[Congressional Record Volume 151, Number 65 (Tuesday, May 17, 2005)]
[Senate]
[Pages S5329-S5365]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      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.
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