[Congressional Record Volume 155, Number 179 (Friday, December 4, 2009)]
[Senate]
[Pages S12416-S12459]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 2880. Mr. JOHANNS submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 2074, after line 25, insert the following:

                    TITLE X--DELAYED IMPLEMENTATION

     SEC. 10001. DELAYED IMPLEMENTATION.

       Notwithstanding any other provision of this Act, or the 
     amendments made by this Act, such provisions or amendments 
     shall not take effect before the date that the Board of 
     Trustees of the Federal Hospital Insurance Trust Fund under 
     section 1817 of the Social Security Act (42 U.S.C. 1395i) 
     submits an annual report to Congress under subsection (b)(2) 
     of such section that includes a statement that such Trust 
     Fund is projected to be solvent through 2037.
                                 ______
                                 
  SA 2881. Mr. JOHANNS submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 1999, strike lines 1 through 20.
                                 ______
                                 
  SA 2882. Mr. JOHANNS submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 816, after line 20, insert the following:

     SEC. 3115. PROTECTING MEDICARE BENEFICIARIES' ACCESS TO HOME 
                   HEALTH SERVICES.

       Notwithstanding the provisions of, and amendments made by, 
     sections 3131 and 3401(e), such provisions and amendments are 
     repealed.
                                 ______
                                 
  SA 2883. Ms. STABENOW (for herself, Mr. Kerry, and Mr. Brown) 
submitted an amendment intended to be proposed to amendment SA 2786 
proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       In subtitle C of title IV, insert the following at the end:

     SEC. 4208. CENTERS OF EXCELLENCE FOR DEPRESSION.

       (a) Short Title.--This section may be cited as the 
     ``Establishing a Network of Health-Advancing National Centers 
     of Excellence for Depression Act of 2009'' or the ``ENHANCED 
     Act of 2009''.
       (b) Centers of Excellence for Depression.--Subpart 3 of 
     part B of title V of the Public Health Service Act (42 U.S.C. 
     290bb et

[[Page S12417]]

     seq.) is amended by inserting after section 520A the 
     following:

     ``SEC. 520B. NATIONAL CENTERS OF EXCELLENCE FOR DEPRESSION.

       ``(a) Depressive Disorder Defined.--In this section, the 
     term `depressive disorder' means a mental or brain disorder 
     relating to depression, including major depression, bipolar 
     disorder, and related mood disorders.
       ``(b) Grant Program.--
       ``(1) In general.--The Secretary, acting through the 
     Administrator, shall award grants on a competitive basis to 
     eligible entities to establish national centers of excellence 
     for depression (referred to in this section as `centers of 
     excellence'), which shall engage in activities related to the 
     treatment of depressive disorders.
       ``(2) Allocation of awards.--If the funds authorized under 
     subsection (f) are appropriated in the amounts provided for 
     under such subsection, the Secretary shall allocate such 
     amounts so that--
       ``(A) not later than 1 year after the date of enactment of 
     the ENHANCED Act of 2009, not more than 20 centers of 
     excellence may be established; and
       ``(B) not later than September 30, 2016, not more than 30 
     centers of excellence may be established.
       ``(3) Grant period.--
       ``(A) In general.--A grant awarded under this section shall 
     be for a period of 5 years.
       ``(B) Renewal.--A grant awarded under subparagraph (A) may 
     be renewed, on a competitive basis, for 1 additional 5-year 
     period, at the discretion of the Secretary. In determining 
     whether to renew a grant, the Secretary shall consider the 
     report cards issued under subsection (e)(2).
       ``(4) Use of funds.--Grant funds awarded under this 
     subsection shall be used for the establishment and ongoing 
     activities of the recipient of such funds.
       ``(5) Eligible entities.--
       ``(A) Requirements.--To be eligible to receive a grant 
     under this section, an entity shall--
       ``(i) be an institution of higher education or a public or 
     private nonprofit research institution; and
       ``(ii) submit an application to the Secretary at such time 
     and in such manner as the Secretary may require, as described 
     in subparagraph (B).
       ``(B) Application.--An application described in 
     subparagraph (A)(ii) shall include--
       ``(i) evidence that such entity--

       ``(I) provides, or is capable of coordinating with other 
     entities to provide, comprehensive medical services with a 
     focus on mental health services and subspecialty expertise 
     for depressive disorders;
       ``(II) collaborates with--

       ``(aa) other medical subspecialists to address co-occurring 
     mental illnesses;
       ``(bb) community organizations; and
       ``(cc) other members of the network;

       ``(III) is capable of training health professionals about 
     mental health; and

       ``(ii) such other information, as the Secretary may 
     require.
       ``(C) Priorities.--In awarding grants under this section, 
     the Secretary shall give priority to eligible entities that 
     meet 1 or more of the following criteria:
       ``(i) Demonstrated capacity and expertise to serve the 
     targeted population.
       ``(ii) Existing infrastructure or expertise to provide 
     appropriate, evidence-based and culturally competent 
     services.
       ``(iii) A location in a geographic area with 
     disproportionate numbers of underserved and at-risk 
     populations in medically underserved areas and health 
     professional shortage areas.
       ``(iv) A history of serving the population described in 
     clause (iii).
       ``(v) Proposed innovative approaches for outreach to 
     initiate or expand services.
       ``(vi) Use of the most up-to-date science, practices, and 
     interventions available.
       ``(vii) Demonstrated coordination and collaboration, or 
     having a viable plan to coordinate, with a community mental 
     health center or other community mental health resources.
       ``(viii) Capacity to establish cooperative agreements with 
     other community entities to provide social and human services 
     to individuals with depressive disorders.
       ``(ix) Demonstrated potential for replication and 
     dissemination of evidence-based research and practices.
       ``(6) Specialty centers.--Of the centers of excellence 
     receiving a grant under this section, the Secretary may 
     select 1 or more such centers to specialize in--
       ``(A) subspecialties such as prepartum and postpartum 
     depression, traumatic stress disorder, suicidal tendency, 
     bipolar disorder, and depression; and
       ``(B) providing mental health services to communities with 
     problems of access, such as rural communities and 
     economically depressed communities.
       ``(7) National coordinating center.--
       ``(A) In general.--The Secretary, acting through the 
     Administrator, shall designate 1 recipient of a grant under 
     this section to be the coordinating center of excellence for 
     depression (referred to in this section as the `coordinating 
     center'). The Secretary shall select such coordinating center 
     on a competitive basis, based upon the demonstrated capacity 
     of such center to perform the duties described in 
     subparagraph (C).
       ``(B) Application.--A center of excellence that has been 
     awarded a grant under paragraph (1) may apply for designation 
     as the coordinating center by submitting an application to 
     the Secretary at such time, in such manner, and containing 
     such information as the Secretary may require.
       ``(C) Duties.--The coordinating center shall--
       ``(i) develop, administer, and coordinate the network of 
     centers of excellence under this section;
       ``(ii) oversee and coordinate the national database 
     described in subsection (d);
       ``(iii) lead a strategy to disseminate the findings and 
     activities of the centers of excellence through such 
     database;
       ``(iv) serve as a liaison with the Administration, the 
     National Registry of Evidence-based Programs and Practices of 
     the Administration, and any Federal interagency or 
     interagency forum on mental health; and
       ``(v) establish a common network infrastructure to advance 
     services provided by the centers of excellence and 
     demonstrate effectiveness in fostering a collaborative 
     community among such centers for sharing knowledge and 
     skills.
       ``(8) Matching funds.--The Secretary may not award a grant 
     or contract under this section to an entity unless the entity 
     agrees that it will make available (directly or through 
     contributions from other public or private entities) non-
     Federal contributions toward the activities to be carried out 
     under the grant or contract in an amount equal to $1 for each 
     $5 of Federal funds provided under the grant or contract. 
     Such non-Federal matching funds may be provided directly or 
     through donations from public or private entities and may be 
     in cash or in-kind, fairly evaluated, including plant, 
     equipment, or services.
       ``(c) Activities of the Centers of Excellence.--Each center 
     of excellence shall carry out the following activities:
       ``(1) General activities.--Each center of excellence 
     shall--
       ``(A) integrate basic, clinical, or health services 
     interdisciplinary research and practice in the development of 
     evidence-based interventions;
       ``(B) involve a broad cross-section of stakeholders, such 
     as researchers, clinicians, consumers, families of consumers, 
     and voluntary health organizations, to develop the research 
     agenda and disseminate the research findings of such center, 
     and to provide support in the implementation of evidence-
     based practices;
       ``(C) provide training and technical assistance to mental 
     health professionals, and engage in and disseminate 
     translational research with a focus on meeting the needs of 
     individuals with depressive disorders;
       ``(D) facilitate the dissemination and communication of 
     research findings and depressive disorder-related information 
     from the institutions of higher education to the public; and
       ``(E) educate policy makers, employers, community leaders, 
     and the general public about depressive disorders to reduce 
     stigma and raise awareness of available treatments for such 
     disorders.
       ``(2) Improved treatment standards, clinical guidelines, 
     and diagnostic protocols.--Each center of excellence shall 
     collaborate with other centers of excellence in the network 
     to--
       ``(A) develop and implement treatment standards, clinical 
     guidelines, and protocols to improve the accuracy and 
     timeliness of diagnosis of depressive disorders; and
       ``(B) develop and implement treatment standards that 
     emphasize early intervention and treatment for, primary 
     prevention and the prevention of recurrences of, and recovery 
     from, depressive disorders.
       ``(3) Coordination and integration of physical, mental, and 
     social care.--Each center of excellence shall--
       ``(A) incorporate principles of chronic care coordination 
     and integration of services that address physical, mental, 
     and social conditions in the treatment of depressive 
     disorders;
       ``(B) foster communication with other providers attending 
     to co-occurring physical health conditions such as 
     cardiovascular, diabetes, cancer, and substance abuse 
     disorders;
       ``(C) identify how treatment for depression interacts with 
     such co-occurring illnesses to improve overall health 
     outcomes;
       ``(D) leverage available community resources, develop and 
     implement improved self-management programs, and, when 
     appropriate, involve family and other providers of social 
     support in the development and implementation of care plans; 
     and
       ``(E) use electronic health records and telehealth 
     technology to better coordinate and manage, and improve 
     access to, care, as determined by the coordinating center.
       ``(4) Translational research through collaboration of 
     centers of excellence and community-based organizations.--
     Each center of excellence shall--
       ``(A) demonstrate effective use of a public-private 
     partnership to foster collaborations among members of the 
     network and community-based organizations such as community 
     mental health centers and other social and human services 
     providers;
       ``(B) expand multidisciplinary, translational, and patient-
     oriented research and treatment by fostering such 
     collaborations; and
       ``(C) coordinate with accredited academic programs to 
     provide ongoing opportunities, in academic and in community 
     settings, for the professional and continuing education of 
     mental health providers.
       ``(d) National Database.--

[[Page S12418]]

       ``(1) In general.--The coordinating center shall establish 
     and maintain a national, publicly available database to 
     improve prevention programs, evidence-based interventions, 
     and disease management programs for depressive disorders, 
     using data collected from the centers of excellence, as 
     described in paragraph (2).
       ``(2) Data collection.--
       ``(A) Data.--Each center of excellence shall submit data 
     gathered at such center, as appropriate, to the coordinating 
     center regarding--
       ``(i) the prevalence and incidence of depressive disorders;
       ``(ii) the health and social outcomes of individuals with 
     depressive disorders;
       ``(iii) the effectiveness of interventions designed, 
     tested, and evaluated;
       ``(iv) the progress in the prevention of, and recovery 
     from, depressive disorders; and
       ``(v) the economic impact of the activities of such center.
       ``(B) Financial information.--Each center of excellence 
     shall provide to the coordinating center appropriately 
     summarized financial information to enable the coordinating 
     center to assess the efficiency and financial sustainability 
     of such center.
       ``(3) Submission of data to the administrator.--The 
     coordinating center shall submit to the Administrator the 
     data and financial information gathered under paragraph (2).
       ``(4) Publication using data from the database.--A center 
     of excellence, or an individual affiliated with a center of 
     excellence, may publish findings using the data described in 
     paragraph (2)(A) only if such center submits such data to the 
     coordinating center, as required under such paragraph.
       ``(e) Establishment of Standards; Report Cards and 
     Recommendations; Third Party Review.--
       ``(1) Establishment of standards.--The Secretary, acting 
     through the Administrator, shall establish performance 
     standards for--
       ``(A) each center of excellence; and
       ``(B) the network of centers of excellence as a whole.
       ``(2) Report cards.--The Secretary, acting through the 
     Administrator, shall--
       ``(A) for each center of excellence, not later than 3 years 
     after the date on which such center of excellence is 
     established and annually thereafter, issue a report card to 
     the coordinating center to rate the performance of such 
     center of excellence; and
       ``(B) not later than 3 years after the date on which the 
     first grant is awarded under subsection (b)(1) and annually 
     thereafter, issue a report card to Congress to rate the 
     performance of the network of centers of excellence as a 
     whole.
       ``(3) Recommendations.--Based upon the report cards 
     described in paragraph (1), the Secretary shall, not later 
     than September 30, 2015--
       ``(A) make recommendations to the centers of excellence 
     regarding improvements such centers shall make; and
       ``(B) make recommendations to Congress for expanding the 
     centers of excellence to serve individuals with other types 
     of mental disorders.
       ``(4) Third party review.--Not later than 3 years after the 
     date on which the first grant is awarded under subsection 
     (b)(1) and annually thereafter, the Secretary shall arrange 
     for an independent third party to conduct an evaluation of 
     the network of centers of excellence to ensure that such 
     centers are meeting the goals of this section.
       ``(f) Authorization of Appropriations.--
       ``(1) In general.--To carry out this section, there are 
     authorized to be appropriated--
       ``(A) $100,000,000 for each of the fiscal years 2011 
     through 2015; and
       ``(B) $150,000,000 for each of the fiscal years 2016 
     through 2020.
       ``(2) Allocation of funds authorized.--Of the amount 
     appropriated under paragraph (1) for a fiscal year, the 
     Secretary shall determine the allocation of each center of 
     excellence receiving a grant under this section, but in no 
     case may the allocation be more than $5,000,000, except that 
     the Secretary may allocate not more than $10,000,000 to the 
     coordinating center.''.
       (c) Sense of the Senate.--It is the sense of the Senate 
     that the knowledge and research developed by the centers of 
     excellence for depression established under section 520B of 
     the Public Health Service Act should be disseminated broadly 
     within the medical community and the Federal Government, 
     particularly to agencies with an interest in mental health, 
     including other agencies within the Department of Health and 
     Human Services and the Departments of Justice, Defense, 
     Labor, and Veterans Affairs.
                                 ______
                                 
  SA 2884. Ms. STABENOW (for herself, Mr. Kerry, Mrs. Boxer, Ms. 
Klobuchar, Mr. Bayh, Mr. Lautenberg, and Mr. Johnson) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       At the end of title VII, insert the following:

 Subtitle C--Heart Disease Education, Analysis Research, and Treatment 
                               for Women

     SEC. 7201. SHORT TITLE.

       This subtitle may be cited as the ``Heart Disease 
     Education, Analysis Research, and Treatment for Women Act'' 
     or the ``HEART for Women Act''.

     SEC. 7202. REPORTING OF DATA IN APPLICATIONS FOR DRUGS, 
                   BIOLOGICAL PRODUCTS, AND DEVICES.

       (a) Drugs.--
       (1) New drug applications.--Section 505(b) of the Federal 
     Food, Drug, and Cosmetic Act (21 U.S.C. 355(b)) is amended--
       (A) in paragraph (1), in the second sentence--
       (i) by striking ``drug, and (G)'' and inserting ``drug; 
     (G)''; and
       (ii) by inserting before the period the following: ``; and 
     (H) the information required under paragraph (7)''; and
       (B) by adding at the end the following:
       ``(7)(A) With respect to clinical data in an application 
     under this subsection, the Secretary may deny such an 
     application if the application fails to meet the requirements 
     of sections 314.50(d)(5)(v) and 314.50(d)(5)(vi)(a) of title 
     21, Code of Federal Regulations.
       ``(B) The Secretary shall modify the sections referred to 
     in subparagraph (A) to require that an application under this 
     subsection include any clinical data possessed by the 
     applicant that relates to the safety or effectiveness of the 
     drug involved by gender, age, and racial subgroup.
       ``(C) Promptly after approving an application under this 
     subsection, the Secretary shall, through an Internet Web site 
     of the Department of Health and Human Services, make 
     available to the public the information submitted to the 
     Secretary pursuant to subparagraphs (A) and (B), subject to 
     sections 301(j) and 520(h)(1) of this Act, subsection (b)(4) 
     of section 552 of title 5, United States Code (commonly 
     referred to as the `Freedom of Information Act'), and other 
     provisions of law that relate to trade secrets or 
     confidential commercial information.
       ``(D) The Secretary shall develop guidance for staff of the 
     Food and Drug Administration to ensure that applications 
     under this subsection are adequately reviewed to determine 
     whether the applications include the information required 
     pursuant to subparagraphs (A) and (B).''.
       (2) Investigational new drug applications.--Section 505(i) 
     of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
     355(i)) is amended--
       (A) in paragraph (2), by striking ``Subject to paragraph 
     (3),'' and inserting ``Subject to paragraphs (3) and (5),'' ; 
     and
       (B) by adding at the end the following:
       ``(5)(A) The Secretary may place a clinical hold (as 
     described in paragraph (3)) on an investigation if the 
     sponsor of the investigation fails to meet the requirements 
     of section 312.33(a) of title 21, Code of Federal 
     Regulations.
       ``(B) The Secretary shall modify the section referred to in 
     subparagraph (A) to require that reports under such section 
     include any clinical data possessed by the sponsor of the 
     investigation that relates to the safety or effectiveness of 
     the drug involved by gender, age, and racial subgroup.''.
       (b) Biological Product License Applications.--Section 351 
     of the Public Health Service Act (42 U.S.C. 262), as amended 
     by section 7002, is further amended by adding at the end the 
     following:
       ``(n) The provisions of section 505(b)(7) of the Federal 
     Food, Drug, and Cosmetic Act (relating to clinical data 
     submission) apply with respect to an application under 
     subsection (a) of this section to the same extent and in the 
     same manner as such provisions apply with respect to an 
     application under section 505(b) of such Act.''.
       (c) Devices.--
       (1) Premarket approval.--Section 515 of the Federal Food, 
     Drug, and Cosmetic Act (21 U.S.C. 360e) is amended--
       (A) in subsection (c)(1)--
       (i) in subparagraph (G)--

       (I) by moving the margin 2 ems to the left; and
       (II) by striking ``and'' after the semicolon at the end;

       (ii) by redesignating subparagraph (H) as subparagraph (I); 
     and
       (iii) by inserting after subparagraph (G) the following 
     subparagraph:
       ``(H) the information required under subsection (d)(7); 
     and''; and
       (B) in subsection (d), by adding at the end the following 
     paragraph:
       ``(7) To the extent consistent with the regulation of 
     devices, the provisions of section 505(b)(7) (relating to 
     clinical data submission) apply with respect to an 
     application for premarket approval of a device under 
     subsection (c) of this section to the same extent and in the 
     same manner as such provisions apply with respect to an 
     application for premarket approval of a drug under section 
     505(b).''.
       (2) Investigational devices.--Section 520(g)(2) of the 
     Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360j(g)(2)) 
     is amended by adding at the end the following subparagraph:
       ``(D) To the extent consistent with the regulation of 
     devices, the provisions of section 505(i)(5) (relating to 
     individual study information) apply with respect to an 
     application for an exemption pursuant to subparagraph (A) of 
     this paragraph to the same extent and in the same manner as 
     such provisions apply with respect to an application for an 
     exemption under section 505(i).''.

[[Page S12419]]

       (d) Rules of Construction.--This subtitle and the 
     amendments made by this subtitle may not be construed--
       (1) as establishing new requirements under the Federal 
     Food, Drug, and Cosmetic Act relating to the design of 
     clinical investigations  that were not otherwise in effect on 
     the day before the date of the enactment of this Act; or
       (2) as having any effect on the authority of the Secretary 
     of Health and Human Services to enforce regulations under the 
     Federal Food, Drug, and Cosmetic Act that are not expressly 
     referenced in this subtitle or the amendments made by this 
     subtitle.
       (e) Application.--This section and the amendments made by 
     this section apply only with respect to applications received 
     under section 505 or 515 of the Federal Food, Drug, and 
     Cosmetic Act (21 U.S.C. 355, 360e) or section 351 of the 
     Public Health Service Act (42 U.S.C. 262) on or after the 
     date of the enactment of this Act.

     SEC. 7203. REPORTING AND ANALYSIS OF PATIENT SAFETY DATA.

       (a) Data Standards.--Section 923(b) of the Public Health 
     Service Act (42 U.S.C. 299b-23(b)) is amended by adding at 
     the end the following: ``The Secretary shall provide that all 
     nonidentifiable patient safety work product reported to and 
     among the network of patient safety databases be stratified 
     by sex.''.
       (b) Use of Information.--Section 923(c) of the Public 
     Health Service Act (42 U.S.C. 299b-23(c)) is amended by 
     adding at the end the following: ``Such analyses take into 
     account data that specifically relates to women and any 
     disparities between treatment and the quality of care between 
     males and females.''.

     SEC. 7204. QUALITY OF CARE REPORTS BY THE AGENCY FOR 
                   HEALTHCARE RESEARCH AND QUALITY.

       Section 903 of the Public Health Service Act (42 U.S.C. 
     299a-1) is amended--
       (1) in subsection (b)(1)(B), by inserting before the 
     semicolon the following: ``, and including quality of and 
     access to care for women with heart disease, stroke, and 
     other cardiovascular diseases''; and
       (2) in subsection (c), by adding at the end the following:
       ``(4) Annual report on women and heart disease.--Not later 
     than September 30, 2011, and annually thereafter, the 
     Secretary, acting through the Director, shall prepare and 
     submit to Congress a report concerning the findings related 
     to the quality of and access to care for women with heart 
     disease, stroke, and other cardiovascular diseases. The 
     report shall contain recommendations for eliminating 
     disparities in, and improving the treatment of, heart 
     disease, stroke, and other cardiovascular diseases in 
     women.''.

     SEC. 7205. EXTENSION OF WISEWOMAN PROGRAM.

       Section 1509 of the Public Health Service Act (42 U.S.C. 
     300n-4a) is amended--
       (1) in subsection (a)--
       (A) by striking the heading and inserting ``In General.--
     ''; and
       (B) in the matter preceding paragraph (1), by striking 
     ``may make grants'' and all that follows through ``purpose'' 
     and inserting the following: ``may make grants to such States 
     for the purpose''; and
       (2) in subsection (d)(1), by striking ``there are 
     authorized'' and all that follows through the period and 
     inserting ``there are authorized to be appropriated 
     $70,000,000 for fiscal year 2010, $73,500,000 for fiscal year 
     2011, $77,000,000 for fiscal year 2012, $81,000,000 for 
     fiscal year 2013, and $85,000,000 for fiscal year 2014.''.
                                 ______
                                 
  SA 2885. Ms. STABENOW submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the end of subtitle B of title IV, insert the following:

     SEC. 4109. REAUTHORIZATION OF TELEHEALTH PROGRAMS.

       (a) Telemedicine; Incentive Grants Regarding Coordination 
     Among States.--Section 102(b) of the Health Care Safety Net 
     Amendments of 2002 (42 U.S.C. 254c-17(b)) is amended by 
     striking ``2002 through 2006'' and inserting ``2011 through 
     2015''.
       (b) Telehealth Network and Telehealth Resource Centers 
     Grant Programs.--Section 330I(s) of the Public Health Service 
     Act (42 U.S.C. 254c-14(s)) is amended--
       (1) in paragraph (1), by striking ``2003 through 2006'' and 
     inserting ``2011 through 2015''; and
       (2) in paragraph (2), by striking ``2003 through 2006'' and 
     inserting ``2011 through 2015''.
       (c) Mental Health Services Delivered Via Telehealth.--
     Section 330K(g) of the Public Health Service Act (42 U.S.C. 
     254c-16(g)) is amended by striking ``2003 through 2006'' and 
     inserting ``2011 through 2015''.
                                 ______
                                 
  SA 2886. Mr. FEINGOLD (for himself, Ms. Klobuchar, Mr. Kohl, and Mr. 
Wyden) submitted an amendment intended to be proposed to amendment SA 
2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       Beginning on page 751, between lines 2 and 3, insert the 
     following:

     SEC. 3022A. IMPROVEMENTS IN THE MEDICARE SHARED SAVINGS 
                   PROGRAM.

       (a) In General.--Section 1899 of the Social Security Act, 
     as added by section 3022, is amended--
       (1) in subsection (b)--
       (A) in paragraph (1)(D), by inserting ``or critical access 
     hospitals'' before the period at the end; and
       (B) in paragraph (2), by adding at the end the following 
     new subparagraph:
       ``(I) The ACO shall take into account the special needs of 
     hospitals located in rural areas.''; and
       (2) by striking subsection (d)(1)(B)(ii) and inserting the 
     following new clause:
       ``(ii) Establish and update benchmark.--The Secretary shall 
     estimate a benchmark for each agreement period for each ACO 
     that is based--

       ``(I) 50 percent on the most recent available 3 years of 
     per-beneficiary expenditures for parts A and B services for 
     Medicare fee-for-service beneficiaries assigned to the ACO; 
     and
       ``(II) 50 percent on the national average of the most 
     recent available 3 years of per-beneficiary expenditures for 
     parts A and B services for Medicare fee-for-service 
     beneficiaries.

     Such benchmark shall be adjusted for beneficiary 
     characteristics and such other factors as the Secretary 
     determines appropriate and updated by the projected absolute 
     amount of growth in national per capita expenditures for 
     parts A and B services under the original Medicare fee-for-
     service program, as estimated by the Secretary. Such 
     benchmark shall be reset at the start of each agreement 
     period. In establishing the benchmarks under this clause, the 
     Secretary implements the amendment made by section 3022A(2) 
     in a budget-neutral manner.''.
       (b) GAO Study and Report.--
       (1) Study.--The Comptroller General of the United States 
     shall conduct a study on the applicability of Accountable 
     Care Organizations (ACOs) in rural, frontier areas. Such 
     study shall include an analysis of--
       (A) ways to demonstrate that Accountable Care Organizations 
     or similar models might successfully form in rural, frontier 
     areas in order to ensure that under-populated areas are able 
     to benefit from the shared savings and care coordination 
     offered by Accountable Care Organizations; and
       (B) other areas determined appropriate by the Secretary.
       (2) Report.--Not later than January 1, 2011, the 
     Comptroller General of the United States shall submit to 
     Congress a report containing the results of the study 
     conducted under paragraph (1), together with recommendations 
     for such legislation and administrative action as the 
     Comptroller General determines appropriate.
                                 ______
                                 
  SA 2887. Mr. CORNYN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Strike section 1302 and insert the following:

     SEC. 1302. ESSENTIAL HEALTH BENEFITS REQUIREMENTS.

       In this title, the term ``essential health benefits'' 
     means, with respect to any health plan, coverage that meets 
     the same statutory requirements for plans offered to Members 
     of Congress (as enumerated in section 8904(a) of title 5, 
     United States Code).
                                 ______
                                 
  SA 2888. Mr. CORNYN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the end of section 1323, add the following:
       (1) Implementation.--Notwithstanding any other provision of 
     this title (or an amendment made by this title), this section 
     shall not take effect until such time as the Office of the 
     Actuary for the Centers for Medicare & Medicaid Services, in 
     consultation with the National Association of Insurance 
     Commissioners, certifies to Congress that the Medicare 
     program under title XVIII of the Social Security Act (42 
     U.S.C. 1395 et seq.) meets the standards for risk-based 
     capital as established by the National Association of 
     Insurance Commissioners.

[[Page S12420]]

                                 ______
                                 
  SA 2889. Mr. CARPER submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Beginning on page 1979, strike line 20 and all that follows 
     through page 1996, line 3, and insert the following:

     SEC. 9001. CAP ON EXCESS MEDICAL INFLATION.

       (a) In General.--Chapter 43 of the Internal Revenue Code of 
     1986, as amended by this Act, is amended by adding at the end 
     the following new section:

     ``SEC. 4980I. EXCESS MEDICAL COSTS OF HEALTH BENEFITS PLANS.

       ``(a) General Rule.--In the case of any health benefits 
     plan which has excess health plan costs in any plan year, 
     there is hereby imposed a penalty equal to 40 percent of such 
     excess health plan costs.
       ``(b) Excess Health Plan Costs.--For purposes of this 
     section--
       ``(1) Excess health plan costs.--The term `excess health 
     plan costs' means, with respect to any health benefits plan 
     which has an excess medical inflation rate in excess of zero 
     for any year, the product of--
       ``(A) the applicable premium of such health benefits plan 
     for such year, and
       ``(B) the excess medical inflation rate for such plan for 
     such year.
       ``(2) Excess medical inflation rate.--The term `excess 
     medical inflation rate' means, with respect to any health 
     benefits plan for any year, the amount equal to the excess 
     of--
       ``(A) the core medical inflation trend rate of such health 
     benefits plan for such year, over
       ``(B) the medical inflation cap for such year.
       ``(3) Core medical trend rate.--The term `core medical 
     trend rate' means, with respect to any health benefits plan 
     for any year, the amount (expressed as a percentage), if any, 
     by which--
       ``(A) the actuarially adjusted premium of such plan for 
     such plan for such year, exceeds
       ``(B) the applicable premium of such plan for the preceding 
     plan year.
       ``(4) Medical inflation cap.--
       ``(A) Years 2013 to 2019.--
       ``(i) In general.--In the case of any plan year beginning 
     in a calendar year after 2012 and before 2020, the medical 
     inflation cap shall be the sum of--

       ``(I) the annualized rate of growth of the gross domestic 
     product for the preceding calendar year (as calculated in the 
     third quarter of the preceding year), plus
       ``(II) the applicable amount.

       ``(ii) Applicable amount.--For purposes of clause (i)(II), 
     the applicable amount shall be determined as follows:


------------------------------------------------------------------------
 ``In the case of a plan year beginning in
              calendar year--                The applicable amount is--
------------------------------------------------------------------------
2013......................................  1.1 percentage points
2014......................................  0.8 percentage points
2015, 2016, 2017, 2018, or 2019...........  0.5 percentage points
------------------------------------------------------------------------

       ``(B) Years after 2019.--
       ``(i) In general.--In the case of any plan year beginning 
     in a calendar year after 2019, the medical inflation cap 
     shall be equal to the amount (expressed as a percentage), if 
     any, by which--

       ``(I) the average applicable premium for a low-cost plan 
     for such calendar year, exceeds
       ``(II) the average applicable premium for a low-cost plan 
     for the preceding calendar year.

       ``(ii) Average applicable premium for a low-cost plan.--For 
     purposes of this subparagraph, the term `average applicable 
     premium for a low-cost plan' means the average of the 
     applicable premiums for health benefits plans with applicable 
     premiums below the 33rd percentile, determined by weighting 
     such health benefits plans by the number of individuals 
     enrolled in the plan.
       ``(c) Applicable Premium; Actuarially Adjusted Premium.--
     For purposes of this section--
       ``(1) Applicable premium.--The term `applicable premium' 
     has the meaning given such term under section 4980B(f)(4).
       ``(2) Actuarially adjusted premium.--
       ``(A) In general.--The term `actuarially adjusted premium' 
     means, for any health benefits plan for any year, the 
     applicable premium for such year adjusted, according to 
     actuarial standards and the method prescribed by the 
     Secretary under subparagraph (B), by excluding any cost 
     attributable to--
       ``(i) the attributes of individuals (such as age, gender, 
     and health risk measures) covered under the plan,
       ``(ii) the different categories of family structure covered 
     under the plan (such as the policies with self-only coverage, 
     family coverage, or other categories of coverage), and
       ``(iii) changes in benefits or cost-sharing that result in 
     changes the actuarial value of the plan.
       ``(B) Methodology.--The Secretary, in consultation with the 
     Secretary of Health and Human Services, shall issue 
     regulations establishing a standard methodology for adjusting 
     a health benefits plan's applicable premiums under 
     subparagraph (A). In the case of any change described in 
     subparagraph (A)(iii), premiums shall be adjusted so that the 
     calculation of the core medical trend rate is made as a 
     comparison between two actuarially equivalent plans.
       ``(d) Liability for Penalties.--
       ``(1) In general.--Each coverage provider shall pay the 
     penalty imposed by subsection (a).
       ``(2) Coverage provider.--For purposes of this subsection, 
     the term `coverage provider' means each of the following:
       ``(A) Health insurance coverage.--In the case of a health 
     benefits plan provided under a group health plan which 
     provides health insurance coverage, the health insurance 
     issuer.
       ``(B) Other coverage.--In the case of any other health 
     benefits plan, the person that administers the plan benefits.
       ``(e) Exemptions.--
       ``(1) New insurers and new employers.--This section shall 
     not apply to any health benefits plan which has provided 
     coverage for less than 12 months.
       ``(2) Fixed indemnity health coverage purchased with after-
     tax dollars.--This section shall not apply to any coverage 
     described in section 9832(c)(3) the payment for which is not 
     excludable from gross income and for which a deduction under 
     section 162(l) is not allowable.
       ``(3) Certain government plans.--This section shall not 
     apply to the following:
       ``(A) Medicare.--Coverage under part A, part B, part C, or 
     part D of title XVIII of the Social Security Act.
       ``(B) Medicaid.--Coverage for medical assistance under 
     title XIX of the Social Security Act.
       ``(C) Members of the armed forces and dependents (including 
     tricare).--Coverage under chapter 55 of title 10, United 
     States Code, including similar coverage furnished under 
     section 1781 of title 38 of such Code.
       ``(D) VA.--Coverage under the veteran's health care program 
     under chapter 17 of title 38, United States Code, but only if 
     the coverage for the individual involved is determined by the 
     Secretary of Health and Human Services in coordination with 
     the Secretary to be not less than a level specified by the 
     Secretary of Health and Human Services, based on the 
     individual's priority for services as provided under section 
     1705(a) of such title.
       ``(4) Low-cost plans.--
       ``(A) In general.--This section shall not apply to any 
     health benefits plan for which the actuarial value for the 
     plan year is not more than the applicable threshold.
       ``(B) Applicable threshold.--For purposes of this 
     paragraph, the applicable threshold means the dollar amount 
     which is equal to the actuarial value of the health benefits 
     plan which is at the 10th percentile of actuarial value for 
     all health benefits plans.
       ``(f) Other Definitions and Special Rules.--
       ``(1) Health benefits plan.--
       ``(A) In general.--The term `health benefits plan' means 
     health insurance coverage and a group health plan.
       ``(B) Government plans included.--Such term shall include a 
     plan established and maintained for its civilian employees by 
     the Government of the United States or the government of any 
     State or political subdivision thereof, or by any agency or 
     instrumentality of any such government.
       ``(2) Health insurance coverage and issuer.--The terms 
     `health insurance coverage' and `health insurance issuer' 
     have the meanings given such terms by section 9832(b).
       ``(3) Group health plan.--The term `group health plan' has 
     the meaning given such term under section 5000(b).
       ``(4) Regulations for health benefits plans with different 
     product lines.--The Secretary, in consultation with the 
     Secretary of Health and Human Services, shall prescribe by 
     regulations a uniform method for the combination of product 
     lines of health benefits plans of any health insurance issuer 
     for the purpose of calculating the core medical trend rate 
     provided that the combined core medical trend rate for such 
     plans would not reduce the sum of the excess health plan 
     costs determined separately with respect to each product 
     line.
       ``(5) Special rule in the event of a merger, acquisition or 
     sell-offs among employers and insurers.--In the event of any 
     merger, acquisition, or sell-off of a health benefit plan, 
     the core medical trend rate for such plan shall be calculated 
     by attributing the applicable premium for the preceding plan 
     year to the coverage of health plan members in their previous 
     group.
       ``(6) Administration and procedure.--Any penalty under this 
     section shall be paid upon notice and demand by the 
     Secretary, and shall be assessed and collected in the same 
     manner as an assessable penalty under subchapter B of chapter 
     68.''.
       (b) Clerical Amendment.--The table of sections for chapter 
     43 of such Code, as amended by this Act, is amended by adding 
     at the end the following new item:

``Sec. 4980I. Excess medical inflation cap.''.

       (c) Effective Date.--The amendments made by this section 
     shall apply to plan years beginning after December 31, 2012.
                                 ______
                                 
  SA 2890. Mr. CARPER submitted an amendment intended to be proposed to

[[Page S12421]]

amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the appropriate place in title I, insert the following:

     SEC. __. ADVANCE CARE PLANNING.

       (a) Dissemination of Advance Care Planning Information.--
       (1) In general.--A qualified health plan (as defined in 
     section 1301(a)) shall--
       (A) provide for the dissemination of information related to 
     end-of-life planning to individuals seeking enrollment in 
     qualified health plans offered through an Exchange;
       (B) present such individuals with--
       (i) the option to establish advanced directives and 
     physician's orders for life sustaining treatment according to 
     the laws of the State in which the individual resides; and
       (ii) information related to other planning tools; and
       (C) not promote suicide, assisted suicide, euthanasia, or 
     mercy killing.

