
intercity passenger rail security that may include research
and development projects to--
(1) reduce the vulnerability of passenger trains, stations,
and equipment to explosives and hazardous chemical,
biological, and radioactive substances;
(2) test new emergency response techniques and
technologies;
(3) develop improved freight technologies, including--
(A) technologies for sealing rail cars;
(B) automatic inspection of rail cars;
(C) communication-based train controls; and
(D) emergency response training;
(4) test wayside detectors that can detect tampering with
railroad equipment;
(5) support enhanced security for the transportation of
hazardous materials by rail, including--
(A) technologies to detect a breach in a tank car or other
rail car used to transport hazardous materials and transmit
information about the integrity of cars to the train crew or
dispatcher;
(B) research to improve tank car integrity, with a focus on
tank cars that carry high hazard materials (as defined in
section 305(g) of this Act;
(C) techniques to transfer hazardous materials from rail
cars that are damaged or otherwise represent an unreasonable
risk to human life or public safety; and
(6) other projects that address vulnerabilities and risks
identified under section 302.
(b) Coordination With Other Research Initiatives.--The
Secretary of Transportation shall ensure that the research
and development program authorized by this section is
coordinated with other research and development initiatives
at the Department of Transportation and the Department of
Homeland Security. The Secretary shall carry out any research
and development project authorized by this section through a
reimbursable agreement with the Under Secretary of Homeland
Security for Science and Technology, if the Under Secretary--

[[Page S5313]]

(1) is already sponsoring a research and development
project in a similar area; or
(2) has a unique facility or capability that would be
useful in carrying out the project.
(c) Grants and Accountability.--To carry out the research
and development program, the Secretary may award grants to
the entities described in section 305(a) and shall adopt
necessary procedures, including audits, to ensure that grants
made under this section are expended in accordance with the
purposes of this Act and the priorities and other criteria
developed by the Secretary.
(d) Authorization of Appropriations.--Out of funds
appropriated pursuant to section 102 of this Act, there shall
be made available to the Secretary of Transportation to carry
out this section--
(1) $35,000,000 for fiscal year 2006;
(2) $35,000,000 for fiscal year 2007; and
(3) $35,000,000 for fiscal year 2008.

Amounts made available pursuant to this subsection shall
remain available until expended.

SEC. 307. OVERSIGHT AND GRANT PROCEDURES.

(a) Secretarial Oversight.--The Secretary of Homeland
Security, in consultation with the Assistant Secretary of
Homeland Security (Transportation Security Administration),
may use up to 0.5 percent of amounts made available for
capital projects under the Rail Security Act of 2005 to enter
into contracts for the review of proposed capital projects
and related program management plans and to oversee
construction of such projects.
(b) Use of Funds.--The Secretary may use amounts available
under subsection (a) of this subsection to make contracts for
safety, procurement, management, and financial compliance
reviews and audits of a recipient of amounts under this Act.
(c) Procedures for Grant Award.--The Secretary shall
prescribe procedures and schedules for the awarding of grants
under this Act, including application and qualification
procedures (including a requirement that the applicant have a
security plan), and a record of decision on applicant
eligibility. The procedures shall include the execution of a
grant agreement between the grant recipient and the Secretary
and shall be consistent, to the extent practicable, with the
grant procedures established under section 70107 of title 46,
United States Code. The Secretary shall issue a final rule
establishing the procedures not later than 90 days after the
date of enactment of this Act.

SEC. 308. AMTRAK PLAN TO ASSIST FAMILIES OF PASSENGERS
INVOLVED IN RAIL PASSENGER ACCIDENTS.

(a) In General.--Chapter 243 of title 49, United States
Code, is amended by adding at the end the following:

``Sec. 24316. Plans to address needs of families of
passengers involved in rail passenger accidents

``(a) Submission of Plan.--Not later than 6 months after
the date of the enactment of the Rail Security Act of 2005,
Amtrak shall submit to the Chairman of the National
Transportation Safety Board and the Secretary of
Transportation a plan for addressing the needs of the
families of passengers involved in any rail passenger
accident involving an Amtrak intercity train and resulting in
a loss of life.
``(b) Contents of Plans.--The plan to be submitted by
Amtrak under subsection (a) shall include, at a minimum, the
following:
``(1) A process by which Amtrak will maintain and provide
to the National Transportation Safety Board and the Secretary
of Transportation, immediately upon request, a list (which is
based on the best available information at the time of the
request) of the names of the passengers aboard the train
(whether or not such names have been verified), and will
periodically update the list. The plan shall include a
procedure, with respect to unreserved trains and passengers
not holding reservations on other trains, for Amtrak to use
reasonable efforts to ascertain the number and names of
passengers aboard a train involved in an accident.
``(2) A plan for creating and publicizing a reliable, toll-
free telephone number within 4 hours after such an accident
occurs, and for providing staff, to handle calls from the
families of the passengers.
``(3) A process for notifying the families of the
passengers, before providing any public notice of the names
of the passengers, by suitably trained individuals.
``(4) A process for providing the notice described in
paragraph (2) to the family of a passenger as soon as Amtrak
has verified that the passenger was aboard the train (whether
or not the names of all of the passengers have been
verified).
``(5) A process by which the family of each passenger will
be consulted about the disposition of all remains and
personal effects of the passenger within Amtrak's control;
that any possession of the passenger within Amtrak's control
will be returned to the family unless the possession is
needed for the accident investigation or any criminal
investigation; and that any unclaimed possession of a
passenger within Amtrak's control will be retained by the
rail passenger carrier for at least 18 months.
``(6) A process by which the treatment of the families of
nonrevenue passengers will be the same as the treatment of
the families of revenue passengers.
``(7) An assurance that Amtrak will provide adequate
training to its employees and agents to meet the needs of
survivors and family members following an accident.
``(c) Use of Information.--The National Transportation
Safety Board, the Secretary of Transportation, and Amtrak may
not release to any person information on a list obtained
under subsection (b)(1) but may provide information on the
list about a passenger to the family of the passenger to the
extent that the Board or Amtrak considers appropriate.
``(d) Limitation on Liability.--Amtrak shall not be liable
for damages in any action brought in a Federal or State court
arising out of the performance of Amtrak in preparing or
providing a passenger list, or in providing information
concerning a train reservation, pursuant to a plan submitted
by Amtrak under subsection (b), unless such liability was
caused by Amtrak's conduct.
``(e) Limitation on Statutory Construction.--Nothing in
this section may be construed as limiting the actions that
Amtrak may take, or the obligations that Amtrak may have, in
providing assistance to the families of passengers involved
in a rail passenger accident.
``(f) Funding.--Out of funds appropriated pursuant to
section 102 of the Rail Security Act of 2005, there shall be
made available to the Secretary of Transportation for the use
of Amtrak $500,000 for fiscal year 2006 to carry out this
section. Amounts made available pursuant to this subsection
shall remain available until expended.''.
(b) Conforming Amendment.--The chapter analysis for chapter
243 of title 49, United States Code, is amended by adding at
the end the following:

``24316. Plan to assist families of passengers involved in rail
passenger accidents.''.

SEC. 309. NORTHERN BORDER RAIL PASSENGER REPORT.

Within 180 days after the date of enactment of this Act,
the Secretary of Transportation, in consultation with the
Secretary of Homeland Security, the Assistant Secretary of
Homeland Security (Transportation Security Administration),
heads of other appropriate Federal departments, and agencies
and the National Railroad Passenger Corporation, shall
transmit a report to the Senate Committee on Commerce,
Science, and Transportation and the House of Representatives
Committee on Transportation and Infrastructure that
contains--
(1) a description of the current system for screening
passengers and baggage on passenger rail service between the
United States and Canada;
(2) an assessment of the current program to provide
preclearance of airline passengers between the United States
and Canada as outlined in ``The Agreement on Air Transport
Preclearance between the Government of Canada and the
Government of the United States of America'', dated January
18, 2001;
(3) an assessment of the current program to provide
preclearance of freight railroad traffic between the United
States and Canada as outlined in the ``Declaration of
Principle for the Improved Security of Rail Shipments by
Canadian National Railway and Canadian Pacific Railway from
Canada to the United States'', dated April 2, 2003;
(4) information on progress by the Department of Homeland
Security and other Federal agencies towards finalizing a
bilateral protocol with Canada that would provide for
preclearance of passengers on trains operating between the
United States and Canada;
(5) a description of legislative, regulatory, budgetary, or
policy barriers within the United States Government to
providing pre-screened passenger lists for rail passengers
traveling between the United States and Canada to the
Department of Homeland Security;
(6) a description of the position of the Government of
Canada and relevant Canadian agencies with respect to
preclearance of such passengers;
(7) a draft of any changes in existing Federal law
necessary to provide for pre-screening of such passengers and
providing pre-screened passenger lists to the Department of
Homeland Security; and
(8) an analysis of the feasibility of reinstating United
States Customs and Border Patrol rolling inspections onboard
international Amtrak trains.

SEC. 310. RAIL WORKER SECURITY TRAINING PROGRAM.

(a) In General.--Not later than 60 days after the date of
enactment of this Act, the Secretary of Homeland Security and
the Secretary of Transportation, in consultation with
appropriate law enforcement, security, and terrorism experts,
representatives of railroad carriers, and nonprofit employee
organizations that represent rail workers, shall develop and
issue detailed guidance for a rail worker security training
program to prepare front-line workers for potential threat
conditions.
(b) Program Elements.--The guidance developed under
subsection (a) shall require such a program to include, at a
minimum, elements as appropriate to passenger and freight
rail service, that address the following:
(1) Determination of the seriousness of any occurrence.
(2) Crew communication and coordination.
(3) Appropriate responses to defend oneself.
(4) Use of protective devices.
(5) Evacuation procedures.
(6) Psychology of terrorists to cope with hijacker behavior
and passenger responses.
(7) Live situational training exercises regarding various
threat conditions, including tunnel evacuation procedures.

[[Page S5314]]

(8) Any other subject the Secretary considers appropriate.
(c) Railroad Carrier Programs.--Not later than 60 days
after the Secretary issues guidance under subsection (a) in
final form, each railroad carrier shall develop a rail worker
security training program in accordance with that guidance
and submit it to the Secretary for approval. Not later than
30 days after receiving a railroad carrier's program under
this subsection, the Secretary shall review the program and
approve it or require the railroad carrier to make any
revisions the Secretary considers necessary for the program
to meet the guidance requirements.
(d) Training.--Not later than 180 days after the Secretary
approves the training program developed by a railroad carrier
under this section, the railroad carrier shall complete the
training of all front-line workers in accordance with that
program.
(e) Updates.--The Secretary shall update the training
guidance issued under subsection (a) from time to time to
reflect new or different security threats, and require
railroad carriers to revise their programs accordingly and
provide additional training to their front-line workers.
(f) Front-line Workers Defined.--In this section, the term
``front-line workers'' means security personnel, dispatchers,
train operators, other onboard employees, maintenance and
support personnel, bridge tenders, and other appropriate
employees of railroad carriers.
(g) Other Employees.--The Secretary of Homeland Security
shall issue guidance and best practices for a rail shipper
employee security program containing the elements listed
under subsection (b) as appropriate.

SEC. 311. WHISTLEBLOWER PROTECTION PROGRAM.

(a) In General.--Subchapter A of chapter 201 of title 49,
United States Code, is amended by inserting after section
20117 the following:

``Sec. 20118. Whistleblower protection for rail security
matters

``(a) Discrimination Against Employee.--No rail carrier
engaged in interstate or foreign commerce may discharge a
railroad employee or otherwise discriminate against a
railroad employee because the employee (or any person acting
pursuant to a request of the employee)--
(1) provided, caused to be provided, or is about to provide
or cause to be provided, to the employer or the Federal
Government information relating to a perceived threat to
security; or
``(2) provided, caused to be provided, or is about to
provide or cause to be provided, testimony before Congress or
at any Federal or State proceeding regarding a perceived
threat to security; or
``(3) refused to violate or assist in the violation of any
law, rule or regulation related to rail security.
``(b) Dispute Resolution.--A dispute, grievance, or claim
arising under this section is subject to resolution under
section 3 of the Railway Labor Act (45 U.S.C. 153). In a
proceeding by the National Railroad Adjustment Board, a
division or delegate of the Board, or another board of
adjustment established under section 3 to resolve the
dispute, grievance, or claim the proceeding shall be
expedited and the dispute, grievance, or claim shall be
resolved not later than 180 days after it is filed. If the
violation is a form of discrimination that does not involve
discharge, suspension, or another action affecting pay, and
no other remedy is available under this subsection, the
Board, division, delegate, or other board of adjustment may
award the employee reasonable damages, including punitive
damages, of not more than $20,000.
``(c) Procedural Requirements.--Except as provided in
subsection (b), the procedure set forth in section
42121(b)(2)(B) of this title, including the burdens of proof,
applies to any complaint brought under this section.
``(d) Election of Remedies.--An employee of a railroad
carrier may not seek protection under both this section and
another provision of law for the same allegedly unlawful act
of the carrier.
``(e) Disclosure of Identity.--
``(1) Except as provided in paragraph (2) of this
subsection, or with the written consent of the employee, the
Secretary of Transportation may not disclose the name of an
employee of a railroad carrier who has provided information
about an alleged violation of this section.
``(2) The Secretary shall disclose to the Attorney General
the name of an employee described in paragraph (1) of this
subsection if the matter is referred to the Attorney General
for enforcement.''.
(b) Conforming Amendment.--The chapter analysis for chapter
201 of title 49, United States Code, is amended by inserting
after the item relating to section 20117 the following:

``20118. Whistleblower protection for rail security matters.''.

SEC. 312. HIGH HAZARD MATERIAL SECURITY THREAT MITIGATION
PLANS.

(a) In General.--The Secretary of Homeland Security, in
consultation with the Assistant Secretary of Homeland
Security (Transportation Security Administration) and the
Secretary of Transportation, shall require rail carriers
transporting a high hazard material, as defined in section
305(g) of this Act and of a quantity equal or exceeding the
quantities of such material listed in subpart 172.800, title
49, Federal Code of Regulations, to develop a high hazard
material security threat mitigation plans containing
appropriate measures, including alternative routing and
temporary shipment suspension options, to address assessed
risks to high consequence targets.
(b) Implementation.--A high hazard material security threat
mitigation plan shall be put into effect by a rail carrier
for the shipment of high hazardous materials by rail on the
rail carrier's right-of-way when the threat levels of the
Homeland Security Advisory System are high or severe and
specific intelligence of probable or imminent threat exists
towards--
(1) a high-consequence target that is within the
catastrophic impact zone of a railroad right-of-way used to
transport high hazardous material; or
(2) rail infrastructure or operations within the immediate
vicinity of a high-consequence target.
(c) Completion and Review of Plans.--
(1) Plans required.--Each rail carrier shall--
(A) submit a list of routes used to transport high hazard
materials to the Secretary of Homeland Security within 60
days after the date of enactment of this Act; and
(B) develop and submit a high hazard material security
threat mitigation plan to the Secretary within 180 days after
it receives the notice of high consequence targets on such
routes by the Secretary.
(2) Review and updates.--The Secretary, with assistance of
the Secretary of Transportation, shall review and approve the
plans. Each rail carrier shall update and resubmit its plan
for review not less than every 2 years.
(d) Definitions.--In this section:
(1) The term ``high-consequence target'' means a building,
buildings, infrastructure, public space, or natural resource
designated by the Secretary of Homeland Security that is
viable terrorist target of national significance, the attack
of which could result in--
(A) catastrophic loss of life; and
(B) significantly damaged national security and defense
capabilities; or
(C) national economic harm;
(2) The term ``catastrophic impact zone'' means the area
immediately adjacent to, under, or above an active railroad
right-of-way used to ship high hazard materials in which the
potential release or explosion of the high hazard material
being transported would likely cause--
(A) loss of life; or
(B) significant damage to property or structures.
(3) The term ``rail carrier'' has the meaning given that
term by section 10102(5) of title 49, United States Code.

SEC. 313. MEMORANDUM OF AGREEMENT.

(a) Memorandum of Agreement.--Within 1 year after the date
of enactment of this Act, the Secretary of Transportation and
the Secretary of Homeland Security shall execute and develop
an annex to the memorandum of agreement between the two
departments signed on September 28, 2004, governing the
specific roles, delineations of responsibilities, resources
and commitments of the Department of Transportation and the
Department of Homeland Security, respectively, in addressing
railroad transportation security matters, including the
processes the departments will follow to promote
communications, efficiency, and nonduplication of effort.
(b) Rail Safety Regulations.--Section 20103(a) of title 49,
United States Code, is amended by striking ``safety'' the
first place it appears, and inserting ``safety, including
security,''.

SEC. 314. RAIL SECURITY ENHANCEMENTS.

(a) Rail Police Officers.--Section 28101 of title 49,
United States Code, is amended--
(1) by inserting ``(a) In General.--'' before ``Under'';
(2) by striking ``the rail carrier'' each place it appears
and inserting ``any rail carrier''; and
(3) by adding at the end the following:
``(b) Limitation.--Except to the extent necessary to carry
out subsection (a), a rail police officer employed by a Class
I or Class II railroad as identified by the Surface
Transportation Board has no authority to enforce any rule,
policy, or practice of, or labor agreement by, a rail carrier
relating to personnel management or labor relations other
than those involving safety or security. Nothing in this
subsection shall preclude a rail police officer from
performing any activities not covered by subsection (a) that
may be performed by any other employee of a railroad,
provided that the rail police officer does not use his or her
position as a rail police officer in performing such
activities.''.
(b) Review of Rail Regulations.--Within 1 year after the
date of enactment of this Act, the Secretary of
Transportation, in consultation with the Secretary of
Homeland Security and the Assistant Secretary of Homeland
Security (Transportation Security Administration), shall
review existing rail regulations of the Department of
Transportation for the purpose of identifying areas in which
those regulations need to be revised to improve rail
security.

SEC. 315. WELDED RAIL AND TANK CAR SAFETY IMPROVEMENTS.

(a) Track Standards.--
(1) In general.--Within 90 days after the date of enactment
of this Act, the Federal Railroad Administration shall--
(A) require each track owner using continuous welded rail
track to include procedures

[[Page S5315]]

(in its procedures filed with the Administration pursuant to
section 213.119 of title 49, Code of Federal Regulations) to
improve the identification of cracks in rail joint bars;
(B) instruct Administration track inspectors to obtain
copies of the most recent continuous welded rail programs of
each railroad within the inspectors' areas of responsibility
and require that inspectors use those programs when
conducting track inspections; and
(C) establish a program to review continuous welded rail
joint bar inspection data from railroads and Administration
track inspectors periodically.
(2) Inspection.--Whenever the Administration determines
that it is necessary or appropriate the Administration may
require railroads to increase the frequency of inspection, or
improve the methods of inspection, of joint bars in
continuous welded rail.
(b) Tank Car Standards.--The Federal Railroad
Administration shall--
(1) validate a predictive model to quantify the relevant
dynamic forces acting on railroad tank cars under accident
conditions within 1 year after the date of enactment of this
Act; and
(2) initiate a rulemaking to develop and implement
appropriate design standards for pressurized tank cars within
18 months after the date of enactment of this Act.
(c) Older Tank Car Impact Resistance Analysis and Report.--
Within 1 year after the date of enactment of this Act the
Federal Railroad Administration shall conduct a comprehensive
analysis to determine the impact resistance of the steels in
the shells of pressure tank cars constructed before 1989.
Within 6 months after completing that analysis the
Administration shall--
(1) establish a program to rank those cars according to
their risk of catastrophic fracture and separation;
(2) implement measures to eliminate or mitigate this risk;
and
(3) transmit a report to the Senate Committee on Commerce,
Science, and Transportation and the House of Representatives
Committee on Transportation and Infrastructure setting forth
the measures implemented.
(d) Authorization of Appropriations.--There are authorized
to be appropriated to the Federal Railroad Administration
$1,000,000 for fiscal year 2006 to carry out this section,
such sums to remain available until expended.

SEC. 316. REPORT REGARDING IMPACT ON SECURITY OF TRAIN TRAVEL
IN COMMUNITIES WITHOUT GRADE SEPARATION.

(a) Study.--The Secretary of Transportation, in
consultation with the Secretary of Homeland Security, the
Assistant Secretary of Homeland Security (Transportation
Security Administration), and State and local government
officials, shall conduct a study on the impact of blocked
highway-railroad grade crossings on the ability of emergency
responders, including ambulances and police, fire, and other
emergency vehicles, to perform public safety and security
duties in the event of a terrorist attack.
(b) Report.--Not later than 1 year after the date of
enactment of this Act, the Secretary shall submit a report to
the Committee on Transportation and Infrastructure of the
House of Representatives and the Committee on Commerce,
Science, and Transportation of the Senate on the findings of
the study conducted under subsection (a) and recommendations
for reducing the impact of blocked crossings on emergency
response capabilities.

SEC. 317. STUDY OF FOREIGN RAIL TRANSPORT SECURITY PROGRAMS.

(a) Requirement for Study.--Within one year after the date
of enactment of the Rail Security Act of 2005, the
Comptroller General shall complete a study of the rail
passenger transportation security programs that are carried
out for rail transportation systems in Japan, member nations
of the European Union, and other foreign countries.
(b) Purpose.--The purpose of the study shall be to identify
effective rail transportation security measures that are in
use in foreign rail transportation systems, including
innovative measures and screening procedures determined
effective.
(c) Report.--The Comptroller General shall submit a report
on the results of the study to the Senate Committee on
Commerce, Science, and Transportation and the House of
Representatives Committee on Transportation and
Infrastructure. The report shall include the Comptroller
General's assessment regarding whether it is feasible to
implement within the United States any of the same or similar
security measures that are determined effective under the
study.

SEC. 318. PASSENGER, BAGGAGE, AND CARGO SCREENING.

(a) Requirement for Study and Report.--The Secretary of
Homeland Security, in cooperation with the Secretary of
Transportation through the Assistant Secretary of Homeland
Security (Transportation Security Administration) and other
appropriate agencies, shall--
(1) study the cost and feasibility of requiring security
screening for passengers, baggage, and cargo on passenger
trains including an analysis of any passenger train screening
pilot programs undertaken by the Department of Homeland
Security; and
(2) report the results of the study, together with any
recommendations that the Secretary of Homeland Security may
have for implementing a rail security screening program to
the Senate Committee on Commerce, Science, and Transportation
and the House of Representatives Committee on Transportation
and Infrastructure within 1 year after the date of enactment
of this Act.
(b) Authorization of Appropriations.--Out of funds
appropriated pursuant to section 114(u)(2) of title 49,
United States Code, there shall be made available to the
Secretary of Homeland Security to carry out this section
$1,000,000 for fiscal year 2006.

SEC. 319. PUBLIC AWARENESS.

Not later than 90 days after the date of enactment of this
Act, the Secretary of Homeland Security, in consultation with
the Secretary of Transportation, shall develop a national
plan for public outreach and awareness. Such plan shall be
designed to increase awareness of measures that the general
public, railroad passengers, and railroad employees can take
to increase railroad system security. Such plan shall also
provide outreach to railroad carriers and their employees to
improve their awareness of available technologies, ongoing
research and development efforts, and available Federal
funding sources to improve railroad security. Not later than
9 months after the date of enactment of this Act, the
Secretary of Transportation shall implement the plan
developed under this section.

SEC. 320. RAILROAD HIGH HAZARD MATERIAL TRACKING.

(a) Wireless Communications.--
(1) In general.--Within 6 months after the date of
enactment of this Act, the Secretary of Transportation shall
develop a program that will encourage the equipping of rail
cars transporting high hazard materials (as defined in
section 305(g) of this Act) in quantities equal to or greater
than the quantities specified in subpart 171.800 of title 49,
Code of Federal Regulations, with wireless terrestrial or
satellite communications technology that provides--
(A) car position location and tracking capabilities;
(B) notification of rail car depressurization, breach, or
unsafe temperature; and
(C) notification of hazardous material release.
(2) Coordination.--In developing the program required by
paragraph (1), the Secretary shall--
(A) consult with the Secretary of Homeland Security and the
Assistant Secretary of Homeland Security (Transportation
Security Administration) to coordinate the program with any
ongoing or planned efforts for rail car tracking at the
Department of Homeland Security; and
(B) ensure that the program is consistent with
recommendations and findings of the Department of Homeland
Security's hazardous material tank rail car tracking pilot
programs.
(b) Funding.--Out of funds appropriated pursuant to section
102 of this Act, there shall be made available to the
Secretary of Homeland Security through the Assistant
Secretary of Homeland Security (Transportation Security
Administration) to carry out this section $3,000,000 for each
of fiscal years 2006, 2007, and 2008.

TITLE IV--IMPROVED MOTOR CARRIER, BUS, AND HAZARDOUS MATERIAL SECURITY

SEC. 401. BACKGROUND CHECKS FOR DRIVERS HAULING HAZARDOUS
MATERIALS.

(a) Foreign Drivers.--
(1) In general.--No commercial motor vehicle operator
registered to operate in Mexico or Canada may operate a
commercial motor vehicle transporting a hazardous material in
commerce in the United States until the operator has
undergone a background records check similar to the
background records check required for commercial motor
vehicle operators licensed in the United States to transport
hazardous materials in commerce.
(2) Definitions.--In this subsection:
(A) Hazardous materials.--The term ``hazardous material''
has the meaning given that term in section 5102(2) of title
49, United States Code.
(B) Commercial motor vehicle.--The term ``commercial motor
vehicle'' has the meaning given that term by section 31101 of
title 49, United States Code.
(b) Other Drivers.--
(1) Employer notification.--Within 90 days after the date
of enactment of this Act, the Assistant Secretary of Homeland
Security (Transportation Security Administration), shall
develop and implement a process for the notification of a
hazmat employer (as defined in section 5102(4) of title 49,
United States Code), if appropriate considering the potential
security implications, designated by an applicant seeking a
threat assessment under part 1572 of title 49, Code of
Federal Regulations, if the Transportation Security
Administration, in an initial notification of threat
assessment or a final notification of threat assessment,
served on the applicant determines that the applicant does
not meet the standards set forth in section 1572.5(d) of
title 49, Code of Federal Regulations.
(2) Relationship to other background records checks.--
(A) Elimination of redundant checks.--An individual with
respect to whom the Transportation Security Administration--
(i) has performed a security threat assessment under part
1572 of title 49, Code of Federal Regulations, and
(ii) has issued a notification of no security threat under
section 1572.5(g) of that title,

is deemed to have met the requirements of any other
background check that is equivalent to, or less stringent
than, the background check performed under section 5103a

[[Page S5316]]

of title 49, United States Code, that is required for
purposes of any Federal law applicable to transportation
workers.
(B) Determination by assistant secretary.--Within 30 days
after the date of enactment of this Act, the Assistant
Secretary of Homeland Security (Transportation Security
Administration) shall initiate a rulemaking proceeding,
including notice and opportunity for comment, that sets forth
the background checks and other similar security or threat
assessment requirements applicable to transportation workers
under Federal law to which subparagraph (A) applies.
(C) Future rulemakings.--The Assistant Secretary shall make
a determination under the criteria established under
subparagraph (B) with respect to any rulemaking proceeding to
establish or modify required background checks for
transportation workers initiated after the date of enactment
of this Act.
(c) Appeals Process for More Stringent State Procedures.--
If a State establishes standards for applicants for a
hazardous materials endorsement to a commercial driver's
license that, as determined by the Secretary of Homeland
Security, are more stringent than the standards set forth in
section 1572.5(d) of title 49, Code of Federal Regulations,
then the State shall also provide an appeals process similar
to the process provided under section 1572.141 of title 49,
Code of Federal Regulations, by which an applicant denied a
hazardous materials endorsement to a commercial driver's
license by that State may appeal that denial in a manner
substantially similar to, and to the same extent as, an
individual who received an initial notification of threat
assessment under part 1572 of that title.
(d) Clarification of Term Defined in Regulations.--The term
``severe transportation security incident'', as defined in
section 1572.3 of title 49, Code of Federal Regulations, does
not include a work stoppage or other nonviolent employee-
related action resulting from an employer-employee dispute.
Within 30 days after the date of enactment of this Act, the
Secretary of Homeland Security shall modify the definition of
that term to reflect the preceding sentence.
(e) Background Check Capacity.--The Assistant Secretary of
Homeland Security (Transportation Security Administration)
shall transmit a report by October 1, 2005, to the Senate
Committee on Commerce, Science, and Transportation and the
House of Representatives Committee on Homeland Security on
the implementation of fingerprint-based security threat
assessments and the adequacy of fingerprinting locations,
personnel, and resources to accomplish the timely processing
of fingerprint-based security threat assessments for
individuals holding commercial driver's licenses who are
applying to renew hazardous materials endorsements.

SEC. 402. WRITTEN PLANS FOR HAZARDOUS MATERIALS HIGHWAY
ROUTING.

Within 180 days after the date of enactment of this Act,
the Secretary of Transportation shall require each motor
carrier that is required to have a hazardous material safety
permit under part 385 of title 49, Code of Federal
Regulations, to maintain a written route plan that meets the
requirements of section 397.101 of that title when
transporting the type and quantity of hazardous materials
described in section 385.403 of that title.

SEC. 403. MOTOR CARRIER HIGH HAZARD MATERIAL TRACKING.

(a) Wireless Communications.--Within 2 years after the date
of enactment of this Act, the Assistant Secretary of Homeland
Security (Transportation Security Administration), in
consultation with the Secretary of Transportation, shall
require, consistent with the recommendations and finding
contained in the report on the Hazardous Material Safety and
Security Operation Field Test released by the Federal Motor
Carrier Safety Administration on November 11, 2004,
commercial motor vehicles transporting high hazard materials
(as defined in section 305(g) of this Act) in quantities
equal to or greater than the quantities specified in subpart
171.800 of title 49, Code of Federal Regulations, to be
equipped with wireless terrestrial or satellite
communications technology that provides--
(1) continuous communications;
(2) vehicle position location and tracking capabilities;
and
(3) a feature that allows a driver of such vehicles to
broadcast an emergency message.
(b) Exemptions.--The Assistant Secretary may grant a 2-year
waiver of this requirement for a motor carrier for the
commercial motor vehicles it operates if--
(1) adequate technology is not readily available;
(2) available technology is not sufficiently reliable; or
(3) the size of a motor carrier or the infrequency with
which it transports high hazard material shipments makes the
requirement overly burdensome.
(c) Assistance Program.--The Assistant Secretary may
develop an assistance program to provide technical guidance
and grants to motor carriers who receive waivers under
subsection (b)(3) to expedite compliance with subsection (a)
of this section.

SEC. 404. TRUCK LEASING SECURITY TRAINING GUIDELINES.

(a) In general.--Within 180 days after the date of
enactment of this Act the Assistant Secretary of Homeland
Security (Transportation Security Administration), in
consultation with the Federal Motor Carrier Safety
Administration, shall develop and make available in written
or electronic form security training guidelines for short-
term truck leasing operations.
(b) Contents.--The truck leasing security training
guidelines shall--
(1) include information for short-term truck leasing
companies on the appropriate contents of employee security
training efforts designed to enable employees to recognize
terrorist threats and criminal activity; and
(2) contain a list of best practices developed by the
Assistant Secretary.
(c) Outreach.--The Assistant Secretary, through each
Federal maritime and land regional security manager, shall
hold public information and outreach sessions to present the
truck leasing security training guidelines to short-term
truck leasing companies.
(d) Funding.--Out of funds appropriated pursuant to section
114(u)(2) of title 49, United States Code, there shall be
made available to the Assistant Secretary of Homeland
Security (Transportation Security Administration), to carry
out this section $1,000,000 for fiscal year 2006.

SEC. 405. HAZARDOUS MATERIALS SECURITY INSPECTIONS AND
ENFORCEMENT.

(a) In General.--The Assistant Secretary of Homeland
Security (Transportation Security Administration) shall
establish a program within the Transportation Security
Administration, in consultation with the Secretary of
Transportation, for reviewing hazardous materials security
plans required under part 172, title 49, Code of Federal
Regulations, within 180 days after the date of enactment of
this Act.
(b) Civil Penalty.--The failure, by a shipper, carrier, or
other person subject to part 172 of title 49, Code of Federal
Regulations, to comply with any applicable section of that
part within 180 days after being notified by the Assistant
Secretary of such failure to comply, is punishable by a civil
penalty imposed by the Assistant Secretary under title 49,
United States Code. For purposes of this subsection, each day
of noncompliance after the 181st day following the date on
which the pipeline operator received notice of the failure
shall constitute a separate failure.
(c) Compliance Review.--In reviewing the compliance of
hazardous materials shippers, carriers, or other persons
subject to part 172 of title 49, Code of Federal Regulations,
with the provisions of that part, the Assistant Secretary
shall utilize risk assessment methodologies to prioritize
vulnerabilities and to target review and enforcement actions
to the most vulnerable and critical hazardous materials
transportation operations.
(d) Funding.--Out of funds appropriated pursuant to section
114(u)(2) of title 49, United States Code, there shall be
made available to the Assistant Secretary of Homeland
Security (Transportation Security Administration), to carry
out this section--
(1) $2,000,000 for fiscal year 2006;
(2) $2,000,000 for fiscal year 2007; and
(3) $2,000,000 for fiscal year 2008.

SEC. 406. PIPELINE SECURITY AND INCIDENT RECOVERY PLAN.

(a) In General.--The Secretary of Homeland Security, in
consultation with the Secretary of Transportation and the
Pipeline and Hazardous Materials Safety Administration, and
in accordance with the Memorandum of Understanding Annex
executed under section 408, shall develop a Pipeline Security
and Incident Recovery Protocols Plan. The plan shall
include--
(1) a plan for the Federal Government to provide increased
security support to the most critical interstate and
intrastate natural gas and hazardous liquid transmission
pipeline infrastructure and operations as determined under
section 407--
(A) at high or severe security threat levels of alert; and
(B) when specific security threat information relating to
such pipeline infrastructure or operations exists; and
(2) an incident recovery protocol plan, developed in
conjunction with interstate and intrastate transmission and
distribution pipeline operators and terminals and facilities
operators connected to pipelines, to develop protocols to
ensure the continued transportation of natural gas and
hazardous liquids to essential markets and for essential
public health or national defense uses in the event of an
incident affecting the interstate and intrastate natural gas
and hazardous liquid transmission and distribution pipeline
system, which shall include protocols for granting access to
pipeline operators for pipeline infrastructure repair,
replacement or bypass following an incident.
(b) Existing Private and Public Sector Efforts.--The plan
shall take into account actions taken or planned by both
public and private entities to address identified pipeline
security issues and assess the effective integration of such
actions.
(c) Consultation.--In developing the plan under subsection
(a), the Secretary shall consult with interstate and
intrastate transmission and distribution pipeline operators,
pipeline labor, first responders, shippers of hazardous
materials, State Departments of Transportation, public safety
officials, and other relevant parties.
(d) Report.--
(1) Contents.--Not later than 180 days after the date of
enactment of this Act, the Secretary shall transmit to the
Committee on Commerce, Science, and Transportation

[[Page S5317]]

of the Senate, the Committee on Homeland Security of the
House of Representatives, and the Committee on Transportation
and Infrastructure of the House of Representatives a report
containing the plan required by subsection (a), along with an
estimate of the cost to implement any recommendations.
(2) Format.--The Secretary may submit the report in both
classified and redacted formats if the Secretary determines
that such action is appropriate or necessary.
(e) Funding.--Out of funds appropriated pursuant to section
114(u)(2) of title 49, United States Code, there shall be
made available to the Secretary of Homeland Security to carry
out this section $1,000,000 for fiscal year 2006.

SEC. 407. PIPELINE SECURITY INSPECTIONS AND ENFORCEMENT.

(a) In General.--Within 180 days after the date of
enactment of this Act the Assistant Secretary of Homeland
Security (Transportation Security Administration), in
consultation with the Secretary of Transportation, shall
establish a program within the Transportation Security
Administration for reviewing pipeline operator adoption of
recommendations in the September, 5, 2002, Department of
Transportation Research and Special Programs Administration
Pipeline Security Information Circular, including the review
of pipeline security plans and critical facility inspections,
as determined by the Assistant Secretary.
(b) Review and Inspection.--Within 9 months after the date
of enactment of this Act the Assistant Secretary shall
complete a review of the pipeline security plan and an
inspection of the critical facilities of the 100 most
critical pipeline operators, as determined by the Assistant
Secretary, covered by the September, 5, 2002, circular.
(c) Compliance Review Methodology.--In reviewing pipeline
operator compliance under subsections (a) and (b), the
Assistant Secretary shall utilize risk assessment
methodologies to prioritize vulnerabilities and to target
inspection and enforcement actions to the most vulnerable and
critical pipeline assets.
(d) Regulations.--Within 1 year after the date of enactment
of this Act, the Assistant Secretary shall issue security
regulations for natural gas and hazardous liquid pipelines
and pipeline facilities. The regulations should incorporate
the guidance provided to pipeline operators by the September
5, 2002, Department of Transportation Research and Special
Programs Administration's Pipeline Security Information
Circular and contain additional requirements as necessary
based upon the results of the inspections performed under
subsection (b). The regulations shall include the imposition
of civil penalties for non-compliance. The Assistant
Secretary shall publish a schedule of those civil penalties.
(e) Funding.--Out of funds appropriated pursuant to section
114(u)(2) of title 49, United States Code, there shall be
made available to the Assistant Secretary of Homeland
Security (Transportation Security Administration), to carry
out this section--
(1) $2,000,000 for fiscal year 2006;
(2) $2,000,000 for fiscal year 2007; and
(3) $2,000,000 for fiscal year 2008.

SEC. 408. MEMORANDUM OF AGREEMENT.

Within 1 year after the date of enactment of this Act, the
Secretary of Transportation and the Assistant Secretary of
Homeland Security (Transportation Security Administration),
shall execute and develop an annex to the memorandum of
agreement between the two departments signed on September 28,
2004, governing the specific roles, delineations of
responsibilities, resources and commitments of the Department
of Transportation and the Department of Homeland Security,
respectively, in addressing pipeline security and hazardous
material transportation security matters, including the
processes the departments will follow to promote
communications, efficiency, and nonduplication of effort.

SEC. 409. NATIONAL PUBLIC SECTOR RESPONSE SYSTEM.

(a) Development.--The Secretary of Homeland Security, in
conjunction with the Secretary of Transportation, shall
develop a national public sector response system to receive
security alerts, emergency messages, and other information
generated by various wireless terrestrial or satellite
communications technologies used to track the transportation
of high hazard materials which can provide accurate, timely,
and actionable information to appropriate first responder,
law enforcement and public safety, and homeland security
officials, as appropriate, regarding accidents, threats,
thefts, or other safety and security risks or incidents. In
developing this system, they shall consult with law
enforcement and public safety officials, hazardous material
shippers, motor carriers, railroads, organizations
representing hazardous material employees, State
transportation and hazardous materials officials, Operation
Respond, and commercial motor vehicle and hazardous material
safety groups. The development of the national public sector
response system shall be based upon the public sector
response center developed for the hazardous material safety
and security operational field test undertaken by the Federal
Motor Carrier Safety Administration.
(b) Capability.--The national public sector response system
shall be able to receive, as appropriate,--
(1) negative driver verification alerts;
(2) Out-of-route alerts;
(3) Driver panic or emergency alerts; and
(4) tampering or release alerts.
(c) Characteristics.--The national public sector response
system shall--
(1) be an exception-based system;
(2) be integrated with other private and public sector
operation reporting and response systems and all Federal
homeland security threat analysis systems or centers
(including the National Response Center); and
(3) provide users the ability to create rules for alert
notification messages.
(d) Carrier Participation.--Within 180 days after the
national public sector response system is operational, as
determined by the Secretary, each motor carrier and railroad
transporting high hazard materials, or entities acting on
their behalf who receive such wireless communication alerts
from motor carriers or railroads, shall provide the
information listed in subsection (b) to the national public
sector response system and vehicle or rail car location
information to extent possible with the wireless
communication technology used by the motor carrier or
railroad.
(e) Call-In Number.--The national public sector response
system shall be designed to include an automated call-in
system that allows commercial motor vehicle drivers, railroad
employees, and hazardous material employees involved in the
transportation of high hazard materials to report accidents,
threats, thefts, or other safety and security risks or
incidents to the national public sector response system using
cellular or other telephone technology.
(f) Data Privacy.--The national public sector response
system shall be designed to ensure appropriate protection of
data and information relating to motor carriers and drivers.
(g) Report.--Not later than 180 days after the date of
enactment of this Act, the Secretary shall transmit to the
Senate Committee on Commerce, Science, and Transportation and
the House of Representatives Committee on Transportation and
Infrastructure a report on the estimated total cost to
establish and annually operate the national public sector
response system under subsection (a), together with any
recommendations for generating private sector participation
and investment in the development and operation of the
national public sector response system.
(h) Funding.--Out of funds appropriated pursuant to section
114(u)(2) of title 49, United States Code, there shall be
made available to the Secretary of Homeland Security to carry
out this section--
(1) $1,000,000 for fiscal year 2006;
(2) $1,000,000 for fiscal year 2007; and
(3) $1,000,000 for fiscal year 2008.

SEC. 410. OVER-THE-ROAD BUS SECURITY ASSISTANCE.

