[Congressional Record (Bound Edition), Volume 154 (2008), Part 2]
[Senate]
[Pages 2074-2078]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 4019. Mr. JOHNSON submitted an amendment intended to be proposed 
by him to the bill S. 1200, to amend the Indian Health Care Improvement 
Act to revise and extend the Act; which was ordered to lie on the 
table; as follows:

       On page 298, after line 25, insert the following:

     ``SEC. 71_. TESTIMONY BY SERVICE EMPLOYEES IN CASES OF RAPE 
                   AND SEXUAL ASSAULT.

       ``(a) Approval by Director.--
       ``(1) In general.--The Director shall approve or 
     disapprove, in writing, any request or subpoena for a sexual 
     assault nurse examiner employed by the Service to provide 
     testimony in a deposition, trial, or other similar proceeding 
     regarding information obtained in carrying out the official 
     duties of the nurse examiner.
       ``(2) Requirement.--The Director shall approve a request or 
     subpoena under paragraph (1) if the request or subpoena does 
     not violate the policy of the Department to maintain strict 
     impartiality with respect to private causes of action.
       ``(3) Treatment.--If the Director fails to approve or 
     disapprove a request or subpoena by the date that is 7 days 
     after the date of receipt of the request or subpoena, the 
     request or subpoena shall be considered to be approved for 
     purposes of this subsection.
       ``(b) Policies and Protocol.--The Director, in coordination 
     with the Director of the Office on Violence Against Women of 
     the Department of Justice, in consultation with Indian Tribes 
     and Tribal Organizations, and in conference with Urban Indian 
     Organizations, shall develop standardized sexual assault 
     policies and protocol for the facilities of the Service.
                                 ______
                                 
  SA 4020. Mr. TESTER proposed an amendment to amendment SA 3899 
proposed by Mr. Dorgan (for himself, Ms. Murkowski, Mr. Baucus, Mr. 
Kennedy, Mr. Smith, Mr. Nelson of Nebraska, and Mr. Salazar) to the 
bill S. 1200, to amend the Indian Health Care Improvement Act to revise 
and extend the Act; as follows:

       On page 336, between lines 2 and 3, insert the following:

     ``SEC. 815. SENSE OF CONGRESS REGARDING LAW ENFORCEMENT AND 
                   METHAMPHETAMINE ISSUES IN INDIAN COUNTRY.

       ``It is the sense of Congress that Congress encourages 
     State, local, and Indian tribal law enforcement agencies to 
     enter into memoranda of agreement between and among those 
     agencies for purposes of streamlining law enforcement 
     activities and maximizing the use of limited resources--
       ``(1) to improve law enforcement services provided to 
     Indian tribal communities; and
       ``(2) to increase the effectiveness of measures to address 
     problems relating to methamphetamine use in Indian Country 
     (as defined in section 1151 of title 18, United States Code).
                                 ______
                                 
  SA 4021. Mr. THUNE submitted an amendment intended to be proposed to 
amendment SA 3899 proposed by Mr. Dorgan (for himself, Ms. Murkowski, 
Mr. Baucus, Mr. Kennedy, Mr. Smith, Mr. Nelson of Nebraska, and Mr. 
Salazar) to the bill S. 1200, to amend the Indian Health Care 
Improvement Act to revise and extend the Act; which was ordered to lie 
on the table; as follows:

       On page 347, after line 24, add the following:

[[Page 2075]]



     SEC. 104. GAO STUDY OF TRIBAL JUSTICE SYSTEMS.

