S.Amdt. 2923

SA 2923. Mr. DORGAN (for himself, Mr. Whitehouse, Mr. Udall of New
Mexico, Mr. Begich, Mr. Johnson, Mr. Franken, Ms. Cantwell, Mr. Udall
of Colorado, Mr. Tester, and Mr. Inouye) submitted an amendment
intended to be proposed to amendment SA 2786 proposed by Mr. Reid (for
himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill H.R. 3590,
to amend the Internal Revenue Code of 1986 to modify the first-time
homebuyers credit in the case of members of the Armed Forces and
certain other Federal employees, and for other purposes; as follows:

At the end, add the following:

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

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

Sec. 1. Short title; table of contents.

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

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

Subtitle A--Indian Health Manpower

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

Subtitle B--Health Services

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

Subtitle C--Health Facilities

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

Subtitle D--Access to Health Services

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

Subtitle E--Health Services for Urban Indians

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

Subtitle F--Organizational Improvements

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

Subtitle G--Behavioral Health Programs

Sec. 181. Behavioral health programs.

Subtitle H--Miscellaneous

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

TITLE II--AMENDMENTS TO OTHER ACTS

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

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

SEC. 101. REAUTHORIZATION.

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

``SEC. 825. AUTHORIZATION OF APPROPRIATIONS.

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

SEC. 102. FINDINGS.

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

[[Page S12434]]

SEC. 103. DECLARATION OF NATIONAL INDIAN HEALTH POLICY.

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

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

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

SEC. 104. DEFINITIONS.

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

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

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

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

``(ii) providing--

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

(8) by striking paragraph (9) (as redesignated by paragraph
(3)) and inserting the following:
``(9) FAS.--The term `fetal alcohol syndrome' or `FAS'
means a syndrome in which, with a history of maternal alcohol
consumption during pregnancy, the following criteria are met:
``(A) Central nervous system involvement such as mental
retardation, developmental delay, intellectual deficit,
microencephaly, or neurologic abnormalities.
``(B) Craniofacial abnormalities with at least 2 of the
following: microophthalmia, short palpebral fissures, poorly
developed philtrum, thin upper lip, flat nasal bridge, and
short upturned nose.
``(C) Prenatal or postnatal growth delay.'';
(9) by striking paragraphs (11) and (12) (as redesignated
by paragraph (3)) and inserting the following:
``(11) Health promotion.--The term `health promotion' means
any activity for--
``(A) fostering social, economic, environmental, and
personal factors conducive to health, including raising
public awareness regarding health matters and enabling
individuals to cope with health problems by increasing
knowledge and providing valid information;
``(B) encouraging adequate and appropriate diet, exercise,
and sleep;
``(C) promoting education and work in accordance with
physical and mental capacity;
``(D) making available safe water and sanitary facilities;
``(E) improving the physical, economic, cultural,
psychological, and social environment;
``(F) promoting culturally competent care; and
``(G) providing adequate and appropriate programs,
including programs for--
``(i) abuse prevention (mental and physical);
``(ii) community health;
``(iii) community safety;
``(iv) consumer health education;
``(v) diet and nutrition;
``(vi) immunization and other methods of prevention of
communicable diseases, including HIV/AIDS;
``(vii) environmental health;
``(viii) exercise and physical fitness;
``(ix) avoidance of fetal alcohol spectrum disorders;
``(x) first aid and CPR education;
``(xi) human growth and development;
``(xii) injury prevention and personal safety;
``(xiii) behavioral health;
``(xiv) monitoring of disease indicators between health
care provider visits through appropriate means, including
Internet-based health care management systems;
``(xv) personal health and wellness practices;
``(xvi) personal capacity building;
``(xvii) prenatal, pregnancy, and infant care;
``(xviii) psychological well-being;
``(xix) reproductive health and family planning;
``(xx) safe and adequate water;
``(xxi) healthy work environments;
``(xxii) elimination, reduction, and prevention of
contaminants that create unhealthy household conditions
(including mold and other allergens);
``(xxiii) stress control;
``(xxiv) substance abuse;
``(xxv) sanitary facilities;
``(xxvi) sudden infant death syndrome prevention;
``(xxvii) tobacco use cessation and reduction;
``(xxviii) violence prevention; and
``(xxix) such other activities identified by the Service, a
tribal health program, or an urban Indian organization to
promote achievement of any of the objectives referred to in
section 3(2).
``(12) Indian health program.--The term `Indian health
program' means--
``(A) any health program administered directly by the
Service;
``(B) any tribal health program; and
``(C) any Indian tribe or tribal organization to which the
Secretary provides funding pursuant to section 23 of the Act
of June 25, 1910 (25 U.S.C. 47) (commonly known as the `Buy
Indian Act').'';
(10) by inserting after paragraph (14) (as redesignated by
paragraph (3)) the following:
``(15) Junior or community college.--The term `junior or
community college' has the meaning given the term in section
312(e) of the Higher Education Act of 1965 (20 U.S.C.
1058(e)).
``(16) Reservation.--
``(A) In general.--The term `reservation' means a
reservation, Pueblo, or colony of any Indian tribe.
``(B) Inclusions.--The term `reservation' includes--
``(i) former reservations in Oklahoma;
``(ii) Indian allotments; and
``(iii) Alaska Native Regions established pursuant to the
Alaska Native Claims Settlement Act (43 U.S.C. 1601 et
seq.).'';
(11) by striking paragraph (20) (as redesignated by
paragraph (3)) and inserting the following:
``(20) Service unit.--The term `Service unit' means an
administrative entity of the Service or a tribal health
program through which services are provided, directly or by
contract, to eligible Indians within a defined geographic
area.'';
(12) by inserting after paragraph (21) (as redesignated by
paragraph (3)) the following:

