[Congressional Record (Bound Edition), Volume 149 (2003), Part 4]
[Senate]
[Pages 5439-5521]
[From the U.S. Government Publishing Office, www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Ms. SNOWE (for herself, Mr. Bond, Mr. Talent, Mrs. Dole, Mr. 
        McCain, Mr. Coleman, and Mrs. Hutchison):
  S. 545. A bill to amend title I of the Employee Retirement Income 
Security Act of 1974 to improve access and choice for entrepreneurs 
with small businesses with respect to medical care for their employees; 
to the Committee on Health, Education, Labor, and Pensions.
  Ms. SNOWE. Mr. President, today I am introducing a bill that will 
provide revolutionary changes to the health insurance choices available 
for small businesses. This bill, ``The Small Business Health Fairness 
Act of 2003'' will give small businesses the same market-based 
advantages and leverage that large employers and unions currently enjoy 
to provide health insurance for their employees.
  One month ago, I convened my first hearing as Chair of the Committee 
on Small Business and Entrepreneurship to explore the crisis small 
businesses are currently facing in their attempts to find affordable 
health care for their employees. The reason I made this my first 
hearing was that whenever I spoke to small businesses this is the 
number one issue they wanted to discuss. Small businesses in my State 
are literally desperate for more health insurance options; some 
business owners even say this is keeping them awake at night.
  At the hearing small businesses from my home State of Maine made it 
clear that they have only one choice for their health care. Even when 
they band together in local purchasing pools, they are unable to 
attract any other insurance carriers to provide them with less 
expensive and more flexible options. Even though they have cut back on 
the coverage and increased the costs to the employees, they are still 
finding it almost impossible to provide health insurance to their 
employees. And as the costs to the employees increases, many employees 
find this too much to absorb, which leaves them uncovered and, 
therefore, increase the ranks of the employed but uninsured.
  Indeed, the Washington Post reported on February 28 that worries 
about rising health care costs registered higher in a poll conducted by 
the Kaiser Family Foundation than even concerns over the stock market 
or terrorist attacks. Thirty-eight percent of the respondents were 
``very worried'' that the cost of their health care or health insurance 
would increase compared to 22 percent who were ``very worried'' about 
losing their savings in the stock market, or 19 percent who were ``very 
worried'' about being a victim of a terrorist attack.
  With small businesses creating up to 75 percent of net new jobs in 
America and with a shocking 56 percent of the

[[Page 5440]]

41.2 million uninsured in this country already either working a full-
time, full-year job or depending on one who does, we have an obligation 
to ensure that more of these individuals can receive insurance through 
their employers. So when the Kaiser 2002 Employer Health Benefits 
Survey reports that only 61 percent of all small businesses are 
offering health benefits--and that's down from 67 percent just three 
years ago--is there any question that we're headed in exactly the wrong 
direction?
  This is a crisis, and it's even worse in businesses with fewer than 
50 employees. Of those, only 47 percent currently provide health 
insurance benefits, and the Department of Labor reports that only 24 
percent of small businesses that employ ``low-wage'' workers offer 
health plans.
  The fact is, with more than two-thirds of all Americans relying on 
their employer for health insurance, we can't afford to continue the 
disturbing trend identified by the Kaiser Family Foundation, where 
monthly premiums for employer-sponsored health insurance on average 
rose 11 percent from 2000 to 2001, and then 12.7 percent from 2001 to 
2002--the second straight year of double digit increases. As a result, 
22 percent of all firms increased employee deductibles in 2002, and 32 
percent told Kaiser they are likely to do so this year.
  The problem is all the more acute for small businesses. For those 
with fewer than 10 workers, the employer and employees together pay--on 
average--about 8 percent more in premiums than the amount paid by 
larger companies. And for all firms under 200 employees, 84 percent 
indicated to Kaiser that cost was an important factor in not offering 
health care.
  The result of all this isn't hard to predict. Businesses can and 
clearly are dropping health benefits. Others struggle onward in 
providing coverage, but only at the cost of the growth of the business, 
or offering packages with higher premiums, or a combination of both.
  If we can do something that will help more small businesses provide 
health insurance to their employees, then we can significantly reduce 
the number of those who are without health insurance in this country.
  The Small Business Health Fairness Act of 2003 will improve access to 
affordable health care for small businesses by giving them the same 
advantages currently enjoyed by large employers and unions. The bill 
employs a very basic principle--that volume purchasing of insurance by 
small businesses will work as it does for any other commodity and for 
any large business or union that purchases health insurance coverage--
it will help reduce the cost. As President Bush has said, ``It makes no 
sense in America to isolate small businesses as little health care 
islands unto themselves. We must have association health plans.''
  The Act will allow small businesses to pool together nationally, 
under the auspices of their bona fide associations, and either purchase 
their insurance from a provider, or self-insure in the same way that 
large employers and unions currently do. These association health 
plans, AHPS, would be monitored and regulated by the Department of 
Labor's Employee Benefits Security Administration in the same way that 
more than 275,000 plans offered by large employers and unions are 
currently regulated.
  This agency is currently overseeing plans that cover 72 million 
people. The Department of Labor released a report last week that 
reveals high rates of compliance by group health plans with health care 
laws enacted under the Employee Retirement Income Security Act, ERISA. 
More importantly, the report and the compliance project that is the 
subject of the report, are further evidence of the Labor Department's 
commitment and proven success in effectively monitoring health plans. 
The report establishes that the Department is prepared to oversee 
association health plans.
  Studies by the Small Business Administration, the General Accounting 
Office, and the Congressional Budget Office have all found that these 
types of plans operate with between 13 and 30 percent lower 
administrative costs. These lower costs can then be translated into 
reducing costs to subscribers or providing more benefits.
  Another reason AHPs will be able to offer less expensive plans, and 
also greater flexibility, is because they will be exempt from the 
myriad State benefit regulations. Associations will be able to design 
their plans to meet the needs of their members and their employees. By 
administering one national plan, it will further reduce the 
administrative costs instead of trying to administer a plan subject to 
the mandates of each State.
  Even though the benefit mandates will not be in effect, associations 
will need to design their plans so that enough members participate in 
them to attract the necessary employees to make them work. This means 
that they will naturally provide a full range of benefits similar to 
what many States currently require. In many cases, the plans offered by 
large employers and unions, which are also exempt from the State 
benefit mandates, are the most generous plans available. People will 
often stay in those jobs specifically to keep their health care 
coverage.
  The Act would also provide extensive new protections to ensure that 
the health care coverage was there when employees need it. Associations 
sponsoring these plans would need to be established for at least three 
years for purposes other than providing health insurance--this is 
intended to prevent the current epidemic of fraud and abuse that is 
occurring through sham associations who take money from unsuspecting 
small businesses and then cease to exist when some files a claim.
  In addition, association health plans would be required to have 
sufficient funds in reserve, specific stop-loss insurances, 
indemnification insurance, and other funding and certification 
requirements to make sure the insurance coverage would be available 
when needed. None of these requirements apply to any of the plans 
currently regulated by the Department of Labor, either the large 
employer plans under the Employee Retirement Income Security Act, 
ERISA, or the union plans under the Taft-Hartley Act.
  The approach of this bill is, I believe, a good one--but I also 
consider it a starting point. And in that light, I intend to work with 
all groups and interested parties that are committed to passing this 
bill so that we can improve this bill and finally provide small 
businesses with more health insurance options at lower costs. The 
current situation is simply unacceptable. Those who oppose this bill 
and believe the status quo only needs to be modified slightly are not 
paying attention--they are not listening to the millions of small 
businesses who are desperate for more choices, or the small employers 
who are unable to get health insurance at any cost.
  The time for stalling on providing relief for small businesses unable 
to get affordable health insurance is over. We must act now, and we 
must pass the Small Business Health Fairness Act of 2003 to bring small 
businesses more choices and use the power of competition to bring them 
better options.
  I ask unanimous consent that the text of The Small Business Health 
Fairness Act of 2003 and an explanation of its provisions be printed in 
the Record.
  There being no objection, the bill and additional material was 
ordered to be printed in the Record, as follows:

                                 S. 545

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

     SECTION 1. SHORT TITLE AND TABLE OF CONTENTS.

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

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

           ``Part 8--Rules Governing Association Health Plans

``Sec. 801. Association health plans.
``Sec. 802. Certification of association health plans.
``Sec. 803. Requirements relating to sponsors and boards of trustees.

[[Page 5441]]

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

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

     SEC. 2. RULES GOVERNING ASSOCIATION HEALTH PLANS.

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

           ``Part 8--Rules Governing Association Health Plans

     ``SEC. 801. ASSOCIATION HEALTH PLANS.

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

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

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

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

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

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

[[Page 5442]]

     requirements would otherwise be met if the franchiser were 
     deemed to be the sponsor referred to in section 801(b), such 
     network were deemed to be an association described in section 
     801(b), and each franchisee were deemed to be a member (of 
     the association and the sponsor) referred to in section 
     801(b); and
       ``(2) the requirements of section 804(a)(1) shall be deemed 
     met.

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

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

     ``SEC. 804. PARTICIPATION AND COVERAGE REQUIREMENTS.

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

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

       ``(a) In General.--The requirements of this section are met 
     with respect to an association health plan if the following 
     requirements are met:
       ``(1) Contents of governing instruments.--The instruments 
     governing the plan include a written instrument, meeting the 
     requirements of an instrument required under section 
     402(a)(1), which--
       ``(A) provides that the board of trustees serves as the 
     named fiduciary required for plans under section 402(a)(1) 
     and serves in the capacity of a plan administrator (referred 
     to in section 3(16)(A));
       ``(B) provides that the sponsor of the plan is to serve as 
     plan sponsor (referred to in section 3(16)(B)); and
       ``(C) incorporates the requirements of section 806.
       ``(2) Contribution rates must be nondiscriminatory.--
       ``(A) The contribution rates for any participating small 
     employer do not vary on the basis of any health status-
     related factor in relation to employees of such employer or 
     their beneficiaries and do not vary on the basis of the type 
     of business or industry in which such employer is engaged.
       ``(B) Nothing in this title or any other provision of law 
     shall be construed to preclude an association health plan, or 
     a health insurance issuer offering health insurance coverage 
     in connection with an association health plan, from--
       ``(i) setting contribution rates based on the claims 
     experience of the plan; or
       ``(ii) varying contribution rates for small employers in a 
     State to the extent that such rates could vary using the same 
     methodology employed in such State for regulating premium 
     rates in the small group market with respect to health 
     insurance coverage offered in connection with bona fide 
     associations (within the meaning of section 2791(d)(3) of the 
     Public Health Service Act),
     subject to the requirements of section 702(b) relating to 
     contribution rates.
       ``(3) Floor for number of covered individuals with respect 
     to certain plans.--If any benefit option under the plan does 
     not consist of health insurance coverage, the plan has as of 
     the beginning of the plan year not fewer than 1,000 
     participants and beneficiaries.
       ``(4) Marketing requirements.--
       ``(A) In general.--If a benefit option which consists of 
     health insurance coverage is offered under the plan, State-
     licensed insurance agents shall be used to distribute to 
     small employers coverage which does not consist of health 
     insurance coverage in a manner comparable to the manner in 
     which such agents are used to distribute health insurance 
     coverage.
       ``(B) State-licensed insurance agents.--For purposes of 
     subparagraph (A), the term `State-licensed insurance agents' 
     means one or more agents who are licensed in a State and are 
     subject to the laws of such State relating to licensure, 
     qualification, testing, examination, and continuing education 
     of persons authorized to offer, sell, or solicit health 
     insurance coverage in such State.
       ``(5) Regulatory requirements.--Such other requirements as 
     the applicable authority determines are necessary to carry 
     out the purposes of this part, which shall be prescribed by 
     the applicable authority by regulation through negotiated 
     rulemaking.
       ``(b) Ability of Association Health Plans To Design Benefit 
     Options.--Subject to section 514(d), nothing in this part or 
     any provision of State law (as defined in section 514(c)(1)) 
     shall be construed to preclude an association health plan, or 
     a health insurance issuer offering health insurance coverage 
     in connection with an association health plan, from 
     exercising its sole discretion in selecting the specific 
     items and services consisting of medical care to be included 
     as benefits under such plan or coverage, except (subject to 
     section 514) in the case of any law to the extent that it (1) 
     prohibits an exclusion of a specific disease from such 
     coverage, or (2) is not preempted under section 731(a)(1) 
     with respect to matters governed by section 711 or 712.

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

       ``(a) In General.--The requirements of this section are met 
     with respect to an association health plan if--
       ``(1) the benefits under the plan consist solely of health 
     insurance coverage; or
       ``(2) if the plan provides any additional benefit options 
     which do not consist of health insurance coverage, the plan--
       ``(A) establishes and maintains reserves with respect to 
     such additional benefit options, in amounts recommended by 
     the qualified actuary, consisting of--
       ``(i) a reserve sufficient for unearned contributions;
       ``(ii) a reserve sufficient for benefit liabilities which 
     have been incurred, which have not been satisfied, and for 
     which risk of loss has not yet been transferred, and for 
     expected administrative costs with respect to such benefit 
     liabilities;
       ``(iii) a reserve sufficient for any other obligations of 
     the plan; and

[[Page 5443]]

       ``(iv) a reserve sufficient for a margin of error and other 
     fluctuations, taking into account the specific circumstances 
     of the plan; and
       ``(B) establishes and maintains aggregate and specific 
     excess/stop loss insurance and solvency indemnification, with 
     respect to such additional benefit options for which risk of 
     loss has not yet been transferred, as follows:
       ``(i) The plan shall secure aggregate excess/stop loss 
     insurance for the plan with an attachment point which is not 
     greater than 125 percent of expected gross annual claims. The 
     applicable authority may by regulation, through negotiated 
     rulemaking, provide for upward adjustments in the amount of 
     such percentage in specified circumstances in which the plan 
     specifically provides for and maintains reserves in excess of 
     the amounts required under subparagraph (A).
       ``(ii) The plan shall secure specific excess/stop loss 
     insurance for the plan with an attachment point which is at 
     least equal to an amount recommended by the plan's qualified 
     actuary. The applicable authority may by regulation, through 
     negotiated rulemaking, provide for adjustments in the amount 
     of such insurance in specified circumstances in which the 
     plan specifically provides for and maintains reserves in 
     excess of the amounts required under subparagraph (A).
       ``(iii) The plan shall secure indemnification insurance for 
     any claims which the plan is unable to satisfy by reason of a 
     plan termination.

     Any regulations prescribed by the applicable authority 
     pursuant to clause (i) or (ii) of subparagraph (B) may allow 
     for such adjustments in the required levels of excess/stop 
     loss insurance as the qualified actuary may recommend, taking 
     into account the specific circumstances of the plan.
       ``(b) Minimum Surplus in Addition to Claims Reserves.--In 
     the case of any association health plan described in 
     subsection (a)(2), the requirements of this subsection are 
     met if the plan establishes and maintains surplus in an 
     amount at least equal to--
       ``(1) $500,000, or
       ``(2) such greater amount (but not greater than $2,000,000) 
     as may be set forth in regulations prescribed by the 
     applicable authority through negotiated rulemaking, based on 
     the level of aggregate and specific excess/stop loss 
     insurance provided with respect to such plan.
       ``(c) Additional Requirements.--In the case of any 
     association health plan described in subsection (a)(2), the 
     applicable authority may provide such additional requirements 
     relating to reserves and excess/stop loss insurance as the 
     applicable authority considers appropriate. Such requirements 
     may be provided by regulation, through negotiated rulemaking, 
     with respect to any such plan or any class of such plans.
       ``(d) Adjustments for Excess/Stop Loss Insurance.--The 
     applicable authority may provide for adjustments to the 
     levels of reserves otherwise required under subsections (a) 
     and (b) with respect to any plan or class of plans to take 
     into account excess/stop loss insurance provided with respect 
     to such plan or plans.
       ``(e) Alternative Means of Compliance.--The applicable 
     authority may permit an association health plan described in 
     subsection (a)(2) to substitute, for all or part of the 
     requirements of this section (except subsection 
     (a)(2)(B)(iii)), such security, guarantee, hold-harmless 
     arrangement, or other financial arrangement as the applicable 
     authority determines to be adequate to enable the plan to 
     fully meet all its financial obligations on a timely basis 
     and is otherwise no less protective of the interests of 
     participants and beneficiaries than the requirements for 
     which it is substituted. The applicable authority may take 
     into account, for purposes of this subsection, evidence 
     provided by the plan or sponsor which demonstrates an 
     assumption of liability with respect to the plan. Such 
     evidence may be in the form of a contract of indemnification, 
     lien, bonding, insurance, letter of credit, recourse under 
     applicable terms of the plan in the form of assessments of 
     participating employers, security, or other financial 
     arrangement.
       ``(f) Measures To Ensure Continued Payment of Benefits by 
     Certain Plans in Distress.--
       ``(1) Payments by certain plans to association health plan 
     fund.--
       ``(A) In general.--In the case of an association health 
     plan described in subsection (a)(2), the requirements of this 
     subsection are met if the plan makes payments into the 
     Association Health Plan Fund under this subparagraph when 
     they are due. Such payments shall consist of annual payments 
     in the amount of $5,000, and, in addition to such annual 
     payments, such supplemental payments as the Secretary may 
     determine to be necessary under paragraph (2). Payments under 
     this paragraph are payable to the Fund at the time determined 
     by the Secretary. Initial payments are due in advance of 
     certification under this part. Payments shall continue to 
     accrue until a plan's assets are distributed pursuant to a 
     termination procedure.
       ``(B) Penalties for failure to make payments.--If any 
     payment is not made by a plan when it is due, a late payment 
     charge of not more than 100 percent of the payment which was 
     not timely paid shall be payable by the plan to the Fund.
       ``(C) Continued duty of the secretary.--The Secretary shall 
     not cease to carry out the provisions of paragraph (2) on 
     account of the failure of a plan to pay any payment when due.
       ``(2) Payments by secretary to continue excess/stop loss 
     insurance coverage and indemnification insurance coverage for 
     certain plans.--In any case in which the applicable authority 
     determines that there is, or that there is reason to believe 
     that there will be: (A) a failure to take necessary 
     corrective actions under section 809(a) with respect to an 
     association health plan described in subsection (a)(2); or 
     (B) a termination of such a plan under section 809(b) or 
     810(b)(8) (and, if the applicable authority is not the 
     Secretary, certifies such determination to the Secretary), 
     the Secretary shall determine the amounts necessary to make 
     payments to an insurer (designated by the Secretary) to 
     maintain in force excess/stop loss insurance coverage or 
     indemnification insurance coverage for such plan, if the 
     Secretary determines that there is a reasonable expectation 
     that, without such payments, claims would not be satisfied by 
     reason of termination of such coverage. The Secretary shall, 
     to the extent provided in advance in appropriation Acts, pay 
     such amounts so determined to the insurer designated by the 
     Secretary.
       ``(3) Association health plan fund.--
       ``(A) In general.--There is established on the books of the 
     Treasury a fund to be known as the `Association Health Plan 
     Fund'. The Fund shall be available for making payments 
     pursuant to paragraph (2). The Fund shall be credited with 
     payments received pursuant to paragraph (1)(A), penalties 
     received pursuant to paragraph (1)(B); and earnings on 
     investments of amounts of the Fund under subparagraph (B).
       ``(B) Investment.--Whenever the Secretary determines that 
     the moneys of the fund are in excess of current needs, the 
     Secretary may request the investment of such amounts as the 
     Secretary determines advisable by the Secretary of the 
     Treasury in obligations issued or guaranteed by the United 
     States.
       ``(g) Excess/Stop Loss Insurance.--For purposes of this 
     section--
       ``(1) Aggregate excess/stop loss insurance.--The term 
     `aggregate excess/stop loss insurance' means, in connection 
     with an association health plan, a contract--
       ``(A) under which an insurer (meeting such minimum 
     standards as the applicable authority may prescribe by 
     regulation through negotiated rulemaking) provides for 
     payment to the plan with respect to aggregate claims under 
     the plan in excess of an amount or amounts specified in such 
     contract;
       ``(B) which is guaranteed renewable; and
       ``(C) which allows for payment of premiums by any third 
     party on behalf of the insured plan.
       ``(2) Specific excess/stop loss insurance.--The term 
     `specific excess/stop loss insurance' means, in connection 
     with an association health plan, a contract--
       ``(A) under which an insurer (meeting such minimum 
     standards as the applicable authority may prescribe by 
     regulation through negotiated rulemaking) provides for 
     payment to the plan with respect to claims under the plan in 
     connection with a covered individual in excess of an amount 
     or amounts specified in such contract in connection with such 
     covered individual;
       ``(B) which is guaranteed renewable; and
       ``(C) which allows for payment of premiums by any third 
     party on behalf of the insured plan.
       ``(h) Indemnification Insurance.--For purposes of this 
     section, the term `indemnification insurance' means, in 
     connection with an association health plan, a contract--
       ``(1) under which an insurer (meeting such minimum 
     standards as the applicable authority may prescribe through 
     negotiated rulemaking) provides for payment to the plan with 
     respect to claims under the plan which the plan is unable to 
     satisfy by reason of a termination pursuant to section 809(b) 
     (relating to mandatory termination);
       ``(2) which is guaranteed renewable and noncancellable for 
     any reason (except as the applicable authority may prescribe 
     by regulation through negotiated rulemaking); and
       ``(3) which allows for payment of premiums by any third 
     party on behalf of the insured plan.
       ``(i) Reserves.--For purposes of this section, the term 
     `reserves' means, in connection with an association health 
     plan, plan assets which meet the fiduciary standards under 
     part 4 and such additional requirements regarding liquidity 
     as the applicable authority may prescribe through negotiated 
     rulemaking.
       ``(j) Solvency Standards Working Group.--
       ``(1) In general.--Within 90 days after the date of the 
     enactment of the Small Business Health Fairness Act of 2003, 
     the applicable authority shall establish a Solvency Standards 
     Working Group. In prescribing the initial regulations under 
     this section, the applicable authority shall take into 
     account the recommendations of such Working Group.
       ``(2) Membership.--The Working Group shall consist of not 
     more than 15 members appointed by the applicable authority. 
     The

[[Page 5444]]

     applicable authority shall include among persons invited to 
     membership on the Working Group at least one of each of the 
     following:
       ``(A) a representative of the National Association of 
     Insurance Commissioners;
       ``(B) a representative of the American Academy of 
     Actuaries;
       ``(C) a representative of the State governments, or their 
     interests;
       ``(D) a representative of existing self-insured 
     arrangements, or their interests;
       ``(E) a representative of associations of the type referred 
     to in section 801(b)(1), or their interests; and
       ``(F) a representative of multiemployer plans that are 
     group health plans, or their interests.

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

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

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

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

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

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

       ``(a) Actions To Avoid Depletion of Reserves.--An 
     association health plan which is certified under this part 
     and which provides benefits other than health insurance 
     coverage shall continue to meet the requirements of section 
     806, irrespective of whether such certification continues in 
     effect. The board of trustees of such plan shall determine 
     quarterly whether the requirements of section 806 are met. In 
     any case in which the board determines that there is reason 
     to believe that there is or will be a failure to meet such 
     requirements, or the applicable authority makes such a 
     determination and so notifies the board, the board shall 
     immediately notify the qualified actuary engaged by the plan, 
     and such actuary shall, not later than the end of the next 
     following month, make such recommendations to the board for 
     corrective action as the actuary determines necessary to 
     ensure compliance with section 806. Not later than 30 days 
     after receiving from the actuary recommendations for 
     corrective actions, the board shall notify the applicable 
     authority (in such form and manner as the applicable 
     authority may prescribe by regulation through negotiated 
     rulemaking) of such recommendations of the actuary for 
     corrective action, together with a description of the actions 
     (if any) that the board has taken or plans to take in 
     response to such recommendations. The board shall thereafter 
     report to the applicable authority, in such form and 
     frequency as the applicable authority may specify to the 
     board, regarding corrective action taken by the board until 
     the requirements of section 806 are met.

[[Page 5445]]

       ``(b) Mandatory Termination.--In any case in which--
       ``(1) the applicable authority has been notified under 
     subsection (a) of a failure of an association health plan 
     which is or has been certified under this part and is 
     described in section 806(a)(2) to meet the requirements of 
     section 806 and has not been notified by the board of 
     trustees of the plan that corrective action has restored 
     compliance with such requirements; and
       ``(2) the applicable authority determines that there is a 
     reasonable expectation that the plan will continue to fail to 
     meet the requirements of section 806,

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

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

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

     ``SEC. 811. STATE ASSESSMENT AUTHORITY.

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

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

       ``(a) Definitions.--For purposes of this part--
       ``(1) Group health plan.--The term `group health plan' has 
     the meaning provided in section 733(a)(1) (after applying 
     subsection (b) of this section).
       ``(2) Medical care.--The term `medical care' has the 
     meaning provided in section 733(a)(2).
       ``(3) Health insurance coverage.--The term `health 
     insurance coverage' has the meaning provided in section 
     733(b)(1).
       ``(4) Health insurance issuer.--The term `health insurance 
     issuer' has the meaning provided in section 733(b)(2).
       ``(5) Applicable authority.--
       ``(A) In general.--Except as provided in subparagraph (B), 
     the term `applicable authority' means, in connection with an 
     association health plan--
       ``(i) the State recognized pursuant to subsection (c) of 
     section 506 as the State to which authority has been 
     delegated in connection with such plan; or
       ``(ii) if there if no State referred to in clause (i), the 
     Secretary.
       ``(B) Exceptions.--
       ``(i) Joint authorities.--Where such term appears in 
     section 808(3), section 807(e) (in the first instance), 
     section 809(a) (in the second instance), section 809(a) (in 
     the fourth

[[Page 5446]]

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

[[Page 5447]]

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

           ``Part 8--Rules Governing Association Health Plans

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

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

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

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

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

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

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

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

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

[[Page 5448]]

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

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

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

     SEC. 6. COOPERATION BETWEEN FEDERAL AND STATE AUTHORITIES.

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

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

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

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


             The Small Business Health Fairness Act of 2003

     SEC. 421. RULES GOVERNING ASSOCIATION HEALTH PLANS

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

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

     SEC. 801. ASSOCIATION HEALTH PLANS.

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

     SEC. 802. CERTIFICATION OF ASSOCIATION HEALTH PLANS.

       This section establishes a procedure for the certification 
     of Association Health Plans as prescribed by the Secretary of 
     Labor or other applicable authority (applicable authority). 
     In the case of an association health plan that provides at 
     least one benefit option that does not consist of health 
     insurance

[[Page 5449]]

     coverage, the applicable authority shall grant certification 
     only if the applicable requirements are met (or, upon the 
     date on which the plan is to commence operations, will be 
     met). Such self-insured association health plans may only be 
     certified if they also (1) offered such coverage on the date 
     of enactment of this Act; (2) the sponsor does not restrict 
     membership to one or more trades or businesses or industries 
     and whose eligible participating employers represent a broad 
     cross-section of trades or businesses or industries; and (3) 
     the plan's eligible participating employers represent one or 
     more trades or businesses, or one or more industries, which 
     have been indicated as having average or above-average health 
     insurance risk or health claims experience by reason of state 
     rate filings, denials of coverage, or proposed premium rate 
     levels, or other means demonstrated by such plan in accord 
     with regulations prescribed through negotiated rulemaking by 
     the applicable authority.
       The applicable authority may provide by regulation for 
     continued certification of association health plans. A 
     ``class certification'' procedure is established to speed the 
     approval of plans that offer only fully-insured health 
     insurance coverage.
       In essence, this procedure has the same effect as requiring 
     the Secretary to implement authority under current law to 
     issue exemptions for association health plans (see ERISA 
     section 514(b)(6)(B)). An AHP that is certified must also 
     meet the applicable requirements of Part 8 as described 
     below.

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

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

     SEC. 804. PARTICIPATION AND COVERAGE REQUIREMENTS.

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

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

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

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

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

     SEC. 807. REQUIREMENTS FOR APPLICATION AND RELATED 
                   REQUIREMENTS.

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

     SEC. 808. NOTICE REQUIREMENTS FOR VOLUNTARY TERMINATION.

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

[[Page 5450]]



     SEC. 809. CORRECTIVE ACTIONS AND MANDATORY TERMINATION.

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

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

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

     SEC. 811. STATE ASSESSMENT AUTHORITY.

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

     SEC. 812. DEFINITIONS.

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

                 Subsection (b). Conforming Amendments.

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

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

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

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

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

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

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

     SEC. 425. COOPERATION BETWEEN FEDERAL AND STATE AUTHORITIES

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

     SEC. 426. EFFECTIVE DATE; TRANSITIONAL RULES.

       In general, the amendments made by Section 421, 424, and 
     425 of the Act are effective one year after enactment of the 
     Act. Sections 422 and 423 are effective upon date of 
     enactment. In addition, the Secretary is required to issue 
     all regulations needed to carry out the amendments within one 
     year after enactment of the Act.
       The provisions of section 805(a)(2) relating to health 
     insurance coverage do not apply to group health plans 
     existing on the date of enactment if they do not provide 
     health insurance coverage, but later qualify for 
     certification.
       AHPs not in existence on the date of enactment and desiring 
     to offer benefits which do not consist of health insurance 
     must demonstrate to the Secretary that their risk is at least 
     average or above average. The Secretary shall report to 
     Congress the affect on reducing the number of uninsured after 
     five years.
                                 ______
                                 
      By Mr. AKAKA (for himself, Mr. Baucus, Mr. Campbell, Mr. Durbin, 
        Mrs. Feinstein, Mr. Roberts, and Mr. Leahy):
  S. 546. A bill to provide for the protection of paleontological 
resources on Federal lands, and for other purposes; to the Committee on 
Energy and Natural Resources.
  Mr. AKAKA. Mr. President, I rise today to introduce The 
Paleontological Resources Preservation Act to protect

[[Page 5451]]

and preserve the Nation's important fossil record for the benefit of 
our citizens. I am pleased to have Senators Baucus, Campbell, Durbin, 
Feinstein, Leahy, and Roberts join me as original cosponsors on this 
significant legislation.
  This bill was reported favorably by the Energy and Natural Resources 
Committee, and approved by unanimous consent during the 107th Congress. 
I plan to work closely with my colleagues to enact this bill during the 
108th Congress.
  In 1999, Congress requested that the Secretary of the Interior review 
and report on the Federal policy concerning paleontological resources 
on Federal lands. In its request, Congress noted that no unified 
Federal policy existed regarding the treatment of fossils by Federal 
land management agencies, and emphasized Congress's concerns that lack 
of appropriate standards would lead to the deterioration or loss of 
fossils, which are valuable scientific resources.
  In response, seven Federal agencies and the Smithsonian Institution 
released a report in May 2000 entitled ``Assessment of Fossil 
Management on Federal and Indian Lands.'' This assessment outlined 
governing principles for the management of fossils on Federal lands. 
The report recommended that penalties for fossil theft be strengthened 
and that Federal fossil collections be preserved and available for 
research and public education. The interagency group also stated that 
fossils on Federal lands are rare and a part of America's heritage and 
that effective stewardship requires accurate information and 
inventories.
  The Paleontological Resources Preservation Act embodies these 
principles, and provides the paleontological equivalent of protections 
found in the Archeological Resources Preservation Act. The bill finds 
that fossil resources on Federal lands are an irreplaceable part of the 
heritage of the United States. It affirms that reasonable access to 
fossil resources should be provided for scientific, educational, and 
recreational purposes. The bill acknowledges the value of amateur 
collecting, but protects vertebrate fossils found on Federal lands 
under a system of permits.
  I would like to emphasize that this bill in no way affects 
archaeological or cultural resources under the Archaeological Resources 
Protection Act of 1979 or the Native American Graves Protection and 
Rehabilitation Act. They are exempted. This bill covers paleontological 
remains--fossils on Federal lands only.
  As we look toward the future, public access to fossil resources will 
take on a new meaning as digital images of fossils become available 
worldwide. The National Museum of Natural History, one of the premier 
Smithsonian museums, already has an online catalogue of 9 million 
specimens, some of which include digital images. Museums will be able 
to provide global access for researchers, collectors, and educators to 
study fossil collections through online catalogs and images. Many 
scientists in developing countries currently lack vital information 
about fossils because they cannot afford travel costs to museums. This 
digital advance will truly make fossils a global resource for the 
public.
  Discoveries in paleontology are made more frequently than we realize. 
They shape how we learn about the world around us. In January of this 
year, Nature reported that Chinese scientists at Beijing's Institute of 
Vertebrate Paleontology and Paleoanthropology discovered several four-
winged dinosaur fossils. This discovery is providing us with critical 
insight into the phenomenon of flight. The Paleontological Resources 
Preservation Act would create a legacy of scientific knowledge for 
future generations.
  The protections offered in this Act are not new. Federal land 
management agencies have individual regulations prohibiting theft of 
government property. However, the reality is that U.S. Attorneys are 
reluctant to prosecute cases involving fossil theft because they are 
difficult. Congress has not provided a clear statute stating the value 
of paleontological resources to our Nation, as has been provided for 
archeological resources. Fossils are too valuable to be left within the 
general theft provisions that are difficult to prosecute, and they are 
too valuable to the education of our children not to ensure public 
access. We need to work together to make sure that we fulfill our 
responsibility as stewards of public lands, and as protectors of our 
Nation's natural resources.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 546

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Paleontological Resources 
     Preservation Act''.

     SEC. 2. FINDINGS.

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

     SEC. 3. PURPOSE.

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

     SEC. 4. DEFINITIONS.

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

     SEC. 5. MANAGEMENT.

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

[[Page 5452]]



     SEC. 6. PUBLIC AWARENESS AND EDUCATION PROGRAM.

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

     SEC. 7. COLLECTION OF PALEONTOLOGICAL RESOURCES.

       (a) Permit Requirement.--
       (1) In general.--Except as provided in this Act, a 
     paleontological resource may not be collected from Federal 
     lands without a permit issued under this Act by the 
     Secretary.
       (2) Casual collecting exception.--The Secretary may allow 
     casual collecting without a permit on Federal lands 
     administered by the Bureau of Land Management, the Bureau of 
     Reclamation, and the U.S. Forest Service, where such 
     collection is not inconsistent with the laws governing the 
     management of those Federal lands and this Act.
       (3) Previous permit exception.--Nothing in this section 
     shall affect a valid permit issued prior to the date of 
     enactment of this Act.
       (b) Criteria for Issuance of a Permit.--The Secretary may 
     issue a permit for the collection of a paleontological 
     resource pursuant to an application if the Secretary 
     determines that--
       (1) the applicant is qualified to carry out the permitted 
     activity;
       (2) the permitted activity is undertaken for the purpose of 
     furthering paleontological knowledge or for public education;
       (3) the permitted activity is consistent with any 
     management plan applicable to the Federal lands concerned; 
     and
       (4) the proposed methods of collecting will not threaten 
     significant natural or cultural resources.
       (c) Permit Specifications.--A permit for the collection of 
     a paleontological resource issued under this section shall 
     contain such terms and conditions as the Secretary deems 
     necessary to carry out the purposes of this Act. Every permit 
     shall include requirements that--
       (1) the paleontological resource that is collected from 
     Federal lands under the permit will remain the property of 
     the United States;
       (2) the paleontological resource and copies of associated 
     records will be preserved for the public in an approved 
     repository, to be made available for scientific research and 
     public education; and
       (3) specific locality data will not be released by the 
     permittee or repository without the written permission of the 
     Secretary.
       (d) Modification, Suspension, and Revocation of Permits.--
       (1) The Secretary may modify, suspend, or revoke a permit 
     issued under this section--
       (A) for resource, safety, or other management 
     considerations; or
       (B) when there is a violation of term or condition of a 
     permit issued pursuant to this section.
       (2) The permit shall be revoked if any person working under 
     the authority of the permit is convicted under section 9 or 
     is assessed a civil penalty under section 10.
       (e) Area Closures.--In order to protect paleontological or 
     other resources and to provide for public safety, the 
     Secretary may restrict access to or close areas under the 
     Secretary's jurisdiction to the collection of paleontological 
     resources.

     SEC. 8. CURATION OF RESOURCES.

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

     SEC. 9. PROHIBITED ACTS; PENALTIES.

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

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

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

     SEC. 11. REWARDS FORFEITURE.

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

     SEC. 12. CONFIDENTIALITY.

       Information concerning the nature and specific location of 
     a paleontological resource the collection of which requires a 
     permit under this Act or under any other provision of Federal 
     law shall be withheld from the public under subchapter II of 
     chapter 5 of title 5, United States Code, or under any other 
     provision of law unless the responsible Secretary determines 
     that disclosure would--

[[Page 5453]]

       (1) further the purposes of this Act;
       (2) not create risk of harm to or theft or destruction of 
     the resource or the site containing the resource; and
       (3) be in accordance with other applicable laws.

     SEC. 13. REGULATIONS.

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

     SEC. 14. SAVINGS PROVISIONS.

       Nothing in this Act shall be construed to--
       (1) invalidate, modify, or impose any additional 
     restrictions or permitting requirements on any activities 
     permitted at any time under the general mining laws, the 
     mineral or geothermal leasing laws, laws providing for 
     minerals materials disposal, or laws providing for the 
     management or regulation of the activities authorized by the 
     aforementioned laws including but not limited to the Federal 
     Land Policy Management Act (43 U.S.C. 1701-1784), the Mining 
     in the Parks Act, the Surface Mining Control and Reclamation 
     Act of 1977 (30 U.S.C. 1201-1358), and the Organic 
     Administration Act (16 U.S.C. 478, 482, 551);
       (2) invalidate, modify, or impose any additional 
     restrictions or permitting requirements on any activities 
     permitted at any time existing laws and authorities relating 
     to reclamation and multiple uses of the public lands;
       (3) apply to, or require a permit for, amateur collecting 
     of a rock, mineral, or invertebrate or plant fossil that is 
     not protected under this Act;
       (4) affect any lands other than Federal lands or affect the 
     lawful recovery, collection, or sale of paleontological 
     resources from lands other than Federal lands;
       (5) alter or diminish the authority of a Federal agency 
     under any other law to provide protection for paleontolgical 
     resources on Federal lands in addition to the protection 
     provided under this Act; or
       (6) create any right, privilege, benefit, or entitlement 
     for any person who is not an officer or employee of the 
     United States acting in that capacity. No person who is not 
     an officer or employee of the United States acting in that 
     capacity shall have standing to file any civil action in a 
     court of the United States to enforce any provision or 
     amendment made by this Act.

     SEC. 15. AUTHORIZATION OF APPROPRIATIONS.

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

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

                                 S. 547

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

     SECTION 1. CONSERVE BY BICYCLING PROGRAM.

       (a) Definitions.--In this section:
       (1) Program.--The term ``program'' means the Conserve by 
     Bicycling Program established by subsection (b).
       (2) Secretary.--The term ``Secretary'' means the Secretary 
     of Transportation.
       (b) Establishment.--There is established within the 
     Department of Transportation a program to be known as the 
     ``Conserve by Bicycling Program''.
       (c) Projects.--
       (1) In general.--In carrying out the program, the Secretary 
     shall establish not more than 10 pilot projects that are--
       (A) dispersed geographically throughout the United States; 
     and
       (B) designed to conserve energy resources by encouraging 
     the use of bicycles in place of motor vehicles.
       (2) Requirements.--A pilot project described in paragraph 
     (1) shall--
       (A) use education and marketing to convert motor vehicle 
     trips to bicycle trips;
       (B) document project results and energy savings (in 
     estimated units of energy conserved);
       (C) facilitate partnerships among interested parties in at 
     least 2 of the fields of--
       (i) transportation;
       (ii) law enforcement;
       (iii) education;
       (iv) public health;
       (v) environment; and
       (vi) energy;
       (D) maximize bicycle facility investments;
       (E) demonstrate methods that may be used in other regions 
     of the United States; and
       (F) facilitate the continuation of ongoing programs that 
     are sustained by local resources.

[[Page 5454]]

       (3) Cost sharing.--At least 20 percent of the cost of each 
     pilot project described in paragraph (1) shall be provided 
     from State or local sources.
       (d) Energy and Bicycling Research Study.--
       (1) In general.--Not later than 2 years after the date of 
     enactment of this Act, the Secretary shall enter into a 
     contract with the National Academy of Sciences for, and the 
     National Academy of Sciences shall conduct and submit to 
     Congress a report on, a study on the feasibility of 
     converting motor vehicle trips to bicycle trips.
       (2) Components.--The study shall--
       (A) document the results or progress of the pilot projects 
     under subsection (b);
       (B) determine the type and duration of motor vehicle trips 
     that people in the United States may feasibly make by 
     bicycle, taking into consideration factors such as--
       (i) weather;
       (ii) land use and traffic patterns;
       (iii) the carrying capacity of bicycles; and
       (iv) bicycle infrastructure;
       (C) determine any energy savings that would result from the 
     conversion of motor vehicle trips to bicycle trips;
       (D) include a cost-benefit analysis of bicycle 
     infrastructure investments; and
       (E) include a description of any factors that would 
     encourage more motor vehicle trips to be replaced with 
     bicycle trips.
       (f) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $6,200,000, to 
     remain available until expended, of which--
       (1) $5,150,000 shall be used to carry out pilot projects 
     described in subsection (c);
       (2) $300,000 shall be used by the Secretary to coordinate, 
     publicize, and disseminate the results of the program; and
       (3) $750,000 shall be used to carry out subsection (e).

  Ms. COLLINS. Mr. President, I am pleased to join my colleague from 
Illinois in reintroducing this legislation to recognize and promote 
bicycling's important impact on energy savings and public health.
  With America becoming more and more dependent on foreign oil, it is 
vital that we look to the contribution that bike travel can make toward 
solving our Nation's energy challenges. This legislation would 
establish a Conserve by Bike pilot program that would oversee pilot 
projects throughout the country designed to conserve energy resources 
by providing education and marketing tools to convert car trips to bike 
trips. Right now, fewer than one trip in one hundred is by bicycle. If 
we could increase this statistic to one and a half trips per hundred, 
we would save over 462 million gallons of gasoline in a year, worth 
over $721 million.
  While more bike trips would benefit our energy conservation efforts, 
that would also help improve the public's health. According to the U.S. 
Surgeon General, fewer than one-third of Americans meet Federal 
recommendations to engage in at least 30 minutes of moderate physical 
activity at least 5 days a week. Even more disturbing is the fact that 
approximately 300,000 U.S. death a year are associated with being obese 
or overweight. By promoting biking, we are working to ensue that 
Americans will increase their physical activity.
  The Conserve by Bike Act has received widespread support on the 
national, state, and local level, and I urge my colleagues to support 
this legislation.
                                 ______
                                 
      By Mr. ROCKEFELLER:
  S. 548. A bill to improve mental health programs for veterans, and 
for other purposes; to the Committee on Veterans' Affairs.
  Mr. ROCKEFELLER. Mr. President, as a senior member of the Senate 
Committee on Veterans' Affairs, I am proud to reintroduce legislation 
today intended to strengthen mental health programs within the 
Department of Veterans Affairs a key element of caring for those who 
have served on the battlefield.
  Historically, as many as one-third of all veterans seeking care at VA 
have received mental health treatment, and research suggests that 
serious mental illnesses affect at least one-fifth of the veterans who 
use the VA health care system. About 450,000 of the approximately 2.3 
million veterans who receive compensation from VA have service-
connected psychiatric and neurological disorders.
  I remain concerned about the viability of some of the programs 
developed to care for veterans with mental health needs. I have heard 
testimony about a number of these programs endangered by budget 
constraints and a shift in focus from inpatient care to outpatient 
clinics. Specialized programs particularly for substance use disorders 
and PTSD shut down, reduced in size, or understaffed--offering little 
or no care to veterans suffering from these seriously debilitating 
disorders.
  Congress previously enacted a provision to designate $15 million in 
VA funding specifically to assist medical facilities in their efforts 
to improve care for veterans with substance use disorders and PTSD. 
This additional funding has enabled VA to develop better outpatient 
substance abuse and PTSD treatment programs, outpatient dual-diagnosis 
programs, more PTSD community clinical teams, and more residential 
substance abuse disorder rehabilitation programs.
  The funds for these mental health programs, mandated by the 
Millennium Benefits and Health Care Act of 1999, will soon revert to a 
general fund. The bill I am introducing today ensures that this funding 
will remain ``protected'' for three more years and increases the total 
amount of funding identified specifically for treatment of substance 
use disorders and PTSD from $15 million to $25 million.
  Another provision of the legislation I am introducing today concerns 
VA's Mental Illness Research, Education, and Clinical Centers, called 
``MIRECCs. In 1996, Congress authorized VA to establish five of these 
centers dedicated to mental illness research, education, and clinical 
activities. This provision will allow VA to establish up to ten more 
MIRECCs to study and treat mental illnesses. MIRECCs have encouraged 
research, given VA caregivers more and better tools to treat patients 
with mental disorders, and increased our fundamental understanding of 
mental illnesses. Much more can be done in this area if the program is 
expanded.
  Another critical area of VA care involves counseling and treatment 
for veterans who were victims of sexual harassment or sexual assault 
during active military service. In 1992, Congress authorized VA to 
provide counseling to women who experienced sexual trauma during active 
military service. Two years later, recognizing that sexual trauma is 
not limited to women, Congress expanded VA's mandate to offer 
counseling and treatment regardless of gender. The Veterans Millennium 
Health Care and Benefits Act of 1999 broadened VA's responsibilities 
toward victims of sexual trauma even further, strengthening outreach 
efforts and extending the programs through December 2004. The 
legislation I am reintroducing today would provide permanent authority 
to VA for counseling and treatment of veterans who have experienced 
military sexual trauma, so that veterans and health care professionals 
can depend upon these critical services.
  I hope my colleagues will join me in supporting the expansion of 
these enormously important mental health programs with the Department 
of Veterans Affairs. We owe our service men and women no less.
  I ask unanimous consent that the text of this bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 548

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

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

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

[[Page 5455]]



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

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

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

       (a) Increase in Funding.--Subsection (c) of section 116 of 
     the Veterans Millennium Health Care and Benefits Act (Public 
     Law 106-117; 113 Stat. 1559; 38 U.S.C. 1712A note) is 
     amended--
       (1) in paragraph (1), by striking ``$15,000,000'' and 
     inserting ``$25,000,000 in each of fiscal years 2004, 2005, 
     and 2006'';
       (2) in paragraph (2), by striking ``$15,000,000'' and 
     inserting ``$25,000,000''; and
       (3) in paragraph (3)--
       (A) by inserting ``(A)'' after ``(3)''; and
       (B) by adding at the end the following new subparagraph:
       ``(B) For purposes of this paragraph, in fiscal years 2004, 
     2005, and 2006, the fiscal year utilized to determine the 
     baseline amount shall be fiscal year 2003.''.
       (b) Allocation of Funds.--Subsection (d) of that section is 
     amended--
       (1) by striking ``The Secretary'' and inserting ``(1) In 
     each of fiscal years 2004, 2005, and 2006, the Secretary''; 
     and
       (2) by adding at the end the following new paragraphs:
       ``(2) In allocating funds to facilities in a fiscal year 
     under paragraph (1), the Secretary shall ensure that--
       ``(A) not less than $10,000,000 is allocated by direct 
     grants to programs that are identified by the Mental Health 
     Strategic Health Care Group and the Committee on Care of 
     Severely Chronically Mentally Ill Veterans;
       ``(B) not less than $5,000,000 is allocated for programs on 
     post-traumatic stress disorder; and
       ``(C) not less than $5,000,000 is allocated for programs on 
     substance abuse disorder.
       ``(3) The Secretary shall provide that the funds to be 
     allocated under this section during each of fiscal years 
     2004, 2005, and 2006 are funds for a special purpose program 
     for which funds are not allocated through the Veterans 
     Equitable Resource Allocation system.''.
                                 ______
                                 
      By Mr. CAMPBELL (for himself, Mr. Inouye, and Mr. Thomas):
  S. 550. A bill to amend the Indian Land Consolidation Act to improve 
provisions relating to probate of trust and restricted land, and for 
other purposes; to the Committee on Indian Affairs.
  Mr. CAMPBELL. Mr. President, I am pleased to be joined by Senators 
Inouye and Thomas in introducing key legislation to help stop Indian 
land fractionation.
  One of the most enduring and damaging legacies of late-19th century 
Federal Indian policy is the continuing fractionation of Indian trust 
lands.
  The results of this ever-growing problem make it nearly impossible 
for affected Indian tribes to devise economic development strategies.
  By attempting to ``break up the tribal landmass'' and turning Indians 
into yeoman farmers, the Dawes Act of 1887 resulted in millions of 
acres of land transferred out of Indian ownership.
  By virtue of Indian heirship and probate rules and the steady march 
of time, millions more acres have passed from their original Indian 
allottees to thousands of descendants with undivided interests in 
parcels of land.
  In strict economic terms, these interests are practically worthless.
  Congressional efforts to counter this problem have focused on the 
Indian Land Consolidation Act and amendments made to the Act.
  Key escheat sections designed to return individual-owned fractionated 
lands to tribal ownership have been held unconstitutional by the U.S. 
Supreme Court in 1987, Hodel v. Irving, and in 1997, Babbitt v. Youpee.
  Congress and the Administration have also sought to return these 
interests to tribal ownership through voluntary purchase.
  The ``Indian Land Consolidation Program'' was enacted as part of the 
Fiscal Year 1999 Omnibus Appropriation and has proven a success.
  In 1999 I introduced amendments to the ILCA to limit disposition of 
Indian lands to Indian heirs, life estates to non-Indian heirs, or the 
tribe with jurisdiction over the lands.
  The bill I am re-introducing today was considered by the Committee on 
Indian Affairs and passed by the Senate last session. In light of this, 
it is my intention to expedite consideration of the measure.
  I urge my colleagues to join me in supporting this important bill.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 550

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``American Indian Probate 
     Reform Act of 2003''.

     SEC. 2. FINDINGS.

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

     SEC. 3. INDIAN PROBATE REFORM.

       (a) Testamentary Disposition.--Section 207 of the Indian 
     Land Consolidation Act (25 U.S.C. 2206) is amended by 
     striking subsection (a) and inserting the following:
       ``(a) Testamentary Disposition.--
       ``(1) General devise of an interest in trust or restricted 
     land.--
       ``(A) In general.--Subject to any applicable Federal law 
     relating to the devise or descent of trust or restricted 
     land, or a tribal probate code enacted in accordance with 
     section 206, the owner of an interest in trust or restricted 
     land may devise such an interest to--
       ``(i) an Indian tribe with jurisdiction over the land; or
       ``(ii) any Indian in trust or restricted status (or as a 
     passive trust interest as provided for in section 207A).
       ``(B) Status.--The devise of an interest in trust or 
     restricted land to an Indian under subparagraph (A)(ii) shall 
     not alter the status of such an interest as a trust or 
     restricted interest unless the testator provides that the 
     interest is to be held as a passive trust interest.
       ``(2) Devise of trust or restricted land in passive trust 
     or fee.--
       ``(A) In general.--Except as provided under any applicable 
     Federal law, any interest in trust or restricted land that is 
     not devised in accordance with paragraph (1) may be devised 
     only--
       ``(i) as a life estate to any non-Indian person, with the 
     remainder being devised only in accordance with clause (ii), 
     subparagraph (C), or paragraph (1)(A);
       ``(ii) to the lineal descendant or heir of the first or 
     second degree of the testator or, if the testator does not 
     have an heir of the first or second degree or a lineal 
     descendant, to any lineal descendant of an Indian grandparent 
     of the testator, as a passive trust interest (referred to in 
     this section as an `eligible passive trust devisee'); or
       ``(iii) in fee in accordance with subparagraph (C).
       ``(B) Presumed devise of passive trust interest.--Any 
     devise to an eligible passive

[[Page 5456]]

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

       ``(I) the decedent--

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[[Page 5457]]

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

       ``(B) Children.--
       ``(i) In general.--If a testator executed the will of the 
     testator before the birth or adoption of 1 or more children 
     of the testator, and the omission of the children from the 
     will is a product of inadvertence rather than an intentional 
     omission, the children shall share in the intestate interests 
     of the decedent in trust or restricted land as if the 
     decedent had died intestate.
       ``(ii) Adopted heirs.--Any person recognized as an heir by 
     virtue of adoption under the Act of July 8, 1940 (25 U.S.C. 
     372a), shall be treated as the child of a decedent under this 
     subsection.
       ``(6) Divorce.--
       ``(A) Surviving spouse.--
       ``(i) In general.--An individual who is divorced from a 
     decedent, or whose marriage to the decedent has been 
     annulled, shall not be considered to be a surviving spouse 
     unless, by virtue of a subsequent marriage, the individual is 
     married to the decedent at the time of death of the decedent.
       ``(ii) Separation.--A decree of separation that does not 
     dissolve a marriage, and terminate the status of husband and 
     wife, shall not be considered a divorce for the purpose of 
     this subsection.
       ``(iii) No effect on adjudications.--Nothing in clause (i) 
     prevents an entity responsible for adjudicating an interest 
     in trust or restricted land from giving effect to a property 
     right settlement if 1 of the parties to the settlement dies 
     before the issuance of a final decree dissolving the marriage 
     of the parties to the property settlement.
       ``(B) Effect of subsequent divorce on a will or devise.--
       ``(i) In general.--If, after executing a will, a testator 
     is divorced or the marriage of the testator is annulled, on 
     the effective date of the divorce or annulment, any 
     disposition of interests in trust or restricted land made by 
     the will to the former spouse of the testator shall be 
     considered to be revoked unless the will expressly provides 
     otherwise.
       ``(ii) Property.--Property that is prevented from passing 
     to a former spouse of a decedent under clause (i) shall pass 
     as if the former spouse failed to survive the decedent.
       ``(iii) Provisions of wills.--Any provision of a will that 
     is considered to be revoked solely by operation of this 
     subparagraph shall be revived by the remarriage of a testator 
     to the former spouse of the testator.
       ``(7) Notice.--
       ``(A) In general.--To the maximum extent practicable, the 
     Secretary shall notify each owner of trust and restricted 
     land of the provisions of this Act.
       ``(B) Combined notices.--The notice under subparagraph (A) 
     may, at the discretion of the Secretary, be provided with the 
     notice required under section 207(g).''.
       (c) Rule of Construction.--Section 207 of the Indian Land 
     Consolidation Act (25 U.S.C. 2206) is amended by adding at 
     the end the following:
       ``(h) Applicable Federal Law.--
       ``(1) In general.--For purpose of subsections (a) and (b), 
     any reference to applicable Federal law includes--
       ``(A) Public Law 91-627 (84 Stat. 1874);
       ``(B) Public Law 92-377 (86 Stat. 530);
       ``(C) Public Law 92-443 (86 Stat. 744);
       ``(D) Public Law 96-274 (94 Stat. 537); and
       ``(E) Public Law 98-513 (98 Stat. 2411).
       ``(2) No effect on laws.--Nothing in this section amends or 
     otherwise affects any law described in paragraph (1), or any 
     other Federal law, that provides for the devise and descent 
     of any trust or restricted land located on a specific Indian 
     reservation.''.
       (d) Passive Trust Interest Status for Trust or Restricted 
     Land.--The Indian Land Consolidation Act is amended by 
     inserting after section 207 (25 U.S.C. 2206) the following:

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

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

     SEC. 4. PARTITION OF INDIAN LAND.

       Section 205 of the Indian Land Consolidation Act (25 U.S.C. 
     2204) is amended by adding at the end the following:
       ``(c) Partition.--
       ``(1) Definitions.--In this subsection:
       ``(A) Eligible indian tribe.--The term `eligible Indian 
     tribe' means an Indian tribe that--
       ``(i) owns eligible land; and
       ``(ii) consents to partition of the eligible land.
       ``(B) Eligible land.--The term `eligible land' means an 
     undivided parcel of land that--
       ``(i) is located within the reservation of an Indian tribe; 
     or
       ``(ii) is otherwise under the jurisdiction of an Indian 
     tribe.
       ``(2) Requirements.--Notwithstanding any other provision of 
     law, in accordance with this subsection and subject to 
     paragraphs (3), (4), and (5)--

[[Page 5458]]

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

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

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

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

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

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

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

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

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

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

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

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

       ``(ii) Failure to object to partition.--If the owners of 50 
     percent or more of undivided ownership interest in or to a 
     parcel of eligible land consent to the partition of the 
     eligible land, or do not object to the partition by

[[Page 5459]]

     such date as may be established by the Secretary, the 
     Secretary shall inform the owners of the eligible land of the 
     right to appeal the determination of the Secretary to 
     partition the eligible land (including the results of the 
     final appraisal issued under subparagraph (B)(v)(I)).
       ``(iii) Objection to partition.--If the owners of 50 
     percent or more of the undivided ownership interest in a 
     parcel of eligible land object to the partition of the 
     eligible land--

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

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

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

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

     SEC. 5. ADDITIONAL AMENDMENTS.