     The information presented under subparagraph (B) shall not 
     presume the withdrawal of treatment and shall include end-of-
     life planning information that includes options to maintain 
     all or most medical interventions.
       (2) Construction.--Nothing in this subsection shall be 
     construed--
       (A) to require an individual to complete an advanced 
     directive or a physician's order for life sustaining 
     treatment or other end-of-life planning document;
       (B) to require an individual to consent to restrictions on 
     the amount, duration, or scope of medical benefits otherwise 
     covered under a qualified health plan; or
       (C) to promote suicide, assisted suicide, euthanasia, or 
     mercy killing.
       (3) Advanced directive defined.--In this subsection, the 
     term ``advanced directive'' includes a living will, a comfort 
     care order, or a durable power of attorney for health care.
       (4) Prohibition on the promotion of assisted suicide.--
       (A) In general.--Subject to subparagraph (C), information 
     provided to meet the requirements of paragraph (1)(B) shall 
     not include advanced directives or other planning tools that 
     list or describe as an option suicide, assisted suicide, 
     euthanasia, or mercy killing, regardless of legality.
       (B) Construction.--Nothing in subparagraph (A) shall be 
     construed to apply to or affect any option to--
       (i) withhold or withdraw of medical treatment or medical 
     care;
       (ii) withhold or withdraw of nutrition or hydration; and
       (iii) provide palliative or hospice care or use an item, 
     good, benefit, or service furnished for the purpose of 
     alleviating pain or discomfort, even if such use may increase 
     the risk of death, so long as such item, good, benefit, or 
     service is not also furnished for the purpose of causing, or 
     the purpose of assisting in causing, death, for any reason.
       (C) No preemption of state law.--Nothing in this subsection 
     shall be construed to preempt or otherwise have any effect on 
     State laws regarding advance care planning, palliative care, 
     or end-of-life decision-making.
       (b) Voluntary Advance Care Planning Consultation Under the 
     Medicare Program.--
       (1) In general.--Section 1861 of the Social Security Act 
     (42 U.S.C. 1395x), as amended by section 4103, is amended--
       (A) in subsection (s)(2)--
       (i) by striking ``and'' at the end of subparagraph (EE);
       (ii) by adding ``and'' at the end of subparagraph (FF); and
       (iii) by adding at the end the following new subparagraph:
       ``(GG) voluntary advance care planning consultation (as 
     defined in subsection (iii)(1));''; and
       (B) by adding at the end the following new subsection:

             ``Voluntary Advance Care Planning Consultation

       ``(iii)(1) Subject to paragraphs (3) and (4), the term 
     `voluntary advance care planning consultation' means an 
     optional consultation between the individual and a 
     practitioner described in paragraph (2) regarding advance 
     care planning. Such consultation may include the following, 
     as specified by the Secretary:
       ``(A) An explanation by the practitioner of advance care 
     planning, including a review of key questions and 
     considerations, advance directives (including living wills 
     and durable powers of attorney) and their uses.
       ``(B) An explanation by the practitioner of the role and 
     responsibilities of a health care proxy and of the continuum 
     of end-of-life services and supports available, including 
     palliative care and hospice, and benefits for such services 
     and supports that are available under this title.
       ``(C) An explanation by the practitioner of physician 
     orders regarding life sustaining treatment or similar orders, 
     in States where such orders or similar orders exist.
       ``(2) A practitioner described in this paragraph is--
       ``(A) a physician (as defined in subsection (r)(1)); and
       ``(B) another health care professional (as specified by the 
     Secretary and who has the authority under State law to sign 
     orders for life sustaining treatments, such as a nurse 
     practitioner or physician assistant).
       ``(3) An individual may receive the voluntary advance care 
     planning care planning consultation provided for under this 
     subsection no more than once every 5 years unless there is a 
     significant change in the health or health-related condition 
     of the individual.
       ``(4) For purposes of this section, the term `order 
     regarding life sustaining treatment' means, with respect to 
     an individual, an actionable medical order relating to the 
     treatment of that individual that effectively communicates 
     the individual's preferences regarding life sustaining 
     treatment, is signed and dated by a practitioner, and is in a 
     form that permits it to be followed by health care 
     professionals across the continuum of care.''.
       (2) Construction.--The voluntary advance care planning 
     consultation described in section 1861(iii) of the Social 
     Security Act, as added by paragraph (1), shall be completely 
     optional. Nothing in this subsection shall--
       (A) require an individual to complete an advance directive, 
     an order for life sustaining treatment, or other advance care 
     planning document;
       (B) require an individual to consent to restrictions on the 
     amount, duration, or scope of medical benefits an individual 
     is entitled to receive under this title; or
       (C) encourage the promotion of suicide or assisted suicide.
       (3) Payment.--Section 1848(j)(3) of the Social Security Act 
     (42 U.S.C. 1395w-4(j)(3)), as amended by section 4103, is 
     amended by inserting ``(2)(GG),'' after ``assessment),''.
       (4) Frequency limitation.--Section 1862(a) of the Social 
     Security Act (42 U.S.C. 1395y(a)), as amended by section 
     4103, is amended--
       (A) in paragraph (1)--
       (i) in subparagraph (O), by striking ``and'' at the end;
       (ii) in subparagraph (P) by striking the semicolon at the 
     end and inserting ``, and''; and
       (iii) by adding at the end the following new subparagraph:
       ``(Q) in the case of voluntary advance care planning 
     consultations (as defined in paragraph (1) of section 
     1861(iii)), which are performed more frequently than is 
     covered under such section;''; and
       (B) in paragraph (7), by striking ``or (P)'' and inserting 
     ``(P), or (Q)''.
       (5) Effective date.--The amendments made by this subsection 
     shall apply to consultations furnished on or after January 1, 
     2011.
                                 ______
                                 
  SA 2891. Mr. CARPER submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 1240, between lines 5 and 6, insert the following:

     SEC. 4208. WORKPLACE WELLNESS GRANTS FOR SMALL BUSINESSES.

       (a) In General.--Beginning in fiscal year 2011, the 
     Secretary of Health and Human Services (referred to in this 
     section as the ``Secretary'') shall award grants to eligible 
     small businesses to provide access to comprehensive, 
     evidence-based workplace wellness programs.
       (b) Eligibility.--To be eligible to receive a grant under 
     subsection (a), a small business shall--
       (1) employ less than 100 full or part-time employees; and
       (2) submit to the Secretary an application at such time, in 
     such manner, and containing such information as the Secretary 
     may require, including a description of the wellness program 
     to be carried out using grant funds.
       (c) Use of Funds.--
       (1) In general.--A small business shall use amounts 
     received under a grant under this section to carry out a 
     qualifying wellness program described in paragraph (2).
       (2) Qualifying wellness program.--A qualifying wellness 
     program is described in this paragraph is a program--
       (A) under which all employees would be eligible to 
     participate;
       (B) that is consistent with evidence-based research and 
     best practices, as determined by the Secretary, such as 
     research and practices described in the Guide to Community 
     Preventive Services and Guide to Clinical Preventive Services 
     and the National Registry for Effective Programs; and
       (C) that includes the following components that have proven 
     to be effective in helping employees make health choices:
       (i) Health awareness (such as health education, preventive 
     screenings and health risk assessments).
       (ii) Employee engagement (such as mechanisms to encourage 
     employee participation).
       (iii) Behavioral change (including elements proven to help 
     alter unhealthy lifestyles such as counseling, seminars, on-
     line programs, self help materials).
       (iv) Supportive environment (such as creating on-site 
     policies that encourage healthy

[[Page S12422]]

     lifestyles, healthy eating, physical activity and mental 
     health).
       (d) Appropriations.--There is authorized to be 
     appropriated, and there is appropriated to carry out this 
     section, $200,000,000 to be used for the 5-fiscal year period 
     beginning with fiscal year 2011.
                                 ______
                                 
  SA 2892. Mr. CARPER submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 1996, between lines 3 and 4, insert the following:

     SEC. 9002. CAP ON EXCESS MEDICAL INFLATION.

       (a) In General.--Chapter 43 of the Internal Revenue Code of 
     1986, as amended by this Act, is amended by adding at the end 
     the following new section:

     ``SEC. 4980J. EXCESS MEDICAL COSTS OF HEALTH BENEFITS PLANS.

       ``(a) General Rule.--In the case of any health benefits 
     plan which has excess health plan costs in any plan year, 
     there is hereby imposed a penalty equal to 40 percent of such 
     excess health plan costs.
       ``(b) Limitation.--No penalty shall be imposed under 
     subsection (a) with respect to a health benefits plan for a 
     plan year if the excess health plan costs of such plan for 
     such year is equal to or less than 0.2 percent.
       ``(c) Excess Health Plan Costs.--For purposes of this 
     section--
       ``(1) Excess health plan costs.--The term `excess health 
     plan costs' means, with respect to any health benefits plan 
     which has an excess medical inflation rate in excess of 0.2 
     percent for any year, the product of--
       ``(A) the applicable premium of such health benefits plan 
     for such year, and
       ``(B) the excess medical inflation rate for such plan for 
     such year.
       ``(2) Excess medical inflation rate.--The term `excess 
     medical inflation rate' means, with respect to any health 
     benefits plan for any year, the amount equal to the excess 
     of--
       ``(A) the core medical inflation trend rate of such health 
     benefits plan for such year, over
       ``(B) the medical inflation cap for such year.
       ``(3) Core medical trend rate.--The term `core medical 
     trend rate' means, with respect to any health benefits plan 
     for any year, the amount (expressed as a percentage), if any, 
     by which--
       ``(A) the actuarially adjusted premium of such plan for 
     such plan for such year, exceeds
       ``(B) the applicable premium of such plan for the preceding 
     plan year.
       ``(4) Medical inflation cap.--
       ``(A) Years 2013 to 2019.--
       ``(i) In general.--In the case of any plan year beginning 
     in a calendar year after 2012 and before 2020, the medical 
     inflation cap shall be the sum of--

       ``(I) the annualized rate of growth of the gross domestic 
     product for the preceding calendar year (as calculated in the 
     third quarter of the preceding year), plus
       ``(II) the applicable amount.

       ``(ii) Applicable amount.--For purposes of clause (i)(II), 
     the applicable amount shall be determined as follows:


------------------------------------------------------------------------
 ``In the case of a plan year beginning in
              calendar year--                The applicable amount is--
------------------------------------------------------------------------
2013......................................  2.7 percentage points
2014......................................  2.4 percentage points
2015......................................  2.1 percentage points
2016......................................  1.8 percentage points
2017, 2018, or 2019.......................  1.5 percentage points
------------------------------------------------------------------------

       ``(B) Years after 2019.--
       ``(i) In general.--In the case of any plan year beginning 
     in a calendar year after 2019, the medical inflation cap 
     shall be equal to the amount (expressed as a percentage), if 
     any, by which--

       ``(I) the average applicable premium for a low-cost plan 
     for such calendar year, exceeds
       ``(II) the average applicable premium for a low-cost plan 
     for the preceding calendar year.

       ``(ii) Average applicable premium for a low-cost plan.--For 
     purposes of this subparagraph, the term `average applicable 
     premium for a low-cost plan' means the average of the 
     applicable premiums for health benefits plans with applicable 
     premiums below the 33rd percentile, determined by weighting 
     such health benefits plans by the number of individuals 
     enrolled in the plan.
       ``(d) Applicable Premium; Actuarially Adjusted Premium.--
     For purposes of this section--
       ``(1) Applicable premium.--The term `applicable premium' 
     has the meaning given such term under section 4980B(f)(4).
       ``(2) Actuarially adjusted premium.--
       ``(A) In general.--The term `actuarially adjusted premium' 
     means, for any health benefits plan for any year, the 
     applicable premium for such year adjusted, according to 
     actuarial standards and the method prescribed by the 
     Secretary under subparagraph (B), by excluding any cost 
     attributable to--
       ``(i) the attributes of individuals (such as age, gender, 
     and health risk measures) covered under the plan,
       ``(ii) the different categories of family structure covered 
     under the plan (such as the policies with self-only coverage, 
     family coverage, or other categories of coverage), and
       ``(iii) changes in benefits or cost-sharing that result in 
     changes the actuarial value of the plan.
       ``(B) Methodology.--The Secretary, in consultation with the 
     Secretary of Health and Human Services, shall issue 
     regulations establishing a standard methodology for adjusting 
     a health benefits plan's applicable premiums under 
     subparagraph (A). In the case of any change described in 
     subparagraph (A)(iii), premiums shall be adjusted so that the 
     calculation of the core medical trend rate is made as a 
     comparison between two actuarially equivalent plans.
       ``(e) Liability for Penalties.--
       ``(1) In general.--Each coverage provider shall pay the 
     penalty imposed by subsection (a).
       ``(2) Coverage provider.--For purposes of this subsection, 
     the term `coverage provider' means each of the following:
       ``(A) Health insurance coverage.--In the case of a health 
     benefits plan provided under a group health plan which 
     provides health insurance coverage, the health insurance 
     issuer.
       ``(B) Other coverage.--In the case of any other health 
     benefits plan, the person that administers the plan benefits.
       ``(f) Exemptions.--
       ``(1) New insurers and new employers.--This section shall 
     not apply to any health benefits plan which has provided 
     coverage for less than 12 months.
       ``(2) Fixed indemnity health coverage purchased with after-
     tax dollars.--This section shall not apply to any coverage 
     described in section 9832(c)(3) the payment for which is not 
     excludable from gross income and for which a deduction under 
     section 162(l) is not allowable.
       ``(3) Certain government plans.--This section shall not 
     apply to the following:
       ``(A) Medicare.--Coverage under part A, part B, part C, or 
     part D of title XVIII of the Social Security Act.
       ``(B) Medicaid.--Coverage for medical assistance under 
     title XIX of the Social Security Act.
       ``(C) Members of the armed forces and dependents (including 
     tricare).--Coverage under chapter 55 of title 10, United 
     States Code, including similar coverage furnished under 
     section 1781 of title 38 of such Code.
       ``(D) VA.--Coverage under the veteran's health care program 
     under chapter 17 of title 38, United States Code, but only if 
     the coverage for the individual involved is determined by the 
     Secretary of Health and Human Services in coordination with 
     the Secretary to be not less than a level specified by the 
     Secretary of Health and Human Services, based on the 
     individual's priority for services as provided under section 
     1705(a) of such title.
       ``(4) Low-cost plans.--
       ``(A) In general.--This section shall not apply to any 
     health benefits plan for which the actuarial value for the 
     plan year is not more than the applicable threshold.
       ``(B) Applicable threshold.--For purposes of this 
     paragraph, the applicable threshold means the dollar amount 
     which is equal to the actuarial value of the health benefits 
     plan which is at the 10th percentile of actuarial value for 
     all health benefits plans.
       ``(g) Other Definitions and Special Rules.--
       ``(1) Health benefits plan.--
       ``(A) In general.--The term `health benefits plan' means 
     health insurance coverage and a group health plan.
       ``(B) Government plans included.--Such term shall include a 
     plan established and maintained for its civilian employees by 
     the Government of the United States or the government of any 
     State or political subdivision thereof, or by any agency or 
     instrumentality of any such government.
       ``(2) Health insurance coverage and issuer.--The terms 
     `health insurance coverage' and `health insurance issuer' 
     have the meanings given such terms by section 9832(b).
       ``(3) Group health plan.--The term `group health plan' has 
     the meaning given such term under section 5000(b).
       ``(4) Regulations for health benefits plans with different 
     product lines.--The Secretary, in consultation with the 
     Secretary of Health and Human Services, shall prescribe by 
     regulations a uniform method for the combination of product 
     lines of health benefits plans of any health insurance issuer 
     for the purpose of calculating the core medical trend rate 
     provided that the combined core medical trend rate for such 
     plans would not reduce the sum of the excess health plan 
     costs determined separately with respect to each product 
     line.
       ``(5) Special rule in the event of a merger, acquisition or 
     sell-offs among employers and insurers.--In the event of any 
     merger, acquisition, or sell-off of a health benefit plan, 
     the core medical trend rate for such plan shall be calculated 
     by attributing the applicable premium for the preceding plan 
     year to the coverage of health plan members in their previous 
     group.
       ``(6) Administration and procedure.--Any penalty under this 
     section shall be paid upon notice and demand by the 
     Secretary, and shall be assessed and collected in the same 
     manner as an assessable penalty under subchapter B of chapter 
     68.''.

[[Page S12423]]

       (b) Clerical Amendment.--The table of sections for chapter 
     43 of such Code, as amended by this Act, is amended by adding 
     at the end the following new item:

``Sec. 4980J. Excess medical inflation cap.''.

       (c) Effective Date.--The amendments made by this section 
     shall apply to plan years beginning after December 31, 2012.
                                 ______
                                 
  SA 2893. Mr. CASEY (for himself and Mr. Specter) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       On page 923, between lines 7 and 8, insert the following:

     SEC. 3211. IMPROVEMENTS TO TRANSITIONAL EXTRA BENEFITS UNDER 
                   MEDICARE ADVANTAGE.

       Section 1853(p) of the Social Security Act, as added by 
     section 3201, is amended--
       (1) in paragraph (3)--
       (A) by redesignating subparagraph (C) as subparagraph (D);
       (B) in subparagraph (D), as so redesignated, by striking 
     ``(A) or (B)'' and inserting ``(A), (B), or (C)''; and
       (C) by inserting after subparagraph (B) the following new 
     subparagraph:
       ``(C) A county where the percentage of Medicare Advantage 
     eligible beneficiaries in the county who are enrolled in an 
     MA plan for the year is greater than 45 percent (as 
     determined by the Secretary).''; and
       (2) in paragraph (5), by striking ``$5,000,000,000'' and 
     inserting ``$7,500,000,000''.
                                 ______
                                 
  SA 2894. Mr. BROWN (for himself, Mr. Schumer, and Mr. Sanders) 
submitted an amendment intended to be proposed to amendment SA 2786 
proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       On page 938, strike lines 17, 18, and 19 and insert the 
     following:
       ``(A) In general.--The term `discounted price' means--
       ``(i) in the case of an applicable drug that is a biologic 
     product, 75 percent of the negotiated price of the applicable 
     drug of the manufacturer; and
       ``(ii) in the case of any other applicable drug, 50 percent 
     of the negotiated price of the applicable drug of the 
     manufacturer.
                                 ______
                                 
  SA 2895. Mr. BROWN (for himself, Mr. Schumer, and Mr. Sanders) 
submitted an amendment intended to be proposed to amendment SA 2786 
proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       On page 1906, between lines 5 and 6, insert the following:
       (i) Biological Product Exclusivity Period.--
       (1) Amendment to the public health service act.--Section 
     351 of the Public Health Service Act (as amended by 
     subsections (a) and (g)), is further amended--
       (A) in subsection (k)(7), by striking subparagraph (A) and 
     inserting the following:
       ``(A) Effective date of biosimilar application approval.--
       ``(i) In general.--Approval of an application under this 
     subsection may not be made effective by the Secretary until 
     the earlier of--

       ``(I) the date that is 12 years after the date on which the 
     reference product was first licensed under subsection (a); or
       ``(II) the date on which the Secretary determines that the 
     gross sales in the United States of the reference product 
     equals or exceeds $3,500,000,000.

       ``(ii) Annual reporting.--As a condition for receiving the 
     period of exclusivity described in clause (i), a person who 
     receives a license for a biological product under subsection 
     (a) shall, not later than January 31 of each year, report to 
     the Secretary the amount of the annual gross sales in the 
     United States in the preceding calendar year for such 
     biological product.''; and
       (B) in subsection (m)(2)(A), by striking ``12 years and 6 
     months rather than 12 years'' and inserting ``the date that 
     is 6 months after the date described in subsection 
     (k)(7)(A)(i) rather than the date described in such 
     subsection.''.
       (2) Conforming amendment.--Section 7002(h)(2) of this Act 
     is amended by striking ``the 12-year period described in 
     subsection (k)(7) of such section 351'' and inserting ``the 
     period of exclusivity described in subsection (k)(7)(A)(i) of 
     such section 351''.
                                 ______
                                 
  SA 2896. Mr. UDALL of New Mexico submitted an amendment intended to 
be proposed to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. 
Baucus, Mr. Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the 
Internal Revenue Code of 1986 to modify the first-time homebuyers 
credit in the case of members of the Armed Forces and certain other 
Federal employees, and for other purposes; which was ordered to lie on 
the table; as follows:

       On page 128, between lines 6 and 7, insert the following:
       (e) Medical Loss Ratio.--The Secretary shall develop a 
     definition for the term ``medical loss ratio'', and provide 
     standards for such term, including methods for calculating 
     loss ratios and determinations of what constitutes an 
     administrative cost.

     SEC. 1305. HEALTH INSURANCE REPORT CARDS.

       (a) In General.--Not later than one year after the date of 
     enactment of this Act, the Secretary shall develop a 
     standardized health insurance report card.
       (b) Standards.--The report card described in subsection (a) 
     shall provide measures of the performance of qualified health 
     plans with regard to--
       (1) the adequacy of the provider network;
       (2) the timeliness and accuracy of payment of claims, 
     measured with regard to claims overall and claims associated 
     with selected health conditions and medical services;
       (3) appeals and grievance procedures;
       (4) adherence to fair marketing practices;
       (5) satisfaction of minimum medical loss ratios;
       (6) non-discrimination on the basis of health status;
       (7) quality measures, as determined by the Secretary;
       (8) renewal rate increases; and
       (9) other factors, as the Secretary determines appropriate.
       (c) Data Collection.--The Secretary shall, in cooperation 
     with State insurance regulators, collect data for the purpose 
     of determining the performance of qualified health plans with 
     regard to the standards described in subsection (b).
       (d) Report Cards.--The data collected under subsection (c) 
     shall be compiled into a standardized health insurance report 
     card, described in subsection (a), and shall be made 
     available to consumers for the purpose of facilitating health 
     plan comparison and choice, including by making such report 
     cards available through the Internet portal established under 
     section 1103(a).
       (e) Use of Health Plan Report Cards by the Secretary.--The 
     Secretary--
       (1) may use the data collected under subsection (c) for 
     administrative purposes;
       (2) shall use such data to determine unreasonable increases 
     in premiums for health insurance coverage, which may trigger 
     action by the Secretary, such as imposing premium rebates or 
     other sanctions, as appropriate; and
       (3) may share such data with State insurance regulators, 
     the Secretary of the Treasury, and the Secretary of Labor, 
     for purposes of oversight and enforcement of the requirements 
     under this title, including sharing such data with 
     administrators of the Exchanges and using such data in 
     negotiations with health insurance issuers over the terms of 
     participation in such Exchanges.
                                 ______
                                 
  SA 2897. Mr. UDALL of New Mexico submitted an amendment intended to 
be proposed to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. 
Baucus, Mr. Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the 
Internal Revenue Code of 1986 to modify the first-time homebuyers 
credit in the case of members of the Armed Forces and certain other 
Federal employees, and for other purposes; which was ordered to lie on 
the table; as follows:

       On page 1529, between lines 2 and 3, insert the following:

     SEC. 1572. INCREASED FUNDING FOR WORKFORCE PROGRAMS; 
                   LIMITATION ON DEDUCTION FOR DIRECT TO CONSUMER 
                   ADVERTISING EXPENSES FOR PRESCRIPTION 
                   PHARMACEUTICALS.

       (a) Limitation on Deduction for Direct to Consumer 
     Advertising Expenses for Prescription Pharmaceuticals.--
       (1) In general.--Section 274 of the Internal Revenue Code 
     of 1986 (relating to disallowance of certain entertainment, 
     etc., expenses) is amended by redesignating subsection (o) as 
     subsection (p) and by inserting after subsection (n) the 
     following new subsection:
       ``(o) Limitation on Deduction for Direct to Consumer 
     Advertising Expenses for Prescription Pharmaceuticals.--The 
     amount allowable as a deduction under this chapter for 
     expenses relating to direct to consumer advertising in any 
     media of prescription pharmaceuticals shall not exceed 30 
     percent of the amount of such expenses which would (but for 
     this paragraph) be allowable as a deduction under this 
     chapter.''.
       (2) Effective date.--The amendments made by this subsection 
     shall apply to amounts paid or incurred after December 31, 
     2009, in taxable years ending after such date.
       (b) Health Professionals Training for Diversity.--Section 
     740(a) of the Public Health Service Act, as amended by 
     section 5402, is further amended by striking ``$51,000,000'' 
     and inserting ``$100,000,000''.

[[Page S12424]]

       (c) Teaching Health Centers.--Section 340H(g) of the Public 
     Health Service Act, as added by section 5508, is amended by 
     striking ``$230,000,000'' and inserting ``$460,000,000''.
       (d) National Health Service Corps.--Section 338H of the 
     Public Health Service Act, as amended by section 5207, is 
     further amended by striking ``$320,461,632'' and inserting 
     ``$600,000,000''.
       (e) Primary Care Training and Enhancement.--Section 747 of 
     the Public Health Service Act, as amended by section 5301, is 
     further amended by striking ``$125,000,000'' and inserting 
     ``$250,000,000''.
       (f) Training in General, Pediatric, and Public Health 
     Dentistry.--Section 748 of the Public Health Service Act, as 
     added by section 5303, is amended by striking ``$30,000,000'' 
     and inserting ``$60,000,000''.
       (g) Primary Care Extension Program.--Section 399W(f) of the 
     Public Health Service Act, as added by section 5405, is 
     amended by striking ``$120,000,000'' and inserting 
     ``$240,000,000''.
                                 ______
                                 
  SA 2898. Mr. LIEBERMAN (for himself and Ms. Collins) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       On page 1134, between lines 3 and 4, insert the following:

 Subtitle G--Additional Health Care Quality and Efficiency Improvements

     SEC. 3601. REPORT ON DEMONSTRATION AND PILOT PROGRAMS.

       (a) Report.--Not later than 12 months after the date of 
     enactment of this Act, and every 3 years thereafter, the 
     Secretary of Health and Human Services shall submit to the 
     appropriate committees of Congress a report that describes 
     all pilot programs and demonstration projects that the 
     Secretary has authority to carry out (regardless of whether 
     such programs or projects are actually implemented), as 
     authorized by law, during the period for which the report is 
     submitted.
       (b) Requirements.--A report under subsection (a) shall--
       (1) list all pilot programs or demonstration projects 
     involved and indicate whether each program or project is--
       (A) not yet being implemented;
       (B) currently being implemented; or
       (C) complete and awaiting further determinations; and
       (2) with respect to programs or projects described in 
     subparagraphs (A) or (B) of paragraph (1), include the 
     recommendations of the Secretary as to whether such programs 
     or projects are necessary.
       (c) Actions Based on Recommendations.--Based on the 
     recommendations of the Secretary under subsection (b)(2)--
       (1) if the Secretary determines that a program or project 
     is necessary, the Secretary shall submit to Congress a 
     strategic plan for the implementation of the program or 
     project and may transfer such program or project into the 
     jurisdiction of the Innovation Center of the Centers for 
     Medicare & Medicaid Services; or
       (2) if the Secretary determines that a program or project 
     is unnecessary, the Secretary may terminate the program.
       (d) Action by Congress.--Congress may continue in effect 
     any program or project terminated by the Secretary under 
     subsection (c)(2) through the enactment of a Concurrent 
     Resolution expressing the sense of Congress to continue the 
     program or project involved.

     SEC. 3602. AVAILABILITY OF DATA ON DENIAL OF CLAIMS.

       Section 2715(b)(3) of the Public Health Service Act, as 
     added by section 1001, is amended--
       (1) in subparagraph (H), by striking ``and'' at the end;
       (2) by redesignating subparagraph (I) as subparagraph (J): 
     and
       (3) by inserting after subparagraph (H) the following new 
     subparagraph:
       ``(I) a statement relating to claims procedures including 
     the percentage of claims that are annually denied by the plan 
     or coverage and the percentage of such denials that are 
     overturned on appeal; and''.

     SEC. 3603. ACCELERATION AND INCREASE OF THE PAYMENT 
                   ADJUSTMENT FOR CONDITIONS ACQUIRED IN 
                   HOSPITALS.

       Section 1886(p) of the Social Security Act (42 U.S.C. 
     1395(p)), as added by section 3008(a), is amended--
       (1) in paragraph (1)--
       (A) by striking ``2015'' and inserting ``2013''; and
       (B) by striking ``99 percent'' and inserting ``98 
     percent''; and
       (2) in paragraph (5), by striking ``2015'' and inserting 
     ``2013''.

     SEC. 3604. IMPROVEMENTS TO NATIONAL PILOT PROGRAM ON PAYMENT 
                   BUNDLING.

       Section 1866D of the Social Security Act, as added by 
     section 3023, is amended--
       (1) in subsection (a)(3), by striking ``January 1, 2013'' 
     and inserting ``January 1, 2012''; and
       (2) by amending subsection (g) to read as follows:
       ``(g) Authority to Expand Implementation.--
       ``(1) In general.--Taking into account the evaluation under 
     subparagraph (e), the Secretary may, through rulemaking, 
     expand (including implementation on a nationwide basis) the 
     duration and the scope of the pilot program, to the extent 
     determined appropriate by the Secretary, if--
       ``(A) the Secretary determines that such expansion is 
     expected to--
       ``(i) reduce spending under this title without reducing the 
     quality of care; or
       ``(ii) improve the quality of care and reduce spending; and
       ``(B) the Chief Actuary of the Centers for Medicare & 
     Medicaid Services certifies that such expansion would reduce 
     program spending under this title.
       ``(2) Implementation plan.--In the case where the Secretary 
     does not exercise the authority under paragraph (1) by 
     January 1, 2015, not later than such date, the Secretary 
     shall submit a plan for the implementation of an expansion of 
     the pilot program if the Secretary determines that such 
     expansion will result in improving or not reducing the 
     quality of patient care and reducing spending under this 
     title.''.

     SEC. 3605. ENCOURAGING MEDICARE BENEFICIARIES TO CHOOSE HIGH 
                   PERFORMING PROVIDERS.

       (a) Authorization to Establish a Pilot Program to Encourage 
     Choice of High Performing Providers.--
       (1) In general.--The Secretary of Health and Human Services 
     (in this section referred to as the ``Secretary'') may 
     establish a pilot program under which Medicare beneficiaries 
     are encouraged to choose high performing providers under the 
     Medicare program under title XVIII of the Social Security 
     Act.
       (2) Consideration of medicare value-based purchasing 
     reforms.--If the Secretary establishes a pilot program under 
     paragraph (1), the Secretary shall, as the Secretary 
     determines appropriate, take into consideration information 
     obtained under value-based purchasing reforms implemented 
     under the Medicare program, including such reforms under the 
     provisions of and amendments made by this Act, in 
     establishing such pilot program.
       (b) Development of Physician Compare Internet Website.--
       (1) In general.--Not later than January 1, 2011, the 
     Secretary shall develop a Physician Compare Internet website 
     for use by Medicare beneficiaries to access quality and 
     utilization data with respect to physicians (as defined in 
     section 1861(r) of the Social Security Act (42 U.S.C. 
     1395x(r))) participating in the Medicare program.
       (2) Information available.--Information shall be made 
     available on such Internet website on an ongoing basis as 
     follows:
       (A) Not later than January 1, 2011 (and for each subsequent 
     year before 2015), the Internet website shall include 
     information regarding which physicians received an incentive 
     payment for quality reporting under section 1848(m) of the 
     Social Security Act (42 U.S.C. 1395w-4(m)) of the Social 
     Security Act for the preceding year (and, beginning with 
     2015, which physicians received an incentive payment 
     adjustment under section 1848(a)(8) of such Act, as added by 
     section 3002(b) for the year).
       (B) On or after January 1, 2013, the Internet website may, 
     as determined appropriate by the Secretary, include 
     information on the utilization rates of physicians, as 
     determined for purposes of section 1848(a)(9) of such Act, as 
     added by section 3003.
       (C) On or after January 1, 2014, the Internet website may, 
     as determined appropriate by the Secretary, include 
     information on quality measures selected by the Secretary, in 
     consultation with the Physician Payment Advisory Committee, 
     from among measures reported under the physician reporting 
     system under section 1848(k) of such Act (42 U.S.C. 1395w-
     4(k)).
       (D) On or after January 1, 2017, the Internet website shall 
     include results of the application of the value-based payment 
     modifier established under section 1848(p) of the Social 
     Security Act, as added by section 3007, together with the 
     results of any similar provisions under title XVIII of such 
     Act, in order for Medicare beneficiaries to see how the 
     quality and cost of services furnished by physicians compares 
     to the quality and cost of services furnished by their peers. 
     Such information should, if the Secretary determines 
     appropriate, identify physicians performing in the top 50, 
     60, 70, and 80th percentiles as compared to their peers.
       (3) Report to congress.--Not later than January 1, 2019, 
     the Secretary shall submit to Congress a report on the 
     Physician Compare Internet website developed under this 
     subsection, together with recommendations for such 
     legislation and administrative action as the Secretary 
     determines appropriate.
       (4) Expansion.--At any time before the date on which the 
     report is submitted under paragraph (3), the Secretary may 
     expand (including expansion to other providers of services 
     and suppliers under part B of title XVIII of the Social 
     Security Act) the information made available on such website 
     if the Secretary determines such expansion would improve the 
     quality of care and reduce spending under such title.
       (c) Providing Financial Incentives to Beneficiaries Under 
     the Center for Medicare and Medicaid Innovation.--Section 
     1115A(b)(2)(B) of the Social Security Act, as added by 
     section 3021, is amended by adding at the end the following 
     new clause:

[[Page S12425]]

       ``(xix) Effective beginning on or after January 1, 2018, 
     providing financial incentives to Medicare beneficiaries who 
     are furnished services by high performing physicians, as 
     determined by the Secretary, taking into consideration 
     information made available on the Physician Compare Internet 
     website developed under section 3009(b) of the Patient 
     Protection and Affordable Care Act.''.
                                 ______
                                 
  SA 2899. Ms. STABENOW submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; as follows:

       At the appropriate place, insert the following:

     SEC. __. NO CUTS IN GUARANTEED BENEFITS.

       Nothing in this Act shall result in the reduction or 
     elimination of any benefits guaranteed by law to participants 
     in Medicare Advantage plans.
                                 ______
                                 
  SA 2900. Mr. UDALL of New Mexico submitted an amendment intended to 
be proposed to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. 
Baucus, Mr. Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the 
Internal Revenue Code of 1986 to modify the first-time homebuyers 
credit in the case of members of the Armed Forces and certain other 
Federal employees, and for other purposes; which was ordered to lie on 
the table; as follows:

       At the end of subtitle D of title V, insert the following:

     SEC. 5316. PREVENTIVE MEDICINE AND PUBLIC HEALTH TRAINING 
                   PROGRAMS.

       (a) In General.--Section 768 of the Public Health Service 
     Act (42 U.S.C. 295c) is amended to read as follows:

     ``SEC. 768. PREVENTIVE MEDICINE AND PUBLIC HEALTH TRAINING 
                   GRANT PROGRAM.

       ``(a) Grants.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration and in consultation with the Director of the 
     Centers for Disease Control and Prevention, shall award 
     grants to, or enter into contracts with, eligible entities to 
     provide training to graduate medical residents in preventive 
     medicine specialties.
       ``(b) Eligibility.--To be eligible for a grant or contract 
     under subsection (a), an entity shall be--
       ``(1) an accredited school of public health or school of 
     medicine or osteopathic medicine;
       ``(2) an accredited public or private nonprofit hospital;
       ``(3) a State, local, or tribal health department; or
       ``(4) a consortium of 2 or more entities described in 
     paragraphs (1) through (3).
       ``(c) Use of Funds.--Amounts received under a grant or 
     contract under this section shall be used to--
       ``(1) plan, develop (including the development of 
     curricula), operate, or participate in an accredited 
     residency or internship program in preventive medicine or 
     public health;
       ``(2) defray the costs of practicum experiences, as 
     required in such a program; and
       ``(3) establish, maintain, or improve--
       ``(A) academic administrative units (including departments, 
     divisions, or other appropriate units) in preventive medicine 
     and public health; or
       ``(B) programs that improve clinical teaching in preventive 
     medicine and public health.
       ``(d) Report.--The Secretary shall submit to the Congress 
     an annual report on the program carried out under this 
     section.''.
       (b) Reauthorization.--Section 770(a) of the Public Health 
     Service Act (42 U.S.C. 295e(a)) is amended to read as 
     follows:
       ``(a) In General.--For the purpose of carrying out this 
     subpart, there is authorized to be appropriated $43,000,000 
     for fiscal year 2011, and such sums as may be necessary for 
     each of the fiscal years 2012 through 2015.''.
                                 ______
                                 
  SA 2901. Mr. THUNE proposed an amendment to amendment SA 2786 
proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; as follows:

       Beginning on page 1925, strike line 15 and all that follows 
     through line 15 on page 1979.

                                 ______
                                 
  SA 2902. Ms. STABENOW submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the appropriate place, insert the following:

     SEC. __. NO CUTS IN GUARANTEED BENEFITS.