       (a) In General.--Not later than 1 year after the date of 
     enactment of this Act, the Comptroller General of the United 
     States shall conduct, and submit to Congress a report 
     describing the results of, a study of the tribal justice 
     systems of Indian tribes located in the States of North 
     Dakota and South Dakota.
       (b) Inclusions.--The study under subsection (a) shall 
     include, with respect to the tribal system of each Indian 
     tribe described in subsection (a) and the tribal justice 
     system as a whole--
       (1)(A) a description of how the tribal justice systems 
     function, or are supposed to function; and
       (B) a description of the components of the tribal justice 
     systems, such as tribal trial courts, courts of appeal, 
     applicable tribal law, judges, qualifications of judges, the 
     selection and removal of judges, turnover of judges, the 
     creation of precedent, the recording of precedent, the 
     jurisdictional authority of the tribal court system, and the 
     separation of powers between the tribal court system, the 
     tribal council, and the head of the tribal government;
       (2) a review of the origins of the tribal justice systems, 
     such as the development of the systems pursuant to the Act of 
     June 18, 1934 (25 U.S.C. 461 et seq.) (commonly known as the 
     ``Indian Reorganization Act''), which promoted tribal 
     constitutions and addressed the tribal court system;
       (3) an analysis of the weaknesses of the tribal justice 
     systems, including the adequacy of law enforcement personnel 
     and detention facilities, in particular in relation to crime 
     rates; and
       (4) an analysis of the measures that tribal officials 
     suggest could be carried out to improve the tribal justice 
     systems, including an analysis of how Federal law could 
     improve and stabilize the tribal court system.
                                 ______
                                 
  SA 4022. Mr. GREGG proposed an amendment to amendment SA 3900 
proposed by Mr. Sanders (for himself, Mr. Obama, Ms. Cantwell, Mr. 
Kerry, Ms. Snowe, Ms. Collins, Mr. Sununu, Mr. Menendez, Mr. Leahy, 
Mrs. Clinton, Mr. Kennedy, and Mr. Durbin) to the amendment SA 3899 
proposed by Mr. Dorgan (for himself, Ms. Murkowski, Mr. Baucus, Mr. 
Kennedy, Mr. Smith, Mr. Nelson of Nebraska, and Mr. Salazar) to the 
bill S. 1200, to amend the Indian Health Care Improvement Act to revise 
and extend the Act; as follows:

       Strike all after line 1 and insert the following:

                        TITLE III--MISCELLANEOUS

     SEC. 301. LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM.

       (a) In General.--There are authorized to be appropriated, 
     and there are appropriated, out of any money in the Treasury 
     not otherwise appropriated--
       (1) $400,000,000 (to remain available until expended) for 
     making payments under subsections (a) through (d) of section 
     2604 of the Low-Income Home Energy Assistance Act of 1981 (42 
     U.S.C. 8623); and
       (2) $400,000,000 (to remain available until expended) for 
     making payments under section 2604(e) of the Low-Income Home 
     Energy Assistance Act of 1981 (42 U.S.C. 8623(e)), 
     notwithstanding the designation requirement of section 
     2602(e) of that Act (42 U.S.C. 8621(e)).
       (b) Rescission.--
       (1) In general.--Notwithstanding any other provision of 
     law, each discretionary amount provided by the Consolidated 
     Appropriations Act, 2008 (Public Law 110-161; 121 Stat. 
     1844), excluding the amounts made available for the purposes 
     described in paragraph (2), is reduced by the pro rata 
     percentage required to reduce the total amount provided by 
     that Act by $800,000,000.
       (2) Excepted purposes.--The reduction under paragraph (1) 
     shall not apply to any discretionary amount made available in 
     the Consolidated Appropriations Act, 2008 (Public Law 110-
     161; 121 Stat. 1844), for purposes of--
       (A) the Department of Defense; or
       (B) the low-income home energy assistance program 
     established under the Low-Income Home Energy Assistance Act 
     of 1981 (42 U.S.C. 8621 et seq.).
                                 ______
                                 
  SA 4023. Ms. MIKULSKI (for herself, Mr. Coleman, and Ms. Klobuchar) 
submitted an amendment intended to be proposed to amendment SA 3899 
proposed by Mr. Dorgan (for himself, Ms. Murkowski, Mr. Baucus, Mr. 
Kennedy, Mr. Smith, Mr. Nelson of Nebraska, and Mr. Salazar) to the 
bill S. 1200, to amend the Indian Health Care Improvement Act to revise 
and extend the Act; which was ordered to lie on the table; as follows:

       On page 397, after line 2, add the following:

     SEC. 213. MORATORIUM ON IMPLEMENTATION OF CHANGES TO CASE 
                   MANAGEMENT AND TARGETED CASE MANAGEMENT PAYMENT 
                   REQUIREMENTS UNDER MEDICAID.