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

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

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

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

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

       (I) in subparagraph (A)--

       (aa) by striking the subparagraph heading and all that 
     follows through ``Paragraph (1) shall apply'' and inserting 
     the following:
       ``(A) Nonapplicability to certain interests.--
       ``(i) In general.--Paragraph (1) shall not apply'';
       (bb) in clause (i) (as designated by item (a)), by striking 
     ``if, while'' and inserting the following: ``if--

       ``(I) while'';

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

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

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

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

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

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

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

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

       (ii) in paragraph (3), by striking ``10 percent of more of 
     the undivided interests'' and inserting ``an undivided 
     interest'';
       (5) in section 214 (25 U.S.C. 2213), by striking subsection 
     (b) and inserting the following:
       ``(b) Application of Revenue From Acquired Interests to 
     Land Consolidation Pilot Program.--
       ``(1) In general.--The Secretary shall have a lien on any 
     revenue accruing to an interest described in subsection (a) 
     until the Secretary provides for the removal of the lien 
     under paragraph (3) or (4).
       ``(2) Requirements.--
       ``(A) In general.--Until the Secretary removes a lien from 
     an interest in land under paragraph (1)--
       ``(i) any lease, resource sale contract, right-of-way, or 
     other document evidencing a transaction affecting the 
     interest shall contain a clause providing that all revenue 
     derived from the interest shall be paid to the Secretary; and
       ``(ii) any revenue derived from any interest acquired by 
     the Secretary in accordance with section 213 shall be 
     deposited in the fund created under section 216.
       ``(B) Approval of transactions.--Notwithstanding section 16 
     of the Act of June 18,

[[Page 5460]]

     1934 (commonly known as the `Indian Reorganization Act') (25 
     U.S.C. 476), or any other provision of law, until the 
     Secretary removes a lien from an interest in land under 
     paragraph (1), the Secretary may approve a transaction 
     covered under this section on behalf of an Indian tribe.
       ``(3) Removal of lien after findings.--The Secretary may 
     remove a lien referred to in paragraph (1) if the Secretary 
     makes a finding that--
       ``(A) the costs of administering the interest from which 
     revenue accrues under the lien will equal or exceed the 
     projected revenues for the parcel of land involved;
       ``(B) in the discretion of the Secretary, it will take an 
     unreasonable period of time for the parcel of land to 
     generate revenue that equals the purchase price paid for the 
     interest; or
       ``(C) a subsequent decrease in the value of land or 
     commodities associated with the parcel of land make it likely 
     that the interest will be unable to generate revenue that 
     equals the purchase price paid for the interest in a 
     reasonable time.
       ``(4) Other removal of lien.--In accordance with 
     regulations to be promulgated by the Secretary, and in 
     consultation with tribal governments and other entities 
     described in section 213(b)(3), the Secretary shall 
     periodically remove liens referred to in paragraph (1) from 
     interests in land acquired by the Secretary.'';
       (6) in section 216 (25 U.S.C. 2215)--
       (A) in subsection (a), by striking paragraph (2) and 
     inserting the following:
       ``(2) collect all revenues received from the lease, permit, 
     or sale of resources from interests acquired under section 
     213 or paid by Indian landowners under section 213.''; and
       (B) in subsection (b)--
       (i) in paragraph (1)--

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

       ``(C) be used to acquire undivided interests on the 
     reservation from which the income was derived.''; and
       (ii) by striking paragraph (2) and inserting the following:
       ``(2) Use of funds.--The Secretary may use the revenue 
     deposited in the Acquisition Fund under paragraph (1) to 
     acquire some or all of the undivided interests in any parcels 
     of land in accordance with section 205.'';
       (7) in section 217 (25 U.S.C. 2216)--
       (A) in subsection (e)(3), by striking ``prospective 
     applicants for the leasing, use, or consolidation of'' and 
     insert ``any person that is leasing, using, or consolidating, 
     or is applying to lease, use, or consolidate,''; and
       (B) by striking subsection (f) and inserting the following:
       ``(f) Purchase of Land by Indian Tribe.--
       ``(1) In general.--Except as provided in paragraph (2), 
     before the Secretary approves an application to terminate the 
     trust status or remove the restrictions on alienation from a 
     parcel of trust or restricted land, the Indian tribe that 
     exercises jurisdiction over the parcel shall have the 
     opportunity--
       ``(A) to match any offer contained in the application; or
       ``(B) in a case in which there is no purchase price 
     offered, to acquire the interest in the parcel by paying the 
     fair market value of the interest.
       ``(2) Exception for family farms.--
       ``(A) In general.--Paragraph (1) shall not apply to a 
     parcel of trust or restricted land that is part of a family 
     farm that is conveyed to a member of the family of a 
     landowner (as defined in section 206(c)(2)(A)(iv)) if--
       ``(i) the interest is offered for sale to an entity that is 
     not a member of the family of the landowner; and
       ``(ii) the Indian tribe that exercises jurisdiction over 
     the land is afforded the opportunity to purchase the 
     interest.
       ``(B) Applicability.--Section 206(c)(2)(A) shall apply with 
     respect to the recording and mortgaging of any trust or 
     restricted land referred to in subparagraph (A).''; and
       (8) in section 219(b)(1)(A) (25 U.S.C. 2218(b)(1)(A)), by 
     striking ``100'' and inserting ``90''.
       (b) Definition.--
       (1) In general.--Section 202 of the Indian Land 
     Consolidation Act (25 U.S.C. 2201) is amended by striking 
     paragraph (2) and inserting the following:
       ``(2) Indian.--
       ``(A) In general.--The term `Indian' means--
       ``(i) any person that is a member of any Indian tribe or is 
     eligible to become a member of any Indian tribe;
       ``(ii) subject to subparagraph (B), any person that has 
     been found to meet the definition of `Indian' under any 
     Federal law; and
       ``(iii) with respect to the ownership, devise, or descent 
     of trust or restricted land in the State of California, any 
     person that meets the definition of `Indians of California' 
     contained in the first section of the Act of May 18, 1928 (25 
     U.S.C. 651), until otherwise provided by Congress in 
     accordance with section 809(b) of the Indian Health Care 
     Improvement Act (25 U.S.C. 1679(b));''.
       ``(B) Exclusions.--The term `Indian' does not include any 
     person excluded from a definition described in subparagraph 
     (A)(ii) by a regulation promulgated by the Secretary in a 
     case in which the Secretary determines that the definition is 
     not consistent with the purposes of this Act, unless the 
     definition described in subparagraph (A)(ii) is contained in 
     a law relating to--
       ``(i) agriculture;
       ``(ii) cultural resources;
       ``(iii) economic development;
       ``(iv) grazing;
       ``(v) housing;
       ``(vi) Indian schools;
       ``(vii) natural resources;
       ``(viii) any other program with benefits intended to run to 
     Indian landowners; or
       ``(ix) any land-related program that takes effect after the 
     date of enactment of this subparagraph.''.
       (2) Applicability.--Any exclusion referred to in the 
     amendment made by paragraph (1) shall apply only to a 
     decedent who dies after the date on which the Secretary of 
     the Interior promulgates a regulation providing for the 
     exclusion.
       (c) Mortgages and Deeds of Trust.--The Act of March 29, 
     1956 (25 U.S.C. 483a), is amended in the first sentence of 
     subsection (a) by inserting after ``any land'' the following: 
     ``(including land owned by any person in passive trust status 
     in accordance with section 207A of the Indian Land 
     Consolidation Act)''.
       (d) Issuance of Patents.--Section 5 of the Act of February 
     8, 1887 (25 U.S.C. 348), is amended by striking the second 
     proviso and inserting the following: ``Provided, That the 
     rules of intestate succession under the Indian Land 
     Consolidation Act (25 U.S.C. 2201 et seq.) (including a 
     tribal probate code approved under that Act or regulations 
     promulgated under that Act) shall apply to that land for 
     which patents have been executed and delivered:''.
       (e) Transfers of Restricted Indian Land.--Section 4 of the 
     Act of June 18, 1934 (25 U.S.C. 464), is amended in the first 
     proviso by striking ``, in accordance with'' and all that 
     follows through the colon and inserting ``in accordance with 
     the Indian Land Consolidation Act (25 U.S.C. 2201 et seq.) 
     (including a tribal probate code approved under that Act or 
     regulations promulgated under that Act):''.

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

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

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

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

     SEC. 7. EFFECTIVE DATE.

       The amendments made by this Act shall not apply to the 
     estate of an individual who dies before the later of--
       (1) the date that is 1 year after the date of enactment of 
     this Act; or
       (2) the date specified in section 207(g)(5) of the Indian 
     Land Consolidation Act (25 U.S.C. 2206(g)(5)).
                                 ______
                                 
      By Mr. CAMPBELL:
  S. 551. A bill to provide for the implementation of air quality 
programs developed in accordance with an Intergovernmental Agreement 
between the Southern Ute Indian Tribe and the State of Colorado 
concerning Air Quality Control on the Southern Ute Indian Reservation, 
and for other purposes; to

[[Page 5461]]

the Committee on Environment and Public Works.
  Mr. CAMPBELL. Mr. President, today I am re-introducing a bill that is 
important to the State of Colorado, the Southern Ute Indian Tribe and 
all Coloradans that live in the southwest corner of our beautiful 
State.
  More than thirty years of experience with environmental laws shows us 
that local design and implementation of such laws almost always trumps 
the ``one size fits all'' approach advocated by many in Washington, 
D.C.
  The Federal Clean Air Act authorizes States and Indian tribes to 
accept responsibility for air quality plans and standards, and 
implement many of the regulatory programs needed to maintain or improve 
air quality.
  In 1984 Congress ratified a jurisdiction and boundary agreement 
between the Tribe and the State that spared both sides litigation costs 
and a fight over the jurisdictional status of each square inch on the 
reservation. The 1984 pact permits the Tribe and the State to work out 
jurisdictional issues for themselves.
  Some uncertainty remains with respect to environmental issues and 
rather than placing the Environmental Protection Agency in the middle 
of a controversy about whether it is authorized to delegate Clean Air 
Act programs within the Ute Reservation, the Tribe and the State signed 
an agreement to eliminate any ambiguities.
  First, consistent with Congress' mandate in the Clean Air Act, the 
Tribe will be the entity responsible for administering Clean Air Act 
programs within the reservation.
  Second, an equal number of Tribal and State representatives will sit 
on the Commission established to hear and make decisions, and will set 
the pace for Tribal applications for delegations of authority. Finally, 
Federal court review is available to hear challenges to decisions by 
the Commission.
  In closing, let me again commend the efforts of both the Tribe and 
the State in negotiating and signing this historic agreement.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 551

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

     SECTION. 1. SHORT TITLE.

       This Act may be cited as the ``Southern Ute and Colorado 
     Intergovernmental Agreement Implementation Act of 2003''.

     SEC. 2. FINDINGS AND PURPOSE.

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

     SEC. 3. DEFINITIONS.

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

     SEC. 4. TRIBAL AUTHORITY.

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

     SEC. 5. CIVIL ENFORCEMENT.

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

     SEC. 6. JUDICIAL REVIEW.

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

     SEC. 7. DISCLAIMER.

       Nothing in this Act--
       (1) modifies any provision of--
       (A) the Clean Air Act (42 U.S.C. 7401 et seq.);
       (B) Public Law 98-290 (25 U.S.C. 668 note); or
       (C) any lawful administrative rule promulgated in 
     accordance with those statutes; or
       (2) affects or influences in any manner any past or 
     prospective judicial interpretation or application of those 
     statutes by the United States, the Tribe, the State, or any 
     Federal, tribal, or State court.
                                 ______
                                 
      By Mr. GRASSLEY (for himself, Mr. Schumer, Mr. DeWine, Mr. Allen, 
        Mr. Craig, Mr. Graham of South Carolina, Mr. Allard, and Mr. 
        Talent):
  S. 554. A bill to allow media coverage of court proceedings; to the 
Committee on the Judiciary.
  Mr. GRASSLEY. Mr. President, I rise today to introduce the Sunshine 
in the Courtroom Act of 2003, a bill to allow media coverage of court 
proceedings. This legislation will provide Federal judges with the 
statutory authority to exercise their discretion to allow the 
photographing, electronic recording, broadcasting and televising of 
federal court proceedings.
  During the 107th Congress, the Judiciary Committee reported identical 
legislation favorably, by a vote of 12 to 7. It's my hope that the full 
Senate will have the opportunity to act on this bill as early as 
possible in the 108th Congress.
  Sunshine bill will help the American people to become better informed 
about the judicial process. Moreover, this bill will help to produce a 
better judiciary. Increased public awareness and scrutiny will bring 
about greater accountability and help judges to do a better job.
  Allowing cameras in the Federal courts is consistent with the intent 
of our Nation's Founders that trials should be held in front of as many 
people as choose to attend them. In my view, the First Amendment to the 
Constitution requires that court proceedings must be open to the public 
and, by extension, to the news media. As the Supreme Court has said, 
``what transpires in the courtroom is public property.''
  Clearly, the basic American values of openness and education are 
served by allowing electronic media access to Federal courtrooms. There 
are many beneficial and no substantial detrimental effects to allowing 
greater public access to the inner workings of our federal courts. 
Fifteen States have conducted studies aimed specifically at the 
educational benefits that are derived from camera access to courtrooms. 
They all determined that camera coverage contributes to greater public 
understanding of the judicial system.

[[Page 5462]]

  Moroever, the experience of the States with electronic media access 
to judicial proceedings demonstrate that still and video cameras can be 
used without any problems, and that procedural discipline is preserved. 
According to the National Center for State Courts, all fifty States 
allow at least some degree of camera access to judicial proceedings 
under a wide variety of rules and conditions. My own State of Iowa, for 
example, has operated successfully in this open manner for more than 20 
years.
  Furthermore, at the Federal level, the Federal Judicial Center 
conducted a pilot program in 1994 that studied the effects of allowing 
camera access to courtrooms. The study found ``small or no effects of 
camera presence on participants in judicial proceedings, courtroom 
decorum, or the administration of justice.''
  Based on the experience of the States, as well as state and Federal 
studies, Senator Schumer and I are introducing this bill with a well-
founded confidence that it represents sound public policy. 
Nevertheless, in order to provide a mechanism for Congress to study the 
effects of this legislation on our judiciary before making this change 
permanent, we have included a three-year sunset provision in our bill.
  The Supreme Court of the United States has recognized that there is a 
strong public interest in electronic media access to important court 
cases. At my urging and that of Senator Schumer, Chief Justice 
Rehnquist permitted the delayed audio broadcasting of the oral 
arguments before the Supreme Court in the historic 2000 presidential 
election dispute. The Supreme Court's response to our request was a 
major step in the right direction.
  It is important to emphasize, that this bill does not require any 
Federal judge in any Federal court to allow camera access to judicial 
proceedings. Rather, it simply gives Federal judges the discretion to 
allow cameras or other electronic media access if they see fit. The 
bill also protects the privacy and safety of non-party witnesses by 
giving them the right to have their faces and voices obscured.
  This piece of sunshine legislation will bring greater openness and 
accountability to the Nation's Federal courts. The best way to maintain 
confidence in our Federal judiciary, which has tremendous power, is to 
let the sun shine in by allowing judges to exercise their discretion in 
opening Federal courtrooms to public view through the broadcasting and 
televising of judicial proceedings. I urge my colleagues to join me in 
co-sponsoring the Sunshine in the Courtroom Act.
  I ask unanimous consent that the text of bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:
       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. DEFINITIONS.

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

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

       (a) Authority of Appellate Courts.--Notwithstanding any 
     other provision of law, the presiding judge of an appellate 
     court of the United States may, in the discretion of that 
     judge, permit the photographing, electronic recording, 
     broadcasting, or televising to the public of court 
     proceedings over which that judge presides.
       (b) Authority of District Courts.--
       (1) In general.--Notwithstanding any other provision of 
     law, any presiding judge of a district court of the United 
     States may, in the discretion of that judge, permit the 
     photographing, electronic recording, broadcasting, or 
     televising to the public of court proceedings over which that 
     judge presides.
       (2) Obscuring of witnesses.--
       (A) In general.--Upon the request of any witness in a trial 
     proceeding other than a party, the court shall order the face 
     and voice of the witness to be disguised or otherwise 
     obscured in such manner as to render the witness 
     unrecognizable to the broadcast audience of the trial 
     proceeding.
       (B) Notification to witnesses.--The presiding judge in a 
     trial proceeding shall inform each witness who is not a party 
     that the witness has the right to request that the image and 
     voice of that witness be obscured during the witness' 
     testimony.
       (c) Advisory Guidelines.--The Judicial Conference of the 
     United States may promulgate advisory guidelines to which a 
     presiding judge, in the discretion of that judge, may refer 
     in making decisions with respect to the management and 
     administration of photographing, recording, broadcasting, or 
     televising described under subsections (a) and (b).

     SEC. 3. SUNSET.

       The authority under section 2(b) shall terminate 3 years 
     after the date of the enactment of this Act.
                                 ______
                                 
      By Mr. CAMPBELL (for himself and Mr. Inouye):
  S. 555. A bill to establish the Native American Health and Wellness 
Foundation, and for other purposes; to the Committee on Indian Affairs.
                                 ______
                                 
      By Mr. CAMPBELL (for himself, Mr. Inouye, and Mr. McCain):
  S. 556. A bill to amend the Indian Health Care Improvement Act to 
revise and extend that Act; to the Committee on Indian Affairs.
  Mr. CAMPBELL. Mr. President today I am pleased to be joined by 
Senators Inouye and McCain in introducing two bills vitally important 
to the health of Native Americans: the ``Indian Health Care Improvement 
Act Reauthorization of 2003''.
  It is an unfortunate fact that the health status of Native people in 
the United States is poor. In fact, in the western hemisphere only the 
people of Haiti are in worse shape.
  Alcohol, drug abuse, and mental illness, tuberculosis, cancer, 
obesity and diabetes, heart disease, infant mortality, and a host of 
related pathologies plague Native people.
  Last fall's reauthorization of the Special Indian Diabetes Program 
showed the Federal commitment to ending the scourge of diabetes in 
Native communities.
  The ``Indian Health Care Improvement Act Reauthorization of 2003'' 
will reauthorize the programs administered by the Indian Health Service 
and will increase the direct management of health care services by 
tribes, Native Alaskans and Urban Indian health centers.
  This bill is the product of intense consultation between tribes, 
Native Alaskan health providers, and Urban Indian health centers, and 
relevant Federal agencies and representatives of the public and private 
health care sectors.
  The efforts of the IHS and Native health providers have been 
successful in improving the health status of Native people. Just in the 
last 10 years, infant and maternal mortality rates have declined by 30 
percent and 40 percent, respectively. Similarly, tuberculosis mortality 
rates have also been reduced 53 percent. Other indicia of Native health 
status have also shown marked improvement.
  Even with modest increases in recent spending bills, funding for 
Native health care continues to lag far behind the level of need.
  To help close this gap, we must be creative and tap other sources of 
funds for Native health including the private, tribal and non-profit 
sectors of our economy.
  The second bill I am introducing will do just that and will 
facilitate the contribution of funds for purposes of Native health care 
by establishing a non-profit, charitable foundation to receive funds 
and in-kind contributions for such purposes.
  This is not a radical step as similar foundations have been 
established for other purposes. In recent years Congress has created 
both the American Indian Education Foundation and the Fish and Wildlife 
Foundation, which have proven to be very successful in achieving their 
purposes.
  I urge my colleagues to join me in supporting these important bills.

[[Page 5463]]

  I ask unanimous consent that the text of the bills be printed in the 
Record.
  There being no objection, the bills were ordered to be printed in the 
Record, as follows:

                                 S. 555

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Native American Health and 
     Wellness Foundation Act of 2003''.

     SEC. 2. NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION.

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

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

     ``SEC. 801. DEFINITIONS.

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

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

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

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

       ``(iii) Qualification.--The members of the Board shall be 
     United States citizens who are knowledgeable or experienced 
     in Native American health care and related matters.
       ``(C) Compensation.--A member of the Board shall not 
     receive compensation for service as a member, but shall be 
     reimbursed for actual and necessary travel and subsistence 
     expenses incurred in the performance of the duties of the 
     Foundation.
       ``(g) Officers.--
       ``(1) In general.--The officers of the Foundation shall 
     be--
       ``(A) a secretary, elected from among the members of the 
     Board; and
       ``(B) any other officers provided for in the constitution 
     and bylaws of the Foundation.
       ``(2) Secretary.--The secretary of the Foundation shall 
     serve, at the direction of the Board, as the chief operating 
     officer of the Foundation.
       ``(3) Election.--The manner of election, term of office, 
     and duties of the officers of the Foundation shall be as 
     provided in the constitution and bylaws of the Foundation.
       ``(h) Powers.--The Foundation--
       ``(1) shall adopt a constitution and bylaws for the 
     management of the property of the Foundation and the 
     regulation of the affairs of the Foundation;
       ``(2) may adopt and alter a corporate seal;
       ``(3) may enter into contracts;
       ``(4) may acquire (through a gift or otherwise), own, 
     lease, encumber, and transfer real or personal property as 
     necessary or convenient to carry out the purposes of the 
     Foundation;
       ``(5) may sue and be sued; and
       ``(6) may perform any other act necessary and proper to 
     carry out the purposes of the Foundation.
       ``(i) Principal Office.--
       ``(1) In General.--The principal office of the Foundation 
     shall be in the District of Columbia.
       ``(2) Activities; offices.--The activities of the 
     Foundation may be conducted, and offices may be maintained, 
     throughout the United States in accordance with the 
     constitution and bylaws of the Foundation.
       ``(j) Service of Process.--The Foundation shall comply with 
     the law on service of process of each State in which the 
     Foundation is incorporated and of each State in which the 
     Foundation carries on activities.
       ``(k) Liability of Officers, Employees, and Agents.--
       ``(1) In general.--The Foundation shall be liable for the 
     acts of the officers, employees, and agents of the Foundation 
     acting within the scope of their authority.
       ``(2) Personal liability.--A member of the Board shall be 
     personally liable only for gross negligence in the 
     performance of the duties of the member.
       ``(l) Restrictions.--
       ``(1) Limitation on spending.--Beginning with the fiscal 
     year following the first full fiscal year during which the 
     Foundation is in operation, the administrative costs of the 
     Foundation shall not exceed 10 percent of the sum of--
       ``(A) the amounts transferred to the Foundation under 
     subsection (m) during the preceding fiscal year; and
       ``(B) donations received from private sources during the 
     preceding fiscal year.
       ``(2) Appointment and hiring.--The appointment of officers 
     and employees of the Foundation shall be subject to the 
     availability of funds.
       ``(3) Status.--A member of the Board or officer, employee, 
     or agent of the Foundation shall not by reason of association 
     with the Foundation be considered to be an officer, employee, 
     or agent of the United States.
       ``(m) Transfer of Donated Funds.--The Secretary may 
     transfer to the Foundation funds held by the Department of 
     Health and Human Services under the Act of August 5, 1954 (42 
     U.S.C. 2001 et seq.) if the transfer or use of the funds is 
     not prohibited by any term under which the funds were 
     donated.
       ``(n) Audits.--The Foundation shall comply with section 
     10101 of title 36, United States Code, as if the Foundation 
     were a corporation under part B of subtitle II of that title.

     ``SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT.

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

[[Page 5464]]

     
                                  ____
                                 S. 556

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Indian 
     Health Care Improvement Act Reauthorization of 2003''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title.

   TITLE I--REAUTHORIZATION AND REVISIONS OF THE INDIAN HEALTH CARE 
                            IMPROVEMENT ACT

Sec. 101. Amendment to the Indian Health Care Improvement Act.

       TITLE II--CONFORMING AMENDMENTS TO THE SOCIAL SECURITY ACT

                          Subtitle A--Medicare

Sec. 201. Limitations on charges.
Sec. 202. Qualified Indian health program.

                          Subtitle B--Medicaid

Sec. 211. State consultation with Indian health programs.
Sec. 212. Fmap for services provided by Indian health programs.
Sec. 213. Indian Health Service programs.

         Subtitle C--State Children's Health Insurance Program

Sec. 221. Enhanced fmap for State children's health insurance program.
Sec. 222. Direct funding of State children's health insurance program.

              Subtitle D--Authorization of Appropriations

Sec. 231. Authorization of appropriations.

                  TITLE III--MISCELLANEOUS PROVISIONS

Sec. 301. Repeals.
Sec. 302. Severability provisions.
Sec. 303. Effective date.

   TITLE I--REAUTHORIZATION AND REVISIONS OF THE INDIAN HEALTH CARE 
                            IMPROVEMENT ACT

     SEC. 101. AMENDMENT TO THE INDIAN HEALTH CARE IMPROVEMENT 
                   ACT.

       The Indian Health Care Improvement Act (25 U.S.C. 1601 et 
     seq.) is amended to read as follows:

     ``SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

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

``Sec. 1. Short title; table of contents.
``Sec. 2. Findings.
``Sec. 3. Declaration of health objectives.
``Sec. 4. Definitions.

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

``Sec. 101. Purpose.
``Sec. 102. General requirements.
``Sec. 103. Health professions recruitment program for Indians.
``Sec. 104. Health professions preparatory scholarship program for 
              Indians.
``Sec. 105. Indian health professions scholarships.
``Sec. 106. American Indians into psychology program.
``Sec. 107. Indian Health Service extern programs.
``Sec. 108. Continuing education allowances.
``Sec. 109. Community health representative program.
``Sec. 110. Indian Health Service loan repayment program.
``Sec. 111. Scholarship and loan repayment recovery fund.
``Sec. 112. Recruitment activities.
``Sec. 113. Tribal recruitment and retention program.
``Sec. 114. Advanced training and research.
``Sec. 115. Nursing programs; Quentin N. Burdick American Indians into 
              Nursing Program.
``Sec. 116. Tribal culture and history.
``Sec. 117. INMED program.
``Sec. 118. Health training programs of community colleges.
``Sec. 119. Retention bonus.
``Sec. 120. Nursing residency program.
``Sec. 121. Community health aide program for Alaska.
``Sec. 122. Tribal health program administration.
``Sec. 123. Health professional chronic shortage demonstration project.
``Sec. 124. Scholarships.
``Sec. 125. National Health Service Corps.
``Sec. 126. Substance abuse counselor education demonstration project.
``Sec. 127. Mental health training and community education.
``Sec. 128. Authorization of appropriations.

                      ``TITLE II--HEALTH SERVICES

``Sec. 201. Indian Health Care Improvement Fund.
``Sec. 202. Catastrophic Health Emergency Fund.
``Sec. 203. Health promotion and disease prevention services.
``Sec. 204. Diabetes prevention, treatment, and control.
``Sec. 205. Shared services.
``Sec. 206. Health services research.
``Sec. 207. Mammography and other cancer screening.
``Sec. 208. Patient travel costs.
``Sec. 209. Epidemiology centers.
``Sec. 210. Comprehensive school health education programs.
``Sec. 211. Indian youth program.
``Sec. 212. Prevention, control, and elimination of communicable and 
              infectious diseases.
``Sec. 213. Authority for provision of other services.
``Sec. 214. Indian women's health care.
``Sec. 215. Environmental and nuclear health hazards.
``Sec. 216. Arizona as a contract health service delivery area.
``Sec. 216A. North Dakota as a contract health service delivery area.
``Sec. 216B. South Dakota as a contract health service delivery area.
``Sec. 217. California contract health services demonstration program.
``Sec. 218. California as a contract health service delivery area.
``Sec. 219. Contract health services for the Trenton service area.
``Sec. 220. Programs operated by Indian tribes and tribal 
              organizations.
``Sec. 221. Licensing.
``Sec. 222. Authorization for emergency contract health services.
``Sec. 223. Prompt action on payment of claims.
``Sec. 224. Liability for payment.
``Sec. 225. Authorization of appropriations.

                        ``TITLE III--FACILITIES

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

                 ``TITLE IV--ACCESS TO HEALTH SERVICES

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

[[Page 5465]]

              ``TITLE V--HEALTH SERVICES FOR URBAN INDIANS

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

                ``TITLE VI--ORGANIZATIONAL IMPROVEMENTS

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

                ``TITLE VII--BEHAVIORAL HEALTH PROGRAMS

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

                      ``TITLE VIII--MISCELLANEOUS

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

     ``SEC. 2. FINDINGS.

       ``Congress makes the following findings:
       ``(1) Federal delivery of health services and funding of 
     tribal and urban Indian health programs to maintain and 
     improve the health of the Indians are consonant with and 
     required by the Federal Government's historical and unique 
     legal relationship with the American Indian people, as 
     reflected in the Constitution, treaties, Federal laws, and 
     the course of dealings of the United States with Indian 
     Tribes, and the United States' resulting government to 
     government and trust responsibility and obligations to the 
     American Indian people.
       ``(2) From the time of European occupation and colonization 
     through the 20th century, the policies and practices of the 
     United States caused or contributed to the severe health 
     conditions of Indians.
       ``(3) Indian Tribes have, through the cession of over 
     400,000,000 acres of land to the United States in exchange 
     for promises, often reflected in treaties, of health care 
     secured a de facto contract that entitles Indians to health 
     care in perpetuity, based on the moral, legal, and historic 
     obligation of the United States.
       ``(4) The population growth of the Indian people that began 
     in the later part of the 20th century increases the need for 
     Federal health care services.
       ``(5) A major national goal of the United States is to 
     provide the quantity and quality of health services which 
     will permit the health status of Indians, regardless of where 
     they live, to be raised to the highest possible level, a 
     level that is not less than that of the general population, 
     and to provide for the maximum participation of Indian 
     Tribes, tribal organizations, and urban Indian organizations 
     in the planning, delivery, and management of those services.
       ``(6) Federal health services to Indians have resulted in a 
     reduction in the prevalence and incidence of illnesses among, 
     and unnecessary and premature deaths of, Indians.
       ``(7) Despite such services, the unmet health needs of the 
     American Indian people remain alarmingly severe, and even 
     continue to increase, and the health status of the Indians is 
     far below the health status of the general population of the 
     United States.
       ``(8) The disparity in health status that is to be 
     addressed is formidable. In death rates for example, Indian 
     people suffer a death rate for diabetes mellitus that is 249 
     percent higher than the death rate for all races in the 
     United States, a pneumonia and influenza death rate that is 
     71 percent higher, a tuberculosis death rate that is 533 
     percent higher, and a death rate from alcoholism that is 627 
     percent higher.

     ``SEC. 3. DECLARATION OF HEALTH OBJECTIVES.

       ``Congress hereby declares that it is the policy of the 
     United States, in fulfillment of its special trust 
     responsibilities and legal obligations to the American Indian 
     people--
       ``(1) to assure the highest possible health status for 
     Indians and to provide all resources necessary to effect that 
     policy;
       ``(2) to raise the health status of Indians by the year 
     2010 to at least the levels set forth in the goals contained 
     within the Healthy People 2010, or any successor standards 
     thereto;
       ``(3) in order to raise the health status of Indian people 
     to at least the levels set forth in the goals contained 
     within the Healthy People 2010, or any successor standards 
     thereto, to permit Indian Tribes and tribal organizations to 
     set their own health care priorities and establish goals that 
     reflect their unmet needs;
       ``(4) to increase the proportion of all degrees in the 
     health professions and allied and associated health 
     professions awarded to Indians so that the proportion of 
     Indian health professionals in each geographic service area 
     is raised to at least the level of that of the general 
     population;
       ``(5) to require meaningful, active consultation with 
     Indian Tribes, Indian organizations, and urban Indian 
     organizations to implement this Act and the national policy 
     of Indian self-determination; and
       ``(6) that funds for health care programs and facilities 
     operated by Tribes and tribal organizations be provided in 
     amounts that are not less than the funds that are provided to 
     programs and facilities operated directly by the Service.

     ``SEC. 4. DEFINITIONS.

       ``In this Act:
       ``(1) Accredited and accessible.--The term `accredited and 
     accessible', with respect to an entity, means a community 
     college or other appropriate entity that is on or near a 
     reservation and accredited by a national or regional 
     organization with accrediting authority.
       ``(2) Area office.--The term `area office' means an 
     administrative entity including a program office, within the 
     Indian Health Service through which services and funds are 
     provided to the service units within a defined geographic 
     area.
       ``(3) Assistant secretary.--The term `Assistant Secretary' 
     means the Assistant Secretary of the Indian Health as 
     established under section 601.
       ``(4) Contract health service.--The term `contract health 
     service' means a health service that is provided at the 
     expense of the Service, Indian Tribe, or tribal organization 
     by a public or private medical provider or hospital, other 
     than a service funded under the Indian Self-Determination and 
     Education Assistance Act or under this Act.
       ``(5) Department.--The term `Department', unless 
     specifically provided otherwise, means the Department of 
     Health and Human Services.
       ``(6) Fund.--The terms `fund' or `funding' mean the 
     transfer of monies from the Department to any eligible entity 
     or individual under this Act by any legal means, including 
     funding agreements, contracts, memoranda of understanding, 
     Buy Indian Act contracts, or otherwise.
       ``(7) Funding agreement.--The term `funding agreement' 
     means any agreement to

[[Page 5466]]

     transfer funds for the planning, conduct, and administration 
     of programs, functions, services and activities to Tribes and 
     tribal organizations from the Secretary under the authority 
     of the Indian Self-Determination and Education Assistance 
     Act.
       ``(8) Health profession.--The term `health profession' 
     means allopathic medicine, family medicine, internal 
     medicine, pediatrics, geriatric medicine, obstetrics and 
     gynecology, podiatric medicine, nursing, public health 
     nursing, dentistry, psychiatry, osteopathy, optometry, 
     pharmacy, psychology, public health, social work, marriage 
     and family therapy, chiropractic medicine, environmental 
     health and engineering, and allied health professions, or any 
     other health profession.
       ``(9) Health promotion; disease prevention.--The terms 
     `health promotion' and `disease prevention' shall have the 
     meanings given such terms in paragraphs (1) and (2) of 
     section 203(c).
       ``(10) Indian.--The term `Indian' and `Indians' shall have 
     meanings given such terms for purposes of the Indian Self-
     Determination and Education Assistance Act.
       ``(11) Indian health program.--The term `Indian health 
     program' shall have the meaning given such term in section 
     110(a)(2)(A).
       ``(12) Indian tribe.--The term `Indian tribe' shall have 
     the meaning given such term in section 4(e) of the Indian 
     Self Determination and Education Assistance Act.
       ``(13) Reservation.--The term `reservation' means any 
     Federally recognized Indian tribe's reservation, Pueblo or 
     colony, including former reservations in Oklahoma, Alaska 
     Native Regions established pursuant to the Alaska Native 
     Claims Settlement Act, and Indian allotments.
       ``(14) Secretary.--The term `Secretary', unless 
     specifically provided otherwise, means the Secretary of 
     Health and Human Services.
       ``(15) Service.--The term `Service' means the Indian Health 
     Service.
       ``(16) Service area.--The term `service area' means the 
     geographical area served by each area office.
       ``(17) Service unit.--The term `service unit' means--
       ``(A) an administrative entity within the Indian Health 
     Service; or
       ``(B) a tribe or tribal organization operating health care 
     programs or facilities with funds from the Service under the 
     Indian Self-Determination and Education Assistance Act, 
     through which services are provided, directly or by contract, 
     to the eligible Indian population within a defined geographic 
     area.
       ``(18) Traditional health care practices.--The term 
     `traditional health care practices' means the application by 
     Native healing practitioners of the Native healing sciences 
     (as opposed or in contradistinction to western healing 
     sciences) which embodies the influences or forces of innate 
     tribal discovery, history, description, explanation and 
     knowledge of the states of wellness and illness and which 
     calls upon these influences or forces, including physical, 
     mental, and spiritual forces in the promotion, restoration, 
     preservation and maintenance of health, well-being, and 
     life's harmony.
       ``(19) Tribal organization.--The term `tribal organization' 
     shall have the meaning given such term in section 4(l) of the 
     Indian Self Determination and Education Assistance Act.
       ``(20) Tribally controlled community college.--The term 
     `tribally controlled community college' shall have the 
     meaning given such term in section 126 (g)(2).
       ``(21) Urban center.--The term `urban center' means any 
     community that has a sufficient urban Indian population with 
     unmet health needs to warrant assistance under title V, as 
     determined by the Secretary.
       ``(22) Urban indian.--The term `urban Indian' means any 
     individual who resides in an urban center and who--
       ``(A) for purposes of title V and regardless of whether 
     such individual lives on or near a reservation, is a member 
     of a tribe, band or other organized group of Indians, 
     including those tribes, bands or groups terminated since 1940 
     and those tribes, bands or groups that are recognized by the 
     States in which they reside, or who is a descendant in the 
     first or second degree of any such member;
       ``(B) is an Eskimo or Aleut or other Alaskan Native;
       ``(C) is considered by the Secretary of the Interior to be 
     an Indian for any purpose; or
       ``(D) is determined to be an Indian under regulations 
     promulgated by the Secretary.
       ``(23) Urban indian organization.--The term `urban Indian 
     organization' means a nonprofit corporate body situated in an 
     urban center, governed by an urban Indian controlled board of 
     directors, and providing for the participation of all 
     interested Indian groups and individuals, and which is 
     capable of legally cooperating with other public and private 
     entities for the purpose of performing the activities 
     described in section 503(a).

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

     ``SEC. 101. PURPOSE.

       ``The purpose of this title is to increase, to the maximum 
     extent feasible, the number of Indians entering the health 
     professions and providing health services, and to assure an 
     optimum supply of health professionals to the Service, Indian 
     tribes, tribal organizations, and urban Indian organizations 
     involved in the provision of health services to Indian 
     people.

     ``SEC. 102. GENERAL REQUIREMENTS.

       ``(a) Service Area Priorities.--Unless specifically 
     provided otherwise, amounts appropriated for each fiscal year 
     to carry out each program authorized under this title shall 
     be allocated by the Secretary to the area office of each 
     service area using a formula--
       ``(1) to be developed in consultation with Indian Tribes, 
     tribal organizations and urban Indian organizations;
       ``(2) that takes into account the human resource and 
     development needs in each such service area; and
       ``(3) that weighs the allocation of amounts appropriated in 
     favor of those service areas where the health status of 
     Indians within the area, as measured by life expectancy based 
     upon the most recent data available, is significantly lower 
     than the average health status for Indians in all service 
     areas, except that amounts allocated to each such area using 
     such a weighted allocation formula shall not be less than the 
     amounts allocated to each such area in the previous fiscal 
     year.
       ``(b) Consultation.--Each area office receiving funds under 
     this title shall actively and continuously consult with 
     representatives of Indian tribes, tribal organizations, and 
     urban Indian organizations to prioritize the utilization of 
     funds provided under this title within the service area.
       ``(c) Reallocation.--Unless specifically prohibited, an 
     area office may reallocate funds provided to the office under 
     this title among the programs authorized by this title, 
     except that scholarship and loan repayment funds shall not be 
     used for administrative functions or expenses.
       ``(d) Limitation.--This section shall not apply with 
     respect to individual recipients of scholarships, loans or 
     other funds provided under this title (as this title existed 
     1 day prior to the date of enactment of this Act) until such 
     time as the individual completes the course of study that is 
     supported through the use of such funds.

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

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

[[Page 5467]]



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

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

     ``SEC. 105. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.

       ``(a) Scholarships.--
       ``(1) In general.--In order to meet the needs of Indians, 
     Indian tribes, tribal organizations, and urban Indian 
     organizations for health professionals, the Secretary, acting 
     through the Service and in accordance with this section, 
     shall provide scholarships through the area offices to 
     Indians who are enrolled full or part time in accredited 
     schools and pursuing courses of study in the health 
     professions. Such scholarships shall be designated Indian 
     Health Scholarships and shall, except as provided in 
     subsection (b), be made in accordance with section 338A of 
     the Public Health Service Act (42 U.S.C. 254l).
       ``(2) No delegation.--The Director of the Service shall 
     administer this section and shall not delegate any 
     administrative functions under a funding agreement pursuant 
     to the Indian Self-Determination and Education Assistance 
     Act.
       ``(b) Eligibility.--
       ``(1) Enrollment.--An Indian shall be eligible for a 
     scholarship under subsection (a) in any year in which such 
     individual is enrolled full or part time in a course of study 
     referred to in subsection (a)(1).
       ``(2) Service obligation.--
       ``(A) Public health service act.--The active duty service 
     obligation under a written contract with the Secretary under 
     section 338A of the Public Health Service Act (42 U.S.C. 
     254l) that an Indian has entered into under that section 
     shall, if that individual is a recipient of an Indian Health 
     Scholarship, be met in full-time practice on an equivalent 
     year for year obligation, by service--
       ``(i) in the Indian Health Service;
       ``(ii) in a program conducted under a funding agreement 
     entered into under the Indian Self-Determination and 
     Education Assistance Act;
       ``(iii) in a program assisted under title V; or
       ``(iv) in the private practice of the applicable profession 
     if, as determined by the Secretary, in accordance with 
     guidelines promulgated by the Secretary, such practice is 
     situated in a physician or other health professional shortage 
     area and addresses the health care needs of a substantial 
     number of Indians.
       ``(B) Deferring active service.--At the request of any 
     Indian who has entered into a contract referred to in 
     subparagraph (A) and who receives a degree in medicine 
     (including osteopathic or allopathic medicine), dentistry, 
     optometry, podiatry, or pharmacy, the Secretary shall defer 
     the active duty service obligation of that individual under 
     that contract, in order that such individual may complete any 
     internship, residency, or other advanced clinical training 
     that is required for the practice of that health profession, 
     for an appropriate period (in years, as determined by the 
     Secretary), subject to the following conditions:
       ``(i) No period of internship, residency, or other advanced 
     clinical training shall be counted as satisfying any period 
     of obligated service that is required under this section.
       ``(ii) The active duty service obligation of that 
     individual shall commence not later than 90 days after the 
     completion of that advanced clinical training (or by a date 
     specified by the Secretary).
       ``(iii) The active duty service obligation will be served 
     in the health profession of that individual, in a manner 
     consistent with clauses (i) through (iv) of subparagraph (A).
       ``(C) New scholarship recipients.--A recipient of an Indian 
     Health Scholarship that is awarded after December 31, 2003, 
     shall meet the active duty service obligation under such 
     scholarship by providing service within the service area from 
     which the scholarship was awarded. In placing the recipient 
     for active duty the area office shall give priority to the 
     program that funded the recipient, except that in cases of 
     special circumstances, a recipient may be placed in a 
     different service area pursuant to an agreement between the 
     areas or programs involved.
       ``(D) Priority in assignment.--Subject to subparagraph (C), 
     the area office, in making assignments of Indian Health 
     Scholarship recipients required to meet the active duty 
     service obligation described in subparagraph (A), shall give 
     priority to assigning individuals to service in those 
     programs specified in subparagraph (A) that have a need for 
     health professionals to provide health care services as a 
     result of individuals having breached contracts entered into 
     under this section.
       ``(3) Part-time enrollment.--In the case of an Indian 
     receiving a scholarship under this section who is enrolled 
     part time in an approved course of study--
       ``(A) such scholarship shall be for a period of years not 
     to exceed the part-time equivalent of 4 years, as determined 
     by the appropriate area office;
       ``(B) the period of obligated service described in 
     paragraph (2)(A) shall be equal to the greater of--
       ``(i) the part-time equivalent of 1 year for each year for 
     which the individual was provided a scholarship (as 
     determined by the area office); or
       ``(ii) two years; and
       ``(C) the amount of the monthly stipend specified in 
     section 338A(g)(1)(B) of the Public Health Service Act (42 
     U.S.C. 254l(g)(1)(B)) shall be reduced pro rata (as 
     determined by the Secretary) based on the number of hours 
     such student is enrolled.
       ``(4) Breach of contract.--
       ``(A) In general.--An Indian who has, on or after the date 
     of the enactment of this paragraph, entered into a written 
     contract with the area office pursuant to a scholarship under 
     this section and who--
       ``(i) fails to maintain an acceptable level of academic 
     standing in the educational institution in which he or she is 
     enrolled (such level determined by the educational 
     institution under regulations of the Secretary);
       ``(ii) is dismissed from such educational institution for 
     disciplinary reasons;
       ``(iii) voluntarily terminates the training in such an 
     educational institution for which he or she is provided a 
     scholarship under such contract before the completion of such 
     training; or
       ``(iv) fails to accept payment, or instructs the 
     educational institution in which he or she is enrolled not to 
     accept payment, in whole or in part, of a scholarship under 
     such contract;
     in lieu of any service obligation arising under such 
     contract, shall be liable to the United States for the amount 
     which has been paid to him or her, or on his or her behalf, 
     under the contract.
       ``(B) Failure to perform service obligation.--If for any 
     reason not specified in subparagraph (A) an individual 
     breaches his or her written contract by failing either to 
     begin such individual's service obligation under this section 
     or to complete such service obligation, the United States 
     shall be entitled to recover from the individual an amount 
     determined in accordance with the formula specified in 
     subsection (l) of section 110 in the manner provided for in 
     such subsection.
       ``(C) Death.--Upon the death of an individual who receives 
     an Indian Health Scholarship, any obligation of that 
     individual for service or payment that relates to that 
     scholarship shall be canceled.
       ``(D) Waiver.--The Secretary shall provide for the partial 
     or total waiver or suspension of any obligation of service or 
     payment of a recipient of an Indian Health Scholarship if the 
     Secretary, in consultation with the appropriate area office, 
     Indian tribe, tribal organization, and urban Indian 
     organization, determines that--
       ``(i) it is not possible for the recipient to meet that 
     obligation or make that payment;
       ``(ii) requiring that recipient to meet that obligation or 
     make that payment would result in extreme hardship to the 
     recipient; or
       ``(iii) the enforcement of the requirement to meet the 
     obligation or make the payment would be unconscionable.
       ``(E) Hardship or good cause.--Notwithstanding any other 
     provision of law, in any case of extreme hardship or for 
     other good cause shown, the Secretary may waive, in whole or 
     in part, the right of the United States to recover funds made 
     available under this section.
       ``(F) Bankruptcy.--Notwithstanding any other provision of 
     law, with respect to a recipient of an Indian Health 
     Scholarship, no obligation for payment may be released by a 
     discharge in bankruptcy under title 11, United States Code, 
     unless that discharge is granted after the expiration of the 
     5-year period beginning on the initial date on which

[[Page 5468]]

     that payment is due, and only if the bankruptcy court finds 
     that the nondischarge of the obligation would be 
     unconscionable.
       ``(c) Funding for Tribes for Scholarship Programs.--
       ``(1) Provision of funds.--
       ``(A) In general.--The Secretary shall make funds 
     available, through area offices, to Indian Tribes and tribal 
     organizations for the purpose of assisting such Tribes and 
     tribal organizations in educating Indians to serve as health 
     professionals in Indian communities.
       ``(B) Limitation.--The Secretary shall ensure that amounts 
     available for grants under subparagraph (A) for any fiscal 
     year shall not exceed an amount equal to 5 percent of the 
     amount available for each fiscal year for Indian Health 
     Scholarships under this section.
       ``(C) Application.--An application for funds under 
     subparagraph (A) shall be in such form and contain such 
     agreements, assurances and information as consistent with 
     this section.
       ``(2) Requirements.--
       ``(A) In general.--An Indian Tribe or tribal organization 
     receiving funds under paragraph (1) shall agree to provide 
     scholarships to Indians in accordance with the requirements 
     of this subsection.
       ``(B) Matching requirement.--With respect to the costs of 
     providing any scholarship pursuant to subparagraph (A)--
       ``(i) 80 percent of the costs of the scholarship shall be 
     paid from the funds provided under paragraph (1) to the 
     Indian Tribe or tribal organization; and
       ``(ii) 20 percent of such costs shall be paid from any 
     other source of funds.
       ``(3) Eligibility.--An Indian Tribe or tribal organization 
     shall provide scholarships under this subsection only to 
     Indians who are enrolled or accepted for enrollment in a 
     course of study (approved by the Secretary) in one of the 
     health professions described in this Act.
       ``(4) Contracts.--In providing scholarships under paragraph 
     (1), the Secretary and the Indian Tribe or tribal 
     organization shall enter into a written contract with each 
     recipient of such scholarship. Such contract shall--
       ``(A) obligate such recipient to provide service in an 
     Indian health program (as defined in section 110(a)(2)(A)) in 
     the same service area where the Indian Tribe or tribal 
     organization providing the scholarship is located, for--
       ``(i) a number of years equal to the number of years for 
     which the scholarship is provided (or the part-time 
     equivalent thereof, as determined by the Secretary), or for a 
     period of 2 years, whichever period is greater; or
       ``(ii) such greater period of time as the recipient and the 
     Indian Tribe or tribal organization may agree;
       ``(B) provide that the scholarship--
       ``(i) may only be expended for--

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

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

     ``SEC. 106. AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM.

       ``(a) In General.--Notwithstanding section 102, the 
     Secretary shall provide funds to at least 3 colleges and 
     universities for the purpose of developing and maintaining 
     American Indian psychology career recruitment programs as a 
     means of encouraging Indians to enter the mental health 
     field. These programs shall be located at various colleges 
     and universities throughout the country to maximize their 
     availability to Indian students and new programs shall be 
     established in different locations from time to time.
       ``(b) Quentin N. Burdick American Indians Into Psychology 
     Program.--The Secretary shall provide funds under subsection 
     (a) to develop and maintain a program at the University of 
     North Dakota to be known as the `Quentin N. Burdick American 
     Indians Into Psychology Program'. Such program shall, to the 
     maximum extent feasible, coordinate with the Quentin N. 
     Burdick American Indians Into Nursing Program authorized 
     under section 115, the Quentin N. Burdick Indians into Health 
     Program authorized under section 117, and existing university 
     research and communications networks.
       ``(c) Requirements.--
       ``(1) Regulations.--The Secretary shall promulgate 
     regulations pursuant to this Act for the competitive awarding 
     of funds under this section.
       ``(2) Program.--Applicants for funds under this section 
     shall agree to provide a program which, at a minimum--
       ``(A) provides outreach and recruitment for health 
     professions to Indian communities including elementary, 
     secondary and accredited and accessible community colleges 
     that will be served by the program;
       ``(B) incorporates a program advisory board comprised of 
     representatives from the Tribes and communities that will be 
     served by the program;
       ``(C) provides summer enrichment programs to expose Indian 
     students to the various fields of psychology through 
     research, clinical, and experimental activities;
       ``(D) provides stipends to undergraduate and graduate 
     students to pursue a career in psychology;
       ``(E) develops affiliation agreements with tribal community 
     colleges, the Service, university affiliated programs, and 
     other appropriate accredited and accessible entities to 
     enhance the education of Indian students;
       ``(F) utilizes, to the maximum extent feasible, existing 
     university tutoring, counseling and student support services; 
     and
       ``(G) employs, to the maximum extent feasible, qualified 
     Indians in the program.
       ``(d) Active Duty Obligation.--The active duty service 
     obligation prescribed under section 338C of the Public Health 
     Service Act (42 U.S.C. 254m) shall be met by each graduate 
     who receives a stipend described in subsection (c)(2)(C) that 
     is funded under this section. Such obligation shall be met by 
     service--
       ``(1) in the Indian Health Service;
       ``(2) in a program conducted under a funding agreement 
     contract entered into under the Indian Self-Determination and 
     Education Assistance Act;
       ``(3) in a program assisted under title V; or
       ``(4) in the private practice of psychology if, as 
     determined by the Secretary, in accordance with guidelines 
     promulgated by the

[[Page 5469]]

     Secretary, such practice is situated in a physician or other 
     health professional shortage area and addresses the health 
     care needs of a substantial number of Indians.

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

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

     ``SEC. 108. CONTINUING EDUCATION ALLOWANCES.

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

     ``SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PROGRAM.

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

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

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

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

       ``(iii) by an urban Indian organization pursuant to title 
     V.
       ``(B) State.--The term `State' has the same meaning given 
     such term in section 331(i)(4) of the Public Health Service 
     Act.
       ``(b) Eligibility.--To be eligible to participate in the 
     Loan Repayment Program, an individual must--
       ``(1)(A) be enrolled--
       ``(i) in a course of study or program in an accredited 
     institution, as determined by the Secretary, within any State 
     and be scheduled to complete such course of study in the same 
     year such individual applies to participate in such program; 
     or
       ``(ii) in an approved graduate training program in a health 
     profession; or
       ``(B) have--
       ``(i) a degree in a health profession; and
       ``(ii) a license to practice a health profession in a 
     State;
       ``(2)(A) be eligible for, or hold, an appointment as a 
     commissioned officer in the Regular or Reserve Corps of the 
     Public Health Service;
       ``(B) be eligible for selection for civilian service in the 
     Regular or Reserve Corps of the Public Health Service;
       ``(C) meet the professional standards for civil service 
     employment in the Indian Health Service; or
       ``(D) be employed in an Indian health program without a 
     service obligation; and
       ``(3) submit to the Secretary an application for a contract 
     described in subsection (f).
       ``(c) Forms.--
       ``(1) In general.--In disseminating application forms and 
     contract forms to individuals desiring to participate in the 
     Loan Repayment Program, the Secretary shall include with such 
     forms a fair summary of the rights and liabilities of an 
     individual whose application is approved (and whose contract 
     is accepted) by the Secretary, including in the summary a 
     clear explanation of the damages to which the United States 
     is entitled under subsection (l) in the case of the 
     individual's breach of the contract. The Secretary shall 
     provide such individuals with sufficient information 
     regarding the advantages and disadvantages of service as a 
     commissioned officer in the Regular or Reserve Corps of the 
     Public Health Service or a civilian employee of the Indian 
     Health Service to enable the individual to make a decision on 
     an informed basis.
       ``(2) Forms to be understandable.--The application form, 
     contract form, and all other information furnished by the 
     Secretary under this section shall be written in a manner 
     calculated to be understood by the average individual 
     applying to participate in the Loan Repayment Program.
       ``(3) Availability.--The Secretary shall make such 
     application forms, contract forms, and other information 
     available to individuals desiring to participate in the Loan 
     Repayment Program on a date sufficiently early to ensure that 
     such individuals have adequate time to carefully review and 
     evaluate such forms and information.
       ``(d) Priority.--
       ``(1) Annual determinations.--The Secretary, acting through 
     the Service and in accordance with subsection (k), shall 
     annually--
       ``(A) identify the positions in each Indian health program 
     for which there is a need or a vacancy; and
       ``(B) rank those positions in order of priority.
       ``(2) Priority in approval.--Notwithstanding the priority 
     determined under paragraph (1), the Secretary, in determining 
     which applications under the Loan Repayment Program to 
     approve (and which contracts to accept), shall--
       ``(A) give first priority to applications made by 
     individual Indians; and
       ``(B) after making determinations on all applications 
     submitted by individual Indians as required under 
     subparagraph (A), give priority to--
       ``(i) individuals recruited through the efforts an Indian 
     tribe, tribal organization, or urban Indian organization; and
       ``(ii) other individuals based on the priority rankings 
     under paragraph (1).
       ``(e) Contracts.--
       ``(1) In general.--An individual becomes a participant in 
     the Loan Repayment Program

[[Page 5470]]

     only upon the Secretary and the individual entering into a 
     written contract described in subsection (f).
       ``(2) Notice.--Not later than 21 days after considering an 
     individual for participation in the Loan Repayment Program 
     under paragraph (1), the Secretary shall provide written 
     notice to the individual of--
       ``(A) the Secretary's approving of the individual's 
     participation in the Loan Repayment Program, including 
     extensions resulting in an aggregate period of obligated 
     service in excess of 4 years; or
       ``(B) the Secretary's disapproving an individual's 
     participation in such Program.
       ``(f) Written Contract.--The written contract referred to 
     in this section between the Secretary and an individual shall 
     contain--
       ``(1) an agreement under which--
       ``(A) subject to paragraph (3), the Secretary agrees--
       ``(i) to pay loans on behalf of the individual in 
     accordance with the provisions of this section; and
       ``(ii) to accept (subject to the availability of 
     appropriated funds for carrying out this section) the 
     individual into the Service or place the individual with a 
     tribe, tribal organization, or urban Indian organization as 
     provided in subparagraph (B)(iii); and
       ``(B) subject to paragraph (3), the individual agrees--
       ``(i) to accept loan payments on behalf of the individual;
       ``(ii) in the case of an individual described in subsection 
     (b)(1)--

       ``(I) to maintain enrollment in a course of study or 
     training described in subsection (b)(1)(A) until the 
     individual completes the course of study or training; and
       ``(II) while enrolled in such course of study or training, 
     to maintain an acceptable level of academic standing (as 
     determined under regulations of the Secretary by the 
     educational institution offering such course of study or 
     training);

       ``(iii) to serve for a time period (referred to in this 
     section as the `period of obligated service') equal to 2 
     years or such longer period as the individual may agree to 
     serve in the full-time clinical practice of such individual's 
     profession in an Indian health program to which the 
     individual may be assigned by the Secretary;
       ``(2) a provision permitting the Secretary to extend for 
     such longer additional periods, as the individual may agree 
     to, the period of obligated service agreed to by the 
     individual under paragraph (1)(B)(iii);
       ``(3) a provision that any financial obligation of the 
     United States arising out of a contract entered into under 
     this section and any obligation of the individual which is 
     conditioned thereon is contingent upon funds being 
     appropriated for loan repayments under this section;
       ``(4) a statement of the damages to which the United States 
     is entitled under subsection (l) for the individual's breach 
     of the contract; and
       ``(5) such other statements of the rights and liabilities 
     of the Secretary and of the individual, not inconsistent with 
     this section.
       ``(g) Loan Repayments.--
       ``(1) In general.--A loan repayment provided for an 
     individual under a written contract under the Loan Repayment 
     Program shall consist of payment, in accordance with 
     paragraph (2), on behalf of the individual of the principal, 
     interest, and related expenses on government and commercial 
     loans received by the individual regarding the undergraduate 
     or graduate education of the individual (or both), which 
     loans were made for--
       ``(A) tuition expenses;
       ``(B) all other reasonable educational expenses, including 
     fees, books, and laboratory expenses, incurred by the 
     individual; and
       ``(C) reasonable living expenses as determined by the 
     Secretary.
       ``(2) Amount of payment.--
       ``(A) In general.--For each year of obligated service that 
     an individual contracts to serve under subsection (f) the 
     Secretary may pay up to $35,000 (or an amount equal to the 
     amount specified in section 338B(g)(2)(A) of the Public 
     Health Service Act) on behalf of the individual for loans 
     described in paragraph (1). In making a determination of the 
     amount to pay for a year of such service by an individual, 
     the Secretary shall consider the extent to which each such 
     determination--
       ``(i) affects the ability of the Secretary to maximize the 
     number of contracts that can be provided under the Loan 
     Repayment Program from the amounts appropriated for such 
     contracts;
       ``(ii) provides an incentive to serve in Indian health 
     programs with the greatest shortages of health professionals; 
     and
       ``(iii) provides an incentive with respect to the health 
     professional involved remaining in an Indian health program 
     with such a health professional shortage, and continuing to 
     provide primary health services, after the completion of the 
     period of obligated service under the Loan Repayment Program.
       ``(B) Time for payment.--Any arrangement made by the 
     Secretary for the making of loan repayments in accordance 
     with this subsection shall provide that any repayments for a 
     year of obligated service shall be made not later than the 
     end of the fiscal year in which the individual completes such 
     year of service.
       ``(3) Schedule for payments.--The Secretary may enter into 
     an agreement with the holder of any loan for which payments 
     are made under the Loan Repayment Program to establish a 
     schedule for the making of such payments.
       ``(h) Counting of Individuals.--Notwithstanding any other 
     provision of law, individuals who have entered into written 
     contracts with the Secretary under this section, while 
     undergoing academic training, shall not be counted against 
     any employment ceiling affecting the Department.
       ``(i) Recruiting Programs.--The Secretary shall conduct 
     recruiting programs for the Loan Repayment Program and other 
     health professional programs of the Service at educational 
     institutions training health professionals or specialists 
     identified in subsection (a).
       ``(j) Nonapplication of Certain Provision.--Section 214 of 
     the Public Health Service Act (42 U.S.C. 215) shall not apply 
     to individuals during their period of obligated service under 
     the Loan Repayment Program.
       ``(k) Assignment of Individuals.--The Secretary, in 
     assigning individuals to serve in Indian health programs 
     pursuant to contracts entered into under this section, 
     shall--
       ``(1) ensure that the staffing needs of Indian health 
     programs administered by an Indian tribe or tribal or health 
     organization receive consideration on an equal basis with 
     programs that are administered directly by the Service; and
       ``(2) give priority to assigning individuals to Indian 
     health programs that have a need for health professionals to 
     provide health care services as a result of individuals 
     having breached contracts entered into under this section.
       ``(l) Breach of Contract.--
       ``(1) In general.--An individual who has entered into a 
     written contract with the Secretary under this section and 
     who--
       ``(A) is enrolled in the final year of a course of study 
     and who--
       ``(i) fails to maintain an acceptable level of academic 
     standing in the educational institution in which he is 
     enrolled (such level determined by the educational 
     institution under regulations of the Secretary);
       ``(ii) voluntarily terminates such enrollment; or
       ``(iii) is dismissed from such educational institution 
     before completion of such course of study; or
       ``(B) is enrolled in a graduate training program, and who 
     fails to complete such training program, and does not receive 
     a waiver from the Secretary under subsection (b)(1)(B)(ii),

     shall be liable, in lieu of any service obligation arising 
     under such contract, to the United States for the amount 
     which has been paid on such individual's behalf under the 
     contract.
       ``(2) Amount of recovery.--If, for any reason not specified 
     in paragraph (1), an individual breaches his written contract 
     under this section by failing either to begin, or complete, 
     such individual's period of obligated service in accordance 
     with subsection (f), the United States shall be entitled to 
     recover from such individual an amount to be determined in 
     accordance with the following formula:

                              A=3Z(t-s/t)

     in which--
       ``(A) `A' is the amount the United States is entitled to 
     recover;
       ``(B) `Z' is the sum of the amounts paid under this section 
     to, or on behalf of, the individual and the interest on such 
     amounts which would be payable if, at the time the amounts 
     were paid, they were loans bearing interest at the maximum 
     legal prevailing rate, as determined by the Treasurer of the 
     United States;
       ``(C) `t' is the total number of months in the individual's 
     period of obligated service in accordance with subsection 
     (f); and
       ``(D) `s' is the number of months of such period served by 
     such individual in accordance with this section.