       Nothing in this Act shall result in the reduction or 
     elimination of any benefits guaranteed by law to participants 
     in Medicare Advantage plans.
                                 ______
                                 
  SA 2903. Ms. SNOWE (for herself, Mr. Durbin, Mr. Merkley, and Ms. 
Landrieu) submitted an amendment intended to be proposed to amendment 
SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and 
Mr. Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code 
of 1986 to modify the first-time homebuyers credit in the case of 
members of the Armed Forces and certain other Federal employees, and 
for other purposes; which was ordered to lie on the table; as follows:

       On page 126, strike lines 10 through 16.
                                 ______
                                 
  SA 2904. Ms. SNOWE submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 167, strike lines 1 through 4, and insert the 
     following:
       (d) No Interference With State Regulatory Authority.--
       (1) In general.--Except as provided in paragraph (2), 
     nothing in this title shall be construed to preempt any State 
     law that does not prevent the application of the provisions 
     of this title.
       (2) Exception for small employer mandates.--The provisions 
     of, and the amendments made by, this title shall preempt any 
     State law enacted after the date of enactment of this Act 
     that would impose a requirement on any employer with less 
     than 50 full-time employees to, or would impose a penalty on 
     such an employer for failing to, offer health insurance to 
     its employees.
                                 ______
                                 
  SA 2905. Mrs. LINCOLN (for herself, Mr. Lautenberg, Mr. Menendez, Mr. 
Franken, Mrs. Boxer, and Mr. Reed) proposed an amendment to amendment 
SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and 
Mr. Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code 
of 1986 to modify the first-time homebuyers credit in the case of 
members of the Armed Forces and certain other Federal employees, and 
for other purposes; as follows:

       On page 2040, strike line 14 and insert the following:
       (b) Dollar Limit Not To Exceed Compensation of the 
     President.--
       (1) In general.--Paragraph (6) of section 162(m) of the 
     Internal Revenue Code of 1986, as added by subsection (a), is 
     amended by adding at the end the following new subparagraph:
       ``(I) Dollar limit not to exceed compensation of the 
     president.--In the case of a taxable year in which the 
     $500,000 amount in clauses (i) and (ii) of subparagraph (A) 
     exceeds the dollar amount of the compensation received by the 
     President under section 102 of title 3, United States Code, 
     for such taxable year, such clauses shall be applied by 
     substituting the dollar amount provided in such section 102 
     for such $500,000 amount.''.
       (2) Revenue increase to be transferred to medicare trust 
     fund.--Section 1817(a) of the Social Security Act (42 U.S.C. 
     1395i(a)) is amended--
       (A) by striking ``and'' at the end of paragraph (1),
       (B) by striking the period at the end of paragraph (2) and 
     inserting ``; and'', and
       (C) by inserting after paragraph (2) the following new 
     paragraph:
       ``(3) the revenues resulting from the application of 
     section 162(m)(6) of the Internal Revenue Code of 1986, as 
     determined by the Secretary of the Treasury or such 
     Secretary's delegate.''.
       (c) Effective Date.--The amendments made by
                                 ______
                                 
  SA 2906. Ms. COLLINS submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Beginning on page 308, line 16, strike all through page 
     314, line 6, and insert the following:
       ``(c) Phaseout of Credit Amount Based on Number of 
     Employees and Average Wages.--
       ``(1) In general.--The amount of the credit determined 
     under subsection (b) without regard to this subsection shall 
     be reduced (but

[[Page S12426]]

     not below zero) by the sum of the following amounts:
       ``(A) Such amount multiplied by a fraction the numerator of 
     which is the total number of full-time equivalent employees 
     of the employer in excess of 10 and the denominator of which 
     is 40.
       ``(B) Such amount multiplied by a fraction the numerator of 
     which is the average annual wages of the employer in excess 
     of the dollar amount in effect under subsection (d)(3)(B) and 
     the denominator of which is such dollar amount.
       ``(2) Safeharbor for growing employers.--
       ``(A) In general.--Notwithstanding paragraph (1) and except 
     as provided in subparagraph (B), the amount of the credit 
     determined under subsection (b) for any taxpayer for the 
     second or third taxable year of the credit period for such 
     taxpayer shall not be reduced by an amount greater than the 
     amount by which it would be reduced if such reduction amount 
     were determined by using the same fractions determined under 
     paragraph (1) for the first taxable year of such credit 
     period.
       ``(B) Reduction in aggregate amount of contributions.--For 
     purposes of determining the amount of the credit under 
     subsection (b) for any taxpayer to whom subparagraph (A) 
     applies for any taxable year of the taxpayer in the credit 
     period after the first such taxable year, the amount of the 
     nonelective contributions made on behalf of any employee 
     whose annual wages exceed twice the dollar amount in effect 
     under subsection (d)(3)(B) for such taxable year which may be 
     taken into account under subsection (b) shall not exceed such 
     annual wages multiplied by a fraction the numerator of which 
     is twice the dollar amount so in effect and the denominator 
     of which is such annual wages.
       ``(d) Eligible Small Employer.--For purposes of this 
     section--
       ``(1) In general.--The term `eligible small employer' 
     means, with respect to any taxable year, an employer--
       ``(A) which has no more than 50 full-time equivalent 
     employees for the taxable year,
       ``(B) the average annual wages of which do not exceed an 
     amount equal to twice the dollar amount in effect under 
     paragraph (3)(B) for the taxable year, and
       ``(C) which has in effect an arrangement described in 
     paragraph (4).
     Notwithstanding subparagraphs (A) and (B), an employer which 
     is an eligible small employer for the first taxable year in a 
     credit period shall be treated as an eligible small employer 
     for the remaining taxable years in such credit period.
       ``(2) Full-time equivalent employees.--
       ``(A) In general.--The term `full-time equivalent 
     employees' means a number of employees equal to the number 
     determined by dividing--
       ``(i) the total number of hours of service for which wages 
     were paid by the employer to employees during the taxable 
     year, by
       ``(ii) 2,080.

     Such number shall be rounded to the next lowest whole number 
     if not otherwise a whole number.
       ``(B) Excess hours not counted.--If an employee works in 
     excess of 2,080 hours of service during any taxable year, 
     such excess shall not be taken into account under 
     subparagraph (A).
       ``(C) Hours of service.--The Secretary, in consultation 
     with the Secretary of Labor, shall prescribe such 
     regulations, rules, and guidance as may be necessary to 
     determine the hours of service of an employee, including 
     rules for the application of this paragraph to employees who 
     are not compensated on an hourly basis.
       ``(3) Average annual wages.--
       ``(A) In general.--The average annual wages of an eligible 
     small employer for any taxable year is the amount determined 
     by dividing--
       ``(i) the aggregate amount of wages which were paid by the 
     employer to employees during the taxable year, by
       ``(ii) the number of full-time equivalent employees of the 
     employee determined under paragraph (2) for the taxable year.

     Such amount shall be rounded to the next lowest multiple of 
     $1,000 if not otherwise such a multiple.
       ``(B) Dollar amount.--For purposes of paragraph (1)(B)--
       ``(i) 2011, 2012, and 2013.--The dollar amount in effect 
     under this paragraph for taxable years beginning in 2011, 
     2012, or 2013 is $25,000.
       ``(ii) Subsequent years.--In the case of a taxable year 
     beginning in a calendar year after 2013, the dollar amount in 
     effect under this paragraph shall be equal to $25,000, 
     multiplied by the cost-of-living adjustment determined under 
     section 1(f)(3) for the calendar year, determined by 
     substituting `calendar year 2012' for `calendar year 1992' in 
     subparagraph (B) thereof.
       ``(4) Contribution arrangement.--An arrangement is 
     described in this paragraph if it requires an eligible small 
     employer to make a nonelective contribution on behalf of each 
     employee who enrolls in a qualified health plan offered to 
     employees by the employer through an exchange in an amount 
     equal to a uniform percentage (not less than 50 percent) of 
     the premium cost of the qualified health plan.
       ``(5) Seasonal worker hours and wages not counted.--For 
     purposes of this subsection--
       ``(A) In general.--The number of hours of service worked 
     by, and wages paid to, a seasonal worker of an employer shall 
     not be taken into account in determining the full-time 
     equivalent employees and average annual wages of the employer 
     unless the worker works for the employer on more than 120 
     days during the taxable year.
       ``(B) Definition of seasonal worker.--The term `seasonal 
     worker' means a worker who performs labor or services on a 
     seasonal basis as defined by the Secretary of Labor, 
     including workers covered by section 500.20(s)(1) of title 
     29, Code of Federal Regulations and retail workers employed 
     exclusively during holiday seasons.
       ``(e) Other Rules and Definitions.--For purposes of this 
     section--
       ``(1) Employee.--
       ``(A) Certain employees excluded.--The term `employee' 
     shall not include--
       ``(i) an employee within the meaning of section 401(c)(1),
       ``(ii) any 2-percent shareholder (as defined in section 
     1372(b)) of an eligible small business which is an S 
     corporation,
       ``(iii) any 5-percent owner (as defined in section 
     416(i)(1)(B)(i)) of an eligible small business, or
       ``(iv) any individual who bears any of the relationships 
     described in subparagraphs (A) through (G) of section 
     152(d)(2) to, or is a dependent described in section 
     152(d)(2)(H) of, an individual described in clause (i), (ii), 
     or (iii).
       ``(B) Leased employees.--The term `employee' shall include 
     a leased employee within the meaning of section 414(n).
       ``(2) Credit period.--The term `credit period' means, with 
     respect to any eligible small employer, the 3-consecutive-
     taxable year period beginning with the 1st taxable year in 
     which the employer (or any predecessor) offers 1 or more 
     qualified health plans to its employees through an Exchange.
                                 ______
                                 
  SA 2907. Ms. KLOBUCHAR (for herself, Mr. Thune, and Mr. Johnson) 
submitted an amendment intended to be proposed to amendment SA 2786 
proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       On page 828, between lines 3 and 4, insert the following:

     SEC. 3130. REMOTE MONITORING PILOT PROJECTS.

       (a) Pilot Projects.--
       (1) In general.--Not later than 9 months after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services (in this section referred to as the ``Secretary'') 
     shall conduct pilot projects under title XVIII of the Social 
     Security Act for the purpose of providing incentives to home 
     health agencies to utilize home monitoring and communications 
     technologies that--
       (A) enhance health outcomes for medicare beneficiaries; and
       (B) reduce expenditures under such title.
       (2) Site requirements.--
       (A) Urban and rural.--The Secretary shall conduct the pilot 
     projects under this section in both urban and rural areas.
       (B) Site in a small state.--The Secretary shall conduct at 
     least 1 of the pilot projects in a State with a population of 
     less than 1,000,000.
       (3) Definition of home health agency.--In this section, the 
     term ``home health agency'' has the meaning given that term 
     in section 1861(o) of the Social Security Act (42 U.S.C. 
     1395x(o)).
       (b) Medicare Beneficiaries Within the Scope of Projects.--
     The Secretary shall specify the criteria for identifying 
     those medicare beneficiaries who shall be considered within 
     the scope of the pilot projects under this section for 
     purposes of the application of subsection (c) and for the 
     assessment of the effectiveness of the home health agency in 
     achieving the objectives of this section. Such criteria may 
     provide for the inclusion in the projects of medicare 
     beneficiaries who begin receiving home health services under 
     title XVIII of the Social Security Act after the date of the 
     implementation of the projects.
       (c) Incentives.--
       (1) Performance targets.--The Secretary shall establish for 
     each home health agency participating in a pilot project 
     under this section a performance target using one of the 
     following methodologies, as determined appropriate by the 
     Secretary:
       (A) Adjusted historical performance target.--The Secretary 
     shall establish for the agency--
       (i) a base expenditure amount equal to the average total 
     payments made to the agency under parts A and B of title 
     XVIII of the Social Security Act for medicare beneficiaries 
     determined to be within the scope of the pilot project in a 
     base period determined by the Secretary; and
       (ii) an annual per capita expenditure target for such 
     beneficiaries, reflecting the base expenditure amount 
     adjusted for risk and adjusted growth rates.
       (B) Comparative performance target.--The Secretary shall 
     establish for the agency a comparative performance target 
     equal to the average total payments under such parts A and B 
     during the pilot project for comparable individuals in the 
     same geographic area that are not determined to be within the 
     scope of the pilot project.

[[Page S12427]]

       (2) Incentive.--Subject to paragraph (3), the Secretary 
     shall pay to each participating home care agency an incentive 
     payment for each year under the pilot project equal to a 
     portion of the medicare savings realized for such year 
     relative to the performance target under paragraph (1).
       (3) Limitation on expenditures.--The Secretary shall limit 
     incentive payments under this section in order to ensure that 
     the aggregate expenditures under title XVIII of the Social 
     Security Act (including incentive payments under this 
     subsection) do not exceed the amount that the Secretary 
     estimates would have been expended if the pilot projects 
     under this section had not been implemented.
       (d) Waiver Authority.--The Secretary may waive such 
     provisions of titles XI and XVIII of the Social Security Act 
     as the Secretary determines to be appropriate for the conduct 
     of the pilot projects under this section.
       (e) Report to Congress.--Not later than 5 years after the 
     date that the first pilot project under this section is 
     implemented, the Secretary shall submit to Congress a report 
     on the pilot projects. Such report shall contain a detailed 
     description of issues related to the expansion of the 
     projects under subsection (f) and recommendations for such 
     legislation and administrative actions as the Secretary 
     considers appropriate.
       (f) Expansion.--If the Secretary determines that any of the 
     pilot projects under this section enhance health outcomes for 
     Medicare beneficiaries and reduce expenditures under title 
     XVIII of the Social Security Act, the Secretary may initiate 
     comparable projects in additional areas.
       (g) Incentive Payments Have No Effect on Other Medicare 
     Payments to Agencies.--An incentive payment under this 
     section--
       (1) shall be in addition to the payments that a home health 
     agency would otherwise receive under title XVIII of the 
     Social Security Act for the provision of home health 
     services; and
       (2) shall have no effect on the amount of such payments.
                                 ______
                                 
  SA 2908. Ms. KLOBUCHAR (for herself and Mr. Kohl) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       On page 492, between lines 15 and 16, insert the following:

     SEC. 2407. SUPPORT FOR FAMILY CAREGIVERS UNDER MEDICARE AND 
                   MEDICAID.

       (a) Medicare Family Caregiver Information and Referral.--
     State health insurance assistance programs, the Administrator 
     of the Centers for Medicare & Medicaid Services, and the 
     Assistant Secretary of the Administration on Aging shall, in 
     collaboration with each other, directly or by contract, 
     develop practical, easy-to-understand information and 
     referral protocols for health care providers, social workers, 
     and other appropriate individuals to provide to family 
     caregivers of Medicare beneficiaries either on admission to 
     or discharge from a hospital (including a discharge from a 
     hospital emergency room or a hospital outpatient department 
     which has furnished a surgical service) or a post-acute care 
     setting (including a skilled nursing facility (as defined in 
     section 1819(a) of the Social Security Act (42 U.S.C. 1395i-
     3(a)), a comprehensive rehabilitation facility (as defined in 
     section 1861(cc)(2) of such Act (42 U.S.C. 1395x(cc)(2)) or a 
     rehabilitation agency, a provider of long-term care services, 
     and a home health agency (as defined in section 1861(o) of 
     such Act (42 U.S.C. 1395x(o)). Information developed under 
     the preceding sentence shall--
       (1) include information on national, State, and community-
     based resources for seniors, individuals with disabilities 
     and their caregivers, which shall be updated on a semi-annual 
     basis (or as frequently as practicable);
       (2) be disseminated by health care providers, social 
     workers, and other appropriate individuals as printed 
     materials (including materials in Spanish and other languages 
     (other than English) as appropriate); and
       (3) be made available on the Internet websites of State 
     health insurance assistance programs, the Centers for 
     Medicare & Medicaid Services, and the Administration on 
     Aging.
       (b) Medicaid Assessment of Family Caregiver Support 
     Needs.--
       (1) In general.--Section 1915 of the Social Security Act 
     (42 U.S.C. 1396n), as amended by section 2401, is amended--
       (A) in subsection (c)(2)--
       (i) in subparagraph (D), by striking ``and'' at the end;
       (ii) in subparagraph (E), by striking the period at the end 
     and inserting ``; and''; and
       (iii) by adding at the end the following new subparagraph:
       ``(F) under such waiver the State may provide for an 
     assessment of family caregiver support needs (in accordance 
     with subsection (l)).'';
       (B) in subsection (d)(2)--
       (i) in subparagraph (B), by striking ``and'' at the end;
       (ii) in subparagraph (C), by striking the period at the end 
     and inserting ``; and''; and
       (iii) by adding at the end the following new subparagraph:
       ``(D) under such waiver the State may provide for an 
     assessment of family caregiver support needs (in accordance 
     with subsection (l)).'';
       (C) in subsection (i)(1)(F), by adding at the end the 
     following new clause:
       ``(vii) Where appropriate, an assessment of family 
     caregiver support needs (in accordance with subsection 
     (l)).''; and
       (D) by adding at the end the following new subsection:
       ``(l) Assessment of Family Caregiver Support Needs.--
       ``(1) In general.--In the case of an individual who is 
     determined to be eligible for home and community-based 
     services under a waiver under subsection (c) or (d) or under 
     section 1115, under a State plan amendment under subsection 
     (i), under an MFP demonstration project established under 
     section 6071 of the Deficit Reduction Act of 2005, or as part 
     of self-directed personal assistance services provided 
     pursuant to a written plan of care in accordance with the 
     requirements of subsection (j), and who is dependent upon the 
     assistance of a family caregiver, the State may provide for 
     an assessment of the family caregiver support needs of the 
     individual. Such assessment shall, to the extent feasible, be 
     conducted at the same time as, or closely coordinated with, 
     the determination of the eligibility of the individual for 
     such services.
       ``(2) Questionnaire.--
       ``(A) In general.--Such assessment shall include asking the 
     family caregiver of the individual questions in order to 
     determine whether they would benefit from targeted support 
     services (such as those services described in paragraph (3)).
       ``(B) Completion on a voluntary basis.--The answering of 
     questions under subparagraph (A) by a family caregiver shall 
     be on a voluntary basis.
       ``(3) Targeted support services described.--The following 
     targeted support services are described in this paragraph:
       ``(A) Respite care and emergency back-up services 
     (including short-term help for the individual that gives the 
     family caregiver a break from providing such care).
       ``(B) Individual counseling (including advice and 
     consultation sessions to bolster emotional support for the 
     family caregiver to make well-informed decisions about how to 
     cope with the strain of supporting the individual).
       ``(C) Support groups, including groups which provide help 
     for family caregivers to--
       ``(i) locate a support group either locally or online to 
     share experiences and reduce isolation;
       ``(ii) make well-informed decisions about caring for the 
     individual; and
       ``(iii) reduce isolation.
       ``(D) Information and assistance (including brochures and 
     online resources for researching a disease or disability or 
     learning and managing a regular caregiving role, new 
     technologies that can assist family caregivers, and practical 
     assistance for locating services).
       ``(E) Chore services (such as house cleaning).
       ``(F) Personal care (including outside help).
       ``(G) Education and training (including workshops and other 
     resources available with information about stress management, 
     self-care to maintain good physical and mental health, 
     understanding and communicating with individuals with 
     dementia, medication management, normal aging processes, 
     change in disease and disability, the role of assistive 
     technologies, and other relevant topics).
       ``(H) Legal and financial planning and consultation 
     (including advice and counseling regarding long-term care 
     planning, estate planning, powers of attorney, community 
     property laws, tax advice, employment leave advice, advance 
     directives, and end-of-life care).
       ``(I) Transportation (including transportation to medical 
     appointments).
       ``(J) Other targeted support services the Secretary or the 
     State determines appropriate.
       ``(4) Referrals.--In the case where a questionnaire 
     completed by a family caregiver under paragraph (2) indicates 
     that the family caregiver would benefit from 1 or more of the 
     targeted support services described in paragraph (3), the 
     State shall provide referrals to the family caregiver for 
     local, State, and private-sector family caregiver programs 
     and other resources that provide such targeted support 
     services.''.
       (2) Effective date.--The amendments made by paragraph (1) 
     shall apply to medical assistance for home and community-
     based services that is provided on or after the date of 
     enactment of this Act.
                                 ______
                                 
  SA 2909. Mr. NELSON of Florida (for himself, Mr. Reid, Mr. Schumer, 
Mr. Kerry, Ms. Stabenow, and Mr. Leahy) submitted an amendment intended 
to be proposed to amendment SA 2786 proposed by Mr. Reid (for himself, 
Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend 
the Internal Revenue Code of 1986 to modify the first-time homebuyers 
credit in the case of members of the Armed Forces and certain other 
Federal employees,

[[Page S12428]]

and for other purposes; which was ordered to lie on the table; as 
follows:

       Beginning on page 1449, strike line 1 and all that follows 
     through page 1458, line 5, and insert the following:

     SEC. 5503. DISTRIBUTION OF ADDITIONAL RESIDENCY POSITIONS.

       (a) In General.--Section 1886(h) of the Social Security Act 
     (42 U.S.C. 1395ww(h)) is amended--
       (1) in paragraph (4)(F)(i), by striking ``paragraph (7)'' 
     and inserting ``paragraphs (7) and (8)'';
       (2) in paragraph (4)(H)(i), by striking ``paragraph (7)'' 
     and inserting ``paragraphs (7) and (8)''; and
       (3) by adding at the end the following new paragraph:
       ``(8) Distribution of additional residency positions.--
       ``(A) Additional residency positions.--
       ``(i) Reduction in limit based on unused positions.--

       ``(I) In general.--The Secretary shall reduce the otherwise 
     applicable resident limit for a hospital that the Secretary 
     determines had residency positions that were unused for all 5 
     of the most recent cost reporting periods ending prior to the 
     date of enactment of this paragraph by an amount that is 
     equal to the number of such unused residency positions.
       ``(II) Exception for rural hospitals and certain other 
     hospitals.--This subparagraph shall not apply to a hospital--

       ``(aa) located in a rural area (as defined in subsection 
     (d)(2)(D)(ii));
       ``(bb) that has participated in a voluntary reduction plan 
     under paragraph (6); or
       ``(cc) that has participated in a demonstration project 
     approved as of October 31, 2003, under the authority of 
     section 402 of Public Law 90-248.
       ``(ii) Number available for distribution.--The number of 
     additional residency positions available for distribution 
     under subparagraph (B) shall be an amount that the Secretary 
     determines would result in a 15 percent increase in the 
     aggregate number of full-time equivalent residents in 
     approved medical training programs (as determined based on 
     the most recent cost reports available at the time of 
     distribution). One-third of such number shall only be 
     available for distribution to hospitals described in 
     subclause (I) of subparagraph (B)(ii) under such 
     subparagraph.
       ``(B) Distribution.--
       ``(i) In general.--The Secretary shall increase the 
     otherwise applicable resident limit for each qualifying 
     hospital that submits an application under this subparagraph 
     by such number as the Secretary may approve for portions of 
     cost reporting periods occurring on or after the date of 
     enactment of this paragraph. The aggregate number of 
     increases in the otherwise applicable resident limit under 
     this subparagraph shall be equal to the number of additional 
     residency positions available for distribution under 
     subparagraph (A)(ii).
       ``(ii) Distribution to hospitals already operating over 
     resident limit.--

       ``(I) In general.--Subject to subclause (II), in the case 
     of a hospital in which the reference resident level of the 
     hospital (as specified in clause (iii)) is greater than the 
     otherwise applicable resident limit, the increase in the 
     otherwise applicable resident limit under this subparagraph 
     shall be an amount equal to the product of the total number 
     of additional residency positions available for distribution 
     under subparagraph (A)(ii) and the quotient of--

       ``(aa) the number of resident positions by which the 
     reference resident level of the hospital exceeds the 
     otherwise applicable resident limit for the hospital; and
       ``(bb) the number of resident positions by which the 
     reference resident level of all such hospitals with respect 
     to which an application is approved under this subparagraph 
     exceeds the otherwise applicable resident limit for such 
     hospitals.

       ``(II) Requirements.--A hospital described in subclause 
     (I)--

       ``(aa) is not eligible for an increase in the otherwise 
     applicable resident limit under this subparagraph unless the 
     amount by which the reference resident level of the hospital 
     exceeds the otherwise applicable resident limit is not less 
     than 10 and the hospital trains at least 25 percent of the 
     full-time equivalent residents of the hospital in primary 
     care and general surgery (as of the date of enactment of this 
     paragraph); and
       ``(bb) shall continue to train at least 25 percent of the 
     full-time equivalent residents of the hospital in primary 
     care and general surgery for the 10-year period beginning on 
     such date.

     In the case where the Secretary determines that a hospital no 
     longer meets the requirement of item (bb), the Secretary may 
     reduce the otherwise applicable resident limit of the 
     hospital by the amount by which such limit was increased 
     under this clause.
       ``(III) Clarification regarding eligibility for other 
     additional residency positions.--Nothing in this clause shall 
     be construed as preventing a hospital described in subclause 
     (I) from applying for additional residency positions under 
     this paragraph that are not reserved for distribution under 
     this clause.

       ``(iii) Reference resident level.--

       ``(I) In general.--Except as otherwise provided in 
     subclause (II), the reference resident level specified in 
     this clause for a hospital is the resident level for the most 
     recent cost reporting period of the hospital ending on or 
     before the date of enactment of this paragraph, for which a 
     cost report has been settled (or, if not, submitted (subject 
     to audit)), as determined by the Secretary.
       ``(II) Use of most recent accounting period to recognize 
     expansion of existing program or establishment of new 
     program.--If a hospital submits a timely request to increase 
     its resident level due to an expansion of an existing 
     residency training program or the establishment of a new 
     residency training program that is not reflected on the most 
     recent cost report that has been settled (or, if not, 
     submitted (subject to audit)), subject to the discretion of 
     the Secretary, the reference resident level for such hospital 
     is the resident level for the cost reporting period that 
     includes the additional residents attributable to such 
     expansion or establishment, as determined by the Secretary.

       ``(C) Considerations in redistribution.--In determining for 
     which hospitals the increase in the otherwise applicable 
     resident limit is provided under subparagraph (B) (other than 
     an increase under subparagraph (B)(ii)), the Secretary shall 
     take into account the demonstrated likelihood of the hospital 
     filling the positions within the first 3 cost reporting 
     periods beginning on or after July 1, 2010, made available 
     under this paragraph, as determined by the Secretary.
       ``(D) Priority for certain areas.--In determining for which 
     hospitals the increase in the otherwise applicable resident 
     limit is provided under subparagraph (B) (other than an 
     increase under subparagraph (B)(ii)), the Secretary shall 
     distribute the increase to hospitals based on the following 
     criteria:
       ``(i) The Secretary shall give preference to hospitals that 
     submit applications for new primary care and general surgery 
     residency positions. In the case of any increase based on 
     such preference, a hospital shall ensure that--

       ``(I) the position made available as a result of such 
     increase remains a primary care or general surgery residency 
     position for not less than 10 years after the date on which 
     the position is filled; and
       ``(II) the total number of primary care and general surgery 
     residency positions in the hospital (determined based on the 
     number of such positions as of the date of such increase, 
     including any position added as a result of such increase) is 
     not decreased during such 10-year period.

     In the case where the Secretary determines that a hospital no 
     longer meets the requirement of subclause (II), the Secretary 
     may reduce the otherwise applicable resident limit of the 
     hospital by the amount by which such limit was increased 
     under this paragraph.
       ``(ii) The Secretary shall give preference to hospitals 
     that emphasize training in community health centers and other 
     community-based clinical settings.
       ``(iii) The Secretary shall give preference to hospitals in 
     States that have more medical students than residency 
     positions available (including a greater preference for those 
     States with smaller resident-to-medical-student ratios). In 
     determining the number of medical students in a State for 
     purposes of the preceding sentence, the Secretary shall 
     include planned students at medical schools which have 
     provisional accreditation by the Liaison Committee on Medical 
     Education or the American Osteopathic Association.
       ``(iv) The Secretary shall give preference to hospitals in 
     States that have low resident-to-population ratios (including 
     a greater preference for those States with lower resident-to-
     population ratios).
       ``(E) Limitation.--
       ``(i) In general.--Except as provided in clause (ii), in no 
     case may a hospital (other than a hospital described in 
     subparagraph (B)(ii)(I), subject to the limitation under 
     subparagraph (B)(ii)(III)) apply for more than 50 full-time 
     equivalent additional residency positions under this 
     paragraph.
       ``(ii) Increase in number of additional positions available 
     for distribution.--The Secretary shall increase the number of 
     full-time equivalent additional residency positions a 
     hospital may apply for under this paragraph if the Secretary 
     determines that the number of additional residency positions 
     available for distribution under subparagraph (A)(ii) exceeds 
     the number of such applications approved.
       ``(F) Application of per resident amounts for primary care 
     and nonprimary care.--With respect to additional residency 
     positions in a hospital attributable to the increase provided 
     under this paragraph, the approved FTE resident amounts are 
     deemed to be equal to the hospital per resident amounts for 
     primary care and nonprimary care computed under paragraph 
     (2)(D) for that hospital.
       ``(G) Distribution.--The Secretary shall distribute the 
     increase to hospitals under this paragraph not later than 2 
     years after the date of enactment of this paragraph.''.
       (b) IME.--
       (1) In general.--Section 1886(d)(5)(B)(v) of the Social 
     Security Act (42 U.S.C. 1395ww(d)(5)(B)(v)), in the second 
     sentence, is amended--
       (A) by striking ``subsection (h)(7)'' and inserting 
     ``subsections (h)(7) and (h)(8)''; and
       (B) by striking ``it applies'' and inserting ``they 
     apply''.
       (2) Conforming provision.--Section 1886(d)(5)(B) of the 
     Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended by 
     adding at the end the following clause:
       ``(x) For discharges occurring on or after the date of 
     enactment of this clause, insofar as an additional payment 
     amount under this

[[Page S12429]]

     subparagraph is attributable to resident positions 
     distributed to a hospital under subsection (h)(8)(B), the 
     indirect teaching adjustment factor shall be computed in the 
     same manner as provided under clause (ii) with respect to 
     such resident positions.''.
                                 ______
                                 
  SA 2910. Mr. FRANKEN (for himself, Mr. Rockefeller, Mrs. Lincoln, Mr. 
Whitehouse, Mr. Leahy, Mr. Sanders, Mr. Brown, and Mr. Begich) 
submitted an amendment intended to be proposed to amendment SA 2786 
proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       After section 1003, insert the following:

     SEC. 1004. BRINGING DOWN THE COST OF HEALTH CARE COVERAGE.

       (a) In General.--Section 2718 of the Public Health Service 
     Act, as added by section 1001, is amended to read as follows:

     ``SEC. 2718. BRINGING DOWN THE COST OF HEALTH CARE COVERAGE.

       ``(a) Clear Accounting for Costs.--A group health plan and 
     a health insurance issuer offering group or individual health 
     insurance coverage shall, with respect to each plan year, 
     submit to the Secretary a report concerning the percentage of 
     total premium revenue that such coverage expends--
       ``(1) on reimbursement for clinical services provided to 
     enrollees under such coverage;
       ``(2) for activities that improve health care quality; and
       ``(3) on all other non-claims costs, including an 
     explanation of the nature of such costs, and excluding State 
     taxes and licensing or regulatory fees.

     The Secretary shall make reports received under this section 
     available to the public on the Internet website of the 
     Department of Health and Human Services.
       ``(b) Ensuring That Consumers Receive Value for Their 
     Premium Payments.--
       ``(1) Requirement to provide value for premium payments.--A 
     group health plan and a health insurance issuer offering 
     group or individual health insurance coverage shall, with 
     respect to each plan year, provide an annual rebate to each 
     enrollee under such coverage, on a pro rata basis, in an 
     amount that is equal to the amount by which premium revenue 
     expended by the plan or issuer on activities described in 
     subsection (a)(3) exceeds 10 percent, or such lower 
     percentage as a State may by regulation determine.
       ``(2) Consideration in setting percentages.--In determining 
     the percentages under paragraph (1), a State shall seek to 
     ensure adequate participation by group health plans and 
     health insurance issuers, competition in the health insurance 
     market in the State, and value for consumers so that premiums 
     are used for clinical services and quality improvements.
       ``(3) Enforcement.--The Secretary shall promulgate 
     regulations for enforcing the provisions of this section and 
     may provide for appropriate penalties.
       ``(c) Standard Hospital Charges.--Each hospital operating 
     within the United States shall for each year establish (and 
     update) and make public (in accordance with guidelines 
     developed by the Secretary) a list of the hospital's standard 
     charges for items and services provided by the hospital, 
     including for diagnosis-related groups established under 
     section 1886(d)(4) of the Social Security Act.
       ``(d) Definitions.--Not later than December 31, 2010, the 
     Secretary, in consultation with the National Association of 
     Insurance Commissioners, shall establish uniform definitions 
     of the activities reported under subsection (a) and 
     standardized methodologies for calculating measures of such 
     activities.''.
       (b) Technical Amendments.--
       (1) ERISA.--Section 715(b) of the Employee Retirement 
     Income Security Act, as amended by section 1562(e), is 
     further amended by striking ``sections 2716 and 2718'' and 
     inserting ``section 2716''.
       (2) IRC.--Section 9815(b) of the Internal Revenue Code of 
     1986 is amended by striking ``sections 2716 and 2718'' and 
     inserting ``section 2716''.
                                 ______
                                 
  SA 2911. Mr. FRANKEN (for himself and Mr. Lugar) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       At the end of subtitle C of title IV, insert the following:

     SEC. 4208. NATIONAL DIABETES PREVENTION PROGRAM.

       Part P of title III of the Public Health Service Act 42 
     U.S.C. 280g et seq.), as amended by section 5405, is further 
     amended by adding at the end the following:

     ``SEC. 399V-2. NATIONAL DIABETES PREVENTION PROGRAM.

       ``(a) In General.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention, 
     shall establish a national diabetes prevention program 
     (referred to in this section as the `program') targeted at 
     adults at high risk for diabetes in order to eliminate the 
     preventable burden of diabetes.
       ``(b) Program Activities.--The program described in 
     subsection (a) shall include--
       ``(1) a grant program for community-based diabetes 
     prevention program model sites;
       ``(2) a program within the Centers for Disease Control and 
     Prevention to determine eligibility of entities to deliver 
     community-based diabetes prevention services;
       ``(3) a training and outreach program for lifestyle 
     intervention instructors; and
       ``(4) evaluation, monitoring and technical assistance, and 
     applied research carried out by the Centers for Disease 
     Control and Prevention.
       ``(c) Eligible Entities.--To be eligible for a grant under 
     subsection (b)(1), an entity shall be a State or local health 
     department, a tribal organization, a national network of 
     community-based non-profits focused on health and wellbeing, 
     an academic institution, or other entity, as the Secretary 
     determines.
       ``(d) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there are authorized to be 
     appropriated such sums as may be necessary for each of fiscal 
     years 2010 through 2014.''.
                                 ______
                                 
  SA 2912. Mr. WHITEHOUSE submitted an amendment intended to be 
proposed to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. 
Baucus, Mr. Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the 
Internal Revenue Code of 1986 to modify the first-time homebuyers 
credit in the case of members of the Armed Forces and certain other 
Federal employees, and for other purposes; which was ordered to lie on 
the table; as follows:

       At the appropriate place in title IV, insert the following:

     SEC. __. PROGRAM OF PAYMENTS TO CHILDREN'S HOSPITALS THAT 
                   OPERATE GRADUATE MEDICAL EDUCATION PROGRAMS.

       Section 340E(g)(2) of the Public Health Service Act (42 
     U.S.C. 256e(g)) is amended--
       (1) by striking ``means a'' and inserting ``means--
       ``(A) a'';
       (2) by striking the period and inserting ``; or''; and
       (3) by adding at the end the following:
       ``(B) a freestanding psychiatric hospital with 90 percent 
     or more inpatients under the age of 18, that has its own 
     Medicare provider number as of December 6, 1999, and that has 
     an accredited residency program.''.
                                 ______
                                 
  SA 2913. Mr. WHITEHOUSE (for himself and Mr. Casey) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       On page 1507, after line 19, insert the following:

     SEC. 5510. SUPPORT OF GRADUATE MEDICAL EDUCATION PROGRAMS IN 
                   WOMEN'S HOSPITALS.

       Subpart IX of part D of title III of the Public Health 
     Service Act (42 U.S.C. 256e et seq.) is amended--
       (1) in the subpart heading, by adding ``and Women's 
     Hospitals'' at the end; and
       (2) by adding at the end the following:

     ``SEC. 340E-1. SUPPORT OF GRADUATE MEDICAL EDUCATION PROGRAMS 
                   IN WOMEN'S HOSPITALS.

       ``(a) Payments.--The Secretary shall make two payments 
     under this section to each women's hospital for each of 
     fiscal years 2010 through 2014, one for the direct expenses 
     and the other for indirect expenses associated with operating 
     approved graduate medical residency training programs. The 
     Secretary shall promulgate regulations pursuant to the 
     rulemaking requirements of title 5, United States Code, which 
     shall govern payments made under this subpart.
       ``(b) Amount of Payments.--
       ``(1) In general.--Subject to paragraphs (2) and (3), the 
     amounts payable under this section to a women's hospital for 
     an approved graduate medical residency training program for a 
     fiscal year shall be each of the following:
       ``(A) Direct expense amount.--The amount determined in 
     accordance with subsection (c) for direct expenses associated 
     with operating approved graduate medical residency training 
     programs for a fiscal year.
       ``(B) Indirect expense amount.--The amount determined in 
     accordance with subsection (c) for indirect expenses 
     associated with the treatment of more severely ill patients 
     and the additional costs relating to teaching residents in 
     such programs for a fiscal year.
       ``(2) Capped amount.--
       ``(A) In general.--The total of the payments made to 
     women's hospitals under

[[Page S12430]]

     paragraph (1)(A) or paragraph (1)(B) in a fiscal year shall 
     not exceed the funds appropriated under subsection (e) for 
     such payments for that fiscal year.
       ``(B) Pro rata reductions of payments for direct 
     expenses.--If the Secretary determines that the amount of 
     funds appropriated under subsection (e) for a fiscal year is 
     insufficient to provide the total amount of payments 
     otherwise due for such periods under paragraph (1)(A), the 
     Secretary shall reduce the amounts so payable on a pro rata 
     basis to reflect such shortfall.
       ``(3) Annual reporting required.--The provisions of 
     subsection (b)(3) of section 340E shall apply to women's 
     hospitals under this section in the same manner as such 
     provisions apply to children's hospitals under such section 
     340E. In applying such provisions, the Secretary may make 
     such modifications as may be necessary to apply such 
     provisions to women's hospitals.
       ``(c) Application of Certain Provisions.--The provisions of 
     subsections (c) and (d) of section 340E shall apply to 
     women's hospitals under this section in the same manner as 
     such provisions apply to children's hospitals under such 
     section 340E. In applying such provisions, the Secretary may 
     make such modifications as may be necessary to apply such 
     provisions to women's hospitals.
       ``(d) Making of Payments.--
       ``(1) Interim payments.--The Secretary shall determine, 
     before the beginning of each fiscal year involved for which 
     payments may be made for a hospital under this section, the 
     amounts of the payments for direct graduate medical education 
     and indirect medical education for such fiscal year and shall 
     (subject to paragraph (2)) make the payments of such amounts 
     in 12 equal interim installments during such period. Such 
     interim payments to each individual hospital shall be based 
     on the number of residents reported in the hospital's most 
     recently filed Medicare cost report prior to the application 
     date for the Federal fiscal year for which the interim 
     payment amounts are established. In the case of a hospital 
     that does not report residents on a Medicare cost report, 
     such interim payments shall be based on the number of 
     residents trained during the hospital's most recently 
     completed Medicare cost report filing period.
       ``(2) Withholding.--The Secretary shall withhold up to 25 
     percent from each interim installment for direct and indirect 
     graduate medical education paid under paragraph (1) as 
     necessary to ensure a hospital will not be overpaid on an 
     interim basis.
       ``(3) Reconciliation.--Prior to the end of each fiscal 
     year, the Secretary shall determine any changes to the number 
     of residents reported by a hospital in the application of the 
     hospital for the current fiscal year to determine the final 
     amount payable to the hospital for the current fiscal year 
     for both direct expense and indirect expense amounts. Based 
     on such determination, the Secretary shall recoup any 
     overpayments made and pay any balance due to the extent 
     possible. The final amount so determined shall be considered 
     a final intermediary determination for the purposes of 
     section 1878 of the Social Security Act and shall be subject 
     to administrative and judicial review under that section in 
     the same manner as the amount of payment under section 
     1886(d) of such Act is subject to review under such section.
       ``(e) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, 
     $12,000,000 for fiscal year 2010, and such sums as may be 
     necessary for each of fiscal years 2011 through 2014.
       ``(f) Definitions.--In this section:
       ``(1) Approved graduate medical residency training 
     program.--The term `approved graduate medical residency 
     training program' has the meaning given the term `approved 
     medical residency training program' in section 1886(h)(5)(A) 
     of the Social Security Act.
       ``(2) Direct graduate medical education costs.--The term 
     `direct graduate medical education costs' has the meaning 
     given such term in section 1886(h)(5)(C) of the Social 
     Security Act.
       ``(3) Women's hospital.--The term `women's hospital' means 
     a hospital--
       ``(A) that has a Medicare provider agreement under title 
     XVIII of the Social Security Act;
       ``(B) that has an approved graduate medical residency 
     training program;
       ``(C) that has not been excluded from the Medicare 
     prospective payment system;
       ``(D) that had at least 3,000 births during 2007, as 
     determined by the Centers for Medicare & Medicaid Services; 
     and
       ``(E) with respect to which and as determined by the 
     Centers for Medicare & Medicaid Services, less than 4 percent 
     of the total discharges from the hospital during 2007 were 
     Medicare discharges of individuals who, as of the time of the 
     discharge--
       ``(i) were enrolled in the original Medicare fee-for-
     service program under part A of title XVIII of the Social 
     Security Act; and
       ``(ii) were not enrolled in--

       ``(I) a Medicare Advantage plan under part C of title XVIII 
     of that Act;
       ``(II) an eligible organization under section 1876 of that 
     Act; or
       ``(III) a PACE program under section 1894 of that Act.''.