       (a) Moratorium.--
       (1) Delayed implementation of december 4, 2007, interim 
     final rule.--The interim final rule published on December 4, 
     2007, at pages 68,077 through 68,093 of volume 72 of the 
     Federal Register (relating to parts 431, 440, and 441 of 
     title 42 of the Code of Federal Regulations) shall not take 
     effect before April 1, 2009.
       (2) Continuation of 2007 payment policies and practices.--
     Notwithstanding any other provision of law, the Secretary of 
     Health and Human Services shall not, prior to April 1, 2009, 
     take any action (through promulgation of regulation, issuance 
     of regulatory guidance, use of Federal payment audit 
     procedures, or other administrative action, policy or 
     practice, including a Medical Assistance Manual transmittal 
     or issuance of a letter to State Medicaid directors) to 
     restrict coverage or payment under title XIX of the Social 
     Security Act for case management and targeted case management 
     services if such action is more restrictive than the 
     administrative action, policy, or practice that applies to 
     coverage of, or payment for, such services under title XIX of 
     the Social Security Act on December 3, 2007. Any such action 
     taken by the Secretary of Health and Human Services during 
     the period that begins on December 4, 2007, and ends on March 
     31, 2009, that is based in whole or in part on the interim 
     final rule described in subsection (a) is null and void.
       (b) Inclusion of Medicare Providers and Suppliers in 
     Federal Payment Levy and Administrative Offset Program.--
       (1) In general.--Section 1874 of the Social Security Act 
     (42 U.S.C. 1395kk) is amended by adding at the end the 
     following new subsection:
       ``(d) Inclusion of Medicare Provider and Supplier Payments 
     in Federal Payment Levy Program.--
       ``(1) In general.--The Centers for Medicare & Medicaid 
     Services shall take all necessary steps to participate in the 
     Federal Payment Levy Program under section 6331(h) of the 
     Internal Revenue Code of 1986 as soon as possible and shall 
     ensure that--
       ``(A) at least 50 percent of all payments under parts A and 
     B are processed through such program beginning within 1 year 
     after the date of the enactment of this section;
       ``(B) at least 75 percent of all payments under parts A and 
     B are processed through such program beginning within 2 years 
     after such date; and
       ``(C) all payments under parts A and B are processed 
     through such program beginning not later than September 30, 
     2011.
       ``(2) Assistance.--The Financial Management Service and the 
     Internal Revenue Service shall provide assistance to the 
     Centers for Medicare & Medicaid Services to ensure that all 
     payments described in paragraph (1) are included in the 
     Federal Payment Levy Program by the deadlines specified in 
     that subsection.''.
       (2) Application of administrative offset provisions to 
     medicare provider or supplier payments.--Section 3716 of 
     title 31, United States Code, is amended--
       (A) by inserting ``the Department of Health and Human 
     Services,'' after ``United States Postal Service,'' in 
     subsection (c)(1)(A); and
       (B) by adding at the end of subsection (c)(3) the following 
     new subparagraph:
       ``(D) This section shall apply to payments made after the 
     date which is 90 days after the enactment of this 
     subparagraph (or such earlier date as designated by the 
     Secretary of Health and Human Services) with respect to 
     claims or debts, and to amounts payable, under title XVIII of 
     the Social Security Act.''.
       (3) Effective date.--The amendments made by this subsection 
     shall take effect on the date of the enactment of this Act.
                                 ______
                                 
  SA 4024. Mr. COBURN submitted an amendment intended to be proposed by 
him to the bill S. 1200, to amend the Indian Health Care Improvement 
Act to revise and extend the Act; which was ordered to lie on the 
table; as follows:

       At the appropriate place in title VIII of the Indian Health 
     Care Improvement Act (as amended by section 101), insert the 
     following:

     ``SEC. 8__. SCIENTIFICALLY EFFECTIVE HEALTH PROMOTION 
                   SERVICES.