(a) In General.--The Assistant Secretary of Homeland
Security (Transportation Security Administration), shall
establish a program for making grants to private operators of
over-the-road buses for system-wide security improvements to
their operations, including--
(1) constructing and modifying terminals, garages,
facilities, or over-the-road buses to assure their security;
(2) protecting or isolating the driver;
(3) acquiring, upgrading, installing, or operating
equipment, software, or accessorial services for collection,
storage, or exchange of passenger and driver information
through ticketing systems or otherwise, and information links
with government agencies;
(4) training employees in recognizing and responding to
security threats, evacuation procedures, passenger screening
procedures, and baggage inspection;
(5) hiring and training security officers;
(6) installing cameras and video surveillance equipment on
over-the-road buses and at terminals, garages, and over-the-
road bus facilities;
(7) creating a program for employee identification or
background investigation;
(8) establishing and upgrading an emergency communications
system linking operational headquarters, over-the-road buses,
law enforcement, and emergency personnel; and
(9) implementing and operating passenger screening programs
at terminals and on over-the-road buses.
(b) Reimbursement.--A grant under this section may be used
to provide reimbursement to private operators of over-the-
road buses for extraordinary security-related costs for
improvements described in paragraphs (1) through (9) of
subsection (a), determined by the Assistant Secretary to have
been incurred by such operators since September 11, 2001.
(c) Federal Share.--The Federal share of the cost for which
any grant is made under this section shall be 90 percent.
(d) Due Consideration.--In making grants under this
section, the Assistant Secretary shall give due consideration
to private operators of over-the-road buses that have taken
measures to enhance bus transportation security from those in
effect before September 11, 2001, and shall prioritize grant
funding based on the magnitude and severity of the security
threat to bus passengers and the ability of the funded
project to reduce, or respond to, that threat.
(e) Grant Requirements.--A grant under this section shall
be subject to all the terms and conditions that a grant is
subject to under section 3038(f) of the Transportation Equity
Act for the 21st Century (49 U.S.C. 5310 note; 112 Stat.
393).
(f) Plan Requirement.--

[[Page S5318]]

(1) In General.--The Assistant Secretary may not make a
grant under this section to a private operator of over-the-
road buses until the operator has first submitted to the
Assistant Secretary--
(A) a plan for making security improvements described in
subsection (a) and the Assistant Secretary has approved the
plan; and
(B) such additional information as the Assistant Secretary
may require to ensure accountability for the obligation and
expenditure of amounts made available to the operator under
the grant.
(2) Coordination.--To the extent that an application for a
grant under this section proposes security improvements
within a specific terminal owned and operated by an entity
other than the applicant, the applicant shall demonstrate to
the satisfaction of the Assistant Secretary that the
applicant has coordinated the security improvements for the
terminal with that entity.
(g) Over-the-road Bus Defined.--In this section, the term
``over-the-road bus'' means a bus characterized by an
elevated passenger deck located over a baggage compartment.
(h) Bus Security Assessment.--
(1) In general.--Not later than 180 days after the date of
enactment of this Act, the Assistant Secretary of Homeland
Security (Transportation Security Administration), shall
transmit to the Committee on Commerce, Science, and
Transportation of the Senate, the Committee on Transportation
and Infrastructure of the House of Representatives, a
preliminary report in accordance with the requirements of
this section.
(2) Contents of preliminary report.--The preliminary report
shall include--
(A) an assessment of the over-the-road bus security grant
program;
(B) an assessment of actions already taken to address
identified security issues by both public and private
entities and recommendations on whether additional safety and
security enforcement actions are needed;
(C) an assessment of whether additional legislation is
needed to provide for the security of Americans traveling on
over-the-road buses;
(D) an assessment of the economic impact that security
upgrades of buses and bus facilities may have on the over-
the-road bus transportation industry and its employees;
(E) an assessment of ongoing research and the need for
additional research on over-the-road bus security, including
engine shut-off mechanisms, chemical and biological weapon
detection technology, and the feasibility of
compartmentalization of the driver; and
(F) an assessment of industry best practices to enhance
security.
(3) Consultation with industry, labor, and other groups.--
In carrying out this section, the Assistant Secretary shall
consult with over-the-road bus management and labor
representatives, public safety and law enforcement officials,
and the National Academy of Sciences.
(i) Funding.--Out of funds appropriated pursuant to section
114(u)(2) of title 49, United States Code, there shall be
made available to the Assistant Secretary of Homeland
Security (Transportation Security Administration), to carry
out this section--
(1) $50,000,000 for fiscal year 2006;
(2) $50,000,000 for fiscal year 2007; and
(3) $50,000,000 for fiscal year 2008.

Amounts made available pursuant to this subsection shall
remain available until expended.

TITLE V--IMPROVED MARITIME SECURITY

SEC. 501. ESTABLISHMENT OF ADDITIONAL JOINT OPERATIONAL
CENTERS FOR PORT SECURITY.

(a) In General.--In order to improve interagency
cooperation, unity of command, and the sharing of
intelligence information in a common mission to provide
greater protection for port and intermodal transportation
systems against acts of terrorism, the Secretary of Homeland
Security, acting through the Commandant of the Coast Guard,
shall establish joint operational centers for port security
at all Tier 1 ports to the extent practicable within 2 years
ater the date of enactment of this Act.
(b) Characteristics.--The joint operational centers shall--
(1) be based on the most appropriate compositional and
operational characteristics of the pilot project joint
operational centers for port security in Miami, Florida,
Norfolk/Hampton Roads, Virginia, Charleston, South Carolina,
and San Diego, California;
(2) be adapted to meet the security needs, requirements,
and resources of the individual port area at which each is
operating;
(3) provide for participation by the United States Customs
and Border Protection Agency, the Transportation Security
Administration, the Department of Defense, and other Federal
agencies, as determined to be appropriate by the Secretary of
Homeland Security, and State and local law enforcement or
port security agencies and personnel; and
(4) be incorporated in the implementation of--
(A) maritime transportation security plans developed under
section 70103 of title 46, United States Code;
(B) maritime intelligence activities under section 70113 of
that title;
(C) short and long range vessel tracking under sections
70114 and 70115 of that title;
(D) secure transportation systems under section 70116 of
that title;
(E) the Bureau of Customs and Border Protection's screening
and high-risk cargo inspection programs; and
(F) the transportation security incident response plans
required by section 70104 of that title.
(c) 2005 Act Report Requirement.--Nothing in this section
relieves the Commandant of the Coast Guard from compliance
with the requirements of section 807 of the Coast Guard and
Maritime Transportation Act of 2004. The Commandant shall
utilize the information developed in making the report
required by that section in carrying out the requirements of
this section.
(d) Budget and Cost-Sharing Analysis.--Within 180 days
after the date of enactment of this Act, the Secretary shall
transmit to the Senate Committee on Commerce, Science, and
Transportation and the House of Representatives Committee on
Transportation and Infrastructure a proposed budget analysis
for implementing subsection (a), including cost-sharing
arrangements with other Federal departments and agencies
involved in the joint operation of the centers.

SEC. 502. AMTS PLAN TO INCLUDE SALVAGE RESPONSE PLAN.

Section 70103(b)(2) of title 46, United States Code, is
amended--
(1) by striking ``and'' after the semicolon in subparagraph
(E);
(2) by redesignating subparagraph (F) as subparagraph (G);
and
(3) by inserting after subparagraph (E) the following:
``(F) include a salvage response plan--
``(i) to identify salvage equipment capable of restoring
operational trade capacity; and
``(ii) to ensure that the flow of cargo through United
States ports is re-established as efficiently and quickly as
possible after a transportation security incident.''.

SEC. 503. PRIORITY TO CERTAIN VESSELS IN POST-INCIDENT
RESUMPTION OF TRADE.

Section 70103(a)(2)(J) of title 46, United States Code, is
amended by inserting after ``incident.'' the following: ``The
plan shall provide, to the extent practicable, preference in
the reestablishment of the flow of cargo through United
States ports after a transportation security incident to--
``(i) vessels that have a vessel security plan approved
under subsection (c); and
``(ii) vessels manned by individuals who are described in
section 70105(b)(2)(B) and who have undergone a background
records check under section 70105(d) or who hold
transportation security cards issued under section 70105.''.

SEC. 504. ASSISTANCE FOR FOREIGN PORTS.

(a) In General.--Section 70109 of title 46, United States
Code, is amended--
(1) by adding at the end the following:
``(c) Foreign Assistance Programs.--
``(1) In general.--The Administrator of the Maritime
Administration, in coordination with the Secretary of State
and the Secretary of Energy, shall identify foreign
assistance programs that could facilitate implementation of
port security antiterrorism measures in foreign countries.
The Administrator and the Secretary shall establish a program
to utilize those programs that are capable of implementing
port security antiterrorism measures at ports in foreign
countries that the Secretary finds, under section 70108, to
lack effective antiterrorism measures.
``(2) Caribbean basin.--The Administrator, in coordination
with the Secretary of State and in consultation with the
Organization of American States, shall place particular
emphasis on utilizing programs to facilitate the
implementation of port security antiterrorism measures at the
ports located in the Caribbean Basin, as such ports pose
unique security and safety threats to the United States due
to--
``(A) the strategic location of such ports between South
America and United States;
``(B) the relative openness of such ports; and
``(C) the significant number of shipments of narcotics to
the United States that are moved through such ports.''.
(b) Report on Security at Ports in the Caribbean Basin.--
Not later than 60 days after the date of enactment of this
Act, the Secretary of Homeland Security shall submit to the
Committee on Commerce, Science, and Transportation of the
Senate and Committee on Transportation and Infrastructure of
the House of Representatives a report on the security of
ports in the Caribbean Basin. The report shall include the
following:
(1) An assessment of the effectiveness of the measures
employed to improve security at ports in the Caribbean Basin
and recommendations for any additional measures to improve
such security.
(2) An estimate of the number of ports in the Caribbean
Basin that will not be secured by January 1, 2006, and an
estimate of the financial impact in the United States of any
action taken pursuant to section 70110 of title 46, United
States Code, that affects trade between such ports and the
United States.
(3) An assessment of the additional resources and program
changes that are necessary to maximize security at ports in
the Caribbean Basin.

SEC. 505. IMPROVED DATA USED FOR TARGETED CARGO SEARCHES.

(a) In General.--In order to provide the best possible data
for the automated target system that identifies high-risk
cargo for inspection, the Secretary of Homeland Security
shall require importers shipping goods to the United State
via cargo container to supply entry data under the advance
notification requirements under section 4.7 of the Customs
Regulations (19 C.F.R. 4.7).

[[Page S5319]]

(b) Deadline.--The requirement imposed under subsection (a)
shall apply to goods entered after December 31, 2006.
(c) Authorization of Appropriations.--There are authorized
to be appropriated to the Secretary of Homeland Security
$5,000,000 for each of fiscal years 2006, 2007, and 2008 to
carry out the automated targeting system program to identify
high-risk oceanborne container cargo for inspection. The
amounts authorized by this subsection shall be in addition to
any other amounts authorized to be appropriated to carry out
that program.
(d) Evaluation by Comptroller General.--
(1) In general.--The Comptroller General shall evaluate
action taken by the Department of Homeland Security to
address the deficiencies in its automated targeting system
strategy identified in the Government Accountability Office's
report entitled ``Homeland Security Challenges Remain in the
Targeting of Oceangoing Cargo Containers for Inspection''
(GAO-04-352NI). In making the evaluation, the Comptroller
General shall assess whether all key elements of a risk
management framework and recognized modeling practices have
been incorporated in the Department's strategy, including--
(A) threat, criticality, vulnerability, and risk
assessments;
(B) external peer review of the automated targeting system;
(C) a mandatory random sampling program;
(D) simulated events to test the targeting strategy; and
(E) effectiveness reviews of risk mitigation actions.
(2) Report.--The Comptroller General shall transmit a
report to the Senate Committee on Commerce, Science, and
Transportation and the House of Representatives Committee on
Transportation and Infrastructure within 1 year after the
date of enactment of this Act containing the results of the
evaluation, together with any recommendations the Comptroller
General deems appropriate.

SEC. 506. INCREASE IN NUMBER OF CUSTOMS INSPECTORS ASSIGNED
OVERSEAS.

(a) In General.--The Secretary of Homeland Security shall
substantially increase the number of United States Customs
Service inspectors assigned to duty outside the United States
under the Container Security Initiative of the United States
Customs Service with responsibility for inspecting intermodal
shipping containers being shipped to the United States.
(b) Staffing Criteria.--In carrying out subsection (a) the
Secretary of Homeland Security shall determine the
appropriate level for assignment and density of customs
inspectors at selected international port facilities by a
threat, vulnerability, and risk analysis which, at a minimum,
considers--
(1) the volume of containers shipped;
(2) the ability of the host government to assist in both
manning and providing equipment and resources;
(3) terrorist intelligence known of importer vendors,
suppliers or manufactures; and
(4) other criteria as determined in consult with experts in
the shipping industry, terrorism, and shipping container
security.
(c) Minimum Number.--The total number of customs inspectors
assigned to international port facilities shall not be less
than the number determined as a result of the threat,
vulnerability, and risk assessment analysis which is
validated by the Administrator of the Transportation Security
Administration within 180 days after the date of enactment of
this Act.
(d) Plan.--The Secretary shall submit a plan to the Senate
Committee on Commerce, Science, and Transportation and the
House of Representatives Committee on Transportation and
Infrastructure, with timelines, for phasing inspectors into
selected port facilities within 180 days after the enactment
of this Act.

SEC. 507. RANDOM INSPECTION OF CONTAINERS.

(a) In General.--The Under Secretary of Homeland Security
for Border and Transportation Security shall develop and
implement a plan for random inspection of shipping containers
in addition to any targeted or pre-shipment inspection of
such containers required by law or regulation or conducted
under any other program conducted by the Under Secretary.
(b) Civil Penalty for Erroneous Manifest.--
(1) In general.--Except as provided in paragraph (2), if
the Under Secretary determines on the basis of an inspection
conducted under subsection (a) that there is a discrepancy
between the contents of a shipping container and the manifest
for that container, the Under Secretary may impose a civil
penalty.
(2) Manifest discrepancy reporting.--The Under Secretary
may not impose a civil penalty under paragraph (1) if a
manifest discrepancy report is filed with respect to the
discrepancy within the time limits established by Customs
Directive No. 3240-067A (or any subsequently issued directive
governing the matters therein) for filing a manifest
discrepancy report.

SEC. 508. CARGO SECURITY.

(a) In General.--Chapter 701 of title 46, United States
Code, is amended--
(1) by redesignating the second section 70118 (relating to
firearms, arrests, and seizure of property), as added by
section 801(a) of the Coast Guard and Maritime Transportation
Act of 2004, as section 70119;
(2) by redesignating the first section 70119 (relating to
enforcement by State and local officers), as added by section
801(a) of the Coast Guard and Maritime Transportation Act of
2004, as section 70120;
(3) by redesignating the second section 70119 (relating to
civil penalty), as redesignated by section 802(a)(1) of the
Coast Guard and Maritime Transportation Act of 2004, as
section 70122; and
(4) by inserting after section 70120 the following:

``Sec. 70121. Container security initiative

``(a) In General.--Pursuant to the standards established
under subsection (b)(1) of section 70116--
``(1) the Secretary of Homeland Security shall promulgate
standards and procedures for--
``(A) the inspection of cargo in a foreign port intended
for shipment to the United States by physical examination or
nonintrusive examination by technological means; and
``(B) evaluating and screening cargo prior to loading in a
foreign port for shipment to the United States, either
directly or via a foreign port; and
``(2) the Commissioner of Customs and Border Protection
shall--
``(A) execute inspection and screening protocols with
authorities in foreign ports to ensure that the standards and
procedures promulgated under paragraph (1) are implemented in
an effective manner; and
``(B) in consultation with the Transportation Security
Oversight Board, develop and maintain an antiterrorism cargo
identification, tracking, and screening system for
containerized cargo shipped to and from the United States,
either directly or via a foreign port.
``(b) Authorization of Appropriations.--There are
authorized to be appropriated to the Secretary of Homeland
Security such sums as may be necessary to carry out this
section.''.
(b) Conforming Amendments.--
(1) The chapter analysis for chapter 701 of title 46,
United States Code, is amended by striking the items
following the item relating to section 70116 and inserting
the following:

``70117. In rem liability for civil penalties and certain costs
``70118. Withholding of clearance
``70119. Firearms, arrests, and seizure of property
``70120. Enforcement by State and local officers
``70121. Container security initiative
``70122. Civil penalty''.

(2) Section 70117(a) of title 46, United States Code, as
redesignated by subsection (a)(3) of this section, is amended
by striking ``section 70120'' and inserting ``section
70122''.
(3) Section 70118(a) of such title is amended by striking
``under section 70120,'' and inserting ``under that
section,''.
(4) Section 111 of the Maritime Transportation Security Act
of 2002 is repealed.

SEC. 509. SECURE SYSTEMS OF INTERNATIONAL INTERMODAL
TRANSPORTATION.

(a) In General.--Section 70116(a) of title 46, United
States Code, is amended--
(1) by striking ``transportation.'' and inserting
``transportation--
``(1) to ensure the security and integrity of shipments of
goods to the United States from the point at which such goods
are initially packed or loaded for international shipment
until they reach their ultimate destination; and
``(2) to facilitate the movement of such goods through the
entire supply chain through an expedited security and
clearance program.''.
(b) Program Enhancements.--Section 70116(b) of title 46,
United States Code, is amended to read as follows:
``(b) Program Elements.--In establishing and conducting the
program under subsection (a) the Assistant Secretary shall--
``(1) establish standards and procedures for verifying, at
the point at which goods are placed in a cargo container for
shipping, that the container is free of unauthorized
hazardous chemical, biological, or nuclear material and for
securely sealing such containers after the contents are so
verified;
``(2) establish standards and procedures for securing cargo
and monitoring that security while in transit from the point
at which it is loaded to the point at which it is finally
unloaded;
``(3) develop performance standards to enhance the physical
security of shipping containers, including performance
standards for seals and locks as part of the container
security initiative;
``(4) establish standards and procedures for allowing the
United States Government to ensure and validate compliance
with this program; and
``(5) incorporate any other measures the Assistant
Secretary considers necessary to ensure the security and
integrity of international intermodal transport movements.''.
(b) Port Security User Fee Study.--The Secretary of
Homeland Security shall conduct a study of the feasibility
and desirability of establishing a system of oceanborne and
port-related intermodal transportation user fees that could
be imposed and collected as a dedicated revenue source, on a
temporary or continuing basis, to provide necessary funding
for the improvement and maintenance of enhanced port
security. The Assistant Secretary shall submit a report

[[Page S5320]]

containing the Assistant Secretary's findings, conclusions,
and recommendations (including legislative recommendations if
appropriate) to the Senate Committee on Commerce, Science,
and Transportation and the House of Representatives Committee
on Transportation and Infrastructure within 1 year after date
of enactment of this Act.

SEC. 510. TECHNOLOGY FOR MARITIME TRANSPORTATION SECURITY.

(a) Minimum Technology Implementation Authorization.--
Section 70107(i)(2)(B) of title 46, United States Code, is
amended by inserting ``not less than'' after ``Secretary''.
(b) Set-asides for Research and Development.--
Notwithstanding any provision of law to the contrary, in the
administration of the Department of Homeland Security, the
Secretary of Homeland Security shall ensure that, for each
fiscal year beginning after the date of enactment of this
Act, not less than--
(1) 8 percent of the amounts appropriated to the
Transportation Security Administration and the Directorate of
Science and Technology for research and development for the
fiscal year are obligated or expended for maritime security
related projects or programs; and
(2) 2 percent of such amounts are obligated or expended for
rail security related projects or programs.
(c) Strategic Plan.--
(1) In general.--Within 90 days after the date of enactment
of this Act, the Secretary of Homeland Security shall
promulgate a strategic plan for transportation research and
development. The Secretary shall update the plan no less
frequently than every 2 years thereafter.
(2) Contents.--In the strategic plan, the Secretary shall--
(A) ensure that the research needs for security of all
modes of transportation, including aviation, maritime, rail,
pipeline, and transit security, are addressed;
(B) identify goals and include measurable objectives;
(C) include an adequate amount of basic research;
(D) define the research and development roles of the
Transportation Security Administration and the Directorate of
Science and Technology, respectively, to ensure that--
(i) they are aligned;
(ii) the efficient use of research funds is maximized; and
(iii) duplication of projects is prevented or minimized;
(E) coordinate transportation research and development
under the plan with the transportation research and
development activities of other Federal agencies, including
the Department of Transportation and the National Aeronautics
and Space Administration; and
(F) base the plan on vulnerability and criticality
assessments.
(3) Annual evaluation.--The Homeland Security Science and
Technology Advisory Committee shall evaluate the plan by
October 15th each year, measure progress under the plan
against the goals set forth in the plan, and recommend
changes to the transportation security research program under
the plan.
(4) Annual report to congress.--The Secretary shall
transmit a copy of the strategic plan, and any revisions of
that plan, and a copy of the annual evaluations and
recommendations made by the Advisory Committee to the
Congress.
(d) NIST Transportation Security Program.--The Secretary of
Homeland Security may transfer up to $15,000,000 each fiscal
year to the National Institute of Science and Technology to
be obligated or expended for a focused program in
transportation security under section 28 of the National
Institute of Science and Technology Act (15 U.S.C. 278n).
(e) Secure Workforce Initiative.--Section 70107 of title
46, United States Code, is amended by adding at the end the
following:
``(j) Secure Workforce Initiative.--
``(1) In general.--The Secretary shall develop a program in
conjunction with technical and community colleges to train
port security workforces. The program shall focus on teaching
port workers to utilize new technologies and processes to
improve port security through the use of screening
technologies, information technologies, detection devices,
incident response training, and other advanced technologies.
``(2) Authorization of appropriations.--There are
authorized to be appropriated to the Secretary of Homeland
Security $15,000,000 for each of fiscal years 2005 through
2009 to carry out the program developed under paragraph
(1).''.
(f) Establishment of Competitive Research Program.--
(1) In general.--Title III of the Homeland Security Act of
2002 (6 U.S.C. 181 et seq.) is amended by adding at the end
the following:

``SEC. 314. COMPETITIVE RESEARCH PROGRAM.

``(a) In General.--
``(1) Establishment.--The Secretary, acting through the
Under Secretary for Science and Technology, shall establish a
competitive research program within the Directorate.
``(2) Director.--The program shall be headed by a Director,
who shall be appointed by the Secretary. The Director shall
report to the Under Secretary.
``(3) Duties of Director.--In the administration of the
program, the Director shall--
``(A) establish a cofunding mechanism for States with
academic facilities that have not fully developed security-
related science and technology to support burgeoning research
efforts by the faculty or link them to established
investigators;
``(B) provide for conferences, workshops, outreach, and
technical assistance to researchers and institutions of
higher education in States on topics related to developing
science and technology expertise in areas of high interest
and relevance to the Department;
``(C) monitor the efforts of States to develop programs
that support the Department's mission;
``(D) implement a merit review program, consistent with
program objectives, to ensure the quality of research
conducted with Program funding; and
``(E) provide annual reports on the progress and
achievements of the Program to the Secretary.
``(b) Assistance Under the Program.--
``(1) Scope.--The Director shall provide assistance under
the program for research and development projects that are
related to, or qualify as, homeland security research (as
defined in section 307(a)(2)) under the program.
``(2) Form of assistance.--Assistance under the program can
take the form of grants, contracts, or cooperative
arrangements.
``(3) Applications.--Applicants shall submit proposals or
applications in such form, at such times, and containing such
information as the Director may require.
``(c) Implementation.--
``(1) Start-up phases.--For the first 3 fiscal years
beginning after the date of enactment of the Border
Infrastructure and Technology Integration Act of 2004,
assistance under the program shall be limited to institutions
of higher education located in States in which an institution
of higher education with a grant from, or a contract or
cooperative agreement with, the National Science Foundation
under section 113 of the National Science Foundation Act of
1988 (42 U.S.C. 1862) is located.
``(2) Subsequent fiscal years.--
``(A) In general.--Beginning with the 4th fiscal year after
the date of enactment of this Act, the Director shall rank
order the States (excluding any noncontiguous State (as
defined in section 2(14)) other than Alaska, Hawaii, the
Commonwealth of Puerto Rico, and the Virgin Islands) in
descending order in terms of the average amount of funds
received by institutions of higher education (as that term is
defined in section 101(a) of the Higher Education Act of 1965
(20 U.S.C. 1001(a)) in each State that received financial
assistance in the form of grants, contracts, or cooperative
arrangements under this title during each of the preceding 3
fiscal years.
``(B) Allocation.--Beginning with the 4th fiscal year after
the date of enactment of this Act, assistance under the
program for any fiscal year is limited to institutions of
higher education located in States in the lowest third of
those ranked under subparagraph (A) for that fiscal year.
``(C) Determination of location.--For purposes of this
paragraph, an institution of higher education shall be
considered to be located in the State in which its home
campus is located, except that assistance provided under the
program to a division, institute, or other facility located
in another State for use in that State shall be considered to
have been provided to an institution of higher education
located in that other State.
``(D) Multiyear assistance.--For purposes of this
paragraph, assistance under the program that is provided on a
multi-year basis shall be counted as provided in each such
year in the amount so provided for that year.
``(d) Funding.--The Secretary shall ensure that no less
than 5 percent of the amount appropriated for each fiscal
year to the Acceleration Fund for Research and Development of
Homeland Security Technologies established by section
307(c)(1) is allocated to the program established by
subsection (a).''.
(2) Conforming amendment.--The table of contents of the
Homeland Security Act of 2002 is amended by inserting after
the item relating to section 313 the following:

``Sec. 314. Competitive research program.''.

SEC. 511. DEADLINE FOR TRANSPORTATION SECURITY CARDS.

The Secretary shall issue a final rule under section 70105
of title 46, United States Code, no later than January 1,
2006.

SEC. 512. EVALUATION AND REPORT.

Within 90 days after the date of enactment of this Act the
Secretary of Homeland Security shall transmit a report to the
Senate Committee on Commerce, Science, and Transportation and
the House of Representatives Committee on Transportation and
Infrastructure containing--
(1) an evaluation of the Operation Safe Commerce program
and the Customs-Trade Partnership Against Terrorism program;
(2) a report on the establishment and implementation of
performance standards for oceanborne and intermodal cargo
seals and locks under section 70116(b) of title 46, United
States Code;
(3) a report on progress made and current operational
practices for monitoring oceanborne cargo through the entire
supply chain;
(4) recommendations as to how the practices, programs, and
procedures can be further integrated into a wider screening
network for oceanborne cargo that can be applied on an
international basis;
(5) recommendations as to how inspection and screening
procedures developed for

[[Page S5321]]

oceanborne cargo might be adapted for application to the
shipment of domestically-produced cargo within the United
States;
(6) a status report on progress in preparing the plan for
implementing secure systems of transportation required by
section 809(c) of the Coast Guard and Maritime Transportation
Act of 2004 (Pub. L. 108-293; 118 Stat. 1086);
(7) a report on the security of noncontainerized cargo
including roll-on roll-off cargo, break bulk cargo, and
liquid and dry bulk cargo; and
(8) a report on whether the increased use of waterborne
transportation in the domestic movement of hazardous
materials would be an effective and efficient means to
enhance the safety of hazardous material shipments.

SEC. 513. PORT SECURITY GRANTS.

(a) Basis for Grants.--Section 70107(a) of title 46, United
States Code, is amended by striking ``for making a fair and
equitable allocation of funds'' and inserting ``based on risk
and vulnerability''.
(b) Letters of Intent.--Section 70107(e) of title 46,
United States Code, is amended by adding at the end the
following:
``(5) Letters of intent.--The Secretary may execute letters
of intent to commit funding to port sponsors from the
Fund.''.

SEC. 514. WORK STOPPAGES AND EMPLOYEE-EMPLOYER DISPUTES.

Section 70101(6) is amended by inserting after ``area.''
the following: ``In this paragraph, the term `economic
disruption' does not include a work stoppage or other
nonviolent employee-related action resulting from an
employee-employer dispute.''.

SEC. 515. APPEAL OF DENIAL OF WAIVER FOR TRANSPORTATION
SECURITY CARD.

Section 70105(c)(3) of title 46, United States Code, is
amended by inserting ``or a waiver under paragraph (2)''
after ``card''.
______

By Mr. LOTT:
S. 1053. A bill to amend the Federal Election Campaign Act of 1971 to
clarify when organizations described in section 527 of the Internal
Revenue Code of 1986 must register as political committees, and for
other purposes; from the Committee on Rules and Administration; placed
on the calendar.
Mr. LOTT. Mr. President, 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. 1053

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 ``527 Reform Act of 2005''.

SEC. 2. TREATMENT OF SECTION 527 ORGANIZATIONS.

(a) Definition of Political Committee.--Section 301(4) of
the Federal Election Campaign Act of 1971 (2 U.S.C. 431(4))
is amended by striking the period at the end of subparagraph
(C) and inserting ``; or'' and by adding at the end the
following:
``(D) any applicable 527 organization.''.
(b) Definition of Applicable 527 Organization.--Section 301
of the Federal Election Campaign Act of 1971 (2 U.S.C. 431)
is amended by adding at the end the following new paragraph:
``(27) Applicable 527 organization.--For purposes of
paragraph (4)(D)--
``(A) In general.--The term `applicable 527 organization'
means a committee, club, association, or group of persons
that--
``(i) has given notice to the Secretary of the Treasury
under section 527(i) of the Internal Revenue Code of 1986
that it is to be treated as an organization described in
section 527 of such Code, and
``(ii) is not described in subparagraph (B).
``(B) Excepted organizations.--A committee, club,
association, or other group of persons described in this
subparagraph is--
``(i) an organization described in section 527(i)(5) of the
Internal Revenue Code of 1986,
``(ii) an organization which is a committee, club,
association or other group of persons that is organized,
operated, and makes disbursements exclusively for paying
expenses described in the last sentence of section 527(e)(2)
of the Internal Revenue Code of 1986 or expenses of a
newsletter fund described in section 527(g) of such Code,
``(iii) an organization which is a committee, club,
association, or other group that consists solely of
candidates for State or local office, individuals holding
State or local office, or any combination of either, but only
if the organization refers only to one or more non-Federal
candidates or applicable State or local issues in all of its
voter drive activities and does not refer to a Federal
candidate or a political party in any of its voter drive
activities,
``(iv) an organization which is a committee, club,
association, or other group of persons--

``(I) the election or nomination activities of which relate
exclusively to any voter drive activity described in
subparagraphs (A) through (D) of section 325(d)(1),
``(II) the public communications of which relate
exclusively to activities described in subparagraphs (A)
through (D) of section 325(d)(1), and
``(III) which does not engage in any broadcast, cable, or
satellite communications, or

``(v) an organization described in subparagraph (C).
``(C) Applicable organization.--For purposes of
subparagraph (B)(v), an organization described in this
subparagraph is a committee, club, association, or other
group of persons whose election or nomination activities
relate exclusively to--
``(i) elections where no candidate for Federal office
appears on the ballot; or
``(ii) one or more of the following purposes:

``(I) Influencing the selection, nomination, election, or
appointment of one or more candidates to non-Federal offices.
``(II) Influencing one or more applicable State or local
issues.
``(III) Influencing the selection, appointment, nomination,
or confirmation of one or more individuals to non-elected
offices.

``(D) Exclusivity test.--A committee, club, association, or
other group of persons shall not be treated as meeting the
exclusivity requirement of subparagraphs (B)(iv) and (C) if
it makes disbursements aggregating more than $1,000 for any
of the following:
``(i) A public communication that promotes, supports,
attacks, or opposes a clearly identified candidate for
Federal office during the 1-year period ending on the date of
the general election for the office sought by the clearly
identified candidate (but if a run-off election is held for
that office, the 1-year period shall be extended and shall
end on the date of the run-off election).
``(ii) Any voter drive activity during a calendar year,
except that no disbursements for any voter drive activity
shall be taken into account under this subparagraph if the
committee, club, association, or other group of persons
during such calendar year--

``(I) makes disbursements for voter drive activities with
respect to elections in only 1 State and complies with all
applicable election laws of that State, including laws
related to registration and reporting requirements and
contribution limitations;
``(II) refers to one or more non-Federal candidates or
applicable State or local issues in all of its voter drive
activities and does not refer to a Federal candidate or a
political party;
``(III) does not have a candidate for Federal office, an
individual who holds any Federal office, a national political
party, or an agent of any of the foregoing, control or
materially participate in the direction of the organization,
solicit contributions to the organization (other than funds
which are described under clauses (i) and (ii) of section
323(e)(1)(B)), or direct disbursements, in whole or in part,
by the organization; and
``(IV) makes no contributions to Federal candidates.

Clause (ii) shall not apply to disbursements by any
committee, club, or association, or other group of persons
described in subparagraph (B)(iv).
``(E) Voter drive activity.--For purposes of this
paragraph, the term `voter drive activity' has the meaning
given such term by section 325(d)(1).
``(F) Applicable state or local issue.--For purposes of
this paragraph, the term `applicable State or local issue'
means any State or local ballot initiative, State or local
referendum, State or local constitutional amendment, State or
local bond issue, or other State or local ballot issue.
``(G) Reference to federal candidates.--For purposes of
this paragraph, any prohibition on a reference to a Federal
candidate shall not include any reference described in
section 325(d)(4).
``(H) Reference to political parties.--For purposes of this
paragraph, any prohibition on a reference to a political
party shall not include any reference described in section
325(d)(5).''.
(c) Regulations.--The Federal Election Commission shall
promulgate regulations to implement this section not later
than 60 days after the date of enactment of this Act.
(d) Effective Date.--The amendments made by this section
shall take effect on the date which is 60 days after the date
of enactment of this Act.

SEC. 3. RULES FOR ALLOCATION OF EXPENSES BETWEEN FEDERAL AND
NON-FEDERAL ACTIVITIES.

(a) In General.--Title III of the Federal Election Campaign
Act of 1971 (2 U.S.C. 431 et seq.) is amended by adding at
the end the following:

``SEC. 325. ALLOCATION AND FUNDING RULES FOR CERTAIN EXPENSES
RELATING TO FEDERAL AND NON-FEDERAL ACTIVITIES.

``(a) In General.--In the case of any disbursements by any
political committee that is a separate segregated fund or
nonconnected committee for which allocation rules are
provided under subsection (b)--
``(1) the disbursements shall be allocated between Federal
and non-Federal accounts in accordance with this section and
regulations prescribed by the Commission, and
``(2) in the case of disbursements allocated to non-Federal
accounts, may be paid only from a qualified non-Federal
account.
``(b) Costs To Be Allocated and Allocation Rules.--
Disbursements by any separate segregated fund or nonconnected
committee, other than an organization described in section
323(b)(1), for any of the following categories of activity
shall be allocated as follows:
``(1) 100 percent of the expenses for public communications
or voter drive activities that refer to one or more clearly
identified Federal candidates, but do not refer to any
clearly identified non-Federal candidates,

[[Page S5322]]

shall be paid with funds from a Federal account, without
regard to whether the communication refers to a political
party.
``(2) At least 50 percent, or a greater percentage if the
Commission so determines by regulation, of the expenses for
public communications and voter drive activities that refer
to one or more clearly identified candidates for Federal
office and one or more clearly identified non-Federal
candidates shall be paid with funds from a Federal account,
without regard to whether the communication refers to a
political party.
``(3) At least 50 percent, or a greater percentage if the
Commission so determines by regulation, of the expenses for
public communications or voter drive activities that refer to
a political party, but do not refer to any clearly identified
Federal or non-Federal candidate, shall be paid with funds
from a Federal account, except that this paragraph shall not
apply to communications or activities that relate exclusively
to elections where no candidate for Federal office appears on
the ballot.
``(4) At least 50 percent, or a greater percentage if the
Commission so determines by regulation, of the expenses for
public communications or voter drive activities that refer to
a political party and refer to one or more clearly identified
non-Federal candidates, but do not refer to any clearly
identified Federal candidates, shall be paid with funds from
a Federal account, except that this paragraph shall not apply
to communications or activities that relate exclusively to
elections where no candidate for Federal office appears on
the ballot.
``(5) Unless otherwise determined by the Commission in its
regulations, at least 50 percent of any administrative
expenses, including rent, utilities, office supplies, and
salaries not attributable to a clearly identified candidate,
shall be paid with funds from a Federal account, except that
for a separate segregated fund such expenses may be paid
instead by its connected organization.
``(6) At least 50 percent, or a greater percentage if the
Commission so determines by regulation, of the direct costs
of a fundraising program or event, including disbursements
for solicitation of funds and for planning and administration
of actual fundraising events, where Federal and non-Federal
funds are collected through such program or event shall be
paid with funds from a Federal account, except that for a
separate segregated fund such costs may be paid instead by
its connected organization. This paragraph shall not apply to
any fundraising solicitations or any other activity that
constitutes a public communication.
``(c) Qualified Non-Federal Account.--For purposes of this
section--
``(1) In general.--The term `qualified non-Federal account'
means an account which consists solely of amounts--
``(A) that, subject to the limitations of paragraphs (2)
and (3), are raised by the separate segregated fund or
nonconnected committee only from individuals, and
``(B) with respect to which all requirements of Federal,
State, or local law (including any law relating to
contribution limits) are met.
``(2) Limitation on individual donations.--
``(A) In general.--A separate segregated fund or
nonconnected committee may not accept more than $25,000 in
funds for its qualified non-Federal account from any one
individual in any calendar year.
``(B) Affiliation.--For purposes of this paragraph, all
qualified non-Federal accounts of separate segregated funds
or nonconnected committees which are directly or indirectly
established, financed, maintained, or controlled by the same
person or persons shall be treated as one account.
``(3) Fundraising limitation.--
``(A) In general.--No donation to a qualified non-Federal
account may be solicited, received, directed, transferred, or
spent by or in the name of any person described in subsection
(a) or (e) of section 323.
``(B) Funds not treated as subject to act.--Except as
provided in subsection (a)(2) and this subsection, any funds
raised for a qualified non-Federal account in accordance with
the requirements of this section shall not be considered
funds subject to the limitations, prohibitions, and reporting
requirements of this Act for any purpose (including for
purposes of subsection (a) or (e) of section 323 or
subsection (d)(2) of this section).
``(d) Definitions and Special Rules.--For purposes of this
section--
``(1) Voter drive activity.--The term `voter drive
activity' means any of the following activities conducted in
connection with an election in which a candidate for Federal
office appears on the ballot (regardless of whether a
candidate for State or local office also appears on the
ballot):
``(A) Voter registration activity.
``(B) Voter identification.
``(C) Get-out-the-vote activity.
``(D) Generic campaign activity.
``(E) Any public communication related to activities
described in subparagraphs (A) through (D).
Such term shall not include any activity described in
subparagraph (A) or (B) of section 316(b)(2).
``(2) Federal account.--The term `Federal account' means an
account which consists solely of contributions subject to the
limitations, prohibitions, and reporting requirements of this
Act. Nothing in this section or in section 323(b)(2)(B)(iii)
shall be construed to infer that a limit other than the limit
under section 315(a)(1)(C) applies to contributions to the
account.
``(3) Nonconnected committee.--The term `nonconnected
committee' shall not include a political committee of a
political party.
``(4) Certain references to federal candidates not taken
into account.--A public communication or voter drive activity
shall not be treated as referring to any clearly identified
Federal candidate if the only reference is--
``(A) a reference, in connection with an election for a
non-Federal office, to a Federal candidate who is also a
candidate for such non-Federal office; or
``(B) a reference to the fact that a Federal candidate has
endorsed a non-Federal candidate or an applicable State or
local issue (as defined in section 301(27)(F)), including a
reference that constitutes the endorsement itself.
``(5) Certain references to political parties not taken
into account.--A public communication or voter drive activity
shall not be treated as referring to a political party if the
only reference is--
``(A) a reference to a political party for the purpose of
identifying a non-Federal candidate;
``(B) a reference to a political party for the purpose of
identifying the entity making the public communication or
carrying out the voter drive activity; or
``(C) a reference to a political party in a manner or
context that does not reflect support for or opposition to a
Federal candidate or candidates and does reflect support for
or opposition to a State or local candidate or candidates or
an applicable State or local issue.''.
(b) Reporting Requirements.--Section 304(e) of the Federal
Election Campaign Act of 1971 (2 U.S.C. 434(e)) is amended by
redesignating paragraphs (3) and (4) as paragraphs (4) and
(5), respectively, and by inserting after paragraph (2) the
following new paragraph:
``(3) Receipts and disbursements from qualified non-federal
accounts.--In addition to any other reporting requirement
applicable under this Act, a political committee to which
section 325(a) applies shall report all receipts and
disbursements from a qualified non-Federal account (as
defined in section 325(c)).''.
(c) Regulations.--The Federal Election Commission shall
promulgate regulations to implement the amendments made by
this section not later than 180 days after the date of
enactment of this Act.
(d) Effective Date.--The amendments made by this section
shall take effect on the date which is 180 days after the
date of enactment of this Act.

SEC. 4. TELEVISION MEDIA RATES.