                                 ______
                                 
  SA 2914. Mr. WHITEHOUSE submitted an amendment intended to be 
proposed to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. 
Baucus, Mr. Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the 
Internal Revenue Code of 1986 to modify the first-time homebuyers 
credit in the case of members of the Armed Forces and certain other 
Federal employees, and for other purposes; which was ordered to lie on 
the table; as follows:

       On page 2029, between lines 4 and 5, insert the following:
       (c) Performance Adjustment to Annual Fee.--
       (1) In general.--The Secretary shall--
       (A) in the case of a penalized covered entity, increase the 
     fee determined under subsection (b) for a calendar year as 
     provided in paragraph (3), and
       (B) in the case of any other covered entity, reduce the fee 
     determined under subsection (b) for a calendar year as 
     provided in paragraph (4).
       (2) Penalized covered entity described.--
       (A) In general.--For purposes of this paragraph, the term 
     ``penalized covered entity'' means a covered entity that the 
     Secretary determines has failed to meet the key performance 
     thresholds (established under subparagraph (B)) for the 
     calendar year involved.
       (B) Key performance thresholds.--The key performance 
     thresholds established under this subparagraph are as 
     follows:
       (i) Medical loss ratio threshold.--The covered entity has a 
     medical loss ratio, as reported under section 2718(a)(1) of 
     the Public Health Service Act, of not less than 85 percent. 
     The Secretary, in consultation with the Secretary of Health 
     and Human Services may increase, but not decrease, such 
     percentage by regulation.
       (ii) Maximum financial reserve threshold.--

       (I) In general.--The covered entity has a financial reserve 
     which is not greater than the amount established under 
     regulations by the Secretary, in consultation with the 
     Secretary of Health and Human Services. The Secretary may 
     establish different thresholds for different categories of 
     covered entity under this section. The Secretary, in 
     consultation with the National Association of Insurance 
     Commissioners, shall establish a uniform methodology for 
     reporting financial reserve levels and determining maximum 
     financial reserve thresholds under this subparagraph.
       (II) Reports.--Each covered entity shall annually submit a 
     report (in a manner to be established by the Secretary 
     through regulation) to the Secretary and the Secretary of 
     Health and Human Services containing such information about 
     the financial reserves of the entity as the Secretary may 
     require. The rules of subsection (g)(2) shall apply to the 
     information required to be reported under this subclause.

       (3) Amount of fee increase.--
       (A) In general.--In the case of a penalized covered entity, 
     the fee determined under subsection (b) for the calendar year 
     shall be increased by the penalty amount.
       (B) Penalty amount.--
       (i) In general.--The penalty amount shall be the product 
     of--

       (I) the amount determined under subsection (b), and
       (II) the sum of the amounts determined under subparagraphs 
     (C) and (D).

       (ii) Limitation.--The penalty amount shall not exceed 20 
     percent of the amount determined under subsection (b).
       (C) Medical loss ratio component.--The amount determined 
     under this subparagraph is the amount equal to the excess 
     of--
       (i) the medical loss ratio threshold established under 
     paragraph (2)(A), over
       (ii) the medical loss ratio (expressed in decimal form) of 
     the penalized covered entity.
       (D) Financial reserve component.--The amount determined 
     under this subparagraph is the amount equal to the ratio of--
       (i) the excess of--

       (I) the financial reserves of the penalized covered entity, 
     over
       (II) the maximum financial reserve threshold established 
     under paragraph (2)(B)(ii), to

       (ii) such maximum financial reserve threshold.
       (4) Reduction in fee.--
       (A) In general.--
       (i) Amount of reduction.--In the case of any covered entity 
     that is not a penalized covered entity, the fee determined 
     under subsection (b) for the calendar year shall be reduced 
     by an amount equal to the product of--

       (I) the sum of all penalty amounts assessed in the calendar 
     year under paragraph (3), and
       (II) the fee redistribution ratio.

       (ii) Limitation.--The reduction under this paragraph shall 
     not exceed 20 percent of the amount determined under 
     subsection (b).
       (B) Fee distribution ratio.--For purposes of this 
     paragraph, the fee redistribution ratio is the ratio of--
       (i) the weighted net written premium amount of the covered 
     entity, to
       (ii) the aggregate of the weighted net written premium 
     amount of all covered entities.
       (C) Weighted net written premium amount.--For purposes of 
     this paragraph, the weighted net written premium amount with 
     respect to any covered entity is the amount described in 
     subsection (b)(1)(A)(i) with respect to such covered entity, 
     increased by the product of--
       (i) such amount, and
       (ii) the product of 0.05 and the sum of the amounts 
     determined under subparagraphs (D) and (E).

[[Page S12431]]

       (D) Medical loss ratio component.--The amount determined 
     under this subparagraph is the amount equal to the excess 
     of--
       (i) the medical loss ratio (expressed as a percentage) of 
     the covered entity, over
       (ii) the medical loss ratio threshold established under 
     paragraph (2)(A).
       (E) Financial reserve component.--The amount determined 
     under this subparagraph is the amount equal to the ratio of--
       (i) the excess of--

       (I) the maximum financial reserve threshold established 
     under paragraph (2)(B)(ii), over
       (II) the financial reserves of the covered entity, to

       (ii) such maximum financial reserve threshold.
                                 ______
                                 
  SA 2915. Mrs. SHAHEEN (for herself, Mr. Brown, Mr. Menendez, and Mr. 
Lautenberg) submitted an amendment intended to be proposed to amendment 
SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and 
Mr. Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code 
of 1986 to modify the first-time homebuyers credit in the case of 
members of the Armed Forces and certain other Federal employees, and 
for other purposes; which was ordered to lie on the table; as follows:

       On page 531, line 2, insert the following after the period: 
     ``In awarding planning grants, the Secretary shall give 
     preference to States that agree to develop a State plan 
     amendment that includes methodologies and procedures that are 
     intended to improve coordination of care for eligible 
     individuals with chronic conditions who are high users of 
     health care services (including emergency room and inpatient 
     hospital services), including through the use of referrals to 
     health homes and outreach care management services.''
                                 ______
                                 
  SA 2916. Mr. UDALL of New Mexico (for himself and Mr. Bingaman) 
submitted an amendment intended to be proposed to amendment SA 2786 
proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       On page 1539, line 7, insert ``in a rural area (as defined 
     in section 1886(d)(2)(D)), a medically underserved community 
     (as defined in section 799B(6) of the Public Health Service 
     Act), or'' after ``located''.
                                 ______
                                 
  SA 2917. Mr. MENENDEZ submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 116, between lines 6 and 7, insert the following:
       (4) Special rule regarding pregnancy.--An individual who 
     becomes pregnant and is enrolled in a catastrophic plan 
     described under this subsection may, notwithstanding any 
     other provision of law, enroll in another qualified health 
     plan during such individual's pregnancy.
                                 ______
                                 
  SA 2918. Mr. MENENDEZ (for himself, Ms. Stabenow, and Mr. Sanders) 
submitted an amendment intended to be proposed to amendment SA 2786 
proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. 
Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 
1986 to modify the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employees, and for other 
purposes; which was ordered to lie on the table; as follows:

       On page 116, between lines 13 and 14, insert the following:
       (g) Payments to Federally-Qualified Health Centers.--If any 
     item or service covered by a qualified health plan is 
     provided by a Federally-qualified health center (as defined 
     in section 1905(l)(2)(B) of the Social Security Act (42 
     U.S.C. 1396d(l)(2)(B)) to an enrollee of the plan, the 
     offeror of the plan shall pay to the center for the item or 
     service an amount that is not less than the amount of payment 
     that would have been paid to the center under section 
     1902(bb) of such Act (42 U.S.C. 1396a(bb)) for such item or 
     service.
                                 ______
                                 
  SA 2919. Mr. MENENDEZ submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Beginning on page 33, strike line 5 and all that follows 
     through line 4 on page 34 and insert the following:

     ``SEC. 2719. APPEALS PROCESS.

       ``(a) Internal Claims Appeals.--A group health plan and a 
     health insurance issuer offering group or individual health 
     insurance coverage shall implement an effective appeals 
     process for appeals of coverage determinations and claims, 
     under which the plan or issuer shall, at a minimum--
       ``(1) have in effect an internal claims appeal process;
       ``(2) provide notice to enrollees, in a culturally and 
     linguistically appropriate manner, of available internal and 
     external appeals processes, and the availability of any 
     applicable office of health insurance consumer assistance or 
     ombudsman established under section 2793 to assist such 
     enrollees with the appeals processes; and
       ``(3) allow an enrollee to review their file, to present 
     evidence and testimony as part of the appeals process, and to 
     receive continued coverage pending the outcome of the appeals 
     process.
       ``(b) External Review.--A group health plan and a health 
     insurance issuer offering group or individual health 
     insurance coverage--
       ``(1) shall comply with the applicable State external 
     review process for such plans and issuers that, at a minimum, 
     includes the consumer protections set forth in the Uniform 
     External Review Model Act promulgated by the National 
     Association of Insurance Commissioners and is binding on such 
     plans; or
       ``(2) shall implement an effective external review process 
     that meets minimum standards established by the Secretary 
     through guidance and that is similar to the process described 
     under paragraph (1)--
       ``(A) if the applicable State has not established an 
     external review process that meets the requirements of 
     paragraph (1); or
       ``(B) if the plan is a self-insured plan that is not 
     subject to State insurance regulation (including a State law 
     that establishes an external review process described in 
     paragraph (1)).''.
                                 ______
                                 
  SA 2920. Mr. MENENDEZ submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       After section 1103, insert the following:

     SEC. 1104. REPORTING REQUIREMENTS REGARDING THE RATE OF 
                   DENIAL OF COVERAGE AND ENROLLMENT BY HEALTH 
                   INSURANCE ISSUERS.

       (a) Requirements Regarding Denial of Coverage for Medical 
     Services.--
       (1) In general.--Not later than 90 days after the date of 
     enactment of this Act, the Secretary shall promulgate 
     regulations requiring health insurance issuers to report 
     annually to the Secretary data concerning--
       (A) each denial of coverage for medical services to a plan 
     enrollee in the preceding year, listed by the types of 
     services for which coverage was denied; and
       (B) the reasons such coverage was denied.
       (2) Publication of data.--The Secretary shall make the data 
     reported under paragraph (1) available to the public on the 
     Internet website described in section 1103(a).
       (b) Requirements Regarding Denial of Enrollment in a Health 
     Insurance Plan.--
       (1) In general.--Not later than January 1, 2011, the 
     Secretary shall issue regulations requiring each health 
     insurance issuer to report annually to the Secretary data 
     concerning--
       (A) each incident in which such issuer, in the preceding 
     year, denied the application of an individual to enroll in a 
     health insurance plan offered by such issuer; and
       (B) the reasons each such application was denied.
       (2) Publication of data.--The Secretary shall make the data 
     reported under paragraph (1) available to the public on the 
     Internet website described in section 1103(a).
       (3) Sunset.--The requirements under this subsection shall 
     cease to have effect on January 1, 2014.
       (c) Consultation.--In developing the regulations under 
     subsection (a)(1) and (b)(1) and collecting data as required 
     by such subsections, the Secretary shall consult with State 
     insurance commissioners and the National Association of 
     Insurance Commissioners.
       (d) Applicability of Requirements.--The reporting 
     requirements under this section shall apply to all health 
     insurance issuers and all health insurance plans, without 
     regard to whether such issuer offers a qualified health plan, 
     or whether such plan is a qualified health plan, as described 
     in subtitle D.
                                 ______
                                 
  SA 2921. Ms. STABENOW (for herself and Mrs. McCaskill) submitted an 
amendment intended to be proposed to amendment SA 2786 proposed by Mr.

[[Page S12432]]

Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; which was 
ordered to lie on the table; as follows:

       On page 2074, after line 25, insert the following:

    Subtitle C--Provisions Related to Improving Tax Incentives for 
                Individuals and Employers Under Title I

                       PART I--GENERAL PROVISIONS

     SEC. 9031. PREMIUM ASSISTANCE CREDIT.

       (a) In General.--Section 36B(b)(3)(A)(i) of the Internal 
     Revenue Code of 1986, as added by section 1401, is amended by 
     striking ``7'' each place it appears and inserting ``6''.
       (b) Effective Date.--The amendment made by this section 
     shall take effect as if included in section 1401.

     SEC. 9032. SMALL EMPLOYER HEALTH INSURANCE CREDIT.

       (a) In General.--Notwithstanding section 1421(f) of this 
     Act--
       (1) the amendments made by subsections (a), (b), (d), and 
     (e) of section 1421 shall apply to taxable years beginning 
     after December 31, 2009, and
       (2) the amendments made by subsection (c) of section 1421 
     shall apply to credits determined under section 45R of the 
     Internal Revenue Code of 1986 in taxable years beginning 
     after December 31, 2009.
       (b) Conforming Amendments.--
       (1) Clause (i) of section 45R(d)(3)(B) of the Internal 
     Revenue Code of 1986, as added by section 1421, is amended by 
     inserting ``2010,'' before ``2011'' each place it appears in 
     the text and in the heading.
       (2) Subsection (g) of section 45R of such Code, as added by 
     section 1421, is amended by inserting ``2010,'' before 
     ``2011'' each place it appears in the text and in the 
     heading.
       (3) Section 280C(h) of such Code, as added by section 1421, 
     is amended by inserting ``2010,'' before ``2011''.
       (c) Effective Date.--The amendments made by subsection (b) 
     shall apply to taxable years beginning after December 31, 
     2009.

                      PART II--REVENUE PROVISIONS

     SEC. 9035. SURTAX ON INVESTMENT INCOME.

       (a) In General.--
       (1) Surtax.--
       (A) Imposition of tax.--Subtitle A of the Internal Revenue 
     Code of 1986 is amended by redesignating chapter 3 as chapter 
     4 and by inserting after chapter 2 the following new chapter:

                 ``CHAPTER 3--TAX ON INVESTMENT INCOME

``Sec. 1411. Rate of tax.
``Sec. 1412. Investment income.

     ``SEC. 1411. RATE OF TAX.

       ``(a) In General.--In addition to other taxes, there shall 
     be imposed for each taxable year on the investment income of 
     every taxpayer (other than a corporation, estate, or trust) a 
     tax equal to 1.45 percent of such investment income for such 
     taxable year.
       ``(b) Phase-in of Rate.--The rate under subsection (a) 
     (determined without regard to this subsection) shall be 
     reduced (but not below zero) by the amount which bears the 
     same ratio to such rate as--
       ``(1) the excess of--
       ``(A) $240,000 ($290,000 in the case of a joint return), 
     over
       ``(B) the taxpayer's adjusted gross income for the taxable 
     year, bears to
       ``(2) $40,000.

     ``SEC. 1412. INVESTMENT INCOME.

       ``(a) In General.--For purposes of this chapter, the term 
     `investment income' means the sum of--
       ``(1) capital gain net income, and
       ``(2) net investment income.
       ``(b) Net Investment Income.--For purposes of this chapter, 
     the term `net investment income' means the net income (other 
     than income which is included in self-employment income for 
     purposes of chapter 2) from--
       ``(1) dividends,
       ``(2) interest (other than interest which is excludable 
     from income under chapter 1), and
       ``(3) investment property income.
       ``(c) Investment Property.--For purposes of this chapter, 
     the term `investment property income' means income 
     (determined after taking into account any deduction allowed 
     under chapter 1 with respect to such income) derived from--
       ``(1) any property held for the production of rents or 
     royalties,
       ``(2) any partnership or S corporation,
       ``(3) any estate or trust in which the taxpayer is a 
     beneficiary, and
       ``(4) any real estate mortgage investment conduit in which 
     the taxpayer is a residual holder.
       ``(d) Taxable Years Ending as the Result of a Death.--Rules 
     similar to the rules of section 1402(f) shall apply with 
     respect to investment income in a taxable year which ends as 
     a result of the death of the taxpayer.''.
       (2) Estimated taxes.--Section 6654 of the Internal Revenue 
     Code of 1986 is amended --
       (A) in subsection (a), by striking ``and the tax under 
     chapter 2'' and inserting ``the tax under chapter 2, and the 
     tax under chapter 3'', and
       (B) in subsection (f)--
       (i) by striking ``minus'' at the end of paragraph (2) and 
     inserting ``plus'', and
       (ii) by redesignating paragraph (3) as paragraph (4) and by 
     inserting after paragraph (2) the following new paragraph:
       ``(3) the taxed imposed by chapter 3, minus''.
       (3) Returns.--
       (A) In general.--Subpart B of part II of subchapter A of 
     chapter 61 of the Internal Revenue Code of 1986 is amended by 
     adding at the end the following new section:

     ``SEC. 6017A. INVESTMENT INCOME TAX RETURNS.

       ``Every taxpayer (other than a corporation, estate, or 
     trust) having investment income for the taxable year shall 
     make a return with respect to the investment income tax 
     imposed by chapter 3.''.
       (B) Conforming amendment.--The table of sections for 
     subpart B of part II of subchapter A of chapter 61 of such 
     Code is amended by adding at the end the following new item:

``Sec. 6017A. Investment income tax returns.''.

       (4) Conforming amendments.--
       (A) The following sections of the Internal Revenue Code of 
     1986 are amended by striking ``chapter 3'' and inserting 
     ``chapter 4'' each place it appears:
       (i) Section 33.
       (ii) Section 864(b).
       (iii) Section 871(k)(1)(B)(ii).
       (iv) Section 877A(d)(5).
       (v) Section 896(a).
       (vi) Section 3402(t)(2)(A).
       (vii) Section 3405(e)(1)(B)(iii).
       (viii) Paragraphs (2)(C)(iv), (5)(A), and (5)(B) of section 
     6049(b).
       (ix) Section 6414.
       (x) Paragraphs (1) and (2) of section 6501(b).
       (xi) Subsections (b)(3) and (c) of section 6513.
       (xii) Paragraphs (1) and (2) of section 6724(d).
       (B) Clerical amendment.--The table of chapters for subtitle 
     A of chapter 1 of the Internal Revenue Code of 1986 is 
     amended by redesignating the item relating to chapter 3 as 
     relating to chapter 4 and by inserting after the item 
     relating to chapter 2 the following new item:

                ``Chapter 3--Tax on Investment Income''.

       (5) Effective date.--The amendments made by this subsection 
     shall apply to taxable years beginning after December 31, 
     2012.
       (b) Transfer of Amounts to Federal Hospital Insurance Trust 
     Fund.--Section 1817(a) of the Social Security Act (42 U.S.C. 
     1395i(a)) is amended by striking ``and'' at the end of 
     paragraph (1), by striking the period at the end of paragraph 
     (2) and inserting ``; and'', and by inserting after paragraph 
     (2) the following new paragraph:
       ``(3) the taxes imposed by section 1411 of the Internal 
     Revenue Code of 1986 with respect to investment income 
     reported to the Secretary of the Treasury or his delegate on 
     tax returns under subtitle F of such Code, as determined by 
     the Secretary of the Treasury by applying the applicable rate 
     of tax under such section to such investment income, which 
     investment income shall be certified by the Commissioner of 
     Social Security on the basis of records of investment income 
     established and maintained by the Commissioner of Social 
     Security.''.
                                 ______
                                 
  SA 2922. Mr. DORGAN submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 567, after line 19, add the following:

     SEC. 2903. FUNDING FOR CONTRACT MEDICAL CARE FOR INDIANS.

       Title VIII of the Indian Health Care Improvement Act (25 
     U.S.C. 1671 et seq.) is amended by adding at the end the 
     following:

     ``SEC. 826. FUNDING FOR CONTRACT MEDICAL CARE.

       ``(a) Appropriation.--For the purpose of the Secretary, 
     acting through the Service, providing payment for contract 
     medical care to Indians, there is appropriated, out of any 
     money in the Treasury not otherwise appropriated, such sums 
     as may be necessary, not to exceed--
       ``(1) for fiscal year 2010, $625,000,000;
       ``(2) for fiscal year 2011, $2,500,000,000;
       ``(3) for each of fiscal years 2012 through 2014, the limit 
     specified under this subsection for the preceding fiscal 
     year, increased by the percentage increase (if any) in the 
     medical care component of the Consumer Price Index for All 
     Urban Consumers (all items; United States city average) over 
     such preceding fiscal year; and
       ``(4) for the first quarter of fiscal year 2015, one-fourth 
     of the limit specified under this subsection for fiscal year 
     2014, increased by the percentage increase (if any) in the 
     medical care component of the Consumer Price Index for All 
     Urban Consumers (all items; United States city average) over 
     such preceding fiscal year.
       ``(b) No Effect on Other Funding for This Act; 
     Availability.--Funds appropriated under subsection (a) 
     shall--
       ``(1) be in addition to any other amounts made available 
     under law (including under a

[[Page S12433]]

     provision of this Act, the Social Security Act, the Indian 
     Self-Determination and Education Assistance Act (25 U.S.C. 
     450 et seq.), or any other law) for payment for providing 
     contract medical care to Indians; and
       ``(2) remain available until expended.
       ``(c) Study and Report.--Not later than October 1, 2015, 
     the Secretary shall study and submit a report to the 
     Committee on Natural Resources of the House of 
     Representatives and the Committee on Indian Affairs of the 
     Senate on the extent to which the funds appropriated under 
     this section have assisted in reducing health disparities 
     among Indians.
       ``(d) Budget Authority.--This section constitutes budget 
     authority in advance of appropriations Acts and represents 
     the obligation of the Federal Government to provide for 
     payment of the amounts provided under subsection (a).
       ``(e) Definition.--In this section, the term `Indian health 
     program' means--
       ``(1) any health program administered directly by the 
     Service;
       ``(2) any tribal health program; and
       ``(3) any Indian tribe or tribal organization to which the 
     Secretary of Health and Human Services provides funding 
     pursuant to section 23 of the Act of June 25, 1910 (25 U.S.C. 
     47) (commonly known as the `Buy Indian Act').''.
                                 ______
                                 
  SA 2923. Mr. DORGAN (for himself, Mr. Whitehouse, Mr. Udall of New 
Mexico, Mr. Begich, Mr. Johnson, Mr. Franken, Ms. Cantwell, Mr. Udall 
of Colorado, Mr. Tester, and Mr. Inouye) submitted an amendment 
intended to be proposed to amendment SA 2786 proposed by Mr. Reid (for 
himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill H.R. 3590, 
to amend the Internal Revenue Code of 1986 to modify the first-time 
homebuyers credit in the case of members of the Armed Forces and 
certain other Federal employees, and for other purposes; as follows:

       At the end, add the following:

  DIVISION B--INDIAN HEALTH CARE IMPROVEMENT ACT REAUTHORIZATION AND 
                               EXTENSION

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Indian 
     Health Care Improvement Reauthorization and Extension Act of 
     2009''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.

    TITLE I--INDIAN HEALTH CARE IMPROVEMENT ACT REAUTHORIZATION AND 
                               AMENDMENTS

Sec. 101. Reauthorization.
Sec. 102. Findings.
Sec. 103. Declaration of national Indian health policy.
Sec. 104. Definitions.

                   Subtitle A--Indian Health Manpower

Sec. 111. Community Health Aide Program.
Sec. 112. Health professional chronic shortage demonstration programs.
Sec. 113. Exemption from payment of certain fees.

                      Subtitle B--Health Services

Sec. 121. Indian Health Care Improvement Fund.
Sec. 122. Catastrophic Health Emergency Fund.
Sec. 123. Diabetes prevention, treatment, and control.
Sec. 124. Other authority for provision of services; shared services 
              for long-term care.
Sec. 125. Reimbursement from certain third parties of costs of health 
              services.
Sec. 126. Crediting of reimbursements.
Sec. 127. Behavioral health training and community education programs.
Sec. 128. Cancer screenings.
Sec. 129. Patient travel costs.
Sec. 130. Epidemiology centers.
Sec. 131. Indian youth grant program.
Sec. 132. American Indians Into Psychology Program.
Sec. 133. Prevention, control, and elimination of communicable and 
              infectious diseases.
Sec. 134. Methods to increase clinician recruitment and retention 
              issues.
Sec. 135. Liability for payment.
Sec. 136. Offices of Indian Men's Health and Indian Women's Health.
Sec. 137. Contract health service administration and disbursement 
              formula.

                     Subtitle C--Health Facilities

Sec. 141. Health care facility priority system.
Sec. 142. Indian health care delivery demonstration projects.
Sec. 143. Tribal management of federally owned quarters.
Sec. 144. Other funding, equipment, and supplies for facilities.
Sec. 145. Indian country modular component facilities demonstration 
              program.
Sec. 146. Mobile health stations demonstration program.

                 Subtitle D--Access to Health Services

Sec. 151. Treatment of payments under Social Security Act health 
              benefits programs.
Sec. 152. Purchasing health care coverage.
Sec. 153. Grants to and contracts with the Service, Indian tribes, 
              tribal organizations, and urban Indian organizations to 
              facilitate outreach, enrollment, and coverage of Indians 
              under Social Security Act health benefit programs and 
              other health benefits programs.
Sec. 154. Sharing arrangements with Federal agencies.
Sec. 155. Eligible Indian veteran services.
Sec. 156. Nondiscrimination under Federal health care programs in 
              qualifications for reimbursement for services.
Sec. 157. Access to Federal insurance.
Sec. 158. General exceptions.
Sec. 159. Navajo Nation Medicaid Agency feasibility study.

             Subtitle E--Health Services for Urban Indians

Sec. 161. Facilities renovation.
Sec. 162. Treatment of certain demonstration projects.
Sec. 163. Requirement to confer with urban Indian organizations.
Sec. 164. Expanded program authority for urban Indian organizations.
Sec. 165. Community health representatives.
Sec. 166. Use of Federal Government facilities and sources of supply; 
              health information technology.

                Subtitle F--Organizational Improvements

Sec. 171. Establishment of the Indian Health Service as an agency of 
              the Public Health Service.
Sec. 172. Office of Direct Service Tribes.
Sec. 173. Nevada area office.

                 Subtitle G--Behavioral Health Programs

Sec. 181. Behavioral health programs.

                       Subtitle H--Miscellaneous

Sec. 191. Confidentiality of medical quality assurance records; 
              qualified immunity for participants.
Sec. 192. Arizona, North Dakota, and South Dakota as contract health 
              service delivery areas; eligibility of California 
              Indians.
Sec. 193. Methods to increase access to professionals of certain corps.
Sec. 194. Health services for ineligible persons.
Sec. 195. Annual budget submission.
Sec. 196. Prescription drug monitoring.
Sec. 197. Tribal health program option for cost sharing.
Sec. 198. Disease and injury prevention report.
Sec. 199. Other GAO reports.
Sec. 199A. Traditional health care practices.
Sec. 199B. Director of HIV/AIDS Prevention and Treatment.

                   TITLE II--AMENDMENTS TO OTHER ACTS

Sec. 201. Medicare amendments.
Sec. 202. Reauthorization of Native Hawaiian health care programs.

    TITLE I--INDIAN HEALTH CARE IMPROVEMENT ACT REAUTHORIZATION AND 
                               AMENDMENTS

     SEC. 101. REAUTHORIZATION.

       (a) In General.--Section 825 of the Indian Health Care 
     Improvement Act (25 U.S.C. 1680o) is amended to read as 
     follows:

     ``SEC. 825. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated such sums as are 
     necessary to carry out this Act for fiscal year 2010 and each 
     fiscal year thereafter, to remain available until 
     expended.''.
       (b) Repeals.--The following provisions of the Indian Health 
     Care Improvement Act are repealed:
       (1) Section 123 (25 U.S.C. 1616p).
       (2) Paragraph (6) of section 209(m) (25 U.S.C. 1621h(m)).
       (3) Subsection (g) of section 211 (25 U.S.C. 1621j).
       (4) Subsection (e) of section 216 (25 U.S.C. 1621o).
       (5) Section 224 (25 U.S.C. 1621w).
       (6) Section 309 (25 U.S.C. 1638a).
       (7) Section 407 (25 U.S.C. 1647).
       (8) Subsection (c) of section 512 (25 U.S.C. 1660b).
       (9) Section 514 (25 U.S.C. 1660d).
       (10) Section 603 (25 U.S.C. 1663).
       (11) Section 805 (25 U.S.C. 1675).
       (c) Conforming Amendments.--
       (1) Section 204(c)(1) of the Indian Health Care Improvement 
     Act (25 U.S.C. 1621c(c)(1)) is amended by striking ``through 
     fiscal year 2000''.
       (2) Section 213 of the Indian Health Care Improvement Act 
     (25 U.S.C. 1621l) is amended by striking ``(a) The 
     Secretary'' and inserting ``The Secretary''.
       (3) Section 310 of the Indian Health Care Improvement Act 
     (25 U.S.C. 1638b) is amended by striking ``funds provided 
     pursuant to the authorization contained in section 309'' each 
     place it appears and inserting ``funds made available to 
     carry out this title''.

     SEC. 102. FINDINGS.

       Section 2 of the Indian Health Care Improvement Act (25 
     U.S.C. 1601) is amended--
       (1) by redesignating subsections (a), (b), (c), and (d) as 
     paragraphs (1), (3), (4), and (5), respectively, and 
     indenting the paragraphs appropriately; and
       (2) by inserting after paragraph (1) (as so redesignated) 
     the following:
       ``(2) A major national goal of the United States is to 
     provide the resources, processes, and structure that will 
     enable Indian tribes and tribal members to obtain the 
     quantity and quality of health care services and 
     opportunities that will eradicate the health disparities 
     between Indians and the general population of the United 
     States.''.

[[Page S12434]]

     SEC. 103. DECLARATION OF NATIONAL INDIAN HEALTH POLICY.

       Section 3 of the Indian Health Care Improvement Act (25 
     U.S.C. 1602) is amended to read as follows:

     ``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 ensure the highest possible health status for 
     Indians and urban Indians and to provide all resources 
     necessary to effect that policy;
       ``(2) to raise the health status of Indians and urban 
     Indians to at least the levels set forth in the goals 
     contained within the Healthy People 2010 initiative or 
     successor objectives;
       ``(3) to ensure maximum Indian participation in the 
     direction of health care services so as to render the persons 
     administering such services and the services themselves more 
     responsive to the needs and desires of Indian communities;
       ``(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 that all actions under this Act shall be 
     carried out with active and meaningful consultation with 
     Indian tribes and tribal organizations, and conference with 
     urban Indian organizations, to implement this Act and the 
     national policy of Indian self-determination;
       ``(6) to ensure that the United States and Indian tribes 
     work in a government-to-government relationship to ensure 
     quality health care for all tribal members; and
       ``(7) 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. 104. DEFINITIONS.

       Section 4 of the Indian Health Care Improvement Act (25 
     U.S.C. 1603) is amended--
       (1) by striking the matter preceding subsection (a) and 
     inserting ``In this Act:'';
       (2) in each of subsections (c), (j), (k), and (l), by 
     redesignating the paragraphs contained in the subsections as 
     subparagraphs and indenting the subparagraphs appropriately;
       (3) by redesignating subsections (a) through (q) as 
     paragraphs (17), (18), (13), (14), (26), (28), (27), (29), 
     (1), (20), (11), (7), (19), (10), (21), (8), and (9), 
     respectively, indenting the paragraphs appropriately, and 
     moving the paragraphs so as to appear in numerical order;
       (4) in each paragraph (as so redesignated), by inserting a 
     heading the text of which is comprised of the term defined in 
     the paragraph;
       (5) by inserting ``The term'' after each paragraph heading;
       (6) by inserting after paragraph (1) (as redesignated by 
     paragraph (3)) the following:
       ``(2) Behavioral health.--
       ``(A) In general.--The term `behavioral health' means the 
     blending of substance (alcohol, drugs, inhalants, and 
     tobacco) abuse and mental health disorders prevention and 
     treatment for the purpose of providing comprehensive 
     services.
       ``(B) Inclusions.--The term `behavioral health' includes 
     the joint development of substance abuse and mental health 
     treatment planning and coordinated case management using a 
     multidisciplinary approach.
       ``(3) California indian.--The term `California Indian' 
     means any Indian who is eligible for health services provided 
     by the Service pursuant to section 809.
       ``(4) Community college.--The term `community college' 
     means--
       ``(A) a tribal college or university; or
       ``(B) a junior or community college.
       ``(5) Contract health service.--The term `contract health 
     service' means any health service that is--
       ``(A) delivered based on a referral by, or at the expense 
     of, an Indian health program; and
       ``(B) provided by a public or private medical provider or 
     hospital that is not a provider or hospital of the Indian 
     health program.
       ``(6) Department.--The term `Department', unless otherwise 
     designated, means the Department of Health and Human 
     Services.'';
       (7) by striking paragraph (7) (as redesignated by paragraph 
     (3)) and inserting the following:
       ``(7) Disease prevention.--
       ``(A) In general.--The term `disease prevention' means any 
     activity for--
       ``(i) the reduction, limitation, and prevention of--

       ``(I) disease; and
       ``(II) complications of disease; and

       ``(ii) the reduction of consequences of disease.
       ``(B) Inclusions.--The term `disease prevention' includes 
     an activity for--
       ``(i) controlling--

       ``(I) the development of diabetes;
       ``(II) high blood pressure;
       ``(III) infectious agents;
       ``(IV) injuries;
       ``(V) occupational hazards and disabilities;
       ``(VI) sexually transmittable diseases; or
       ``(VII) toxic agents; or

       ``(ii) providing--

       ``(I) fluoridation of water; or
       ``(II) immunizations.'';

       (8) by striking paragraph (9) (as redesignated by paragraph 
     (3)) and inserting the following:
       ``(9) 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 mental 
     retardation, 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.'';
       (9) by striking paragraphs (11) and (12) (as redesignated 
     by paragraph (3)) and inserting the following:
       ``(11) Health promotion.--The term `health promotion' means 
     any activity for--
       ``(A) fostering social, economic, environmental, and 
     personal factors conducive to health, including raising 
     public awareness regarding health matters and enabling 
     individuals to cope with health problems by increasing 
     knowledge and providing valid information;
       ``(B) encouraging adequate and appropriate diet, exercise, 
     and sleep;
       ``(C) promoting education and work in accordance with 
     physical and mental capacity;
       ``(D) making available safe water and sanitary facilities;
       ``(E) improving the physical, economic, cultural, 
     psychological, and social environment;
       ``(F) promoting culturally competent care; and
       ``(G) providing adequate and appropriate programs, 
     including programs for--
       ``(i) abuse prevention (mental and physical);
       ``(ii) community health;
       ``(iii) community safety;
       ``(iv) consumer health education;
       ``(v) diet and nutrition;
       ``(vi) immunization and other methods of prevention of 
     communicable diseases, including HIV/AIDS;
       ``(vii) environmental health;
       ``(viii) exercise and physical fitness;
       ``(ix) avoidance of fetal alcohol spectrum 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) healthy work environments;
       ``(xxii) elimination, reduction, and prevention of 
     contaminants that create unhealthy household conditions 
     (including mold and other allergens);
       ``(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 referred to in 
     section 3(2).
       ``(12) Indian health program.--The term `Indian health 
     program' means--
       ``(A) any health program administered directly by the 
     Service;
       ``(B) any tribal health program; and
       ``(C) any Indian tribe or tribal organization to which the 
     Secretary provides funding pursuant to section 23 of the Act 
     of June 25, 1910 (25 U.S.C. 47) (commonly known as the `Buy 
     Indian Act').'';
       (10) by inserting after paragraph (14) (as redesignated by 
     paragraph (3)) the following:
       ``(15) Junior or community college.--The term `junior or 
     community college' has the meaning given the term in section 
     312(e) of the Higher Education Act of 1965 (20 U.S.C. 
     1058(e)).
       ``(16) Reservation.--
       ``(A) In general.--The term `reservation' means a 
     reservation, Pueblo, or colony of any Indian tribe.
       ``(B) Inclusions.--The term `reservation' includes--
       ``(i) former reservations in Oklahoma;
       ``(ii) Indian allotments; and
       ``(iii) Alaska Native Regions established pursuant to the 
     Alaska Native Claims Settlement Act (43 U.S.C. 1601 et 
     seq.).'';
       (11) by striking paragraph (20) (as redesignated by 
     paragraph (3)) and inserting the following:
       ``(20) Service unit.--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.'';
       (12) by inserting after paragraph (21) (as redesignated by 
     paragraph (3)) the following:

[[Page S12435]]

       ``(22) Telehealth.--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)).
       ``(23) Telemedicine.--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.
       ``(24) Tribal college or university.--The term `tribal 
     college or university' has the meaning given the term in 
     section 316(b) of the Higher Education Act of 1965 (20 U.S.C. 
     1059c(b)).
       ``(25) Tribal health program.--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.).''; and
       (13) by striking paragraph (26) (as redesignated by 
     paragraph (3)) and inserting the following:
       ``(26) Tribal organization.--The term `tribal organization' 
     has the meaning given the term in section 4 of the Indian 
     Self-Determination and Education Assistance Act (25 U.S.C. 
     450b).''.