     Amounts not paid within such period shall be subject to 
     collection through deductions in medicare payments pursuant 
     to section 1892 of the Social Security Act.
       ``(3) Damages.--
       ``(A) Time for payment.--Any amount of damages which the 
     United States is entitled to recover under this subsection 
     shall be paid to the United States within the 1-year period 
     beginning on the date of the breach of contract or such 
     longer period beginning on such date as shall be specified by 
     the Secretary.
       ``(B) Delinquencies.--If damages described in subparagraph 
     (A) are delinquent for 3 months, the Secretary shall, for the 
     purpose of recovering such damages--
       ``(i) utilize collection agencies contracted with by the 
     Administrator of the General Services Administration; or
       ``(ii) enter into contracts for the recovery of such 
     damages with collection agencies selected by the Secretary.
       ``(C) Contracts for recovery of damages.--Each contract for 
     recovering damages pursuant to this subsection shall provide 
     that the contractor will, not less than once each 6 months, 
     submit to the Secretary a status report on the success of the 
     contractor in collecting such damages. Section

[[Page 5471]]

     3718 of title 31, United States Code, shall apply to any such 
     contract to the extent not inconsistent with this subsection.
       ``(m) Cancellation, Waiver or Release.--
       ``(1) Cancellation.--Any obligation of an individual under 
     the Loan Repayment Program for service or payment of damages 
     shall be canceled upon the death of the individual.
       ``(2) Waiver of service obligation.--The Secretary shall by 
     regulation provide for the partial or total waiver or 
     suspension of any obligation of service or payment by an 
     individual under the Loan Repayment Program whenever 
     compliance by the individual is impossible or would involve 
     extreme hardship to the individual and if enforcement of such 
     obligation with respect to any individual would be 
     unconscionable.
       ``(3) Waiver of rights of united states.--The Secretary may 
     waive, in whole or in part, the rights of the United States 
     to recover amounts under this section in any case of extreme 
     hardship or other good cause shown, as determined by the 
     Secretary.
       ``(4) Release.--Any obligation of an individual under the 
     Loan Repayment Program for payment of damages may be released 
     by a discharge in bankruptcy under title 11 of the United 
     States Code only if such discharge is granted after the 
     expiration of the 5-year period beginning on the first date 
     that payment of such damages is required, and only if the 
     bankruptcy court finds that nondischarge of the obligation 
     would be unconscionable.
       ``(n) Report.--The Secretary shall submit to the President, 
     for inclusion in each report required to be submitted to the 
     Congress under section 801, a report concerning the previous 
     fiscal year which sets forth--
       ``(1) the health professional positions maintained by the 
     Service or by tribal or Indian organizations for which 
     recruitment or retention is difficult;
       ``(2) the number of Loan Repayment Program applications 
     filed with respect to each type of health profession;
       ``(3) the number of contracts described in subsection (f) 
     that are entered into with respect to each health profession;
       ``(4) the amount of loan payments made under this section, 
     in total and by health profession;
       ``(5) the number of scholarship grants that are provided 
     under section 105 with respect to each health profession;
       ``(6) the amount of scholarship grants provided under 
     section 105, in total and by health profession;
       ``(7) the number of providers of health care that will be 
     needed by Indian health programs, by location and profession, 
     during the 3 fiscal years beginning after the date the report 
     is filed; and
       ``(8) the measures the Secretary plans to take to fill the 
     health professional positions maintained by the Service or by 
     tribes, tribal organizations, or urban Indian organizations 
     for which recruitment or retention is difficult.

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

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

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

     ``SEC. 112. RECRUITMENT ACTIVITIES.

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

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

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

     ``SEC. 114. ADVANCED TRAINING AND RESEARCH.

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

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

       ``(a) Grants.--Notwithstanding section 102, the Secretary, 
     acting through the Service, shall provide funds to--
       ``(1) public or private schools of nursing;
       ``(2) tribally controlled community colleges and tribally 
     controlled postsecondary vocational institutions (as defined 
     in section 390(2) of the Tribally Controlled Vocational 
     Institutions Support Act of 1990 (20 U.S.C. 2397h(2)); and
       ``(3) nurse midwife programs, and advance practice nurse 
     programs, that are provided by any tribal college accredited 
     nursing program, or in the absence of such, any other public 
     or private institution,

     for the purpose of increasing the number of nurses, nurse 
     midwives, and nurse practitioners who deliver health care 
     services to Indians.
       ``(b) Use of Grants.--Funds provided under subsection (a) 
     may be used to--
       ``(1) recruit individuals for programs which train 
     individuals to be nurses, nurse midwives, or advanced 
     practice nurses;
       ``(2) provide scholarships to Indian individuals enrolled 
     in such programs that may be used to pay the tuition charged 
     for such program and for other expenses incurred in 
     connection with such program, including books, fees, room and 
     board, and stipends for living expenses;
       ``(3) provide a program that encourages nurses, nurse 
     midwives, and advanced practice nurses to provide, or 
     continue to provide, health care services to Indians;
       ``(4) provide a program that increases the skills of, and 
     provides continuing education to, nurses, nurse midwives, and 
     advanced practice nurses; or
       ``(5) provide any program that is designed to achieve the 
     purpose described in subsection (a).

[[Page 5472]]

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

     ``SEC. 116. TRIBAL CULTURE AND HISTORY.

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

     ``SEC. 117. INMED PROGRAM.

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

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

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

     Such courses of study may be offered in conjunction with the 
     college or university with which the community college has 
     entered into the agreement required under subsection 
     (b)(2)(C).
       ``(e) Priority.--Priority shall be provided under this 
     section to tribally controlled colleges in service areas that 
     meet the requirements of subsection (b).
       ``(f) Definitions.--In this section:
       ``(1) Community college.--The term `community college' 
     means--
       ``(A) a tribally controlled community college; or
       ``(B) a junior or community college.
       ``(2) Junior or community college.--The term `junior or 
     community college' has the meaning given such term by section 
     312(e) of the Higher Education Act of 1965 (20 U.S.C. 
     1058(e)).
       ``(3) Tribally controlled college.--The term `tribally 
     controlled college' has the meaning given the term `tribally 
     controlled community college' by section 2(4) of the Tribally 
     Controlled Community College Assistance Act of 1978.

     ``SEC. 119. RETENTION BONUS.

       ``(a) In General.--The Secretary may pay a retention bonus 
     to any health professional employed by, or assigned to, and 
     serving in, the Service, an Indian tribe, a tribal 
     organization, or an urban Indian organization either as a 
     civilian employee or as a commissioned officer in the Regular 
     or Reserve Corps of the Public Health Service who--
       ``(1) is assigned to, and serving in, a position for which 
     recruitment or retention of personnel is difficult;
       ``(2) the Secretary determines is needed by the Service, 
     tribe, tribal organization, or urban organization;
       ``(3) has--
       ``(A) completed 3 years of employment with the Service; 
     tribe, tribal organization, or urban organization; or
       ``(B) completed any service obligations incurred as a 
     requirement of--

[[Page 5473]]

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

     ``SEC. 120. NURSING RESIDENCY PROGRAM.

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

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

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

     ``SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION.

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

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

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

     ``SEC. 124. SCHOLARSHIPS.

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

     ``SEC. 125. NATIONAL HEALTH SERVICE CORPS.

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

     unless the Secretary, acting through the Service, tribes or 
     tribal organization, has ensured that the Indians receiving 
     services from such member will experience no reduction in 
     services.
       ``(b) Designation of Service Areas as Health Professional 
     Shortage Areas.--All service areas served by programs 
     operated by the Service or by a tribe or tribal organization 
     under the Indian Self-Determination and Education Assistance 
     Act, or by an urban Indian organization, shall be designated 
     under section 332 of the Public Health Service Act (42 U.S.C. 
     254e) as Health Professional Shortage Areas.
       ``(c) Full Time Equivalent.--National Health Service Corps 
     scholars that qualify for the commissioned corps in the 
     Public Health Service shall be exempt from the full time 
     equivalent limitations of the National Health Service Corps 
     and the Service when such scholars serve as commissioned 
     corps officers in a health program operated by an Indian 
     tribe or tribal organization under the Indian Self-
     Determination and Education Assistance Act or by an urban 
     Indian organization.

     ``SEC. 126. SUBSTANCE ABUSE COUNSELOR EDUCATION DEMONSTRATION 
                   PROJECT.

       ``(a) Demonstration Projects.--The Secretary, acting 
     through the Service, may enter into contracts with, or make 
     grants to, accredited tribally controlled community colleges, 
     tribally controlled postsecondary vocational institutions, 
     and eligible accredited and accessible community colleges to 
     establish demonstration projects to develop educational 
     curricula for substance abuse counseling.
       ``(b) Use of Funds.--Funds provided under this section 
     shall be used only for developing and providing educational 
     curricula for substance abuse counseling (including paying 
     salaries for instructors). Such curricula may be provided 
     through satellite campus programs.
       ``(c) Term of Grant.--A contract entered into or a grant 
     provided under this section shall be for a period of 1 year. 
     Such contract or grant may be renewed for an additional 1 
     year period upon the approval of the Secretary.
       ``(d) Review of Applications.--Not later than 180 days 
     after the date of the enactment of this Act, the Secretary, 
     after consultation

[[Page 5474]]

     with Indian tribes and administrators of accredited tribally 
     controlled community colleges, tribally controlled 
     postsecondary vocational institutions, and eligible 
     accredited and accessible community colleges, shall develop 
     and issue criteria for the review and approval of 
     applications for funding (including applications for renewals 
     of funding) under this section. Such criteria shall ensure 
     that demonstration projects established under this section 
     promote the development of the capacity of such entities to 
     educate substance abuse counselors.
       ``(e) Technical Assistance.--The Secretary shall provide 
     such technical and other assistance as may be necessary to 
     enable grant recipients to comply with the provisions of this 
     section.
       ``(f) Report.--The Secretary shall submit to the President, 
     for inclusion in the report required to be submitted under 
     section 801 for fiscal year 1999, a report on the findings 
     and conclusions derived from the demonstration projects 
     conducted under this section.
       ``(g) Definitions.--In this section:
       ``(1) Educational curriculum.--The term `educational 
     curriculum' means 1 or more of the following:
       ``(A) Classroom education.
       ``(B) Clinical work experience.
       ``(C) Continuing education workshops.
       ``(2) Tribally controlled community college.--The term 
     `tribally controlled community college' has the meaning given 
     such term in section 2(a)(4) of the Tribally Controlled 
     Community College Assistance Act of 1978 (25 U.S.C. 
     1801(a)(4)).
       ``(3) Tribally controlled postsecondary vocational 
     institution.--The term `tribally controlled postsecondary 
     vocational institution' has the meaning given such term in 
     section 390(2) of the Tribally Controlled Vocational 
     Institutions Support Act of 1990 (20 U.S.C. 2397h(2)).

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

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

     ``SEC. 128. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2015 to 
     carry out this title.

                      ``TITLE II--HEALTH SERVICES

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

       ``(a) In General.--The Secretary may expend funds, directly 
     or under the authority of the Indian Self-Determination and 
     Education Assistance Act, that are appropriated under the 
     authority of this section, for the purposes of--
       ``(1) eliminating the deficiencies in the health status and 
     resources of all Indian tribes;
       ``(2) eliminating backlogs in the provision of health care 
     services to Indians;
       ``(3) meeting the health needs of Indians in an efficient 
     and equitable manner;
       ``(4) eliminating inequities in funding for both direct 
     care and contract health service programs; and
       ``(5) augmenting the ability of the Service to meet the 
     following health service responsibilities with respect to 
     those Indian tribes with the highest levels of health status 
     and resource deficiencies:
       ``(A) clinical care, including inpatient care, outpatient 
     care (including audiology, clinical eye and vision care), 
     primary care, secondary and tertiary care, and long term 
     care;
       ``(B) preventive health, including mammography and other 
     cancer screening in accordance with section 207;
       ``(C) dental care;
       ``(D) mental health, including community mental health 
     services, inpatient mental health services, dormitory mental 
     health services, therapeutic and residential treatment 
     centers, and training of traditional health care 
     practitioners;
       ``(E) emergency medical services;
       ``(F) treatment and control of, and rehabilitative care 
     related to, alcoholism and drug abuse (including fetal 
     alcohol syndrome) among Indians;
       ``(G) accident prevention programs;
       ``(H) home health care;
       ``(I) community health representatives;
       ``(J) maintenance and repair; and
       ``(K) traditional health care practices.
       ``(b) Use of Funds.--
       ``(1) Limitation.--Any funds appropriated under the 
     authority of this section shall not be used to offset or 
     limit any other appropriations made to the Service under this 
     Act, the Act of November 2, 1921 (25 U.S.C. 13) (commonly 
     known as the `Snyder Act'), or any other provision of law.
       ``(2) Allocation.--
       ``(A) In general.--Funds appropriated under the authority 
     of this section shall be allocated to service units or Indian 
     tribes or tribal organizations. The funds allocated to each 
     tribe, tribal organization, or service unit under this 
     subparagraph shall be used to improve the health status and 
     reduce the resource deficiency of each tribe served by such 
     service unit, tribe or tribal organization. Such allocation 
     shall weigh the amounts appropriated in favor of those 
     service areas where the health status of Indians within the 
     area, as measured by life expectancy based upon the most 
     recent data available, is significantly lower than the 
     average health status for Indians for all service areas, 
     except that amounts allocated to each such area using such a 
     weighted allocation formula shall not be less than the 
     amounts allocated to each such area in the previous fiscal 
     year.
       ``(B) Apportionment.--The apportionment of funds allocated 
     to a service unit, tribe or tribal organization under 
     subparagraph (A) among the health service responsibilities 
     described in subsection (a)(4) shall be determined by the 
     Service in consultation with, and with the active 
     participation of, the affected Indian tribes in accordance 
     with this section and such rules as may be established under 
     title VIII.
       ``(c) Health Status and Resource Deficiency.--In this 
     section:
       ``(1) Definition.--The term `health status and resource 
     deficiency' means the extent to which--
       ``(A) the health status objective set forth in section 3(2) 
     is not being achieved; and
       ``(B) the Indian tribe or tribal organization does not have 
     available to it the health resources it needs, taking into 
     account the actual cost of providing health care services 
     given local geographic, climatic, rural, or other 
     circumstances.
       ``(2) Resources.--The health resources available to an 
     Indian tribe or tribal organization shall include health 
     resources provided by the Service as well as health resources 
     used by the Indian Tribe or tribal organization, including 
     services and financing systems provided by any Federal 
     programs, private insurance, and programs of State or local 
     governments.
       ``(3) Review of determination.--The Secretary shall 
     establish procedures which allow

[[Page 5475]]

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

     ``SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND.

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

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

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

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

[[Page 5476]]

       ``(xx) safe and adequate water;
       ``(xxi) safe housing;
       ``(xxii) safe work environments;
       ``(xxiii) stress control;
       ``(xxiv) substance abuse;
       ``(xxv) sanitary facilities;
       ``(xxvi) tobacco use cessation and reduction;
       ``(xxvii) violence prevention; and
       ``(xxviii) such other activities identified by the Service, 
     an Indian tribe or tribal organization, to promote the 
     achievement of the objective described in section 3(b).
       ``(d) Evaluation.--The Secretary, after obtaining input 
     from affected Indian tribes and tribal organizations, shall 
     submit to the President for inclusion in each statement which 
     is required to be submitted to Congress under section 801 an 
     evaluation of--
       ``(1) the health promotion and disease prevention needs of 
     Indians;
       ``(2) the health promotion and disease prevention 
     activities which would best meet such needs;
       ``(3) the internal capacity of the Service to meet such 
     needs; and
       ``(4) the resources which would be required to enable the 
     Service to undertake the health promotion and disease 
     prevention activities necessary to meet such needs.

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

       ``(a) Determination.--The Secretary, in consultation with 
     Indian tribes and tribal organizations, shall determine--
       ``(1) by tribe, tribal organization, and service unit of 
     the Service, the prevalence of, and the types of 
     complications resulting from, diabetes among Indians; and
       ``(2) based on paragraph (1), the measures (including 
     patient education) each service unit should take to reduce 
     the prevalence of, and prevent, treat, and control the 
     complications resulting from, diabetes among Indian tribes 
     within that service unit.
       ``(b) Screening.--The Secretary shall screen each Indian 
     who receives services from the Service for diabetes and for 
     conditions which indicate a high risk that the individual 
     will become diabetic. Such screening may be done by an Indian 
     tribe or tribal organization operating health care programs 
     or facilities with funds from the Service under the Indian 
     Self-Determination and Education Assistance Act.
       ``(c) Continued Funding.--The Secretary shall continue to 
     fund, through fiscal year 2015, each effective model diabetes 
     project in existence on the date of the enactment of this Act 
     and such other diabetes programs operated by the Secretary or 
     by Indian tribes and tribal organizations and any additional 
     programs added to meet existing diabetes needs. Indian tribes 
     and tribal organizations shall receive recurring funding for 
     the diabetes programs which they operate pursuant to this 
     section. Model diabetes projects shall consult, on a regular 
     basis, with tribes and tribal organizations in their regions 
     regarding diabetes needs and provide technical expertise as 
     needed.
       ``(d) Dialysis Programs.--The Secretary shall provide 
     funding through the Service, Indian tribes and tribal 
     organizations to establish dialysis programs, including funds 
     to purchase dialysis equipment and provide necessary 
     staffing.
       ``(e) Other Activities.--The Secretary shall, to the extent 
     funding is available--
       ``(1) in each area office of the Service, consult with 
     Indian tribes and tribal organizations regarding programs for 
     the prevention, treatment, and control of diabetes;
       ``(2) establish in each area office of the Service a 
     registry of patients with diabetes to track the prevalence of 
     diabetes and the complications from diabetes in that area; 
     and
       ``(3) ensure that data collected in each area office 
     regarding diabetes and related complications among Indians is 
     disseminated to tribes, tribal organizations, and all other 
     area offices.

     ``SEC. 205. SHARED SERVICES.

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

     ``SEC. 206. HEALTH SERVICES RESEARCH.

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

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

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

     ``SEC. 208. PATIENT TRAVEL COSTS.

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

     ``SEC. 209. EPIDEMIOLOGY CENTERS.

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

[[Page 5477]]

       ``(G) provide disease surveillance and assist Indian 
     tribes, tribal organizations, and urban Indian organizations 
     to promote public health.
       ``(3) Technical assistance.--The director of the Centers 
     for Disease Control and Prevention shall provide technical 
     assistance to the centers in carrying out the requirements of 
     this subsection.
       ``(b) Funding.--The Secretary may make funding available to 
     Indian tribes, tribal organizations, and eligible intertribal 
     consortia or urban Indian organizations to conduct 
     epidemiological studies of Indian communities.

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

       ``(a) In General.--The Secretary, acting through the 
     Service, shall provide funding to Indian tribes, tribal 
     organizations, and urban Indian organizations to develop 
     comprehensive school health education programs for children 
     from preschool through grade 12 in schools for the benefit of 
     Indian and urban Indian children.
       ``(b) Use of Funds.--Funds awarded under this section may 
     be used to--
       ``(1) develop and implement health education curricula both 
     for regular school programs and after school programs;
       ``(2) train teachers in comprehensive school health 
     education curricula;
       ``(3) integrate school-based, community-based, and other 
     public and private health promotion efforts;
       ``(4) encourage healthy, tobacco-free school environments;
       ``(5) coordinate school-based health programs with existing 
     services and programs available in the community;
       ``(6) develop school programs on nutrition education, 
     personal health, oral health, and fitness;
       ``(7) develop mental health wellness programs;
       ``(8) develop chronic disease prevention programs;
       ``(9) develop substance abuse prevention programs;
       ``(10) develop injury prevention and safety education 
     programs;
       ``(11) develop activities for the prevention and control of 
     communicable diseases;
       ``(12) develop community and environmental health education 
     programs that include traditional health care practitioners;
       ``(13) carry out violence prevention activities; and
       ``(14) carry out activities relating to such other health 
     issues as are appropriate.
       ``(c) Technical Assistance.--The Secretary shall, upon 
     request, provide technical assistance to Indian tribes, 
     tribal organizations and urban Indian organizations in the 
     development of comprehensive health education plans, and the 
     dissemination of comprehensive health education materials and 
     information on existing health programs and resources.
       ``(d) Criteria.--The Secretary, in consultation with Indian 
     tribes, tribal organizations, and urban Indian organizations 
     shall establish criteria for the review and approval of 
     applications for funding under this section.
       ``(e) Comprehensive School Health Education Program.--
       ``(1) Development.--The Secretary of the Interior, acting 
     through the Bureau of Indian Affairs and in cooperation with 
     the Secretary and affected Indian tribes and tribal 
     organizations, shall develop a comprehensive school health 
     education program for children from preschool through grade 
     12 for use in schools operated by the Bureau of Indian 
     Affairs.
       ``(2) Requirements.--The program developed under paragraph 
     (1) shall include--
       ``(A) school programs on nutrition education, personal 
     health, oral health, and fitness;
       ``(B) mental health wellness programs;
       ``(C) chronic disease prevention programs;
       ``(D) substance abuse prevention programs;
       ``(E) injury prevention and safety education programs; and
       ``(F) activities for the prevention and control of 
     communicable diseases.
       ``(3) Training and coordination.--The Secretary of the 
     Interior shall--
       ``(A) provide training to teachers in comprehensive school 
     health education curricula;
       ``(B) ensure the integration and coordination of school-
     based programs with existing services and health programs 
     available in the community; and
       ``(C) encourage healthy, tobacco-free school environments.

     ``SEC. 211. INDIAN YOUTH PROGRAM.

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

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

       ``(a) In General.--The Secretary, acting through the 
     Service after consultation with Indian tribes, tribal 
     organizations, urban Indian organizations, and the Centers 
     for Disease Control and Prevention, may make funding 
     available to Indian tribes and tribal organizations for--
       ``(1) projects for the prevention, control, and elimination 
     of communicable and infectious diseases, including 
     tuberculosis, hepatitis, HIV, respiratory syncitial virus, 
     hanta virus, sexually transmitted diseases, and H. Pylori, 
     which projects may include screening, testing and treatment 
     for HCV and other infectious and communicable diseases;
       ``(2) public information and education programs for the 
     prevention, control, and elimination of communicable and 
     infectious diseases;
       ``(3) education, training, and clinical skills improvement 
     activities in the prevention, control, and elimination of 
     communicable and infectious diseases for health 
     professionals, including allied health professionals; and
       ``(4) a demonstration project that studies the 
     seroprevalence of the Hepatitis C virus among a random sample 
     of American Indian and Alaskan Native populations and 
     identifies prevalence rates among a variety of tribes and 
     geographic regions.
       ``(b) Requirement of Application.--The Secretary may 
     provide funds under subsection (a) only if an application or 
     proposal for such funds is submitted.
       ``(c) Technical Assistance and Report.--In carrying out 
     this section, the Secretary--
       ``(1) may, at the request of an Indian tribe or tribal 
     organization, provide technical assistance; and
       ``(2) shall prepare and submit, biennially, a report to 
     Congress on the use of funds under this section and on the 
     progress made toward the prevention, control, and elimination 
     of communicable and infectious diseases among Indians and 
     urban Indians.

     ``SEC. 213. AUTHORITY FOR PROVISION OF OTHER SERVICES.

       ``(a) In General.--The Secretary, acting through the 
     Service, Indian tribes, and tribal organizations, may provide 
     funding under this Act to meet the objective set forth in 
     section 3 through health care related services and programs 
     not otherwise described in this Act. Such services and 
     programs shall include services and programs related to--
       ``(1) hospice care and assisted living;
       ``(2) long-term health care;
       ``(3) home- and community-based services;
       ``(4) public health functions; and
       ``(5) traditional health care practices.
       ``(b) Availability of Services for Certain Individuals.--At 
     the discretion of the Service, Indian tribe, or tribal 
     organization, services hospice care, home health care (under 
     section 201), home- and community-based care, assisted 
     living, and long term care may be provided (on a cost basis) 
     to individuals otherwise ineligible for the health care 
     benefits of the Service. Any funds received under this 
     subsection shall not be used to offset or limit the funding 
     allocated to a tribe or tribal organization.
       ``(c) Definitions.--In this section:
       ``(1) Home- and community-based services.--The term `home- 
     and community-based services' means 1 or more of the 
     following:
       ``(A) Homemaker/home health aide services.
       ``(B) Chore services.
       ``(C) Personal care services.
       ``(D) Nursing care services provided outside of a nursing 
     facility by, or under the supervision of, a registered nurse.
       ``(E) Training for family members.
       ``(F) Adult day care.
       ``(G) Such other home- and community-based services as the 
     Secretary or a tribe or tribal organization may approve.
       ``(2) Hospice care.--The term `hospice care' means the 
     items and services specified in subparagraphs (A) through (H) 
     of section 1861(dd)(1) of the Social Security Act (42 U.S.C. 
     1395x(dd)(1)), and such other services which an Indian tribe 
     or tribal organization determines are necessary and 
     appropriate to provide in furtherance of such care.
       ``(3) Public health functions.--The term `public health 
     functions' means public health related programs, functions, 
     and services including assessments, assurances, and policy 
     development that Indian tribes and tribal organizations are 
     authorized and encouraged,

[[Page 5478]]

     in those circumstances where it meets their needs, to carry 
     out by forming collaborative relationships with all levels of 
     local, State, and Federal governments.

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

       ``The Secretary acting through the Service, Indian tribes, 
     tribal organizations, and urban Indian organizations shall 
     provide funding to monitor and improve the quality of health 
     care for Indian women of all ages through the planning and 
     delivery of programs administered by the Service, in order to 
     improve and enhance the treatment models of care for Indian 
     women.

     ``SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH HAZARDS.

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

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

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

       ``(a) In General.--For fiscal years beginning with the 
     fiscal year ending September 30, 1983, and ending with the 
     fiscal year ending September 30, 2015, the State of Arizona 
     shall be designated as a contract health service delivery 
     area by the Service for the purpose of providing contract 
     health care services to members of federally recognized 
     Indian Tribes of Arizona.
       ``(b) Limitation.--The Service shall not curtail any health 
     care services provided to Indians residing on Federal 
     reservations in the State of Arizona if such curtailment is 
     due to the provision of contract services in such State 
     pursuant to the designation of such State as a contract 
     health service delivery area pursuant to subsection (a).

     ``SEC. 216A. NORTH DAKOTA AS A CONTRACT HEALTH SERVICE 
                   DELIVERY AREA.

       ``(a) In General.--For fiscal years beginning with the 
     fiscal year ending September 30, 2003, and ending with the 
     fiscal year ending September 30, 2015, the State of North 
     Dakota shall be designated as a contract health service 
     delivery area by the Service for the purpose of providing 
     contract health care services to members of federally 
     recognized Indian Tribes of North Dakota.
       ``(b) Limitation.--The Service shall not curtail any health 
     care services provided to Indians residing on Federal 
     reservations in the State of North Dakota if such curtailment 
     is due to the provision of contract services in such State 
     pursuant to the designation of such State as a contract 
     health service delivery area pursuant to subsection (a).

     ``SEC. 216B. SOUTH DAKOTA AS A CONTRACT HEALTH SERVICE 
                   DELIVERY AREA.

       ``(a) In General.--For fiscal years beginning with the 
     fiscal year ending September 30, 2003, and ending with the 
     fiscal year ending September 30, 2015, the State of South 
     Dakota shall be designated as a contract health service 
     delivery area by the Service for the purpose of providing 
     contract health care services to members of federally 
     recognized Indian Tribes of South Dakota.
       ``(b) Limitation.--The Service shall not curtail any health 
     care services provided to Indians residing on Federal 
     reservations in the State of South Dakota if such curtailment 
     is due to the provision of contract services in such State 
     pursuant to the designation of such State as a contract 
     health service delivery area pursuant to subsection (a).

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

       ``(a) In General.--The Secretary may fund a program that 
     utilizes the California Rural Indian Health Board as a 
     contract care intermediary to improve the accessibility of 
     health services to California Indians.
       ``(b) Reimbursement of Board.--
       ``(1) Agreement.--The Secretary shall enter into an 
     agreement with the California Rural Indian Health Board to 
     reimburse the Board for costs (including reasonable 
     administrative costs) incurred pursuant to this section in 
     providing medical treatment under contract to California 
     Indians described in section 809(b) throughout the California 
     contract health services delivery area described in section 
     218 with respect to high-cost contract care cases.
       ``(2) Administration.--Not more than 5 percent of the 
     amounts provided to the Board under this section for any 
     fiscal year may be used for reimbursement for administrative 
     expenses incurred by the Board during such fiscal year.
       ``(3) Limitation.--No payment may be made for treatment 
     provided under this section to the extent that payment may be

[[Page 5479]]

     made for such treatment under the Catastrophic Health 
     Emergency Fund described in section 202 or from amounts 
     appropriated or otherwise made available to the California 
     contract health service delivery area for a fiscal year.
       ``(c) Advisory Board.--There is hereby established an 
     advisory board that shall advise the California Rural Indian 
     Health Board in carrying out this section. The advisory board 
     shall be composed of representatives, selected by the 
     California Rural Indian Health Board, from not less than 8 
     tribal health programs serving California Indians covered 
     under this section, at least 50 percent of whom are not 
     affiliated with the California Rural Indian Health Board.

     ``SEC. 218. CALIFORNIA AS A CONTRACT HEALTH SERVICE DELIVERY 
                   AREA.

       ``The State of California, excluding the counties of 
     Alameda, Contra Costa, Los Angeles, Marin, Orange, 
     Sacramento, San Francisco, San Mateo, Santa Clara, Kern, 
     Merced, Monterey, Napa, San Benito, San Joaquin, San Luis 
     Obispo, Santa Cruz, Solano, Stanislaus, and Ventura shall be 
     designated as a contract health service delivery area by the 
     Service for the purpose of providing contract health services 
     to Indians in such State, except that any of the counties 
     described in this section may be included in the contract 
     health services delivery area if funding is specifically 
     provided by the Service for such services in those counties.

     ``SEC. 219. CONTRACT HEALTH SERVICES FOR THE TRENTON SERVICE 
                   AREA.

       ``(a) In General.--The Secretary, acting through the 
     Service, shall provide contract health services to members of 
     the Turtle Mountain Band of Chippewa Indians that reside in 
     the Trenton Service Area of Divide, McKenzie, and Williams 
     counties in the State of North Dakota and the adjoining 
     counties of Richland, Roosevelt, and Sheridan in the State of 
     Montana.
       ``(b) Rule of Construction.--Nothing in this section shall 
     be construed as expanding the eligibility of members of the 
     Turtle Mountain Band of Chippewa Indians for health services 
     provided by the Service beyond the scope of eligibility for 
     such health services that applied on May 1, 1986.

     ``SEC. 220. PROGRAMS OPERATED BY INDIAN TRIBES AND TRIBAL 
                   ORGANIZATIONS.

       ``The Service shall provide funds for health care programs 
     and facilities operated by Indian tribes and tribal 
     organizations under funding agreements with the Service 
     entered into under the Indian Self-Determination and 
     Education Assistance Act on the same basis as such funds are 
     provided to programs and facilities operated directly by the 
     Service.

     ``SEC. 221. LICENSING.

       ``Health care professionals employed by Indian Tribes and 
     tribal organizations to carry out agreements under the Indian 
     Self-Determination and Education Assistance Act, shall, if 
     licensed in any State, be exempt from the licensing 
     requirements of the State in which the agreement is 
     performed.

     ``SEC. 222. AUTHORIZATION FOR EMERGENCY CONTRACT HEALTH 
                   SERVICES.

       ``With respect to an elderly Indian or an Indian with a 
     disability receiving emergency medical care or services from 
     a non-Service provider or in a non-Service facility under the 
     authority of this Act, the time limitation (as a condition of 
     payment) for notifying the Service of such treatment or 
     admission shall be 30 days.

     ``SEC. 223. PROMPT ACTION ON PAYMENT OF CLAIMS.

       ``(a) Requirement.--The Service shall respond to a 
     notification of a claim by a provider of a contract care 
     service with either an individual purchase order or a denial 
     of the claim within 5 working days after the receipt of such 
     notification.
       ``(b) Failure To Respond.--If the Service fails to respond 
     to a notification of a claim in accordance with subsection 
     (a), the Service shall accept as valid the claim submitted by 
     the provider of a contract care service.
       ``(c) Payment.--The Service shall pay a valid contract care 
     service claim within 30 days after the completion of the 
     claim.

     ``SEC. 224. LIABILITY FOR PAYMENT.

       ``(a) No Liability.--A patient who receives contract health 
     care services that are authorized by the Service shall not be 
     liable for the payment of any charges or costs associated 
     with the provision of such services.
       ``(b) Notification.--The Secretary shall notify a contract 
     care provider and any patient who receives contract health 
     care services authorized by the Service that such patient is 
     not liable for the payment of any charges or costs associated 
     with the provision of such services.
       ``(c) Limitation.--Following receipt of the notice provided 
     under subsection (b), or, if a claim has been deemed accepted 
     under section 223(b), the provider shall have no further 
     recourse against the patient who received the services 
     involved.

     ``SEC. 225. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2015 to 
     carry out this title.

                        ``TITLE III--FACILITIES

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

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

     except that the priority of any project established under the 
     construction priority system in effect on the date of this 
     Act shall not be affected by any change in the construction 
     priority system taking place thereafter if the project was 
     identified as one of the top 10 priority inpatient projects 
     or one of the top 10 outpatient projects in the Indian Health 
     Service budget justification for fiscal year 2003, or if the 
     project had completed both Phase I and Phase II of the 
     construction priority system in effect on the date of this 
     Act.
       ``(2) Report.--The Secretary shall submit to the President, 
     for inclusion in each report required to be transmitted to 
     the Congress under section 801, a report that includes--
       ``(A) a description of the health care facility priority 
     system of the Service, as established under paragraph (1);
       ``(B) health care facility lists, including--
       ``(i) the total health care facility planning, design, 
     construction and renovation needs for Indians;
       ``(ii) the 10 top-priority inpatient care facilities;
       ``(iii) the 10 top-priority outpatient care facilities;
       ``(iv) the 10 top-priority specialized care facilities 
     (such as long-term care and alcohol and drug abuse 
     treatment); and
       ``(v) any staff quarters associated with such prioritized 
     facilities;
       ``(C) the justification for the order of priority among 
     facilities;
       ``(D) the projected cost of the projects involved; and
       ``(E) the methodology adopted by the Service in 
     establishing priorities under its health care facility 
     priority system.
       ``(3) Consultation.--In preparing each report required 
     under paragraph (2) (other than the initial report) the 
     Secretary shall annually--
       ``(A) consult with, and obtain information on all health 
     care facilities needs from, Indian tribes and tribal 
     organizations including those tribes or tribal organizations 
     operating health programs or facilities under any funding 
     agreement entered into with the Service under the Indian 
     Self-Determination and Education Assistance Act; and
       ``(B) review the total unmet needs of all tribes and tribal 
     organizations for health

[[Page 5480]]

     care facilities (including staff quarters), including needs 
     for renovation and expansion of existing facilities.
       ``(4) Criteria.--For purposes of this subsection, the 
     Secretary shall, in evaluating the needs of facilities 
     operated under any funding agreement entered into with the 
     Service under the Indian Self-Determination and Education 
     Assistance Act, use the same criteria that the Secretary uses 
     in evaluating the needs of facilities operated directly by 
     the Service.
       ``(5) Equitable integration.--The Secretary shall ensure 
     that the planning, design, construction, and renovation needs 
     of Service and non-Service facilities, operated under funding 
     agreements in accordance with the Indian Self-Determination 
     and Education Assistance Act are fully and equitably 
     integrated into the health care facility priority system.
       ``(d) Review of Need for Facilities.--
       ``(1) Report.--Beginning in 2004, the Secretary shall 
     annually submit to the President, for inclusion in the report 
     required to be transmitted to Congress under section 801 of 
     this Act, a report which sets forth the needs of the Service 
     and all Indian tribes and tribal organizations, including 
     urban Indian organizations, for inpatient, outpatient and 
     specialized care facilities, including the needs for 
     renovation and expansion of existing facilities.
       ``(2) Consultation.--In preparing each report required 
     under paragraph (1) (other than the initial report), the 
     Secretary shall consult with Indian tribes and tribal 
     organizations including those tribes or tribal organizations 
     operating health programs or facilities under any funding 
     agreement entered into with the Service under the Indian 
     Self-Determination and Education Assistance Act, and with 
     urban Indian organizations.
       ``(3) Criteria.--For purposes of this subsection, the 
     Secretary shall, in evaluating the needs of facilities 
     operated under any funding agreement entered into with the 
     Service under the Indian Self-Determination and Education 
     Assistance Act, use the same criteria that the Secretary uses 
     in evaluating the needs of facilities operated directly by 
     the Service.
       ``(4) Equitable integration.--The Secretary shall ensure 
     that the planning, design, construction, and renovation needs 
     of facilities operated under funding agreements, in 
     accordance with the Indian Self-Determination and Education 
     Assistance Act, are fully and equitably integrated into the 
     development of the health facility priority system.
       ``(5) Annual nominations.--Each year the Secretary shall 
     provide an opportunity for the nomination of planning, 
     design, and construction projects by the Service and all 
     Indian tribes and tribal organizations for consideration 
     under the health care facility priority system.
       ``(e) Inclusion of Certain Programs.--All funds 
     appropriated under the Act of November 2, 1921 (25 U.S.C. 
     13), for the planning, design, construction, or renovation of 
     health facilities for the benefit of an Indian tribe or 
     tribes shall be subject to the provisions of section 102 of 
     the Indian Self-Determination and Education Assistance Act.
       ``(f) Innovative Approaches.--The Secretary shall consult 
     and cooperate with Indian tribes, tribal organizations and 
     urban Indian organizations in developing innovative 
     approaches to address all or part of the total unmet need for 
     construction of health facilities, including those provided 
     for in other sections of this title and other approaches.

     ``SEC. 302. SAFE WATER AND SANITARY WASTE DISPOSAL 
                   FACILITIES.

       ``(a) Findings.--Congress finds and declares that--
       ``(1) the provision of safe water supply facilities and 
     sanitary sewage and solid waste disposal facilities is 
     primarily a health consideration and function;
       ``(2) Indian people suffer an inordinately high incidence 
     of disease, injury, and illness directly attributable to the 
     absence or inadequacy of such facilities;

       ``(3) the long-term cost to the United States of treating 
     and curing such disease, injury, and illness is substantially 
     greater than the short-term cost of providing such facilities 
     and other preventive health measures;
       ``(4) many Indian homes and communities still lack safe 
     water supply facilities and sanitary sewage and solid waste 
     disposal facilities; and
       ``(5) it is in the interest of the United States, and it is 
     the policy of the United States, that all Indian communities 
     and Indian homes, new and existing, be provided with safe and 
     adequate water supply facilities and sanitary sewage waste 
     disposal facilities as soon as possible.
       ``(b) Provision of Facilities and Services.--
       ``(1) In general.--In furtherance of the findings and 
     declarations made in subsection (a), Congress reaffirms the 
     primary responsibility and authority of the Service to 
     provide the necessary sanitation facilities and services as 
     provided in section 7 of the Act of August 5, 1954 (42 U.S.C. 
     2004a).
       ``(2) Assistance.--The Secretary, acting through the 
     Service, is authorized to provide under section 7 of the Act 
     of August 5, 1954 (42 U.S.C. 2004a)--
       ``(A) financial and technical assistance to Indian tribes, 
     tribal organizations and Indian communities in the 
     establishment, training, and equipping of utility 
     organizations to operate and maintain Indian sanitation 
     facilities, including the provision of existing plans, 
     standard details, and specifications available in the 
     Department, to be used at the option of the tribe or tribal 
     organization;
       ``(B) ongoing technical assistance and training in the 
     management of utility organizations which operate and 
     maintain sanitation facilities; and
       ``(C) priority funding for the operation, and maintenance 
     assistance for, and emergency repairs to, tribal sanitation 
     facilities when necessary to avoid an imminent health threat 
     or to protect the investment in sanitation facilities and the 
     investment in the health benefits gained through the 
     provision of sanitation facilities.
       ``(3) Provisions relating to funding.--Notwithstanding any 
     other provision of law--
       ``(A) the Secretary of Housing and Urban Development is 
     authorized to transfer funds appropriated under the Native 
     American Housing Assistance and Self-Determination Act of 
     1996 to the Secretary of Health and Human Services;
       ``(B) the Secretary of Health and Human Services is 
     authorized to accept and use such funds for the purpose of 
     providing sanitation facilities and services for Indians 
     under section 7 of the Act of August 5, 1954 (42 U.S.C. 
     2004a);
       ``(C) unless specifically authorized when funds are 
     appropriated, the Secretary of Health and Human Services 
     shall not use funds appropriated under section 7 of the Act 
     of August 5, 1954 (42 U.S.C. 2004a) to provide sanitation 
     facilities to new homes constructed using funds provided by 
     the Department of Housing and Urban Development;
       ``(D) the Secretary of Health and Human Services is 
     authorized to accept all Federal funds that are available for 
     the purpose of providing sanitation facilities and related 
     services and place those funds into funding agreements, 
     authorized under the Indian Self-Determination and Education 
     Assistance Act, between the Secretary and Indian tribes and 
     tribal organizations;
       ``(E) the Secretary may permit funds appropriated under the 
     authority of section 4 of the Act of August 5, 1954 (42 
     U.S.C. 2004) to be used to fund up to 100 percent of the 
     amount of a tribe's loan obtained under any Federal program 
     for new projects to construct eligible sanitation facilities 
     to serve Indian homes;
       ``(F) the Secretary may permit funds appropriated under the 
     authority of section 4 of the Act of August 5, 1954 (42 
     U.S.C. 2004) to be used to meet matching or cost 
     participation requirements under other Federal and non-
     Federal programs for new projects to construct eligible 
     sanitation facilities;
       ``(G) all Federal agencies are authorized to transfer to 
     the Secretary funds identified, granted, loaned or 
     appropriated and thereafter the Department's applicable 
     policies, rules, regulations shall apply in the 
     implementation of such projects;
       ``(H) the Secretary of Health and Human Services shall 
     enter into inter-agency agreements with the Bureau of Indian 
     Affairs, the Department of Housing and Urban Development, the 
     Department of Agriculture, the Environmental Protection 
     Agency and other appropriate Federal agencies, for the 
     purpose of providing financial assistance for safe water 
     supply and sanitary sewage disposal facilities under this 
     Act; and
       ``(I) the Secretary of Health and Human Services shall, by 
     regulation developed through rulemaking under section 802, 
     establish standards applicable to the planning, design and 
     construction of water supply and sanitary sewage and solid 
     waste disposal facilities funded under this Act.
       ``(c) 10-Year Funding Plan.--The Secretary, acting through 
     the Service and in consultation with Indian tribes and tribal 
     organizations, shall develop and implement a 10-year funding 
     plan to provide safe water supply and sanitary sewage and 
     solid waste disposal facilities serving existing Indian homes 
     and communities, and to new and renovated Indian homes.
       ``(d) Capability of Tribe or Community.--The financial and 
     technical capability of an Indian tribe or community to 
     safely operate and maintain a sanitation facility shall not 
     be a prerequisite to the provision or construction of 
     sanitation facilities by the Secretary.
       ``(e) Financial Assistance.--The Secretary may provide 
     financial assistance to Indian tribes, tribal organizations 
     and communities for the operation, management, and 
     maintenance of their sanitation facilities.
       ``(f) Responsibility for Fees for Operation and 
     Maintenance.--The Indian family, community or tribe involved 
     shall have the primary responsibility to establish, collect, 
     and use reasonable user fees, or otherwise set aside funding, 
     for the purpose of operating and maintaining sanitation 
     facilities. If a community facility is threatened with 
     imminent failure and there is a lack of tribal capacity to 
     maintain the integrity or the health benefit of the facility, 
     the Secretary may assist the Tribe in the resolution of the 
     problem on a short term basis through cooperation with the 
     emergency coordinator or

[[Page 5481]]

     by providing operation and maintenance service.
       ``(g) Eligibility of Certain Tribes or Organizations.--
     Programs administered by Indian tribes or tribal 
     organizations under the authority of the Indian Self-
     Determination and Education Assistance Act shall be eligible 
     for--
       ``(1) any funds appropriated pursuant to this section; and
       ``(2) any funds appropriated for the purpose of providing 
     water supply, sewage disposal, or solid waste facilities;
     on an equal basis with programs that are administered 
     directly by the Service.
       ``(h) Report.--
       ``(1) In general.--The Secretary shall submit to the 
     President, for inclusion in each report required to be 
     transmitted to the Congress under section 801, a report which 
     sets forth--
       ``(A) the current Indian sanitation facility priority 
     system of the Service;
       ``(B) the methodology for determining sanitation 
     deficiencies;
       ``(C) the level of initial and final sanitation deficiency 
     for each type sanitation facility for each project of each 
     Indian tribe or community; and
       ``(D) the amount of funds necessary to reduce the 
     identified sanitation deficiency levels of all Indian tribes 
     and communities to a level I sanitation deficiency as 
     described in paragraph (4)(A).
       ``(2) Consultation.--In preparing each report required 
     under paragraph (1), the Secretary shall consult with Indian 
     tribes and tribal organizations (including those tribes or 
     tribal organizations operating health care programs or 
     facilities under any funding agreements entered into with the 
     Service under the Indian Self-Determination and Education 
     Assistance Act) to determine the sanitation needs of each 
     tribe and in developing the criteria on which the needs will 
     be evaluated through a process of negotiated rulemaking.
       ``(3) Methodology.--The methodology used by the Secretary 
     in determining, preparing cost estimates for and reporting 
     sanitation deficiencies for purposes of paragraph (1) shall 
     be applied uniformly to all Indian tribes and communities.
       ``(4) Sanitation deficiency levels.--For purposes of this 
     subsection, the sanitation deficiency levels for an 
     individual or community sanitation facility serving Indian 
     homes are as follows:
       ``(A) A level I deficiency is a sanitation facility serving 
     and individual or community--
       ``(i) which complies with all applicable water supply, 
     pollution control and solid waste disposal laws; and
       ``(ii) in which the deficiencies relate to routine 
     replacement, repair, or maintenance needs.
       ``(B) A level II deficiency is a sanitation facility 
     serving and individual or community--
       ``(i) which substantially or recently complied with all 
     applicable water supply, pollution control and solid waste 
     laws, in which the deficiencies relate to small or minor 
     capital improvements needed to bring the facility back into 
     compliance;
       ``(ii) in which the deficiencies relate to capital 
     improvements that are necessary to enlarge or improve the 
     facilities in order to meet the current needs for domestic 
     sanitation facilities; or
       ``(iii) in which the deficiencies relate to the lack of 
     equipment or training by an Indian Tribe or community to 
     properly operate and maintain the sanitation facilities.
       ``(C) A level III deficiency is an individual or community 
     facility with water or sewer service in the home, piped 
     services or a haul system with holding tanks and interior 
     plumbing, or where major significant interruptions to water 
     supply or sewage disposal occur frequently, requiring major 
     capital improvements to correct the deficiencies. There is no 
     access to or no approved or permitted solid waste facility 
     available.
       ``(D) A level IV deficiency is an individual or community 
     facility where there are no piped water or sewer facilities 
     in the home or the facility has become inoperable due to 
     major component failure or where only a washeteria or central 
     facility exists.
       ``(E) A level V deficiency is the absence of a sanitation 
     facility, where individual homes do not have access to safe 
     drinking water or adequate wastewater disposal.
       ``(i) Definitions.--In this section:
       ``(1) Facility.--The terms `facility' or `facilities' shall 
     have the same meaning as the terms `system' or `systems' 
     unless the context requires otherwise.
       ``(2) Indian community.--The term `Indian community' means 
     a geographic area, a significant proportion of whose 
     inhabitants are Indians and which is served by or capable of 
     being served by a facility described in this section.

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

       ``(a) In General.--The Secretary, acting through the 
     Service, may utilize the negotiating authority of the Act of 
     June 25, 1910 (25 U.S.C. 47), to give preference to any 
     Indian or any enterprise, partnership, corporation, or other 
     type of business organization owned and controlled by an 
     Indian or Indians including former or currently federally 
     recognized Indian tribes in the State of New York 
     (hereinafter referred to as an `Indian firm') in the 
     construction and renovation of Service facilities pursuant to 
     section 301 and in the construction of safe water and 
     sanitary waste disposal facilities pursuant to section 302. 
     Such preference may be accorded by the Secretary unless the 
     Secretary finds, pursuant to rules and regulations 
     promulgated by the Secretary, that the project or function to 
     be contracted for will not be satisfactory or such project or 
     function cannot be properly completed or maintained under the 
     proposed contract. The Secretary, in arriving at such 
     finding, shall consider whether the Indian or Indian firm 
     will be deficient with respect to--
       ``(1) ownership and control by Indians;
       ``(2) equipment;
       ``(3) bookkeeping and accounting procedures;
       ``(4) substantive knowledge of the project or function to 
     be contracted for;
       ``(5) adequately trained personnel; or
       ``(6) other necessary components of contract performance.
       ``(b) Exemption From Davis-Bacon.--For the purpose of 
     implementing the provisions of this title, construction or 
     renovation of facilities constructed or renovated in whole or 
     in part by funds made available pursuant to this title are 
     exempt from the Act of March 3, 1931 (40 U.S.C. 276a--276a-5, 
     known as the Davis-Bacon Act). For all health facilities, 
     staff quarters and sanitation facilities, construction and 
     renovation subcontractors shall be paid wages at rates that 
     are not less than the prevailing wage rates for similar 
     construction in the locality involved, as determined by the 
     Indian tribe, Tribes, or tribal organizations served by such 
     facilities.

     ``SEC. 304. SOBOBA SANITATION FACILITIES.

       ``Nothing in the Act of December 17, 1970 (84 Stat. 1465) 
     shall be construed to preclude the Soboba Band of Mission 
     Indians and the Soboba Indian Reservation from being provided 
     with sanitation facilities and services under the authority 
     of section 7 of the Act of August 5, 1954 (68 Stat 674), as 
     amended by the Act of July 31, 1959 (73 Stat. 267).

     ``SEC. 305. EXPENDITURE OF NONSERVICE FUNDS FOR RENOVATION.

       ``(a) Permissibility.--
       ``(1) In general.--Notwithstanding any other provision of 
     law, the Secretary is authorized to accept any major 
     expansion, renovation or modernization by any Indian tribe of 
     any Service facility, or of any other Indian health facility 
     operated pursuant to a funding agreement entered into under 
     the Indian Self-Determination and Education Assistance Act, 
     including--
       ``(A) any plans or designs for such expansion, renovation 
     or modernization; and
       ``(B) any expansion, renovation or modernization for which 
     funds appropriated under any Federal law were lawfully 
     expended;
     but only if the requirements of subsection (b) are met.
       ``(2) Priority list.--The Secretary shall maintain a 
     separate priority list to address the need for increased 
     operating expenses, personnel or equipment for such 
     facilities described in paragraph (1). The methodology for 
     establishing priorities shall be developed by negotiated 
     rulemaking under section 802. The list of priority facilities 
     will be revised annually in consultation with Indian tribes 
     and tribal organizations.
       ``(3) Report.--The Secretary shall submit to the President, 
     for inclusion in each report required to be transmitted to 
     the Congress under section 801, the priority list maintained 
     pursuant to paragraph (2).
       ``(b) Requirements.--The requirements of this subsection 
     are met with respect to any expansion, renovation or 
     modernization if--
       ``(1) the tribe or tribal organization--
       ``(A) provides notice to the Secretary of its intent to 
     expand, renovate or modernize; and
       ``(B) applies to the Secretary to be placed on a separate 
     priority list to address the needs of such new facilities for 
     increased operating expenses, personnel or equipment; and
       ``(2) the expansion renovation or modernization--
       ``(A) is approved by the appropriate area director of the 
     Service for Federal facilities; and
       ``(B) is administered by the Indian tribe or tribal 
     organization in accordance with any applicable regulations 
     prescribed by the Secretary with respect to construction or 
     renovation of Service facilities.
       ``(c) Right of Tribe in Case of Failure of Facility To Be 
     Used as a Service Facility.--If any Service facility which 
     has been expanded, renovated or modernized by an Indian tribe 
     under this section ceases to be used as a Service facility 
     during the 20-year period beginning on the date such 
     expansion, renovation or modernization is completed, such 
     Indian tribe shall be entitled to recover from the United 
     States an amount which bears the same ratio to the value of 
     such facility at the time of such cessation as the value of 
     such expansion, renovation or modernization (less the total 
     amount of any funds provided specifically for such facility 
     under any Federal program that were expended for such 
     expansion, renovation or modernization) bore to the value of 
     such facility at the time of the completion of such 
     expansion, renovation or modernization.

[[Page 5482]]



     ``SEC. 306. FUNDING FOR THE CONSTRUCTION, EXPANSION, AND 
                   MODERNIZATION OF SMALL AMBULATORY CARE 
                   FACILITIES.