(a) Lowest Unit Charge.--Section 315 of the Communications
Act of 1934 (47 U.S.C. 315) is amended by adding at the end
the following:
``(f) Television Media Rates.--
``(1) Lowest unit charge.--Notwithstanding any other
provision of law, the charges made for the use of any
television broadcast station, or by a provider of cable or
satellite television service, to any person who is a legally
qualified candidate for any public office in connection with
the campaign of such candidate for nomination for election,
or election, to such office or by a national committee of a
political party on behalf of such candidate in connection
with such campaign, shall not exceed the lowest charge of the
station (at any time during the 365-day period preceding the
date of the use) for pre-emptible use thereof for the same
amount of time for the same period.
``(2) Preemption.--
``(A) In general.--Except as provided in subparagraph (B),
and notwithstanding the requirements of paragraph (1), a
licensee shall not preempt the use of a broadcasting station
by an eligible candidate or political committee of a
political party who has purchased and paid for such use.
``(B) Circumstances beyond control of licensee.--If a
program to be broadcast by a broadcasting station is
preempted because of circumstances beyond the control of the
station, any candidate or party advertising spot scheduled to
be broadcast during that program shall be treated in the same
fashion as a comparable commercial advertising spot.
``(3) Audits.--
``(A) In general.--During the 45-day period preceding a
primary election and the 60-day period preceding a general
election, the Commission shall conduct such audits as it
deems necessary to ensure that each broadcaster to which this
subsection applies is allocating television broadcast
advertising time in accordance with this subsection and
section 312.
``(B) Markets.--Each audit conducted under subparagraph (A)
shall cover the following markets:
``(i) At least 6 of the top 50 largest designated market
areas (as defined in section 122(j)(2)(C) of title 17, United
States Code).
``(ii) At least 3 of the 51-100 largest designated market
areas (as so defined).
``(iii) At least 3 of the 101-150 largest designated market
areas (as so defined).
``(iv) At least 3 of the 151-210 largest designated market
areas (as so defined).
``(C) Broadcast stations.--Each audit conducted under
subparagraph (A) shall include each of the 3 largest
television broadcast networks, 1 independent network, and 1
cable network.''.
(b) Conforming Amendment.--Section 504 of the Bipartisan
Campaign Reform Act of

[[Page S5323]]

2002 (Public Law 107-155) is amended by striking ``315), as
amended by this Act, is amended by redesignating subsections
(e) and (f) as subsections (f) and (g), respectively, and''
and inserting ``315) is amended by''.
(c) Stylistic Amendments.--Section 315(c) the
Communications Act of 1934 (47 U.S.C. 315(c)) is amended--
(1) by striking ``For purposes of this section--'' and
inserting ``In this section:'';
(2) in paragraph (1), by striking ``the'' and inserting
``Broadcasting station.--The''; and
(3) in paragraph (2), by striking ``the'' and inserting
``Licensee; station licensee.--The''.

SEC. 5. MODIFICATION OF DEFINITION OF PUBLIC COMMUNICATION.

(a) In General.--Paragraph (22) of section 301 of the
Federal Election Campaign Act of 1971 (2 U.S.C. 431(22)) is
amended by adding at the end the following new sentence:
``Such term shall not include communications over the
Internet.''.
(b) Effective Date.--The amendment made by this section
shall take effect on the date of the enactment of this Act.

SEC. 6. INCREASE IN CONTRIBUTION LIMITS FOR POLITICAL
COMMITTEES.

(a) Increase in Political Committee Contribution Limits.--
Section 315(a)(1)(C) of the Federal Election Campaign Act of
1971 (2 U.S.C. 441a(a)(1)(C)) is amended by striking
``$5,000'' and inserting ``$7,500''.
(b) Increase in Multicandidate Limits.--Section 315(a)(2)
of the Federal Election Campaign Act of 1971 (2 U.S.C.
441a(a)(2)) is amended--
(1) in subparagraph (A), by striking ``$5,000'' and
inserting ``$7,500'';
(2) in subparagraph (B), by striking ``$15,000'' and
inserting ``$25,000''; and
(3) in subparagraph (C), by striking ``$5,000'' and
inserting ``$7,500''.
(c) Indexing.--
(1) In general.--Section 315(c)(1)(B) of the Federal
Election Campaign Act of 1971 (2 U.S.C. 441a(c)(1)(B)) is
amended to read as follows:
``(B) Except as provided in subparagraph (C)--
``(i) in any calendar year after 2002--

``(I) a limitation established by subsection (a)(1)(A),
(a)(1)(B), (a)(3), (b), (d), or (h) shall be increased by the
percent difference determined under subparagraph (A);
``(II) each amount so increased shall remain in effect for
the calendar year; and
``(III) if any amount after the adjustment under subclause
(I) is not a multiple of $100, such amount shall be rounded
to the nearest multiple of $100; and

``(ii) in any calendar year after 2006--

``(I) a limitation established by subsection (a)(1)(C),
(a)(1)(D), or (a)(2) shall be increased by the percent
difference determined under subparagraph (A);
``(II) each amount so increased shall remain in effect for
the calendar year; and
``(III) if any amount after the adjustment under subclause
(I) is not a multiple of $100, such amount shall be rounded
to the nearest multiple of $100.''.

(2) Conforming amendments.--Section 315(c) of the Federal
Election Campaign Act of 1971 (2 U.S.C. 441a(c)) is amended--
(A) in paragraph (1)(C), by striking ``subsections
(a)(1)(A), (a)(1)(B), (a)(3),'' and inserting ``subsections
(a)''; and
(B) in paragraph (2)(B)--
(i) by striking ``and'' at the end of clause (i);
(ii) by striking the period at the end of clause (ii) and
inserting ``; and''; and
(iii) by adding at the end the following new clause:
``(iii) for purposes of subsections (a)(1)(C), (a)(1)(D)
and (a)(2), calendar year 2005.''.
(d) Special Rule for Transfers From Leadership PACs to
National Party Committees.--Paragraph (4) of section 315(a)
of the Federal Election Campaign Act of 1971 (2 U.S.C.
441a(a)(4)) is amended--
(1) by inserting ``(A)'' before ``The limitations''; and
(2) by adding at the end the following:
``(B) The limitations on contributions contained in
paragraphs (1) and (2) do not apply to transfers between any
committee (other than an authorized committee) established,
financed, maintained, or controlled by a candidate or an
individual holding a Federal office and political committees
established and maintained by a national political party.''.
(e) Elimination of Certain Restrictions on Solicitations by
Corporations and Labor Organizations.--
(1) Written solicitations.--Subparagraph (B) of section
316(b)(4) of the Federal Election Campaign Act of 1971 (2
U.S.C. 441b(b)(4)(B)) is amended--
(A) by striking ``2''; and
(B) by striking ``during the calendar year''.
(2) Prior approval of solicitation for trade
associations.--Subparagraph (D) of section 316(b)(4) of the
Federal Election Campaign Act of 1971 (2 U.S.C.
441b(b)(4)(D)) is amended by striking ``to the extent that
such solicitation'' and all that follows and inserting a
period.
(f) Increase in Threshold for Political Committees.--
(1) In general.--Section 301(4)(A) of the Federal Election
Campaign Act of 1971 (2 U.S.C. 431(4)(A)) is amended by
striking ``$1,000'' each place it appears and inserting
``$10,000''.
(2) Local committees.--
(A) Contributions received.--Section 301(4)(C) of the
Federal Election Campaign Act of 1971 (2 U.S.C. 431(4)(C)) is
amended by striking ``$5,000'' each place it appears and
inserting ``$10,000''.
(B) Contributions made.--Section 301(4)(C) of the Federal
Election Campaign Act of 1971 (2 U.S.C. 431(4)(C)) is amended
by striking ``$1,000'' each place it appears and inserting
``$10,000''.
(g) Effective Date.--The amendments made by this section
shall apply to calendar years beginning after December 31,
2005.

SEC. 7. SEVERABILITY.

If any provision of this Act or amendment made by this Act,
or the application of a provision or amendment to any person
or circumstance, is held to be unconstitutional, the
remainder of this Act and amendments made by this Act, and
the application of the provisions and amendment to any person
or circumstance, shall not be affected by the holding.

SEC. 8. CONSTRUCTION.

No provision of this Act, or amendment made by this Act,
shall be construed--
(1) as approving, ratifying, or endorsing a regulation
promulgated by the Federal Election Commission,
(2) as establishing, modifying, or otherwise affecting the
definition of political organization for purposes of the
Internal Revenue Code of 1986, or
(3) as affecting the determination of whether a group
organized under section 501(c) of the Internal Revenue Code
of 1986 is a political committee under section 301(4) of the
Federal Election Campaign Act of 1971.

SEC. 9. JUDICIAL REVIEW.

(a) Special Rules for Actions Brought on Constitutional
Grounds.--If any action is brought for declaratory or
injunctive relief to challenge the constitutionality of any
provision of this Act or any amendment made by this Act, the
following rules shall apply:
(1) The action shall be filed in the United States District
Court for the District of Columbia and shall be heard by a 3-
judge court convened pursuant to section 2284 of title 28,
United States Code.
(2) A copy of the complaint shall be delivered promptly to
the Clerk of the House of Representatives and the Secretary
of the Senate.
(3) A final decision in the action shall be reviewable only
by appeal directly to the Supreme Court of the United States.
Such appeal shall be taken by the filing of a notice of
appeal within 10 days, and the filing of a jurisdictional
statement within 30 days, of the entry of the final decision.
(4) It shall be the duty of the United States District
Court for the District of Columbia and the Supreme Court of
the United States to advance on the docket and to expedite to
the greatest possible extent the disposition of the action
and appeal.
(b) Intervention by Members of Congress.--In any action in
which the constitutionality of any provision of this Act or
any amendment made by this Act is raised (including but not
limited to an action described in subsection (a)), any Member
of the House of Representatives (including a Delegate or
Resident Commissioner to Congress) or Senate shall have the
right to intervene either in support of or opposition to the
position of a party to the case regarding the
constitutionality of the provision or amendment. To avoid
duplication of efforts and reduce the burdens placed on the
parties to the action, the court in any such action may make
such orders as it considers necessary, including orders to
require intervenors taking similar positions to file joint
papers or to be represented by a single attorney at oral
argument.
(c) Challenge by Members of Congress.--Any Member of
Congress may bring an action, subject to the special rules
described in subsection (a), for declaratory or injunctive
relief to challenge the constitutionality of any provision of
this Act or any amendment made by this Act.
(d) Applicability.--
(1) Initial claims.--With respect to any action initially
filed on or before December 31, 2008, the provisions of
subsection (a) shall apply with respect to each action
described in such subsection.
(2) Subsequent actions.--With respect to any action
initially filed after December 31, 2008, the provisions of
subsection (a) shall not apply to any action described in
such subsection unless the person filing such action elects
such provisions to apply to the action.
______

By Mrs. FEINSTEIN (for herself and Mr. Ensign):
S. 1054. A bill to amend the Elementary and Secondary Education Act
of 1965 to specify the purposes for which funds provided under part A
of title I may be used; to the Committee on Health, Education, Labor,
and Pensions.
Mrs. FEINSTEIN. Mr. President. I rise today with Senator Ensign to
introduce a bill to ensure that Title I funds are directed towards
instructional services to teach our neediest students.
Title I provides assistance to virtually every school district in the
country to serve children attending schools with high concentrations of
low-income students, from preschool to high school.
It has been the ``anchor'' of Federal assistance to schools, since
its inception in 1965. Although it has always

[[Page S5324]]

been the intent of Congress for Title I funds to be used for
instruction and instructional services, the Federal Government has
never provided a clear definition of what instructional services should
entail.
This lack of federal guidance has become especially clear now, as
States scramble to comply with the Title I accountability standards
established in ``No Child Left Behind.''
While State Administrators of Title I are directed by law to meet
these specific requirements, they have been given little guidance as to
how to ensure that they are in compliance with the law.
I believe that the Federal Government is responsible for making this
process as clear to States as possible.
In my view, as it relates to Title I, we have not lived up to our end
of the bargain.
During consideration of ``No Child Left Behind,'' I worked hard to
get my bill defining appropriate Title I uses included in the Senate
version of the bill.
Unfortunately, during conference consideration, my bill was stripped
out and in its place language directing the General Accounting Office
(GAO) to report on how states use their Title I funds was inserted.
In April 2003, GAO released the report that Congress directed them to
submit on Title I Administrative Expenditures.
What GAO found is that while districts spent a relatively small
amount, no more than 13 percent, of Title I funds on administrative
services, these findings were based on their own definition ``because
there is no common definition on what constitutes administrative
expenditures.''
Therefore, the accounting office could not precisely measure how much
of schools' Title I funds were used for administration.
Because Title I funds are not defined consistently throughout the
states, the accounting office created their own definition by compiling
aspects of state priorities to complete the report.
You see, the very reason I worked to define how Title I funds should
be used--to create consistency and distribution priority nationwide--
became the definitive aspect preventing GAO from effectively drawing
conclusions to their report.
The report highlights two concerns that I have with the absence of
universal definitions in the Title I program: the lack of Federal
guidance on effective uses of Title I funds. The government's inability
to accurately measure whether the academic needs of low-income students
are being met.
My bill takes some strong steps by balancing the needs for states to
retain Title I flexibility and providing them with the guidance needed
to administer the program uniformly throughout the country.
Current law on Title I is much too vague.
It says, ``a State or local educational agency shall use funds
received under this part only to supplement the amount of funds that
would, in the absence of such Federal funds, be made available from
non-Federal sources for the education of pupils participating in
programs assisted under this part, and not to supplant such funds.''
Basically, it says that Title I funds are to be used for the
``education of pupils.'' This is too nebulous.
The U.S. Department of Education has given states a guidance document
that explains how Title I funds can be used.
Under this guidance document, only two uses are specifically
prohibited: 1. construction or acquisition of real property; and 2.
payment to parents to attend a meeting or training session or to
reimburse a parent for a salary lost due to attendance at a ``parental
involvement'' meeting.
I believe we should give the Department, states and districts a
clearer guidance in law.
This legislation does the following: defines Title I direct and
indirect instructional services. Sets a standard for the amount of
Title I funds that can be used to achieve the academic and
administrative objectives of this program. Ensures that the majority of
Title I funds are used to improve academic achievement by stipulating
that a local educational agency may use not more than 10 percent of
Title I funds received for indirect instructional services.
By limiting the amount of funds that schools can spend on
administrative or indirect services, school districts are restricted
from shuffling the majority of Title I to pay for non-academic
services, but it also gives the districts flexibility to use the
remaining funds for the indirect costs administering Title I
distribution.
Furthermore, by defining direct and indirect services, all states can
apply the same standards for how Title I funds are used nationwide.
Examples of permissible Direct Services are: employing teachers and
other instructional personnel, including employee benefits. Intervening
and taking corrective actions to improve student achievement. Extending
academic instruction beyond the normal school day and year, including
summer school. Providing instructional services to pre-kindergarten
children for the transition to kindergarten. Purchasing instructional
resources such as books, materials, computers, and other instructional
equipment. Professional development. Developing and administering
curriculum, educational materials and assessments.
Examples of Indirect Services limited to no more than 10 percent of
Title I expenditures are: business services relating to administering
the program. Purchasing or providing facilities maintenance,
janitorial, gardening, or landscaping services or the payment of
utility costs. Buying food. Paying for travel to and attendance at
conferences or meetings, except if necessary for professional
development.
My reasons for introducing this bill are two-fold: First, I believe
that states must use their limited federal dollars for the fundamental
purpose of providing academic instruction to help students learn.
Secondly, I believe that it is nearly impossible to do so without
providing a clear definition of what is considered an instructional
service.
I am not suggesting that it is the fault of the school districts for
not focusing their Title I funds on academic instruction. They are
simply exercising the flexibility that Congress has given them.
If Congress also intended for those funds to educate our neediest
children, Federal guidance must be given to ensure that it happens.
It is my view that Title I cannot do everything. Federal funding is
only 8 percent of the total funding for elementary and secondary
education and Title I is even a smaller percentage of total support for
public schools.
That is why it is imperative to better focus Title I funds on
academic instruction, teaching the fundamentals and helping
disadvantaged children achieve.
Schools must focus their general administrative budget to pay for
expenses that fall outside of the realm of direct educational services
and retain the majority of Federal funds to improve academic
achievement.
It is time to better direct Title I funds to the true goal of
education: to help students learn. This is one step towards that
important goal.
I urge my colleagues to support this legislation.
I ask for unanimous consent that the text of the legislation directly
follow this statement in the Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:

S. 1054

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 ``Title I Integrity Act of
2005''.

SEC. 2. DIRECT AND INDIRECT INSTRUCTIONAL SERVICES.

Subpart 1 of part A of title I of the Elementary and
Secondary Education Act of 1965 (20 U.S.C. 6311 et seq.) is
amended by adding at the end the following:

``SEC. 1120C. DIRECT AND INDIRECT INSTRUCTIONAL SERVICES.

``(a) In General.--
``(1) Use of funds.--Notwithstanding any other provision of
this Act, a local educational agency shall use funds received
under this part only for direct instructional services and
indirect instructional services.
``(2) Limitation on indirect instructional services.--A
local educational agency may use not more than 10 percent of
funds received under this part for indirect instructional
services.
``(b) Instructional Services.--
``(1) Direct instructional services.--In this section, the
term `direct instructional services' means--

[[Page S5325]]

``(A) the implementation of instructional interventions and
corrective actions to improve student achievement;
``(B) the extension of academic instruction beyond the
normal school day and year, including during summer school;
``(C) the employment of teachers and other instructional
personnel, including providing teachers and instructional
personnel with employee benefits;
``(D) the provision of instructional services to
prekindergarten children to prepare such children for the
transition to kindergarten;
``(E) the purchase of instructional resources, such as
books, materials, computers, other instructional equipment,
and wiring to support instructional equipment;
``(F) the development and administration of curricula,
educational materials, and assessments;
``(G) the transportation of students to assist the students
in improving academic achievement;
``(H) the employment of title I coordinators, including
providing title I coordinators with employee benefits; and
``(I) the provision of professional development for
teachers and other instructional personnel.
``(2) Indirect instructional services.--In this section,
the term `indirect instructional services' includes--
``(A) the purchase or provision of facilities maintenance,
gardening, landscaping, or janitorial services, or the
payment of utility costs;
``(B) the payment of travel and attendance costs at
conferences or other meetings;
``(C) the payment of legal services;
``(D) the payment of business services, including payroll,
purchasing, accounting, and data processing costs; and
``(E) any other services determined appropriate by the
Secretary that indirectly improve student achievement.''.
______

By Mr. KENNEDY:
S. 1055. A bill to improve elementary and secondary education; to the
Committee on Health, Education, Labor, and Pensions.
Mr. KENNEDY. Mr. President, I ask unanimous consent that the text of
the bill I introduced today, an Act to improve elementary and secondary
education that may be cited as the ``No Child Left Behind Improvement
Act of 2005,'' be printed in the Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:

S. 1055

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 ``No Child Left Behind
Improvement Act of 2005''.

TITLE I--PUBLIC SCHOOL CHOICE, SUPPLEMENTAL EDUCATIONAL SERVICES, AND
TEACHER QUALITY

SEC. 101. PUBLIC SCHOOL CHOICE CAPACITY.

(a) School Capacity.--Section 1116(b)(1)(E) of the
Elementary and Secondary Education Act of 1965 (20 U.S.C.
6316(b)(1)(E)) is amended--
(1) in clause (i), by striking ``In the case'' and
inserting ``Subject to clauses (ii) and (iii), in the case'';
(2) by redesignating clause (ii) as clause (iii);
(3) by inserting after clause (i) the following:
``(ii) School capacity.--The obligation of a local
educational agency to provide the option to transfer to
students under clause (i) is subject to all applicable State
and local health and safety code requirements regarding
facility capacity.''; and
(4) in clause (iii) (as redesignated by paragraph (2)), by
inserting ``and subject to clause (ii),'' after ``public
school,''.
(b) Grants for School Construction and Renovation.--Subpart
1 of part A of title I of the Elementary and Secondary
Education Act of 1965 (20 U.S.C. 6311 et seq.) is amended by
adding at the end the following:

``SEC. 1120C. GRANTS FOR SCHOOL CONSTRUCTION AND RENOVATION.

``(a) Program Authorized.--From funds appropriated under
subsection (g), the Secretary is authorized to award grants
to local educational agencies experiencing overcrowding in
the schools served by the local educational agencies, for the
construction and renovation of safe, healthy, high-
performance school buildings.
``(b) Application.--Each local educational agency desiring
a grant under this section shall submit an application to the
Secretary at such time, in such manner, and accompanied by
such additional information as the Secretary may require.
``(c) Priority.--In awarding grants under this section, the
Secretary shall give priority to local educational agencies--
``(1) who have documented difficulties in meeting the
public school choice requirements of paragraph (1)(E),
(5)(A), (7)(C)(i), or (8)(A)(i) of section 1116(b), or
section 1116(c)(10)(C)(vii); and
``(2) with the highest number of schools at or above
capacity.
``(d) Award Basis.--From funds remaining after awarding
grants under subsection (c), the Secretary shall award grants
to local educational agencies that are experiencing
overcrowding in the schools served by the local educational
agencies.
``(e) Prevailing Wages.--Any laborer or mechanic employed
by any contractor or subcontractor in the performance of work
on any construction funded by a grant awarded under this
section will be paid wages at rates not less than those
prevailing on similar construction in the locality as
determined by the Secretary of Labor under subchapter IV of
chapter 31 of title 40, United States Code (commonly referred
to as the Davis-Bacon Act).
``(f) Definitions.--In this section:
``(1) At or above capacity.--The term `at or above
capacity', in reference to a school, means a school in which
1 additional student would increase the average class size of
the school above the average class size of all schools in the
State in which the school is located.
``(2) Healthy, high-performance school building.--The term
`healthy, high-performance school building' has the meaning
given such term in section 5586.
``(g) Authorization of Appropriations.--There are
authorized to be appropriated to carry out this section
$250,000,000 for fiscal year 2006, and such sums as may be
necessary for each of the 2 succeeding fiscal years.''.

SEC. 102. SUPPLEMENTAL EDUCATIONAL SERVICES.

Section 1116(e) of the Elementary and Secondary Education
Act of 1965 (20 U.S.C. 6316(e)) is amended--
(1) in paragraph (4)--
(A) in subparagraph (B), by striking the semicolon and
inserting ``, including criteria that--
``(i) ensure that personnel delivering supplemental
educational services to students have adequate
qualifications; and
``(ii) may, at the State's discretion, ensure that
personnel delivering supplemental educational services to
students are teachers that are highly qualified, as such term
is defined in section 9101;'';
(B) in subparagraph (D), by striking ``and'' after the
semicolon;
(C) in subparagraph (E), by striking the period and
inserting ``; and''; and
(D) by adding at the end the following:
``(F) ensure that the list of approved providers of
supplemental educational services described in subparagraph
(C) includes a choice of providers that have sufficient
capacity to provide effective services for children who are
limited English proficient and children with disabilities.'';
(2) in paragraph (5)(C)--
(A) by striking ``applicable''; and
(B) by inserting before the period ``, and acknowledge in
writing that, as an approved provider in the relevant State
educational agency program of providing supplemental
educational services, the provider is deemed to be a
recipient of Federal financial assistance'';
(3) by redesignating paragraphs (6), (7), (8), (9), (10),
(11), and (12) as paragraphs (7), (8), (9), (10), (11), (12),
and (13), respectively;
(4) by inserting after paragraph (5) the following:
``(6) Rule of construction.--Nothing in this section shall
be construed to prohibit a local educational agency from
being considered by a State educational agency as a potential
provider of supplemental educational services under this
subsection, if such local educational agency meets the
criteria adopted by the State educational agency in
accordance with paragraph (5).'';
(5) in paragraph (13) (as redesignated by paragraph (3))--
(A) in subparagraph (B)--
(i) in clause (ii), by striking ``and'' after the
semicolon;
(ii) in clause (iii), by striking ``and'' after the
semicolon; and
(iii) by adding at the end the following:
``(iv) may employ teachers who are highly qualified as such
term is defined in section 9101; and
``(v) pursuant to its inclusion on the relevant State
educational agency's list described in paragraph (4)(C), is
deemed to be a recipient of Federal financial assistance;
and''; and
(B) in subparagraph (C)--
(i) in the matter preceding subclause (i), by striking
``are'';
(ii) in subclause (i)--

(I) by inserting ``are'' before ``in addition''; and
(II) by striking ``and'' after the semicolon;

(iii) in subclause (ii), by striking the period and
inserting ``; and''; and
(iv) by adding at the end the following:
``(iii) if provided by providers that are included on the
relevant State educational agency's list described in
paragraph (4)(C), shall be deemed to be programs or
activities of the relevant State educational agency.''; and
(6) by adding at the end the following:
``(14) Civil rights.--In providing supplemental educational
services under this subsection, no State educational agency
or local educational agency may, directly or through
contractual, licensing, or other arrangements with a provider
of supplemental educational services, engage in any form of
discrimination prohibited by--
``(A) title VI of the Civil Rights Act of 1964;
``(B) title IX of the Education Amendments of 1972;
``(C) section 504 of the Rehabilitation Act of 1973;
``(D) titles II and III of the Americans with Disabilities
Act;
``(E) the Age Discrimination Act of 1975;

[[Page S5326]]

``(F) regulations promulgated under the authority of the
laws listed in subparagraphs (A) through (E); or
``(G) other Federal civil rights laws.''.

SEC. 103. QUALIFICATIONS FOR TEACHERS AND PARAPROFESSIONALS.

(a) High Objective Uniform State Standard of Evaluation.--
Section 1119 of the Elementary and Secondary Education Act of
1965 (20 U.S.C. 6319) is amended--
(1) in subsection (a)(2)--
(A) by redesignating subparagraphs (A) through (C) as
clauses (i) through (iii), respectively, and indenting as
appropriate;
(B) by striking ``(2) state plan.--As part'' and inserting
the following:
``(2) State plan.--
``(A) In general.--As part''; and
(C) by adding at the end the following:
``(B) Availability of state standards.--Each State
educational agency shall make available to teachers in the
State the high objective uniform State standard of
evaluation, as described in section 9101(23)(C)(ii), for the
purpose of meeting the teacher qualification requirements
established under this section.'';
(2) by redesignating subsections (e), (f), (g), (h), (i),
(j), (k), and (l) as subsections (f), (g), (h), (i), (j),
(k), (l), and (m), respectively;
(3) by inserting after subsection (d) the following:
``(e) State Responsibilities.--Each State educational
agency shall ensure that local educational agencies in the
State make available all options described in subparagraphs
(A) through (C) of subsection (c)(1) to each new or existing
paraprofessional for the purpose of demonstrating the
qualifications of the paraprofessional, consistent with the
requirements of this section.''; and
(4) in subsection (l) (as redesignated in paragraph (2)),
by striking ``subsection (l)'' and inserting ``subsection
(m)''.
(b) Definition of Highly Qualified Teachers.--Section
9101(23)(B)(ii) of the Elementary and Secondary Education Act
of 1965 (20 U.S.C. 7801(23)(B)(ii)) is amended--
(1) in subclause (I), by striking ``or'' after the
semicolon;
(2) in subclause (II), by striking ``and'' after the
semicolon; and
(3) by adding at the end the following:

``(III) in the case of a middle school teacher, passing a
State-approved middle school generalist exam when the teacher
receives a license to teach middle school in the State;
``(IV) obtaining a State middle school or secondary school
social studies certificate that qualifies the teacher to
teach history, geography, economics, civics, and government
in middle schools or in secondary schools, respectively, in
the State; or
``(V) obtaining a State middle school or secondary school
science certificate that qualifies the teacher to teach earth
science, biology, chemistry, and physics in middle schools or
secondary schools, respectively, in the State; and''.

SEC. 104. ENSURING HIGHLY QUALIFIED TEACHERS.

(a) Requirement.--The Secretary of Education shall improve
coordination among the teacher quality programs authorized
under the Elementary and Secondary Education Act of 1965 (20
U.S.C. 6301 et seq.), the Individuals with Disabilities
Education Act (20 U.S.C. 1400 et seq.), the Higher Education
Act of 1965 (20 U.S.C. 1001 et seq.), and the Carl D. Perkins
Vocational and Technical Education Act of 1998 (20 U.S.C.
2301 et seq.), to provide a unified effort in strengthening
the American teaching workforce and ensuring highly qualified
teachers.
(b) Report.--Not later than 6 months after the date of
enactment of this Act, the Secretary of Education shall
submit a report to the relevant committees of Congress on
efforts to coordinate programs pursuant to subsection (a),
which shall be made available on the website of the
Department of Education.

TITLE II--ADEQUATE YEARLY PROGRESS DETERMINATIONS

SEC. 201. REVIEW OF ADEQUATE YEARLY PROGRESS DETERMINATIONS
FOR SCHOOLS FOR THE 2002-2003 SCHOOL YEAR.

(a) In General.--The Secretary shall require each local
educational agency to provide each school served by the
agency with an opportunity to request a review of a
determination by the agency that the school did not make
adequate yearly progress for the 2002-2003 school year.
(b) Final Determination.--Not later than 30 days after
receipt of a request by a school for a review under this
section, a local educational agency shall issue and make
publicly available a final determination on whether the
school made adequate yearly progress for the 2002-2003 school
year.
(c) Evidence.--In conducting a review under this section, a
local educational agency shall--
(1) allow the principal of the school involved to submit
evidence on whether the school made adequate yearly progress
for the 2002-2003 school year; and
(2) consider that evidence before making a final
determination under subsection (b).
(d) Standard of Review.--In conducting a review under this
section, a local educational agency shall revise, consistent
with the applicable State plan under section 1111 of the
Elementary and Secondary Education Act of 1965 (20 U.S.C.
6311), the local educational agency's original determination
that a school did not make adequate yearly progress for the
2002-2003 school year if the agency finds that the school
made such progress, taking into consideration--
(1) the amendments made to part 200 of title 34, Code of
Federal Regulations (68 Fed. Reg. 68698) (relating to
accountability for the academic achievement of students with
the most significant cognitive disabilities); or
(2) any regulation or guidance that, subsequent to the date
of such original determination, was issued by the Secretary
relating to--
(A) the assessment of limited English proficient children;
(B) the inclusion of limited English proficient children as
part of the subgroup described in section
1111(b)(2)(C)(v)(II)(dd) of the Elementary and Secondary
Education Act of 1965 (20 U.S.C. 6311(b)(2)(C)(v)(II)(dd))
after such children have obtained English proficiency; or
(C) any requirement under section 1111(b)(2)(I)(ii) of the
Elementary and Secondary Education Act of 1965 (20 U.S.C.
6311(b)(2)(I)(ii)).
(e) Effect of Revised Determination.--
(1) In general.--If pursuant to a review under this section
a local educational agency determines that a school made
adequate yearly progress for the 2002-2003 school year, upon
such determination--
(A) any action by the Secretary, the State educational
agency, or the local educational agency that was taken
because of a prior determination that the school did not make
such progress shall be terminated; and
(B) any obligations or actions required of the local
educational agency or the school because of the prior
determination shall cease to be required.
(2) Exceptions.--Notwithstanding paragraph (1), a
determination under this section shall not affect any
obligation or action required of a local educational agency
or school under the following:
(A) Section 1116(b)(13) of the Elementary and Secondary
Education Act of 1965 (20 U.S.C. 6316(b)(13)) (requiring a
local educational agency to continue to permit a child who
transferred to another school under such section to remain in
that school until completion of the highest grade in the
school).
(B) Section 1116(e)(9) of the Elementary and Secondary
Education Act of 1965 (as redesignated by section 102(3)) (20
U.S.C. 6316(e)(9)) (requiring a local educational agency to
continue to provide supplemental educational services under
such section until the end of the school year).
(3) Subsequent determinations.--In determining whether a
school is subject to school improvement, corrective action,
or restructuring as a result of not making adequate yearly
progress, the Secretary, a State educational agency, or a
local educational agency may not take into account a
determination that the school did not make adequate yearly
progress for the 2002-2003 school year if such determination
was revised under this section and the school received a
final determination of having made adequate yearly progress
for the 2002-2003 school year.
(f) Notification.--The Secretary--
(1) shall require each State educational agency to notify
each school served by the agency of the school's ability to
request a review under this section; and
(2) not later than 30 days after the date of enactment of
this section, shall notify the public by means of the
Department of Education's website of the review process
established under this section.

SEC. 202. REVIEW OF ADEQUATE YEARLY PROGRESS DETERMINATIONS
FOR LOCAL EDUCATIONAL AGENCIES FOR THE 2002-
2003 SCHOOL YEAR.

(a) In General.--The Secretary shall require each State
educational agency to provide each local educational agency
in the State with an opportunity to request a review of a
determination by the State educational agency that the local
educational agency did not make adequate yearly progress for
the 2002-2003 school year.
(b) Application of Certain Provisions.--Except as
inconsistent with, or inapplicable to, this section, the
provisions of section 201 shall apply to review by a State
educational agency of a determination described in subsection
(a) in the same manner and to the same extent as such
provisions apply to review by a local educational agency of a
determination described in section 201(a).

SEC. 203. DEFINITIONS.

In this title:
(1) The term ``adequate yearly progress'' has the meaning
given to that term in section 1111(b)(2)(C) of the Elementary
and Secondary Education Act of 1965 (20 U.S.C.
6311(b)(2)(C)).
(2) The term ``local educational agency'' means a local
educational agency (as that term is defined in section 9101
of the Elementary and Secondary Education Act of 1965 (20
U.S.C. 7801)) receiving funds under part A of title I of such
Act (20 U.S.C. 6311 et seq.).
(3) The term ``Secretary'' means the Secretary of
Education.
(4) The term ``school'' means an elementary school or a
secondary school (as those terms are defined in section 9101
of the Elementary and Secondary Education Act of 1965 (20
U.S.C. 7801)) served under part A of title I of such Act (20
U.S.C. 6311 et seq.).
(5) The term ``State educational agency'' means a State
educational agency (as that term is defined in section 9101
of the Elementary and Secondary Education Act of 1965 (20
U.S.C. 7801)) receiving funds under part A of title I of such
Act (20 U.S.C. 6311 et seq.).

[[Page S5327]]

TITLE III--IMPROVING ASSESSMENT AND ACCOUNTABILITY

SEC. 301. GRANTS FOR INCREASING DATA CAPACITY FOR PURPOSES OF
ASSESSMENT AND ACCOUNTABILITY.

(a) Program Authorized.--From funds appropriated under
subsection (g) for a fiscal year, the Secretary may award
grants, on a competitive basis, to State educational
agencies--
(1) to enable the State educational agencies to develop or
increase the capacity of data systems for assessment and
accountability purposes, including the collection of
graduation rates; and
(2) to award subgrants to increase the capacity of local
educational agencies to upgrade, create, or manage
longitudinal data systems for the purpose of measuring
student academic progress and achievement.
(b) State Application.--Each State educational agency
desiring a grant under this section shall submit an
application to the Secretary at such time, in such manner,
and containing such information as the Secretary may require.
(c) State Use of Funds.--Each State educational agency that
receives a grant under this section shall use--
(1) not more than 20 percent of the grant funds for the
purpose of--
(A) increasing the capacity of, or creating, State
databases to collect, disaggregate, and report information
related to student achievement, enrollment, and graduation
rates for assessment and accountability purposes; and
(B) reporting, on an annual basis, for the elementary
schools and secondary schools within the State, on--
(i) the enrollment data from the beginning of the academic
year;
(ii) the enrollment data from the end of the academic year;
and
(iii) the twelfth grade graduation rates; and
(2) not less than 80 percent of the grant funds to award
subgrants to local educational agencies within the State to
enable the local educational agencies to carry out the
authorized activities described in subsection (e).
(d) Local Application.--Each local educational agency
desiring a subgrant under this section shall submit an
application to the State educational agency at such time, in
such manner, and containing such information as the State
educational agency may require. Each such application shall
include, at a minimum, a demonstration of the local
educational agency's ability to put a longitudinal data
system in place.
(e) Local Authorized Activities.--Each local educational
agency that receives a subgrant under this section shall use
the subgrant funds to increase the capacity of the local
educational agency to upgrade or manage longitudinal data
systems consistent with the uses in subsection (c)(1), by--
(1) purchasing database software or hardware;
(2) hiring additional staff for the purpose of managing
such data;
(3) providing professional development or additional
training for such staff; and
(4) providing professional development or training for
principals and teachers on how to effectively use such data
to implement instructional strategies to improve student
achievement and graduation rates.
(f) Definitions.--In this section:
(1) The term ``graduation rate'' means the percentage
that--
(A) the total number of students who--
(i) graduate from a secondary school with a regular diploma
(which shall not include the recognized equivalent of a
secondary school diploma or an alternative degree) in an
academic year; and
(ii) graduated on time by progressing 1 grade per academic
year; represents of
(B) the total number of students who entered the secondary
school in the entry level academic year applicable to the
graduating students.
(2) The terms ``State educational agency'' and ``local
educational agency'' have the meanings given such terms in
section 9101 of the Elementary and Secondary Education Act of
1965 (20 U.S.C. 7801).
(3) The term ``Secretary'' means the Secretary of
Education.
(g) Authorization of Appropriations.--There are authorized
to be appropriated to carry out this section $100,000,000 for
fiscal year 2006, and such sums as may be necessary for each
of the 2 succeeding fiscal years.

SEC. 302. GRANTS FOR ASSESSMENT OF CHILDREN WITH DISABILITIES
AND CHILDREN WHO ARE LIMITED ENGLISH
PROFICIENT.

Part E of title I of the Elementary and Secondary Education
Act of 1965 (20 U.S.C. 6491 et seq.) is amended by adding at
the end the following:

``SEC. 1505. GRANTS FOR ASSESSMENT OF CHILDREN WITH
DISABILITIES AND CHILDREN WHO ARE LIMITED
ENGLISH PROFICIENT.

``(a) Grants Authorized.--From amounts authorized under
subsection (e) for a fiscal year, the Secretary shall award
grants, on a competitive basis, to State educational
agencies, or to consortia of State educational agencies, to
enable the State educational agencies or consortia to
collaborate with institutions of higher education, research
institutions, or other organizations--
``(1) to design and improve State academic assessments for
students who are limited English proficient and students with
disabilities; and
``(2) to ensure the most accurate, valid, and reliable
means to assess academic content standards and student
academic achievement standards for students who are limited
English proficient and students with disabilities.
``(b) Authorized Activities.--A State educational agency or
consortium that receives a grant under this section shall use
the grant funds to carry out 1 or more of the following
activities:
``(1) Developing alternate assessments for students with
disabilities, consistent with section 1111 and the amendments
made on December 9, 2003, to part 200 of title 34, Code of
Federal Regulations (68 Fed. Reg. 68698) (relating to
accountability for the academic achievement of students with
the most significant cognitive disabilities), including--
``(A) the alignment of such assessments, as appropriate and
consistent with such amendments, with--
``(i) State academic achievement standards and State
academic content standards for all students; or
``(ii) alternate State academic achievement standards that
reflect the intended instructional construct for students
with disabilities;
``(B) activities to ensure that such assessments do not
reflect the disabilities, or associated characteristics, of
the students that are extraneous to the intent of the
measurement;
``(C) the development of an implementation plan for pilot
tests for such assessments, in order to determine the level
of appropriateness and feasibility of full-scale
administration; and
``(D) activities that provide for the retention of all
feasible standardized features in the alternate assessments.
``(2) Developing alternate assessments that meet the
requirements of section 1111 for students who are limited
English proficient, including--
``(A) the alignment of such assessments with State academic
achievement standards and State academic content standards
for all students;
``(B) the development of parallel native language
assessments or linguistically modified assessments for
limited English proficient students that meet the
requirements of section 1111(b)(3)(C)(ix)(III);
``(C) the development of an implementation plan for pilot
tests for such assessments, in order to determine the level
of appropriateness and feasibility of full-scale
administration; and
``(D) activities that provide for the retention of all
feasible standardized features in the alternate assessments.
``(3) Developing, modifying, or revising State policies and
criteria for appropriate accommodations to ensure the full
participation of students who are limited English proficient
and students with disabilities in State academic assessments,
including--
``(A) developing a plan to ensure that assessments provided
with accommodations are fully included and integrated into
the accountability system, for the purpose of making the
determinations of adequate yearly progress required under
section 1116;
``(B) ensuring the validity, reliability, and
appropriateness of such accommodations, such as--
``(i) a modification to the presentation or format of the
assessment;
``(ii) the use of assistive devices;
``(iii) an extension of the time allowed for testing;
``(iv) an alteration of the test setting or procedures;
``(v) the administration of portions of the test in a
method appropriate for the level of language proficiency of
the test taker;
``(vi) the use of a glossary or dictionary; and
``(vii) the use of a linguistically modified assessment;
``(C) ensuring that State policies and criteria for
appropriate accommodations take into account the form or
program of instruction provided to students, including the
level of difficulty, reliability, cultural difference, and
content equivalence of such form or program;
``(D) ensuring that such policies are consistent with the
standards prepared by the Joint Committee on Standards for
Educational and Psychological Testing of the American
Educational Research Association, the American Psychological
Association, and the National Council on Measurement in
Education; and
``(E) developing a plan for providing training on the use
of accommodations to school instructional staff, families,
students, and other appropriate parties.
``(4) Developing universally designed assessments that can
be accessible to all students, including--
``(A) examining test item or test performance for students
with disabilities and students who are limited English
proficient, to determine the extent to which the test item or
test is universally designed;
``(B) using think aloud and cognitive laboratory
procedures, as well as item statistics, to identify test
items that may pose particular problems for students with
disabilities or students who are limited English proficient;
``(C) developing and implementing a plan to ensure that
developers and reviewers of test items are trained in the
principles of universal design; and
``(D) developing computer-based applications of universal
design principles.
``(c) Application.--Each State educational agency, or
consortium of State educational agencies, desiring to apply
for a grant under

[[Page S5328]]

this section shall submit an application to the Secretary at
such time, in such manner, and containing such information as
the Secretary may require, including--
``(1) information regarding the institutions of higher
education, research institutions, or other organizations that
are collaborating with the State educational agency or
consortium, in accordance with subsection (a);
``(2) in the case of a consortium of State educational
agencies, the designation of 1 State educational agency as
the fiscal agent for the receipt of grant funds;
``(3) a description of the process and criteria by which
the State educational agency will identify students that are
unable to participate in general State content assessments
and are eligible to take alternate assessments, consistent
with the amendments made to part 200 of title 34, Code of
Federal Regulations (68 Fed. Reg. 68698);
``(4) in the case of a State educational agency or
consortium carrying out the activity described in subsection
(b)(1)(A), a description of how the State educational agency
or consortium plans to fulfill the requirement of subsection
(b)(1)(A);
``(5) in the case of a State educational agency or
consortium carrying out the activities described in
paragraphs (1), (2), and (4) of subsection (b), information
regarding the proposed techniques for the development of
alternate assessments, including a description of the
technical adequacy of, technical aspects of, and scoring for,
such assessments;
``(6) a plan for providing training for school
instructional staff, families, students, and other
appropriate parties on the use of alternate assessments; and
``(7) information on how the scores of students
participating in alternate assessments will be reported to
the public and to parents.
``(d) Evaluation and Reporting Requirements.--Each State
educational agency receiving a grant under this section shall
submit an annual report to the Secretary describing the
activities carried out under the grant and the result of such
activities, including--
``(1) details on the effectiveness of the activities
supported under this section in helping students with
disabilities, or students who are limited English proficient,
better participate in State assessment programs; and
``(2) information on the change in achievement, if any, of
students with disabilities and students who are limited
English proficient, as a result of a more accurate assessment
of such students.
``(e) Authorization of Appropriations.--There are
authorized to be appropriated to carry out this section
$50,000,000 for fiscal year 2006, and such sums as may be
necessary for each of the 2 succeeding fiscal years.''.

