[Congressional Record (Bound Edition), Volume 154 (2008), Part 2]
[Senate]
[Pages 2728-2776]
[From the U.S. Government Publishing Office, www.gpo.gov]




         INDIAN HEALTH CARE IMPROVEMENT ACT AMENDMENTS OF 2007

  On Tuesday, February 26, 2008, the Senate passed S. 1200, as amended, 
as follows:

                                S. 1200

       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 Amendments of 2008''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.

                   TITLE I--AMENDMENTS TO INDIAN LAWS

Sec. 101. Indian Health Care Improvement Act amended.
Sec. 102. Soboba sanitation facilities.
Sec. 103. Native American Health and Wellness Foundation.
Sec. 104. Modification of term.
Sec. 105. GAO study and report on payments for contract health 
              services.
Sec. 106. GAO study of membership criteria for federally recognized 
              Indian tribes.
Sec. 107. GAO study of tribal justice systems.

 TITLE II--IMPROVEMENT OF INDIAN HEALTH CARE PROVIDED UNDER THE SOCIAL 
                              SECURITY ACT

Sec. 201. Expansion of payments under Medicare, Medicaid, and SCHIP for 
              all covered services furnished by Indian Health Programs.

[[Page 2729]]

Sec. 202. Increased outreach to Indians under Medicaid and SCHIP and 
              improved cooperation in the provision of items and 
              services to Indians under Social Security Act health 
              benefit programs.
Sec. 203. Additional provisions to increase outreach to, and enrollment 
              of, Indians in SCHIP and Medicaid.
Sec. 204. Premiums and cost sharing protections under Medicaid, 
              eligibility determinations under Medicaid and SCHIP, and 
              protection of certain Indian property from Medicaid 
              estate recovery.
Sec. 205. Nondiscrimination in qualifications for payment for services 
              under Federal health care programs.
Sec. 206. Consultation on Medicaid, SCHIP, and other health care 
              programs funded under the Social Security Act involving 
              Indian Health Programs and Urban Indian Organizations.
Sec. 207. Exclusion waiver authority for affected Indian Health 
              Programs and safe harbor transactions under the Social 
              Security Act.
Sec. 208. Rules applicable under Medicaid and SCHIP to managed care 
              entities with respect to Indian enrollees and Indian 
              health care providers and Indian managed care entities.
Sec. 209. Annual report on Indians served by Social Security Act health 
              benefit programs.
Sec. 210. Development of recommendations to improve interstate 
              coordination of Medicaid and SCHIP coverage of Indian 
              children and other children who are outside of their 
              State of residency because of educational or other needs.
Sec. 211. Establishment of National Child Welfare Resource Center for 
              Tribes.
Sec. 212. Adjustment to the Medicare Advantage stabilization fund.
Sec. 213. Moratorium on implementation of changes to case management 
              and targeted case management payment requirements under 
              Medicaid.
Sec. 214. Increased civil money penalties and criminal fines for 
              Medicare fraud and abuse.
Sec. 215. Increased sentences for felonies involving Medicare fraud and 
              abuse.

                        TITLE III--MISCELLANEOUS

Sec. 301. Resolution of apology to Native Peoples of United States.

                   TITLE I--AMENDMENTS TO INDIAN LAWS

     SEC. 101. INDIAN HEALTH CARE IMPROVEMENT ACT AMENDED.

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

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

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

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

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

``Sec. 101. Purpose.
``Sec. 102. Health professions recruitment program for Indians.
``Sec. 103. Health professions preparatory scholarship program for 
              Indians.
``Sec. 104. Indian health professions scholarships.
``Sec. 105. American Indians Into Psychology Program.
``Sec. 106. Scholarship programs for Indian Tribes.
``Sec. 107. Indian Health Service extern programs.
``Sec. 108. Continuing education allowances.
``Sec. 109. Community Health Representative Program.
``Sec. 110. Indian Health Service Loan Repayment Program.
``Sec. 111. Scholarship and Loan Repayment Recovery Fund.
``Sec. 112. Recruitment activities.
``Sec. 113. Indian recruitment and retention program.
``Sec. 114. Advanced training and research.
``Sec. 115. Quentin N. Burdick American Indians Into Nursing Program.
``Sec. 116. Tribal cultural orientation.
``Sec. 117. INMED Program.
``Sec. 118. Health training programs of community colleges.
``Sec. 119. Retention bonus.
``Sec. 120. Nursing residency program.
``Sec. 121. Community Health Aide Program.
``Sec. 122. Tribal Health Program administration.
``Sec. 123. Health professional chronic shortage demonstration 
              programs.
``Sec. 124. National Health Service Corps.
``Sec. 125. Substance abuse counselor educational curricula 
              demonstration programs.
``Sec. 126. Behavioral health training and community education 
              programs.
``Sec. 127. Authorization of appropriations.

                      ``TITLE II--HEALTH SERVICES

``Sec. 201. Indian Health Care Improvement Fund.
``Sec. 202. Catastrophic Health Emergency Fund.
``Sec. 203. Health promotion and disease prevention services.
``Sec. 204. Diabetes prevention, treatment, and control.
``Sec. 205. Shared services for long-term care.
``Sec. 206. Health services research.
``Sec. 207. Mammography and other cancer screening.
``Sec. 208. Patient travel costs.
``Sec. 209. Epidemiology centers.
``Sec. 210. Comprehensive school health education programs.
``Sec. 211. Indian youth program.
``Sec. 212. Prevention, control, and elimination of communicable and 
              infectious diseases.
``Sec. 213. Other authority for provision of services.
``Sec. 214. Indian women's health care.
``Sec. 215. Environmental and nuclear health hazards.
``Sec. 216. Arizona as a contract health service delivery area.
``Sec. 216A. North Dakota and South Dakota as a contract health service 
              delivery area.
``Sec. 217. California contract health services program.
``Sec. 218. California as a contract health service delivery area.
``Sec. 219. Contract health services for the Trenton service area.
``Sec. 220. Programs operated by Indian Tribes and Tribal 
              Organizations.
``Sec. 221. Licensing.
``Sec. 222. Notification of provision of emergency contract health 
              services.
``Sec. 223. Prompt action on payment of claims.
``Sec. 224. Liability for payment.
``Sec. 225. Office of Indian Men's Health.
``Sec. 226. Authorization of appropriations.

                        ``TITLE III--FACILITIES

``Sec. 301. Consultation; construction and renovation of facilities; 
              reports.
``Sec. 302. Sanitation facilities.
``Sec. 303. Preference to Indians and Indian firms.
``Sec. 304. Expenditure of non-Service funds for renovation.
``Sec. 305. Funding for the construction, expansion, and modernization 
              of small ambulatory care facilities.
``Sec. 306. Indian health care delivery demonstration projects.
``Sec. 307. Land transfer.
``Sec. 308. Leases, contracts, and other agreements.
``Sec. 309. Study on loans, loan guarantees, and loan repayment.
``Sec. 310. Tribal leasing.
``Sec. 311. Indian Health Service/tribal facilities joint venture 
              program.
``Sec. 312. Location of facilities.
``Sec. 313. Maintenance and improvement of health care facilities.
``Sec. 314. Tribal management of Federally-owned quarters.
``Sec. 315. Applicability of Buy American Act requirement.
``Sec. 316. Other funding for facilities.
``Sec. 317. Authorization of appropriations.

                 ``TITLE IV--ACCESS TO HEALTH SERVICES

``Sec. 401. Treatment of payments under Social Security Act health 
              benefits programs.
``Sec. 402. Grants to and contracts with the Service, Indian Tribes, 
              Tribal Organizations, and Urban Indian Organizations to 
              facilitate outreach, enrollment, and coverage of Indians 
              under Social Security Act health benefit programs and 
              other health benefits programs.
``Sec. 403. Reimbursement from certain third parties of costs of health 
              services.
``Sec. 404. Crediting of reimbursements.
``Sec. 405. Purchasing health care coverage.
``Sec. 406. Sharing arrangements with Federal agencies.
``Sec. 407. Eligible Indian veteran services.
``Sec. 408. Payor of last resort.
``Sec. 409. Nondiscrimination under Federal health care programs in 
              qualifications for reimbursement for services.
``Sec. 410. Consultation.
``Sec. 411. State Children's Health Insurance Program (SCHIP).
``Sec. 412. Exclusion waiver authority for affected Indian Health 
              Programs and safe harbor transactions under the Social 
              Security Act.
``Sec. 413. Premium and cost sharing protections and eligibility 
              determinations under Medicaid and SCHIP and protection of 
              certain Indian property from Medicaid estate recovery.

[[Page 2730]]

``Sec. 414. Treatment under Medicaid and SCHIP managed care.
``Sec. 415. Navajo Nation Medicaid Agency feasibility study.
``Sec. 416. General exceptions.
``Sec. 417. Authorization of appropriations.

              ``TITLE V--HEALTH SERVICES FOR URBAN INDIANS

``Sec. 501. Purpose.
``Sec. 502. Contracts with, and grants to, Urban Indian Organizations.
``Sec. 503. Contracts and grants for the provision of health care and 
              referral services.
``Sec. 504. Contracts and grants for the determination of unmet health 
              care needs.
``Sec. 505. Evaluations; renewals.
``Sec. 506. Other contract and grant requirements.
``Sec. 507. Reports and records.
``Sec. 508. Limitation on contract authority.
``Sec. 509. Facilities.
``Sec. 510. Division 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. Conferring with Urban Indian Organizations.
``Sec. 515. Urban youth treatment center demonstration.
``Sec. 516. Grants for diabetes prevention, treatment, and control.
``Sec. 517. Community Health Representatives.
``Sec. 518. Effective date.
``Sec. 519. Eligibility for services.
``Sec. 520. Authorization of appropriations.

                ``TITLE VI--ORGANIZATIONAL IMPROVEMENTS

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

                ``TITLE VII--BEHAVIORAL HEALTH PROGRAMS

``Sec. 701. Behavioral health prevention and treatment services.
``Sec. 702. Memoranda of agreement with the Department of the Interior.
``Sec. 703. Comprehensive behavioral health prevention and treatment 
              program.
``Sec. 704. Mental health technician program.
``Sec. 705. Licensing requirement for mental health care workers.
``Sec. 706. Indian women treatment programs.
``Sec. 707. Indian youth program.
``Sec. 708. Indian youth telemental health demonstration project.
``Sec. 709. Inpatient and community-based mental health facilities 
              design, construction, and staffing.
``Sec. 710. Training and community education.
``Sec. 711. Behavioral health program.
``Sec. 712. Fetal alcohol spectrum disorders programs.
``Sec. 713. Child sexual abuse and prevention treatment programs.
``Sec. 714. Domestic and sexual violence prevention and treatment.
``Sec. 715. Testimony by service employees in cases of rape and sexual 
              assault.
``Sec. 716. Behavioral health research.
``Sec. 717. Definitions.
``Sec. 718. 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 relating to abortion.
``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. Tribal employment.
``Sec. 812. Severability provisions.
``Sec. 813. Establishment of National Bipartisan Commission on Indian 
              Health Care.
``Sec. 814. Confidentiality of medical quality assurance records; 
              qualified immunity for participants.
``Sec. 815. Sense of Congress regarding law enforcement and 
              methamphetamine issues in Indian Country.
``Sec. 816. Tribal Health Program option for cost sharing.
``Sec. 817. Testing for sexually transmitted diseases in cases of 
              sexual violence.
``Sec. 818. Study on tobacco-related disease and disproportionate 
              health effects on tribal populations.
``Sec. 819. Appropriations; availability.
``Sec. 820. GAO report on coordination of services.
``Sec. 821. Authorization of appropriations.

     ``SEC. 2. FINDINGS.

       ``Congress makes the following findings:
       ``(1) Federal health services to maintain and improve the 
     health of the Indians are consonant with and required by the 
     Federal Government's historical and unique legal relationship 
     with, and resulting responsibility to, the American Indian 
     people.
       ``(2) A major national goal of the United States is to 
     provide the resources, processes, and structure that will 
     enable Indian Tribes and tribal members to obtain the 
     quantity and quality of health care services and 
     opportunities that will eradicate the health disparities 
     between Indians and the general population of the United 
     States.
       ``(3) A major national goal of the United States is to 
     provide the quantity and quality of health services which 
     will permit the health status of Indians to be raised to the 
     highest possible level and to encourage the maximum 
     participation of Indians in the planning and management of 
     those services.
       ``(4) Federal health services to Indians have resulted in a 
     reduction in the prevalence and incidence of preventable 
     illnesses among, and unnecessary and premature deaths of, 
     Indians.
       ``(5) Despite such services, the unmet health needs of the 
     American Indian people are severe and the health status of 
     the Indians is far below that of the general population of 
     the United States.

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

       ``Congress declares that it is the policy of this Nation, 
     in fulfillment of its special trust responsibilities and 
     legal obligations to Indians--
       ``(1) to assure the highest possible health status for 
     Indians and Urban Indians and to provide all resources 
     necessary to effect that policy;
       ``(2) to raise the health status of Indians and Urban 
     Indians to at least the levels set forth in the goals 
     contained within the Healthy People 2010 or successor 
     objectives;
       ``(3) to ensure maximum Indian participation in the 
     direction of health care services so as to render the persons 
     administering such services and the services themselves more 
     responsive to the needs and desires of Indian communities;
       ``(4) to increase the proportion of all degrees in the 
     health professions and allied and associated health 
     professions awarded to Indians so that the proportion of 
     Indian health professionals in each Service Area is raised to 
     at least the level of that of the general population;
       ``(5) to require that all actions under this Act shall be 
     carried out with active and meaningful consultation with 
     Indian Tribes and Tribal Organizations, and conference with 
     Urban Indian Organizations, to implement this Act and the 
     national policy of Indian self-determination;
       ``(6) to ensure that the United States and Indian Tribes 
     work in a government-to-government relationship to ensure 
     quality health care for all tribal members; and
       ``(7) to provide funding for programs and facilities 
     operated by Indian Tribes and Tribal Organizations in amounts 
     that are not less than the amounts provided to programs and 
     facilities operated directly by the Service.

     ``SEC. 4. DEFINITIONS.

       ``For purposes of this Act:
       ``(1) The term `accredited and accessible' means on or near 
     a reservation and accredited by a national or regional 
     organization with accrediting authority.
       ``(2) The term `Area Office' means an administrative 
     entity, including a program office, within the Service 
     through which services and funds are provided to the Service 
     Units within a defined geographic area.
       ``(3)(A) The term `behavioral health' means the blending of 
     substance (alcohol, drugs, inhalants, and tobacco) abuse and 
     mental health prevention and treatment, for the purpose of 
     providing comprehensive services.
       ``(B) The term `behavioral health' includes the joint 
     development of substance abuse and mental health treatment 
     planning and coordinated case management using a 
     multidisciplinary approach.
       ``(4) The term `California Indians' means those Indians who 
     are eligible for health services of the Service pursuant to 
     section 806.
       ``(5) The term `community college' means--
       ``(A) a tribal college or university, or
       ``(B) a junior or community college.
       ``(6) The term `contract health service' means health 
     services provided at the expense of the Service or a Tribal 
     Health Program by public or private medical providers or 
     hospitals, other than the Service Unit or the Tribal Health 
     Program at whose expense the services are provided.
       ``(7) The term `Department' means, unless otherwise 
     designated, the Department of Health and Human Services.
       ``(8) The term `Director' means the Director of the 
     Service.
       ``(9) The term `disease prevention' means the reduction, 
     limitation, and prevention of disease and its complications 
     and reduction in the consequences of disease, including--
       ``(A) controlling--
       ``(i) the development of diabetes;
       ``(ii) high blood pressure;
       ``(iii) infectious agents;
       ``(iv) injuries;
       ``(v) occupational hazards and disabilities;
       ``(vi) sexually transmittable diseases; and
       ``(vii) toxic agents; and
       ``(B) providing--

[[Page 2731]]

       ``(i) fluoridation of water; and
       ``(ii) immunizations.
       ``(10) The term `health profession' means allopathic 
     medicine, family medicine, internal medicine, pediatrics, 
     geriatric medicine, obstetrics and gynecology, podiatric 
     medicine, nursing, public health nursing, dentistry, 
     psychiatry, osteopathy, optometry, pharmacy, psychology, 
     public health, social work, marriage and family therapy, 
     chiropractic medicine, environmental health and engineering, 
     allied health professions, and any other health profession.
       ``(11) The term `health promotion' means--
       ``(A) fostering social, economic, environmental, and 
     personal factors conducive to health, including raising 
     public awareness about health matters and enabling the people 
     to cope with health problems by increasing their knowledge 
     and providing them with valid information;
       ``(B) encouraging adequate and appropriate diet, exercise, 
     and sleep;
       ``(C) promoting education and work in conformity with 
     physical and mental capacity;
       ``(D) making available safe water and sanitary facilities;
       ``(E) improving the physical, economic, cultural, 
     psychological, and social environment;
       ``(F) promoting culturally competent care; and
       ``(G) providing adequate and appropriate programs, which 
     may include--
       ``(i) abuse prevention (mental and physical);
       ``(ii) community health;
       ``(iii) community safety;
       ``(iv) consumer health education;
       ``(v) diet and nutrition;
       ``(vi) immunization and other prevention of communicable 
     diseases, including HIV/AIDS;
       ``(vii) environmental health;
       ``(viii) exercise and physical fitness;
       ``(ix) avoidance of fetal alcohol spectrum disorders;
       ``(x) first aid and CPR education;
       ``(xi) human growth and development;
       ``(xii) injury prevention and personal safety;
       ``(xiii) behavioral health;
       ``(xiv) monitoring of disease indicators between health 
     care provider visits, through appropriate means, including 
     Internet-based health care management systems;
       ``(xv) personal health and wellness practices;
       ``(xvi) personal capacity building;
       ``(xvii) prenatal, pregnancy, and infant care;
       ``(xviii) psychological well-being;
       ``(xix) family planning;
       ``(xx) safe and adequate water;
       ``(xxi) healthy work environments;
       ``(xxii) elimination, reduction, and prevention of 
     contaminants that create unhealthy household conditions 
     (including mold and other allergens);
       ``(xxiii) stress control;
       ``(xxiv) substance abuse;
       ``(xxv) sanitary facilities;
       ``(xxvi) sudden infant death syndrome prevention;
       ``(xxvii) tobacco use cessation and reduction;
       ``(xxviii) violence prevention; and
       ``(xxix) such other activities identified by the Service, a 
     Tribal Health Program, or an Urban Indian Organization, to 
     promote achievement of any of the objectives described in 
     section 3(2).
       ``(12) The term `Indian', unless otherwise designated, 
     means any person who is a member of an Indian Tribe or is 
     eligible for health services under section 806, except that, 
     for the purpose of sections 102 and 103, the term also means 
     any individual who--
       ``(A)(i) irrespective of whether the individual lives on or 
     near a reservation, is a member of a tribe, band, or other 
     organized group of Indians, including those tribes, bands, or 
     groups terminated since 1940 and those recognized now or in 
     the future by the State in which they reside; or
       ``(ii) is a descendant, in the first or second degree, of 
     any such member;
       ``(B) is an Eskimo or Aleut or other Alaska Native;
       ``(C) is considered by the Secretary of the Interior to be 
     an Indian for any purpose; or
       ``(D) is determined to be an Indian under regulations 
     promulgated by the Secretary.
       ``(13) The term `Indian Health Program' means--
       ``(A) any health program administered directly by the 
     Service;
       ``(B) any Tribal Health Program; or
       ``(C) any Indian Tribe or Tribal Organization to which the 
     Secretary provides funding pursuant to section 23 of the Act 
     of June 25, 1910 (25 U.S.C. 47) (commonly known as the `Buy 
     Indian Act').
       ``(14) The term `Indian Tribe' has the meaning given the 
     term in the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450 et seq.).
       ``(15) The term `junior or community college' has the 
     meaning given the term by section 312(e) of the Higher 
     Education Act of 1965 (20 U.S.C. 1058(e)).
       ``(16) The term `reservation' means any federally 
     recognized Indian Tribe's reservation, Pueblo, or colony, 
     including former reservations in Oklahoma, Indian allotments, 
     and Alaska Native Regions established pursuant to the Alaska 
     Native Claims Settlement Act (43 U.S.C. 1601 et seq.).
       ``(17) The term `Secretary', unless otherwise designated, 
     means the Secretary of Health and Human Services.
       ``(18) The term `Service' means the Indian Health Service.
       ``(19) The term `Service Area' means the geographical area 
     served by each Area Office.
       ``(20) The term `Service Unit' means an administrative 
     entity of the Service, or a Tribal Health Program through 
     which services are provided, directly or by contract, to 
     eligible Indians within a defined geographic area.
       ``(21) The term `telehealth' has the meaning given the term 
     in section 330K(a) of the Public Health Service Act (42 
     U.S.C. 254c-16(a)).
       ``(22) The term `telemedicine' means a telecommunications 
     link to an end user through the use of eligible equipment 
     that electronically links health professionals or patients 
     and health professionals at separate sites in order to 
     exchange health care information in audio, video, graphic, or 
     other format for the purpose of providing improved health 
     care services.
       ``(23) The term `tribal college or university' has the 
     meaning given the term in section 316(b)(3) of the Higher 
     Education Act (20 U.S.C. 1059c(b)(3)).
       ``(24) The term `Tribal Health Program' means an Indian 
     Tribe or Tribal Organization that operates any health 
     program, service, function, activity, or facility funded, in 
     whole or part, by the Service through, or provided for in, a 
     contract or compact with the Service under the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.).
       ``(25) The term `Tribal Organization' has the meaning given 
     the term in the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450 et seq.).
       ``(26) The term `Urban Center' means any community which 
     has a sufficient Urban Indian population with unmet health 
     needs to warrant assistance under title V of this Act, as 
     determined by the Secretary.
       ``(27) The term `Urban Indian' means any individual who 
     resides in an Urban Center and who meets 1 or more of the 
     following criteria:
       ``(A) Irrespective of whether the individual lives on or 
     near a reservation, the individual is a member of a tribe, 
     band, or other organized group of Indians, including those 
     tribes, bands, or groups terminated since 1940 and those 
     tribes, bands, or groups that are recognized by the States in 
     which they reside, or who is a descendant in the first or 
     second degree of any such member.
       ``(B) The individual is an Eskimo, Aleut, or other Alaska 
     Native.
       ``(C) The individual is considered by the Secretary of the 
     Interior to be an Indian for any purpose.
       ``(D) The individual is determined to be an Indian under 
     regulations promulgated by the Secretary.
       ``(28) The term `Urban Indian Organization' means a 
     nonprofit corporate body that (A) is situated in an Urban 
     Center; (B) is governed by an Urban Indian-controlled board 
     of directors; (C) provides for the participation of all 
     interested Indian groups and individuals; and (D) is capable 
     of legally cooperating with other public and private entities 
     for the purpose of performing the activities described in 
     section 503(a).

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

     ``SEC. 101. PURPOSE.

       ``The purpose of this title is to increase, to the maximum 
     extent feasible, the number of Indians entering the health 
     professions and providing health services, and to assure an 
     optimum supply of health professionals to the Indian Health 
     Programs and Urban Indian Organizations involved in the 
     provision of health services to Indians.

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

       ``(a) In General.--The Secretary, acting through the 
     Service, shall make grants to public or nonprofit private 
     health or educational entities, Tribal Health Programs, or 
     Urban Indian Organizations to assist such entities in meeting 
     the costs of--
       ``(1) identifying Indians with a potential for education or 
     training in the health professions and encouraging and 
     assisting them--
       ``(A) to enroll in courses of study in such health 
     professions; or
       ``(B) if they are not qualified to enroll in any such 
     courses of study, to undertake such postsecondary education 
     or training as may be required to qualify them for 
     enrollment;
       ``(2) publicizing existing sources of financial aid 
     available to Indians enrolled in any course of study referred 
     to in paragraph (1) or who are undertaking training necessary 
     to qualify them to enroll in any such course of study; or
       ``(3) establishing other programs which the Secretary 
     determines will enhance and facilitate the enrollment of 
     Indians in, and the subsequent pursuit and completion by them 
     of, courses of study referred to in paragraph (1).
       ``(b) Grants.--
       ``(1) Application.--The Secretary shall not make a grant 
     under this section unless an application has been submitted 
     to, and approved by, the Secretary. Such application

[[Page 2732]]

     shall be in such form, submitted in such manner, and contain 
     such information, as the Secretary shall by regulation 
     prescribe pursuant to this Act. The Secretary shall give a 
     preference to applications submitted by Tribal Health 
     Programs or Urban Indian Organizations.
       ``(2) Amount of grants; payment.--The amount of a grant 
     under this section shall be determined by the Secretary. 
     Payments pursuant to this section may be made in advance or 
     by way of reimbursement, and at such intervals and on such 
     conditions as provided for in regulations issued pursuant to 
     this Act. To the extent not otherwise prohibited by law, 
     grants shall be for 3 years, as provided in regulations 
     issued pursuant to this Act.

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

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

     ``SEC. 104. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.

       ``(a) In General.--
       ``(1) Authority.--The Secretary, acting through the 
     Service, shall make scholarship grants to Indians who are 
     enrolled full or part time in accredited schools pursuing 
     courses of study in the health professions. Such scholarships 
     shall be designated Indian Health Scholarships and shall be 
     made in accordance with section 338A of the Public Health 
     Services Act (42 U.S.C. 254l), except as provided in 
     subsection (b) of this section.
       ``(2) Determinations by secretary.--The Secretary, acting 
     through the Service, shall determine--
       ``(A) who shall receive scholarship grants under subsection 
     (a); and
       ``(B) the distribution of the scholarships among health 
     professions on the basis of the relative needs of Indians for 
     additional service in the health professions.
       ``(3) Certain delegation not allowed.--The administration 
     of this section shall be a responsibility of the Director and 
     shall not be delegated in a contract or compact under the 
     Indian Self-Determination and Education Assistance Act (25 
     U.S.C. 450 et seq.).
       ``(b) Active Duty Service Obligation.--
       ``(1) Obligation met.--The active duty service obligation 
     under a written contract with the Secretary under this 
     section that an Indian has entered into shall, if that 
     individual is a recipient of an Indian Health Scholarship, be 
     met in full-time practice equal to 1 year for each school 
     year for which the participant receives a scholarship award 
     under this part, or 2 years, whichever is greater, by service 
     in 1 or more of the following:
       ``(A) In an Indian Health Program.
       ``(B) In a program assisted under title V of this Act.
       ``(C) In the private practice of the applicable profession 
     if, as determined by the Secretary, in accordance with 
     guidelines promulgated by the Secretary, such practice is 
     situated in a physician or other health professional shortage 
     area and addresses the health care needs of a substantial 
     number of Indians.
       ``(D) In a teaching capacity in a tribal college or 
     university nursing program (or a related health profession 
     program) if, as determined by the Secretary, the health 
     service provided to Indians would not decrease.
       ``(2) Obligation deferred.--At the request of any 
     individual who has entered into a contract referred to in 
     paragraph (1) and who receives a degree in medicine 
     (including osteopathic or allopathic medicine), dentistry, 
     optometry, podiatry, or pharmacy, the Secretary shall defer 
     the active duty service obligation of that individual under 
     that contract, in order that such individual may complete any 
     internship, residency, or other advanced clinical training 
     that is required for the practice of that health profession, 
     for an appropriate period (in years, as determined by the 
     Secretary), subject to the following conditions:
       ``(A) No period of internship, residency, or other advanced 
     clinical training shall be counted as satisfying any period 
     of obligated service under this subsection.
       ``(B) The active duty service obligation of that individual 
     shall commence not later than 90 days after the completion of 
     that advanced clinical training (or by a date specified by 
     the Secretary).
       ``(C) The active duty service obligation will be served in 
     the health profession of that individual in a manner 
     consistent with paragraph (1).
       ``(D) A recipient of a scholarship under this section may, 
     at the election of the recipient, meet the active duty 
     service obligation described in paragraph (1) by service in a 
     program specified under that paragraph that--
       ``(i) is located on the reservation of the Indian Tribe in 
     which the recipient is enrolled; or
       ``(ii) serves the Indian Tribe in which the recipient is 
     enrolled.
       ``(3) Priority when making assignments.--Subject to 
     paragraph (2), the Secretary, in making assignments of Indian 
     Health Scholarship recipients required to meet the active 
     duty service obligation described in paragraph (1), shall 
     give priority to assigning individuals to service in those 
     programs specified in paragraph (1) that have a need for 
     health professionals to provide health care services as a 
     result of individuals having breached contracts entered into 
     under this section.
       ``(c) Part-Time Students.--In the case of an individual 
     receiving a scholarship under this section who is enrolled 
     part time in an approved course of study--
       ``(1) such scholarship shall be for a period of years not 
     to exceed the part-time equivalent of 4 years, as determined 
     by the Secretary;
       ``(2) the period of obligated service described in 
     subsection (b)(1) shall be equal to the greater of--
       ``(A) the part-time equivalent of 1 year for each year for 
     which the individual was provided a scholarship (as 
     determined by the Secretary); or
       ``(B) 2 years; and
       ``(3) the amount of the monthly stipend specified in 
     section 338A(g)(1)(B) of the Public Health Service Act (42 
     U.S.C. 254l(g)(1)(B)) shall be reduced pro rata (as 
     determined by the Secretary) based on the number of hours 
     such student is enrolled.
       ``(d) Breach of Contract.--
       ``(1) Specified breaches.--An individual shall be liable to 
     the United States for the amount which has been paid to the 
     individual, or on behalf of the individual, under a contract 
     entered into with the Secretary under this section on or 
     after the date of enactment of the Indian Health Care 
     Improvement Act Amendments of 2008 if that individual--
       ``(A) fails to maintain an acceptable level of academic 
     standing in the educational institution in which he or she is 
     enrolled (such level determined by the educational 
     institution under regulations of the Secretary);
       ``(B) is dismissed from such educational institution for 
     disciplinary reasons;
       ``(C) voluntarily terminates the training in such an 
     educational institution for which he or she is provided a 
     scholarship under such contract before the completion of such 
     training; or
       ``(D) fails to accept payment, or instructs the educational 
     institution in which he or she is enrolled not to accept 
     payment, in whole or in part, of a scholarship under such 
     contract, in lieu of any service obligation arising under 
     such contract.
       ``(2) Other breaches.--If for any reason not specified in 
     paragraph (1) an individual breaches a written contract by 
     failing either to begin such individual's service obligation 
     required under such contract or to complete such service 
     obligation, the United States shall be entitled to recover 
     from the individual an amount determined in accordance with 
     the formula specified in subsection (l) of section 110 in the 
     manner provided for in such subsection.
       ``(3) Cancellation upon death of recipient.--Upon the death 
     of an individual who receives an Indian Health Scholarship, 
     any outstanding obligation of that individual for service or 
     payment that relates to that scholarship shall be canceled.
       ``(4) Waivers and suspensions.--
       ``(A) In general.--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 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.
       ``(B) Factors for consideration.--Before waiving or 
     suspending an obligation of service or payment under 
     subparagraph (A), the

[[Page 2733]]

     Secretary shall consult with the affected Area Office, Indian 
     Tribes, or Tribal Organizations, or confer with the affected 
     Urban Indian Organizations, and may take into consideration 
     whether the obligation may be satisfied in a teaching 
     capacity at a tribal college or university nursing program 
     under subsection (b)(1)(D).
       ``(5) Extreme hardship.--Notwithstanding any other 
     provision of law, in any case of extreme hardship or for 
     other good cause shown, the Secretary may waive, in whole or 
     in part, the right of the United States to recover funds made 
     available under this section.
       ``(6) Bankruptcy.--Notwithstanding any other provision of 
     law, with respect to a recipient of an Indian Health 
     Scholarship, no obligation for payment may be released by a 
     discharge in bankruptcy under title 11, United States Code, 
     unless that discharge is granted after the expiration of the 
     5-year period beginning on the initial date on which that 
     payment is due, and only if the bankruptcy court finds that 
     the nondischarge of the obligation would be unconscionable.

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

       ``(a) Grants Authorized.--The Secretary, acting through the 
     Service, shall make grants of not more than $300,000 to each 
     of 9 colleges and universities for the purpose of developing 
     and maintaining Indian psychology career recruitment programs 
     as a means of encouraging Indians to enter the behavioral 
     health field. These programs shall be located at various 
     locations throughout the country to maximize their 
     availability to Indian students and new programs shall be 
     established in different locations from time to time.
       ``(b) Quentin N. Burdick Program Grant.--The Secretary 
     shall provide a grant authorized under subsection (a) to 
     develop and maintain a program at the University of North 
     Dakota to be known as the `Quentin N. Burdick American 
     Indians Into Psychology Program'. Such program shall, to the 
     maximum extent feasible, coordinate with the Quentin N. 
     Burdick Indian Health Programs authorized under section 
     117(b), the Quentin N. Burdick American Indians Into Nursing 
     Program authorized under section 115(e), and existing 
     university research and communications networks.
       ``(c) Regulations.--The Secretary shall issue regulations 
     pursuant to this Act for the competitive awarding of grants 
     provided under this section.
       ``(d) Conditions of Grant.--Applicants under this section 
     shall agree to provide a program which, at a minimum--
       ``(1) provides outreach and recruitment for health 
     professions to Indian communities including elementary, 
     secondary, and accredited and accessible community colleges 
     that will be served by the program;
       ``(2) incorporates a program advisory board comprised of 
     representatives from the tribes and communities that will be 
     served by the program;
       ``(3) provides summer enrichment programs to expose Indian 
     students to the various fields of psychology through 
     research, clinical, and experimental activities;
       ``(4) provides stipends to undergraduate and graduate 
     students to pursue a career in psychology;
       ``(5) develops affiliation agreements with tribal colleges 
     and universities, the Service, university affiliated 
     programs, and other appropriate accredited and accessible 
     entities to enhance the education of Indian students;
       ``(6) to the maximum extent feasible, uses existing 
     university tutoring, counseling, and student support 
     services; and
       ``(7) to the maximum extent feasible, employs qualified 
     Indians in the program.
       ``(e) Active Duty Service Requirement.--The active duty 
     service obligation prescribed under section 338C of the 
     Public Health Service Act (42 U.S.C. 254m) shall be met by 
     each graduate who receives a stipend described in subsection 
     (d)(4) that is funded under this section. Such obligation 
     shall be met by service--
       ``(1) in an Indian Health Program;
       ``(2) in a program assisted under title V of this Act; or
       ``(3) in the private practice of psychology if, as 
     determined by the Secretary, in accordance with guidelines 
     promulgated by the Secretary, such practice is situated in a 
     physician or other health professional shortage area and 
     addresses the health care needs of a substantial number of 
     Indians.
       ``(f) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $2,700,000 for 
     each of fiscal years 2008 through 2017.

     ``SEC. 106. SCHOLARSHIP PROGRAMS FOR INDIAN TRIBES.

       ``(a) In General.--
       ``(1) Grants authorized.--The Secretary, acting through the 
     Service, shall make grants to Tribal Health Programs for the 
     purpose of providing scholarships for Indians to serve as 
     health professionals in Indian communities.
       ``(2) Amount.--Amounts available under paragraph (1) for 
     any fiscal year shall not exceed 5 percent of the amounts 
     available for each fiscal year for Indian Health Scholarships 
     under section 104.
       ``(3) Application.--An application for a grant under 
     paragraph (1) shall be in such form and contain such 
     agreements, assurances, and information as consistent with 
     this section.
       ``(b) Requirements.--
       ``(1) In general.--A Tribal Health Program receiving a 
     grant under subsection (a) shall provide scholarships to 
     Indians in accordance with the requirements of this section.
       ``(2) Costs.--With respect to costs of providing any 
     scholarship pursuant to subsection (a)--
       ``(A) 80 percent of the costs of the scholarship shall be 
     paid from the funds made available pursuant to subsection 
     (a)(1) provided to the Tribal Health Program; and
       ``(B) 20 percent of such costs may be paid from any other 
     source of funds.
       ``(c) Course of Study.--A Tribal Health Program shall 
     provide scholarships under this section only to Indians 
     enrolled or accepted for enrollment in a course of study 
     (approved by the Secretary) in 1 of the health professions 
     contemplated by this Act.
       ``(d) Contract.--
       ``(1) In general.--In providing scholarships under 
     subsection (b), the Secretary and the Tribal Health Program 
     shall enter into a written contract with each recipient of 
     such scholarship.
       ``(2) Requirements.--Such contract shall--
       ``(A) obligate such recipient to provide service in an 
     Indian Health Program or Urban Indian Organization, in the 
     same Service Area where the Tribal Health Program providing 
     the scholarship is located, for--
       ``(i) a number of years for which the scholarship is 
     provided (or the part-time equivalent thereof, as determined 
     by the Secretary), or for a period of 2 years, whichever 
     period is greater; or
       ``(ii) such greater period of time as the recipient and the 
     Tribal Health Program may agree;
       ``(B) provide that the amount of 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)), with 
     such amount to be reduced pro rata (as determined by the 
     Secretary) based on the number of hours such student is 
     enrolled, and not to exceed, for any year of attendance for 
     which the scholarship is provided, the total amount required 
     for the year for the purposes authorized in this clause; and

       ``(ii) may not exceed, for any year of attendance for which 
     the scholarship is provided, the total amount required for 
     the year for the purposes authorized in 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 each 
     health profession.
       ``(3) Service in other service areas.--The contract may 
     allow the recipient to serve in another Service Area, 
     provided the Tribal Health Program and Secretary approve and 
     services are not diminished to Indians in the Service Area 
     where the Tribal Health Program providing the scholarship is 
     located.
       ``(e) Breach of Contract.--
       ``(1) Specific breaches.--An individual who has entered 
     into a written contract with the Secretary and a Tribal 
     Health Program under subsection (d) shall be liable to the 
     United States for the Federal share of the amount which has 
     been paid to him or her, or on his or her behalf, under the 
     contract if that individual--
       ``(A) fails to maintain an acceptable level of academic 
     standing in the educational institution in which he or she is 
     enrolled (such level as determined by the educational 
     institution under regulations of the Secretary);
       ``(B) is dismissed from such educational institution for 
     disciplinary reasons;
       ``(C) voluntarily terminates the training in such an 
     educational institution for which he or she is provided a 
     scholarship under such contract before the completion of such 
     training; or
       ``(D) fails to accept payment, or instructs the educational 
     institution in which he or she is enrolled not to accept 
     payment, in whole or in part, of a scholarship under such 
     contract, in lieu of any service obligation arising under 
     such contract.
       ``(2) Other breaches.--If for any reason not specified in 
     paragraph (1), an individual breaches a written contract by 
     failing to either begin such individual's service obligation 
     required under such contract or to complete such service 
     obligation, the United States shall be entitled to recover 
     from the individual an amount determined in accordance with 
     the formula specified in subsection (l) of section 110 in the 
     manner provided for in such subsection.
       ``(3) Cancellation upon death of recipient.--Upon the death 
     of an individual who receives an Indian Health Scholarship, 
     any outstanding obligation of that individual for service or 
     payment that relates to that scholarship shall be canceled.

[[Page 2734]]

       ``(4) Information.--The Secretary may carry out this 
     subsection on the basis of information received from Tribal 
     Health Programs involved or on the basis of information 
     collected through such other means as the Secretary deems 
     appropriate.
       ``(f) Relation to Social Security Act.--The recipient of a 
     scholarship under this section shall agree, in providing 
     health care pursuant to the requirements herein--
       ``(1) not to discriminate against an individual seeking 
     care on the basis of the ability of the individual to pay for 
     such care or on the basis that payment for such care will be 
     made pursuant to a program established in title XVIII of the 
     Social Security Act or pursuant to the programs established 
     in title XIX or title XXI of such Act; and
       ``(2) to accept assignment under section 1842(b)(3)(B)(ii) 
     of the Social Security Act for all services for which payment 
     may be made under part B of title XVIII of such Act, and to 
     enter into an appropriate agreement with the State agency 
     that administers the State plan for medical assistance under 
     title XIX, or the State child health plan under title XXI, of 
     such Act to provide service to individuals entitled to 
     medical assistance or child health assistance, respectively, 
     under the plan.
       ``(g) Continuance of Funding.--The Secretary shall make 
     payments under this section to a Tribal Health Program for 
     any fiscal year subsequent to the first fiscal year of such 
     payments unless the Secretary determines that, for the 
     immediately preceding fiscal year, the Tribal Health Program 
     has not complied with the requirements of this section.

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

       ``(a) Employment Preference.--Any individual who receives a 
     scholarship pursuant to section 104 or 106 shall be given 
     preference for employment in the Service, or may be employed 
     by a Tribal Health Program or an Urban Indian Organization, 
     or other agencies of the Department as available, during any 
     nonacademic period of the year.
       ``(b) Not Counted Toward Active Duty Service Obligation.--
     Periods of employment pursuant to this subsection shall not 
     be counted in determining fulfillment of the service 
     obligation incurred as a condition of the scholarship.
       ``(c) Timing; Length of Employment.--Any individual 
     enrolled in a program, including a high school program, 
     authorized under section 102(a) may be employed by the 
     Service or by a Tribal Health Program or an Urban Indian 
     Organization during any nonacademic period of the year. Any 
     such employment shall not exceed 120 days during any calendar 
     year.
       ``(d) Nonapplicability of Competitive Personnel System.--
     Any employment pursuant to this section shall be made without 
     regard to any competitive personnel system or agency 
     personnel limitation and to a position which will enable the 
     individual so employed to receive practical experience in the 
     health profession in which he or she is engaged in study. Any 
     individual so employed shall receive payment for his or her 
     services comparable to the salary he or she would receive if 
     he or she were employed in the competitive system. Any 
     individual so employed shall not be counted against any 
     employment ceiling affecting the Service or the Department.

     ``SEC. 108. CONTINUING EDUCATION ALLOWANCES.

       ``In order to encourage scholarship and stipend recipients 
     under sections 104, 105, 106, and 115 and health 
     professionals, including community health representatives and 
     emergency medical technicians, to join or continue in an 
     Indian Health Program, in the case of nurses, to obtain 
     training and certification as sexual assault nurse examiners, 
     and to provide their services in the rural and remote areas 
     where a significant portion of Indians reside, the Secretary, 
     acting through the Service, may--
       ``(1) provide programs or allowances to transition into an 
     Indian Health Program, including licensing, board or 
     certification examination assistance, and technical 
     assistance in fulfilling service obligations under sections 
     104, 105, 106, and 115; and
       ``(2) provide programs or allowances to health 
     professionals employed in an Indian Health Program to enable 
     them for a period of time each year prescribed by regulation 
     of the Secretary to take leave of their duty stations for 
     professional consultation, management, leadership, refresher 
     training courses, and, in the case of nurses, additional 
     clinical sexual assault nurse examiner experience to maintain 
     competency or certification.

     ``SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PROGRAM.