       ``Notwithstanding any other provision of this Act, coverage 
     of health promotion services under this Act shall only be for 
     medical or preventive health services or activities--
       ``(1) for which scientific evidence demonstrates a direct 
     connection to improving health; and
       ``(2) that are provided in accordance with applicable 
     medical standards of care.
                                 ______
                                 
  SA 4025. Mr. COBURN submitted an amendment intended to be proposed by 
him to the bill S. 1200, to amend the Indian Health Care Improvement 
Act to revise and extend the Act; which was ordered to lie on the 
table; as follows:

       At the appropriate place in title VIII of the Indian Health 
     Care Improvement Act (as amended by section 101), insert the 
     following:

     ``SEC. 8__. NO RACIAL PREFERENCE IN EMPLOYMENT.

       ``Notwithstanding any other provision of this Act, nothing 
     in this Act authorizes any racial preference in employment.

[[Page 2076]]


                                 ______
                                 
  SA 4026. Mr. COBURN submitted an amendment intended to be proposed by 
him to the bill S. 1200, to amend the Indian Health Care Improvement 
Act to revise and extend the Act; which was ordered to lie on the 
table; as follows:

       Strike paragraph (5) of section 713(b) of the Indian Health 
     Care Improvement Act (as amended by section 101) and insert 
     the following:
       ``(5) To identify and provide behavioral health treatment 
     to Indian perpetrators and perpetrators who are members of an 
     Indian household making efforts to begin offender and 
     behavioral health treatment while the perpetrator is 
     incarcerated or at the earliest possible date if the 
     perpetrator is not incarcerated.
       At the end of section 713 of the Indian Health Care 
     Improvement Act (as amended by section 101), add the 
     following:
       ``(d) Limitation on Funding.--Treatment shall be provided 
     for a perpetrator pursuant to this section only if the 
     treatment is scientifically demonstrated to reduce the 
     potential of the perpetrator to commit child sexual abuse 
     again, and shall not provide the basis to reduce any 
     applicable criminal punishment or civil liability for that 
     abuse.
                                 ______
                                 
  SA 4027. Mr. COBURN submitted an amendment intended to be proposed by 
him to the bill S. 1200, to amend the Indian Health Care Improvement 
Act to revise and extend the Act; which was ordered to lie on the 
table; as follows:

       At the appropriate place in title VII of the Indian Health 
     Care Improvement Act (as amended by section 101), insert the 
     following:

     ``SEC. 7__. CRIMINAL CONDUCT.

       ``Nothing in this title--
       ``(1) establishes any defense, not otherwise applicable 
     under law, for any individual accused of any crime, including 
     physical or sexual abuse of children or family violence; or
       ``(2) preempts or otherwise affects any applicable 
     requirement for--
       ``(A) reporting of criminal conduct, including for child 
     abuse or family violence; or
       ``(B) creating any new privilege concerning disclosure.
                                 ______
                                 
  SA 4028. Mr. COBURN submitted an amendment intended to be proposed by 
him to the bill S. 1200, to amend the Indian Health Care Improvement 
Act to revise and extend the Act; which was ordered to lie on the 
table; as follows:

       On page 347, after line 24, add the following:

     SEC. 104. BLOOD QUANTUM REQUIREMENT FOR FEDERAL RECOGNITION 
                   OF INDIAN TRIBES.

       Effective beginning on the date of enactment of this Act, 
     in determining whether to extend Federal recognition to an 
     Indian tribe or other Indian group under part 83 of title 25, 
     Code of Federal Regulations (or successor regulations), the 
     Secretary of the Interior shall require that each member of 
     the Indian tribe or group possess a degree of Indian blood of 
     not less than \1/512\.
                                 ______
                                 
  SA 4029. Mr. COBURN submitted an amendment intended to be proposed by 
him to the bill S. 1200, to amend the Indian Health Care Improvement 
Act to revise and extend the Act; which was ordered to lie on the 
table; as follows:

       On page 347, after line 24, add the following:

     SEC. 104. GAO STUDY OF MEMBERSHIP CRITERIA FOR FEDERALLY 
                   RECOGNIZED INDIAN TRIBES.