                   Subtitle A--Indian Health Manpower

     SEC. 111. COMMUNITY HEALTH AIDE PROGRAM.

       Section 119 of the Indian Health Care Improvement Act (25 
     U.S.C. 1616l) is amended to read as follows:

     ``SEC. 119. COMMUNITY HEALTH AIDE PROGRAM.

       ``(a) General Purposes of Program.--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 develop and operate a Community Health Aide Program in 
     the State of Alaska under which the Service--
       ``(1) provides for the training of Alaska Natives as health 
     aides or community health practitioners;
       ``(2) uses those 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 those 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 those 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 regarding 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 that 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;
       ``(6) develop a system under which the work of community 
     health aides and community health practitioners is reviewed 
     and evaluated to ensure the provision of quality health care, 
     health promotion, and disease prevention services; and
       ``(7) ensure that--
       ``(A) pulpal therapy (not including pulpotomies on 
     deciduous teeth) or extraction of adult teeth can be 
     performed by a dental health aide therapist only after 
     consultation with a licensed dentist who determines that the 
     procedure is a medical emergency that cannot be resolved with 
     palliative treatment; and
       ``(B) dental health aide therapists are strictly prohibited 
     from performing all other oral or jaw surgeries, subject to 
     the condition that uncomplicated extractions shall not be 
     considered oral surgery under this section.
       ``(c) Program Review.--
       ``(1) Neutral panel.--
       ``(A) Establishment.--The Secretary, acting through the 
     Service, shall establish a neutral panel to carry out the 
     study under paragraph (2).
       ``(B) Membership.--Members of the neutral panel shall be 
     appointed by the Secretary from among clinicians, economists, 
     community practitioners, oral epidemiologists, and Alaska 
     Natives.
       ``(2) Study.--
       ``(A) In general.--The neutral panel established under 
     paragraph (1) shall conduct a study of the dental health aide 
     therapist services provided by the Community Health Aide 
     Program under this section to ensure that the quality of care 
     provided through those services is adequate and appropriate.
       ``(B) Parameters of study.--The Secretary, in consultation 
     with interested parties, including professional dental 
     organizations, shall develop the parameters of the study.
       ``(C) Inclusions.--The study shall include a determination 
     by the neutral panel with respect to--
       ``(i) the ability of the dental health aide therapist 
     services under this section to address the dental care needs 
     of Alaska Natives;
       ``(ii) the quality of care provided through those services, 
     including any training, improvement, or additional oversight 
     required to improve the quality of care; and
       ``(iii) whether safer and less costly alternatives to the 
     dental health aide therapist services exist.
       ``(D) Consultation.--In carrying out the study under this 
     paragraph, the neutral panel shall consult with Alaska tribal 
     organizations with respect to the adequacy and accuracy of 
     the study.
       ``(3) Report.--The neutral panel shall submit to the 
     Secretary, the Committee on Indian Affairs of the Senate, and 
     the Committee on Natural Resources of the House of 
     Representatives a report describing the results of the study 
     under paragraph (2), including a description of--
       ``(A) any determination of the neutral panel under 
     paragraph (2)(C); and
       ``(B) any comments received from Alaska tribal 
     organizations under paragraph (2)(D).
       ``(d) Nationalization of Program.--
       ``(1) In general.--Except as provided in paragraph (2), the 
     Secretary, acting through the Service, may establish a 
     national Community Health Aide Program in accordance with the 
     program under this section, as the Secretary determines to be 
     appropriate.
       ``(2) Requirement; exclusion.--In establishing a national 
     program under paragraph (1), the Secretary--
       ``(A) shall not reduce the amounts provided for the 
     Community Health Aide Program described in subsections (a) 
     and (b); and
       ``(B) shall exclude dental health aide therapist services 
     from services covered under the program.''.

     SEC. 112. HEALTH PROFESSIONAL CHRONIC SHORTAGE DEMONSTRATION 
                   PROGRAMS.

       Title I of the Indian Health Care Improvement Act (25 
     U.S.C. 1611 et seq.) (as amended by section 101(b)) is 
     amended by adding at the end the following:

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

       ``(a) Demonstration Programs.--The Secretary, acting 
     through the Service, may fund demonstration programs for 
     Indian health programs to address the chronic shortages of 
     health professionals.
       ``(b) Purposes of Programs.--The purposes of demonstration 
     programs under subsection (a) shall be--
       ``(1) to provide direct clinical and practical experience 
     within an Indian health program to health profession students 
     and residents from medical schools;
       ``(2) to improve the quality of health care for Indians by 
     ensuring access to qualified health professionals;
       ``(3) to provide academic and scholarly opportunities for 
     health professionals serving Indians by identifying all 
     academic and scholarly resources of the region; and
       ``(4) to provide training and support for alternative 
     provider types, such as community health representatives, and 
     community health aides.
       ``(c) Advisory Board.--The demonstration programs 
     established pursuant to subsection (a) shall incorporate a 
     program advisory board, which may be composed of 
     representatives of tribal governments, Indian health 
     programs, and Indian communities in the areas to be served by 
     the demonstration programs.''.

     SEC. 113. EXEMPTION FROM PAYMENT OF CERTAIN FEES.

       Title I of the Indian Health Care Improvement Act (25 
     U.S.C. 1611 et seq.) (as amended by section 112) is amended 
     by adding at the end the following:

     ``SEC. 124. EXEMPTION FROM PAYMENT OF CERTAIN FEES.

       ``Employees of a tribal health program or urban Indian 
     organization shall be exempt from payment of licensing, 
     registration, and any other fees imposed by a Federal agency 
     to the same extent that officers of the commissioned corps of 
     the Public Health Service and other employees of the Service 
     are exempt from those fees.''.

                      Subtitle B--Health Services

     SEC. 121. INDIAN HEALTH CARE IMPROVEMENT FUND.

       Section 201 of the Indian Health Care Improvement Act (25 
     U.S.C. 1621) is amended to read as follows:

     ``SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND.

       ``(a) Use of Funds.--The Secretary, acting through the 
     Service, is authorized to expend

[[Page S12436]]

     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.
       ``(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) Injury prevention programs, including data collection 
     and evaluation, demonstration projects, training, and 
     capacity building.
       ``(H) Home health care.
       ``(I) Community health representatives.
       ``(J) Maintenance and improvement.
       ``(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 sections 
     3(1) and 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 Reauthorization and Extension Act of 2009, 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, 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. 122. CATASTROPHIC HEALTH EMERGENCY FUND.

       Section 202 of the Indian Health Care Improvement Act (25 
     U.S.C. 1621a) is amended to read as follows:

     ``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 headquarters 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 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. 123. DIABETES PREVENTION, TREATMENT, AND CONTROL.

       Section 204 of the Indian Health Care Improvement Act (25 
     U.S.C. 1621c) is amended to read as follows:

[[Page S12437]]

     ``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 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) Diabetes Projects.--The Secretary shall continue to 
     maintain each model diabetes project in existence on the date 
     of enactment of the Indian Health Care Improvement 
     Reauthorization and Extension Act of 2009, 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 Reauthorization and Extension Act of 2009 and for 
     projects which are added and funded thereafter.
       ``(d) Dialysis Programs.--The Secretary is authorized to 
     provide, through the Service, Indian tribes, and tribal 
     organizations, dialysis programs, including the purchase of 
     dialysis equipment and the provision of necessary staffing.
       ``(e) Other Duties of the Secretary.--
       ``(1) In general.--The Secretary shall, to the extent 
     funding is available--
       ``(A) in each area office, consult with Indian tribes and 
     tribal organizations regarding programs for the prevention, 
     treatment, and control of diabetes;
       ``(B) 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
       ``(C) 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.
       ``(2) Diabetes control officers.--
       ``(A) In general.--The Secretary may establish and maintain 
     in each area office a position of diabetes control officer to 
     coordinate and manage any activity of that area office 
     relating to the prevention, treatment, or control of diabetes 
     to assist the Secretary in carrying out a program under this 
     section or section 330C of the Public Health Service Act (42 
     U.S.C. 254c-3).
       ``(B) Certain activities.--Any activity carried out by a 
     diabetes control officer under subparagraph (A) that is the 
     subject of a contract or compact under the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.), and any funds made available to carry out such an 
     activity, shall not be divisible for purposes of that Act.''.

     SEC. 124. OTHER AUTHORITY FOR PROVISION OF SERVICES; SHARED 
                   SERVICES FOR LONG-TERM CARE.

       (a) Other Authority for Provision of Services.--
       (1) In general.--Section 205 of the Indian Health Care 
     Improvement Act (25 U.S.C. 1621d) is amended to read as 
     follows:

     ``SEC. 205. OTHER AUTHORITY FOR PROVISION OF SERVICES.

       ``(a) Definitions.--In this section:
       ``(1) Assisted living service.--The term `assisted living 
     service' means any service provided by an assisted living 
     facility (as defined in section 232(b) of the National 
     Housing Act (12 U.S.C. 1715w(b))), except that such an 
     assisted living facility--
       ``(A) shall not be required to obtain a license; but
       ``(B) shall meet all applicable standards for licensure.
       ``(2) Home- and community-based service.--The term `home- 
     and community-based service' means 1 or more of the services 
     specified in paragraphs (1) through (9) of section 1929(a) of 
     the Social Security Act (42 U.S.C. 1396t(a)) (whether 
     provided by the Service or by an Indian tribe or tribal 
     organization pursuant to the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 450 et seq.)) that are or 
     will be provided in accordance with applicable standards.
       ``(3) Hospice care.--The term `hospice care' means--
       ``(A) 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
       ``(B) such other services as an Indian tribe or tribal 
     organization determines are necessary and appropriate to 
     provide in furtherance of that care.
       ``(4) Long-term care services.--The term `long-term care 
     services' has the meaning given the term `qualified long-term 
     care services' in section 7702B(c) of the Internal Revenue 
     Code of 1986.
       ``(b) 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 for the 
     following services:
       ``(1) Hospice care.
       ``(2) Assisted living services.
       ``(3) Long-term care services.
       ``(4) Home- and community-based services.
       ``(c) Eligibility.--The following individuals shall be 
     eligible to receive long-term care services under this 
     section:
       ``(1) Individuals who are unable to perform a certain 
     number of activities of daily living without assistance.
       ``(2) Individuals with a mental impairment, such as 
     dementia, Alzheimer's disease, or another disabling mental 
     illness, who may be able to perform activities of daily 
     living under supervision.
       ``(3) Such other individuals as an applicable tribal health 
     program determines to be appropriate.
       ``(d) Authorization of Convenient Care Services.--The 
     Secretary, acting through the Service, Indian tribes, and 
     tribal organizations, may also provide funding under this Act 
     to meet the objectives set forth in section 3 for convenient 
     care services programs pursuant to section 307(c)(2)(A).''.
       (2) Repeal.--Section 821 of the Indian Health Care 
     Improvement Act (25 U.S.C. 1680k) is repealed.
       (b) Shared Services for Long-Term Care.--Section 822 of the 
     Indian Health Care Improvement Act (25 U.S.C. 1680l) is 
     amended to read as follows:

     ``SEC. 822. SHARED SERVICES FOR LONG-TERM CARE.

       ``(a) Long-Term Care.--
       ``(1) In general.--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 (including 
     health care services associated with long-term care) provided 
     in a facility to Indians.
       ``(2) Inclusions.--Each agreement under paragraph (1) shall 
     provide for the sharing of staff or other services between 
     the Service or a tribal health program and a long-term care 
     or related 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 the 
     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 the Indian tribe or tribal 
     organization such powers of supervision and control over 
     Service employees as the Secretary determines to be 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 the 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 (42 U.S.C. 1396r).
       ``(d) Other Assistance.--The Secretary shall provide such 
     technical and other assistance as may be necessary to enable 
     applicants to comply with 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. 125. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS 
                   OF HEALTH SERVICES.

       Section 206 of the Indian Health Care Improvement Act (25 
     U.S.C. 1621e) is amended to read as follows:

     ``SEC. 206. 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 billed by the Secretary, an Indian tribe, 
     or tribal organization in providing health services through 
     the Service, an Indian tribe, or tribal organization, or, if 
     higher, the highest amount the third party would pay for care 
     and services furnished by providers other than governmental 
     entities, to any individual to the same extent that such 
     individual, or any nongovernmental provider of such services, 
     would be eligible

[[Page S12438]]

     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) Nonapplicability 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 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).
       ``(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 separate 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.
       ``(3) Recovery from tortfeasors.--
       ``(A) In general.--In any case in which an Indian tribe or 
     tribal organization that is authorized or required under a 
     compact or contract issued pursuant to the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.) to furnish or pay for health services to a person who 
     is injured or suffers a disease on or after the date of 
     enactment of the Indian Health Care Improvement 
     Reauthorization and Extension Act of 2009 under circumstances 
     that establish grounds for a claim of liability against the 
     tortfeasor with respect to the injury or disease, the Indian 
     tribe or tribal organization shall have a right to recover 
     from the tortfeasor (or an insurer of the tortfeasor) the 
     reasonable value of the health services so furnished, paid 
     for, or to be paid for, in accordance with the Federal 
     Medical Care Recovery Act (42 U.S.C. 2651 et seq.), to the 
     same extent and under the same circumstances as the United 
     States may recover under that Act.
       ``(B) Treatment.--The right of an Indian tribe or tribal 
     organization to recover under subparagraph (A) shall be 
     independent of the rights of the injured or diseased person 
     served by the Indian tribe or tribal organization.
       ``(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 Attorney's Fees.--In any action brought to 
     enforce the provisions of this section, a prevailing 
     plaintiff shall be awarded its reasonable attorney's fees and 
     costs of litigation.
       ``(h) Nonapplicability 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.''.

     SEC. 126. CREDITING OF REIMBURSEMENTS.

       Section 207 of the Indian Health Care Improvement Act (25 
     U.S.C. 1621f) is amended to read as follows:

     ``SEC. 207. CREDITING OF REIMBURSEMENTS.

       ``(a) Use of Amounts.--
       ``(1) Retention by program.--Except as provided in sections 
     202(a)(2) and 813, all reimbursements received or recovered 
     under any of the programs described in paragraph (2), 
     including under section 813, 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 813.
       ``(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. 127. BEHAVIORAL HEALTH TRAINING AND COMMUNITY EDUCATION 
                   PROGRAMS.

       Section 209 of the Indian Health Care Improvement Act (25 
     U.S.C. 1621h) is amended by striking subsection (d) and 
     inserting the following:
       ``(d) Behavioral Health Training and Community Education 
     Programs.--
       ``(1) 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 paragraph (2) whose qualifications include, or 
     should include, training in the identification, prevention, 
     education, referral, or treatment of mental illness, or 
     dysfunctional and self destructive behavior.
       ``(2) Positions.--The positions referred to in paragraph 
     (1) are--
       ``(A) staff positions within the Bureau of Indian Affairs, 
     including existing positions, in the fields of--
       ``(i) elementary and secondary education;
       ``(ii) social services and family and child welfare;
       ``(iii) law enforcement and judicial services; and
       ``(iv) alcohol and substance abuse;
       ``(B) staff positions within the Service; and
       ``(C) staff positions similar to those identified in 
     subparagraphs (A) and (B) established and maintained by 
     Indian tribes and tribal organizations (without regard to the 
     funding source).
       ``(3) Training criteria.--
       ``(A) In general.--The appropriate Secretary shall provide 
     training criteria appropriate to each type of position 
     identified in paragraphs (2)(A) and (2)(B) 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 paragraph 
     (2)(C), the respective Secretaries shall provide appropriate 
     training to, or provide funds to, an Indian tribe or tribal 
     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.
       ``(B) 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.
       ``(4) 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 paragraph, 
     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.
       ``(5) Plan.--Not later than 90 days after the date of 
     enactment of the Indian Health Care Improvement 
     Reauthorization and Extension

[[Page S12439]]

     Act of 2009, 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 that Act, with at least 
     200 of such positions devoted to child, adolescent, and 
     family services. The plan developed under this paragraph 
     shall be implemented under the Act of November 2, 1921 (25 
     U.S.C. 13) (commonly known as the `Snyder Act').''.

     SEC. 128. CANCER SCREENINGS.

       Section 212 of the Indian Health Care Improvement Act (25 
     U.S.C. 1621k) is amended by inserting ``and other cancer 
     screenings'' before the period at the end.

     SEC. 129. PATIENT TRAVEL COSTS.

       Section 213 of the Indian Health Care Improvement Act (25 
     U.S.C. 1621l) is amended to read as follows:

     ``SEC. 213. PATIENT TRAVEL COSTS.

       ``(a) Definition of Qualified Escort.--In this section, the 
     term `qualified escort' means--
       ``(1) an adult escort (including a parent, guardian, or 
     other family member) who is required because of the physical 
     or mental condition, or age, of the applicable patient;
       ``(2) a health professional for the purpose of providing 
     necessary medical care during travel by the applicable 
     patient; or
       ``(3) other escorts, as the Secretary or applicable Indian 
     Health Program determines to be appropriate.
       ``(b) Provision of Funds.--The Secretary, acting through 
     the Service and Tribal Health Programs, is authorized to 
     provide funds for the following patient travel costs, 
     including 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. 130. EPIDEMIOLOGY CENTERS.

       Section 214 of the Indian Health Care Improvement Act (25 
     U.S.C. 1621m) is amended to read as follows:

     ``SEC. 214. EPIDEMIOLOGY CENTERS.

       ``(a) Establishment of Centers.--
       ``(1) In general.--The Secretary shall establish an 
     epidemiology center in each Service area to carry out the 
     functions described in subsection (b).
       ``(2) New centers.--
       ``(A) In general.--Subject to subparagraph (B), any new 
     center established after the date of enactment of the Indian 
     Health Care Improvement Reauthorization and Extension Act of 
     2009 may be operated under a grant authorized by subsection 
     (d).
       ``(B) Requirement.--Funding provided in a grant described 
     in subparagraph (A) shall not be divisible.
       ``(3) Funds not divisible.--An epidemiology center 
     established under this subsection shall be subject to the 
     Indian Self-Determination and Education Assistance Act (25 
     U.S.C. 450 et seq.), but the funds for the center shall not 
     be divisible.
       ``(b) Functions of Centers.--In consultation with and on 
     the request of Indian tribes, tribal organizations, and urban 
     Indian organizations, each Service area epidemiology center 
     established under this section shall, with respect to the 
     applicable 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 highest-priority health 
     status objectives and the services needed to achieve those 
     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 communities 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 this section.
       ``(d) Grants for Studies.--
       ``(1) In general.--The Secretary may make grants to Indian 
     tribes, tribal organizations, Indian organizations, and 
     eligible intertribal consortia to conduct epidemiological 
     studies of Indian communities.
       ``(2) Eligible intertribal consortia.--An intertribal 
     consortium or Indian organization shall be eligible to 
     receive a grant under this subsection if the intertribal 
     consortium is--
       ``(A) incorporated for the primary purpose of improving 
     Indian health; and
       ``(B) representative of the Indian tribes or urban Indian 
     communities residing in the area in which the intertribal 
     consortium is located.
       ``(3) Applications.--An application for a grant under this 
     subsection shall be submitted in such manner and at such time 
     as the Secretary shall prescribe.
       ``(4) Requirements.--An applicant for a grant under this 
     subsection shall--
       ``(A) demonstrate the technical, administrative, and 
     financial expertise necessary to carry out the functions 
     described in paragraph (5);
       ``(B) consult and cooperate with providers of related 
     health and social services in order to avoid duplication of 
     existing services; and
       ``(C) demonstrate cooperation from Indian tribes or urban 
     Indian organizations in the area to be served.
       ``(5) Use of funds.--A grant provided under paragraph (1) 
     may be used--
       ``(A) to carry out the functions described in subsection 
     (b);
       ``(B) to provide information to, and consult with, tribal 
     leaders, urban Indian community leaders, and related health 
     staff regarding health care and health service management 
     issues; and
       ``(C) in collaboration with Indian tribes, tribal 
     organizations, and urban Indian organizations, to provide to 
     the Service information regarding ways to improve the health 
     status of Indians.
       ``(e) Access to Information.--
       ``(1) In general.--An epidemiology center operated by a 
     grantee pursuant to a grant awarded under subsection (d) 
     shall be treated as a public health authority (as defined in 
     section 164.501 of title 45, Code of Federal Regulations (or 
     a successor regulation)) for purposes of the Health Insurance 
     Portability and Accountability Act of 1996 (Public Law 104-
     191; 110 Stat. 1936).
       ``(2) Access to information.--The Secretary shall grant to 
     each epidemiology center described in paragraph (1) access to 
     use of the data, data sets, monitoring systems, delivery 
     systems, and other protected health information in the 
     possession of the Secretary.
       ``(3) Requirement.--The activities of an epidemiology 
     center described in paragraph (1) shall be for the purposes 
     of research and for preventing and controlling disease, 
     injury, or disability (as those activities are described in 
     section 164.512 of title 45, Code of Federal Regulations (or 
     a successor regulation)), for purposes of the Health 
     Insurance Portability and Accountability Act of 1996 (Public 
     Law 104-191; 110 Stat. 1936).''.

     SEC. 131. INDIAN YOUTH GRANT PROGRAM.

       Section 216(b)(2) of the Indian Health Care Improvement Act 
     (25 U.S.C. 1621o(b)(2)) is amended by striking ``section 
     209(m)'' and inserting ``section 708(c)''.

     SEC. 132. AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM.

       Section 217 of the Indian Health Care Improvement Act (25 
     U.S.C. 1621p) is amended to read as follows:

     ``SEC. 217. AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM.

       ``(a) Grants Authorized.--The Secretary, acting through the 
     Service, shall make grants of not more than $300,000 to each 
     of 9 colleges and universities for the purpose of developing 
     and maintaining Indian psychology career recruitment programs 
     as a means of encouraging Indians to enter the behavioral 
     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;

[[Page S12440]]

       ``(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; 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.
       ``(f) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $2,700,000 for 
     fiscal year 2010 and each fiscal year thereafter.''.

     SEC. 133. PREVENTION, CONTROL, AND ELIMINATION OF 
                   COMMUNICABLE AND INFECTIOUS DISEASES.

       Section 218 of the Indian Health Care Improvement Act (25 
     U.S.C. 1621q) is amended to read as follows:

     ``SEC. 218. PREVENTION, CONTROL, AND ELIMINATION OF 
                   COMMUNICABLE AND INFECTIOUS DISEASES.

       ``(a) Grants Authorized.--The Secretary, acting through the 
     Service, and after consultation with the Centers for Disease 
     Control and Prevention, may make grants available to Indian 
     tribes and tribal organizations for the following:
       ``(1) Projects for the prevention, control, and elimination 
     of communicable and infectious diseases, including 
     tuberculosis, hepatitis, HIV, respiratory syncytial 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 and 
     tribal 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 or tribal 
     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. 134. METHODS TO INCREASE CLINICIAN RECRUITMENT AND 
                   RETENTION ISSUES.

       (a) Licensing.--Section 221 of the Indian Health Care 
     Improvement Act (25 U.S.C. 1621t) is amended to read as 
     follows:

     ``SEC. 221. LICENSING.

       ``Licensed health professionals employed by a tribal health 
     program shall be exempt, if licensed in any State, from the 
     licensing requirements of the State in which the tribal 
     health program performs the services described in the 
     contract or compact of the tribal health program under the 
     Indian Self-Determination and Education Assistance Act (25 
     U.S.C. 450 et seq.).''.
       (b) Treatment of Scholarships for Certain Purposes.--Title 
     I of the Indian Health Care Improvement Act (25 U.S.C. 1611 
     et seq.) (as amended by section 113) is amended by adding at 
     the end the following:

     ``SEC. 125. TREATMENT OF SCHOLARSHIPS FOR CERTAIN PURPOSES.

       ``A scholarship provided to an individual pursuant to this 
     title shall be considered to be a qualified scholarship for 
     purposes of section 117 of the Internal Revenue Code of 
     1986.''.
       (c) Continuing Education Allowances.--Section 106 of the 
     Indian Health Care Improvement Act (25 U.S.C. 1615) is 
     amended to read as follows:

     ``SEC. 106. CONTINUING EDUCATION ALLOWANCES.

       ``In order to encourage scholarship and stipend recipients 
     under sections 104, 105, and 115 and health professionals, 
     including community health representatives and emergency 
     medical technicians, to join or continue in an Indian health 
     program and to provide services in the rural and remote areas 
     in which a significant portion of Indians reside, the 
     Secretary, acting through the Service, may--
       ``(1) provide programs or allowances to transition into an 
     Indian health program, including licensing, board or 
     certification examination assistance, and technical 
     assistance in fulfilling service obligations under sections 
     104, 105, and 115; and
       ``(2) provide programs or allowances to health 
     professionals employed in an Indian health program to enable 
     those professionals, for a period of time each year 
     prescribed by regulation of the Secretary, to take leave of 
     the duty stations of the professionals for professional 
     consultation, management, leadership, and refresher training 
     courses.''.

     SEC. 135. LIABILITY FOR PAYMENT.

       Section 222 of the Indian Health Care Improvement Act (25 
     U.S.C. 1621u) is amended to read as follows:

     ``SEC. 222. 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 220(b), the provider shall have no 
     further recourse against the patient who received the 
     services.''.

     SEC. 136. OFFICES OF INDIAN MEN'S HEALTH AND INDIAN WOMEN'S 
                   HEALTH.

       Section 223 of the Indian Health Care Improvement Act (25 
     U.S.C. 1621v) is amended--
       (1) by striking the section designation and heading and all 
     that follows through ``oversee efforts of the Service to'' 
     and inserting the following:

     ``SEC. 223. OFFICES OF INDIAN MEN'S HEALTH AND INDIAN WOMEN'S 
                   HEALTH.

       ``(a) Office of Indian Men's Health.--
       ``(1) Establishment.--The Secretary may establish within 
     the Service an office, to be known as the `Office of Indian 
     Men's Health'.
       ``(2) Director.--
       ``(A) In general.--The Office of Indian Men's Health shall 
     be headed by a director, to be appointed by the Secretary.
       ``(B) Duties.--The director shall coordinate and promote 
     the health status of Indian men in the United States.
       ``(3) Report.--Not later than 2 years after the date of 
     enactment of the Indian Health Care Improvement 
     Reauthorization and Extension Act of 2009, the Secretary, 
     acting through the Service, shall submit to Congress a report 
     describing--
       ``(A) any activity carried out by the director as of the 
     date on which the report is prepared; and
       ``(B) any finding of the director with respect to the 
     health of Indian men.
       ``(b) Office of Indian Women's Health.--The Secretary, 
     acting through the Service, shall establish an office, to be 
     known as the `Office of Indian Women's Health', to''; and
       (2) in subsection (b) (as so redesignated) by inserting 
     ``(including urban Indian women)'' before ``of all ages''.

     SEC. 137. CONTRACT HEALTH SERVICE ADMINISTRATION AND 
                   DISBURSEMENT FORMULA.

       Title II of the Indian Health Care Improvement Act (25 
     U.S.C. 1621 et seq.) is amended by adding at the end the 
     following:

     ``SEC. 226. CONTRACT HEALTH SERVICE ADMINISTRATION AND 
                   DISBURSEMENT FORMULA.

       ``(a) Submission of Report.--As soon as practicable after 
     the date of enactment of the Indian Health Care Improvement 
     Reauthorization and Extension Act of 2009, the Comptroller 
     General of the United States shall submit to the Secretary, 
     the Committee on Indian Affairs of the Senate, and the 
     Committee on Natural Resources of the House of 
     Representatives, and make available to each Indian tribe, a 
     report describing the results of the study of the Comptroller 
     General regarding the funding of the contract health service 
     program (including historic funding levels and a 
     recommendation of the funding level needed for the program) 
     and the administration of the contract health service program 
     (including the distribution of funds pursuant to the 
     program), as requested by Congress in March 2009, or pursuant 
     to section 830.
       ``(b) Consultation With Tribes.--On receipt of the report 
     under subsection (a), the Secretary shall consult with Indian 
     tribes regarding the contract health service program, 
     including the distribution of funds pursuant to the program--
       ``(1) to determine whether the current distribution formula 
     would require modification if the contract health service 
     program were funded at the level recommended by the 
     Comptroller General;
       ``(2) to identify any inequities in the current 
     distribution formula under the current funding level or 
     inequitable results for any Indian tribe under the funding 
     level recommended by the Comptroller General;
       ``(3) to identify any areas of program administration that 
     may result in the inefficient or ineffective management of 
     the program; and
       ``(4) to identify any other issues and recommendations to 
     improve the administration of the contract health services 
     program and correct any unfair results or funding disparities 
     identified under paragraph (2).
       ``(c) Subsequent Action by Secretary.--If, after 
     consultation with Indian tribes under subsection (b), the 
     Secretary determines that any issue described in subsection 
     (b)(2) exists, the Secretary may initiate procedures under 
     subchapter III of chapter 5 of

[[Page S12441]]

     title 5, United States Code, to negotiate or promulgate 
     regulations to establish a disbursement formula for the 
     contract health service program funding.''.

                     Subtitle C--Health Facilities

     SEC. 141. HEALTH CARE FACILITY PRIORITY SYSTEM.

       Section 301 of the Indian Health Care Improvement Act (25 
     U.S.C. 1631) is amended--
       (1) by redesignating subsection (d) as subsection (h); and
       (2) by striking subsection (c) and inserting the following:
       ``(c) Health Care Facility Priority System.--
       ``(1) In general.--
       ``(A) Priority system.--The Secretary, acting through the 
     Service, shall maintain a health care facility priority 
     system, which--
       ``(i) shall be developed in consultation with Indian tribes 
     and tribal organizations;
       ``(ii) shall give Indian tribes' needs the highest 
     priority;
       ``(iii)(I) may include the lists required in paragraph 
     (2)(B)(ii); and
       ``(II) shall include the methodology required in paragraph 
     (2)(B)(v); and
       ``(III) may include such health care facilities, and such 
     renovation or expansion needs of any health care facility, as 
     the Service may identify; and
       ``(iv) shall provide an opportunity for the nomination of 
     planning, design, and construction projects by the Service, 
     Indian tribes, and tribal organizations for consideration 
     under the priority system at least once every 3 years, or 
     more frequently as the Secretary determines to be 
     appropriate.
       ``(B) Needs of facilities under isdeaa agreements.--The 
     Secretary shall ensure that the planning, design, 
     construction, renovation, and expansion 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.
       ``(C) Criteria for evaluating needs.--For purposes of this 
     subsection, the Secretary, in evaluating the needs of 
     facilities operated under a contract or compact under the 
     Indian Self-Determination and Education Assistance Act (25 
     U.S.C. 450 et seq.), shall use the criteria used by the 
     Secretary in evaluating the needs of facilities operated 
     directly by the Service.
       ``(D) Priority of certain projects protected.--The priority 
     of any project established under the construction priority 
     system in effect on the date of enactment of the Indian 
     Health Care Improvement Reauthorization and Extension Act of 
     2009 shall not be affected by any change in the construction 
     priority system taking place after that date if the project--
       ``(i) was identified in the fiscal year 2008 Service budget 
     justification as--

       ``(I) 1 of the 10 top-priority inpatient projects;
       ``(II) 1 of the 10 top-priority outpatient projects;
       ``(III) 1 of the 10 top-priority staff quarters 
     developments; or
       ``(IV) 1 of the 10 top-priority Youth Regional Treatment 
     Centers;

       ``(ii) had completed both Phase I and Phase II of the 
     construction priority system in effect on the date of 
     enactment of such Act; or
       ``(iii) is not included in clause (i) or (ii) and is 
     selected, as determined by the Secretary--

       ``(I) on the initiative of the Secretary; or
       ``(II) pursuant to a request of an Indian tribe or tribal 
     organization.

       ``(2) Report; contents.--
       ``(A) Initial comprehensive report.--
       ``(i) Definitions.--In this subparagraph:

       ``(I) Facilities appropriation advisory board.--The term 
     `Facilities Appropriation Advisory Board' means the advisory 
     board, comprised of 12 members representing Indian tribes and 
     2 members representing the Service, established at the 
     discretion of the Director--

       ``(aa) to provide advice and recommendations for policies 
     and procedures of the programs funded pursuant to facilities 
     appropriations; and
       ``(bb) to address other facilities issues.

       ``(II) Facilities needs assessment workgroup.--The term 
     `Facilities Needs Assessment Workgroup' means the workgroup 
     established at the discretion of the Director--

       ``(aa) to review the health care facilities construction 
     priority system; and
       ``(bb) to make recommendations to the Facilities 
     Appropriation Advisory Board for revising the priority 
     system.
       ``(ii) Initial report.--

       ``(I) In general.--Not later than 1 year after the date of 
     enactment of the Indian Health Care Improvement 
     Reauthorization and Extension Act of 2009, the Secretary 
     shall submit to the Committee on Indian Affairs of the Senate 
     and the Committee on Natural Resources of the House of 
     Representatives a report that describes the comprehensive, 
     national, ranked list of all health care facilities needs for 
     the Service, Indian tribes, and tribal organizations 
     (including inpatient health care facilities, outpatient 
     health care facilities, specialized health care facilities 
     (such as for long-term care and alcohol and drug abuse 
     treatment), wellness centers, and staff quarters, and the 
     renovation and expansion needs, if any, of such facilities) 
     developed by the Service, Indian tribes, and tribal 
     organizations for the Facilities Needs Assessment Workgroup 
     and the Facilities Appropriation Advisory Board.
       ``(II) Inclusions.--The initial report shall include--

       ``(aa) the methodology and criteria used by the Service in 
     determining the needs and establishing the ranking of the 
     facilities needs; and
       ``(bb) such other information as the Secretary determines 
     to be appropriate.
       ``(iii) Updates of report.--Beginning in calendar year 
     2011, the Secretary shall--

       ``(I) update the report under clause (ii) not less 
     frequently that once every 5 years; and
       ``(II) include the updated report in the appropriate annual 
     report under subparagraph (B) for submission to Congress 
     under section 801.

       ``(B) Annual reports.--The Secretary shall submit to the 
     President, for inclusion in the report required to be 
     transmitted to Congress under section 801, a report which 
     sets forth the following:
       ``(i) A description of the health care facility priority 
     system of the Service established under paragraph (1).
       ``(ii) Health care facilities lists, which may include--

       ``(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); and
       ``(IV) the 10 top-priority staff quarters developments 
     associated with health care facilities.

       ``(iii) The justification for such order of priority.
       ``(iv) The projected cost of such projects.
       ``(v) The methodology adopted by the Service in 
     establishing priorities under its health care facility 
     priority system.
       ``(3) Requirements for preparation of reports.--In 
     preparing the report required under paragraph (2), the 
     Secretary shall--
       ``(A) consult with and obtain information on all health 
     care facilities needs from Indian tribes and tribal 
     organizations; and
       ``(B) review the total unmet needs of all Indian tribes and 
     tribal organizations for health care facilities (including 
     staff quarters), including needs for renovation and expansion 
     of existing facilities.
       ``(d) Review of Methodology Used for Health Facilities 
     Construction Priority System.--
       ``(1) In general.--Not later than 1 year after the 
     establishment of the priority system under subsection 
     (c)(1)(A), the Comptroller General of the United States shall 
     prepare and finalize a report reviewing the methodologies 
     applied, and the processes followed, by the Service in making 
     each assessment of needs for the list under subsection 
     (c)(2)(A)(ii) and developing the priority system under 
     subsection (c)(1), including a review of--
       ``(A) the recommendations of the Facilities Appropriation 
     Advisory Board and the Facilities Needs Assessment Workgroup 
     (as those terms are defined in subsection (c)(2)(A)(i)); and
       ``(B) the relevant criteria used in ranking or prioritizing 
     facilities other than hospitals or clinics.
       ``(2) Submission to congress.--The Comptroller General of 
     the United States shall submit the report under paragraph (1) 
     to--
       ``(A) the Committees on Indian Affairs and Appropriations 
     of the Senate;
       ``(B) the Committees on Natural Resources and 
     Appropriations of the House of Representatives; and
       ``(C) the Secretary.
       ``(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 section 
     102 of the Indian Self-Determination and Education Assistance 
     Act (25 U.S.C. 450f) or sections 504 and 505 of that Act (25 
     U.S.C. 458aaa-3, 458aaa-4).
       ``(f) Development of Innovative Approaches.--The Secretary 
     shall consult and cooperate with Indian tribes and tribal 
     organizations, and confer with urban Indian organizations, in 
     developing innovative approaches to address all or part of 
     the total unmet need for construction of health facilities, 
     that may include--
       ``(1) the establishment of an area distribution fund in 
     which a portion of health facility construction funding could 
     be devoted to all Service areas;
       ``(2) approaches provided for in other provisions of this 
     title; and
       ``(3) other approaches, as the Secretary determines to be 
     appropriate.''.

     SEC. 142. INDIAN HEALTH CARE DELIVERY DEMONSTRATION PROJECTS.

       Section 307 of the Indian Health Care Improvement Act (25 
     U.S.C. 1637) is amended to read as follows:

     ``SEC. 307. INDIAN HEALTH CARE DELIVERY DEMONSTRATION 
                   PROJECTS.