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

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

       ``(a) Establishment.--The Secretary, acting through the 
     Service, shall establish and administer a program to be known 
     as the Service Loan Repayment Program (hereinafter referred 
     to as the `Loan Repayment Program') in order to ensure an 
     adequate supply of trained health professionals necessary to 
     maintain accreditation of, and provide health care services 
     to Indians through, Indian Health Programs and Urban Indian 
     Organizations.
       ``(b) Eligible Individuals.--To be eligible to participate 
     in the Loan Repayment Program, an individual must--
       ``(1)(A) be enrolled--
       ``(i) in a course of study or program in an accredited 
     educational institution (as determined by the Secretary under 
     section 338B(b)(1)(c)(i) of the Public Health Service Act (42 
     U.S.C. 254l-1(b)(1)(c)(i))) and be scheduled to complete such 
     course of study in the same year such individual applies to 
     participate in such program; or
       ``(ii) in an approved graduate training program in a health 
     profession; or
       ``(B) have--
       ``(i) a degree in a health profession; and
       ``(ii) a license to practice a health profession;
       ``(2)(A) be eligible for, or hold, an appointment as a 
     commissioned officer in the Regular or Reserve Corps of the 
     Public Health Service;
       ``(B) be eligible for selection for civilian service in the 
     Regular or Reserve Corps of the Public Health Service;
       ``(C) meet the professional standards for civil service 
     employment in the Service; or
       ``(D) be employed in an Indian Health Program or Urban 
     Indian Organization without a service obligation; and
       ``(3) submit to the Secretary an application for a contract 
     described in subsection (e).
       ``(c) Application.--
       ``(1) Information to be included with forms.--In 
     disseminating application forms and contract forms to 
     individuals desiring to participate in the Loan Repayment 
     Program, the Secretary shall include with such forms a fair 
     summary of the rights and liabilities of an individual whose 
     application is approved (and whose contract is accepted) by 
     the Secretary, including in the summary a clear explanation 
     of the damages to which the United States is entitled under 
     subsection (l) in the case of the individual's breach of 
     contract. The Secretary shall provide such individuals with 
     sufficient information regarding the advantages and 
     disadvantages of service as a commissioned officer in the 
     Regular or Reserve Corps of the Public Health Service or a 
     civilian employee of the Service to enable the individual to 
     make a decision on an informed basis.
       ``(2) Clear language.--The application form, contract form, 
     and all other information furnished by the Secretary under 
     this section shall be written in a manner calculated to be 
     understood by the average individual applying to participate 
     in the Loan Repayment Program.
       ``(3) Timely availability of forms.--The Secretary shall 
     make such application forms, contract forms, and other 
     information available to individuals desiring to participate 
     in the Loan Repayment Program on a date sufficiently early to 
     ensure that such individuals have adequate time to carefully 
     review and evaluate such forms and information.
       ``(d) Priorities.--
       ``(1) List.--Consistent with subsection (k), the Secretary 
     shall annually--
       ``(A) identify the positions in each Indian Health Program 
     or Urban Indian Organization for which there is a need or a 
     vacancy; and

[[Page 2735]]

       ``(B) rank those positions in order of priority.
       ``(2) Approvals.--Notwithstanding the priority determined 
     under paragraph (1), the Secretary, in determining which 
     applications under the Loan Repayment Program to approve (and 
     which contracts to accept), shall--
       ``(A) give first priority to applications made by 
     individual Indians; and
       ``(B) after making determinations on all applications 
     submitted by individual Indians as required under 
     subparagraph (A), give priority to--
       ``(i) individuals recruited through the efforts of an 
     Indian Health Program or Urban Indian Organization; and
       ``(ii) other individuals based on the priority rankings 
     under paragraph (1).
       ``(e) Recipient Contracts.--
       ``(1) Contract required.--An individual becomes a 
     participant in the Loan Repayment Program only upon the 
     Secretary and the individual entering into a written contract 
     described in paragraph (2).
       ``(2) Contents of contract.--The written contract referred 
     to in this section between the Secretary and an individual 
     shall contain--
       ``(A) an agreement under which--
       ``(i) subject to subparagraph (C), the Secretary agrees--

       ``(I) to pay loans on behalf of the individual in 
     accordance with the provisions of this section; and
       ``(II) to accept (subject to the availability of 
     appropriated funds for carrying out this section) the 
     individual into the Service or place the individual with a 
     Tribal Health Program or Urban Indian Organization as 
     provided in clause (ii)(III); and

       ``(ii) subject to subparagraph (C), the individual agrees--

       ``(I) to accept loan payments on behalf of the individual;
       ``(II) in the case of an individual described in subsection 
     (b)(1)--

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

       ``(III) to serve for a time period (hereinafter in this 
     section referred to as the `period of obligated service') 
     equal to 2 years or such longer period as the individual may 
     agree to serve in the full-time clinical practice of such 
     individual's profession in an Indian Health Program or Urban 
     Indian Organization to which the individual may be assigned 
     by the Secretary;

       ``(B) a provision permitting the Secretary to extend for 
     such longer additional periods, as the individual may agree 
     to, the period of obligated service agreed to by the 
     individual under subparagraph (A)(ii)(III);
       ``(C) a provision that any financial obligation of the 
     United States arising out of a contract entered into under 
     this section and any obligation of the individual which is 
     conditioned thereon is contingent upon funds being 
     appropriated for loan repayments under this section;
       ``(D) a statement of the damages to which the United States 
     is entitled under subsection (l) for the individual's breach 
     of the contract; and
       ``(E) such other statements of the rights and liabilities 
     of the Secretary and of the individual, not inconsistent with 
     this section.
       ``(f) Deadline for Decision on Application.--The Secretary 
     shall provide written notice to an individual within 21 days 
     on--
       ``(1) the Secretary's approving, under subsection (e)(1), 
     of the individual's participation in the Loan Repayment 
     Program, including extensions resulting in an aggregate 
     period of obligated service in excess of 4 years; or
       ``(2) the Secretary's disapproving an individual's 
     participation in such Program.
       ``(g) Payments.--
       ``(1) In general.--A loan repayment provided for an 
     individual under a written contract under the Loan Repayment 
     Program shall consist of payment, in accordance with 
     paragraph (2), on behalf of the individual of the principal, 
     interest, and related expenses on government and commercial 
     loans received by the individual regarding the undergraduate 
     or graduate education of the individual (or both), which 
     loans were made for--
       ``(A) tuition expenses;
       ``(B) all other reasonable educational expenses, including 
     fees, books, and laboratory expenses, incurred by the 
     individual; and
       ``(C) reasonable living expenses as determined by the 
     Secretary.
       ``(2) Amount.--For each year of obligated service that an 
     individual contracts to serve under subsection (e), the 
     Secretary may pay up to $35,000 or an amount equal to the 
     amount specified in section 338B(g)(2)(A) of the Public 
     Health Service Act, whichever is more, on behalf of the 
     individual for loans described in paragraph (1). In making a 
     determination of the amount to pay for a year of such service 
     by an individual, the Secretary shall consider the extent to 
     which each such determination--
       ``(A) affects the ability of the Secretary to maximize the 
     number of contracts that can be provided under the Loan 
     Repayment Program from the amounts appropriated for such 
     contracts;
       ``(B) provides an incentive to serve in Indian Health 
     Programs and Urban Indian Organizations with the greatest 
     shortages of health professionals; and
       ``(C) provides an incentive with respect to the health 
     professional involved remaining in an Indian Health Program 
     or Urban Indian Organization with such a health professional 
     shortage, and continuing to provide primary health services, 
     after the completion of the period of obligated service under 
     the Loan Repayment Program.
       ``(3) Timing.--Any arrangement made by the Secretary for 
     the making of loan repayments in accordance with this 
     subsection shall provide that any repayments for a year of 
     obligated service shall be made no later than the end of the 
     fiscal year in which the individual completes such year of 
     service.
       ``(4) Reimbursements for tax liability.--For the purpose of 
     providing reimbursements for tax liability resulting from a 
     payment under paragraph (2) on behalf of an individual, the 
     Secretary--
       ``(A) in addition to such payments, may make payments to 
     the individual in an amount equal to not less than 20 percent 
     and not more than 39 percent of the total amount of loan 
     repayments made for the taxable year involved; and
       ``(B) may make such additional payments as the Secretary 
     determines to be appropriate with respect to such purpose.
       ``(5) Payment schedule.--The Secretary may enter into an 
     agreement with the holder of any loan for which payments are 
     made under the Loan Repayment Program to establish a schedule 
     for the making of such payments.
       ``(h) Employment Ceiling.--Notwithstanding any other 
     provision of law, individuals who have entered into written 
     contracts with the Secretary under this section shall not be 
     counted against any employment ceiling affecting the 
     Department while those individuals are undergoing academic 
     training.
       ``(i) Recruitment.--The Secretary shall conduct recruiting 
     programs for the Loan Repayment Program and other manpower 
     programs of the Service at educational institutions training 
     health professionals or specialists identified in subsection 
     (a).
       ``(j) Applicability of Law.--Section 214 of the Public 
     Health Service Act (42 U.S.C. 215) shall not apply to 
     individuals during their period of obligated service under 
     the Loan Repayment Program.
       ``(k) Assignment of Individuals.--The Secretary, in 
     assigning individuals to serve in Indian Health Programs or 
     Urban Indian Organizations pursuant to contracts entered into 
     under this section, shall--
       ``(1) ensure that the staffing needs of Tribal Health 
     Programs and Urban Indian Organizations receive consideration 
     on an equal basis with programs that are administered 
     directly by the Service; and
       ``(2) give priority to assigning individuals to Indian 
     Health Programs and Urban Indian Organizations that have a 
     need for health professionals to provide health care services 
     as a result of individuals having breached contracts entered 
     into under this section.
       ``(l) Breach of Contract.--
       ``(1) Specific breaches.--An individual who has entered 
     into a written contract with the Secretary under this section 
     and has not received a waiver under subsection (m) shall be 
     liable, in lieu of any service obligation arising under such 
     contract, to the United States for the amount which has been 
     paid on such individual's behalf under the contract if that 
     individual--
       ``(A) is enrolled in the final year of a course of study 
     and--
       ``(i) fails to maintain an acceptable level of academic 
     standing in the educational institution in which he or she is 
     enrolled (such level determined by the educational 
     institution under regulations of the Secretary);
       ``(ii) voluntarily terminates such enrollment; or
       ``(iii) is dismissed from such educational institution 
     before completion of such course of study; or
       ``(B) is enrolled in a graduate training program and fails 
     to complete such training program.
       ``(2) Other breaches; formula for amount owed.--If, for any 
     reason not specified in paragraph (1), an individual breaches 
     his or her written contract under this section by failing 
     either to begin, or complete, such individual's period of 
     obligated service in accordance with subsection (e)(2), the 
     United States shall be entitled to recover from such 
     individual an amount to be determined in accordance with the 
     following formula: A=3Z(t-s/t) in which--
       ``(A) `A' is the amount the United States is entitled to 
     recover;
       ``(B) `Z' is the sum of the amounts paid under this section 
     to, or on behalf of, the individual and the interest on such 
     amounts which would be payable if, at the time the amounts 
     were paid, they were loans bearing interest at the maximum 
     legal prevailing rate, as determined by the Secretary of the 
     Treasury;
       ``(C) `t' is the total number of months in the individual's 
     period of obligated service in accordance with subsection 
     (f); and

[[Page 2736]]

       ``(D) `s' is the number of months of such period served by 
     such individual in accordance with this section.
       ``(3) Deductions in medicare payments.--Amounts not paid 
     within such period shall be subject to collection through 
     deductions in Medicare payments pursuant to section 1892 of 
     the Social Security Act.
       ``(4) Time period for repayment.--Any amount of damages 
     which the United States is entitled to recover under this 
     subsection shall be paid to the United States within the 1-
     year period beginning on the date of the breach or such 
     longer period beginning on such date as shall be specified by 
     the Secretary.
       ``(5) Recovery of delinquency.--
       ``(A) In general.--If damages described in paragraph (4) 
     are delinquent for 3 months, the Secretary shall, for the 
     purpose of recovering such damages--
       ``(i) use collection agencies contracted with by the 
     Administrator of General Services; or
       ``(ii) enter into contracts for the recovery of such 
     damages with collection agencies selected by the Secretary.
       ``(B) Report.--Each contract for recovering damages 
     pursuant to this subsection shall provide that the contractor 
     will, not less than once each 6 months, submit to the 
     Secretary a status report on the success of the contractor in 
     collecting such damages. Section 3718 of title 31, United 
     States Code, shall apply to any such contract to the extent 
     not inconsistent with this subsection.
       ``(m) Waiver or Suspension of Obligation.--
       ``(1) In general.--The Secretary shall by regulation 
     provide for the partial or total waiver or suspension of any 
     obligation of service or payment by an individual under the 
     Loan Repayment Program whenever compliance by the individual 
     is impossible or would involve extreme hardship to the 
     individual and if enforcement of such obligation with respect 
     to any individual would be unconscionable.
       ``(2) Canceled upon death.--Any obligation of an individual 
     under the Loan Repayment Program for service or payment of 
     damages shall be canceled upon the death of the individual.
       ``(3) Hardship waiver.--The Secretary may waive, in whole 
     or in part, the rights of the United States to recover 
     amounts under this section in any case of extreme hardship or 
     other good cause shown, as determined by the Secretary.
       ``(4) Bankruptcy.--Any obligation of an individual under 
     the Loan Repayment Program for payment of damages may be 
     released by a discharge in bankruptcy under title 11 of the 
     United States Code only if such discharge is granted after 
     the expiration of the 5-year period beginning on the first 
     date that payment of such damages is required, and only if 
     the bankruptcy court finds that nondischarge of the 
     obligation would be unconscionable.
       ``(n) Report.--The Secretary shall submit to the President, 
     for inclusion in the report required to be submitted to 
     Congress under section 801, a report concerning the previous 
     fiscal year which sets forth by Service Area the following:
       ``(1) A list of the health professional positions 
     maintained by Indian Health Programs and Urban Indian 
     Organizations for which recruitment or retention is 
     difficult.
       ``(2) The number of Loan Repayment Program applications 
     filed with respect to each type of health profession.
       ``(3) The number of contracts described in subsection (e) 
     that are entered into with respect to each health profession.
       ``(4) The amount of loan payments made under this section, 
     in total and by health profession.
       ``(5) The number of scholarships that are provided under 
     sections 104 and 106 with respect to each health profession.
       ``(6) The amount of scholarship grants provided under 
     section 104 and 106, in total and by health profession.
       ``(7) The number of providers of health care that will be 
     needed by Indian Health Programs and Urban Indian 
     Organizations, by location and profession, during the 3 
     fiscal years beginning after the date the report is filed.
       ``(8) The measures the Secretary plans to take to fill the 
     health professional positions maintained by Indian Health 
     Programs or Urban Indian Organizations for which recruitment 
     or retention is difficult.

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

       ``(a) Establishment.--There is established in the Treasury 
     of the United States a fund to be known as the Indian Health 
     Scholarship and Loan Repayment Recovery Fund (hereafter in 
     this section referred to as the `LRRF'). The LRRF shall 
     consist of such amounts as may be collected from individuals 
     under section 104(d), section 106(e), and section 110(l) for 
     breach of contract, such funds as may be appropriated to the 
     LRRF, and interest earned on amounts in the LRRF. All amounts 
     collected, appropriated, or earned relative to the LRRF shall 
     remain available until expended.
       ``(b) Use of Funds.--
       ``(1) By secretary.--Amounts in the LRRF may be expended by 
     the Secretary, acting through the Service, to make payments 
     to an Indian Health Program--
       ``(A) to which a scholarship recipient under section 104 
     and 106 or a loan repayment program participant under section 
     110 has been assigned to meet the obligated service 
     requirements pursuant to such sections; and
       ``(B) that has a need for a health professional to provide 
     health care services as a result of such recipient or 
     participant having breached the contract entered into under 
     section 104, 106, or section 110.
       ``(2) By tribal health programs.--A Tribal Health Program 
     receiving payments pursuant to paragraph (1) may expend the 
     payments to provide scholarships or recruit and employ, 
     directly or by contract, health professionals to provide 
     health care services.
       ``(c) Investment of Funds.--The Secretary of the Treasury 
     shall invest such amounts of the LRRF as the Secretary of 
     Health and Human Services determines are not required to meet 
     current withdrawals from the LRRF. Such investments may be 
     made only in interest bearing obligations of the United 
     States. For such purpose, such obligations may be acquired on 
     original issue at the issue price, or by purchase of 
     outstanding obligations at the market price.
       ``(d) Sale of Obligations.--Any obligation acquired by the 
     LRRF may be sold by the Secretary of the Treasury at the 
     market price.
       ``(e) Effective Date.--This section takes effect on October 
     1, 2009.

     ``SEC. 112. RECRUITMENT ACTIVITIES.

       ``(a) Reimbursement for Travel.--The Secretary, acting 
     through the Service, may reimburse health professionals 
     seeking positions with Indian Health Programs or Urban Indian 
     Organizations, including individuals considering entering 
     into a contract under section 110 and their spouses, for 
     actual and reasonable expenses incurred in traveling to and 
     from their places of residence to an area in which they may 
     be assigned for the purpose of evaluating such area with 
     respect to such assignment.
       ``(b) Recruitment Personnel.--The Secretary, acting through 
     the Service, shall assign 1 individual in each Area Office to 
     be responsible on a full-time basis for recruitment 
     activities.

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

       ``(a) In General.--The Secretary, acting through the 
     Service, shall fund, on a competitive basis, innovative 
     demonstration projects for a period not to exceed 3 years to 
     enable Tribal Health Programs and Urban Indian Organizations 
     to recruit, place, and retain health professionals to meet 
     their staffing needs.
       ``(b) Eligible Entities; Application.--Any Tribal Health 
     Program or Urban Indian Organization may submit an 
     application for funding of a project pursuant to this 
     section.

     ``SEC. 114. ADVANCED TRAINING AND RESEARCH.

       ``(a) Demonstration Program.--The Secretary, acting through 
     the Service, shall establish a demonstration project to 
     enable health professionals who have worked in an Indian 
     Health Program or Urban Indian Organization for a substantial 
     period of time to pursue advanced training or research areas 
     of study for which the Secretary determines a need exists.
       ``(b) Service Obligation.--An individual who participates 
     in a program under subsection (a), where the educational 
     costs are borne by the Service, shall incur an obligation to 
     serve in an Indian Health Program or Urban Indian 
     Organization for a period of obligated service equal to at 
     least the period of time during which the individual 
     participates in such program. In the event that the 
     individual fails to complete such obligated service, the 
     individual shall be liable to the United States for the 
     period of service remaining. In such event, with respect to 
     individuals entering the program after the date of enactment 
     of the Indian Health Care Improvement Act Amendments of 2008, 
     the United States shall be entitled to recover from such 
     individual an amount to be determined in accordance with the 
     formula specified in subsection (l) of section 110 in the 
     manner provided for in such subsection.
       ``(c) Equal Opportunity for Participation.--Health 
     professionals from Tribal Health Programs and Urban Indian 
     Organizations shall be given an equal opportunity to 
     participate in the program under subsection (a).

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

       ``(a) Grants Authorized.--For the purpose of increasing the 
     number of nurses, nurse midwives, and nurse practitioners who 
     deliver health care services to Indians, the Secretary, 
     acting through the Service, shall provide grants to the 
     following:
       ``(1) Public or private schools of nursing.
       ``(2) Tribal colleges or universities.
       ``(3) Nurse midwife programs and advanced practice nurse 
     programs that are provided by any tribal college or 
     university accredited nursing program, or in the absence of 
     such, any other public or private institutions.
       ``(b) Use of Grants.--Grants provided under subsection (a) 
     may be used for 1 or more of the following:
       ``(1) To recruit individuals for programs which train 
     individuals to be nurses, nurse midwives, or advanced 
     practice nurses.
       ``(2) To provide scholarships to Indians enrolled in such 
     programs that may pay the

[[Page 2737]]

     tuition charged for such program and other expenses incurred 
     in connection with such program, including books, fees, room 
     and board, and stipends for living expenses.
       ``(3) To provide a program that encourages nurses, nurse 
     midwives, and advanced practice nurses to provide, or 
     continue to provide, health care services to Indians.
       ``(4) To provide a program that increases the skills of, 
     and provides continuing education to, nurses, nurse midwives, 
     and advanced practice nurses.
       ``(5) To provide any program that is designed to achieve 
     the purpose described in subsection (a).
       ``(c) Applications.--Each application for a grant under 
     subsection (a) shall include such information as the 
     Secretary may require to establish the connection between the 
     program of the applicant and a health care facility that 
     primarily serves Indians.
       ``(d) Preferences for Grant Recipients.--In providing 
     grants under subsection (a), the Secretary shall extend a 
     preference to the following:
       ``(1) Programs that provide a preference to Indians.
       ``(2) Programs that train nurse midwives or advanced 
     practice nurses.
       ``(3) Programs that are interdisciplinary.
       ``(4) Programs that are conducted in cooperation with a 
     program for gifted and talented Indian students.
       ``(5) Programs conducted by tribal colleges and 
     universities.
       ``(e) Quentin N. Burdick Program Grant.--The Secretary 
     shall provide 1 of the grants authorized under subsection (a) 
     to establish and maintain a program at the University of 
     North Dakota to be known as the `Quentin N. Burdick American 
     Indians Into Nursing Program'. Such program shall, to the 
     maximum extent feasible, coordinate with the Quentin N. 
     Burdick Indian Health Programs established under section 
     117(b) and the Quentin N. Burdick American Indians Into 
     Psychology Program established under section 105(b).
       ``(f) Active Duty Service Obligation.--The active duty 
     service obligation prescribed under section 338C of the 
     Public Health Service Act (42 U.S.C. 254m) shall be met by 
     each individual who receives training or assistance described 
     in paragraph (1) or (2) of subsection (b) that is funded by a 
     grant provided under subsection (a). Such obligation shall be 
     met by service--
       ``(1) in the Service;
       ``(2) in a program of an Indian Tribe or Tribal 
     Organization conducted under the Indian Self-Determination 
     and Education Assistance Act (25 U.S.C. 450 et seq.) 
     (including programs under agreements with the Bureau of 
     Indian Affairs);
       ``(3) in a program assisted under title V of this Act;
       ``(4) in the private practice of nursing if, as determined 
     by the Secretary, in accordance with guidelines promulgated 
     by the Secretary, such practice is situated in a physician or 
     other health shortage area and addresses the health care 
     needs of a substantial number of Indians; or
       ``(5) in a teaching capacity in a tribal college or 
     university nursing program (or a related health profession 
     program) if, as determined by the Secretary, health services 
     provided to Indians would not decrease.

     ``SEC. 116. TRIBAL CULTURAL ORIENTATION.

       ``(a) Cultural Education of Employees.--The Secretary, 
     acting through the Service, shall require that appropriate 
     employees of the Service who serve Indian Tribes in each 
     Service Area receive educational instruction in the history 
     and culture of such Indian Tribes and their relationship to 
     the Service.
       ``(b) Program.--In carrying out subsection (a), the 
     Secretary shall establish a program which shall, to the 
     extent feasible--
       ``(1) be developed in consultation with the affected Indian 
     Tribes, Tribal Organizations, and Urban Indian Organizations;
       ``(2) be carried out through tribal colleges or 
     universities;
       ``(3) include instruction in American Indian studies; and
       ``(4) describe the use and place of traditional health care 
     practices of the Indian Tribes in the Service Area.

     ``SEC. 117. INMED PROGRAM.

       ``(a) Grants Authorized.--The Secretary, acting through the 
     Service, is authorized to provide grants to colleges and 
     universities for the purpose of maintaining and expanding the 
     Indian health careers recruitment program known as the 
     `Indians Into Medicine Program' (hereinafter in this section 
     referred to as `INMED') as a means of encouraging Indians to 
     enter the health professions.
       ``(b) Quentin N. Burdick Grant.--The Secretary shall 
     provide 1 of the grants authorized under subsection (a) to 
     maintain the INMED program at the University of North Dakota, 
     to be known as the `Quentin N. Burdick Indian Health 
     Programs', unless the Secretary makes a determination, based 
     upon program reviews, that the program is not meeting the 
     purposes of this section. Such program shall, to the maximum 
     extent feasible, coordinate with the Quentin N. Burdick 
     American Indians Into Psychology Program established under 
     section 105(b) and the Quentin N. Burdick American Indians 
     Into Nursing Program established under section 115.
       ``(c) Regulations.--The Secretary, pursuant to this Act, 
     shall develop regulations to govern grants pursuant to this 
     section.
       ``(d) Requirements.--Applicants for grants provided under 
     this section shall agree to provide a program which--
       ``(1) provides outreach and recruitment for health 
     professions to Indian communities including elementary and 
     secondary schools and community colleges located on 
     reservations which will be served by the program;
       ``(2) incorporates a program advisory board comprised of 
     representatives from the Indian Tribes and Indian communities 
     which will be served by the program;
       ``(3) provides summer preparatory programs for Indian 
     students who need enrichment in the subjects of math and 
     science in order to pursue training in the health 
     professions;
       ``(4) provides tutoring, counseling, and support to 
     students who are enrolled in a health career program of study 
     at the respective college or university; and
       ``(5) to the maximum extent feasible, employs qualified 
     Indians in the program.

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

       ``(a) Grants To Establish Programs.--
       ``(1) In general.--The Secretary, acting through the 
     Service, shall award grants to accredited and accessible 
     community colleges for the purpose of assisting such 
     community colleges in the establishment of programs which 
     provide education in a health profession leading to a degree 
     or diploma in a health profession for individuals who desire 
     to practice such profession on or near a reservation or in an 
     Indian Health Program.
       ``(2) Amount of grants.--The amount of any grant awarded to 
     a community college under paragraph (1) for the first year in 
     which such a grant is provided to the community college shall 
     not exceed $250,000.
       ``(b) Grants for Maintenance and Recruiting.--
       ``(1) In general.--The Secretary, acting through the 
     Service, shall award grants to accredited and accessible 
     community colleges that have established a program described 
     in subsection (a)(1) for the purpose of maintaining the 
     program and recruiting students for the program.
       ``(2) Requirements.--Grants may only be made under this 
     section to a community college which--
       ``(A) is accredited;
       ``(B) has a relationship with a hospital facility, Service 
     facility, or hospital that could provide training of nurses 
     or health professionals;
       ``(C) has entered into an agreement with an accredited 
     college or university medical school, the terms of which--
       ``(i) provide a program that enhances the transition and 
     recruitment of students into advanced baccalaureate or 
     graduate programs that train health professionals; and
       ``(ii) stipulate certifications necessary to approve 
     internship and field placement opportunities at Indian Health 
     Programs;
       ``(D) has a qualified staff which has the appropriate 
     certifications;
       ``(E) is capable of obtaining State or regional 
     accreditation of the program described in subsection (a)(1); 
     and
       ``(F) agrees to provide for Indian preference for 
     applicants for programs under this section.
       ``(c) Technical Assistance.--The Secretary shall encourage 
     community colleges described in subsection (b)(2) to 
     establish and maintain programs described in subsection 
     (a)(1) by--
       ``(1) entering into agreements with such colleges for the 
     provision of qualified personnel of the Service to teach 
     courses of study in such programs; and
       ``(2) providing technical assistance and support to such 
     colleges.
       ``(d) Advanced Training.--
       ``(1) Required.--Any program receiving assistance under 
     this section that is conducted with respect to a health 
     profession shall also offer courses of study which provide 
     advanced training for any health professional who--
       ``(A) has already received a degree or diploma in such 
     health profession; and
       ``(B) provides clinical services on or near a reservation 
     or for an Indian Health Program.
       ``(2) May be offered at alternate site.--Such courses of 
     study may be offered in conjunction with the college or 
     university with which the community college has entered into 
     the agreement required under subsection (b)(2)(C).
       ``(e) Priority.--Where the requirements of subsection (b) 
     are met, grant award priority shall be provided to tribal 
     colleges and universities in Service Areas where they exist.

     ``SEC. 119. RETENTION BONUS.

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

[[Page 2738]]

       ``(3) has--
       ``(A) completed 2 years of employment with an Indian Health 
     Program or Urban Indian Organization; or
       ``(B) completed any service obligations incurred as a 
     requirement of--
       ``(i) any Federal scholarship program; or
       ``(ii) any Federal education loan repayment program; and
       ``(4) enters into an agreement with an Indian Health 
     Program or Urban Indian Organization for continued employment 
     for a period of not less than 1 year.
       ``(b) Rates.--The Secretary may establish rates for the 
     retention bonus which shall provide for a higher annual rate 
     for multiyear agreements than for single year agreements 
     referred to in subsection (a)(4), but in no event shall the 
     annual rate be more than $25,000 per annum.
       ``(c) Default of Retention Agreement.--Any health 
     professional failing to complete the agreed upon term of 
     service, except where such failure is through no fault of the 
     individual, shall be obligated to refund to the Government 
     the full amount of the retention bonus for the period covered 
     by the agreement, plus interest as determined by the 
     Secretary in accordance with section 110(l)(2)(B).
       ``(d) Other Retention Bonus.--The Secretary may pay a 
     retention bonus to any health professional employed by a 
     Tribal Health Program if such health professional is serving 
     in a position which the Secretary determines is--
       ``(1) a position for which recruitment or retention is 
     difficult; and
       ``(2) necessary for providing health care services to 
     Indians.

     ``SEC. 120. NURSING RESIDENCY PROGRAM.

       ``(a) Establishment of Program.--The Secretary, acting 
     through the Service, shall establish a program to enable 
     Indians who are licensed practical nurses, licensed 
     vocational nurses, and registered nurses who are working in 
     an Indian Health Program or Urban Indian Organization, and 
     have done so for a period of not less than 1 year, to pursue 
     advanced training. Such program shall include a combination 
     of education and work study in an Indian Health Program or 
     Urban Indian Organization leading to an associate or 
     bachelor's degree (in the case of a licensed practical nurse 
     or licensed vocational nurse), a bachelor's degree (in the 
     case of a registered nurse), or advanced degrees or 
     certifications in nursing and public health.
       ``(b) Service Obligation.--An individual who participates 
     in a program under subsection (a), where the educational 
     costs are paid by the Service, shall incur an obligation to 
     serve in an Indian Health Program or Urban Indian 
     Organization for a period of obligated service equal to 1 
     year for every year that nonprofessional employee (licensed 
     practical nurses, licensed vocational nurses, nursing 
     assistants, and various health care technicals), or 2 years 
     for every year that professional nurse (associate degree and 
     bachelor-prepared registered nurses), 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.

       ``(a) General Purposes of Program.--Under the authority of 
     the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as 
     the `Snyder Act'), the Secretary, acting through the Service, 
     shall develop and operate a Community Health Aide Program in 
     Alaska under which the Service--
       ``(1) provides for the training of Alaska Natives as health 
     aides or community health practitioners;
       ``(2) uses such aides or practitioners in the provision of 
     health care, health promotion, and disease prevention 
     services to Alaska Natives living in villages in rural 
     Alaska; and
       ``(3) provides for the establishment of teleconferencing 
     capacity in health clinics located in or near such villages 
     for use by community health aides or community health 
     practitioners.
       ``(b) Specific Program Requirements.--The Secretary, acting 
     through the Community Health Aide Program of the Service, 
     shall--
       ``(1) using trainers accredited by the Program, provide a 
     high standard of training to community health aides and 
     community health practitioners to ensure that such aides and 
     practitioners provide quality health care, health promotion, 
     and disease prevention services to the villages served by the 
     Program;
       ``(2) in order to provide such training, develop a 
     curriculum that--
       ``(A) combines education in the theory of health care with 
     supervised practical experience in the provision of health 
     care;
       ``(B) provides instruction and practical experience in the 
     provision of acute care, emergency care, health promotion, 
     disease prevention, and the efficient and effective 
     management of clinic pharmacies, supplies, equipment, and 
     facilities; and
       ``(C) promotes the achievement of the health status 
     objectives specified in section 3(2);
       ``(3) establish and maintain a Community Health Aide 
     Certification Board to certify as community health aides or 
     community health practitioners individuals who have 
     successfully completed the training described in paragraph 
     (1) or can demonstrate equivalent experience;
       ``(4) develop and maintain a system which identifies the 
     needs of community health aides and community health 
     practitioners for continuing education in the provision of 
     health care, including the areas described in paragraph 
     (2)(B), and develop programs that meet the needs for such 
     continuing education;
       ``(5) develop and maintain a system that provides close 
     supervision of community health aides and community health 
     practitioners;
       ``(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; and
       ``(7) ensure that pulpal therapy (not including pulpotomies 
     on deciduous teeth) or extraction of adult teeth can be 
     performed by a dental health aide therapist only after 
     consultation with a licensed dentist who determines that the 
     procedure is a medical emergency that cannot be resolved with 
     palliative treatment, and further that dental health aide 
     therapists are strictly prohibited from performing all other 
     oral or jaw surgeries, provided that uncomplicated 
     extractions shall not be considered oral surgery under this 
     section.
       ``(c) Program Review.--
       ``(1) Neutral panel.--
       ``(A) Establishment.--The Secretary, acting through the 
     Service, shall establish a neutral panel to carry out the 
     study under paragraph (2).
       ``(B) Membership.--Members of the neutral panel shall be 
     appointed by the Secretary from among clinicians, economists, 
     community practitioners, oral epidemiologists, and Alaska 
     Natives.
       ``(2) Study.--
       ``(A) In general.--The neutral panel established under 
     paragraph (1) shall conduct a study of the dental health aide 
     therapist services provided by the Community Health Aide 
     Program under this section to ensure that the quality of care 
     provided through those services is adequate and appropriate.
       ``(B) Parameters of study.--The Secretary, in consultation 
     with interested parties, including professional dental 
     organizations, shall develop the parameters of the study.
       ``(C) Inclusions.--The study shall include a determination 
     by the neutral panel with respect to--
       ``(i) the ability of the dental health aide therapist 
     services under this section to address the dental care needs 
     of Alaska Natives;
       ``(ii) the quality of care provided through those services, 
     including any training, improvement, or additional oversight 
     required to improve the quality of care; and
       ``(iii) whether safer and less costly alternatives to the 
     dental health aide therapist services exist.
       ``(D) Consultation.--In carrying out the study under this 
     paragraph, the neutral panel shall consult with Alaska Tribal 
     Organizations with respect to the adequacy and accuracy of 
     the study.
       ``(3) Report.--The neutral panel shall submit to the 
     Secretary, the Committee on Indian Affairs of the Senate, and 
     the Committee on Natural Resources of the House of 
     Representatives a report describing the results of the study 
     under paragraph (2), including a description of--
       ``(A) any determination of the neutral panel under 
     paragraph (2)(C); and
       ``(B) any comments received from an Alaska Tribal 
     Organization under paragraph (2)(D).
       ``(d) Nationalization of Program.--
       ``(1) In general.--Except as provided in paragraph (2), the 
     Secretary, acting through the Service, may establish a 
     national Community Health Aide Program in accordance with the 
     program under this section, as the Secretary determines to be 
     appropriate.
       ``(2) Exception.--The national Community Health Aide 
     Program under paragraph (1) shall not include dental health 
     aide therapist services.
       ``(3) Requirement.--In establishing a national program 
     under paragraph (1), the Secretary shall not reduce the 
     amount of funds provided for the Community Health Aide 
     Program described in subsections (a) and (b).

     ``SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION.

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

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

       ``(a) Demonstration Programs Authorized.--The Secretary, 
     acting through the Service, may fund demonstration programs 
     for Tribal Health Programs to address the chronic shortages 
     of health professionals.
       ``(b) Purposes of Programs.--The purposes of demonstration 
     programs funded under subsection (a) shall be--

[[Page 2739]]

       ``(1) to provide direct clinical and practical experience 
     at a Service Unit to health profession students and residents 
     from medical schools;
       ``(2) to improve the quality of health care for Indians by 
     assuring access to qualified health care professionals; and
       ``(3) to provide academic and scholarly opportunities for 
     health professionals serving Indians by identifying all 
     academic and scholarly resources of the region.
       ``(c) Advisory Board.--The demonstration programs 
     established pursuant to subsection (a) shall incorporate a 
     program advisory board composed of representatives from the 
     Indian Tribes and Indian communities in the area which will 
     be served by the program.

     ``SEC. 124. NATIONAL HEALTH SERVICE CORPS.

       ``The Secretary shall not--
       ``(1) remove a member of the National Health Service Corps 
     from an Indian Health Program or Urban Indian Organization; 
     or
       ``(2) withdraw funding used to support such member, unless 
     the Secretary, acting through the Service, has ensured that 
     the Indians receiving services from such member will 
     experience no reduction in services.

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

       ``(a) Contracts and Grants.--The Secretary, acting through 
     the Service, may enter into contracts with, or make grants 
     to, accredited tribal colleges and universities and eligible 
     accredited and accessible community colleges to establish 
     demonstration programs to develop educational curricula for 
     substance abuse counseling.
       ``(b) Use of Funds.--Funds provided under this section 
     shall be used only for developing and providing educational 
     curriculum for substance abuse counseling (including paying 
     salaries for instructors). Such curricula may be provided 
     through satellite campus programs.
       ``(c) Time Period of Assistance; Renewal.--A contract 
     entered into or a grant provided under this section shall be 
     for a period of 3 years. Such contract or grant may be 
     renewed for an additional 2-year period upon the approval of 
     the Secretary.
       ``(d) Criteria for Review and Approval of Applications.--
     Not later than 180 days after the date of enactment of the 
     Indian Health Care Improvement Act Amendments of 2008, the 
     Secretary, after consultation with Indian Tribes and 
     administrators of tribal colleges and universities and 
     eligible accredited and accessible community colleges, shall 
     develop and issue criteria for the review and approval of 
     applications for funding (including applications for renewals 
     of funding) under this section. Such criteria shall ensure 
     that demonstration programs established under this section 
     promote the development of the capacity of such entities to 
     educate substance abuse counselors.
       ``(e) Assistance.--The Secretary shall provide such 
     technical and other assistance as may be necessary to enable 
     grant recipients to comply with the provisions of this 
     section.
       ``(f) Report.--Each fiscal year, the Secretary shall submit 
     to the President, for inclusion in the report which is 
     required to be submitted under section 801 for that fiscal 
     year, a report on the findings and conclusions derived from 
     the demonstration programs conducted under this section 
     during that fiscal year.
       ``(g) Definition.--For the purposes of this section, the 
     term `educational curriculum' means 1 or more of the 
     following:
       ``(1) Classroom education.
       ``(2) Clinical work experience.
       ``(3) Continuing education workshops.

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

       ``(a) Study; List.--The Secretary, acting through the 
     Service, and the Secretary of the Interior, in consultation 
     with Indian Tribes and Tribal Organizations, shall conduct a 
     study and compile a list of the types of staff positions 
     specified in subsection (b) whose qualifications include, or 
     should include, training in the identification, prevention, 
     education, referral, or treatment of mental illness, or 
     dysfunctional and self destructive behavior.
       ``(b) Positions.--The positions referred to in subsection 
     (a) are--
       ``(1) staff positions within the Bureau of Indian Affairs, 
     including existing positions, in the fields of--
       ``(A) elementary and secondary education;
       ``(B) social services and family and child welfare;
       ``(C) law enforcement and judicial services; and
       ``(D) alcohol and substance abuse;
       ``(2) staff positions within the Service; and
       ``(3) staff positions similar to those identified in 
     paragraphs (1) and (2) established and maintained by Indian 
     Tribes and Tribal Organizations (without regard to the 
     funding source).
       ``(c) Training Criteria.--
       ``(1) In general.--The appropriate Secretary shall provide 
     training criteria appropriate to each type of position 
     identified in subsection (b)(1) and (b)(2) and ensure that 
     appropriate training has been, or shall be provided to any 
     individual in any such position. With respect to any such 
     individual in a position identified pursuant to subsection 
     (b)(3), the respective Secretaries shall provide appropriate 
     training to, or provide funds to, an Indian Tribe or Tribal 
     Organization for training of appropriate individuals. In the 
     case of positions funded under a contract or compact under 
     the Indian Self-Determination and Education Assistance Act 
     (25 U.S.C. 450 et seq.), the appropriate Secretary shall 
     ensure that such training costs are included in the contract 
     or compact, as the Secretary determines necessary.
       ``(2) Position specific training criteria.--Position 
     specific training criteria shall be culturally relevant to 
     Indians and Indian Tribes and shall ensure that appropriate 
     information regarding traditional health care practices is 
     provided.
       ``(d) Community Education on Mental Illness.--The Service 
     shall develop and implement, on request of an Indian Tribe, 
     Tribal Organization, or Urban Indian Organization, or assist 
     the Indian Tribe, Tribal Organization, or Urban Indian 
     Organization to develop and implement, a program of community 
     education on mental illness. In carrying out this subsection, 
     the Service shall, upon request of an Indian Tribe, Tribal 
     Organization, or Urban Indian Organization, provide technical 
     assistance to the Indian Tribe, Tribal Organization, or Urban 
     Indian Organization to obtain and develop community 
     educational materials on the identification, prevention, 
     referral, and treatment of mental illness and dysfunctional 
     and self-destructive behavior.
       ``(e) Plan.--Not later than 90 days after the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2008, the Secretary shall develop a plan under 
     which the Service will increase the health care staff 
     providing behavioral health services by at least 500 
     positions within 5 years after the date of enactment of this 
     section, with at least 200 of such positions devoted to 
     child, adolescent, and family services. The plan developed 
     under this subsection shall be implemented under the Act of 
     November 2, 1921 (25 U.S.C. 13) (commonly known as the 
     `Snyder Act').

     ``SEC. 127. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2017 to 
     carry out this title.

                      ``TITLE II--HEALTH SERVICES

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

       ``(a) Use of Funds.--The Secretary, acting through the 
     Service, is authorized to expend funds, directly or under the 
     authority of the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450 et seq.), which are 
     appropriated under the authority of this section, for the 
     purposes of--
       ``(1) eliminating the deficiencies in health status and 
     health resources of all Indian Tribes;
       ``(2) eliminating backlogs in the provision of health care 
     services to Indians;
       ``(3) meeting the health needs of Indians in an efficient 
     and equitable manner, including the use of telehealth and 
     telemedicine when appropriate;
       ``(4) eliminating inequities in funding for both direct 
     care and contract health service programs; and
       ``(5) augmenting the ability of the Service to meet the 
     following health service responsibilities with respect to 
     those Indian Tribes with the highest levels of health status 
     deficiencies and resource deficiencies:
       ``(A) Clinical care, including inpatient care, outpatient 
     care (including audiology, clinical eye, and vision care), 
     primary care, secondary and tertiary care, and long-term 
     care.
       ``(B) Preventive health, including mammography and other 
     cancer screening in accordance with section 207.
       ``(C) Dental care.
       ``(D) Mental health, including community mental health 
     services, inpatient mental health services, dormitory mental 
     health services, therapeutic and residential treatment 
     centers, and training of traditional health care 
     practitioners.
       ``(E) Emergency medical services.
       ``(F) Treatment and control of, and rehabilitative care 
     related to, alcoholism and drug abuse (including fetal 
     alcohol spectrum disorders) among Indians.
       ``(G) Injury prevention programs, including training.
       ``(H) Home health care.
       ``(I) Community health representatives.
       ``(J) Maintenance and improvement.
       ``(b) No Offset or Limitation.--Any funds appropriated 
     under the authority of this section shall not be used to 
     offset or limit any other appropriations made to the Service 
     under this Act or the Act of November 2, 1921 (25 U.S.C. 13) 
     (commonly known as the `Snyder Act'), or any other provision 
     of law.
       ``(c) Allocation; Use.--
       ``(1) In general.--Funds appropriated under the authority 
     of this section shall be allocated to Service Units, Indian 
     Tribes, or Tribal Organizations. The funds allocated to each 
     Indian Tribe, Tribal Organization, or Service Unit under this 
     paragraph shall be used by the Indian Tribe, Tribal 
     Organization, or Service Unit under this paragraph to improve 
     the health status and reduce the resource deficiency of each 
     Indian Tribe served by such Service Unit, Indian Tribe, or 
     Tribal Organization.

[[Page 2740]]

       ``(2) Apportionment of allocated funds.--The apportionment 
     of funds allocated to a Service Unit, Indian Tribe, or Tribal 
     Organization under paragraph (1) among the health service 
     responsibilities described in subsection (a)(5) shall be 
     determined by the Service in consultation with, and with the 
     active participation of, the affected Indian Tribes and 
     Tribal Organizations.
       ``(d) Provisions Relating to Health Status and Resource 
     Deficiencies.--For the purposes of this section, the 
     following definitions apply:
       ``(1) Definition.--The term `health status and resource 
     deficiency' means the extent to which--
       ``(A) the health status objectives set forth in section 
     3(2) are not being achieved; and
       ``(B) the Indian Tribe or Tribal Organization does not have 
     available to it the health resources it needs, taking into 
     account the actual cost of providing health care services 
     given local geographic, climatic, rural, or other 
     circumstances.
       ``(2) Available resources.--The health resources available 
     to an Indian Tribe or Tribal Organization include health 
     resources provided by the Service as well as health resources 
     used by the Indian Tribe or Tribal Organization, including 
     services and financing systems provided by any Federal 
     programs, private insurance, and programs of State or local 
     governments.
       ``(3) Process for review of determinations.--The Secretary 
     shall establish procedures which allow any Indian Tribe or 
     Tribal Organization to petition the Secretary for a review of 
     any determination of the extent of the health status and 
     resource deficiency of such Indian Tribe or Tribal 
     Organization.
       ``(e) Eligibility for Funds.--Tribal Health Programs shall 
     be eligible for funds appropriated under the authority of 
     this section on an equal basis with programs that are 
     administered directly by the Service.
       ``(f) Report.--By no later than the date that is 3 years 
     after the date of enactment of the Indian Health Care 
     Improvement Act Amendments of 2008, the Secretary shall 
     submit to Congress the current health status and resource 
     deficiency report of the Service for each Service Unit, 
     including newly recognized or acknowledged Indian Tribes. 
     Such report shall set out--
       ``(1) the methodology then in use by the Service for 
     determining Tribal health status and resource deficiencies, 
     as well as the most recent application of that methodology;
       ``(2) the extent of the health status and resource 
     deficiency of each Indian Tribe served by the Service or a 
     Tribal Health Program;
       ``(3) the amount of funds necessary to eliminate the health 
     status and resource deficiencies of all Indian Tribes served 
     by the Service or a Tribal Health Program; and
       ``(4) an estimate of--
       ``(A) the amount of health service funds appropriated under 
     the authority of this Act, or any other Act, including the 
     amount of any funds transferred to the Service for the 
     preceding fiscal year which is allocated to each Service 
     Unit, Indian Tribe, or Tribal Organization;
       ``(B) the number of Indians eligible for health services in 
     each Service Unit or Indian Tribe or Tribal Organization; and
       ``(C) the number of Indians using the Service resources 
     made available to each Service Unit, Indian Tribe or Tribal 
     Organization, and, to the extent available, information on 
     the waiting lists and number of Indians turned away for 
     services due to lack of resources.
       ``(g) Inclusion in Base Budget.--Funds appropriated under 
     this section for any fiscal year shall be included in the 
     base budget of the Service for the purpose of determining 
     appropriations under this section in subsequent fiscal years.
       ``(h) Clarification.--Nothing in this section is intended 
     to diminish the primary responsibility of the Service to 
     eliminate existing backlogs in unmet health care needs, nor 
     are the provisions of this section intended to discourage the 
     Service from undertaking additional efforts to achieve equity 
     among Indian Tribes and Tribal Organizations.
       ``(i) Funding Designation.--Any funds appropriated under 
     the authority of this section shall be designated as the 
     `Indian Health Care Improvement Fund'.

     ``SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND.