       Not later than 1 year after the date of enactment of this 
     Act, the Comptroller General of the United States shall 
     conduct a study of membership criteria for federally 
     recognized Indian tribes, including--
       (1) the number of federally recognized Indian tribes in 
     existence on the date on which the study is conducted;
       (2) the number of those Indian tribes that use blood 
     quantum as a criterion for membership in the Indian tribe and 
     the importance assigned to that criterion;
       (3) the percentage of members of federally recognized 
     Indian tribes that possesses degrees of Indian blood of--
       (A) \1/4\;
       (B) \1/8\; and
       (C) \1/16\; and
       (4) the variance in wait times and rationing of health care 
     services within the Service between federally recognized 
     Indian Tribes that use blood quantum as a criterion for 
     membership and those Indian Tribes that do not use blood 
     quantum as such a criterion.
                                 ______
                                 
  SA 4030. Mr. COBURN submitted an amendment intended to be proposed by 
him to the bill S. 1200, to amend the Indian Health Care Improvement 
Act to revise and extend the Act; which was ordered to lie on the 
table; as follows:

       Strike section 221 of the Indian Health Care Improvement 
     Act (as amended by section 101) and insert the following:

     ``SEC. 221. LICENSING.

       ``Nothing in this Act preempts any State requirement 
     regarding licensing of any health care personnel.
                                 ______
                                 
  SA 4031. Mr. COBURN submitted an amendment intended to be proposed by 
him to the bill S. 1200, to amend the Indian Health Care Improvement 
Act to revise and extend the Act; which was ordered to lie on the 
table; as follows:

       At the appropriate place in title VIII of the Indian Health 
     Care Improvement Act (as amended by section 101), insert the 
     following:

     ``SEC. 8__. GAO ASSESSMENT.

       ``Not later than 1 year after the date of enactment of the 
     Indian Health Care Improvement Act Amendments of 2008, the 
     Comptroller General of the United States shall conduct, and 
     submit to Congress a report describing the results of, an 
     assessment of--
       ``(1) the average wait time of patients in the Service;
       ``(2) the extent of rationing of health care services in 
     the Service;
       ``(3) the average per capita health care spending on 
     Indians eligible for health care services through the 
     Service;
       ``(4) the overall health outcomes in Indians, as compared 
     to the overall health outcomes of other residents of the 
     United States;
       ``(5) patient satisfaction of Indians receiving health care 
     services through the Service;
       ``(6) the total amount of funds of the Service expended 
     for--
       ``(A) direct medical care; and
       ``(B) administrative expenses;
       ``(7) the health care coverage options available to Indians 
     receiving health care services through the Service;
       ``(8) the health care services options available to 
     Indians; and
       ``(9) the health care provider options available to 
     Indians.
                                 ______
                                 
  SA 4032. Mr. COBURN submitted an amendment intended to be proposed by 
him to the bill S. 1200, to amend the Indian Health Care Improvement 
Act to revise and extend the Act; which was ordered to lie on the 
table; as follows:

       At the appropriate place in the Indian Health Care 
     Improvement Act (as amended by section 101), insert the 
     following:

     ``SEC. ___. TESTING FOR SEXUALLY TRANSMITTED DISEASES IN 
                   CASES OF SEXUAL VIOLENCE.

       ``The Attorney General shall ensure that, with respect to 
     any Federal criminal action involving a sexual assault, rape, 
     or other incident of sexual violence against an Indian--
       ``(1)(A) at the request of the victim, a defendant is 
     tested for the human immunodeficiency virus (HIV) and such 
     other sexually transmitted diseases as are requested by the 
     victim not later than 48 hours after the date on which the 
     applicable information or indictment is presented;
       ``(B) a notification of the test results is provided to the 
     victim or the parent or guardian of the victim and the 
     defendant as soon as practicable after the results are 
     generated; and
       ``(C) such follow-up tests for HIV and other sexually 
     transmitted diseases are provided as are medically 
     appropriate, with the test results made available in 
     accordance with subparagraph (B); and
       ``(2) pursuant to section 714(a), HIV and other sexually 
     transmitted disease testing, treatment, and counseling is 
     provided for victims of sexual abuse.
                                 ______
                                 