       ``(a) Purpose and General Authority.--
       ``(1) Purpose.--The purpose of this section is to encourage 
     the establishment of demonstration projects that meet the 
     applicable criteria of this section to be carried out by the 
     Secretary, acting through the Service, or Indian tribes or 
     tribal organizations acting pursuant to contracts or compacts 
     under the Indian Self Determination and Education Assistance 
     Act (25 U.S.C. 450 et seq.)--

[[Page S12442]]

       ``(A) to test alternative means of delivering health care 
     and services to Indians through facilities; or
       ``(B) to use alternative or innovative methods or models of 
     delivering health care services to Indians (including primary 
     care services, contract health services, or any other program 
     or service authorized by this Act) through convenient care 
     services (as defined in subsection (c)), community health 
     centers, or cooperative agreements or arrangements with other 
     health care providers that share or coordinate the use of 
     facilities, funding, or other resources, or otherwise 
     coordinate or improve the coordination of activities of the 
     Service, Indian tribes, or tribal organizations, with those 
     of the other health care providers.
       ``(2) Authority.--The Secretary, acting through the 
     Service, is authorized to carry out, or to 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 to carry out, health care 
     delivery demonstration projects that--
       ``(A) test alternative means of delivering health care and 
     services to Indians through facilities; or
       ``(B) otherwise carry out the purposes of this section.
       ``(b) Use of Funds.--The Secretary, in approving projects 
     pursuant to this section--
       ``(1) may authorize such contracts for the construction and 
     renovation of hospitals, health centers, health stations, and 
     other facilities to deliver health care services; and
       ``(2) is authorized--
       ``(A) to waive any leasing prohibition;
       ``(B) to permit use and carryover of funds appropriated for 
     the provision of health care services under this Act 
     (including for the purchase of health benefits coverage, as 
     authorized by section 402(a));
       ``(C) to permit the use of other available funds, including 
     other Federal funds, funds from third-party collections in 
     accordance with sections 206, 207, and 401, and non-Federal 
     funds contributed by State or local governmental agencies or 
     facilities or private health care providers pursuant to 
     cooperative or other agreements with the Service, 1 or more 
     Indian tribes, or tribal organizations;
       ``(D) to permit the use of funds or property donated or 
     otherwise provided from any source for project purposes;
       ``(E) to provide for the reversion of donated real or 
     personal property to the donor; and
       ``(F) to permit the use of Service funds to match other 
     funds, including Federal funds.
       ``(c) Health Care Demonstration Projects.--
       ``(1) Definition of convenient care service.--In this 
     subsection, the term `convenient care service' means any 
     primary health care service, such as urgent care services, 
     nonemergent care services, prevention services and 
     screenings, and any service authorized by section 203 or 
     205(d), that is offered--
       ``(A) at an alternative setting; or
       ``(B) during hours other than regular working hours.
       ``(2) General projects.--
       ``(A) Criteria.--The Secretary may approve under this 
     section demonstration projects that meet the following 
     criteria:
       ``(i) There is a need for a new facility or program, such 
     as a program for convenient care services, or an improvement 
     in, increased efficiency at, or reorientation of an existing 
     facility or program.
       ``(ii) A significant number of Indians, including Indians 
     with low health status, will be served by the project.
       ``(iii) The project has the potential to deliver services 
     in an efficient and effective manner.
       ``(iv) The project is economically viable.
       ``(v) For projects carried out by an Indian tribe or tribal 
     organization, the Indian tribe or tribal organization has the 
     administrative and financial capability to administer the 
     project.
       ``(vi) The project is integrated with providers of related 
     health or social services (including State and local health 
     care agencies or other health care providers) and is 
     coordinated with, and avoids duplication of, existing 
     services in order to expand the availability of services.
       ``(B) Priority.--In approving demonstration projects under 
     this paragraph, the Secretary shall give priority to 
     demonstration projects, to the extent the projects meet the 
     criteria described in subparagraph (A), located in any of the 
     following Service units:
       ``(i) Cass Lake, Minnesota.
       ``(ii) Mescalero, New Mexico.
       ``(iii) Owyhee and Elko, Nevada.
       ``(iv) Schurz, Nevada.
       ``(v) Ft. Yuma, California.
       ``(3) Innovative health services delivery demonstration 
     project.--
       ``(A) Application or request.--On receipt of an application 
     or request from an Indian tribe, a consortium of Indian 
     tribes, or a tribal organization within a Service area, the 
     Secretary shall take into consideration alternative or 
     innovated methods to deliver health care services within the 
     Service area (or a portion of, or facility within, the 
     Service area) as described in the application or request, 
     including medical, dental, pharmaceutical, nursing, clinical 
     laboratory, contract health services, convenient care 
     services, community health centers, or any other health care 
     services delivery models designed to improve access to, or 
     efficiency or quality of, the health care, health promotion, 
     or disease prevention services and programs under this Act.
       ``(B) Approval.--In addition to projects described in 
     paragraph (2), in any fiscal year, the Secretary is 
     authorized under this paragraph to approve not more than 10 
     applications for health care delivery demonstration projects 
     that meet the criteria described in subparagraph (C).
       ``(C) Criteria.--The Secretary shall approve under 
     subparagraph (B) demonstration projects that meet all of the 
     following criteria:
       ``(i) The criteria set forth in paragraph (2)(A).
       ``(ii) There is a lack of access to health care services at 
     existing health care facilities, which may be due to limited 
     hours of operation at those facilities or other factors.
       ``(iii) The project--

       ``(I) expands the availability of services; or
       ``(II) reduces--

       ``(aa) the burden on Contract Health Services; or
       ``(bb) the need for emergency room visits.
       ``(d) Technical Assistance.--On receipt of an application 
     or request from an Indian tribe, a consortium of Indian 
     tribes, or a tribal organization, the Secretary shall provide 
     such technical and other assistance as may be necessary to 
     enable applicants to comply with this section, including 
     information regarding the Service unit budget and available 
     funding for carrying out the proposed demonstration project.
       ``(e) Service to Ineligible Persons.--Subject to section 
     813, 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 813, may be included, subject to the terms of that 
     section, in any demonstration project approved pursuant to 
     this section.
       ``(f) Equitable Treatment.--For purposes of subsection (c), 
     the Secretary, 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.), shall use 
     the same criteria that the Secretary uses in evaluating 
     facilities operated directly by the Service.
       ``(g) Equitable Integration of Facilities.--The Secretary 
     shall ensure that the planning, design, construction, 
     renovation, and expansion needs of Service and non-Service 
     facilities that 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. 143. TRIBAL MANAGEMENT OF FEDERALLY OWNED QUARTERS.

       Title III of the Indian Health Care Improvement Act (as 
     amended by section 101(b)) is amended by inserting after 
     section 308 (25 U.S.C. 1638) the following:

     ``SEC. 309. TRIBAL MANAGEMENT OF FEDERALLY OWNED QUARTERS.

       ``(a) Rental Rates.--
       ``(1) Establishment.--Notwithstanding any other provision 
     of law, a tribal health program that operates a hospital or 
     other health facility and the federally owned quarters 
     associated with such a facility pursuant to a contract or 
     compact under the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450 et seq.) may establish the 
     rental rates charged to the occupants of those quarters, on 
     providing notice to the Secretary.
       ``(2) Objectives.--In establishing rental rates under this 
     subsection, a tribal health program shall attempt--
       ``(A) to base the rental rates on the reasonable value of 
     the quarters to the occupants of the quarters; and
       ``(B) to generate sufficient funds to prudently provide for 
     the operation and maintenance of the quarters, and at the 
     discretion of the tribal health program, to supply reserve 
     funds for capital repairs and replacement of the quarters.
       ``(3) Equitable funding.--A federally owned quarters the 
     rental rates for which are established by a tribal health 
     program under this subsection shall remain eligible to 
     receive improvement and repair funds to the same extent that 
     all federally owned quarters used to house personnel in 
     programs of the Service are eligible to receive those funds.
       ``(4) Notice of rate change.--A tribal health program that 
     establishes a rental rate under this subsection shall provide 
     occupants of the federally owned quarters a notice of any 
     change in the rental rate by not later than the date that is 
     60 days notice before the effective date of the change.
       ``(5) Rates in alaska.--A rental rate established by a 
     tribal health program under this section for a federally 
     owned quarters in the State of Alaska 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.
       ``(b) Direct Collection of Rent.--
       ``(1) In general.--Notwithstanding any other provision of 
     law, and subject to paragraph (2), a tribal health program 
     may collect rent directly from Federal employees who occupy 
     federally owned quarters if the tribal health program submits 
     to the Secretary and the employees a notice of the election 
     of the tribal health program to collect rents directly from 
     the employees.
       ``(2) Action by employees.--On receipt of a notice 
     described in paragraph (1)--

[[Page S12443]]

       ``(A) the affected Federal employees shall pay rent for 
     occupancy of a federally owned quarters directly to the 
     applicable tribal health program; and
       ``(B) the Secretary shall not have the authority to collect 
     rent from the employees through payroll deduction or 
     otherwise.
       ``(3) Use of payments.--The rent payments under this 
     subsection--
       ``(A) shall be retained by the applicable tribal health 
     program in 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, as 
     the tribal health program determines to be appropriate; and
       ``(B) shall not be made payable to, or otherwise be 
     deposited with, the United States.
       ``(4) Retrocession of authority.--If a tribal health 
     program that elected to collect rent directly under paragraph 
     (1) requests retrocession of the authority of the tribal 
     health program to collect that rent, the retrocession shall 
     take effect on the earlier of--
       ``(A) the first day of the month that begins not less than 
     180 days after the tribal health program submits the request; 
     and
       ``(B) such other date as may be mutually agreed on by the 
     Secretary and the tribal health program.''.

     SEC. 144. OTHER FUNDING, EQUIPMENT, AND SUPPLIES FOR 
                   FACILITIES.

       Title III of the Indian Health Care Improvement Act (25 
     U.S.C. 1631 et seq.) is amended by adding at the end the 
     following:

     ``SEC. 311. OTHER FUNDING, EQUIPMENT, AND SUPPLIES FOR 
                   FACILITIES.

       ``(a) Authorization.--
       ``(1) Authority to transfer funds.--The head of any Federal 
     agency to which funds, equipment, or other supplies are made 
     available for the planning, design, construction, or 
     operation of a health care or sanitation facility may 
     transfer the funds, equipment, or supplies to the Secretary 
     for the planning, design, construction, or operation of a 
     health care or sanitation facility to achieve--
       ``(A) the purposes of this Act; and
       ``(B) the purposes for which the funds, equipment, or 
     supplies were made available to the Federal agency.
       ``(2) Authority to accept funds.--The Secretary may--
       ``(A) accept from any source, including Federal and State 
     agencies, funds, equipment, or supplies that are available 
     for the construction or operation of health care or 
     sanitation facilities; and
       ``(B) use those funds, equipment, and supplies to plan, 
     design, construct, and operate health care or sanitation 
     facilities for Indians, including pursuant to a contract or 
     compact under the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450 et seq.).
       ``(3) Effect of receipt.--Receipt of funds by the Secretary 
     under this subsection shall not affect any priority 
     established under section 301.
       ``(b) Interagency Agreements.--The Secretary may enter into 
     interagency agreements with Federal or State agencies and 
     other entities, and accept funds, equipment, or other 
     supplies from those entities, to provide for the planning, 
     design, construction, and operation of health care or 
     sanitation facilities to be administered by Indian health 
     programs to achieve--
       ``(1) the purposes of this Act; and
       ``(2) the purposes for which the funds were appropriated or 
     otherwise provided.
       ``(c) Establishment of Standards.--
       ``(1) In general.--The Secretary, acting through the 
     Service, shall establish, by regulation, standards for the 
     planning, design, construction, and operation of health care 
     or sanitation facilities serving Indians under this Act.
       ``(2) Other regulations.--Notwithstanding any other 
     provision of law, any other applicable regulations of the 
     Department shall apply in carrying out projects using funds 
     transferred under this section.
       ``(d) Definition of Sanitation Facility.--In this section, 
     the term `sanitation facility' means a safe and adequate 
     water supply system, sanitary sewage disposal system, or 
     sanitary solid waste system (including all related equipment 
     and support infrastructure).''.

     SEC. 145. INDIAN COUNTRY MODULAR COMPONENT FACILITIES 
                   DEMONSTRATION PROGRAM.

       Title III of the Indian Health Care Improvement Act (25 
     U.S.C. 1631 et seq.) (as amended by section 144) is amended 
     by adding at the end the following:

     ``SEC. 312. INDIAN COUNTRY MODULAR COMPONENT FACILITIES 
                   DEMONSTRATION PROGRAM.

       ``(a) Definition of Modular Component Health Care 
     Facility.--In this section, the term `modular component 
     health care facility' means a health care facility that is 
     constructed--
       ``(1) off-site using prefabricated component units for 
     subsequent transport to the destination location; and
       ``(2) represents a more economical method for provision of 
     health care facility than a traditionally constructed health 
     care building.
       ``(b) Establishment.--The Secretary, acting through the 
     Service, shall establish a demonstration program under which 
     the Secretary shall award no less than 3 grants for purchase, 
     installation and maintenance of modular component health care 
     facilities in Indian communities for provision of health care 
     services.
       ``(c) Selection of Locations.--
       ``(1) Petitions.--
       ``(A) Solicitation.--The Secretary shall solicit from 
     Indian tribes petitions for location of the modular component 
     health care facilities in the Service areas of the 
     petitioning Indian tribes.
       ``(B) Petition.--To be eligible to receive a grant under 
     this section, an Indian tribe or tribal organization must 
     submit to the Secretary a petition to construct a modular 
     component health care facility in the Indian community of the 
     Indian tribe, at such time, in such manner, and containing 
     such information as the Secretary may require.
       ``(2) Selection.--In selecting the location of each modular 
     component health care facility to be provided under the 
     demonstration program, the Secretary shall give priority to 
     projects already on the Indian Health Service facilities 
     construction priority list and petitions which demonstrate 
     that erection of a modular component health facility--
       ``(A) is more economical than construction of a 
     traditionally constructed health care facility;
       ``(B) can be constructed and erected on the selected 
     location in less time than traditional construction; and
       ``(C) can adequately house the health care services needed 
     by the Indian population to be served.
       ``(3) Effect of selection.--A modular component health care 
     facility project selected for participation in the 
     demonstration program shall not be eligible for entry on the 
     facilities construction priorities list entitled `IHS Health 
     Care Facilities FY 2011 Planned Construction Budget' and 
     dated May 7, 2009 (or any successor list).
       ``(d) Eligibility.--
       ``(1) In general.--An Indian tribe may submit a petition 
     under subsection (c)(1)(B) regardless of whether the Indian 
     tribe is a party to any contract or compact under the Indian 
     Self-Determination and Education Assistance Act (25 U.S.C. 
     450 et seq.).
       ``(2) Administration.--At the election of an Indian tribe 
     or tribal organization selected for participation in the 
     demonstration program, the funds provided for the project 
     shall be subject to the provisions of the Indian Self-
     Determination and Education Assistance Act.
       ``(e) Reports.--Not later than 1 year after the date on 
     which funds are made available for the demonstration program 
     and annually thereafter, the Secretary shall submit to 
     Congress a report describing--
       ``(1) each activity carried out under the demonstration 
     program, including an evaluation of the success of the 
     activity; and
       ``(2) the potential benefits of increased use of modular 
     component health care facilities in other Indian communities.
       ``(f) Authorization of Appropriations.--There are 
     authorized to be appropriated $50,000,000 to carry out the 
     demonstration program under this section for the first 5 
     fiscal years, and such sums as may be necessary to carry out 
     the program in subsequent fiscal years.''.

     SEC. 146. MOBILE HEALTH STATIONS DEMONSTRATION PROGRAM.

       Title III of the Indian Health Care Improvement Act (25 
     U.S.C. 1631 et seq.) (as amended by section 145) is amended 
     by adding at the end the following:

     ``SEC. 313. MOBILE HEALTH STATIONS DEMONSTRATION PROGRAM.

       ``(a) Definitions.--In this section:
       ``(1) Eligible tribal consortium.--The term `eligible 
     tribal consortium' means a consortium composed of 2 or more 
     Service units between which a mobile health station can be 
     transported by road in up to 8 hours. A Service unit operated 
     by the Service or by an Indian tribe or tribal organization 
     shall be equally eligible for participation in such 
     consortium.
       ``(2) Mobile health station.--The term `mobile health 
     station' means a health care unit that--
       ``(A) is constructed, maintained, and capable of being 
     transported within a semi-trailer truck or similar vehicle;
       ``(B) is equipped for the provision of 1 or more specialty 
     health care services; and
       ``(C) can be equipped to be docked to a stationary health 
     care facility when appropriate.
       ``(3) Specialty health care service.--
       ``(A) In general.--The term `specialty health care service' 
     means a health care service which requires the services of a 
     health care professional with specialized knowledge or 
     experience.
       ``(B) Inclusions.--The term `specialty health care service' 
     includes any service relating to--
       ``(i) dialysis;
       ``(ii) surgery;
       ``(iii) mammography;
       ``(iv) dentistry; or
       ``(v) any other specialty health care service.
       ``(b) Establishment.--The Secretary, acting through the 
     Service, shall establish a demonstration program under which 
     the Secretary shall provide at least 3 mobile health station 
     projects.
       ``(c) Petition.--To be eligible to receive a mobile health 
     station under the demonstration program, an eligible tribal 
     consortium shall submit to the Secretary, a petition at such 
     time, in such manner, and containing--
       ``(1) a description of the Indian population to be served;
       ``(2) a description of the specialty service or services 
     for which the mobile health station is requested and the 
     extent to which such service or services are currently 
     available to the Indian population to be served; and

[[Page S12444]]

       ``(3) such other information as the Secretary may require.
       ``(d) Use of Funds.--The Secretary shall use amounts made 
     available to carry out the demonstration program under this 
     section--
       ``(1)(A) to establish, purchase, lease, or maintain mobile 
     health stations for the eligible tribal consortia selected 
     for projects; and
       ``(B) to provide, through the mobile health station, such 
     specialty health care services as the affected eligible 
     tribal consortium determines to be necessary for the Indian 
     population served;
       ``(2) to employ an existing mobile health station 
     (regardless of whether the mobile health station is owned or 
     rented and operated by the Service) to provide specialty 
     health care services to an eligible tribal consortium; and
       ``(3) to establish, purchase, or maintain docking equipment 
     for a mobile health station, including the establishment or 
     maintenance of such equipment at a modular component health 
     care facility (as defined in section 312(a)), if applicable.
       ``(e) Reports.--Not later than 1 year after the date on 
     which the demonstration program is established under 
     subsection (b) and annually thereafter, the Secretary, acting 
     through the Service, shall submit to Congress a report 
     describing--
       ``(1) each activity carried out under the demonstration 
     program including an evaluation of the success of the 
     activity; and
       ``(2) the potential benefits of increased use of mobile 
     health stations to provide specialty health care services for 
     Indian communities.
       ``(f) Authorization of Appropriations.--There are 
     authorized to be appropriated $5,000,000 per year to carry 
     out the demonstration program under this section for the 
     first 5 fiscal years, and such sums as may be needed to carry 
     out the program in subsequent fiscal years.''.

                 Subtitle D--Access to Health Services

     SEC. 151. TREATMENT OF PAYMENTS UNDER SOCIAL SECURITY ACT 
                   HEALTH BENEFITS PROGRAMS.

       Section 401 of the Indian Health Care Improvement Act (25 
     U.S.C. 1641) is amended to read as follows:

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

       ``(a) Disregard of Medicare, Medicaid, and CHIP Payments in 
     Determining Appropriations.--Any payments received by an 
     Indian health program or by an urban Indian organization 
     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 XI of the Social 
     Security Act in preference to an Indian without such 
     coverage.
       ``(c) Use of Funds.--
       ``(1) Special fund.--
       ``(A) 100 percent pass-through of payments due to 
     facilities.--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 title XVIII 
     or XIX of the Social Security Act shall be placed in a 
     special fund to be held by the Secretary. 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 either such title.
       ``(B) Use of funds.--Amounts received by a facility of the 
     Service under subparagraph (A) by reason of a provision of 
     title XVIII or XIX of the Social Security Act shall first be 
     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 operated by or 
     through such facility which may be necessary to achieve or 
     maintain compliance with the applicable conditions and 
     requirements of such respective title. Any amounts so 
     received that are in excess of the amount necessary to 
     achieve or maintain such conditions and requirements shall, 
     subject to consultation with the Indian tribes being served 
     by the Service unit, be used for reducing the health resource 
     deficiencies (as determined in section 201(c)) of such Indian 
     tribes, including the provision of services pursuant to 
     section 205.
       ``(2) Direct payment option.--Paragraph (1) shall not apply 
     to a tribal health program upon the election of such 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 by such program during the period of such election.
       ``(d) Direct Billing.--
       ``(1) In general.--Subject to complying with the 
     requirements of paragraph (2), a tribal health program may 
     elect to directly bill for, and receive payment for, health 
     care items and services provided by such program 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 making the 
     election 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 subsection (c)(1), except that all amounts 
     so reimbursed shall be used by the tribal health program for 
     the purpose of making any improvements in facilities of the 
     tribal health program 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 
     (including coverage for a service or service within a 
     contract health service delivery area or any portion of a 
     contract health service delivery area that would otherwise be 
     provided as a contract health service), or otherwise to 
     achieve the objectives provided in section 3 of this Act.
       ``(B) Audits.--The amounts paid to a tribal health program 
     making the election described in paragraph (1) with respect 
     to a program under title XVIII, XIX, or XXI of the Social 
     Security Act shall be subject to all auditing requirements 
     applicable to the program under such title, as well as all 
     auditing requirements applicable to programs administered by 
     an Indian health program. Nothing in the preceding sentence 
     shall be construed as limiting the application of auditing 
     requirements applicable to amounts paid under title XVIII, 
     XIX, or XXI of the Social Security Act.
       ``(C) Identification of source of payments.--Any tribal 
     health program that receives reimbursements or payments under 
     title XVIII, XIX, or XXI of the Social Security Act shall 
     provide to the Service a list of each provider enrollment 
     number (or other identifier) under which such program 
     receives such reimbursements or payments.
       ``(3) Examination and implementation of changes.--
       ``(A) In general.--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 
     title XIX or XXI of the Social Security Act.
       ``(B) Coordination of information.--The Service shall 
     provide the Administrator of the Centers for Medicare & 
     Medicaid Services with copies of the lists submitted to the 
     Service under paragraph (2)(C), enrollment data regarding 
     patients served by the Service (and by tribal health 
     programs, to the extent such data is available to the 
     Service), and such other information as the Administrator may 
     require for purposes of administering title XVIII, XIX, or 
     XXI 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.
       ``(5) Termination for failure to comply with 
     requirements.--The Secretary may terminate the participation 
     of a tribal health program or in the direct billing program 
     established under this subsection if the Secretary determines 
     that the program has failed to comply with the requirements 
     of paragraph (2). The Secretary shall provide a tribal health 
     program with notice of a determination that the program has 
     failed to comply with any such requirement and a reasonable 
     opportunity to correct such noncompliance prior to 
     terminating the program's participation in the direct billing 
     program established under this subsection.
       ``(e) Related Provisions Under the Social Security Act.--
     For provisions related to subsections (c) and (d), see 
     sections 1880, 1911, and 2107(e)(1)(D) of the Social Security 
     Act.''.

     SEC. 152. PURCHASING HEALTH CARE COVERAGE.

       Section 402 of the Indian Health Care Improvement Act (25 
     U.S.C. 1642) is amended to read as follows:

     ``SEC. 402. 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 
     (25 U.S.C. 450 et seq.), or other law, other than under 
     section 404) 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 (including coverage for a service, or 
     service within a contract health service delivery area, or 
     any portion of a contract health service delivery area that 
     would otherwise be provided as a contract health service) for 
     such beneficiaries in any manner, including through--
       ``(1) a tribally owned and operated health care plan;

[[Page S12445]]

       ``(2) a State or locally authorized or licensed health care 
     plan;
       ``(3) a health insurance provider or managed care 
     organization;
       ``(4) a self-insured plan; or
       ``(5) a high deductible or health savings account plan.
       ``(b) Financial Need.--The purchase of coverage under 
     subsection (a) by an Indian tribe, tribal organization, or 
     urban Indian organization may be based on the financial needs 
     of such beneficiaries (as determined by the 1 or more Indian 
     tribes being served based on a schedule of income levels 
     developed or implemented by such 1 ore more Indian tribes).
       ``(c) 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.
       ``(d) Construction.--Nothing in this section shall be 
     construed as affecting the use of any amounts not referred to 
     in subsection (a).''.

     SEC. 153. GRANTS TO AND CONTRACTS WITH THE SERVICE, INDIAN 
                   TRIBES, TRIBAL ORGANIZATIONS, AND URBAN INDIAN 
                   ORGANIZATIONS TO FACILITATE OUTREACH, 
                   ENROLLMENT, AND COVERAGE OF INDIANS UNDER 
                   SOCIAL SECURITY ACT HEALTH BENEFIT PROGRAMS AND 
                   OTHER HEALTH BENEFITS PROGRAMS.

       Section 404 of the Indian Health Care Improvement Act (25 
     U.S.C. 1644) is amended to read as follows:

     ``SEC. 404. GRANTS TO AND CONTRACTS WITH THE SERVICE, INDIAN 
                   TRIBES, TRIBAL ORGANIZATIONS, AND URBAN INDIAN 
                   ORGANIZATIONS TO FACILITATE OUTREACH, 
                   ENROLLMENT, AND COVERAGE OF INDIANS UNDER 
                   SOCIAL SECURITY ACT HEALTH BENEFIT PROGRAMS AND 
                   OTHER HEALTH BENEFITS PROGRAMS.

       ``(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, including programs to provide 
     outreach and enrollment through video, electronic delivery 
     methods, or telecommunication devices that allow real-time or 
     time-delayed communication between individual Indians and the 
     benefit program, to assist individual Indians--
       ``(1) to enroll for benefits under a program established 
     under title XVIII, XIX, or XXI of the Social Security Act and 
     other health benefits programs; and
       ``(2) with respect to such programs for which the charging 
     of premiums and cost sharing is not prohibited under such 
     programs, to pay premiums or cost sharing for coverage for 
     such benefits, which may be based on financial need (as 
     determined by the Indian tribe or tribes or tribal 
     organizations being served based on a schedule of income 
     levels developed or implemented by such tribe, tribes, or 
     tribal organizations).
       ``(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 benefits under such 
     programs.
       ``(c) 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.
       ``(d) Facilitating Cooperation.--The Secretary, acting 
     through the Centers for Medicare & Medicaid Services, shall 
     develop and disseminate best practices that will serve to 
     facilitate cooperation with, and agreements between, States 
     and the Service, Indian tribes, tribal organizations, or 
     urban Indian organizations with respect to the provision of 
     health care items and services to Indians under the programs 
     established under title XVIII, XIX, or XXI of the Social 
     Security Act.
       ``(e) Agreements Relating to Improving Enrollment of 
     Indians Under Social Security Act Health Benefits Programs.--
     For provisions relating to agreements of the Secretary, 
     acting through the Service, for the collection, preparation, 
     and submission of applications by Indians for assistance 
     under the Medicaid and children's health insurance programs 
     established under titles XIX and XXI of the Social Security 
     Act, and benefits under the Medicare program established 
     under title XVIII of such Act, see subsections (a) and (b) of 
     section 1139 of the Social Security Act.
       ``(f) Definition of Premiums and Cost Sharing.--In this 
     section:
       ``(1) Premium.--The term `premium' includes any enrollment 
     fee or similar charge.
       ``(2) Cost sharing.--The term `cost sharing' includes any 
     deduction, deductible, copayment, coinsurance, or similar 
     charge.''.

     SEC. 154. SHARING ARRANGEMENTS WITH FEDERAL AGENCIES.

       Section 405 of the Indian Health Care Improvement Act (25 
     U.S.C. 1645) is amended to read as follows:

     ``SEC. 405. 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. 155. ELIGIBLE INDIAN VETERAN SERVICES.

       Title IV of the Indian Health Care Improvement Act (25 
     U.S.C. 1641 et seq.) (as amended by section 101(b)) is 
     amended by adding at the end the following:

     ``SEC. 407. ELIGIBLE INDIAN VETERAN SERVICES.

       ``(a) Findings; Purpose.--
       ``(1) Findings.--Congress finds that--
       ``(A) collaborations between the Secretary and the 
     Secretary of Veterans Affairs regarding the treatment of 
     Indian veterans at facilities of the Service should be 
     encouraged to the maximum extent practicable; and
       ``(B) increased enrollment for services of the Department 
     of Veterans Affairs by veterans who are members of Indian 
     tribes should be encouraged to the maximum extent 
     practicable.
       ``(2) Purpose.--The purpose of this section is to reaffirm 
     the goals stated in the document entitled `Memorandum of 
     Understanding Between the VA/Veterans Health Administration 
     And HHS/Indian Health Service' and dated February 25, 2003 
     (relating to cooperation and resource sharing between the 
     Veterans Health Administration and Service).
       ``(b) Definitions.--In this section:
       ``(1) Eligible indian veteran.--The term `eligible Indian 
     veteran' means an Indian or Alaska Native veteran who 
     receives any medical service that is--
       ``(A) authorized under the laws administered by the 
     Secretary of Veterans Affairs; and
       ``(B) administered at a facility of the Service (including 
     a facility operated by an Indian tribe or tribal organization 
     through a contract or compact with the Service under the 
     Indian Self-Determination and Education Assistance Act (25 
     U.S.C. 450 et seq.)) pursuant to a local memorandum of 
     understanding.
       ``(2) Local memorandum of understanding.--The term `local 
     memorandum of understanding' means a memorandum of 
     understanding between the Secretary (or a designee, including 
     the director of any area office of the Service) and the 
     Secretary of Veterans Affairs (or a designee) to implement 
     the document entitled `Memorandum of Understanding Between 
     the VA/Veterans Health Administration And HHS/Indian Health 
     Service' and dated February 25, 2003 (relating to cooperation 
     and resource sharing between the Veterans Health 
     Administration and Indian Health Service).
       ``(c) Eligible Indian Veterans Expenses.--
       ``(1) In general.--Notwithstanding any other provision of 
     law, the Secretary shall

[[Page S12446]]

     provide for veteran-related expenses incurred by eligible 
     Indian veterans as described in subsection (b)(1)(B).
       ``(2) Method of payment.--The Secretary shall establish 
     such guidelines as the Secretary determines to be appropriate 
     regarding the method of payments to the Secretary of Veterans 
     Affairs under paragraph (1).
       ``(d) Tribal Approval of Memoranda.--In negotiating a local 
     memorandum of understanding with the Secretary of Veterans 
     Affairs regarding the provision of services to eligible 
     Indian veterans, the Secretary shall consult with each Indian 
     tribe that would be affected by the local memorandum of 
     understanding.
       ``(e) Funding.--
       ``(1) Treatment.--Expenses incurred by the Secretary in 
     carrying out subsection (c)(1) shall not be considered to be 
     Contract Health Service expenses.
       ``(2) Use of funds.--Of funds made available to the 
     Secretary in appropriations Acts for the Service (excluding 
     funds made available for facilities, Contract Health 
     Services, or contract support costs), the Secretary shall use 
     such sums as are necessary to carry out this section.''.

     SEC. 156. NONDISCRIMINATION UNDER FEDERAL HEALTH CARE 
                   PROGRAMS IN QUALIFICATIONS FOR REIMBURSEMENT 
                   FOR SERVICES.

       Title IV of the Indian Health Care Improvement Act (25 
     U.S.C. 1641 et seq.) (as amended by section 155) is amended 
     by adding at the end the following:

     ``SEC. 408. NONDISCRIMINATION UNDER FEDERAL HEALTH CARE 
                   PROGRAMS IN QUALIFICATIONS FOR REIMBURSEMENT 
                   FOR SERVICES.

       ``(a) Requirement To Satisfy Generally Applicable 
     Participation Requirements.--
       ``(1) In general.--A Federal health care program must 
     accept an entity that is operated by the Service, an Indian 
     tribe, tribal organization, or urban Indian organization as a 
     provider eligible to receive payment under the program for 
     health care services furnished to an Indian on the same basis 
     as any other provider qualified to participate as a provider 
     of health care services under the program if the entity meets 
     generally applicable State or other requirements for 
     participation as a provider of health care services under the 
     program.
       ``(2) Satisfaction of state or local licensure or 
     recognition requirements.--Any requirement for participation 
     as a provider of health care services under a Federal health 
     care program that an entity be licensed or recognized under 
     the State or local law where the entity is located to furnish 
     health care services shall be deemed to have been met in the 
     case of an entity operated by the Service, an Indian tribe, 
     tribal organization, or urban Indian organization if the 
     entity meets all the applicable standards for such licensure 
     or recognition, regardless of whether the entity obtains a 
     license or other documentation under such State or local law. 
     In accordance with section 221, the absence of the licensure 
     of a health professional employed by such an entity under the 
     State or local law where the entity is located shall not be 
     taken into account for purposes of determining whether the 
     entity meets such standards, if the professional is licensed 
     in another State.
       ``(b) Application of Exclusion From Participation in 
     Federal Health Care Programs.--
       ``(1) Excluded entities.--No entity operated by the 
     Service, an Indian tribe, tribal organization, or urban 
     Indian organization that has been excluded from participation 
     in any Federal health care program or for which a license is 
     under suspension or has been revoked by the State where the 
     entity is located shall be eligible to receive payment or 
     reimbursement under any such program for health care services 
     furnished to an Indian.
       ``(2) Excluded individuals.--No individual who has been 
     excluded from participation in any Federal health care 
     program or whose State license is under suspension shall be 
     eligible to receive payment or reimbursement under any such 
     program for health care services furnished by that 
     individual, directly or through an entity that is otherwise 
     eligible to receive payment for health care services, to an 
     Indian.
       ``(3) Federal health care program defined.--In this 
     subsection, the term, `Federal health care program' has the 
     meaning given that term in section 1128B(f) of the Social 
     Security Act (42 U.S.C. 1320a-7b(f)), except that, for 
     purposes of this subsection, such term shall include the 
     health insurance program under chapter 89 of title 5, United 
     States Code.
       ``(c) Related Provisions.--For provisions related to 
     nondiscrimination against providers operated by the Service, 
     an Indian tribe, tribal organization, or urban Indian 
     organization, see section 1139(c) of the Social Security Act 
     (42 U.S.C. 1320b-9(c)).''.

     SEC. 157. ACCESS TO FEDERAL INSURANCE.

       Title IV of the Indian Health Care Improvement Act (25 
     U.S.C. 1641 et seq.) (as amended by section 156) is amended 
     by adding at the end the following:

     ``SEC. 409. ACCESS TO FEDERAL INSURANCE.

       ``Notwithstanding the provisions of title 5, United States 
     Code, Executive order, or administrative regulation, an 
     Indian tribe or tribal organization carrying out programs 
     under the Indian Self-Determination and Education Assistance 
     Act (25 U.S.C. 450 et seq.) or an urban Indian organization 
     carrying out programs under title V of this Act shall be 
     entitled to purchase coverage, rights, and benefits for the 
     employees of such Indian tribe or tribal organization, or 
     urban Indian organization, under chapter 89 of title 5, 
     United States Code, and chapter 87 of such title if necessary 
     employee deductions and agency contributions in payment for 
     the coverage, rights, and benefits for the period of 
     employment with such Indian tribe or tribal organization, or 
     urban Indian organization, are currently deposited in the 
     applicable Employee's Fund under such title.''.

     SEC. 158. GENERAL EXCEPTIONS.

       Title IV of the Indian Health Care Improvement Act (25 
     U.S.C. 1641 et seq.) (as amended by section 157) is amended 
     by adding at the end the following:

     ``SEC. 410. GENERAL EXCEPTIONS.

       ``The requirements of this title shall not apply to any 
     excepted benefits described in paragraph (1)(A) or (3) of 
     section 2791(c) of the Public Health Service Act (42 U.S.C. 
     300gg-91).''.

     SEC. 159. NAVAJO NATION MEDICAID AGENCY FEASIBILITY STUDY.

       Title IV of the Indian Health Care Improvement Act (25 
     U.S.C. 1641 et seq.) (as amended by section 158) is amended 
     by adding at the end the following:

     ``SEC. 411. 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 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 Care Improvement 
     Reauthorization and Extension Act of 2009, the Secretary 
     shall submit to the Committee on Indian Affairs and Committee 
     on Finance of the Senate and the Committee on Natural 
     Resources and Committee on Energy and Commerce 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.''.

             Subtitle E--Health Services for Urban Indians

     SEC. 161. FACILITIES RENOVATION.

       Section 509 of the Indian Health Care Improvement Act (25 
     U.S.C. 1659) is amended by inserting ``or construction or 
     expansion of facilities'' after ``renovations to 
     facilities''.

     SEC. 162. TREATMENT OF CERTAIN DEMONSTRATION PROJECTS.

       Section 512 of the Indian Health Care Improvement Act (25 
     U.S.C. 1660b) is amended to read as follows:

     ``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 and operating 
     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 (25 U.S.C. 450 et seq.).''.

     SEC. 163. REQUIREMENT TO CONFER WITH URBAN INDIAN 
                   ORGANIZATIONS.

       (a) Conferring With Urban Indian Organizations.--Title V of 
     the Indian Health Care Improvement Act (25 U.S.C. 1651 et 
     seq.) (as amended by section 101(b)) is amended by adding at 
     the end the following:

[[Page S12447]]

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

       ``(a) Definition of Confer.--In this section, the term 
     `confer' means to engage in an open and free exchange of 
     information and opinions that--
       ``(1) leads to mutual understanding and comprehension; and
       ``(2) emphasizes trust, respect, and shared responsibility.
       ``(b) Requirement.--The Secretary shall ensure that the 
     Service confers, to the maximum extent practicable, with 
     urban Indian organizations in carrying out this Act.''.
       (b) Contracts With, and Grants to, Urban Indian 
     Organizations.--Section 502 of the Indian Health Care 
     Improvement Act (25 U.S.C. 1652) is amended to read as 
     follows:

     ``SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN INDIAN 
                   ORGANIZATIONS.

       ``(a) In General.--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 enter into 
     contracts with, or make grants to, urban Indian organizations 
     to assist the urban Indian organizations in the establishment 
     and administration, within urban centers, of programs that 
     meet the requirements of this title.
       ``(b) Conditions.--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. 164. EXPANDED PROGRAM AUTHORITY FOR URBAN INDIAN 
                   ORGANIZATIONS.

       Title V of the Indian Health Care Improvement Act (25 
     U.S.C. 1651 et seq.) (as amended by section 163(a)) is 
     amended by adding at the end the following:

     ``SEC. 515. EXPANDED PROGRAM AUTHORITY FOR URBAN INDIAN 
                   ORGANIZATIONS.

