[Senate Report 118-34]
[From the U.S. Government Publishing Office]


                                                       Calendar No. 80
118th Congress      }                                           Report
                                 SENATE
 1st Session        }                                           118-34

======================================================================



 
                     URBAN INDIAN HEALTH CONFER ACT

                                _______
                                

                  May 30, 2023.--Ordered to be printed

                                _______
                                

           Mr. Schatz, from the Committee on Indian Affairs, 
                        submitted the following

                              R E P O R T

                         [To accompany S. 460]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Indian Affairs, to which was referred the 
bill (S. 460) to amend the Indian Health Care Improvement Act 
to establish an urban Indian organization confer policy for the 
Department of Health and Human Services, having considered the 
same, reports favorably thereon without amendment, and 
recommends that the bill do pass.

                                PURPOSE

    The purpose of S. 460 is to amend the Indian Health Care 
Improvement Act (IHCIA) to require the Department of Health and 
Human Services (HHS) and its agencies and offices to confer 
with urban Indian organizations (UIOs)\1\ regarding matters 
that would impact health care for American Indians and Alaska 
Natives (AIANs) living in urban areas.
---------------------------------------------------------------------------
    \1\The term ``urban Indian organization'' refers to a nonprofit 
corporate body situated in an urban center, governed by an urban Indian 
controlled board of directors, and providing for the maximum 
participation of all interested Indian groups and individuals, which 
body is capable of legally cooperating with other public and private 
entities for the purpose of performing the activities. 25 U.S.C. 
Sec. 1603(29).
---------------------------------------------------------------------------

                               BACKGROUND

    The Indian Health Service (IHS) supports contracts and 
grants to 41 UIO programs in cities across the nation to ensure 
the highest possible health status for urban AIANs and provide 
resources necessary to effect that policy pursuant to the 
IHCIA.\2\ UIOs are a critical part of the three-prong IHS 
system, which also includes direct service IHS facilities and 
Tribal programs, and they provide health care services to most 
AIANs.\3\
---------------------------------------------------------------------------
    \2\25 U.S.C. Sec. 1602(1).
    \3\Seventy percent of AIAN people reportedly live outside of Tribal 
jurisdictions. Legislative Hearing on H.J. Res. 55, H.R. 441, H.R. 
2402, H.R. 4881, and H.R. 5221 Before the H. Subcomm. On Indigenous 
Peoples of the U.S., H. Comm. on Natural Resources, 117th Cong. (2021) 
(statement of Walter Murillo, President, National Council of Urban 
Indian Health).
---------------------------------------------------------------------------
    ``Urban confer'' is an adaptation of the government-to-
government Tribal consultation process between Tribes and the 
federal government. It allows IHS to engage with UIOs to ensure 
the United States is fulfilling its trust responsibility to 
AIANs living in urban areas. Congress first established IHS's 
UIO confer policy through reauthorization of the IHCIA in 
2010.\4\
---------------------------------------------------------------------------
    \4\25 U.S.C. Sec. 1660d.
---------------------------------------------------------------------------

                          NEED FOR LEGISLATION

    S. 460 would expand the urban confer process and require 
all agencies and offices within HHS to confer with UIOs on 
policies and initiatives related to healthcare for urban AIANs, 
furthering the fulfillment of the trust responsibility to urban 
AIANs.

                          SUMMARY OF THE BILL

    This bill requires HHS and agencies and offices within the 
Department to confer with UIOs on issues concerning the IHCIA 
and other provisions of law relating to Indian health care.