       ``(a) Establishment.--There is established an Indian 
     Catastrophic Health Emergency Fund (hereafter in this section 
     referred to as the `CHEF') consisting of--
       ``(1) the amounts deposited under subsection (f); and
       ``(2) the amounts appropriated to CHEF under this section.
       ``(b) Administration.--CHEF shall be administered by the 
     Secretary, acting through the headquarters of the Service, 
     solely for the purpose of meeting the extraordinary medical 
     costs associated with the treatment of victims of disasters 
     or catastrophic illnesses who are within the responsibility 
     of the Service.
       ``(c) Conditions on Use of Fund.--No part of CHEF or its 
     administration shall be subject to contract or grant under 
     any law, including the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 450 et seq.), nor shall 
     CHEF funds be allocated, apportioned, or delegated on an Area 
     Office, Service Unit, or other similar basis.
       ``(d) Regulations.--The Secretary shall promulgate 
     regulations consistent with the provisions of this section 
     to--
       ``(1) establish a definition of disasters and catastrophic 
     illnesses for which the cost of the treatment provided under 
     contract would qualify for payment from CHEF;
       ``(2) provide that a Service Unit shall not be eligible for 
     reimbursement for the cost of treatment from CHEF until its 
     cost of treating any victim of such catastrophic illness or 
     disaster has reached a certain threshold cost which the 
     Secretary shall establish at--
       ``(A) the 2000 level of $19,000; and
       ``(B) for any subsequent year, not less than the threshold 
     cost of the previous year increased by the percentage 
     increase in the medical care expenditure category of the 
     consumer price index for all urban consumers (United States 
     city average) for the 12-month period ending with December of 
     the previous year;
       ``(3) establish a procedure for the reimbursement of the 
     portion of the costs that exceeds such threshold cost 
     incurred by--
       ``(A) Service Units; or
       ``(B) whenever otherwise authorized by the Service, non-
     Service facilities or providers;
       ``(4) establish a procedure for payment from CHEF in cases 
     in which the exigencies of the medical circumstances warrant 
     treatment prior to the authorization of such treatment by the 
     Service; and
       ``(5) establish a procedure that will ensure that no 
     payment shall be made from CHEF to any provider of treatment 
     to the extent that such provider is eligible to receive 
     payment for the treatment from any other Federal, State, 
     local, or private source of reimbursement for which the 
     patient is eligible.
       ``(e) No Offset or Limitation.--Amounts appropriated to 
     CHEF under this section shall not be used to offset or limit 
     appropriations made to the Service under the authority of the 
     Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the 
     `Snyder Act'), or any other law.
       ``(f) Deposit of Reimbursement Funds.--There shall be 
     deposited into CHEF all reimbursements to which the Service 
     is entitled from any Federal, State, local, or private source 
     (including third party insurance) by reason of treatment 
     rendered to any victim of a disaster or catastrophic illness 
     the cost of which was paid from CHEF.

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

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

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

       ``(a) Determinations Regarding Diabetes.--The Secretary, 
     acting through the Service, and in consultation with Indian 
     Tribes and Tribal Organizations, shall determine--
       ``(1) by Indian Tribe and by Service Unit, the incidence 
     of, and the types of complications resulting from, diabetes 
     among Indians; and
       ``(2) based on the determinations made pursuant to 
     paragraph (1), the measures (including patient education and 
     effective ongoing monitoring of disease indicators) each 
     Service Unit should take to reduce the incidence of, and 
     prevent, treat, and control the complications resulting from, 
     diabetes among Indian Tribes within that Service Unit.
       ``(b) Diabetes Screening.--To the extent medically 
     indicated and with informed consent, the Secretary shall 
     screen each Indian who receives services from the Service for 
     diabetes and for conditions which indicate a high risk that 
     the individual will become diabetic and establish a cost-
     effective approach to ensure ongoing monitoring of disease 
     indicators. Such screening and monitoring may be conducted by 
     a Tribal Health Program and may be conducted through 
     appropriate Internet-based health care management programs.
       ``(c) Diabetes Projects.--The Secretary shall continue to 
     maintain each model diabetes project in existence on the date 
     of enactment of the Indian Health Care Improvement

[[Page 2741]]

     Act Amendments of 2008, any such other diabetes programs 
     operated by the Service or Tribal Health Programs, and any 
     additional diabetes projects, such as the Medical Vanguard 
     program provided for in title IV of Public Law 108-87, as 
     implemented to serve Indian Tribes. Tribal Health Programs 
     shall receive recurring funding for the diabetes projects 
     that they operate pursuant to this section, both at the date 
     of enactment of the Indian Health Care Improvement Act 
     Amendments of 2008 and for projects which are added and 
     funded thereafter.
       ``(d) Dialysis Programs.--The Secretary is authorized to 
     provide, through the Service, Indian Tribes, and Tribal 
     Organizations, dialysis programs, including the purchase of 
     dialysis equipment and the provision of necessary staffing.
       ``(e) Other Duties of the Secretary.--
       ``(1) In general.--The Secretary shall, to the extent 
     funding is available--
       ``(A) in each Area Office, consult with Indian Tribes and 
     Tribal Organizations regarding programs for the prevention, 
     treatment, and control of diabetes;
       ``(B) establish in each Area Office a registry of patients 
     with diabetes to track the incidence of diabetes and the 
     complications from diabetes in that area; and
       ``(C) ensure that data collected in each Area Office 
     regarding diabetes and related complications among Indians 
     are disseminated to all other Area Offices, subject to 
     applicable patient privacy laws.
       ``(2) Diabetes control officers.--
       ``(A) In general.--The Secretary may establish and maintain 
     in each Area Office a position of diabetes control officer to 
     coordinate and manage any activity of that Area Office 
     relating to the prevention, treatment, or control of diabetes 
     to assist the Secretary in carrying out a program under this 
     section or section 330C of the Public Health Service Act (42 
     U.S.C. 254c-3).
       ``(B) Certain activities.--Any activity carried out by a 
     diabetes control officer under subparagraph (A) that is the 
     subject of a contract or compact under the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.), and any funds made available to carry out such an 
     activity, shall not be divisible for purposes of that Act.

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

       ``(a) Long-Term Care.--Notwithstanding any other provision 
     of law, the Secretary, acting through the Service, is 
     authorized to provide directly, or enter into contracts or 
     compacts under the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450 et seq.) with Indian Tribes or 
     Tribal Organizations for, the delivery of long-term care 
     (including health care services associated with long-term 
     care) provided in a facility to Indians. Such agreements 
     shall provide for the sharing of staff or other services 
     between the Service or a Tribal Health Program and a long-
     term care or related facility owned and operated (directly or 
     through a contract or compact under the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.)) by such Indian Tribe or Tribal Organization.
       ``(b) Contents of Agreements.--An agreement entered into 
     pursuant to subsection (a)--
       ``(1) may, at the request of the Indian Tribe or Tribal 
     Organization, delegate to such Indian Tribe or Tribal 
     Organization such powers of supervision and control over 
     Service employees as the Secretary deems necessary to carry 
     out the purposes of this section;
       ``(2) shall provide that expenses (including salaries) 
     relating to services that are shared between the Service and 
     the Tribal Health Program be allocated proportionately 
     between the Service and the Indian Tribe or Tribal 
     Organization; and
       ``(3) may authorize such Indian Tribe or Tribal 
     Organization to construct, renovate, or expand a long-term 
     care or other similar facility (including the construction of 
     a facility attached to a Service facility).
       ``(c) Minimum Requirement.--Any nursing facility provided 
     for under this section shall meet the requirements for 
     nursing facilities under section 1919 of the Social Security 
     Act.
       ``(d) Other Assistance.--The Secretary shall provide such 
     technical and other assistance as may be necessary to enable 
     applicants to comply with the provisions of this section.
       ``(e) Use of Existing or Underused Facilities.--The 
     Secretary shall encourage the use of existing facilities that 
     are underused or allow the use of swing beds for long-term or 
     similar care.

     ``SEC. 206. HEALTH SERVICES RESEARCH.

       ``(a) In General.--The Secretary, acting through the 
     Service, shall make funding available for research to further 
     the performance of the health service responsibilities of 
     Indian Health Programs.
       ``(b) Coordination of Resources and Activities.--The 
     Secretary shall also, to the maximum extent practicable, 
     coordinate departmental research resources and activities to 
     address relevant Indian Health Program research needs.
       ``(c) Availability.--Tribal Health Programs shall be given 
     an equal opportunity to compete for, and receive, research 
     funds under this section.
       ``(d) Use of Funds.--This funding may be used for both 
     clinical and nonclinical research.
       ``(e) Evaluation and Dissemination.--The Secretary shall 
     periodically--
       ``(1) evaluate the impact of research conducted under this 
     section; and
       ``(2) disseminate to Tribal Health Programs information 
     regarding that research as the Secretary determines to be 
     appropriate.

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

       ``The Secretary, acting through the Service or Tribal 
     Health Programs, shall provide for screening as follows:
       ``(1) Screening mammography (as defined in section 1861(jj) 
     of the Social Security Act) for Indian women at a frequency 
     appropriate to such women under accepted and appropriate 
     national standards, and under such terms and conditions as 
     are consistent with standards established by the Secretary to 
     ensure the safety and accuracy of screening mammography under 
     part B of title XVIII of such Act.
       ``(2) Other cancer screening that receives an A or B rating 
     as recommended by the United States Preventive Services Task 
     Force established under section 915(a)(1) of the Public 
     Health Service Act (42 U.S.C. 299b-4(a)(1)). The Secretary 
     shall ensure that screening provided for under this paragraph 
     complies with the recommendations of the Task Force with 
     respect to--
       ``(A) frequency;
       ``(B) the population to be served;
       ``(C) the procedure or technology to be used;
       ``(D) evidence of effectiveness; and
       ``(E) other matters that the Secretary determines 
     appropriate.

     ``SEC. 208. PATIENT TRAVEL COSTS.

       ``(a) Definition of Qualified Escort.--In this section, the 
     term `qualified escort' means--
       ``(1) an adult escort (including a parent, guardian, or 
     other family member) who is required because of the physical 
     or mental condition, or age, of the applicable patient;
       ``(2) a health professional for the purpose of providing 
     necessary medical care during travel by the applicable 
     patient; or
       ``(3) other escorts, as the Secretary or applicable Indian 
     Health Program determines to be appropriate.
       ``(b) Provision of Funds.--The Secretary, acting through 
     the Service and Tribal Health Programs, is authorized to 
     provide funds for the following patient travel costs, 
     including qualified escorts, associated with receiving health 
     care services provided (either through direct or contract 
     care or through a contract or compact under the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.)) under this Act--
       ``(1) emergency air transportation and non-emergency air 
     transportation where ground transportation is infeasible;
       ``(2) transportation by private vehicle (where no other 
     means of transportation is available), specially equipped 
     vehicle, and ambulance; and
       ``(3) transportation by such other means as may be 
     available and required when air or motor vehicle 
     transportation is not available.

     ``SEC. 209. EPIDEMIOLOGY CENTERS.

       ``(a) Establishment of Centers.--The Secretary shall 
     establish an epidemiology center in each Service Area to 
     carry out the functions described in subsection (b). Any new 
     center established after the date of enactment of the Indian 
     Health Care Improvement Act Amendments of 2008 may be 
     operated under a grant authorized by subsection (d), but 
     funding under such a grant shall not be divisible.
       ``(b) Functions of Centers.--In consultation with and upon 
     the request of Indian Tribes, Tribal Organizations, and Urban 
     Indian communities, each Service Area epidemiology center 
     established under this section shall, with respect to such 
     Service Area--
       ``(1) collect data relating to, and monitor progress made 
     toward meeting, each of the health status objectives of the 
     Service, the Indian Tribes, Tribal Organizations, and Urban 
     Indian communities in the Service Area;
       ``(2) evaluate existing delivery systems, data systems, and 
     other systems that impact the improvement of Indian health;
       ``(3) assist Indian Tribes, Tribal Organizations, and Urban 
     Indian Organizations in identifying their highest priority 
     health status objectives and the services needed to achieve 
     such objectives, based on epidemiological data;
       ``(4) make recommendations for the targeting of services 
     needed by the populations served;
       ``(5) make recommendations to improve health care delivery 
     systems for Indians and Urban Indians;
       ``(6) provide requested technical assistance to Indian 
     Tribes, Tribal Organizations, and Urban Indian Organizations 
     in the development of local health service priorities and 
     incidence and prevalence rates of disease and other illness 
     in the community; and
       ``(7) provide disease surveillance and assist Indian 
     Tribes, Tribal Organizations, and Urban Indian communities to 
     promote public health.
       ``(c) Technical Assistance.--The Director of the Centers 
     for Disease Control and Prevention shall provide technical 
     assistance to the centers in carrying out the requirements of 
     this section.

[[Page 2742]]

       ``(d) Grants for Studies.--
       ``(1) In general.--The Secretary may make grants to Indian 
     Tribes, Tribal Organizations, Indian organizations, and 
     eligible intertribal consortia to conduct epidemiological 
     studies of Indian communities.
       ``(2) Eligible intertribal consortia.--An intertribal 
     consortium or Indian organization is eligible to receive a 
     grant under this subsection if--
       ``(A) the intertribal consortium is incorporated for the 
     primary purpose of improving Indian health; and
       ``(B) the intertribal consortium is representative of the 
     Indian Tribes or urban Indian communities in which the 
     intertribal consortium is located.
       ``(3) Applications.--An application for a grant under this 
     subsection shall be submitted in such manner and at such time 
     as the Secretary shall prescribe.
       ``(4) Requirements.--An applicant for a grant under this 
     subsection shall--
       ``(A) demonstrate the technical, administrative, and 
     financial expertise necessary to carry out the functions 
     described in paragraph (5);
       ``(B) consult and cooperate with providers of related 
     health and social services in order to avoid duplication of 
     existing services; and
       ``(C) demonstrate cooperation from Indian Tribes or Urban 
     Indian Organizations in the area to be served.
       ``(5) Use of funds.--A grant awarded under paragraph (1) 
     may be used--
       ``(A) to carry out the functions described in subsection 
     (b);
       ``(B) to provide information to and consult with tribal 
     leaders, urban Indian community leaders, and related health 
     staff on health care and health service management issues; 
     and
       ``(C) in collaboration with Indian Tribes, Tribal 
     Organizations, and urban Indian communities, to provide the 
     Service with information regarding ways to improve the health 
     status of Indians.
       ``(e) Access to Information.--The Secretary shall grant 
     epidemiology centers operated by a grantee pursuant to a 
     grant awarded under subsection (d) access to use of the data, 
     data sets, monitoring systems, delivery systems, and other 
     protected health information in the possession of the 
     Secretary. Such activities shall be for the purposes of 
     research and for preventing and controlling disease, injury, 
     or disability for purposes of the Health Insurance 
     Portability and Accountability Act of 1996 (Public Law 104-
     191; 110 Stat. 2033), as such activities are described in 
     part 164.512 of title 45, Code of Federal regulations (or a 
     successor regulation).

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

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

     ``SEC. 211. INDIAN YOUTH PROGRAM.

       ``(a) Program Authorized.--The Secretary, acting through 
     the Service, is authorized to establish and administer a 
     program to provide grants to Indian Tribes, Tribal 
     Organizations, and Urban Indian Organizations for innovative 
     mental and physical disease prevention and health promotion 
     and treatment programs for Indian preadolescent and 
     adolescent youths.
       ``(b) Use of Funds.--
       ``(1) Allowable uses.--Funds made available under this 
     section may be used to--
       ``(A) develop prevention and treatment programs for Indian 
     youth which promote mental and physical health and 
     incorporate cultural values, community and family 
     involvement, and traditional health care practitioners; and
       ``(B) develop and provide community training and education.
       ``(2) Prohibited use.--Funds made available under this 
     section may not be used to provide services described in 
     section 707(c).
       ``(c) Duties of the Secretary.--The Secretary shall--
       ``(1) disseminate to Indian Tribes and Tribal 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 or Tribal 
     Organization, provide technical assistance in the 
     implementation of such models.
       ``(d) Criteria for Review and Approval of Applications.--
     The Secretary, in consultation with Indian Tribes and Tribal 
     Organizations, and in conference with Urban Indian 
     Organizations, shall establish criteria for the review and 
     approval of applications or proposals under this section.

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

       ``(a) Grants Authorized.--The Secretary, acting through the 
     Service, and after consultation with the Centers for Disease 
     Control and Prevention, may make grants available to Indian 
     Tribes and Tribal Organizations for the following:
       ``(1) Projects for the prevention, control, and elimination 
     of communicable and infectious diseases, including 
     tuberculosis, hepatitis, HIV, respiratory syncytial virus, 
     hanta virus, sexually transmitted diseases, and H. Pylori.
       ``(2) Public information and education programs for the 
     prevention, control, and elimination of communicable and 
     infectious diseases.
       ``(3) Education, training, and clinical skills improvement 
     activities in the prevention, control, and elimination of 
     communicable and infectious diseases for health 
     professionals, including allied health professionals.
       ``(4) Demonstration projects for the screening, treatment, 
     and prevention of hepatitis C virus (HCV).
       ``(b) Application Required.--The Secretary may provide 
     funding under subsection (a) only if an application or 
     proposal for funding is submitted to the Secretary.
       ``(c) Coordination With Health Agencies.--Indian Tribes and 
     Tribal Organizations receiving funding under this section are 
     encouraged to coordinate their activities with the Centers 
     for Disease Control and Prevention and State and local health 
     agencies.
       ``(d) Technical Assistance; Report.--In carrying out this 
     section, the Secretary--
       ``(1) may, at the request of an Indian Tribe or Tribal 
     Organization, provide technical assistance; and
       ``(2) shall prepare and submit a report to Congress 
     biennially on the use of funds under this section and on the 
     progress made toward

[[Page 2743]]

     the prevention, control, and elimination of communicable and 
     infectious diseases among Indians and Urban Indians.

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

       ``(a) Funding Authorized.--The Secretary, acting through 
     the Service, Indian Tribes, and Tribal Organizations, may 
     provide funding under this Act to meet the objectives set 
     forth in section 3 of this Act through health care-related 
     services and programs not otherwise described in this Act for 
     the following services:
       ``(1) Hospice care.
       ``(2) Assisted living services.
       ``(3) Long-term care services.
       ``(4) Home- and community-based services.
       ``(b) Eligibility.--The following individuals shall be 
     eligible to receive long-term care under this section:
       ``(1) Individuals who are unable to perform a certain 
     number of activities of daily living without assistance.
       ``(2) Individuals with a mental impairment, such as 
     dementia, Alzheimer's disease, or another disabling mental 
     illness, who may be able to perform activities of daily 
     living under supervision.
       ``(3) Such other individuals as an applicable Indian Health 
     Program determines to be appropriate.
       ``(c) Definitions.--For the purposes of this section, the 
     following definitions shall apply:
       ``(1) The term `assisted living services' means any service 
     provided by an assisted living facility (as defined in 
     section 232(b) of the National Housing Act (12 U.S.C. 
     1715w(b))), except that such an assisted living facility--
       ``(A) shall not be required to obtain a license; but
       ``(B) shall meet all applicable standards for licensure.
       ``(2) The term `home- and community-based services' means 1 
     or more of the services specified in paragraphs (1) through 
     (9) of section 1929(a) of the Social Security Act (42 U.S.C. 
     1396t(a)) (whether provided by the Service or by an Indian 
     Tribe or Tribal Organization pursuant to the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.)) that are or will be provided in accordance with 
     applicable standards.
       ``(3) The term `hospice care' means the items and services 
     specified in subparagraphs (A) through (H) of section 
     1861(dd)(1) of the Social Security Act (42 U.S.C. 
     1395x(dd)(1)), and such other services which an Indian Tribe 
     or Tribal Organization determines are necessary and 
     appropriate to provide in furtherance of this care.
       ``(4) The term `long-term care services' has the meaning 
     given the term `qualified long-term care services' in section 
     7702B(c) of the Internal Revenue Code of 1986.
       ``(d) Authorization of Convenient Care Services.--The 
     Secretary, acting through the Service, Indian Tribes, and 
     Tribal Organizations, may also provide funding under this Act 
     to meet the objectives set forth in section 3 of this Act for 
     convenient care services programs pursuant to section 
     306(c)(2)(A).

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

       ``The Secretary, acting through the Service and Indian 
     Tribes, Tribal Organizations, and Urban Indian Organizations, 
     shall monitor and improve the quality of health care for 
     Indian women of all ages through the planning and delivery of 
     programs administered by the Service, in order to improve and 
     enhance the treatment models of care for Indian women.

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

       ``(a) Studies and Monitoring.--The Secretary and the 
     Service shall conduct, in conjunction with other appropriate 
     Federal agencies and in consultation with concerned Indian 
     Tribes and Tribal Organizations, studies and ongoing 
     monitoring programs to determine trends in the health hazards 
     to Indian miners and to Indians on or near reservations and 
     Indian communities as a result of environmental hazards which 
     may result in chronic or life threatening health problems, 
     such as nuclear resource development, petroleum 
     contamination, and contamination of water sources and of the 
     food chain. Such studies shall include--
       ``(1) an evaluation of the nature and extent of health 
     problems caused by environmental hazards currently exhibited 
     among Indians and the causes of such health problems;
       ``(2) an analysis of the potential effect of ongoing and 
     future environmental resource development on or near 
     reservations and Indian communities, including the cumulative 
     effect over time on health;
       ``(3) an evaluation of the types and nature of activities, 
     practices, and conditions causing or affecting such health 
     problems, including uranium mining and milling, uranium mine 
     tailing deposits, nuclear power plant operation and 
     construction, and nuclear waste disposal; oil and gas 
     production or transportation on or near reservations or 
     Indian communities; and other development that could affect 
     the health of Indians and their water supply and food chain;
       ``(4) a summary of any findings and recommendations 
     provided in Federal and State studies, reports, 
     investigations, and inspections during the 5 years prior to 
     the date of enactment of the Indian Health Care Improvement 
     Act Amendments of 2008 that directly or indirectly relate to 
     the activities, practices, and conditions affecting the 
     health or safety of such Indians; and
       ``(5) the efforts that have been made by Federal and State 
     agencies and resource and economic development companies to 
     effectively carry out an education program for such Indians 
     regarding the health and safety hazards of such development.
       ``(b) Health Care Plans.--Upon completion of such studies, 
     the Secretary and the Service shall take into account the 
     results of such studies and develop health care plans to 
     address the health problems studied under subsection (a). The 
     plans shall include--
       ``(1) methods for diagnosing and treating Indians currently 
     exhibiting such health problems;
       ``(2) preventive care and testing for Indians who may be 
     exposed to such health hazards, including the monitoring of 
     the health of individuals who have or may have been exposed 
     to excessive amounts of radiation or affected by other 
     activities that have had or could have a serious impact upon 
     the health of such individuals; and
       ``(3) a program of education for Indians who, by reason of 
     their work or geographic proximity to such nuclear or other 
     development activities, may experience health problems.
       ``(c) Submission of Report and Plan to Congress.--The 
     Secretary and the Service shall submit to Congress the study 
     prepared under subsection (a) no later than 18 months after 
     the date of enactment of the Indian Health Care Improvement 
     Act Amendments of 2008. The health care plan prepared under 
     subsection (b) shall be submitted in a report no later than 1 
     year after the study prepared under subsection (a) is 
     submitted to Congress. Such report shall include recommended 
     activities for the implementation of the plan, as well as an 
     evaluation of any activities previously undertaken by the 
     Service to address such health problems.
       ``(d) Intergovernmental Task Force.--
       ``(1) Establishment; members.--There is established an 
     Intergovernmental Task Force to be composed of the following 
     individuals (or their designees):
       ``(A) The Secretary of Energy.
       ``(B) The Secretary of the Environmental Protection Agency.
       ``(C) The Director of the Bureau of Mines.
       ``(D) The Assistant Secretary for Occupational Safety and 
     Health.
       ``(E) The Secretary of the Interior.
       ``(F) The Secretary of Health and Human Services.
       ``(G) The Director.
       ``(2) Duties.--The Task Force shall--
       ``(A) identify existing and potential operations related to 
     nuclear resource development or other environmental hazards 
     that affect or may affect the health of Indians on or near a 
     reservation or in an Indian community; and
       ``(B) enter into activities to correct existing health 
     hazards and ensure that current and future health problems 
     resulting from nuclear resource or other development 
     activities are minimized or reduced.
       ``(3) Chairman; meetings.--The Secretary of Health and 
     Human Services shall be the Chairman of the Task Force. The 
     Task Force shall meet at least twice each year.
       ``(e) Health Services to Certain Employees.--In the case of 
     any Indian who--
       ``(1) as a result of employment in or near a uranium mine 
     or mill or near any other environmental hazard, suffers from 
     a work-related illness or condition;
       ``(2) is eligible to receive diagnosis and treatment 
     services from an Indian Health Program; and
       ``(3) by reason of such Indian's employment, is entitled to 
     medical care at the expense of such mine or mill operator or 
     entity responsible for the environmental hazard, the Indian 
     Health Program shall, at the request of such Indian, render 
     appropriate medical care to such Indian for such illness or 
     condition and may be reimbursed for any medical care so 
     rendered to which such Indian is entitled at the expense of 
     such operator or entity from such operator or entity. Nothing 
     in this subsection shall affect the rights of such Indian to 
     recover damages other than such amounts paid to the Indian 
     Health Program from the employer for providing medical care 
     for such illness or condition.

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

       ``(a) In General.--For fiscal years beginning with the 
     fiscal year ending September 30, 1983, and ending with the 
     fiscal year ending September 30, 2016, the State of Arizona 
     shall be designated as a contract health service delivery 
     area by the Service for the purpose of providing contract 
     health care services to members of federally recognized 
     Indian Tribes of Arizona.
       ``(b) Maintenance of Services.--The Service shall not 
     curtail any health care services provided to Indians residing 
     on reservations in the State of Arizona if such curtailment 
     is due to the provision of contract services in such State 
     pursuant to the designation of such State as a contract 
     health service delivery area pursuant to subsection (a).

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

       ``(a) In General.--Beginning in fiscal year 2003, the 
     States of North Dakota and South

[[Page 2744]]

     Dakota shall be designated as a contract health service 
     delivery area by the Service for the purpose of providing 
     contract health care services to members of federally 
     recognized Indian Tribes of North Dakota and South Dakota.
       ``(b) Limitation.--The Service shall not curtail any health 
     care services provided to Indians residing on any 
     reservation, or in any county that has a common boundary with 
     any reservation, in the State of North Dakota or South Dakota 
     if such curtailment is due to the provision of contract 
     services in such States pursuant to the designation of such 
     States as a contract health service delivery area pursuant to 
     subsection (a).

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

       ``(a) Funding Authorized.--The Secretary is authorized to 
     fund a program using the California Rural Indian Health Board 
     (hereafter in this section referred to as the `CRIHB') as a 
     contract care intermediary to improve the accessibility of 
     health services to California Indians.
       ``(b) Reimbursement Contract.--The Secretary shall enter 
     into an agreement with the CRIHB to reimburse the CRIHB for 
     costs (including reasonable administrative costs) incurred 
     pursuant to this section, in providing medical treatment 
     under contract to California Indians described in section 
     806(a) throughout the California contract health services 
     delivery area described in section 218 with respect to high 
     cost contract care cases.
       ``(c) Administrative Expenses.--Not more than 5 percent of 
     the amounts provided to the CRIHB under this section for any 
     fiscal year may be for reimbursement for administrative 
     expenses incurred by the CRIHB during such fiscal year.
       ``(d) Limitation on Payment.--No payment may be made for 
     treatment provided hereunder to the extent payment may be 
     made for such treatment under the Indian Catastrophic Health 
     Emergency Fund described in section 202 or from amounts 
     appropriated or otherwise made available to the California 
     contract health service delivery area for a fiscal year.
       ``(e) Advisory Board.--There is established an advisory 
     board which shall advise the CRIHB in carrying out this 
     section. The advisory board shall be composed of 
     representatives, selected by the CRIHB, from not less than 8 
     Tribal Health Programs serving California Indians covered 
     under this section at least \1/2\ of whom of whom are not 
     affiliated with the CRIHB.

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

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

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

       ``(a) Authorization for Services.--The Secretary, acting 
     through the Service, is directed to provide contract health 
     services to members of the Turtle Mountain Band of Chippewa 
     Indians that reside in the Trenton Service Area of Divide, 
     McKenzie, and Williams counties in the State of North Dakota 
     and the adjoining counties of Richland, Roosevelt, and 
     Sheridan in the State of Montana.
       ``(b) No Expansion of Eligibility.--Nothing in this section 
     may be construed as expanding the eligibility of members of 
     the Turtle Mountain Band of Chippewa Indians for health 
     services provided by the Service beyond the scope of 
     eligibility for such health services that applied on May 1, 
     1986.

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

       ``The Service shall provide funds for health care programs 
     and facilities operated by Tribal Health Programs on the same 
     basis as such funds are provided to programs and facilities 
     operated directly by the Service.

     ``SEC. 221. LICENSING.

       ``Health care professionals employed by a Tribal Health 
     Program shall, if licensed in any State, be exempt from the 
     licensing requirements of the State in which the Tribal 
     Health Program performs the services described in its 
     contract or compact under the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 450 et seq.).

     ``SEC. 222. NOTIFICATION OF PROVISION OF EMERGENCY CONTRACT 
                   HEALTH SERVICES.

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

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

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

     ``SEC. 224. LIABILITY FOR PAYMENT.

       ``(a) No Patient Liability.--A patient who receives 
     contract health care services that are authorized by the 
     Service shall not be liable for the payment of any charges or 
     costs associated with the provision of such services.
       ``(b) Notification.--The Secretary shall notify a contract 
     care provider and any patient who receives contract health 
     care services authorized by the Service that such patient is 
     not liable for the payment of any charges or costs associated 
     with the provision of such services not later than 5 business 
     days after receipt of a notification of a claim by a provider 
     of contract care services.
       ``(c) No Recourse.--Following receipt of the notice 
     provided under subsection (b), or, if a claim has been deemed 
     accepted under section 223(b), the provider shall have no 
     further recourse against the patient who received the 
     services.

     ``SEC. 225. OFFICE OF INDIAN MEN'S HEALTH.

       ``(a) Establishment.--The Secretary may establish within 
     the Service an office to be known as the `Office of Indian 
     Men's Health' (referred to in this section as the `Office').
       ``(b) Director.--
       ``(1) In general.--The Office shall be headed by a 
     director, to be appointed by the Secretary.
       ``(2) Duties.--The director shall coordinate and promote 
     the status of the health of Indian men in the United States.
       ``(c) Report.--Not later than 2 years after the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2008, the Secretary, acting through the 
     director of the Office, shall submit to Congress a report 
     describing--
       ``(1) any activity carried out by the director as of the 
     date on which the report is prepared; and
       ``(2) any finding of the director with respect to the 
     health of Indian men.

     ``SEC. 226. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2017 to 
     carry out this title.

                        ``TITLE III--FACILITIES

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

       ``(a) Prerequisites for Expenditure of Funds.--Prior to the 
     expenditure of, or the making of any binding commitment to 
     expend, any funds appropriated for the planning, design, 
     construction, or renovation of facilities pursuant to the Act 
     of November 2, 1921 (25 U.S.C. 13) (commonly known as the 
     `Snyder Act'), the Secretary, acting through the Service, 
     shall--
       ``(1) consult with any Indian Tribe that would be 
     significantly affected by such expenditure for the purpose of 
     determining and, whenever practicable, honoring tribal 
     preferences concerning size, location, type, and other 
     characteristics of any facility on which such expenditure is 
     to be made; and
       ``(2) ensure, whenever practicable and applicable, that 
     such facility meets the construction standards of any 
     accrediting body recognized by the Secretary for the purposes 
     of the Medicare, Medicaid, and SCHIP programs under titles 
     XVIII, XIX, and XXI of the Social Security Act by not later 
     than 1 year after the date on which the construction or 
     renovation of such facility is completed.
       ``(b) Closures and Reductions in Hours of Service.--
       ``(1) Evaluation required.--Notwithstanding any other 
     provision of law, no facility operated by the Service, or any 
     portion of such facility, may be closed or have the hours of 
     service of the facility reduced if the Secretary has not 
     submitted to Congress not less than 1 year, and not more than 
     2 years, before the date of the proposed closure or reduction 
     in hours of service an evaluation, completed not more than 2 
     years before the submission, of the impact of the proposed 
     closure or reduction in hours of service that specifies, in 
     addition to other considerations--
       ``(A) the accessibility of alternative health care 
     resources for the population served by such facility;
       ``(B) the cost-effectiveness of such closure or reduction 
     in hours of service;
       ``(C) the quality of health care to be provided to the 
     population served by such facility after such closure or 
     reduction in hours of service;
       ``(D) the availability of contract health care funds to 
     maintain existing levels of service;
       ``(E) the views of the Indian Tribes served by such 
     facility concerning such closure or reduction in hours of 
     service;

[[Page 2745]]

       ``(F) the level of use of such facility by all eligible 
     Indians; and
       ``(G) the distance between such facility and the nearest 
     operating Service hospital.
       ``(2) Exception for certain temporary closures and 
     reductions.--Paragraph (1) shall not apply to any temporary 
     closure or reduction in hours of service of a facility or any 
     portion of a facility if such closure or reduction in hours 
     of service is necessary for medical, environmental, or 
     construction safety reasons.
       ``(c) Health Care Facility Priority System.--
       ``(1) In general.--
       ``(A) Priority system.--The Secretary, acting through the 
     Service, shall maintain a health care facility priority 
     system, which--
       ``(i) shall be developed in consultation with Indian Tribes 
     and Tribal Organizations;
       ``(ii) shall give Indian Tribes' needs the highest 
     priority;
       ``(iii)(I) may include the lists required in paragraph 
     (2)(B)(ii); and
       ``(II) shall include the methodology required in paragraph 
     (2)(B)(v); and
       ``(III) may include such health care facilities, and such 
     renovation or expansion needs of any health care facility, as 
     the Service may identify; and
       ``(iv) shall provide an opportunity for the nomination of 
     planning, design, and construction projects by the Service, 
     Indian Tribes, and Tribal Organizations for consideration 
     under the priority system at least once every 3 years, or 
     more frequently as the Secretary determines to be 
     appropriate.
       ``(B) Needs of facilities under isdeaa agreements.--The 
     Secretary shall ensure that the planning, design, 
     construction, renovation, and expansion needs of Service and 
     non-Service facilities operated under contracts or compacts 
     in accordance with the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 450 et seq.) are fully 
     and equitably integrated into the health care facility 
     priority system.
       ``(C) Criteria for evaluating needs.--For purposes of this 
     subsection, the Secretary, in evaluating the needs of 
     facilities operated under a contract or compact under the 
     Indian Self-Determination and Education Assistance Act (25 
     U.S.C. 450 et seq.), shall use the criteria used by the 
     Secretary in evaluating the needs of facilities operated 
     directly by the Service.
       ``(D) Priority of certain projects protected.--The priority 
     of any project established under the construction priority 
     system in effect on the date of enactment of the Indian 
     Health Care Improvement Act Amendments of 2008 shall not be 
     affected by any change in the construction priority system 
     taking place after that date if the project--
       ``(i) was identified in the fiscal year 2008 Service budget 
     justification as--

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

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

       ``(I) on the initiative of the Secretary; or
       ``(II) pursuant to a request of an Indian Tribe or Tribal 
     Organization.

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

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

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

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

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

       ``(I) In general.--Not later than 1 year after the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2008, the Secretary shall submit to the 
     Committee on Indian Affairs of the Senate and the Committee 
     on Natural Resources of the House of Representatives a report 
     that describes the comprehensive, national, ranked list of 
     all health care facilities needs for the Service, Indian 
     Tribes, and Tribal Organizations (including inpatient health 
     care facilities, outpatient health care facilities, 
     specialized health care facilities (such as for long-term 
     care and alcohol and drug abuse treatment), wellness centers, 
     and staff quarters, and the renovation and expansion needs, 
     if any, of such facilities) developed by the Service, Indian 
     Tribes, and Tribal Organizations for the Facilities Needs 
     Assessment Workgroup and the Facilities Appropriation 
     Advisory Board.
       ``(II) Inclusions.--The initial report shall include--

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

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

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

       ``(I) the 10 top-priority inpatient health care facilities;
       ``(II) the 10 top-priority outpatient health care 
     facilities;
       ``(III) the 10 top-priority specialized health care 
     facilities (such as long-term care and alcohol and drug abuse 
     treatment); and
       ``(IV) the 10 top-priority staff quarters developments 
     associated with health care facilities.

       ``(iii) The justification for such order of priority.
       ``(iv) The projected cost of such projects.
       ``(v) The methodology adopted by the Service in 
     establishing priorities under its health care facility 
     priority system.
       ``(3) Requirements for preparation of reports.--In 
     preparing the report required under paragraph (2), the 
     Secretary shall--
       ``(A) consult with and obtain information on all health 
     care facilities needs from Indian Tribes and Tribal 
     Organizations; and
       ``(B) review the total unmet needs of all Indian Tribes and 
     Tribal Organizations for health care facilities (including 
     staff quarters), including needs for renovation and expansion 
     of existing facilities.
       ``(d) Review of Methodology Used for Health Facilities 
     Construction Priority System.--
       ``(1) In general.--Not later than 1 year after the 
     establishment of the priority system under subsection 
     (c)(1)(A), the Comptroller General of the United States shall 
     prepare and finalize a report reviewing the methodologies 
     applied, and the processes followed, by the Service in making 
     each assessment of needs for the list under subsection 
     (c)(2)(A)(ii) and developing the priority system under 
     subsection (c)(1), including a review of--
       ``(A) the recommendations of the Facilities Appropriation 
     Advisory Board and the Facilities Needs Assessment Workgroup 
     (as those terms are defined in subsection (c)(2)(A)(i)); and
       ``(B) the relevant criteria used in ranking or prioritizing 
     facilities other than hospitals or clinics.
       ``(2) Submission to congress.--The Comptroller General of 
     the United States shall submit the report under paragraph (1) 
     to--
       ``(A) the Committees on Indian Affairs and Appropriations 
     of the Senate;
       ``(B) the Committees on Natural Resources and 
     Appropriations of the House of Representatives; and
       ``(C) the Secretary.
       ``(e) Funding Condition.--All funds appropriated under the 
     Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the 
     `Snyder Act'), for the planning, design, construction, or 
     renovation of health facilities for the benefit of 1 or more 
     Indian Tribes shall be subject to the provisions of section 
     102 of the Indian Self-Determination and Education Assistance 
     Act (25 U.S.C. 450f) or sections 504 and 505 of that Act (25 
     U.S.C. 458aaa-3, 458aaa-4).
       ``(f) Development of Innovative Approaches.--The Secretary 
     shall consult and cooperate with Indian Tribes and Tribal 
     Organizations, and confer with Urban Indian Organizations, in 
     developing innovative approaches to address all or part of 
     the total unmet need for construction of health facilities, 
     that may include--
       ``(1) the establishment of an area distribution fund in 
     which a portion of health facility construction funding could 
     be devoted to all Service Areas;
       ``(2) approaches provided for in other provisions of this 
     title; and
       ``(3) other approaches, as the Secretary determines to be 
     appropriate.

     ``SEC. 302. SANITATION FACILITIES.

       ``(a) Findings.--Congress finds the following:
       ``(1) The provision of sanitation facilities is primarily a 
     health consideration and function.
       ``(2) Indian people suffer an inordinately high incidence 
     of disease, injury, and illness directly attributable to the 
     absence or inadequacy of sanitation facilities.
       ``(3) The long-term cost to the United States of treating 
     and curing such disease,

[[Page 2746]]

     injury, and illness is substantially greater than the short-
     term cost of providing sanitation facilities and other 
     preventive health measures.
       ``(4) Many Indian homes and Indian communities still lack 
     sanitation facilities.
       ``(5) It is in the interest of the United States, and it is 
     the policy of the United States, that all Indian communities 
     and Indian homes, new and existing, be provided with 
     sanitation facilities.
       ``(b) Facilities and Services.--In furtherance of the 
     findings made in subsection (a), Congress reaffirms the 
     primary responsibility and authority of the Service to 
     provide the necessary sanitation facilities and services as 
     provided in section 7 of the Act of August 5, 1954 (42 U.S.C. 
     2004a). Under such authority, the Secretary, acting through 
     the Service, is authorized to provide the following:
       ``(1) Financial and technical assistance to Indian Tribes, 
     Tribal Organizations, and Indian communities in the 
     establishment, training, and equipping of utility 
     organizations to operate and maintain sanitation facilities, 
     including the provision of existing plans, standard details, 
     and specifications available in the Department, to be used at 
     the option of the Indian Tribe, Tribal Organization, or 
     Indian community.
       ``(2) Ongoing technical assistance and training to Indian 
     Tribes, Tribal Organizations, and Indian communities in the 
     management of utility organizations which operate and 
     maintain sanitation facilities.
       ``(3) Priority funding for operation and maintenance 
     assistance for, and emergency repairs to, sanitation 
     facilities operated by an Indian Tribe, Tribal Organization 
     or Indian community when necessary to avoid an imminent 
     health threat or to protect the investment in sanitation 
     facilities and the investment in the health benefits gained 
     through the provision of sanitation facilities.
       ``(c) Funding.--Notwithstanding any other provision of 
     law--
       ``(1) the Secretary of Housing and Urban Development is 
     authorized to transfer funds appropriated under the Native 
     American Housing Assistance and Self-Determination Act of 
     1996 (25 U.S.C. 4101 et seq.) to the Secretary of Health and 
     Human Services;
       ``(2) the Secretary of Health and Human Services is 
     authorized to accept and use such funds for the purpose of 
     providing sanitation facilities and services for Indians 
     under section 7 of the Act of August 5, 1954 (42 U.S.C. 
     2004a);
       ``(3) unless specifically authorized when funds are 
     appropriated, the Secretary shall not use funds appropriated 
     under section 7 of the Act of August 5, 1954 (42 U.S.C. 
     2004a), to provide sanitation facilities to new homes 
     constructed using funds provided by the Department of Housing 
     and Urban Development;
       ``(4) the Secretary of Health and Human Services is 
     authorized to accept from any source, including Federal and 
     State agencies, funds for the purpose of providing sanitation 
     facilities and services and place these funds into contracts 
     or compacts under the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450 et seq.);
       ``(5) the Secretary is authorized to establish a program 
     under which the Secretary may, in accordance with this 
     subsection and with paragraphs (2), (3), (4), and (5) of 
     section 330(d) of the Public Health Service Act (42 U.S.C. 
     254b(d)) related to a loan guarantee program, guarantee the 
     principal and interest on loans made by lenders to Indian 
     Tribes for new projects to construct eligible sanitation 
     facilities to serve Indian homes, but only to the extent that 
     appropriations are provided in advance specifically for such 
     program, and without reducing funds made available for the 
     provision of domestic and community sanitation facilities for 
     Indians, as authorized by section 7 of the Act of August 5, 
     1954 (42 U.S.C. 2004a), the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 450 et seq.), and this 
     Act;
       ``(6) except as otherwise prohibited by this section, the 
     Secretary may use funds appropriated under the authority of 
     section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a) to 
     meet matching or cost participation requirements under other 
     Federal and non-Federal programs for new projects to 
     construct eligible sanitation facilities;
       ``(7) all Federal agencies are authorized to transfer to 
     the Secretary funds identified, granted, loaned, or 
     appropriated whereby the Department's applicable policies, 
     rules, and regulations shall apply in the implementation of 
     such projects;
       ``(8) the Secretary of Health and Human Services shall 
     enter into interagency agreements with Federal and State 
     agencies for the purpose of providing financial assistance 
     for sanitation facilities and services under this Act;
       ``(9) the Secretary of Health and Human Services shall, by 
     regulation, establish standards applicable to the planning, 
     design, and construction of sanitation facilities funded 
     under this Act; and
       ``(10) the Secretary of Health and Human Services is 
     authorized to accept payments for goods and services 
     furnished by the Service from appropriate public authorities, 
     nonprofit organizations or agencies, or Indian Tribes, as 
     contributions by that authority, organization, agency, or 
     tribe to agreements made under section 7 of the Act of August 
     5, 1954 (42 U.S.C. 2004a), and such payments shall be 
     credited to the same or subsequent appropriation account as 
     funds appropriated under the authority of section 7 of the 
     Act of August 5, 1954 (42 U.S.C. 2004a).
       ``(d) Certain Capabilities Not Prerequisite.--The financial 
     and technical capability of an Indian Tribe, Tribal 
     Organization, or Indian community to safely operate, manage, 
     and maintain a sanitation facility shall not be a 
     prerequisite to the provision or construction of sanitation 
     facilities by the Secretary.
       ``(e) Financial Assistance.--The Secretary is authorized to 
     provide financial assistance to Indian Tribes, Tribal 
     Organizations, and Indian communities for operation, 
     management, and maintenance of their sanitation facilities.
       ``(f) Operation, Management, and Maintenance of 
     Facilities.--The Indian Tribe has the primary responsibility 
     to establish, collect, and use reasonable user fees, or 
     otherwise set aside funding, for the purpose of operating, 
     managing, and maintaining sanitation facilities. If a 
     sanitation facility serving a community that is operated by 
     an Indian Tribe or Tribal Organization is threatened with 
     imminent failure and such operator lacks capacity to maintain 
     the integrity or the health benefits of the sanitation 
     facility, then the Secretary is authorized to assist the 
     Indian Tribe, Tribal Organization, or Indian community in the 
     resolution of the problem on a short-term basis through 
     cooperation with the emergency coordinator or by providing 
     operation, management, and maintenance service.
       ``(g) ISDEAA Program Funded on Equal Basis.--Tribal Health 
     Programs shall be eligible (on an equal basis with programs 
     that are administered directly by the Service) for--
       ``(1) any funds appropriated pursuant to this section; and
       ``(2) any funds appropriated for the purpose of providing 
     sanitation facilities.
       ``(h) Report.--
       ``(1) Required contents.--The Secretary, in consultation 
     with the Secretary of Housing and Urban Development, Indian 
     Tribes, Tribal Organizations, and tribally designated housing 
     entities (as defined in section 4 of the Native American 
     Housing Assistance and Self-Determination Act of 1996 (25 
     U.S.C. 4103)) shall submit to the President, for inclusion in 
     the report required to be transmitted to Congress under 
     section 801, a report which sets forth--
       ``(A) the current Indian sanitation facility priority 
     system of the Service;
       ``(B) the methodology for determining sanitation 
     deficiencies and needs;
       ``(C) the criteria on which the deficiencies and needs will 
     be evaluated;
       ``(D) the level of initial and final sanitation deficiency 
     for each type of sanitation facility for each project of each 
     Indian Tribe or Indian community;
       ``(E) the amount and most effective use of funds, derived 
     from whatever source, necessary to accommodate the sanitation 
     facilities needs of new homes assisted with funds under the 
     Native American Housing Assistance and Self-Determination Act 
     (25 U.S.C. 4101 et seq.), and to reduce the identified 
     sanitation deficiency levels of all Indian Tribes and Indian 
     communities to level I sanitation deficiency as defined in 
     paragraph (3)(A); and
       ``(F) a 10-year plan to provide sanitation facilities to 
     serve existing Indian homes and Indian communities and new 
     and renovated Indian homes.
       ``(2) Uniform methodology.--The methodology used by the 
     Secretary in determining, preparing cost estimates for, and 
     reporting sanitation deficiencies for purposes of paragraph 
     (1) shall be applied uniformly to all Indian Tribes and 
     Indian communities.
       ``(3) Sanitation deficiency levels.--For purposes of this 
     subsection, the sanitation deficiency levels for an 
     individual, Indian Tribe, or Indian community sanitation 
     facility to serve Indian homes are determined as follows:
       ``(A) A level I deficiency exists if a sanitation facility 
     serving an individual, Indian Tribe, or Indian community--
       ``(i) complies with all applicable water supply, pollution 
     control, and solid waste disposal laws; and
       ``(ii) deficiencies relate to routine replacement, repair, 
     or maintenance needs.
       ``(B) A level II deficiency exists if a sanitation facility 
     serving an individual, Indian Tribe, or Indian community 
     substantially or recently complied with all applicable water 
     supply, pollution control, and solid waste laws and any 
     deficiencies relate to--
       ``(i) small or minor capital improvements needed to bring 
     the facility back into compliance;
       ``(ii) capital improvements that are necessary to enlarge 
     or improve the facilities in order to meet the current needs 
     for domestic sanitation facilities; or
       ``(iii) the lack of equipment or training by an Indian 
     Tribe, Tribal Organization, or an Indian community to 
     properly operate and maintain the sanitation facilities.
       ``(C) A level III deficiency exists if a sanitation 
     facility serving an individual, Indian Tribe or Indian 
     community meets 1 or more of the following conditions--

[[Page 2747]]

       ``(i) water or sewer service in the home is provided by a 
     haul system with holding tanks and interior plumbing;
       ``(ii) major significant interruptions to water supply or 
     sewage disposal occur frequently, requiring major capital 
     improvements to correct the deficiencies; or
       ``(iii) there is no access to or no approved or permitted 
     solid waste facility available.
       ``(D) A level IV deficiency exists--
       ``(i) if a sanitation facility for an individual home, an 
     Indian Tribe, or an Indian community exists but--

       ``(I) lacks--

       ``(aa) a safe water supply system; or
       ``(bb) a waste disposal system;

       ``(II) contains no piped water or sewer facilities; or
       ``(III) has become inoperable due to a major component 
     failure; or

       ``(ii) if only a washeteria or central facility exists in 
     the community.
       ``(E) A level V deficiency exists in the absence of a 
     sanitation facility, where individual homes do not have 
     access to safe drinking water or adequate wastewater 
     (including sewage) disposal.
       ``(i) Definitions.--For purposes of this section, the 
     following terms apply:
       ``(1) Indian community.--The term `Indian community' means 
     a geographic area, a significant proportion of whose 
     inhabitants are Indians and which is served by or capable of 
     being served by a facility described in this section.
       ``(2) Sanitation facilities.--The terms `sanitation 
     facility' and `sanitation facilities' mean safe and adequate 
     water supply systems, sanitary sewage disposal systems, and 
     sanitary solid waste systems (and all related equipment and 
     support infrastructure).