       ``Notwithstanding any other provision of this Act, the 
     Secretary, acting through the Service, is authorized to 
     establish programs, including programs for awarding grants, 
     for urban Indian organizations that are identical to any 
     programs established pursuant to sections 218, 702, and 
     708(g).''.

     SEC. 165. COMMUNITY HEALTH REPRESENTATIVES.

       Title V of the Indian Health Care Improvement Act (25 
     U.S.C. 1651 et seq.) (as amended by section 164) is amended 
     by adding at the end the following:

     ``SEC. 516. 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 Representative 
     Program under section 107 in the provision of health care, 
     health promotion, and disease prevention services to urban 
     Indians.''.

     SEC. 166. USE OF FEDERAL GOVERNMENT FACILITIES AND SOURCES OF 
                   SUPPLY; HEALTH INFORMATION TECHNOLOGY.

       Title V of the Indian Health Care Improvement Act (25 
     U.S.C. 1651 et seq.) (as amended by section 165) is amended 
     by adding at the end the following:

     ``SEC. 517. USE OF FEDERAL GOVERNMENT FACILITIES AND SOURCES 
                   OF SUPPLY.

       ``(a) In General.--The Secretary may permit an urban Indian 
     organization that has entered into a contract or received a 
     grant pursuant to this title, in carrying out the contract or 
     grant, to use, in accordance with such terms and conditions 
     for use and maintenance as are agreed on by the Secretary and 
     the urban Indian organizations--
       ``(1) any existing facility under the jurisdiction of the 
     Secretary;
       ``(2) all equipment contained in or pertaining to such an 
     existing facility; and
       ``(3) any other personal property of the Federal Government 
     under the jurisdiction of the Secretary.
       ``(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 the purposes of carrying out the contract or grant.
       ``(c) Acquisition of Property.--The Secretary may acquire 
     excess or surplus personal or real property of the Federal 
     Government 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 purposes of the contract or 
     grant.
       ``(d) Priority.--If the Secretary receives from an urban 
     Indian organization or an Indian tribe or tribal organization 
     a request for a specific item of personal or real property 
     described in subsection (b) or (c), the Secretary shall give 
     priority to the request for donation to the Indian tribe or 
     tribal organization, if the Secretary receives the request 
     from the Indian tribe or tribal organization before the 
     earlier of--
       ``(1) the date on which the Secretary transfers title to 
     the property to the urban Indian organization; and
       ``(2) the date on which the Secretary transfers the 
     property physically to the urban Indian organization.
       ``(e) Executive Agency Status.--For purposes of section 
     501(a) of title 40, United States Code, an urban Indian 
     organization that has entered into a contract or received a 
     grant pursuant to this title may be considered to be an 
     Executive agency in carrying out the contract or grant.

     ``SEC. 518. HEALTH INFORMATION TECHNOLOGY.

       ``The Secretary, acting through the Service, may make 
     grants to urban Indian organizations under this title for the 
     development, adoption, and implementation of health 
     information technology (as defined in section 3000 of the 
     Public Health Service Act (42 U.S.C. 300jj)), telemedicine 
     services development, and related infrastructure.''.

                Subtitle F--Organizational Improvements

     SEC. 171. ESTABLISHMENT OF THE INDIAN HEALTH SERVICE AS AN 
                   AGENCY OF THE PUBLIC HEALTH SERVICE.

       Section 601 of the Indian Health Care Improvement Act (25 
     U.S.C. 1661) is amended to read as follows:

     ``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) Director.--The Service shall be administered by a 
     Director, who shall be appointed by the President, by and 
     with the advice and consent of the Senate. The Director 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, 2008, the term of 
     service of the Director shall be 4 years. A Director may 
     serve more than 1 term.
       ``(3) Incumbent.--The individual serving in the position of 
     Director of the Service on the day before the date of 
     enactment of the Indian Health Care Improvement 
     Reauthorization and Extension Act of 2009 shall serve as 
     Director.
       ``(4) Advocacy and consultation.--The position of Director 
     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 Director shall--
       ``(1) perform all functions that were, on the day before 
     the date of enactment of the Indian Health Care Improvement 
     Reauthorization and Extension Act of 2009, 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, including by 
     ensuring that all agency directors, managers, and chief 
     executive officers have appropriate and adequate training, 
     experience, skill levels, knowledge, abilities, and education 
     (including continuing training requirements) to competently 
     fulfill the duties of the positions and the mission of the 
     Service;
       ``(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) directly advise the Secretary concerning the 
     development of 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 
     Director, shall have the authority--

[[Page S12448]]

       ``(A) except to the extent provided for in paragraph (2), 
     to appoint and compensate employees for the Service in 
     accordance with title 5, United States Code;
       ``(B) to enter into contracts for the procurement of goods 
     and services to carry out the functions of the Service; and
       ``(C) to manage, expend, and obligate all funds 
     appropriated for the Service.
       ``(2) Personnel actions.--Notwithstanding any other 
     provision of law, the provisions of section 12 of the Act of 
     June 18, 1934 (48 Stat. 986; 25 U.S.C. 472), shall apply to 
     all personnel actions taken with respect to new positions 
     created within the Service as a result of its establishment 
     under subsection (a).''.

     SEC. 172. OFFICE OF DIRECT SERVICE TRIBES.

       Title VI of the Indian Health Care Improvement Act (25 
     U.S.C. 1661 et seq.) (as amended by section 101(b)) is 
     amended by adding at the end the following:

     ``SEC. 603. OFFICE OF DIRECT SERVICE TRIBES.

       ``(a) Establishment.--There is established within the 
     Service an office, to be known as the `Office of Direct 
     Service Tribes'.
       ``(b) Treatment.--The Office of Direct Service Tribes shall 
     be located in the Office of the Director.
       ``(c) Duties.--The Office of Direct Service Tribes shall be 
     responsible for--
       ``(1) providing Service-wide leadership, guidance and 
     support for direct service tribes to include strategic 
     planning and program evaluation;
       ``(2) ensuring maximum flexibility to tribal health and 
     related support systems for Indian beneficiaries;
       ``(3) serving as the focal point for consultation and 
     participation between direct service tribes and organizations 
     and the Service in the development of Service policy;
       ``(4) holding no less than biannual consultations with 
     direct service tribes in appropriate locations to gather 
     information and aid in the development of health policy; and
       ``(5) directing a national program and providing leadership 
     and advocacy in the development of health policy, program 
     management, budget formulation, resource allocation, and 
     delegation support for direct service tribes.''.

     SEC. 173. NEVADA AREA OFFICE.

       Title VI of the Indian Health Care Improvement Act (25 
     U.S.C. 1661 et seq.) (as amended by section 172) is amended 
     by adding at the end the following:

     ``SEC. 604. NEVADA AREA OFFICE.

       ``(a) In General.--Not later than 1 year after the date of 
     enactment of this section, in a manner consistent with the 
     tribal consultation policy of the Service, the Secretary 
     shall submit to Congress a plan describing the manner and 
     schedule by which an area office, separate and distinct from 
     the Phoenix Area Office of the Service, can be established in 
     the State of Nevada.
       ``(b) Failure to Submit Plan.--
       ``(1) Definition of operations funds.--In this subsection, 
     the term `operations funds' means only the funds used for--
       ``(A) the administration of services, including functional 
     expenses such as overtime, personnel salaries, and associated 
     benefits; or
       ``(B) related tasks that directly affect the operations 
     described in subparagraph (A).
       ``(2) Withholding of funds.--If the Secretary fails to 
     submit a plan in accordance with subsection (a), the 
     Secretary shall withhold the operations funds reserved for 
     the Office of the Director, subject to the condition that the 
     withholding shall not adversely impact the capacity of the 
     Service to deliver health care services.
       ``(3) Restoration.--The operations funds withheld pursuant 
     to paragraph (2) may be restored, at the discretion of the 
     Secretary, to the Office of the Director on achievement by 
     that Office of compliance with this section.''.

                 Subtitle G--Behavioral Health Programs

     SEC. 181. BEHAVIORAL HEALTH PROGRAMS.

       Title VII of the Indian Health Care Improvement Act (25 
     U.S.C. 1665 et seq.) is amended to read as follows:

                ``TITLE VII--BEHAVIORAL HEALTH PROGRAMS

                     ``Subtitle A--General Programs

     ``SEC. 701. DEFINITIONS.

       ``In this subtitle:
       ``(1) Alcohol-related neurodevelopmental disorders; arnd.--
     The term `alcohol-related neurodevelopmental disorders' or 
     `ARND' means, with a history of maternal alcohol consumption 
     during pregnancy, central nervous system abnormalities, which 
     may range from minor intellectual deficits and developmental 
     delays to mental retardation. ARND children may have 
     behavioral problems, learning disabilities, problems with 
     executive functioning, and attention disorders. The 
     neurological defects of ARND may be as severe as FAS, but 
     facial anomalies and other physical characteristics are not 
     present in ARND, thus making diagnosis difficult.
       ``(2) Assessment.--The term `assessment' means the 
     systematic collection, analysis, and dissemination of 
     information on health status, health needs, and health 
     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 as a 
     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.
       ``(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 spectrum disorders.--
       ``(A) In general.--The term `fetal alcohol spectrum 
     disorders' includes a range of effects that can occur in an 
     individual whose mother drank alcohol during pregnancy, 
     including physical, mental, behavioral, and/or learning 
     disabilities with possible lifelong implications.
       ``(B) Inclusions.--The term `fetal alcohol spectrum 
     disorders' may include--
       ``(i) fetal alcohol syndrome (FAS);
       ``(ii) partial fetal alcohol syndrome (partial FAS);
       ``(iii) alcohol-related birth defects (ARBD); and
       ``(iv) alcohol-related neurodevelopmental disorders (ARND).
       ``(6) FAS or fetal alcohol syndrome.--The term `FAS' or 
     `fetal alcohol syndrome' 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 mental 
     retardation, developmental delay, intellectual deficit, 
     microencephaly, or neurological abnormalities.
       ``(B) Craniofacial abnormalities with at least 2 of the 
     following:
       ``(i) Microophthalmia.
       ``(ii) Short palpebral fissures.
       ``(iii) Poorly developed philtrum.
       ``(iv) Thin upper lip.
       ``(v) Flat nasal bridge.
       ``(vi) Short upturned nose.
       ``(C) Prenatal or postnatal growth delay.
       ``(7) Rehabilitation.--The term `rehabilitation' means 
     medical and health care services that--
       ``(A) are recommended by a physician or licensed 
     practitioner of the healing arts within the scope of their 
     practice under applicable law;
       ``(B) are furnished in a facility, home, or other setting 
     in accordance with applicable standards; and
       ``(C) have as their purpose any of the following:
       ``(i) The maximum attainment of physical, mental, and 
     developmental functioning.
       ``(ii) Averting deterioration in physical or mental 
     functional status.
       ``(iii) The maintenance of physical or mental health 
     functional status.
       ``(8) Substance abuse.--The term `substance abuse' includes 
     inhalant abuse.

     ``SEC. 702. 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, and tribal 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, 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, and tribal 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.

[[Page S12449]]

       ``(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 coordinate with existing national 
     clearinghouses and information centers to include at the 
     clearinghouses and centers 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, 
     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) diagnostic services; and
       ``(J) promotion of healthy approaches to risk and safety 
     issues, including injury prevention.
       ``(2) Child care.--Behavioral health services for Indians 
     from birth through age 17, including--
       ``(A) preschool and school age fetal alcohol spectrum 
     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 spectrum 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, 
     Indian tribes, and tribal organizations, 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, 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 Reauthorization and Extension Act of 2009, 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. 703. MEMORANDA OF AGREEMENT WITH THE DEPARTMENT OF 
                   INTERIOR.

       ``(a) Contents.--Not later than 1 year after the date of 
     enactment of the Indian Health Care Improvement 
     Reauthorization and Extension Act of 2009, 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 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 (25 U.S.C. 2401 et seq.)) 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 702(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

[[Page S12450]]

     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) 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. 704. COMPREHENSIVE BEHAVIORAL HEALTH PREVENTION AND 
                   TREATMENT PROGRAM.

       ``(a) Establishment.--
       ``(1) In general.--The Secretary, acting through the 
     Service, shall provide a program of comprehensive behavioral 
     health, prevention, treatment, and aftercare, which may 
     include, if feasible and appropriate, systems of care, and 
     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, 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. 705. MENTAL HEALTH TECHNICIAN PROGRAM.

       ``(a) In General.--Pursuant to 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, 
     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, 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 section involves the use and 
     promotion of the traditional health care practices of the 
     Indian tribes to be served.

     ``SEC. 706. LICENSING REQUIREMENT FOR MENTAL HEALTH CARE 
                   WORKERS.

       ``(a) In General.--Subject to section 221, and except as 
     provided in subsection (b), any individual 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 psychologist, social worker, or marriage and 
     family therapist, respectively.
       ``(b) Trainees.--An individual may be employed as a trainee 
     in psychology, social work, or marriage and family therapy to 
     provide mental health care services described in subsection 
     (a) if such individual--
       ``(1) works under the direct supervision of a licensed 
     psychologist, social worker, or marriage and family 
     therapist, respectively;
       ``(2) is enrolled in or has completed at least 2 years of 
     course work at a post-secondary, accredited education program 
     for psychology, social work, marriage and family therapy, or 
     counseling; and
       ``(3) meets such other training, supervision, and quality 
     review requirements as the Secretary may establish.

     ``SEC. 707. INDIAN WOMEN TREATMENT PROGRAMS.

       ``(a) Grants.--The Secretary, consistent with section 702, 
     may make grants 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 cultural, historical, social, and 
     child care needs of Indian women, regardless of age.
       ``(b) Use of Grant Funds.--A grant made pursuant to this 
     section may be used--
       ``(1) to develop and provide community training, education, 
     and prevention programs for Indian women relating to 
     behavioral health issues, including fetal alcohol spectrum 
     disorders;
       ``(2) to identify and provide psychological services, 
     counseling, advocacy, support, and relapse prevention to 
     Indian women and their families; and
       ``(3) to 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) Allocation of Funds for Urban Indian Organizations.--
     20 percent of the funds appropriated pursuant to this section 
     shall be used to make grants to urban Indian organizations.

     ``SEC. 708. INDIAN YOUTH PROGRAM.

       ``(a) Detoxification and Rehabilitation.--The Secretary, 
     acting through the Service, consistent with section 702, 
     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 (25 U.S.C. 450 et 
     seq.). 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, 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 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, may provide intermediate behavioral health services, 
     which may, if feasible and appropriate, incorporate systems 
     of care, 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

[[Page S12451]]

       ``(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 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, 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, shall provide, consistent with section 
     702, 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.
       ``(h) Indian Youth Mental Health.--The Secretary, acting 
     through the Service, shall collect data for the report under 
     section 801 with respect to--
       ``(1) the number of Indian youth who are being provided 
     mental health services through the Service and tribal health 
     programs;
       ``(2) a description of, and costs associated with, the 
     mental health services provided for Indian youth through the 
     Service and tribal health programs;
       ``(3) the number of youth referred to the Service or tribal 
     health programs for mental health services;
       ``(4) the number of Indian youth provided residential 
     treatment for mental health and behavioral problems through 
     the Service and tribal health programs, reported separately 
     for on- and off-reservation facilities; and
       ``(5) the costs of the services described in paragraph (4).

     ``SEC. 709. 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 Reauthorization and Extension 
     Act of 2009, the Secretary, acting through the Service, 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. 710. TRAINING AND COMMUNITY EDUCATION.

       ``(a) Program.--The Secretary, in cooperation with the 
     Secretary of the Interior, shall develop and implement or 
     assist 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. Such program may 
     also include community-based training to develop local 
     capacity and tribal community provider training for 
     prevention, intervention, treatment, and aftercare.
       ``(b) Instruction.--The Secretary, acting through the 
     Service, shall 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 spectrum 
     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 abuse and other 
     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. 711. BEHAVIORAL HEALTH PROGRAM.

       ``(a) Innovative Programs.--The Secretary, acting through 
     the Service, consistent with section 702, may plan, develop, 
     implement, and carry out programs to deliver innovative 
     community-based behavioral health services to Indians.
       ``(b) Awards; Criteria.--The Secretary may award a grant 
     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.

     ``SEC. 712. FETAL ALCOHOL SPECTRUM DISORDERS PROGRAMS.

       ``(a) Programs.--
       ``(1) Establishment.--The Secretary, consistent with 
     section 702, acting through the Service, Indian tribes, and 
     Tribal Organizations, is authorized to establish and operate 
     fetal alcohol spectrum disorders programs as provided in this 
     section for the purposes of meeting the health status 
     objectives specified in section 3.
       ``(2) Use of funds.--
       ``(A) In general.--Funding provided pursuant to this 
     section shall be used for the following:
       ``(i) To develop and provide for Indians community and in-
     school training, education, and prevention programs relating 
     to fetal alcohol spectrum disorders.
       ``(ii) To identify and provide behavioral health treatment 
     to high-risk Indian women and high-risk women pregnant with 
     an Indian's child.
       ``(iii) To identify and provide appropriate psychological 
     services, educational and vocational support, counseling, 
     advocacy, and information to fetal alcohol spectrum 
     disorders-affected Indians and their families or caretakers.

[[Page S12452]]

       ``(iv) To develop and implement counseling and support 
     programs in schools for fetal alcohol spectrum disorders-
     affected Indian children.
       ``(v) To develop prevention and intervention models which 
     incorporate practitioners of traditional health care 
     practices, cultural values, and community involvement.
       ``(vi) To develop, print, and disseminate education and 
     prevention materials on fetal alcohol spectrum disorders.
       ``(vii) To develop and implement, in consultation with 
     Indian tribes and tribal organizations, and in conference 
     with urban Indian organizations, culturally sensitive 
     assessment and diagnostic tools including dysmorphology 
     clinics and multidisciplinary fetal alcohol spectrum 
     disorders clinics for use in Indian communities and urban 
     centers.
       ``(viii) To develop and provide training on fetal alcohol 
     spectrum disorders to professionals providing services to 
     Indians, including medical and allied health practitioners, 
     social service providers, educators, and law enforcement, 
     court officials and corrections personnel in the juvenile and 
     criminal justice systems.
       ``(B) Additional uses.--In addition to any purpose under 
     subparagraph (A), funding provided pursuant to this section 
     may be used for 1 or more of the following:
       ``(i) Early childhood intervention projects from birth on 
     to mitigate the effects of fetal alcohol spectrum disorders 
     among Indians.
       ``(ii) Community-based support services for Indians and 
     women pregnant with Indian children.
       ``(iii) Community-based housing for adult Indians with 
     fetal alcohol spectrum disorders.
       ``(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, 
     Indian tribes, and tribal organizations, shall--
       ``(1) develop and provide services for the prevention, 
     intervention, treatment, and aftercare for those affected by 
     fetal alcohol spectrum disorders in Indian communities; and
       ``(2) provide supportive services, including services to 
     meet the special educational, vocational, school-to-work 
     transition, and independent living needs of adolescent and 
     adult Indians with fetal alcohol spectrum disorders.
       ``(c) Applied Research Projects.--The Secretary, acting 
     through the Substance Abuse and Mental Health Services 
     Administration, shall make grants 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 spectrum 
     disorders.
       ``(d) 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. 713. CHILD SEXUAL ABUSE PREVENTION AND TREATMENT 
                   PROGRAMS.

       ``(a) Establishment.--The Secretary, acting through the 
     Service, shall establish, consistent with section 702, 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) other members of the household or family of the 
     victims described in paragraph (1).
       ``(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 
     values, and community involvement.
       ``(4) To develop and implement culturally sensitive 
     assessment and diagnostic tools for use in Indian communities 
     and urban centers.
       ``(c) Coordination.--The programs established under 
     subsection (a) shall be carried out in coordination with 
     programs and services authorized under the Indian Child 
     Protection and Family Violence Prevention Act (25 U.S.C. 3201 
     et seq.).

     ``SEC. 714. DOMESTIC AND SEXUAL VIOLENCE PREVENTION AND 
                   TREATMENT.

       ``(a) In General.--The Secretary, in accordance with 
     section 702, is authorized to establish in each Service area 
     programs involving the prevention and treatment of--
       ``(1) Indian victims of domestic violence or sexual abuse; 
     and
       ``(2) other members of the household or family of the 
     victims described in paragraph (1).
       ``(b) Use of Funds.--Funds made available to carry out this 
     section shall be used--
       ``(1) to develop and implement prevention programs and 
     community education programs relating to domestic violence 
     and sexual abuse;
       ``(2) to provide behavioral health services, including 
     victim support services, and medical treatment (including 
     examinations performed by sexual assault nurse examiners) to 
     Indian victims of domestic violence or sexual abuse;
       ``(3) to purchase rape kits; and
       ``(4) to develop prevention and intervention models, which 
     may incorporate traditional health care practices.
       ``(c) Training and Certification.--
       ``(1) In general.--Not later than 1 year after the date of 
     enactment of the Indian Health Care Improvement 
     Reauthorization and Extension Act of 2009, the Secretary 
     shall establish appropriate protocols, policies, procedures, 
     standards of practice, and, if not available elsewhere, 
     training curricula and training and certification 
     requirements for services for victims of domestic violence 
     and sexual abuse.
       ``(2) Report.--Not later than 18 months after the date of 
     enactment of the Indian Health Care Improvement 
     Reauthorization and Extension Act of 2009, the Secretary 
     shall submit to the Committee on Indian Affairs of the Senate 
     and the Committee on Natural Resources of the House of 
     Representatives a report that describes the means and extent 
     to which the Secretary has carried out paragraph (1).
       ``(d) Coordination.--
       ``(1) In general.--The Secretary, in coordination with the 
     Attorney General, Federal and tribal law enforcement 
     agencies, Indian health programs, and domestic violence or 
     sexual assault victim organizations, shall develop 
     appropriate victim services and victim advocate training 
     programs--
       ``(A) to improve domestic violence or sexual abuse 
     responses;
       ``(B) to improve forensic examinations and collection;
       ``(C) to identify problems or obstacles in the prosecution 
     of domestic violence or sexual abuse; and
       ``(D) to meet other needs or carry out other activities 
     required to prevent, treat, and improve prosecutions of 
     domestic violence and sexual abuse.
       ``(2) Report.--Not later than 2 years after the date of 
     enactment of the Indian Health Care Improvement 
     Reauthorization and Extension Act of 2009, the Secretary 
     shall submit to the Committee on Indian Affairs of the Senate 
     and the Committee on Natural Resources of the House of 
     Representatives a report that describes, with respect to the 
     matters described in paragraph (1), the improvements made and 
     needed, problems or obstacles identified, and costs necessary 
     to address the problems or obstacles, and any other 
     recommendations that the Secretary determines to be 
     appropriate.

     ``SEC. 715. BEHAVIORAL HEALTH RESEARCH.

       ``(a) In General.--The Secretary, in consultation with 
     appropriate Federal agencies, shall make grants to, or enter 
     into contracts with, 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 multifactorial causes of Indian youth suicide, 
     including--
       ``(A) protective and risk factors and scientific data that 
     identifies those factors; and
       ``(B) the effects of loss of cultural identity and the 
     development of scientific data on those effects;
       ``(2) 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
       ``(3) the development of models of prevention techniques.
       ``(b) Emphasis.--The effect of the interrelationships and 
     interdependencies referred to in subsection (a)(2) on 
     children, and the development of prevention techniques under 
     subsection (a)(3) applicable to children, shall be 
     emphasized.

             ``Subtitle B--Indian Youth Suicide Prevention

     ``SEC. 721. FINDINGS AND PURPOSE.

       ``(a) Findings.--Congress finds that--
       ``(1)(A) the rate of suicide of American Indians and Alaska 
     Natives is 1.9 times higher than the national average rate; 
     and
       ``(B) the rate of suicide of Indian and Alaska Native youth 
     aged 15 through 24 is--
       ``(i) 3.5 times the national average rate; and
       ``(ii) the highest rate of any population group in the 
     United States;
       ``(2) many risk behaviors and contributing factors for 
     suicide are more prevalent in Indian country than in other 
     areas, including--
       ``(A) history of previous suicide attempts;
       ``(B) family history of suicide;
       ``(C) history of depression or other mental illness;
       ``(D) alcohol or drug abuse;
       ``(E) health disparities;
       ``(F) stressful life events and losses;
       ``(G) easy access to lethal methods;
       ``(H) exposure to the suicidal behavior of others;
       ``(I) isolation; and
       ``(J) incarceration;
       ``(3) according to national data for 2005, suicide was the 
     second-leading cause of death for Indians and Alaska Natives 
     of both sexes aged 10 through 34;

[[Page S12453]]

       ``(4)(A) the suicide rates of Indian and Alaska Native 
     males aged 15 through 24 are--
       ``(i) as compared to suicide rates of males of any other 
     racial group, up to 4 times greater; and
       ``(ii) as compared to suicide rates of females of any other 
     racial group, up to 11 times greater; and
       ``(B) data demonstrates that, over their lifetimes, females 
     attempt suicide 2 to 3 times more often than males;
       ``(5)(A) Indian tribes, especially Indian tribes located in 
     the Great Plains, have experienced epidemic levels of 
     suicide, up to 10 times the national average; and
       ``(B) suicide clustering in Indian country affects entire 
     tribal communities;
       ``(6) death rates for Indians and Alaska Natives are 
     statistically underestimated because many areas of Indian 
     country lack the proper resources to identify and monitor the 
     presence of disease;
       ``(7)(A) the Indian Health Service experiences health 
     professional shortages, with physician vacancy rates of 
     approximately 17 percent, and nursing vacancy rates of 
     approximately 18 percent, in 2007;
       ``(B) 90 percent of all teens who die by suicide suffer 
     from a diagnosable mental illness at time of death;
       ``(C) more than \1/2\ of teens who die by suicide have 
     never been seen by a mental health provider; and
       ``(D) \1/3\ of health needs in Indian country relate to 
     mental health;
       ``(8) often, the lack of resources of Indian tribes and the 
     remote nature of Indian reservations make it difficult to 
     meet the requirements necessary to access Federal assistance, 
     including grants;
       ``(9) the Substance Abuse and Mental Health Services 
     Administration and the Service have established specific 
     initiatives to combat youth suicide in Indian country and 
     among Indians and Alaska Natives throughout the United 
     States, including the National Suicide Prevention Initiative 
     of the Service, which has worked with Service, tribal, and 
     urban Indian health programs since 2003;
       ``(10) the National Strategy for Suicide Prevention was 
     established in 2001 through a Department of Health and Human 
     Services collaboration among--
       ``(A) the Substance Abuse and Mental Health Services 
     Administration;
       ``(B) the Service;
       ``(C) the Centers for Disease Control and Prevention;
       ``(D) the National Institutes of Health; and
       ``(E) the Health Resources and Services Administration; and
       ``(11) the Service and other agencies of the Department of 
     Health and Human Services use information technology and 
     other programs to address the suicide prevention and mental 
     health needs of Indians and Alaska Natives.
       ``(b) Purposes.--The purposes of this subtitle are--
       ``(1) to authorize the Secretary to carry out a 
     demonstration project to test the use of telemental health 
     services in suicide prevention, intervention, and treatment 
     of Indian youth, including through--
       ``(A) the use of psychotherapy, psychiatric assessments, 
     diagnostic interviews, therapies for mental health conditions 
     predisposing to suicide, and alcohol and substance abuse 
     treatment;
       ``(B) the provision of clinical expertise to, consultation 
     services with, and medical advice and training for frontline 
     health care providers working with Indian youth;
       ``(C) training and related support for community leaders, 
     family members, and health and education workers who work 
     with Indian youth;
       ``(D) the development of culturally relevant educational 
     materials on suicide; and
       ``(E) data collection and reporting;
       ``(2) to encourage Indian tribes, tribal organizations, and 
     other mental health care providers serving residents of 
     Indian country to obtain the services of predoctoral 
     psychology and psychiatry interns; and
       ``(3) to enhance the provision of mental health care 
     services to Indian youth through existing grant programs of 
     the Substance Abuse and Mental Health Services 
     Administration.

     ``SEC. 722. DEFINITIONS.

       ``In this subtitle:
       ``(1) Administration.--The term `Administration' means the 
     Substance Abuse and Mental Health Services Administration.
       ``(2) Demonstration project.--The term `demonstration 
     project' means the Indian youth telemental health 
     demonstration project authorized under section 723(a).
       ``(3) Telemental health.--The term `telemental health' 
     means the use of electronic information and 
     telecommunications technologies to support long-distance 
     mental health care, patient and professional-related 
     education, public health, and health administration.

     ``SEC. 723. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRATION 
                   PROJECT.

       ``(a) Authorization.--
       ``(1) In general.--The Secretary, acting through the 
     Service, is authorized to carry out a demonstration project 
     to award grants for the provision of telemental health 
     services to Indian youth who--
       ``(A) have expressed suicidal ideas;
       ``(B) have attempted suicide; or
       ``(C) have behavioral health conditions that increase or 
     could increase the risk of suicide.
       ``(2) Eligibility for grants.--Grants under paragraph (1) 
     shall be awarded to Indian tribes and tribal organizations 
     that operate 1 or more facilities--
       ``(A) located in an area with documented disproportionately 
     high rates of suicide;
       ``(B) reporting active clinical telehealth capabilities; or
       ``(C) offering school-based telemental health services to 
     Indian youth.
       ``(3) Grant period.--The Secretary shall award grants under 
     this section for a period of up to 4 years.
       ``(4) Maximum number of grants.--Not more than 5 grants 
     shall be provided under paragraph (1), with priority 
     consideration given to Indian tribes and tribal organizations 
     that--
       ``(A) serve a particular community or geographic area in 
     which there is a demonstrated need to address Indian youth 
     suicide;
       ``(B) enter into collaborative partnerships with Service or 
     other tribal health programs or facilities to provide 
     services under this demonstration project;
       ``(C) serve an isolated community or geographic area that 
     has limited or no access to behavioral health services; or
       ``(D) operate a detention facility at which Indian youth 
     are detained.
       ``(5) Consultation with administration.--In developing and 
     carrying out the demonstration project under this subsection, 
     the Secretary shall consult with the Administration as the 
     Federal agency focused on mental health issues, including 
     suicide.
       ``(b) Use of Funds.--
       ``(1) In general.--An Indian tribe or tribal organization 
     shall use a grant received under subsection (a) for the 
     following purposes:
       ``(A) To provide telemental health services to Indian 
     youth, including the provision of--
       ``(i) psychotherapy;
       ``(ii) psychiatric assessments and diagnostic interviews, 
     therapies for mental health conditions predisposing to 
     suicide, and treatment; and
       ``(iii) alcohol and substance abuse treatment.
       ``(B) To provide clinician-interactive medical advice, 
     guidance and training, assistance in diagnosis and 
     interpretation, crisis counseling and intervention, and 
     related assistance to Service or tribal clinicians and health 
     services providers working with youth being served under the 
     demonstration project.
       ``(C) To assist, educate, and train community leaders, 
     health education professionals and paraprofessionals, tribal 
     outreach workers, and family members who work with the youth 
     receiving telemental health services under the demonstration 
     project, including with identification of suicidal 
     tendencies, crisis intervention and suicide prevention, 
     emergency skill development, and building and expanding 
     networks among those individuals and with State and local 
     health services providers.
       ``(D) To develop and distribute culturally appropriate 
     community educational materials regarding--
       ``(i) suicide prevention;
       ``(ii) suicide education;
       ``(iii) suicide screening;
       ``(iv) suicide intervention; and
       ``(v) ways to mobilize communities with respect to the 
     identification of risk factors for suicide.
       ``(E) To conduct data collection and reporting relating to 
     Indian youth suicide prevention efforts.
       ``(2) Traditional health care practices.--In carrying out 
     the purposes described in paragraph (1), an Indian tribe or 
     tribal organization may use and promote the traditional 
     health care practices of the Indian tribes of the youth to be 
     served.
       ``(c) Applications.--
       ``(1) In general.--Subject to paragraph (2), to be eligible 
     to receive a grant under subsection (a), an Indian tribe or 
     tribal organization shall prepare and submit to the Secretary 
     an application, at such time, in such manner, and containing 
     such information as the Secretary may require, including--
       ``(A) a description of the project that the Indian tribe or 
     tribal organization will carry out using the funds provided 
     under the grant;
       ``(B) a description of the manner in which the project 
     funded under the grant would--
       ``(i) meet the telemental health care needs of the Indian 
     youth population to be served by the project; or
       ``(ii) improve the access of the Indian youth population to 
     be served to suicide prevention and treatment services;
       ``(C) evidence of support for the project from the local 
     community to be served by the project;
       ``(D) a description of how the families and leadership of 
     the communities or populations to be served by the project 
     would be involved in the development and ongoing operations 
     of the project;
       ``(E) a plan to involve the tribal community of the youth 
     who are provided services by the project in planning and 
     evaluating the behavioral health care and suicide prevention 
     efforts provided, in order to ensure the integration of 
     community, clinical, environmental, and cultural components 
     of the treatment; and
       ``(F) a plan for sustaining the project after Federal 
     assistance for the demonstration project has terminated.
       ``(2) Efficiency of grant application process.--The 
     Secretary shall carry out such measures as the Secretary 
     determines to be necessary to maximize the time and workload 
     efficiency of the process by which Indian tribes and tribal 
     organizations apply for grants under paragraph (1).

[[Page S12454]]

       ``(d) Collaboration.--The Secretary, acting through the 
     Service, shall encourage Indian tribes and tribal 
     organizations receiving grants under this section to 
     collaborate to enable comparisons regarding best practices 
     across projects.
       ``(e) Annual Report.--Each grant recipient shall submit to 
     the Secretary an annual report that--
       ``(1) describes the number of telemental health services 
     provided; and
       ``(2) includes any other information that the Secretary may 
     require.
       ``(f) Reports to Congress.--
       ``(1) Initial report.--
       ``(A) In general.--Not later than 2 years after the date on 
     which the first grant is awarded under this section, the 
     Secretary shall submit to the Committee on Indian Affairs of 
     the Senate and the Committee on Natural Resources and the 
     Committee on Energy and Commerce of the House of 
     Representatives a report that--
       ``(i) describes each project funded by a grant under this 
     section during the preceding 2-year period, including a 
     description of the level of success achieved by the project; 
     and
       ``(ii) evaluates whether the demonstration project should 
     be continued during the period beginning on the date of 
     termination of funding for the demonstration project under 
     subsection (g) and ending on the date on which the final 
     report is submitted under paragraph (2).
       ``(B) Continuation of demonstration project.--On a 
     determination by the Secretary under clause (ii) of 
     subparagraph (A) that the demonstration project should be 
     continued, the Secretary may carry out the demonstration 
     project during the period described in that clause using such 
     sums otherwise made available to the Secretary as the 
     Secretary determines to be appropriate.
       ``(2) Final report.--Not later than 270 days after the date 
     of termination of funding for the demonstration project under 
     subsection (g), the Secretary shall submit to the Committee 
     on Indian Affairs of the Senate and the Committee on Natural 
     Resources and the Committee on Energy and Commerce of the 
     House of Representatives a final report that--
       ``(A) describes the results of the projects funded by 
     grants awarded under this section, including any data 
     available that indicate the number of attempted suicides;
       ``(B) evaluates the impact of the telemental health 
     services funded by the grants in reducing the number of 
     completed suicides among Indian youth;
       ``(C) evaluates whether the demonstration project should 
     be--
       ``(i) expanded to provide more than 5 grants; and
       ``(ii) designated as a permanent program; and
       ``(D) evaluates the benefits of expanding the demonstration 
     project to include urban Indian organizations.
       ``(g) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $1,500,000 for 
     each of fiscal years 2010 through 2013.

     ``SEC. 724. SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES 
                   ADMINISTRATION GRANTS.

       ``(a) Grant Applications.--
       ``(1) Efficiency of grant application process.--The 
     Secretary, acting through the Administration, shall carry out 
     such measures as the Secretary determines to be necessary to 
     maximize the time and workload efficiency of the process by 
     which Indian tribes and tribal organizations apply for grants 
     under any program administered by the Administration, 
     including by providing methods other than electronic methods 
     of submitting applications for those grants, if necessary.
       ``(2) Priority for certain grants.--
       ``(A) In general.--To fulfill the trust responsibility of 
     the United States to Indian tribes, in awarding relevant 
     grants pursuant to a program described in subparagraph (B), 
     the Secretary shall take into consideration the needs of 
     Indian tribes or tribal organizations, as applicable, that 
     serve populations with documented high suicide rates, 
     regardless of whether those Indian tribes or tribal 
     organizations possess adequate personnel or infrastructure to 
     fulfill all applicable requirements of the relevant program.
       ``(B) Description of grant programs.--A grant program 
     referred to in subparagraph (A) is a grant program--
       ``(i) administered by the Administration to fund activities 
     relating to mental health, suicide prevention, or suicide-
     related risk factors; and
       ``(ii) under which an Indian tribe or tribal organization 
     is an eligible recipient.
       ``(3) Clarification regarding indian tribes and tribal 
     organizations.--Notwithstanding any other provision of law, 
     in applying for a grant under any program administered by the 
     Administration, no Indian tribe or tribal organization shall 
     be required to apply through a State or State agency.
       ``(4) Requirements for affected states.--
       ``(A) Definitions.--In this paragraph:
       ``(i) Affected state.--The term `affected State' means a 
     State--

       ``(I) the boundaries of which include 1 or more Indian 
     tribes; and
       ``(II) the application for a grant under any program 
     administered by the Administration of which includes 
     statewide data.

       ``(ii) Indian population.--The term `Indian population' 
     means the total number of residents of an affected State who 
     are Indian.
       ``(B) Requirements.--As a condition of receipt of a grant 
     under any program administered by the Administration, each 
     affected State shall--
       ``(i) describe in the grant application--

       ``(I) the Indian population of the affected State; and
       ``(II) the contribution of that Indian population to the 
     statewide data used by the affected State in the application; 
     and

       ``(ii) demonstrate to the satisfaction of the Secretary 
     that--

       ``(I) of the total amount of the grant, the affected State 
     will allocate for use for the Indian population of the 
     affected State an amount equal to the proportion that--

       ``(aa) the Indian population of the affected State; bears 
     to
       ``(bb) the total population of the affected State; and

       ``(II) the affected State will take reasonable efforts to 
     collaborate with each Indian tribe located within the 
     affected State to carry out youth suicide prevention and 
     treatment measures for members of the Indian tribe.