SEC. 303. REPORTS ON STUDENT ENROLLMENT AND GRADUATION RATES.

Part E of title I of the Elementary and Secondary Education
Act of 1965 (as amended by section 302) (20 U.S.C. 6491 et
seq.) is amended by adding at the end the following:

``SEC. 1506. REPORTS ON STUDENT ENROLLMENT AND GRADUATION
RATES.

``(a) In General.--The Secretary shall collect from each
State educational agency, local educational agency, and
school, on an annual basis, the following data:
``(1) The number of students enrolled in each of grades 7
through 12 at the beginning of the most recent school year.
``(2) The number of students enrolled in each of grades 7
through 12 at the end of the most recent school year.
``(3) The graduation rate for the most recent school year.
``(4) The data described in paragraphs (1) through (3),
disaggregated by the groups of students described in section
1111(b)(2)(C)(v)(II).
``(b) Annual Report.--The Secretary shall report the
information collected under subsection (a) on an annual
basis.''.

TITLE IV--CIVIL RIGHTS

SEC. 401. CIVIL RIGHTS.

Section 9534 of the Elementary and Secondary Education Act
of 1965 (20 U.S.C. 7914) is amended--
(1) by redesignating subsections (a) and (b) as subsections
(b) and (c), respectively; and
(2) by inserting before subsection (b) (as redesignated by
paragraph (1)) the following:
``(a) Prohibition of Discrimination.--Discrimination on the
basis of race, color, religion, sex (except as otherwise
permitted under title IX of the Education Amendments of
1972), national origin, or disability in any program funded
under this Act is prohibited.''.

TITLE V--TECHNICAL ASSISTANCE

SEC. 501. TECHNICAL ASSISTANCE.

Part F of title IX of the Elementary and Secondary
Education Act of 1965 (20 U.S.C. 7941) is amended--
(1) in the part heading, by inserting ``AND TECHNICAL
ASSISTANCE'' after ``EVALUATIONS''; and
(2) by adding at the end the following:

``SEC. 9602. TECHNICAL ASSISTANCE.

``The Secretary shall ensure that the technical assistance
provided by, and the research developed and disseminated
through, the Institute of Education Sciences and other
offices or agencies of the Department provide educators and
parents with the needed information and support for
identifying and using educational strategies, programs, and
practices, including strategies, programs, and practices
available through the clearinghouses supported under the
Education Sciences Reform Act of 2002 (20 U.S.C. 9501 et
seq.) and other federally-supported clearinghouses, that have
been successful in improving educational opportunities and
achievement for all students.''.
______

By Mr. REID (for himself and Mr. Ensign):
S. 1056. A bill to direct the Secretary of the Interior to convey to
the City of Henderson, Nevada, certain Federal land located in the
City, and for other purposes; to the Committee on Energy and Natural
Resources.
Mr. REID. Mr. President, I rise today for myself and Senator Ensign
to introduce the Southern Nevada Limited Transition Area Act, which
will enhance the ability of a rapidly growing community to diversify
its economy, gainfully employ its residents, and achieve fiscal
sustainability.
In addition to creating a vital economic center in Henderson with
this legislation, we hope at a future date to add another title to this
bill that will allow Clark County to convey a small parcel of land to
the Nevada National Guard for no consideration so that a new armory can
be developed. Conversations are currently taking place at the State and
county levels that may impact this conveyance, so we are awaiting more
information.
The bill I am introducing today would convey approximately 547 acres
of land from the Bureau of Land Management to the city of Henderson,
NV, for development as an employment and business center.
The Bureau of Land Management has designated this parcel for disposal
because of its urban surroundings and its isolation from other public
land, which renders it difficult for the agency to manage.
The parcel is located in a rapidly growing area of the city, but is
impacted by aircraft noise and overflights from the nearby Henderson
Executive Airport, making it unsuitable for residential use.
Rather than shying away from this property because of the limitations
on its use, the city of Henderson has put together a forward looking
plan that will turn the area into a bustling business center. In
addition to productively diversifying the land use pattern in the Las
Vegas Valley, the proposed development of this land will encourage a
broad range of employment opportunities for the region, while also
helping to pay for public infrastructure in nearby residential areas.
The way that the land privatization would work is as follows. The
bill would convey the land to the city by patent. The city would then
subdivide and sell lots at fair market value. As in previous
conveyances of Federal land designated in the Southern Nevada Public
Lands Management Act for disposal, 85 percent of the proceeds from
sales would return to the BLM's Special Account for a variety of
conservation purposes in Nevada. Five percent of the proceeds would
fund the State of Nevada's general education program. And the city of
Henderson could use the remaining 10 percent to cover expenses
associated with subdividing the property and providing infrastructure.
Henderson is a rapidly growing city. Its leaders are dedicated to
making the city a national model of logical development, diversified
employment, and fiscal sustainability. This bill helps establish the
conditions needed to realize that vision.
This bill provides key assistance to southern Nevada by enabling the
City of Henderson to move forward with an important economic
development project. This is a simple, but an important effort that
this body can make to further strengthen our Nation's economy. I look
forward working with the Energy Committee and the Senate to pass this
legislation.
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. 1056

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 Nevada Limited
Transition Area Act''.

SEC. 2. DEFINITIONS.

In this Act:
(1) City.--The term ``City'' means the City of Henderson,
Nevada.
(2) Secretary.--The term ``Secretary'' means the Secretary
of the Interior.

[[Page S5329]]

(3) Special account.--The term ``Special Account'' means
the special account established under section 4(e)(1)(C) of
the Southern Nevada Public Land Management Act of 1998 (112
Stat. 2345).
(4) State.--The term ``State'' means the State of Nevada.
(5) Transition area.--The term ``Transition Area'' means
the approximately 547 acres of Federal land located in
Henderson, Nevada, and identified as ``Limited Transition
Area'' on the map entitled ``Southern Nevada Limited
Transition Area Act'' and dated November 16, 2004.

SEC. 3. SOUTHERN NEVADA LIMITED TRANSITION AREA.

(a) Conveyance.--Notwithstanding the Federal Land Policy
and Management Act of 1976 (43 U.S.C. 1701 et seq.), on
request of the City, the Secretary shall, without
consideration and subject to all valid existing rights,
convey to the City all right, title, and interest of the
United States in and to the Transition Area.
(b) Use of Land for Nonresidential Development.--
(1) In general.--After the conveyance to the City under
subsection (a), the City may sell any portion or portions of
the Transition Area for purposes of nonresidential
development.
(2) Method of sale.--The sale of land under paragraph (1)
shall be--
(A) through a competitive bidding process; and
(B) for not less than fair market value.
(3) Compliance with charter.--Except as provided in
paragraphs (2) and (4), the City may sell parcels within the
Transition Area only in accordance with the procedures for
conveyances established in the City Charter.
(4) Disposition of proceeds.--Of the gross proceeds from
the sale of land under paragraph (1), the City shall--
(A) deposit 85 percent in the Special Account;
(B) retain 10 percent as compensation for the costs
incurred by the City--
(i) in carrying out land sales under paragraph (1); and
(ii) for the provision of public infrastructure to serve
the Transition Area, including planning, engineering,
surveying, and subdividing the Transition Area for
nonresidential development; and
(C) pay 5 percent to the State for use in the general
education program of the State.
(c) Use of Land for Recreation or Other Public Purposes.--
The City may elect to retain parcels in the Transition Area
for public recreation or other public purposes consistent
with the Act of June 14, 1926 (commonly known as the
``Recreation and Public Purposes Act'') (43 U.S.C. 869 et
seq.) by providing to the Secretary written notice of the
election.
(d) Noise Compatibility Requirements.--The City shall--
(1) plan and manage the Transition Area in accordance with
section 47504 of title 49, United States Code (relating to
airport noise compatibility planning), and regulations
promulgated in accordance with that section; and
(2) agree that if any land in the Transition Area is sold,
leased, or otherwise conveyed by the City, the sale, lease,
or conveyance shall contain a limitation to require uses
compatible with that airport noise compatibility planning.
(e) Reversion.--
(1) In general.--If any parcel of land in the Transition
Area is not conveyed for nonresidential development under
this Act or reserved for recreation or other public purposes
under subsection (c) within 20 years after the date of the
enactment of this Act, the parcel of land shall, if
determined to be appropriate by the Secretary, revert to the
United States.
(2) Inconsistent use.--If the City uses any parcel of land
within the Transition Area in a manner that is inconsistent
with the uses specified in this section--
(A) at the election of the Secretary, the parcel shall
revert to the United States; or
(B) if the Secretary does not make an election under
paragraph (1), the City shall sell the parcel of land in
accordance with subsection (b)(2).
______

By Mr. McCAIN (for himself and Mr. Dorgan):
S. 1057. A bill to amend the Indian Health Care Improvement Act to
revise and extend that Act; to the Committee on Indian Affairs.
Mr. McCAIN. Mr. President today I am pleased to introduce the Indian
Health Care Improvement Act Amendments of 2005 to revise and extend the
Act.
Six years ago a steering committee of Tribal leaders, with extensive
consultation by the Indian Health Service, developed a broad consensus
in Indian Country about what needs to be done to improve and update
health services for Indian people. In the 108th Congress significant
progress was made in crafting a bill that was acceptable to all parties
but still did not pass the full Senate. In the legislation introduced
today, I have tried to address concerns raised last year, but
understand that there may still be some differences. I look forward to
continuing discussions on these differences, but am introducing the
bill to get the process moving because we want to get this legislation
enacted.
Over the years, Indian health care delivery has greatly expanded and
tribes are taking over more health care services on the local level.
Nearly 30 years ago, Congress enacted the Indian Health Care
Improvement Act to meet the fundamental trust obligation of the United
States to ensure that comprehensive health care would be provided to
American Indians and Alaska Natives. The health status of Indian people
remains much worse than that of other Americans.
The Indian Health Care Improvement Act is the statutory framework for
the Indian health system and covers just about every aspect of health
care. It provides grants and scholarships to recruit Indians into
health professions serving native communities and funds to expand the
health care infrastructure. It lifted the prohibition against Medicare
and Medicaid reimbursement for health services provided by the Indian
Health Service or the Indian tribes, and established health services
for Indians in urban areas.
Reauthorization of this Act is a high legislative priority. Critical
improvements have been provided in this bill including provisions
exploring options for long-term care, governing children and senior
issues and the following: new sources of funding for recruitment and
retention purposes; access to health care, especially for Indian
children and low-income Indians; more flexibility in facility
construction programs; consolidated behavioral health programs for more
comprehensive care; and a Commission to study and recommend the best
means of providing Indian health care.
I look forward to working with my colleagues on both sides of the
aisle to ensure passage of this important legislation. I ask unanimous
consent that the full 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. 1057

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 ``Indian Health Care
Improvement Act Amendments of 2005''.

SEC. 2. INDIAN HEALTH CARE IMPROVEMENT ACT AMENDED.

(a) In General.--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 National Indian health policy.
``Sec. 4. Definitions.

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

``Sec. 101. Purpose.
``Sec. 102. Health professions recruitment program for Indians.
``Sec. 103. Health professions preparatory scholarship program for
Indians.
``Sec. 104. Indian health professions scholarships.
``Sec. 105. American Indians Into Psychology program.
``Sec. 106. Funding for tribes for scholarship programs.
``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. Indian recruitment and retention program.
``Sec. 114. Advanced training and research.
``Sec. 115. Quentin N. Burdick American Indians Into Nursing program.
``Sec. 116. Tribal cultural orientation.
``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
programs.
``Sec. 124. National Health Service Corps.
``Sec. 125. Substance abuse counselor educational curricula
demonstration programs.

[[Page S5330]]

``Sec. 126. Behavioral health training and community education
programs.
``Sec. 127. 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 for long-term care.
``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 and South Dakota as a contract health service
delivery area.
``Sec. 217. California contract health services program.
``Sec. 218. California as a contract health service delivery area.
``Sec. 219. Contract health services for the Trenton service area.
``Sec. 220. Programs operated by Indian tribes and tribal
organizations.
``Sec. 221. Licensing.
``Sec. 222. Notification of provision of 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. Sanitation facilities.
``Sec. 303. Preference to Indians and Indian firms.
``Sec. 304. Expenditure of nonservice funds for renovation.
``Sec. 305. Funding for the construction, expansion, and modernization
of small ambulatory care facilities.
``Sec. 306. Indian health care delivery demonstration project.
``Sec. 307. Land transfer.
``Sec. 308. Leases, contracts, and other agreements.
``Sec. 309. Loans, loan guarantees, and loan repayment.
``Sec. 310. Tribal leasing.
``Sec. 311. Indian Health Service/tribal facilities joint venture
program.
``Sec. 312. Location of facilities.
``Sec. 313. Maintenance and improvement of health care facilities.
``Sec. 314. Tribal management of Federally owned quarters.
``Sec. 315. Applicability of Buy American Act requirement.
``Sec. 316. Other funding for facilities.
``Sec. 317. Authorization of appropriations.

``TITLE IV--ACCESS TO HEALTH SERVICES

``Sec. 401. Treatment of payments under Social Security Act health care
programs.
``Sec. 402. Grants to and contracts with the Service, Indian tribes,
Tribal Organizations, and Urban Indian Organizations.
``Sec. 403. Reimbursement from certain third parties of costs of health
services.
``Sec. 404. Crediting of reimbursements.
``Sec. 405. Purchasing health care coverage.
``Sec. 406. Sharing arrangements with Federal agencies.
``Sec. 407. Payor of last resort.
``Sec. 408. Nondiscrimination in qualifications for reimbursement for
services.
``Sec. 409. Consultation.
``Sec. 410. State Children's Health Insurance Program (SCHIP).
``Sec. 411. Social Security Act sanctions.
``Sec. 412. Cost sharing.
``Sec. 413. Treatment under Medicaid managed care.
``Sec. 414. Navajo Nation Medicaid Agency feasibility study.
``Sec. 415. 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 Claim 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. Eligibility for services.
``Sec. 522. 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. Memoranda 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.
``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 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. Severability provisions.
``Sec. 814. Establishment of National Bipartisan Commission on Indian
Health Care.
``Sec. 815. Appropriations; availability.
``Sec. 816. Authorization of appropriations.

``SEC. 2. FINDINGS.

``Congress makes the following findings:
``(1) Federal health services 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, and resulting responsibility to, the American Indian
people.
``(2) 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 to be raised to the
highest possible level and to encourage the maximum
participation of Indians in the planning and management of
those services.
``(3) Federal health services to Indians have resulted in a
reduction in the prevalence and incidence of preventable
illnesses among, and unnecessary and premature deaths of,
Indians.
``(4) Despite such services, the unmet health needs of the
American Indian people are severe and the health status of
the Indians is far below that of the general population of
the United States.

``SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POLICY.

``Congress declares that it is the policy of this Nation,
in fulfillment of its special trust responsibilities and
legal obligations to Indians--
``(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 successor objectives;
``(3) to the greatest extent possible, to allow Indians 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 Service Area is raised to
at least the level of that of the general population;
``(5) to require meaningful consultation with Indian
Tribes, Tribal Organizations, and Urban Indian Organizations
to implement this Act and the national policy of Indian self-
determination; and

[[Page S5331]]

``(6) to provide funding for programs and facilities
operated by Indian Tribes and Tribal Organizations in amounts
that are not less than the amounts provided to programs and
facilities operated directly by the Service.

``SEC. 4. DEFINITIONS.

``For purposes of this Act:
``(1) The term `accredited and accessible' means on or near
a reservation and accredited by a national or regional
organization with accrediting authority.
``(2) The term `Area Office' means an administrative
entity, including a program office, within the Service
through which services and funds are provided to the Service
Units within a defined geographic area.
``(3) The term `Assistant Secretary' means the Assistant
Secretary of Indian Health.
``(4)(A) The term `behavioral health' means the blending of
substance (alcohol, drugs, inhalants, and tobacco) abuse and
mental health prevention and treatment, for the purpose of
providing comprehensive services.
``(B) The term `behavioral health' includes the joint
development of substance abuse and mental health treatment
planning and coordinated case management using a
multidisciplinary approach.
``(5) The term `California Indians' means those Indians who
are eligible for health services of the Service pursuant to
section 806.
``(6) The term `community college' means--
``(A) a tribal college or university, or
``(B) a junior or community college.
``(7) The term `contract health service' means health
services provided at the expense of the Service or a Tribal
Health Program by public or private medical providers or
hospitals, other than the Service Unit or the Tribal Health
Program at whose expense the services are provided.
``(8) The term `Department' means, unless otherwise
designated, the Department of Health and Human Services.
``(9) The term `disease prevention' means the reduction,
limitation, and prevention of disease and its complications
and reduction in the consequences of disease, including--
``(A) controlling--
``(i) development of 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) fluoridation of water; and
``(ii) immunizations.
``(10) 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,
allied health professions, and any other health profession.
``(11) The term `health promotion' means--
``(A) fostering social, economic, environmental, and
personal factors conducive to health, including raising
public awareness about health matters and enabling the people
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;
``(D) making available suitable housing, safe water, and
sanitary facilities;
``(E) improving the physical, economic, cultural,
psychological, and social environment;
``(F) promoting adequate opportunity for spiritual,
religious, and Traditional Health Care Practices; and
``(G) providing adequate and appropriate programs,
including--
``(i) abuse prevention (mental and physical);
``(ii) community health;
``(iii) community safety;
``(iv) consumer health education;
``(v) diet and nutrition;
``(vi) immunization and other prevention of communicable
diseases, including HIV/AIDS;
``(vii) environmental health;
``(viii) exercise and physical fitness;
``(ix) avoidance of fetal alcohol disorders;
``(x) first aid and CPR education;
``(xi) human growth and development;
``(xii) injury prevention and personal safety;
``(xiii) behavioral health;
``(xiv) monitoring of disease indicators between health
care provider visits, through appropriate means, including
Internet-based health care management systems;
``(xv) personal health and wellness practices;
``(xvi) personal capacity building;
``(xvii) prenatal, pregnancy, and infant care;
``(xviii) psychological well-being;
``(xix) reproductive health and family planning;
``(xx) safe and adequate water;
``(xxi) safe housing, relating to elimination, reduction,
and prevention of contaminants that create unhealthy housing
conditions;
``(xxii) safe work environments;
``(xxiii) stress control;
``(xxiv) substance abuse;
``(xxv) sanitary facilities;
``(xxvi) sudden infant death syndrome prevention;
``(xxvii) tobacco use cessation and reduction;
``(xxviii) violence prevention; and
``(xxix) such other activities identified by the Service, a
Tribal Health Program, or an Urban Indian Organization, to
promote achievement of any of the objectives described in
section 3(2).
``(12) The term `Indian', unless otherwise designated,
means any person who is a member of an Indian tribe or is
eligible for health services under section 806, except that,
for the purpose of sections 102 and 103, the term also means
any individual who--
``(A)(i) irrespective of whether the 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 recognized now or in
the future by the State in which they reside; or
``(ii) is a descendant, in the first or second degree, of
any such member;
``(B) is an Eskimo or Aleut or other Alaska Native;
``(C) is considered by the Secretary of the Interior to be
an Indian for any purpose; or
``(D) is determined be an Indian under regulations
promulgated by the Secretary.
``(13) The term `Indian Health Program' means--
``(A) any health program administered directly by the
Service;
``(B) any Tribal Health Program; or
``(C) any Indian Tribe or Tribal Organization to which the
Secretary provides funding pursuant to section 23 of the Act
of April 30, 1908 (25 U.S.C. 47), commonly known as the `Buy
Indian Act'.
``(14) The term `Indian Tribe' has the meaning given the
term in the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.).
``(15) The term `junior or community college' has the
meaning given the term by section 312(e) of the Higher
Education Act of 1965 (20 U.S.C. 1058(e)).
``(16) The term `reservation' means any federally
recognized Indian Tribe's reservation, Pueblo, or colony,
including former reservations in Oklahoma, Indian allotments,
and Alaska Native Regions established pursuant to the Alaska
Native Claims Settlement Act (25 U.S.C. 1601 et seq.).
``(17) The term `Secretary', unless otherwise designated,
means the Secretary of Health and Human Services.
``(18) The term `Service' means the Indian Health Service.
``(19) The term `Service Area' means the geographical area
served by each Area Office.
``(20) The term `Service Unit' means an administrative
entity of the Service, or a Tribal Health Program through
which services are provided, directly or by contract, to
eligible Indians within a defined geographic area.
``(21) The term `telehealth' has the meaning given the term
in section 330K(a) of the Public Health Service Act (42
U.S.C. 254c-16(a)).
``(22) The term `telemedicine' means a telecommunications
link to an end user through the use of eligible equipment
that electronically links health professionals or patients
and health professionals at separate sites in order to
exchange health care information in audio, video, graphic, or
other format for the purpose of providing improved health
care services.
``(23) 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 embody the influences or
forces of innate Tribal discovery, history, description,
explanation and knowledge of the states of wellness and
illness and which call 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.
``(24) The term `tribal college or university' has the
meaning given the term in section 316(b)(3) of the Higher
Education Act (20 U.S.C. 1059c(b)(3)).
``(25) The term `Tribal Health Program' means an Indian
Tribe or Tribal Organization that operates any health
program, service, function, activity, or facility funded, in
whole or part, by the Service through, or provided for in, a
contract or compact with the Service under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.).
``(26) The term `Tribal Organization' has the meaning given
the term in the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.).
``(27) The term `Urban Center' means any community which
has a sufficient Urban Indian population with unmet health
needs to warrant assistance under title V of this Act, as
determined by the Secretary.
``(28) The term `Urban Indian' means any individual who
resides in an Urban Center and who meets 1 or more of the
following criteria:
``(A) Irrespective of whether the individual lives on or
near a reservation, the individual 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.

[[Page S5332]]

``(B) The individual is an Eskimo, Aleut, or other Alaskan
Native.
``(C) The individual is considered by the Secretary of the
Interior to be an Indian for any purpose.
``(D) The individual is determined to be an Indian under
regulations promulgated by the Secretary.
``(29) The term `Urban Indian Organization' means a
nonprofit corporate body that (A) is situated in an Urban
Center; (B) is governed by an Urban Indian-controlled board
of directors; (C) provides for the participation of all
interested Indian groups and individuals; and (D) 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 Indian Health
Programs and Urban Indian Organizations involved in the
provision of health services to Indians.

``SEC. 102. HEALTH PROFESSIONS RECRUITMENT PROGRAM FOR
INDIANS.

``(a) In General.--The Secretary, acting through the
Service, shall make grants to public or nonprofit private
health or educational entities, Tribal Health Programs, or
Urban Indian 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 Secretary
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) Funding.--
``(1) Application.--The Secretary shall not make a grant
under this section unless an application has been submitted
to, and approved by, the Secretary. Such application shall be
in such form, submitted in such manner, and contain such
information, as the Secretary shall by regulation prescribe
pursuant to this Act. The Secretary shall give a preference
to applications submitted by Tribal Health Programs or Urban
Indian Organizations.
``(2) Amount of funds; payment.--The amount of a grant
under this section shall be determined by the Secretary.
Payments pursuant to 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 issued pursuant to
this Act. To the extent not otherwise prohibited by law,
funding commitments shall be for 3 years, as provided in
regulations issued pursuant to this Act.

``SEC. 103. HEALTH PROFESSIONS PREPARATORY SCHOLARSHIP
PROGRAM FOR INDIANS.

``(a) Scholarships Authorized.--The Secretary, acting
through the Service, shall provide scholarship grants to
Indians who--
``(1) have successfully completed their high school
education or high school equivalency; and
``(2) have demonstrated the potential to successfully
complete courses of study in the health professions.
``(b) Purposes.--Scholarships provided pursuant to this
section shall be for the following purposes:
``(1) Compensatory preprofessional education of any
recipient, such scholarship not to exceed 2 years on a full-
time basis (or the part-time equivalent thereof, as
determined by the Secretary pursuant to regulations issued
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. An extension of up to 2
years (or the part-time equivalent thereof, as determined by
the Secretary pursuant to regulations issued pursuant to this
Act) may be approved.
``(c) Other Conditions.--Scholarships under this section--
``(1) may cover costs of tuition, books, transportation,
board, and other necessary related expenses of a recipient
while attending school;
``(2) shall not be denied solely on the basis of the
applicant's scholastic achievement if such applicant has been
admitted to, or maintained good standing at, an accredited
institution; and
``(3) shall not be denied solely by reason of such
applicant's eligibility for assistance or benefits under any
other Federal program.

``SEC. 104. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.

``(a) In General.--
``(1) Authority.--The Secretary, acting through the
Service, shall make scholarship grants to Indians who are
enrolled full or part time in accredited schools pursuing
courses of study in the health professions. Such scholarships
shall be designated Indian Health Scholarships and shall be
made in accordance with section 338A of the Public Health
Services Act (42 U.S.C. 2541), except as provided in
subsection (b) of this section.
``(2) Allocation by formula.--Except as provided in
paragraph (3), the funding authorized by this section shall
be allocated by Service Area by a formula developed in
consultation with Indian Tribes, Tribal Organizations, and
Urban Indian Organizations. Such formula shall consider the
human resource development needs in each Service Area.
``(3) Continuity of prior scholarships.--Paragraph (2)
shall not apply with respect to individual recipients of
scholarships provided under this section (as in effect 1 day
prior to the date of enactment of the Indian Health Care
Improvement Act Amendments of 2005) until such time as the
individual completes the course of study that is supported
through such scholarship.
``(4) Certain delegation not allowed.--The administration
of this section shall be a responsibility of the Assistant
Secretary and shall not be delegated in a contract or compact
under the Indian Self-Determination and Education Assistance
Act (25 U.S.C. 450 et seq.).
``(b) Active Duty Service Obligation.--
``(1) Obligation met.--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 in one or more of the following:
``(A) In an Indian Health Program.
``(B) In a program assisted under title V of this Act.
``(C) 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.
``(2) Obligation deferred.--At the request of any
individual who has entered into a contract referred to in
paragraph (1) 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:
``(A) No period of internship, residency, or other advanced
clinical training shall be counted as satisfying any period
of obligated service under this subsection.
``(B) 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).
``(C) The active duty service obligation will be served in
the health profession of that individual in a manner
consistent with paragraph (1).
``(D) A recipient of a scholarship under this section may,
at the election of the recipient, meet the active duty
service obligation described in paragraph (1) by service in a
program specified under that paragraph that--
``(i) is located on the reservation of the Indian Tribe in
which the recipient is enrolled; or
``(ii) serves the Indian Tribe in which the recipient is
enrolled.
``(3) Priority when making assignments.--Subject to
paragraph (2), the Secretary, in making assignments of Indian
Health Scholarship recipients required to meet the active
duty service obligation described in paragraph (1), shall
give priority to assigning individuals to service in those
programs specified in paragraph (1) 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.
``(c) Part-Time Students.--In the case of an individual
receiving a scholarship under this section who is enrolled
part time in an approved course of study--
``(1) such scholarship shall be for a period of years not
to exceed the part-time equivalent of 4 years, as determined
by the Area Office;
``(2) the period of obligated service described in
subsection (b)(1) shall be equal to the greater of--
``(A) 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
``(B) 2 years; and
``(3) 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.
``(d) Breach of Contract.--
``(1) Specified breaches.--An individual shall be liable to
the United States for the amount which has been paid to the
individual, or on behalf of the individual, under a contract
entered into with the Secretary

[[Page S5333]]

under this section on or after the date of enactment of the
Indian Health Care Improvement Act Amendments of 2005 if that
individual--
``(A) 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);
``(B) is dismissed from such educational institution for
disciplinary reasons;
``(C) 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
``(D) 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.
``(2) Other breaches.--If for any reason not specified in
paragraph (1) an individual breaches a written contract by
failing either to 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.
``(3) Cancellation upon death of recipient.--Upon the death
of an individual who receives an Indian Health Scholarship,
any outstanding obligation of that individual for service or
payment that relates to that scholarship shall be canceled.
``(4) Waivers and suspensions.--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
affected Area Office, Indian Tribes, Tribal Organizations,
and Urban Indian Organizations, determines that--
``(A) it is not possible for the recipient to meet that
obligation or make that payment;
``(B) requiring that recipient to meet that obligation or
make that payment would result in extreme hardship to the
recipient; or
``(C) the enforcement of the requirement to meet the
obligation or make the payment would be unconscionable.
``(5) Extreme hardship.--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.
``(6) 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.

``SEC. 105. AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM.

``(a) Grants Authorized.--The Secretary, acting through the
Service, shall make grants to at least 3 colleges and
universities for the purpose of developing and maintaining
Indian psychology career recruitment programs as a means of
encouraging Indians to enter the mental health field. These
programs shall be located at various locations 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 Program Grant.--The Secretary
shall provide a grant authorized 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 Indian Health Programs authorized under section
117(b), the Quentin N. Burdick American Indians Into Nursing
Program authorized under section 115(e), and existing
university research and communications networks.
``(c) Regulations.--The Secretary shall issue regulations
pursuant to this Act for the competitive awarding of grants
provided under this section.
``(d) Conditions of Grant.--Applicants under this section
shall agree to provide a program which, at a minimum--
``(1) 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;
``(2) incorporates a program advisory board comprised of
representatives from the tribes and communities that will be
served by the program;
``(3) provides summer enrichment programs to expose Indian
students to the various fields of psychology through
research, clinical, and experimental activities;
``(4) provides stipends to undergraduate and graduate
students to pursue a career in psychology;
``(5) develops affiliation agreements with tribal colleges
and universities, the Service, university affiliated
programs, and other appropriate accredited and accessible
entities to enhance the education of Indian students;
``(6) to the maximum extent feasible, uses existing
university tutoring, counseling, and student support
services; and
``(7) to the maximum extent feasible, employs qualified
Indians in the program.
``(e) Active Duty Service Requirement.--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
(d)(4) that is funded under this section. Such obligation
shall be met by service--
``(1) in an Indian Health Program;
``(2) in a program assisted under title V of this Act; or
``(3) 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. 106. FUNDING FOR TRIBES FOR SCHOLARSHIP PROGRAMS.

``(a) In General.--
``(1) Grants authorized.--The Secretary, acting through the
Service, shall make grants to Tribal Health Programs for the
purpose of providing scholarships for Indians to serve as
health professionals in Indian communities.
``(2) Amount.--Amounts available under paragraph (1) for
any fiscal year shall not exceed 5 percent of the amounts
available for each fiscal year for Indian Health Scholarships
under section 104.
``(3) Application.--An application for a grant under
paragraph (1) shall be in such form and contain such
agreements, assurances, and information as consistent with
this section.
``(b) Requirements.--
``(1) In general.--A Tribal Health Program receiving a
grant under subsection (a) shall provide scholarships to
Indians in accordance with the requirements of this section.
``(2) Costs.--With respect to costs of providing any
scholarship pursuant to subsection (a)--
``(A) 80 percent of the costs of the scholarship shall be
paid from the funds made available pursuant to subsection
(a)(1) provided to the Tribal Health Program; and
``(B) 20 percent of such costs may be paid from any other
source of funds.
``(c) Course of Study.--A Tribal Health Program shall
provide scholarships under this section only to Indians
enrolled or accepted for enrollment in a course of study
(approved by the Secretary) in one of the health professions
contemplated by this Act.
``(d) Contract.--In providing scholarships under subsection
(b), the Secretary and the Tribal Health Program shall enter
into a written contract with each recipient of such
scholarship. Such contract shall--
``(1) obligate such recipient to provide service in an
Indian Health Program or Urban Indian Organization, in the
same Service Area where the Tribal Health Program providing
the scholarship is located, for--
``(A) a 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
``(B) such greater period of time as the recipient and the
Tribal Health Program may agree;
``(2) provide that the amount of the scholarship--
``(A) 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)), with
such amount to be reduced pro rata (as determined by the
Secretary) based on the number of hours such student is
enrolled, and not to exceed, for any year of attendance for
which the scholarship is provided, the total amount required
for the year for the purposes authorized in this clause; and
``(B) may not exceed, for any year of attendance for which
the scholarship is provided, the total amount required for
the year for the purposes authorized in subparagraph (A);
``(3) 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
``(4) require the recipient of such scholarship to meet the
educational and licensure requirements appropriate to each
health profession.
``(e) Breach of Contract.--
``(1) Specific breaches.--An individual who has entered
into a written contract with the Secretary and a Tribal
Health Program under subsection (d) 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 if that individual--
``(A) fails to maintain an acceptable level of academic
standing in the educational institution in which he or she is
enrolled (such level as determined by the educational
institution under regulations of the Secretary);
``(B) is dismissed from such educational institution for
disciplinary reasons;
``(C) 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

[[Page S5334]]

``(D) 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.
``(2) Other breaches.--If for any reason not specified in
paragraph (1), an individual breaches a 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.
``(3) Cancellation upon death of recipient.--Upon the death
of an individual who receives an Indian Health Scholarship,
any outstanding obligation of that individual for service or
payment that relates to that scholarship shall be canceled.
``(4) Information.--The Secretary may carry out this
subsection on the basis of information received from Tribal
Health Programs involved or on the basis of information
collected through such other means as the Secretary deems
appropriate.
``(f) Relation to Social Security Act.--The recipient of a
scholarship under this section shall agree, in providing
health care pursuant to the requirements herein--
``(1) 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 a program established in title XVIII of the
Social Security Act or pursuant to the programs established
in title XIX or title XXI of such Act; and
``(2) 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, or the State child health plan under title XXI, of
such Act to provide service to individuals entitled to
medical assistance or child health assistance, respectively,
under the plan.
``(g) Continuance of Funding.--The Secretary shall make
payments under this section to a Tribal Health Program for
any fiscal year subsequent to the first fiscal year of such
payments unless the Secretary determines that, for the
immediately preceding fiscal year, the Tribal Health Program
has not complied with the requirements of this section.

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

``(a) Employment Preference.--Any individual who receives a
scholarship pursuant to section 104 or 106 shall be given
preference for employment in the Service, or may be employed
by a Tribal Health Program or an Urban Indian Organization,
or other agencies of the Department as available, during any
nonacademic period of the year.
``(b) Not Counted Toward Active Duty Service Obligation.--
Periods of employment pursuant to this subsection shall not
be counted in determining fulfillment of the service
obligation incurred as a condition of the scholarship.
``(c) Timing; Length of Employment.--Any individual
enrolled in a program, including a high school program,
authorized under section 102(a) may be employed by the
Service or by a Tribal Health Program or an Urban Indian
Organization during any nonacademic period of the year. Any
such employment shall not exceed 120 days during any calendar
year.
``(d) Nonapplicability of Competitive Personnel System.--
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
community health representatives and emergency medical
technicians, to join or continue in an Indian Health Program
or an Urban Indian Organization and to provide their services
in the rural and remote areas where a significant portion of
Indians reside, the Secretary, acting through the Service,
may provide allowances to health professionals employed in an
Indian Health Program or an Urban Indian Organization to
enable them for a period of time each year prescribed by
regulation of the Secretary to take leave of their duty
stations 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, acting through the Service,
shall maintain a Community Health Representative Program
under which Indian Health Programs--
``(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) Duties.--The Community Health Representative Program
of the Service, 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 the 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
develop programs that meet the needs for 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.--The Secretary, acting through the
Service, shall establish and administer a program to be known
as the Service Loan Repayment Program (hereinafter referred
to as the `Loan Repayment Program') in order to ensure an
adequate supply of trained health professionals necessary to
maintain accreditation of, and provide health care services
to Indians through, Indian Health Programs and Urban Indian
Organizations.
``(b) Eligible Individuals.--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
educational institution (as determined by the Secretary under
section 338B(b)(1)(c)(i) of the Public Health Service Act (42
U.S.C. 254l-1(b)(1)(c)(i))) 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;
``(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 Service; or
``(D) be employed in an Indian Health Program or Urban
Indian Organization without a service obligation; and
``(3) submit to the Secretary an application for a contract
described in subsection (e).
``(c) Application.--
``(1) Information to be included with forms.--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
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 Service to enable the individual to
make a decision on an informed basis.
``(2) Clear language.--The application form, contract form,
and all other information furnished by the Secretary under
this section shall be written in a manner calculated to be
understood by the average individual applying to participate
in the Loan Repayment Program.
``(3) Timely availability of forms.--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) Priorities.--
``(1) List.--Consistent with subsection (k), the Secretary
shall annually--
``(A) identify the positions in each Indian Health Program
or Urban Indian Organization for which there is a need or a
vacancy; and
``(B) rank those positions in order of priority.

[[Page S5335]]

``(2) Approvals.--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 of an
Indian Health Program or Urban Indian Organization; and
``(ii) other individuals based on the priority rankings
under paragraph (1).
``(e) Recipient Contracts.--
``(1) Contract required.--An individual becomes a
participant in the Loan Repayment Program only upon the
Secretary and the individual entering into a written contract
described in paragraph (2).
``(2) Contents of contract.--The written contract referred
to in this section between the Secretary and an individual
shall contain--
``(A) an agreement under which--
``(i) subject to subparagraph (C), 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
Tribal Health Program or Urban Indian Organization as
provided in clause (ii)(III); and

``(ii) subject to subparagraph (C), 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)--

``(aa) 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
``(bb) 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); and

``(III) to serve for a time period (hereinafter in this
section referred to 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 or Urban
Indian Organization to which the individual may be assigned
by the Secretary;

``(B) 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 subparagraph (A)(ii)(III);
``(C) 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;
``(D) a statement of the damages to which the United States
is entitled under subsection (l) for the individual's breach
of the contract; and
``(E) such other statements of the rights and liabilities
of the Secretary and of the individual, not inconsistent with
this section.
``(f) Deadline for Decision on Application.--The Secretary
shall provide written notice to an individual within 21 days
on--
``(1) the Secretary's approving, under subsection (e)(1),
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
``(2) the Secretary's disapproving an individual's
participation in such Program.
``(g) Payments.--
``(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.--For each year of obligated service that an
individual contracts to serve under subsection (e), 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, whichever is more, 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--
``(A) 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;
``(B) provides an incentive to serve in Indian Health
Programs and Urban Indian Organizations with the greatest
shortages of health professionals; and
``(C) provides an incentive with respect to the health
professional involved remaining in an Indian Health Program
or Urban Indian Organization 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.
``(3) Timing.--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 no later than the end of the
fiscal year in which the individual completes such year of
service.
``(4) Reimbursements for tax liability.--For the purpose of
providing reimbursements for tax liability resulting from a
payment under paragraph (2) on behalf of an individual, the
Secretary--
``(A) in addition to such payments, may make payments to
the individual in an amount equal to not less than 20 percent
and not more than 39 percent of the total amount of loan
repayments made for the taxable year involved; and
``(B) may make such additional payments as the Secretary
determines to be appropriate with respect to such purpose.
``(5) Payment schedule.--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) Employment Ceiling.--Notwithstanding any other
provision of law, individuals who have entered into written
contracts with the Secretary under this section shall not be
counted against any employment ceiling affecting the
Department while those individuals are undergoing academic
training.
``(i) Recruitment.--The Secretary shall conduct recruiting
programs for the Loan Repayment Program and other Service
manpower programs of the Service at educational institutions
training health professionals or specialists identified in
subsection (a).
``(j) Applicability of Law.--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 or
Urban Indian Organizations pursuant to contracts entered into
under this section, shall--
``(1) ensure that the staffing needs of Tribal Health
Programs and Urban Indian Organizations 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 and Urban Indian Organizations 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) Specific breaches.--An individual who has entered
into a written contract with the Secretary under this section
and has not received a waiver under subsection (m) 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 if that
individual--
``(A) is enrolled in the final year of a course of study
and--
``(i) fails to maintain an acceptable level of academic
standing in the educational institution in which he or she is
enrolled (such level determined by the educational
institution under regulations of the Secretary);
``(ii) 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 fails
to complete such training program.
``(2) Other breaches; formula for amount owed.--If, for any
reason not specified in paragraph (1), an individual breaches
his or her written contract under this section by failing
either to begin, or complete, such individual's period of
obligated service in accordance with subsection (e)(2), 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 Secretary of the
Treasury;
``(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.
``(3) Deductions in medicare payments.--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.
``(4) Time period for repayment.--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

[[Page S5336]]

breach or such longer period beginning on such date as shall
be specified by the Secretary.
``(5) Recovery of delinquency.--
``(A) In general.--If damages described in paragraph (4)
are delinquent for 3 months, the Secretary shall, for the
purpose of recovering such damages--
``(i) use collection agencies contracted with by the
Administrator of General Services; or
``(ii) enter into contracts for the recovery of such
damages with collection agencies selected by the Secretary.
``(B) Report.--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) Waiver or Suspension of Obligation.--
``(1) In general.--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.
``(2) Canceled upon death.--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.
``(3) Hardship waiver.--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) Bankruptcy.--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
Congress under section 801, a report concerning the previous
fiscal year which sets forth by Service Area the following:
``(1) A list of the health professional positions
maintained by Indian Health Programs and Urban 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 (e)
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 scholarships that are provided under
sections 104 and 106 with respect to each health profession.
``(6) The amount of scholarship grants provided under
section 104 and 106, in total and by health profession.
``(7) The number of providers of health care that will be
needed by Indian Health Programs and Urban Indian
Organizations, by location and profession, during the 3
fiscal years beginning after the date the report is filed.
``(8) The measures the Secretary plans to take to fill the
health professional positions maintained by Indian Health
Programs or Urban Indian Organizations for which recruitment
or retention is difficult.