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

       ``(a) Discretionary Authority; Covered Activities.--The 
     Secretary, acting through the Service, may utilize the 
     negotiating authority of section 23 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 that the project or function 
     cannot be properly completed or maintained under the proposed 
     contract. The Secretary, in arriving at such a finding, shall 
     consider whether the Indian or Indian firm will be deficient 
     with respect to--
       ``(1) ownership and control by Indians;
       ``(2) equipment;
       ``(3) bookkeeping and accounting procedures;
       ``(4) substantive knowledge of the project or function to 
     be contracted for;
       ``(5) adequately trained personnel; or
       ``(6) other necessary components of contract performance.
       ``(b) Pay Rates.--For the purpose of implementing the 
     provisions of this title, the Secretary shall assure that the 
     rates of pay for personnel engaged in the construction or 
     renovation of facilities constructed or renovated in whole or 
     in part by funds made available pursuant to this title are 
     not less than the prevailing local wage rates for similar 
     work as determined in accordance with sections 3141 through 
     3144, 3146, and 3147 of title 40, United States Code.

     ``SEC. 304. EXPENDITURE OF NON-SERVICE FUNDS FOR RENOVATION.

       ``(a) In General.--Notwithstanding any other provision of 
     law, if the requirements of subsection (c) are met, the 
     Secretary, acting through the Service, is authorized to 
     accept any major expansion, renovation, or modernization by 
     any Indian Tribe or Tribal Organization of any Service 
     facility or of any other Indian health facility operated 
     pursuant to a contract or compact under the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.), including--
       ``(1) any plans or designs for such expansion, renovation, 
     or modernization; and
       ``(2) any expansion, renovation, or modernization for which 
     funds appropriated under any Federal law were lawfully 
     expended.
       ``(b) Priority List.--
       ``(1) In general.--The Secretary shall maintain a separate 
     priority list to address the needs for increased operating 
     expenses, personnel, or equipment for such facilities. The 
     methodology for establishing priorities shall be developed 
     through regulations. The list of priority facilities will be 
     revised annually in consultation with Indian Tribes and 
     Tribal Organizations.
       ``(2) Report.--The Secretary shall submit to the President, 
     for inclusion in the report required to be transmitted to 
     Congress under section 801, the priority list maintained 
     pursuant to paragraph (1).
       ``(c) Requirements.--The requirements of this subsection 
     are met with respect to any expansion, renovation, or 
     modernization if--
       ``(1) the Indian Tribe or Tribal Organization--
       ``(A) provides notice to the Secretary of its intent to 
     expand, renovate, or modernize; and
       ``(B) applies to the Secretary to be placed on a separate 
     priority list to address the needs of such new facilities for 
     increased operating expenses, personnel, or equipment; and
       ``(2) the expansion, renovation, or modernization--
       ``(A) is approved by the appropriate area Director for 
     Federal facilities; and
       ``(B) is administered by the Indian Tribe or Tribal 
     Organization in accordance with any applicable regulations 
     prescribed by the Secretary with respect to construction or 
     renovation of Service facilities.
       ``(d) Additional Requirement for Expansion.--In addition to 
     the requirements under subsection (c), for any expansion, the 
     Indian Tribe or Tribal Organization shall provide to the 
     Secretary additional information pursuant to regulations, 
     including additional staffing, equipment, and other costs 
     associated with the expansion.
       ``(e) Closure or Conversion of Facilities.--If any Service 
     facility which has been expanded, renovated, or modernized by 
     an Indian Tribe or Tribal Organization under this section 
     ceases to be used as a Service facility during the 20-year 
     period beginning on the date such expansion, renovation, or 
     modernization is completed, such Indian Tribe or Tribal 
     Organization shall be entitled to recover from the United 
     States an amount which bears the same ratio to the value of 
     such facility at the time of such cessation as the value of 
     such expansion, renovation, or modernization (less the total 
     amount of any funds provided specifically for such facility 
     under any Federal program that were expended for such 
     expansion, renovation, or modernization) bore to the value of 
     such facility at the time of the completion of such 
     expansion, renovation, or modernization.

     ``SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, AND 
                   MODERNIZATION OF SMALL AMBULATORY CARE 
                   FACILITIES.

       ``(a) Grants.--
       ``(1) In general.--The Secretary, acting through the 
     Service, shall make grants to Indian Tribes and Tribal 
     Organizations for the construction, expansion, or 
     modernization of facilities for the provision of ambulatory 
     care services to eligible Indians (and noneligible persons 
     pursuant to subsections (b)(2) and (c)(1)(C)). A grant made 
     under this section may cover up to 100 percent of the costs 
     of such construction, expansion, or modernization. For the 
     purposes of this section, the term `construction' includes 
     the replacement of an existing facility.
       ``(2) Grant agreement required.--A grant under paragraph 
     (1) may only be made available to a Tribal Health Program 
     operating an Indian health facility (other than a facility 
     owned or constructed by the Service, including a facility 
     originally owned or constructed by the Service and 
     transferred to an Indian Tribe or Tribal Organization).
       ``(b) Use of Grant Funds.--
       ``(1) Allowable uses.--A grant awarded under this section 
     may be used for the construction, expansion, or modernization 
     (including the planning and design of such construction, 
     expansion, or modernization) of an ambulatory care facility--
       ``(A) located apart from a hospital;
       ``(B) not funded under section 301 or section 306; and
       ``(C) which, upon completion of such construction or 
     modernization will--
       ``(i) have a total capacity appropriate to its projected 
     service population;
       ``(ii) provide annually no fewer than 150 patient visits by 
     eligible Indians and other users who are eligible for 
     services in such facility in accordance with section 
     807(c)(2); and
       ``(iii) provide ambulatory care in a Service Area 
     (specified in the contract or compact under the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.)) with a population of no fewer than 1,500 eligible 
     Indians and other users who are eligible for services in such 
     facility in accordance with section 807(c)(2).
       ``(2) Additional allowable use.--The Secretary may also 
     reserve a portion of the funding provided under this section 
     and use those reserved funds to reduce an outstanding debt 
     incurred by Indian Tribes or Tribal Organizations for the 
     construction, expansion, or modernization of an ambulatory 
     care facility that meets the requirements under paragraph 
     (1). The provisions of this section shall apply, except that 
     such applications for funding under this paragraph shall be 
     considered separately from applications for funding under 
     paragraph (1).
       ``(3) Use only for certain portion of costs.--A grant 
     provided under this section may be used only for the cost of 
     that portion of a construction, expansion, or modernization 
     project that benefits the Service population identified above 
     in subsection (b)(1)(C) (ii) and (iii). The requirements of 
     clauses (ii) and (iii) of paragraph (1)(C) shall not apply to 
     an Indian Tribe or Tribal Organization applying for a grant 
     under this section for a health care facility located or to 
     be constructed on an island or when such facility is

[[Page 2748]]

     not located on a road system providing direct access to an 
     inpatient hospital where care is available to the Service 
     population.
       ``(c) Grants.--
       ``(1) Application.--No grant may be made under this section 
     unless an application or proposal for the grant has been 
     approved by the Secretary in accordance with applicable 
     regulations and has set forth reasonable assurance by the 
     applicant that, at all times after the construction, 
     expansion, or modernization of a facility carried out using a 
     grant 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 grants under this section, the 
     Secretary shall give priority to Indian Tribes and Tribal 
     Organizations that demonstrate--
       ``(A) a need for increased ambulatory care services; and
       ``(B) insufficient capacity to deliver such services.
       ``(3) Peer review panels.--The Secretary may provide for 
     the establishment of peer review panels, as necessary, to 
     review and evaluate applications and proposals and to advise 
     the Secretary regarding such applications using the criteria 
     developed pursuant to subsection (a)(1).
       ``(d) Reversion of Facilities.--If any facility (or portion 
     thereof) with respect to which funds have been paid under 
     this section, ceases, at any time after completion of the 
     construction, expansion, or modernization carried out with 
     such funds, to be used for the purposes of providing health 
     care services to eligible Indians, all of the right, title, 
     and interest in and to such facility (or portion thereof) 
     shall transfer to the United States unless otherwise 
     negotiated by the Service and the Indian Tribe or Tribal 
     Organization.
       ``(e) Funding Nonrecurring.--Funding provided under this 
     section shall be nonrecurring and shall not be available for 
     inclusion in any individual Indian Tribe's tribal share for 
     an award under the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450 et seq.) or for reallocation or 
     redesign thereunder.

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

       ``(a) In General.--The Secretary, acting through the 
     Service, is authorized to carry out, or to enter into 
     construction agreements under the Indian Self-Determination 
     and Education Assistance Act (25 U.S.C. 450 et seq.) with 
     Indian Tribes or Tribal Organizations to carry out, a health 
     care delivery demonstration project to test alternative means 
     of delivering health care and services to Indians through 
     facilities.
       ``(b) Use of Funds.--The Secretary, in approving projects 
     pursuant to this section, may authorize such construction 
     agreements 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) Health Care Demonstration Projects.--
       ``(1) General projects.--
       ``(A) Criteria.--The Secretary may approve under this 
     section demonstration projects that meet the following 
     criteria:
       ``(i) There is a need for a new facility or program, such 
     as a program for convenient care services, or the 
     reorientation of an existing facility or program.
       ``(ii) A significant number of Indians, including Indians 
     with low health status, will be served by the project.
       ``(iii) The project has the potential to deliver services 
     in an efficient and effective manner.
       ``(iv) The project is economically viable.
       ``(v) For projects carried out by an Indian Tribe or Tribal 
     Organization, the Indian Tribe or Tribal Organization has the 
     administrative and financial capability to administer the 
     project.
       ``(vi) The project is integrated with providers of related 
     health and social services and is coordinated with, and 
     avoids duplication of, existing services in order to expand 
     the availability of services.
       ``(B) Priority.--In approving demonstration projects under 
     this paragraph, the Secretary shall give priority to 
     demonstration projects, to the extent the projects meet the 
     criteria described in subparagraph (A), located in any of the 
     following Service Units:
       ``(i) Cass Lake, Minnesota.
       ``(ii) Mescalero, New Mexico.
       ``(iii) Owyhee, Nevada.
       ``(iv) Schurz, Nevada.
       ``(v) Ft. Yuma, California.
       ``(2) Convenient care service projects.--
       ``(A) Definition of convenient care service.--In this 
     paragraph, the term `convenient care service' means any 
     primary health care service, such as urgent care services, 
     nonemergent care services, prevention services and 
     screenings, and any service authorized by sections 203 or 
     213(d), that is--
       ``(i) provided outside the regular hours of operation of a 
     health care facility; or
       ``(ii) offered at an alternative setting, including through 
     telehealth.
       ``(B) Approval.--In addition to projects described in 
     paragraph (1), in any fiscal year, the Secretary is 
     authorized to approve not more than 10 applications for 
     health care delivery demonstration projects that--
       ``(i) include a convenient care services program as an 
     alternative means of delivering health care services to 
     Indians; and
       ``(ii) meet the criteria described in subparagraph (C).
       ``(C) Criteria.--The Secretary shall approve under 
     subparagraph (B) demonstration projects that meet all of the 
     following criteria:
       ``(i) The criteria set forth in paragraph (1)(A).
       ``(ii) There is a lack of access to health care services at 
     existing health care facilities, which may be due to limited 
     hours of operation at those facilities or other factors.
       ``(iii) The project--

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

       ``(aa) the burden on Contract Health Services; or
       ``(bb) the need for emergency room visits.
       ``(d) Peer Review Panels.--The Secretary may provide for 
     the establishment of peer review panels, as necessary, to 
     review and evaluate applications using the criteria described 
     in paragraphs (1)(A) and (2)(C) of subsection (c).
       ``(e) Technical Assistance.--The Secretary shall provide 
     such technical and other assistance as may be necessary to 
     enable applicants to comply with this section.
       ``(f) Service to Ineligible Persons.--Subject to section 
     807, the authority to provide services to persons otherwise 
     ineligible for the health care benefits of the Service, and 
     the authority to extend hospital privileges in Service 
     facilities to non-Service health practitioners as provided in 
     section 807, may be included, subject to the terms of that 
     section, in any demonstration project approved pursuant to 
     this section.
       ``(g) Equitable Treatment.--For purposes of subsection (c), 
     the Secretary, in evaluating facilities operated under any 
     contract or compact under the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 450 et seq.), shall use 
     the same criteria that the Secretary uses in evaluating 
     facilities operated directly by the Service.
       ``(h) Equitable Integration of Facilities.--The Secretary 
     shall ensure that the planning, design, construction, 
     renovation, and expansion needs of Service and non-Service 
     facilities that are the subject of a contract or compact 
     under the Indian Self-Determination and Education Assistance 
     Act (25 U.S.C. 450 et seq.) for health services are fully and 
     equitably integrated into the implementation of the health 
     care delivery demonstration projects under this section.

     ``SEC. 307. LAND TRANSFER.

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

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

       ``The Secretary, acting through the Service, may enter into 
     leases, contracts, and other agreements with Indian Tribes 
     and Tribal Organizations which hold (1) title to, (2) a 
     leasehold interest in, or (3) a beneficial interest in (when 
     title is held by the United States in trust for the benefit 
     of an Indian Tribe) facilities used or to be used for the 
     administration and delivery of health services by an Indian 
     Health Program. Such leases, contracts, or agreements may 
     include provisions for construction or renovation and provide 
     for compensation to the Indian Tribe or Tribal Organization 
     of rental and other costs consistent with section 105(l) of 
     the Indian Self-Determination and Education Assistance Act 
     (25 U.S.C. 450j(l)) and regulations thereunder.

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

       ``(a) In General.--The Secretary, in consultation with the 
     Secretary of the Treasury, Indian Tribes, and Tribal 
     Organizations, shall carry out a study to determine the 
     feasibility of establishing a loan fund to provide to Indian 
     Tribes and Tribal Organizations direct loans or guarantees 
     for loans for the construction of health care facilities, 
     including--
       ``(1) inpatient facilities;
       ``(2) outpatient facilities;
       ``(3) staff quarters; and
       ``(4) specialized care facilities, such as behavioral 
     health and elder care facilities.
       ``(b) Determinations.--In carrying out the study under 
     subsection (a), the Secretary shall determine--
       ``(1) the maximum principal amount of a loan or loan 
     guarantee that should be offered to a recipient from the loan 
     fund;

[[Page 2749]]

       ``(2) the percentage of eligible costs, not to exceed 100 
     percent, that may be covered by a loan or loan guarantee from 
     the loan fund (including costs relating to planning, design, 
     financing, site land development, construction, 
     rehabilitation, renovation, conversion, improvements, medical 
     equipment and furnishings, and other facility-related costs 
     and capital purchase (but excluding staffing));
       ``(3) the cumulative total of the principal of direct loans 
     and loan guarantees, respectively, that may be outstanding at 
     any 1 time;
       ``(4) the maximum term of a loan or loan guarantee that may 
     be made for a facility from the loan fund;
       ``(5) the maximum percentage of funds from the loan fund 
     that should be allocated for payment of costs associated with 
     planning and applying for a loan or loan guarantee;
       ``(6) whether acceptance by the Secretary of an assignment 
     of the revenue of an Indian Tribe or Tribal Organization as 
     security for any direct loan or loan guarantee from the loan 
     fund would be appropriate;
       ``(7) whether, in the planning and design of health 
     facilities under this section, users eligible under section 
     807(c) may be included in any projection of patient 
     population;
       ``(8) whether funds of the Service provided through loans 
     or loan guarantees from the loan fund should be eligible for 
     use in matching other Federal funds under other programs;
       ``(9) the appropriateness of, and best methods for, 
     coordinating the loan fund with the health care priority 
     system of the Service under section 301; and
       ``(10) any legislative or regulatory changes required to 
     implement recommendations of the Secretary based on results 
     of the study.
       ``(c) Report.--Not later than September 30, 2009, the 
     Secretary shall submit to the Committee on Indian Affairs of 
     the Senate and the Committee on Natural Resources and the 
     Committee on Energy and Commerce of the House of 
     Representatives a report that describes--
       ``(1) the manner of consultation made as required by 
     subsection (a); and
       ``(2) the results of the study, including any 
     recommendations of the Secretary based on results of the 
     study.

     ``SEC. 310. TRIBAL LEASING.

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

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

       ``(a) In General.--The Secretary, acting through the 
     Service, shall make arrangements with Indian Tribes and 
     Tribal Organizations to establish joint venture demonstration 
     projects under which an Indian Tribe or Tribal Organization 
     shall expend tribal, private, or other available funds, for 
     the acquisition or construction of a health facility for a 
     minimum of 10 years, under a no-cost lease, in exchange for 
     agreement by the Service to provide the equipment, supplies, 
     and staffing for the operation and maintenance of such a 
     health facility. An Indian Tribe or Tribal Organization may 
     use tribal funds, private sector, or other available 
     resources, including loan guarantees, to fulfill its 
     commitment under a joint venture entered into under this 
     subsection. An Indian Tribe or Tribal Organization shall be 
     eligible to establish a joint venture project if, when it 
     submits a letter of intent, it--
       ``(1) has begun but not completed the process of 
     acquisition or construction of a health facility to be used 
     in the joint venture project; or
       ``(2) has not begun the process of acquisition or 
     construction of a health facility for use in the joint 
     venture project.
       ``(b) Requirements.--The Secretary shall make such an 
     arrangement with an Indian Tribe or Tribal Organization only 
     if--
       ``(1) the Secretary first determines that the Indian Tribe 
     or Tribal Organization has the administrative and financial 
     capabilities necessary to complete the timely acquisition or 
     construction of the relevant health facility; and
       ``(2) the Indian Tribe or Tribal Organization meets the 
     need criteria determined using the criteria developed under 
     the health care facility priority system under section 301, 
     unless the Secretary determines, pursuant to regulations, 
     that other criteria will result in a more cost-effective and 
     efficient method of facilitating and completing construction 
     of health care facilities.
       ``(c) Continued Operation.--The Secretary shall negotiate 
     an agreement with the Indian Tribe or Tribal Organization 
     regarding the continued operation of the facility at the end 
     of the initial 10 year no-cost lease period.
       ``(d) Breach of Agreement.--An Indian Tribe or Tribal 
     Organization that has entered into a written agreement with 
     the Secretary under this section, and that breaches or 
     terminates without cause such agreement, shall be liable to 
     the United States for the amount that has been paid to the 
     Indian Tribe or Tribal Organization, or paid to a third party 
     on the Indian Tribe's or Tribal Organization's behalf, under 
     the agreement. The Secretary has the right to recover 
     tangible property (including supplies) and equipment, less 
     depreciation, and any funds expended for operations and 
     maintenance under this section. The preceding sentence does 
     not apply to any funds expended for the delivery of health 
     care services, personnel, or staffing.
       ``(e) Recovery for Nonuse.--An Indian Tribe or Tribal 
     Organization that has entered into a written agreement with 
     the Secretary under this subsection shall be entitled to 
     recover from the United States an amount that is proportional 
     to the value of such facility if, at any time within the 10-
     year term of the agreement, the Service ceases to use the 
     facility or otherwise breaches the agreement.
       ``(f) Definition.--For the purposes of this section, the 
     term `health facility' or `health facilities' includes 
     quarters needed to provide housing for staff of the relevant 
     Tribal Health Program.

     ``SEC. 312. LOCATION OF FACILITIES.

       ``(a) In General.--In all matters involving the 
     reorganization or development of Service facilities or in the 
     establishment of related employment projects to address 
     unemployment conditions in economically depressed areas, the 
     Bureau of Indian Affairs and the Service shall give priority 
     to locating such facilities and projects on Indian lands, or 
     lands in Alaska owned by any Alaska Native village, or 
     village or regional corporation under the Alaska Native 
     Claims Settlement Act (43 U.S.C. 1601 et seq.), or any land 
     allotted to any Alaska Native, 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. Top priority shall be given to Indian land 
     owned by 1 or more Indian Tribes.
       ``(b) Definition.--For purposes of this section, the term 
     `Indian lands' means--
       ``(1) all lands within the exterior boundaries of any 
     reservation; and
       ``(2) any lands title to which is held in trust by the 
     United States for the benefit of any Indian Tribe or 
     individual Indian or held by any Indian Tribe or individual 
     Indian subject to restriction by the United States against 
     alienation.

     ``SEC. 313. MAINTENANCE AND IMPROVEMENT OF HEALTH CARE 
                   FACILITIES.

       ``(a) Report.--The Secretary shall submit to the President, 
     for inclusion in the report required to be transmitted to 
     Congress under section 801, a report which identifies the 
     backlog of maintenance and repair work required at both 
     Service and tribal health care facilities, including new 
     health care facilities expected to be in operation in the 
     next fiscal year. The report shall also identify the need for 
     renovation and expansion of existing facilities to support 
     the growth of health care programs.
       ``(b) Maintenance of Newly Constructed Space.--The 
     Secretary, acting through the Service, is authorized to 
     expend maintenance and improvement funds to support 
     maintenance of newly constructed space only if such space 
     falls within the approved supportable space allocation for 
     the Indian Tribe or Tribal Organization. Supportable space 
     allocation shall be defined through the health care facility 
     priority system under section 301(c).
       ``(c) Replacement Facilities.--In addition to using 
     maintenance and improvement funds for renovation, 
     modernization, and expansion of facilities, an Indian Tribe 
     or Tribal Organization may use maintenance and improvement 
     funds for construction of a replacement facility if the costs 
     of renovation of such facility would exceed a maximum 
     renovation cost threshold. The maximum renovation cost 
     threshold shall be determined through the negotiated 
     rulemaking process provided for under section 802.

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

       ``(a) Rental Rates.--
       ``(1) Establishment.--Notwithstanding any other provision 
     of law, a Tribal Health Program which operates a hospital or 
     other health facility and the federally-owned quarters 
     associated therewith pursuant to a contract or compact under 
     the Indian Self-Determination and Education Assistance Act 
     (25 U.S.C. 450 et seq.) shall have the authority to establish 
     the rental rates charged to the occupants of such quarters by 
     providing notice to the Secretary of its election to exercise 
     such authority.
       ``(2) Objectives.--In establishing rental rates pursuant to 
     authority of this subsection, a Tribal Health Program shall 
     endeavor to achieve the following objectives:
       ``(A) To base such rental rates on the reasonable value of 
     the quarters to the occupants thereof.
       ``(B) To generate sufficient funds to prudently provide for 
     the operation and maintenance of the quarters, and subject to 
     the discretion of the Tribal Health Program, to supply 
     reserve funds for capital repairs and replacement of the 
     quarters.
       ``(3) Equitable funding.--Any quarters whose rental rates 
     are established by a Tribal Health Program pursuant to this 
     subsection shall remain eligible for quarters improvement and 
     repair funds to the same extent as all federally-owned 
     quarters used to house personnel in Services-supported 
     programs.
       ``(4) Notice of rate change.--A Tribal Health Program which 
     exercises the authority provided under this subsection shall 
     provide occupants with no less than 60 days notice of any 
     change in rental rates.

[[Page 2750]]

       ``(b) Direct Collection of Rent.--
       ``(1) In general.--Notwithstanding any other provision of 
     law, and subject to paragraph (2), a Tribal Health Program 
     shall have the authority to collect rents directly from 
     Federal employees who occupy such quarters in accordance with 
     the following:
       ``(A) The Tribal Health Program shall notify the Secretary 
     and the subject Federal employees of its election to exercise 
     its authority to collect rents directly from such Federal 
     employees.
       ``(B) Upon receipt of a notice described in subparagraph 
     (A), the Federal employees shall pay rents for occupancy of 
     such quarters directly to the Tribal Health Program and the 
     Secretary shall have no further authority to collect rents 
     from such employees through payroll deduction or otherwise.
       ``(C) Such rent payments shall be retained by the Tribal 
     Health Program and shall not be made payable to or otherwise 
     be deposited with the United States.
       ``(D) Such rent payments shall be deposited into a separate 
     account which shall be used by the Tribal Health Program for 
     the maintenance (including capital repairs and replacement) 
     and operation of the quarters and facilities as the Tribal 
     Health Program shall determine.
       ``(2) Retrocession of authority.--If a Tribal Health 
     Program which has made an election under paragraph (1) 
     requests retrocession of its authority to directly collect 
     rents from Federal employees occupying federally-owned 
     quarters, such retrocession shall become effective on the 
     earlier of--
       ``(A) the first day of the month that begins no less than 
     180 days after the Tribal Health Program notifies the 
     Secretary of its desire to retrocede; or
       ``(B) such other date as may be mutually agreed by the 
     Secretary and the Tribal Health Program.
       ``(c) Rates in Alaska.--To the extent that a Tribal Health 
     Program, pursuant to authority granted in subsection (a), 
     establishes rental rates for federally-owned quarters 
     provided to a Federal employee in Alaska, such rents may be 
     based on the cost of comparable private rental housing in the 
     nearest established community with a year-round population of 
     1,500 or more individuals.

     ``SEC. 315. APPLICABILITY OF BUY AMERICAN ACT REQUIREMENT.

       ``(a) Applicability.--The Secretary shall ensure that the 
     requirements of the Buy American Act apply to all 
     procurements made with funds provided pursuant to section 
     317. Indian Tribes and Tribal Organizations shall be exempt 
     from these requirements.
       ``(b) Effect of Violation.--If it has been finally 
     determined by a court or Federal agency that any person 
     intentionally affixed a label bearing a `Made in America' 
     inscription or any inscription with the same meaning, to any 
     product sold in or shipped to the United States that is not 
     made in the United States, such person shall be ineligible to 
     receive any contract or subcontract made with funds provided 
     pursuant to section 317, pursuant to the debarment, 
     suspension, and ineligibility procedures described in 
     sections 9.400 through 9.409 of title 48, Code of Federal 
     Regulations.
       ``(c) Definitions.--For purposes of this section, the term 
     `Buy American Act' means title III of the Act entitled `An 
     Act making appropriations for the Treasury and Post Office 
     Departments for the fiscal year ending June 30, 1934, and for 
     other purposes', approved March 3, 1933 (41 U.S.C. 10a et 
     seq.).

     ``SEC. 316. OTHER FUNDING FOR FACILITIES.

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

     ``SEC. 317. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2017 to 
     carry out this title.

                 ``TITLE IV--ACCESS TO HEALTH SERVICES

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

       ``(a) Disregard of Medicare, Medicaid, and SCHIP Payments 
     in Determining Appropriations.--Any payments received by an 
     Indian Health Program or by an Urban Indian Organization 
     under title XVIII, XIX, or XXI of the Social Security Act for 
     services provided to Indians eligible for benefits under such 
     respective titles shall not be considered in determining 
     appropriations for the provision of health care and services 
     to Indians.
       ``(b) Nonpreferential Treatment.--Nothing in this Act 
     authorizes the Secretary to provide services to an Indian 
     with coverage under title XVIII, XIX, or XXI of the Social 
     Security Act in preference to an Indian without such 
     coverage.
       ``(c) Use of Funds.--
       ``(1) Special fund.--
       ``(A) 100 percent pass-through of payments due to 
     facilities.--Notwithstanding any other provision of law, but 
     subject to paragraph (2), payments to which a facility of the 
     Service is entitled by reason of a provision of the Social 
     Security Act shall be placed in a special fund to be held by 
     the Secretary. In making payments from such fund, the 
     Secretary shall ensure that each Service Unit of the Service 
     receives 100 percent of the amount to which the facilities of 
     the Service, for which such Service Unit makes collections, 
     are entitled by reason of a provision of the Social Security 
     Act.
       ``(B) Use of funds.--Amounts received by a facility of the 
     Service under subparagraph (A) shall first be used (to such 
     extent or in such amounts as are provided in appropriation 
     Acts) for the purpose of making any improvements in the 
     programs of the Service operated by or through such facility 
     which may be necessary to achieve or maintain compliance with 
     the applicable conditions and requirements of titles XVIII 
     and XIX of the Social Security Act. Any amounts so received 
     that are in excess of the amount necessary to achieve or 
     maintain such conditions and requirements shall, subject to 
     consultation with the Indian Tribes being served by the 
     Service Unit, be used for reducing the health resource 
     deficiencies (as determined under section 201(d)) of such 
     Indian Tribes.
       ``(2) Direct payment option.--Paragraph (1) shall not apply 
     to a Tribal Health Program upon the election of such Program 
     under subsection (d) to receive payments directly. No payment 
     may be made out of the special fund described in such 
     paragraph with respect to reimbursement made for services 
     provided by such Program during the period of such election.
       ``(d) Direct Billing.--
       ``(1) In general.--Subject to complying with the 
     requirements of paragraph (2), a Tribal Health Program may 
     elect to directly bill for, and receive payment for, health 
     care items and services provided by such Program for which 
     payment is made under title XVIII or XIX of the Social 
     Security Act or from any other third party payor.
       ``(2) Direct reimbursement.--
       ``(A) Use of funds.--Each Tribal Health Program making the 
     election described in paragraph (1) with respect to a program 
     under a title of the Social Security Act shall be reimbursed 
     directly by that program for items and services furnished 
     without regard to subsection (c)(1), but all amounts so 
     reimbursed shall be used by the Tribal Health Program for the 
     purpose of making any improvements in facilities of the 
     Tribal Health Program that may be necessary to achieve or 
     maintain compliance with the conditions and requirements 
     applicable generally to such items and services under the 
     program under such title and to provide additional health 
     care services, improvements in health care facilities and 
     Tribal Health Programs, any health care related purpose, or 
     otherwise to achieve the objectives provided in section 3 of 
     this Act.
       ``(B) Audits.--The amounts paid to a Tribal Health Program 
     making the election described in paragraph (1) with respect 
     to a program under a title of the Social Security Act shall 
     be subject to all auditing requirements applicable to the 
     program under such title, as well as all auditing 
     requirements applicable to programs administered by an Indian 
     Health Program. Nothing in the preceding sentence shall be 
     construed as limiting the application of auditing 
     requirements applicable to amounts paid under title XVIII, 
     XIX, or XXI of the Social Security Act.
       ``(C) Identification of source of payments.--Any Tribal 
     Health Program that receives reimbursements or payments under 
     title XVIII, XIX, or XXI of the Social Security Act, shall 
     provide to the Service a list of each provider enrollment 
     number (or other identifier) under which such Program 
     receives such reimbursements or payments.
       ``(3) Examination and implementation of changes.--
       ``(A) In general.--The Secretary, acting through the 
     Service and with the assistance of the Administrator of the 
     Centers for Medicare & Medicaid Services, shall examine on an 
     ongoing basis and implement any administrative changes that 
     may be necessary to facilitate direct billing and 
     reimbursement under the program established under this 
     subsection, including any agreements with States that may be 
     necessary to provide for direct billing under a program under 
     a title of the Social Security Act.
       ``(B) Coordination of information.--The Service shall 
     provide the Administrator of

[[Page 2751]]

     the Centers for Medicare & Medicaid Services with copies of 
     the lists submitted to the Service under paragraph (2)(C), 
     enrollment data regarding patients served by the Service (and 
     by Tribal Health Programs, to the extent such data is 
     available to the Service), and such other information as the 
     Administrator may require for purposes of administering title 
     XVIII, XIX, or XXI of the Social Security Act.
       ``(4) Withdrawal from program.--A Tribal Health Program 
     that bills directly under the program established under this 
     subsection may withdraw from participation in the same manner 
     and under the same conditions that an Indian Tribe or Tribal 
     Organization may retrocede a contracted program to the 
     Secretary under the authority of the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.). All cost accounting and billing authority under the 
     program established under this subsection shall be returned 
     to the Secretary upon the Secretary's acceptance of the 
     withdrawal of participation in this program.
       ``(5) Termination for failure to comply with 
     requirements.--The Secretary may terminate the participation 
     of a Tribal Health Program or in the direct billing program 
     established under this subsection if the Secretary determines 
     that the Program has failed to comply with the requirements 
     of paragraph (2). The Secretary shall provide a Tribal Health 
     Program with notice of a determination that the Program has 
     failed to comply with any such requirement and a reasonable 
     opportunity to correct such noncompliance prior to 
     terminating the Program's participation in the direct billing 
     program established under this subsection.
       ``(e) Related Provisions Under the Social Security Act.--
     For provisions related to subsections (c) and (d), see 
     sections 1880, 1911, and 2107(e)(1)(D) of the Social Security 
     Act.

     ``SEC. 402. GRANTS TO AND CONTRACTS WITH THE SERVICE, INDIAN 
                   TRIBES, TRIBAL ORGANIZATIONS, AND URBAN INDIAN 
                   ORGANIZATIONS TO FACILITATE OUTREACH, 
                   ENROLLMENT, AND COVERAGE OF INDIANS UNDER 
                   SOCIAL SECURITY ACT HEALTH BENEFIT PROGRAMS AND 
                   OTHER HEALTH BENEFITS PROGRAMS.

       ``(a) Indian Tribes and Tribal Organizations.--From funds 
     appropriated to carry out this title in accordance with 
     section 417, the Secretary, acting through the Service, shall 
     make grants to or enter into contracts with Indian Tribes and 
     Tribal Organizations to assist such Tribes and Tribal 
     Organizations in establishing and administering programs on 
     or near reservations and trust lands, including programs to 
     provide outreach and enrollment through video, electronic 
     delivery methods, or telecommunication devices that allow 
     real-time or time-delayed communication between individual 
     Indians and the benefit program, to assist individual 
     Indians--
       ``(1) to enroll for benefits under a program established 
     under title XVIII, XIX, or XXI of the Social Security Act and 
     other health benefits programs; and
       ``(2) with respect to such programs for which the charging 
     of premiums and cost sharing is not prohibited under such 
     programs, to pay premiums or cost sharing for coverage for 
     such benefits, which may be based on financial need (as 
     determined by the Indian Tribe or Tribes or Tribal 
     Organizations being served based on a schedule of income 
     levels developed or implemented by such Tribe, Tribes, or 
     Tribal Organizations).
       ``(b) Conditions.--The Secretary, acting through the 
     Service, shall place conditions as deemed necessary to effect 
     the purpose of this section in any grant or contract which 
     the Secretary makes with any Indian Tribe or Tribal 
     Organization pursuant to this section. Such conditions shall 
     include requirements that the Indian Tribe or Tribal 
     Organization successfully undertake--
       ``(1) to determine the population of Indians eligible for 
     the benefits described in subsection (a);
       ``(2) to educate Indians with respect to the benefits 
     available under the respective programs;
       ``(3) to provide transportation for such individual Indians 
     to the appropriate offices for enrollment or applications for 
     such benefits; and
       ``(4) to develop and implement methods of improving the 
     participation of Indians in receiving benefits under such 
     programs.
       ``(c) Application to Urban Indian Organizations.--
       ``(1) In general.--The provisions of subsection (a) shall 
     apply with respect to grants and other funding to Urban 
     Indian Organizations with respect to populations served by 
     such organizations in the same manner they apply to grants 
     and contracts with Indian Tribes and Tribal Organizations 
     with respect to programs on or near reservations.
       ``(2) Requirements.--The Secretary shall include in the 
     grants or contracts made or provided under paragraph (1) 
     requirements that are--
       ``(A) consistent with the requirements imposed by the 
     Secretary under subsection (b);
       ``(B) appropriate to Urban Indian Organizations and Urban 
     Indians; and
       ``(C) necessary to effect the purposes of this section.
       ``(d) Facilitating Cooperation.--The Secretary, acting 
     through the Centers for Medicare & Medicaid Services, shall 
     develop and disseminate best practices that will serve to 
     facilitate cooperation with, and agreements between, States 
     and the Service, Indian Tribes, Tribal Organizations, or 
     Urban Indian Organizations with respect to the provision of 
     health care items and services to Indians under the programs 
     established under title XVIII, XIX, or XXI of the Social 
     Security Act.
       ``(e) Agreements Relating to Improving Enrollment of 
     Indians Under Social Security Act Health Benefits Programs.--
     For provisions relating to agreements between the Secretary, 
     acting through the Service, and Indian Tribes, Tribal 
     Organizations, and Urban Indian Organizations for the 
     collection, preparation, and submission of applications by 
     Indians for assistance under the Medicaid and State 
     children's health insurance programs established under titles 
     XIX and XXI of the Social Security Act, and benefits under 
     the Medicare program established under title XVIII of such 
     Act, see subsections (a) and (b) of section 1139 of the 
     Social Security Act.
       ``(f) Definition of Premiums and Cost Sharing.--In this 
     section:
       ``(1) Premium.--The term `premium' includes any enrollment 
     fee or similar charge.
       ``(2) Cost sharing.--The term `cost sharing' includes any 
     deduction, deductible, copayment, coinsurance, or similar 
     charge.

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

       ``(a) Right of Recovery.--Except as provided in subsection 
     (f), the United States, an Indian Tribe, or Tribal 
     Organization shall have the right to recover from an 
     insurance company, health maintenance organization, employee 
     benefit plan, third-party tortfeasor, or any other 
     responsible or liable third party (including a political 
     subdivision or local governmental entity of a State) the 
     reasonable charges billed by the Secretary, an Indian Tribe, 
     or Tribal Organization in providing health services through 
     the Service, an Indian Tribe, or Tribal Organization to any 
     individual to the same extent that such individual, or any 
     nongovernmental provider of such services, would be eligible 
     to receive damages, reimbursement, or indemnification for 
     such charges or expenses if--
       ``(1) such services had been provided by a nongovernmental 
     provider; and
       ``(2) such individual had been required to pay such charges 
     or expenses and did pay such charges or expenses.
       ``(b) Limitations on Recoveries From States.--Subsection 
     (a) shall provide a right of recovery against any State, only 
     if the injury, illness, or disability for which health 
     services were provided is covered under--
       ``(1) workers' compensation laws; or
       ``(2) a no-fault automobile accident insurance plan or 
     program.
       ``(c) Nonapplication of Other Laws.--No law of any State, 
     or of any political subdivision of a State and no provision 
     of any contract, insurance or health maintenance organization 
     policy, employee benefit plan, self-insurance plan, managed 
     care plan, or other health care plan or program entered into 
     or renewed after the date of the enactment of the Indian 
     Health Care Amendments of 1988, shall prevent or hinder the 
     right of recovery of the United States, an Indian Tribe, or 
     Tribal Organization under subsection (a).
       ``(d) No Effect on Private Rights of Action.--No action 
     taken by the United States, an Indian Tribe, or Tribal 
     Organization to enforce the right of recovery provided under 
     this section shall operate to deny to the injured person the 
     recovery for that portion of the person's damage not covered 
     hereunder.
       ``(e) Enforcement.--
       ``(1) In general.--The United States, an Indian Tribe, or 
     Tribal Organization may enforce the right of recovery 
     provided under subsection (a) by--
       ``(A) intervening or joining in any civil action or 
     proceeding brought--
       ``(i) by the individual for whom health services were 
     provided by the Secretary, an Indian Tribe, or Tribal 
     Organization; or
       ``(ii) by any representative or heirs of such individual, 
     or
       ``(B) instituting a civil action, including a civil action 
     for injunctive relief and other relief and including, with 
     respect to a political subdivision or local governmental 
     entity of a State, such an action against an official 
     thereof.
       ``(2) Notice.--All reasonable efforts shall be made to 
     provide notice of action instituted under paragraph (1)(B) to 
     the individual to whom health services were provided, either 
     before or during the pendency of such action.
       ``(3) Recovery from tortfeasors.--
       ``(A) In general.--In any case in which an Indian Tribe or 
     Tribal Organization that is authorized or required under a 
     compact or contract issued pursuant to the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.) to furnish or pay for health services to a person who 
     is injured or suffers a disease on or after the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2008 under circumstances that establish grounds 
     for a claim of liability against the tortfeasor with respect 
     to the injury or disease, the Indian Tribe or Tribal 
     Organization shall have a

[[Page 2752]]

     right to recover from the tortfeasor (or an insurer of the 
     tortfeasor) the reasonable value of the health services so 
     furnished, paid for, or to be paid for, in accordance with 
     the Federal Medical Care Recovery Act (42 U.S.C. 2651 et 
     seq.), to the same extent and under the same circumstances as 
     the United States may recover under that Act.
       ``(B) Treatment.--The right of an Indian Tribe or Tribal 
     Organization to recover under subparagraph (A) shall be 
     independent of the rights of the injured or diseased person 
     served by the Indian Tribe or Tribal Organization.
       ``(f) Limitation.--Absent specific written authorization by 
     the governing body of an Indian Tribe for the period of such 
     authorization (which may not be for a period of more than 1 
     year and which may be revoked at any time upon written notice 
     by the governing body to the Service), the United States 
     shall not have a right of recovery under this section if the 
     injury, illness, or disability for which health services were 
     provided is covered under a self-insurance plan funded by an 
     Indian Tribe, Tribal Organization, or Urban Indian 
     Organization. Where such authorization is provided, the 
     Service may receive and expend such amounts for the provision 
     of additional health services consistent with such 
     authorization.
       ``(g) Costs and Attorneys' Fees.--In any action brought to 
     enforce the provisions of this section, a prevailing 
     plaintiff shall be awarded its reasonable attorneys' fees and 
     costs of litigation.
       ``(h) Nonapplication of Claims Filing Requirements.--An 
     insurance company, health maintenance organization, self-
     insurance plan, managed care plan, or other health care plan 
     or program (under the Social Security Act or otherwise) may 
     not deny a claim for benefits submitted by the Service or by 
     an Indian Tribe or Tribal Organization based on the format in 
     which the claim is submitted if such format complies with the 
     format required for submission of claims under title XVIII of 
     the Social Security Act or recognized under section 1175 of 
     such Act.
       ``(i) Application to Urban Indian Organizations.--The 
     previous provisions of this section shall apply to Urban 
     Indian Organizations with respect to populations served by 
     such Organizations in the same manner they apply to Indian 
     Tribes and Tribal Organizations with respect to populations 
     served by such Indian Tribes and Tribal Organizations.
       ``(j) Statute of Limitations.--The provisions of section 
     2415 of title 28, United States Code, shall apply to all 
     actions commenced under this section, and the references 
     therein to the United States are deemed to include Indian 
     Tribes, Tribal Organizations, and Urban Indian Organizations.
       ``(k) Savings.--Nothing in this section shall be construed 
     to limit any right of recovery available to the United 
     States, an Indian Tribe, or Tribal Organization under the 
     provisions of any applicable, Federal, State, or Tribal law, 
     including medical lien laws.