                          LEGISLATIVE HISTORY

    Senators Smith (D-MN) and Mullin (R-OK) introduced S. 460 
on February 15, 2023. It was referred to the Committee on the 
same day. On March 23, 2023, Senator Lujan joined S. 460 as a 
cosponsor. On March 29, 2023, the Committee met at a duly 
convened business meeting to consider S. 460 with three other 
bills. The Committee passed three of the four bills, including 
S. 460, en bloc by voice vote and ordered the bills to be 
reported favorably.
    Representatives Grijalva (D-NM), Stansbury (D-NM), and 
Davids (D-KS), introduced H.R. 630, an identical bill, on 
January 30, 2023. On the same day, it was referred to the House 
Committee on Natural Resources (HNR) and the House Committee on 
Energy and Commerce (E&C). On February 21, 2023, the bill was 
further referred to the HNR Subcommittee on Indian and Insular 
Affairs. Representatives Stansbury (D-NM), Davids (D-KS), Case 
(D-HI), McCollum (D-MN), Lee (D-CA), Cohen (D-TN), Huffman (D-
CA), Leger Fernandez (D-NM), Stanton (D-AZ), Bonamici (D-OR), 
Smith (D-WA), Hayes (D-CT), Peltola (D-AK), Garcia (D-IL), and 
Kilmer (D-WA) and Delegate Holmes Norton (D-DC) subsequently 
joined as cosponsors.
    117th Congress. On September 10, 2021, Representatives 
Grijalva (D-AZ), McCollum (D-MN), Cole (R-OK), Bass (D-CA), and 
Young (R-AK), and Delegate Holmes Norton (D-DC) introduced H.R. 
5221, the Urban Indian Health Confer Act. The House of 
Representatives referred the bill to HNR and E&C on the same 
day. On September 13, 2021, H.R. 5221 was further referred to 
the HNR Subcommittee for Indigenous Peoples of the United 
States (SCIP) and the E&C Subcommittee on Health. 
Representatives Joyce (R-OH), Gallego (D-AZ), Huffman (D-CA), 
Garcia (D-IL), and Smith (D-WA) subsequently joined the bill as 
co-sponsors.
    On October 5, 2021, SCIP held a legislative hearing. 
Representatives Cohen (D-TN), Davids (D-KS), Leger Fernandez 
(D-NM), Bonamici (D-OR), and Stansbury (D-NM) subsequently 
joined H.R. 5221 as cosponsors. On October 13, 2021, SCIP 
discharged the bill, and on the same day, HNR held a mark-up 
session and ordered H.R. 5221 to be reported by unanimous 
consent. Representatives Case (D-HI), Stanton (D-AZ), Mullin 
(R-OK), and Hayes (D-CT) subsequently joined the bill as 
cosponsors.
    On November 1, 2021, HNR reported H.R. 5221, and E&C 
discharged the bill, which was then placed on the Union 
Calendar. On November 2, 2021, pursuant to H. Res. 486, the 
House passed H.R. 5221 under suspension of the rules.
    The Senate received the bill on November 3, 2021 and 
referred the matter to the Senate Committee on Indian Affairs. 
On July 20, 2022, the Committee held a hearing on H.R. 5221. It 
took no further action on the bill before the conclusion of the 
117th Congress.
    Senators Smith (D-MN) and Lankford (R-OK) introduced S. 
4323, an identical companion bill, on May 26, 2022. The Senate 
referred the bill to the Committee on Indian Affairs on the 
same day. The Committee took no further action on S. 4323 
before the conclusion of the 117th Congress.

       SECTION-BY-SECTION ANALYSIS OF S. 460 AS ORDERED REPORTED

Section 1--Short title

    This section sets forth the short title as the ``Urban 
Indian Health Confer Act.''

Section 2--Urban Indian Organization Confer Policy

    This section amends section 514 of the Indian Health Care 
Improvement Act to direct the Secretary of the Interior to 
confer, to the maximum extent practicable, with urban Indian 
organizations in carrying out the requirements of the Act and 
other laws relating to Indian health care.

                   COST AND BUDGETARY CONSIDERATIONS

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]


    S. 460 would require the Department of Health and Human 
Services (HHS) to confer with urban Indian organizations 
regrading matters pertaining to the Indian Health Care 
Improvement Act and other provisions of law relating to Indian 
health care. According to the Indian Health Service (IHS), 
there are 41 urban Indian organizations that provide primary 
care services to urban Indian populations and others in 22 
states nationwide. The urban Indian organizations are not part 
of the IHS service delivery network but receive grant funding 
from IHS. Current law only requires IHS to confer with urban 
Indian organizations and the bill would require other agencies 
within HHS to confer with them as well. CBO estimates that 
enacting S. 460 would not affect direct spending or revenues 
and would have an insignificant effect on spending subject to 
appropriation for HHS staff to confer periodically with urban 
Indian organizations.
    The CBO staff contact for this estimate is Robert Stewart. 
The estimate was reviewed by Chad Chirico, Deputy Director of 
Budget Analysis.
                                         Phillip L. Swagel,
                             Director, Congressional Budget Office.

               REGULATORY AND PAPERWORK IMPACT STATEMENT

    Paragraph 11(b) of rule XXVI of the Standing Rules of the 
Senate requires each report accompanying a bill to evaluate the 
regulatory and paperwork impact that would be incurred in 
carrying out the bill. The Committee believes that S. 460 will 
have minimal impact on regulatory or paperwork requirements.

                        EXECUTIVE COMMUNICATIONS

    The Committee has received no communications from the 
Executive Branch regarding S. 460.

                        CHANGES IN EXISTING LAW

    On February 11, 2021, the Committee unanimously approved a 
motion to waive subsection 12 of rule XXVI of the Standing 
Rules of the Senate. In the opinion of the Committee, it is 
necessary to dispense with subsection 12 of rule XXVI of the 
Standing Rules of the Senate to expedite the business of the 
Senate.

                                  [all]