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

``(a) Establishment.--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 (hereafter in
this section referred to as the `LRRF'). The LRRF shall
consist of such amounts as may be collected from individuals
under section 104(d), section 106(e), and section 110(l) for
breach of contract, such funds as may be appropriated to the
LRRF, and interest earned on amounts in the LRRF. All amounts
collected, appropriated, or earned relative to the LRRF shall
remain available until expended.
``(b) Use of Funds.--
``(1) By secretary.--Amounts in the LRRF may be expended by
the Secretary, acting through the Service, to make payments
to an Indian Health Program--
``(A) to which a scholarship recipient under section 104
and 106 or a loan repayment program participant under section
110 has been assigned to meet the obligated service
requirements pursuant to such 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 104, 106, or section 110.
``(2) By tribal health programs.--A Tribal Health Program
receiving payments pursuant to paragraph (1) may expend the
payments to provide scholarships or recruit and employ,
directly or by contract, health professionals to provide
health care services.
``(c) Investment of Funds.--The Secretary of the Treasury
shall invest such amounts of the LRRF as the Secretary of
Health and Human Services 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.
``(d) Sale of Obligations.--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 for Travel.--The Secretary, acting
through the Service, may reimburse health professionals
seeking positions with Indian Health Programs or Urban Indian
Organizations, including 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) Recruitment 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. INDIAN RECRUITMENT AND RETENTION PROGRAM.

``(a) In General.--The Secretary, acting through the
Service, shall fund, on a competitive basis, innovative
demonstration projects for a period not to exceed 3 years to
enable Tribal Health Programs and Urban Indian Organizations
to recruit, place, and retain health professionals to meet
their staffing needs.
``(b) Eligible Entities; Application.--Any Tribal Health
Program 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 Program.--The Secretary, acting through
the Service, shall establish a demonstration project to
enable health professionals who have worked in an Indian
Health Program or Urban Indian Organization for a substantial
period of time to pursue advanced training or research areas
of study for which the Secretary determines a need exists.
``(b) Service Obligation.--An individual who participates
in a program under subsection (a), where the educational
costs are borne by the Service, shall incur an obligation to
serve in an Indian Health Program or Urban Indian
Organization for a period of obligated service equal to at
least the period of time during which the individual
participates in such program. In the event that the
individual fails to complete such obligated service, the
individual shall be liable to the United States for the
period of service remaining. In such event, with respect to
individuals entering the program after the date of enactment
of the Indian Health Care Improvement Act Amendments of 2005,
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) Equal Opportunity for Participation.--Health
professionals from Tribal Health Programs and Urban Indian
Organizations shall be given an equal opportunity to
participate in the program under subsection (a).

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

``(a) Grants Authorized.--For the purpose of increasing the
number of nurses, nurse midwives, and nurse practitioners who
deliver health care services to Indians, the Secretary,
acting through the Service, shall provide grants to the
following:
``(1) Public or private schools of nursing.
``(2) Tribal colleges or universities.
``(3) Nurse midwife programs and advanced practice nurse
programs that are provided by any tribal college or
university accredited nursing program, or in the absence of
such, any other public or private institutions.
``(b) Use of Grants.--Grants provided under subsection (a)
may be used for one or more of the following:
``(1) To recruit individuals for programs which train
individuals to be nurses, nurse midwives, or advanced
practice nurses.
``(2) To provide scholarships to Indians enrolled in such
programs that may pay the tuition charged for such program
and other expenses incurred in connection with such program,
including books, fees, room and board, and stipends for
living expenses.
``(3) To provide a program that encourages nurses, nurse
midwives, and advanced practice nurses to provide, or
continue to provide, health care services to Indians.
``(4) To provide a program that increases the skills of,
and provides continuing education to, nurses, nurse midwives,
and advanced practice nurses.
``(5) To provide any program that is designed to achieve
the purpose described in subsection (a).
``(c) Applications.--Each application for funding 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 for Grant Recipients.--In providing
grants under subsection (a), the Secretary shall extend a
preference to the following:

[[Page S5337]]

``(1) Programs that provide a preference to Indians.
``(2) Programs that train nurse midwives or advanced
practice nurses.
``(3) Programs that are interdisciplinary.
``(4) Programs that are conducted in cooperation with a
program for gifted and talented Indian students.
``(e) Quentin N. Burdick Program Grant.--The Secretary
shall provide one of the grants authorized under subsection
(a) 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 Indian Health Programs established under section
117(b) and the Quentin N. Burdick American Indians Into
Psychology Program established under section 105(b).
``(f) Active Duty 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 by a
grant provided under subsection (a). Such obligation shall be
met by service--
``(1) in the Service;
``(2) in a program of an Indian Tribe or Tribal
Organization conducted under the Indian Self-Determination
and Education Assistance Act (including programs under
agreements with the Bureau of Indian Affairs);
``(3) in a program assisted under title V of this Act; 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 shortage area and addresses the health care
needs of a substantial number of Indians.

``SEC. 116. TRIBAL CULTURAL ORIENTATION.

``(a) Cultural Education of Employees.--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 Indian Tribes and their relationship to
the Service.
``(b) Program.--In carrying out subsection (a), the
Secretary shall establish a program which shall, to the
extent feasible--
``(1) be developed in consultation with the affected Indian
Tribes, Tribal Organizations, and Urban Indian Organizations;
``(2) be carried out through tribal colleges or
universities;
``(3) include instruction in American Indian studies; and
``(4) describe the use and place of Traditional Health Care
Practices of the Indian Tribes in the Service Area.

``SEC. 117. INMED PROGRAM.

``(a) Grants Authorized.--The Secretary, acting through the
Service, is authorized to provide grants to colleges and
universities for the purpose of maintaining and expanding the
Indian health careers recruitment program known as the
`Indians Into Medicine Program' (hereinafter in this section
referred to as `INMED') as a means of encouraging Indians to
enter the health professions.
``(b) Quentin N. Burdick Grant.--The Secretary shall
provide one of the grants authorized under subsection (a) to
maintain the INMED program at the University of North Dakota,
to be known as the `Quentin N. Burdick Indian Health
Programs', 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 105(b) and the Quentin N. Burdick American Indians
Into Nursing Program established under section 115.
``(c) Regulations.--The Secretary, pursuant to this Act,
shall develop regulations to govern grants pursuant to this
section.
``(d) Requirements.--Applicants for grants provided under
this section shall agree to provide a program which--
``(1) provides outreach and recruitment for health
professions to Indian communities including elementary and
secondary schools and community colleges located on
reservations which will be served by the program;
``(2) incorporates a program advisory board comprised of
representatives from the Indian Tribes and Indian communities
which will be served by the program;
``(3) 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;
``(4) provides tutoring, counseling, and support to
students who are enrolled in a health career program of study
at the respective college or university; and
``(5) to the maximum extent feasible, employs qualified
Indians in the program.

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

``(a) Grants To Establish Programs.--
``(1) In general.--The Secretary, acting through the
Service, shall award grants to accredited and accessible
community colleges for the purpose of assisting such
community 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 or near a reservation or in an
Indian Health Program.
``(2) Amount of grants.--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) Grants for Maintenance and Recruiting.--
``(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) Requirements.--Grants may only be made under this
section to a community college which--
``(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 Indian 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) 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) Advanced Training.--
``(1) Required.--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--
``(A) has already received a degree or diploma in such
health profession; and
``(B) provides clinical services on or near a reservation
or for an Indian Health Program.
``(2) May be offered at alternate site.--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) Funding Priority.--Where the requirements of
subsection (b) are met, funding priority shall be provided to
tribal colleges and universities in Service Areas where they
exist.

``SEC. 119. RETENTION BONUS.

``(a) Bonus Authorized.--The Secretary may pay a retention
bonus to any health professional employed by, or assigned to,
and serving in, an Indian Health Program or Urban Indian
Organization either as a civilian employee or as a
commissioned officer in the Regular or Reserve Corps of the
Public Health Service who--
``(1) is assigned to, and serving in, a position for which
recruitment or retention of personnel is difficult;
``(2) the Secretary determines is needed by Indian Health
Programs and Urban Indian Organizations;
``(3) has--
``(A) completed 3 years of employment with an Indian Health
Program or Urban Indian 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 an Indian Health
Program 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) Default of Retention Agreement.--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) Other Retention Bonus.--The Secretary may pay a
retention bonus to any health professional employed by a
Tribal Health Program 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 of Program.--The Secretary, acting
through the Service, shall

[[Page S5338]]

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 or Urban
Indian Organization, and have done so for a period of not
less than 1 year, to pursue advanced training. Such program
shall include a combination of education and work study in an
Indian Health Program or Urban Indian Organization leading to
an associate or bachelor's degree (in the case of a licensed
practical nurse or licensed vocational nurse), a bachelor's
degree (in the case of a registered nurse), or advanced
degrees or certifications in nursing and public health.
``(b) 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 or Urban Indian
Organization 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) General Purposes of Program.--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 develop and operate 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) Specific Program Requirements.--The Secretary, acting
through the Community Health Aide Program of the Service,
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
objectives specified in section 3(2);
``(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 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.
``(c) National Community Health Aide Program.--
``(1) In general.--The Secretary, acting through the
Service, is authorized to establish a national Community
Health Aide Program in accordance with subsection (a), except
as provided in paragraphs (2) and (3), without reducing funds
for the Community Health Aide Program for Alaska.
``(2) Limited certification.--Except for any dental health
aide in the State of Alaska, the Secretary, acting through
the Community Health Aide Program of the Service, shall
ensure that, for a period of 4 years, dental health aides are
certified only to provide services relating to--
``(A) early childhood dental disease prevention and
reversible dental procedures; and
``(B) the development of local capacity to provide those
dental services.
``(3) Review.--
``(A) In general.--During the 4-year period described in
paragraph (2), the Secretary, acting through the Community
Health Aide Program of the Service, shall conduct a review of
the dental health aide program in the State of Alaska to
determine the ability of the program to address the dental
care needs of Native Alaskans, the quality of care provided
(including any training, improvement, or additional oversight
needed), and whether the program is appropriate and necessary
to carry out in any other Indian community.
``(B) Report.--After conducting the review under
subparagraph (A), the Secretary shall submit to the Committee
on Indian Affairs of the Senate and the Committee on
Resources of the House of Representatives a report describing
any finding of the Secretary under the review.
``(C) Future authorization of certifications.--Before
authorizing any dental procedure not described in paragraph
(2)(A), the Secretary shall consult with Indian tribes,
Tribal Organizations, Urban Indian Organizations, and other
interested parties to ensure that the safety and quality of
care of the Community Health Aide Program are adequate and
appropriate.

``SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION.

``The Secretary, acting through the Service, shall, by
contract or otherwise, provide training for Indians in the
administration and planning of Tribal Health Programs.

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

``(a) Demonstration Programs Authorized.--The Secretary,
acting through the Service, may fund demonstration programs
for Tribal Health Programs to address the chronic shortages
of health professionals.
``(b) Purposes of Programs.--The purposes of demonstration
programs funded under subsection (a) shall be--
``(1) to provide direct clinical and practical experience
at a Service Unit to health profession students and residents
from medical schools;
``(2) to improve the quality of health care for Indians by
assuring access to qualified health care professionals; and
``(3) to provide academic and scholarly opportunities for
health professionals serving Indians by identifying all
academic and scholarly resources of the region.
``(c) Advisory Board.--The demonstration programs
established pursuant to subsection (a) shall incorporate a
program advisory board composed of representatives from the
Indian Tribes and Indian communities in the area which will
be served by the program.

``SEC. 124. NATIONAL HEALTH SERVICE CORPS.

``(a) No Reduction in Services.--The Secretary shall not--
``(1) remove a member of the National Health Service Corps
from an Indian Health Program or Urban Indian Organization;
or
``(2) withdraw funding used to support such member, unless
the Secretary, acting through the Service, Indian Tribes, or
Tribal Organizations, has ensured that the Indians receiving
services from such member will experience no reduction in
services.
``(b) Exemption From Limitations.--National Health Service
Corps scholars qualifying for the Commissioned Corps in the
United States Public Health Service shall be exempt from the
full-time equivalent limitations of the National Health
Service Corps and the Service when serving as a commissioned
corps officer in a Tribal Health Program or an Urban Indian
Organization.

``SEC. 125. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL CURRICULA
DEMONSTRATION PROGRAMS.

``(a) Grants and Contracts.--The Secretary, acting through
the Service, may enter into contracts with, or make grants
to, accredited tribal colleges and universities and eligible
accredited and accessible community colleges to establish
demonstration programs 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
curriculum for substance abuse counseling (including paying
salaries for instructors). Such curricula may be provided
through satellite campus programs.
``(c) Time Period of Assistance; Renewal.--A contract
entered into or a grant provided under this section shall be
for a period of 1 year. Such contract or grant may be renewed
for an additional 1-year period upon the approval of the
Secretary.
``(d) Criteria for Review and Approval of Applications.--
Not later than 180 days after the date of enactment of the
Indian Health Care Improvement Act Amendments of 2005, the
Secretary, after consultation with Indian Tribes and
administrators of tribal colleges and universities 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 programs established under this section
promote the development of the capacity of such entities to
educate substance abuse counselors.
``(e) 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.--Each fiscal year, the Secretary shall submit
to the President, for inclusion in the report which is
required to be submitted under section 801 for that fiscal
year, a report on the findings and conclusions derived from
the demonstration programs conducted under this section
during that fiscal year.
``(g) Definition.--For the purposes of this section, the
term `educational curriculum' means 1 or more of the
following:

[[Page S5339]]

``(1) Classroom education.
``(2) Clinical work experience.
``(3) Continuing education workshops.

``SEC. 126. BEHAVIORAL HEALTH TRAINING AND COMMUNITY
EDUCATION PROGRAMS.

``(a) Study; List.--The Secretary, acting through the
Service, 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, or
dysfunctional and self destructive behavior.
``(b) Positions.--The positions referred to in subsection
(a) are--
``(1) staff positions within the Bureau of Indian Affairs,
including existing positions, in the fields of--
``(A) elementary and secondary education;
``(B) social services and family and child welfare;
``(C) law enforcement and judicial services; and
``(D) alcohol and substance abuse;
``(2) staff positions within the Service; and
``(3) staff positions similar to those identified in
paragraphs (1) and (2) established and maintained by Indian
Tribes, Tribal Organizations (without regard to the funding
source), and Urban Indian Organizations.
``(c) Training Criteria.--
``(1) In general.--The appropriate Secretary shall provide
training criteria appropriate to each type of position
identified in subsection (b)(1) and (b)(2) and ensure that
appropriate training has been, or shall be provided to any
individual in any such position. With respect to any such
individual in a position identified pursuant to subsection
(b)(3), the respective Secretaries shall provide appropriate
training to, or provide funds to, an Indian Tribe, Tribal
Organization, or Urban Indian Organization for training of
appropriate individuals. In the case of positions funded
under a contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.), the appropriate Secretary shall ensure that such
training costs are included in the contract or compact, as
the Secretary determines necessary.
``(2) Position specific training criteria.--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.
``(d) Community Education on Mental Illness.--The Service
shall develop and implement, on request of an Indian Tribe,
Tribal Organization, or Urban Indian Organization, or assist
the Indian Tribe, Tribal Organization, or Urban Indian
Organization to develop and implement, a program of community
education on mental illness. In carrying out this subsection,
the Service shall, upon request of an Indian Tribe, Tribal
Organization, or Urban Indian Organization, provide technical
assistance to the Indian Tribe, Tribal Organization, or Urban
Indian Organization to obtain and develop community
educational materials on the identification, prevention,
referral, and treatment of mental illness and dysfunctional
and self-destructive behavior.
``(e) Plan.--Not later than 90 days after the date of
enactment of the Indian Health Care Improvement Act
Amendments of 2005, the Secretary shall develop a plan under
which the Service will increase the health care staff
providing behavioral health services by at least 500
positions within 5 years after the date of enactment of this
section, with at least 200 of such positions devoted to
child, adolescent, and family services. The plan developed
under this subsection shall be implemented under the Act of
November 2, 1921 (25 U.S.C. 13) (commonly known as the
`Snyder Act').

``SEC. 127. 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) Use of Funds.--The Secretary, acting through the
Service, is authorized to expend funds, directly or under the
authority of the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.), which are
appropriated under the authority of this section, for the
purposes of--
``(1) eliminating the deficiencies in health status and
health 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, including the use of telehealth and
telemedicine when appropriate;
``(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
deficiencies 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.
``(K) Traditional Health Care Practices.
``(b) No Offset or 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 or the Act of November 2, 1921 (25 U.S.C. 13)
(commonly known as the `Snyder Act'), or any other provision
of law.
``(c) Allocation; Use.--
``(1) In general.--Funds appropriated under the authority
of this section shall be allocated to Service Units, Indian
Tribes, or Tribal Organizations. The funds allocated to each
Indian Tribe, Tribal Organization, or Service Unit under this
paragraph shall be used by the Indian Tribe, Tribal
Organization, or Service Unit under this paragraph to improve
the health status and reduce the resource deficiency of each
Indian Tribe served by such Service Unit, Indian Tribe, or
Tribal Organization.
``(2) Apportionment of allocated funds.--The apportionment
of funds allocated to a Service Unit, Indian Tribe, or Tribal
Organization under paragraph (1) among the health service
responsibilities described in subsection (a)(5) shall be
determined by the Service in consultation with, and with the
active participation of, the affected Indian Tribes and
Tribal Organizations.
``(d) Provisions Relating to Health Status and Resource
Deficiencies.--For the purposes of this section, the
following definitions apply:
``(1) Definition.--The term `health status and resource
deficiency' means the extent to which--
``(A) the health status objectives set forth in section
3(2) are 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) Available resources.--The health resources available
to an Indian Tribe or Tribal Organization 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) Process for review of determinations.--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 Indian Tribe or Tribal
Organization.
``(e) Eligibility for Funds.--Tribal Health Programs 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.
``(f) Report.--By no later than the date that is 3 years
after the date of enactment of the Indian Health Care
Improvement Act Amendments of 2005, the Secretary shall
submit to Congress the current health status and resource
deficiency report of the Service for each Service Unit,
including newly recognized or acknowledged Indian 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 or a
Tribal Health Program;
``(3) the amount of funds necessary to eliminate the health
status and resource deficiencies of all Indian Tribes served
by the Service or a Tribal Health Program; 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 Tribal Organization;
``(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, 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.
``(g) Inclusion in Base Budget.--Funds appropriated under
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.
``(h) Clarification.--Nothing in this section is intended
to diminish the primary responsibility of the Service to
eliminate existing backlogs in unmet health care needs,

[[Page S5340]]

nor are the provisions of this section intended to discourage
the Service from undertaking additional efforts to achieve
equity among Indian Tribes and Tribal Organizations.
``(i) Funding 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.--There is established an Indian
Catastrophic Health Emergency Fund (hereafter in this section
referred to as the `CHEF') consisting of--
``(1) the amounts deposited under subsection (f); and
``(2) the amounts appropriated to CHEF under this section.
``(b) Administration.--CHEF shall be administered by the
Secretary, acting through the central office of the Service,
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.
``(c) Conditions on Use of Fund.--No part of CHEF or its
administration shall be subject to contract or grant under
any law, including the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.), nor shall
CHEF funds be allocated, apportioned, or delegated on an Area
Office, Service Unit, or other similar basis.
``(d) Regulations.--The Secretary shall, through the
negotiated rulemaking process under title VIII, promulgate
regulations consistent with the provisions of this section
to--
``(1) establish a definition of disasters and catastrophic
illnesses for which the cost of the treatment provided under
contract would qualify for payment from CHEF;
``(2) provide that a Service Unit shall not be eligible for
reimbursement for the cost of treatment from CHEF until its
cost of treating any victim of such catastrophic illness or
disaster has reached a certain threshold cost which the
Secretary shall establish at--
``(A) the 2000 level of $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 that exceeds such threshold cost
incurred by--
``(A) Service Units; or
``(B) whenever otherwise authorized by the Service, non-
Service facilities or providers;
``(4) establish a procedure for payment from 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 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.
``(e) No Offset or Limitation.--Amounts appropriated to
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.
``(f) Deposit of Reimbursement Funds.--There shall be
deposited into 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 CHEF.

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

``(a) Findings.--Congress finds that health promotion and
disease prevention activities--
``(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 Tribal Health Programs, shall provide health
promotion and disease prevention services to Indians to
achieve the health status objectives set forth in section
3(2).
``(c) Evaluation.--The Secretary, after obtaining input
from the affected Tribal Health Programs, shall submit to the
President for inclusion in each report which is required to
be submitted to Congress under section 801 an evaluation of--
``(1) the health promotion and disease prevention needs of
Indians;
``(2) the health promotion and disease prevention
activities which would best meet such needs;
``(3) the internal capacity of the Service and Tribal
Health Programs to meet such needs; and
``(4) the resources which would be required to enable the
Service and Tribal Health Programs to undertake the health
promotion and disease prevention activities necessary to meet
such needs.

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

``(a) Determinations Regarding Diabetes.--The Secretary,
acting through the Service, and in consultation with Indian
Tribes and Tribal Organizations, shall determine--
``(1) by Indian Tribe and by Service Unit, the incidence
of, and the types of complications resulting from, diabetes
among Indians; and
``(2) based on the determinations made pursuant to
paragraph (1), the measures (including patient education and
effective ongoing monitoring of disease indicators) each
Service Unit should take to reduce the incidence of, and
prevent, treat, and control the complications resulting from,
diabetes among Indian Tribes within that Service Unit.
``(b) Diabetes Screening.--To the extent medically
indicated and with informed consent, 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 and, in consultation with
Indian Tribes, Urban Indian Organizations, and appropriate
health care providers, establish a cost-effective approach to
ensure ongoing monitoring of disease indicators. Such
screening and monitoring may be conducted by a Tribal Health
Program and may be conducted through appropriate Internet-
based health care management programs.
``(c) Funding for Diabetes.--The Secretary shall continue
to maintain each model diabetes project in existence on the
date of enactment of the Indian Health Amendments Care
Improvement Act of 2005, any such other diabetes programs
operated by the Service or Tribal Health Programs, and any
additional diabetes projects, such as the Medical Vanguard
program provided for in title IV of Public Law 108-87, as
implemented to serve Indian Tribes. Tribal Health Programs
shall receive recurring funding for the diabetes projects
that they operate pursuant to this section, both at the date
of enactment of the Indian Health Care Improvement Act
Amendments of 2005 and for projects which are added and
funded thereafter.
``(d) Funding for Dialysis Programs.--The Secretary is
authorized to provide funding through the Service, Indian
Tribes, and Tribal Organizations to establish dialysis
programs, including funding to purchase dialysis equipment
and provide necessary staffing.
``(e) Other Duties of the Secretary.--The Secretary shall,
to the extent funding is available--
``(1) in each Area Office, consult with Indian Tribes and
Tribal Organizations regarding programs for the prevention,
treatment, and control of diabetes;
``(2) establish in each Area Office a registry of patients
with diabetes to track the incidence 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
are disseminated to all other Area Offices, subject to
applicable patient privacy laws.

``SEC. 205. SHARED SERVICES FOR LONG-TERM CARE.

``(a) Long-term Care.--Notwithstanding any other provision
of law, the Secretary, acting through the Service, is
authorized to provide directly, or enter into contracts or
compacts under the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.) with Indian Tribes or
Tribal Organizations for, the delivery of long-term care and
similar services to Indians. Such agreements shall provide
for the sharing of staff or other services between the
Service or a Tribal Health Program and a long-term care or
other similar facility owned and operated (directly or
through a contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.)) by such Indian Tribe or Tribal Organization.
``(b) Contents of Agreements.--An agreement entered into
pursuant to subsection (a)--
``(1) may, at the request of the Indian Tribe or Tribal
Organization, delegate to such Indian 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 Health Program be allocated proportionately
between the Service and the Indian Tribe or Tribal
Organization; and
``(3) may authorize such Indian 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) Minimum Requirement.--Any nursing facility provided
for under this section shall meet the requirements for
nursing facilities under section 1919 of the Social Security
Act.
``(d) Other 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) Use of Existing or Underused Facilities.--The
Secretary shall encourage the use of existing facilities that
are underused or allow the use of swing beds for long-term or
similar care.

``SEC. 206. HEALTH SERVICES RESEARCH.

``The Secretary, acting through the Service, shall make
funding available for research to further the performance of
the health service responsibilities of Indian Health
Programs. The Secretary shall also, to the maximum extent
practicable, coordinate departmental research resources and

[[Page S5341]]

activities to address relevant Indian Health Program research
needs. Tribal Health Programs shall be given an equal
opportunity to compete for, and receive, research funds under
this section. This funding may be used for both clinical and
nonclinical research.

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

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

``SEC. 208. PATIENT TRAVEL COSTS.

``The Secretary, acting through the Service and Tribal
Health Programs, is authorized to 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 a contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.)) under this Act--
``(1) emergency air transportation and non-emergency air
transportation where ground transportation is infeasible;
``(2) transportation by private vehicle (where no other
means of transportation is available), specially equipped
vehicle, and ambulance; and
``(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) Additional Centers.--In addition to those
epidemiology centers already established as of the date of
enactment of this Act, and without reducing the funding
levels for such centers, not later than 180 days after the
date of enactment of the Indian Health Care Improvement Act
Amendments of 2005, the Secretary, acting through the
Service, shall establish and fund an epidemiology center in
each Service Area which does not yet have one to carry out
the functions described in subsection (b). Any new centers so
established may be operated by Tribal Health Programs, but
such funding shall not be divisible.
``(b) Functions of Centers.--In consultation with and upon
the request of Indian Tribes, Tribal Organizations, and Urban
Indian Organizations, each Service Area epidemiology center
established under this subsection shall, with respect to such
Service Area--
``(1) collect data relating to, and monitor progress made
toward meeting, each of the health status objectives of the
Service, the Indian Tribes, Tribal Organizations, and Urban
Indian Organizations in the Service Area;
``(2) evaluate existing delivery systems, data systems, and
other systems that impact the improvement of Indian health;
``(3) 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;
``(4) make recommendations for the targeting of services
needed by the populations served;
``(5) make recommendations to improve health care delivery
systems for Indians and Urban Indians;
``(6) provide requested technical assistance to Indian
Tribes, Tribal Organizations, 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
``(7) provide disease surveillance and assist Indian
Tribes, Tribal Organizations, and Urban Indian Organizations
to promote public health.
``(c) 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.
``(d) Funding for Studies.--The Secretary may make funding
available to Indian Tribes, Tribal Organizations, and Urban
Indian Organizations to conduct epidemiological studies of
Indian communities.

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

``(a) Funding for Development of Programs.--In addition to
carrying out any other program for health promotion or
disease prevention, the Secretary, acting through the
Service, is authorized to award grants to Indian Tribes,
Tribal Organizations, and Urban Indian Organizations to
develop comprehensive school health education programs for
children from pre-school through grade 12 in schools for the
benefit of Indian and Urban Indian children.
``(b) Use of Funds.--Funding provided under this section
may be used for purposes which may include, but are not
limited to, the following:
``(1) Developing and implementing health education
curricula both for regular school programs and afterschool
programs.
``(2) Training teachers in comprehensive school health
education curricula.
``(3) Integrating school-based, community-based, and other
public and private health promotion efforts.
``(4) Encouraging healthy, tobacco-free school
environments.
``(5) Coordinating school-based health programs with
existing services and programs available in the community.
``(6) Developing school programs on nutrition education,
personal health, oral health, and fitness.
``(7) Developing behavioral health wellness programs.
``(8) Developing chronic disease prevention programs.
``(9) Developing substance abuse prevention programs.
``(10) Developing injury prevention and safety education
programs.
``(11) Developing activities for the prevention and control
of communicable diseases.
``(12) Developing community and environmental health
education programs that include traditional health care
practitioners.
``(13) Violence prevention.
``(14) Such other health issues as are appropriate.
``(c) Technical Assistance.--Upon request, the Secretary,
acting through the Service, shall 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 for Review and Approval of Applications.--
The Secretary, acting through the Service, and in
consultation with Indian Tribes, Tribal Organizations, and
Urban Indian Organizations, shall establish criteria for the
review and approval of applications for funding provided
pursuant to this section.
``(e) Development of Program for BIA Funded Schools.--
``(1) In general.--The Secretary of the Interior, acting
through the Bureau of Indian Affairs and in cooperation with
the Secretary, acting through the Service, and affected
Indian Tribes and Tribal Organizations, shall develop a
comprehensive school health education program for children
from preschool through grade 12 in schools for which support
is provided by the Bureau of Indian Affairs.
``(2) Requirements for programs.--Such programs shall
include--
``(A) school programs on nutrition education, personal
health, oral health, and fitness;
``(B) behavioral 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) Duties of the secretary.--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) Program Authorized.--The Secretary, acting through
the Service, is authorized to establish and administer a
program 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) Allowable uses.--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) Prohibited use.--Funds made available under this
section may not be used to provide services described in
section 707(c).
``(c) Duties of the Secretary.--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 for Review and Approval of Applications.--
The Secretary, in consultation with Indian Tribes, Tribal
Organizations, and Urban Indian Organizations, shall
establish criteria for the review and approval of
applications or proposals under this section.

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

``(a) Funding Authorized.--The Secretary, acting through
the Service, and after consultation with Indian Tribes,
Tribal Organizations, Urban Indian Organizations, and the

[[Page S5342]]

Centers for Disease Control and Prevention, may make funding
available to Indian Tribes, Tribal Organizations, and Urban
Indian Organizations for the following:
``(1) Projects for the prevention, control, and elimination
of communicable and infectious diseases, including
tuberculosis, hepatitis, HIV, respiratory syncitial virus,
hanta virus, sexually transmitted diseases, and H. Pylori.
``(2) Public information and education programs for the
prevention, control, and elimination of communicable and
infectious diseases.
``(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.
``(4) Demonstration projects for the screening, treatment,
and prevention of hepatitis C virus (HCV).
``(b) Application Required.--The Secretary may provide
funding under subsection (a) only if an application or
proposal for funding is submitted to the Secretary.
``(c) Coordination With Health Agencies.--Indian Tribes,
Tribal Organizations, and Urban Indian Organizations
receiving funding under this section are encouraged to
coordinate their activities with the Centers for Disease
Control and Prevention and State and local health agencies.
``(d) Technical Assistance; Report.--In carrying out this
section, the Secretary--
``(1) may, at the request of an Indian Tribe, Tribal
Organization, or Urban Indian Organization, provide technical
assistance; and
``(2) shall prepare and submit a report to Congress
biennially 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) Funding Authorized.--The Secretary, acting through
the Service, Indian Tribes, and Tribal Organizations, may
provide funding under this Act to meet the objectives set
forth in section 3 through health care-related services and
programs not otherwise described in this Act, including--
``(1) hospice care;
``(2) assisted living;
``(3) long-term health care;
``(4) home- and community-based services; and
``(5) public health functions.
``(b) Services to Otherwise Ineligible Persons.--Subject to
section 807, at the discretion of the Service, Indian Tribes,
or Tribal Organizations, services provided for hospice care,
home- and community-based care, assisted living, and long-
term care may be provided (subject to reimbursement) to
persons 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 the
Service or an Indian Tribe or Tribal Organization.
``(c) Definitions.--For the purposes of this section, the
following definitions shall apply:
``(1) 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) Respite care.
``(F) Training for family members.
``(G) Adult day care.
``(H) Such other home- and community-based services as the
Secretary, an Indian tribe, or a Tribal Organization may
approve.
``(2) 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 this care.
``(3) The term `public health functions' means the
provision of public health-related programs, functions, and
services, including assessment, assurance, and policy
development which Indian Tribes and Tribal Organizations are
authorized and encouraged, in those circumstances where it
meets their needs, to do by forming collaborative
relationships with all levels of local, State, and Federal
Government.

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

``The Secretary, acting through the Service and Indian
Tribes, Tribal Organizations, and Urban Indian Organizations,
shall 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) Studies and Monitoring.--The Secretary and the
Service shall conduct, in conjunction with other appropriate
Federal agencies and in consultation with concerned Indian
Tribes and Tribal Organizations, studies and ongoing
monitoring programs to determine trends in the health hazards
to Indian miners and to Indians on or near reservations and
Indian communities as a result of environmental hazards which
may result in chronic or life threatening health problems,
such as nuclear resource development, petroleum
contamination, and contamination of water source and of the
food chain. Such studies shall include--
``(1) an evaluation of the nature and extent of health
problems caused by environmental hazards currently exhibited
among Indians and the causes of such health problems;
``(2) an analysis of the potential effect of ongoing and
future environmental resource development on or near
reservations and Indian communities, including the cumulative
effect 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 reservations or
Indian communities; and other development that could affect
the health of Indians and their water supply and food chain;
``(4) a summary of any findings and recommendations
provided in Federal and State studies, reports,
investigations, and inspections during the 5 years prior to
the date of enactment of the Indian Health Care Improvement
Act Amendments of 2005 that directly or indirectly relate to
the activities, practices, and conditions affecting the
health or safety of such Indians; and
``(5) 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) Health Care Plans.--Upon completion of such studies,
the Secretary and the Service shall take into account the
results of such studies and, in consultation with Indian
Tribes and Tribal Organizations, develop health care plans to
address the health problems studied under subsection (a). 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 of Report and Plan to Congress.--The
Secretary and the Service shall submit to Congress the study
prepared under subsection (a) no later than 18 months after
the date of enactment of the Indian Health Care Improvement
Act Amendments of 2005. The health care plan prepared under
subsection (b) shall be submitted in a report no later than 1
year after the study prepared under subsection (a) is
submitted to Congress. Such report 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 such health problems.
``(d) Intergovernmental Task Force.--
``(1) Establishment; members.--There is established an
Intergovernmental Task Force to be composed of the following
individuals (or their designees):
``(A) The Secretary of Energy.
``(B) The Secretary 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.
``(F) The Secretary of Health and Human Services.
``(G) The Director of the Indian Health Service.
``(2) Duties.--The Task Force shall--
``(A) 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 a
reservation or in an Indian community; and
``(B) 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) Chairman; meetings.--The Secretary of Health and
Human Services shall be the Chairman of the Task Force. The
Task Force shall meet at least twice each year.
``(e) Health Services to Certain Employees.--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 an Indian Health Program; 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 Indian
Health Program shall, at the request of such Indian, render
appropriate medical care to such Indian for such illness or
condition and may be reimbursed for 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

[[Page S5343]]

rights of such Indian to recover damages other than such
amounts paid to the Indian Health Program from the employer
for providing medical care 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) Maintenance of Services.--The Service shall not
curtail any health care services provided to Indians residing
on 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 AND SOUTH DAKOTA AS CONTRACT HEALTH
SERVICE DELIVERY AREA.

``(a) In General.--Beginning in fiscal year 2003, the
States of North Dakota and 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 North Dakota
and South Dakota.
``(b) Limitation.--The Service shall not curtail any health
care services provided to Indians residing on any
reservation, or in any county that has a common boundary with
any reservation, in the State of North Dakota or South Dakota
if such curtailment is due to the provision of contract
services in such States pursuant to the designation of such
States as a contract health service delivery area pursuant to
subsection (a).

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

``(a) Funding Authorized.--The Secretary is authorized to
fund a program using the California Rural Indian Health Board
(hereafter in this section referred to as the `CRIHB') as a
contract care intermediary to improve the accessibility of
health services to California Indians.
``(b) Reimbursement Contract.--The Secretary shall enter
into an agreement with the CRIHB to reimburse the CRIHB for
costs (including reasonable administrative costs) incurred
pursuant to this section, in providing medical treatment
under contract to California Indians described in section
806(a) throughout the California contract health services
delivery area described in section 218 with respect to high
cost contract care cases.
``(c) Administrative Expenses.--Not more than 5 percent of
the amounts provided to the CRIHB under this section for any
fiscal year may be for reimbursement for administrative
expenses incurred by the CRIHB during such fiscal year.
``(d) Limitation on Payment.--No payment may be made for
treatment provided hereunder to the extent payment may be
made for such treatment under the Indian 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.
``(e) Advisory Board.--There is established an advisory
board which shall advise the CRIHB in carrying out this
section. The advisory board shall be composed of
representatives, selected by the CRIHB, from not less than 8
Tribal Health Programs serving California Indians covered
under this section at least one half of whom of whom are not
affiliated with the CRIHB.

``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 California Indians. However, any of the counties listed
herein may only 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) Authorization for Services.--The Secretary, acting
through the Service, is directed to provide contract health
services to members of the Turtle Mountain Band of Chippewa
Indians that reside in the Trenton Service Area of Divide,
McKenzie, and Williams counties in the State of North Dakota
and the adjoining counties of Richland, Roosevelt, and
Sheridan in the State of Montana.
``(b) No Expansion of Eligibility.--Nothing in this section
may 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 Tribal Health Programs 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 a Tribal Health
Program shall, if licensed in any State, be exempt from the
licensing requirements of the State in which the Tribal
Health Program performs the services described in its
contract or compact under the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.).

``SEC. 222. NOTIFICATION OF PROVISION OF 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) Deadline for Response.--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) Effect of Untimely Response.--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) Deadline for Payment of Valid Claim.--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 Patient 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 not later than 5 business
days after receipt of a notification of a claim by a provider
of contract care services.
``(c) No Recourse.--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.

``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) Prerequisites for Expenditure of Funds.--Prior to the
expenditure of, or the making of any binding 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 and applicable, that
such facility meets the construction standards of any
accrediting body recognized by the Secretary for the purposes
of the medicare, medicaid, and SCHIP programs under titles
XVIII, XIX, and XXI of the Social Security Act by not later
than 1 year after the date on which the construction or
renovation of such facility is completed.
``(b) Closures.--
``(1) Evaluation required.--Notwithstanding any other
provision of law, no facility operated by the Service may be
closed if the Secretary has not submitted to Congress at
least 1 year prior to the date of the proposed closure an
evaluation of the impact of the proposed closure which
specifies, in addition to other considerations--
``(A) the accessibility of alternative health care
resources for the population served by such facility;
``(B) the cost-effectiveness of such closure;
``(C) the quality of health care to be provided to the
population served by such 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
facility concerning such closure;
``(F) the level of use of such facility by all eligible
Indians; and
``(G) the distance between such facility and the nearest
operating Service hospital.
``(2) Exception for certain temporary closures.--Paragraph
(1) shall not apply to any temporary closure of a facility or
any portion of a facility if such closure is necessary for
medical, environmental, or construction safety reasons.
``(c) Health Care Facility Priority System.--

[[Page S5344]]

``(1) In general.--
``(A) Establishment.--The Secretary, acting through the
Service, shall establish a health care facility priority
system, which shall--
``(i) be developed with Indian Tribes and Tribal
Organizations through negotiated rulemaking under section
802;
``(ii) give Indian Tribes' needs the highest priority; and
``(iii) at a minimum, include the lists required in
paragraph (2)(B) and the methodology required in paragraph
(2)(E).
``(B) Priority of certain projects protected.--The priority
of any project established under the construction priority
system in effect on the date of the Indian Health Care
Improvement Act Amendments of 2005 shall not be affected by
any change in the construction priority system taking place
thereafter if the project was identified as 1 of the 10 top-
priority inpatient projects, 1 of the 10 top-priority
outpatient projects, 1 of the 10 top-priority staff quarters
developments, or 1 of the 10 top-priority Youth Regional
Treatment Centers in the fiscal year 2005 Indian Health
Service budget justification, or if the project had completed
both Phase I and Phase II of the construction priority system
in effect on the date of enactment of such Act.
``(2) Report; contents.--The Secretary shall submit to the
President, for inclusion in each report required to be
transmitted to Congress under section 801, a report which
sets forth the following:
``(A) A description of the health care facility priority
system of the Service, established under paragraph (1).
``(B) Health care facilities lists, including--
``(i) the 10 top-priority inpatient health care facilities;
``(ii) the 10 top-priority outpatient health care
facilities;
``(iii) the 10 top-priority specialized health care
facilities (such as long-term care and alcohol and drug abuse
treatment);
``(iv) the 10 top-priority staff quarters developments
associated with health care facilities; and
``(v) the 10 top-priority hostels associated with health
care facilities.
``(C) The justification for such order of priority.
``(D) The projected cost of such projects.
``(E) The methodology adopted by the Service in
establishing priorities under its health care facility
priority system.
``(3) Requirements for preparation of reports.--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, Tribal
Organizations, and Urban Indian Organizations; and
``(B) review the total unmet needs of all Indian Tribes,
Tribal Organizations, and Urban Indian Organizations for
health care facilities (including hostels and staff
quarters), including needs for renovation and expansion of
existing facilities.
``(4) Criteria for evaluating needs.--For purposes of this
subsection, the Secretary shall, in evaluating the needs of
facilities operated under any contract or compact under the
Indian Self-Determination and Education Assistance Act (25
U.S.C. 450 et seq.) use the same criteria that the Secretary
uses in evaluating the needs of facilities operated directly
by the Service.
``(5) Needs of facilities under isdeaa agreements.--The
Secretary shall ensure that the planning, design,
construction, and renovation needs of Service and non-Service
facilities operated under contracts or compacts in accordance
with the Indian Self-Determination and Education Assistance
Act (25 U.S.C. 450 et seq.) are fully and equitably
integrated into the health care facility priority system.
``(d) Review of Need for Facilities.--
``(1) Initial report.--In the year 2006, the Government
Accountability Office shall prepare and finalize a report
which sets forth the needs of the Service, Indian Tribes,
Tribal Organizations, and Urban Indian Organizations, for the
facilities listed under subsection (c)(2)(B), including the
needs for renovation and expansion of existing facilities.
The Government Accountability Office shall submit the report
to the appropriate authorizing and appropriations committees
of Congress and to the Secretary.
``(2) Beginning in the year 2006, the Secretary shall
update the report required under paragraph (1) every 5 years.
``(3) The Comptroller General and the Secretary shall
consult with Indian Tribes, Tribal Organizations, and Urban
Indian Organizations. The Secretary shall submit the reports
required by paragraphs (1) and (2), to the President for
inclusion in the report required to be transmitted to
Congress under section 801.
``(4) For purposes of this subsection, the reports shall,
regarding the needs of facilities operated under any contract
or compact under the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.), be based on the same
criteria that the Secretary uses in evaluating the needs of
facilities operated directly by the Service.
``(5) The planning, design, construction, and renovation
needs of facilities operated under contracts or compacts
under the Indian Self-Determination and Education Assistance
Act (25 U.S.C. 450 et seq.) shall be fully and equitably
integrated into the development of the health facility
priority system.
``(6) Beginning in 2007 and each fiscal year thereafter,
the Secretary shall provide an opportunity for nomination of
planning, design, and construction projects by the Service,
Indian Tribes, Tribal Organizations, and Urban Indian
Organizations for consideration under the health care
facility priority system.
``(e) Funding Condition.--All funds appropriated under the
Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the
`Snyder Act'), for the planning, design, construction, or
renovation of health facilities for the benefit of 1 or more
Indian Tribes shall be subject to the provisions of the
Indian Self-Determination and Education Assistance Act (25
U.S.C. 450 et seq.).
``(f) Development of 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. SANITATION FACILITIES.