     ``SEC. 404. CREDITING OF REIMBURSEMENTS.

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

     ``SEC. 405. PURCHASING HEALTH CARE COVERAGE.

       ``(a) In General.--Insofar as amounts are made available 
     under law (including a provision of the Social Security Act, 
     the Indian Self-Determination and Education Assistance Act 
     (25 U.S.C. 450 et seq.), or other law, other than under 
     section 402) to Indian Tribes, Tribal Organizations, and 
     Urban Indian Organizations for health benefits for Service 
     beneficiaries, Indian Tribes, Tribal Organizations, and Urban 
     Indian Organizations may use such amounts to purchase health 
     benefits coverage for such beneficiaries in any manner, 
     including through--
       ``(1) a tribally owned and operated health care plan;
       ``(2) a State or locally authorized or licensed health care 
     plan;
       ``(3) a health insurance provider or managed care 
     organization;
       ``(4) a self-insured plan; or
       ``(5) a high deductible or health savings account plan.

     The purchase of such coverage by an Indian Tribe, Tribal 
     Organization, or Urban Indian Organization may be based on 
     the financial needs of such beneficiaries (as determined by 
     the Indian Tribe or Tribes being served based on a schedule 
     of income levels developed or implemented by such Indian 
     Tribe or Tribes).
       ``(b) Expenses for Self-Insured Plan.--In the case of a 
     self-insured plan under subsection (a)(4), the amounts may be 
     used for expenses of operating the plan, including 
     administration and insurance to limit the financial risks to 
     the entity offering the plan.
       ``(c) Construction.--Nothing in this section shall be 
     construed as affecting the use of any amounts not referred to 
     in subsection (a).

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

       ``(a) Authority.--
       ``(1) In general.--The Secretary may enter into (or expand) 
     arrangements for the sharing of medical facilities and 
     services between the Service, Indian Tribes, and Tribal 
     Organizations and the Department of Veterans Affairs and the 
     Department of Defense.
       ``(2) Consultation by secretary required.--The Secretary 
     may not finalize any arrangement between the Service and a 
     Department described in paragraph (1) without first 
     consulting with the Indian Tribes which will be significantly 
     affected by the arrangement.
       ``(b) Limitations.--The Secretary shall not take any action 
     under this section or under subchapter IV of chapter 81 of 
     title 38, United States Code, which would impair--
       ``(1) the priority access of any Indian to health care 
     services provided through the Service and the eligibility of 
     any Indian to receive health services through the Service;
       ``(2) the quality of health care services provided to any 
     Indian through the Service;
       ``(3) the priority access of any veteran to health care 
     services provided by the Department of Veterans Affairs;
       ``(4) the quality of health care services provided by the 
     Department of Veterans Affairs or the Department of Defense; 
     or
       ``(5) the eligibility of any Indian who is a veteran to 
     receive health services through the Department of Veterans 
     Affairs.
       ``(c) Reimbursement.--The Service, Indian Tribe, or Tribal 
     Organization shall be reimbursed by the Department of 
     Veterans Affairs or the Department of Defense (as the case 
     may be) where services are provided through the Service, an 
     Indian Tribe, or a Tribal Organization to beneficiaries 
     eligible for services from either such Department, 
     notwithstanding any other provision of law.
       ``(d) Construction.--Nothing in this section may be 
     construed as creating any right of a non-Indian veteran to 
     obtain health services from the Service.

     ``SEC. 407. ELIGIBLE INDIAN VETERAN SERVICES.

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

[[Page 2753]]

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

     ``SEC. 408. PAYOR OF LAST RESORT.

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

     ``SEC. 409. NONDISCRIMINATION UNDER FEDERAL HEALTH CARE 
                   PROGRAMS IN QUALIFICATIONS FOR REIMBURSEMENT 
                   FOR SERVICES.

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

     ``SEC. 410. CONSULTATION.

       ``For provisions related to consultation with 
     representatives of Indian Health Programs and Urban Indian 
     Organizations with respect to the health care programs 
     established under titles XVIII, XIX, and XXI of the Social 
     Security Act, see section 1139(d) of the Social Security Act 
     (42 U.S.C. 1320b-9(d)).

     ``SEC. 411. STATE CHILDREN'S HEALTH INSURANCE PROGRAM 
                   (SCHIP).

       ``For provisions relating to--
       ``(1) outreach to families of Indian children likely to be 
     eligible for child health assistance under the State 
     children's health insurance program established under title 
     XXI of the Social Security Act, see sections 2105(c)(2)(C) 
     and 1139(a) of such Act (42 U.S.C. 1397ee(c)(2), 1320b-9); 
     and
       ``(2) ensuring that child health assistance is provided 
     under such program to targeted low-income children who are 
     Indians and that payments are made under such program to 
     Indian Health Programs and Urban Indian Organizations 
     operating in the State that provide such assistance, see 
     sections 2102(b)(3)(D) and 2105(c)(6)(B) of such Act (42 
     U.S.C. 1397bb(b)(3)(D), 1397ee(c)(6)(B)).

     ``SEC. 412. EXCLUSION WAIVER AUTHORITY FOR AFFECTED INDIAN 
                   HEALTH PROGRAMS AND SAFE HARBOR TRANSACTIONS 
                   UNDER THE SOCIAL SECURITY ACT.

       ``For provisions relating to--
       ``(1) exclusion waiver authority for affected Indian Health 
     Programs under the Social Security Act, see section 1128(k) 
     of the Social Security Act (42 U.S.C. 1320a-7(k)); and
       ``(2) certain transactions involving Indian Health Programs 
     deemed to be in safe harbors under that Act, see section 
     1128B(b)(4) of the Social Security Act (42 U.S.C. 1320a-
     7b(b)(4)).

     ``SEC. 413. PREMIUM AND COST SHARING PROTECTIONS AND 
                   ELIGIBILITY DETERMINATIONS UNDER MEDICAID AND 
                   SCHIP AND PROTECTION OF CERTAIN INDIAN PROPERTY 
                   FROM MEDICAID ESTATE RECOVERY.

       ``For provisions relating to--
       ``(1) premiums or cost sharing protections for Indians 
     furnished items or services directly by Indian Health 
     Programs or through referral under the contract health 
     service under the Medicaid program established under title 
     XIX of the Social Security Act, see sections 1916(j) and 
     1916A(a)(1) of the Social Security Act (42 U.S.C. 1396o(j), 
     1396o-1(a)(1));
       ``(2) rules regarding the treatment of certain property for 
     purposes of determining eligibility under such programs, see 
     sections 1902(e)(13) and 2107(e)(1)(B) of such Act (42 U.S.C. 
     1396a(e)(13), 1397gg(e)(1)(B)); and
       ``(3) the protection of certain property from estate 
     recovery provisions under the Medicaid program, see section 
     1917(b)(3)(B) of such Act (42 U.S.C. 1396p(b)(3)(B)).

     ``SEC. 414. TREATMENT UNDER MEDICAID AND SCHIP MANAGED CARE.

       ``For provisions relating to the treatment of Indians 
     enrolled in a managed care entity under the Medicaid program 
     under title XIX of the Social Security Act and Indian Health 
     Programs and Urban Indian Organizations that are providers of 
     items or services to such Indian enrollees, see sections 
     1932(h) and 2107(e)(1)(H) of the Social Security Act (42 
     U.S.C. 1396u-2(h), 1397gg(e)(1)(H)).

     ``SEC. 415. NAVAJO NATION MEDICAID AGENCY FEASIBILITY STUDY.

       ``(a) Study.--The Secretary shall conduct a study to 
     determine the feasibility of treating the Navajo Nation as a 
     State for the purposes of title XIX of the Social Security 
     Act, to provide services to Indians living within the 
     boundaries of the Navajo Nation through an entity established 
     having the same authority and performing the same functions 
     as single-State medicaid agencies responsible for the 
     administration of the State plan under title XIX of the 
     Social Security Act.
       ``(b) Considerations.--In conducting the study, the 
     Secretary shall consider the feasibility of--
       ``(1) assigning and paying all expenditures for the 
     provision of services and related administration funds, under 
     title XIX of the Social Security Act, to Indians living 
     within the boundaries of the Navajo Nation that are currently 
     paid to or would otherwise be paid to the State of Arizona, 
     New Mexico, or Utah;
       ``(2) providing assistance to the Navajo Nation in the 
     development and implementation of such entity for the 
     administration, eligibility, payment, and delivery of medical 
     assistance under title XIX of the Social Security Act;
       ``(3) providing an appropriate level of matching funds for 
     Federal medical assistance with respect to amounts such 
     entity expends for medical assistance for services and 
     related administrative costs; and
       ``(4) authorizing the Secretary, at the option of the 
     Navajo Nation, to treat the Navajo Nation as a State for the 
     purposes of title XIX of the Social Security Act (relating to 
     the State children's health insurance program) under terms 
     equivalent to those described in paragraphs (2) through (4).
       ``(c) Report.--Not later then 3 years after the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2008, the Secretary shall submit to the 
     Committee on Indian Affairs and Committee on Finance of the 
     Senate and the Committee on Natural Resources and Committee 
     on Energy and Commerce of the House of Representatives a 
     report that includes--
       ``(1) the results of the study under this section;
       ``(2) a summary of any consultation that occurred between 
     the Secretary and the Navajo Nation, other Indian Tribes, the 
     States of Arizona, New Mexico, and Utah, counties which 
     include Navajo Lands, and other interested parties, in 
     conducting this study;
       ``(3) projected costs or savings associated with 
     establishment of such entity, and any

[[Page 2754]]

     estimated impact on services provided as described in this 
     section in relation to probable costs or savings; and
       ``(4) legislative actions that would be required to 
     authorize the establishment of such entity if such entity is 
     determined by the Secretary to be feasible.

     ``SEC. 416. GENERAL EXCEPTIONS.

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

     ``SEC. 417. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2017 to 
     carry out this title.

              ``TITLE V--HEALTH SERVICES FOR URBAN INDIANS

     ``SEC. 501. PURPOSE.

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

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

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

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

       ``(a) Requirements for Grants and Contracts.--Under 
     authority of the Act of November 2, 1921 (25 U.S.C. 13) 
     (commonly known as the `Snyder Act'), the Secretary, acting 
     through the Service, shall enter into contracts with, and 
     make grants to, Urban Indian Organizations for the provision 
     of health care and referral services for Urban Indians. Any 
     such contract or grant shall include requirements that the 
     Urban Indian Organization successfully undertake to--
       ``(1) estimate the population of Urban Indians residing in 
     the Urban Center or centers that the organization proposes to 
     serve who are or could be recipients of health care or 
     referral services;
       ``(2) estimate the current health status of Urban Indians 
     residing in such Urban Center or centers;
       ``(3) estimate the current health care needs of Urban 
     Indians residing in such Urban Center or centers;
       ``(4) provide basic health education, including health 
     promotion and disease prevention education, to Urban Indians;
       ``(5) make recommendations to the Secretary and Federal, 
     State, local, and other resource agencies on methods of 
     improving health service programs to meet the needs of Urban 
     Indians; and
       ``(6) where necessary, provide, or enter into contracts for 
     the provision of, health care services for Urban Indians.
       ``(b) Criteria.--The Secretary, acting through the Service, 
     shall, by regulation, 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, or under any current public health service 
     project funded in a manner other than pursuant to this title;
       ``(4) the capability of an Urban Indian Organization to 
     perform the activities set forth in subsection (a) and to 
     enter into a contract with the Secretary or to meet the 
     requirements for receiving a grant under this section;
       ``(5) the satisfactory performance and successful 
     completion by an Urban Indian Organization of other contracts 
     with the Secretary under this title;
       ``(6) the appropriateness and likely effectiveness of 
     conducting the activities set forth in subsection (a) in an 
     Urban Center or centers; and
       ``(7) the extent of existing or likely future participation 
     in the activities set forth in subsection (a) by appropriate 
     health and health-related Federal, State, local, and other 
     agencies.
       ``(c) Access to Health Promotion and Disease Prevention 
     Programs.--The Secretary, acting through the Service, shall 
     facilitate access to or provide health promotion and disease 
     prevention services for Urban Indians through grants made to 
     Urban Indian Organizations administering contracts entered 
     into or receiving grants under subsection (a).
       ``(d) Immunization Services.--
       ``(1) Access or services provided.--The Secretary, acting 
     through the Service, shall facilitate access to, or provide, 
     immunization services for Urban Indians through grants made 
     to Urban Indian Organizations administering contracts entered 
     into or receiving grants under this section.
       ``(2) Definition.--For purposes of this subsection, the 
     term `immunization services' means services to provide 
     without charge immunizations against vaccine-preventable 
     diseases.
       ``(e) Behavioral Health Services.--
       ``(1) Access or services provided.--The Secretary, acting 
     through the Service, shall facilitate access to, or provide, 
     behavioral health services for Urban Indians through grants 
     made to Urban Indian Organizations administering contracts 
     entered into or receiving grants under subsection (a).
       ``(2) Assessment required.--Except as provided by paragraph 
     (3)(A), a grant may not be made under this subsection to an 
     Urban Indian Organization until that organization has 
     prepared, and the Service has approved, an assessment of the 
     following:
       ``(A) The behavioral health needs of the Urban Indian 
     population concerned.
       ``(B) The behavioral health services and other related 
     resources available to that population.
       ``(C) The barriers to obtaining those services and 
     resources.
       ``(D) The needs that are unmet by such services and 
     resources.
       ``(3) Purposes of grants.--Grants may be made under this 
     subsection for the following:
       ``(A) To prepare assessments required under paragraph (2).
       ``(B) To provide outreach, educational, and referral 
     services to Urban Indians regarding the availability of 
     direct behavioral health services, to educate Urban Indians 
     about behavioral health issues and services, and effect 
     coordination with existing behavioral health providers in 
     order to improve services to Urban Indians.
       ``(C) To provide outpatient behavioral health services to 
     Urban Indians, including the identification and assessment of 
     illness, therapeutic treatments, case management, support 
     groups, family treatment, and other treatment.
       ``(D) To develop innovative behavioral health service 
     delivery models which incorporate Indian cultural support 
     systems and resources.
       ``(f) Prevention of Child Abuse.--
       ``(1) Access or services provided.--The Secretary, acting 
     through the Service, shall facilitate access to or provide 
     services for Urban Indians through grants to Urban Indian 
     Organizations administering contracts entered into or 
     receiving grants under subsection (a) to prevent and treat 
     child abuse (including sexual abuse) among Urban Indians.
       ``(2) Evaluation required.--Except as provided by paragraph 
     (3)(A), a grant may not be made under this subsection to an 
     Urban Indian Organization until that organization has 
     prepared, and the Service has approved, an assessment that 
     documents the prevalence of child abuse in the Urban Indian 
     population concerned and specifies the services and programs 
     (which may not duplicate existing services and programs) for 
     which the grant is requested.
       ``(3) Purposes of grants.--Grants may be made under this 
     subsection for the following:
       ``(A) To prepare assessments required under paragraph (2).
       ``(B) For the development of prevention, training, and 
     education programs for Urban Indians, including child 
     education, parent education, provider training on 
     identification and intervention, education on reporting 
     requirements, prevention campaigns, and establishing service 
     networks of all those involved in Indian child protection.
       ``(C) To provide direct outpatient treatment services 
     (including individual treatment, family treatment, group 
     therapy, and support groups) to Urban Indians who are child 
     victims of abuse (including sexual abuse) or adult survivors 
     of child sexual abuse, to the families of such child victims, 
     and to Urban Indian perpetrators of child abuse (including 
     sexual abuse).
       ``(4) Considerations when making grants.--In making grants 
     to carry out this subsection, the Secretary shall take into 
     consideration--
       ``(A) the support for the Urban Indian Organization 
     demonstrated by the child protection authorities in the area, 
     including committees or other services funded under the 
     Indian Child Welfare Act of 1978 (25 U.S.C. 1901 et seq.), if 
     any;
       ``(B) the capability and expertise demonstrated by the 
     Urban Indian Organization to address the complex problem of 
     child sexual abuse in the community; and
       ``(C) the assessment required under paragraph (2).
       ``(g) Other Grants.--The Secretary, acting through the 
     Service, may enter into a contract with or make grants to an 
     Urban Indian Organization that provides or arranges for the 
     provision of health care services (through satellite 
     facilities, provider networks, or otherwise) to Urban Indians 
     in more than 1 Urban Center.

[[Page 2755]]



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

       ``(a) Grants and Contracts Authorized.--Under authority of 
     the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as 
     the `Snyder Act'), the Secretary, acting through the Service, 
     may enter into contracts with or make grants to Urban Indian 
     Organizations situated in Urban Centers for which contracts 
     have not been entered into or grants have not been made under 
     section 503.
       ``(b) Purpose.--The purpose of a contract or grant made 
     under this section shall be the determination of the matters 
     described in subsection (c)(1) in order to assist the 
     Secretary in assessing the health status and health care 
     needs of Urban Indians in the Urban Center involved and 
     determining whether the Secretary should enter into a 
     contract or make a grant under section 503 with respect to 
     the Urban Indian Organization which the Secretary has entered 
     into a contract with, or made a grant to, under this section.
       ``(c) Grant and Contract Requirements.--Any contract 
     entered into, or grant made, by the Secretary under this 
     section shall include requirements that--
       ``(1) the Urban Indian Organization successfully undertakes 
     to--
       ``(A) document the health care status and unmet health care 
     needs of Urban Indians in the Urban Center involved; and
       ``(B) with respect to Urban Indians in the Urban Center 
     involved, determine the matters described in paragraphs (2), 
     (3), (4), and (7) of section 503(b); and
       ``(2) the Urban Indian Organization complete performance of 
     the contract, or carry out the requirements of the grant, 
     within 1 year after the date on which the Secretary and such 
     organization enter into such contract, or within 1 year after 
     such organization receives such grant, whichever is 
     applicable.
       ``(d) No Renewals.--The Secretary may not renew any 
     contract entered into or grant made under this section.

     ``SEC. 505. EVALUATIONS; RENEWALS.

       ``(a) Procedures for Evaluations.--The Secretary, acting 
     through the Service, shall develop procedures to evaluate 
     compliance with grant requirements and compliance with and 
     performance of contracts entered into by Urban Indian 
     Organizations under this title. Such procedures shall include 
     provisions for carrying out the requirements of this section.
       ``(b) Evaluations.--The Secretary, acting through the 
     Service, shall evaluate the compliance of each Urban Indian 
     Organization which has entered into a contract or received a 
     grant under section 503 with the terms of such contract or 
     grant. For purposes of this evaluation, the Secretary shall--
       ``(1) acting through the Service, conduct an annual onsite 
     evaluation of the organization; or
       ``(2) accept in lieu of such onsite evaluation evidence of 
     the organization's provisional or full accreditation by a 
     private independent entity recognized by the Secretary for 
     purposes of conducting quality reviews of providers 
     participating in the Medicare program under title XVIII of 
     the Social Security Act.
       ``(c) Noncompliance; Unsatisfactory Performance.--If, as a 
     result of the evaluations conducted under this section, the 
     Secretary determines that an Urban Indian Organization has 
     not complied with the requirements of a grant or complied 
     with or satisfactorily performed a contract under section 
     503, the Secretary shall, prior to renewing such contract or 
     grant, attempt to resolve with the organization the areas of 
     noncompliance or unsatisfactory performance and modify the 
     contract or grant to prevent future occurrences of 
     noncompliance or unsatisfactory performance. If the Secretary 
     determines that the noncompliance or unsatisfactory 
     performance cannot be resolved and prevented in the future, 
     the Secretary shall not renew the contract or grant with the 
     organization and is authorized to enter into a contract or 
     make a grant under section 503 with another Urban Indian 
     Organization which is situated in the same Urban Center as 
     the Urban Indian Organization whose contract or grant is not 
     renewed under this section.
       ``(d) Considerations for Renewals.--In determining whether 
     to renew a contract or grant with an Urban Indian 
     Organization under section 503 which has completed 
     performance of a contract or grant under section 504, the 
     Secretary shall review the records of the Urban Indian 
     Organization, the reports submitted under section 507, and 
     shall consider the results of the onsite evaluations or 
     accreditations under subsection (b).

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

       ``(a) Procurement.--Contracts with Urban Indian 
     Organizations entered into pursuant to this title shall be in 
     accordance with all Federal contracting laws and regulations 
     relating to procurement except that in the discretion of the 
     Secretary, such contracts may be negotiated without 
     advertising and need not conform to the provisions of 
     sections 1304 and 3131 through 3133 of title 40, United 
     States Code.
       ``(b) Payments Under Contracts or Grants.--
       ``(1) In general.--Payments under any contracts or grants 
     pursuant to this title, notwithstanding any term or condition 
     of such contract or grant--
       ``(A) may be made in a single advance payment by the 
     Secretary to the Urban Indian Organization by no later than 
     the end of the first 30 days of the funding period with 
     respect to which the payments apply, unless the Secretary 
     determines through an evaluation under section 505 that the 
     organization is not capable of administering such a single 
     advance payment; and
       ``(B) if any portion thereof is unexpended by the Urban 
     Indian Organization during the funding period with respect to 
     which the payments initially apply, shall be carried forward 
     for expenditure with respect to allowable or reimbursable 
     costs incurred by the organization during 1 or more 
     subsequent funding periods without additional justification 
     or documentation by the organization as a condition of 
     carrying forward the availability for expenditure of such 
     funds.
       ``(2) Semiannual and quarterly payments and 
     reimbursements.--If the Secretary determines under paragraph 
     (1)(A) that an Urban Indian Organization is not capable of 
     administering an entire single advance payment, on request of 
     the Urban Indian Organization, the payments may be made--
       ``(A) in semiannual or quarterly payments by not later than 
     30 days after the date on which the funding period with 
     respect to which the payments apply begins; or
       ``(B) by way of reimbursement.
       ``(c) Revision or Amendment of Contracts.--Notwithstanding 
     any provision of law to the contrary, the Secretary may, at 
     the request and consent of an Urban Indian Organization, 
     revise or amend any contract entered into by the Secretary 
     with such organization under this title as necessary to carry 
     out the purposes of this title.
       ``(d) Fair and Uniform Services and Assistance.--Contracts 
     with or grants to Urban Indian Organizations and regulations 
     adopted pursuant to this title shall include provisions to 
     assure the fair and uniform provision to Urban Indians of 
     services and assistance under such contracts or grants by 
     such organizations.

     ``SEC. 507. REPORTS AND RECORDS.

       ``(a) Reports.--
       ``(1) In general.--For each fiscal year during which an 
     Urban Indian Organization receives or expends funds pursuant 
     to a contract entered into or a grant received pursuant to 
     this title, such Urban Indian Organization shall submit to 
     the Secretary not more frequently than every 6 months, a 
     report that includes the following:
       ``(A) In the case of a contract or grant under section 503, 
     recommendations pursuant to section 503(a)(5).
       ``(B) Information on activities conducted by the 
     organization pursuant to the contract or grant.
       ``(C) An accounting of the amounts and purpose for which 
     Federal funds were expended.
       ``(D) A minimum set of data, using uniformly defined 
     elements, as specified by the Secretary after consultation 
     with Urban Indian Organizations.
       ``(2) Health status and services.--
       ``(A) In general.--Not later than 18 months after the date 
     of enactment of the Indian Health Care Improvement Act 
     Amendments of 2008, the Secretary, acting through the Service 
     and working with a national membership-based consortium of 
     Urban Indian Organizations, shall submit to Congress a report 
     evaluating--
       ``(i) the health status of Urban Indians;
       ``(ii) the services provided to Indians pursuant to this 
     title; and
       ``(iii) areas of unmet needs in the delivery of health 
     services to Urban Indians, including unmet health care 
     facilities needs.
       ``(B) Consultation and contracts.--In preparing the report 
     under paragraph (1), the Secretary--
       ``(i) shall confer with Urban Indian Organizations; and
       ``(ii) may enter into a contract with a national 
     organization representing Urban Indian Organizations to 
     conduct any aspect of the report.
       ``(b) Audit.--The reports and records of the Urban Indian 
     Organization with respect to a contract or grant under this 
     title shall be subject to audit by the Secretary and the 
     Comptroller General of the United States.
       ``(c) Costs of Audits.--The Secretary shall allow as a cost 
     of any contract or grant entered into or awarded under 
     section 502 or 503 the cost of an annual independent 
     financial audit conducted by--
       ``(1) a certified public accountant; or
       ``(2) a certified public accounting firm qualified to 
     conduct Federal compliance audits.

     ``SEC. 508. LIMITATION ON CONTRACT AUTHORITY.

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

     ``SEC. 509. FACILITIES.

       ``(a) Grants.--The Secretary, acting through the Service, 
     may make grants to contractors or grant recipients under this 
     title for the lease, purchase, renovation, construction, or 
     expansion of facilities, including leased facilities, in 
     order to assist such

[[Page 2756]]

     contractors or grant recipients in complying with applicable 
     licensure or certification requirements.
       ``(b) Loan Fund Study.--The Secretary, acting through the 
     Service, may carry out a study to determine the feasibility 
     of establishing a loan fund to provide to Urban Indian 
     Organizations direct loans or guarantees for loans for the 
     construction of health care facilities in a manner consistent 
     with section 309, including by submitting a report in 
     accordance with subsection (c) of that section.

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

       ``There is established within the Service a Division 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 working with a national membership-based 
     consortium of Urban Indian Organizations.

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

       ``(a) Grants Authorized.--The Secretary, acting through the 
     Service, may make grants for the provision of health-related 
     services in prevention of, treatment of, rehabilitation of, 
     or school- and community-based education regarding, alcohol 
     and substance abuse, including fetal alcohol spectrum 
     disorders, in Urban Centers to those Urban Indian 
     Organizations with which the Secretary has entered into a 
     contract under this title or under section 201.
       ``(b) Goals.--Each grant made pursuant to subsection (a) 
     shall set forth the goals to be accomplished pursuant to the 
     grant. The goals shall be specific to each grant as agreed to 
     between the Secretary and the grantee.
       ``(c) Criteria.--The Secretary shall establish criteria for 
     the grants made under subsection (a), including criteria 
     relating to the following:
       ``(1) The size of the Urban Indian population.
       ``(2) Capability of the organization to adequately perform 
     the activities required under the grant.
       ``(3) Satisfactory performance standards for the 
     organization in meeting the goals set forth in such grant. 
     The standards shall be negotiated and agreed to between the 
     Secretary and the grantee on a grant-by-grant basis.
       ``(4) Identification of the need for services.
       ``(d) Allocation of Grants.--The Secretary shall develop a 
     methodology for allocating grants made pursuant to this 
     section based on the criteria established pursuant to 
     subsection (c).
       ``(e) Grants Subject to Criteria.--Any grant received by an 
     Urban Indian Organization under this Act for substance abuse 
     prevention, treatment, and rehabilitation shall be subject to 
     the criteria set forth in subsection (c).

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

       ``Notwithstanding any other provision of law, the Tulsa 
     Clinic and Oklahoma City Clinic demonstration projects 
     shall--
       ``(1) be permanent programs within the Service's direct 
     care program;
       ``(2) continue to be treated as Service Units and Operating 
     Units in the allocation of resources and coordination of 
     care; and
       ``(3) continue to meet the requirements and definitions of 
     an Urban Indian Organization in this Act, and shall not be 
     subject to the provisions of the Indian Self-Determination 
     and Education Assistance Act (25 U.S.C. 450 et seq.).

     ``SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS.

       ``(a) Grants and Contracts.--The Secretary, through the 
     Division of Urban Indian Health, shall make grants to, or 
     enter into contracts with, Urban Indian Organizations, to 
     take effect not later than September 30, 2010, for the 
     administration of Urban Indian alcohol programs that were 
     originally established under the National Institute on 
     Alcoholism and Alcohol Abuse (hereafter in this section 
     referred to as `NIAAA') and transferred to the Service.
       ``(b) Use of Funds.--Grants provided or contracts entered 
     into under this section shall be used to provide support for 
     the continuation of alcohol prevention and treatment services 
     for Urban Indian populations and such other objectives as are 
     agreed upon between the Service and a recipient of a grant or 
     contract under this section.
       ``(c) Eligibility.--Urban Indian Organizations that operate 
     Indian alcohol programs originally funded under the NIAAA and 
     subsequently transferred to the Service are eligible for 
     grants or contracts under this section.
       ``(d) Report.--The Secretary shall evaluate and report to 
     Congress on the activities of programs funded under this 
     section not less than every 5 years.

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

       ``(a) In General.--The Secretary shall ensure that the 
     Service confers or conferences, to the greatest extent 
     practicable, with Urban Indian Organizations.
       ``(b) Definition of Confer; Conference.--In this section, 
     the terms `confer' and `conference' mean an open and free 
     exchange of information and opinions that--
       ``(1) leads to mutual understanding and comprehension; and
       ``(2) emphasizes trust, respect, and shared responsibility.

     ``SEC. 515. URBAN YOUTH TREATMENT CENTER DEMONSTRATION.

       ``(a) Construction and Operation.--
       ``(1) In general.--The Secretary, acting through the 
     Service, through grant or contract, shall fund the 
     construction and operation of at least 1 residential 
     treatment center in each Service Area that meets the 
     eligibility requirements set forth in subsection (b) to 
     demonstrate the provision of alcohol and substance abuse 
     treatment services to Urban Indian youth in a culturally 
     competent residential setting.
       ``(2) Treatment.--Each residential treatment center 
     described in paragraph (1) shall be in addition to any 
     facilities constructed under section 707(b).
       ``(b) Eligibility Requirements.--To be eligible to obtain a 
     facility under subsection (a)(1), a Service Area shall meet 
     the following requirements:
       ``(1) There is an Urban Indian Organization in the Service 
     Area.
       ``(2) There reside in the Service Area Urban Indian youth 
     with need for alcohol and substance abuse treatment services 
     in a residential setting.
       ``(3) There is a significant shortage of culturally 
     competent residential treatment services for Urban Indian 
     youth in the Service Area.

     ``SEC. 516. GRANTS FOR DIABETES PREVENTION, TREATMENT, AND 
                   CONTROL.

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

     ``SEC. 517. COMMUNITY HEALTH REPRESENTATIVES.

       ``The Secretary, acting through the Service, may enter into 
     contracts with, and make grants to, Urban Indian 
     Organizations for the employment of Indians trained as health 
     service providers through the Community Health 
     Representatives Program under section 109 in the provision of 
     health care, health promotion, and disease prevention 
     services to Urban Indians.

     ``SEC. 518. EFFECTIVE DATE.

       ``The amendments made by the Indian Health Care Improvement 
     Act Amendments of 2008 to this title shall take effect 
     beginning on the date of enactment of that Act, regardless of 
     whether the Secretary has promulgated regulations 
     implementing such amendments.

     ``SEC. 519. ELIGIBILITY FOR SERVICES.

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

     ``SEC. 520. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2017 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.

[[Page 2757]]

       ``(2) Director.--The Service shall be administered by a 
     Director, who shall be appointed by the President, by and 
     with the advice and consent of the Senate. The Director shall 
     report to the Secretary. Effective with respect to an 
     individual appointed by the President, by and with the advice 
     and consent of the Senate, after January 1, 2008, the term of 
     service of the Director shall be 4 years. A Director may 
     serve more than 1 term.
       ``(3) Incumbent.--The individual serving in the position of 
     Director of the Service on the day before the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2008 shall serve as Director.
       ``(4) Advocacy and consultation.--The position of Director 
     is established to, in a manner consistent with the 
     government-to-government relationship between the United 
     States and Indian Tribes--
       ``(A) facilitate advocacy for the development of 
     appropriate Indian health policy; and
       ``(B) promote consultation on matters relating to Indian 
     health.
       ``(b) Agency.--The Service shall be an agency within the 
     Public Health Service of the Department, and shall not be an 
     office, component, or unit of any other agency of the 
     Department.
       ``(c) Duties.--The Director shall--
       ``(1) perform all functions that were, on the day before 
     the date of enactment of the Indian Health Care Improvement 
     Act Amendments of 2008, carried out by or under the direction 
     of the individual serving as Director of the Service on that 
     day;
       ``(2) perform all functions of the Secretary relating to 
     the maintenance and operation of hospital and health 
     facilities for Indians and the planning for, and provision 
     and utilization of, health services for Indians;
       ``(3) administer all health programs under which health 
     care is provided to Indians based upon their status as 
     Indians which are administered by the Secretary, including 
     programs under--
       ``(A) this Act;
       ``(B) the Act of November 2, 1921 (25 U.S.C. 13);
       ``(C) the Act of August 5, 1954 (42 U.S.C. 2001 et seq.);
       ``(D) the Act of August 16, 1957 (42 U.S.C. 2005 et seq.); 
     and
       ``(E) the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450 et seq.);
       ``(4) administer all scholarship and loan functions carried 
     out under title I;
       ``(5) directly advise the Secretary concerning the 
     development of all policy- and budget-related matters 
     affecting Indian health;
       ``(6) collaborate with the Assistant Secretary for Health 
     concerning appropriate matters of Indian health that affect 
     the agencies of the Public Health Service;
       ``(7) advise each Assistant Secretary of the Department 
     concerning matters of Indian health with respect to which 
     that Assistant Secretary has authority and responsibility;
       ``(8) advise the heads of other agencies and programs of 
     the Department concerning matters of Indian health with 
     respect to which those heads have authority and 
     responsibility;
       ``(9) coordinate the activities of the Department 
     concerning matters of Indian health; and
       ``(10) perform such other functions as the Secretary may 
     designate.
       ``(d) Authority.--
       ``(1) In general.--The Secretary, acting through the 
     Director, shall have the authority--
       ``(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 shall establish an 
     automated management information system for the Service.
       ``(2) Requirements of system.--The information system 
     established under paragraph (1) shall include--
       ``(A) a financial management system;
       ``(B) a patient care information system for each area 
     served by the Service;
       ``(C) a privacy component that protects the privacy of 
     patient information held by, or on behalf of, the Service;
       ``(D) a services-based cost accounting component that 
     provides estimates of the costs associated with the provision 
     of specific medical treatments or services in each Area 
     office of the Service;
       ``(E) an interface mechanism for patient billing and 
     accounts receivable system; and
       ``(F) a training component.
       ``(b) Provision of Systems to Tribes and Organizations.--
     The Secretary shall provide each Tribal Health Program 
     automated management information systems which--
       ``(1) meet the management information needs of such Tribal 
     Health Program with respect to the treatment by the Tribal 
     Health Program of patients of the Service; and
       ``(2) meet the management information needs of the Service.
       ``(c) Access to Records.--Notwithstanding any other 
     provision of law, each patient shall have reasonable access 
     to the medical or health records of such patient which are 
     held by, or on behalf of, the Service.
       ``(d) Authority To Enhance Information Technology.--The 
     Secretary, acting through the Director, 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 2017 to 
     carry out this title.

                ``TITLE VII--BEHAVIORAL HEALTH PROGRAMS

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

       ``(a) Purposes.--The purposes of this section are as 
     follows:
       ``(1) To authorize and direct the Secretary, acting through 
     the Service, Indian Tribes and Tribal Organizations to 
     develop a comprehensive behavioral health prevention and 
     treatment program which emphasizes collaboration among 
     alcohol and substance abuse, social services, and mental 
     health programs.
       ``(2) To provide information, direction, and guidance 
     relating to mental illness and dysfunction and self-
     destructive behavior, including child abuse and family 
     violence, to those Federal, tribal, State, and local agencies 
     responsible for programs in Indian communities in areas of 
     health care, education, social services, child and family 
     welfare, alcohol and substance abuse, law enforcement, and 
     judicial services.
       ``(3) To assist Indian Tribes to identify services and 
     resources available to address mental illness and 
     dysfunctional and self-destructive behavior.
       ``(4) To provide authority and opportunities for Indian 
     Tribes and Tribal Organizations to develop, implement, and 
     coordinate with community-based programs which include 
     identification, prevention, education, referral, and 
     treatment services, including through multidisciplinary 
     resource teams.
       ``(5) To ensure that Indians, as citizens of the United 
     States and of the States in which they reside, have the same 
     access to behavioral health services to which all citizens 
     have access.
       ``(6) To modify or supplement existing programs and 
     authorities in the areas identified in paragraph (2).
       ``(b) Plans.--
       ``(1) Development.--The Secretary, acting through the 
     Service, Indian Tribes, and Tribal Organizations, shall 
     encourage Indian Tribes and Tribal Organizations to develop 
     tribal plans and to participate in developing areawide plans 
     for Indian Behavioral Health Services. The plans shall 
     include, to the extent feasible, the following components:
       ``(A) An assessment of the scope of alcohol or other 
     substance abuse, mental illness, and dysfunctional and self-
     destructive behavior, including suicide, child abuse, and 
     family violence, among Indians, including--
       ``(i) the number of Indians served who are directly or 
     indirectly affected by such illness or behavior; or
       ``(ii) an estimate of the financial and human cost 
     attributable to such illness or behavior.
       ``(B) An assessment of the existing and additional 
     resources necessary for the prevention and treatment of such 
     illness and behavior, including an assessment of the progress 
     toward achieving the availability of the full continuum of 
     care described in subsection (c).
       ``(C) An estimate of the additional funding needed by the 
     Service, Indian Tribes, and Tribal Organizations to meet 
     their responsibilities under the plans.
       ``(2) Coordination with national clearinghouses and 
     information centers.--The Secretary, acting through the 
     Service, shall coordinate with existing national 
     clearinghouses and information centers to include at the 
     clearinghouses and centers plans and reports on the outcomes 
     of such plans developed by Indian Tribes, Tribal 
     Organizations, and Service Areas relating to behavioral 
     health. The Secretary shall ensure access to these plans and 
     outcomes by any Indian Tribe, Tribal Organization, or the 
     Service.
       ``(3) Technical assistance.--The Secretary shall provide 
     technical assistance to Indian Tribes and Tribal 
     Organizations in preparation of plans under this section and 
     in developing standards of care that may be used and adopted 
     locally.
       ``(c) Programs.--The Secretary, acting through the Service, 
     Indian Tribes, and Tribal Organizations, shall provide, to 
     the extent feasible and if funding is available, programs 
     including the following:

[[Page 2758]]

       ``(1) Comprehensive care.--A comprehensive continuum of 
     behavioral health care which provides--
       ``(A) community-based prevention, intervention, outpatient, 
     and behavioral health aftercare;
       ``(B) detoxification (social and medical);
       ``(C) acute hospitalization;
       ``(D) intensive outpatient/day treatment;
       ``(E) residential treatment;
       ``(F) transitional living for those needing a temporary, 
     stable living environment that is supportive of treatment and 
     recovery goals;
       ``(G) emergency shelter;
       ``(H) intensive case management;
       ``(I) diagnostic services; and
       ``(J) promotion of healthy approaches to risk and safety 
     issues, including injury prevention.
       ``(2) Child care.--Behavioral health services for Indians 
     from birth through age 17, including--
       ``(A) preschool and school age fetal alcohol spectrum 
     disorder services, including assessment and behavioral 
     intervention;
       ``(B) mental health and substance abuse services 
     (emotional, organic, alcohol, drug, inhalant, and tobacco);
       ``(C) identification and treatment of co-occurring 
     disorders and comorbidity;
       ``(D) prevention of alcohol, drug, inhalant, and tobacco 
     use;
       ``(E) early intervention, treatment, and aftercare; and
       ``(F) identification and treatment of neglect and physical, 
     mental, and sexual abuse.
       ``(3) Adult care.--Behavioral health services for Indians 
     from age 18 through 55, including--
       ``(A) early intervention, treatment, and aftercare;
       ``(B) mental health and substance abuse services 
     (emotional, alcohol, drug, inhalant, and tobacco), including 
     sex specific services;
       ``(C) identification and treatment of co-occurring 
     disorders (dual diagnosis) and comorbidity;
       ``(D) promotion of healthy approaches for risk-related 
     behavior;
       ``(E) treatment services for women at risk of a fetal 
     alcohol-exposed pregnancy; and
       ``(F) sex specific treatment for sexual assault and 
     domestic violence.
       ``(4) Family care.--Behavioral health services for 
     families, including--
       ``(A) early intervention, treatment, and aftercare for 
     affected families;
       ``(B) treatment for sexual assault and domestic violence; 
     and
       ``(C) promotion of healthy approaches relating to 
     parenting, domestic violence, and other abuse issues.
       ``(5) Elder care.--Behavioral health services for Indians 
     56 years of age and older, including--
       ``(A) early intervention, treatment, and aftercare;
       ``(B) mental health and substance abuse services 
     (emotional, alcohol, drug, inhalant, and tobacco), including 
     sex specific services;
       ``(C) identification and treatment of co-occurring 
     disorders (dual diagnosis) and comorbidity;
       ``(D) promotion of healthy approaches to managing 
     conditions related to aging;
       ``(E) sex specific treatment for sexual assault, domestic 
     violence, neglect, physical and mental abuse and 
     exploitation; and
       ``(F) identification and treatment of dementias regardless 
     of cause.
       ``(d) Community Behavioral Health Plan.--
       ``(1) Establishment.--The governing body of any Indian 
     Tribe or Tribal Organization may adopt a resolution for the 
     establishment of a community behavioral health plan providing 
     for the identification and coordination of available 
     resources and programs to identify, prevent, or treat 
     substance abuse, mental illness, or dysfunctional and self-
     destructive behavior, including child abuse and family 
     violence, among its members or its service population. This 
     plan should include behavioral health services, social 
     services, intensive outpatient services, and continuing 
     aftercare.
       ``(2) Technical assistance.--At the request of an Indian 
     Tribe or Tribal Organization, 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 and implementation of such plan.
       ``(3) Funding.--The Secretary, acting through the Service, 
     may make funding available to Indian Tribes and Tribal 
     Organizations which adopt a resolution pursuant to paragraph 
     (1) to obtain technical assistance for the development of a 
     community behavioral health plan and to provide 
     administrative support in the implementation of such plan.
       ``(e) Coordination for Availability of Services.--The 
     Secretary, acting through the Service, Indian Tribes, and 
     Tribal Organizations, shall coordinate behavioral health 
     planning, to the extent feasible, with other Federal agencies 
     and with State agencies, to encourage comprehensive 
     behavioral health services for Indians regardless of their 
     place of residence.
       ``(f) Mental Health Care Need Assessment.--Not later than 1 
     year after the date of enactment of the Indian Health Care 
     Improvement Act Amendments of 2008, the Secretary, acting 
     through the Service, shall make an assessment of the need for 
     inpatient mental health care among Indians and the 
     availability and cost of inpatient mental health facilities 
     which can meet such need. In making such assessment, the 
     Secretary shall consider the possible conversion of existing, 
     underused Service hospital beds into psychiatric units to 
     meet such need.

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

       ``(a) Contents.--Not later than 12 months after the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2008, the Secretary, acting through the 
     Service, and the Secretary of the Interior shall develop and 
     enter into a memoranda of agreement, or review and update any 
     existing memoranda of agreement, as required by section 4205 
     of the Indian Alcohol and Substance Abuse Prevention and 
     Treatment Act of 1986 (25 U.S.C. 2411) under which the 
     Secretaries address the following:
       ``(1) The scope and nature of mental illness and 
     dysfunctional and self-destructive behavior, including child 
     abuse and family violence, among Indians.
       ``(2) The existing Federal, tribal, State, local, and 
     private services, resources, and programs available to 
     provide behavioral health services for Indians.
       ``(3) The unmet need for additional services, resources, 
     and programs necessary to meet the needs identified pursuant 
     to paragraph (1).
       ``(4)(A) The right of Indians, as citizens of the United 
     States and of the States in which they reside, to have access 
     to behavioral health services to which all citizens have 
     access.
       ``(B) The right of Indians to participate in, and receive 
     the benefit of, such services.
       ``(C) The actions necessary to protect the exercise of such 
     right.
       ``(5) The responsibilities of the Bureau of Indian Affairs 
     and the Service, including mental illness identification, 
     prevention, education, referral, and treatment services 
     (including services through multidisciplinary resource 
     teams), at the central, area, and agency and Service Unit, 
     Service Area, and headquarters levels to address the problems 
     identified in paragraph (1).
       ``(6) A strategy for the comprehensive coordination of the 
     behavioral health services provided by the Bureau of Indian 
     Affairs and the Service to meet the problems identified 
     pursuant to paragraph (1), including--
       ``(A) the coordination of alcohol and substance abuse 
     programs of the Service, the Bureau of Indian Affairs, and 
     Indian Tribes and Tribal Organizations (developed under the 
     Indian Alcohol and Substance Abuse Prevention and Treatment 
     Act of 1986 (25 U.S.C. 2401 et seq.)) with behavioral health 
     initiatives pursuant to this Act, particularly with respect 
     to the referral and treatment of dually diagnosed individuals 
     requiring behavioral health and substance abuse treatment; 
     and
       ``(B) ensuring that the Bureau of Indian Affairs and 
     Service programs and services (including multidisciplinary 
     resource teams) addressing child abuse and family violence 
     are coordinated with such non-Federal programs and services.
       ``(7) Directing appropriate officials of the Bureau of 
     Indian Affairs and the Service, particularly at the agency 
     and Service Unit levels, to cooperate fully with tribal 
     requests made pursuant to community behavioral health plans 
     adopted under section 701(c) and section 4206 of the Indian 
     Alcohol and Substance Abuse Prevention and Treatment Act of 
     1986 (25 U.S.C. 2412).
       ``(8) Providing for an annual review of such agreement by 
     the Secretaries which shall be provided to Congress and 
     Indian Tribes and Tribal Organizations.
       ``(b) Specific Provisions Required.--The memoranda of 
     agreement updated or entered into pursuant to subsection (a) 
     shall include specific provisions pursuant to which the 
     Service shall assume responsibility for--
       ``(1) the determination of the scope of the problem of 
     alcohol and substance abuse among Indians, including the 
     number of Indians within the jurisdiction of the Service who 
     are directly or indirectly affected by alcohol and substance 
     abuse and the financial and human cost;
       ``(2) an assessment of the existing and needed resources 
     necessary for the prevention of alcohol and substance abuse 
     and the treatment of Indians affected by alcohol and 
     substance abuse; and
       ``(3) an estimate of the funding necessary to adequately 
     support a program of prevention of alcohol and substance 
     abuse and treatment of Indians affected by alcohol and 
     substance abuse.
       ``(c) Publication.--Each memorandum of agreement entered 
     into or renewed (and amendments or modifications thereto) 
     under subsection (a) shall be published in the Federal 
     Register. At the same time as publication in the Federal 
     Register, the Secretary shall provide a copy of such 
     memoranda, amendment, or modification to each Indian Tribe, 
     Tribal Organization, and Urban Indian Organization.