       ``(a) Availability of Funding.--
       ``(1) In general.--The Secretary, acting through the 
     Service and in consultation with Indian tribes and tribal 
     organization, shall make funding available to tribes and 
     tribal organizations for the construction, expansion, or 
     modernization of facilities for the provision of ambulatory 
     care services to eligible Indians (and noneligible persons as 
     provided for in subsections (b)(2) and (c)(1)(C)). Funding 
     under this section may cover up to 100 percent of the costs 
     of such construction, expansion, or modernization. For the 
     purposes of this section, the term `construction' includes 
     the replacement of an existing facility.
       ``(2) Requirement.--Funding under paragraph (1) may only be 
     made available to an Indian tribe or tribal organization 
     operating an Indian health facility (other than a facility 
     owned or constructed by the Service, including a facility 
     originally owned or constructed by the Service and 
     transferred to an Indian tribe or tribal organization) 
     pursuant to a funding agreement entered into under the Indian 
     Self-Determination and Education Assistance Act.
       ``(b) Use of Funds.--
       ``(1) In general.--Funds provided under this section may be 
     used only for the construction, expansion, or modernization 
     (including the planning and design of such construction, 
     expansion, or modernization) of an ambulatory care facility--
       ``(A) located apart from a hospital;
       ``(B) not funded under section 301 or section 307; and
       ``(C) which, upon completion of such construction, 
     expansion, or modernization will--
       ``(i) have a total capacity appropriate to its projected 
     service population;
       ``(ii) provide annually not less than 500 patient visits by 
     eligible Indians and other users who are eligible for 
     services in such facility in accordance with section 
     807(b)(1)(B); and
       ``(iii) provide ambulatory care in a service area 
     (specified in the funding agreement entered into under the 
     Indian Self-Determination and Education Assistance Act) with 
     a population of not less than 1,500 eligible Indians and 
     other users who are eligible for services in such facility in 
     accordance with section 807(b)(1)(B).
       ``(2) Limitation.--Funding provided under this section may 
     be used only for the cost of that portion of a construction, 
     expansion or modernization project that benefits the service 
     population described in clauses (ii) and (iii) of paragraph 
     (1)(C). The requirements of such clauses (ii) and (iii) shall 
     not apply to a tribe or tribal organization applying for 
     funding under this section whose principal office for health 
     care administration is located on an island or where such 
     office is not located on a road system providing direct 
     access to an inpatient hospital where care is available to 
     the service population.
       ``(c) Application and Priority.--
       ``(1) Application.--No funding may be made available under 
     this section unless an application for such funding has been 
     submitted to and approved by the Secretary. An application or 
     proposal for funding under this section shall be submitted in 
     accordance with applicable regulations and shall set forth 
     reasonable assurance by the applicant that, at all times 
     after the construction, expansion, or modernization of a 
     facility carried out pursuant to funding received under this 
     section--
       ``(A) adequate financial support will be available for the 
     provision of services at such facility;
       ``(B) such facility will be available to eligible Indians 
     without regard to ability to pay or source of payment; and
       ``(C) such facility will, as feasible without diminishing 
     the quality or quantity of services provided to eligible 
     Indians, serve noneligible persons on a cost basis.
       ``(2) Priority.--In awarding funds under this section, the 
     Secretary shall give priority to tribes and tribal 
     organizations that demonstrate--
       ``(A) a need for increased ambulatory care services; and
       ``(B) insufficient capacity to deliver such services.
       ``(d) Failure To Use Facility as Health Facility.--If any 
     facility (or portion thereof) with respect to which funds 
     have been paid under this section, ceases, within 5 years 
     after completion of the construction, expansion, or 
     modernization carried out with such funds, to be utilized for 
     the purposes of providing health care services to eligible 
     Indians, all of the right, title, and interest in and to such 
     facility (or portion thereof) shall transfer to the United 
     States unless otherwise negotiated by the Service and the 
     Indian tribe or tribal organization.
       ``(e) No Inclusion in Tribal Share.--Funding provided to 
     Indian tribes and tribal organizations under this section 
     shall be non-recurring and shall not be available for 
     inclusion in any individual tribe's tribal share for an award 
     under the Indian Self-Determination and Education Assistance 
     Act or for reallocation or redesign thereunder.

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

       ``(a) Health Care Delivery Demonstration Projects.--The 
     Secretary, acting through the Service and in consultation 
     with Indian tribes and tribal organizations, may enter into 
     funding agreements with, or make grants or loan guarantees 
     to, Indian tribes or tribal organizations for the purpose of 
     carrying out a health care delivery demonstration project to 
     test alternative means of delivering health care and services 
     through health facilities, including hospice, traditional 
     Indian health and child care facilities, to Indians.
       ``(b) Use of Funds.--The Secretary, in approving projects 
     pursuant to this section, may authorize funding for the 
     construction and renovation of hospitals, health centers, 
     health stations, and other facilities to deliver health care 
     services and is authorized to--
       ``(1) waive any leasing prohibition;
       ``(2) permit carryover of funds appropriated for the 
     provision of health care services;
       ``(3) permit the use of other available funds;
       ``(4) permit the use of funds or property donated from any 
     source for project purposes;
       ``(5) provide for the reversion of donated real or personal 
     property to the donor; and
       ``(6) permit the use of Service funds to match other funds, 
     including Federal funds.
       ``(c) Criteria.--
       ``(1) In general.--The Secretary shall develop and publish 
     regulations through rulemaking under section 802 for the 
     review and approval of applications submitted under this 
     section. The Secretary may enter into a contract, funding 
     agreement or award a grant under this section for projects 
     which meet the following criteria:
       ``(A) There is a need for a new facility or program or the 
     reorientation of an existing facility or program.
       ``(B) A significant number of Indians, including those with 
     low health status, will be served by the project.
       ``(C) The project has the potential to address the health 
     needs of Indians in an innovative manner.
       ``(D) The project has the potential to deliver services in 
     an efficient and effective manner.
       ``(E) The project is economically viable.
       ``(F) The Indian tribe or tribal organization has the 
     administrative and financial capability to administer the 
     project.
       ``(G) The project is integrated with providers of related 
     health and social services and is coordinated with, and 
     avoids duplication of, existing services.
       ``(2) Peer review panels.--The Secretary may provide for 
     the establishment of peer review panels, as necessary, to 
     review and evaluate applications and to advise the Secretary 
     regarding such applications using the criteria developed 
     pursuant to paragraph (1).
       ``(3) Priority.--The Secretary shall give priority to 
     applications for demonstration projects under this section in 
     each of the following service units to the extent that such 
     applications are filed in a timely manner and otherwise meet 
     the criteria specified in paragraph (1):
       ``(A) Cass Lake, Minnesota.
       ``(B) Clinton, Oklahoma.
       ``(C) Harlem, Montana.
       ``(D) Mescalero, New Mexico.
       ``(E) Owyhee, Nevada.
       ``(F) Parker, Arizona.
       ``(G) Schurz, Nevada.
       ``(H) Winnebago, Nebraska.
       ``(I) Ft. Yuma, California.
       ``(d) Technical Assistance.--The Secretary shall provide 
     such technical and other assistance as may be necessary to 
     enable applicants to comply with the provisions of this 
     section.
       ``(e) Service to Ineligible Persons.--The authority to 
     provide services to persons otherwise ineligible for the 
     health care benefits of the Service and the authority to 
     extend hospital privileges in Service facilities to non-
     Service health care practitioners as provided in section 807 
     may be included, subject to the terms of such section, in any 
     demonstration project approved pursuant to this section.
       ``(f) Equitable Treatment.--For purposes of subsection 
     (c)(1)(A), the Secretary shall, in evaluating facilities 
     operated under any funding agreement entered into with the 
     Service under the Indian Self-Determination and Education 
     Assistance Act, use the same criteria that the Secretary uses 
     in evaluating facilities operated directly by the Service.
       ``(g) Equitable Integration of Facilities.--The Secretary 
     shall ensure that the planning, design, construction, 
     renovation and expansion needs of Service and non-Service 
     facilities which are the subject of a funding agreement for 
     health services entered into with the Service under the 
     Indian Self-Determination and Education Assistance Act, are 
     fully and equitably integrated into the implementation of the 
     health care delivery demonstration projects under this 
     section.

     ``SEC. 308. LAND TRANSFER.

       ``(a) General Authority for Transfers.--Notwithstanding any 
     other provision of law, the Bureau of Indian Affairs and all 
     other agencies and departments of the United States are 
     authorized to transfer, at no cost, land and improvements to 
     the Service for the provision of health care services. The 
     Secretary is authorized to accept such land and improvements 
     for such purposes.

[[Page 5483]]

       ``(b) Chemawa Indian School.--The Bureau of Indian Affairs 
     is authorized to transfer, at no cost, up to 5 acres of land 
     at the Chemawa Indian School, Salem, Oregon, to the Service 
     for the provision of health care services. The land 
     authorized to be transferred by this section is that land 
     adjacent to land under the jurisdiction of the Service and 
     occupied by the Chemawa Indian Health Center.

     ``SEC. 309. LEASES.

       ``(a) In General.--Notwithstanding any other provision of 
     law, the Secretary is authorized, in carrying out the 
     purposes of this Act, to enter into leases with Indian tribes 
     and tribal organizations for periods not in excess of 20 
     years. Property leased by the Secretary from an Indian tribe 
     or tribal organization may be reconstructed or renovated by 
     the Secretary pursuant to an agreement with such Indian tribe 
     or tribal organization.
       ``(b) Facilities for the Administration and Delivery of 
     Health Services.--The Secretary may enter into leases, 
     contracts, and other legal agreements with Indian tribes or 
     tribal organizations which hold--
       ``(1) title to;
       ``(2) a leasehold interest in; or
       ``(3) a beneficial interest in (where title is held by the 
     United States in trust for the benefit of a tribe);
     facilities used for the administration and delivery of health 
     services by the Service or by programs operated by Indian 
     tribes or tribal organizations to compensate such Indian 
     tribes or tribal organizations for costs associated with the 
     use of such facilities for such purposes, and such leases 
     shall be considered as operating leases for the purposes of 
     scoring under the Budget Enforcement Act, notwithstanding any 
     other provision of law. Such costs include rent, depreciation 
     based on the useful life of the building, principal and 
     interest paid or accrued, operation and maintenance expenses, 
     and other expenses determined by regulation to be allowable 
     pursuant to regulations under section 105(l) of the Indian 
     Self-Determination and Education Assistance Act.

     ``SEC. 310. LOANS, LOAN GUARANTEES AND LOAN REPAYMENT.

       ``(a) Health Care Facilities Loan Fund.--There is 
     established in the Treasury of the United States a fund to be 
     known as the `Health Care Facilities Loan Fund' (referred to 
     in this Act as the `HCFLF') to provide to Indian Tribes and 
     tribal organizations direct loans, or guarantees for loans, 
     for the construction of health care facilities (including 
     inpatient facilities, outpatient facilities, associated staff 
     quarters and specialized care facilities such as behavioral 
     health and elder care facilities).
       ``(b) Standards and Procedures.--The Secretary may 
     promulgate regulations, developed through rulemaking as 
     provided for in section 802, to establish standards and 
     procedures for governing loans and loan guarantees under this 
     section, subject to the following conditions:
       ``(1) The principal amount of a loan or loan guarantee may 
     cover up to 100 percent of eligible costs, including costs 
     for the planning, design, financing, site land development, 
     construction, rehabilitation, renovation, conversion, 
     improvements, medical equipment and furnishings, other 
     facility related costs and capital purchase (but excluding 
     staffing).
       ``(2) The cumulative total of the principal of direct loans 
     and loan guarantees, respectively, outstanding at any one 
     time shall not exceed such limitations as may be specified in 
     appropriation Acts.
       ``(3) In the discretion of the Secretary, the program under 
     this section may be administered by the Service or the Health 
     Resources and Services Administration (which shall be 
     specified by regulation).
       ``(4) The Secretary may make or guarantee a loan with a 
     term of the useful estimated life of the facility, or 25 
     years, whichever is less.
       ``(5) The Secretary may allocate up to 100 percent of the 
     funds available for loans or loan guarantees in any year for 
     the purpose of planning and applying for a loan or loan 
     guarantee.
       ``(6) The Secretary may accept an assignment of the revenue 
     of an Indian tribe or tribal organization as security for any 
     direct loan or loan guarantee under this section.
       ``(7) In the planning and design of health facilities under 
     this section, users eligible under section 807(b) may be 
     included in any projection of patient population.
       ``(8) The Secretary shall not collect loan application, 
     processing or other similar fees from Indian tribes or tribal 
     organizations applying for direct loans or loan guarantees 
     under this section.
       ``(9) Service funds authorized under loans or loan 
     guarantees under this section may be used in matching other 
     Federal funds.
       ``(c) Funding.--
       ``(1) In general.--The HCFLF shall consist of--
       ``(A) such sums as may be initially appropriated to the 
     HCFLF and as may be subsequently appropriated under paragraph 
     (2);
       ``(B) such amounts as may be collected from borrowers; and
       ``(C) all interest earned on amounts in the HCFLF.
       ``(2) Authorization of appropriations.--There is authorized 
     to be appropriated such sums as may be necessary to initiate 
     the HCFLF. For each fiscal year after the initial year in 
     which funds are appropriated to the HCFLF, there is 
     authorized to be appropriated an amount equal to the sum of 
     the amount collected by the HCFLF during the preceding fiscal 
     year, and all accrued interest on such amounts.
       ``(3) Availability of funds.--Amounts appropriated, 
     collected or earned relative to the HCFLF shall remain 
     available until expended.
       ``(d) Funding Agreements.--Amounts in the HCFLF and 
     available pursuant to appropriation Acts may be expended by 
     the Secretary, acting through the Service, to make loans 
     under this section to an Indian tribe or tribal organization 
     pursuant to a funding agreement entered into under the Indian 
     Self-Determination and Education Assistance Act.
       ``(e) Investments.--The Secretary of the Treasury shall 
     invest such amounts of the HCFLF as such Secretary determines 
     are not required to meet current withdrawals from the HCFLF. 
     Such investments may be made only in interest-bearing 
     obligations of the United States. For such purpose, such 
     obligations may be acquired on original issue at the issue 
     price, or by purchase of outstanding obligations at the 
     market price. Any obligation acquired by the fund may be sold 
     by the Secretary of the Treasury at the market price.
       ``(f) Grants.--The Secretary is authorized to establish a 
     program to provide grants to Indian tribes and tribal 
     organizations for the purpose of repaying all or part of any 
     loan obtained by an Indian tribe or tribal organization for 
     construction and renovation of health care facilities 
     (including inpatient facilities, outpatient facilities, 
     associated staff quarters and specialized care facilities). 
     Loans eligible for such repayment grants shall include loans 
     that have been obtained under this section or otherwise.

     ``SEC. 311. TRIBAL LEASING.

       ``Indian Tribes and tribal organizations providing health 
     care services pursuant to a funding agreement contract 
     entered into under the Indian Self-Determination and 
     Education Assistance Act may lease permanent structures for 
     the purpose of providing such health care services without 
     obtaining advance approval in appropriation Acts.

     ``SEC. 312. INDIAN HEALTH SERVICE/TRIBAL FACILITIES JOINT 
                   VENTURE PROGRAM.

       ``(a) Authority.--
       ``(1) In general.--The Secretary, acting through the 
     Service, shall make arrangements with Indian tribes and 
     tribal organizations to establish joint venture demonstration 
     projects under which an Indian tribe or tribal organization 
     shall expend tribal, private, or other available funds, for 
     the acquisition or construction of a health facility for a 
     minimum of 10 years, under a no-cost lease, in exchange for 
     agreement by the Service to provide the equipment, supplies, 
     and staffing for the operation and maintenance of such a 
     health facility.
       ``(2) Use of resources.--A tribe or tribal organization may 
     utilize tribal funds, private sector, or other available 
     resources, including loan guarantees, to fulfill its 
     commitment under this subsection.
       ``(3) Eligibility of certain entities.--A tribe that has 
     begun and substantially completed the process of acquisition 
     or construction of a health facility shall be eligible to 
     establish a joint venture project with the Service using such 
     health facility.
       ``(b) Requirements.--
       ``(1) In general.--The Secretary shall enter into an 
     arrangement under subsection (a)(1) with an Indian tribe or 
     tribal organization only if--
       ``(A) the Secretary first determines that the Indian tribe 
     or tribal organization has the administrative and financial 
     capabilities necessary to complete the timely acquisition or 
     construction of the health facility described in subsection 
     (a)(1); and
       ``(B) the Indian tribe or tribal organization meets the 
     needs criteria that shall be developed through the negotiated 
     rulemaking process provided for under section 802.
       ``(2) Continued operation of facility.--The Secretary shall 
     negotiate an agreement with the Indian tribe or tribal 
     organization regarding the continued operation of a facility 
     under this section at the end of the initial 10 year no-cost 
     lease period.
       ``(3) Breach or termination of agreement.--An Indian tribe 
     or tribal organization that has entered into a written 
     agreement with the Secretary under this section, and that 
     breaches or terminates without cause such agreement, shall be 
     liable to the United States for the amount that has been paid 
     to the tribe or tribal organization, or paid to a third party 
     on the tribe's or tribal organization's behalf, under the 
     agreement. The Secretary has the right to recover tangible 
     property (including supplies), and equipment, less 
     depreciation, and any funds expended for operations and 
     maintenance under this section. The preceding sentence shall 
     not apply to any funds expended for the delivery of health 
     care services, or for personnel or staffing.
       ``(d) Recovery for Non-Use.--An Indian tribe or tribal 
     organization that has entered into a written agreement with 
     the Secretary under this section shall be entitled to recover 
     from the United States an amount

[[Page 5484]]

     that is proportional to the value of such facility should at 
     any time within 10 years the Service ceases to use the 
     facility or otherwise breaches the agreement.
       ``(e) Definition.--In this section, the terms `health 
     facility' or `health facilities' include staff quarters 
     needed to provide housing for the staff of the tribal health 
     program.

     ``SEC. 313. LOCATION OF FACILITIES.

       ``(a) Priority.--The Bureau of Indian Affairs and the 
     Service shall, in all matters involving the reorganization or 
     development of Service facilities, or in the establishment of 
     related employment projects to address unemployment 
     conditions in economically depressed areas, give priority to 
     locating such facilities and projects on Indian lands if 
     requested by the Indian owner and the Indian tribe with 
     jurisdiction over such lands or other lands owned or leased 
     by the Indian tribe or tribal organization so long as 
     priority is given to Indian land owned by an Indian tribe or 
     tribes.
       ``(b) Definition.--In this section, the term `Indian lands' 
     means--
       ``(1) all lands within the exterior boundaries of any 
     Indian reservation;
       ``(2) any lands title to which is held in trust by the 
     United States for the benefit of any Indian tribe or 
     individual Indian, or held by any Indian tribe or individual 
     Indian subject to restriction by the United States against 
     alienation and over which an Indian tribe exercises 
     governmental power; and
       ``(3) all lands in Alaska owned by any Alaska Native 
     village, or any village or regional corporation under the 
     Alaska Native Claims Settlement Act, or any land allotted to 
     any Alaska Native.

     ``SEC. 314. MAINTENANCE AND IMPROVEMENT OF HEALTH CARE 
                   FACILITIES.

       ``(a) Report.--The Secretary shall submit to the President, 
     for inclusion in the report required to be transmitted to 
     Congress under section 801, a report that identifies the 
     backlog of maintenance and repair work required at both 
     Service and tribal facilities, including new facilities 
     expected to be in operation in the fiscal year after the year 
     for which the report is being prepared. The report shall 
     identify the need for renovation and expansion of existing 
     facilities to support the growth of health care programs.
       ``(b) Maintenance of Newly Constructed Space.--
       ``(1) In general.--The Secretary may expend maintenance and 
     improvement funds to support the maintenance of newly 
     constructed space only if such space falls within the 
     approved supportable space allocation for the Indian tribe or 
     tribal organization.
       ``(2) Definition.--For purposes of paragraph (1), the term 
     `supportable space allocation' shall be defined through the 
     negotiated rulemaking process provided for under section 802.
       ``(c) Construction of Replacement Facilities.--
       ``(1) In general.--In addition to using maintenance and 
     improvement funds for the maintenance of facilities under 
     subsection (b)(1), an Indian tribe or tribal organization may 
     use such funds for the construction of a replacement facility 
     if the costs of the renovation of such facility would exceed 
     a maximum renovation cost threshold.
       ``(2) Definition.--For purposes of paragraph (1), the term 
     `maximum renovation cost threshold' shall be defined through 
     the negotiated rulemaking process provided for under section 
     802.

     ``SEC. 315. TRIBAL MANAGEMENT OF FEDERALLY-OWNED QUARTERS.

       ``(a) Establishment of Rental Rates.--
       ``(1) In general.--Notwithstanding any other provision of 
     law, an Indian tribe or tribal organization which operates a 
     hospital or other health facility and the Federally-owned 
     quarters associated therewith, pursuant to a funding 
     agreement under the Indian Self-Determination and Education 
     Assistance Act, may establish the rental rates charged to the 
     occupants of such quarters by providing notice to the 
     Secretary of its election to exercise such authority.
       ``(2) Objectives.--In establishing rental rates under 
     paragraph (1), an Indian tribe or tribal organization shall 
     attempt to achieve the following objectives:
       ``(A) The rental rates should be based on the reasonable 
     value of the quarters to the occupants thereof.
       ``(B) The rental rates should generate sufficient funds to 
     prudently provide for the operation and maintenance of the 
     quarters, and, subject to the discretion of the Indian tribe 
     or tribal organization, to supply reserve funds for capital 
     repairs and replacement of the quarters.
       ``(3) Eligibility for quarters improvement and repair.--Any 
     quarters whose rental rates are established by an Indian 
     tribe or tribal organization under this subsection shall 
     continue to be eligible for quarters improvement and repair 
     funds to the same extent as other Federally-owned quarters 
     that are used to house personnel in Service-supported 
     programs.
       ``(4) Notice of change in rates.--An Indian tribe or tribal 
     organization that exercises the authority provided under this 
     subsection shall provide occupants with not less than 60 days 
     notice of any change in rental rates.
       ``(b) Collection of Rents.--
       ``(1) In general.--Notwithstanding any other provision of 
     law, and subject to paragraph (2), an Indian tribe or a 
     tribal organization that operates Federally-owned quarters 
     pursuant to a funding agreement under the Indian Self-
     Determination and Education Assistance Act shall have the 
     authority to collect rents directly from Federal employees 
     who occupy such quarters in accordance with the following:
       ``(A) The Indian tribe or tribal organization shall notify 
     the Secretary and the Federal employees involved of its 
     election to exercise its authority to collect rents directly 
     from such Federal employees.
       ``(B) Upon the receipt of a notice described in 
     subparagraph (A), the Federal employees involved shall pay 
     rents for the occupancy of such quarters directly to the 
     Indian tribe or tribal organization and the Secretary shall 
     have no further authority to collect rents from such 
     employees through payroll deduction or otherwise.
       ``(C) Such rent payments shall be retained by the Indian 
     tribe or tribal organization and shall not be made payable to 
     or otherwise be deposited with the United States.
       ``(D) Such rent payments shall be deposited into a separate 
     account which shall be used by the Indian tribe or tribal 
     organization for the maintenance (including capital repairs 
     and replacement expenses) and operation of the quarters and 
     facilities as the Indian tribe or tribal organization shall 
     determine appropriate.
       ``(2) Retrocession.--If an Indian tribe or tribal 
     organization which has made an election under paragraph (1) 
     requests retrocession of its authority to directly collect 
     rents from Federal employees occupying Federally-owned 
     quarters, such retrocession shall become effective on the 
     earlier of--
       ``(A) the first day of the month that begins not less than 
     180 days after the Indian tribe or tribal organization 
     notifies the Secretary of its desire to retrocede; or
       ``(B) such other date as may be mutually agreed upon by the 
     Secretary and the Indian tribe or tribal organization.
       ``(c) Rates.--To the extent that an Indian tribe or tribal 
     organization, pursuant to authority granted in subsection 
     (a), establishes rental rates for Federally-owned quarters 
     provided to a Federal employee in Alaska, such rents may be 
     based on the cost of comparable private rental housing in the 
     nearest established community with a year-round population of 
     1,500 or more individuals.

     ``SEC. 316. APPLICABILITY OF BUY AMERICAN REQUIREMENT.

       ``(a) In General.--The Secretary shall ensure that the 
     requirements of the Buy American Act apply to all 
     procurements made with funds provided pursuant to the 
     authorization contained in section 318, except that Indian 
     tribes and tribal organizations shall be exempt from such 
     requirements.
       ``(b) False or Misleading Labeling.--If it has been finally 
     determined by a court or Federal agency that any person 
     intentionally affixed a label bearing a `Made in America' 
     inscription, or any inscription with the same meaning, to any 
     product sold in or shipped to the United States that is not 
     made in the United States, such person shall be ineligible to 
     receive any contract or subcontract made with funds provided 
     pursuant to the authorization contained in section 318, 
     pursuant to the debarment, suspension, and ineligibility 
     procedures described in sections 9.400 through 9.409 of title 
     48, Code of Federal Regulations.
       (c) Definition.--In this section, the term `Buy American 
     Act' means title III of the Act entitled `An Act making 
     appropriations for the Treasury and Post Office Departments 
     for the fiscal year ending June 30, 1934, and for other 
     purposes', approved March 3, 1933 (41 U.S.C. 10a et seq.).

     ``SEC. 317. OTHER FUNDING FOR FACILITIES.

       ``Notwithstanding any other provision of law--
       ``(1) the Secretary may accept from any source, including 
     Federal and State agencies, funds that are available for the 
     construction of health care facilities and use such funds to 
     plan, design and construct health care facilities for Indians 
     and to place such funds into funding agreements authorized 
     under the Indian Self-Determination and Education Assistance 
     Act (25 U.S.C. 450f et seq.) between the Secretary and an 
     Indian tribe or tribal organization, except that the receipt 
     of such funds shall not have an effect on the priorities 
     established pursuant to section 301;
       ``(2) the Secretary may enter into interagency agreements 
     with other Federal or State agencies and other entities and 
     to accept funds from such Federal or State agencies or other 
     entities to provide for the planning, design and construction 
     of health care facilities to be administered by the Service 
     or by Indian tribes or tribal organizations under the Indian 
     Self-Determination and Education Assistance Act in order to 
     carry out the purposes of this Act, together with the 
     purposes for which such funds are appropriated to such other 
     Federal or State agency or for which the funds were otherwise 
     provided;
       ``(3) any Federal agency to which funds for the 
     construction of health care facilities are appropriated is 
     authorized to transfer such funds to the Secretary for the 
     construction of health care facilities to carry out the 
     purposes of this Act as well as the purposes for which such 
     funds are appropriated to such other Federal agency; and

[[Page 5485]]

       ``(4) the Secretary, acting through the Service, shall 
     establish standards under regulations developed through 
     rulemaking under section 802, for the planning, design and 
     construction of health care facilities serving Indians under 
     this Act.

     ``SEC. 318. AUTHORIZATION OF APPROPRIATIONS.

       ``There is authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2015 to 
     carry out this title.

                 ``TITLE IV--ACCESS TO HEALTH SERVICES

     ``SEC. 401. TREATMENT OF PAYMENTS UNDER MEDICARE PROGRAM.

       ``(a) In General.--Any payments received by the Service, by 
     an Indian tribe or tribal organization pursuant to a funding 
     agreement under the Indian Self-Determination and Education 
     Assistance Act, or by an urban Indian organization pursuant 
     to title V of this Act for services provided to Indians 
     eligible for benefits under title XVIII of the Social 
     Security Act shall not be considered in determining 
     appropriations for health care and services to Indians.
       ``(b) Equal Treatment.--Nothing in this Act authorizes the 
     Secretary to provide services to an Indian beneficiary with 
     coverage under title XVIII of the Social Security Act in 
     preference to an Indian beneficiary without such coverage.
       ``(c) Special Fund.--
       ``(1) Use of funds.--Notwithstanding any other provision of 
     this title or of title XVIII of the Social Security Act, 
     payments to which any facility of the Service is entitled by 
     reason of this section shall be placed in a special fund to 
     be held by the Secretary and first used (to such extent or in 
     such amounts as are provided in appropriation Acts) for the 
     purpose of making any improvements in the programs of the 
     Service which may be necessary to achieve or maintain 
     compliance with the applicable conditions and requirements of 
     this title and of title XVIII of the Social Security Act. Any 
     funds to be reimbursed which are in excess of the amount 
     necessary to achieve or maintain such conditions and 
     requirements shall, subject to the consultation with tribes 
     being served by the service unit, be used for reducing the 
     health resource deficiencies of the Indian tribes.
       ``(2) Nonapplication in case of election for direct 
     billing.--Paragraph (1) shall not apply upon the election of 
     an Indian tribe or tribal organization under section 405 to 
     receive direct payments for services provided to Indians 
     eligible for benefits under title XVIII of the Social 
     Security Act.

     ``SEC. 402. TREATMENT OF PAYMENTS UNDER MEDICAID PROGRAM.

       ``(a) Special Fund.--
       ``(1) Use of funds.--Notwithstanding any other provision of 
     law, payments to which any facility of the Service (including 
     a hospital, nursing facility, intermediate care facility for 
     the mentally retarded, or any other type of facility which 
     provides services for which payment is available under title 
     XIX of the Social Security Act) is entitled under a State 
     plan by reason of section 1911 of such Act shall be placed in 
     a special fund to be held by the Secretary and first used (to 
     such extent or in such amounts as are provided in 
     appropriation Acts) for the purpose of making any 
     improvements in the facilities of such Service which may be 
     necessary to achieve or maintain compliance with the 
     applicable conditions and requirements of such title. Any 
     payments which are in excess of the amount necessary to 
     achieve or maintain such conditions and requirements shall, 
     subject to the consultation with tribes being served by the 
     service unit, be used for reducing the health resource 
     deficiencies of the Indian tribes. In making payments from 
     such fund, the Secretary shall ensure that each service unit 
     of the Service receives 100 percent of the amounts to which 
     the facilities of the Service, for which such service unit 
     makes collections, are entitled by reason of section 1911 of 
     the Social Security Act.
       ``(2) Nonapplication in case of election for direct 
     billing.--Paragraph (1) shall not apply upon the election of 
     an Indian tribe or tribal organization under section 405 to 
     receive direct payments for services provided to Indians 
     eligible for medical assistance under title XIX of the Social 
     Security Act.
       ``(b) Payments Disregarded for Appropriations.--Any 
     payments received under section 1911 of the Social Security 
     Act for services provided to Indians eligible for benefits 
     under title XIX of the Social Security Act shall not be 
     considered in determining appropriations for the provision of 
     health care and services to Indians.
       ``(c) Direct Billing.--For provisions relating to the 
     authority of certain Indian tribes and tribal organizations 
     to elect to directly bill for, and receive payment for, 
     health care services provided by a hospital or clinic of such 
     tribes or tribal organizations and for which payment may be 
     made under this title, see section 405.

     ``SEC. 403. REPORT.

       ``(a) Inclusion in Annual Report.--The Secretary shall 
     submit to the President, for inclusion in the report required 
     to be transmitted to the Congress under section 801, an 
     accounting on the amount and use of funds made available to 
     the Service pursuant to this title as a result of 
     reimbursements under titles XVIII and XIX of the Social 
     Security Act.
       ``(b) Identification of Source of Payments.--If an Indian 
     tribe or tribal organization receives funding from the 
     Service under the Indian Self-Determination and Education 
     Assistance Act or an urban Indian organization receives 
     funding from the Service under Title V of this Act and 
     receives reimbursements or payments under title XVIII, XIX, 
     or XXI of the Social Security Act, such Indian tribe or 
     tribal organization, or urban Indian organization, shall 
     provide to the Service a list of each provider enrollment 
     number (or other identifier) under which it receives such 
     reimbursements or payments.

     ``SEC. 404. GRANTS TO AND FUNDING AGREEMENTS WITH THE 
                   SERVICE, INDIAN TRIBES OR TRIBAL ORGANIZATIONS, 
                   AND URBAN INDIAN ORGANIZATIONS.

       ``(a) In General.--The Secretary shall make grants to or 
     enter into funding agreements with Indian tribes and tribal 
     organizations to assist such organizations in establishing 
     and administering programs on or near Federal Indian 
     reservations and trust areas and in or near Alaska Native 
     villages to assist individual Indians to--
       ``(1) enroll under sections 1818, 1836, and 1837 of the 
     Social Security Act;
       ``(2) pay premiums for health insurance coverage; and
       ``(3) apply for medical assistance provided pursuant to 
     titles XIX and XXI of the Social Security Act.
       ``(b) Conditions.--The Secretary shall place conditions as 
     deemed necessary to effect the purpose of this section in any 
     funding agreement or grant which the Secretary makes with any 
     Indian tribe or tribal organization pursuant to this section. 
     Such conditions shall include, but are not limited to, 
     requirements that the organization successfully undertake 
     to--
       ``(1) determine the population of Indians to be served that 
     are or could be recipients of benefits or assistance under 
     titles XVIII, XIX, and XXI of the Social Security Act;
       ``(2) assist individual Indians in becoming familiar with 
     and utilizing such benefits and assistance;
       ``(3) provide transportation to such individual Indians to 
     the appropriate offices for enrollment or applications for 
     such benefits and assistance;
       ``(4) develop and implement--
       ``(A) a schedule of income levels to determine the extent 
     of payments of premiums by such organizations for health 
     insurance coverage of needy individuals; and
       ``(B) methods of improving the participation of Indians in 
     receiving the benefits and assistance provided under titles 
     XVIII, XIX, and XXI of the Social Security Act.
       ``(c) Agreements for Receipt and Processing of 
     Applications.--The Secretary may enter into an agreement with 
     an Indian tribe or tribal organization, or an urban Indian 
     organization, which provides for the receipt and processing 
     of applications for medical assistance under title XIX of the 
     Social Security Act, child health assistance under title XXI 
     of such Act and benefits under title XVIII of such Act by a 
     Service facility or a health care program administered by 
     such Indian tribe or tribal organization, or urban Indian 
     organization, pursuant to a funding agreement under the 
     Indian Self-Determination and Education Assistance Act or a 
     grant or contract entered into with an urban Indian 
     organization under title V of this Act. Notwithstanding any 
     other provision of law, such agreements shall provide for 
     reimbursement of the cost of outreach, education regarding 
     eligibility and benefits, and translation when such services 
     are provided. The reimbursement may be included in an 
     encounter rate or be made on a fee-for-service basis as 
     appropriate for the provider. When necessary to carry out the 
     terms of this section, the Secretary, acting through the 
     Health Care Financing Administration or the Service, may 
     enter into agreements with a State (or political subdivision 
     thereof) to facilitate cooperation between the State and the 
     Service, an Indian tribe or tribal organization, and an urban 
     Indian organization.
       ``(d) Grants.--
       ``(1) In general.--The Secretary shall make grants or enter 
     into contracts with urban Indian organizations to assist such 
     organizations in establishing and administering programs to 
     assist individual urban Indians to--
       ``(A) enroll under sections 1818, 1836, and 1837 of the 
     Social Security Act;
       ``(B) pay premiums on behalf of such individuals for 
     coverage under title XVIII of such Act; and
       ``(C) apply for medical assistance provided under title XIX 
     of such Act and for child health assistance under title XXI 
     of such Act.
       ``(2) Requirements.--The Secretary shall include in the 
     grants or contracts made or entered into under paragraph (1) 
     requirements that are--
       ``(A) consistent with the conditions imposed by the 
     Secretary under subsection (b);
       ``(B) appropriate to urban Indian organizations and urban 
     Indians; and
       ``(C) necessary to carry out the purposes of this section.

     ``SEC. 405. DIRECT BILLING AND REIMBURSEMENT OF MEDICARE, 
                   MEDICAID, AND OTHER THIRD PARTY PAYORS.

       ``(a) Establishment of Direct Billing Program.--

[[Page 5486]]

       ``(1) In general.--The Secretary shall establish a program 
     under which Indian tribes, tribal organizations, and Alaska 
     Native health organizations that contract or compact for the 
     operation of a hospital or clinic of the Service under the 
     Indian Self-Determination and Education Assistance Act may 
     elect to directly bill for, and receive payment for, health 
     care services provided by such hospital or clinic for which 
     payment is made under the medicare program established under 
     title XVIII of the Social Security Act (42 U.S.C. 1395 et 
     seq.), under the medicaid program established under title XIX 
     of the Social Security Act (42 U.S.C. 1396 et seq.), or from 
     any other third party payor.
       ``(2) Application of 100 percent fmap.--The third sentence 
     of section 1905(b) of the Social Security Act (42 U.S.C. 
     1396d(b)) shall apply for purposes of reimbursement under 
     title XIX of the Social Security Act for health care services 
     directly billed under the program established under this 
     section.
       ``(b) Direct Reimbursement.--
       ``(1) Use of funds.--Each hospital or clinic participating 
     in the program described in subsection (a) of this section 
     shall be reimbursed directly under titles XVIII and XIX of 
     the Social Security Act for services furnished, without 
     regard to the provisions of section 1880(c) of the Social 
     Security Act (42 U.S.C. 1395qq(c)) and sections 402(a) and 
     807(b)(2)(A), but all funds so reimbursed shall first be used 
     by the hospital or clinic for the purpose of making any 
     improvements in the hospital or clinic that may be necessary 
     to achieve or maintain compliance with the conditions and 
     requirements applicable generally to facilities of such type 
     under title XVIII or XIX of the Social Security Act. Any 
     funds so reimbursed which are in excess of the amount 
     necessary to achieve or maintain such conditions shall be 
     used--
       ``(A) solely for improving the health resources deficiency 
     level of the Indian tribe; and
       ``(B) in accordance with the regulations of the Service 
     applicable to funds provided by the Service under any 
     contract entered into under the Indian Self-Determination Act 
     (25 U.S.C. 450f et seq.).
       ``(2) Audits.--The amounts paid to the hospitals and 
     clinics participating in the program established under this 
     section shall be subject to all auditing requirements 
     applicable to programs administered directly by the Service 
     and to facilities participating in the medicare and medicaid 
     programs under titles XVIII and XIX of the Social Security 
     Act.
       ``(3) Secretarial oversight.--The Secretary shall monitor 
     the performance of hospitals and clinics participating in the 
     program established under this section, and shall require 
     such hospitals and clinics to submit reports on the program 
     to the Secretary on an annual basis.
       ``(4) No payments from special funds.--Notwithstanding 
     section 1880(c) of the Social Security Act (42 U.S.C. 
     1395qq(c)) or section 402(a), no payment may be made out of 
     the special funds described in such sections for the benefit 
     of any hospital or clinic during the period that the hospital 
     or clinic participates in the program established under this 
     section.
       ``(c) Requirements for Participation.--
       ``(1) Application.--Except as provided in paragraph (2)(B), 
     in order to be eligible for participation in the program 
     established under this section, an Indian tribe, tribal 
     organization, or Alaska Native health organization shall 
     submit an application to the Secretary that establishes to 
     the satisfaction of the Secretary that--
       ``(A) the Indian tribe, tribal organization, or Alaska 
     Native health organization contracts or compacts for the 
     operation of a facility of the Service;
       ``(B) the facility is eligible to participate in the 
     medicare or medicaid programs under section 1880 or 1911 of 
     the Social Security Act (42 U.S.C. 1395qq; 1396j);
       ``(C) the facility meets the requirements that apply to 
     programs operated directly by the Service; and
       ``(D) the facility--
       ``(i) is accredited by an accrediting body as eligible for 
     reimbursement under the medicare or medicaid programs; or
       ``(ii) has submitted a plan, which has been approved by the 
     Secretary, for achieving such accreditation.
       ``(2) Approval.--
       ``(A) In general.--The Secretary shall review and approve a 
     qualified application not later than 90 days after the date 
     the application is submitted to the Secretary unless the 
     Secretary determines that any of the criteria set forth in 
     paragraph (1) are not met.
       ``(B) Grandfather of demonstration program participants.--
     Any participant in the demonstration program authorized under 
     this section as in effect on the day before the date of 
     enactment of the Alaska Native and American Indian Direct 
     Reimbursement Act of 2000 shall be deemed approved for 
     participation in the program established under this section 
     and shall not be required to submit an application in order 
     to participate in the program.
       ``(C) Duration.--An approval by the Secretary of a 
     qualified application under subparagraph (A), or a deemed 
     approval of a demonstration program under subparagraph (B), 
     shall continue in effect as long as the approved applicant or 
     the deemed approved demonstration program meets the 
     requirements of this section.
       ``(d) Examination and Implementation of Changes.--
       ``(1) In general.--The Secretary, acting through the 
     Service, and with the assistance of the Administrator of the 
     Health Care Financing Administration, shall examine on an 
     ongoing basis and implement--
       ``(A) any administrative changes that may be necessary to 
     facilitate direct billing and reimbursement under the program 
     established under this section, including any agreements with 
     States that may be necessary to provide for direct billing 
     under title XIX of the Social Security Act; and
       ``(B) any changes that may be necessary to enable 
     participants in the program established under this section to 
     provide to the Service medical records information on 
     patients served under the program that is consistent with the 
     medical records information system of the Service.
       ``(2) Accounting information.--The accounting information 
     that a participant in the program established under this 
     section shall be required to report shall be the same as the 
     information required to be reported by participants in the 
     demonstration program authorized under this section as in 
     effect on the day before the date of enactment of the Alaska 
     Native and American Indian Direct Reimbursement Act of 2000. 
     The Secretary may from time to time, after consultation with 
     the program participants, change the accounting information 
     submission requirements.
       ``(e) Withdrawal From Program.--A participant in the 
     program established under this section may withdraw from 
     participation in the same manner and under the same 
     conditions that a tribe or tribal organization may retrocede 
     a contracted program to the Secretary under authority of the 
     Indian Self-Determination Act (25 U.S.C. 450 et seq.). All 
     cost accounting and billing authority under the program 
     established under this section shall be returned to the 
     Secretary upon the Secretary's acceptance of the withdrawal 
     of participation in this program.

     ``SEC. 406. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS 
                   OF HEALTH SERVICES.

       ``(a) Right of Recovery.--Except as provided in subsection 
     (g), the United States, an Indian tribe or tribal 
     organization shall have the right to recover the reasonable 
     charges billed or expenses incurred by the Secretary or an 
     Indian tribe or tribal organization in providing health 
     services, through the Service or an Indian tribe or tribal 
     organization to any individual to the same extent that such 
     individual, or any nongovernmental provider of such services, 
     would be eligible to receive reimbursement or indemnification 
     for such charges or expenses if--
       ``(1) such services had been provided by a nongovernmental 
     provider; and
       ``(2) such individual had been required to pay such charges 
     or expenses and did pay such expenses.
       ``(b) Urban Indian Organizations.--Except as provided in 
     subsection (g), an urban Indian organization shall have the 
     right to recover the reasonable charges billed or expenses 
     incurred by the organization in providing health services to 
     any individual to the same extent that such individual, or 
     any other nongovernmental provider of such services, would be 
     eligible to receive reimbursement or indemnification for such 
     charges or expenses if such individual had been required to 
     pay such charges or expenses and did pay such charges or 
     expenses.
       ``(c) Limitations on Recoveries From States.--Subsections 
     (a) and (b) shall provide a right of recovery against any 
     State, only if the injury, illness, or disability for which 
     health services were provided is covered under--
       ``(1) workers' compensation laws; or
       ``(2) a no-fault automobile accident insurance plan or 
     program.
       ``(d) Nonapplication of Other Laws.--No law of any State, 
     or of any political subdivision of a State and no provision 
     of any contract entered into or renewed after the date of 
     enactment of the Indian Health Care Amendments of 1988, shall 
     prevent or hinder the right of recovery of the United States 
     or an Indian tribe or tribal organization under subsection 
     (a), or an urban Indian organization under subsection (b).
       ``(e) No Effect on Private Rights of Action.--No action 
     taken by the United States or an Indian tribe or tribal 
     organization to enforce the right of recovery provided under 
     subsection (a), or by an urban Indian organization to enforce 
     the right of recovery provided under subsection (b), shall 
     affect the right of any person to any damages (other than 
     damages for the cost of health services provided by the 
     Secretary through the Service).
       ``(f) Methods of Enforcement.--
       ``(1) In general.--The United States or an Indian tribe or 
     tribal organization may enforce the right of recovery 
     provided under subsection (a), and an urban Indian 
     organization may enforce the right of recovery provided under 
     subsection (b), by--
       ``(A) intervening or joining in any civil action or 
     proceeding brought--
       ``(i) by the individual for whom health services were 
     provided by the Secretary, an Indian tribe or tribal 
     organization, or urban Indian organization; or

[[Page 5487]]

       ``(ii) by any representative or heirs of such individual; 
     or
       ``(B) instituting a civil action.
       ``(2) Notice.--All reasonable efforts shall be made to 
     provide notice of an action instituted in accordance with 
     paragraph (1)(B) to the individual to whom health services 
     were provided, either before or during the pendency of such 
     action.
       ``(g) Limitation.--Notwithstanding this section, absent 
     specific written authorization by the governing body of an 
     Indian tribe for the period of such authorization (which may 
     not be for a period of more than 1 year and which may be 
     revoked at any time upon written notice by the governing body 
     to the Service), neither the United States through the 
     Service, nor an Indian tribe or tribal organization under a 
     funding agreement pursuant to the Indian Self-Determination 
     and Education Assistance Act, nor an urban Indian 
     organization funded under title V, shall have a right of 
     recovery under this section if the injury, illness, or 
     disability for which health services were provided is covered 
     under a self-insurance plan funded by an Indian tribe or 
     tribal organization, or urban Indian organization. Where such 
     tribal authorization is provided, the Service may receive and 
     expend such funds for the provision of additional health 
     services.
       ``(h) Costs and Attorneys' Fees.--In any action brought to 
     enforce the provisions of this section, a prevailing 
     plaintiff shall be awarded reasonable attorneys' fees and 
     costs of litigation.
       ``(i) Right of Action Against Insurers and Employee Benefit 
     Plans.--
       ``(1) In general.--Where an insurance company or employee 
     benefit plan fails or refuses to pay the amount due under 
     subsection (a) for services provided to an individual who is 
     a beneficiary, participant, or insured of such company or 
     plan, the United States or an Indian tribe or tribal 
     organization shall have a right to assert and pursue all the 
     claims and remedies against such company or plan, and against 
     the fiduciaries of such company or plan, that the individual 
     could assert or pursue under applicable Federal, State or 
     tribal law.
       ``(2) Urban indian organizations.--Where an insurance 
     company or employee benefit plan fails or refuses to pay the 
     amounts due under subsection (b) for health services provided 
     to an individual who is a beneficiary, participant, or 
     insured of such company or plan, the urban Indian 
     organization shall have a right to assert and pursue all the 
     claims and remedies against such company or plan, and against 
     the fiduciaries of such company or plan, that the individual 
     could assert or pursue under applicable Federal or State law.
       ``(j) Nonapplication of Claims Filing Requirements.--
     Notwithstanding any other provision in law, the Service, an 
     Indian tribe or tribal organization, or an urban Indian 
     organization shall have a right of recovery for any otherwise 
     reimbursable claim filed on a current HCFA-1500 or UB-92 
     form, or the current NSF electronic format, or their 
     successors. No health plan shall deny payment because a claim 
     has not been submitted in a unique format that differs from 
     such forms.

     ``SEC. 407. CREDITING OF REIMBURSEMENTS.

       ``(a) Retention of Funds.--Except as provided in section 
     202(d), this title, and section 807, all reimbursements 
     received or recovered under the authority of this Act, Public 
     Law 87-693, or any other provision of law, by reason of the 
     provision of health services by the Service or by an Indian 
     tribe or tribal organization under a funding agreement 
     pursuant to the Indian Self-Determination and Education 
     Assistance Act, or by an urban Indian organization funded 
     under title V, shall be retained by the Service or that tribe 
     or tribal organization and shall be available for the 
     facilities, and to carry out the programs, of the Service or 
     that tribe or tribal organization to provide health care 
     services to Indians.
       ``(b) No Offset of Funds.--The Service may not offset or 
     limit the amount of funds obligated to any service unit or 
     entity receiving funding from the Service because of the 
     receipt of reimbursements under subsection (a).

     ``SEC. 408. PURCHASING HEALTH CARE COVERAGE.

       ``An Indian tribe or tribal organization, and an urban 
     Indian organization may utilize funding from the Secretary 
     under this Act to purchase managed care coverage for Service 
     beneficiaries (including insurance to limit the financial 
     risks of managed care entities) from--
       ``(1) a tribally owned and operated managed care plan;
       ``(2) a State or locally-authorized or licensed managed 
     care plan; or
       ``(3) a health insurance provider.

     ``SEC. 409. INDIAN HEALTH SERVICE, DEPARTMENT OF VETERAN'S 
                   AFFAIRS, AND OTHER FEDERAL AGENCY HEALTH 
                   FACILITIES AND SERVICES SHARING.

       ``(a) Examination of Feasibility of Arrangements.--
       ``(1) In general.--The Secretary shall examine the 
     feasibility of entering into arrangements or expanding 
     existing arrangements for the sharing of medical facilities 
     and services between the Service and the Veterans' 
     Administration, and other appropriate Federal agencies, 
     including those within the Department, and shall, in 
     accordance with subsection (b), prepare a report on the 
     feasibility of such arrangements.
       ``(2) Submission of report.--Not later than September 30, 
     2003, the Secretary shall submit the report required under 
     paragraph (1) to Congress.
       ``(3) Consultation required.--The Secretary may not 
     finalize any arrangement described in paragraph (1) without 
     first consulting with the affected Indian tribes.
       ``(b) Limitations.--The Secretary shall not take any action 
     under this section or under subchapter IV of chapter 81 of 
     title 38, United States Code, which would impair--
       ``(1) the priority access of any Indian to health care 
     services provided through the Service;
       ``(2) the quality of health care services provided to any 
     Indian through the Service;
       ``(3) the priority access of any veteran to health care 
     services provided by the Veterans' Administration;
       ``(4) the quality of health care services provided to any 
     veteran by the Veteran's Administration;
       ``(5) the eligibility of any Indian to receive health 
     services through the Service; or
       ``(6) the eligibility of any Indian who is a veteran to 
     receive health services through the Veterans' Administration 
     provided, however, the Service or the Indian tribe or tribal 
     organization shall be reimbursed by the Veterans' 
     Administration where services are provided through the 
     Service or Indian tribes or tribal organizations to 
     beneficiaries eligible for services from the Veterans' 
     Administration, notwithstanding any other provision of law.
       ``(c) Agreements for Parity in Services.--The Service may 
     enter into agreements with other Federal agencies to assist 
     in achieving parity in services for Indians. Nothing in this 
     section may be construed as creating any right of a veteran 
     to obtain health services from the Service.

     ``SEC. 410. PAYOR OF LAST RESORT.

       ``The Service, and programs operated by Indian tribes or 
     tribal organizations, or urban Indian organizations shall be 
     the payor of last resort for services provided to individuals 
     eligible for services from the Service and such programs, 
     notwithstanding any Federal, State or local law to the 
     contrary, unless such law explicitly provides otherwise.

     ``SEC. 411. RIGHT TO RECOVER FROM FEDERAL HEALTH CARE 
                   PROGRAMS.

       ``Notwithstanding any other provision of law, the Service, 
     Indian tribes or tribal organizations, and urban Indian 
     organizations (notwithstanding limitations on who is eligible 
     to receive services from such entities) shall be entitled to 
     receive payment or reimbursement for services provided by 
     such entities from any Federally funded health care program, 
     unless there is an explicit prohibition on such payments in 
     the applicable authorizing statute.

     ``SEC. 412. TUBA CITY DEMONSTRATION PROJECT.

       ``(a) In General.--Notwithstanding any other provision of 
     law, including the Anti-Deficiency Act, provided the Indian 
     tribes to be served approve, the Service in the Tuba City 
     Service Unit may--
       ``(1) enter into a demonstration project with the State of 
     Arizona under which the Service would provide certain 
     specified medicaid services to individuals dually eligible 
     for services from the Service and for medical assistance 
     under title XIX of the Social Security Act in return for 
     payment on a capitated basis from the State of Arizona; and
       ``(2) purchase insurance to limit the financial risks under 
     the project.
       ``(b) Extension of Project.--The demonstration project 
     authorized under subsection (a) may be extended to other 
     service units in Arizona, subject to the approval of the 
     Indian tribes to be served in such service units, the 
     Service, and the State of Arizona.

     ``SEC. 413. ACCESS TO FEDERAL INSURANCE.

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

     ``SEC. 414. CONSULTATION AND RULEMAKING.

       ``(a) Consultation.--Prior to the adoption of any policy or 
     regulation by the Health Care Financing Administration, the 
     Secretary shall require the Administrator of that 
     Administration to--
       ``(1) identify the impact such policy or regulation may 
     have on the Service, Indian tribes or tribal organizations, 
     and urban Indian organizations;
       ``(2) provide to the Service, Indian tribes or tribal 
     organizations, and urban Indian organizations the information 
     described in paragraph (1);

[[Page 5488]]

       ``(3) engage in consultation, consistent with the 
     requirements of Executive Order 13084 of May 14, 1998, with 
     the Service, Indian tribes or tribal organizations, and urban 
     Indian organizations prior to enacting any such policy or 
     regulation.
       ``(b) Rulemaking.--The Administrator of the Health Care 
     Financing Administration shall participate in the negotiated 
     rulemaking provided for under title VIII with regard to any 
     regulations necessary to implement the provisions of this 
     title that relate to the Social Security Act.

     ``SEC. 415. LIMITATIONS ON CHARGES.

       ``No provider of health services that is eligible to 
     receive payments or reimbursements under titles XVIII, XIX, 
     or XXI of the Social Security Act or from any Federally 
     funded (whether in whole or part) health care program may 
     seek to recover payment for services--
       ``(1) that are covered under and furnished to an individual 
     eligible for the contract health services program operated by 
     the Service, by an Indian tribe or tribal organization, or 
     furnished to an urban Indian eligible for health services 
     purchased by an urban Indian organization, in an amount in 
     excess of the lowest amount paid by any other payor for 
     comparable services; or
       ``(2) for examinations or other diagnostic procedures that 
     are not medically necessary if such procedures have already 
     been performed by the referring Indian health program and 
     reported to the provider.

     ``SEC. 416. LIMITATION ON SECRETARY'S WAIVER AUTHORITY.

       ``Notwithstanding any other provision of law, the Secretary 
     may not waive the application of section 1902(a)(13)(D) of 
     the Social Security Act to any State plan under title XIX of 
     the Social Security Act.

     ``SEC. 417. WAIVER OF MEDICARE AND MEDICAID SANCTIONS.

       ``Notwithstanding any other provision of law, the Service 
     or an Indian tribe or tribal organization or an urban Indian 
     organization operating a health program under the Indian 
     Self-Determination and Education Assistance Act shall be 
     entitled to seek a waiver of sanctions imposed under title 
     XVIII, XIX, or XXI of the Social Security Act as if such 
     entity were directly responsible for administering the State 
     health care program.

     ``SEC. 418. MEANING OF `REMUNERATION' FOR PURPOSES OF SAFE 
                   HARBOR PROVISIONS; ANTITRUST IMMUNITY.

       ``(a) Meaning of Remuneration.--Notwithstanding any other 
     provision of law, the term `remuneration' as used in sections 
     1128A and 1128B of the Social Security Act shall not include 
     any exchange of anything of value between or among--
       ``(1) any Indian tribe or tribal organization or an urban 
     Indian organization that administers health programs under 
     the authority of the Indian Self-Determination and Education 
     Assistance Act;
       ``(2) any such Indian tribe or tribal organization or urban 
     Indian organization and the Service;
       ``(3) any such Indian tribe or tribal organization or urban 
     Indian organization and any patient served or eligible for 
     service under such programs, including patients served or 
     eligible for service pursuant to section 813 of this Act (as 
     in effect on the day before the date of enactment of the 
     Indian Health Care Improvement Act Reauthorization of 2003); 
     or
       ``(4) any such Indian tribe or tribal organization or urban 
     Indian organization and any third party required by contract, 
     section 206 or 207 of this Act (as so in effect), or other 
     applicable law, to pay or reimburse the reasonable health 
     care costs incurred by the United States or any such Indian 
     tribe or tribal organization or urban Indian organization;

     provided the exchange arises from or relates to such health 
     programs.
       ``(b) Antitrust Immunity.--An Indian tribe or tribal 
     organization or an urban Indian organization that administers 
     health programs under the authority of the Indian Self-
     Determination and Education Assistance Act or title V shall 
     be deemed to be an agency of the United States and immune 
     from liability under the Acts commonly known as the Sherman 
     Act, the Clayton Act, the Robinson-Patman Anti-Discrimination 
     Act, the Federal Trade Commission Act, and any other Federal, 
     State, or local antitrust laws, with regard to any 
     transaction, agreement, or conduct that relates to such 
     programs.

     ``SEC. 419. CO-INSURANCE, CO-PAYMENTS, DEDUCTIBLES AND 
                   PREMIUMS.