``(a) Findings.--Congress finds the following:
``(1) The provision of sanitation 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 sanitation 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 sanitation
facilities and other preventive health measures.
``(4) Many Indian homes and Indian communities still lack
sanitation facilities.
``(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
sanitation facilities.
``(b) Facilities and Services.--In furtherance of the
findings 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). Under such authority, the Secretary, acting through
the Service, is authorized to provide the following:
``(1) 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 sanitation facilities,
including the provision of existing plans, standard details,
and specifications available in the Department, to be used at
the option of the Indian Tribe, Tribal Organization, or
Indian community.
``(2) Ongoing technical assistance and training to Indian
Tribes, Tribal Organizations, and Indian communities in the
management of utility organizations which operate and
maintain sanitation facilities.
``(3) Priority funding for operation and maintenance
assistance for, and emergency repairs to, sanitation
facilities operated by an Indian Tribe, Tribal Organization
or Indian community 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.
``(c) Funding.--Notwithstanding any other provision of
law--
``(1) 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;
``(2) 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);
``(3) unless specifically authorized when funds are
appropriated, the Secretary 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;
``(4) the Secretary of Health and Human Services is
authorized to accept from any source, including Federal and
State agencies, funds for the purpose of providing sanitation
facilities and services and place these funds into contracts
or compacts under the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.);
``(5) except as otherwise prohibited by this section, the
Secretary may use funds appropriated under the authority of
section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a) to
fund up to 100 percent of the amount of an Indian Tribe's
loan obtained under any Federal program for new projects to
construct eligible sanitation facilities to serve Indian
homes;
``(6) except as otherwise prohibited by this section, the
Secretary may use funds appropriated under the authority of
section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a) to
meet matching or cost participation requirements under other
Federal and non-Federal programs for new projects to
construct eligible sanitation facilities;

[[Page S5345]]

``(7) all Federal agencies are authorized to transfer to
the Secretary funds identified, granted, loaned, or
appropriated whereby the Department's applicable policies,
rules, and regulations shall apply in the implementation of
such projects;
``(8) the Secretary of Health and Human Services shall
enter into interagency agreements with Federal and State
agencies for the purpose of providing financial assistance
for sanitation facilities and services under this Act; and
``(9) 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 sanitation facilities funded under this Act.
``(d) Certain Capabilities Not Prerequisite.--The financial
and technical capability of an Indian Tribe, Tribal
Organization, or Indian community to safely operate, manage,
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 is authorized to
provide financial assistance to Indian Tribes, Tribal
Organizations, and Indian communities for operation,
management, and maintenance of their sanitation facilities.
``(f) Operation, Management, and Maintenance of
Facilities.--The Indian Tribe has the primary responsibility
to establish, collect, and use reasonable user fees, or
otherwise set aside funding, for the purpose of operating,
managing, and maintaining sanitation facilities. If a
sanitation facility serving a community that is operated by
an Indian Tribe or Tribal Organization is threatened with
imminent failure and such operator lacks capacity to maintain
the integrity or the health benefits of the sanitation
facility, then the Secretary is authorized to assist the
Indian Tribe, Tribal Organization, or Indian community in the
resolution of the problem on a short-term basis through
cooperation with the emergency coordinator or by providing
operation, management, and maintenance service.
``(g) ISDEAA Program Funded on Equal Basis.--Tribal Health
Programs shall be eligible (on an equal basis with programs
that are administered directly by the Service) for--
``(1) any funds appropriated pursuant to this section; and
``(2) any funds appropriated for the purpose of providing
sanitation facilities.
``(h) Report.--
``(1) Required; contents.--The Secretary, in consultation
with the Secretary of Housing and Urban Development, Indian
Tribes, Tribal Organizations, and tribally designated housing
entities (as defined in section 4 of the Native American
Housing Assistance and Self-Determination Act of 1996 (25
U.S.C. 4103)) shall submit to the President, for inclusion in
each report required to be transmitted to 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 and needs;
``(C) the level of initial and final sanitation deficiency
for each type of sanitation facility for each project of each
Indian Tribe or Indian community;
``(D) the amount and most effective use of funds, derived
from whatever source, necessary to accommodate the sanitation
facilities needs of new homes assisted with funds under the
Native American Housing Assistance and Self-Determination
Act, and to reduce the identified sanitation deficiency
levels of all Indian Tribes and Indian communities to level I
sanitation deficiency as defined in paragraph (4)(A); and
``(E) a 10-year plan to provide sanitation facilities to
serve existing Indian homes and Indian communities and new
and renovated Indian homes.
``(2) Criteria.--The criteria on which the deficiencies and
needs will be evaluated shall be developed through negotiated
rulemaking pursuant to section 802.
``(3) Uniform 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
Indian communities.
``(4) Sanitation deficiency levels.--For purposes of this
subsection, the sanitation deficiency levels for an
individual, Indian Tribe, or Indian community sanitation
facility to serve Indian homes are determined as follows:
``(A) A level I deficiency exists if a sanitation facility
serving an individual, Indian Tribe, or Indian community--
``(i) complies with all applicable water supply, pollution
control, and solid waste disposal laws; and
``(ii) deficiencies relate to routine replacement, repair,
or maintenance needs.
``(B) A level II deficiency exists if a sanitation facility
serving an individual, Indian Tribe, or Indian community
substantially or recently complied with all applicable water
supply, pollution control, and solid waste laws and any
deficiencies relate to--
``(i) small or minor capital improvements needed to bring
the facility back into compliance;
``(ii) capital improvements that are necessary to enlarge
or improve the facilities in order to meet the current needs
for domestic sanitation facilities; or
``(iii) the lack of equipment or training by an Indian
Tribe, Tribal Organization, or an Indian community to
properly operate and maintain the sanitation facilities.
``(C) A level III deficiency exists if a sanitation
facility serving an individual, Indian Tribe or Indian
community meets one or more of the following conditions--
``(i) water or sewer service in the home is provided by a
haul system with holding tanks and interior plumbing;
``(ii) major significant interruptions to water supply or
sewage disposal occur frequently, requiring major capital
improvements to correct the deficiencies; or
``(iii) there is no access to or no approved or permitted
solid waste facility available.
``(D) A level IV deficiency exists if--
``(i) a sanitation facility of an individual, Indian Tribe,
Tribal Organization, or Indian community has no piped water
or sewer facilities in the home or the facility has become
inoperable due to major component failure; or
``(ii) where only a washeteria or central facility exists
in the community.
``(E) A level V deficiency exists in the absence of a
sanitation facility, where individual homes do not have
access to safe drinking water or adequate wastewater
(including sewage) disposal.
``(i) Definitions.--For purposes of this section, the
following terms apply:
``(1) 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.
``(2) Sanitation facilities.--The terms `sanitation
facility' and `sanitation facilities' mean safe and adequate
water supply systems, sanitary sewage disposal systems, and
sanitary solid waste systems (and all related equipment and
support infrastructure).

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

``(a) Buy Indian Act.--The Secretary, acting through the
Service, may use the negotiating authority of section 23 of
the Act of June 25, 1910 (25 U.S.C. 47, commonly known as the
`Buy Indian Act'), 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 sanitation facilities pursuant to section
302. Such preference may be accorded by the Secretary unless
the Secretary finds, pursuant to regulations adopted pursuant
to section 802, 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 a 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) Labor Standards.--
``(1) In general.--For the purposes of implementing the
provisions of this title, contracts for the construction or
renovation of health care facilities, staff quarters, and
sanitation facilities, and related support infrastructure,
funded in whole or in part with funds made available pursuant
to this title, shall contain a provision requiring compliance
with subchapter IV of chapter 31 of title 40, United States
Code (commonly known as the `Davis-Bacon Act'), unless such
construction or renovation--
``(A) is performed by a contractor pursuant to a contract
with an Indian Tribe or Tribal Organization with funds
supplied through a contract or compact authorized by the
Indian Self-Determination and Education Assistance Act, or
other statutory authority; and
``(B) is subject to prevailing wage rates for similar
construction or renovation in the locality as determined by
the Indian Tribes or Tribal Organizations to be served by the
construction or renovation.
``(2) Exception.--This subsection shall not apply to
construction or renovation carried out by an Indian Tribe or
Tribal Organization with its own employees.

``SEC. 304. EXPENDITURE OF NONSERVICE FUNDS FOR RENOVATION.

``(a) In General.--Notwithstanding any other provision of
law, if the requirements of subsection (c) are met, the
Secretary, acting through the Service, is authorized to
accept any major expansion, renovation, or modernization by
any Indian Tribe or Tribal Organization of any Service
facility or of any other Indian health facility operated
pursuant to a contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.), including--
``(1) any plans or designs for such expansion, renovation,
or modernization; and
``(2) any expansion, renovation, or modernization for which
funds appropriated under any Federal law were lawfully
expended.
``(b) Priority List.--
``(1) In general.--The Secretary shall maintain a separate
priority list to address

[[Page S5346]]

the needs for increased operating expenses, personnel, or
equipment for such facilities. The methodology for
establishing priorities shall be developed through negotiated
rulemaking under section 802. The list of priority facilities
will be revised annually in consultation with Indian Tribes
and Tribal Organizations.
``(2) Report.--The Secretary shall submit to the President,
for inclusion in each report required to be transmitted to
Congress under section 801, the priority list maintained
pursuant to paragraph (1).
``(c) Requirements.--The requirements of this subsection
are met with respect to any expansion, renovation, or
modernization if--
``(1) the Indian 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.
``(d) Additional Requirement for Expansion.--In addition to
the requirements under subsection (c), for any expansion, the
Indian Tribe or Tribal Organization shall provide to the
Secretary additional information developed through negotiated
rulemaking under section 802, including additional staffing,
equipment, and other costs associated with the expansion.
``(e) Closure or Conversion of Facilities.--If any Service
facility which has been expanded, renovated, or modernized by
an Indian Tribe or Tribal Organization 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 or Tribal
Organization 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. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, AND
MODERNIZATION OF SMALL AMBULATORY CARE
FACILITIES.

``(a) Funding.--
``(1) In general.--The Secretary, acting through the
Service, in consultation with Indian Tribes and Tribal
Organizations, shall make grants to Indian 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
pursuant to subsections (b)(2) and (c)(1)(C)). Funding made
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) Agreement required.--Funding under paragraph (1) may
only be made available to a Tribal Health Program 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).
``(b) Use of Funds.--
``(1) Allowable uses.--Funding provided under this section
may be used 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 or
modernization will--
``(i) have a total capacity appropriate to its projected
service population;
``(ii) provide annually no fewer than 150 patient visits by
eligible Indians and other users who are eligible for
services in such facility in accordance with section
807(c)(2); and
``(iii) provide ambulatory care in a Service Area
(specified in the contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.)) with a population of no fewer than 1,500 eligible
Indians and other users who are eligible for services in such
facility in accordance with section 807(c)(2).
``(2) Additional allowable use.--The Secretary may also
reserve a portion of the funding provided under this section
and use those reserved funds to reduce an outstanding debt
incurred by Indian Tribes or Tribal Organizations for the
construction, expansion, or modernization of an ambulatory
care facility that meets the requirements under paragraph
(1). The provisions of this section shall apply, except that
such applications for funding under this paragraph shall be
considered separately from applications for funding under
paragraph (1).
``(3) Use only for certain portion of costs.--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 identified above
in subsection (b)(1)(C) (ii) and (iii). The requirements of
clauses (ii) and (iii) of paragraph (1)(C) shall not apply to
an Indian Tribe or Tribal Organization applying for funding
under this section for a health care facility located or to
be constructed on an island or when such facility is not
located on a road system providing direct access to an
inpatient hospital where care is available to the Service
population.
``(c) Funding.--
``(1) Application.--No funding may be made available under
this section unless an application or proposal for such
funding has been approved by the Secretary in accordance with
applicable regulations and has 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 funding under this section,
the Secretary shall give priority to Indian Tribes and Tribal
Organizations that demonstrate--
``(A) a need for increased ambulatory care services; and
``(B) insufficient capacity to deliver such services.
``(3) Peer review panels.--The Secretary may provide for
the establishment of peer review panels, as necessary, to
review and evaluate applications and proposals and to advise
the Secretary regarding such applications using the criteria
developed during consultations pursuant to subsection (a)(1).
``(d) Reversion of Facilities.--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 used 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) Funding Nonrecurring.--Funding provided under this
section shall be nonrecurring and shall not be available for
inclusion in any individual Indian Tribe's tribal share for
an award under the Indian Self-Determination and Education
Assistance Act or for reallocation or redesign thereunder.

``SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRATION
PROJECT.

``(a) Health Care Demonstration Projects.--The Secretary,
acting through the Service, and in consultation with Indian
Tribes and Tribal Organizations, is authorized to enter into
construction agreements under the Indian Self-Determination
and Education Assistance Act (25 U.S.C. 450 et seq.) with
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
to Indians through facilities.
``(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) Regulations.--The Secretary shall develop and
promulgate regulations not later than 1 year after the date
of enactment of the Indian Health Care Improvement Act
Amendments of 2005. If the Secretary has not promulgated
regulations by that date, the Secretary shall develop and
publish regulations, through rulemaking under section 802,
for the review and approval of applications submitted under
this section.
``(d) Criteria.--The Secretary may approve projects that
meet the following criteria:
``(1) There is a need for a new facility or program or the
reorientation of an existing facility or program.
``(2) A significant number of Indians, including those with
low health status, will be served by the project.
``(3) The project has the potential to deliver services in
an efficient and effective manner.
``(4) The project is economically viable.
``(5) The Indian Tribe or Tribal Organization has the
administrative and financial capability to administer the
project.
``(6) The project is integrated with providers of related
health and social services

[[Page S5347]]

and is coordinated with, and avoids duplication of, existing
services.
``(e) Peer Review Panels.--The Secretary may provide for
the establishment of peer review panels, as necessary, to
review and evaluate applications using the criteria developed
pursuant to subsection (d).
``(f) Priority.--The Secretary shall give priority to
applications for demonstration projects in each of the
following Service Units to the extent that such applications
are timely filed and meet the criteria specified in
subsection (d):
``(1) Cass Lake, Minnesota.
``(2) Clinton, Oklahoma.
``(3) Harlem, Montana.
``(4) Mescalero, New Mexico.
``(5) Owyhee, Nevada.
``(6) Parker, Arizona.
``(7) Schurz, Nevada.
``(8) Winnebago, Nebraska.
``(9) Ft. Yuma, California.
``(g) 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.
``(h) Service to Ineligible Persons.--Subject to section
807, 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 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.
``(i) Equitable Treatment.--For purposes of subsection
(d)(1), the Secretary shall, in evaluating facilities
operated under any contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.), use the same criteria that the Secretary uses in
evaluating facilities operated directly by the Service.
``(j) 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 contract or compact
under the Indian Self-Determination and Education Assistance
Act (25 U.S.C. 450 et seq.) for health services are fully and
equitably integrated into the implementation of the health
care delivery demonstration projects under this section.

``SEC. 307. LAND TRANSFER.

``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.

``SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS.

``The Secretary, acting through the Service, may enter into
leases, contracts, and other agreements with Indian Tribes
and Tribal Organizations which hold (1) title to, (2) a
leasehold interest in, or (3) a beneficial interest in (when
title is held by the United States in trust for the benefit
of an Indian Tribe) facilities used or to be used for the
administration and delivery of health services by an Indian
Health Program. Such leases, contracts, or agreements may
include provisions for construction or renovation and provide
for compensation to the Indian Tribe or Tribal Organization
of rental and other costs consistent with section 105(l) of
the Indian Self-Determination and Education Assistance Act
and regulations thereunder.

``SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND LOAN
REPAYMENT.

``(a) In General.--The Secretary, in consultation with the
Secretary of the Treasury, Indian Tribes, and Tribal
Organizations, shall carry out a study to determine the
feasibility of establishing a loan fund to provide to Indian
Tribes and Tribal Organizations direct loans or guarantees
for loans for the construction of health care facilities,
including--
``(1) inpatient facilities;
``(2) outpatient facilities;
``(3) staff quarters;
``(4) hostels; and
``(5) specialized care facilities, such as behavioral
health and elder care facilities.
``(b) Determinations.--In carrying out the study under
subsection (a), the Secretary shall determine--
``(1) the maximum principal amount of a loan or loan
guarantee that should be offered to a recipient from the loan
fund;
``(2) the percentage of eligible costs, not to exceed 100
percent, that may be covered by a loan or loan guarantee from
the loan fund (including costs relating to planning, design,
financing, site land development, construction,
rehabilitation, renovation, conversion, improvements, medical
equipment and furnishings, and other facility-related costs
and capital purchase (but excluding staffing));
``(3) the cumulative total of the principal of direct loans
and loan guarantees, respectively, that may be outstanding at
any 1 time;
``(4) the maximum term of a loan or loan guarantee that may
be made for a facility from the loan fund;
``(5) the maximum percentage of funds from the loan fund
that should be allocated for payment of costs associated with
planning and applying for a loan or loan guarantee;
``(6) whether acceptance by the Secretary of an assignment
of the revenue of an Indian Tribe or Tribal Organization as
security for any direct loan or loan guarantee from the loan
fund would be appropriate;
``(7) whether, in the planning and design of health
facilities under this section, users eligible under section
807(c) may be included in any projection of patient
population;
``(8) whether funds of the Service provided through loans
or loan guarantees from the loan fund should be eligible for
use in matching other Federal funds under other programs;
``(9) the appropriateness of, and best methods for,
coordinating the loan fund with the health care priority
system of the Service under section 301; and
``(10) any legislative or regulatory changes required to
implement recommendations of the Secretary based on results
of the study.
``(c) Report.--Not later than September 30, 2007, the
Secretary shall submit to the Committee on Indian Affairs of
the Senate and the Committee on Resources and the Committee
on Energy and Commerce of the House of Representatives a
report that describes--
``(1) the manner of consultation made as required by
subsection (a); and
``(2) the results of the study, including any
recommendations of the Secretary based on results of the
study.

``SEC. 310. TRIBAL LEASING.

``A Tribal Health Program may lease permanent structures
for the purpose of providing health care services without
obtaining advance approval in appropriation Acts.

``SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES JOINT
VENTURE PROGRAM.

``(a) 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. An Indian Tribe or Tribal Organization may
use tribal funds, private sector, or other available
resources, including loan guarantees, to fulfill its
commitment under a joint venture entered into under this
subsection. An Indian Tribe or Tribal Organization shall be
eligible to establish a joint venture project if, when it
submits a letter of intent, it--
``(1) has begun but not completed the process of
acquisition or construction of a health facility to be used
in the joint venture project; or
``(2) has not begun the process of acquisition or
construction of a health facility for use in the joint
venture project.
``(b) Requirements.--The Secretary shall make such an
arrangement with an Indian Tribe or Tribal Organization only
if--
``(1) 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 relevant health facility; and
``(2) the Indian Tribe or Tribal Organization meets the
need criteria which shall be developed through the negotiated
rulemaking process provided for under section 802.
``(c) Continued Operation.--The Secretary shall negotiate
an agreement with the Indian Tribe or Tribal Organization
regarding the continued operation of the facility at the end
of the initial 10 year no-cost lease period.
``(d) Breach 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
Indian Tribe or Tribal Organization, or paid to a third party
on the Indian 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 does
not apply to any funds expended for the delivery of health
care services, personnel, or staffing.
``(e) Recovery for Nonuse.--An Indian Tribe or Tribal
Organization that has entered into a written agreement with
the Secretary under this subsection shall be entitled to
recover from the United States an amount that is proportional
to the value of such facility if, at any time within the 10-
year term of the agreement, the Service ceases to use the
facility or otherwise breaches the agreement.
``(f) Definition.--For the purposes of this section, the
term `health facility' or `health facilities' includes
quarters needed to provide housing for staff of the relevant
Tribal Health Program.

``SEC. 312. LOCATION OF FACILITIES.

``(a) In General.--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, the
Bureau of Indian Affairs and the Service shall give priority
to locating such facilities and projects on Indian lands, or
lands in Alaska owned by any Alaska Native village, or
village or regional corporation under the Alaska Native
Claims Settlement Act, or any land allotted to any Alaska
Native, if requested by the Indian owner and

[[Page S5348]]

the Indian Tribe with jurisdiction over such lands or other
lands owned or leased by the Indian Tribe or Tribal
Organization. Top priority shall be given to Indian land
owned by 1 or more Indian Tribes.
``(b) Definition.--For purposes of this section, the term
`Indian lands' means--
``(1) all lands within the exterior boundaries of any
reservation; and
``(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.

``SEC. 313. 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 which identifies the
backlog of maintenance and repair work required at both
Service and tribal health care facilities, including new
health care facilities expected to be in operation in the
next fiscal year. The report shall also identify the need for
renovation and expansion of existing facilities to support
the growth of health care programs.
``(b) Maintenance of Newly Constructed Space.--The
Secretary, acting through the Service, is authorized to
expend maintenance and improvement funds to support
maintenance of newly constructed space only if such space
falls within the approved supportable space allocation for
the Indian Tribe or Tribal Organization. Supportable space
allocation shall be defined through the negotiated rulemaking
process provided for under section 802.
``(c) Replacement Facilities.--In addition to using
maintenance and improvement funds for renovation,
modernization, and expansion of facilities, an Indian Tribe
or Tribal Organization may use maintenance and improvement
funds for construction of a replacement facility if the costs
of renovation of such facility would exceed a maximum
renovation cost threshold. The maximum renovation cost
threshold shall be determined through the negotiated
rulemaking process provided for under section 802.

``SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY OWNED QUARTERS.

``(a) Rental Rates.--
``(1) Establishment.--Notwithstanding any other provision
of law, a Tribal Health Program which operates a hospital or
other health facility and the federally owned quarters
associated therewith pursuant to a contract or compact under
the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450 et seq.) shall have the authority to establish
the rental rates charged to the occupants of such quarters by
providing notice to the Secretary of its election to exercise
such authority.
``(2) Objectives.--In establishing rental rates pursuant to
authority of this subsection, a Tribal Health Program shall
endeavor to achieve the following objectives:
``(A) To base such rental rates on the reasonable value of
the quarters to the occupants thereof.
``(B) To generate sufficient funds to prudently provide for
the operation and maintenance of the quarters, and subject to
the discretion of the Tribal Health Program, to supply
reserve funds for capital repairs and replacement of the
quarters.
``(3) Equitable funding.--Any quarters whose rental rates
are established by a Tribal Health Program pursuant to this
subsection shall remain eligible for quarters improvement and
repair funds to the same extent as all federally owned
quarters used to house personnel in Services-supported
programs.
``(4) Notice of rate change.--A Tribal Health Program which
exercises the authority provided under this subsection shall
provide occupants with no less than 60 days notice of any
change in rental rates.
``(b) Direct Collection of Rent.--
``(1) In general.--Notwithstanding any other provision of
law, and subject to paragraph (2), a Tribal Health Program
shall have the authority to collect rents directly from
Federal employees who occupy such quarters in accordance with
the following:
``(A) The Tribal Health Program shall notify the Secretary
and the subject Federal employees of its election to exercise
its authority to collect rents directly from such Federal
employees.
``(B) Upon receipt of a notice described in subparagraph
(A), the Federal employees shall pay rents for occupancy of
such quarters directly to the Tribal Health Program 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 Tribal
Health Program 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 Tribal Health Program for
the maintenance (including capital repairs and replacement)
and operation of the quarters and facilities as the Tribal
Health Program shall determine.
``(2) Retrocession of authority.--If a Tribal Health
Program 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 no less than
180 days after the Tribal Health Program notifies the
Secretary of its desire to retrocede; or
``(B) such other date as may be mutually agreed by the
Secretary and the Tribal Health Program.
``(c) Rates in Alaska.--To the extent that a Tribal Health
Program, 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. 315. APPLICABILITY OF BUY AMERICAN ACT REQUIREMENT.

``(a) Applicability.--The Secretary shall ensure that the
requirements of the Buy American Act apply to all
procurements made with funds provided pursuant to section
317. Indian Tribes and Tribal Organizations shall be exempt
from these requirements.
``(b) Effect of Violation.--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 section 317, pursuant to the debarment,
suspension, and ineligibility procedures described in
sections 9.400 through 9.409 of title 48, Code of Federal
Regulations.
``(c) Definitions.--For purposes of 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. 316. OTHER FUNDING FOR FACILITIES.

``(a) Authority To Accept Funds.--The Secretary is
authorized to 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 a contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.). Receipt of such funds shall have no effect on the
priorities established pursuant to section 301.
``(b) Interagency Agreements.--The Secretary is authorized
to enter into interagency agreements with other Federal
agencies or State agencies and other entities and to accept
funds from such Federal or State agencies or other sources to
provide for the planning, design, and construction of health
care facilities to be administered by Indian Health Programs
in order to carry out the purposes of this Act and the
purposes for which the funds were appropriated or for which
the funds were otherwise provided.
``(c) Transferred Funds.--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.
``(d) Establishment of Standards.--The Secretary, through
the Service, shall establish standards by regulation,
developed by rulemaking under section 802, for the planning,
design, and construction of health care facilities serving
Indians under this Act.

``SEC. 317. 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 IV--ACCESS TO HEALTH SERVICES

``SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SECURITY ACT
HEALTH CARE PROGRAMS.

``(a) Disregard of Medicare, Medicaid, and SCHIP Payments
in Determining Appropriations.--Any payments received by an
Indian Health Program or by an Urban Indian Organization made
under title XVIII, XIX, or XXI of the Social Security Act for
services provided to Indians eligible for benefits under such
respective titles shall not be considered in determining
appropriations for the provision of health care and services
to Indians.
``(b) Nonpreferential Treatment.--Nothing in this Act
authorizes the Secretary to provide services to an Indian
with coverage under title XVIII, XIX, or XXI of the Social
Security Act in preference to an Indian without such
coverage.
``(c) Use of Funds.--
``(1) Special fund.--Notwithstanding any other provision of
law, but subject to paragraph (2), payments to which a
facility of the Service is entitled by reason of a provision
of the Social Security 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 programs of the
Service which may be necessary to achieve or maintain
compliance with the applicable conditions and requirements of
titles XVIII, XIX, and XXI of the Social Security Act. Any
amounts to be reimbursed that are in excess of the amount
necessary to achieve or maintain such conditions and
requirements shall, subject to the consultation with Indian
Tribes being served by the Service Unit, be used for reducing
the

[[Page S5349]]

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
amount to which the facilities of the Service, for which such
Service Unit makes collections, are entitled by reason of a
provision of the Social Security Act.
``(2) Direct payment option.--Paragraph (1) shall not apply
upon the election of a Tribal Health Program under subsection
(d) to receive payments directly. No payment may be made out
of the special fund described in such paragraph with respect
to reimbursement made for services provided during the period
of such election.
``(d) Direct Billing.--
``(1) In general.--A Tribal Health Program may directly
bill for, and receive payment for, health care items and
services provided by such Indian Tribe or Tribal organization
for which payment is made under title XVIII, XIX, or XXI of
the Social Security Act or from any other third party payor.
``(2) Direct reimbursement.--
``(A) Use of funds.--Each Tribal Health Program exercising
the option described in paragraph (1) with respect to a
program under a title of the Social Security Act shall be
reimbursed directly by that program for items and services
furnished without regard to section 401(c), but all amounts
so reimbursed shall be used by the Tribal Health Program for
the purpose of making any improvements in Tribal facilities
or Tribal Health Programs that may be necessary to achieve or
maintain compliance with the conditions and requirements
applicable generally to such items and services under the
program under such title and to provide additional health
care services, improvements in health care facilities and
Tribal Health Programs, any health care-related purpose, or
otherwise to achieve the objectives provided in section 3 of
this Act.
``(B) Audits.--The amounts paid to an Indian Tribe or
Tribal Organization exercising the option described in
paragraph (1) with respect to a program under a title of the
Social Security Act shall be subject to all auditing
requirements applicable to programs administered by an Indian
Health Program.
``(C) 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.
``(3) Examination and implementation of changes.--The
Secretary, acting through the Service and with the assistance
of the Administrator of the Centers for Medicare & Medicaid
Services, shall examine on an ongoing basis and implement any
administrative changes that may be necessary to facilitate
direct billing and reimbursement under the program
established under this subsection, including any agreements
with States that may be necessary to provide for direct
billing under a program under a title of the Social Security
Act.
``(4) Withdrawal from program.--A Tribal Health Program
that bills directly under the program established under this
subsection may withdraw from participation in the same manner
and under the same conditions that an Indian Tribe or Tribal
Organization may retrocede a contracted program to the
Secretary under the authority of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.). All cost accounting and billing authority under the
program established under this subsection shall be returned
to the Secretary upon the Secretary's acceptance of the
withdrawal of participation in this program.

``SEC. 402. GRANTS TO AND CONTRACTS WITH THE SERVICE, INDIAN
TRIBES, TRIBAL ORGANIZATIONS, AND URBAN INDIAN
ORGANIZATIONS.

``(a) Indian Tribes and Tribal Organizations.--The
Secretary, acting through the Service, shall make grants to
or enter into contracts with Indian Tribes and Tribal
Organizations to assist such Tribes and Tribal Organizations
in establishing and administering programs on or near
reservations and trust lands to assist individual Indians--
``(1) to enroll for benefits under title XVIII, XIX, or XXI
of the Social Security Act and other health benefits
programs; and
``(2) to pay premiums for coverage for such benefits, which
may be based on financial need (as determined by the Indian
Tribe or Tribes being served based on a schedule of income
levels developed or implemented by such Tribe or Tribes).
``(b) Conditions.--The Secretary, acting through the
Service, shall place conditions as deemed necessary to effect
the purpose of this section in any grant or contract which
the Secretary makes with any Indian Tribe or Tribal
Organization pursuant to this section. Such conditions shall
include requirements that the Indian Tribe or Tribal
Organization successfully undertake--
``(1) to determine the population of Indians eligible for
the benefits described in subsection (a);
``(2) to educate Indians with respect to the benefits
available under the respective programs;
``(3) to provide transportation for such individual Indians
to the appropriate offices for enrollment or applications for
such benefits; and
``(4) to develop and implement methods of improving the
participation of Indians in receiving the benefits provided
under titles XVIII, XIX, and XXI of the Social Security Act.
``(c) Agreements Relating to Improving Enrollment of
Indians Under Social Security Act Programs.--
``(1) Agreements with secretary to improve receipt and
processing of applications.--
``(A) Authorization.--The Secretary, acting through the
Service, may enter into an agreement with an Indian Tribe,
Tribal Organization, or Urban Indian Organization which
provides for the receipt and processing of applications by
Indians for assistance under titles XIX and XXI of the Social
Security Act, and benefits under title XVIII of such Act, by
an Indian Health Program or Urban Indian Organization.
``(B) Reimbursement of costs.--Such agreements may provide
for reimbursement of costs of outreach, education regarding
eligibility and benefits, and translation when such services
are provided. The reimbursement may, as appropriate, be added
to the applicable rate per encounter or be provided as a
separate fee-for-service payment to the Indian Tribe or
Tribal Organization.
``(C) Processing clarified.--In this paragraph, the term
`processing' does not include a final determination of
eligibility.
``(2) Agreements with states for outreach on or near
reservation.--
``(A) In general.--In order to improve the access of
Indians residing on or near a reservation to obtain benefits
under title XIX or XXI of the Social Security Act, the
Secretary shall encourage the State to take steps to provide
for enrollment on or near the reservation. Such steps may
include outreach efforts such as the outstationing of
eligibility workers, entering into agreements with Indian
Tribes and Tribal Organizations to provide outreach,
education regarding eligibility and benefits, enrollment, and
translation services when such services are provided.
``(B) Construction.--Nothing in subparagraph (A) shall be
construed as affecting arrangements entered into between
States and Indian Tribes and Tribal Organizations for such
Indian Tribes and Tribal Organizations to conduct
administrative activities under such titles.
``(d) Facilitating Cooperation.--The Secretary, acting
through the Centers for Medicare & Medicaid Services, shall
take such steps as are necessary to facilitate cooperation
with, and agreements between, States and the Service, Indian
Tribes, Tribal Organizations, or Urban Indian Organizations.
``(e) Application to Urban Indian Organizations.--
``(1) In general.--The provisions of subsection (a) shall
apply with respect to grants and other funding to Urban
Indian Organizations with respect to populations served by
such organizations in the same manner they apply to grants
and contracts with Indian Tribes and Tribal Organizations
with respect to programs on or near reservations.
``(2) Requirements.--The Secretary shall include in the
grants or contracts made or provided under paragraph (1)
requirements that are--
``(A) consistent with the requirements imposed by the
Secretary under subsection (b);
``(B) appropriate to Urban Indian Organizations and Urban
Indians; and
``(C) necessary to effect the purposes of this section.

``SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS
OF HEALTH SERVICES.

``(a) Right of Recovery.--Except as provided in subsection
(f), the United States, an Indian Tribe, or Tribal
Organization shall have the right to recover from an
insurance company, health maintenance organization, employee
benefit plan, third-party tortfeasor, or any other
responsible or liable third party (including a political
subdivision or local governmental entity of a State) the
reasonable charges as determined by the Secretary, and billed
by the Secretary, an Indian Tribe, or Tribal Organization, in
providing health services, through the Service, 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 damages,
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 charges or expenses.
``(b) Limitations on Recoveries From States.--Subsection
(a) 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.
``(c) Nonapplication of Other Laws.--No law of any State,
or of any political subdivision of a State and no provision
of any contract, insurance or health maintenance organization
policy, employee benefit plan, self-insurance plan, managed
care plan, or other health care plan or program entered into
or renewed after the date of the enactment of the Indian
Health Care Amendments of 1988, shall prevent or hinder the
right of recovery of the United States, an Indian Tribe, or
Tribal Organization under subsection (a).

[[Page S5350]]

``(d) No Effect on Private Rights of Action.--No action
taken by the United States, an Indian Tribe, or Tribal
Organization to enforce the right of recovery provided under
this section shall operate to deny to the injured person the
recovery for that portion of the person's damage not covered
hereunder.
``(e) Enforcement.--
``(1) In general.--The United States, an Indian Tribe, or
Tribal Organization may enforce the right of recovery
provided under subsection (a) 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
``(ii) by any representative or heirs of such individual,
or
``(B) instituting a civil action, including a civil action
for injunctive relief and other relief and including, with
respect to a political subdivision or local governmental
entity of a State, such an action against an official
thereof.
``(2) Notice.--All reasonable efforts shall be made to
provide notice of action instituted under paragraph (1)(B) to
the individual to whom health services were provided, either
before or during the pendency of such action.
``(f) Limitation.--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), the United States
shall not 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, Tribal Organization, or Urban Indian
Organization. Where such authorization is provided, the
Service may receive and expend such amounts for the provision
of additional health services consistent with such
authorization.
``(g) Costs and Attorneys' Fees.--In any action brought to
enforce the provisions of this section, a prevailing
plaintiff shall be awarded its reasonable attorneys' fees and
costs of litigation.
``(h) Nonapplication of Claims Filing Requirements.--An
insurance company, health maintenance organization, self-
insurance plan, managed care plan, or other health care plan
or program (under the Social Security Act or otherwise) may
not deny a claim for benefits submitted by the Service or by
an Indian Tribe or Tribal Organization based on the format in
which the claim is submitted if such format complies with the
format required for submission of claims under title XVIII of
the Social Security Act or recognized under section 1175 of
such Act.
``(i) Application to Urban Indian Organizations.--The
previous provisions of this section shall apply to Urban
Indian Organizations with respect to populations served by
such Organizations in the same manner they apply to Indian
Tribes and Tribal Organizations with respect to populations
served by such Indian Tribes and Tribal Organizations.
``(j) Statute of Limitations.--The provisions of section
2415 of title 28, United States Code, shall apply to all
actions commenced under this section, and the references
therein to the United States are deemed to include Indian
Tribes, Tribal Organizations, and Urban Indian Organizations.
``(k) Savings.--Nothing in this section shall be construed
to limit any right of recovery available to the United
States, an Indian Tribe, or Tribal Organization under the
provisions of any applicable, Federal, State, or Tribal law,
including medical lien laws and the Federal Medical Care
Recovery Act (42 U.S.C. 2651 et seq.).

``SEC. 404. CREDITING OF REIMBURSEMENTS.

``(a) Use of Amounts.--
``(1) Retention by program.--Except as provided in section
202(g) (relating to the Catastrophic Health Emergency Fund)
and section 807 (relating to health services for ineligible
persons), all reimbursements received or recovered under any
of the programs described in paragraph (2), including under
section 807, by reason of the provision of health services by
the Service, by an Indian Tribe or Tribal Organization, or by
an Urban Indian Organization, shall be credited to the
Service, such Indian Tribe or Tribal Organization, or such
Urban Indian Organization, respectively, and may be used as
provided in section 401. In the case of such a service
provided by or through a Service Unit, such amounts shall be
credited to such unit and used for such purposes.
``(2) Programs covered.--The programs referred to in
paragraph (1) are the following:
``(A) Titles XVIII, XIX, and XXI of the Social Security
Act.
``(B) This Act, including section 807.
``(C) Public Law 87-693.
``(D) Any other provision of law.
``(b) No Offset of Amounts.--The Service may not offset or
limit any amount obligated to any Service Unit or entity
receiving funding from the Service because of the receipt of
reimbursements under subsection (a).

``SEC. 405. PURCHASING HEALTH CARE COVERAGE.

``(a) In General.--Insofar as amounts are made available
under law (including a provision of the Social Security Act,
the Indian Self-Determination and Education Assistance Act,
or other law, other than under section 402) to Indian Tribes,
Tribal Organizations, and Urban Indian Organizations for
health benefits for Service beneficiaries, Indian Tribes,
Tribal Organizations, and Urban Indian Organizations may use
such amounts to purchase health benefits coverage for such
beneficiaries in any manner, including through--
``(1) a tribally owned and operated health care plan;
``(2) a State or locally authorized or licensed health care
plan;
``(3) a health insurance provider or managed care
organization; or
``(4) a self-insured plan.
The purchase of such coverage by an Indian Tribe, Tribal
Organization, or Urban Indian Organization may be based on
the financial needs of such beneficiaries (as determined by
the Indian Tribe or Tribes being served based on a schedule
of income levels developed or implemented by such Indian
Tribe or Tribes).
``(b) Expenses for Self-Insured Plan.--In the case of a
self-insured plan under subsection (a)(4), the amounts may be
used for expenses of operating the plan, including
administration and insurance to limit the financial risks to
the entity offering the plan.
``(c) Construction.--Nothing in this section shall be
construed as affecting the use of any amounts not referred to
in subsection (a).

``SEC. 406. SHARING ARRANGEMENTS WITH FEDERAL AGENCIES.

``(a) Authority.--
``(1) In general.--The Secretary may enter into (or expand)
arrangements for the sharing of medical facilities and
services between the Service, Indian Tribes, and Tribal
Organizations and the Department of Veterans Affairs and the
Department of Defense.
``(2) Consultation by secretary required.--The Secretary
may not finalize any arrangement between the Service and a
Department described in paragraph (1) without first
consulting with the Indian Tribes which will be significantly
affected by the arrangement.
``(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 and the eligibility of
any Indian to receive health services 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 Department of Veterans Affairs;
``(4) the quality of health care services provided by the
Department of Veterans Affairs or the Department of Defense;
or
``(5) the eligibility of any Indian who is a veteran to
receive health services through the Department of Veterans
Affairs.
``(c) Reimbursement.--The Service, Indian Tribe, or Tribal
Organization shall be reimbursed by the Department of
Veterans Affairs or the Department of Defense (as the case
may be) where services are provided through the Service, an
Indian Tribe, or a Tribal Organization to beneficiaries
eligible for services from either such Department,
notwithstanding any other provision of law.
``(d) Construction.--Nothing in this section may be
construed as creating any right of a non-Indian veteran to
obtain health services from the Service.

``SEC. 407. PAYOR OF LAST RESORT.

``Indian Health Programs and health care programs operated
by Urban Indian Organizations shall be the payor of last
resort for services provided to persons eligible for services
from Indian Health Programs and Urban Indian Organizations,
notwithstanding any Federal, State, or local law to the
contrary.

``SEC. 408. NONDISCRIMINATION IN QUALIFICATIONS FOR
REIMBURSEMENT FOR SERVICES.