  SA 4033. Mr. COBURN (for himself and Mr. DeMint) submitted an 
amendment intended to be proposed to amendment SA 3899 proposed by Mr. 
Dorgan (for himself, Ms. Murkowski, Mr. Baucus, Mr. Kennedy, Mr. Smith, 
Mr. Nelson of Nebraska, and Mr. Salazar) to the bill S. 1200, to amend 
the Indian Health Care Improvement Act to revise and extend the Act; 
which was ordered to lie on the table; as follows:

       On page 336, between lines 13 and 14, insert the following:

     ``SEC. 817. TRIBAL MEMBER CHOICE DEMONSTRATION PROJECT.

       ``(a) In General.--The Secretary shall establish a 
     demonstration project in not less than 3 Service Areas 
     (chosen by the Secretary for optimal participation) under 
     which eligible participants shall be provided with a risk-
     adjusted subsidy for the purchase of qualified health 
     insurance (as defined in subsection (f)) in order to--
       ``(1) improve Indian access to high quality health care 
     services;
       ``(2) provide incentives to Indian patients to seek 
     preventive health care services;
       ``(3) create opportunities for Indians to participate in 
     the health care decision process;
       ``(4) encourage effective use of health care services by 
     Indians; and
       ``(5) allow Indians to make health care coverage and 
     delivery decisions and choices.
       ``(b) Eligible Participant.--
       ``(1) Voluntary enrollment for 12-month periods.--
       ``(A) In general.--In this section, the term `eligible 
     participant' means an Indian who--
       ``(i) is a member of a federally-recognized Indian Tribe; 
     and

[[Page 2077]]

       ``(ii) voluntarily agrees to enroll in the project 
     conducted under this section (or in the case of a minor, is 
     voluntarily enrolled on their behalf by a parent or 
     caretaker) for a period of not less than 12 months in lieu of 
     obtaining items or services through any Indian Health Program 
     or any other federally-funded program during any period in 
     which the Indian is enrolled in the project.
       ``(B) Voluntary extensions of enrollment.--An eligible 
     participant may voluntarily extend the participant's 
     enrollment in the project for additional 12-month periods.
       ``(2) Hardship exception.--The Secretary shall specify 
     criteria for permitting an eligible participant to disenroll 
     from the project before the end of any 12-month period of 
     enrollment to prevent undue hardship.
       ``(c) Subsidies Requirement.--The average amount of all 
     subsidies provided to eligible participants enrolled in the 
     demonstration project established under this section for each 
     12-month period during which the project is conducted shall 
     not exceed the amount equal to the average of the per capita 
     expenditures for providing Indians items or services from all 
     Indian Health Programs for the most recent fiscal year for 
     which data is available.
       ``(d) Special Rules.--
       ``(1) Treatment.--The amount of a subsidy provided to an 
     eligible participant in the project shall not be counted as 
     income or assets for purposes of determining eligibility for 
     benefits under any Federal public assistance program.
       ``(2) Budget neutrality.--In conducting the demonstration 
     project under this section, the Secretary shall ensure that 
     the aggregate payments made to carry out the project do not 
     exceed the amount of Federal expenditures which would have 
     been made for the provision of health care items and services 
     to eligible participants if the project had not been 
     implemented.
       ``(e) Demonstration Period; Reports to Congress.--
       ``(1) Demonstration period.--
       ``(A) Initial period.--The demonstration project 
     established under this section shall begin not later than the 
     date that is 1 year after the date of enactment of this 
     section and shall be conducted for a period of 5 years.
       ``(B) Extensions.--The Secretary may extend the project for 
     such additional periods as the Secretary determines 
     appropriate, unless the Secretary determines that the project 
     is unsuccessful in achieving the purposes described in 
     subsection (a), taking into account cost-effectiveness, 
     quality of care, and such other criteria as the Secretary may 
     specify.
       ``(2) Periodic reports to congress.--During the 5-year 
     period described in paragraph (1), the Secretary shall 
     periodically submit reports to Congress regarding the 
     progress of demonstration project conducted under this 
     section. Each report shall include information concerning the 
     populations participating in the project, participant 
     satisfaction (determined by indicators of satisfaction with 
     security, affordability, access, choice, and quality) as 
     compared with items and services that the participant would 
     have received from Indian Health Programs, and the impact of 
     the project on access to, and the availability of, high 
     quality health care services for Indians.
       ``(f) Qualified Health Insurance.--
       ``(1) In general.--In this section, the term `qualified 
     health insurance' means insurance which constitutes medical 
     care as defined in section 213(d) of the Internal Revenue 
     Code of 1986 without regard to--
       ``(A) paragraph (1)(C) thereof, and
       ``(B) so much of paragraph (1)(D) thereof as relates to 
     qualified long-term care insurance contracts.
       ``(2) Exclusion of certain other contracts.--Such term 
     shall not include insurance if a substantial portion of its 
     benefits are excepted benefits (as defined in section 9832(c) 
     of such Code).''.
                                 ______
                                 