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

       ``(a) Establishment.--

[[Page 2759]]

       ``(1) In general.--The Secretary, acting through the 
     Service, Indian Tribes, and Tribal Organizations, shall 
     provide a program of comprehensive behavioral health, 
     prevention, treatment, and aftercare, which shall include--
       ``(A) prevention, through educational intervention, in 
     Indian communities;
       ``(B) acute detoxification, psychiatric hospitalization, 
     residential, and intensive outpatient treatment;
       ``(C) community-based rehabilitation and aftercare;
       ``(D) community education and involvement, including 
     extensive training of health care, educational, and 
     community-based personnel;
       ``(E) specialized residential treatment programs for high-
     risk populations, including pregnant and postpartum women and 
     their children; and
       ``(F) diagnostic services.
       ``(2) Target populations.--The target population of such 
     programs shall be members of Indian Tribes. Efforts to train 
     and educate key members of the Indian community shall also 
     target employees of health, education, judicial, law 
     enforcement, legal, and social service programs.
       ``(b) Contract Health Services.--
       ``(1) In general.--The Secretary, acting through the 
     Service, Indian Tribes, and Tribal Organizations, may enter 
     into contracts with public or private providers of behavioral 
     health treatment services for the purpose of carrying out the 
     program required under subsection (a).
       ``(2) Provision of assistance.--In carrying out this 
     subsection, the Secretary shall provide assistance to Indian 
     Tribes and Tribal Organizations to develop criteria for the 
     certification of behavioral health service providers and 
     accreditation of service facilities which meet minimum 
     standards for such services and facilities.

     ``SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM.

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

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

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

     ``SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.

       ``(a) Grants.--The Secretary, consistent with section 701, 
     may make grants to Indian Tribes, Tribal Organizations, and 
     Urban Indian Organizations to develop and implement a 
     comprehensive behavioral health program of prevention, 
     intervention, treatment, and relapse prevention services that 
     specifically addresses the cultural, historical, social, and 
     child care needs of Indian women, regardless of age.
       ``(b) Use of Grant Funds.--A grant made pursuant to this 
     section may be used to--
       ``(1) develop and provide community training, education, 
     and prevention programs for Indian women relating to 
     behavioral health issues, including fetal alcohol spectrum 
     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) Allocation of Certain Funds.--Twenty percent of the 
     funds appropriated pursuant to this section shall be used to 
     make grants to Urban Indian Organizations.

     ``SEC. 707. INDIAN YOUTH PROGRAM.

       ``(a) Detoxification and Rehabilitation.--The Secretary, 
     acting through the Service, consistent with section 701, 
     shall develop and implement a program for acute 
     detoxification and treatment for Indian youths, including 
     behavioral health services. The program shall include 
     regional treatment centers designed to include detoxification 
     and rehabilitation for both sexes on a referral basis and 
     programs developed and implemented by Indian Tribes or Tribal 
     Organizations at the local level under the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.). Regional centers shall be integrated with the intake 
     and rehabilitation programs based in the referring Indian 
     community.
       ``(b) Alcohol and Substance Abuse Treatment Centers or 
     Facilities.--
       ``(1) Establishment.--
       ``(A) In general.--The Secretary, acting through the 
     Service, Indian Tribes, and Tribal Organizations, shall 
     construct, renovate, or, as necessary, purchase, and 
     appropriately staff and operate, at least 1 youth regional 
     treatment center or treatment network in each area under the 
     jurisdiction of an Area Office.
       ``(B) Area office in california.--For the purposes of this 
     subsection, the Area Office in California shall be considered 
     to be 2 Area Offices, 1 office whose jurisdiction shall be 
     considered to encompass the northern area of the State of 
     California, and 1 office whose jurisdiction shall be 
     considered to encompass the remainder of the State of 
     California for the purpose of implementing California 
     treatment networks.
       ``(2) Funding.--For the purpose of staffing and operating 
     such centers or facilities, funding shall be pursuant to the 
     Act of November 2, 1921 (25 U.S.C. 13).
       ``(3) Location.--A youth treatment center constructed or 
     purchased under this subsection shall be constructed or 
     purchased at a location within the area described in 
     paragraph (1) agreed upon (by appropriate tribal resolution) 
     by a majority of the Indian Tribes to be served by such 
     center.
       ``(4) Specific provision of funds.--
       ``(A) In general.--Notwithstanding any other provision of 
     this title, the Secretary may, from amounts authorized to be 
     appropriated for the purposes of carrying out this section, 
     make funds available to--
       ``(i) the Tanana Chiefs Conference, Incorporated, for the 
     purpose of leasing, constructing, renovating, operating, and 
     maintaining a residential youth treatment facility in 
     Fairbanks, Alaska; and
       ``(ii) the Southeast Alaska Regional Health Corporation to 
     staff and operate a residential youth treatment facility 
     without regard to the proviso set forth in section 4(l) of 
     the Indian Self-Determination and Education Assistance Act 
     (25 U.S.C. 450b(l)).
       ``(B) Provision of services to eligible youths.--Until 
     additional residential youth treatment facilities are 
     established in Alaska pursuant to this section, the 
     facilities specified in subparagraph (A) shall make every 
     effort to provide services to all eligible Indian youths 
     residing in Alaska.
       ``(c) Intermediate Adolescent Behavioral Health Services.--
       ``(1) In general.--The Secretary, acting through the 
     Service, Indian Tribes, and Tribal Organizations, may provide 
     intermediate behavioral health services to Indian children 
     and adolescents, including--
       ``(A) pretreatment assistance;
       ``(B) inpatient, outpatient, and aftercare services;
       ``(C) emergency care;
       ``(D) suicide prevention and crisis intervention; and
       ``(E) prevention and treatment of mental illness and 
     dysfunctional and self-destructive behavior, including child 
     abuse and family violence.
       ``(2) Use of funds.--Funds provided under this subsection 
     may be used--
       ``(A) to construct or renovate an existing health facility 
     to provide intermediate behavioral health services;
       ``(B) to hire behavioral health professionals;
       ``(C) to staff, operate, and maintain an intermediate 
     mental health facility, group home, sober housing, 
     transitional housing or similar facilities, or youth shelter 
     where intermediate behavioral health services are being 
     provided;

[[Page 2760]]

       ``(D) to make renovations and hire appropriate staff to 
     convert existing hospital beds into adolescent psychiatric 
     units; and
       ``(E) for intensive home- and community-based services.
       ``(3) Criteria.--The Secretary, acting through the Service, 
     shall, in consultation with Indian Tribes and Tribal 
     Organizations, establish criteria for the review and approval 
     of applications or proposals for funding made available 
     pursuant to this subsection.
       ``(d) Federally-Owned Structures.--
       ``(1) In general.--The Secretary, in consultation with 
     Indian Tribes and Tribal Organizations, shall--
       ``(A) identify and use, where appropriate, federally-owned 
     structures suitable for local residential or regional 
     behavioral health treatment for Indian youths; and
       ``(B) establish guidelines for determining the suitability 
     of any such federally-owned structure to be used for local 
     residential or regional behavioral health treatment for 
     Indian youths.
       ``(2) Terms and conditions for use of structure.--Any 
     structure described in paragraph (1) may be used under such 
     terms and conditions as may be agreed upon by the Secretary 
     and the agency having responsibility for the structure and 
     any Indian Tribe or Tribal Organization operating the 
     program.
       ``(e) Rehabilitation and Aftercare Services.--
       ``(1) In general.--The Secretary, Indian Tribes, or Tribal 
     Organizations, in cooperation with the Secretary of the 
     Interior, shall develop and implement within each Service 
     Unit, community-based rehabilitation and follow-up services 
     for Indian youths who are having significant behavioral 
     health problems, and require long-term treatment, community 
     reintegration, and monitoring to support the Indian youths 
     after their return to their home community.
       ``(2) Administration.--Services under paragraph (1) shall 
     be provided by trained staff within the community who can 
     assist the Indian youths in their continuing development of 
     self-image, positive problem-solving skills, and nonalcohol 
     or substance abusing behaviors. Such staff may include 
     alcohol and substance abuse counselors, mental health 
     professionals, and other health professionals and 
     paraprofessionals, including community health 
     representatives.
       ``(f) Inclusion of Family in Youth Treatment Program.--In 
     providing the treatment and other services to Indian youths 
     authorized by this section, the Secretary, acting through the 
     Service, Indian Tribes, and Tribal Organizations, shall 
     provide for the inclusion of family members of such youths in 
     the treatment programs or other services as may be 
     appropriate. Not less than 10 percent of the funds 
     appropriated for the purposes of carrying out subsection (e) 
     shall be used for outpatient care of adult family members 
     related to the treatment of an Indian youth under that 
     subsection.
       ``(g) Multidrug Abuse Program.--The Secretary, acting 
     through the Service, Indian Tribes, and Tribal Organizations, 
     shall provide, consistent with section 701, programs and 
     services to prevent and treat the abuse of multiple forms of 
     substances, including alcohol, drugs, inhalants, and tobacco, 
     among Indian youths residing in Indian communities, on or 
     near reservations, and in urban areas and provide appropriate 
     mental health services to address the incidence of mental 
     illness among such youths.
       ``(h) Indian Youth Mental Health.--The Secretary, acting 
     through the Service, shall collect data for the report under 
     section 801 with respect to--
       ``(1) the number of Indian youth who are being provided 
     mental health services through the Service and Tribal Health 
     Programs;
       ``(2) a description of, and costs associated with, the 
     mental health services provided for Indian youth through the 
     Service and Tribal Health Programs;
       ``(3) the number of youth referred to the Service or Tribal 
     Health Programs for mental health services;
       ``(4) the number of Indian youth provided residential 
     treatment for mental health and behavioral problems through 
     the Service and Tribal Health Programs, reported separately 
     for on- and off-reservation facilities; and
       ``(5) the costs of the services described in paragraph (4).

     ``SEC. 708. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRATION 
                   PROJECT.

       ``(a) Purpose.--The purpose of this section is to authorize 
     the Secretary to carry out a demonstration project to test 
     the use of telemental health services in suicide prevention, 
     intervention and treatment of Indian youth, including 
     through--
       ``(1) the use of psychotherapy, psychiatric assessments, 
     diagnostic interviews, therapies for mental health conditions 
     predisposing to suicide, and alcohol and substance abuse 
     treatment;
       ``(2) the provision of clinical expertise to, consultation 
     services with, and medical advice and training for frontline 
     health care providers working with Indian youth;
       ``(3) training and related support for community leaders, 
     family members and health and education workers who work with 
     Indian youth;
       ``(4) the development of culturally-relevant educational 
     materials on suicide; and
       ``(5) data collection and reporting.
       ``(b) Definitions.--For the purpose of this section, the 
     following definitions shall apply:
       ``(1) Demonstration project.--The term `demonstration 
     project' means the Indian youth telemental health 
     demonstration project authorized under subsection (c).
       ``(2) Telemental health.--The term `telemental health' 
     means the use of electronic information and 
     telecommunications technologies to support long distance 
     mental health care, patient and professional-related 
     education, public health, and health administration.
       ``(c) Authorization.--
       ``(1) In general.--The Secretary is authorized to award 
     grants under the demonstration project for the provision of 
     telemental health services to Indian youth who--
       ``(A) have expressed suicidal ideas;
       ``(B) have attempted suicide; or
       ``(C) have mental health conditions that increase or could 
     increase the risk of suicide.
       ``(2) Eligibility for grants.--Such grants shall be awarded 
     to Indian Tribes and Tribal Organizations that operate 1 or 
     more facilities--
       ``(A) located in Alaska and part of the Alaska Federal 
     Health Care Access Network;
       ``(B) reporting active clinical telehealth capabilities; or
       ``(C) offering school-based telemental health services 
     relating to psychiatry to Indian youth.
       ``(3) Grant period.--The Secretary shall award grants under 
     this section for a period of up to 4 years.
       ``(4) Awarding of grants.--Not more than 5 grants shall be 
     provided under paragraph (1), with priority consideration 
     given to Indian Tribes and Tribal Organizations that--
       ``(A) serve a particular community or geographic area where 
     there is a demonstrated need to address Indian youth suicide;
       ``(B) enter in to collaborative partnerships with Indian 
     Health Service or Tribal Health Programs or facilities to 
     provide services under this demonstration project;
       ``(C) serve an isolated community or geographic area which 
     has limited or no access to behavioral health services; or
       ``(D) operate a detention facility at which Indian youth 
     are detained.
       ``(d) Use of Funds.--
       ``(1) In general.--An Indian Tribe or Tribal Organization 
     shall use a grant received under subsection (c) for the 
     following purposes:
       ``(A) To provide telemental health services to Indian 
     youth, including the provision of--
       ``(i) psychotherapy;
       ``(ii) psychiatric assessments and diagnostic interviews, 
     therapies for mental health conditions predisposing to 
     suicide, and treatment; and
       ``(iii) alcohol and substance abuse treatment.
       ``(B) To provide clinician-interactive medical advice, 
     guidance and training, assistance in diagnosis and 
     interpretation, crisis counseling and intervention, and 
     related assistance to Service, tribal, or urban clinicians 
     and health services providers working with youth being served 
     under this demonstration project.
       ``(C) To assist, educate and train community leaders, 
     health education professionals and paraprofessionals, tribal 
     outreach workers, and family members who work with the youth 
     receiving telemental health services under this demonstration 
     project, including with identification of suicidal 
     tendencies, crisis intervention and suicide prevention, 
     emergency skill development, and building and expanding 
     networks among these individuals and with State and local 
     health services providers.
       ``(D) To develop and distribute culturally appropriate 
     community educational materials on--
       ``(i) suicide prevention;
       ``(ii) suicide education;
       ``(iii) suicide screening;
       ``(iv) suicide intervention; and
       ``(v) ways to mobilize communities with respect to the 
     identification of risk factors for suicide.
       ``(E) For data collection and reporting related to Indian 
     youth suicide prevention efforts.
       ``(2) Traditional health care practices.--In carrying out 
     the purposes described in paragraph (1), an Indian Tribe or 
     Tribal Organization may use and promote the traditional 
     health care practices of the Indian Tribes of the youth to be 
     served.
       ``(e) Applications.--To be eligible to receive a grant 
     under subsection (c), an Indian Tribe or Tribal Organization 
     shall prepare and submit to the Secretary an application, at 
     such time, in such manner, and containing such information as 
     the Secretary may require, including--
       ``(1) a description of the project that the Indian Tribe or 
     Tribal Organization will carry out using the funds provided 
     under the grant;
       ``(2) a description of the manner in which the project 
     funded under the grant would--
       ``(A) meet the telemental health care needs of the Indian 
     youth population to be served by the project; or
       ``(B) improve the access of the Indian youth population to 
     be served to suicide prevention and treatment services;

[[Page 2761]]

       ``(3) evidence of support for the project from the local 
     community to be served by the project;
       ``(4) a description of how the families and leadership of 
     the communities or populations to be served by the project 
     would be involved in the development and ongoing operations 
     of the project;
       ``(5) a plan to involve the tribal community of the youth 
     who are provided services by the project in planning and 
     evaluating the mental health care and suicide prevention 
     efforts provided, in order to ensure the integration of 
     community, clinical, environmental, and cultural components 
     of the treatment; and
       ``(6) a plan for sustaining the project after Federal 
     assistance for the demonstration project has terminated.
       ``(f) Collaboration; Reporting to National Clearinghouse.--
       ``(1) Collaboration.--The Secretary, acting through the 
     Service, shall encourage Indian Tribes and Tribal 
     Organizations receiving grants under this section to 
     collaborate to enable comparisons about best practices across 
     projects.
       ``(2) Reporting to national clearinghouse.--The Secretary, 
     acting through the Service, shall also encourage Indian 
     Tribes and Tribal Organizations receiving grants under this 
     section to submit relevant, declassified project information 
     to the national clearinghouse authorized under section 
     701(b)(2) in order to better facilitate program performance 
     and improve suicide prevention, intervention, and treatment 
     services.
       ``(g) Annual Report.--Each grant recipient shall submit to 
     the Secretary an annual report that--
       ``(1) describes the number of telemental health services 
     provided; and
       ``(2) includes any other information that the Secretary may 
     require.
       ``(h) Report to Congress.--Not later than 270 days after 
     the termination of the demonstration project, the Secretary 
     shall submit to the Committee on Indian Affairs of the Senate 
     and the Committee on Natural Resources and Committee on 
     Energy and Commerce of the House of Representatives a final 
     report, based on the annual reports provided by grant 
     recipients under subsection (h), that--
       ``(1) describes the results of the projects funded by 
     grants awarded under this section, including any data 
     available which indicates the number of attempted suicides;
       ``(2) evaluates the impact of the telemental health 
     services funded by the grants in reducing the number of 
     completed suicides among Indian youth;
       ``(3) evaluates whether the demonstration project should 
     be--
       ``(A) expanded to provide more than 5 grants; and
       ``(B) designated a permanent program; and
       ``(4) evaluates the benefits of expanding the demonstration 
     project to include Urban Indian Organizations.
       ``(i) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $1,500,000 for 
     each of fiscal years 2008 through 2011.

     ``SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL HEALTH 
                   FACILITIES DESIGN, CONSTRUCTION, AND STAFFING.

       ``Not later than 1 year after the date of enactment of the 
     Indian Health Care Improvement Act Amendments of 2008, the 
     Secretary, acting through the Service, Indian Tribes, and 
     Tribal Organizations, may provide, in each area of the 
     Service, not less than 1 inpatient mental health care 
     facility, or the equivalent, for Indians with behavioral 
     health problems. For the purposes of this subsection, 
     California shall be considered to be 2 Area Offices, 1 office 
     whose location shall be considered to encompass the northern 
     area of the State of California and 1 office whose 
     jurisdiction shall be considered to encompass the remainder 
     of the State of California. The Secretary shall consider the 
     possible conversion of existing, underused Service hospital 
     beds into psychiatric units to meet such need.

     ``SEC. 710. TRAINING AND COMMUNITY EDUCATION.

       ``(a) Program.--The Secretary, in cooperation with the 
     Secretary of the Interior, shall develop and implement or 
     assist Indian Tribes and Tribal Organizations to develop and 
     implement, within each Service Unit or tribal program, a 
     program of community education and involvement which shall be 
     designed to provide concise and timely information to the 
     community leadership of each tribal community. Such program 
     shall include education about behavioral health issues to 
     political leaders, Tribal judges, law enforcement personnel, 
     members of tribal health and education boards, health care 
     providers including traditional practitioners, and other 
     critical members of each tribal community. Such program may 
     also include community-based training to develop local 
     capacity and tribal community provider training for 
     prevention, intervention, treatment, and aftercare.
       ``(b) Instruction.--The Secretary, acting through the 
     Service, shall, either directly or through Indian Tribes and 
     Tribal Organizations, provide instruction in the area of 
     behavioral health issues, including instruction in crisis 
     intervention and family relations in the context of alcohol 
     and substance abuse, child sexual abuse, youth alcohol and 
     substance abuse, and the causes and effects of fetal alcohol 
     spectrum disorders to appropriate employees of the Bureau of 
     Indian Affairs and the Service, and to personnel in schools 
     or programs operated under any contract with the Bureau of 
     Indian Affairs or the Service, including supervisors of 
     emergency shelters and halfway houses described in section 
     4213 of the Indian Alcohol and Substance Abuse Prevention and 
     Treatment Act of 1986 (25 U.S.C. 2433).
       ``(c) Training Models.--In carrying out the education and 
     training programs required by this section, the Secretary, in 
     consultation with Indian Tribes, Tribal Organizations, Indian 
     behavioral health experts, and Indian alcohol and substance 
     abuse prevention experts, shall develop and provide 
     community-based training models. Such models shall address--
       ``(1) the elevated risk of alcohol 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. 711. BEHAVIORAL HEALTH PROGRAM.

       ``(a) Innovative Programs.--The Secretary, acting through 
     the Service, Indian Tribes, and Tribal Organizations, 
     consistent with section 701, may plan, develop, implement, 
     and carry out programs to deliver innovative community-based 
     behavioral health services to Indians.
       ``(b) Awards; Criteria.--The Secretary may award a grant 
     for a project under subsection (a) to an Indian Tribe or 
     Tribal Organization and may consider the following criteria:
       ``(1) The project will address significant unmet behavioral 
     health needs among Indians.
       ``(2) The project will serve a significant number of 
     Indians.
       ``(3) The project has the potential to deliver services in 
     an efficient and effective manner.
       ``(4) The Indian Tribe or Tribal Organization has the 
     administrative and financial capability to administer the 
     project.
       ``(5) The project may deliver services in a manner 
     consistent with traditional health care practices.
       ``(6) The project is coordinated with, and avoids 
     duplication of, existing services.
       ``(c) Equitable Treatment.--For purposes of this 
     subsection, the Secretary shall, in evaluating project 
     applications or proposals, use the same criteria that the 
     Secretary uses in evaluating any other application or 
     proposal for such funding.

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

       ``(a) Programs.--
       ``(1) Establishment.--The Secretary, consistent with 
     section 701, acting through the Service, Indian Tribes, and 
     Tribal Organizations, is authorized to establish and operate 
     fetal alcohol spectrum disorders programs as provided in this 
     section for the purposes of meeting the health status 
     objectives specified in section 3.
       ``(2) Use of funds.--
       ``(A) In general.--Funding provided pursuant to this 
     section shall be used for the following:
       ``(i) To develop and provide for Indians community and in-
     school training, education, and prevention programs relating 
     to fetal alcohol spectrum disorders.
       ``(ii) To identify and provide behavioral health treatment 
     to high-risk Indian women and high-risk women pregnant with 
     an Indian's child.
       ``(iii) To identify and provide appropriate psychological 
     services, educational and vocational support, counseling, 
     advocacy, and information to fetal alcohol spectrum 
     disorders-affected Indians and their families or caretakers.
       ``(iv) To develop and implement counseling and support 
     programs in schools for fetal alcohol spectrum disorders-
     affected Indian children.
       ``(v) To develop prevention and intervention models which 
     incorporate practitioners of traditional health care 
     practices, cultural values, and community involvement.
       ``(vi) To develop, print, and disseminate education and 
     prevention materials on fetal alcohol spectrum disorders.
       ``(vii) To develop and implement, in consultation with 
     Indian Tribes and Tribal Organizations, and in conference 
     with Urban Indian Organizations, culturally sensitive 
     assessment and diagnostic tools including dysmorphology 
     clinics and multidisciplinary fetal alcohol spectrum 
     disorders clinics for use in Indian communities and Urban 
     Centers.
       ``(B) Additional uses.--In addition to any purpose under 
     subparagraph (A), funding provided pursuant to this section 
     may be used for 1 or more of the following:
       ``(i) Early childhood intervention projects from birth on 
     to mitigate the effects of fetal alcohol spectrum disorders 
     among Indians.
       ``(ii) Community-based support services for Indians and 
     women pregnant with Indian children.

[[Page 2762]]

       ``(iii) Community-based housing for adult Indians with 
     fetal alcohol spectrum disorders.
       ``(3) Criteria for applications.--The Secretary shall 
     establish criteria for the review and approval of 
     applications for funding under this section.
       ``(b) Services.--The Secretary, acting through the Service, 
     Indian Tribes, and Tribal Organizations, shall--
       ``(1) develop and provide services for the prevention, 
     intervention, treatment, and aftercare for those affected by 
     fetal alcohol spectrum disorders in Indian communities; and
       ``(2) provide supportive services, including services to 
     meet the special educational, vocational, school-to-work 
     transition, and independent living needs of adolescent and 
     adult Indians with fetal alcohol spectrum disorders.
       ``(c) Task Force.--The Secretary shall establish a task 
     force to be known as the Fetal Alcohol Spectrum Disorders 
     Task Force to advise the Secretary in carrying out subsection 
     (b). Such task force shall be composed of representatives 
     from the following:
       ``(1) The National Institute on Drug Abuse.
       ``(2) The National Institute on Alcohol and Alcoholism.
       ``(3) The Office of Substance Abuse Prevention.
       ``(4) The National Institute of Mental Health.
       ``(5) The Service.
       ``(6) The Office of Minority Health of the Department of 
     Health and Human Services.
       ``(7) The Administration for Native Americans.
       ``(8) The National Institute of Child Health and Human 
     Development (NICHD).
       ``(9) The Centers for Disease Control and Prevention.
       ``(10) The Bureau of Indian Affairs.
       ``(11) Indian Tribes.
       ``(12) Tribal Organizations.
       ``(13) Urban Indian communities.
       ``(14) Indian fetal alcohol spectrum disorders experts.
       ``(d) Applied Research Projects.--The Secretary, acting 
     through the Substance Abuse and Mental Health Services 
     Administration, shall make grants to Indian Tribes, Tribal 
     Organizations, and Urban Indian Organizations for applied 
     research projects which propose to elevate the understanding 
     of methods to prevent, intervene, treat, or provide 
     rehabilitation and behavioral health aftercare for Indians 
     and Urban Indians affected by fetal alcohol spectrum 
     disorders.
       ``(e) Funding for Urban Indian Organizations.--Ten percent 
     of the funds appropriated pursuant to this section shall be 
     used to make grants to Urban Indian Organizations funded 
     under title V.

     ``SEC. 713. CHILD SEXUAL ABUSE PREVENTION AND TREATMENT 
                   PROGRAMS.

       ``(a) Establishment.--The Secretary, acting through the 
     Service, and the Secretary of the Interior, Indian Tribes, 
     and Tribal Organizations, shall establish, consistent with 
     section 701, in every Service Area, programs involving 
     treatment for victims of sexual abuse who are Indian children 
     or children in an Indian household.
       ``(b) Use of Funds.--Funding provided pursuant to this 
     section shall be used for the following:
       ``(1) To develop and provide community education and 
     prevention programs related to sexual abuse of Indian 
     children or children in an Indian household.
       ``(2) To identify and provide behavioral health treatment 
     to victims of sexual abuse who are Indian children or 
     children in an Indian household, and to their family members 
     who are affected by sexual abuse.
       ``(3) To develop prevention and intervention models which 
     incorporate traditional health care practices, cultural 
     values, and community involvement.
       ``(4) To develop and implement culturally sensitive 
     assessment and diagnostic tools for use in Indian communities 
     and Urban Centers.
       ``(5) To identify and provide behavioral health treatment 
     to Indian perpetrators and perpetrators who are members of an 
     Indian household--
       ``(A) making efforts to begin offender and behavioral 
     health treatment while the perpetrator is incarcerated or at 
     the earliest possible date if the perpetrator is not 
     incarcerated; and
       ``(B) providing treatment after the perpetrator is 
     released, until it is determined that the perpetrator is not 
     a threat to children.
       ``(c) Coordination.--The programs established under 
     subsection (a) shall be carried out in coordination with 
     programs and services authorized under the Indian Child 
     Protection and Family Violence Prevention Act (25 U.S.C. 3201 
     et seq.).

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

       ``(a) In General.--The Secretary, in accordance with 
     section 701, is authorized to establish in each Service Area 
     programs involving the prevention and treatment of--
       ``(1) Indian victims of domestic violence or sexual abuse; 
     and
       ``(2) perpetrators of domestic violence or sexual abuse who 
     are Indian or members of an Indian household.
       ``(b) Use of Funds.--Funds made available to carry out this 
     section shall be used--
       ``(1) to develop and implement prevention programs and 
     community education programs relating to domestic violence 
     and sexual abuse;
       ``(2) to provide behavioral health services, including 
     victim support services, and medical treatment (including 
     examinations performed by sexual assault nurse examiners) to 
     Indian victims of domestic violence or sexual abuse;
       ``(3) to purchase rape kits,
       ``(4) to develop prevention and intervention models, which 
     may incorporate traditional health care practices; and
       ``(5) to identify and provide behavioral health treatment 
     to perpetrators who are Indian or members of an Indian 
     household.
       ``(c) Training and Certification.--
       ``(1) In general.--Not later than 1 year after the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2008, the Secretary shall establish appropriate 
     protocols, policies, procedures, standards of practice, and, 
     if not available elsewhere, training curricula and training 
     and certification requirements for services for victims of 
     domestic violence and sexual abuse.
       ``(2) Report.--Not later than 18 months after the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2008, the Secretary shall submit to the 
     Committee on Indian Affairs of the Senate and the Committee 
     on Natural Resources of the House of Representatives a report 
     that describes the means and extent to which the Secretary 
     has carried out paragraph (1).
       ``(d) Coordination.--
       ``(1) In general.--The Secretary, in coordination with the 
     Attorney General, Federal and tribal law enforcement 
     agencies, Indian Health Programs, and domestic violence or 
     sexual assault victim organizations, shall develop 
     appropriate victim services and victim advocate training 
     programs--
       ``(A) to improve domestic violence or sexual abuse 
     responses;
       ``(B) to improve forensic examinations and collection;
       ``(C) to identify problems or obstacles in the prosecution 
     of domestic violence or sexual abuse; and
       ``(D) to meet other needs or carry out other activities 
     required to prevent, treat, and improve prosecutions of 
     domestic violence and sexual abuse.
       ``(2) Report.--Not later than 2 years after the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2008, the Secretary shall submit to the 
     Committee on Indian Affairs of the Senate and the Committee 
     on Natural Resources of the House of Representatives a report 
     that describes, with respect to the matters described in 
     paragraph (1), the improvements made and needed, problems or 
     obstacles identified, and costs necessary to address the 
     problems or obstacles, and any other recommendations that the 
     Secretary determines to be appropriate.

     ``SEC. 715. 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 30 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.

     ``SEC. 716. BEHAVIORAL HEALTH RESEARCH.

       ``The Secretary, in consultation with appropriate Federal 
     agencies, shall make grants to, or enter into contracts with, 
     Indian Tribes, Tribal Organizations, and Urban Indian 
     Organizations or enter into contracts with, or make grants to 
     appropriate institutions for, the conduct of research on the 
     incidence and prevalence of behavioral health problems among 
     Indians served by the Service, Indian Tribes, or Tribal 
     Organizations and among Indians in urban areas. Research 
     priorities under this section shall include--
       ``(1) the multifactorial causes of Indian youth suicide, 
     including--
       ``(A) protective and risk factors and scientific data that 
     identifies those factors; and
       ``(B) the effects of loss of cultural identity and the 
     development of scientific data on those effects;
       ``(2) the interrelationship and interdependence of 
     behavioral health problems with alcoholism and other 
     substance abuse, suicide,

[[Page 2763]]

     homicides, other injuries, and the incidence of family 
     violence; and
       ``(3) the development of models of prevention techniques.

     The effect of the interrelationships and interdependencies 
     referred to in paragraph (2) on children, and the development 
     of prevention techniques under paragraph (3) applicable to 
     children, shall be emphasized.

     ``SEC. 717. DEFINITIONS.

       ``For the purpose of this title, the following definitions 
     shall apply:
       ``(1) Assessment.--The term `assessment' means the 
     systematic collection, analysis, and dissemination of 
     information on health status, health needs, and health 
     problems.
       ``(2) Alcohol-related neurodevelopmental disorders or 
     arnd.--The term `alcohol-related neurodevelopmental 
     disorders' or `ARND' means any 1 of a spectrum of effects 
     that--
       ``(A) may occur when a woman drinks alcohol during 
     pregnancy; and
       ``(B) involves a central nervous system abnormality that 
     may be structural, neurological, or functional.
       ``(3) Behavioral health aftercare.--The term `behavioral 
     health aftercare' includes those activities and resources 
     used to support recovery following inpatient, residential, 
     intensive substance abuse, or mental health outpatient or 
     outpatient treatment. The purpose is to help prevent or deal 
     with relapse by ensuring that by the time a client or patient 
     is discharged from a level of care, such as outpatient 
     treatment, an aftercare plan has been developed with the 
     client. An aftercare plan may use such resources as a 
     community-based therapeutic group, transitional living 
     facilities, a 12-step sponsor, a local 12-step or other 
     related support group, and other community-based providers.
       ``(4) Dual diagnosis.--The term `dual diagnosis' means 
     coexisting substance abuse and mental illness conditions or 
     diagnosis. Such clients are sometimes referred to as mentally 
     ill chemical abusers (MICAs).
       ``(5) Fetal alcohol spectrum disorders.--
       ``(A) In general.--The term `fetal alcohol spectrum 
     disorders' includes a range of effects that can occur in an 
     individual whose mother drank alcohol during pregnancy, 
     including physical, mental, behavioral, and/or learning 
     disabilities with possible lifelong implications.
       ``(B) Inclusions.--The term `fetal alcohol spectrum 
     disorders' may include--
       ``(i) fetal alcohol syndrome (FAS);
       ``(ii) fetal alcohol effect (FAE);
       ``(iii) alcohol-related birth defects; and
       ``(iv) alcohol-related neurodevelopmental disorders (ARND).
       ``(6) Fetal alcohol syndrome or fas.--The term `fetal 
     alcohol syndrome' or `FAS' means any 1 of a spectrum of 
     effects that may occur when a woman drinks alcohol during 
     pregnancy, the diagnosis of which involves the confirmed 
     presence of the following 3 criteria:
       ``(A) Craniofacial abnormalities.
       ``(B) Growth deficits.
       ``(C) Central nervous system abnormalities.
       ``(7) Rehabilitation.--The term `rehabilitation' means to 
     restore the ability or capacity to engage in usual and 
     customary life activities through education and therapy.
       ``(8) Substance abuse.--The term `substance abuse' includes 
     inhalant abuse.

     ``SEC. 718. AUTHORIZATION OF APPROPRIATIONS.

       ``There is authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2017 to 
     carry out the provisions of this title.

                      ``TITLE VIII--MISCELLANEOUS

     ``SEC. 801. REPORTS.

       ``For each fiscal year following the date of enactment of 
     the Indian Health Care Improvement Act Amendments of 2008, 
     the Secretary shall transmit to Congress a report containing 
     the following:
       ``(1) A report on the progress made in meeting the 
     objectives of this Act, including a review of programs 
     established or assisted pursuant to this Act and assessments 
     and recommendations of additional programs or additional 
     assistance necessary to, at a minimum, provide health 
     services to Indians and ensure a health status for Indians, 
     which are at a parity with the health services available to 
     and the health status of the general population.
       ``(2) A report on whether, and to what extent, new national 
     health care programs, benefits, initiatives, or financing 
     systems have had an impact on the purposes of this Act and 
     any steps that the Secretary may have taken to consult with 
     Indian Tribes, Tribal Organizations, and Urban Indian 
     Organizations to address such impact, including a report on 
     proposed changes in allocation of funding pursuant to section 
     808.
       ``(3) A report on the use of health services by Indians--
       ``(A) on a national and area or other relevant geographical 
     basis;
       ``(B) by gender and age;
       ``(C) by source of payment and type of service;
       ``(D) comparing such rates of use with rates of use among 
     comparable non-Indian populations; and
       ``(E) provided under contracts.
       ``(4) A report of contractors to the Secretary on Health 
     Care Educational Loan Repayments every 6 months required by 
     section 110.
       ``(5) A general audit report of the Secretary on the Health 
     Care Educational Loan Repayment Program as required by 
     section 110(n).
       ``(6) A report of the findings and conclusions of 
     demonstration programs on development of educational 
     curricula for substance abuse counseling as required in 
     section 125(f).
       ``(7) A separate statement which specifies the amount of 
     funds requested to carry out the provisions of section 201.
       ``(8) A report of the evaluations of health promotion and 
     disease prevention as required in section 203(c).
       ``(9) A biennial report to Congress on infectious diseases 
     as required by section 212.
       ``(10) A report on environmental and nuclear health hazards 
     as required by section 215.
       ``(11) An annual report on the status of all health care 
     facilities needs as required by section 301(c)(2)(B) and 
     301(d).
       ``(12) Reports on safe water and sanitary waste disposal 
     facilities as required by section 302(h).
       ``(13) An annual report on the expenditure of non-Service 
     funds for renovation as required by sections 304(b)(2).
       ``(14) A report identifying the backlog of maintenance and 
     repair required at Service and tribal facilities required by 
     section 313(a).
       ``(15) A report providing an accounting of reimbursement 
     funds made available to the Secretary under titles XVIII, 
     XIX, and XXI of the Social Security Act.
       ``(16) A report on any arrangements for the sharing of 
     medical facilities or services, as authorized by section 406.
       ``(17) A report on evaluation and renewal of Urban Indian 
     programs under section 505.
       ``(18) A report on the evaluation of programs as required 
     by section 513(d).
       ``(19) A report on alcohol and substance abuse as required 
     by section 701(f).
       ``(20) A report on Indian youth mental health services as 
     required by section 707(h).
       ``(21) A report on the reallocation of base resources if 
     required by section 808.

     ``SEC. 802. REGULATIONS.

       ``(a) Deadlines.--
       ``(1) Procedures.--Not later than 90 days after the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2008, the Secretary shall initiate procedures 
     under subchapter III of chapter 5 of title 5, United States 
     Code, to negotiate and promulgate such regulations or 
     amendments thereto that are necessary to carry out titles II 
     (except section 202) and VII, the sections of title III for 
     which negotiated rulemaking is specifically required, and 
     section 807. Unless otherwise required, the Secretary may 
     promulgate regulations to carry out titles I, III, IV, and V, 
     and section 202, using the procedures required by chapter V 
     of title 5, United States Code (commonly known as the 
     `Administrative Procedure Act').
       ``(2) Proposed regulations.--Proposed regulations to 
     implement this Act shall be published in the Federal Register 
     by the Secretary no later than 2 years after the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2008 and shall have no less than a 120-day 
     comment period.
       ``(3) Final regulations.--The Secretary shall publish in 
     the Federal Register final regulations to implement this Act 
     by not later than 3 years after the date of enactment of the 
     Indian Health Care Improvement Act Amendments of 2008.
       ``(b) Committee.--A negotiated rulemaking committee 
     established pursuant to section 565 of title 5, United States 
     Code, to carry out this section shall have as its members 
     only representatives of the Federal Government and 
     representatives of Indian Tribes, and Tribal Organizations, a 
     majority of whom shall be nominated by and be representatives 
     of Indian Tribes and Tribal Organizations from each Service 
     Area.
       ``(c) Adaptation of Procedures.--The Secretary shall adapt 
     the negotiated rulemaking procedures to the unique context of 
     self-governance and the government-to-government relationship 
     between the United States and Indian Tribes.
       ``(d) Lack of Regulations.--The lack of promulgated 
     regulations shall not limit the effect of this Act.
       ``(e) Inconsistent Regulations.--The provisions of this Act 
     shall supersede any conflicting provisions of law in effect 
     on the day before the date of enactment of the Indian Health 
     Care Improvement Act Amendments of 2008, and the Secretary is 
     authorized to repeal any regulation inconsistent with the 
     provisions of this Act.

     ``SEC. 803. PLAN OF IMPLEMENTATION.

       ``Not later than 9 months after the date of enactment of 
     the Indian Health Care Improvement Act Amendments of 2008, 
     the Secretary, in consultation with Indian Tribes and Tribal 
     Organizations, and in conference with Urban Indian 
     Organizations, shall submit to Congress a plan explaining the 
     manner and schedule, by title and section, by which the 
     Secretary will implement the provisions of this Act. This 
     consultation may be conducted jointly with the annual budget 
     consultation pursuant to the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 450 et seq).

     ``SEC. 804. AVAILABILITY OF FUNDS.

       ``The funds appropriated pursuant to this Act shall remain 
     available until expended.

[[Page 2764]]



     ``SEC. 805. LIMITATION RELATING TO ABORTION.

       ``(a) Definition of Health Benefits Coverage.--In this 
     section, the term `health benefits coverage' means a health-
     related service or group of services provided pursuant to a 
     contract, compact, grant, or other agreement.
       ``(b) Limitation.--
       ``(1) In general.--Except as provided in paragraph (2), no 
     funds or facilities of the Service may be used--
       ``(A) to provide any abortion; or
       ``(B) to provide, or pay any administrative cost of, any 
     health benefits coverage that includes coverage of an 
     abortion.
       ``(2) Exceptions.--The limitation described in paragraph 
     (1) shall not apply in any case in which--
       ``(A) a pregnancy is the result of an act of rape, or an 
     act of incest against a minor; or
       ``(B) the woman suffers from a physical disorder, physical 
     injury, or physical illness that, as certified by a 
     physician, would place the woman in danger of death unless an 
     abortion is performed, including a life-endangering physical 
     condition caused by or arising from the pregnancy itself.
       ``(c) Traditional Health Care Practices.--Although the 
     Secretary may promote traditional health care practices, 
     consistent with the Service standards for the provision of 
     health care, health promotion, and disease prevention under 
     this Act, the United States is not liable for any provision 
     of traditional health care practices pursuant to this Act 
     that results in damage, injury, or death to a patient. 
     Nothing in this subsection shall be construed to alter any 
     liability or other obligation that the United States may 
     otherwise have under the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 450 et seq.) or this Act.
       ``(d) Firearm Programs.--None of the funds made available 
     to carry out this Act may be used to carry out any 
     antifirearm program, gun buy-back program, or program to 
     discourage or stigmatize the private ownership of firearms 
     for collecting, hunting, or self-defense purposes.

     ``SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS.

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

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

       ``(a) Children.--Any individual who--
       ``(1) has not attained 19 years of age;
       ``(2) is the natural or adopted child, stepchild, foster 
     child, legal ward, or orphan of an eligible Indian; and
       ``(3) is not otherwise eligible for health services 
     provided by the Service,

     shall be eligible for all health services provided by the 
     Service on the same basis and subject to the same rules that 
     apply to eligible Indians until such individual attains 19 
     years of age. The existing and potential health needs of all 
     such individuals shall be taken into consideration by the 
     Service in determining the need for, or the allocation of, 
     the health resources of the Service. If such an individual 
     has been determined to be legally incompetent prior to 
     attaining 19 years of age, such individual shall remain 
     eligible for such services until 1 year after the date of a 
     determination of competency.
       ``(b) Spouses.--Any spouse of an eligible Indian who is not 
     an Indian, or who is of Indian descent but is not otherwise 
     eligible for the health services provided by the Service, 
     shall be eligible for such health services if all such 
     spouses or spouses who are married to members of each Indian 
     Tribe being served are made eligible, as a class, by an 
     appropriate resolution of the governing body of the Indian 
     Tribe or Tribal Organization providing such services. The 
     health needs of persons made eligible under this paragraph 
     shall not be taken into consideration by the Service in 
     determining the need for, or allocation of, its health 
     resources.
       ``(c) Provision of Services to Other Individuals.--
       ``(1) In general.--The Secretary is authorized to provide 
     health services under this subsection through health programs 
     operated directly by the Service to individuals who reside 
     within the Service Unit and who are not otherwise eligible 
     for such health services if--
       ``(A) the Indian Tribes served by such Service Unit request 
     such provision of health services to such individuals; and
       ``(B) the Secretary and the served Indian Tribes have 
     jointly determined that--
       ``(i) the provision of such health services will not result 
     in a denial or diminution of health services to eligible 
     Indians; and
       ``(ii) there is no reasonable alternative health facilities 
     or services, within or without the Service Unit, available to 
     meet the health needs of such individuals.
       ``(2) ISDEAA programs.--In the case of health programs and 
     facilities operated under a contract or compact entered into 
     under the Indian Self-Determination and Education Assistance 
     Act (25 U.S.C. 450 et seq.), the governing body of the Indian 
     Tribe or Tribal Organization providing health services under 
     such contract or compact is authorized to determine whether 
     health services should be provided under such contract 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 
     paragraph (1)(B).
       ``(3) Payment for services.--
       ``(A) In general.--Persons receiving health services 
     provided by the Service under this subsection shall be liable 
     for payment of such health services under a schedule of 
     charges prescribed by the Secretary which, in the judgment of 
     the Secretary, results in reimbursement in an amount not less 
     than the actual cost of providing the health services. 
     Notwithstanding section 404 of this Act or any other 
     provision of law, amounts collected under this subsection, 
     including Medicare, Medicaid, or SCHIP reimbursements under 
     titles XVIII, XIX, and XXI of the Social Security Act, shall 
     be credited to the account of the program providing the 
     service and shall be used for the purposes listed in section 
     401(d)(2) and amounts collected under this subsection shall 
     be available for expenditure within such program.
       ``(B) Indigent people.--Health services may be provided by 
     the Secretary through the Service under this subsection to an 
     indigent individual who would not be otherwise eligible for 
     such health services but for the provisions of paragraph (1) 
     only if an agreement has been entered into with a State or 
     local government under which the State or local government 
     agrees to reimburse the Service for the expenses incurred by 
     the Service in providing such health services to such 
     indigent individual.
       ``(4) Revocation of consent for services.--
       ``(A) Single tribe service area.--In the case of a Service 
     Area which serves only 1 Indian Tribe, the authority of the 
     Secretary to provide health services under paragraph (1) 
     shall terminate at the end of the fiscal year succeeding the 
     fiscal year in which the governing body of the Indian Tribe 
     revokes its concurrence to the provision of such health 
     services.
       ``(B) Multitribal service area.--In the case of a 
     multitribal Service Area, the authority of the Secretary to 
     provide health services under paragraph (1) shall terminate 
     at the end of the fiscal year succeeding the fiscal year in 
     which at least 51 percent of the number of Indian Tribes in 
     the Service Area revoke their concurrence to the provisions 
     of such health services.
       ``(d) Other Services.--The Service may provide health 
     services under this subsection to individuals who are not 
     eligible for health services provided by the Service under 
     any other provision of law in order to--
       ``(1) achieve stability in a medical emergency;
       ``(2) prevent the spread of a communicable disease or 
     otherwise deal with a public health hazard;
       ``(3) provide care to non-Indian women pregnant with an 
     eligible Indian's child for the duration of the pregnancy 
     through postpartum; or
       ``(4) provide care to immediate family members of an 
     eligible individual if such care is directly related to the 
     treatment of the eligible individual.
       ``(e) Hospital Privileges for Practitioners.--Hospital 
     privileges in health facilities operated and maintained by 
     the Service or operated under a contract or compact pursuant 
     to the Indian Self-Determination and Education Assistance Act 
     (25 U.S.C. 450 et seq.) may be extended to non-Service health 
     care practitioners who provide services to individuals 
     described in subsection (a), (b), (c), or (d). Such non-
     Service health care practitioners may, as part of the 
     privileging process, be designated as employees of the 
     Federal Government for purposes of section 1346(b) and 
     chapter 171 of title 28, United States Code (relating to 
     Federal tort claims) only with respect to acts or omissions 
     which occur in the course of providing services to eligible 
     individuals as a part of the conditions under which such 
     hospital privileges are extended.
       ``(f) Eligible Indian.--For purposes of this section, the 
     term `eligible Indian' means any Indian who is eligible for 
     health services provided by the Service without regard to the 
     provisions of this section.