``For purposes of determining the eligibility of an entity
that is operated by the Service, an Indian Tribe, Tribal
Organization, or Urban Indian Organization to receive payment
or reimbursement from any federally funded health care
program for health care services it furnishes to an Indian.
Such program must provide that such entity, meeting generally
applicable State or other requirements applicable for
participation, must be accepted as a provider on the same
basis as any other qualified provider, except that any
requirement that the entity be licensed or recognized under
State or local law to furnish such services shall be deemed
to have been met if the entity meets all the applicable
standards for such licensure, but the entity need not obtain
a license or other documentation. In determining whether the
entity meets such standards, the absence of licensure of any
staff member of the entity may not be taken into account.

``SEC. 409. CONSULTATION.

``(a) Tribal Technical Advisory Group (TTAG).--The
Secretary shall maintain within the Centers for Medicaid &
Medicare Services (CMS) a Tribal Technical Advisory Group,
established in accordance with requirements of the charter
dated September 30, 2003, and in such group shall include a
representative of the Urban Indian Organizations and the
Service. The representative of the Urban Indian Organization
shall be deemed to be an elected officer of a tribal
government for purposes of applying section 204(b) of the
Unfunded Mandates Reform Act of 1995 (2 U.S.C. 1534(b)).
``(b) Solicitation of Medicaid Advice.--
``(1) In general.--As part of its plan under title XIX of
the Social Security Act, a State in which the Service
operates or funds health care programs, or in which 1 or more
Indian Health Programs or Urban Indian Organizations provide
health care in the State for

[[Page S5351]]

which medical assistance is available under such title, may
establish a process under which the State seeks advice on a
regular, ongoing basis from designees of such Indian Health
Programs and Urban Indian Organizations on matters relating
to the application of such title to and likely to have a
direct effect on such Indian Health Programs and Urban Indian
Organizations.
``(2) Manner of advice.--The process described in paragraph
(1) should include solicitation of advice prior to submission
of any plan amendments, waiver requests, and proposals for
demonstration projects likely to have a direct effect on
Indians, Indian Health Programs, or Urban Indian
Organizations. Such process may include appointment of an
advisory committee and of a designee of such Indian Health
Programs and Urban Indian Organizations to the medical care
advisory committee advising the State on its medicaid plan.
``(3) Payment of expenses.--The reasonable expenses of
carrying out this subsection shall be eligible for
reimbursement under section 1903(a) of the Social Security
Act.
``(c) Construction.--Nothing in this section shall be
construed as superseding existing advisory committees,
working groups, or other advisory procedures established by
the Secretary or by any State.

``SEC. 410. STATE CHILDREN'S HEALTH INSURANCE PROGRAM
(SCHIP).

``(a) Optional Use of Funds for Indian Health Program
Payments.--Subject to the succeeding provisions of this
section, a State may provide under its State child health
plan under title XXI of the Social Security Act (regardless
of whether such plan is implemented under such title, title
XIX of such Act, or both) for payments under this section to
Indian Health Programs and Urban Indian Organizations
operating in the State. Such payments shall be treated under
title XXI of the Social Security Act as expenditures
described in section 2105(a)(1)(A) of such Act.
``(b) Use of Funds.--Payments under this section may be
used only for expenditures described in clauses (i) through
(iii) of section 2105(a)(1)(D) of the Social Security Act for
targeted low-income children or other low-income children (as
defined in 2110 of such Act) who are--
``(1) Indians; or
``(2) otherwise eligible for health services from the
Indian Health Program involved.
``(c) Special Restrictions.--The following conditions apply
to a State electing to provide payments under this section:
``(1) No limitation on other schip participation of, or
provider payments to, indian health programs.--The State may
not exclude or limit participation of otherwise eligible
Indian Health Programs in its State child health program
under title XXI of the Social Security Act or its medicaid
program under title XIX of such Act or pay such Programs less
than they otherwise would as participating providers on the
basis that payments are made to such Programs under this
section.
``(2) No limitation on other schip eligibility of
indians.--The State may not exclude or limit participation of
otherwise eligible Indian children in such State child health
or medicaid program on the basis that payments are made for
assistance for such children under this section.
``(3) Limitation on acceptance of contributions.--
``(A) In general.--The State may not accept contributions
or condition making of payments under this section upon
contribution of funds from any Indian Health Program to meet
the State's non-Federal matching fund requirements under
titles XIX and XXI of the Social Security Act.
``(B) Contribution defined.--For purposes of subparagraph
(A), the term `contribution' includes any tax, donation, fee,
or other payment made, whether made voluntarily or
involuntarily.
``(d) Application of Separate 10 Percent Limitation.--
Payment may be made under section 2105(a) of the Social
Security Act to a State for a fiscal year for payments under
this section up to an amount equal to 10 percent of the total
amount available under title XXI of such Act (including
allotments and reallotments available from previous fiscal
years) to the State with respect to the fiscal year.
``(e) General Terms.--A payment under this section shall
only be made upon application to the State from the Indian
Health Program involved and under such terms and conditions,
and in a form and manner, as the Secretary determines
appropriate.

``SEC. 411. SOCIAL SECURITY ACT SANCTIONS.

``(a) Requests for Waiver of Sanctions.--
``(1) In general.--For purposes of applying any authority
under a provision of title XI, XVIII, XIX, or XXI of the
Social Security Act to seek a waiver of a sanction imposed
against a health care provider insofar as that provider
provides services to individuals through an Indian Health
Program, the Indian Health Program shall request the State to
seek such waiver, and if such State has not sought the waiver
within 60 days of the Indian Health Program request, the
Indian Health Program itself may petition the Secretary for
such waiver.
``(2) Procedure.--In seeking a waiver under paragraph (1),
the Indian Health Program must provide notice and a copy of
the request, including the reasons for the waiver sought, to
the State. The Secretary may consider the State's views in
the determination of the waiver request, but may not withhold
or delay a determination based on the lack of the State's
views.
``(b) Safe Harbor for Transactions Between and Among Indian
Health Care Programs.--For purposes of applying section
1128B(b) of the Social Security Act, the exchange of anything
of value between or among the following shall not be treated
as remuneration if the exchange arises from or relates to any
of the following health programs:
``(1) An exchange between or among the following:
``(A) Any Indian Health Program.
``(B) Any Urban Indian Organization.
``(2) An exchange between an Indian Tribe, Tribal
Organization, or an Urban Indian Organization and any patient
served or eligible for service from an Indian Tribe, Tribal
Organization, or Urban Indian Organization, including
patients served or eligible for service pursuant to section
807, but only if such exchange--
``(A) is for the purpose of transporting the patient for
the provision of health care items or services;
``(B) is for the purpose of providing housing to the
patient (including a pregnant patient) and immediate family
members or an escort incidental to assuring the timely
provision of health care items and services to the patient;
``(C) is for the purpose of paying premiums, copayments,
deductibles, or other cost-sharing on behalf of patients; or
``(D) consists of an item or service of small value that is
provided as a reasonable incentive to secure timely and
necessary preventive and other items and services.
``(3) Other exchanges involving an Indian Health Program,
an Urban Indian Organization, or an Indian Tribe or Tribal
Organization that meet such standards as the Secretary of
Health and Human Services, in consultation with the Attorney
General, determines is appropriate, taking into account the
special circumstances of such Indian Health Programs, Urban
Indian Organizations, Indian Tribes, and Tribal Organizations
and of patients served by Indian Health Programs, Urban
Indian Organizations, Indian Tribes, and Tribal
Organizations.

``SEC. 412. COST SHARING.

``(a) Coinsurance, Copayments, and Deductibles.--
Notwithstanding any other provision of Federal or State law--
``(1) Protection for eligible indians under social security
act health programs.--No Indian who is furnished an item or
service for which payment may be made under title XIX or XXI
of the Social Security Act may be charged a deductible,
copayment, or coinsurance.
``(2) Protection for indians.--No Indian who is furnished
an item or service by the Service may be charged a
deductible, copayment, or coinsurance.
``(3) No reduction in amount of payment to indian health
providers.--The payment or reimbursement due to the Service,
Indian Tribe, Tribal Organization, or Urban Indian
Organization under title XIX or XXI of the Social Security
Act may not be reduced by the amount of the deductible,
copayment, or coinsurance that would be due from the Indian
but for the operation of this section.
``(b) Exemption From Medicaid and SCHIP Premiums.--
Notwithstanding any other provision of Federal or State law,
no Indian who is otherwise eligible for services under title
XIX of the Social Security Act (relating to the medicaid
program) or title XXI of such Act (relating to the State
children's health insurance program) may be charged a
premium, enrollment fee, or similar charge as a condition of
receiving benefits under the program under the respective
title.
``(c) Treatment of Certain Property for Medicaid
Eligibility.--Notwithstanding any other provision of Federal
or State law, the following property may not be included when
determining eligibility for services under title XIX of the
Social Security Act:
``(1) Property, including real property and improvements,
located on a reservation, including any federally recognized
Indian Tribe's reservation, Pueblo, or Colony, including
former reservations in Oklahoma, Alaska Native regions
established by the Alaska Native Claims Settlement Act and
Indian allotments on or near a reservation as designated and
approved by the Bureau of Indian Affairs of the Department of
the Interior.
``(2) For any federally recognized Tribe not described in
paragraph (1), property located within the most recent
boundaries of a prior Federal reservation.
``(3) Ownership interests in rents, leases, royalties, or
usage rights related to natural resources (including
extraction of natural resources or harvesting of timber,
other plants and plant products, animals, fish, and
shellfish) resulting from the exercise of federally protected
rights.
``(4) Ownership interests in or usage rights to items not
covered by paragraphs (1) through (3) that have unique
religious, spiritual, traditional, or cultural significance
or rights that support subsistence or a traditional life
style according to applicable tribal law or custom.
``(d) Continuation of Current Law Protections of Certain
Indian Property From Medicaid Estate Recovery.--Income,
resources, and property that are exempt from medicaid estate
recovery under title XIX of the Social Security Act as of
April 1, 2003, under manual instructions issued to carry out
section 1917(b)(3) of such Act because of Federal
responsibility for Indian Tribes and

[[Page S5352]]

Alaska Native Villages shall remain so exempt. Nothing in
this subsection shall be construed as preventing the
Secretary from providing additional medicaid estate recovery
exemptions for Indians.

``SEC. 413. TREATMENT UNDER MEDICAID MANAGED CARE.

``(a) Provision of Services, to Enrollees With Non-Indian
Medicaid Managed Care Entities, by Indian Health Programs and
Urban Indian Organizations.--
``(1) Payment rules.--
``(A) In general.--Subject to subparagraph (B), in the case
of an Indian who is enrolled with a non-Indian medicaid
managed care entity (as defined in subsection (c)) and who
receives covered medicaid managed care services from an
Indian Health Program or an Urban Indian Organization,
whether or not it is a participating provider with respect to
such entity, the following rules apply:
``(i) Direct payment.--The entity shall make prompt payment
(in accordance with rules applicable to medicaid managed care
entities under title XIX of the Social Security Act) to the
Indian Health Program or Urban Indian Organization at a rate
established by the entity for such services that is equal to
the rate negotiated between such entity and the Program or
Organization involved or, if such a rate has not been
negotiated, a rate that is not less than the level and amount
of payment which the entity would make for the services if
the services were furnished by a provider which is not such a
Program or Organization.
``(ii) Payment through state.--If there is no arrangement
for direct payment under clause (i) or if a State provides
for this clause to apply in lieu of clause (i), the State
shall provide for payment to the Indian Health Program or
Urban Indian Organization under its State program under title
XIX of such Act at the rate that would be otherwise
applicable for such services under such program and shall
provide for an appropriate adjustment of the capitation
payment made to the entity to take into account such payment.
``(B) Compliance with generally applicable requirements.--
``(i) In general.--Except as otherwise provided, as a
condition of payment under subparagraph (A), the Indian
Health Program or Urban Indian Organization shall comply with
the generally applicable requirements of title XIX of the
Social Security Act with respect to covered services.
``(ii) Satisfaction of claim requirement.--Any requirement
for the submission of a claim or other documentation for
services covered under subparagraph (A) by the enrollee is
deemed to be satisfied through the submission of a claim or
other documentation by the Indian Health Program or Urban
Indian Organization consistent with section 403(h).
``(C) Construction.--Nothing in this subsection shall be
construed as waiving the application of section
1902(a)(30)(A) of the Social Security Act (relating to
application of standards to assure that payments are
consistent with efficiency, economy, and quality of care).
``(2) Enrollee option to select an indian health program or
urban indian organization as primary care provider.--In the
case of a non-Indian medicaid managed care entity that--
``(A) has an Indian enrolled with the entity; and
``(B) has an Indian Health Program or Urban Indian
Organization that is participating as a primary care provider
within the network of the entity,
insofar as the Indian is otherwise eligible to receive
services from such Program or Organization and the Program or
Organization has the capacity to provide primary care
services to such Indian, the Indian shall be allowed to
choose such Program or Organization as the Indian's primary
care provider under the entity.
``(b) Offering of Managed Care Through Indian Medicaid
Managed Care Entities.--If--
``(1) a State elects to provide services through medicaid
managed care entities under its medicaid managed care
program; and
``(2) an Indian Health Program or Urban Indian Organization
that is funded in whole or in part by the Service, or a
consortium thereof, has established an Indian medicaid
managed care entity in the State that meets generally
applicable standards required of such an entity under such
medicaid managed care program,
the State shall offer to enter into an agreement with the
entity to serve as a medicaid managed care entity with
respect to eligible Indians served by such entity under such
program.
``(c) Special Rules for Indian Managed Care Entities.--The
following are special rules regarding the application of a
medicaid managed care program to Indian medicaid managed care
entities:
``(1) Enrollment.--
``(A) Limitation to indians.--An Indian medicaid managed
care entity may restrict enrollment under such program to
Indians and to members of specific Tribes in the same manner
as Indian Health Programs may restrict the delivery of
services to such Indians and tribal members.
``(B) No less choice of plans.--Under such program the
State may not limit the choice of an Indian among medicaid
managed care entities only to Indian medicaid managed care
entities or to be more restrictive than the choice of managed
care entities offered to individuals who are not Indians.
``(C) Default enrollment.--
``(i) In general.--If such program of a State requires the
enrollment of Indians in a medicaid managed care entity in
order to receive benefits, the State shall provide for the
enrollment of Indians described in clause (ii) who are not
otherwise enrolled with such an entity in an Indian medicaid
managed care entity described in such clause.
``(ii) Indian described.--An Indian described in this
clause, with respect to an Indian medicaid managed care
entity, is an Indian who, based upon the service area and
capacity of the entity, is eligible to be enrolled with the
entity consistent with subparagraph (A).
``(D) Exception to state lock-in.--A request by an Indian
who is enrolled under such program with a non-Indian medicaid
managed care entity to change enrollment with that entity to
enrollment with an Indian medicaid managed care entity shall
be considered cause for granting such request under
procedures specified by the Secretary.
``(2) Flexibility in application of solvency.--In applying
section 1903(m)(1) of the Social Security Act to an Indian
medicaid managed care entity--
``(A) any reference to a `State' in subparagraph (A)(ii) of
that section shall be deemed to be a reference to the
`Secretary'; and
``(B) the entity shall be deemed to be a public entity
described in subparagraph (C)(ii) of that section.
``(3) Exceptions to advance directives.--The Secretary may
modify or waive the requirements of section 1902(w) of the
Social Security Act (relating to provision of written
materials on advance directives) insofar as the Secretary
finds that the requirements otherwise imposed are not an
appropriate or effective way of communicating the information
to Indians.
``(4) Flexibility in information and marketing.--
``(A) Materials.--The Secretary may modify requirements
under section 1932(a)(5) of the Social Security Act in a
manner that improves the materials to take into account the
special circumstances of such entities and their enrollees
while maintaining and clearly communicating to potential
enrollees their rights, protections, and benefits.
``(B) Distribution of marketing materials.--The provisions
of section 1932(d)(2)(B) of the Social Security Act requiring
the distribution of marketing materials to an entire service
area shall be deemed satisfied in the case of an Indian
medicaid managed care entity that distributes appropriate
materials only to those Indians who are potentially eligible
to enroll with the entity in the service area.
``(d) Malpractice Insurance.--Insofar as, under a medicaid
managed care program, a health care provider is required to
have medical malpractice insurance coverage as a condition of
contracting as a provider with a medicaid managed care
entity, an Indian Health Program, or an Urban Indian
Organization that is a Federally-qualified health center
under title XIX of the Social Security Act, that is covered
under the Federal Tort Claims Act (28 U.S.C. 1346(b), 2671 et
seq.) is deemed to satisfy such requirement.
``(e) Definitions.--For purposes of this section:
``(1) Medicaid managed care entity.--The term `medicaid
managed care entity' means a managed care entity (whether a
managed care organization or a primary care case manager)
under title XIX of the Social Security Act, whether pursuant
to section 1903(m) or section 1932 of such Act, a waiver
under section 1115 or 1915(b) of such Act, or otherwise.
``(2) Indian medicaid managed care entity.--The term
`Indian medicaid managed care entity' means a managed care
entity that is controlled (within the meaning of the last
sentence of section 1903(m)(1)(C) of the Social Security Act)
by the Indian Health Service, a Tribe, Tribal Organization,
or Urban Indian Organization (as such terms are defined in
section 4), or a consortium, which may be composed of 1 or
more Tribes, Tribal Organizations, or Urban Indian
Organizations, and which also may include the Service.
``(3) Non-Indian medicaid managed care entity.--The term
`non-Indian medicaid managed care entity' means a medicaid
managed care entity that is not an Indian medicaid managed
care entity.
``(4) Covered medicaid managed care services.--The term
`covered medicaid managed care services' means, with respect
to an individual enrolled with a medicaid managed care
entity, items and services that are within the scope of items
and services for which benefits are available with respect to
the individual under the contract between the entity and the
State involved.
``(5) Medicaid managed care program.--The term `medicaid
managed care program' means a program under sections 1903(m)
and 1932 of the Social Security Act and includes a managed
care program operating under a waiver under section 1915(b)
or 1115 of such Act or otherwise.

``SEC. 414. NAVAJO NATION MEDICAID AGENCY FEASIBILITY STUDY.

``(a) Study.--The Secretary shall conduct a study to
determine the feasibility of treating the Navajo Nation as a
State for the purposes of title XIX of the Social Security
Act, to provide services to Indians living within the
boundaries of the Navajo Nation through

[[Page S5353]]

an entity established having the same authority and
performing the same functions as single-State medicaid
agencies responsible for the administration of the State plan
under title XIX of the Social Security Act.
``(b) Considerations.--In conducting the study, the
Secretary shall consider the feasibility of--
``(1) assigning and paying all expenditures for the
provision of services and related administration funds, under
title XIX of the Social Security Act, to Indians living
within the boundaries of the Navajo Nation that are currently
paid to or would otherwise be paid to the State of Arizona,
New Mexico, or Utah;
``(2) providing assistance to the Navajo Nation in the
development and implementation of such entity for the
administration, eligibility, payment, and delivery of medical
assistance under title XIX of the Social Security Act;
``(3) providing an appropriate level of matching funds for
Federal medical assistance with respect to amounts such
entity expends for medical assistance for services and
related administrative costs; and
``(4) authorizing the Secretary, at the option of the
Navajo Nation, to treat the Navajo Nation as a State for the
purposes of title XIX of the Social Security Act (relating to
the State children's health insurance program) under terms
equivalent to those described in paragraphs (2) through (4).
``(c) Report.--Not later then 3 years after the date of
enactment of the Indian Health Act Improvement Act Amendments
of 2005, the Secretary shall submit to the Committee of
Indian Affairs and Committee on Finance of the Senate and the
Committee on Resources and Committee on Ways and Means of the
House of Representatives a report that includes--
``(1) the results of the study under this section;
``(2) a summary of any consultation that occurred between
the Secretary and the Navajo Nation, other Indian Tribes, the
States of Arizona, New Mexico, and Utah, counties which
include Navajo Lands, and other interested parties, in
conducting this study;
``(3) projected costs or savings associated with
establishment of such entity, and any estimated impact on
services provided as described in this section in relation to
probable costs or savings; and
``(4) legislative actions that would be required to
authorize the establishment of such entity if such entity is
determined by the Secretary to be feasible.

``SEC. 415. 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 V--HEALTH SERVICES FOR URBAN INDIANS

``SEC. 501. PURPOSE.

``The purpose of this title is to establish and maintain
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 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,
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. Subject to section 506, the Secretary,
acting through the Service, shall include such conditions as
the Secretary considers necessary to effect the purpose of
this title in any contract into which the Secretary enters
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) Requirements for Grants and Contracts.--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, 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) Access to Health Promotion and Disease Prevention
Programs.--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 or receiving grants under subsection (a).
``(d) Immunization Services.--
``(1) Access or services provided.--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.--For purposes of this subsection, the
term `immunization services' means services to provide
without charge immunizations against vaccine-preventable
diseases.
``(e) Behavioral Health Services.--
``(1) Access or services provided.--The Secretary, acting
through the Service, shall facilitate access to, or provide,
behavioral health services for Urban Indians through grants
made to Urban Indian Organizations administering contracts
entered into or receiving grants under subsection (a).
``(2) Assessment required.--Except as provided by paragraph
(3)(A), 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
following:
``(A) The behavioral health needs of the Urban Indian
population concerned.
``(B) The behavioral health services and other related
resources available to that population.
``(C) The barriers to obtaining those services and
resources.
``(D) The needs that are unmet by such services and
resources.
``(3) Purposes of grants.--Grants may be made under this
subsection for the following:
``(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.
``(D) To develop innovative behavioral health service
delivery models which incorporate Indian cultural support
systems and resources.
``(f) Prevention of Child Abuse.--
``(1) Access or services provided.--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 or
receiving grants under subsection (a) to prevent and treat
child abuse (including sexual abuse) among Urban Indians.
``(2) Evaluation required.--Except as provided by paragraph
(3)(A), 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) Purposes of grants.--Grants may be made under this
subsection for the following:
``(A) To prepare assessments required under paragraph (2).
``(B) For the development of prevention, training, and
education programs for Urban Indians, 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.

[[Page S5354]]

``(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 when making grants.--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) Other Grants.--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 1 Urban Center.

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

``(a) Grants and Contracts Authorized.--Under authority of
the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as
the `Snyder Act'), the Secretary, acting through the Service,
may enter into contracts with or make grants to Urban Indian
Organizations situated in Urban Centers for which contracts
have not been entered into or grants have not been made under
section 503.
``(b) Purpose.--The purpose of a contract or grant made
under this section shall be the determination of the matters
described in subsection (c)(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.
``(c) Grant and Contract Requirements.--Any contract
entered into, or grant made, by the Secretary under this
section shall include requirements that--
``(1) the Urban Indian Organization successfully undertakes
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.
``(d) No Renewals.--The Secretary may not renew any
contract entered into or grant made under this section.

``SEC. 505. EVALUATIONS; RENEWALS.

``(a) Procedures for Evaluations.--The Secretary, acting
through the Service, shall develop procedures to evaluate
compliance with grant requirements 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) Evaluations.--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 this evaluation, in determining the
capacity of an Urban Indian Organization to deliver quality
patient care the Secretary shall, at the option of the
organization--
``(1) acting through the Service, conduct an annual onsite
evaluation of the organization; or
``(2) accept in lieu of such 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; Unsatisfactory Performance.--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 the organization the areas of
noncompliance or unsatisfactory performance and modify the
contract or grant to prevent future occurrences of
noncompliance or unsatisfactory performance. If the Secretary
determines that the noncompliance or unsatisfactory
performance cannot be resolved and prevented in the future,
the Secretary shall not renew the contract or grant with the
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) Considerations for Renewals.--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
shall consider the results of the onsite evaluations or
accreditations under subsection (b).

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

``(a) Procurement.--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
sections 1304 and 3131 through 3133 of title 40, United
States Code.
``(b) Payments Under Contracts or Grants.--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 no 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 any portion thereof is unexpended by the Urban
Indian Organization during the funding period with respect to
which the payments initially apply, shall 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 availability for expenditure of such
funds.
``(c) Revision or Amendment of Contracts.--Notwithstanding
any provision of law to the contrary, the Secretary may, at
the request and 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 Services and Assistance.--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.

``SEC. 507. REPORTS AND RECORDS.

``(a) Reports.--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 Urban Indian Organization shall submit to the
Secretary not more frequently than every 6 months, a report
that includes the following:
``(1) In the case of a contract or grant under section 503,
recommendations pursuant to section 503(a)(5).
``(2) Information on activities conducted by the
organization pursuant to the contract or grant.
``(3) An accounting of the amounts and purpose for which
Federal funds were expended.
``(4) A minimum set of data, using uniformly defined
elements, as specified by the Secretary after consultation
with Urban Indian Organizations.
``(b) Audit.--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) Costs of Audits.--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, acting through the Service,
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) Loan Fund Study.--The Secretary, acting through the
Services, may carry out a study to determine the feasibility
of establishing a loan fund to provide to Urban Indian
Organizations direct loans or guarantees for loans for the
construction of health care facilities in a manner consistent
with section 309.

[[Page S5355]]

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

``There is 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 Authorized.--The Secretary, acting through the
Service, may make grants for the provision of health-related
services in prevention of, treatment of, rehabilitation of,
or school- and community-based education regarding, alcohol
and substance abuse in Urban Centers to those Urban Indian
Organizations with which the Secretary has entered into a
contract under this title or under section 201.
``(b) Goals.--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 following:
``(1) The 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.
The standards shall be negotiated and agreed to between the
Secretary and the grantee on a grant-by-grant basis.
``(4) Identification of the need for services.
``(d) Allocation of Grants.--The Secretary shall develop a
methodology for allocating grants made pursuant to this
section based on the criteria established pursuant to
subsection (c).
``(e) Grants Subject to Criteria.--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.

``Notwithstanding any other provision of law, the Tulsa
Clinic and Oklahoma City Clinic demonstration projects
shall--
``(1) be permanent programs within the Service's direct
care program;
``(2) continue to be treated as Service Units in the
allocation of resources and coordination of care; and
``(3) continue to meet the requirements and definitions of
an urban Indian organization in this Act, and shall not be
subject to the provisions of the Indian Self-Determination
and Education Assistance Act.

``SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS.

``(a) Grants and Contracts.--The Secretary, through the
Office of Urban Indian Health, shall make grants or enter
into contracts 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 (hereafter in this section
referred to as `NIAAA') and transferred to the Service. Such
grants and contracts shall become effective no later than
September 30, 2008.
``(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 the NIAAA and
subsequently transferred to the Service are eligible for
grants or contracts under this section.
``(d) Report.--The Secretary shall evaluate and report to
Congress on the activities of programs funded under this
section not less than every 5 years.

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

``(a) In General.--The Secretary shall ensure that the
Service consults, to the greatest extent practicable, with
Urban Indian Organizations.
``(b) Definition of Consultation.--For purposes of
subsection (a), consultation is the open and free exchange of
information and opinions which leads to mutual understanding
and comprehension and which emphasizes trust, respect, and
shared responsibility.

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

``(a) In General.--With respect to claims resulting from
the performance of functions during fiscal year 2005 and
thereafter, or claims asserted after September 30, 2004, but
resulting from the performance of functions prior to fiscal
year 2005, under a contract, grant agreement, or any other
agreement authorized under this title, an Urban Indian
Organization is deemed hereafter to be part of the Service in
the Department of Health and Human Services while carrying
out any such contract or agreement and its employees are
deemed employees of the Service while acting within the scope
of their employment in carrying out the contract or
agreement. After September 30, 2003, any civil action or
proceeding involving such claims brought hereafter against
any Urban Indian Organization or any employee of such Urban
Indian Organization covered by this provision shall be deemed
to be an action against the United States and will be
defended by the Attorney General and be afforded the full
protection and coverage of the Federal Tort Claims Act (28
U.S.C. 1346(b), 2671 et seq.). Future coverage under that Act
shall be contingent on cooperation of the Urban Indian
Organization with the Attorney General in prosecuting past
claims.
``(b) Claims Resulting From Performance of Contract or
Grant.--Beginning for fiscal year 2005 and thereafter, the
Secretary shall request through annual appropriations funds
sufficient to reimburse the Treasury for any claims paid in
the prior fiscal year pursuant to the foregoing provisions.

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

``(a) Construction and Operation.--The Secretary, acting
through the Service, through grant or contract, is authorized
to fund 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) Definition of State.--A State described in this
subsection is a State in which--
``(1) there resides Urban Indian youth with 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) Authorization for Use.--The Secretary, acting through
the Service, shall allow 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) Donations.--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 for Donation.--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 donation of a specific item of personal or real
property described in subsection (b) or (c) from both an
Urban Indian Organization and from an Indian Tribe or Tribal
Organization, the Secretary shall give priority to the
request for donation of the Indian Tribe or Tribal
Organization if the Secretary receives the request from the
Indian Tribe or Tribal Organization before the date the
Secretary transfers title to the property or, if earlier, the
date the Secretary transfers the property physically to the
Urban Indian Organization.
``(e) Urban Indian Organizations Deemed Executive Agency
for Certain Purposes.--For purposes of section 501 of title
40, United States Code, (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.

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

``(a) Grants Authorized.--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 and treatment of,
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 to
between the Secretary and the grantee.
``(c) Establishment of Criteria.--The Secretary shall
establish criteria for the grants made under subsection (a)
relating to--
``(1) the size and location of the Urban Indian population
to be served;
``(2) the need for prevention of and treatment of, and
control of the complications resulting from, diabetes among
the Urban Indian population to be served;
``(3) performance standards for the organization in meeting
the goals set forth in such grant that are negotiated and
agreed to by the Secretary and the grantee;

[[Page S5356]]

``(4) the capability of the organization to adequately
perform the activities required under the grant; and
``(5) the willingness of the 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) Funds Subject to 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 employment of Indians trained as health
service providers through the Community Health
Representatives Program under section 109 in the provision of
health care, health promotion, and disease prevention
services to Urban Indians.

``SEC. 520. REGULATIONS.

``(a) Requirements for Regulations.--The Secretary may
promulgate regulations to implement the provisions of this
title in accordance with the following:
``(1) Proposed regulations to implement this Act shall be
published in the Federal Register by the Secretary no later
than 9 months after the date of enactment of this Act and
shall have no less than a 4-month comment period.
``(2) The authority to promulgate regulations under this
Act shall expire 18 months from the date of enactment of this
Act.
``(b) Effective Date of Title.--The amendments to this
title made by the Indian Health Care Improvement Act
Amendments of 2005 shall be effective on the date of
enactment of such amendments, regardless of whether the
Secretary has promulgated regulations implementing such
amendments have been promulgated.

``SEC. 521. ELIGIBILITY FOR SERVICES.

``Urban Indians shall be eligible and the ultimate
beneficiaries for health care or referral services provided
pursuant to this title.

``SEC. 522. 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 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 Assistant 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, 2005, the term of
service of the Assistant Secretary shall be 4 years. An
Assistant Secretary may serve more than 1 term.
``(3) Incumbent.--The individual serving in the position of
Director of the Indian Health Service on the day before the
date of enactment of the Indian Health Care Improvement Act
Amendments of 2005 shall serve as Assistant Secretary.
``(4) Advocacy and consultation.--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.
``(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) Duties.--The Assistant Secretary of Indian Health
shall--
``(1) perform all functions that were, on the day before
the date of enactment of the Indian Health Care Improvement
Act Amendments of 2005, carried out by or under the direction
of the individual serving as Director of the Service on that
day;
``(2) perform 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) administer 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 and Education
Assistance Act (25 U.S.C. 450 et seq.);
``(4) administer all scholarship and loan functions carried
out under title I;
``(5) report directly to the Secretary concerning all
policy- and budget-related matters affecting Indian health;
``(6) collaborate with the Assistant Secretary for Health
concerning appropriate matters of Indian health that affect
the agencies of the Public Health Service;
``(7) advise each Assistant Secretary of the Department
concerning matters of Indian health with respect to which
that Assistant Secretary has authority and responsibility;
``(8) 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;
``(9) coordinate the activities of the Department
concerning matters of Indian health; and
``(10) perform such other functions as the Secretary may
designate.
``(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).
``(e) 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.

``SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM.

``(a) Establishment.--
``(1) In general.--The Secretary 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 for each area
served by the Service;
``(C) a privacy component that protects the privacy of
patient information held by, or on behalf of, the Service;
``(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 Tribal Health Program
automated management information systems which--
``(1) meet the management information needs of such Tribal
Health Program with respect to the treatment by the Tribal
Health Program 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.--The purposes of this section are as
follows:
``(1) To authorize and direct the Secretary, acting through
the Service, Indian Tribes, Tribal Organizations, and Urban
Indian Organizations, to develop a comprehensive behavioral
health prevention and treatment program which emphasizes
collaboration among alcohol and substance abuse, social
services, and mental health programs.
``(2) To 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,

[[Page S5357]]

social services, child and family welfare, alcohol and
substance abuse, law enforcement, and judicial services.
``(3) To assist Indian Tribes to identify services and
resources available to address mental illness and
dysfunctional and self-destructive behavior.
``(4) To provide authority and opportunities for Indian
Tribes and Tribal Organizations to develop, implement, and
coordinate with community-based programs which include
identification, prevention, education, referral, and
treatment services, including through multidisciplinary
resource teams.
``(5) To 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.
``(6) To modify or supplement existing programs and
authorities in the areas identified in paragraph (2).
``(b) Plans.--
``(1) Development.--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, and Urban
Indian Organizations to develop local plans, and for all such
groups to participate in developing areawide plans for Indian
Behavioral Health Services. The plans shall include, to the
extent feasible, the following components:
``(A) An assessment of the scope of alcohol or other
substance abuse, mental illness, and 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; or
``(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).
``(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, acting
through the Service, shall establish a national clearinghouse
of plans and reports on the outcomes of such plans developed
by Indian Tribes, Tribal Organizations, Urban Indian
Organizations, and Service Areas relating to behavioral
health. The Secretary shall ensure access to these 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
used and adopted locally.
``(c) Programs.--The Secretary, acting through the Service,
Indian Tribes, and Tribal Organizations, shall provide, to
the extent feasible and if funding is available, programs
including the following:
``(1) Comprehensive care.--A comprehensive continuum of
behavioral health care which provides--
``(A) community-based prevention, intervention, outpatient,
and behavioral health aftercare;
``(B) detoxification (social and medical);
``(C) acute hospitalization;
``(D) intensive outpatient/day treatment;
``(E) residential treatment;
``(F) transitional living for those needing a temporary,
stable living environment that is supportive of treatment and
recovery goals;
``(G) emergency shelter;
``(H) intensive case management;
``(I) Traditional Health Care Practices; and
``(J) diagnostic services.
``(2) Child care.--Behavioral health services for Indians
from birth through age 17, including--
``(A) preschool and school age fetal alcohol disorder
services, including assessment and behavioral intervention;
``(B) mental health and substance abuse services
(emotional, organic, alcohol, drug, inhalant, and tobacco);
``(C) identification and treatment of co-occurring
disorders and comorbidity;
``(D) prevention of alcohol, drug, inhalant, and tobacco
use;
``(E) early intervention, treatment, and aftercare;
``(F) promotion of healthy approaches to risk and safety
issues; and
``(G) identification and treatment of neglect and physical,
mental, and sexual abuse.
``(3) Adult care.--Behavioral health services for Indians
from age 18 through 55, including--
``(A) early intervention, treatment, and aftercare;
``(B) mental health and substance abuse services
(emotional, alcohol, drug, inhalant, and tobacco), including
sex specific services;
``(C) identification and treatment of co-occurring
disorders (dual diagnosis) and comorbidity;
``(D) promotion of healthy approaches for risk-related
behavior;
``(E) treatment services for women at risk of giving birth
to a child with a fetal alcohol disorder; and
``(F) sex specific treatment for sexual assault and
domestic violence.
``(4) Family care.--Behavioral health services for
families, including--
``(A) early intervention, treatment, and aftercare for
affected families;
``(B) treatment for sexual assault and domestic violence;
and
``(C) promotion of healthy approaches relating to
parenting, domestic violence, and other abuse issues.
``(5) Elder care.--Behavioral health services for Indians
56 years of age and older, including--
``(A) early intervention, treatment, and aftercare;
``(B) mental health and substance abuse services
(emotional, alcohol, drug, inhalant, and tobacco), including
sex specific services;
``(C) identification and treatment of co-occurring
disorders (dual diagnosis) and comorbidity;
``(D) promotion of healthy approaches to managing
conditions related to aging;
``(E) sex specific treatment for sexual assault, domestic
violence, neglect, physical and mental abuse and
exploitation; and
``(F) identification and treatment of dementias regardless
of cause.
``(d) Community Behavioral Health Plan.--
``(1) Establishment.--The governing body of any Indian
Tribe, Tribal Organization, or Urban Indian Organization may
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 substance abuse, mental illness, or
dysfunctional and self-destructive behavior, including child
abuse and family violence, among its members or its service
population. This plan should include behavioral health
services, social services, intensive outpatient services, and
continuing aftercare.
``(2) Technical assistance.--At the request of an Indian
Tribe, Tribal Organization, or Urban Indian Organization, the
Bureau of Indian Affairs and the Service shall cooperate with
and provide technical assistance to the Indian Tribe, Tribal
Organization, or Urban Indian Organization in the development
and implementation of such plan.
``(3) Funding.--The Secretary, acting through the Service,
may make funding available to Indian Tribes and Tribal
Organizations which adopt 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) Coordination for Availability of Services.--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 agencies and with State
agencies, to encourage comprehensive behavioral health
services for Indians regardless of their place of residence.
``(f) Mental Health Care Need Assessment.--Not later than 1
year after the date of enactment of the Indian Health Care
Improvement Act Amendments of 2005, 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,
underused Service hospital beds into psychiatric units to
meet such need.

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

``(a) Contents.--Not later than 12 months after the date of
enactment of the Indian Health Care Improvement Act
Amendments of 2005, the Secretary, acting through the
Service, and the Secretary of the Interior shall develop and
enter into a memoranda of agreement, or review and update any
existing memoranda of agreement, as required by section 4205
of the Indian Alcohol and Substance Abuse Prevention and
Treatment Act of 1986 (25 U.S.C. 2411) under which the
Secretaries address the following:
``(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 behavioral 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 behavioral health services to which all citizens have
access.
``(B) The right of Indians to participate in, and receive
the benefit of, such services.
``(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 illness identification,
prevention, education, referral, and treatment services
(including services through multidisciplinary resource
teams), at the central, area, and agency and Service Unit,
Service Area, and headquarters levels to address the problems
identified in paragraph (1).
``(6) A strategy for the comprehensive coordination of the
behavioral health services

[[Page S5358]]

provided by the Bureau of Indian Affairs and the Service to
meet the problems identified pursuant to paragraph (1),
including--
``(A) the coordination of alcohol and substance abuse
programs of the Service, the Bureau of Indian Affairs, and
Indian Tribes and Tribal Organizations (developed under the
Indian Alcohol and Substance Abuse Prevention and Treatment
Act of 1986) with behavioral health initiatives pursuant to
this Act, particularly with respect to the referral and
treatment of dually diagnosed individuals requiring
behavioral health and substance abuse treatment; and
``(B) ensuring that the 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) Directing 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).
``(8) Providing for an annual review of such agreement by
the Secretaries which shall be provided to Congress and
Indian Tribes and Tribal Organizations.
``(b) Specific Provisions Required.--The memoranda 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 Indians, 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, acting through the
Service, and the Secretary of the Interior shall, in
developing the memoranda of agreement under subsection (a),
consult with and solicit the comments from--
``(1) Indian Tribes and Tribal Organizations;
``(2) Indians;
``(3) Urban Indian Organizations and other Indian
organizations; and
``(4) behavioral health service providers.
``(d) Publication.--Each memorandum of agreement entered
into or renewed (and amendments or modifications thereto)
under subsection (a) shall be published in the Federal
Register. At the same time as publication in the Federal
Register, the Secretary shall provide a copy of such
memoranda, amendment, or modification 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, shall
provide a program of comprehensive behavioral health,
prevention, treatment, and aftercare, including Traditional
Health Care Practices, which shall include--
``(A) prevention, through educational intervention, in
Indian communities;
``(B) acute detoxification, psychiatric hospitalization,
residential, and intensive outpatient treatment;
``(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 postpartum women and
their children; and
``(F) diagnostic services.
``(2) Target populations.--The target population of such
programs shall be members of Indian Tribes. Efforts to train
and educate key members of the Indian community shall also
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, 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) Paraprofessional Training.--In carrying out
subsection (a), the Secretary, acting through the Service,
Indian Tribes, and Tribal Organizations, 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 of Technicians.--The
Secretary, acting through the Service, Indian Tribes, and
Tribal Organizations, shall supervise and evaluate the mental
health technicians in the training program.
``(d) Traditional Health Care Practices.--The Secretary,
acting through the Service, shall ensure that the program
established pursuant to this subsection involves the use and
promotion of the Traditional Health Care Practices of the
Indian Tribes to be served.

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

``Subject to the provisions of section 221, 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 this Act
is required to be licensed as a clinical psychologist, social
worker, or marriage and family therapist, respectively, or
working under the direct supervision of a licensed clinical
psychologist, social worker, or marriage and family
therapist, respectively.

``SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.

``(a) Funding.--The Secretary, consistent with section 701,
shall make funds available to Indian Tribes, Tribal
Organizations, and Urban Indian Organizations 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.--Funds made available pursuant to this
section may be used to--
``(1) develop and provide community training, education,
and prevention programs for Indian women relating to
behavioral health issues, including fetal alcohol disorders;
``(2) identify and provide psychological services,
counseling, advocacy, support, and relapse prevention to
Indian women and their families; and
``(3) develop prevention and intervention models for Indian
women which incorporate Traditional Health Care Practices,
cultural values, and community and family involvement.
``(c) Criteria.--The Secretary, in consultation with Indian
Tribes and Tribal Organizations, shall establish criteria for
the review and approval of applications and proposals for
funding under this section.
``(d) Earmark of Certain Funds.--Twenty percent of the
funds appropriated pursuant to this section shall be used to
make grants to Urban Indian Organizations.