       ``(a) Exemption From Cost-Sharing Requirements.--
     Notwithstanding any other provision of Federal or State law, 
     no Indian who is eligible for services under title XVIII, 
     XIX, or XXI of the Social Security Act, or under any other 
     Federally funded health care programs, may be charged a 
     deductible, co-payment, or co-insurance for any service 
     provided by or through the Service, an Indian tribe or tribal 
     organization or urban Indian organization, nor may the 
     payment or reimbursement due to the Service or an Indian 
     tribe or tribal organization or urban Indian organization be 
     reduced by the amount of the deductible, co-payment, or co-
     insurance that would be due from the Indian but for the 
     operation of this section. For the purposes of this section, 
     the term `through' shall include services provided directly, 
     by referral, or under contracts or other arrangements between 
     the Service, an Indian tribe or tribal organization or an 
     urban Indian organization and another health provider.
       ``(b) Exemption From Premiums.--
       ``(1) Medicaid and state children's health insurance 
     program.--Notwithstanding any other provision of Federal or 
     State law, no Indian who is otherwise eligible for medical 
     assistance under title XIX of the Social Security Act or 
     child health assistance under title XXI of such Act may be 
     charged a premium as a condition of receiving such assistance 
     under title XIX of XXI of such Act.
       ``(2) Medicare enrollment premium penalties.--
     Notwithstanding section 1839(b) of the Social Security Act or 
     any other provision of Federal or State law, no Indian who is 
     eligible for benefits under part B of title XVIII of the 
     Social Security Act, but for the payment of premiums, shall 
     be charged a penalty for enrolling in such part at a time 
     later than the Indian might otherwise have been first 
     eligible to do so. The preceding sentence applies whether an 
     Indian pays for premiums under such part directly or such 
     premiums are paid by another person or entity, including a 
     State, the Service, an Indian Tribe or tribal organization, 
     or an urban Indian organization.

     ``SEC. 420. INCLUSION OF INCOME AND RESOURCES FOR PURPOSES OF 
                   MEDICALLY NEEDY MEDICAID ELIGIBILITY.

       ``For the purpose of determining the eligibility under 
     section 1902(a)(10)(A)(ii)(IV) of the Social Security Act of 
     an Indian for medical assistance under a State plan under 
     title XIX of such Act, the cost of providing services to an 
     Indian in a health program of the Service, an Indian Tribe or 
     tribal organization, or an urban Indian organization shall be 
     deemed to have been an expenditure for health care by the 
     Indian.

     ``SEC. 421. ESTATE RECOVERY PROVISIONS.

       ``Notwithstanding any other provision of Federal or State 
     law, the following property may not be included when 
     determining eligibility for services or implementing estate 
     recovery rights under title XVIII, XIX, or XXI of the Social 
     Security Act, or any other health care programs funded in 
     whole or part with Federal funds:
       ``(1) Income derived from rents, leases, or royalties of 
     property held in trust for individuals by the Federal 
     Government.
       ``(2) Income derived from rents, leases, royalties, or 
     natural resources (including timber and fishing activities) 
     resulting from the exercise of Federally protected rights, 
     whether collected by an individual or a tribal group and 
     distributed to individuals.
       ``(3) Property, including interests in real property 
     currently or formerly held in trust by the Federal Government 
     which is protected under applicable Federal, State or tribal 
     law or custom from recourse, including public domain 
     allotments.
       ``(4) Property that has unique religious or cultural 
     significance or that supports subsistence or traditional life 
     style according to applicable tribal law or custom.

     ``SEC. 422. MEDICAL CHILD SUPPORT.

       ``Notwithstanding any other provision of law, a parent 
     shall not be responsible for reimbursing the Federal 
     Government or a State for the cost of medical services 
     provided to a child by or through the Service, an Indian 
     tribe or tribal organization or an urban Indian organization. 
     For the purposes of this subsection, the term `through' 
     includes services provided directly, by referral, or under 
     contracts or other arrangements between the Service, an 
     Indian Tribe or tribal organization or an urban Indian 
     organization and another health provider.

     ``SEC. 423. PROVISIONS RELATING TO MANAGED CARE.

       ``(a) Recovery From Managed Care Plans.--Notwithstanding 
     any other provision in law, the Service, an Indian Tribe or 
     tribal organization or an urban Indian organization shall 
     have a right of recovery under section 408 from all private 
     and public health plans or programs, including the medicare, 
     medicaid, and State children's health insurance programs 
     under titles XVIII, XIX, and XXI of the Social Security Act, 
     for the reasonable costs of delivering health services to 
     Indians entitled to receive services from the Service, an 
     Indian Tribe or tribal organization or an urban Indian 
     organization.
       ``(b) Limitation.--No provision of law or regulation, or of 
     any contract, may be relied upon or interpreted to deny or 
     reduce payments otherwise due under subsection (a), except to 
     the extent the Service, an Indian tribe or tribal 
     organization, or an urban Indian organization has entered 
     into an agreement with a managed care entity regarding 
     services to be provided to Indians or rates to be paid for 
     such services, provided that such an agreement may not be 
     made a prerequisite for such payments to be made.
       ``(c) Parity.--Payments due under subsection (a) from a 
     managed care entity may not be paid at a rate that is less 
     than the rate paid to a `preferred provider' by the entity 
     or, in the event there is no such rate, the usual and 
     customary fee for equivalent services.
       ``(d) No Claim Requirement.--A managed care entity may not 
     deny payment under subsection (a) because an enrollee with 
     the entity has not submitted a claim.

[[Page 5489]]

       ``(e) Direct Billing.--Notwithstanding the preceding 
     subsections of this section, the Service, an Indian tribe or 
     tribal organization, or an urban Indian organization that 
     provides a health service to an Indian entitled to medical 
     assistance under the State plan under title XIX of the Social 
     Security Act or enrolled in a child health plan under title 
     XXI of such Act shall have the right to be paid directly by 
     the State agency administering such plans notwithstanding any 
     agreements the State may have entered into with managed care 
     organizations or providers.
       ``(f) Requirement for Medicaid Managed Care Entities.--A 
     managed care entity (as defined in section 1932(a)(1)(B) of 
     the Social Security Act shall, as a condition of 
     participation in the State plan under title XIX of such Act, 
     offer a contract to health programs administered by the 
     Service, an Indian tribe or tribal organization or an urban 
     Indian organization that provides health services in the 
     geographic area served by the managed care entity and such 
     contract (or other provider participation agreement) shall 
     contain terms and conditions of participation and payment no 
     more restrictive or onerous than those provided for in this 
     section.
       ``(g) Prohibition.--Notwithstanding any other provision of 
     law or any waiver granted by the Secretary no Indian may be 
     assigned automatically or by default under any managed care 
     entity participating in a State plan under title XIX or XXI 
     of the Social Security Act unless the Indian had the option 
     of enrolling in a managed care plan or health program 
     administered by the Service, an Indian tribe or tribal 
     organization, or an urban Indian organization.
       ``(h) Indian Managed Care Plans.--Notwithstanding any other 
     provision of law, any State entering into agreements with one 
     or more managed care organizations to provide services under 
     title XIX or XXI of the Social Security Act shall enter into 
     such an agreement with the Service, an Indian tribe or tribal 
     organization or an urban Indian organization under which such 
     an entity may provide services to Indians who may be eligible 
     or required to enroll with a managed care organization 
     through enrollment in an Indian managed care organization 
     that provides services similar to those offered by other 
     managed care organizations in the State. The Secretary and 
     the State are hereby authorized to waive requirements 
     regarding discrimination, capitalization, and other matters 
     that might otherwise prevent an Indian managed care 
     organization or health program from meeting Federal or State 
     standards applicable to such organizations, provided such 
     Indian managed care organization or health program offers 
     Indian enrollees services of an equivalent quality to that 
     required of other managed care organizations.
       ``(i) Advertising.--A managed care organization entering 
     into a contract to provide services to Indians on or near an 
     Indian reservation shall provide a certificate of coverage or 
     similar type of document that is written in the Indian 
     language of the majority of the Indian population residing on 
     such reservation.

     ``SEC. 424. NAVAJO NATION MEDICAID AGENCY.

       ``(a) In General.--Notwithstanding any other provision of 
     law, the Secretary may treat the Navajo Nation as a State 
     under title XIX of the Social Security Act for purposes of 
     providing medical assistance to Indians living within the 
     boundaries of the Navajo Nation.
       ``(b) Assignment and Payment.--Notwithstanding any other 
     provision of law, the Secretary may assign and pay all 
     expenditures related to the provision of services to Indians 
     living within the boundaries of the Navajo Nation under title 
     XIX of the Social Security Act (including administrative 
     expenditures) that are currently paid to or would otherwise 
     be paid to the States of Arizona, New Mexico, and Utah, to an 
     entity established by the Navajo Nation and approved by the 
     Secretary, which shall be denominated the Navajo Nation 
     Medicaid Agency.
       ``(c) Authority.--The Navajo Nation Medicaid Agency shall 
     serve Indians living within the boundaries of the Navajo 
     Nation and shall have the same authority and perform the same 
     functions as other State agency responsible for the 
     administration of the State plan under title XIX of the 
     Social Security Act.
       ``(d) Technical Assistance.--The Secretary may directly 
     assist the Navajo Nation in the development and 
     implementation of a Navajo Nation Medicaid Agency for the 
     administration, eligibility, payment, and delivery of medical 
     assistance under title XIX of the Social Security Act (which 
     shall, for purposes of reimbursement to such Nation, include 
     Western and traditional Navajo healing services) within the 
     Navajo Nation. Such assistance may include providing funds 
     for demonstration projects conducted with such Nation.
       ``(e) FMAP.--Notwithstanding section 1905(b) of the Social 
     Security Act, the Federal medical assistance percentage shall 
     be 100 per cent with respect to amounts the Navajo Nation 
     Medicaid agency expends for medical assistance and related 
     administrative costs.
       ``(f) Waiver Authority.--The Secretary shall have the 
     authority to waive applicable provisions of Title XIX of the 
     Social Security Act to establish, develop and implement the 
     Navajo Nation Medicaid Agency.
       ``(g) SCHIP.--At the option of the Navajo Nation, the 
     Secretary may treat the Navajo Nation as a State for purposes 
     of title XXI of the Social Security Act under terms 
     equivalent to those described in the preceding subsections of 
     this section.

     ``SEC. 425. INDIAN ADVISORY COMMITTEES.

       ``(a) National Indian Technical Advisory Group.--The 
     Administrator of the Health Care Financing Administration 
     shall establish and fund the expenses of a National Indian 
     Technical Advisory Group which shall have no fewer than 14 
     members, including at least 1 member designated by the Indian 
     tribes and tribal organizations in each service area, 1 urban 
     Indian organization representative, and 1 member representing 
     the Service. The scope of the activities of such group shall 
     be established under section 802 provided that such scope 
     shall include providing comment on and advice regarding the 
     programs funded under titles XVIII, XIX, and XXI of the 
     Social Security Act or regarding any other health care 
     program funded (in whole or part) by the Health Care 
     Financing Administration.
       ``(b) Indian Medicaid Advisory Committees.--The 
     Administrator of the Health Care Financing Administration 
     shall establish and provide funding for a Indian Medicaid 
     Advisory Committee made up of designees of the Service, 
     Indian tribes and tribal organizations and urban Indian 
     organizations in each State in which the Service directly 
     operates a health program or in which there is one or more 
     Indian tribe or tribal organization or urban Indian 
     organization.

     ``SEC. 426. AUTHORIZATION OF APPROPRIATIONS.

       There is authorized to be appropriated such sums as may be 
     necessary for each of fiscal years 2004 through 2015 to carry 
     out this title.''.

              ``TITLE V--HEALTH SERVICES FOR URBAN INDIANS

     ``SEC. 501. PURPOSE.

       ``The purpose of this title is to establish programs in 
     urban centers to make health services more accessible and 
     available to urban Indians.

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

       ``Under the authority of the Act of November 2, 1921 (25 
     U.S.C. 13) (commonly known as the Snyder Act), the Secretary, 
     through the Service, shall enter into contracts with, or make 
     grants to, urban Indian organizations to assist such 
     organizations in the establishment and administration, within 
     urban centers, of programs which meet the requirements set 
     forth in this title. The Secretary, through the Service, 
     subject to section 506, shall include such conditions as the 
     Secretary considers necessary to effect the purpose of this 
     title in any contract which the Secretary enters into with, 
     or in any grant the Secretary makes to, any urban Indian 
     organization pursuant to this title.

     ``SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION OF HEALTH 
                   CARE AND REFERRAL SERVICES.

       ``(a) Authority.--Under the authority of the Act of 
     November 2, 1921 (25 U.S.C. 13) (commonly known as the Snyder 
     Act), the Secretary, acting through the Service, shall enter 
     into contracts with, and make grants to, urban Indian 
     organizations for the provision of health care and referral 
     services for urban Indians. Any such contract or grant shall 
     include requirements that the urban Indian organization 
     successfully undertake to--
       ``(1) estimate the population of urban Indians residing in 
     the urban center or centers that the organization proposes to 
     serve who are or could be recipients of health care or 
     referral services;
       ``(2) estimate the current health status of urban Indians 
     residing in such urban center or centers;
       ``(3) estimate the current health care needs of urban 
     Indians residing in such urban center or centers;
       ``(4) provide basic health education, including health 
     promotion and disease prevention education, to urban Indians;
       ``(5) make recommendations to the Secretary and Federal, 
     State, local, and other resource agencies on methods of 
     improving health service programs to meet the needs of urban 
     Indians; and
       ``(6) where necessary, provide, or enter into contracts for 
     the provision of, health care services for urban Indians.
       ``(b) Criteria.--The Secretary, acting through the Service, 
     shall by regulation adopted pursuant to section 520 prescribe 
     the criteria for selecting urban Indian organizations to 
     enter into contracts or receive grants under this section. 
     Such criteria shall, among other factors, include--
       ``(1) the extent of unmet health care needs of urban 
     Indians in the urban center or centers involved;
       ``(2) the size of the urban Indian population in the urban 
     center or centers involved;
       ``(3) the extent, if any, to which the activities set forth 
     in subsection (a) would duplicate any project funded under 
     this title;
       ``(4) the capability of an urban Indian organization to 
     perform the activities set forth in subsection (a) and to 
     enter into a contract with the Secretary or to meet the 
     requirements for receiving a grant under this section;

[[Page 5490]]

       ``(5) the satisfactory performance and successful 
     completion by an urban Indian organization of other contracts 
     with the Secretary under this title;
       ``(6) the appropriateness and likely effectiveness of 
     conducting the activities set forth in subsection (a) in an 
     urban center or centers; and
       ``(7) the extent of existing or likely future participation 
     in the activities set forth in subsection (a) by appropriate 
     health and health-related Federal, State, local, and other 
     agencies.
       ``(c) Health Promotion and Disease Prevention.--The 
     Secretary, acting through the Service, shall facilitate 
     access to, or provide, health promotion and disease 
     prevention services for urban Indians through grants made to 
     urban Indian organizations administering contracts entered 
     into pursuant to this section or receiving grants under 
     subsection (a).
       ``(d) Immunization Services.--
       ``(1) In general.--The Secretary, acting through the 
     Service, shall facilitate access to, or provide, immunization 
     services for urban Indians through grants made to urban 
     Indian organizations administering contracts entered into, or 
     receiving grants, under this section.
       ``(2) Definition.--In this section, the term `immunization 
     services' means services to provide without charge 
     immunizations against vaccine-preventable diseases.
       ``(e) Mental Health Services.--
       ``(1) In general.--The Secretary, acting through the 
     Service, shall facilitate access to, or provide, mental 
     health services for urban Indians through grants made to 
     urban Indian organizations administering contracts entered 
     into, or receiving grants, under this section.
       ``(2) Assessment.--A grant may not be made under this 
     subsection to an urban Indian organization until that 
     organization has prepared, and the Service has approved, an 
     assessment of the mental health needs of the urban Indian 
     population concerned, the mental health services and other 
     related resources available to that population, the barriers 
     to obtaining those services and resources, and the needs that 
     are unmet by such services and resources.
       ``(3) Use of funds.--Grants may be made under this 
     subsection--
       ``(A) to prepare assessments required under paragraph (2);
       ``(B) to provide outreach, educational, and referral 
     services to urban Indians regarding the availability of 
     direct behavioral health services, to educate urban Indians 
     about behavioral health issues and services, and effect 
     coordination with existing behavioral health providers in 
     order to improve services to urban Indians;
       ``(C) to provide outpatient behavioral health services to 
     urban Indians, including the identification and assessment of 
     illness, therapeutic treatments, case management, support 
     groups, family treatment, and other treatment; and
       ``(D) to develop innovative behavioral health service 
     delivery models which incorporate Indian cultural support 
     systems and resources.
       ``(f) Child Abuse.--
       ``(1) In general.--The Secretary, acting through the 
     Service, shall facilitate access to, or provide, services for 
     urban Indians through grants to urban Indian organizations 
     administering contracts entered into pursuant to this section 
     or receiving grants under subsection (a) to prevent and treat 
     child abuse (including sexual abuse) among urban Indians.
       ``(2) Assessment.--A grant may not be made under this 
     subsection to an urban Indian organization until that 
     organization has prepared, and the Service has approved, an 
     assessment that documents the prevalence of child abuse in 
     the urban Indian population concerned and specifies the 
     services and programs (which may not duplicate existing 
     services and programs) for which the grant is requested.
       ``(3) Use of funds.--Grants may be made under this 
     subsection--
       ``(A) to prepare assessments required under paragraph (2);
       ``(B) for the development of prevention, training, and 
     education programs for urban Indian populations, including 
     child education, parent education, provider training on 
     identification and intervention, education on reporting 
     requirements, prevention campaigns, and establishing service 
     networks of all those involved in Indian child protection; 
     and
       ``(C) to provide direct outpatient treatment services 
     (including individual treatment, family treatment, group 
     therapy, and support groups) to urban Indians who are child 
     victims of abuse (including sexual abuse) or adult survivors 
     of child sexual abuse, to the families of such child victims, 
     and to urban Indian perpetrators of child abuse (including 
     sexual abuse).
       ``(4) Considerations.--In making grants to carry out this 
     subsection, the Secretary shall take into consideration--
       ``(A) the support for the urban Indian organization 
     demonstrated by the child protection authorities in the area, 
     including committees or other services funded under the 
     Indian Child Welfare Act of 1978 (25 U.S.C. 1901 et seq.), if 
     any;
       ``(B) the capability and expertise demonstrated by the 
     urban Indian organization to address the complex problem of 
     child sexual abuse in the community; and
       ``(C) the assessment required under paragraph (2).
       ``(g) Multiple Urban Centers.--The Secretary, acting 
     through the Service, may enter into a contract with, or make 
     grants to, an urban Indian organization that provides or 
     arranges for the provision of health care services (through 
     satellite facilities, provider networks, or otherwise) to 
     urban Indians in more than one urban center.

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

       ``(a) Authority.--
       ``(1) In general.--Under authority of the Act of November 
     2, 1921 (25 U.S.C. 13) (commonly known as the Snyder Act), 
     the Secretary, acting through the Service, may enter into 
     contracts with, or make grants to, urban Indian organizations 
     situated in urban centers for which contracts have not been 
     entered into, or grants have not been made, under section 
     503.
       ``(2) Purpose.--The purpose of a contract or grant made 
     under this section shall be the determination of the matters 
     described in subsection (b)(1) in order to assist the 
     Secretary in assessing the health status and health care 
     needs of urban Indians in the urban center involved and 
     determining whether the Secretary should enter into a 
     contract or make a grant under section 503 with respect to 
     the urban Indian organization which the Secretary has entered 
     into a contract with, or made a grant to, under this section.
       ``(b) Requirements.--Any contract entered into, or grant 
     made, by the Secretary under this section shall include 
     requirements that--
       ``(1) the urban Indian organization successfully undertake 
     to--
       ``(A) document the health care status and unmet health care 
     needs of urban Indians in the urban center involved; and
       ``(B) with respect to urban Indians in the urban center 
     involved, determine the matters described in paragraphs (2), 
     (3), (4), and (7) of section 503(b); and
       ``(2) the urban Indian organization complete performance of 
     the contract, or carry out the requirements of the grant, 
     within 1 year after the date on which the Secretary and such 
     organization enter into such contract, or within 1 year after 
     such organization receives such grant, whichever is 
     applicable.
       ``(c) Limitation on Renewal.--The Secretary may not renew 
     any contract entered into, or grant made, under this section.

     ``SEC. 505. EVALUATIONS; RENEWALS.

       ``(a) Procedures.--The Secretary, acting through the 
     Service, shall develop procedures to evaluate compliance with 
     grant requirements under this title and compliance with, and 
     performance of contracts entered into by urban Indian 
     organizations under this title. Such procedures shall include 
     provisions for carrying out the requirements of this section.
       ``(b) Compliance With Terms.--The Secretary, acting through 
     the Service, shall evaluate the compliance of each urban 
     Indian organization which has entered into a contract or 
     received a grant under section 503 with the terms of such 
     contract or grant. For purposes of an evaluation under this 
     subsection, the Secretary, in determining the capacity of an 
     urban Indian organization to deliver quality patient care 
     shall, at the option of the organization--
       ``(1) conduct, through the Service, an annual onsite 
     evaluation of the organization; or
       ``(2) accept, in lieu of an onsite evaluation, evidence of 
     the organization's provisional or full accreditation by a 
     private independent entity recognized by the Secretary for 
     purposes of conducting quality reviews of providers 
     participating in the medicare program under Title XVIII of 
     the Social Security Act.
       ``(c) Noncompliance.--
       ``(1) In general.--If, as a result of the evaluations 
     conducted under this section, the Secretary determines that 
     an urban Indian organization has not complied with the 
     requirements of a grant or complied with or satisfactorily 
     performed a contract under section 503, the Secretary shall, 
     prior to renewing such contract or grant, attempt to resolve 
     with such organization the areas of noncompliance or 
     unsatisfactory performance and modify such contract or grant 
     to prevent future occurrences of such noncompliance or 
     unsatisfactory performance.
       ``(2) Nonrenewal.--If the Secretary determines, under an 
     evaluation under this section, that noncompliance or 
     unsatisfactory performance cannot be resolved and prevented 
     in the future, the Secretary shall not renew such contract or 
     grant with such organization and is authorized to enter into 
     a contract or make a grant under section 503 with another 
     urban Indian organization which is situated in the same urban 
     center as the urban Indian organization whose contract or 
     grant is not renewed under this section.
       ``(d) Determination of Renewal.--In determining whether to 
     renew a contract or grant with an urban Indian organization 
     under section 503 which has completed performance of a 
     contract or grant under section 504, the Secretary shall 
     review the

[[Page 5491]]

     records of the urban Indian organization, the reports 
     submitted under section 507, and, in the case of a renewal of 
     a contract or grant under section 503, shall consider the 
     results of the onsite evaluations or accreditation under 
     subsection (b).

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

       ``(a) Application of Federal Law.--Contracts with urban 
     Indian organizations entered into pursuant to this title 
     shall be in accordance with all Federal contracting laws and 
     regulations relating to procurement except that, in the 
     discretion of the Secretary, such contracts may be negotiated 
     without advertising and need not conform to the provisions of 
     the Act of August 24, 1935 (40 U.S.C. 270a, et seq.).
       ``(b) Payments.--Payments under any contracts or grants 
     pursuant to this title shall, notwithstanding any term or 
     condition of such contract or grant--
       ``(1) be made in their entirety by the Secretary to the 
     urban Indian organization by not later than the end of the 
     first 30 days of the funding period with respect to which the 
     payments apply, unless the Secretary determines through an 
     evaluation under section 505 that the organization is not 
     capable of administering such payments in their entirety; and
       ``(2) if unexpended by the urban Indian organization during 
     the funding period with respect to which the payments 
     initially apply, be carried forward for expenditure with 
     respect to allowable or reimbursable costs incurred by the 
     organization during 1 or more subsequent funding periods 
     without additional justification or documentation by the 
     organization as a condition of carrying forward the 
     expenditure of such funds.
       ``(c) Revising or Amending Contract.--Notwithstanding any 
     provision of law to the contrary, the Secretary may, at the 
     request or consent of an urban Indian organization, revise or 
     amend any contract entered into by the Secretary with such 
     organization under this title as necessary to carry out the 
     purposes of this title.
       ``(d) Fair and Uniform Provision of Services.--Contracts 
     with, or grants to, urban Indian organizations and 
     regulations adopted pursuant to this title shall include 
     provisions to assure the fair and uniform provision to urban 
     Indians of services and assistance under such contracts or 
     grants by such organizations.
       ``(e) Eligibility of Urban Indians.--Urban Indians, as 
     defined in section 4(f), shall be eligible for health care or 
     referral services provided pursuant to this title.

     ``SEC. 507. REPORTS AND RECORDS.

       ``(a) Report.--For each fiscal year during which an urban 
     Indian organization receives or expends funds pursuant to a 
     contract entered into, or a grant received, pursuant to this 
     title, such organization shall submit to the Secretary, on a 
     basis no more frequent than every 6 months, a report 
     including--
       ``(1) in the case of a contract or grant under section 503, 
     information gathered pursuant to paragraph (5) of subsection 
     (a) of such section;
       ``(2) information on activities conducted by the 
     organization pursuant to the contract or grant;
       ``(3) an accounting of the amounts and purposes for which 
     Federal funds were expended; and
       ``(4) a minimum set of data, using uniformly defined 
     elements, that is specified by the Secretary, after 
     consultations consistent with section 514, with urban Indian 
     organizations.
       ``(b) Audits.--The reports and records of the urban Indian 
     organization with respect to a contract or grant under this 
     title shall be subject to audit by the Secretary and the 
     Comptroller General of the United States.
       ``(c) Cost of Audit.--The Secretary shall allow as a cost 
     of any contract or grant entered into or awarded under 
     section 502 or 503 the cost of an annual independent 
     financial audit conducted by--
       ``(1) a certified public accountant; or
       ``(2) a certified public accounting firm qualified to 
     conduct Federal compliance audits.

     ``SEC. 508. LIMITATION ON CONTRACT AUTHORITY.

       ``The authority of the Secretary to enter into contracts or 
     to award grants under this title shall be to the extent, and 
     in an amount, provided for in appropriation Acts.

     ``SEC. 509. FACILITIES.

       ``(a) Grants.--The Secretary may make grants to contractors 
     or grant recipients under this title for the lease, purchase, 
     renovation, construction, or expansion of facilities, 
     including leased facilities, in order to assist such 
     contractors or grant recipients in complying with applicable 
     licensure or certification requirements.
       ``(b) Loans or Loan Guarantees.--The Secretary, acting 
     through the Service or through the Health Resources and 
     Services Administration, may provide loans to contractors or 
     grant recipients under this title from the Urban Indian 
     Health Care Facilities Revolving Loan Fund (referred to in 
     this section as the `URLF') described in subsection (c), or 
     guarantees for loans, for the construction, renovation, 
     expansion, or purchase of health care facilities, subject to 
     the following requirements:
       ``(1) The principal amount of a loan or loan guarantee may 
     cover 100 percent of the costs (other than staffing) relating 
     to the facility, including planning, design, financing, site 
     land development, construction, rehabilitation, renovation, 
     conversion, medical equipment, furnishings, and capital 
     purchase.
       ``(2) The total amount of the principal of loans and loan 
     guarantees, respectively, outstanding at any one time shall 
     not exceed such limitations as may be specified in 
     appropriations Acts.
       ``(3) The loan or loan guarantee may have a term of the 
     shorter of the estimated useful life of the facility, or 25 
     years.
       ``(4) An urban Indian organization may assign, and the 
     Secretary may accept assignment of, the revenue of the 
     organization as security for a loan or loan guarantee under 
     this subsection.
       ``(5) The Secretary shall not collect application, 
     processing, or similar fees from urban Indian organizations 
     applying for loans or loan guarantees under this subsection.
       ``(c) Urban Indian Health Care Facilities Revolving Loan 
     Fund.--
       ``(1) Establishment.--There is established in the Treasury 
     of the United States a fund to be known as the Urban Indian 
     Health Care Facilities Revolving Loan Fund. The URLF shall 
     consist of--
       ``(A) such amounts as may be appropriated to the URLF;
       ``(B) amounts received from urban Indian organizations in 
     repayment of loans made to such organizations under paragraph 
     (2); and
       ``(C) interest earned on amounts in the URLF under 
     paragraph (3).
       ``(2) Use of urlf.--Amounts in the URLF may be expended by 
     the Secretary, acting through the Service or the Health 
     Resources and Services Administration, to make loans 
     available to urban Indian organizations receiving grants or 
     contracts under this title for the purposes, and subject to 
     the requirements, described in subsection (b). Amounts 
     appropriated to the URLF, amounts received from urban Indian 
     organizations in repayment of loans, and interest on amounts 
     in the URLF shall remain available until expended.
       ``(3) Investments.--The Secretary of the Treasury shall 
     invest such amounts of the URLF as such Secretary determines 
     are not required to meet current withdrawals from the URLF. 
     Such investments may be made only in interest-bearing 
     obligations of the United States. For such purpose, such 
     obligations may be acquired on original issue at the issue 
     price, or by purchase of outstanding obligations at the 
     market price. Any obligation acquired by the URLF may be sold 
     by the Secretary of the Treasury at the market price.

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

       ``There is hereby established within the Service an Office 
     of Urban Indian Health which shall be responsible for--
       ``(1) carrying out the provisions of this title;
       ``(2) providing central oversight of the programs and 
     services authorized under this title; and
       ``(3) providing technical assistance to urban Indian 
     organizations.

     ``SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE RELATED 
                   SERVICES.

       ``(a) Grants.--The Secretary may make grants for the 
     provision of health-related services in prevention of, 
     treatment of, rehabilitation of, or school and community-
     based education in, alcohol and substance abuse in urban 
     centers to those urban Indian organizations with whom the 
     Secretary has entered into a contract under this title or 
     under section 201.
       ``(b) Goals of Grant.--Each grant made pursuant to 
     subsection (a) shall set forth the goals to be accomplished 
     pursuant to the grant. The goals shall be specific to each 
     grant as agreed to between the Secretary and the grantee.
       ``(c) Criteria.--The Secretary shall establish criteria for 
     the grants made under subsection (a), including criteria 
     relating to the--
       ``(1) size of the urban Indian population;
       ``(2) capability of the organization to adequately perform 
     the activities required under the grant;
       ``(3) satisfactory performance standards for the 
     organization in meeting the goals set forth in such grant, 
     which standards shall be negotiated and agreed to between the 
     Secretary and the grantee on a grant-by-grant basis; and
       ``(4) identification of need for services.
     The Secretary shall develop a methodology for allocating 
     grants made pursuant to this section based on such criteria.
       ``(d) Treatment of Funds Received by Urban Indian 
     Organizations.--Any funds received by an urban Indian 
     organization under this Act for substance abuse prevention, 
     treatment, and rehabilitation shall be subject to the 
     criteria set forth in subsection (c).

     ``SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION PROJECTS.

       ``(a) Tulsa and Oklahoma City Clinics.--Notwithstanding any 
     other provision of law, the Tulsa and Oklahoma City Clinic 
     demonstration projects shall become permanent programs within 
     the Service's direct care program and continue to be treated 
     as service units in the allocation of resources and

[[Page 5492]]

     coordination of care, and shall continue to meet the 
     requirements and definitions of an urban Indian organization 
     in this title, and as such will not be subject to the 
     provisions of the Indian Self-Determination and Education 
     Assistance Act.
       ``(b) Report.--The Secretary shall submit to the President, 
     for inclusion in the report required to be submitted to the 
     Congress under section 801 for fiscal year 1999, a report on 
     the findings and conclusions derived from the demonstration 
     projects specified in subsection (a).

     ``SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS.

       ``(a) Grants and Contracts.--The Secretary, acting through 
     the Office of Urban Indian Health of the Service, shall make 
     grants or enter into contracts, effective not later than 
     September 30, 2004, with urban Indian organizations for the 
     administration of urban Indian alcohol programs that were 
     originally established under the National Institute on 
     Alcoholism and Alcohol Abuse (referred to in this section to 
     as `NIAAA') and transferred to the Service.
       ``(b) Use of Funds.--Grants provided or contracts entered 
     into under this section shall be used to provide support for 
     the continuation of alcohol prevention and treatment services 
     for urban Indian populations and such other objectives as are 
     agreed upon between the Service and a recipient of a grant or 
     contract under this section.
       ``(c) Eligibility.--Urban Indian organizations that operate 
     Indian alcohol programs originally funded under NIAAA and 
     subsequently transferred to the Service are eligible for 
     grants or contracts under this section.
       ``(d) Evaluation and Report.--The Secretary shall evaluate 
     and report to the Congress on the activities of programs 
     funded under this section at least every 5 years.

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

       ``(a) In General.--The Secretary shall ensure that the 
     Service, the Health Care Financing Administration, and other 
     operating divisions and staff divisions of the Department 
     consult, to the maximum extent practicable, with urban Indian 
     organizations (as defined in section 4) prior to taking any 
     action, or approving Federal financial assistance for any 
     action of a State, that may affect urban Indians or urban 
     Indian organizations.
       ``(b) Requirement.--In subsection (a), the term 
     `consultation' means the open and free exchange of 
     information and opinion among urban Indian organizations and 
     the operating and staff divisions of the Department which 
     leads to mutual understanding and comprehension and which 
     emphasizes trust, respect, and shared responsibility.

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

       ``For purposes of section 224 of the Public Health Service 
     Act (42 U.S.C. 233), with respect to claims by any person, 
     initially filed on or after October 1, 1999, whether or not 
     such person is an Indian or Alaska Native or is served on a 
     fee basis or under other circumstances as permitted by 
     Federal law or regulations, for personal injury (including 
     death) resulting from the performance prior to, including, or 
     after October 1, 1999, of medical, surgical, dental, or 
     related functions, including the conduct of clinical studies 
     or investigations, or for purposes of section 2679 of title 
     28, United States Code, with respect to claims by any such 
     person, on or after October 1, 1999, for personal injury 
     (including death) resulting from the operation of an 
     emergency motor vehicle, an urban Indian organization that 
     has entered into a contract or received a grant pursuant to 
     this title is deemed to be part of the Public Health Service 
     while carrying out any such contract or grant and its 
     employees (including those acting on behalf of the 
     organization as provided for in section 2671 of title 28, 
     United States Code, and including an individual who provides 
     health care services pursuant to a personal services contract 
     with an urban Indian organization for the provision of 
     services in any facility owned, operated, or constructed 
     under the jurisdiction of the Indian Health Service) are 
     deemed employees of the Service while acting within the scope 
     of their employment in carrying out the contract or grant, 
     except that such employees shall be deemed to be acting 
     within the scope of their employment in carrying out the 
     contract or grant when they are required, by reason of their 
     employment, to perform medical, surgical, dental or related 
     functions at a facility other than a facility operated by the 
     urban Indian organization pursuant to such contract or grant, 
     but only if such employees are not compensated for the 
     performance of such functions by a person or entity other 
     than the urban Indian organization.

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

       ``(a) Construction and Operation.--The Secretary, acting 
     through the Service, shall, through grants or contracts, make 
     payment for the construction and operation of at least 2 
     residential treatment centers in each State described in 
     subsection (b) to demonstrate the provision of alcohol and 
     substance abuse treatment services to urban Indian youth in a 
     culturally competent residential setting.
       ``(b) States.--A State described in this subsection is a 
     State in which--
       ``(1) there reside urban Indian youth with a need for 
     alcohol and substance abuse treatment services in a 
     residential setting; and
       ``(2) there is a significant shortage of culturally 
     competent residential treatment services for urban Indian 
     youth.

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

       ``(a) In General.--The Secretary shall permit an urban 
     Indian organization that has entered into a contract or 
     received a grant pursuant to this title, in carrying out such 
     contract or grant, to use existing facilities and all 
     equipment therein or pertaining thereto and other personal 
     property owned by the Federal Government within the 
     Secretary's jurisdiction under such terms and conditions as 
     may be agreed upon for their use and maintenance.
       ``(b) Donation of Property.--Subject to subsection (d), the 
     Secretary may donate to an urban Indian organization that has 
     entered into a contract or received a grant pursuant to this 
     title any personal or real property determined to be excess 
     to the needs of the Service or the General Services 
     Administration for purposes of carrying out the contract or 
     grant.
       ``(c) Acquisition of Property.--The Secretary may acquire 
     excess or surplus government personal or real property for 
     donation, subject to subsection (d), to an urban Indian 
     organization that has entered into a contract or received a 
     grant pursuant to this title if the Secretary determines that 
     the property is appropriate for use by the urban Indian 
     organization for a purpose for which a contract or grant is 
     authorized under this title.
       ``(d) Priority.--In the event that the Secretary receives a 
     request for a specific item of personal or real property 
     described in subsections (b) or (c) from an urban Indian 
     organization and from an Indian tribe or tribal organization, 
     the Secretary shall give priority to the request for donation 
     to the Indian tribe or tribal organization if the Secretary 
     receives the request from the Indian tribe or tribal 
     organization before the date on which the Secretary transfers 
     title to the property or, if earlier, the date on which the 
     Secretary transfers the property physically, to the urban 
     Indian organization.
       ``(e) Relation to Federal Sources of Supply.--For purposes 
     of section 201(a) of the Federal Property and Administrative 
     Services Act of 1949 (40 U.S.C. 481(a)) (relating to Federal 
     sources of supply, including lodging providers, airlines, and 
     other transportation providers), an urban Indian organization 
     that has entered into a contract or received a grant pursuant 
     to this title shall be deemed an executive agency when 
     carrying out such contract or grant, and the employees of the 
     urban Indian organization shall be eligible to have access to 
     such sources of supply on the same basis as employees of an 
     executive agency have such access.

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

       ``(a) Authority.--The Secretary may make grants to those 
     urban Indian organizations that have entered into a contract 
     or have received a grant under this title for the provision 
     of services for the prevention, treatment, and control of the 
     complications resulting from, diabetes among urban Indians.
       ``(b) Goals.--Each grant made pursuant to subsection (a) 
     shall set forth the goals to be accomplished under the grant. 
     The goals shall be specific to each grant as agreed upon 
     between the Secretary and the grantee.
       ``(c) Criteria.--The Secretary shall establish criteria for 
     the awarding of grants made under subsection (a) relating 
     to--
       ``(1) the size and location of the urban Indian population 
     to be served;
       ``(2) the need for the prevention of, treatment of, and 
     control of the complications resulting from diabetes among 
     the urban Indian population to be served;
       ``(3) performance standards for the urban Indian 
     organization in meeting the goals set forth in such grant 
     that are negotiated and agreed to by the Secretary and the 
     grantee;
       ``(4) the capability of the urban Indian organization to 
     adequately perform the activities required under the grant; 
     and
       ``(5) the willingness of the urban Indian organization to 
     collaborate with the registry, if any, established by the 
     Secretary under section 204(e) in the area office of the 
     Service in which the organization is located.
       ``(d) Application of Criteria.--Any funds received by an 
     urban Indian organization under this Act for the prevention, 
     treatment, and control of diabetes among urban Indians shall 
     be subject to the criteria developed by the Secretary under 
     subsection (c).

     ``SEC. 519. COMMUNITY HEALTH REPRESENTATIVES.

       ``The Secretary, acting through the Service, may enter into 
     contracts with, and make grants to, urban Indian 
     organizations for the use of Indians trained as health 
     service providers through the Community Health 
     Representatives Program under section 107(b) in the provision 
     of health care, health promotion, and disease prevention 
     services to urban Indians.

     ``SEC. 520. REGULATIONS.

       ``(a) Effect of Title.--This title shall be effective on 
     the date of enactment of this Act regardless of whether the 
     Secretary has promulgated regulations implementing this 
     title.

[[Page 5493]]

       ``(b) Promulgation.--
       ``(1) In general.--The Secretary may promulgate regulations 
     to implement the provisions of this title.
       ``(2) Publication.--Proposed regulations to implement this 
     title shall be published by the Secretary in the Federal 
     Register not later than 270 days after the date of enactment 
     of this Act and shall have a comment period of not less than 
     120 days.
       ``(3) Expiration of authority.--The authority to promulgate 
     regulations under this title shall expire on the date that is 
     18 months after the date of enactment of this Act.
       ``(c) Negotiated Rulemaking Committee.--A negotiated 
     rulemaking committee shall be established pursuant to section 
     565 of title 5, United States Code, to carry out this section 
     and shall, in addition to Federal representatives, have as 
     the majority of its members representatives of urban Indian 
     organizations from each service area.
       ``(d) Adaption of Procedures.--The Secretary shall adapt 
     the negotiated rulemaking procedures to the unique context of 
     this Act.

     ``SEC. 521. AUTHORIZATION OF APPROPRIATIONS.

       ``There is authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2015 to 
     carry out this title.

                ``TITLE VI--ORGANIZATIONAL IMPROVEMENTS

     ``SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERVICE AS AN 
                   AGENCY OF THE PUBLIC HEALTH SERVICE.

       ``(a) Establishment.--
       ``(1) In general.--In order to more effectively and 
     efficiently carry out the responsibilities, authorities, and 
     functions of the United States to provide health care 
     services to Indians and Indian tribes, as are or may be 
     hereafter provided by Federal statute or treaties, there is 
     established within the Public Health Service of the 
     Department the Indian Health Service.
       ``(2) Assistant secretary of indian health.--The Service 
     shall be administered by an Assistance Secretary of Indian 
     Health, who shall be appointed by the President, by and with 
     the advice and consent of the Senate. The Assistant Secretary 
     shall report to the Secretary. Effective with respect to an 
     individual appointed by the President, by and with the advice 
     and consent of the Senate, after January 1, 1993, the term of 
     service of the Assistant Secretary shall be 4 years. An 
     Assistant Secretary may serve more than 1 term.
       ``(b) Agency.--The Service shall be an agency within the 
     Public Health Service of the Department, and shall not be an 
     office, component, or unit of any other agency of the 
     Department.
       ``(c) Functions and Duties.--The Secretary shall carry out 
     through the Assistant Secretary of the Service--
       ``(1) all functions which were, on the day before the date 
     of enactment of the Indian Health Care Amendments of 1988, 
     carried out by or under the direction of the individual 
     serving as Director of the Service on such day;
       ``(2) all functions of the Secretary relating to the 
     maintenance and operation of hospital and health facilities 
     for Indians and the planning for, and provision and 
     utilization of, health services for Indians;
       ``(3) all health programs under which health care is 
     provided to Indians based upon their status as Indians which 
     are administered by the Secretary, including programs under--
       ``(A) this Act;
       ``(B) the Act of November 2, 1921 (25 U.S.C. 13);
       ``(C) the Act of August 5, 1954 (42 U.S.C. 2001, et seq.);
       ``(D) the Act of August 16, 1957 (42 U.S.C. 2005 et seq.); 
     and
       ``(E) the Indian Self-Determination Act (25 U.S.C. 450f, et 
     seq.); and
       ``(4) all scholarship and loan functions carried out under 
     title I.
       ``(d) Authority.--
       ``(1) In general.--The Secretary, acting through the 
     Assistant Secretary, shall have the authority--
       ``(A) except to the extent provided for in paragraph (2), 
     to appoint and compensate employees for the Service in 
     accordance with title 5, United States Code;
       ``(B) to enter into contracts for the procurement of goods 
     and services to carry out the functions of the Service; and
       ``(C) to manage, expend, and obligate all funds 
     appropriated for the Service.
       ``(2) Personnel actions.--Notwithstanding any other 
     provision of law, the provisions of section 12 of the Act of 
     June 18, 1934 (48 Stat. 986; 25 U.S.C. 472), shall apply to 
     all personnel actions taken with respect to new positions 
     created within the Service as a result of its establishment 
     under subsection (a).

     ``SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM.

       ``(a) Establishment.--
       ``(1) In general.--The Secretary, in consultation with 
     tribes, tribal organizations, and urban Indian organizations, 
     shall establish an automated management information system 
     for the Service.
       ``(2) Requirements of system.--The information system 
     established under paragraph (1) shall include--
       ``(A) a financial management system;
       ``(B) a patient care information system;
       ``(C) a privacy component that protects the privacy of 
     patient information;
       ``(D) a services-based cost accounting component that 
     provides estimates of the costs associated with the provision 
     of specific medical treatments or services in each area 
     office of the Service;
       ``(E) an interface mechanism for patient billing and 
     accounts receivable system; and
       ``(F) a training component.
       ``(b) Provision of Systems to Tribes and Organizations.--
     The Secretary shall provide each Indian tribe and tribal 
     organization that provides health services under a contract 
     entered into with the Service under the Indian Self-
     Determination Act automated management information systems 
     which--
       ``(1) meet the management information needs of such Indian 
     tribe or tribal organization with respect to the treatment by 
     the Indian tribe or tribal organization of patients of the 
     Service; and
       ``(2) meet the management information needs of the Service.
       ``(c) Access to Records.--Notwithstanding any other 
     provision of law, each patient shall have reasonable access 
     to the medical or health records of such patient which are 
     held by, or on behalf of, the Service.
       ``(d) Authority To Enhance Information Technology.--The 
     Secretary, acting through the Assistant Secretary, shall have 
     the authority to enter into contracts, agreements or joint 
     ventures with other Federal agencies, States, private and 
     nonprofit organizations, for the purpose of enhancing 
     information technology in Indian health programs and 
     facilities.

     ``SEC. 603. AUTHORIZATION OF APPROPRIATIONS.

       ``There is authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2015 to 
     carry out this title.

                ``TITLE VII--BEHAVIORAL HEALTH PROGRAMS

     ``SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREATMENT 
                   SERVICES.

       ``(a) Purposes.--It is the purpose of this section to--
       ``(1) authorize and direct the Secretary, acting through 
     the Service, Indian tribes, tribal organizations, and urban 
     Indian organizations to develop a comprehensive behavioral 
     health prevention and treatment program which emphasizes 
     collaboration among alcohol and substance abuse, social 
     services, and mental health programs;
       ``(2) provide information, direction and guidance relating 
     to mental illness and dysfunction and self-destructive 
     behavior, including child abuse and family violence, to those 
     Federal, tribal, State and local agencies responsible for 
     programs in Indian communities in areas of health care, 
     education, social services, child and family welfare, alcohol 
     and substance abuse, law enforcement and judicial services;
       ``(3) assist Indian tribes to identify services and 
     resources available to address mental illness and 
     dysfunctional and self-destructive behavior;
       ``(4) provide authority and opportunities for Indian tribes 
     to develop and implement, and coordinate with, community-
     based programs which include identification, prevention, 
     education, referral, and treatment services, including 
     through multi-disciplinary resource teams;
       ``(5) ensure that Indians, as citizens of the United States 
     and of the States in which they reside, have the same access 
     to behavioral health services to which all citizens have 
     access; and
       ``(6) modify or supplement existing programs and 
     authorities in the areas identified in paragraph (2).
       ``(b) Behavioral Health Planning.--
       ``(1) Area-wide plans.--The Secretary, acting through the 
     Service, Indian tribes, tribal organizations, and urban 
     Indian organizations, shall encourage Indian tribes and 
     tribal organizations to develop tribal plans, encourage urban 
     Indian organizations to develop local plans, and encourage 
     all such groups to participate in developing area-wide plans 
     for Indian Behavioral Health Services. The plans shall, to 
     the extent feasible, include--
       ``(A) an assessment of the scope of the problem of alcohol 
     or other substance abuse, mental illness, dysfunctional and 
     self-destructive behavior, including suicide, child abuse and 
     family violence, among Indians, including--
       ``(i) the number of Indians served who are directly or 
     indirectly affected by such illness or behavior; and
       ``(ii) an estimate of the financial and human cost 
     attributable to such illness or behavior;
       ``(B) an assessment of the existing and additional 
     resources necessary for the prevention and treatment of such 
     illness and behavior, including an assessment of the progress 
     toward achieving the availability of the full continuum of 
     care described in subsection (c); and
       ``(C) an estimate of the additional funding needed by the 
     Service, Indian tribes, tribal organizations and urban Indian 
     organizations to meet their responsibilities under the plans.
       ``(2) National clearinghouse.--The Secretary shall 
     establish a national clearinghouse of plans and reports on 
     the outcomes

[[Page 5494]]

     of such plans developed under this section by Indian tribes, 
     tribal organizations and by areas relating to behavioral 
     health. The Secretary shall ensure access to such plans and 
     outcomes by any Indian tribe, tribal organization, urban 
     Indian organization or the Service.
       ``(3) Technical assistance.--The Secretary shall provide 
     technical assistance to Indian tribes, tribal organizations, 
     and urban Indian organizations in preparation of plans under 
     this section and in developing standards of care that may be 
     utilized and adopted locally.
       ``(c) Continuum of Care.--The Secretary, acting through the 
     Service, Indian tribes and tribal organizations, shall 
     provide, to the extent feasible and to the extent that 
     funding is available, for the implementation of programs 
     including--
       ``(1) a comprehensive continuum of behavioral health care 
     that provides for--
       ``(A) community based prevention, intervention, outpatient 
     and behavioral health aftercare;
       ``(B) detoxification (social and medical);
       ``(C) acute hospitalization;
       ``(D) intensive outpatient or day treatment;
       ``(E) residential treatment;
       ``(F) transitional living for those needing a temporary 
     stable living environment that is supportive of treatment or 
     recovery goals;
       ``(G) emergency shelter;
       ``(H) intensive case management;
       ``(I) traditional health care practices; and
       ``(J) diagnostic services, including the utilization of 
     neurological assessment technology; and
       ``(2) behavioral health services for particular 
     populations, including--
       ``(A) for persons from birth through age 17, child 
     behavioral health services, that include--
       ``(i) pre-school and school age fetal alcohol disorder 
     services, including assessment and behavioral intervention);
       ``(ii) mental health or substance abuse services 
     (emotional, organic, alcohol, drug, inhalant and tobacco);
       ``(iii) services for co-occurring disorders (multiple 
     diagnosis);
       ``(iv) prevention services that are focused on individuals 
     ages 5 years through 10 years (alcohol, drug, inhalant and 
     tobacco);
       ``(v) early intervention, treatment and aftercare services 
     that are focused on individuals ages 11 years through 17 
     years;
       ``(vi) healthy choices or life style services (related to 
     STD's, domestic violence, sexual abuse, suicide, teen 
     pregnancy, obesity, and other risk or safety issues);
       ``(vii) co-morbidity services;
       ``(B) for persons ages 18 years through 55 years, adult 
     behavioral health services that include--
       ``(i) early intervention, treatment and aftercare services;
       ``(ii) mental health and substance abuse services 
     (emotional, alcohol, drug, inhalant and tobacco);
       ``(iii) services for co-occurring disorders (dual 
     diagnosis) and co-morbidity;
       ``(iv) healthy choices and life style services (related to 
     parenting, partners, domestic violence, sexual abuse, 
     suicide, obesity, and other risk related behavior);
       ``(v) female specific treatment services for--

       ``(I) women at risk of giving birth to a child with a fetal 
     alcohol disorder;
       ``(II) substance abuse requiring gender specific services;
       ``(III) sexual assault and domestic violence; and
       ``(IV) healthy choices and life style (parenting, partners, 
     obesity, suicide and other related behavioral risk); and

       ``(vi) male specific treatment services for--

       ``(I) substance abuse requiring gender specific services;
       ``(II) sexual assault and domestic violence; and
       ``(III) healthy choices and life style (parenting, 
     partners, obesity, suicide and other risk related behavior);

       ``(C) family behavioral health services, including--
       ``(i) early intervention, treatment and aftercare for 
     affected families;
       ``(ii) treatment for sexual assault and domestic violence; 
     and
       ``(iii) healthy choices and life style (related to 
     parenting, partners, domestic violence and other abuse 
     issues);
       ``(D) for persons age 56 years and older, elder behavioral 
     health services including--
       ``(i) early intervention, treatment and aftercare services 
     that include--

       ``(I) mental health and substance abuse services 
     (emotional, alcohol, drug, inhalant and tobacco);
       ``(II) services for co-occurring disorders (dual diagnosis) 
     and co-morbidity; and
       ``(III) healthy choices and life style services (managing 
     conditions related to aging);

       ``(ii) elder women specific services that include--

       ``(I) treatment for substance abuse requiring gender 
     specific services and
       ``(II) treatment for sexual assault, domestic violence and 
     neglect;

       ``(iii) elder men specific services that include--

       ``(I) treatment for substance abuse requiring gender 
     specific services; and
       ``(II) treatment for sexual assault, domestic violence and 
     neglect; and

       ``(iv) services for dementia regardless of cause.
       ``(d) Community Behavioral Health Plan.--
       ``(1) In general.--The governing body of any Indian tribe 
     or tribal organization or urban Indian organization may, at 
     its discretion, adopt a resolution for the establishment of a 
     community behavioral health plan providing for the 
     identification and coordination of available resources and 
     programs to identify, prevent, or treat alcohol and other 
     substance abuse, mental illness or dysfunctional and self-
     destructive behavior, including child abuse and family 
     violence, among its members or its service population. Such 
     plan should include behavioral health services, social 
     services, intensive outpatient services, and continuing after 
     care.
       ``(2) Technical assistance.--In furtherance of a plan 
     established pursuant to paragraph (1) and at the request of a 
     tribe, the appropriate agency, service unit, or other 
     officials of the Bureau of Indian Affairs and the Service 
     shall cooperate with, and provide technical assistance to, 
     the Indian tribe or tribal organization in the development of 
     a plan under paragraph (1). Upon the establishment of such a 
     plan and at the request of the Indian tribe or tribal 
     organization, such officials shall cooperate with the Indian 
     tribe or tribal organization in the implementation of such 
     plan.
       ``(3) Funding.--The Secretary, acting through the Service, 
     may make funding available to Indian tribes and tribal 
     organizations adopting a resolution pursuant to paragraph (1) 
     to obtain technical assistance for the development of a 
     community behavioral health plan and to provide 
     administrative support in the implementation of such plan.
       ``(e) Coordinated Planning.--The Secretary, acting through 
     the Service, Indian tribes, tribal organizations, and urban 
     Indian organizations shall coordinate behavioral health 
     planning, to the extent feasible, with other Federal and 
     State agencies, to ensure that comprehensive behavioral 
     health services are available to Indians without regard to 
     their place of residence.
       ``(f) Facilities Assessment.--Not later than 1 year after 
     the date of enactment of this Act, the Secretary, acting 
     through the Service, shall make an assessment of the need for 
     inpatient mental health care among Indians and the 
     availability and cost of inpatient mental health facilities 
     which can meet such need. In making such assessment, the 
     Secretary shall consider the possible conversion of existing, 
     under-utilized service hospital beds into psychiatric units 
     to meet such need.

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

       ``(a) In General.--Not later than 1 year after the date of 
     enactment of this Act, the Secretary and the Secretary of the 
     Interior shall develop and enter into a memorandum of 
     agreement, or review and update any existing memoranda of 
     agreement as required under section 4205 of the Indian 
     Alcohol and Substance Abuse Prevention and Treatment Act of 
     1986 (25 U.S.C. 2411), and under which the Secretaries 
     address--
       ``(1) the scope and nature of mental illness and 
     dysfunctional and self-destructive behavior, including child 
     abuse and family violence, among Indians;
       ``(2) the existing Federal, tribal, State, local, and 
     private services, resources, and programs available to 
     provide mental health services for Indians;
       ``(3) the unmet need for additional services, resources, 
     and programs necessary to meet the needs identified pursuant 
     to paragraph (1);
       ``(4)(A) the right of Indians, as citizens of the United 
     States and of the States in which they reside, to have access 
     to mental health services to which all citizens have access;
       ``(B) the right of Indians to participate in, and receive 
     the benefit of, such services; and
       ``(C) the actions necessary to protect the exercise of such 
     right;
       ``(5) the responsibilities of the Bureau of Indian Affairs 
     and the Service, including mental health identification, 
     prevention, education, referral, and treatment services 
     (including services through multidisciplinary resource 
     teams), at the central, area, and agency and service unit 
     levels to address the problems identified in paragraph (1);
       ``(6) a strategy for the comprehensive coordination of the 
     mental health services provided by the Bureau of Indian 
     Affairs and the Service to meet the needs identified pursuant 
     to paragraph (1), including--
       ``(A) the coordination of alcohol and substance abuse 
     programs of the Service, the Bureau of Indian Affairs, and 
     the various Indian tribes (developed under the Indian Alcohol 
     and Substance Abuse Prevention and Treatment Act of 1986) 
     with the mental health initiatives pursuant to this Act, 
     particularly with respect to the referral and treatment of 
     dually-diagnosed individuals requiring mental health and 
     substance abuse treatment; and
       ``(B) ensuring that Bureau of Indian Affairs and Service 
     programs and services (including multidisciplinary resource 
     teams) addressing child abuse and family violence are 
     coordinated with such non-Federal programs and services;

[[Page 5495]]

       ``(7) direct appropriate officials of the Bureau of Indian 
     Affairs and the Service, particularly at the agency and 
     service unit levels, to cooperate fully with tribal requests 
     made pursuant to community behavioral health plans adopted 
     under section 701(c) and section 4206 of the Indian Alcohol 
     and Substance Abuse Prevention and Treatment Act of 1986 (25 
     U.S.C. 2412); and
       ``(8) provide for an annual review of such agreement by the 
     2 Secretaries and a report which shall be submitted to 
     Congress and made available to the Indian tribes.
       ``(b) Specific Provisions.--The memorandum of agreement 
     updated or entered into pursuant to subsection (a) shall 
     include specific provisions pursuant to which the Service 
     shall assume responsibility for--
       ``(1) the determination of the scope of the problem of 
     alcohol and substance abuse among Indian people, including 
     the number of Indians within the jurisdiction of the Service 
     who are directly or indirectly affected by alcohol and 
     substance abuse and the financial and human cost;
       ``(2) an assessment of the existing and needed resources 
     necessary for the prevention of alcohol and substance abuse 
     and the treatment of Indians affected by alcohol and 
     substance abuse; and
       ``(3) an estimate of the funding necessary to adequately 
     support a program of prevention of alcohol and substance 
     abuse and treatment of Indians affected by alcohol and 
     substance abuse.
       ``(c) Consultation.--The Secretary and the Secretary of the 
     Interior shall, in developing the memorandum of agreement 
     under subsection (a), consult with and solicit the comments 
     of--
       ``(1) Indian tribes and tribal organizations;
       ``(2) Indian individuals;
       ``(3) urban Indian organizations and other Indian 
     organizations;
       ``(4) behavioral health service providers.
       ``(d) Publication.--The memorandum of agreement under 
     subsection (a) shall be published in the Federal Register. At 
     the same time as the publication of such agreement in the 
     Federal Register, the Secretary shall provide a copy of such 
     memorandum to each Indian tribe, tribal organization, and 
     urban Indian organization.