       ``(C) Report.--Not later than 1 year after the date of 
     receipt of a grant described in subparagraph (B), an affected 
     State shall submit to the Secretary a report describing the 
     measures carried out by the affected State to ensure 
     compliance with the requirements of subparagraph (B)(ii).
       ``(b) No Non-Federal Share Requirement.--Notwithstanding 
     any other provision of law, no Indian tribe or tribal 
     organization shall be required to provide a non-Federal share 
     of the cost of any project or activity carried out using a 
     grant provided under any program administered by the 
     Administration.
       ``(c) Outreach for Rural and Isolated Indian Tribes.--Due 
     to the rural, isolated nature of most Indian reservations and 
     communities (especially those reservations and communities in 
     the Great Plains region), the Secretary shall conduct 
     outreach activities, with a particular emphasis on the 
     provision of telemental health services, to achieve the 
     purposes of this subtitle with respect to Indian tribes 
     located in rural, isolated areas.
       ``(d) Provision of Other Assistance.--
       ``(1) In general.--The Secretary, acting through the 
     Administration, shall carry out such measures (including 
     monitoring and the provision of required assistance) as the 
     Secretary determines to be necessary to ensure the provision 
     of adequate suicide prevention and mental health services to 
     Indian tribes described in paragraph (2), regardless of 
     whether those Indian tribes possess adequate personnel or 
     infrastructure--
       ``(A) to submit an application for a grant under any 
     program administered by the Administration, including due to 
     problems relating to access to the Internet or other 
     electronic means that may have resulted in previous obstacles 
     to submission of a grant application; or
       ``(B) to fulfill all applicable requirements of the 
     relevant program.
       ``(2) Description of indian tribes.--An Indian tribe 
     referred to in paragraph (1) is an Indian tribe--
       ``(A) the members of which experience--
       ``(i) a high rate of youth suicide;
       ``(ii) low socioeconomic status; and
       ``(iii) extreme health disparity;
       ``(B) that is located in a remote and isolated area; and
       ``(C) that lacks technology and communication 
     infrastructure.
       ``(3) Authorization of appropriations.--There are 
     authorized to be appropriated to the Secretary such sums as 
     the Secretary determines to be necessary to carry out this 
     subsection.
       ``(e) Early Intervention and Assessment Services.--
       ``(1) Definition of affected entity.--In this subsection, 
     the term `affected entity' means any entity--
       ``(A) that receives a grant for suicide intervention, 
     prevention, or treatment under a program administered by the 
     Administration; and
       ``(B) the population to be served by which includes Indian 
     youth.
       ``(2) Requirement.--The Secretary, acting through the 
     Administration, shall ensure that each affected entity 
     carrying out a youth suicide early intervention and 
     prevention strategy described in section 520E(c)(1) of the 
     Public Health Service Act (42 U.S.C. 290bb-36(c)(1)), or any 
     other youth suicide-related early intervention and assessment 
     activity, provides training or education to individuals who 
     interact frequently with the Indian youth to be served by the 
     affected entity (including parents, teachers, coaches, and 
     mentors) on identifying warning signs of Indian youth who are 
     at risk of committing suicide.

     ``SEC. 725. USE OF PREDOCTORAL PSYCHOLOGY AND PSYCHIATRY 
                   INTERNS.

       ``The Secretary shall carry out such activities as the 
     Secretary determines to be necessary to encourage Indian 
     tribes, tribal organizations, and other mental health care 
     providers to obtain the services of predoctoral psychology 
     and psychiatry interns--
       ``(1) to increase the quantity of patients served by the 
     Indian tribes, tribal organizations, and other mental health 
     care providers; and
       ``(2) for purposes of recruitment and retention.

     ``SEC. 726. INDIAN YOUTH LIFE SKILLS DEVELOPMENT 
                   DEMONSTRATION PROGRAM.

       ``(a) Purpose.--The purpose of this section is to authorize 
     the Secretary, acting through

[[Page S12455]]

     the Administration, to carry out a demonstration program to 
     test the effectiveness of a culturally compatible, school-
     based, life skills curriculum for the prevention of Indian 
     and Alaska Native adolescent suicide, including through--
       ``(1) the establishment of tribal partnerships to develop 
     and implement such a curriculum, in cooperation with--
       ``(A) behavioral health professionals, with a priority for 
     tribal partnerships cooperating with mental health 
     professionals employed by the Service;
       ``(B) tribal or local school agencies; and
       ``(C) parent and community groups;
       ``(2) the provision by the Administration or the Service 
     of--
       ``(A) technical expertise; and
       ``(B) clinicians, analysts, and educators, as appropriate;
       ``(3) training for teachers, school administrators, and 
     community members to implement the curriculum;
       ``(4) the establishment of advisory councils composed of 
     parents, educators, community members, trained peers, and 
     others to provide advice regarding the curriculum and other 
     components of the demonstration program;
       ``(5) the development of culturally appropriate support 
     measures to supplement the effectiveness of the curriculum; 
     and
       ``(6) projects modeled after evidence-based projects, such 
     as programs evaluated and published in relevant literature.
       ``(b) Demonstration Grant Program.--
       ``(1) Definitions.--In this subsection:
       ``(A) Curriculum.--The term `curriculum' means the 
     culturally compatible, school-based, life skills curriculum 
     for the prevention of Indian and Alaska Native adolescent 
     suicide identified by the Secretary under paragraph (2)(A).
       ``(B) Eligible entity.--The term `eligible entity' means--
       ``(i) an Indian tribe;
       ``(ii) a tribal organization;
       ``(iii) any other tribally authorized entity; and
       ``(iv) any partnership composed of 2 or more entities 
     described in clause (i), (ii), or (iii).
       ``(2) Establishment.--The Secretary, acting through the 
     Administration, may establish and carry out a demonstration 
     program under which the Secretary shall--
       ``(A) identify a culturally compatible, school-based, life 
     skills curriculum for the prevention of Indian and Alaska 
     Native adolescent suicide;
       ``(B) identify the Indian tribes that are at greatest risk 
     for adolescent suicide;
       ``(C) invite those Indian tribes to participate in the 
     demonstration program by--
       ``(i) responding to a comprehensive program requirement 
     request of the Secretary; or
       ``(ii) submitting, through an eligible entity, an 
     application in accordance with paragraph (4); and
       ``(D) provide grants to the Indian tribes identified under 
     subparagraph (B) and eligible entities to implement the 
     curriculum with respect to Indian and Alaska Native youths 
     who--
       ``(i) are between the ages of 10 and 19; and
       ``(ii) attend school in a region that is at risk of high 
     youth suicide rates, as determined by the Administration.
       ``(3) Requirements.--
       ``(A) Term.--The term of a grant provided under the 
     demonstration program under this section shall be not less 
     than 4 years.
       ``(B) Maximum number.--The Secretary may provide not more 
     than 5 grants under the demonstration program under this 
     section.
       ``(C) Amount.--The grants provided under this section shall 
     be of equal amounts.
       ``(D) Certain schools.--In selecting eligible entities to 
     receive grants under this section, the Secretary shall ensure 
     that not less than 1 demonstration program shall be carried 
     out at each of--
       ``(i) a school operated by the Bureau of Indian Education;
       ``(ii) a Tribal school; and
       ``(iii) a school receiving payments under section 8002 or 
     8003 of the Elementary and Secondary Education Act of 1965 
     (20 U.S.C. 7702, 7703).
       ``(4) Applications.--To be eligible to receive a grant 
     under the demonstration program, an eligible entity shall 
     submit to the Secretary an application, at such time, in such 
     manner, and containing such information as the Secretary may 
     require, including--
       ``(A) an assurance that, in implementing the curriculum, 
     the eligible entity will collaborate with 1 or more local 
     educational agencies, including elementary schools, middle 
     schools, and high schools;
       ``(B) an assurance that the eligible entity will 
     collaborate, for the purpose of curriculum development, 
     implementation, and training and technical assistance, with 1 
     or more--
       ``(i) nonprofit entities with demonstrated expertise 
     regarding the development of culturally sensitive, school-
     based, youth suicide prevention and intervention programs; or
       ``(ii) institutions of higher education with demonstrated 
     interest and knowledge regarding culturally sensitive, 
     school-based, life skills youth suicide prevention and 
     intervention programs;
       ``(C) an assurance that the curriculum will be carried out 
     in an academic setting in conjunction with at least 1 
     classroom teacher not less frequently than twice each school 
     week for the duration of the academic year;
       ``(D) a description of the methods by which curriculum 
     participants will be--
       ``(i) screened for mental health at-risk indicators; and
       ``(ii) if needed and on a case-by-case basis, referred to a 
     mental health clinician for further assessment and treatment 
     and with crisis response capability; and
       ``(E) an assurance that supportive services will be 
     provided to curriculum participants identified as high-risk 
     participants, including referral, counseling, and follow-up 
     services for--
       ``(i) drug or alcohol abuse;
       ``(ii) sexual or domestic abuse; and
       ``(iii) depression and other relevant mental health 
     concerns.
       ``(5) Use of funds.--An Indian tribe identified under 
     paragraph (2)(B) or an eligible entity may use a grant 
     provided under this subsection--
       ``(A) to develop and implement the curriculum in a school-
     based setting;
       ``(B) to establish an advisory council--
       ``(i) to advise the Indian tribe or eligible entity 
     regarding curriculum development; and
       ``(ii) to provide support services identified as necessary 
     by the community being served by the Indian tribe or eligible 
     entity;
       ``(C) to appoint and train a school- and community-based 
     cultural resource liaison, who will act as an intermediary 
     among the Indian tribe or eligible entity, the applicable 
     school administrators, and the advisory council established 
     by the Indian tribe or eligible entity;
       ``(D) to establish an on-site, school-based, MA- or PhD-
     level mental health practitioner (employed by the Service, if 
     practicable) to work with tribal educators and other 
     personnel;
       ``(E) to provide for the training of peer counselors to 
     assist in carrying out the curriculum;
       ``(F) to procure technical and training support from 
     nonprofit or State entities or institutions of higher 
     education identified by the community being served by the 
     Indian tribe or eligible entity as the best suited to develop 
     and implement the curriculum;
       ``(G) to train teachers and school administrators to 
     effectively carry out the curriculum;
       ``(H) to establish an effective referral procedure and 
     network;
       ``(I) to identify and develop culturally compatible 
     curriculum support measures;
       ``(J) to obtain educational materials and other resources 
     from the Administration or other appropriate entities to 
     ensure the success of the demonstration program; and
       ``(K) to evaluate the effectiveness of the curriculum in 
     preventing Indian and Alaska Native adolescent suicide.
       ``(c) Evaluations.--Using such amounts made available 
     pursuant to subsection (e) as the Secretary determines to be 
     appropriate, the Secretary shall conduct, directly or through 
     a grant, contract, or cooperative agreement with an entity 
     that has experience regarding the development and operation 
     of successful culturally compatible, school-based, life 
     skills suicide prevention and intervention programs or 
     evaluations, an annual evaluation of the demonstration 
     program under this section, including an evaluation of--
       ``(1) the effectiveness of the curriculum in preventing 
     Indian and Alaska Native adolescent suicide;
       ``(2) areas for program improvement; and
       ``(3) additional development of the goals and objectives of 
     the demonstration program.
       ``(d) Report to Congress.--
       ``(1) In general.--Subject to paragraph (2), not later than 
     180 days after the date of termination of the demonstration 
     program, the Secretary shall submit to the Committee on 
     Indian Affairs and the Committee on Health, Education, Labor, 
     and Pensions of the Senate and the Committee on Natural 
     Resources and the Committee on Education and Labor of the 
     House of Representatives a final report that--
       ``(A) describes the results of the program of each Indian 
     tribe or eligible entity under this section;
       ``(B) evaluates the effectiveness of the curriculum in 
     preventing Indian and Alaska Native adolescent suicide;
       ``(C) makes recommendations regarding--
       ``(i) the expansion of the demonstration program under this 
     section to additional eligible entities;
       ``(ii) designating the demonstration program as a permanent 
     program; and
       ``(iii) identifying and distributing the curriculum through 
     the Suicide Prevention Resource Center of the Administration; 
     and
       ``(D) incorporates any public comments received under 
     paragraph (2).
       ``(2) Public comment.--The Secretary shall provide a notice 
     of the report under paragraph (1) and an opportunity for 
     public comment on the report for a period of not less than 90 
     days before submitting the report to Congress.
       ``(e) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $1,000,000 for 
     each of fiscal years 2010 through 2014.''.

                       Subtitle H--Miscellaneous

     SEC. 191. CONFIDENTIALITY OF MEDICAL QUALITY ASSURANCE 
                   RECORDS; QUALIFIED IMMUNITY FOR PARTICIPANTS.

       Title VIII of the Indian Health Care Improvement Act (as 
     amended by section

[[Page S12456]]

     101(b)) is amended by inserting after section 804 (25 U.S.C. 
     1674) the following:

     ``SEC. 805. CONFIDENTIALITY OF MEDICAL QUALITY ASSURANCE 
                   RECORDS; QUALIFIED IMMUNITY FOR PARTICIPANTS.

       ``(a) Definitions.--In this section:
       ``(1) Health care provider.--The term `health care 
     provider' means any health care professional, including 
     community health aides and practitioners certified under 
     section 119, who is--
       ``(A) granted clinical practice privileges or employed to 
     provide health care services at--
       ``(i) an Indian health program; or
       ``(ii) a health program of an urban Indian organization; 
     and
       ``(B) licensed or certified to perform health care services 
     by a governmental board or agency or professional health care 
     society or organization.
       ``(2) Medical quality assurance program.--The term `medical 
     quality assurance program' means any activity carried out 
     before, on, or after the date of enactment of the Indian 
     Health Care Improvement Reauthorization and Extension Act of 
     2009 by or for any Indian health program or urban Indian 
     organization to assess the quality of medical care, including 
     activities conducted by or on behalf of individuals, Indian 
     health program or urban Indian organization medical or dental 
     treatment review committees, or other review bodies 
     responsible for quality assurance, credentials, infection 
     control, patient safety, patient care assessment (including 
     treatment procedures, blood, drugs, and therapeutics), 
     medical records, health resources management review, and 
     identification and prevention of medical or dental incidents 
     and risks.
       ``(3) Medical quality assurance record.--The term `medical 
     quality assurance record' means the proceedings, records, 
     minutes, and reports that--
       ``(A) emanate from quality assurance program activities 
     described in paragraph (2); and
       ``(B) are produced or compiled by or for an Indian health 
     program or urban Indian organization as part of a medical 
     quality assurance program.
       ``(b) Confidentiality of Records.--Medical quality 
     assurance records created by or for any Indian health program 
     or a health program of an urban Indian organization as part 
     of a medical quality assurance program are confidential and 
     privileged. Such records may not be disclosed to any person 
     or entity, except as provided in subsection (d).
       ``(c) Prohibition on Disclosure and Testimony.--
       ``(1) In general.--No part of any medical quality assurance 
     record described in subsection (b) may be subject to 
     discovery or admitted into evidence in any judicial or 
     administrative proceeding, except as provided in subsection 
     (d).
       ``(2) Testimony.--An individual who reviews or creates 
     medical quality assurance records for any Indian health 
     program or urban Indian organization who participates in any 
     proceeding that reviews or creates such records may not be 
     permitted or required to testify in any judicial or 
     administrative proceeding with respect to such records or 
     with respect to any finding, recommendation, evaluation, 
     opinion, or action taken by such person or body in connection 
     with such records except as provided in this section.
       ``(d) Authorized Disclosure and Testimony.--
       ``(1) In general.--Subject to paragraph (2), a medical 
     quality assurance record described in subsection (b) may be 
     disclosed, and an individual referred to in subsection (c) 
     may give testimony in connection with such a record, only as 
     follows:
       ``(A) To a Federal agency or private organization, if such 
     medical quality assurance record or testimony is needed by 
     such agency or organization to perform licensing or 
     accreditation functions related to any Indian health program 
     or to a health program of an urban Indian organization to 
     perform monitoring, required by law, of such program or 
     organization.
       ``(B) To an administrative or judicial proceeding commenced 
     by a present or former Indian health program or urban Indian 
     organization provider concerning the termination, suspension, 
     or limitation of clinical privileges of such health care 
     provider.
       ``(C) To a governmental board or agency or to a 
     professional health care society or organization, if such 
     medical quality assurance record or testimony is needed by 
     such board, agency, society, or organization to perform 
     licensing, credentialing, or the monitoring of professional 
     standards with respect to any health care provider who is or 
     was an employee of any Indian health program or urban Indian 
     organization.
       ``(D) To a hospital, medical center, or other institution 
     that provides health care services, if such medical quality 
     assurance record or testimony is needed by such institution 
     to assess the professional qualifications of any health care 
     provider who is or was an employee of any Indian health 
     program or urban Indian organization and who has applied for 
     or been granted authority or employment to provide health 
     care services in or on behalf of such program or 
     organization.
       ``(E) To an officer, employee, or contractor of the Indian 
     health program or urban Indian organization that created the 
     records or for which the records were created. If that 
     officer, employee, or contractor has a need for such record 
     or testimony to perform official duties.
       ``(F) To a criminal or civil law enforcement agency or 
     instrumentality charged under applicable law with the 
     protection of the public health or safety, if a qualified 
     representative of such agency or instrumentality makes a 
     written request that such record or testimony be provided for 
     a purpose authorized by law.
       ``(G) In an administrative or judicial proceeding commenced 
     by a criminal or civil law enforcement agency or 
     instrumentality referred to in subparagraph (F), but only 
     with respect to the subject of such proceeding.
       ``(2) Identity of participants.--With the exception of the 
     subject of a quality assurance action, the identity of any 
     person receiving health care services from any Indian health 
     program or urban Indian organization or the identity of any 
     other person associated with such program or organization for 
     purposes of a medical quality assurance program that is 
     disclosed in a medical quality assurance record described in 
     subsection (b) shall be deleted from that record or document 
     before any disclosure of such record is made outside such 
     program or organization.
       ``(e) Disclosure for Certain Purposes.--
       ``(1) In general.--Nothing in this section shall be 
     construed as authorizing or requiring the withholding from 
     any person or entity aggregate statistical information 
     regarding the results of any Indian health program or urban 
     Indian organization's medical quality assurance programs.
       ``(2) Withholding from congress.--Nothing in this section 
     shall be construed as authority to withhold any medical 
     quality assurance record from a committee of either House of 
     Congress, any joint committee of Congress, or the Government 
     Accountability Office if such record pertains to any matter 
     within their respective jurisdictions.
       ``(f) Prohibition on Disclosure of Record or Testimony.--An 
     individual or entity having possession of or access to a 
     record or testimony described by this section may not 
     disclose the contents of such record or testimony in any 
     manner or for any purpose except as provided in this section.
       ``(g) Exemption From Freedom of Information Act.--Medical 
     quality assurance records described in subsection (b) may not 
     be made available to any person under section 552 of title 5, 
     United States Code.
       ``(h) Limitation on Civil Liability.--An individual who 
     participates in or provides information to a person or body 
     that reviews or creates medical quality assurance records 
     described in subsection (b) shall not be civilly liable for 
     such participation or for providing such information if the 
     participation or provision of information was in good faith 
     based on prevailing professional standards at the time the 
     medical quality assurance program activity took place.
       ``(i) Application to Information in Certain Other 
     Records.--Nothing in this section shall be construed as 
     limiting access to the information in a record created and 
     maintained outside a medical quality assurance program, 
     including a patient's medical records, on the grounds that 
     the information was presented during meetings of a review 
     body that are part of a medical quality assurance program.
       ``(j) Regulations.--The Secretary, acting through the 
     Service, shall promulgate regulations pursuant to section 
     802.
       ``(k) Continued Protection.--Disclosure under subsection 
     (d) does not permit redisclosure except to the extent such 
     further disclosure is authorized under subsection (d) or is 
     otherwise authorized to be disclosed under this section.
       ``(l) Inconsistencies.--To the extent that the protections 
     under part C of title IX of the Public Health Service Act (42 
     U.S.C. 229b-21 et seq.) (as amended by the Patient Safety and 
     Quality Improvement Act of 2005 (Public Law 109-41; 119 Stat. 
     424)) and this section are inconsistent, the provisions of 
     whichever is more protective shall control.
       ``(m) Relationship to Other Law.--This section shall 
     continue in force and effect, except as otherwise 
     specifically provided in any Federal law enacted after the 
     date of enactment of the Indian Health Care Improvement 
     Reauthorization and Extension Act of 2009.''.

     SEC. 192. ARIZONA, NORTH DAKOTA, AND SOUTH DAKOTA AS CONTRACT 
                   HEALTH SERVICE DELIVERY AREAS; ELIGIBILITY OF 
                   CALIFORNIA INDIANS.

       Title VIII of the Indian Health Care Improvement Act is 
     amended--
       (1) by striking section 808 (25 U.S.C. 1678) and inserting 
     the following:

     ``SEC. 808. ARIZONA AS CONTRACT HEALTH SERVICE DELIVERY AREA.

       ``(a) In General.--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 Indian tribes in the State 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 the curtailment is 
     due to the provision of contract services in that State 
     pursuant to the designation of the State as a contract health 
     service delivery area by subsection (a).'';
       (2) by inserting after section 808 (25 U.S.C. 1678) the 
     following:

     ``SEC. 808A. NORTH DAKOTA AND SOUTH DAKOTA AS CONTRACT HEALTH 
                   SERVICE DELIVERY AREA.

       ``(a) In General.--The States of North Dakota and South 
     Dakota shall be designated

[[Page S12457]]

     as a contract health service delivery area by the Service for 
     the purpose of providing contract health care services to 
     members of Indian tribes in the States of North Dakota and 
     South Dakota.
       ``(b) Maintenance of Services.--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 the curtailment is due to the provision of 
     contract services in those States pursuant to the designation 
     of the States as a contract health service delivery area by 
     subsection (a).''; and
       (3) by striking section 809 (25 U.S.C. 1679) and inserting 
     the following:

     ``SEC. 809. 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 of 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. 193. METHODS TO INCREASE ACCESS TO PROFESSIONALS OF 
                   CERTAIN CORPS.

       Section 812 of the Indian Health Care Improvement Act (25 
     U.S.C. 1680b) is amended to read as follows:

     ``SEC. 812. NATIONAL HEALTH SERVICE CORPS.

       ``(a) No Reduction in Services.--The Secretary shall not 
     remove a member of the National Health Service Corps from an 
     Indian health program or urban Indian organization or 
     withdraw funding used to support such a member, unless the 
     Secretary, acting through the Service, has ensured that the 
     Indians receiving services from the member will experience no 
     reduction in services.
       ``(b) Treatment of Indian Health Programs.--At the request 
     of an Indian health program, the services of a member of the 
     National Health Service Corps assigned to the Indian health 
     program may be limited to the individuals who are eligible 
     for services from that Indian health program.''.

     SEC. 194. HEALTH SERVICES FOR INELIGIBLE PERSONS.

       Section 813 of the Indian Health Care Improvement Act (25 
     U.S.C. 1680c) is amended to read as follows:

     ``SEC. 813. 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) Health Facilities Providing Health Services.--
       ``(1) In general.--The Secretary is authorized to provide 
     health services under this subsection through health 
     facilities operated directly by the Service to individuals 
     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 
     requests such provision of health services to such 
     individuals, and
       ``(B) the Secretary and the served Indian tribes have 
     jointly determined that the provision of such health services 
     will not result in a denial or diminution of health services 
     to eligible Indians.
       ``(2) ISDEAA programs.--In the case of health 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 eligible for such health services 
     under any other subsection of this section or under any other 
     provision of law. In making such determinations, the 
     governing body of the Indian tribe or tribal organization 
     shall take into account the consideration described in 
     paragraph (1)(B). Any services provided by the Indian tribe 
     or tribal organization pursuant to a determination made under 
     this subparagraph shall be deemed to be provided under the 
     agreement entered into by the Indian tribe or tribal 
     organization under the Indian Self-Determination and 
     Education Assistance Act. The provisions of section 314 of 
     Public Law 101-512 (104 Stat. 1959), as amended by section 
     308 of Public Law 103-138 (107 Stat. 1416), shall apply to 
     any services provided by the Indian tribe or tribal 
     organization pursuant to a determination made under this 
     subparagraph.
       ``(3) Payment for services.--
       ``(A) In general.--Persons receiving health services 
     provided by the Service under 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 207 of this Act or any other 
     provision of law, amounts collected under this subsection, 
     including Medicare, Medicaid, or children's health insurance 
     program reimbursements under titles XVIII, XIX, and XXI of 
     the Social Security Act (42 U.S.C. 1395 et seq.), 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.--
       ``(1) In general.--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 the 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.
       ``(2) Definition.--For purposes of this subsection, the 
     term `non-Service health care practitioner' means a 
     practitioner who is not--
       ``(A) an employee of the Service; or
       ``(B) an employee of an Indian tribe or tribal organization 
     operating a contract or compact under the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.) or an individual who provides health care services 
     pursuant to a personal services contract with such Indian 
     tribe or tribal organization.

[[Page S12458]]

       ``(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. 195. ANNUAL BUDGET SUBMISSION.

       Title VIII of the Indian Health Care Improvement Act (25 
     U.S.C. 1671 et seq.) is amended by adding at the end the 
     following:

     ``SEC. 826. ANNUAL BUDGET SUBMISSION.

       ``Effective beginning with the submission of the annual 
     budget request to Congress for fiscal year 2011, the 
     President shall include, in the amount requested and the 
     budget justification, amounts that reflect any changes in--
       ``(1) the cost of health care services, as indexed for 
     United States dollar inflation (as measured by the Consumer 
     Price Index); and
       ``(2) the size of the population served by the Service.''.

     SEC. 196. PRESCRIPTION DRUG MONITORING.

       Title VIII of the Indian Health Care Improvement Act (25 
     U.S.C. 1671 et seq.) (as amended by section 195) is amended 
     by adding at the end the following:

     ``SEC. 827. PRESCRIPTION DRUG MONITORING.

       ``(a) Monitoring.--
       ``(1) Establishment.--The Secretary, in coordination with 
     the Secretary of the Interior and the Attorney General, shall 
     establish a prescription drug monitoring program, to be 
     carried out at health care facilities of the Service, tribal 
     health care facilities, and urban Indian health care 
     facilities.
       ``(2) Report.--Not later than 18 months after the date of 
     enactment of the Indian Health Care Improvement 
     Reauthorization and Extension Act of 2009, the Secretary 
     shall submit to the Committee on Indian Affairs of the Senate 
     and the Committee on Natural Resources of the House of 
     Representatives a report that describes--
       ``(A) the needs of the Service, tribal health care 
     facilities, and urban Indian health care facilities with 
     respect to the prescription drug monitoring program under 
     paragraph (1);
       ``(B) the planned development of that program, including 
     any relevant statutory or administrative limitations; and
       ``(C) the means by which the program could be carried out 
     in coordination with any State prescription drug monitoring 
     program.
       ``(b) Abuse.--
       ``(1) In general.--The Attorney General, in conjunction 
     with the Secretary and the Secretary of the Interior, shall 
     conduct--
       ``(A) an assessment of the capacity of, and support 
     required by, relevant Federal and tribal agencies--
       ``(i) to carry out data collection and analysis regarding 
     incidents of prescription drug abuse in Indian communities; 
     and
       ``(ii) to exchange among those agencies and Indian health 
     programs information relating to prescription drug abuse in 
     Indian communities, including statutory and administrative 
     requirements and limitations relating to that abuse; and
       ``(B) training for Indian health care providers, tribal 
     leaders, law enforcement officers, and school officials 
     regarding awareness and prevention of prescription drug abuse 
     and strategies for improving agency responses to addressing 
     prescription drug abuse in Indian communities.
       ``(2) Report.--Not later than 18 months after the date of 
     enactment of the Indian Health Care Improvement 
     Reauthorization and Extension Act of 2009, the Attorney 
     General shall submit to the Committee on Indian Affairs of 
     the Senate and the Committee on Natural Resources of the 
     House of Representatives a report that describes--
       ``(A) the capacity of Federal and tribal agencies to carry 
     out data collection and analysis and information exchanges as 
     described in paragraph (1)(A);
       ``(B) the training conducted pursuant to paragraph (1)(B);
       ``(C) infrastructure enhancements required to carry out the 
     activities described in paragraph (1), if any; and
       ``(D) any statutory or administrative barriers to carrying 
     out those activities.''.

     SEC. 197. TRIBAL HEALTH PROGRAM OPTION FOR COST SHARING.

       Title VIII of the Indian Health Care Improvement Act (25 
     U.S.C. 1671 et seq.) (as amended by section 196) is amended 
     by adding at the end the following:

     ``SEC. 828. TRIBAL HEALTH PROGRAM OPTION FOR COST SHARING.

       ``(a) In General.--Nothing in this Act limits the ability 
     of a tribal health program operating any health program, 
     service, function, activity, or facility funded, in whole or 
     part, by the Service through, or provided for in, a compact 
     with the Service pursuant to title V of the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 458aaa 
     et seq.) to charge an Indian for services provided by the 
     tribal health program.
       ``(b) Service.--Nothing in this Act authorizes the 
     Service--
       ``(1) to charge an Indian for services; or
       ``(2) to require any tribal health program to charge an 
     Indian for services.''.

     SEC. 198. DISEASE AND INJURY PREVENTION REPORT.

       Title VIII of the Indian Health Care Improvement Act (25 
     U.S.C. 1671 et seq.) (as amended by section 197) is amended 
     by adding at the end the following:

     ``SEC. 829. DISEASE AND INJURY PREVENTION REPORT.

       ``Not later than 18 months after the date of enactment of 
     the Indian Health Care Improvement Reauthorization and 
     Extension Act of 2009, the Secretary shall submit to the 
     Committee on Indian Affairs of the Senate and the Committees 
     on Natural Resources and Energy and Commerce of the House of 
     Representatives describing--
       ``(1) all disease and injury prevention activities 
     conducted by the Service, independently or in conjunction 
     with other Federal departments and agencies and Indian 
     tribes; and
       ``(2) the effectiveness of those activities, including the 
     reductions of injury or disease conditions achieved by the 
     activities.''.

     SEC. 199. OTHER GAO REPORTS.

       Title VIII of the Indian Health Care Improvement Act (25 
     U.S.C. 1671 et seq.) (as amended by section 198) is amended 
     by adding at the end the following:

     ``SEC. 830. OTHER GAO REPORTS.

       ``(a) Coordination of Services.--
       ``(1) Study and evaluation.--The Comptroller General of the 
     United States shall conduct a study, and evaluate the 
     effectiveness, of coordination of health care services 
     provided to Indians--
       ``(A) through Medicare, Medicaid, or SCHIP;
       ``(B) by the Service; or
       ``(C) using funds provided by--
       ``(i) State or local governments; or
       ``(ii) Indian tribes.
       ``(2) Report.--Not later than 18 months after the date of 
     enactment of the Indian Health Care Improvement 
     Reauthorization and Extension Act of 2009, the Comptroller 
     General shall submit to Congress a report--
       ``(A) describing the results of the evaluation under 
     paragraph (1); and
       ``(B) containing recommendations of the Comptroller General 
     regarding measures to support and increase coordination of 
     the provision of health care services to Indians as described 
     in paragraph (1).
       ``(b) Payments for Contract Health Services.--
       ``(1) In general.--The Comptroller General shall conduct a 
     study on the use of health care furnished by health care 
     providers under the contract health services program funded 
     by the Service and operated by the Service, an Indian tribe, 
     or a tribal organization.
       ``(2) Analysis.--The study conducted under paragraph (1) 
     shall include an analysis of--
       ``(A) the amounts reimbursed under the contract health 
     services program described in paragraph (1) for health care 
     furnished by entities, individual providers, and suppliers, 
     including a comparison of reimbursement for that health care 
     through other public programs and in the private sector;
       ``(B) barriers to accessing care under such contract health 
     services program, including barriers relating to travel 
     distances, cultural differences, and public and private 
     sector reluctance to furnish care to patients under the 
     program;
       ``(C) the adequacy of existing Federal funding for health 
     care under the contract health services program;
       ``(D) the administration of the contract health service 
     program, including the distribution of funds to Indian health 
     programs pursuant to the program; and
       ``(E) any other items determined appropriate by the 
     Comptroller General.
       ``(3) Report.--Not later than 18 months after the date of 
     enactment of the Indian Health Care Improvement 
     Reauthorization and Extension Act of 2009, the Comptroller 
     General shall submit to Congress a report on the study 
     conducted under paragraph (1), together with recommendations 
     regarding--
       ``(A) the appropriate level of Federal funding that should 
     be established for health care under the contract health 
     services program described in paragraph (1);
       ``(B) how to most efficiently use that funding; and
       ``(C) the identification of any inequities in the current 
     distribution formula or inequitable results for any Indian 
     tribe under the funding level, and any recommendations for 
     addressing any inequities or inequitable results identified.
       ``(4) Consultation.--In conducting the study under 
     paragraph (1) and preparing the report under paragraph (3), 
     the Comptroller General shall consult with the Service, 
     Indian tribes, and tribal organizations.''.

     SEC. 199A. TRADITIONAL HEALTH CARE PRACTICES.

       Title VIII of the Indian Health Care Improvement Act (25 
     U.S.C. 1671 et seq.) (as amended by section 199) is amended 
     by adding at the end the following:

     ``SEC. 831. TRADITIONAL HEALTH CARE PRACTICES.

       ``Although the Secretary may promote traditional health 
     care practices, consistent with the Service standards for the 
     provision of health care, health promotion, and disease 
     prevention under this Act, the United States is not liable 
     for any provision of traditional health care practices 
     pursuant to this Act that results in damage, injury, or death 
     to a patient. Nothing in this subsection shall be construed 
     to alter any liability or other obligation that the United 
     States may otherwise have under the Indian Self-Determination 
     and Education Assistance Act (25 U.S.C. 450 et seq.) or this 
     Act.''.

     SEC. 199B. DIRECTOR OF HIV/AIDS PREVENTION AND TREATMENT.

       Title VIII of the Indian Health Care Improvement Act (25 
     U.S.C. 1671 et seq.) (as amended by section 199A) is amended 
     by adding at the end the following:

     ``SEC. 832. DIRECTOR OF HIV/AIDS PREVENTION AND TREATMENT.

       ``(a) Establishment.--The Secretary, acting through the 
     Service, shall establish within the Service the position of 
     the Director of

[[Page S12459]]

     HIV/AIDS Prevention and Treatment (referred to in this 
     section as the `Director').
       ``(b) Duties.--The Director shall--
       ``(1) coordinate and promote HIV/AIDS prevention and 
     treatment activities specific to Indians;
       ``(2) provide technical assistance to Indian tribes, tribal 
     organizations, and urban Indian organizations regarding 
     existing HIV/AIDS prevention and treatment programs; and
       ``(3) ensure interagency coordination to facilitate the 
     inclusion of Indians in Federal HIV/AIDS research and grant 
     opportunities, with emphasis on the programs operated under 
     the Ryan White Comprehensive Aids Resources Emergency Act of 
     1990 (Public Law 101-381; 104 Stat. 576) and the amendments 
     made by that Act.
       ``(c) Report.--Not later than 2 years after the date of 
     enactment of the Indian Health Care Improvement 
     Reauthorization and Extension Act of 2009, and not less 
     frequently than once every 2 years thereafter, the Director 
     shall submit to Congress a report describing, with respect to 
     the preceding 2-year period--
       ``(1) each activity carried out under this section; and
       ``(2) any findings of the Director with respect to HIV/AIDS 
     prevention and treatment activities specific to Indians.''.

                   TITLE II--AMENDMENTS TO OTHER ACTS

     SEC. 201. MEDICARE AMENDMENTS.

       (a) In General.--Section 1880 of the Social Security Act 
     (42 U.S.C. 1395qq) is amended--
       (1) by redesignating subsection (f) as subsection (g); and
       (2) by inserting after subsection (e) the following:
       ``(f) Prohibition.--Payments made pursuant to this section 
     shall not be reduced as a result of any beneficiary 
     deductible, coinsurance, or other charge under section 
     1813.''.
       (b) Payment of Benefits.--Section 1833(a)(1)(B) of the 
     Social Security Act (42 U.S.C. 1395l(a)(1)(B)) is amended by 
     inserting ``or 1880(e)'' after ``section 1861(s)(10)(A)''.

     SEC. 202. REAUTHORIZATION OF NATIVE HAWAIIAN HEALTH CARE 
                   PROGRAMS.

       (a) Reauthorization.--The Native Hawaiian Health Care Act 
     of 1988 (42 U.S.C. 11701 et seq.) is amended by striking 
     ``2001'' each place it appears in sections 6(h)(1), 7(b), and 
     10(c) (42 U.S.C. 11705(h)(1), 11706(b), 11709(c)) and 
     inserting ``2019''.
       (b) Health and Education.--
       (1) In general.--Section 6(c) of the Native Hawaiian Health 
     Care Act of 1988 (42 U.S.C. 11705) is amended by adding at 
     the end the following:
       ``(4) Health and education.--In order to enable privately 
     funded organizations to continue to supplement public efforts 
     to provide educational programs designed to improve the 
     health, capability, and well-being of Native Hawaiians and to 
     continue to provide health services to Native Hawaiians, 
     notwithstanding any other provision of Federal or State law, 
     it shall be lawful for the private educational organization 
     identified in section 7202(16) of the Elementary and 
     Secondary Education Act of 1965 (20 U.S.C. 7512(16)) to 
     continue to offer its educational programs and services to 
     Native Hawaiians (as defined in section 7207 of that Act (20 
     U.S.C. 7517)) first and to others only after the need for 
     such programs and services by Native Hawaiians has been 
     met.''.
       (2) Effective date.--The amendment made by paragraph (1) 
     takes effect on December 5, 2006.
       (c) Definition of Health Promotion.--Section 12(2) of the 
     Native Hawaiian Health Care Act of 1988 (42 U.S.C. 11711(2)) 
     is amended--
       (1) in subparagraph (F), by striking ``and'' at the end;
       (2) in subparagraph (G), by striking the period at the end 
     and inserting ``, and''; and
       (3) by adding at the end the following:
       ``(H) educational programs with the mission of improving 
     the health, capability, and well-being of Native 
     Hawaiians.''.

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