  SA 4034. Mr. COBURN submitted an amendment intended to be proposed to 
amendment SA 3899 proposed by Mr. Dorgan (for himself, Ms. Murkowski, 
Mr. Baucus, Mr. Kennedy, Mr. Smith, Mr. Nelson of Nebraska, and Mr. 
Salazar) to the bill S. 1200, to amend the Indian Health Care 
Improvement Act to revise and extend the Act; which was ordered to lie 
on the table; as follows:

       On page 336, between lines 13 and 14, insert the following:

     ``SEC. 817. TRIBAL MEMBER CHOICE PROGRAM.

       ``(a) In General.--The Secretary shall establish a program 
     in geographically feasible Service Areas (as determined by 
     the Secretary, taking into account those Service Areas that 
     are likely to have optimal participation) under which 
     eligible participants shall be provided with a risk-adjusted 
     subsidy for the purchase of qualified health insurance (as 
     defined in subsection (f)) in order to--
       ``(1) improve Indian access to high quality health care 
     services;
       ``(2) provide incentives to Indian patients to seek 
     preventive health care services;
       ``(3) create opportunities for Indians to participate in 
     the health care decision process;
       ``(4) encourage effective use of health care services by 
     Indians; and
       ``(5) allow Indians to make health care coverage and 
     delivery decisions and choices.
       ``(b) Eligible Participant.--
       ``(1) Voluntary enrollment for 12-month periods.--
       ``(A) In general.--In this section, the term `eligible 
     participant' means an Indian who--
       ``(i) is a member of a federally-recognized Indian Tribe; 
     and
       ``(ii) voluntarily agrees to enroll in the program 
     conducted under this section (or in the case of a minor, is 
     voluntarily enrolled on their behalf by a parent or 
     caretaker) for a period of not less than 12 months in lieu of 
     obtaining items or services through any Indian Health Program 
     or any other federally-funded program during any period in 
     which the Indian is enrolled in the program.
       ``(B) Voluntary extensions of enrollment.--An eligible 
     participant may voluntarily extend the participant's 
     enrollment in the program for additional 12-month periods.
       ``(2) Hardship exception.--The Secretary shall specify 
     criteria for permitting an eligible participant to disenroll 
     from the program before the end of any 12-month period of 
     enrollment to prevent undue hardship.
       ``(c) Subsidies Requirement.--The average amount of all 
     subsidies provided to eligible participants enrolled in the 
     program established under this section for each 12-month 
     period during which the program is conducted shall not exceed 
     the amount equal to the average of the per capita 
     expenditures for providing Indians items or services from all 
     Indian Health Programs for the most recent fiscal year for 
     which data is available.
       ``(d) Special Rules.--
       ``(1) Treatment.--The amount of a subsidy provided to an 
     eligible participant in the program shall not be counted as 
     income or assets for purposes of determining eligibility for 
     benefits under any Federal public assistance program.
       ``(2) Budget neutrality.--In conducting the program under 
     this section, the Secretary shall ensure that the aggregate 
     payments made to carry out the program do not exceed the 
     amount of Federal expenditures which would have been made for 
     the provision of health care items and services to eligible 
     participants if the program had not been implemented.
       ``(e) Implementation; Reports to Congress.--
       ``(1) Implementation.--
       ``(A) Initial period.--The program established under this 
     section shall begin not later than the date that is 1 year 
     after the date of enactment of this section and shall be 
     conducted for a period of at least 5 years.
       ``(B) Extensions.--The Secretary may extend the program for 
     such additional periods as the Secretary determines 
     appropriate, unless the Secretary determines that the program 
     is unsuccessful in achieving the purposes described in 
     subsection (a), taking into account cost-effectiveness, 
     quality of care, and such other criteria as the Secretary may 
     specify.
       ``(2) Reports to congress.--During the initial 5-year 
     period in which the program is conducted, and during any 
     period thereafter in which the program is extended, the 
     Secretary shall periodically submit reports to Congress 
     regarding the progress of program. Each report shall include 
     information concerning the populations participating in the 
     program, participant satisfaction (determined by indicators 
     of satisfaction with security, affordability, access, choice, 
     and quality) as compared with items and services that the 
     participant would have received from Indian Health Programs, 
     and the impact of the program on access to, and the 
     availability of, high quality health care services for 
     Indians.
       ``(f) Qualified Health Insurance.--
       ``(1) In general.--In this section, the term `qualified 
     health insurance' means insurance which constitutes medical 
     care as defined in section 213(d) of the Internal Revenue 
     Code of 1986 without regard to--
       ``(A) paragraph (1)(C) thereof, and
       ``(B) so much of paragraph (1)(D) thereof as relates to 
     qualified long-term care insurance contracts.
       ``(2) Exclusion of certain other contracts.--Such term 
     shall not include insurance if a substantial portion of its 
     benefits are excepted benefits (as defined in section 9832(c) 
     of such Code).''.
                                 ______
                                 