     ``SEC. 808. REALLOCATION OF BASE RESOURCES.

       ``(a) Report Required.--Notwithstanding any other provision 
     of law, any allocation of Service funds for a fiscal year 
     that reduces

[[Page 2765]]

     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 Congress, under section 801, a report on the 
     proposed change in allocation of funding, including the 
     reasons for the change and its likely effects.
       ``(b) Exception.--Subsection (a) shall not apply if the 
     total amount appropriated to the Service for a fiscal year is 
     at least 5 percent less than the amount appropriated to the 
     Service for the previous fiscal year.

     ``SEC. 809. RESULTS OF DEMONSTRATION PROJECTS.

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

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

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

     ``SEC. 811. TRIBAL EMPLOYMENT.

       ``For purposes of section 2(2) of the Act of July 5, 1935 
     (49 Stat. 450, chapter 372), an Indian Tribe or Tribal 
     Organization carrying out a contract or compact pursuant to 
     the Indian Self-Determination and Education Assistance Act 
     (25 U.S.C. 450 et seq.) shall not be considered an 
     `employer'.

     ``SEC. 812. 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. 813. ESTABLISHMENT OF NATIONAL BIPARTISAN COMMISSION 
                   ON INDIAN HEALTH CARE.

       ``(a) Establishment.--There is established the National 
     Bipartisan Indian Health Care Commission (the `Commission').
       ``(b) Duties of Commission.--The duties of the Commission 
     are the following:
       ``(1) To establish a study committee composed of those 
     members of the Commission appointed by the Director and at 
     least 4 members of Congress from among the members of the 
     Commission, the duties of which shall be the following:
       ``(A) To the extent necessary to carry out its duties, 
     collect and compile data necessary to understand the extent 
     of Indian needs with regard to the provision of health 
     services, regardless of the location of Indians, including 
     holding hearings and soliciting the views of Indians, Indian 
     Tribes, Tribal Organizations, and Urban Indian Organizations, 
     which may include authorizing and making funds available for 
     feasibility studies of various models for providing and 
     funding health services for all Indian beneficiaries, 
     including those who live outside of a reservation, 
     temporarily or permanently.
       ``(B) To make legislative recommendations to the Commission 
     regarding the delivery of Federal health care services to 
     Indians. Such recommendations shall include those related to 
     issues of eligibility, benefits, the range of service 
     providers, the cost of such services, financing such 
     services, and the optimal manner in which to provide such 
     services.
       ``(C) To determine the effect of the enactment of such 
     recommendations on (i) the existing system of delivery of 
     health services for Indians, and (ii) the sovereign status of 
     Indian Tribes.
       ``(D) Not later than 12 months after the appointment of all 
     members of the Commission, to submit a written report of its 
     findings and recommendations to the full Commission. The 
     report shall include a statement of the minority and majority 
     position of the Committee and shall be disseminated, at a 
     minimum, to every Indian Tribe, Tribal Organization, and 
     Urban Indian Organization for comment to the Commission.
       ``(E) To report regularly to the full Commission regarding 
     the findings and recommendations developed by the study 
     committee in the course of carrying out its duties under this 
     section.
       ``(2) To review and analyze the recommendations of the 
     report of the study committee.
       ``(3) To make legislative recommendations to Congress 
     regarding the delivery of Federal health care services to 
     Indians. Such recommendations shall include those related to 
     issues of eligibility, benefits, the range of service 
     providers, the cost of such services, financing such 
     services, and the optimal manner in which to provide such 
     services.
       ``(4) Not later than 18 months following the date of 
     appointment of all members of the Commission, submit a 
     written report to Congress regarding the delivery of Federal 
     health care services to Indians. Such recommendations shall 
     include those related to issues of eligibility, benefits, the 
     range of service providers, the cost of such services, 
     financing such services, and the optimal manner in which to 
     provide such services.
       ``(c) Members.--
       ``(1) Appointment.--The Commission shall be composed of 25 
     members, appointed as follows:
       ``(A) Ten members of Congress, including 3 from the House 
     of Representatives and 2 from the Senate, appointed by their 
     respective majority leaders, and 3 from the House of 
     Representatives and 2 from the Senate, appointed by their 
     respective minority leaders, and who shall be members of the 
     standing committees of Congress that consider legislation 
     affecting health care to Indians.
       ``(B) Twelve persons chosen by the congressional members of 
     the Commission, 1 from each Service Area as currently 
     designated by the Director to be chosen from among 3 nominees 
     from each Service Area put forward by the Indian Tribes 
     within the area, with due regard being given to the 
     experience and expertise of the nominees in the provision of 
     health care to Indians and to a reasonable representation on 
     the commission of members who are familiar with various 
     health care delivery modes and who represent Indian Tribes of 
     various size populations.
       ``(C) Three persons appointed by the Director who are 
     knowledgeable about the provision of health care to Indians, 
     at least 1 of whom shall be appointed from among 3 nominees 
     put forward by those programs whose funds are provided in 
     whole or in part by the Service primarily or exclusively for 
     the benefit of Urban Indians.
       ``(D) All those persons chosen by the congressional members 
     of the Commission and by the Director shall be members of 
     federally recognized Indian Tribes.
       ``(2) Chair; vice chair.--The Chair and Vice Chair of the 
     Commission shall be selected by the congressional members of 
     the Commission.
       ``(3) Terms.--The terms of members of the Commission shall 
     be for the life of the Commission.
       ``(4) Deadline for appointments.--Congressional members of 
     the Commission shall be appointed not later than 180 days 
     after the date of enactment of the Indian Health Care 
     Improvement Act Amendments of 2008, and the remaining members 
     of the Commission shall be appointed not later than 60 days 
     following the appointment of the congressional members.
       ``(5) Vacancy.--A vacancy in the Commission shall be filled 
     in the manner in which the original appointment was made.
       ``(d) Compensation.--
       ``(1) Congressional members.--Each congressional member of 
     the Commission shall receive no additional pay, allowances, 
     or benefits by reason of their service on the Commission and 
     shall receive travel expenses and per diem in lieu of 
     subsistence in accordance with sections 5702 and 5703 of 
     title 5, United States Code.
       ``(2) Other members.--Remaining members of the Commission, 
     while serving on the business of the Commission (including 
     travel time), shall be entitled to receive compensation at 
     the per diem equivalent of the rate provided for level IV of 
     the Executive Schedule under section 5315 of title 5, United 
     States Code, and while so serving away from home and the 
     member's regular place of business, a member may be allowed 
     travel expenses, as authorized by the Chairman of the 
     Commission. For purpose of pay (other than pay of members of 
     the Commission) and employment benefits, rights, and 
     privileges, all personnel of the Commission shall be treated 
     as if they were employees of the United States Senate.
       ``(e) Meetings.--The Commission shall meet at the call of 
     the Chair.
       ``(f) Quorum.--A quorum of the Commission shall consist of 
     not less than 15 members, provided that no less than 6 of the 
     members of Congress who are Commission members are present 
     and no less than 9 of the members who are Indians are 
     present.
       ``(g) Executive Director; Staff; Facilities.--
       ``(1) Appointment; pay.--The Commission shall appoint an 
     executive director of the Commission. The executive director 
     shall be paid the rate of basic pay for level V of the 
     Executive Schedule.
       ``(2) Staff appointment.--With the approval of the 
     Commission, the executive director may appoint such personnel 
     as the executive director deems appropriate.
       ``(3) Staff pay.--The staff of the Commission shall be 
     appointed without regard to the provisions of title 5, United 
     States Code, governing appointments in the competitive 
     service, and shall be paid without regard to the provisions 
     of chapter 51 and subchapter III of chapter 53 of such title 
     (relating to classification and General Schedule pay rates).
       ``(4) Temporary services.--With the approval of the 
     Commission, the executive director may procure temporary and 
     intermittent services under section 3109(b) of title 5, 
     United States Code.
       ``(5) Facilities.--The Administrator of General Services 
     shall locate suitable office space for the operation of the 
     Commission. The facilities shall serve as the headquarters of 
     the Commission and shall include all necessary equipment and 
     incidentals required

[[Page 2766]]

     for the proper functioning of the Commission.
       ``(h) Hearings.--(1) For the purpose of carrying out its 
     duties, the Commission may hold such hearings and undertake 
     such other activities as the Commission determines to be 
     necessary to carry out its duties, provided that at least 6 
     regional hearings are held in different areas of the United 
     States in which large numbers of Indians are present. Such 
     hearings are to be held to solicit the views of Indians 
     regarding the delivery of health care services to them. To 
     constitute a hearing under this subsection, at least 5 
     members of the Commission, including at least 1 member of 
     Congress, must be present. Hearings held by the study 
     committee established in this section may count toward the 
     number of regional hearings required by this subsection.
       ``(2)(A) The Director of the Congressional Budget Office or 
     the Chief Actuary of the Centers for Medicare & Medicaid 
     Services, or both, shall provide to the Commission, upon the 
     request of the Commission, such cost estimates as the 
     Commission determines to be necessary to carry out its 
     duties.
       ``(B) The Commission shall reimburse the Director of the 
     Congressional Budget Office for expenses relating to the 
     employment in the office of that Director of such additional 
     staff as may be necessary for the Director to comply with 
     requests by the Commission under subparagraph (A).
       ``(3) 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.
       ``(4) 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.
       ``(5) 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.
       ``(6) The Commission may secure directly from any Federal 
     agency information necessary to enable it to carry out its 
     duties, if the information may be disclosed under section 552 
     of title 4, United States Code. Upon request of the Chairman 
     of the Commission, the head of such agency shall furnish such 
     information to the Commission.
       ``(7) 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.
       ``(8) For purposes of costs relating to printing and 
     binding, including the cost of personnel detailed from the 
     Government Printing Office, the Commission shall be deemed to 
     be a committee of Congress.
       ``(i) Authorization of Appropriations.--There is authorized 
     to be appropriated $4,000,000 to carry out the provisions of 
     this section, which sum shall not be deducted from or affect 
     any other appropriation for health care for Indian persons.
       ``(j) Nonapplicability of FACA.--The Federal Advisory 
     Committee Act (5 U.S.C. App.) shall not apply to the 
     Commission.

     ``SEC. 814. CONFIDENTIALITY OF MEDICAL QUALITY ASSURANCE 
                   RECORDS; QUALIFIED IMMUNITY FOR PARTICIPANTS.

       ``(a) Confidentiality of Records.--Medical quality 
     assurance records created by or for any Indian Health Program 
     or a health program of an Urban Indian Organization as part 
     of a medical quality assurance program are confidential and 
     privileged. Such records may not be disclosed to any person 
     or entity, except as provided in subsection (c).
       ``(b) Prohibition on Disclosure and Testimony.--
       ``(1) In general.--No part of any medical quality assurance 
     record described in subsection (a) may be subject to 
     discovery or admitted into evidence in any judicial or 
     administrative proceeding, except as provided in subsection 
     (c).
       ``(2) Testimony.--A person who reviews or creates medical 
     quality assurance records for any Indian Health Program or 
     Urban Indian Organization who participates in any proceeding 
     that reviews or creates such records may not be permitted or 
     required to testify in any judicial or administrative 
     proceeding with respect to such records or with respect to 
     any finding, recommendation, evaluation, opinion, or action 
     taken by such person or body in connection with such records 
     except as provided in this section.
       ``(c) Authorized Disclosure and Testimony.--
       ``(1) In general.--Subject to paragraph (2), a medical 
     quality assurance record described in subsection (a) may be 
     disclosed, and a person referred to in subsection (b) may 
     give testimony in connection with such a record, only as 
     follows:
       ``(A) To a Federal executive agency or private 
     organization, if such medical quality assurance record or 
     testimony is needed by such agency or organization to perform 
     licensing or accreditation functions related to any Indian 
     Health Program or to a health program of an Urban Indian 
     Organization to perform monitoring, required by law, of such 
     program or organization.
       ``(B) To an administrative or judicial proceeding commenced 
     by a present or former Indian Health Program or Urban Indian 
     Organization provider concerning the termination, suspension, 
     or limitation of clinical privileges of such health care 
     provider.
       ``(C) To a governmental board or agency or to a 
     professional health care society or organization, if such 
     medical quality assurance record or testimony is needed by 
     such board, agency, society, or organization to perform 
     licensing, credentialing, or the monitoring of professional 
     standards with respect to any health care provider who is or 
     was an employee of any Indian Health Program or Urban Indian 
     Organization.
       ``(D) To a hospital, medical center, or other institution 
     that provides health care services, if such medical quality 
     assurance record or testimony is needed by such institution 
     to assess the professional qualifications of any health care 
     provider who is or was an employee of any Indian Health 
     Program or Urban Indian Organization and who has applied for 
     or been granted authority or employment to provide health 
     care services in or on behalf of such program or 
     organization.
       ``(E) To an officer, employee, or contractor of the Indian 
     Health Program or Urban Indian Organization that created the 
     records or for which the records were created. If that 
     officer, employee, or contractor has a need for such record 
     or testimony to perform official duties.
       ``(F) To a criminal or civil law enforcement agency or 
     instrumentality charged under applicable law with the 
     protection of the public health or safety, if a qualified 
     representative of such agency or instrumentality makes a 
     written request that such record or testimony be provided for 
     a purpose authorized by law.
       ``(G) In an administrative or judicial proceeding commenced 
     by a criminal or civil law enforcement agency or 
     instrumentality referred to in subparagraph (F), but only 
     with respect to the subject of such proceeding.
       ``(2) Identity of participants.--With the exception of the 
     subject of a quality assurance action, the identity of any 
     person receiving health care services from any Indian Health 
     Program or Urban Indian Organization or the identity of any 
     other person associated with such program or organization for 
     purposes of a medical quality assurance program that is 
     disclosed in a medical quality assurance record described in 
     subsection (a) shall be deleted from that record or document 
     before any disclosure of such record is made outside such 
     program or organization.
       ``(d) Disclosure for Certain Purposes.--
       ``(1) In general.--Nothing in this section shall be 
     construed as authorizing or requiring the withholding from 
     any person or entity aggregate statistical information 
     regarding the results of any Indian Health Program's or Urban 
     Indian Organization's medical quality assurance programs.
       ``(2) Withholding from congress.--Nothing in this section 
     shall be construed as authority to withhold any medical 
     quality assurance record from a committee of either House of 
     Congress, any joint committee of Congress, or the Government 
     Accountability Office if such record pertains to any matter 
     within their respective jurisdictions.
       ``(e) Prohibition on Disclosure of Record or Testimony.--A 
     person or entity having possession of or access to a record 
     or testimony described by this section may not disclose the 
     contents of such record or testimony in any manner or for any 
     purpose except as provided in this section.
       ``(f) Exemption From Freedom of Information Act.--Medical 
     quality assurance records described in subsection (a) may not 
     be made available to any person under section 552 of title 5.
       ``(g) Limitation on Civil Liability.--A person who 
     participates in or provides information to a person or body 
     that reviews or creates medical quality assurance records 
     described in subsection (a) shall not be civilly liable for 
     such participation or for providing such information if the 
     participation or provision of information was in good faith 
     based on prevailing professional standards at the time the 
     medical quality assurance program activity took place.
       ``(h) Application to Information in Certain Other 
     Records.--Nothing in this section shall be construed as 
     limiting access to the information in a record created and 
     maintained outside a medical quality assurance program, 
     including a patient's medical records, on the grounds that 
     the information was presented during meetings of a review 
     body that are part of a medical quality assurance program.
       ``(i) Regulations.--The Secretary, acting through the 
     Service, is authorized to promulgate regulations pursuant to 
     section 802.
       ``(j) Definitions.--In this section:
       ``(1) The term `health care provider' means any health care 
     professional, including community health aides and 
     practitioners certified under section 121, who are granted 
     clinical practice privileges or employed to provide health 
     care services in an Indian Health Program or health program 
     of an Urban Indian Organization, who is licensed or certified 
     to perform health care services by a governmental board or 
     agency or professional health care society or organization.

[[Page 2767]]

       ``(2) The term `medical quality assurance program' means 
     any activity carried out before, on, or after the date of 
     enactment of this Act by or for any Indian Health Program or 
     Urban Indian Organization to assess the quality of medical 
     care, including activities conducted by or on behalf of 
     individuals, Indian Health Program or Urban Indian 
     Organization medical or dental treatment review committees, 
     or other review bodies responsible for review of adverse 
     incidents, claims, quality assurance, credentials, infection 
     control, patient safety, patient care assessment (including 
     treatment procedures, blood, drugs, and therapeutics), 
     medical records, health resources management review and 
     identification and prevention of medical or dental incidents 
     and risks.
       ``(3) The term `medical quality assurance record' means the 
     proceedings, records, minutes, and reports that emanate from 
     quality assurance program activities described in paragraph 
     (2) and are produced or compiled by or for an Indian Health 
     Program or Urban Indian Organization as part of a medical 
     quality assurance program.
       ``(k) Relationship to Other Law.--This section shall 
     continue in force and effect, except as otherwise 
     specifically provided in any Federal law enacted after the 
     date of enactment of the Indian Health Care Improvement Act 
     Amendments of 2008.

     ``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).

     ``SEC. 816. TRIBAL HEALTH PROGRAM OPTION FOR COST SHARING.

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

     ``SEC. 817. 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.

     ``SEC. 818. STUDY ON TOBACCO-RELATED DISEASE AND 
                   DISPROPORTIONATE HEALTH EFFECTS ON TRIBAL 
                   POPULATIONS.

       ``Not later than 180 days after the date of enactment of 
     the Indian Health Care Improvement Act Amendments of 2008, 
     the Secretary, in consultation with appropriate Federal 
     departments and agencies and acting through the epidemiology 
     centers established under section 209, shall solicit from 
     independent organizations bids to conduct, and shall submit 
     to Congress no later than 5 years after enactment a report 
     describing the results of, a study to determine possible 
     causes for the high prevalence of tobacco use among Indians.

     ``SEC. 819. APPROPRIATIONS; AVAILABILITY.

       ``Any new spending authority (described in subparagraph (A) 
     or (B) of section 401(c)(2) of the Congressional Budget Act 
     of 1974 (Public Law 93-344; 88 Stat. 317)) 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. 820. GAO REPORT ON COORDINATION OF SERVICES.

       ``(a) Study and Evaluation.--The Comptroller General of the 
     United States shall conduct a study, and evaluate the 
     effectiveness, of coordination of health care services 
     provided to Indians--
       ``(1) through Medicare, Medicaid, or SCHIP;
       ``(2) by the Service; or
       ``(3) using funds provided by--
       ``(A) State or local governments; or
       ``(B) Indian Tribes.
       ``(b) Report.--Not later than 18 months after the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2007, the Comptroller General shall submit to 
     Congress a report--
       ``(1) describing the results of the evaluation under 
     subsection (a); and
       ``(2) containing recommendations of the Comptroller General 
     regarding measures to support and increase coordination of 
     the provision of health care services to Indians as described 
     in subsection (a).

     ``SEC. 821. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2017 to 
     carry out this title.''.

     SEC. 102. SOBOBA SANITATION FACILITIES.

       The Act of December 17, 1970 (84 Stat. 1465), is amended by 
     adding at the end the following:
       ``Sec. 9.  Nothing in this Act shall preclude the Soboba 
     Band of Mission Indians and the Soboba Indian Reservation 
     from being provided with sanitation facilities and services 
     under the authority of section 7 of the Act of August 5, 1954 
     (68 Stat. 674), as amended by the Act of July 31, 1959 (73 
     Stat. 267).''.

     SEC. 103. NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION.

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

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

     ``SEC. 801. DEFINITIONS.

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

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

       ``(a) Establishment.--
       ``(1) 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.
       ``(2) Funding determinations.--No funds, gift, property, or 
     other item of value (including any interest accrued on such 
     an item) acquired by the Foundation shall--
       ``(A) be taken into consideration for purposes of 
     determining Federal appropriations relating to the provision 
     of health care and services to Indians; or
       ``(B) otherwise limit, diminish, or affect the Federal 
     responsibility for the provision of health care and services 
     to Indians.
       ``(b) Perpetual Existence.--The Foundation shall have 
     perpetual existence.
       ``(c) Nature of Corporation.--The Foundation--
       ``(1) shall be a charitable and nonprofit federally 
     chartered corporation; and
       ``(2) shall not be an agency or instrumentality of the 
     United States.
       ``(d) Place of Incorporation and Domicile.--The Foundation 
     shall be incorporated and domiciled in the District of 
     Columbia.
       ``(e) Duties.--The Foundation shall--
       ``(1) encourage, accept, and administer private gifts of 
     real and personal property, and any income from or interest 
     in such gifts, for the benefit of, or in support of, the 
     mission of the Service;
       ``(2) undertake and conduct such other activities as will 
     further the health and wellness activities and opportunities 
     of Native Americans; and
       ``(3) participate with and assist Federal, State, and 
     tribal governments, agencies, entities, and individuals in 
     undertaking and conducting activities that will further the 
     health and wellness activities and opportunities of Native 
     Americans.
       ``(f) Committee for the Establishment of Native American 
     Health and Wellness Foundation.--
       ``(1) In general.--The Secretary shall establish the 
     Committee for the Establishment of Native American Health and 
     Wellness Foundation to assist the Secretary in establishing 
     the Foundation.
       ``(2) Duties.--Not later than 180 days after the date of 
     enactment of this section, the Committee shall--
       ``(A) carry out such activities as are necessary to 
     incorporate the Foundation under the laws of the District of 
     Columbia, including acting as incorporators of the 
     Foundation;
       ``(B) ensure that the Foundation qualifies for and 
     maintains the status required to

[[Page 2768]]

     carry out this section, until the Board is established;
       ``(C) establish the constitution and initial bylaws of the 
     Foundation;
       ``(D) provide for the initial operation of the Foundation, 
     including providing for temporary or interim quarters, 
     equipment, and staff; and
       ``(E) appoint the initial members of the Board in 
     accordance with the constitution and initial bylaws of the 
     Foundation.
       ``(g) Board of Directors.--
       ``(1) In general.--The Board of Directors shall be the 
     governing body of the Foundation.
       ``(2) Powers.--The Board may exercise, or provide for the 
     exercise of, the powers of the Foundation.
       ``(3) Selection.--
       ``(A) In general.--Subject to subparagraph (B), the number 
     of members of the Board, the manner of selection of the 
     members (including the filling of vacancies), and the terms 
     of office of the members shall be as provided in the 
     constitution and bylaws of the Foundation.
       ``(B) Requirements.--
       ``(i) Number of members.--The Board shall have at least 11 
     members, who shall have staggered terms.
       ``(ii) Initial voting members.--The initial voting members 
     of the Board--

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

       ``(iii) Qualification.--The members of the Board shall be 
     United States citizens who are knowledgeable or experienced 
     in Native American health care and related matters.
       ``(C) Compensation.--A member of the Board shall not 
     receive compensation for service as a member, but shall be 
     reimbursed for actual and necessary travel and subsistence 
     expenses incurred in the performance of the duties of the 
     Foundation.
       ``(h) Officers.--
       ``(1) In general.--The officers of the Foundation shall 
     be--
       ``(A) a secretary, elected from among the members of the 
     Board; and
       ``(B) any other officers provided for in the constitution 
     and bylaws of the Foundation.
       ``(2) Chief operating officer.--The secretary of the 
     Foundation may serve, at the direction of the Board, as the 
     chief operating officer of the Foundation, or the Board may 
     appoint a chief operating officer, who shall serve at the 
     direction of the Board.
       ``(3) Election.--The manner of election, term of office, 
     and duties of the officers of the Foundation shall be as 
     provided in the constitution and bylaws of the Foundation.
       ``(i) Powers.--The Foundation--
       ``(1) shall adopt a constitution and bylaws for the 
     management of the property of the Foundation and the 
     regulation of the affairs of the Foundation;
       ``(2) may adopt and alter a corporate seal;
       ``(3) may enter into contracts;
       ``(4) may acquire (through a gift or otherwise), own, 
     lease, encumber, and transfer real or personal property as 
     necessary or convenient to carry out the purposes of the 
     Foundation;
       ``(5) may sue and be sued; and
       ``(6) may perform any other act necessary and proper to 
     carry out the purposes of the Foundation.
       ``(j) Principal Office.--
       ``(1) In general.--The principal office of the Foundation 
     shall be in the District of Columbia.
       ``(2) Activities; offices.--The activities of the 
     Foundation may be conducted, and offices may be maintained, 
     throughout the United States in accordance with the 
     constitution and bylaws of the Foundation.
       ``(k) Service of Process.--The Foundation shall comply with 
     the law on service of process of each State in which the 
     Foundation is incorporated and of each State in which the 
     Foundation carries on activities.
       ``(l) Liability of Officers, Employees, and Agents.--
       ``(1) In general.--The Foundation shall be liable for the 
     acts of the officers, employees, and agents of the Foundation 
     acting within the scope of their authority.
       ``(2) Personal liability.--A member of the Board shall be 
     personally liable only for gross negligence in the 
     performance of the duties of the member.
       ``(m) Restrictions.--
       ``(1) Limitation on spending.--Beginning with the fiscal 
     year following the first full fiscal year during which the 
     Foundation is in operation, the administrative costs of the 
     Foundation shall not exceed the percentage described in 
     paragraph (2) of the sum of--
       ``(A) the amounts transferred to the Foundation under 
     subsection (o) during the preceding fiscal year; and
       ``(B) donations received from private sources during the 
     preceding fiscal year.
       ``(2) Percentages.--The percentages referred to in 
     paragraph (1) are--
       ``(A) for the first fiscal year described in that 
     paragraph, 20 percent;
       ``(B) for the following fiscal year, 15 percent; and
       ``(C) for each fiscal year thereafter, 10 percent.
       ``(3) Appointment and hiring.--The appointment of officers 
     and employees of the Foundation shall be subject to the 
     availability of funds.
       ``(4) Status.--A member of the Board or officer, employee, 
     or agent of the Foundation shall not by reason of association 
     with the Foundation be considered to be an officer, employee, 
     or agent of the United States.
       ``(n) Audits.--The Foundation shall comply with section 
     10101 of title 36, United States Code, as if the Foundation 
     were a corporation under part B of subtitle II of that title.
       ``(o) Funding.--
       ``(1) Authorization of appropriations.--There is authorized 
     to be appropriated to carry out subsection (e)(1) $500,000 
     for each fiscal year, as adjusted to reflect changes in the 
     Consumer Price Index for all-urban consumers published by the 
     Department of Labor.
       ``(2) Transfer of donated funds.--The Secretary shall 
     transfer to the Foundation funds held by the Department of 
     Health and Human Services under the Act of August 5, 1954 (42 
     U.S.C. 2001 et seq.), if the transfer or use of the funds is 
     not prohibited by any term under which the funds were 
     donated.

     ``SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT.

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

     SEC. 104. MODIFICATION OF TERM.

       (a) In General.--Except as provided in subsection (b), the 
     Indian Health Care Improvement Act (as amended by section 
     101) and each provision of the Social Security Act amended by 
     title II are amended (as applicable)--
       (1) by striking ``Urban Indian Organizations'' each place 
     it appears and inserting ``urban Indian organizations'';
       (2) by striking ``Urban Indian Organization'' each place it 
     appears and inserting ``urban Indian organization'';
       (3) by striking ``Urban Indians'' each place it appears and 
     inserting ``urban Indians'';
       (4) by striking ``Urban Indian'' each place it appears and 
     inserting ``urban Indian'';
       (5) by striking ``Urban Centers'' each place it appears and 
     inserting ``urban centers''; and
       (6) by striking ``Urban Center'' each place it appears and 
     inserting ``urban center''.
       (b) Exception.--The amendments made by subsection (a) shall 
     not apply with respect to--
       (1) the matter preceding paragraph (1) of section 510 of 
     the Indian Health Care Improvement Act (as amended by section 
     101); and
       (2) ``Urban Indian'' the first place it appears in section 
     513(a) of the Indian Health Care Improvement Act (as amended 
     by section 101).
       (c) Modification of Definition.--Section 4 of the Indian 
     Health Care Improvement Act (as amended by section 101) is 
     amended by striking paragraph (27) and inserting the 
     following:
       ``(27) The term `urban Indian' means any individual who 
     resides in an urban center and who meets 1 or more of the 4 
     criteria in subparagraphs (A) through (D) of paragraph 
     (12).''.

     SEC. 105. GAO STUDY AND REPORT ON PAYMENTS FOR CONTRACT 
                   HEALTH SERVICES.

       (a) Study.--
       (1) In general.--The Comptroller General of the United 
     States (in this section referred to as the ``Comptroller 
     General'') shall conduct a study on the utilization of health 
     care furnished by health care providers under the contract 
     health services program funded by the Indian Health Service 
     and operated by

[[Page 2769]]

     the Indian Health Service, an Indian Tribe, or a Tribal 
     Organization (as those terms are defined in section 4 of the 
     Indian Health Care Improvement Act).
       (2) Analysis.--The study conducted under paragraph (1) 
     shall include an analysis of--
       (A) the amounts reimbursed under the contract health 
     services program described in paragraph (1) for health care 
     furnished by entities, individual providers, and suppliers, 
     including a comparison of reimbursement for such health care 
     through other public programs and in the private sector;
       (B) barriers to accessing care under such contract health 
     services program, including, but not limited to, barriers 
     relating to travel distances, cultural differences, and 
     public and private sector reluctance to furnish care to 
     patients under such program;
       (C) the adequacy of existing Federal funding for health 
     care under such contract health services program; and
       (D) any other items determined appropriate by the 
     Comptroller General.
       (b) Report.--Not later than 18 months after the date of 
     enactment of this Act, the Comptroller General shall submit 
     to Congress a report on the study conducted under subsection 
     (a), together with recommendations regarding--
       (1) the appropriate level of Federal funding that should be 
     established for health care under the contract health 
     services program described in subsection (a)(1); and
       (2) how to most efficiently utilize such funding.
       (c) Consultation.--In conducting the study under subsection 
     (a) and preparing the report under subsection (b), the 
     Comptroller General shall consult with the Indian Health 
     Service, Indian Tribes, and Tribal Organizations.

     SEC. 106. 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.

     SEC. 107. 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.

 TITLE II--IMPROVEMENT OF INDIAN HEALTH CARE PROVIDED UNDER THE SOCIAL 
                              SECURITY ACT

     SEC. 201. EXPANSION OF PAYMENTS UNDER MEDICARE, MEDICAID, AND 
                   SCHIP FOR ALL COVERED SERVICES FURNISHED BY 
                   INDIAN HEALTH PROGRAMS.

       (a) Medicaid.--
       (1) Expansion to all covered services.--Section 1911 of the 
     Social Security Act (42 U.S.C. 1396j) is amended--
       (A) by amending the heading to read as follows:

     ``SEC. 1911. INDIAN HEALTH PROGRAMS.'';

     and
       (B) by amending subsection (a) to read as follows:
       ``(a) Eligibility for Payment for Medical Assistance.--The 
     Indian Health Service and an Indian Tribe, Tribal 
     Organization, or an Urban Indian Organization shall be 
     eligible for payment for medical assistance provided under a 
     State plan or under waiver authority with respect to items 
     and services furnished by the Indian Health Service, Indian 
     Tribe, Tribal Organization, or Urban Indian Organization if 
     the furnishing of such services meets all the conditions and 
     requirements which are applicable generally to the furnishing 
     of items and services under this title and under such plan or 
     waiver authority.''.
       (2) Compliance with conditions and requirements.--
     Subsection (b) of such section is amended to read as follows:
       ``(b) Compliance With Conditions and Requirements.--A 
     facility of the Indian Health Service or an Indian Tribe, 
     Tribal Organization, or an Urban Indian Organization which is 
     eligible for payment under subsection (a) with respect to the 
     furnishing of items and services, but which does not meet all 
     of the conditions and requirements of this title and under a 
     State plan or waiver authority which are applicable generally 
     to such facility, shall make such improvements as are 
     necessary to achieve or maintain compliance with such 
     conditions and requirements in accordance with a plan 
     submitted to and accepted by the Secretary for achieving or 
     maintaining compliance with such conditions and requirements, 
     and shall be deemed to meet such conditions and requirements 
     (and to be eligible for payment under this title), without 
     regard to the extent of its actual compliance with such 
     conditions and requirements, during the first 12 months after 
     the month in which such plan is submitted.''.
       (3) Revision of authority to enter into agreements.--
     Subsection (c) of such section is amended to read as follows:
       ``(c) Authority To Enter Into Agreements.--The Secretary 
     may enter into an agreement with a State for the purpose of 
     reimbursing the State for medical assistance provided by the 
     Indian Health Service, an Indian Tribe, Tribal Organization, 
     or an Urban Indian Organization (as so defined), directly, 
     through referral, or under contracts or other arrangements 
     between the Indian Health Service, an Indian Tribe, Tribal 
     Organization, or an Urban Indian Organization and another 
     health care provider to Indians who are eligible for medical 
     assistance under the State plan or under waiver authority.''.
       (4) Cross-references to special fund for improvement of ihs 
     facilities; direct billing option; definitions.--Such section 
     is further amended by striking subsection (d) and adding at 
     the end the following new subsections:
       ``(d) Special Fund for Improvement of IHS Facilities.--For 
     provisions relating to the authority of the Secretary to 
     place payments to which a facility of the Indian Health 
     Service is eligible for payment under this title into a 
     special fund established under section 401(c)(1) of the 
     Indian Health Care Improvement Act, and the requirement to 
     use amounts paid from such fund for making improvements in 
     accordance with subsection (b), see subparagraphs (A) and (B) 
     of section 401(c)(1) of such Act.
       ``(e) Direct Billing.--For provisions relating to the 
     authority of a Tribal Health Program or an Urban Indian 
     Organization to elect to directly bill for, and receive 
     payment for, health care items and services provided by such 
     Program or Organization for which payment is made under this 
     title, see section 401(d) of the Indian Health Care 
     Improvement Act.
       ``(f) Definitions.--In this section, the terms `Indian 
     Health Program', `Indian Tribe',`Tribal Health Program', 
     `Tribal Organization', and `Urban Indian Organization' have 
     the meanings given those terms in section 4 of the Indian 
     Health Care Improvement Act.''.
       (b) Medicare.--
       (1) Expansion to all covered services.--Section 1880 of 
     such Act (42 U.S.C. 1395qq) is amended--
       (A) by amending the heading to read as follows:

     ``SEC. 1880. INDIAN HEALTH PROGRAMS.'';

     and
       (B) by amending subsection (a) to read as follows:
       ``(a) Eligibility for Payments.--Subject to subsection (e), 
     the Indian Health Service and an Indian Tribe, Tribal 
     Organization, or an Urban Indian Organization shall be 
     eligible for payments under this title with respect to items 
     and services furnished by the Indian Health Service, Indian 
     Tribe, Tribal Organization, or Urban Indian Organization if 
     the furnishing of such services meets all the conditions and 
     requirements which are applicable generally to the furnishing 
     of items and services under this title.''.
       (2) Compliance with conditions and requirements.--
     Subsection (b) of such section is amended to read as follows:
       ``(b) Compliance With Conditions and Requirements.--Subject 
     to subsection (e), a facility of the Indian Health Service or 
     an Indian Tribe, Tribal Organization, or an Urban

[[Page 2770]]

     Indian Organization which is eligible for payment under 
     subsection (a) with respect to the furnishing of items and 
     services, but which does not meet all of the conditions and 
     requirements of this title which are applicable generally to 
     such facility, shall make such improvements as are necessary 
     to achieve or maintain compliance with such conditions and 
     requirements in accordance with a plan submitted to and 
     accepted by the Secretary for achieving or maintaining 
     compliance with such conditions and requirements, and shall 
     be deemed to meet such conditions and requirements (and to be 
     eligible for payment under this title), without regard to the 
     extent of its actual compliance with such conditions and 
     requirements, during the first 12 months after the month in 
     which such plan is submitted.''.
       (3) Cross-references to special fund for improvement of ihs 
     facilities; direct billing option; definitions.--
       (A) In general.--Such section is further amended by 
     striking subsections (c) and (d) and inserting the following 
     new subsections:
       ``(c) Special Fund for Improvement of IHS Facilities.--For 
     provisions relating to the authority of the Secretary to 
     place payments to which a facility of the Indian Health 
     Service is eligible for payment under this title into a 
     special fund established under section 401(c)(1) of the 
     Indian Health Care Improvement Act, and the requirement to 
     use amounts paid from such fund for making improvements in 
     accordance with subsection (b), see subparagraphs (A) and (B) 
     of section 401(c)(1) of such Act.
       ``(d) Direct Billing.--For provisions relating to the 
     authority of a Tribal Health Program or an Urban Indian 
     Organization to elect to directly bill for, and receive 
     payment for, health care items and services provided by such 
     Program or Organization for which payment is made under this 
     title, see section 401(d) of the Indian Health Care 
     Improvement Act.''.
       (B) Conforming amendment.--Paragraph (3) of section 1880(e) 
     of such Act (42 U.S.C. 1395qq(e)) is amended by inserting 
     ``and section 401(c)(1) of the Indian Health Care Improvement 
     Act'' after ``Subsection (c)''.
       (4) Definitions.--Such section is further amended by 
     amending subsection (f) to read as follows:
       ``(f) Definitions.--In this section, the terms `Indian 
     Health Program', `Indian Tribe', `Service Unit', `Tribal 
     Health Program', `Tribal Organization', and `Urban Indian 
     Organization' have the meanings given those terms in section 
     4 of the Indian Health Care Improvement Act.''.
       (c) Application to SCHIP.--Section 2107(e)(1) of the Social 
     Security Act (42 U.S.C. 1397gg(e)(1)) is amended--
       (1) by redesignating subparagraph (D) as subparagraph (E); 
     and
       (2) by inserting after subparagraph (C), the following new 
     subparagraph:
       ``(D) Section 1911 (relating to Indian Health Programs, 
     other than subsection (d) of such section).''.

     SEC. 202. INCREASED OUTREACH TO INDIANS UNDER MEDICAID AND 
                   SCHIP AND IMPROVED COOPERATION IN THE PROVISION 
                   OF ITEMS AND SERVICES TO INDIANS UNDER SOCIAL 
                   SECURITY ACT HEALTH BENEFIT PROGRAMS.

       Section 1139 of the Social Security Act (42 U.S.C. 1320b-9) 
     is amended to read as follows:

     ``SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, HEALTH CARE 
                   FOR INDIANS UNDER TITLES XVIII, XIX, AND XXI.

       ``(a) Agreements With States for Medicaid and SCHIP 
     Outreach on or Near Reservations To Increase the Enrollment 
     of Indians in Those Programs.--
       ``(1) In general.--In order to improve the access of 
     Indians residing on or near a reservation to obtain benefits 
     under the Medicaid and State children's health insurance 
     programs established under titles XIX and XXI, the Secretary 
     shall encourage the State to take steps to provide for 
     enrollment on or near the reservation. Such steps may include 
     outreach efforts such as the outstationing of eligibility 
     workers, entering into agreements with the Indian Health 
     Service, Indian Tribes, Tribal Organizations, and Urban 
     Indian Organizations to provide outreach, education regarding 
     eligibility and benefits, enrollment, and translation 
     services when such services are appropriate.
       ``(2) Construction.--Nothing in subparagraph (A) shall be 
     construed as affecting arrangements entered into between 
     States and the Indian Health Service, Indian Tribes, Tribal 
     Organizations, or Urban Indian Organizations for such 
     Service, Tribes, or Organizations to conduct administrative 
     activities under such titles.
       ``(b) Requirement To Facilitate Cooperation.--The 
     Secretary, acting through the Centers for Medicare & Medicaid 
     Services, shall take such steps as are necessary to 
     facilitate cooperation with, and agreements between, States 
     and the Indian Health Service, Indian Tribes, Tribal 
     Organizations, or Urban Indian Organizations with respect to 
     the provision of health care items and services to Indians 
     under the programs established under title XVIII, XIX, or 
     XXI.
       ``(c) Definition of Indian; Indian Tribe; Indian Health 
     Program; Tribal Organization; Urban Indian Organization.--In 
     this section, the terms `Indian', `Indian Tribe', `Indian 
     Health Program', `Tribal Organization', and `Urban Indian 
     Organization' have the meanings given those terms in section 
     4 of the Indian Health Care Improvement Act.''.

     SEC. 203. ADDITIONAL PROVISIONS TO INCREASE OUTREACH TO, AND 
                   ENROLLMENT OF, INDIANS IN SCHIP AND MEDICAID.

       (a) Nonapplication of 10 Percent Limit on Outreach and 
     Certain Other Expenditures.--Section 2105(c)(2) of the Social 
     Security Act (42 U.S.C. 1397ee(c)(2)) is amended by adding at 
     the end the following new subparagraph:
       ``(C) Nonapplication to expenditures for outreach to 
     increase the enrollment of indian children under this title 
     and title xix.--The limitation under subparagraph (A) on 
     expenditures for items described in subsection (a)(1)(D) 
     shall not apply in the case of expenditures for outreach 
     activities to families of Indian children likely to be 
     eligible for child health assistance under the plan or 
     medical assistance under the State plan under title XIX (or 
     under a waiver of such plan), to inform such families of the 
     availability of, and to assist them in enrolling their 
     children in, such plans, including such activities conducted 
     under grants, contracts, or agreements entered into under 
     section 1139(a).''.
       (b) Assurance of Payments to Indian Health Care Providers 
     for Child Health Assistance.--Section 2102(b)(3)(D) of such 
     Act (42 U.S.C. 1397bb(b)(3)(D)) is amended by striking ``(as 
     defined in section 4(c) of the Indian Health Care Improvement 
     Act, 25 U.S.C. 1603(c))'' and inserting ``, including how the 
     State will ensure that payments are made to Indian Health 
     Programs and Urban Indian Organizations operating in the 
     State for the provision of such assistance''.
       (c) Inclusion of Other Indian Financed Health Care Programs 
     in Exemption From Prohibition on Certain Payments.--Section 
     2105(c)(6)(B) of such Act (42 U.S.C. 1397ee(c)(6)(B)) is 
     amended by striking ``insurance program, other than an 
     insurance program operated or financed by the Indian Health 
     Service'' and inserting ``program, other than a health care 
     program operated or financed by the Indian Health Service or 
     by an Indian Tribe, Tribal Organization, or Urban Indian 
     Organization''.
       (d) Satisfaction of Medicaid Documentation Requirements.--
     Section 1903(x)(3)(B) of the Social Security Act (42 U.S.C. 
     1396b(x)(3)(B)) is amended--
       (1) by redesignating clause (v) as clause (vii); and
       (2) by inserting after clause (iv), the following new 
     clauses:
       ``(v) Except as provided in clause (vi), a document issued 
     by a federally recognized Indian tribe evidencing membership 
     or enrollment in, or affiliation with, such tribe (such as a 
     tribal enrollment card or certificate of degree of Indian 
     blood).
       ``(vi)(I) With respect to those federally recognized Indian 
     tribes located within States having an international border 
     whose membership includes individuals who are not citizens of 
     the United States documentation (including tribal 
     documentation, if appropriate) that the Secretary determines 
     to be satisfactory documentary evidence of United States 
     citizenship or nationality under the regulations adopted 
     pursuant to subclause (II).
       ``(II) Not later than 90 days after the date of enactment 
     of this subclause, the Secretary, in consultation with the 
     tribes referred to in subclause (I), shall promulgate interim 
     final regulations specifying the forms of documentation 
     (including tribal documentation, if appropriate) deemed to be 
     satisfactory evidence of the United States citizenship or 
     nationality of a member of any such Indian tribe for purposes 
     of satisfying the requirements of this subsection.
       ``(III) During the period that begins on the date of 
     enactment of this clause and ends on the effective date of 
     the interim final regulations promulgated under subclause 
     (II), a document issued by a federally recognized Indian 
     tribe referred to in subclause (I) evidencing membership or 
     enrollment in, or affiliation with, such tribe (such as a 
     tribal enrollment card or certificate of degree of Indian 
     blood) accompanied by a signed attestation that the 
     individual is a citizen of the United States and a 
     certification by the appropriate officer or agent of the 
     Indian tribe that the membership or other records maintained 
     by the Indian tribe indicate that the individual was born in 
     the United States is deemed to be a document described in 
     this subparagraph for purposes of satisfying the requirements 
     of this subsection.''.
       (e) Definitions.--Section 2110(c) of such Act (42 U.S.C. 
     1397jj(c)) is amended by adding at the end the following new 
     paragraph:
       ``(9) Indian; indian health program; indian tribe; etc.--
     The terms `Indian', `Indian Health Program', `Indian Tribe', 
     `Tribal Organization', and `Urban Indian Organization' have 
     the meanings given those terms in section 4 of the Indian 
     Health Care Improvement Act.''.