     ``SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PREVENTION AND 
                   TREATMENT PROGRAM.

       ``(a) Establishment.--
       ``(1) In general.--The Secretary, acting through the 
     Service, Indian tribes and tribal organizations consistent 
     with section 701, shall provide a program of comprehensive 
     behavioral health prevention and treatment and aftercare, 
     including systems of care and traditional health care 
     practices, which shall include--
       ``(A) prevention, through educational intervention, in 
     Indian communities;
       ``(B) acute detoxification or psychiatric hospitalization 
     and treatment (residential and intensive outpatient);
       ``(C) community-based rehabilitation and aftercare;
       ``(D) community education and involvement, including 
     extensive training of health care, educational, and 
     community-based personnel;
       ``(E) specialized residential treatment programs for high 
     risk populations including pregnant and post partum women and 
     their children;
       ``(F) diagnostic services utilizing, when appropriate, 
     neuropsychiatric assessments which include the use of the 
     most advances technology available; and
       ``(G) a telepsychiatry program that uses experts in the 
     field of pediatric psychiatry, and that incorporates 
     assessment, diagnosis and treatment for children, including 
     those children with concurrent neurological disorders.
       ``(2) Target populations.--The target population of the 
     program under paragraph (1) shall be members of Indian 
     tribes. Efforts to train and educate key members of the 
     Indian community shall target employees of health, education, 
     judicial, law enforcement, legal, and social service 
     programs.
       ``(b) Contract Health Services.--
       ``(1) In general.--The Secretary, acting through the 
     Service (with the consent of the Indian tribe to be served), 
     Indian tribes and tribal organizations, may enter into 
     contracts with public or private providers of behavioral 
     health treatment services for the purpose of carrying out the 
     program required under subsection (a).
       ``(2) Provision of assistance.--In carrying out this 
     subsection, the Secretary shall provide assistance to Indian 
     tribes and tribal organizations to develop criteria for the 
     certification of behavioral health service providers and 
     accreditation of service facilities which meet minimum 
     standards for such services and facilities.

     ``SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM.

       ``(a) In General.--Under the authority of the Act of 
     November 2, 1921 (25 U.S.C. 13) (commonly known as the Snyder 
     Act), the Secretary shall establish and maintain a Mental 
     Health Technician program within the Service which--
       ``(1) provides for the training of Indians as mental health 
     technicians; and
       ``(2) employs such technicians in the provision of 
     community-based mental health care that includes 
     identification, prevention, education, referral, and 
     treatment services.
       ``(b) Training.--In carrying out subsection (a)(1), the 
     Secretary shall provide high standard paraprofessional 
     training in mental health care necessary to provide quality 
     care to the Indian communities to be served. Such training 
     shall be based upon a curriculum developed or approved by the 
     Secretary which combines education in the theory of mental 
     health care with supervised practical experience in the 
     provision of such care.
       ``(c) Supervision and Evaluation.--The Secretary shall 
     supervise and evaluate the mental health technicians in the 
     training program under this section.
       ``(d) Traditional Care.--The Secretary shall ensure that 
     the program established pursuant to this section involves the 
     utilization and promotion of the traditional Indian health 
     care and treatment practices of the Indian tribes to be 
     served.

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

       ``Subject to section 220, any person employed as a 
     psychologist, social worker, or marriage and family therapist 
     for the purpose of providing mental health care services to 
     Indians in a clinical setting under the authority of this Act 
     or through a funding agreement pursuant to the Indian Self-
     Determination and Education Assistance Act shall--
       ``(1) in the case of a person employed as a psychologist to 
     provide health care services, be licensed as a clinical or 
     counseling psychologist, or working under the direct 
     supervision of a clinical or counseling psychologist;
       ``(2) in the case of a person employed as a social worker, 
     be licensed as a social worker or working under the direct 
     supervision of a licensed social worker; or
       ``(3) in the case of a person employed as a marriage and 
     family therapist, be licensed as a marriage and family 
     therapist or working under the direct supervision of a 
     licensed marriage and family therapist.

     ``SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.

       ``(a) Funding.--The Secretary, consistent with section 701, 
     shall make funding available to Indian tribes, tribal 
     organizations and urban Indian organization to develop and 
     implement a comprehensive behavioral health program of 
     prevention, intervention, treatment, and relapse prevention 
     services that specifically addresses the spiritual, cultural, 
     historical, social, and child care needs of Indian women, 
     regardless of age.
       ``(b) Use of Funds.--Funding provided pursuant to this 
     section may be used to--
       ``(1) develop and provide community training, education, 
     and prevention programs for Indian women relating to 
     behavioral health issues, including fetal alcohol disorders;
       ``(2) identify and provide psychological services, 
     counseling, advocacy, support, and relapse prevention to 
     Indian women and their families; and
       ``(3) develop prevention and intervention models for Indian 
     women which incorporate traditional health care practices, 
     cultural values, and community and family involvement.
       ``(c) Criteria.--The Secretary, in consultation with Indian 
     tribes and tribal organizations, shall establish criteria for 
     the review and approval of applications and proposals for 
     funding under this section.
       ``(d) Earmark of Certain Funds.--Twenty percent of the 
     amounts appropriated to carry out this section shall be used 
     to make grants to urban Indian organizations funded under 
     title V.

     ``SEC. 707. INDIAN YOUTH PROGRAM.

       ``(a) Detoxification and Rehabilitation.--The Secretary 
     shall, consistent with section 701, develop and implement a 
     program for acute detoxification and treatment for Indian 
     youth that includes behavioral health services. The program 
     shall include regional treatment centers designed to include 
     detoxification and rehabilitation for both sexes on a 
     referral basis and programs developed and implemented by 
     Indian tribes or tribal organizations at the local level 
     under the Indian Self-Determination and Education Assistance 
     Act. Regional centers shall be integrated with the intake and 
     rehabilitation programs based in the referring Indian 
     community.
       ``(b) Alcohol and Substance Abuse Treatment Centers or 
     Facilities.--
       ``(1) Establishment.--
       ``(A) In general.--The Secretary, acting through the 
     Service, Indian tribes, or tribal organizations, shall 
     construct, renovate, or, as necessary, purchase, and 
     appropriately staff and operate, at least 1 youth regional 
     treatment center or treatment network in each area under the 
     jurisdiction of an area office.
       ``(B) Area office in california.--For purposes of this 
     subsection, the area office in California shall be considered 
     to be 2 area offices, 1 office whose jurisdiction shall be 
     considered to encompass the northern area of the State of 
     California, and 1 office whose jurisdiction shall be 
     considered to encompass the remainder of the State of 
     California for the purpose of implementing California 
     treatment networks.
       ``(2) Funding.--For the purpose of staffing and operating 
     centers or facilities under this

[[Page 5496]]

     subsection, funding shall be made available pursuant to the 
     Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the 
     Snyder Act).
       ``(3) Location.--A youth treatment center constructed or 
     purchased under this subsection shall be constructed or 
     purchased at a location within the area described in 
     paragraph (1) that is agreed upon (by appropriate tribal 
     resolution) by a majority of the tribes to be served by such 
     center.
       ``(4) Specific provision of funds.--
       ``(A) In general.--Notwithstanding any other provision of 
     this title, the Secretary may, from amounts authorized to be 
     appropriated for the purposes of carrying out this section, 
     make funds available to--
       ``(i) the Tanana Chiefs Conference, Incorporated, for the 
     purpose of leasing, constructing, renovating, operating and 
     maintaining a residential youth treatment facility in 
     Fairbanks, Alaska;
       ``(ii) the Southeast Alaska Regional Health Corporation to 
     staff and operate a residential youth treatment facility 
     without regard to the proviso set forth in section 4(l) of 
     the Indian Self-Determination and Education Assistance Act 
     (25 U.S.C. 450b(l));
       ``(iii) the Southern Indian Health Council, for the purpose 
     of staffing, operating, and maintaining a residential youth 
     treatment facility in San Diego County, California; and
       ``(iv) the Navajo Nation, for the staffing, operation, and 
     maintenance of the Four Corners Regional Adolescent Treatment 
     Center, a residential youth treatment facility in New Mexico.
       ``(B) Provision of services to eligible youth.--Until 
     additional residential youth treatment facilities are 
     established in Alaska pursuant to this section, the 
     facilities specified in subparagraph (A) shall make every 
     effort to provide services to all eligible Indian youth 
     residing in such State.
       ``(c) Intermediate Adolescent Behavioral Health Services.--
       ``(1) In general.--The Secretary, acting through the 
     Service, Indian Tribes and tribal organizations, may provide 
     intermediate behavioral health services, which may 
     incorporate traditional health care practices, to Indian 
     children and adolescents, including--
       ``(A) pre-treatment assistance;
       ``(B) inpatient, outpatient, and after-care services;
       ``(C) emergency care;
       ``(D) suicide prevention and crisis intervention; and
       ``(E) prevention and treatment of mental illness, and 
     dysfunctional and self-destructive behavior, including child 
     abuse and family violence.
       ``(2) Use of funds.--Funds provided under this subsection 
     may be used--
       ``(A) to construct or renovate an existing health facility 
     to provide intermediate behavioral health services;
       ``(B) to hire behavioral health professionals;
       ``(C) to staff, operate, and maintain an intermediate 
     mental health facility, group home, sober housing, 
     transitional housing or similar facilities, or youth shelter 
     where intermediate behavioral health services are being 
     provided; and
       ``(D) to make renovations and hire appropriate staff to 
     convert existing hospital beds into adolescent psychiatric 
     units; and
       ``(E) to provide intensive home- and community-based 
     services, including collaborative systems of care.
       ``(3) Criteria.--The Secretary shall, in consultation with 
     Indian tribes and tribal organizations, establish criteria 
     for the review and approval of applications or proposals for 
     funding made available pursuant to this subsection.
       ``(d) Federally Owned Structures.--
       ``(1) In general.--The Secretary, acting through the 
     Service, shall, in consultation with Indian tribes and tribal 
     organizations--
       ``(A) identify and use, where appropriate, federally owned 
     structures suitable for local residential or regional 
     behavioral health treatment for Indian youth; and
       ``(B) establish guidelines, in consultation with Indian 
     tribes and tribal organizations, for determining the 
     suitability of any such Federally owned structure to be used 
     for local residential or regional behavioral health treatment 
     for Indian youth.
       ``(2) Terms and conditions for use of structure.--Any 
     structure described in paragraph (1) may be used under such 
     terms and conditions as may be agreed upon by the Secretary 
     and the agency having responsibility for the structure and 
     any Indian tribe or tribal organization operating the 
     program.
       ``(e) Rehabilitation and Aftercare Services.--
       ``(1) In general.--The Secretary, an Indian tribe or tribal 
     organization, in cooperation with the Secretary of the 
     Interior, shall develop and implement within each service 
     unit, community-based rehabilitation and follow-up services 
     for Indian youth who have significant behavioral health 
     problems, and require long-term treatment, community 
     reintegration, and monitoring to support the Indian youth 
     after their return to their home community.
       ``(2) Administration.--Services under paragraph (1) shall 
     be administered within each service unit or tribal program by 
     trained staff within the community who can assist the Indian 
     youth in continuing development of self-image, positive 
     problem-solving skills, and nonalcohol or substance abusing 
     behaviors. Such staff may include alcohol and substance abuse 
     counselors, mental health professionals, and other health 
     professionals and paraprofessionals, including community 
     health representatives.
       ``(f) Inclusion of Family in Youth Treatment Program.--In 
     providing the treatment and other services to Indian youth 
     authorized by this section, the Secretary, an Indian tribe or 
     tribal organization shall provide for the inclusion of family 
     members of such youth in the treatment programs or other 
     services as may be appropriate. Not less than 10 percent of 
     the funds appropriated for the purposes of carrying out 
     subsection (e) shall be used for outpatient care of adult 
     family members related to the treatment of an Indian youth 
     under that subsection.
       ``(g) Multidrug Abuse Program.--The Secretary, acting 
     through the Service, Indian tribes, tribal organizations and 
     urban Indian organizations, shall provide, consistent with 
     section 701, programs and services to prevent and treat the 
     abuse of multiple forms of substances, including alcohol, 
     drugs, inhalants, and tobacco, among Indian youth residing in 
     Indian communities, on Indian reservations, and in urban 
     areas and provide appropriate mental health services to 
     address the incidence of mental illness among such youth.

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

       ``(a) In General.--Not later than 1 year after the date of 
     enactment of this section, the Secretary, acting through the 
     Service, Indian tribes and tribal organizations, shall 
     provide, in each area of the Service, not less than 1 
     inpatient mental health care facility, or the equivalent, for 
     Indians with behavioral health problems.
       ``(b) Treatment of California.--For purposes of this 
     section, California shall be considered to be 2 areas of the 
     Service, 1 area whose location shall be considered to 
     encompass the northern area of the State of California and 1 
     area whose jurisdiction shall be considered to encompass the 
     remainder of the State of California.
       ``(c) Conversion of Certain Hospital Beds.--The Secretary 
     shall consider the possible conversion of existing, under-
     utilized Service hospital beds into psychiatric units to meet 
     needs under this section.

     ``SEC. 709. TRAINING AND COMMUNITY EDUCATION.

       ``(a) Community Education.--
       ``(1) In general.--The Secretary, in cooperation with the 
     Secretary of the Interior, shall develop and implement, or 
     provide funding to enable Indian tribes and tribal 
     organization to develop and implement, within each service 
     unit or tribal program a program of community education and 
     involvement which shall be designed to provide concise and 
     timely information to the community leadership of each tribal 
     community.
       ``(2) Education.--A program under paragraph (1) shall 
     include education concerning behavioral health for political 
     leaders, tribal judges, law enforcement personnel, members of 
     tribal health and education boards, and other critical 
     members of each tribal community.
       ``(3) Training.--Community-based training (oriented toward 
     local capacity development) under a program under paragraph 
     (1) shall include tribal community provider training 
     (designed for adult learners from the communities receiving 
     services for prevention, intervention, treatment and 
     aftercare).
       ``(b) Training.--The Secretary shall, either directly or 
     through Indian tribes or tribal organization, provide 
     instruction in the area of behavioral health issues, 
     including instruction in crisis intervention and family 
     relations in the context of alcohol and substance abuse, 
     child sexual abuse, youth alcohol and substance abuse, and 
     the causes and effects of fetal alcohol disorders, to 
     appropriate employees of the Bureau of Indian Affairs and the 
     Service, and to personnel in schools or programs operated 
     under any contract with the Bureau of Indian Affairs or the 
     Service, including supervisors of emergency shelters and 
     halfway houses described in section 4213 of the Indian 
     Alcohol and Substance Abuse Prevention and Treatment Act of 
     1986 (25 U.S.C. 2433).
       ``(c) Community-Based Training Models.--In carrying out the 
     education and training programs required by this section, the 
     Secretary, acting through the Service and in consultation 
     with Indian tribes, tribal organizations, Indian behavioral 
     health experts, and Indian alcohol and substance abuse 
     prevention experts, shall develop and provide community-based 
     training models. Such models shall address--
       ``(1) the elevated risk of alcohol and behavioral health 
     problems faced by children of alcoholics;
       ``(2) the cultural, spiritual, and multigenerational 
     aspects of behavioral health problem prevention and recovery; 
     and
       ``(3) community-based and multidisciplinary strategies for 
     preventing and treating behavioral health problems.

     ``SEC. 710. BEHAVIORAL HEALTH PROGRAM.

       ``(a) Programs for Innovative Services.--The Secretary, 
     acting through the Service,

[[Page 5497]]

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

     ``SEC. 711. FETAL ALCOHOL DISORDER FUNDING.

       ``(a) Establishment of Program.--
       ``(1) In general.--The Secretary, consistent with Section 
     701, acting through Indian tribes, tribal organizations, and 
     urban Indian organizations, shall establish and operate fetal 
     alcohol disorders programs as provided for in this section 
     for the purposes of meeting the health status objective 
     specified in section 3(b).
       ``(2) Use of funds.--Funding provided pursuant to this 
     section shall be used to--
       ``(A) develop and provide community and in-school training, 
     education, and prevention programs relating to fetal alcohol 
     disorders;
       ``(B) identify and provide behavioral health treatment to 
     high-risk women;
       ``(C) identify and provide appropriate educational and 
     vocational support, counseling, advocacy, and information to 
     fetal alcohol disorder affected persons and their families or 
     caretakers;
       ``(D) develop and implement counseling and support programs 
     in schools for fetal alcohol disorder affected children;
       ``(E) develop prevention and intervention models which 
     incorporate traditional practitioners, cultural and spiritual 
     values and community involvement;
       ``(F) develop, print, and disseminate education and 
     prevention materials on fetal alcohol disorders;
       ``(G) develop and implement, through the tribal 
     consultation process, culturally sensitive assessment and 
     diagnostic tools including dysmorphology clinics and 
     multidisciplinary fetal alcohol disorder clinics for use in 
     tribal and urban Indian communities;
       ``(H) develop early childhood intervention projects from 
     birth on to mitigate the effects of fetal alcohol disorders; 
     and
       ``(I) develop and fund community-based adult fetal alcohol 
     disorder housing and support services.
       ``(3) Criteria.--The Secretary shall establish criteria for 
     the review and approval of applications for funding under 
     this section.
       ``(b) Provision of Services.--The Secretary, acting through 
     the Service, Indian tribes, tribal organizations and urban 
     Indian organizations, shall--
       ``(1) develop and provide services for the prevention, 
     intervention, treatment, and aftercare for those affected by 
     fetal alcohol disorders in Indian communities; and
       ``(2) provide supportive services, directly or through an 
     Indian tribe, tribal organization or urban Indian 
     organization, including services to meet the special 
     educational, vocational, school-to-work transition, and 
     independent living needs of adolescent and adult Indians with 
     fetal alcohol disorders.
       ``(c) Task Force.--
       ``(1) In general.--The Secretary shall establish a task 
     force to be known as the Fetal Alcohol Disorders Task Force 
     to advise the Secretary in carrying out subsection (b).
       ``(2) Composition.--The task force under paragraph (1) 
     shall be composed of representatives from the National 
     Institute on Drug Abuse, the National Institute on Alcohol 
     and Alcoholism, the Office of Substance Abuse Prevention, the 
     National Institute of Mental Health, the Service, the Office 
     of Minority Health of the Department of Health and Human 
     Services, the Administration for Native Americans, the 
     National Institute of Child Health & Human Development, the 
     Centers for Disease Control and Prevention, the Bureau of 
     Indian Affairs, Indian tribes, tribal organizations, urban 
     Indian communities, and Indian fetal alcohol disorders 
     experts.
       ``(d) Applied Research.--The Secretary, acting through the 
     Substance Abuse and Mental Health Services Administration, 
     shall make funding available to Indian Tribes, tribal 
     organizations and urban Indian organizations for applied 
     research projects which propose to elevate the understanding 
     of methods to prevent, intervene, treat, or provide 
     rehabilitation and behavioral health aftercare for Indians 
     and urban Indians affected by fetal alcohol disorders.
       ``(e) Urban Indian Organizations.--The Secretary shall 
     ensure that 10 percent of the amounts appropriated to carry 
     out this section shall be used to make grants to urban Indian 
     organizations funded under title V.

     ``SEC. 712. CHILD SEXUAL ABUSE AND PREVENTION TREATMENT 
                   PROGRAMS.

       ``(a) Establishment.--The Secretary and the Secretary of 
     the Interior, acting through the Service, Indian tribes and 
     tribal organizations, shall establish, consistent with 
     section 701, in each service area, programs involving 
     treatment for--
       ``(1) victims of child sexual abuse; and
       ``(2) perpetrators of child sexual abuse.
       ``(b) Use of Funds.--Funds provided under this section 
     shall be used to--
       ``(1) develop and provide community education and 
     prevention programs related to child sexual abuse;
       ``(2) identify and provide behavioral health treatment to 
     children who are victims of sexual abuse and to their 
     families who are affected by sexual abuse;
       ``(3) develop prevention and intervention models which 
     incorporate traditional health care practitioners, cultural 
     and spiritual values, and community involvement;
       ``(4) develop and implement, though the tribal consultation 
     process, culturally sensitive assessment and diagnostic tools 
     for use in tribal and urban Indian communities.
       ``(5) identify and provide behavioral health treatment to 
     perpetrators of child sexual abuse with efforts being made to 
     begin offender and behavioral health treatment while the 
     perpetrator is incarcerated or at the earliest possible date 
     if the perpetrator is not incarcerated, and to provide 
     treatment after release to the community until it is 
     determined that the perpetrator is not a threat to children.

     ``SEC. 713. BEHAVIORAL MENTAL HEALTH RESEARCH.

       ``(a) In General.--The Secretary, acting through the 
     Service and in consultation with appropriate Federal 
     agencies, shall provide funding to Indian Tribes, tribal 
     organizations and urban Indian organizations or, enter into 
     contracts with, or make grants to appropriate institutions, 
     for the conduct of research on the incidence and prevalence 
     of behavioral health problems among Indians served by the 
     Service, Indian Tribes or tribal organizations and among 
     Indians in urban areas. Research priorities under this 
     section shall include--
       ``(1) the inter-relationship and inter-dependence of 
     behavioral health problems with alcoholism and other 
     substance abuse, suicide, homicides, other injuries, and the 
     incidence of family violence; and
       ``(2) the development of models of prevention techniques.
       ``(b) Special Emphasis.--The effect of the inter-
     relationships and interdependencies referred to in subsection 
     (a)(1) on children, and the development of prevention 
     techniques under subsection (a)(2) applicable to children, 
     shall be emphasized.

     ``SEC. 714. DEFINITIONS.

       ``In this title:
       ``(1) Assessment.--The term `assessment' means the 
     systematic collection, analysis and dissemination of 
     information on health status, health needs and health 
     problems.
       ``(2) Alcohol related neurodevelop-
     mental disorders.--The term `alcohol related 
     neurodevelopmental disorders' or `ARND' with respect to an 
     individual means the individual has a history of maternal 
     alcohol consumption during pregnancy, central nervous system 
     involvement such as developmental delay, intellectual 
     deficit, or neurologic abnormalities, that behaviorally, 
     there may be problems with irritability, and failure to 
     thrive as infants, and that as children become older there 
     will likely be hyperactivity, attention deficit, language 
     dysfunction and perceptual and judgment problems.
       ``(3) Behavioral health.--The term `behavioral health' 
     means the blending of substances (alcohol, drugs, inhalants 
     and tobacco) abuse and mental health prevention and 
     treatment, for the purpose of providing comprehensive 
     services. Such term includes the joint development of 
     substance abuse and mental health treatment planning and 
     coordinated case management using a multidisciplinary 
     approach.
       ``(4) Behavioral health aftercare.--
       ``(A) In general.--The term `behavioral health aftercare' 
     includes those activities and resources used to support 
     recovery following inpatient, residential, intensive 
     substance abuse or mental health outpatient or outpatient 
     treatment, to help prevent or treat relapse, including the 
     development of an aftercare plan.
       ``(B) Aftercare plan.--Prior to the time at which an 
     individual is discharged from a level of care, such as 
     outpatient treatment, an aftercare plan shall have been 
     developed for the individual. Such plan may use such 
     resources as community base therapeutic group care, 
     transitional living, a 12-step sponsor, a local 12-step or 
     other related support group, or other community based 
     providers (such as mental health professionals, traditional 
     health care practitioners, community health aides, community 
     health representatives, mental health technicians, or 
     ministers).

[[Page 5498]]

       ``(5) Dual diagnosis.--The term `dual diagnosis' means 
     coexisting substance abuse and mental illness conditions or 
     diagnosis. In individual with a dual diagnosis may be 
     referred to as a mentally ill chemical abuser.
       ``(6) Fetal alcohol disorders.--The term `fetal alcohol 
     disorders' means fetal alcohol syndrome, partial fetal 
     alcohol syndrome, or alcohol related neural developmental 
     disorder.
       ``(7) Fetal alcohol syndrome.--The term `fetal alcohol 
     syndrome' or `FAS' with respect to an individual means a 
     syndrome in which the individual has a history of maternal 
     alcohol consumption during pregnancy, and with respect to 
     which the following criteria should be met:
       ``(A) Central nervous system involvement such as 
     developmental delay, intellectual deficit, microencephaly, or 
     neurologic abnormalities.
       ``(B) Craniofacial abnormalities with at least 2 of the 
     following: microphthalmia, short palpebral fissures, poorly 
     developed philtrum, thin upper lip, flat nasal bridge, and 
     short upturned nose.
       ``(C) Prenatal or postnatal growth delay.
       ``(8) Partial fas.--The term `partial FAS' with respect to 
     an individual means a history of maternal alcohol consumption 
     during pregnancy having most of the criteria of FAS, though 
     not meeting a minimum of at least 2 of the following: micro-
     ophthalmia, short palpebral fissures, poorly developed 
     philtrum, thin upper lip, flat nasal bridge, short upturned 
     nose.
       ``(9) Rehabilitation.--The term `rehabilitation' means to 
     restore the ability or capacity to engage in usual and 
     customary life activities through education and therapy.-
       ``(10) Substance abuse.--The term `substance abuse' 
     includes inhalant abuse.

     ``SEC. 715. AUTHORIZATION OF APPROPRIATIONS.

       ``There is authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2015 to 
     carry out this title.

                      ``TITLE VIII--MISCELLANEOUS

     ``SEC. 801. REPORTS.

       ``The President shall, at the time the budget is submitted 
     under section 1105 of title 31, United States Code, for each 
     fiscal year transmit to the Congress a report containing--
       ``(1) a report on the progress made in meeting the 
     objectives of this Act, including a review of programs 
     established or assisted pursuant to this Act and an 
     assessment and recommendations of additional programs or 
     additional assistance necessary to, at a minimum, provide 
     health services to Indians, and ensure a health status for 
     Indians, which are at a parity with the health services 
     available to and the health status of, the general 
     population, including specific comparisons of appropriations 
     provided and those required for such parity;
       ``(2) a report on whether, and to what extent, new national 
     health care programs, benefits, initiatives, or financing 
     systems have had an impact on the purposes of this Act and 
     any steps that the Secretary may have taken to consult with 
     Indian tribes to address such impact, including a report on 
     proposed changes in the allocation of funding pursuant to 
     section 808;
       ``(3) a report on the use of health services by Indians--
       ``(A) on a national and area or other relevant geographical 
     basis;
       ``(B) by gender and age;
       ``(C) by source of payment and type of service;
       ``(D) comparing such rates of use with rates of use among 
     comparable non-Indian populations; and
       ``(E) on the services provided under funding agreements 
     pursuant to the Indian Self-Determination and Education 
     Assistance Act;
       ``(4) a report of contractors concerning health care 
     educational loan repayments under section 110;
       ``(5) a general audit report on the health care educational 
     loan repayment program as required under section 110(n);
       ``(6) a separate statement that specifies the amount of 
     funds requested to carry out the provisions of section 201;
       ``(7) a report on infectious diseases as required under 
     section 212;
       ``(8) a report on environmental and nuclear health hazards 
     as required under section 214;
       ``(9) a report on the status of all health care facilities 
     needs as required under sections 301(c)(2) and 301(d);
       ``(10) a report on safe water and sanitary waste disposal 
     facilities as required under section 302(h)(1);
       ``(11) a report on the expenditure of non-service funds for 
     renovation as required under sections 305(a)(2) and 
     305(a)(3);
       ``(12) a report identifying the backlog of maintenance and 
     repair required at Service and tribal facilities as required 
     under section 314(a);
       ``(13) a report providing an accounting of reimbursement 
     funds made available to the Secretary under titles XVIII and 
     XIX of the Social Security Act as required under section 
     403(a);
       ``(14) a report on services sharing of the Service, the 
     Department of Veteran's Affairs, and other Federal agency 
     health programs as required under section 412(c)(2);
       ``(15) a report on the evaluation and renewal of urban 
     Indian programs as required under section 505;
       ``(16) a report on the findings and conclusions derived 
     from the demonstration project as required under section 
     512(a)(2);
       ``(17) a report on the evaluation of programs as required 
     under section 513; and
       ``(18) a report on alcohol and substance abuse as required 
     under section 701(f).

     ``SEC. 802. REGULATIONS.

       ``(a) Initiation of Rulemaking Procedures.--
       ``(1) In general.--Not later than 90 days after the date of 
     enactment of this Act, the Secretary shall initiate 
     procedures under subchapter III of chapter 5 of title 5, 
     United States Code, to negotiate and promulgate such 
     regulations or amendments thereto that are necessary to carry 
     out this Act.
       ``(2) Publication.--Proposed regulations to implement this 
     Act shall be published in the Federal Register by the 
     Secretary not later than 270 days after the date of enactment 
     of this Act and shall have not less than a 120 day comment 
     period.
       ``(3) Expiration of authority.--The authority to promulgate 
     regulations under this Act shall expire 18 months from the 
     date of enactment of this Act.
       ``(b) Rulemaking Committee.--A negotiated rulemaking 
     committee established pursuant to section 565 of Title 5, 
     United States Code, to carry out this section shall have as 
     its members only representatives of the Federal Government 
     and representatives of Indian tribes, and tribal 
     organizations, a majority of whom shall be nominated by and 
     be representatives of Indian tribes, tribal organizations, 
     and urban Indian organizations from each service area.
       ``(c) Adaption of Procedures.--The Secretary shall adapt 
     the negotiated rulemaking procedures to the unique context of 
     self-governance and the government-to-government relationship 
     between the United States and Indian Tribes.
       ``(d) Failure To Promulgate Regulations.--The lack of 
     promulgated regulations shall not limit the effect of this 
     Act.
       ``(e) Supremacy of Provisions.--The provisions of this Act 
     shall supersede any conflicting provisions of law (including 
     any conflicting regulations) in effect on the day before the 
     date of enactment of the Indian Self-Determination Contract 
     Reform Act of 1994, and the Secretary is authorized to repeal 
     any regulation that is inconsistent with the provisions of 
     this Act.

     ``SEC. 803. PLAN OF IMPLEMENTATION.

       ``Not later than 240 days after the date of enactment of 
     this Act, the Secretary, in consultation with Indian tribes, 
     tribal organizations, and urban Indian organizations, shall 
     prepare and submit to Congress a plan that shall explain the 
     manner and schedule (including a schedule of appropriate 
     requests), by title and section, by which the Secretary will 
     implement the provisions of this Act.

     ``SEC. 804. AVAILABILITY OF FUNDS.

       ``Amounts appropriated under this Act shall remain 
     available until expended.

     ``SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED TO THE 
                   INDIAN HEALTH SERVICE.

       ``Any limitation on the use of funds contained in an Act 
     providing appropriations for the Department for a period with 
     respect to the performance of abortions shall apply for that 
     period with respect to the performance of abortions using 
     funds contained in an Act providing appropriations for the 
     Service.

     ``SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS.

       ``(a) Eligibility.--
       ``(1) In general.--Until such time as any subsequent law 
     may otherwise provide, the following California Indians shall 
     be eligible for health services provided by the Service:
       ``(1) Any member of a Federally recognized Indian tribe.
       ``(2) Any descendant of an Indian who was residing in 
     California on June 1, 1852, but only if such descendant--
       ``(A) is a member of the Indian community served by a local 
     program of the Service; and
       ``(B) is regarded as an Indian by the community in which 
     such descendant lives.
       ``(3) Any Indian who holds trust interests in public 
     domain, national forest, or Indian reservation allotments in 
     California.
       ``(4) Any Indian in California who is listed on the plans 
     for distribution of the assets of California rancherias and 
     reservations under the Act of August 18, 1958 (72 Stat. 619), 
     and any descendant of such an Indian.
       ``(b) Rule of Construction.--Nothing in this section may be 
     construed as expanding the eligibility of California Indians 
     for health services provided by the Service beyond the scope 
     of eligibility for such health services that applied on May 
     1, 1986.

     ``SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS.

       ``(a) Ineligible Persons.--
       ``(1) In general.--Any individual who--
       ``(A) has not attained 19 years of age;
       ``(B) is the natural or adopted child, step-child, foster-
     child, legal ward, or orphan of an eligible Indian; and
       ``(C) is not otherwise eligible for the health services 
     provided by the Service,
     shall be eligible for all health services provided by the 
     Service on the same basis and subject to the same rules that 
     apply to eligible Indians until such individual attains 19 
     years of age. The existing and potential health needs of all 
     such individuals shall be

[[Page 5499]]

     taken into consideration by the Service in determining the 
     need for, or the allocation of, the health resources of the 
     Service. If such an individual has been determined to be 
     legally incompetent prior to attaining 19 years of age, such 
     individual shall remain eligible for such services until one 
     year after the date such disability has been removed.
       ``(2) Spouses.--Any spouse of an eligible Indian who is not 
     an Indian, or who is of Indian descent but not otherwise 
     eligible for the health services provided by the Service, 
     shall be eligible for such health services if all of such 
     spouses or spouses who are married to members of the Indian 
     tribe being served are made eligible, as a class, by an 
     appropriate resolution of the governing body of the Indian 
     tribe or tribal organization providing such services. The 
     health needs of persons made eligible under this paragraph 
     shall not be taken into consideration by the Service in 
     determining the need for, or allocation of, its health 
     resources.
       ``(b) Programs and Services.--
       ``(1) Programs.--
       ``(A) In general.--The Secretary may provide health 
     services under this subsection through health programs 
     operated directly by the Service to individuals who reside 
     within the service area of a service unit and who are not 
     eligible for such health services under any other subsection 
     of this section or under any other provision of law if--
       ``(i) the Indian tribe (or, in the case of a multi-tribal 
     service area, all the Indian tribes) served by such service 
     unit requests such provision of health services to such 
     individuals; and
       ``(ii) the Secretary and the Indian tribe or tribes have 
     jointly determined that--

       ``(I) the provision of such health services will not result 
     in a denial or diminution of health services to eligible 
     Indians; and

       ``(II) there is no reasonable alternative health program or 
     services, within or without the service area of such service 
     unit, available to meet the health needs of such individuals.

       ``(B) Funding agreements.--In the case of health programs 
     operated under a funding agreement entered into under the 
     Indian Self-Determination and Educational Assistance Act, the 
     governing body of the Indian tribe or tribal organization 
     providing health services under such funding agreement is 
     authorized to determine whether health services should be 
     provided under such funding agreement to individuals who are 
     not eligible for such health services under any other 
     subsection of this section or under any other provision of 
     law. In making such determinations, the governing body of the 
     Indian tribe or tribal organization shall take into account 
     the considerations described in subparagraph (A)(ii).
       ``(2) Liability for payment.--
       ``(A) In general.--Persons receiving health services 
     provided by the Service by reason of this subsection shall be 
     liable for payment of such health services under a schedule 
     of charges prescribed by the Secretary which, in the judgment 
     of the Secretary, results in reimbursement in an amount not 
     less than the actual cost of providing the health services. 
     Notwithstanding section 1880 of the Social Security Act, 
     section 402(a) of this Act, or any other provision of law, 
     amounts collected under this subsection, including medicare 
     or medicaid reimbursements under titles XVIII and XIX of the 
     Social Security Act, shall be credited to the account of the 
     program providing the service and shall be used solely for 
     the provision of health services within that program. Amounts 
     collected under this subsection shall be available for 
     expenditure within such program for not to exceed 1 fiscal 
     year after the fiscal year in which collected.
       ``(B) Services for indigent persons.--Health services may 
     be provided by the Secretary through the Service under this 
     subsection to an indigent person who would not be eligible 
     for such health services but for the provisions of paragraph 
     (1) only if an agreement has been entered into with a State 
     or local government under which the State or local government 
     agrees to reimburse the Service for the expenses incurred by 
     the Service in providing such health services to such 
     indigent person.
       ``(3) Service areas.--
       ``(A) Service to only one tribe.--In the case of a service 
     area which serves only one Indian tribe, the authority of the 
     Secretary to provide health services under paragraph (1)(A) 
     shall terminate at the end of the fiscal year succeeding the 
     fiscal year in which the governing body of the Indian tribe 
     revokes its concurrence to the provision of such health 
     services.
       ``(B) Multi-tribal areas.--In the case of a multi-tribal 
     service area, the authority of the Secretary to provide 
     health services under paragraph (1)(A) shall terminate at the 
     end of the fiscal year succeeding the fiscal year in which at 
     least 51 percent of the number of Indian tribes in the 
     service area revoke their concurrence to the provision of 
     such health services.
       ``(c) Purpose for Providing Services.--The Service may 
     provide health services under this subsection to individuals 
     who are not eligible for health services provided by the 
     Service under any other subsection of this section or under 
     any other provision of law in order to--
       ``(1) achieve stability in a medical emergency;
       ``(2) prevent the spread of a communicable disease or 
     otherwise deal with a public health hazard;
       ``(3) provide care to non-Indian women pregnant with an 
     eligible Indian's child for the duration of the pregnancy 
     through post partum; or
       ``(4) provide care to immediate family members of an 
     eligible person if such care is directly related to the 
     treatment of the eligible person.
       ``(d) Hospital Privileges.--Hospital privileges in health 
     facilities operated and maintained by the Service or operated 
     under a contract entered into under the Indian Self-
     Determination Education Assistance Act may be extended to 
     non-Service health care practitioners who provide services to 
     persons described in subsection (a) or (b). Such non-Service 
     health care practitioners may be regarded as employees of the 
     Federal Government for purposes of section 1346(b) and 
     chapter 171 of title 28, United States Code (relating to 
     Federal tort claims) only with respect to acts or omissions 
     which occur in the course of providing services to eligible 
     persons as a part of the conditions under which such hospital 
     privileges are extended.
       ``(e) Definition.--In this section, the term `eligible 
     Indian' means any Indian who is eligible for health services 
     provided by the Service without regard to the provisions of 
     this section.

     ``SEC. 808. REALLOCATION OF BASE RESOURCES.

       ``(a) Requirement of Report.--Notwithstanding any other 
     provision of law, any allocation of Service funds for a 
     fiscal year that reduces by 5 percent or more from the 
     previous fiscal year the funding for any recurring program, 
     project, or activity of a service unit may be implemented 
     only after the Secretary has submitted to the President, for 
     inclusion in the report required to be transmitted to the 
     Congress under section 801, a report on the proposed change 
     in allocation of funding, including the reasons for the 
     change and its likely effects.
       ``(b) Nonapplication of Section.--Subsection (a) shall not 
     apply if the total amount appropriated to the Service for a 
     fiscal year is less than the amount appropriated to the 
     Service for previous fiscal year.

     ``SEC. 809. RESULTS OF DEMONSTRATION PROJECTS.

       ``The Secretary shall provide for the dissemination to 
     Indian tribes of the findings and results of demonstration 
     projects conducted under this Act.

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

       ``(a) In General.--The Secretary, acting through the 
     Service, shall provide services and benefits for Indians in 
     Montana in a manner consistent with the decision of the 
     United States Court of Appeals for the Ninth Circuit in 
     McNabb for McNabb v. Bowen, 829 F.2d 787 (9th Cr. 1987).
       ``(b) Rule of Construction.--The provisions of subsection 
     (a) shall not be construed to be an expression of the sense 
     of the Congress on the application of the decision described 
     in subsection (a) with respect to the provision of services 
     or benefits for Indians living in any State other than 
     Montana.

     ``SEC. 811. MORATORIUM.

       ``During the period of the moratorium imposed by Public Law 
     100-446 on implementation of the final rule published in the 
     Federal Register on September 16, 1987, by the Health 
     Resources and Services Administration, relating to 
     eligibility for the health care services of the Service, the 
     Service shall provide services pursuant to the criteria for 
     eligibility for such services that were in effect on 
     September 15, 1987, subject to the provisions of sections 806 
     and 807 until such time as new criteria governing eligibility 
     for services are developed in accordance with section 802.

     ``SEC. 812. TRIBAL EMPLOYMENT.

       ``For purposes of section 2(2) of the Act of July 5, 1935 
     (49 Stat. 450, Chapter 372), an Indian tribe or tribal 
     organization carrying out a funding agreement under the Self-
     Determination and Education Assistance Act shall not be 
     considered an employer.

     ``SEC. 813. PRIME VENDOR.

       ``For purposes of section 4 of Public Law 102-585 (38 
     U.S.C. 812) Indian tribes and tribal organizations carrying 
     out a grant, cooperative agreement, or funding agreement 
     under the Indian Self-Determination and Education Assistance 
     Act (25 U.S.C. 450 et seq.) shall be deemed to be an 
     executive agency and part of the Service and, as such, may 
     act as an ordering agent of the Service and the employees of 
     the tribe or tribal organization may order supplies on behalf 
     thereof on the same basis as employees of the Service.

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

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

[[Page 5500]]

       ``(C) two members shall be from the Senate and shall be 
     appointed by the majority leader; and
       ``(D) two members shall be from the Senate and shall be 
     appointed by the minority leader;

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

     All those persons appointed under paragraphs (2) and (3) 
     shall be members of Federally recognized Indian Tribes.
       ``(c) Terms.--
       ``(1) In general.--Members of the Commission shall serve 
     for the life of the Commission.
       ``(2) Appointment of members.--Members of the Commission 
     shall be appointed under subsection (b)(1) not later than 90 
     days after the date of enactment of this Act, and the 
     remaining members of the Commission shall be appointed not 
     later than 60 days after the date on which the members are 
     appointed under such subsection.
       ``(3) Vacancy.--A vacancy in the membership of the 
     Commission shall be filled in the manner in which the 
     original appointment was made.
       ``(d) Duties of the Commission.--The Commission shall carry 
     out the following duties and functions:
       ``(1) Review and analyze the recommendations of the report 
     of the study committee established under paragraph (3) to the 
     Commission.
       ``(2) Make recommendations to Congress for providing health 
     services for Indian persons as an entitlement, giving due 
     regard to the effects of such a programs on existing health 
     care delivery systems for Indian persons and the effect of 
     such programs on the sovereign status of Indian Tribes;
       ``(3) Establish a study committee to be composed of those 
     members of the Commission appointed by the Director of the 
     Service and at least 4 additional members of Congress from 
     among the members of the Commission which shall--
       ``(A) to the extent necessary to carry out its duties, 
     collect and compile data necessary to understand the extent 
     of Indian needs with regard to the provision of health 
     services, regardless of the location of Indians, including 
     holding hearings and soliciting the views of Indians, Indian 
     tribes, tribal organizations and urban Indian organizations, 
     and which may include authorizing and funding feasibility 
     studies of various models for providing and funding health 
     services for all Indian beneficiaries including those who 
     live outside of a reservation, temporarily or permanently;
       ``(B) make recommendations to the Commission for 
     legislation that will provide for the delivery of health 
     services for Indians as an entitlement, which shall, at a 
     minimum, address issues of eligibility, benefits to be 
     provided, including recommendations regarding from whom such 
     health services are to be provided, and the cost, including 
     mechanisms for funding of the health services to be provided;
       ``(C) determine the effect of the enactment of such 
     recommendations on the existing system of the delivery of 
     health services for Indians;
       ``(D) determine the effect of a health services entitlement 
     program for Indian persons on the sovereign status of Indian 
     tribes;
       ``(E) not later than 12 months after the appointment of all 
     members of the Commission, make a written report of its 
     findings and recommendations to the Commission, which report 
     shall include a statement of the minority and majority 
     position of the committee and which shall be disseminated, at 
     a minimum, to each Federally recognized Indian tribe, tribal 
     organization and urban Indian organization for comment to the 
     Commission; and
       ``(F) report regularly to the full Commission regarding the 
     findings and recommendations developed by the committee in 
     the course of carrying out its duties under this section.
       ``(4) Not later than 18 months after the date of 
     appointment of all members of the Commission, submit a 
     written report to Congress containing a recommendation of 
     policies and legislation to implement a policy that would 
     establish a health care system for Indians based on the 
     delivery of health services as an entitlement, together with 
     a determination of the implications of such an entitlement 
     system on existing health care delivery systems for Indians 
     and on the sovereign status of Indian tribes.
       ``(e) Administrative Provisions.--
       ``(1) Compensation and expenses.--
       ``(A) Congressional members.--Each member of the Commission 
     appointed under subsection (b)(1) shall receive no additional 
     pay, allowances, or benefits by reason of their service on 
     the Commission and shall receive travel expenses and per diem 
     in lieu of subsistence in accordance with sections 5702 and 
     5703 of title 5, United States Code.
       ``(B) Other members.--The members of the Commission 
     appointed under paragraphs (2) and (3) of subsection (b), 
     while serving on the business of the Commission (including 
     travel time) shall be entitled to receive compensation at the 
     per diem equivalent of the rate provided for level IV of the 
     Executive Schedule under section 5315 of title 5, United 
     States Code, and while so serving away from home and the 
     member's regular place of business, be allowed travel 
     expenses, as authorized by the chairperson of the Commission. 
     For purposes of pay (other than pay of members of the 
     Commission) and employment benefits, rights, and privileges, 
     all personnel of the Commission shall be treated as if they 
     were employees of the United States Senate.
       ``(2) Meetings and quorum.--
       ``(A) Meetings.--The Commission shall meet at the call of 
     the chairperson.
       ``(B) Quorum.--A quorum of the Commission shall consist of 
     not less than 15 members, of which not less than 6 of such 
     members shall be appointees under subsection (b)(1) and not 
     less than 9 of such members shall be Indians.
       ``(3) Director and staff.--
       ``(A) Executive director.--The members of the Commission 
     shall appoint an executive director of the Commission. The 
     executive director shall be paid the rate of basic pay equal 
     to that for level V of the Executive Schedule.
       ``(B) Staff.--With the approval of the Commission, the 
     executive director may appoint such personnel as the 
     executive director deems appropriate.
       ``(C) Applicability of civil service laws.--The staff of 
     the Commission shall be appointed without regard to the 
     provisions of title 5, United States Code, governing 
     appointments in the competitive service, and shall be paid 
     without regard to the provisions of chapter 51 and subchapter 
     III of chapter 53 of such title (relating to classification 
     and General Schedule pay rates).
       ``(D) Experts and consultants.--With the approval of the 
     Commission, the executive director may procure temporary and 
     intermittent services under section 3109(b) of title 5, 
     United States Code.
       ``(E) Facilities.--The Administrator of the General 
     Services Administration shall locate suitable office space 
     for the operation of the Commission. The facilities shall 
     serve as the headquarters of the Commission and shall include 
     all necessary equipment and incidentals required for the 
     proper functioning of the Commission.
       ``(f) Powers.--
       ``(1) Hearings and other activities.--For the purpose of 
     carrying out its duties, the Commission may hold such 
     hearings and undertake such other activities as the 
     Commission determines to be necessary to carry out its 
     duties, except that at least 6 regional hearings shall be 
     held in different areas of the United States in which large 
     numbers of Indians are present. Such hearings shall be held 
     to solicit the views of Indians regarding the delivery of 
     health care services to them. To constitute a hearing under 
     this paragraph, at least 5 members of the Commission, 
     including at least 1 member of Congress, must be present. 
     Hearings held by the study committee established under this 
     section may be counted towards the number of regional 
     hearings required by this paragraph.
       ``(2) Studies by gao.--Upon request of the Commission, the 
     Comptroller General shall conduct such studies or 
     investigations as the Commission determines to be necessary 
     to carry out its duties.
       ``(3) Cost estimates.--
       ``(A) In general.--The Director of the Congressional Budget 
     Office or the Chief Actuary of the Health Care Financing 
     Administration, or both, shall provide to the Commission, 
     upon the request of the Commission, such cost estimates as 
     the Commission determines to be necessary to carry out its 
     duties.
       ``(B) Reimbursements.--The Commission shall reimburse the 
     Director of the Congressional Budget Office for expenses 
     relating to the employment in the office of the Director of 
     such additional staff as may be necessary for the Director to 
     comply with requests by the Commission under subparagraph 
     (A).
       ``(4) Detail of federal employees.--Upon the request of the 
     Commission, the head of any federal Agency is authorized to 
     detail, without reimbursement, any of the personnel of such 
     agency to the Commission to assist the Commission in carrying 
     out its duties. Any such detail shall not interrupt or 
     otherwise affect the civil service status or privileges of 
     the federal employee.

[[Page 5501]]

       ``(5) Technical assistance.--Upon the request of the 
     Commission, the head of a Federal Agency shall provide such 
     technical assistance to the Commission as the Commission 
     determines to be necessary to carry out its duties.
       ``(6) Use of mails.--The Commission may use the United 
     States mails in the same manner and under the same conditions 
     as Federal Agencies and shall, for purposes of the frank, be 
     considered a commission of Congress as described in section 
     3215 of title 39, United States Code.
       ``(7) Obtaining information.--The Commission may secure 
     directly from the any Federal Agency information necessary to 
     enable it to carry out its duties, if the information may be 
     disclosed under section 552 of title 4, United States Code. 
     Upon request of the chairperson of the Commission, the head 
     of such agency shall furnish such information to the 
     Commission.
       ``(8) Support services.--Upon the request of the 
     Commission, the Administrator of General Services shall 
     provide to the Commission on a reimbursable basis such 
     administrative support services as the Commission may 
     request.
       ``(9) Printing.--For purposes of costs relating to printing 
     and binding, including the cost of personnel detailed from 
     the Government Printing Office, the Commission shall be 
     deemed to be a committee of the Congress.
       ``(g) Authorization of Appropriations.--There is authorized 
     to be appropriated $4,000,000 to carry out this section. The 
     amount appropriated under this subsection shall not be 
     deducted from or affect any other appropriation for health 
     care for Indian persons.

     ``SEC. 815. APPROPRIATIONS; AVAILABILITY.

       ``Any new spending authority (described in subsection 
     (c)(2)(A) or (B) of section 401 of the Congressional Budget 
     Act of 1974) which is provided under this Act shall be 
     effective for any fiscal year only to such extent or in such 
     amounts as are provided in appropriation Acts.

     ``SEC. 816. AUTHORIZATION OF APPROPRIATIONS.

       ``There is authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2015 to 
     carry out this title.''.

       TITLE II--CONFORMING AMENDMENTS TO THE SOCIAL SECURITY ACT

                          Subtitle A--Medicare

     SEC. 201. LIMITATIONS ON CHARGES.

       Section 1866(a)(1) of the Social Security Act (42 U.S.C. 
     1395cc(a)(1)) is amended--
       (1) in subparagraph (R), by striking ``and'' at the end;
       (2) in subparagraph (S), by striking the period and 
     inserting ``, and''; and
       (3) by adding at the end the following:
       ``(T) in the case of hospitals and critical access 
     hospitals which provide inpatient hospital services for which 
     payment may be made under this title, to accept as payment in 
     full for services that are covered under and furnished to an 
     individual eligible for the contract health services program 
     operated by the Indian Health Service, by an Indian tribe or 
     tribal organization, or furnished to an urban Indian eligible 
     for health services purchased by an urban Indian organization 
     (as those terms are defined in section 4 of the Indian Health 
     Care Improvement Act), in accordance with such admission 
     practices and such payment methodology and amounts as are 
     prescribed under regulations issued by the Secretary.''.

     SEC. 202. QUALIFIED INDIAN HEALTH PROGRAM.

       Title XVIII of the Social Security Act (42 U.S.C. 1395 et 
     seq.) is amended by inserting after section 1880 the 
     following:


                   ``qualified indian health program

       ``Sec. 1880A. (a) Definition of Qualified Indian Health 
     Program.--In this section:
       ``(1) In general.--The term `qualified Indian health 
     program' means a health program operated by--
       ``(A) the Indian Health Service;
       ``(B) an Indian tribe or tribal organization or an urban 
     Indian organization (as those terms are defined in section 4 
     of the Indian Health Care Improvement Act) and which is 
     funded in whole or part by the Indian Health Service under 
     the Indian Self Determination and Education Assistance Act; 
     or
       ``(C) an urban Indian organization (as so defined) and 
     which is funded in whole or in part under title V of the 
     Indian Health Care Improvement Act.
       ``(2) Included programs and entities.--Such term may 
     include 1 or more hospital, nursing home, home health 
     program, clinic, ambulance service or other health program 
     that provides a service for which payments may be made under 
     this title and which is covered in the cost report submitted 
     under this title or title XIX for the qualified Indian health 
     program.
       ``(b) Eligibility for Payments.--A qualified Indian health 
     program shall be eligible for payments under this title, 
     notwithstanding sections 1814(c) and 1835(d), if and for so 
     long as the program meets all the conditions and requirements 
     set forth in this section.
       ``(c) Determination of Payments.--
       ``(1) In general.--Notwithstanding any other provision in 
     the law, a qualified Indian health program shall be entitled 
     to receive payment based on an all-inclusive rate which shall 
     be calculated to provide full cost recovery for the cost of 
     furnishing services provided under this section.
       ``(2) Definition of full cost recovery.--
       ``(A) In general.--Subject to subparagraph (B), in this 
     section, the term `full cost recovery' means the sum of--
       ``(i) the direct costs, which are reasonable, adequate and 
     related to the cost of furnishing such services, taking into 
     account the unique nature, location, and service population 
     of the qualified Indian health program, and which shall 
     include direct program, administrative, and overhead costs, 
     without regard to the customary or other charge or any fee 
     schedule that would otherwise be applicable; and
       ``(ii) indirect costs which, in the case of a qualified 
     Indian health program--

       ``(I) for which an indirect cost rate (as that term is 
     defined in section 4(g) of the Indian Self-Determination and 
     Education Assistance Act) has been established, shall be not 
     less than an amount determined on the basis of the indirect 
     cost rate; or
       ``(II) for which no such rate has been established, shall 
     be not less than the administrative costs specifically 
     associated with the delivery of the services being provided.

       ``(B) Limitation.--Notwithstanding any other provision of 
     law, the amount determined to be payable as full cost 
     recovery may not be reduced for co-insurance, co-payments, or 
     deductibles when the service was provided to an Indian 
     entitled under Federal law to receive the service from the 
     Indian Health Service, an Indian tribe or tribal 
     organization, or an urban Indian organization or because of 
     any limitations on payment provided for in any managed care 
     plan.
       ``(3) Outstationing costs.--In addition to full cost 
     recovery, a qualified Indian health program shall be entitled 
     to reasonable outstationing costs, which shall include all 
     administrative costs associated with outreach and acceptance 
     of eligibility applications for any Federal or State health 
     program including the programs established under this title, 
     title XIX, and XXI.
       ``(4) Determination of all-inclusive encounter or per diem 
     amount.--
       ``(A) In general.--Costs identified for services addressed 
     in a cost report submitted by a qualified Indian health 
     program shall be used to determine an all-inclusive encounter 
     or per diem payment amount for such services.
       ``(B) No single report requirement.--Not all qualified 
     Indian health programs provided or administered by the Indian 
     Health Service, an Indian tribe or tribal organization, or an 
     urban Indian organization need be combined into a single cost 
     report.
       ``(C) Payment for items not covered by a cost report.--A 
     full cost recovery payment for services not covered by a cost 
     report shall be made on a fee-for-service, encounter, or per 
     diem basis.
       ``(5) Optional determination.--The full cost recovery rate 
     provided for in paragraphs (1) through (3) may be determined, 
     at the election of the qualified Indian health program, by 
     the Health Care Financing Administration or by the State 
     agency responsible for administering the State plan under 
     title XIX and shall be valid for reimbursements made under 
     this title, title XIX, and title XXI. The costs described in 
     paragraph (2)(A) shall be calculated under whatever 
     methodology yields the greatest aggregate payment for the 
     cost reporting period, provided that such methodology shall 
     be adjusted to include adjustments to such payment to take 
     into account for those qualified Indian health programs that 
     include hospitals--
       ``(A) a significant decrease in discharges;
       ``(B) costs for graduate medical education programs;
       ``(C) additional payment as a disproportionate share 
     hospital with a payment adjustment factor of 10; and
       ``(D) payment for outlier cases.
       ``(6) Election of payment.--A qualified Indian health 
     program may elect to receive payment for services provided 
     under this section--
       ``(A) on the full cost recovery basis provided in 
     paragraphs (1) through (5);
       ``(B) on the basis of the inpatient or outpatient encounter 
     rates established for Indian Health Service facilities and 
     published annually in the Federal Register;
       ``(C) on the same basis as other providers are reimbursed 
     under this title, provided that the amounts determined under 
     paragraph (c)(2)(B) shall be added to any such amount;
       ``(D) on the basis of any other rate or methodology 
     applicable to the Indian Health Service or an Indian Tribe or 
     tribal organization; or
       ``(E) on the basis of any rate or methodology negotiated 
     with the agency responsible for making payment.
       ``(d) Election of Reimbursement for Other Services.--
       ``(1) In general.--A qualified Indian health program may 
     elect to be reimbursed for any service the Indian Health 
     Service, an Indian tribe or tribal organization, or an urban 
     Indian organization may be reimbursed for under section 1880 
     and section 1911.
       ``(2) Option to include additional services.--An election 
     under paragraph (1) may include, at the election of the 
     qualified Indian health program--

[[Page 5502]]

       ``(A) any service when furnished by an employee of the 
     qualified Indian health program who is licensed or certified 
     to perform such a service to the same extent that such 
     service would be reimbursable if performed by a physician and 
     any service or supplies furnished as incident to a 
     physician's service as would otherwise be covered if 
     furnished by a physician or as an incident to a physician's 
     service;
       ``(B) screening, diagnostic, and therapeutic outpatient 
     services including part-time or intermittent screening, 
     diagnostic, and therapeutic skilled nursing care and related 
     medical supplies (other than drugs and biologicals), 
     furnished by an employee of the qualified Indian health 
     program who is licensed or certified to perform such a 
     service for an individual in the individual's home or in a 
     community health setting under a written plan of treatment 
     established and periodically reviewed by a physician, when 
     furnished to an individual as an outpatient of a qualified 
     Indian health program;
       ``(C) preventive primary health services as described under 
     section 330 of the Public Health Service Act, when provided 
     by an employee of the qualified Indian health program who is 
     licensed or certified to perform such a service, regardless 
     of the location in which the service is provided;
       ``(D) with respect to services for children, all services 
     specified as part of the State plan under title XIX, the 
     State child health plan under title XXI, and early and 
     periodic screening, diagnostic, and treatment services as 
     described in section 1905(r);
       ``(E) influenza and pneumococcal immunizations;
       ``(F) other immunizations for prevention of communicable 
     diseases when targeted; and
       ``(G) the cost of transportation for providers or patients 
     necessary to facilitate access for patients.''.