  SA 4035. Mr. COBURN submitted an amendment intended to be proposed by 
him to the bill S. 1200, to amend the Indian Health Care Improvement 
Act to revise and extend the Act; which was ordered to lie on the 
table; as follows:

       At the appropriate place in title VIII of the Indian Health 
     Care Improvement Act (as amended by section 101), insert the 
     following:

     ``SEC. 8__. REQUIREMENT.

       ``Not less than 85 percent of amounts made available to 
     carry out this Act shall be used to provide the medical 
     services authorized by this Act.
                                 ______
                                 
  SA 4036. Mr. COBURN submitted an amendment intended to be proposed by 
him to the bill S. 1200, to amend the Indian Health Care Improvement 
Act to

[[Page 2078]]

revise and extend the Act; which was ordered to lie on the table; as 
follows:

       On page 121, strike line 15 and insert the following:
       ``(c) Prioritization.--Before providing any hospice care, 
     assisted living service, long-term care service, or home- or 
     community-based service pursuant to this section, the 
     Secretary shall give priority to the provision of basic 
     medical services to Indians.
       ``(d) Definitions.--For the purposes of this section,
                                 ______
                                 
  SA 4037. Mr. COBURN submitted an amendment intended to be proposed by 
him to the bill S. 1200, to amend the Indian Health Care Improvement 
Act to revise and extend the Act; which was ordered to lie on the 
table; as follows:

       On page 121, strike line 15 and insert the following:
       ``(c) Effective Date.--
       ``(1) Effective date.--This section takes effect on the 
     date on which the Secretary makes the certification described 
     in paragraph (2).
       ``(2) Certification.--The certification referred to in 
     paragraph (1) is a certification by the Secretary to Congress 
     that--
       ``(A) the service availability, rationing, and wait times 
     for existing health services within the Service are--
       ``(i) acceptable to Indians; and
       ``(ii) comparable to the service availability and wait 
     times experienced by other residents of the United States; 
     and
       ``(B) the provision of services under this section will not 
     divert resources from or negatively affect the provision of 
     basic medical and dental services by the Service.
       ``(d) Definitions.--For the purposes of this section,

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