     SEC. 204. PREMIUMS AND COST SHARING PROTECTIONS UNDER 
                   MEDICAID, ELIGIBILITY DETERMINATIONS UNDER 
                   MEDICAID AND SCHIP, AND PROTECTION OF CERTAIN 
                   INDIAN PROPERTY FROM MEDICAID ESTATE RECOVERY.

       (a) Premiums and Cost Sharing Protection Under Medicaid.--
       (1) In general.--Section 1916 of the Social Security Act 
     (42 U.S.C. 1396o) is amended--

[[Page 2771]]

       (A) in subsection (a), in the matter preceding paragraph 
     (1), by striking ``and (i)'' and inserting ``, (i), and 
     (j)''; and
       (B) by adding at the end the following new subsection:
       ``(j) No Premiums or Cost Sharing for Indians Furnished 
     Items or Services Directly by Indian Health Programs or 
     Through Referral Under the Contract Health Service.--
       ``(1) No cost sharing for indians furnished items or 
     services directly by or through indian health programs.--
       ``(A) No enrollment fees, premiums, or copayments.--
       ``(i) In general.--No enrollment fee, premium, or similar 
     charge, and no deduction, copayment, cost sharing, or similar 
     charge shall be imposed against an Indian who is furnished an 
     item or service directly by the Indian Health Service, an 
     Indian Tribe, a Tribal Organization, or an urban Indian 
     organization, or by a health care provider through referral 
     under the contract health service for which payment may be 
     made under this title.
       ``(ii) Exception.--Clause (i) shall not apply to an 
     individual only eligible for the programs or services under 
     sections 102 and 103 or title V of the Indian Health Care 
     Improvement Act.
       ``(B) No reduction in amount of payment to indian health 
     providers.--Payment due under this title to the Indian Health 
     Service, an Indian Tribe, Tribal Organization, or Urban 
     Indian Organization, or a health care provider through 
     referral under the contract health service for the furnishing 
     of an item or service to an Indian who is eligible for 
     assistance under such title, may not be reduced by the amount 
     of any enrollment fee, premium, or similar charge, or any 
     deduction, copayment, cost sharing, or similar charge that 
     would be due from the Indian but for the operation of 
     subparagraph (A).
       ``(2) Rule of construction.--Nothing in this subsection 
     shall be construed as restricting the application of any 
     other limitations on the imposition of premiums or cost 
     sharing that may apply to an individual receiving medical 
     assistance under this title who is an Indian.
       ``(3) Definitions.--In this subsection, the terms `contract 
     health service', `Indian', `Indian Tribe', `Tribal 
     Organization', and `Urban Indian Organization' have the 
     meanings given those terms in section 4 of the Indian Health 
     Care Improvement Act.''.
       (2) Conforming amendment.--Section 1916A(a)(1) of such Act 
     (42 U.S.C. 1396o-1(a)(1)) is amended by striking ``section 
     1916(g)'' and inserting ``subsections (g), (i), or (j) of 
     section 1916''.
       (3) Effective date.--The amendments made by this subsection 
     take effect on October 1, 2009.
       (b) Treatment of Certain Property for Medicaid and SCHIP 
     Eligibility.--
       (1) Medicaid.--Section 1902(e) of the Social Security Act 
     (42 U.S.C. 1396a) is amended by adding at the end the 
     following new paragraph:
       ``(13) Notwithstanding any other requirement of this title 
     or any other provision of Federal or State law, a State shall 
     disregard the following property for purposes of determining 
     the eligibility of an individual who is an Indian (as defined 
     in section 4 of the Indian Health Care Improvement Act) for 
     medical assistance under this title:
       ``(A) Property, including real property and improvements, 
     that is held in trust, subject to Federal restrictions, or 
     otherwise under the supervision of the Secretary of the 
     Interior, located on a reservation, including any federally 
     recognized Indian Tribe's reservation, pueblo, or colony, 
     including former reservations in Oklahoma, Alaska Native 
     regions established by the Alaska Native Claims Settlement 
     Act, and Indian allotments on or near a reservation as 
     designated and approved by the Bureau of Indian Affairs of 
     the Department of the Interior.
       ``(B) For any federally recognized Tribe not described in 
     subparagraph (A), property located within the most recent 
     boundaries of a prior Federal reservation.
       ``(C) Ownership interests in rents, leases, royalties, or 
     usage rights related to natural resources (including 
     extraction of natural resources or harvesting of timber, 
     other plants and plant products, animals, fish, and 
     shellfish) resulting from the exercise of federally protected 
     rights.
       ``(D) Ownership interests in or usage rights to items not 
     covered by subparagraphs (A) through (C) that have unique 
     religious, spiritual, traditional, or cultural significance 
     or rights that support subsistence or a traditional lifestyle 
     according to applicable tribal law or custom.''.
       (2) Application to schip.--Section 2107(e)(1) of such Act 
     (42 U.S.C. 1397gg(e)(1)) is amended--
       (A) by redesignating subparagraphs (B) through (E), as 
     subparagraphs (C) through (F), respectively; and
       (B) by inserting after subparagraph (A), the following new 
     subparagraph:
       ``(B) Section 1902(e)(13) (relating to disregard of certain 
     property for purposes of making eligibility 
     determinations).''.
       (c) Continuation of Current Law Protections of Certain 
     Indian Property From Medicaid Estate Recovery.--Section 
     1917(b)(3) of the Social Security Act (42 U.S.C. 1396p(b)(3)) 
     is amended--
       (1) by inserting ``(A)'' after ``(3)''; and
       (2) by adding at the end the following new subparagraph:
       ``(B) The standards specified by the Secretary under 
     subparagraph (A) shall require that the procedures 
     established by the State agency under subparagraph (A) exempt 
     income, resources, and property that are exempt from the 
     application of this subsection as of April 1, 2003, under 
     manual instructions issued to carry out this subsection (as 
     in effect on such date) because of the Federal responsibility 
     for Indian Tribes and Alaska Native Villages. Nothing in this 
     subparagraph shall be construed as preventing the Secretary 
     from providing additional estate recovery exemptions under 
     this title for Indians.''.

     SEC. 205. NONDISCRIMINATION IN QUALIFICATIONS FOR PAYMENT FOR 
                   SERVICES UNDER FEDERAL HEALTH CARE PROGRAMS.

       Section 1139 of the Social Security Act (42 U.S.C. 1320b-
     9), as amended by section 202, is amended by redesignating 
     subsection (c) as subsection (d), and inserting after 
     subsection (b) the following new subsection:
       ``(c) Nondiscrimination in Qualifications for Payment for 
     Services Under Federal Health Care Programs.--
       ``(1) Requirement to satisfy generally applicable 
     participation requirements.--
       ``(A) In general.--A Federal health care program must 
     accept an entity that is operated by the Indian Health 
     Service, an Indian Tribe, Tribal Organization, or Urban 
     Indian Organization as a provider eligible to receive payment 
     under the program for health care services furnished to an 
     Indian on the same basis as any other provider qualified to 
     participate as a provider of health care services under the 
     program if the entity meets generally applicable State or 
     other requirements for participation as a provider of health 
     care services under the program.
       ``(B) Satisfaction of state or local licensure or 
     recognition requirements.--Any requirement for participation 
     as a provider of health care services under a Federal health 
     care program that an entity be licensed or recognized under 
     the State or local law where the entity is located to furnish 
     health care services shall be deemed to have been met in the 
     case of an entity operated by the Indian Health Service, an 
     Indian Tribe, Tribal Organization, or Urban Indian 
     Organization if the entity meets all the applicable standards 
     for such licensure or recognition, regardless of whether the 
     entity obtains a license or other documentation under such 
     State or local law. In accordance with section 221 of the 
     Indian Health Care Improvement Act, the absence of the 
     licensure of a health care professional employed by such an 
     entity under the State or local law where the entity is 
     located shall not be taken into account for purposes of 
     determining whether the entity meets such standards, if the 
     professional is licensed in another State.
       ``(2) Prohibition on federal payments to entities or 
     individuals excluded from participation in federal health 
     care programs or whose state licenses are under suspension or 
     have been revoked.--
       ``(A) Excluded entities.--No entity operated by the Indian 
     Health Service, an Indian Tribe, Tribal Organization, or 
     Urban Indian Organization that has been excluded from 
     participation in any Federal health care program or for which 
     a license is under suspension or has been revoked by the 
     State where the entity is located shall be eligible to 
     receive payment under any such program for health care 
     services furnished to an Indian.
       ``(B) Excluded individuals.--No individual who has been 
     excluded from participation in any Federal health care 
     program or whose State license is under suspension or has 
     been revoked shall be eligible to receive payment under any 
     such program for health care services furnished by that 
     individual, directly or through an entity that is otherwise 
     eligible to receive payment for health care services, to an 
     Indian.
       ``(C) Federal health care program defined.--In this 
     subsection, the term, `Federal health care program' has the 
     meaning given that term in section 1128B(f), except that, for 
     purposes of this subsection, such term shall include the 
     health insurance program under chapter 89 of title 5, United 
     States Code.''.

     SEC. 206. CONSULTATION ON MEDICAID, SCHIP, AND OTHER HEALTH 
                   CARE PROGRAMS FUNDED UNDER THE SOCIAL SECURITY 
                   ACT INVOLVING INDIAN HEALTH PROGRAMS AND URBAN 
                   INDIAN ORGANIZATIONS.

       (a) In General.--Section 1139 of the Social Security Act 
     (42 U.S.C. 1320b-9), as amended by sections 202 and 205, is 
     amended by redesignating subsection (d) as subsection (e), 
     and inserting after subsection (c) the following new 
     subsection:
       ``(d) Consultation With Tribal Technical Advisory Group 
     (TTAG).--The Secretary shall maintain within the Centers for 
     Medicaid & Medicare Services (CMS) a Tribal Technical 
     Advisory Group, established in accordance with requirements 
     of the charter dated September 30, 2003, and in such group 
     shall include a representative of the Urban Indian 
     Organizations and the Service. The representative of the 
     Urban Indian Organization shall be deemed to be an elected 
     officer

[[Page 2772]]

     of a tribal government for purposes of applying section 
     204(b) of the Unfunded Mandates Reform Act of 1995 (2 U.S.C. 
     1534(b)).''.
       (b) Solicitation of Advice Under Medicaid and SCHIP.--
       (1) Medicaid state plan amendment.--Section 1902(a) of the 
     Social Security Act (42 U.S.C. 1396a(a)) is amended--
       (A) in paragraph (69), by striking ``and'' at the end;
       (B) in paragraph (70)(B)(iv), by striking the period at the 
     end and inserting ``; and''; and
       (C) by inserting after paragraph (70)(B)(iv), the following 
     new paragraph:
       ``(71) in the case of any State in which the Indian Health 
     Service operates or funds health care programs, or in which 1 
     or more Indian Health Programs or Urban Indian Organizations 
     (as such terms are defined in section 4 of the Indian Health 
     Care Improvement Act) provide health care in the State for 
     which medical assistance is available under such title, 
     provide for a process under which the State seeks advice on a 
     regular, ongoing basis from designees of such Indian Health 
     Programs and Urban Indian Organizations on matters relating 
     to the application of this title that are likely to have a 
     direct effect on such Indian Health Programs and Urban Indian 
     Organizations and that--
       ``(A) shall include solicitation of advice prior to 
     submission of any plan amendments, waiver requests, and 
     proposals for demonstration projects likely to have a direct 
     effect on Indians, Indian Health Programs, or Urban Indian 
     Organizations; and
       ``(B) may include appointment of an advisory committee and 
     of a designee of such Indian Health Programs and Urban Indian 
     Organizations to the medical care advisory committee advising 
     the State on its State plan under this title.''.
       (2) Application to schip.--Section 2107(e)(1) of such Act 
     (42 U.S.C. 1397gg(e)(1)), as amended by section 204(b)(2), is 
     amended--
       (A) by redesignating subparagraphs (B) through (F) as 
     subparagraphs (C) through (G), respectively; and
       (B) by inserting after subparagraph (A), the following new 
     subparagraph:
       ``(B) Section 1902(a)(71) (relating to the option of 
     certain States to seek advice from designees of Indian Health 
     Programs and Urban Indian Organizations).''.
       (c) Rule of Construction.--Nothing in the amendments made 
     by this section shall be construed as superseding existing 
     advisory committees, working groups, guidance, or other 
     advisory procedures established by the Secretary of Health 
     and Human Services or by any State with respect to the 
     provision of health care to Indians.
       (d) Effective Date.--This section and the amendments made 
     by this section take effect on October 1, 2009.

     SEC. 207. EXCLUSION WAIVER AUTHORITY FOR AFFECTED INDIAN 
                   HEALTH PROGRAMS AND SAFE HARBOR TRANSACTIONS 
                   UNDER THE SOCIAL SECURITY ACT.

       (a) Exclusion Waiver Authority.--Section 1128 of the Social 
     Security Act (42 U.S.C. 1320a-7) is amended by adding at the 
     end the following new subsection:
       ``(k) Additional Exclusion Waiver Authority for Affected 
     Indian Health Programs.--In addition to the authority granted 
     the Secretary under subsections (c)(3)(B) and (d)(3)(B) to 
     waive an exclusion under subsection (a)(1), (a)(3), (a)(4), 
     or (b), the Secretary may, in the case of an Indian Health 
     Program, waive such an exclusion upon the request of the 
     administrator of an affected Indian Health Program (as 
     defined in section 4 of the Indian Health Care Improvement 
     Act) who determines that the exclusion would impose a 
     hardship on individuals entitled to benefits under or 
     enrolled in a Federal health care program.''.
       (b) Certain Transactions Involving Indian Health Care 
     Programs Deemed To Be in Safe Harbors.--Section 1128B(b) of 
     the Social Security Act (42 U.S.C. 1320a-7b(b)) is amended by 
     adding at the end the following new paragraph:
       ``(4) Subject to such conditions as the Secretary may 
     promulgate from time to time as necessary to prevent fraud 
     and abuse, for purposes of paragraphs (1) and (2) and section 
     1128A(a), the following transfers shall not be treated as 
     remuneration:
       ``(A) Transfers between indian health programs, indian 
     tribes, tribal organizations, and urban indian 
     organizations.--Transfers of anything of value between or 
     among an Indian Health Program, Indian Tribe, Tribal 
     Organization, or Urban Indian Organization, that are made for 
     the purpose of providing necessary health care items and 
     services to any patient served by such Program, Tribe, or 
     Organization and that consist of--
       ``(i) services in connection with the collection, 
     transport, analysis, or interpretation of diagnostic 
     specimens or test data;
       ``(ii) inventory or supplies;
       ``(iii) staff; or
       ``(iv) a waiver of all or part of premiums or cost sharing.
       ``(B) Transfers between indian health programs, indian 
     tribes, tribal organizations, or urban indian organizations 
     and patients.--Transfers of anything of value between an 
     Indian Health Program, Indian Tribe, Tribal Organization, or 
     Urban Indian Organization and any patient served or eligible 
     for service from an Indian Health Program, Indian Tribe, 
     Tribal Organization, or Urban Indian Organization, including 
     any patient served or eligible for service pursuant to 
     section 807 of the Indian Health Care Improvement Act, but 
     only if such transfers--
       ``(i) consist of expenditures related to providing 
     transportation for the patient for the provision of necessary 
     health care items or services, provided that the provision of 
     such transportation is not advertised, nor an incentive of 
     which the value is disproportionately large in relationship 
     to the value of the health care item or service (with respect 
     to the value of the item or service itself or, for 
     preventative items or services, the future health care costs 
     reasonably expected to be avoided);
       ``(ii) consist of expenditures related to providing housing 
     to the patient (including a pregnant patient) and immediate 
     family members or an escort necessary to assuring the timely 
     provision of health care items and services to the patient, 
     provided that the provision of such housing is not advertised 
     nor an incentive of which the value is disproportionately 
     large in relationship to the value of the health care item or 
     service (with respect to the value of the item or service 
     itself or, for preventative items or services, the future 
     health care costs reasonably expected to be avoided); or
       ``(iii) are for the purpose of paying premiums or cost 
     sharing on behalf of such a patient, provided that the making 
     of such payment is not subject to conditions other than 
     conditions agreed to under a contract for the delivery of 
     contract health services.
       ``(C) Contract health services.--A transfer of anything of 
     value negotiated as part of a contract entered into between 
     an Indian Health Program, Indian Tribe, Tribal Organization, 
     Urban Indian Organization, or the Indian Health Service and a 
     contract care provider for the delivery of contract health 
     services authorized by the Indian Health Service, provided 
     that--
       ``(i) such a transfer is not tied to volume or value of 
     referrals or other business generated by the parties; and
       ``(ii) any such transfer is limited to the fair market 
     value of the health care items or services provided or, in 
     the case of a transfer of items or services related to 
     preventative care, the value of the future health care costs 
     reasonably expected to be avoided.
       ``(D) Other transfers.--Any other transfer of anything of 
     value involving an Indian Health Program, Indian Tribe, 
     Tribal Organization, or Urban Indian Organization, or a 
     patient served or eligible for service from an Indian Health 
     Program, Indian Tribe, Tribal Organization, or Urban Indian 
     Organization, that the Secretary, in consultation with the 
     Attorney General, determines is appropriate, taking into 
     account the special circumstances of such Indian Health 
     Programs, Indian Tribes, Tribal Organizations, and Urban 
     Indian Organizations, and of patients served by such 
     Programs, Tribes, and Organizations.''.

     SEC. 208. RULES APPLICABLE UNDER MEDICAID AND SCHIP TO 
                   MANAGED CARE ENTITIES WITH RESPECT TO INDIAN 
                   ENROLLEES AND INDIAN HEALTH CARE PROVIDERS AND 
                   INDIAN MANAGED CARE ENTITIES.

       (a) In General.--Section 1932 of the Social Security Act 
     (42 U.S.C. 1396u-2) is amended by adding at the end the 
     following new subsection:
       ``(h) Special Rules With Respect to Indian Enrollees, 
     Indian Health Care Providers, and Indian Managed Care 
     Entities.--
       ``(1) Enrollee option to select an indian health care 
     provider as primary care provider.--In the case of a non-
     Indian Medicaid managed care entity that--
       ``(A) has an Indian enrolled with the entity; and
       ``(B) has an Indian health care provider that is 
     participating as a primary care provider within the network 
     of the entity,
     insofar as the Indian is otherwise eligible to receive 
     services from such Indian health care provider and the Indian 
     health care provider has the capacity to provide primary care 
     services to such Indian, the contract with the entity under 
     section 1903(m) or under section 1905(t)(3) shall require, as 
     a condition of receiving payment under such contract, that 
     the Indian shall be allowed to choose such Indian health care 
     provider as the Indian's primary care provider under the 
     entity.
       ``(2) Assurance of payment to indian health care providers 
     for provision of covered services.--Each contract with a 
     managed care entity under section 1903(m) or under section 
     1905(t)(3) shall require any such entity that has a 
     significant percentage of Indian enrollees (as determined by 
     the Secretary), as a condition of receiving payment under 
     such contract to satisfy the following requirements:
       ``(A) Demonstration of participating indian health care 
     providers or application of alternative payment 
     arrangements.--Subject to subparagraph (E), to--
       ``(i) demonstrate that the number of Indian health care 
     providers that are participating providers with respect to 
     such entity are sufficient to ensure timely access to covered 
     Medicaid managed care services for those enrollees who are 
     eligible to receive services from such providers; or

[[Page 2773]]

       ``(ii) agree to pay Indian health care providers who are 
     not participating providers with the entity for covered 
     Medicaid managed care services provided to those enrollees 
     who are eligible to receive services from such providers at a 
     rate equal to the rate negotiated between such entity and the 
     provider involved or, if such a rate has not been negotiated, 
     at a rate that is not less than the level and amount of 
     payment which the entity would make for the services if the 
     services were furnished by a participating provider which is 
     not an Indian health care provider.
       ``(B) Prompt payment.--To agree to make prompt payment (in 
     accordance with rules applicable to managed care entities) to 
     Indian health care providers that are participating providers 
     with respect to such entity or, in the case of an entity to 
     which subparagraph (A)(ii) or (E) applies, that the entity is 
     required to pay in accordance with that subparagraph.
       ``(C) Satisfaction of claim requirement.--To deem any 
     requirement for the submission of a claim or other 
     documentation for services covered under subparagraph (A) by 
     the enrollee to be satisfied through the submission of a 
     claim or other documentation by an Indian health care 
     provider that is consistent with section 403(h) of the Indian 
     Health Care Improvement Act.
       ``(D) Compliance with generally applicable requirements.--
       ``(i) In general.--Subject to clause (ii), as a condition 
     of payment under subparagraph (A), an Indian health care 
     provider shall comply with the generally applicable 
     requirements of this title, the State plan, and such entity 
     with respect to covered Medicaid managed care services 
     provided by the Indian health care provider to the same 
     extent that non-Indian providers participating with the 
     entity must comply with such requirements.
       ``(ii) Limitations on compliance with managed care entity 
     generally applicable requirements.--An Indian health care 
     provider--

       ``(I) shall not be required to comply with a generally 
     applicable requirement of a managed care entity described in 
     clause (i) as a condition of payment under subparagraph (A) 
     if such compliance would conflict with any other statutory or 
     regulatory requirements applicable to the Indian health care 
     provider; and
       ``(II) shall only need to comply with those generally 
     applicable requirements of a managed care entity described in 
     clause (i) as a condition of payment under subparagraph (A) 
     that are necessary for the entity's compliance with the State 
     plan, such as those related to care management, quality 
     assurance, and utilization management.

       ``(E) Application of special payment requirements for 
     federally-qualified health centers and encounter rate for 
     services provided by certain indian health care providers.--
       ``(i) Federally-qualified health centers.--

       ``(I) Managed care entity payment requirement.--To agree to 
     pay any Indian health care provider that is a Federally-
     qualified health center but not a participating provider with 
     respect to the entity, for the provision of covered Medicaid 
     managed care services by such provider to an Indian enrollee 
     of the entity at a rate equal to the amount of payment that 
     the entity would pay a Federally-qualified health center that 
     is a participating provider with respect to the entity but is 
     not an Indian health care provider for such services.
       ``(II) Continued application of state requirement to make 
     supplemental payment.--Nothing in subclause (I) or 
     subparagraph (A) or (B) shall be construed as waiving the 
     application of section 1902(bb)(5) regarding the State plan 
     requirement to make any supplemental payment due under such 
     section to a Federally-qualified health center for services 
     furnished by such center to an enrollee of a managed care 
     entity (regardless of whether the Federally-qualified health 
     center is or is not a participating provider with the 
     entity).

       ``(ii) Continued application of encounter rate for services 
     provided by certain indian health care providers.--If the 
     amount paid by a managed care entity to an Indian health care 
     provider that is not a Federally-qualified health center and 
     that has elected to receive payment under this title as an 
     Indian Health Service provider under the July 11, 1996, 
     Memorandum of Agreement between the Health Care Financing 
     Administration (now the Centers for Medicare & Medicaid 
     Services) and the Indian Health Service for services provided 
     by such provider to an Indian enrollee with the managed care 
     entity is less than the encounter rate that applies to the 
     provision of such services under such memorandum, the State 
     plan shall provide for payment to the Indian health care 
     provider of the difference between the applicable encounter 
     rate under such memorandum and the amount paid by the managed 
     care entity to the provider for such services.
       ``(F) Construction.--Nothing in this paragraph shall be 
     construed as waiving the application of section 
     1902(a)(30)(A) (relating to application of standards to 
     assure that payments are consistent with efficiency, economy, 
     and quality of care).
       ``(3) Offering of managed care through indian medicaid 
     managed care entities.--If--
       ``(A) a State elects to provide services through Medicaid 
     managed care entities under its Medicaid managed care 
     program; and
       ``(B) an Indian health care provider that is funded in 
     whole or in part by the Indian Health Service, or a 
     consortium composed of 1 or more Tribes, Tribal 
     Organizations, or Urban Indian Organizations, and which also 
     may include the Indian Health Service, has established an 
     Indian Medicaid managed care entity in the State that meets 
     generally applicable standards required of such an entity 
     under such Medicaid managed care program,

     the State shall offer to enter into an agreement with the 
     entity to serve as a Medicaid managed care entity with 
     respect to eligible Indians served by such entity under such 
     program.
       ``(4) Special rules for indian managed care entities.--The 
     following are special rules regarding the application of a 
     Medicaid managed care program to Indian Medicaid managed care 
     entities:
       ``(A) Enrollment.--
       ``(i) Limitation to indians.--An Indian Medicaid managed 
     care entity may restrict enrollment under such program to 
     Indians and to members of specific Tribes in the same manner 
     as Indian Health Programs may restrict the delivery of 
     services to such Indians and tribal members.
       ``(ii) No less choice of plans.--Under such program the 
     State may not limit the choice of an Indian among Medicaid 
     managed care entities only to Indian Medicaid managed care 
     entities or to be more restrictive than the choice of managed 
     care entities offered to individuals who are not Indians.
       ``(iii) Default enrollment.--

       ``(I) In general.--If such program of a State requires the 
     enrollment of Indians in a Medicaid managed care entity in 
     order to receive benefits, the State, taking into 
     consideration the criteria specified in subsection 
     (a)(4)(D)(ii)(I), shall provide for the enrollment of Indians 
     described in subclause (II) who are not otherwise enrolled 
     with such an entity in an Indian Medicaid managed care entity 
     described in such clause.
       ``(II) Indian described.--An Indian described in this 
     subclause, with respect to an Indian Medicaid managed care 
     entity, is an Indian who, based upon the service area and 
     capacity of the entity, is eligible to be enrolled with the 
     entity consistent with subparagraph (A).

       ``(iv) Exception to state lock-in.--A request by an Indian 
     who is enrolled under such program with a non-Indian Medicaid 
     managed care entity to change enrollment with that entity to 
     enrollment with an Indian Medicaid managed care entity shall 
     be considered cause for granting such request under 
     procedures specified by the Secretary.
       ``(B) Flexibility in application of solvency.--In applying 
     section 1903(m)(1) to an Indian Medicaid managed care 
     entity--
       ``(i) any reference to a `State' in subparagraph (A)(ii) of 
     that section shall be deemed to be a reference to the 
     `Secretary'; and
       ``(ii) the entity shall be deemed to be a public entity 
     described in subparagraph (C)(ii) of that section.
       ``(C) Exceptions to advance directives.--The Secretary may 
     modify or waive the requirements of section 1902(w) (relating 
     to provision of written materials on advance directives) 
     insofar as the Secretary finds that the requirements 
     otherwise imposed are not an appropriate or effective way of 
     communicating the information to Indians.
       ``(D) Flexibility in information and marketing.--
       ``(i) Materials.--The Secretary may modify requirements 
     under subsection (a)(5) to ensure that information described 
     in that subsection is provided to enrollees and potential 
     enrollees of Indian Medicaid managed care entities in a 
     culturally appropriate and understandable manner that clearly 
     communicates to such enrollees and potential enrollees their 
     rights, protections, and benefits.
       ``(ii) Distribution of marketing materials.--The provisions 
     of subsection (d)(2)(B) requiring the distribution of 
     marketing materials to an entire service area shall be deemed 
     satisfied in the case of an Indian Medicaid managed care 
     entity that distributes appropriate materials only to those 
     Indians who are potentially eligible to enroll with the 
     entity in the service area.
       ``(5) Malpractice insurance.--Insofar as, under a Medicaid 
     managed care program, a health care provider is required to 
     have medical malpractice insurance coverage as a condition of 
     contracting as a provider with a Medicaid managed care 
     entity, an Indian health care provider that is--
       ``(A) a Federally-qualified health center that is covered 
     under the Federal Tort Claims Act (28 U.S.C. 1346(b), 2671 et 
     seq.);
       ``(B) providing health care services pursuant to a contract 
     or compact under the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450 et seq.) that are covered under 
     the Federal Tort Claims Act (28 U.S.C. 1346(b), 2671 et 
     seq.); or
       ``(C) the Indian Health Service providing health care 
     services that are covered under the Federal Tort Claims Act 
     (28 U.S.C. 1346(b), 2671 et seq.);

     are deemed to satisfy such requirement.

[[Page 2774]]

       ``(6) Definitions.--For purposes of this subsection:
       ``(A) Indian health care provider.--The term `Indian health 
     care provider' means an Indian Health Program or an Urban 
     Indian Organization.
       ``(B) Indian; indian health program; service; tribe; tribal 
     organization; urban indian organization.--The terms `Indian', 
     `Indian Health Program', `Service', `Tribe', `tribal 
     organization', `Urban Indian Organization' have the meanings 
     given such terms in section 4 of the Indian Health Care 
     Improvement Act.
       ``(C) Indian medicaid managed care entity.--The term 
     `Indian Medicaid managed care entity' means a managed care 
     entity that is controlled (within the meaning of the last 
     sentence of section 1903(m)(1)(C)) by the Indian Health 
     Service, a Tribe, Tribal Organization, or Urban Indian 
     Organization, or a consortium, which may be composed of 1 or 
     more Tribes, Tribal Organizations, or Urban Indian 
     Organizations, and which also may include the Service.
       ``(D) Non-indian medicaid managed care entity.--The term 
     `non-Indian Medicaid managed care entity' means a managed 
     care entity that is not an Indian Medicaid managed care 
     entity.
       ``(E) Covered medicaid managed care services.--The term 
     `covered Medicaid managed care services' means, with respect 
     to an individual enrolled with a managed care entity, items 
     and services that are within the scope of items and services 
     for which benefits are available with respect to the 
     individual under the contract between the entity and the 
     State involved.
       ``(F) Medicaid managed care program.--The term `Medicaid 
     managed care program' means a program under sections 1903(m) 
     and 1932 and includes a managed care program operating under 
     a waiver under section 1915(b) or 1115 or otherwise.''.
       (b) Application to SCHIP.--Section 2107(e)(1) of such Act 
     (42 U.S.C. 1397gg(1)), as amended by section 206(b)(2), is 
     amended by adding at the end the following new subparagraph:
       ``(H) Subsections (a)(2)(C) and (h) of section 1932.''.
       (c) Effective Date.--This section and the amendments made 
     by this section take effect on October 1, 2009.

     SEC. 209. ANNUAL REPORT ON INDIANS SERVED BY SOCIAL SECURITY 
                   ACT HEALTH BENEFIT PROGRAMS.

       Section 1139 of the Social Security Act (42 U.S.C. 1320b-
     9), as amended by the sections 202, 205, and 206, is amended 
     by redesignating subsection (e) as subsection (f), and 
     inserting after subsection (d) the following new subsection:
       ``(e) Annual Report on Indians Served by Health Benefit 
     Programs Funded Under This Act.--Beginning January 1, 2008, 
     and annually thereafter, the Secretary, acting through the 
     Administrator of the Centers for Medicare & Medicaid Services 
     and the Director of the Indian Health Service, shall submit a 
     report to Congress regarding the enrollment and health status 
     of Indians receiving items or services under health benefit 
     programs funded under this Act during the preceding year. 
     Each such report shall include the following:
       ``(1) The total number of Indians enrolled in, or receiving 
     items or services under, such programs, disaggregated with 
     respect to each such program.
       ``(2) The number of Indians described in paragraph (1) that 
     also received health benefits under programs funded by the 
     Indian Health Service.
       ``(3) General information regarding the health status of 
     the Indians described in paragraph (1), disaggregated with 
     respect to specific diseases or conditions and presented in a 
     manner that is consistent with protections for privacy of 
     individually identifiable health information under section 
     264(c) of the Health Insurance Portability and Accountability 
     Act of 1996.
       ``(4) A detailed statement of the status of facilities of 
     the Indian Health Service or an Indian Tribe, Tribal 
     Organization, or an Urban Indian Organization with respect to 
     such facilities' compliance with the applicable conditions 
     and requirements of titles XVIII, XIX, and XXI, and, in the 
     case of title XIX or XXI, under a State plan under such title 
     or under waiver authority, and of the progress being made by 
     such facilities (under plans submitted under section 1880(b), 
     1911(b) or otherwise) toward the achievement and maintenance 
     of such compliance.
       ``(5) Such other information as the Secretary determines is 
     appropriate.''.

     SEC. 210. DEVELOPMENT OF RECOMMENDATIONS TO IMPROVE 
                   INTERSTATE COORDINATION OF MEDICAID AND SCHIP 
                   COVERAGE OF INDIAN CHILDREN AND OTHER CHILDREN 
                   WHO ARE OUTSIDE OF THEIR STATE OF RESIDENCY 
                   BECAUSE OF EDUCATIONAL OR OTHER NEEDS.

       (a) Study.--The Secretary shall conduct a study to identify 
     barriers to interstate coordination of enrollment and 
     coverage under the Medicaid program under title XIX of the 
     Social Security Act and the State Children's Health Insurance 
     Program under title XXI of such Act of children who are 
     eligible for medical assistance or child health assistance 
     under such programs and who, because of educational needs, 
     migration of families, emergency evacuations, or otherwise, 
     frequently change their State of residency or otherwise are 
     temporarily present outside of the State of their residency. 
     Such study shall include an examination of the enrollment and 
     coverage coordination issues faced by Indian children who are 
     eligible for medical assistance or child health assistance 
     under such programs in their State of residence and who 
     temporarily reside in an out-of-State boarding school or 
     peripheral dormitory funded by the Bureau of Indian Affairs.
       (b) Report.--Not later than 18 months after the date of 
     enactment of this Act, the Secretary, in consultation with 
     directors of State Medicaid programs under title XIX of the 
     Social Security Act and directors of State Children's Health 
     Insurance Programs under title XXI of such Act, shall submit 
     a report to Congress that contains recommendations for such 
     legislative and administrative actions as the Secretary 
     determines appropriate to address the enrollment and coverage 
     coordination barriers identified through the study required 
     under subsection (a).

     SEC. 211. ESTABLISHMENT OF NATIONAL CHILD WELFARE RESOURCE 
                   CENTER FOR TRIBES.

       (a) Establishment.--The Secretary of Health and Human 
     Services shall establish a National Child Welfare Resource 
     Center for Tribes that is--
       (1) specifically and exclusively dedicated to meeting the 
     needs of Indian tribes and tribal organizations through the 
     provision of assistance described in subsection (b); and
       (2) not part of any existing national child welfare 
     resource center.
       (b) Assistance Provided.--
       (1) In general.--The National Child Welfare Resource Center 
     for Tribes shall provide information, advice, educational 
     materials, and technical assistance to Indian tribes and 
     tribal organizations with respect to the types of services, 
     administrative functions, data collection, program 
     management, and reporting that are provided for under State 
     plans under parts B and E of title IV of the Social Security 
     Act.
       (2) Implementation authority.--The Secretary may provide 
     the assistance described in paragraph (1) either directly or 
     through grant or contract with public or private 
     organizations knowledgeable and experienced in the field of 
     Indian tribal affairs and child welfare.
       (c) Appropriations.--There is appropriated to the Secretary 
     of Health and Human Services, out of any money in the 
     Treasury of the United States not otherwise appropriated, 
     $1,000,000 for each of fiscal years 2009 through 2013 to 
     carry out the purposes of this section.

     SEC. 212. ADJUSTMENT TO THE MEDICARE ADVANTAGE STABILIZATION 
                   FUND.

       Section 1858(e)(2)(A)(i) of the Social Security Act (42 
     U.S.C. 1395w-27a(e)(2)(A)(i)), as amended by section 110 of 
     the Medicare, Medicaid, and SCHIP Extension Act of 2007 
     (Public Law 110-173), is amended by striking 
     ``$1,790,000,000'' and inserting ``$1,657,000,000''.

     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--

[[Page 2775]]

       ``(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.

     SEC. 214. INCREASED CIVIL MONEY PENALTIES AND CRIMINAL FINES 
                   FOR MEDICARE FRAUD AND ABUSE.

       (a) Increased Civil Money Penalties.--Section 1128A of the 
     Social Security Act (42 U.S.C. 1320a-7a) is amended--
       (1) in subsection (a), in the flush matter following 
     paragraph (7)--
       (A) by striking ``$10,000'' each place it appears and 
     inserting ``$20,000'';
       (B) by striking ``$15,000'' and inserting ``$30,000''; and
       (C) by striking ``$50,000'' and inserting ``$100,000''; and
       (2) in subsection (b)--
       (A) in paragraph (1), in the flush matter following 
     subparagraph (B), by striking ``$2,000'' and inserting 
     ``$4,000'';
       (B) in paragraph (2), by striking ``$2,000'' and inserting 
     ``$4,000''; and
       (C) in paragraph (3)(A)(i), by striking ``$5,000'' and 
     inserting ``$10,000''.
       (b) Increased Criminal Fines.--Section 1128B of the Social 
     Security Act (42 U.S.C. 1320a-7b) is amended--
       (1) in subsection (a), in the flush matter following 
     paragraph (6)--
       (A) by striking ``$25,000'' and inserting ``$100,000''; and
       (B) by striking ``$10,000'' and inserting ``$20,000'';
       (2) in subsection (b)--
       (A) in paragraph (1), in the flush matter following 
     subparagraph (B), by striking ``$25,000'' and inserting 
     ``$100,000''; and
       (B) in paragraph (2), in the flush matter following 
     subparagraph (B), by striking ``$25,000'' and inserting 
     ``$100,000'';
       (3) in subsection (c), by striking ``$25,000'' and 
     inserting ``$100,000'';
       (4) in subsection (d), in the second flush matter following 
     subparagraph (B), by striking ``$25,000'' and inserting 
     ``$100,000''; and
       (5) in subsection (e), by striking ``$2,000'' and inserting 
     ``$4,000''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to civil money penalties and fines imposed for 
     actions taken on or after the date of enactment of this Act.

     SEC. 215. INCREASED SENTENCES FOR FELONIES INVOLVING MEDICARE 
                   FRAUD AND ABUSE.

       (a) False Statements and Representations.--Section 1128B(a) 
     of the Social Security Act (42 U.S.C. 1320a-7b(a)) is 
     amended, in clause (i) of the flush matter following 
     paragraph (6), by striking ``not more than 5 years'' and 
     inserting ``not more than 10 years''.
       (b) Anti-Kickback.--Section 1128B(b) of the Social Security 
     Act (42 U.S.C. 1320a-7b(b)) is amended--
       (1) in paragraph (1), in the flush matter following 
     subparagraph (B), by striking ``not more than 5 years'' and 
     inserting ``not more than 10 years''; and
       (2) in paragraph (2), in the flush matter following 
     subparagraph (B), by striking ``not more than 5 years'' and 
     inserting ``not more than 10 years''.
       (c) False Statement or Representation With Respect to 
     Conditions or Operations of Facilities.--Section 1128B(c) of 
     the Social Security Act (42 U.S.C. 1320a-7b(c)) is amended by 
     striking ``not more than 5 years'' and inserting ``not more 
     than 10 years''.
       (d) Excess Charges.--Section 1128B(d) of the Social 
     Security Act (42 U.S.C. 1320a-7b(d)) is amended, in the 
     second flush matter following subparagraph (B), by striking 
     ``not more than 5 years'' and inserting ``not more than 10 
     years''.
       (e) Effective Date.--The amendments made by this section 
     shall apply to criminal penalties imposed for actions taken 
     on or after the date of enactment of this Act.

                        TITLE III--MISCELLANEOUS

     SEC. 301. RESOLUTION OF APOLOGY TO NATIVE PEOPLES OF UNITED 
                   STATES.

       (a) Findings.--Congress finds that--
       (1) the ancestors of today's Native Peoples inhabited the 
     land of the present-day United States since time immemorial 
     and for thousands of years before the arrival of people of 
     European descent;
       (2) for millennia, Native Peoples have honored, protected, 
     and stewarded this land we cherish;
       (3) Native Peoples are spiritual people with a deep and 
     abiding belief in the Creator, and for millennia Native 
     Peoples have maintained a powerful spiritual connection to 
     this land, as evidenced by their customs and legends;
       (4) the arrival of Europeans in North America opened a new 
     chapter in the history of Native Peoples;
       (5) while establishment of permanent European settlements 
     in North America did stir conflict with nearby Indian tribes, 
     peaceful and mutually beneficial interactions also took 
     place;
       (6) the foundational English settlements in Jamestown, 
     Virginia, and Plymouth, Massachusetts, owed their survival in 
     large measure to the compassion and aid of Native Peoples in 
     the vicinities of the settlements;
       (7) in the infancy of the United States, the founders of 
     the Republic expressed their desire for a just relationship 
     with the Indian tribes, as evidenced by the Northwest 
     Ordinance enacted by Congress in 1787, which begins with the 
     phrase, ``The utmost good faith shall always be observed 
     toward the Indians'';
       (8) Indian tribes provided great assistance to the 
     fledgling Republic as it strengthened and grew, including 
     invaluable help to Meriwether Lewis and William Clark on 
     their epic journey from St. Louis, Missouri, to the Pacific 
     Coast;
       (9) Native Peoples and non-Native settlers engaged in 
     numerous armed conflicts in which unfortunately, both took 
     innocent lives, including those of women and children;
       (10) the Federal Government violated many of the treaties 
     ratified by Congress and other diplomatic agreements with 
     Indian tribes;
       (11) the United States forced Indian tribes and their 
     citizens to move away from their traditional homelands and 
     onto federally established and controlled reservations, in 
     accordance with such Acts as the Act of May 28, 1830 (4 Stat. 
     411, chapter 148) (commonly known as the ``Indian Removal 
     Act'');
       (12) many Native Peoples suffered and perished--
       (A) during the execution of the official Federal Government 
     policy of forced removal, including the infamous Trail of 
     Tears and Long Walk;
       (B) during bloody armed confrontations and massacres, such 
     as the Sand Creek Massacre in 1864 and the Wounded Knee 
     Massacre in 1890; and
       (C) on numerous Indian reservations;
       (13) the Federal Government condemned the traditions, 
     beliefs, and customs of Native Peoples and endeavored to 
     assimilate them by such policies as the redistribution of 
     land under the Act of February 8, 1887 (25 U.S.C. 331; 24 
     Stat. 388, chapter 119) (commonly known as the ``General 
     Allotment Act''), and the forcible removal of Native children 
     from their families to faraway boarding schools where their 
     Native practices and languages were degraded and forbidden;
       (14) officials of the Federal Government and private United 
     States citizens harmed Native Peoples by the unlawful 
     acquisition of recognized tribal land and the theft of tribal 
     resources and assets from recognized tribal land;
       (15) the policies of the Federal Government toward Indian 
     tribes and the breaking of covenants with Indian tribes have 
     contributed to the severe social ills and economic troubles 
     in many Native communities today;
       (16) despite the wrongs committed against Native Peoples by 
     the United States, Native Peoples have remained committed to 
     the protection of this great land, as evidenced by the fact 
     that, on a per capita basis, more Native Peoples have served 
     in the United States Armed Forces and placed themselves in 
     harm's way in defense of the United States in every major 
     military conflict than any other ethnic group;
       (17) Indian tribes have actively influenced the public life 
     of the United States by continued cooperation with Congress 
     and the Department of the Interior, through the involvement 
     of Native individuals in official Federal Government 
     positions, and by leadership of their own sovereign Indian 
     tribes;
       (18) Indian tribes are resilient and determined to 
     preserve, develop, and transmit to future generations their 
     unique cultural identities;
       (19) the National Museum of the American Indian was 
     established within the Smithsonian Institution as a living 
     memorial to Native Peoples and their traditions; and
       (20) Native Peoples are endowed by their Creator with 
     certain unalienable rights, and among those are life, 
     liberty, and the pursuit of happiness.
       (b) Acknowledgment and Apology.--The United States, acting 
     through Congress--
       (1) recognizes the special legal and political relationship 
     Indian tribes have with the United States and the solemn 
     covenant with the land we share;

[[Page 2776]]

       (2) commends and honors Native Peoples for the thousands of 
     years that they have stewarded and protected this land;
       (3) recognizes that there have been years of official 
     depredations, ill-conceived policies, and the breaking of 
     covenants by the Federal Government regarding Indian tribes;
       (4) apologizes on behalf of the people of the United States 
     to all Native Peoples for the many instances of violence, 
     maltreatment, and neglect inflicted on Native Peoples by 
     citizens of the United States;
       (5) expresses its regret for the ramifications of former 
     wrongs and its commitment to build on the positive 
     relationships of the past and present to move toward a 
     brighter future where all the people of this land live 
     reconciled as brothers and sisters, and harmoniously steward 
     and protect this land together;
       (6) urges the President to acknowledge the wrongs of the 
     United States against Indian tribes in the history of the 
     United States in order to bring healing to this land; and
       (7) commends the State governments that have begun 
     reconciliation efforts with recognized Indian tribes located 
     in their boundaries and encourages all State governments 
     similarly to work toward reconciling relationships with 
     Indian tribes within their boundaries.
       (c) Disclaimer.--Nothing in this section--
       (1) authorizes or supports any claim against the United 
     States; or
       (2) serves as a settlement of any claim against the United 
     States.

                          ____________________