                          Subtitle B--Medicaid

     SEC. 211. STATE CONSULTATION WITH INDIAN HEALTH PROGRAMS.

       Section 1902(a) of the Social Security Act (42 U.S.C. 
     1396a(a)) is amended--
       (1) in paragraph (64), by striking ``and'' at the end:
       (2) in paragraph (65), by striking the period and inserting 
     ``; and''; and
       (3) by inserting after paragraph (65), the following:
       ``(66) if the Indian Health Service operates or funds 
     health programs in the State or if there are Indian tribes or 
     tribal organizations or urban Indian organizations (as those 
     terms are defined in Section 4 of the Indian Health Care 
     Improvement Act) present in the State, provide for meaningful 
     consultation with such entities prior to the submission of, 
     and as a precondition of approval of, any proposed amendment, 
     waiver, demonstration project, or other request that would 
     have the effect of changing any aspect of the State's 
     administration of the State plan under this title, so long 
     as--
       ``(A) the term `meaningful consultation' is defined through 
     the negotiated rulemaking process provided for under section 
     802 of the Indian Health Care Improvement Act; and
       ``(B) such consultation is carried out in collaboration 
     with the Indian Medicaid Advisory Committee established under 
     section 415(a)(3) of that Act.''.

     SEC. 212. FMAP FOR SERVICES PROVIDED BY INDIAN HEALTH 
                   PROGRAMS.

       The third sentence of Section 1905(b) of the Social 
     Security Act (42 U.S.C. 1396d(b)) is amended to read as 
     follows:

     ``Notwithstanding the first sentence of this section, the 
     Federal medical assistance percentage shall be 100 per cent 
     with respect to amounts expended as medical assistance for 
     services which are received through the Indian Health 
     Service, an Indian tribe or tribal organization, or an urban 
     Indian organization (as defined in section 4 of the Indian 
     Health Care Improvement Act) under section 1911, whether 
     directly, by referral, or under contracts or other 
     arrangements between the Indian Health Service, Indian tribe 
     or tribal organization, or urban Indian organization and 
     another health provider.''.

     SEC. 213. INDIAN HEALTH SERVICE PROGRAMS.

       Section 1911 of the Social Security Act (42 U.S.C. 1396j) 
     is amended to read as follows:


                    ``indian health service programs

       ``Sec. 1911. (a) In General.--The Indian Health Service, an 
     Indian tribe or tribal organization, or an urban Indian 
     organization (as those terms are defined in section 4 of the 
     Indian Health Care Improvement Act), shall be eligible for 
     reimbursement for medical assistance provided under a State 
     plan by such entities if and for so long as the Service, 
     Indian tribe or tribal organization, or urban Indian 
     organization provides services or provider types of a type 
     otherwise covered under the State plan and meets the 
     conditions and requirements which are applicable generally to 
     the service for which it seeks reimbursement under this title 
     and for services provided by a qualified Indian health 
     program under section 1880A.
       ``(b) Period for Billing.--Notwithstanding subsection (a), 
     if the Indian Health Service, an Indian tribe or tribal 
     organization, or an urban Indian organization which provides 
     services of a type otherwise covered under the State plan 
     does not meet all of the conditions and requirements of this 
     title which are applicable generally to such services submits 
     to the Secretary within 6 months after the date on which such 
     reimbursement is first sought an acceptable plan for 
     achieving compliance with such conditions and requirements, 
     the Service, an Indian tribe or tribal organization, or urban 
     Indian organization shall be deemed to meet such conditions 
     and requirements (and to be eligible for reimbursement under 
     this title), without regard to the extent of actual 
     compliance with such conditions and requirements during the 
     first 12 months after the month in which such plan is 
     submitted.
       ``(c) Authority To Enter Into Agreements.--The Secretary 
     may enter into agreements with the State agency for the 
     purpose of reimbursing such agency for health care and 
     services provided by the Indian Health Service, Indian tribes 
     or tribal organizations, or urban Indian organizations, 
     directly, through referral, or under contracts or other 
     arrangements between the Indian Health Service, an Indian 
     tribe or tribal organization, or an urban Indian organization 
     and another health care provider to Indians who are eligible 
     for medical assistance under the State plan.''.

         Subtitle C--State Children's Health Insurance Program

     SEC. 221. ENHANCED FMAP FOR STATE CHILDREN'S HEALTH INSURANCE 
                   PROGRAM.

       (a) In General.--Section 2105(b) of the Social Security Act 
     (42 U.S.C. 1397ee(b)) is amended--
       (1) by striking ``For purposes'' and inserting the 
     following:
       ``(1) In general.--Subject to paragraph (2), for 
     purposes''; and
       (2) by adding at the end the following:
       ``(2) Services provided by indian programs.--Without regard 
     to which option a State chooses under section 2101(a), the 
     `enhanced FMAP' for a State for a fiscal year shall be 100 
     per cent with respect to expenditures for child health 
     assistance for services provided through a health program 
     operated by the Indian Health Service, an Indian tribe or 
     tribal organization, or an urban Indian organization (as such 
     terms are defined in section 4 of the Indian Health Care 
     Improvement Act).''.
       (b) Conforming Amendment.--Section 2105(c)(6)(B) of such 
     Act (42 U.S.C. 1397ee(c)(6)(B)) is amended by inserting ``an 
     Indian tribe or tribal organization, or an urban Indian 
     organization (as such terms are defined in section 4 of the 
     Indian Health Care Improvement Act),'' after ``Service,''.

     SEC. 222. DIRECT FUNDING OF STATE CHILDREN'S HEALTH INSURANCE 
                   PROGRAM.

       Title XXI of Social Security Act (42 U.S.C. 1397aa et seq.) 
     is amended by adding at the end the following:

     ``SEC. 2111. DIRECT FUNDING OF INDIAN HEALTH PROGRAMS.

       ``(a) In General.--The Secretary may enter into agreements 
     directly with the Indian Health Service, an Indian tribe or 
     tribal organization, or an urban Indian organization (as such 
     terms are defined in section 4 of the Indian Health Care 
     Improvement Act) for such entities to provide child health 
     assistance to Indians who reside in a service area on or near 
     an Indian reservation. Such agreements may provide for 
     funding under a block grant or such other mechanism as is 
     agreed upon by the Secretary and the Indian Health Service, 
     Indian tribe or tribal organization, or urban Indian 
     organization. Such agreements may not be made contingent on 
     the approval of the State in which the Indians to be served 
     reside.
       ``(b) Transfer of Funds.--Notwithstanding any other 
     provision of law, a State may transfer funds to which it is, 
     or would otherwise be, entitled to under this title to the 
     Indian Health Service, an Indian tribe or tribal organization 
     or an urban Indian organization--
       ``(1) to be administered by such entity to achieve the 
     purposes and objectives of this title under an agreement 
     between the State and the entity; or
       ``(2) under an agreement entered into under subsection (a) 
     between the entity and the Secretary.''.

              Subtitle D--Authorization of Appropriations

     SEC. 231. AUTHORIZATION OF APPROPRIATIONS.

       There is authorized to be appropriated such sums as may be 
     necessary for each of fiscal years 2004 through 2015 to carry 
     out this title and the amendments by this title.

                  TITLE III--MISCELLANEOUS PROVISIONS

     SEC. 301. REPEALS.

       The following are repealed:
       (1) Section 506 of Public Law 101-630 (25 U.S.C. 1653 note) 
     is repealed.
       (2) Section 712 of the Indian Health Care Amendments of 
     1988 is repealed.

     SEC. 302. SEVERABILITY PROVISIONS.

       If any provision of this Act, any amendment made by the 
     Act, or the application of such provision or amendment to any 
     person or circumstances is held to be invalid, the remainder 
     of this Act, the remaining amendments made by this Act, and 
     the application of such provisions to persons or 
     circumstances other than those to which it is held invalid, 
     shall not be affected thereby.

     SEC. 303. EFFECTIVE DATE.

       This Act and the amendments made by this Act take effect on 
     October 1, 2003.
                                 ______
                                 
      By Ms. COLLINS (for herself, Mr. Grassley, Mr. Bingaman, Mr.

[[Page 5503]]

        Cochran, Mr. Daschle, Mr. Sarbanes, and Mr. Smith):
  S. 557. A bill to amend the Internal Revenue Code of 1986 to exclude 
from gross income amounts received on account of claims based on 
certain unlawful discrimination and to allow income averaging for 
backpay and frontpay awards received on account of such claims, and for 
other purposes; to the Committee on Finance.
  Ms. COLLINS. Mr. President, I rise to introduce the Civil Rights Tax 
Relief Act of 2003, a bill designed to promote the fair and equitable 
settlement of civil rights claims. I am very pleased to be joined today 
by Senators Grassley, Daschle, Bingaman, Cochran, and Sarbanes.
  The primary purpose of this bill is to remedy an unintended 
consequence of the Small Business Job Protection Act of 1996, which 
made damage awards that are not based on ``physical injuries or 
physical sickness'' part of a plaintiff's taxable income. Because most 
acts of employment discrimination and civil rights violations do not 
cause physical injuries, this provision has had a direct and negative 
impact on plaintiffs who successfully prove that they have been 
subjected to intentional employment discrimination or other intentional 
violations of their civil rights.
  The problem is compounded by the fact that plaintiffs are now taxed 
on the entirety of their settlements or damage awards in civil rights 
cases, despite the fact that a portion of a settlement or award must be 
paid to the plaintiff's attorney, who in turn is taxed on the same 
funds. This double taxation of attorneys' fees awards penalizes 
Americans who win their civil rights cases.
  I would like to share one example of how individuals can be harmed by 
the current taxation scheme, and even discouraged from challenging 
workplace discrimination. The example was brought to my attention by 
David Webbert, an attorney who practices in Augusta, ME--my State's 
capital. In one of his cases, David represented a person who 
successfully challenged a business' policy of discriminating against 
persons with a particular type of disability. As a result of the case, 
the discriminatory policy was declared illegal and was ended. Although 
the plaintiff did not receive any monetary damages in the case, the law 
did provide for payment of attorney's fees, which were paid by the 
defendant's insurance company. Because of the current law's double 
taxation of attorney's fees, they were taxable to the plaintiff in this 
case, despite the fact that they were also taxable to the attorney. In 
short, plaintiffs in civil rights cases like this could have to pay 
taxes even though they receive no monetary award. Or, in other words, 
under current law, a plaintiff can actually be penalized financially 
for bringing a meritorious case against a company's discriminatory 
policies.
  Our bill would eliminate the unfair taxation of civil rights victims' 
settlements and court awards--taxation that adds insult to a civil 
rights victim's injury and serves as a barrier to the just settlement 
of civil rights claims.
  Our bill would change the taxation of awards received by individuals 
that result from judgments in or settlements of employment 
discrimination cases. First, the bill excludes from gross income 
amounts awarded other than for punitive damages and compensation 
attributable to services that were to be performed, known as 
``backpay,'' or that would have been performed but for a claimed 
violation of law by the employer, known as ``frontpay.'' Second, award 
amounts for frontpay or backpay would be included in income, but would 
be eligible for income averaging according to the time period covered 
by the award. This correction would allow individuals to pay taxes at 
the same marginal rates that would have applied to them had they not 
suffered discrimination. Third, the bill would change the tax code so 
that people who bring civil rights cases are not taxed on the portion 
of any award paid as fees to their attorney. This provision would 
eliminate the double-taxation of such fees, which would still be 
taxable income to the attorney.
  The Civil Rights Tax Relief Act would encourage the fair settlement 
of costly and protracted litigation of employment discrimination 
claims. Our legislation would allow both plaintiffs and defendants to 
settle claims based on the damages suffered, not on the excessive taxes 
that are now levied.
  Our bill has been endorsed by the U.S. Chamber of Commerce, AARP, the 
National Employment Lawyers Association, the No FEAR Coalition, the 
Religious Action Committee for Reform Judaism, the Society for Human 
Resource Management, and others. This bill is a ``win-win'' for civil 
rights plaintiffs and defendant businesses. I invite my colleagues to 
join in support of this common sense legislation.
                                 ______
                                 
      By Mr. McCAIN (for himself, Mr. Bingaman, Mr. Campbell, Mrs. 
        Murray, Mr. Johnson, and Mr. Domenici):
  S. 558. A bill to elevate the position of Director of the Indian 
Health Service within the Department of Health and Human Services to 
Assistant Secretary for Indian Health, and for other purposes; to the 
Committee on Indian Affairs.
  Mr. McCAIN. Mr. President, I rise to introduce legislation to 
designate the Director of the Indian Health Service as an Assistant 
Secretary for Indian Health within the Department of Health and Human 
Services. I'm pleased that my colleagues, Senators Bingaman, Campbell, 
Murray, Johnson, and Domenici are joining me in this effort as original 
co-sponsors.
  The purpose of this legislation is simple. It will redesignate the 
current Director of the Indian Health Service, IHS, as a new Assistant 
Secretary within the Department of Health and Human Services to be 
responsible for Indian health policy and budgetary matters.
  The Indian Health Service is the primary health care delivery system 
and principal advocate for Indian health care needs, both on the 
reservation level and for urban populations. More than 1.6 million 
Indian people are served every year by the IHS, yet the agency has not 
had the necessary resources to fully meet tribal health care needs. The 
IHS will continue to be challenged by a growing Indian population as 
well as an increasing disparity between the health status of Indian 
people as compared to other Americans. Thousands of Indian people 
continue to suffer from the worst imaginable health care conditions in 
Indian country--from diabetes to cancer to infant mortality. In nearly 
every category, the health status of Native Americans falls far below 
the national standard.
  The purpose of this bill is to respond to the desire by Indian people 
for a stronger leadership and policy role within the primary health 
care agency, the Department of Health and Human Services. The Assistant 
Secretary for Indian Health will ensure that critical policy and 
budgetary decisions will be made with the full involvement and 
consultation of not only the Indian Health Service, but also the direct 
involvement of tribal governments.
  This legislation is long overdue in bringing focus and national 
attention to the health care status of Indian people and fulfilling the 
Federal trust responsibility toward Indian tribes. Implementation of 
this bill is intended to support the long-standing policies of Indian 
self-determination and tribal self-governance and assist Indian tribes 
who are making positive strides in providing direct health care to 
their own communities.
  Tribal communities are in dire need of a senior policy official who 
is knowledgeable about the programs administered by the IHS and who can 
provide the leadership for the health care needs of American Indians 
and Alaska Natives. We continue to pursue passage of this legislation 
as many believe that the priority of Indian health issues within the 
Department should be raised to the highest levels within our federal 
government.
  I look forward to working with my colleagues on both sides of the 
aisle and the Administration to ensure prompt passage of this 
legislation. I ask unanimous consent that the text of this bill be 
printed in the Record.

[[Page 5504]]

  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 558

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

     SECTION 1. OFFICE OF ASSISTANT SECRETARY FOR INDIAN HEALTH.

       (a) Definitions.--In this section:
       (1) Assistant secretary.--The term ``Assistant Secretary'' 
     means the Assistant Secretary for Indian Health appointed 
     under subsection (b)(2)(A).
       (2) Department.--The term ``Department'' means the 
     Department of Health and Human Services.
       (3) Office.--The term ``Office'' means the Office of the 
     Assistant Secretary for Indian Health established by 
     subsection (b)(1).
       (4) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (b) Establishment.--
       (1) In general.--There is established within the Department 
     the Office of the Assistant Secretary for Indian Health.
       (2) Assistant secretary.--
       (A) In general.--Except as provided in subparagraph (B), 
     the Office shall be headed by an Assistant Secretary for 
     Indian Health, to be appointed by the President, by and with 
     the advice and consent of the Senate.
       (B) Continued service by incumbent.--The individual serving 
     in the position of Director of the Indian Health Service on 
     the day before the date of enactment of this Act may serve as 
     Assistant Secretary at the pleasure of the President after 
     the date of enactment of this Act.
       (3) Duties.--The position of Assistant Secretary is 
     established to, in a manner consistent with the government-
     to-government relationship between the United States and 
     Indian tribes--
       (A) facilitate advocacy for the development of appropriate 
     Indian health policy; and
       (B) promote consultation on matters relating to Indian 
     health.
       (c) Assistant Secretary for Indian Health.--In addition to 
     the functions performed as of the date of enactment of this 
     Act by the Director of the Indian Health Service, the 
     Assistant Secretary shall--
       (1) report directly to the Secretary concerning all policy- 
     and budget-related matters affecting Indian health;
       (2) collaborate with the Assistant Secretary for Health 
     concerning appropriate matters of Indian health that affect 
     the agencies of the Public Health Service;
       (3) advise each Assistant Secretary of the Department 
     concerning matters of Indian health with respect to which 
     that Assistant Secretary has authority and responsibility;
       (4) advise the heads of other agencies and programs of the 
     Department concerning matters of Indian health with respect 
     to which those heads have authority and responsibility;
       (5) coordinate the activities of the Department concerning 
     matters of Indian health; and
       (6) perform such other functions as the Secretary may 
     designate.
       (d) Rate of Pay.--
       (1) Positions at level iv.--Section 5315 of title 5, United 
     States Code, is amended by striking ``Assistant Secretaries 
     of Health and Human Services (6).'' and inserting ``Assistant 
     Secretaries of Health and Human Services (7).''.
       (2) Positions at level v.--Section 5316 of title 5, United 
     States Code, is amended by striking ``Director, Indian Health 
     Service, Department of Health and Human Services.''.
       (e) Duties of Assistant Secretary for Indian Health.--
     Section 601 of the Indian Health Care Improvement Act (25 
     U.S.C. 1661) is amended by striking the section heading and 
     all that follows through subsection (a) and inserting the 
     following:

     ``SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERVICE AS AN 
                   AGENCY OF THE PUBLIC HEALTH SERVICE.

       ``(a) Establishment.--
       ``(1) In general.--In order to more effectively and 
     efficiently carry out the responsibilities, authorities, and 
     functions of the United States to provide health care 
     services to Indians and Indian tribes, there is established 
     within the Public Health Service of the Department of Health 
     and Human Services the Indian Health Service.
       ``(2) Administration.--The Indian Health Service shall be 
     administered by the Assistant Secretary for Indian Health.
       ``(3) Duties.--In carrying out paragraph (2), the Assistant 
     Secretary shall--
       ``(A) report directly to the Secretary concerning all 
     policy- and budget-related matters affecting Indian health;
       ``(B) collaborate with the Assistant Secretary for Health 
     concerning appropriate matters of Indian health that affect 
     the agencies of the Public Health Service;
       ``(C) advise each Assistant Secretary of the Department of 
     Health and Human Services concerning matters of Indian health 
     with respect to which that Assistant Secretary has authority 
     and responsibility;
       ``(D) advise the heads of other agencies and programs of 
     the Department of Health and Human Services concerning 
     matters of Indian health with respect to which those heads 
     have authority and responsibility;
       ``(E) coordinate the activities of the Department of Health 
     and Human Services concerning matters of Indian health; and
       ``(F) perform such other functions as the Secretary may 
     designate.''.
       (f) Conforming Amendments.--
       (1) Amendments to indian health care improvement act.--The 
     Indian Health Care Improvement Act is amended--
       (A) in section 601 (25 U.S.C. 1661)--
       (i) in subsection (c), by striking ``Director of the Indian 
     Health Service'' each place it appears and inserting 
     ``Assistant Secretary for Indian Health''; and
       (ii) in subsection (d)(1), by striking ``Director of the 
     Indian Health Service'' and inserting ``Assistant Secretary 
     for Indian Health''; and
       (B) in section 816(c)(1) (25 U.S.C. 1680f(c)(1)), by 
     striking ``Director of the Indian Health Service'' and 
     inserting ``Assistant Secretary for Indian Health''.
       (2) Amendments to other provisions of law.--
       (A) Section 3307(b)(1)(C) of the Children's Health Act of 
     2000 (25 U.S.C. 1671 note; Public Law 106-310) is amended by 
     striking ``Director of the Indian Health Service'' and 
     inserting ``Assistant Secretary for Indian Health''.
       (B) The Indian Lands Open Dump Cleanup Act of 1994 is 
     amended--
       (i) in section 3 (25 U.S.C. 3902)--

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

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

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

       (iii) in section 6(a) (25 U.S.C. 3905(a)), in the 
     subsection heading, by striking ``Director'' and inserting 
     ``Assistant Secretary'';
       (iv) in section 9(a) (25 U.S.C. 3908(a)), in the subsection 
     heading, by striking ``Director'' and inserting ``Assistant 
     Secretary''; and
       (v) by striking ``Director'' each place it appears and 
     inserting ``Assistant Secretary''.
       (C) Section 5504(d)(2) of the Augustus F. Hawkins-Robert T. 
     Stafford Elementary and Secondary School Improvement 
     Amendments of 1988 (25 U.S.C. 2001 note; Public Law 100-297) 
     is amended by striking ``Director of the Indian Health 
     Service'' and inserting ``Assistant Secretary for Indian 
     Health''.
       (D) Section 203(a)(1) of the Rehabilitation Act of 1973 (29 
     U.S.C. 763(a)(1)) is amended by striking ``Director of the 
     Indian Health Service'' and inserting ``Assistant Secretary 
     for Indian Health''.
       (E) Subsections (b) and (e) of section 518 of the Federal 
     Water Pollution Control Act (33 U.S.C. 1377) are amended by 
     striking ``Director of the Indian Health Service'' each place 
     it appears and inserting ``Assistant Secretary for Indian 
     Health''.
       (F) Section 317M(b) of the Public Health Service Act (42 
     U.S.C. 247b-14(b)) is amended--
       (i) by striking ``Director of the Indian Health Service'' 
     each place it appears and inserting ``Assistant Secretary for 
     Indian Health''; and
       (ii) in paragraph (2)(A), by striking ``the Directors 
     referred to in such paragraph'' and inserting ``the Director 
     of the Centers for Disease Control and Prevention and the 
     Assistant Secretary for Indian Health''.
       (G) Section 417C(b) of the Public Health Service Act (42 
     U.S.C. 285-9(b)) is amended by striking ``Director of the 
     Indian Health Service'' and inserting ``Assistant Secretary 
     for Indian Health''.
       (H) Section 1452(i) of the Safe Drinking Water Act (42 
     U.S.C. 300j-12(i)) is amended by striking ``Director of the 
     Indian Health Service'' each place it appears and inserting 
     ``Assistant Secretary for Indian Health''.
       (I) Section 803B(d)(1) of the Native American Programs Act 
     of 1974 (42 U.S.C. 2991b-2(d)(1)) is amended in the last 
     sentence by striking ``Director of the Indian Health 
     Service'' and inserting ``Assistant Secretary for Indian 
     Health''.
       (J) Section 203(b) of the Michigan Indian Land Claims 
     Settlement Act (Public Law 105-143; 111 Stat. 2666) is 
     amended by striking ``Director of the Indian Health Service'' 
     and inserting ``Assistant Secretary for Indian Health''.
       (g) References.--Any reference to the Director of the 
     Indian Health Service in any other Federal law, Executive 
     order, rule, regulation, or delegation of authority, or in 
     any document of or relating to the Director of the Indian 
     Health Service, shall be deemed to refer to the Assistant 
     Secretary.
                                 ______
                                 
      By Mr. CAMPBELL:
  S. 559. A bill to amend title 49, United States Code, to permit an 
individual to operate a commercial motor vehicle solely within the 
borders of a State if the individual meets certain minimum standards 
prescribed by the State, and for other purposes; to the

[[Page 5505]]

Committee on Commerce, Science, and Transportation.
  Mr. CAMPBELL. Mr. President, today I am introducing the Commercial 
Driver's License Devolution Act of 2003. This bill is identical to that 
which I introduced in the 107th Congress as a companion bill to 
language originally brought to the floor of the House of 
Representatives by my friend from North Carolina, Representative Howard 
Coble.
  I believe it is no secret to my colleagues here in the Senate, that I 
support small business and returning power to the States. The 
traditional, one-size-fits-all approach to governing has done more harm 
than good, and this bill is an attempt to remedy some of that.
  This legislation will give States the option to establish their own 
commercial driver's license, CDL, requirements for intrastate drivers. 
It will return power to the States by giving them the option to license 
intrastate drivers of commercial motor vehicles based upon testing 
standards determined by the individual States. And I stress, it will be 
an ``option.''
  I want to emphasize that this legislation is not a Federal mandate 
imposed on States. States that choose not to participate would remain 
under Federal guidelines. A State that chooses to exercise this option 
would in no way diminish the role of the CDL in the long-haul trucking 
industry. Additionally, this legislation effectively precludes two or 
more States from using this option as the basis for an interstate 
compact.
  As I am sure my colleagues are aware, the Commercial Motor Vehicle 
Safety Act of 1986, CMVSA, required States to establish a new and 
uniform program of testing and licensure for all operators of 
commercial vehicles both intra and interstate. The principal objectives 
of the Act have been met, and would not be harmed by this legislation 
I'm introducing here today.
  I have no issue with the CMVSA. It is a good law, and at the time the 
provisions it contained were necessary and timely for improving the 
standards of performance for long-haul truck drivers in this country. 
However, I, like my counterpart in the House, believe the CMVSA was 
imposed upon intrastate commerce where the operation of trucks may be a 
small but necessary part of an individual's job. Therefore, the reality 
was that Washington imposed its will on thousands of small businesses 
across this country who aren't involved in long-haul trucking and we 
expected them to adjust to any circumstance that might arise. That's 
unfair and not what government is supposed to be about.
  When you have conditions such as these, I believe it should be within 
a State's discretion to determine what kind of commercial vehicle 
licensure and testing is required for commerce taking place solely 
within its borders.
  This legislation is important to our nation's small businesses, 
especially those dependent upon commercial truck travel, which means 
it's important to the consumers. I urge my colleagues in the Senate to 
support it.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 559

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Commercial Driver's License 
     Devolution Act of 2003''.

     SEC. 2. INTRASTATE OPERATION OF COMMERCIAL MOTOR VEHICLES.

       (a) In General.--Paragraph (1) of section 31305(b) of title 
     49, United States Code, is amended--
       (1) by striking ``paragraph (2)'' and inserting 
     ``paragraphs (2) and (3)''; and
       (2) by adding at the end the following:
       ``(3) An individual may operate a commercial motor vehicle 
     solely within the borders of a State if the individual--
       ``(A) meets the minimum standards prescribed under the laws 
     of that State for ensuring the fitness of an individual to 
     operate a commercial motor vehicle; and
       ``(B) has passed written and driving tests to operate a 
     commercial motor vehicle that meet the minimum standards 
     prescribed under the laws of that State.''.
       (b) Requirements for State Participation.--Section 31311(a) 
     of such title is amended--
       (1) in paragraph (1)--
       (A) by striking ``with'' and inserting ``with either''; and
       (B) by striking ``under section 31305(a)'' and inserting 
     ``or by the State under section 31305''; and
       (2) in paragraph (2), by striking ``the minimum standards'' 
     and inserting ``either the minimum standards prescribed by 
     the Secretary of Transportation or by the State under section 
     31305 of this title''.
                                 ______
                                 
      By Mr. CRAIG (for himself, Mr. Dayton, Mr. Coleman, Mr. Leahy, 
        Mr. Bond, Mr. Bingaman, Ms. Snowe, Mrs. Lincoln, Mr. Shelby, 
        Mr. Jeffords, Mr. Domenici, Mr. Levin, Ms. Collins, Mr. 
        Johnson, Mr. Specter, Mr. Feingold, and Mr. Kohl):
  S. 560. A bill to impose tariff-rate quotas on certain casein and 
milk protein concentrates; to the Committee on Finance.
  Mr. LEAHY. Mr. President, I am pleased to join my colleagues Senator 
Mark Dayton and Senator Larry Craig in introducing the bipartisan Milk 
Import Tariff Equity Act. Our bill will prevent importers of dairy 
products from circumventing U.S. trade laws.
  Although I opposed it at the time, during the Uruguay Round 
multilateral trade negotiations, the United States agreed to allow a 
substantial increase in dairy product imports into this country. Tariff 
rate quotas were established to allow imports of most dairy products to 
rise from an average of 2 percent of domestic consumption to as much as 
five percent. At least initially, these controls appeared to be 
effective. But foreign competitors have found ways to circumvent these 
quotas by adjusting the protein content of nonfat dry milk so that it 
is classified by the U.S. Customs Service as milk protein concentrate, 
MPC. While nonfat dry milk imports are strictly regulated, there are no 
quotas on MPCs and duties are low.
  A recent GAO study requested by Congress determined that MPC imports 
surged by more than 600 percent over a six year period. MPC imports 
lower prices for U.S. dairy farmers by displacing sales of nonfat dry 
milk. According to the GAO study, some exporters are blending 
previously processed dairy proteins, such as casein, whey and nonfat 
dry milk into MPC solely for the purpose of avoiding the U.S. tariff 
rate quota for nonfat dry milk. This practice, specifically cited in 
the GAO report, circumvents statutory U.S. trade provisions designed to 
regulate imports of nonfat dry milk powder.
  It is time to close this loophole. Under our bill, MPCs would be 
regulated in the same manner as all other dairy products: by imposing 
tariff-rate quotas on MPC imports. This legislation also closes a 
similar loophole that exists for casein used in the production of food 
or feed, while continuing to allow unrestricted access for imports of 
casein used in the manufacture of glues and for other industrial 
purposes.
  Most Americans probably don't realize it, because retail fluid milk 
prices have hardly changed, but dairy farmers in Vermont and across 
this Nation are really struggling. Farm-gate milk prices have fallen 
more than 30 percent over the past 18 months and are now at the lowest 
levels in 25 years. Even the most efficient producers are unable to 
make a profit at these prices. Prices are low in part due to these 
imports. Others will argue that MPC imports represent just a small 
fraction of U.S. milk production. But when you are dealing with a 
perishable commodity like milk, even a slight increase in supply can 
have a dramatic effect on prices.
  Closing the MPC loophole is one of the most important steps we can 
take to help our nation's dairy farmers. I commend Senators Dayton and 
Craig for their leadership on this issue, and I urge my colleagues to 
join me in cosponsoring this important legislation.
  Mr. FEINGOLD. Mr. President, I am pleased today to show my support 
for the Milk Import Tariff Equity Act of 2003 by being an original 
cosponsor of Senator Craig's bill. This legislation

[[Page 5506]]

will prevent foreign dairy products from continuing to circumvent U.S. 
trade laws.
  Currently, milk protein concentrate, MPC, is not subject to the same 
quotas required of other dairy products. Foreign dairy producers have 
begun exploiting this loophole by blending previously processed dairy 
proteins with nonfat dry milk to boost its protein content so that it 
qualifies as milk protein concentrate. This allows the milk protein 
concentrate to circumvent any laws that would subject the imports to 
tariff rate quotas.
  The result has been a flood of foreign dairy blends being imported in 
the U.S. market, displacing sales of domestic dairy products and 
lowering prices for American dairy farmers.
  As milk prices are at historic lows, down about 38 percent from 
prices last year, this flood of foreign dairy products has put a strain 
on many of the dairy farmers in my State of Wisconsin.
  Since many of the blended products imported into this country are 
heavily subsidized, American farmers are forced to compete on an unfair 
playing field. This loophole in our tariff schedule allows certain 
heavily subsidized foreign dairy products nearly unfettered access to 
our dairy markets, hurting the American dairy farmers.
  As I travel across Wisconsin, I have heard from any dairy farmers who 
are struggling to stay in business. Many of these farmers are concerned 
about the flood of unfair imports that are hurting our American dairy 
markets.
  In March of 2001, the General Accounting Office, GAO, released a 
report that highlighted the increase of milk protein concentrates 
coming into this country under outdated trade laws. The report pointed 
to a loophole in our trade laws that has resulted in increased imports 
of blended dairy proteins. The importing of blended dairy proteins is 
being done solely for the purpose of avoiding the U.S. tariff rate 
quota for nonfat dry milk.
  The GAO study determined that MPC imports surged by more than 600 
percent in the six years before the report was released. MPC imports 
lower prices for U.S. dairy farmers by displacing sales of domestic 
dairy products.
  Since I have received the results from the General Accounting Office 
study that reported this loophole in U.S. trade laws, I have 
participated in a bipartisan effort to amend this loophole, so that we 
may protect our dairy farmers from unfair trade practices and help them 
in the struggle to farm on such an unfair playing field.
  This bill would close this loophole by regulating milk protein 
concentrate imports in the same manner all other dairy import products 
are regulated. It would correct a loophole that exists in U.S. trade 
law that is contributing to such low dairy prices experienced in my 
state of Wisconsin and across the Nation.
  This loophole depresses the price of milk for farmers, costs U.S. 
taxpayers money, and gives foreign dairy producers an unfair advantage 
over our own dairy farmers. It is time for this Congress to stand 
behind our farmers and that is why I support the Milk Import Tariff 
Equity Act of 2003.
                                 ______
                                 
      By Mr. CRAPO (for himself, Mr. Enzi, Mr. Craig, Mr. Domenici, Mr. 
        Burns, and Mr. Smith):
  S. 561. A bill to preserve the authority of States over water within 
their boundaries, to delegate to States the authority of Congress to 
regulate water, and for other purposes; to the Committee on the 
Judiciary.
   Mr. CRAPO. Mr. President, I rise to introduce the State Water 
Sovereignty Protection Act, a bill to preserve the authority of the 
States over waters within their boundaries, to delegate the authority 
of the Congress to the States to regulate water, and for other 
purposes.
  Since 1866, Congress has recognized and deferred to the States the 
authority to allocate and administer water within their borders. The 
Supreme Court has confirmed that this is an appropriate role for the 
States. Additionally, in 1952, the Congress passed the McCarran 
amendment which provides for the adjudication of State and Federal 
Water claims in State water courts.
  However, despite both judicial and legislative edicts, I am deeply 
concerned that the administration, Federal agencies, and some in the 
Congress are setting the stage for ignoring long established statutory 
provisions concerning State water rights and State water contracts. The 
Endangered Species Act, the Clean Water Act, the Federal Land Policy 
Management Act, and wilderness designations have all been vehicles used 
to erode State sovereignty over its water.
  It is imperative that States maintain sovereignty over management and 
control of their water and river systems. All rights to water or 
reservations of rights for any purposes in States should be subject to 
the substantive and procedural laws of that State, not the Federal 
Government. To protect State water rights, I am introducing the State 
Water Sovereignty Protection Act.
  The State Water Sovereignty Protection Act provides that whenever the 
United States seeks to appropriate water or acquire a water right, it 
will be subject to State procedural and substantive water law. The Act 
further holds that States control the water within their boundaries and 
that the Federal Government may exercise management or control over 
water only in compliance with State law. Finally, in any administrative 
or judicial proceeding in which the United States participates pursuant 
to the McCarran Amendment, the United States is subject to all costs 
and fees to the same extent as costs and fees may be imposed on a 
private party.
                                 ______
                                 
      By Ms. MURKOWSKI (for herself, Mr. Stevens, Mr. Burns, Mr. Craig, 
        Mr. Crapo, Mr. Inhofe, and Mr. Smith):
  S. 562. A bill to amend chapter 3 of title 28, United States Code, to 
divide the Ninth Judicial Circuit of the United States into 2 circuits, 
and for other purposes; to the Committee on the Judiciary.
  Ms. MURKOWSKI. Mr. President, earlier this week, the Senate, in a 94-
0 vote, went on record expressing its unanimous opposition to last 
week's decision by the Ninth Circuit Court of Appeals refusing to 
review a three-judge panel ruling that bars children in public schools 
from voluntarily reciting the Pledge of Allegiance.
  The Pledge decision rendered by the court is not an aberration. It is 
symptomatic of a court that has become dysfunctional and out-of-touch 
with American jurisprudence, common sense, and constitutional values. 
Unfortunately, citizens in the states that are within the Ninth 
Circuit's jurisdiction have had to contend with the court's 
idiosyncratic jurisprudence for decades.
  One should not be surprised that the full Ninth Circuit refused to 
reconsider this ill-conceived decision. The recent history of the court 
suggests a judicial activism that is close to the fringe of legal 
reasoning. And it is for that reason that the Ninth Circuit has, by 
far, the highest reversal rate in the country. During the 1990s, almost 
90 percent of cases from the Ninth Circuit reviewed by the Supreme 
Court were reversed. In 1997, a startling 27 of the 28 cases brought 
before the Supreme Court were reversed--two-thirds by a unanimous vote.
  Over the last three years, one-third of all cases reversed by the 
Supreme Court came from the 9th Circuit. That's three times the number 
of reversals for the next nearest circuit. And 33 times higher than the 
reversal rate for the 10th Circuit
  Last November, on a single day, the Supreme Court summarily and 
unanimously reversed three Ninth Circuit decisions. In one of those 
three cases, the Supreme Court ruled that the circuit had overreached 
its authority and stated that the Court ``exceed[ed] the limits imposed 
on federal habeas review substitut[ing] its own judgment for that of 
the state court.''
  One of the reasons the Ninth Circuit is reversed so often is because 
the circuit has become too large and unwieldy. The Circuit serves a 
population of more than 54 million people, almost 60 percent more than 
are served by the

[[Page 5507]]

next largest circuit. By 2010, the Census Bureau estimates that the 
Ninth Circuit's population will be more than 63 million.
  According to the Administrative Office of the U.S. Courts, the Ninth 
Circuit alone accounts for more than 60 percent of all appeals pending 
for more than a year. And with its huge caseload, the judges on the 
Court just do not have the opportunity to keep up with decisions within 
the circuit, let alone decisions from other circuits
  Another problem unique to the Ninth Circuit is that it never speaks 
with one voice. All other circuits sit as one entity to hear full-
court, en banc, cases. The Ninth Circuit sits in panels of 11. Clearly, 
such a procedure injects unnecessary randomness into decisions. If an 
en banc case is decided 6 to 5, there is no reason to think it 
represents the views of the majority of the court's 24 active members.
  In fact, some commentators believe a majority of the 24 members of 
the court may have disagreed with the Pledge decision, but were 
concerned that a random pick of 11 members of the Court to hear the 
case, en banc, might have resulted in the decision being affirmed.
  It is inconceivable to me that a circuit court could render a 
decision based on its concern about the potential makeup of an en banc 
panel. What kind of jurisprudence is that? Citizens in no other circuit 
face that type of coin-flip justice. That is fundamentally unfair to 
every single one of the 54 million people who live within the 
jurisdiction of the Ninth Circuit and is reason alone to restructure 
the circuit.
  It is time that Congress finally faces the fact that the Ninth 
Circuit is no longer a viable and functioning circuit. It is for that 
reason that I am today introducing the Ninth Circuit Court of Appeals 
Reorganization Act of 2003. I am pleased to be joined in this effort by 
Senators, Stevens, Burns, Craig, Crapo, Inhofe, and Smith.
  The bill we are introducing today would divide the Ninth Circuit into 
two independent circuits. The restructured Ninth Circuit would contain 
California, and Nevada. A new Twelfth Circuit would be composed of 
Alaska, Hawaii, Arizona, Idaho, Montana, Oregon, Washington, Guam, and 
the Northern Mariana Islands.
  Earlier I indicated a number of reasons why I believe the Circuit 
needs to be reorganized. Let us not forget the scope of this circuit 
and the 54 million people who live within it. The Ninth Circuit extends 
from the Arctic Circle to the Mexican border, spans the tropics of 
Hawaii and across the International Dateline to Guam and the Mariana 
Islands. Encompassing some 14 million square miles, the Ninth Circuit, 
by any means of measure, is the largest of all U.S. Circuit Courts of 
Appeal. It is larger than the First, Second, Third, Fourth, Fifth, 
Sixth, Seventh and Eleventh Circuits combined!
  Moreover, because of the sheer magnitude of cases brought before the 
Court, citizens within the court's jurisdiction face unprecedented 
delays in getting their cases heard. Whereas the national average time 
to get a final disposition of an appellate case is nearly 11 months, an 
appeal in the Ninth Circuit takes nearly 50 percent longer--almost one 
year and four months.
  This is not the first time that Congress has recognized that the 
Ninth Circuit needs restructuring. Numerous proposals to divide the 
Ninth Circuit were debated in Congress even before World War II.
  In 1973, the Congressional Commission on the Revision of the Federal 
Court of Appellate System Commission, commonly known as the Hruska 
Commission, recommended that the Ninth Circuit be divided. Also that 
year, the American Bar Association adopted a resolution in support of 
dividing the Ninth Circuit.
  In 1995, a bill was reported from the Senate Judiciary Committee in 
which Chairman Orrin Hatch of Utah declared in his Committee's report 
that the time for a split had arrived: ``The legislative history, in 
conjunction with available statistics and research concerning the Ninth 
Circuit, provides an ample record for an informed decision at this 
point as to whether to divide the Ninth Circuit . . . Upon careful 
consideration the time has indeed come.''

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

[[Page 5508]]

  I ask unanimous consent that the text of my bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 562

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Ninth Circuit Court of 
     Appeals Reorganization Act of 2003''.

     SEC. 2. DEFINITIONS.

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

     SEC. 3. NUMBER AND COMPOSITION OF CIRCUITS.

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

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

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

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

     SEC. 4. NUMBER OF CIRCUIT JUDGES.

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

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

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

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

     SEC. 5. PLACES OF CIRCUIT COURT.

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

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

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

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

     SEC. 6. ELECTION OF ASSIGNMENT BY CIRCUIT JUDGES.

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

     SEC. 7. SENIORITY OF JUDGES.

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

     SEC. 8. APPLICATION TO CASES.

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

     SEC. 9. ADMINISTRATION.

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

     SEC. 10. EFFECTIVE DATE.

       This Act and the amendments made by this Act shall become 
     effective on October 1, 2003.
                                 ______
                                 
      By Ms. LANDRIEU (for herself, Mr. Sununu, Mr. Burns, Mr. Dodd, 
        Mr. Gregg, Mrs. Hutchison, Mr. Inouye, Mr. Jeffords, Mr. Leahy, 
        Mr. Lieberman, Mr. Lott, Ms. Mikulski, Mr. Kennedy, Mr. Miller, 
        Mr. Dorgan, and Mr. Kerry):
  S. 564. A bill to facilitate the deployment of wireless 
telecommunications networks I order to further the availability of the 
Emergency Alert System, and for other purposes; to the Committee on 
Commerce, Science, and Transportation.
  Ms. LANDRIEU. Mr. President, today I rise to introduce the Emergency 
Communications and Competition Act, ECCA, along with my colleague from 
New Hampshire, Senator Sununu. We are joined by twelve of our 
colleagues, led by Senator Burns, the distinguished chairman of the 
Commerce Communications Subcommittee, as well as Senators Dodd, Gregg, 
Hutchison, Inouye, Jeffords, Lott, Kennedy, Leahy, Lieberman, Mikulski, 
and Miller.
  The bill we introduce today is identical to S. 2922, the measure 
which Senator Burns and I co-authored in the 107th Congress. I was very 
pleased and grateful for the tremendous support this legislation 
received from local television broadcasters and a wide range of public 
interest groups that speak for consumers, minority groups, rural 
Americans, health care, public safety, and property rights.
  This bill will ensure that consumers will soon be able to avail 
themselves of an innovative new wireless technology that has been 
approved by the Federal Communications Commission. It is called the 
Multichannel Video Distribution and Data Service, MVDDS, a title which 
accurately describes what this new service will provide consumers: 
cable competition and high speed access to the Internet.
  As I indicated in my introductory remarks to S. 2922 last September, 
unless Congress enacts this legislation, it may be years before MVDDS 
is actually deployed to the public. That would be a lost opportunity 
for consumers. We need to improve our communications infrastructure, 
not only for greater access to cable and the Internet, but also for 
public safety purposes. MVDDS technology can address all of these 
needs, and we should remove unnecessary and counterproductive 
regulatory obstacles that prevent its swift deployment.
  The Consumers Union, like many, has supported ECCA because it will 
help ensure that competition rapidly emerges for video programming as 
well as high speed Internet services. Earlier this year, the Consumers 
Union issued a report, ``Cable Mergers, Monopoly Power and Price 
Increases,'' which documents the most recent steep rate increases 
imposed by cable operators. The report noted, for instance, that cable 
rates in Baton Rouge soared 7 percent last November. This was typical 
of rate increases throughout the country.
  According to the most recent data from the Bureau of Labor 
Statistics, cable rates rose 11.4 percent in just the last two years. 
This compares to a 3.8 percent increase in the Consumer Price Index 
over the same period. According to the FCC, just one percent of cable 
communities enjoy ``effective competition.'' I submit that this 
startling lack of competition, more than anything else, explains why 
local cable rates have increased at three times the inflation rate.
  If MVDDS can go head-to-head with incumbent cable systems in all 
parts of

[[Page 5509]]

the country, I believe that this good old fashioned competition will 
result in lower prices and better service for consumers--even for those 
who don't choose to subscribe to MVDDS.
  Rural organizations recognize the extraordinary opportunity this new 
wireless technology can offer rural Americans. They understand that the 
FCC's Order, which authorized MVDDS, will likely fail to ensure this 
new technology will indeed adequately serve rural America.
  Local television broadcasters support this measure because it will 
ensure consumers in their markets can view all local television 
stations. Today, satellite operators DirecTV and EchoStar do not carry 
over 1,000 local TV channels--and no stations from ten States: Alaska, 
Arkansas, Idaho, Maine, Montana, Mississippi, North and South Dakota, 
West Virginia, and Wyoming. As you know, the satellite operators sought 
to merge so that they would have sufficient capacity to carry all local 
TV stations, but federal regulators rejected the merger on 
anticompetitive grounds.
  The Emergency Communications and Competition Act, which we are re-
introducing today, will restore fairness in the FCC licensing process, 
and in so doing, speed the deployment of MVDDS to applicants that are 
ready to launch service to the public now.
  The bill provides that MVDDS applicants will be licensed in the same 
manner as satellite companies who applied on the same day to share the 
same spectrum. Currently, the FCC plans to subject only MVDDS 
applicants to an auction process. This would impose a discriminatory 
tax on an innovative new technology. Unfortunately, this is more of the 
same burdensome regulation that I believe has contributed to the 
collapse of the telecommunications sector. Government regulation is 
necessary, certainly, but we must be smart in how we regulate business. 
We must ensure that our laws and regulations are technologically 
neutral so that government policies don't replace the role of the 
marketplace in determining the fate of consumer products and services.
  In an Order released last month, the FCC recognized the need to 
prevent disparity in licensing when it authorized certain satellite 
spectrum to be re-used for mobile terrestrial service without requiring 
a spectrum auction. Similarly, the ECCA would prohibit the FCC from 
conducting an auction for licenses that re-use satellite spectrum for 
fixed terrrestrial operations.
  Furthermore, an action would drastically delay the introduction of 
service to the public. Mr. President, this is quite the opposite of 
what spectrum auctions are supposed to do. In this case, industry 
incumbents can abuse the auction process to block the introduction of 
new competition. A company with vast resources available could easily 
trounce a small startup in an auction--and then, under the terms of the 
FCC's Order, it would not have to deploy service for 10 years. 
Consumers cannot and should not have to wait while this spectrum is 
``shelved'' for an entire decade.
  The ECCA solves this problem by ensuring that only qualified 
applicants will be licensed. That is, within six months of enactment, 
the FCC would issue licenses to any applicant that can demonstrate 
through independent testing that it will employ a technology that won't 
cause harmful interference to DBS operators with whom they would share 
spectrum. Then, to be sure that service is in fact deployed, the ECCA 
requires licensees to provide service to consumers within five rather 
than ten years.
  This legislation also requires that parties who apply for licenses 
under this provision must assume specific public interest obligations 
in exchange for their prompt licensing. The bill requires full must-
carry of local television stations, and an additional set aside of 4 
percent of system capacity for other pubic interest purposes such as 
telemedicine and distance learning. I can assure my colleagues that 
these are issues particularly important in rural areas in states like 
Louisiana.
  The ECCA will also promote public safety, in two ways. First, it will 
require MVDDS licensees to air Emergency Alert System warnings, 
including AMBER alerts for missing children. EAS warnings are presently 
carried by cable systems and over-the-air broadcasters, but they are 
not seen by those who get their programming from DBS unless the viewer 
happens to be watching a local channel. Obviously, the need for greater 
dissemination of EAS warnings is particularly important for the ten 
states in which no local stations are carried via satellite.
  Second, this legislation requires MVDDS licensees to make their 
transmission systems available to national security and emergency 
preparedness personnel on a top-priority basis in times of need. We all 
know that when emergencies strike, the need for public safety personnel 
to communicate with one another skyrockets. MVDDS wireless networks, 
which will be deployed ubiquitously throughout the country, can help 
alleviate this thirst for spectrum.
  For these reasons, I believe that Congress should act on this matter 
as soon as possible. I urge my colleagues to support his bill and vote 
for enactment. I ask unanimous consent that the text of this bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 564

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Emergency Communications and 
     Competition Act of 2003''.

     SEC. 2. PURPOSES.

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

      SEC. 3. LICENSING.

       (a) Grant of Certain Licenses.--
       (1) In general.--The Federal Communications Commission 
     shall assign licenses in the 12.2-12.7 GHz band for the 
     provision of fixed terrestrial services using the rules, 
     policies, and procedures used by the Commission to assign 
     licenses in the 12.2-12.7 GHz band for the provision of 
     international or global satellite communications services in 
     accordance with section 647 of the Open-market Reorganization 
     for the Betterment of International Telecommunications Act 
     (47 U.S.C. 765f).
       (2) Deadline.--The Commission shall accept for filing and 
     grant licenses under paragraph (1) to any applicant that is 
     qualified pursuant to subsection (b) not later than six 
     months after the date of the enactment of this Act. The 
     preceding sentence shall not be construed to preclude the 
     Commission from granting licenses under paragraph (1) after 
     the deadline specified in that sentence to applicants that 
     qualify after that deadline.
       (b) Qualifications.--
       (1) Non-interference with direct broadcast satellite 
     service.--A license may be granted under this section only if 
     operations under the license will not cause harmful 
     interference to direct broadcast satellite service.
       (2) Acceptance of applications.--The Commission shall 
     accept an application for a license to operate a fixed 
     terrestrial service in the 12.2-12.7 GHz band if the 
     applicant--
       (A) successfully demonstrates the terrestrial technology it 
     will employ under the license with operational equipment that 
     it furnishes, or has furnished, for independent testing 
     pursuant to section 1012 of the Launching Our Communities' 
     Access to

[[Page 5510]]

     Local Television Act of 2000 (47 U.S.C. 1110); and
       (B) certifies in its application that it has authority to 
     use such terrestrial service technology under the license.
       (3) Clarification.--Section 1012(a) of the Launching Our 
     Communities' Access to Local Television Act of 2000 (47 
     U.S.C. 1110(a); 114 Stat. 2762A-141) is amended by inserting 
     ``, or files,'' after ``has filed''.
       (4) PCS or cellular services.--A license granted under this 
     section may not be used for the provision of Personal 
     Communications Service or terrestrial cellular telephony 
     service.
       (c) Prompt Commencement of Service.--In order to facilitate 
     and ensure the prompt deployment of service to unserved and 
     underserved areas and to prevent stockpiling or warehousing 
     of spectrum by licensees, the Commission shall require that 
     any licensee under this section commence service to consumers 
     within five years of the grant of the license under this 
     section.
       (d) Expansion of Emergency Alert System.--Each licensee 
     under this section shall disseminate Federal, State, and 
     local Emergency Alert System warnings to all subscribers of 
     the licensee under the license under this section.
       (e) Access for Emergency Personnel.--
       (1) Requirement.--Each licensee under this section shall 
     provide immediate access for national security and emergency 
     preparedness personnel to the terrestrial services covered by 
     the license under this section as follows:
       (A) Whenever the Emergency Alert System is activated.
       (B) Otherwise at the request of the Secretary of Homeland 
     Security.
       (2) Nature of access.--Access under paragraph (1) shall 
     ensure that emergency data is transmitted to the public, or 
     between emergency personnel, at a higher priority than any 
     other data transmitted by the service concerned.
       (f) Additional Public Interest Obligations.--
       (1) Additional obligations.--Each licensee under this 
     section shall--
       (A) adhere to rules governing carriage of local television 
     station signals and rules concerning obscenity and indecency 
     consistent with sections 614, 615, 616, 624(d)(2), 639, 640, 
     and 641 of the Communications Act of 1934 (47 U.S.C. 534, 
     535, 536, 544(d)(2), 559, 560, and 561);
       (B) make its facilities available for candidates for public 
     office consistent with sections 312(a)(7) and 315 of the 
     Communications Act of 1934 (47 U.S.C. 312(a)(7) and 315); and
       (C) allocate 4 percent of its capacity for services that 
     promote the public interest, in addition to the capacity 
     utilized to fulfill the obligations required of subparagraphs 
     (A) and (B), such as--
       (i) telemedicine;
       (ii) educational programming, including distance learning;
       (iii) high speed Internet access to unserved and 
     underserved populations; and
       (iv) specialized local data and video services intended to 
     facilitate public participation in local government and 
     community life.
       (2) License boundaries.--In order to ensure compliance with 
     paragraph (1), the Commission shall establish boundaries for 
     licenses under this section that conform to existing 
     television markets, as determined by the Commission for 
     purposes of section 652(h)(1)(C)(i) of the Communications Act 
     of 1934 (47 U.S.C. 534(h)(1)(C)(i)).
       (g) Redesignation of Multichannel Video Distribution and 
     Data Service.--The Commission shall redesignate the 
     Multichannel Video Distribution and Data Service (MVDDS) as 
     the Terrestrial Direct Broadcast Service (TDBS).
                                 ______
                                 
      By Mr. EDWARDS:
  S. 565. A bill to improve homeland security, prevent tax increases, 
support education and health care, and strengthen the economy; to the 
Committee on Appropriations.
  Mr. EDWARDS. Mr. President, I rise today to introduce the Homeland 
Protection and Tax Hike Prevention Act of 2003.
  As I speak, State governments face a budget gap of $80 billion in 
2004, according to the National Governors Association. My own State of 
North Carolina must close a $2 billion deficit this year, the third 
year in a row that we have faced a deficit of $1 billion or more. There 
is an additional $30 billion deficit in 2003 that, for most States, 
must be closed before the fiscal year ends in June. Cities and towns 
face a similar budget pinch. The likely result in many States will be 
steep tax increases and budget cuts.
  Because most States have seen two or three lean years in a row, the 
easiest cuts and sources of revenue have already been tapped. States 
already closed nearly $50 billion in deficits for 2003. According to 
Standard and Poor's, ``With rainy day funds having been depleted 
rapidly over the past three years, few options remain other than tough 
cuts or revenue increases.''
  The State and local budget crisis is a serious threat to our economy. 
State spending cuts and tax increases equaling $100 billion would 
directly lower GDP growth by one percentage point, according to the 
Center on Budget and Policy Priorities. According to the Center, ``The 
only way this blow to the economy can be mitigated is through federal 
fiscal relief for the states.''
  Millions of Americans across the Nation will be directly affected by 
State tax increases and budget cuts. For example, Kansas is considering 
new taxes on hair stylists, theaters, and doctors. Missouri is now 
taxing pharmacies. In fact, policymakers in 15 States are already 
calling for tax increases of approximately $14 billion in 2004.
  New York budget proposals would raise class sizes and cut 43,000 
early education slots in New York City. Florida may take away medical 
coverage for 26,000 low-income people. In California, hundreds of 
nursing homes are in danger of bankruptcy, according to the Washington 
Post. San Diego may close fire stations.
  Portland, OR, will likely trim its school year by 24 days. Oregon 
State police are laying off 129 troopers and abandoning 24-hour 
patrols. The Multnomah county jail will release as many as 500 inmates 
early. Medical benefits will be eliminated for 8,000 elderly and 
disabled people.
  This is wrong. It's wrong for the people being hurt. And it is wrong 
for our economy. That's why I am proposing the Homeland Protection and 
Tax Hike Prevention Act of 2003. This bill would enacts a State relief 
plan I first described last November. It gives States and cities a 
total of $50 billion, allowing them to avoid raising taxes and protect 
critical priorities in public safety, education, and health care.
  First, my legislation would provide $10 billion to states and major 
cities to strengthen homeland security. We have a whole range of 
homeland security priorities that we ought to be meeting but we 
haven't. Although our domestic readiness begins with first responders, 
they are not getting the training and equipment they need to respond to 
an attack with speed, skill, and strength. Our public health system 
isn't fully prepared to respond to biological attacks. We need to 
modernize an emergency warning system that is terribly out of date so 
we can reach Americans at any time, day or night.
  Our infrastructure is exposed. There are 500 large skyscrapers, 250 
major arenas and stadiums, and countless train, subway, and automobile 
bridges and tunnels. Many of these facilities have vulnerable 
ventilation systems, poor emergency exits, and inadequate fire 
retardants and blast-resistant materials. Security at nuclear and 
chemical plants and over shipments is still too lax. At 123 chemical 
plants, a toxic chemical release would endanger a million people or 
more.
  We need to meet all these priorities, and we can ought to meet them 
through a partnership between Washington, states, and local 
communities. This bill goes a long way toward doing that by providing 
$10 billion for homeland security.
  Next, today's bill would provide States $10 billion through higher 
Medicaid reimbursements. Higher Medicaid reimbursements can 
dramatically help State budgets. It can also address serious inequities 
in the way Medicaid funds are distributed today. The legislation is 
based on Senator Rockefeller's excellent proposal. It maintains last 
year's Medicaid matching rate where rates are declining and provides an 
additional modest, temporary increase in the matching rate. This short-
lived relief will help states balance their budgets and protect 
children and seniors who rely on Medicaid.
  Last but not least, my bill will give States and local governments 
$30 billion in general relief. In return for this aid, State and local 
governments must agree not to cut K-12 education funding or raise 
college tuition faster than inflation for low- and middle-income 
families.
  Across the Nation, States and cities are struggling with more needs 
and less revenue. Washington is not doing its part to help. Instead, we 
have created

[[Page 5511]]

new demands through the No Child Left Behind education reform law and 
the Federal special education laws, without delivering the resources 
needed to meet those demands. We ought to help States and localities 
meet those demands, and this bill will do that.
  The Homeland Protection and Tax Hike Protection Act will strengthen 
our homeland security and prevent states and cities from raising taxes 
and cutting schools and health care. I hope my colleagues will join me 
in supporting it.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 565

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Homeland Protection and Tax 
     Hike Prevention Act of 2003''.