``SEC. 707. INDIAN YOUTH PROGRAM.

``(a) Detoxification and Rehabilitation.--The Secretary,
acting through the Service, consistent with section 701,
shall develop and implement a program for acute
detoxification and treatment for Indian youths, including
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, and 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 the 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
such centers or facilities, funding shall be pursuant to the
Act of November 2, 1921 (25 U.S.C. 13).
``(3) Location.--A youth treatment center constructed or
purchased under this subsection shall be constructed or
purchased at

[[Page S5359]]

a location within the area described in paragraph (1) agreed
upon (by appropriate tribal resolution) by a majority of the
Indian 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; and
``(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)).
``(B) Provision of services to eligible youths.--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 youths
residing in Alaska.
``(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) pretreatment assistance;
``(B) inpatient, outpatient, and aftercare 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;
``(D) to make renovations and hire appropriate staff to
convert existing hospital beds into adolescent psychiatric
units; and
``(E) for intensive home- and community-based services.
``(3) Criteria.--The Secretary, acting through the Service,
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, in consultation with
Indian Tribes and Tribal Organizations, shall--
``(A) identify and use, where appropriate, federally owned
structures suitable for local residential or regional
behavioral health treatment for Indian youths; 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 youths.
``(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, Indian Tribes, or Tribal
Organizations, 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 youths who are having significant behavioral
health problems, and require long-term treatment, community
reintegration, and monitoring to support the Indian youths
after their return to their home community.
``(2) Administration.--Services under paragraph (1) shall
be provided by trained staff within the community who can
assist the Indian youths in their 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 youths
authorized by this section, the Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, shall
provide for the inclusion of family members of such youths 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 youths residing
in Indian communities, on or near reservations, and in urban
areas and provide appropriate mental health services to
address the incidence of mental illness among such youths.

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

``Not later than 1 year after the date of enactment of the
Indian Health Care Improvement Act Amendments of 2005, the
Secretary, acting through the Service, Indian Tribes, and
Tribal Organizations, may 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. For the purposes of this subsection,
California shall be considered to be 2 Area Offices, 1 office
whose location 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. The Secretary shall consider the
possible conversion of existing, underused Service hospital
beds into psychiatric units to meet such need.

``SEC. 709. TRAINING AND COMMUNITY EDUCATION.

``(a) Program.--The Secretary, in cooperation with the
Secretary of the Interior, shall develop and implement or
provide funding for Indian Tribes and Tribal Organizations 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. Such program shall include education about
behavioral health issues to political leaders, Tribal judges,
law enforcement personnel, members of tribal health and
education boards, health care providers including traditional
practitioners, and other critical members of each tribal
community. Community-based training (oriented toward local
capacity development) shall also include tribal community
provider training (designed for adult learners from the
communities receiving services for prevention, intervention,
treatment, and aftercare).
``(b) Instruction.--The Secretary, acting through the
Service, shall, either directly or through Indian Tribes and
Tribal Organizations, 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) Training Models.--In carrying out the education and
training programs required by this section, the Secretary, 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) Innovative Programs.--The Secretary, acting through
the Service, Indian Tribes, and Tribal Organizations,
consistent with section 701, may plan, develop, implement,
and carry out programs to deliver innovative community-based
behavioral health services to Indians.
``(b) Funding; Criteria.--The Secretary may award such
funding for a project under subsection (a) to an Indian Tribe
or Tribal Organization and may consider the following
criteria:
``(1) The project will address significant unmet behavioral
health needs among Indians.
``(2) The project will serve a significant number of
Indians.
``(3) The project has the potential to deliver services in
an efficient and effective manner.
``(4) The Indian Tribe or Tribal Organization has the
administrative and financial capability to administer the
project.
``(5) The project may deliver services in a manner
consistent with Traditional Health Care Practices.
``(6) The project is coordinated with, and avoids
duplication of, existing services.
``(c) Equitable Treatment.--For purposes of this
subsection, the Secretary shall, in evaluating project
applications or proposals, use the same criteria that the
Secretary uses in evaluating any other application or
proposal for such funding.

[[Page S5360]]

``SEC. 711. FETAL ALCOHOL DISORDER FUNDING.

``(a) Programs.--
``(1) Establishment.--The Secretary, consistent with
section 701, acting through the Service, Indian Tribes, and
Tribal Organizations, is authorized to establish and operate
fetal alcohol disorder programs as provided in this section
for the purposes of meeting the health status objectives
specified in section 3.
``(2) Use of funds.--Funding provided pursuant to this
section shall be used for the following:
``(A) To develop and provide for Indians community and in
school training, education, and prevention programs relating
to fetal alcohol disorders.
``(B) To identify and provide behavioral health treatment
to high-risk Indian women and high-risk women pregnant with
an Indian's child.
``(C) To identify and provide appropriate psychological
services, educational and vocational support, counseling,
advocacy, and information to fetal alcohol disorder affected
Indians and their families or caretakers.
``(D) To develop and implement counseling and support
programs in schools for fetal alcohol disorder affected
Indian children.
``(E) To develop prevention and intervention models which
incorporate practitioners of Traditional Health Care
Practices, cultural and spiritual values, and community
involvement.
``(F) To develop, print, and disseminate education and
prevention materials on fetal alcohol disorder.
``(G) To 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
Indian communities and Urban Centers.
``(H) To develop early childhood intervention projects from
birth on to mitigate the effects of fetal alcohol disorder
among Indians.
``(I) To develop and fund community-based adult fetal
alcohol disorder housing and support services for Indians and
for women pregnant with an Indian's child.
``(3) Criteria for applications.--The Secretary shall
establish criteria for the review and approval of
applications for funding under this section.
``(b) Services.--The Secretary, acting through the Service
and 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 disorder 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 disorder.
``(c) Task Force.--The Secretary shall establish a task
force to be known as the Fetal Alcohol Disorder Task Force to
advise the Secretary in carrying out subsection (b). Such
task force shall be composed of representatives from the
following:
``(1) The National Institute on Drug Abuse.
``(2) The National Institute on Alcohol and Alcoholism.
``(3) The Office of Substance Abuse Prevention.
``(4) The National Institute of Mental Health.
``(5) The Service.
``(6) The Office of Minority Health of the Department of
Health and Human Services.
``(7) The Administration for Native Americans.
``(8) The National Institute of Child Health and Human
Development (NICHD).
``(9) The Centers for Disease Control and Prevention.
``(10) The Bureau of Indian Affairs.
``(11) Indian Tribes.
``(12) Tribal Organizations.
``(13) Urban Indian Organizations.
``(14) Indian fetal alcohol disorder experts.
``(d) Applied Research Projects.--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 disorder.
``(e) Funding for Urban Indian Organizations.--Ten percent
of the funds appropriated pursuant to 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, acting through the
Service, and the Secretary of the Interior, Indian Tribes,
and Tribal Organizations shall establish, consistent with
section 701, in every Service Area, programs involving
treatment for--
``(1) victims of sexual abuse who are Indian children or
children in an Indian household; and
``(2) perpetrators of child sexual abuse who are Indian or
members of an Indian household.
``(b) Use of Funds.--Funding provided pursuant to this
section shall be used for the following:
``(1) To develop and provide community education and
prevention programs related to sexual abuse of Indian
children or children in an Indian household.
``(2) To identify and provide behavioral health treatment
to victims of sexual abuse who are Indian children or
children in an Indian household, and to their family members
who are affected by sexual abuse.
``(3) To develop prevention and intervention models which
incorporate Traditional Health Care Practices, cultural and
spiritual values, and community involvement.
``(4) To develop and implement, through the tribal
consultation process, culturally sensitive assessment and
diagnostic tools for use in Indian communities and Urban
Centers.
``(5) To identify and provide behavioral health treatment
to Indian perpetrators and perpetrators who are members of an
Indian household--
``(A) making efforts 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
``(B) providing treatment after the perpetrator is
released, until it is determined that the perpetrator is not
a threat to children.

``SEC. 713. BEHAVIORAL HEALTH RESEARCH.

``The Secretary, 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 interrelationship and interdependence 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.
The effect of the interrelationships and interdependencies
referred to in paragraph (1) on children, and the development
of prevention techniques under paragraph (2) applicable to
children, shall be emphasized.

``SEC. 714. DEFINITIONS.

``For the purpose of this title, the following definitions
shall apply:
``(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 or
arnd.--The term `alcohol-related neurodevelopmental
disorders' or `ARND' means, with a history of maternal
alcohol consumption during pregnancy, central nervous system
involvement such as developmental delay, intellectual
deficit, or neurologic abnormalities. Behaviorally, there can
be problems with irritability, and failure to thrive as
infants. As children become older there will likely be
hyperactivity, attention deficit, language dysfunction, and
perceptual and judgment problems.
``(3) Behavioral health aftercare.--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. The purpose is to help prevent or deal
with relapse by ensuring that by the time a client or patient
is discharged from a level of care, such as outpatient
treatment, an aftercare plan has been developed with the
client. An aftercare plan may use such resources a as
community-based therapeutic group, transitional living
facilities, a 12-step sponsor, a local 12-step or other
related support group, and other community-based providers
(mental health professionals, traditional health care
practitioners, community health aides, community health
representatives, mental health technicians, ministers, etc.)
``(4) Dual diagnosis.--The term `dual diagnosis' means
coexisting substance abuse and mental illness conditions or
diagnosis. Such clients are sometimes referred to as mentally
ill chemical abusers (MICAs).
``(5) Fetal alcohol disorders.--The term `fetal alcohol
disorders' means fetal alcohol syndrome, partial fetal
alcohol syndrome and alcohol related neurodevelopmental
disorder (ARND).
``(6) Fetal alcohol syndrome or fas.--The term `fetal
alcohol syndrome' or `FAS' means a syndrome in which, with a
history of maternal alcohol consumption during pregnancy, the
following criteria are 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: microophthalmia, short palpebral fissures, poorly
developed philtrum, thin upper lip, flat nasal bridge, and
short upturned nose.
``(C) Prenatal or postnatal growth delay.
``(7) Partial fas.--The term `partial FAS' means, with 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: microophthalmia,
short palpebral fissures, poorly developed philtrum, thin
upper lip, flat nasal bridge, and short upturned nose.

[[Page S5361]]

``(8) Rehabilitation.--The term `rehabilitation' means to
restore the ability or capacity to engage in usual and
customary life activities through education and therapy.
``(9) 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 the provisions of 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 Congress a report containing the
following:
``(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 assessments
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, Tribal Organizations, and Urban Indian
Organizations to address such impact, including a report on
proposed changes in 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) provided under contracts.
``(4) A report of contractors to the Secretary on Health
Care Educational Loan Repayments every 6 months required by
section 110.
``(5) A general audit report of the Secretary on the Health
Care Educational Loan Repayment Program as required by
section 110(n).
``(6) A report of the findings and conclusions of
demonstration programs on development of educational
curricula for substance abuse counseling as required in
section 125(f).
``(7) A separate statement which specifies the amount of
funds requested to carry out the provisions of section 201.
``(8) A report of the evaluations of health promotion and
disease prevention as required in section 203(c).
``(9) A biennial report to Congress on infectious diseases
as required by section 212.
``(10) A report on environmental and nuclear health hazards
as required by section 215.
``(11) An annual report on the status of all health care
facilities needs as required by section 301(c)(2) and 301(d).
``(12) Reports on safe water and sanitary waste disposal
facilities as required by section 302(h).
``(13) An annual report on the expenditure of nonservice
funds for renovation as required by sections 304(b)(2).
``(14) A report identifying the backlog of maintenance and
repair required at Service and tribal facilities required by
section 313(a).
``(15) A report providing an accounting of reimbursement
funds made available to the Secretary under titles XVIII,
XIX, and XXI of the Social Security Act.
``(16) A report on any arrangements for the sharing of
medical facilities or services, as authorized by section 406.
``(17) A report on evaluation and renewal of Urban Indian
programs under section 505.
``(18) A report on the evaluation of programs as required
by section 513(d).
``(19) A report on alcohol and substance abuse as required
by section 701(f).

``SEC. 802. REGULATIONS.

``(a) Deadlines.--
``(1) Procedures.--Not later than 90 days after the date of
enactment of the Indian Health Care Improvement Act
Amendments of 2005, 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 titles I
(except sections 105, 115, and 117), II, III, and VII. The
Secretary may promulgate regulations to carry out sections
105, 115, 117, and titles IV and V, using the procedures
required by chapter V of title 5, United States Code
(commonly known as the `Administrative Procedure Act'). The
Secretary shall issue no regulations to carry out titles VI
and VIII.
``(2) Proposed regulations.--Proposed regulations to
implement this Act shall be published in the Federal Register
by the Secretary no later than 1 year after the date of
enactment of the Indian Health Care Improvement Act
Amendments of 2005 and shall have no less than a 120-day
comment period.
``(3) Expiration of authority.--Except as otherwise
provided herein, the authority to promulgate regulations
under this Act shall expire 24 months from the date of
enactment of this Act.
``(b) 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. The representative of
the Urban Indian Organization shall be deemed to be an
elected officer of a tribal government for purposes of
applying section 204(b) of the Unfunded Mandates Reform Act
of 1995 (2 U.S.C. 1534(b)).
``(c) Adaptation 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) Lack of Regulations.--The lack of promulgated
regulations shall not limit the effect of this Act.
``(e) Inconsistent Regulations.--The provisions of this Act
shall supersede any conflicting provisions of law) in effect
on the day before the date of enactment of the Indian Health
Care Improvement Act Amendments of 2005, and the Secretary is
authorized to repeal any regulation inconsistent with the
provisions of this Act.

``SEC. 803. PLAN OF IMPLEMENTATION.

``Not later than 9 months after the date of enactment of
the Indian Health Care Improvement Act Amendments of 2005,
the Secretary in consultation with Indian Tribes, Tribal
Organizations, and Urban Indian Organizations, shall submit
to Congress a plan explaining the manner and schedule
(including a schedule of appropriation requests), by title
and section, by which the Secretary will implement the
provisions of this Act.

``SEC. 804. AVAILABILITY OF FUNDS.

``The funds appropriated pursuant to 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) In General.--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, if such descendant--
``(A) is a member of the Indian community served by a local
program of the Service; and
``(B) is regarded as an Indian by the community in which
such descendant lives.
``(3) Any Indian who holds trust interests in public
domain, national forest, or reservation allotments in
California.
``(4) Any Indian in California who is listed on the plans
for distribution of the assets of rancherias and reservations
located within the State of California under the Act of
August 18, 1958 (72 Stat. 619), and any descendant of such an
Indian.
``(b) Clarification.--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) Children.--Any individual who--
``(1) has not attained 19 years of age;
``(2) is the natural or adopted child, stepchild, foster
child, legal ward, or orphan of an eligible Indian; and
``(3) is not otherwise eligible for 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 1 year after the date of a
determination of competency.
``(b) Spouses.--Any spouse of an eligible Indian who is not
an Indian, or who is of Indian descent but is not otherwise
eligible for the health services provided by the Service,
shall be eligible for such health services if all such
spouses or spouses who are married to members of each 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.
``(c) Provision of Services to Other Individuals.--
``(1) In general.--The Secretary is authorized to provide
health services under this subsection through health programs
operated directly by the Service to individuals

[[Page S5362]]

who reside within the Service Unit and who are not otherwise
eligible for such health services if--
``(A) the Indian Tribes served by such Service Unit request
such provision of health services to such individuals; and
``(B) the Secretary and the served Indian 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 facilities
or services, within or without the Service Unit, available to
meet the health needs of such individuals.
``(2) ISDEAA programs.--In the case of health programs and
facilities operated under a contract or compact entered into
under the Indian Self-Determination and Education Assistance
Act (25 U.S.C. 450 et seq.), the governing body of the Indian
Tribe or Tribal Organization providing health services under
such contract or compact is authorized to determine whether
health services should be provided under such contract or
compact to individuals who are not otherwise eligible for
such services under any other subsection of this section or
under any other provision of law. In making such
determination, the governing body of the Indian Tribe or
Tribal organization shall take into account the
considerations described in clauses (i) and (ii) of paragraph
(1)(B).
``(3) Payment for services.--
``(A) In general.--Persons receiving health services
provided by the Service under 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 404 of this Act or any other
provision of law, amounts collected under this subsection,
including medicare, medicaid, or SCHIP reimbursements under
titles XVIII, XIX, and XXI of the Social Security Act, shall
be credited to the account of the program providing the
service and shall be used for the purposes listed in section
401(d)(2) and amounts collected under this subsection shall
be available for expenditure within such program.
``(B) Indigent people.--Health services may be provided by
the Secretary through the Service under this subsection to an
indigent individual who would not be otherwise 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 individual.
``(4) Revocation of consent for services.--
``(A) Single tribe service area.--In the case of a Service
Area which serves only 1 Indian Tribe, the authority of the
Secretary to provide health services under paragraph (1)
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) Multitribal service area.--In the case of a
multitribal Service Area, the authority of the Secretary to
provide health services under paragraph (1) 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 provisions
of such health services.
``(d) Other 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 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 postpartum; or
``(4) provide care to immediate family members of an
eligible individual if such care is directly related to the
treatment of the eligible individual.
``(e) Hospital Privileges for Practitioners.--Hospital
privileges in health facilities operated and maintained by
the Service or operated under a contract or compact pursuant
to the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450 et seq.) may be extended to non-Service health
care practitioners who provide services to individuals
described in subsection (a), (b), (c), or (d). Such non-
Service health care practitioners may, as part of privileging
process, be designated 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 individuals as a part of
the conditions under which such hospital privileges are
extended.
``(f) Eligible Indian.--For purposes of 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) Report Required.--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 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) Exception.--Subsection (a) shall not apply if the
total amount appropriated to the Service for a fiscal year is
at least 5 percent less than the amount appropriated to the
Service for the previous fiscal year.

``SEC. 809. RESULTS OF DEMONSTRATION PROJECTS.

``The Secretary shall provide for the dissemination to
Indian Tribes, Tribal Organizations, and Urban Indian
Organizations of the findings and results of demonstration
projects conducted under this Act.

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

``(a) Consistent With Court Decision.--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 Cir. 1987).
``(b) Clarification.--The provisions of subsection (a)
shall not be construed to be an expression of the sense of
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 on
implementation of the final rule published in the Federal
Register on September 16, 1987, by the Health Resources and
Services Administration of the Public Health Service,
relating to eligibility for the health care services of the
Indian Health Service, the Indian Health 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 contract or compact pursuant to
the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450 et seq.) shall not be considered an
`employer'.

``SEC. 813. 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. 814. ESTABLISHMENT OF NATIONAL BIPARTISAN COMMISSION
ON INDIAN HEALTH CARE.

``(a) Establishment.--There is established the National
Bipartisan Indian Health Care Commission (the `Commission').
``(b) Duties of Commission.--The duties of the Commission
are the following:
``(1) To establish a study committee composed of those
members of the Commission appointed by the Director and at
least 4 members of Congress from among the members of the
Commission, the duties of which shall be the following:
``(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,
which may include authorizing and making funds available for
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) To make legislative recommendations to the Commission
regarding the delivery of Federal health care services to
Indians. Such recommendations shall include those related to
issues of eligibility, benefits, the range of service
providers, the cost of such services, financing such
services, and the optimal manner in which to provide such
services.
``(C) To determine the effect of the enactment of such
recommendations on (i) the existing system of delivery of
health services for Indians, and (ii) the sovereign status of
Indian Tribes.
``(D) Not later than 12 months after the appointment of all
members of the Commission, to submit a written report of its
findings and recommendations to the full Commission. The
report shall include a statement of the minority and majority
position of the Committee and shall be disseminated, at a
minimum, to every Indian Tribe, Tribal Organization, and
Urban Indian Organization for comment to the Commission.
``(E) To report regularly to the full Commission regarding
the findings and recommendations developed by the study
committee in the course of carrying out its duties under this
section.
``(2) To review and analyze the recommendations of the
report of the study committee.

[[Page S5363]]

``(3) To make legislative recommendations to Congress
regarding the delivery of Federal health care services to
Indians. Such recommendations shall include those related to
issues of eligibility, benefits, the range of service
providers, the cost of such services, financing such
services, and the optimal manner in which to provide such
services.
``(4) Not later than 18 months following the date of
appointment of all members of the Commission, submit a
written report to Congress regarding the delivery of Federal
health care services to Indians. Such recommendations shall
include those related to issues of eligibility, benefits, the
range of service providers, the cost of such services,
financing such services, and the optimal manner in which to
provide such services.
``(c) Members.--
``(1) Appointment.--The Commission shall be composed of 25
members, appointed as follows:
``(A) Ten members of Congress, including 3 from the House
of Representatives and 2 from the Senate, appointed by their
respective majority leaders, and 3 from the House of
Representatives and 2 from the Senate, appointed by their
respective minority leaders, and who shall be members of the
standing committees of Congress that consider legislation
affecting health care to Indians.
``(B) Twelve persons chosen by the congressional members of
the Commission, 1 from each Service Area as currently
designated by the Director to be chosen from among 3 nominees
from each Service Area put forward 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 to a reasonable representation on
the commission of members who are familiar with various
health care delivery modes and who represent Indian Tribes of
various size populations.
``(C) Three persons appointed by the Director who are
knowledgeable about the provision of health care to Indians,
at least 1 of whom shall be appointed from among 3 nominees
put forward by those programs whose funds are provided in
whole or in part by the Service primarily or exclusively for
the benefit of Urban Indians.
``(D) All those persons chosen by the congressional members
of the Commission and by the Director shall be members of
federally recognized Indian Tribes.
``(2) Chair; vice chair.--The Chair and Vice Chair of the
Commission shall be selected by the congressional members of
the Commission.
``(3) Terms.--The terms of members of the Commission shall
be for the life of the Commission.
``(4) Deadline for appointments.--Congressional members of
the Commission shall be appointed not later than 180 days
after the date of enactment of the Indian Health Care
Improvement Act Amendments of 2005, and the remaining members
of the Commission shall be appointed not later than 60 days
following the appointment of the congressional members.
``(5) Vacancy.--A vacancy in the Commission shall be filled
in the manner in which the original appointment was made.
``(d) Compensation.--
``(1) Congressional members.--Each congressional member of
the Commission 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.
``(2) Other members.--Remaining members of the Commission,
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, a member may be allowed
travel expenses, as authorized by the Chairman of the
Commission. For purpose 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.
``(e) Meetings.--The Commission shall meet at the call of
the Chair.
``(f) Quorum.--A quorum of the Commission shall consist of
not less than 15 members, provided that no less than 6 of the
members of Congress who are Commission members are present
and no less than 9 of the members who are Indians are
present.
``(g) Executive Director; Staff; Facilities.--
``(1) Appointment; pay.--The Commission shall appoint an
executive director of the Commission. The executive director
shall be paid the rate of basic pay for level V of the
Executive Schedule.
``(2) Staff appointment.--With the approval of the
Commission, the executive director may appoint such personnel
as the executive director deems appropriate.
``(3) Staff pay.--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).
``(4) Temporary services.--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.
``(5) Facilities.--The Administrator of General Services
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.
``(h) Hearings.--(1) 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, provided that at least 6
regional hearings are held in different areas of the United
States in which large numbers of Indians are present. Such
hearings are to be held to solicit the views of Indians
regarding the delivery of health care services to them. To
constitute a hearing under this subsection, at least 5
members of the Commission, including at least 1 member of
Congress, must be present. Hearings held by the study
committee established in this section may count toward the
number of regional hearings required by this subsection.
``(2) 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)(A) The Director of the Congressional Budget Office or
the Chief Actuary of the Centers for Medicare & Medicaid
Services, 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) The Commission shall reimburse the Director of the
Congressional Budget Office for expenses relating to the
employment in the office of the Director of such additional
staff as may be necessary for the Director to comply with
requests by the Commission under subparagraph (A).
``(4) 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) 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) 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) The Commission may secure directly from 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 Chairman
of the Commission, the head of such agency shall furnish such
information to the Commission.
``(8) 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) 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 Congress.
``(i) Authorization of Appropriations.--There is authorized
to be appropriated $4,000,000 to carry out the provisions of
this section, which sum shall not be deducted from or affect
any other appropriation for health care for Indian persons.
``(j) FACA.--The Federal Advisory Committee Act (5 U.S.C.
App.) shall not apply to the Commission.

``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.

``(a) In General.--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.''.
(b) 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''.
(c) Amendments to Other Provisions of Law.--
(1) 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''.
(2) The Indian Lands Open Dump Cleanup Act of 1994 is
amended--
(A) 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

[[Page S5364]]

(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.'';
(B) 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.'';

(C) in section 6(a) (25 U.S.C. 3905(a)), in the subsection
heading, by striking ``Director'' and inserting ``Assistant
Secretary'';
(D) in section 9(a) (25 U.S.C. 3908(a)), in the subsection
heading, by striking ``Director'' and inserting ``Assistant
Secretary''; and
(E) by striking ``Director'' each place it appears and
inserting ``Assistant Secretary''.
(3) 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''.
(4) 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''.
(5) 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''.
(6) Section 317M(b) of the Public Health Service Act (42
U.S.C. 247b-14(b)) is amended--
(A) by striking ``Director of the Indian Health Service''
each place it appears and inserting ``Assistant Secretary for
Indian Health''; and
(B) 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''.
(7) 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''.
(8) 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''.
(9) 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''.
(10) 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''.

SEC. 3. SOBOBA SANITATION FACILITIES.

The Act of December 17, 1970 (84 Stat. 1465), is amended by
adding at the end the following new section:
``Sec. 9. Nothing in this Act shall 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. 4. AMENDMENTS TO THE MEDICAID AND STATE CHILDREN'S
HEALTH INSURANCE PROGRAMS.

(a) Expansion of Medicaid Payment for All Covered Services
Furnished by Indian Health Programs.--
(1) Expansion to all covered services.--Section 1911 of the
Social Security Act (42 U.S.C. 1396j) is amended--
(A) by amending the heading to read as follows:

``indian health programs''; and

(B) by amending subsection (a) to read as follows:
``(a) Eligibility for Reimbursement for Medical
Assistance.--The Indian Health Service and an Indian Tribe,
Tribal Organization, or an urban Indian Organization (as such
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 or under
waiver authority with respect to items and services furnished
by the Indian Health Service, Indian Tribe, Tribal
Organization, or Urban Indian Organization if the furnishing
of such services meets all the conditions and requirements
which are applicable generally to the furnishing of items and
services under this title and under such plan or waiver
authority.''.
(2) Elimination of temporary deeming provision.--Such
section is amended by striking subsection (b).
(3) Revision of authority to enter into agreements.--
Subsection (c) of such section is redesignated as subsection
(b) and is amended to read as follows:
``(b) Authority To Enter Into Agreements.--The Secretary
may enter into an agreement with a State for the purpose of
reimbursing the State for medical assistance provided by the
Indian Health Service, an Indian Tribe, Tribal Organizations,
or an Urban Indian Organization (as so defined), directly,
through referral, or under contracts or other arrangements
between the Indian Health Service, an Indian Tribe, Tribal
Organization, or an Urban Indian Organization and another
health care provider to Indians who are eligible for medical
assistance under the State plan or under waiver authority.''.
(4) Reference correction.--Subsection (d) of such section
is redesignated as subsection (c) and is amended--
(A) by striking ``For'' and inserting ``Direct Billing.--
For''; and
(B) by striking ``section 405'' and inserting ``section
401(d)''.
(b) Special Rules for Indians, Indian Health Care
Providers, and Indian Managed Care Entities.--
(1) In general.--Section 1932 of the Social Security Act
(42 U.S.C. 1396u-2) is amended by adding at the end the
following new subsection:
``(h) Special Rules for Indians, Indian Health Care
Providers, and Indian Managed Care Entities.--A State shall
comply with the provisions of section 413 of the Indian
Health Care Improvement Act (relating to the treatment of
Indians, Indian health care providers, and Indian managed
care entities under a medicaid managed care program).''.
(2) Application to schip.--Section 2107(e)(1) of the Social
Security Act (42 U.S.C. 1397gg(1)) is amended by adding at
the end the following:
``(E) Subsections (a)(2)(C) and (h) of section 1932.''.
(c) SCHIP Treatment of Indian Tribes, Tribal Organizations,
and Urban Indian Organizations.--Section 2105(c) of the
Social Security Act (42 U.S.C. 1397ee(c)) is amended--
(1) in paragraph (2), by adding at the end the following:
``(C) Indian health program payments.--For provisions
relating to authorizing use of allotments under this title
for payments to Indian Health Programs and Urban Indian
Organizations, see section 410 of the Indian Health Care
Improvement Act.''; and
(2) in paragraph (6)(B), by inserting ``or by an Indian
Tribe, Tribal Organization, or Urban Indian Organization (as
such terms are defined in section 4 of the Indian Health Care
Improvement Act)'' after ``Service''.

SEC. 5. 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) Committee.--The term `Committee' means the Committee
for the Establishment of Native American Health and Wellness
Foundation established under section 802(f).
``(3) Foundation.--The term `Foundation' means the Native
American Health and Wellness Foundation established under
section 802.
``(4) Secretary.--The term `Secretary' means the Secretary
of Health and Human Services.
``(5) 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) Duties.--The Foundation shall--
``(1) 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) undertake and conduct such other activities as will
further the health and wellness activities and opportunities
of Native Americans; and
``(3) 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) Committee for the Establishment of Native American
Health and Wellness Foundation.--
``(1) In general.--The Secretary shall establish the
Committee for the Establishment of Native American Health and
Wellness Foundation to assist the Secretary in establishing
the Foundation.
``(2) Duties.--Not later than 180 days after the date of
enactment of this section, the Committee shall--
``(A) carry out such activities as are necessary to
incorporate the Foundation under the laws of the District of
Columbia, including acting as incorporators of the
Foundation;

[[Page S5365]]

``(B) ensure that the Foundation qualifies for and
maintains the status required to carry out this section,
until the Board is established;
``(C) establish the constitution and initial bylaws of the
Foundation;
``(D) provide for the initial operation of the Foundation,
including providing for temporary or interim quarters,
equipment, and staff; and
``(E) appoint the initial members of the Board in
accordance with the constitution and initial bylaws of the
Foundation.
``(g) 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, who shall have staggered terms.
``(ii) Initial voting members.--The initial voting members
of the Board--

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

``(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.
``(h) 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.
``(i) 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.
``(j) Principal Office.--
``(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.
``(k) 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.
``(l) 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.
``(m) 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 (o) 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.
``(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.
``(o) Funding.--
``(1) Authorization of appropriations.--There is authorized
to be appropriated to carry out subsection (e)(1) $500,000
for each fiscal year, as adjusted to reflect changes in the
Consumer Price Index for all-urban consumers published by the
Department of Labor.
``(2) Transfer of donated funds.--The Secretary shall
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.

``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 for initial operating costs and 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''.

Mr. DORGAN. I thank Chairman McCain for his leadership in introducing
the Indian Health Care Improvement Act Amendments of 2005. I have been
pleased to work with him in constructing this legislation. He and I are
united in our agreement that getting the Indian Health Care Improvement
Act reauthorized this year is the Indian Affairs Committee's top
priority.
This legislation was last reauthorized in 1992. Since 1999, the
director of the Indian Health Service and his staff have worked with a
national steering committee of tribal leaders and representatives of
Indian health organizations, as well as with the congressional
authorizing committees, on reauthorization of and amendments to the
Indian Health Care Improvement Act.
The bill that we introduce today reflects many elements of these
discussions and negotiations over recent years, as well as testimony
received at a number of hearings held by the Senate Indian Affairs
Committee and House Resources Committee. It is important that we begin
as soon as possible to receive the views of Indian Country, the
administration and others on this legislation.
I am sure that in the course of this Congress, there will be changes
to the bill that is being proposed today. As Chairman McCain knows, I
am committed to addressing the serious issue of teen suicide that is
epidemic on several Indian reservations, in North Dakota and other
areas of the country. I hope that the recommendations of Indian
parents, students, tribal officials and health professionals may lead
to additional provisions in the Act to deal with this very serious
problem.
I look forward to the comments of the administration, especially the
Indian Health Services, as well as other committees of the Congress,
tribes and tribal organizations, urban Indian entities, and others to
help us craft legislation that will provide creative and effective
solutions to address the health care needs of American Indian and
Alaska Native communities.
______

Mr. SANTORUM (for himself and Mr. Wyden):
S. 1058. A bill to amend the Public Health Service Act to provide
liability protections for volunteer practitioners at health centers
under section 330 of

[[Page S5366]]

such Act; to the Committee on Health, Education, Labor, and Pensions.
Mr. SANTORUM. Mr. President, I rise today to introduce the Community
Health Center Volunteer Physician Protection Act of 2005 along with
Senator Ron Wyden. Representative Tim Murphy of Pennsylvania introduced
identical bipartisan legislation in the House of Representatives, H.R.
1313.
Community health centers offer primary and preventive health care
services to everyone, including low-income, underinsured and uninsured
families. Community health centers are typically located in high-need
areas identified by the Federal Government as having elevated poverty,
higher than average infant mortality, and where few physicians
practice. They tailor their services to fit the special needs and
priorities of their communities, and offer services that help their
patients access health care such as health education, transportation
and home visitation.
While low-income individuals have access to Medicaid and the elderly
and the disabled have access to Medicare, uninsured and underinsured
families often delay seeing a doctor or turn to emergency departments
where treatment is several times more expensive.
Community health centers, however, provide comprehensive and
preventive care that adjusts charges for patient care according to
family income. The Federal Government spends over $23 billion a year to
offset losses incurred by hospitals for patients unable to pay their
bills, and the Department of Health and Human Services note that
medical care at community health centers cost only about $1.30 per day
per patient served. In fact, medical care at community health centers
is around $250 less per patient served than the average annual
expenditure for an office-based medical provider.
Community health centers offer an affordable source of quality health
care, but we need more of them. The President has proposed a $304
million increase for community health center programs to create 1,200
new or expanded sites to serve an additional 6.1 million people by next
year. In order to meet that goal, the centers must double their
workforce by adding double the clinicians by 2006. Hiring this many
doctors would be costly, but encouraging more to volunteer would help
to meet this need. While many physicians are willing to volunteer their
services at these centers, they often hesitate due to the high cost of
medical liability insurance. As a result, there are too few volunteer
physicians to meet our health care needs.
By comparison, volunteer physicians at free health clinics and paid
physicians at community health centers already receive comprehensive
medical liability coverage under the Federal Tort Claims Act (FTCA).
Accordingly, the Community Health Center Volunteer Physician
Protection Act of 2005 would extend the medical liability protections
of FTCA to volunteer physicians at community health centers. These
protections are necessary to ensure that the centers can continue to
play an important role in lowering our Nation's health care costs and
meeting the needs for affordable and access quality health care. The
Community Health Center Volunteer Physician Protection Act of 2005 is
supported by the National Association of Community Health Centers, the
American Medical Association and the American Osteopathic Association.
The impact that community health centers have on the citizens of the
Commonwealth of Pennsylvania is significant. Pennsylvania is the home
to twenty-nine Federal grantees, including 11 of which are rural, and
151 different service delivery sites. These services are crucial in my
home state which also faces a severe medical liability crisis.
We must continue to encourage the spirit of giving and volunteerism,
particularly in the healthcare arena. I urge my colleagues to support
the Community Health Center Volunteer Physician Protection Act of 2005.
______

By Mr. BROWNBACK (for himself, Mr. Smith, Mr. Chambliss, Mr.
Dodd, Mr. Feingold, and Mrs. Clinton):
S.J. Res. 19. A joint resolution calling upon the President to issue
a proclamation recognizing the 30th anniversary of the Helsinki Final
Act; to the Committee on Foreign Relations.
Mr. BROWNBACK. Mr. President, as Chairman of the Commission on
Security and Cooperation in Europe I am pleased to submit a bipartisan
resolution in support of the vital work of the Organization for
Security and Cooperation in Europe (OSCE) in conjunction with the 30th
anniversary of the signing of the Helsinki Final Act on August 1. I am
pleased that Senate Commissioners Smith of Oregon, Chambliss, Dodd,
Feingold, and Clinton are included as original cosponsors of this
resolution.
For three decades the OSCE has provided an important framework for
advancing democracy, human rights and the rule of law in an expansive
region encompassing the U.S. and Canada, Europe and the countries of
Central Asia. Over the years, the OSCE participating States have
hammered out an extensive body of commitments agreed on the basis of
consensus. Our Commission was established by Congress to monitor and
encourage the OSCE participating States--now numbering 55--to implement
the commitments they have accepted. The Commission's mission can be
distilled to a single word, accountability. As President Ford remarked
when signing the Final Act on behalf of the United States, ``History
will judge this Conference . . . not only by the promises we make, but
by the promises we keep.''
The Final Act inspired courageous individuals in the Soviet Union and
Eastern Europe to form monitoring groups to assess how their respective
governments lived up to the commitments they had endorsed on paper. For
their temerity in seeking accountability most activists were
imprisoned, banished or exiled. Many endured years of suffering in the
gulag. Some paid the price with their very lives. Ultimately, their
sacrifice and the work of countless others began to bear fruit,
ushering in the dramatic changes of the late 1980's and early 90's.
A catalyst for change, the Helsinki Final Act and the process it
began provided an important backdrop against which President Ronald
Reagan, standing in front of Berlin's Brandenburg Gate, could boldly
declare, ``Mr. Gorbachev, tear down this wall.'' Bold leadership led to
concrete results with the resolution of hundreds of cases of political
prisoners and prisoners of conscience as well as the reunification of
tens of thousands of families. Progress in implementing existing
commitments paved the way for the participating States to address the
need for systemic change to ensure sustained respect for human rights.
In 1990, as the Iron Curtain began to fall, the leaders of the then--35
participating States declared, ``We undertake to build, consolidate and
strengthen democracy as the only system of government of our nations.''
The following year they categorically and irrevocably declared that
human rights commitments ``are matters of direct and legitimate concern
to all participating States and do not belong exclusively to the
internal affairs of the State concerned.'' In a step designed to
preserve the unity of the Helsinki process, each country that joined
the OSCE after 1975 submitted a letter in which the accepted in their
entirety all commitments and responsibilities contained in the Helsinki
Final Act, and all subsequent documents adopted prior to their
membership. To underscore this continuity, the leaders of each of these
countries signed the actual original 1975 Final Act document.
With the break up of the Soviet Union, many observers believed--or
hoped--that the fall of communism would usher in a new era and the
relatively speedy emergence of states that treat their citizens and
neighbors with respect. Regrettably, the gap between commitment and the
situation on the ground in a number of OSCE participating States
remains wide, and in at least a couple of countries is growing
alarmingly wider.
Elsewhere, the OSCE has played an important role in the aftermath of
conflicts that ravaged much of the Balkans region. The atrocities
committed during these conflicts, in particular during the Bosnian
conflict from 1992 to 1995, represent the most egregious violations of
Helsinki principles in Europe since the Final Act was signed, indeed
since World War II. By placing field missions throughout that region,
the OSCE has helped heal the wounds, in particular by facilitating the
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of those displaced from their homes, by improving conditions for
elections, by training local police and by monitoring borders used by
criminal gangs who profit from the chaos of conflict. There have been
improvements in recent years, but there is still plenty of work to do
to build the democratic institutions and respect for the rule of law.
Freedom is on the march in places some had written off as unsuited
for democracy. Kyrgyzstan's Tulip Revolution, Ukraine's Orange
Revolution, Georgia's Rose Revolution, and Serbia's Democratic
Revolution testify to the enduring power of the ideas reflected in the
Helsinki Final Act and other OSCE documents. As we approach the 30th
anniversary of the Final Act, a number of signatory states--most
notably Russia and Belarus--seem determined to diminish the democratic
content of the OSCE and rewrite related commitments they accepted when
they joined the OSCE. It is imperative that the United States hold firm
to the values that have inspired democratic change in much of the OSCE
region, even as we redouble our efforts to encourage all participating
States to implement their freely accepted commitments.
In recent years the OSCE has made significant inroads in confronting
and combating the rise in anti-Semitism and related violence in the
OSCE region, including the United States. I would point out that the
OSCE was the first multilateral institution to speak out against anti-
Semitism. While many OSCE states have responded appropriately,
vigorously investigating the perpetrators and pursuing criminal
prosecution, we must remain vigilant in addressing manifestations of
anti-Semitism. The OSCE conference on anti-Semitism and other forms of
intolerance to be held in June in Cordoba will provide a timely
opportunity for countries to report on measures they are taking to
address these concerns.
The OSCE is also playing an important role in promoting the right of
individuals to freely profess and practice their faith. A number of
countries in the OSCE region have adopted or are considering laws on
religion that would severely restrict or otherwise regulate this
fundamental right. Similarly, the OSCE has given priority attention to
efforts to combat trafficking in human beings, encouraging a number of
participating States to adopt measures to prevent trafficking,
prosecute perpetrators, and protect victims.
In her confirmation testimony, Secretary of State Rice referred to
the potential role that multilateral institutions can play in
multiplying the strength of freedom-loving nations. Indeed, the OSCE
has tremendous potential to play an even greater role in promoting
democracy, human rights, and rule of law in a region of strategic
importance to the United States.
Over the past three decades the OSCE has served as an important
catalyst for change. An important aspect of the success of the Helsinki
Process has been the strong partnership forged with human rights
advocates, including non-governmental organizations. As we look toward
the work ahead, we would do well to recall the insightful observation
of renowned physicist, humanitarian, and Nobel Peace Prize laureate,
Andrei Sakharov, ``The whole point of the Helsinki Accords is mutual
monitoring, not mutual evasion of difficult problems.''

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