     SEC. 2. PURPOSES.

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

     SEC. 3. DEFINITIONS.

       As used in this Act, the following definitions shall apply:
       (1) State.--Except as used in section 6, the term ``State'' 
     means each of the several States of the United States, the 
     District of Columbia, and the Commonwealth of Puerto Rico.
       (2) Metropolitan statistical area.--The term ``metropolitan 
     statistical area'' means a statistical geographic entity 
     associated with at least 1 urbanized area that has a 
     population of not less than 50,000, as identified by the 
     Office of Management and Budget.
       (3) Metropolitan city.--The term ``metropolitan city'' 
     means--
       (A) a central city within a metropolitan statistical area; 
     and
       (B) any other city within a metropolitan statistical area 
     that has a population of not less than 50,000.
       (4) Unit of general local government.--
       (A) In general.--The term ``unit of general local 
     government'' means--
       (i) a county, parish, township, city, or political 
     subdivision of a county, parish, township, or city, that is a 
     unit of general local government as determined by the 
     Secretary of Commerce for general statistical purposes; and
       (ii) the District of Columbia, the Commonwealth of Puerto 
     Rico, and the recognized governing body of an Indian tribe or 
     Alaskan native village that carries out substantial 
     governmental duties and powers.
       (B) Treatment of subsumed areas.--For purposes of 
     determining a unit of general local government under this 
     section, the rules under section 6720(c) of title 31, United 
     States Code, shall apply.

     SEC. 4. HOMELAND SECURITY GRANTS.

       (a) Grants Authorized.--
       (1) In general.--From the amount appropriated under 
     subsection (d), the Secretary of Homeland Security (referred 
     to in this section as the ``Secretary'') shall, as soon as 
     practicable after the date of enactment of this Act, award 
     grants to States and metropolitan cities, which have 
     submitted an application in accordance with subsection (c) to 
     accomplish the objectives described under subsection (b).
       (2) Allocations to states.--
       (A) Population-based allocations.--The Secretary shall 
     allocate $2,500,000,000 for grants to the States based on the 
     relative population of each State.
       (B) Risk-based allocations.--Subject to paragraph (4), the 
     Secretary shall allocate $2,500,000,000 for grants to the 
     States based on--
       (i) the potential risk, as it pertains to chemical 
     security, of each State;
       (ii) the proximity of each State to the nearest operating 
     nuclear power plant;
       (iii) the proximity of each State to the nearest United 
     States land or water port;
       (iv) the proximity of each State to the nearest 
     international border; and
       (v) the proximity of each State to the nearest Disaster 
     Medical Assistance Team.
       (3) Allocations to metropolitan cities.--
       (A) Population-based allocations.--The Secretary shall 
     allocate $2,500,000,000 for grants to units of general local 
     government within metropolitan cities based on the relative 
     population of each metropolitan statistical area.
       (B) Risk-based allocations.--The Secretary shall allocate 
     $2,500,000,000 for grants to metropolitan cities within 
     metropolitan statistical areas based on--
       (i) the potential risk, as it pertains to chemical 
     security, of each metropolitan statistical area;
       (ii) the proximity of each metropolitan statistical area to 
     the nearest operating nuclear power plant;
       (iii) the proximity of each metropolitan statistical area 
     to the nearest United States land or water port;
       (iv) the proximity of each metropolitan statistical area to 
     the nearest international border; and
       (v) the proximity of each metropolitan statistical area to 
     the nearest Disaster Medical Assistance Team.
       (C) Metropolitan cities.--The Secretary shall distribute 
     the allocations under subparagraphs (A) and (B) to 
     metropolitan cities based on the relative population of each 
     such city.
       (4) Clarification of risk factors.--In allocating funds to 
     States and metropolitan statistical areas under paragraphs 
     (2)(B) and (3)(B), the Secretary shall equally weigh each of 
     the following risk factors:
       (A) Potential risk as it pertains to chemical security.--If 
     a State or metropolitan statistical area is within the 
     vulnerable zone of a worst-case chemical release, as 
     specified in the most recent risk management plans filed with 
     the Environmental Protection Agency or another instrument 
     developed by the Environmental Protection Agency or the 
     Homeland Security Department that captures the same 
     information for the same facilities, the ratio under 
     paragraphs (2)(B)(i) and (3)(B)(i) shall be 1 divided by the 
     total number of States or metropolitan statistical areas that 
     are within such a zone.
       (B) Proximity as it pertains to nuclear security.--If a 
     State or metropolitan statistical area is located within 50 
     miles of an operating nuclear power plant, as identified by 
     the Nuclear Regulatory Commission, the ratio under paragraphs 
     (2)(B)(ii) and (3)(B)(ii) shall be 1 divided by the total 
     number of States or metropolitan statistical areas that are 
     located within 50 miles of an operating nuclear power plant.
       (C) Proximity as it pertains to port security.--If a State 
     or metropolitan statistical area is located within 50 miles 
     of 1 of the 100 largest United States ports, as stated by the 
     Department of Transportation, Bureau of Transportation 
     Statistics, United States Port Report by All Land Modes, or 
     within 50 miles of one of the 30 largest United States water 
     ports by metric tons and value, as stated by the Department 
     of Transportation, Maritime Administration, United States 
     Foreign Waterborne Transportation Statistics, the ratio under 
     paragraphs (2)(B)(iii) and (3)(B)(iii) shall be 1 divided by 
     the total number of States or metropolitan statistical areas 
     that are located within 50 miles of a United States land or 
     water port.
       (D) Proximity to International Borders.--If a State or 
     metropolitan statistical area is located within 50 miles of 
     an international border, the ratio under paragraph (2)(B)(iv) 
     and (3)(B)(iv) shall be 1 divided by the total number of 
     States or metropolitan statistical areas that are located 
     within 50 miles of an international border.
       (E) Proximity to disaster medical assistance teams.--If a 
     State or metropolitan statistical area is located within 50 
     miles of a Disaster Medical Assistance Team, as organized by 
     the National Disaster Medical System through the Department 
     of Public Health, the ratio under paragraphs (2)(B)(v) and 
     (3)(B)(v) shall be 1 divided by the total number of States or 
     metropolitan statistical areas that are located within 50 
     miles of a Disaster Medical Assistance Team.
       (b) Use of Funds.--Grants awarded pursuant to subsection 
     (a) may be used to--
       (1) support police, fire, health, and other emergency 
     personnel by--
       (A) purchasing or upgrading communications systems, 
     protective gear, or hazardous materials detection equipment;
       (B) providing training for emergency responses; and
       (C) providing for expenses related to retention of 
     personnel and overtime;
       (2) improve safeguards against the counterfeiting of 
     official State documents, including--
       (A) the improvement of procedures to obtain proof of 
     identity before issuance of official identification cards; 
     and
       (B) the implementation of biometric identifiers and 
     holograms;
       (3) improve security at chemical plants by--
       (A) strengthening requirements for perimeter security and 
     assisting in meeting such requirements; and
       (B) strengthening requirements for the use and handling of 
     hazardous materials and assisting in meeting such 
     requirements;
       (4) improve security in train and subway cars and stations, 
     on bridges, in tunnels, and in arenas by installing and 
     improving--

[[Page 5512]]

       (A) fire and blast protections;
       (B) ventilation systems;
       (C) entrance security;
       (D) sensors to detect chemical and biological weapons; and
       (E) emergency evacuation systems;
       (5) improve security at and around skyscrapers, public 
     monuments, and other major buildings;
       (6) secure food and water supplies, reservoirs, water 
     treatment plants, and distribution systems;
       (7) strengthen protections of other critical networks, 
     including--
       (A) telecommunications;
       (B) electrical power plants and grids; and
       (C) computer networks and databases;
       (8) plan and prepare for a response for chemical or 
     biological attacks, including--
       (A) purchasing, distributing, and storing treatments and 
     preventive measures;
       (B) providing emergency training for health officials; and
       (C) developing public health surveillance systems to 
     identify the disease outbreaks by monitoring ambulance calls, 
     hospital admittance, and other measures;
       (9) establish systems to notify members of the public and 
     appropriate agencies when a threat has emerged and any 
     precautions the public should take;
       (10) establish programs that offer opportunities for 
     members of the community to participate in terrorism 
     preparation and prevention, including neighborhood watch 
     groups; and
       (11) design, review, and improve disaster response systems, 
     enhancing communities' ability to coordinate efforts and 
     share information, and devise and implement a homeland 
     security plan.
       (c) Application.--
       (1) In general.--Each eligible entity desiring a grant 
     under this section shall submit an application to the 
     Secretary at such time, in such manner, and accompanied by 
     such information as the Secretary may reasonably require.
       (2) Contents.--Each application submitted pursuant to 
     paragraph (1) shall--
       (A) describe the activities for which assistance under this 
     section is sought; and
       (B) provide such additional assurances as the Secretary 
     determines to be necessary to ensure that the grantee will 
     use the proceeds of the grant in compliance with subsection 
     (b).
       (d) Authorization and Appropriation.--There are authorized 
     to be appropriated, and are appropriated, $10,000,000,000 for 
     fiscal year 2003 to carry out this section, which shall 
     remain available through September 30, 2004.

     SEC. 5. BUDGET CRISIS RELIEF GRANTS.

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

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

       (a) Definitions.--In this section, the following 
     definitions shall apply:
       (1) FMAP.--The term ``FMAP'' means the Federal medical 
     assistance percentage, as defined in section 1905(b) of the 
     Social Security Act (42 U.S.C. 1396d(b)).
       (2) State.--The term ``State'' has the meaning given such 
     term for purposes of title XIX of the Social Security Act (42 
     U.S.C. 1396 et seq.).
       (b) Permitting Maintenance of Fiscal Year 2002 FMAP for 
     Last 2 Calendar Quarters of Fiscal Year 2003.--
     Notwithstanding any other provision of law, but subject to 
     subsection (f), if the FMAP determined without regard to this 
     section for a State for fiscal year 2003 is less than the 
     FMAP as so determined for fiscal year 2002, the FMAP for the 
     State for fiscal year 2002 shall be substituted for the 
     State's FMAP for the third and fourth calendar quarters of 
     fiscal year 2003, before the application of this section.
       (c) Permitting Maintenance of Fiscal Year 2003 FMAP for 
     Fiscal Year 2004.--Notwithstanding any other provision of 
     law, but subject to subsection (f), if the FMAP determined 
     without regard to this section for a State for fiscal year 
     2004 is less than the FMAP as so determined for fiscal year 
     2003, the FMAP for the State for fiscal year 2003 shall be 
     substituted for the State's FMAP for each calendar quarter of 
     fiscal year 2004, before the application of this section.
       (d) General 2.45 Percentage Points Increase for Last 2 
     Calendar Quarters of Fiscal Year 2003 and Fiscal Year 2004.--
     Notwithstanding any other provision of law, but subject to 
     subsections (f) and (g), for each State for the third and 
     fourth calendar quarters of fiscal year 2003 and each 
     calendar quarter of fiscal year 2004, the FMAP (taking into 
     account the application of subsections (b) and (c)) shall be 
     increased by 2.45 percentage points.
       (e) Increase in Cap on Medicaid Payments To Territories.--
     Notwithstanding any other provision of law, but subject to 
     subsection (g), with respect to the third and fourth calendar 
     quarters of fiscal year 2003 and each calendar quarter of 
     fiscal year 2004, the amounts otherwise determined for Puerto 
     Rico, the Virgin Islands, Guam, the Northern Mariana Islands, 
     and American Samoa under subsections (f) and (g) of section 
     1108 of the Social Security Act (42 U.S.C. 1308) shall each 
     be increased by an amount equal to 4.90 percent of such 
     amounts.
       (f) Scope of Application.--The increases in the FMAP for a 
     State under this section shall apply only for purposes of 
     title XIX of the Social Security Act and shall not apply with 
     respect to--
       (1) disproportionate share hospital payments described in 
     section 1923 of such Act (42 U.S.C. 1396r-4); or
       (2) payments under title IV or XXI of such Act (42 U.S.C. 
     601 et seq. and 1397aa et seq.).
       (g) State Eligibility.--
       (1) In general.--Subject to paragraph (2), a State is 
     eligible for an increase in its FMAP under subsection (d) or 
     an increase in a cap amount under subsection (e) only if the 
     eligibility under its State plan under title XIX of the 
     Social Security Act (including any waiver under such title or 
     under section 1115 of such Act (42 U.S.C. 1315)) is no more 
     restrictive than the eligibility under such plan (or waiver) 
     as in effect on September 2, 2003.
       (2) State reinstatement of eligibility permitted.--A State 
     that has restricted eligibility under its State plan under 
     title XIX of the Social Security Act (including any waiver 
     under such title or under section 1115 of such Act (42 U.S.C. 
     1315)) after September 2, 2003, but prior to the date of 
     enactment of this Act is eligible for an increase in its FMAP 
     under subsection (d) or an increase in a cap amount under 
     subsection (e) in the first calendar quarter (and subsequent 
     calendar quarters) in which the State has reinstated 
     eligibility that is no more restrictive than the eligibility 
     under such plan (or waiver) as in effect on September 2, 
     2003.
       (3) Rule of construction.--Nothing in paragraph (1) or (2) 
     shall be construed as affecting a State's flexibility with 
     respect to benefits offered under the State medicaid program 
     under title XIX of the Social Security Act (42 U.S.C. 1396 et 
     seq.) (including any waiver under such title or under section 
     1115 of such Act (42 U.S.C. 1315)).
       (h) Sunset Date.--This section is repealed, effective 
     October 1, 2004.
                                 ______
                                 
      By Ms. MIKULSKI (for herself, Mr. Bond, Mr. Kennedy, Mrs. 
        Lincoln, Mr. Breaux, and Mr. Dodd):
  S. 566. A bill to amend the Public Health Service Act to provide for 
Alzheimer's disease research and demonstration grants; to the Committee 
on Health, Education, Labor, and Pensions.
  Mr. MIKULSKI. Mr. President, I rise to introduce the Alzheimer's 
Disease Research, Prevention, and Care Act of 2003. I am pleased that 
Senators Bond, Kennedy, Lincoln, Breaux, and Dodd are joining me as 
original cosponsors of this legislation. This bill expands research on 
Alzheimer's disease at the

[[Page 5513]]

National Institute on Aging and reauthorizes the Alzheimer's 
Demonstration Grant Program that helps patients and families get 
services like respite care and adult day care.
  I believe that ``honor thy mother and father'' is not only a good 
commandment to live by, it's also a good policy to govern by. That's 
why I authored the Alzheimer's Disease Research, Prevention, and Care 
Act--to put values into action and get behind our Nation's families.
  In 1998, the Federal Government was spending just $323 million on 
Alzheimer's disease research, a disease that affects about 4 million 
Americans. I fought for more funding for Alzheimer's disease and the 
National Institute on Aging. Not just an incremental increase--I fought 
to double the funding. I am proud that the National Institute on Aging 
was funded at $1 billion this year. That's double what it was 5 years 
ago. The Federal Government will spend more than $600 million on 
Alzheimer's research this year.
  This investment in Alzheimer's disease research is paying off. 
Scientists have found evidence that a cholesterol-lowering drug may 
prevent Alzheimer's. Researchers are testing a vaccine on mice that may 
prevent the disease in humans. Seven clinical trials are currently 
underway to find out whether estrogen, vitamin E, gingko biloba, and 
aspirin can prevent the disease.
  Even with these victories, there is still a lot more to do. 
Alzheimer's disease is a devastating illness. Four million Americans 
suffer from Alzheimer's, including one in ten people over age 65 and 
nearly half of those over age 85. Nineteen million Americans say they 
have a family member with the disease. The Medicare program alone spent 
$31.9 billion for the care of people with Alzheimer's disease in the 
year 2000. Without a cure, the number of Alzheimer's patients will more 
than triple in the next 50 years. Fourteen million Americans will 
suffer from Alzheimer's by 2050. If science can help delay the onset of 
Alzheimer's by even five years, it would improve the lives of millions 
of families and save billions of dollars.
  This legislation is about more than just statistics--it's about 
helping to meet the day-to-day needs of patients with Alzheimer's and 
the long range needs of the nation. Last year, I chaired a hearing at 
the Gerontology Research Center at the Johns Hopkins Bayview Medical 
center in Baltimore. I heard from Peter Savage, a Baltimore man caring 
for his wife, Ina. Mrs. Savage was diagnosed with early onset 
Alzheimer's disease at just 53 years old. I heard Mr. Savage's pain and 
frustration as he told the Subcommittee on Aging about his family's 
long struggle: watching his wife's slow decline; trying to care for 
Mrs. Savage by himself and with the help of daughters; the difficulty 
of finding someone to help them when the caregiving responsibilities 
were more than the family alone could bear; and the looming costs of 
nursing home care.
  The bill I am introducing gets behind families like the Savages and 
millions of others struggling with this disease. My bill reauthorizes 
and expands the Alzheimer's Demonstration grant Program. This program 
helps patients and families get support services like respite care and 
home health care. These grants connect help states leverage private 
resources to fill in gaps in existing services and make sure that 
programs reach the most vulnerable families. This important program 
needs to be renewed this year. I'm fighting to expand this program to 
nearly every state, to keep our promises to America's families.
  This bill also helps to meet the long-range needs of our Nation by 
increasing the Federal Government's commitment to Alzheimer's disease 
research at the National Institutes of Health and the National 
Institute on Aging. It puts the Alzheimer's Disease Prevention 
Initiative in our Federal law books to speed up the discovery of new 
ways to prevent the disease. My bill sets up a cooperative clinical 
research program to stretch our Federal research dollars, by making it 
easier for researchers across the country to share data and enroll 
patients in clinical trials. It also authorizes research on ways to 
improve the health of Alzheimer's caregivers--and ease some of their 
burden.
  This bill gets behind our Nation's families--both in the lab and in 
the community. I look forward to working with my colleagues to pass 
this important legislation.
                                 ______
                                 
      By Mr. LUGAR (by request):
  S. 571. A bill to establish the Millennium Challenge Account and the 
Millennium Challenge Corporation in order to reduce global poverty 
through increased economic growth by supporting a new compact for 
global development; to the Committee on Foreign Relations.
  Mr. LUGAR. Mr. President, by request, I introduce for appropriate 
reference a bill to establish the Millennium Challenge Account and the 
Millennium Challenge Corporation in order to reduce global poverty 
through increased economic growth by supporting a new compact for 
global development.
  This proposed legislation has been requested by the President of the 
United States, George W. Bush, and I am introducing it in order that 
there may be a specific bill to which Members of the Senate and the 
public may direct their attention and comments.
  I reserve my right to support or oppose this bill, as well as to make 
any suggested amendments to it, as this important initiative of the 
President continues to be considered by the Committee on Foreign 
Relations.
  I ask unanimous consent that the text of the bill be printed in the 
Record together with a section-by-section analysis of the bill and the 
letter from the President of the United States to the Congress of the 
United States dated February 5, 2003.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                 S. 571

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Millennium Challenge Act of 
     2003''.

     TITLE I--THE MILLENNIUM CHALLENGE ACCOUNT

     SEC. 101. STATEMENT OF POLICY.

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

     SEC. 102. ELIGIBILITY CRITERIA.

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

     SEC. 103. MILLENNIUM CHALLENGE CONTRACT.

       (a) In General.--A Millennium Challenge Contract, is an 
     agreement between the United States and an eligible country 
     that establishes a multi-year plan of partnership for 
     achieving shared development objectives in furtherance of the 
     purposes of this Act.
       (b) Elements.--The Millennium Challenge Contract shall 
     contain--
       (1) the specific objectives that the eligible country and 
     the United States expect to achieve;
       (2) the responsibilities of the eligible country and the 
     United States in the achievement of those objectives;
       (3) regular benchmarks to measure progress towards 
     achieving the agreed upon objectives and a description of how 
     the objectives will be sustained once assistance under this 
     Millennium Challenge Contract ends;
       (4) a plan and a timeframe that describes how and when 
     those objectives will be met;
       (5) the role and contribution of the business community, 
     private and voluntary organizations, and other members of 
     civil society

[[Page 5514]]

     in designing that plan and achieving the objectives;
       (6) where appropriate, the contribution of other donors in 
     the achievement of those objectives; and
       (7) a plan to ensure financial accountability of funds used 
     to achieve those objectives.
       (c) Local Input.--The Millennium Challenge Contract should 
     take into account the perspectives of the rural and urban 
     poor in an eligible country, and should reflect consultation 
     with private and voluntary organizations, and the business 
     community in the country.
       (d) Other Donors.--To the maximum extent feasible, 
     activities undertaken to achieve the objectives of the 
     Millennium Challenge Contract should be undertaken in 
     coordination with the assistance activities of other donors.

     SEC. 104. MILLENNIUM CHALLENGE ASSISTANCE.

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

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

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

     SEC. 106. EVALUATION AND ACCOUNT ABILITY.

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

     SEC. 107. GRADUATION.

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

     TITLE II--THE MILLENNIUM CHALLENGE CORPORATION

     SEC. 201. ESTABLISHMENT OF THE MILLENNIUM CHALLENGE 
                   CORPORATION.

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

     SEC. 202. MANAGEMENT OF THE CORPORATION.

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

     SEC. 203. FUNCTIONS OF THE CORPORATION.

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

     SEC. 204. POWERS OF THE CORPORATION.

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

[[Page 5515]]

     property, shall be exempt from taxation now or hereafter 
     imposed by the United States, or any territory or possession 
     thereof, or by any State, county, municipality, or local 
     taxing authority.

     SEC. 205. PERSONNEL AND ADMINISTRATIVE AUTHORITIES.

       (a) Personnel Authorities.--Notwithstanding any provision 
     of title 5, United States Code or of the Foreign Service Act 
     of 1980, as amended, the CEO of the Millennium Challenge 
     Corporation may, in regulations prescribed jointly with the 
     Director of the Office of Personnel Management, establish, 
     and from time to time adjust, a human resources management 
     system, including a retirement benefits programs.
       (1) Any system established under this subsection shall not 
     waive, modify, or otherwise affect, with respect to Civil 
     Service and Foreign Service employees--
       (A) the public employment principles of merit and fitness 
     set forth in section 2301 of title 5, including the 
     principles of hiring based on merit, fair treatment without 
     regard to political affiliation or other non-merit 
     considerations, equal pay for equal work, and protection of 
     employees against reprisal for whistle blowing,
       (B) section 2302 (b) of title 5,
       (C) chapters 72 and 73 of title 5,
       (D) the conflict of interest provisions in title 18, 
     chapter 11 of the United States Code.
       (2) The CEO of the Corporation may, without regard to the 
     civil service and foreign service laws and regulations, 
     appoint and terminate personnel as may be necessary to enable 
     the Corporation to perform its duties.
       (3) The CEO may fix the compensation of the Corporation 
     personnel without regard to the provisions of chapter 51 and 
     subchapter III of chapter 53 of title 5, United States Code, 
     relating to the classification of positions and General 
     Schedule pay rates, and without regard to the provisions of 
     chapters 4 and 5 of the Foreign Service Act, relating to the 
     classification of positions and Foreign Service pay rates.
       (4) The Corporation may utilize such authority contained in 
     the Foreign Service Act of 1980, as amended, as the 
     Corporation deems appropriate.
       (5) The CEO and other personnel who are employees of the 
     Corporation shall be employees under section 2105 of title 5, 
     United States Code, for purposes of chapters 63 (relating to 
     leave), 81 (relating to compensation for work injuries), 85 
     (relating to unemployment benefits), 87 (relating to life 
     insurance benefits), 89 (relating to health insurance 
     benefits), and 90 (relating to long-term care insurance) of 
     that title. If the CEO chooses not to waive chapters 83 and 
     84 (relating to retirement benefits) of title 5, or chapter 8 
     of the Foreign Service Act (relating to Foreign Service 
     retirement systems), employees of the Corporation shall be 
     eligible for benefits under those chapters as otherwise 
     applicable.
       (6) No individual, except for the officers of the 
     Corporation, may be employed by the Corporation for a period 
     in excess of 5 years: Provided, That the CEO, under special 
     circumstances, may approve an extension of the length of 
     employment on an individual basis.
       (7) Individuals employed by the Corporation, including 
     individuals detailed to or contracted by the Corporation, 
     while performing duties in any country or place outside the 
     United States, and their families shall, if they are 
     nationals of or permanently resident in such country or 
     place, enjoy the privileges and immunities of at least the 
     administrative and technical staff of the Mission of the 
     United States to such country and shall be subject to 22 
     U.S.C. 3927 in the same manner as United States Government 
     employees.
       (8) The CEO may procure temporary and intermittent services 
     under section 3109(b) of title 5, United States Code, at 
     rates for individuals which do not exceed the daily 
     equivalent of the annual rate of basic pay prescribed for 
     level V of the Executive Schedule under section 5316 of such 
     title.
       (b) Detail of Personnel to the Corporation.--
       (1) Any Federal Government employee may be detailed to the 
     Corporation on a fully or partially reimbursable or on a 
     nonreimbursable basis, and such detail shall be without 
     interruption or loss of civil service or Foreign Service 
     status or privilege.
       (2) Alternatively, an employee serving under a career or 
     career conditional appointment or the equivalent in an agency 
     who transfers to or converts to an appointment in the 
     Corporation with the consent of the head of the agency is 
     entitled to be returned to the employee's former position or 
     a position of like seniority, status, and pay without grade 
     or pay reduction in the agency if the employee--
       (A) is being separated from the Corporation for reasons 
     other than misconduct, neglect of duty, or malfeasance; and 
     (B) applies for return not later than 30 days before the date 
     of the termination of the employment in the Corporation.
       (3) An employee of a private sector organization assigned 
     to the Corporation under this section is deemed, during the 
     period of assignment, to be on detail to such agency. Such 
     employee--
       (A) may continue to receive pay and benefits from the 
     private sector organization from which he is assigned;
       (B) is deemed to be an employee of the Corporation as 
     specified in (a)(5) of this section, for the purposes of 
     chapters 81 and 85 of title 5 U.S.C.;
       (C) may not have access to any trade secrets or to any 
     other non-public information which is of commercial value to 
     the private sector organization from which he is assigned, 
     and
       (D) is subject to such regulations as the President may 
     prescribe. Such assignment may be made with or without 
     reimbursement by the Corporation for the pay, or a part 
     thereof, of the employee during the period of assignment, or 
     for any contribution of the private sector organization to 
     its employee benefit system. A private sector organization 
     may not charge the Federal Government, as direct or indirect 
     costs under a Federal contract, the costs of pay or benefits 
     paid by the organization to an employee assigned to the 
     Corporation.
       (c) Allocation of Funds.--
       (1) Transfer or Allocation.--The Corporation may allocate 
     or transfer to any agency of the United States Government any 
     part of any funds available for carrying out the purposes of 
     this Act. Such funds shall be available for obligation and 
     expenditure for the purposes for which authorized, in 
     accordance with authority granted in this Act or under 
     authority governing the activities of the agencies of the 
     United States Government to which such funds are allocated or 
     transferred.
       (2) Use of Services.--For carrying out the purposes of this 
     Act, the Corporation may utilize the services and facilities 
     of, or procure commodities from, any agency of the United 
     States Government under such terms and conditions as may be 
     agreed to by the head of such agency and the Corporation.
       (d) Other Authorities.--Except where inconsistent with the 
     provisions of this Act, the Corporation is authorized to use 
     any of the administrative authorities contained in the State 
     Department Basic Authorities Act of 1956 and the Foreign 
     Assistance Act of 1961.
       (e) Government Corporation Control Act.--The Corporation 
     shall be subject to the provisions of the Government 
     Corporation Control Act, title 31, United States Code.
                                  ____


                    Millennium Challenge Act of 2003


                      section-by-section analysis

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

               TITLE I--THE MILLENNIUM CHALLENGE ACCOUNT

     Sec. 101. Statement of policy
       Section 101 states the objective of the Millennium 
     Challenge Account, which is to reduce poverty through 
     promoting sustained economic growth in developing countries 
     committed to implementing good policies.
     Sec. 102. Eligibility criteria
       Section 102 identifies the criteria by which countries will 
     be eligible to receive Millennium Challenge Account (MCA) 
     assistance funds. MCA assistance will go to:
       Very poor countries. It is currently anticipated that in FY 
     2004, countries eligible for MCA funds will be those that are 
     currently eligible to borrow from the International 
     Development Association (IDA) and which have per capita 
     incomes below $1,435 (the historical IDA ``cutoff'' for aid). 
     In FY 2005, all countries with per capita incomes below 
     $1,435 will be eligible for MCA assistance. In FY 2006, the 
     list of eligible countries further expands to those with per 
     capita incomes up to $2,975 (the current World Bank cutoff 
     for lower middle income countries). The per capita income 
     levels will be adjusted on an annual basis.
       Countries with a demonstrated commitment to ruling justly, 
     encouraging economic freedom, and investing in their people. 
     To assess this commitment and identify recipient countries, 
     the MCA will use clear, concrete, and objective criteria. It 
     is the Administration's intent that in 2004, countries will 
     be selected based on 16 indicators chosen because of the 
     relative quality and objectivity of their data, country 
     coverage, public availability, and correlation with growth 
     and poverty reduction. The specific indicators are listed 
     below with their source noted.
       Governing Justly:
       Civil Liberties (Freedom House);
       Political Rights (Freedom House);
       Voice and Accountability (World Bank Institute);
       Government Effectiveness (World Bank Institute);
       Rule of Law (World Bank Institute); and
       Control of Corruption (World Bank Institute).
       Investing in People:
       Public Primary Education Spending as Percent of Gross 
     Domestic Product (GDP) (World Bank/national sources);
       Primary Education Completion Rate (World Bank/national 
     sources);
       Public Expenditures on Health as Percent of GDP (World 
     Bank/national sources); and
       Immunization Rates: DPT (diphtheria, pertussis, tetanus) 
     and Measles (World Bank/UN/national sources).
       Promoting Economic Freedom:
       Country Credit Rating (Institutional Investor Magazine);

[[Page 5516]]

       Inflation (International Monetary Fund [IMF]);
       3-Year Budget Deficit (IMF/national sources);
       Trade Policy (Heritage Foundation);
       Regulatory Quality (World Bank Institute); and
       Days to Start a Business (World Bank).
       Countries that have signed a Millennium Challenge Contract 
     with the United States. The terms of this contract are 
     defined in Section 103 below.
     Sec. 103. Millennium challenge contract
       Section 103 specifies the contractual relationship between 
     recipient nations and the United States. Each MCA country 
     will negotiate and sign a Millennium Challenge Contract with 
     the Millennium Challenge Corporation (MCC), established in 
     Title II. To initiate the negotiation, the selected MCA 
     countries will submit country proposals for MCA funds which 
     integrate official interests with those of the private sector 
     and civil society.
       The negotiated Millennium Challenge Contracts will include 
     a limited number of clear and measurable objectives, regular 
     benchmarks to measure progress toward achieving the 
     objectives, a plan and a timeframe describing how and when 
     the objectives will be met. Each contract will state the 
     responsibilities of the recipient country and the United 
     States, and describe the role and contributions of non-
     governmental entities including other donors as appropriate. 
     In addition, all contracts will provide for the financial 
     accountability of MCA funds.
     Sec. 104. Millennium challenge assistance
       Section 104 authorizes the President to provide assistance 
     for activities that contribute to the achievement of the 
     objectives specified in the contract. These activities will 
     drive productivity and economic growth in MCA countries. 
     Areas of focus for the MCA include agricultural development, 
     education, enterprise and private sector promotion, good 
     governance, health, and trade and investment capacity 
     building.
     Sec. 105. Authorization of the millennium challenge account 
         and authorities
       Section 105 authorizes appropriations to the President of 
     $1.3 billion in FY 2004 to carry out the MCA and such sums as 
     may be necessary for subsequent fiscal years. It is 
     anticipated that funding for MCA will reach $5 billion by FY 
     2006. MCA funds will be available until expended (``no-year 
     funds''). This availability of funds allows the Corporation 
     to obligate funds in the most productive manner.
       Section 105 allows the provision of MCA assistance to 
     countries notwithstanding any other provision of law with the 
     exception of prohibiting MCA assistance to countries that are 
     ineligible to receive assistance under part I of the Foreign 
     Assistance Act of 1961. This provision restricts or prohibits 
     assistance to countries that engage in actions prohibited in 
     part I, including countries that: violate human rights, 
     support trafficking in narcotics or human beings, and 
     contribute to terrorist financing. If the President waives 
     any of these provisions to make a country eligible to receive 
     assistance under part I of the Foreign Assistance Act, then 
     that country also would be eligible to receive MCA 
     assistance. MCA assistance would be subject to the provisions 
     of the Anti-Deficiency Act.
       In addition, section 105 makes the authorities and 
     limitations that are applicable to MCA assistance applicable, 
     as well, to any other funds used in conjunction with MCA 
     funds.
     Sec. 106. Evaluation and accountability
       Section 106 requires the Millennium Challenge Corporation, 
     established in Title II, to make all concluded Millennium 
     Challenge Contracts and their formal performance evaluations 
     publicly available on the Internet. The public nature of MCA 
     performance information makes the recipient countries and 
     implementers of MCA programs directly accountable to the 
     citizens of MCA countries and United States taxpayers.
     Sec. 107. Graduation
       Participation in the MCA will be limited according to the 
     terms of the Millennium Challenge Contracts, which will 
     define the purposes, activities and timeframe. MCA assistance 
     will have a clearly defined end date. For example, at the 
     conclusion of the contract period, MCA assistance will end 
     unless participant countries submit a new proposal and 
     renegotiate a new contract with the Corporation. Each 
     contract will also specify the conditions under which the 
     contract will be amended or terminated, including for reasons 
     of poor performance.

             TITLE II--THE MILLENNIUM CHALLENGE CORPORATION

     Sec. 201. Establishment of the millennium challenge 
         corporation
       Section 201 establishes an independent U.S. Government 
     Corporation that will implement the MCA according to 
     provisions of Title I of this Act.
     Sec. 202. Management of the corporation
       Section 202 establishes a board of directors for the 
     Corporation that will be chaired by the Secretary of State 
     and include the Secretary of the Treasury, and the Director 
     of the Office of Management and Budget. Individuals serving 
     in these positions in an acting capacity may serve on the 
     Board. The Board will direct the exercise of all functions 
     and powers of the Corporation, and shall make the final 
     decision on the eligibility and selection of MCA countries.
       The position of the CEO of the Corporation will be a 
     Senate-confirmed Presidential appointment. The CEO's 
     compensation is fixed at the equivalent of a deputy secretary 
     of a department of level II of the Executive Schedule.
     Sec. 203. Functions of the corporation
       Section 203 authorizes the Corporation to make grants to 
     any private or public entity to carry out the Millennium 
     Challenge Contracts, to provide technical assistance to 
     develop or carry out the Contracts, and to provide for the 
     financial management and evaluation of MCA programs.
     Sec. 204. Powers of the corporation
       Section 204 provides general powers to the MCC to enable it 
     to conduct business operations. The principal office of the 
     MCC is to be established in the Washington, D.C. metropolitan 
     area. The MCC also has the authority to establish overseas 
     offices as it sees fit. Employees of the MCC, and individuals 
     detailed to the MCC, are provided the authority to hold 
     offices with foreign governments, foreign government 
     agencies, or international organizations, so long as no 
     compensation is paid to such employees or individuals by the 
     foreign entity or international organization. Contracts and 
     other commitments of funds may make commitments for the 
     expenditure of funds for such period of time as the MCC deems 
     necessary. This section also provides discretion to the MCC 
     with regard to the making, performance, amendment, or 
     modification of contracts, grants, and other agreements. 
     Finally, this section provides that the MCC and its assets 
     and property are to be exempt from taxation by the United 
     States or by any State or local taxing authority.
     Sec. 205. Personnel and administrative authorities
       Section 205 authorizes the CEO of the MCC, in coordination 
     with the Director of the Office of Personnel Management, to 
     establish a human resources management system for the 
     Corporation, including a retirement benefits program. 
     However, provisions of title 5 of the United States Code 
     related to anti-discrimination, merit systems principles, 
     whistle blowing, and conflicts of interest, are specifically 
     made applicable to the MCC. Employees of the MCC are 
     considered Federal employees for purposes of leave benefits, 
     workers compensation, unemployment benefits, life insurance, 
     health insurance, and long-term care insurance.
       Section 205 also provides the authorities for detailing 
     U.S. government employees and private sector staff to the 
     Corporation. Federal employees have two options for serving 
     in the Corporation. They may be detailed on a reimbursable or 
     nonreimburseable basis without interruption of their civil 
     service status and privileges. Alternatively, they may resign 
     from their home agency and retain employment rights. Private 
     sector organizations may also detail staff to the MCC, while 
     continuing to pay those employees pay and benefits.
       The Corporation has the authority to allocate or transfer 
     money to other agencies; use the services and facilities of 
     any U.S. agency under agreed upon terms; and use any of the 
     administrative authorities contained in the State Department 
     Basic Authorities Act of 1956 and the Foreign Assistance Act 
     of 1961.
       Section 205 also makes the provisions of the Government 
     Corporation Control act applicable to the MCC.
                                  ____

     To the Congress of the United States:
       I am pleased to transmit a legislative proposal to 
     establish the Millennium Challenge Account and the Millennium 
     Challenge Corporation. Also transmitted is a section-by-
     section analysis.
       The Millennium Challenge Account (MCA) represents a new 
     approach to providing and delivering development assistance. 
     This new compact for development breaks with the past by 
     tying increased assistance to performance and creating new 
     accountability for all nations. This proposal implements my 
     commitment to increase current levels of core development 
     assistance by 50 percent over the next 3 years, thus 
     providing an annual increase of $5 billion by fiscal; year 
     2006. To be eligible for this new assistance, countries must 
     demonstrate commitment to three standards--ruling justly, 
     investing in their people, and encouraging economic freedom. 
     Given this commitment, and the link between financial 
     accountability and development success, special attention 
     will be given to fighting corruption.
       The goal of the Millennium Challenge Account initiative is 
     to reduce poverty by significantly increasing economic growth 
     in recipient countries through a variety of targeted 
     investments. The MCA will be administered by a new, small 
     Government corporation, called the Millennium Challenge 
     Corporation, designed to support innovative strategies and to 
     ensure accountability for measurable results. The Corporation 
     will be supervised by a Board of Directors chaired by the 
     Secretary of State and composed of other Cabinet-level 
     officials. The Corporation will be led by a Chief Executive 
     Officer

[[Page 5517]]

     appointed by the President, by and with the advice and 
     consent of the Senate. This proposal provides the Corporation 
     with flexible authorities to optimize program implementation, 
     contracting, and personnel selection while pursuing 
     innovative strategies.
       The Millennium Challenge Account initiative recognizes the 
     need for country ownership, financial oversight, and 
     accountability for results to ensure effective assistance. We 
     cannot accept permanent poverty in a world of progress. The 
     MCA will provide people in developing nations the tools they 
     need to seize the opportunities of the global economy. I urge 
     the prompt and favorable consideration of this legislation.
                                                   George W. Bush.
                                 The White House February 5, 2003.
                                 ______
                                 
      By Mr. FRIST:
  S. 572. A bill to establish a congressional commemorative medal for 
organ donors and their families; to the Committee on Banking, Housing, 
and Urban Affairs.
                                 ______
                                 
      By Mr. FRIST (for himself, Mr. Dodd, and Mr. Enzi):
  S. 573. A bill to amend the Public Health Service Act to promote 
organ donation, and for other purposes; to the Committee on Health, 
Education, Labor and Pensions.
  Mr. FRIST. Mr. President, this year, due to the rapid and tremendous 
advancements in our knowledge and in the science of organ 
transplantation, thousands of Americans will receive a life-saving 
organ transplant. These advances have allowed us to save the lives of 
patients who were once not considered candidates for transplantation.
  As a heart and lung transplant surgeon, I have had the opportunity to 
watch the field develop and grow over the past three decades. I 
remember my own experiences--of conducting some of the first 
transplants using hearts and lungs--and recognize our tremendous 
progress since that time. And I also know the hundreds of my own 
patients who live improved lives due to advances in transplantation.
  But I have also shared in the grief of patients who died before they 
could receive a transplant--a direct result of a large and growing 
shortage of organ donors. Medical advances have produced a staggering 
increase in the number of eligible transplant candidates, while the 
supply of organs fails to keep pace. Today, more than 80,000 patients 
await a transplant (a four-fold increase from just over a decade ago). 
At the same time, more patients die each year before they can receive 
that life-saving organ.
  I have also witnessed firsthand how great, lifesaving hope can spring 
from great tragedy. Earlier this year, I offered my assistance at the 
scene of a horrible automobile accident in Florida. Most of the family 
in the accident died--including two young children. While my heart goes 
out to his family for their terrible loss, from this tragedy has come 
new life. This family agreed to donate the organs of their loved ones. 
This gift has saved the life of a boy from the Virgin Islands. We must 
honor this family, and all other donor families, by redoubling our 
efforts to increasing organ donation.
  There is no need for people to die while awaiting a new organ. In my 
practice, I carried a card that listed my patients who were waiting on 
hearts--always aware that several of them would die before a live-
saving organ would become available. It was this needless loss of life 
that was the most painful, most frustrating and most disappointing part 
of my work.
  In 2000, there were almost 23,000 transplants--a significant increase 
over the roughly 13,000 transplant performed in 1988. Between 1990 and 
2001, the number of organ donors almost doubled, mainly as a result of 
an increase in organs from live donors. In fact, over those ten years, 
the number of cadaveric donors increased only 35 percent while the 
demand for transplant has more than tripled.
  More must be done. There are simply not enough organ donors; public 
awareness has not kept up with the rapid advances of transplantation. 
It is our duty to do all we can to raise awareness about the gift of 
life.
  We must do is work to encourage all Americans to share their desire 
to be an organ donor with their families.
  We must find other ways to improve organ donation--to identify 
eligible organs and work with families to help them better understand 
the value of donation. This is a new science--one that I have had the 
privilege of watching firsthand grow from theories and experiments to 
accepted medical practice. My mentor, Dr. Norman Shumway, was one of 
the leaders in the field; and the advent of cyclosporin was critical to 
its progress. But much remains to be learned, and we must continue to 
move forward.
  That is why one of my first priorities when I came to the Senate in 
1995 was to establish the Congressional Task Force on Organ Donation--
to promote awareness of this important issue and encourage a new 
dialogue seeking answers.
  Recent years have witnessed a new emphasis on highlighting public 
awareness of this need. In particular, I commend Secretary Thompson for 
making organ donation a top priority at the Department of Health and 
Human Services.
  There also are a number of complementary legislative approaches that 
we should pursue towards this end.
  We should provide funding for innovative and bold demonstration 
projects to improve donation and recovery rates. As part of this, we 
should ensure that the projects' results will be evaluated quickly and 
their lessons be disseminated broadly.
  We should provide for the placement and evaluation of organ donation 
coordinators in hospitals--a model that has worked with success in 
other countries.
  We should expand the authority of the Agency for Healthcare Research 
and Quality to conduct important research on the recovery, preservation 
and transportation of organs. The science of organ transplantation has 
been improved and refined since its inception. Yet all too often, organ 
donation efforts are conducted under the same practices as they were 
twenty years ago. We must establish a strong evidence-based approach to 
enhancing organ donation and recovery.
  We must encourage living organ donation by reducing potential 
financial disincentives facing living donors through the reimbursement 
of travel and other expenses incurred by living donors and their 
families.
  We must also seriously evaluate the long-term health effects of 
serving as a living donor by asking the Institute of Medicine to report 
on this issue and by establishing a living donor registry to track the 
health of individuals who have served as living organ donors.
  We must seriously examine and improve the role of organ donor 
registries. These programs have an important role to play in improving 
organ donation rates and have been used with different levels of 
success in some states. However, a number of questions surrounding 
registries remain unanswered and their effectiveness has not been fully 
evaluated.
  We must undertake a high-level systematic examination of the 
effectiveness of a range of organ donation approaches. Specifically, 
the Institute of Medicine should evaluate practices of organ 
procurement organizations, States, and other countries. This study 
should examine existing barriers to organ donation, as well as best 
donation and recovery practices, such as mandated choice and presumed 
consent. The study should evaluate consent practices, existing state 
routine notification laws, and the impact of requests for consent where 
registry listing constitutes express consent under State law. This 
review should be timely and include recommendations for action 
necessary to replicate the best practices identified and to otherwise 
increase organ donation rates.
  We must recognize and honor the sacrificial decisions to give consent 
and give the gift of life made each year by thousands of donors and 
families. We must do this in such a way as to honor those sharing life 
through donation and increase public awareness of this issue.
  These initiatives are contained within two important pieces of 
legislation I am introducing today.
  The Organ Donation and Recovery Improvement Act is a bipartisan, 
comprehensive bill that seeks to improve the overall process of organ 
donation and recovery, enhance our knowledge

[[Page 5518]]

base in these fields, encourage novel approaches to this growing 
problem and increase the number of organs available for transplants 
each year. The bill also seeks to remove potential barriers to 
donation, while identifying and focusing on best practices in organ 
donation. I thank Senator Christopher Dodd and Senator Mike Enzi for 
their assistance on this important bill. I also want to thank the wide 
range of patient and organ transplantation organizations who have done 
good work on this bill, including the American Society of 
Transplantation, American Society of Transplant Surgeons, North 
American Transplant Coordinators Organization, Tennessee Donor 
Services, New Mexico Donor Services, and Golden State Donor Services.
  The Gift of Life Congressional Medal Act will make each donor or 
donor family eligible to receive a commemorative Congressional medal. 
This legislation, which does not cost taxpayers a penny, will recognize 
the thousands of individuals each year who share the gift of life 
through organ donation. Moreover, it will encourage potential donors 
and enhance public awareness of the importance of organ donation to the 
over 80,000 Americans waiting for a transplant. Representative Pete 
Stark will soon be introducing the companion bill in the House of 
Representatives, and I thank him for his dedication in this area.
  Organ donation is one of the most important issues before us today. 
Each year, thousands of donors and families make the important decision 
to give consent and give the gift of life. We must recognize and honor 
their sacrifice, and, in so honoring, work to increase donation rates 
and allow more families to receive this gift of life each year. 
Hundreds of my own patients are alive today because of this gift. Let 
us work together to allow more patients and families to experience this 
miracle.
  I ask unanimous consent that the text of the bills be printed in the 
Record.

                                 S. 572

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Gift of Life Congressional 
     Medal Act of 2003''.

     SEC. 2. CONGRESSIONAL MEDAL.

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

     SEC. 3. ELIGIBILITY REQUIREMENTS.

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

     SEC. 4. PRESENTATION.

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

     SEC. 5. DUPLICATE MEDALS.

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

     SEC. 6. NATIONAL MEDALS.

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

     SEC. 7. GENERAL WAIVER OF PROCUREMENT REGULATIONS.

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

     SEC. 8. SOLICITATION OF DONATIONS.

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

     SEC. 9. DEFINITIONS.

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

     SEC. 10. SUNSET PROVISION.

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

                                 S. 573

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Organ Donation and Recovery 
     Improvement Act''.

                  TITLE I--ORGAN DONATION AND RECOVERY

     SEC. 101. INTERAGENCY TASK FORCE ON ORGAN DONATION.

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

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

       ``(a) In General.--The Secretary shall establish an inter-
     agency task force on organ donation and research (referred to 
     in this section as the `task force') to improve the 
     coordination and evaluation of--
       ``(1) federally supported or conducted organ donation 
     efforts and policies; and
       ``(2) federally supported or conducted basic, clinical and 
     health services research (including research on preservation 
     techniques and organ rejection and compatibility).
       ``(b) Composition.--
       ``(1) In general.--The task force shall be composed of--
       ``(A) the Surgeon General, who shall serve as the 
     chairperson; and
       ``(B) representatives to be appointed by the Secretary from 
     relevant agencies within the Department of Health and Human 
     Services (including the Health Resources and Services 
     Administration, Centers for Medicare & Medicaid Services, 
     National Institutes of Health,

[[Page 5519]]

     and Agency for Healthcare Research and Quality).
       ``(2) Other ex officio members.--The Secretary shall invite 
     the following individuals to serve as ex officio members of 
     the task force:
       ``(A) A representative from the Department of 
     Transportation.
       ``(B) A representative from the Department of Defense.
       ``(C) A representative from the Department of Veterans 
     Affairs.
       ``(D) A representative from the Office of Personnel 
     Management.
       ``(E) A physician representatives from the board of 
     directors of the Organ Procurement and Transplantation 
     Network.
       ``(F) Representatives of other Federal agencies or 
     departments as determined to be appropriate by the Secretary.
       ``(c) Annual Report.--In addition to activities carried out 
     under subsection (a), the task force shall support the 
     development of the annual report under section 378D(c).
       ``(d) Termination.--The task force may be terminated at the 
     discretion of the Secretary following the completion of at 
     least 2 annual reports under section 378D(c). Upon such 
     termination, the Secretary shall provide for the on-going 
     coordination of federally supported or conducted organ 
     donation and research activities.''.

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

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

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

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

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

       ``(a) Authority.--
       ``(1) In general.--The Secretary may award grants to 
     qualified organ procurement organizations under section 371 
     to establish programs coordinating organ donation activities 
     of eligible hospitals and qualified organ procurement 
     organizations under section 371. Such activities shall be 
     coordinated to increase the rate of organ donations for such 
     hospitals.
       ``(2) Eligible hospital.--For purposes of this section, an 
     eligible hospital is a hospital that performs significant 
     trauma care, or a hospital or consortium of hospitals that 
     serves a population base of not fewer than 200,000 
     individuals.
       ``(b) Administration of Coordination Program.--A condition 
     for the receipt of a grant under subsection (a) is that the 
     applicant involved agree that the program under such 
     subsection will be carried out jointly--
       ``(1) by representatives from the eligible hospital and the 
     qualified organ procurement organization with respect to 
     which the grant is made; and
       ``(2) by such other entities as the representatives 
     referred to in paragraph (1) may designate.
       ``(c) Evaluations.--Within 3 years after the award of 
     grants under this section, the Secretary shall ensure an 
     evaluation of programs carried out pursuant to subsection (a) 
     in order to determine the extent to which the programs have 
     increased the rate of organ donation for the eligible 
     hospitals involved. Such evaluation shall include 
     recommendations on whether the program should be expanded to 
     include other grantees, such as hospitals.
       ``(d) Matching Requirement.--The Secretary may not award a 
     grant to a qualifying organ donation entity under this 
     section unless such entity agrees that, with respect to costs 
     to be incurred by the entity in carrying out activities for 
     which the grant was awarded, the entity shall contribute 
     (directly or through donations from public or private 
     entities) non-Federal contributions in cash or in kind, in an 
     amount equal to not less than 30 percent of the amount of the 
     grant awarded to such entity.
       ``(e) Funding.--For the purpose of carrying out this 
     section, there are authorized to be appropriated $3,000,000 
     for fiscal year 2004, and such sums as may be necessary for 
     each of fiscal years 2005 through 2008.''.

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

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

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

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

     SEC. 104. REPORTS.

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

     ``SEC. 378D. REPORTS.

       ``(a) IOM Report on Best Practices.--
       ``(1) In general.--The Secretary shall enter into a 
     contract with the Institute of Medicine to conduct an 
     evaluation of the organ donation practices of organ 
     procurement organizations, States, other countries, and other 
     appropriate organizations.
       ``(2) Considerations.--In conducting the evaluation under 
     paragraph (1), the Institute of Medicine shall examine--

[[Page 5520]]

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

     SEC. 105. TECHNICAL AMENDMENT CONCERNING ORGAN PURCHASES.

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

                   TITLE II--LIVING DONATION EXPENSES

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

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

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

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

                      TITLE III--ORGAN REGISTRIES

     SEC. 301. ADVISORY COMMITTEE.

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

     ``SEC. 371A. ADVISORY COMMITTEE.

       ``(a) In General.--Not later than 6 months after enactment, 
     the Secretary shall establish an advisory committee to study 
     existing organ donor registries and make recommendations to 
     Congress regarding the costs, benefits, and expansion of such 
     registries.
       ``(b) Membership.--The committee shall be composed of 10 
     members of whom--
       ``(1) at least 1 member shall be a physician with 
     experience performing transplants;
       ``(2) at least 1 member shall have experience in organ 
     recovery;
       ``(3) at least 1 member shall be representative of an 
     organization with experience conducting national awareness 
     campaigns and donor outreach;
       ``(4) at least 1 member shall be representative of a State 
     with an existing donor registry;
       ``(5) at least 1 member shall have experience with national 
     information systems where coordination occurs with State-
     based systems; and
       ``(6) at least 1 member shall represent donor families, 
     transplant recipients, and those awaiting transplantation.
       ``(c) Initial Meeting.--Not later than 30 days after the 
     date on which all members of the committee have been 
     appointed, the committee shall hold its first meeting.
       ``(d) Meetings.--The committee shall meet at the call of 
     the Chairman who shall be selected by the Secretary.
       ``(e) Compensation.--Each member of the committee shall not 
     receive compensation for services provided under this 
     section.
       ``(f) Travel Expenses.--The members of the committee shall 
     be allowed travel expenses, including per diem in lieu of 
     subsistence, at rates authorized for employees of agencies 
     under subchapter I of chapter 57 of title 5, United States 
     Code, while away from their homes or regular places of 
     business in the performance of services for the committee.
       ``(g) Administrative Support.--The Secretary shall ensure 
     that the committee is provided with administrative support or 
     any other technical assistance that such committee needs in 
     carrying out its duties.
       ``(h) Permanent Committee.--Section 14 of the Federal 
     Advisory Committee Act shall not apply to the committee 
     established under this section.
       ``(i) Report.--Not later than 1 year after the date on 
     which the committee is established under subsection (a), the 
     committee shall prepare and submit to Congress a report 
     regarding the status of organ donor registries, current best 
     practices, the effect of organ donor registries on organ 
     donation rates, the merits of expanding organ donor 
     registries, issues relating to consent, the efficacy of 
     current privacy protections, potential forms of technical 
     assistance, and recommendations regarding improving the 
     effectiveness and establishing formal linkages between organ 
     donor registries.
       ``(j) Definition.--In this section, the term `organ donor 
     registry' means a listing of individuals who have indicated 
     their desire to donate their organs and tissue upon their 
     death through driver's license preferences or other formal 
     mechanisms.''.

     SEC. 302. NATIONAL LIVING DONOR REGISTRY.

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

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

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

     SEC. 303. QUALIFIED ORGAN PROCUREMENT ORGANIZATIONS.

       Section 371(a) of the Public Health Service Act (42 U.S.C. 
     273(a)) is amended by striking paragraph (3).

  Mr. DODD. Mr. President, for tragic reasons, organ donation has been 
in the spotlight of late. On Saturday, February 23, 2002, 17-year-old 
Jessica Santillan died after receiving organs from a donor with an 
incompatible blood type. I would like to take this opportunity to 
express my heartfelt

[[Page 5521]]

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

                          ____________________