[[Page S12435]]

``(22) Telehealth.--The term `telehealth' has the meaning
given the term in section 330K(a) of the Public Health
Service Act (42 U.S.C. 254c-16(a)).
``(23) Telemedicine.--The term `telemedicine' means a
telecommunications link to an end user through the use of
eligible equipment that electronically links health
professionals or patients and health professionals at
separate sites in order to exchange health care information
in audio, video, graphic, or other format for the purpose of
providing improved health care services.
``(24) Tribal college or university.--The term `tribal
college or university' has the meaning given the term in
section 316(b) of the Higher Education Act of 1965 (20 U.S.C.
1059c(b)).
``(25) Tribal health program.--The term `tribal health
program' means an Indian tribe or tribal organization that
operates any health program, service, function, activity, or
facility funded, in whole or part, by the Service through, or
provided for in, a contract or compact with the Service under
the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450 et seq.).''; and
(13) by striking paragraph (26) (as redesignated by
paragraph (3)) and inserting the following:
``(26) Tribal organization.--The term `tribal organization'
has the meaning given the term in section 4 of the Indian
Self-Determination and Education Assistance Act (25 U.S.C.
450b).''.

Subtitle A--Indian Health Manpower

SEC. 111. COMMUNITY HEALTH AIDE PROGRAM.

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

``SEC. 119. COMMUNITY HEALTH AIDE PROGRAM.

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

SEC. 112. HEALTH PROFESSIONAL CHRONIC SHORTAGE DEMONSTRATION
PROGRAMS.

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

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

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

SEC. 113. EXEMPTION FROM PAYMENT OF CERTAIN FEES.

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

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

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

Subtitle B--Health Services

SEC. 121. INDIAN HEALTH CARE IMPROVEMENT FUND.

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

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

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

[[Page S12436]]

funds, directly or under the authority of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.), which are appropriated under the authority of this
section, for the purposes of--
``(1) eliminating the deficiencies in health status and
health resources of all Indian tribes;
``(2) eliminating backlogs in the provision of health care
services to Indians;
``(3) meeting the health needs of Indians in an efficient
and equitable manner, including the use of telehealth and
telemedicine when appropriate;
``(4) eliminating inequities in funding for both direct
care and contract health service programs; and
``(5) augmenting the ability of the Service to meet the
following health service responsibilities with respect to
those Indian tribes with the highest levels of health status
deficiencies and resource deficiencies:
``(A) Clinical care, including inpatient care, outpatient
care (including audiology, clinical eye, and vision care),
primary care, secondary and tertiary care, and long-term
care.
``(B) Preventive health, including mammography and other
cancer screening.
``(C) Dental care.
``(D) Mental health, including community mental health
services, inpatient mental health services, dormitory mental
health services, therapeutic and residential treatment
centers, and training of traditional health care
practitioners.
``(E) Emergency medical services.
``(F) Treatment and control of, and rehabilitative care
related to, alcoholism and drug abuse (including fetal
alcohol syndrome) among Indians.
``(G) Injury prevention programs, including data collection
and evaluation, demonstration projects, training, and
capacity building.
``(H) Home health care.
``(I) Community health representatives.
``(J) Maintenance and improvement.
``(b) No Offset or Limitation.--Any funds appropriated
under the authority of this section shall not be used to
offset or limit any other appropriations made to the Service
under this Act or the Act of November 2, 1921 (25 U.S.C. 13)
(commonly known as the `Snyder Act'), or any other provision
of law.
``(c) Allocation; Use.--
``(1) In general.--Funds appropriated under the authority
of this section shall be allocated to Service units, Indian
tribes, or tribal organizations. The funds allocated to each
Indian tribe, tribal organization, or Service unit under this
paragraph shall be used by the Indian tribe, tribal
organization, or Service unit under this paragraph to improve
the health status and reduce the resource deficiency of each
Indian tribe served by such Service unit, Indian tribe, or
tribal organization.
``(2) Apportionment of allocated funds.--The apportionment
of funds allocated to a Service unit, Indian tribe, or tribal
organization under paragraph (1) among the health service
responsibilities described in subsection (a)(5) shall be
determined by the Service in consultation with, and with the
active participation of, the affected Indian tribes and
tribal organizations.
``(d) Provisions Relating to Health Status and Resource
Deficiencies.--For the purposes of this section, the
following definitions apply:
``(1) Definition.--The term `health status and resource
deficiency' means the extent to which--
``(A) the health status objectives set forth in sections
3(1) and 3(2) are not being achieved; and
``(B) the Indian tribe or tribal organization does not have
available to it the health resources it needs, taking into
account the actual cost of providing health care services
given local geographic, climatic, rural, or other
circumstances.
``(2) Available resources.--The health resources available
to an Indian tribe or tribal organization include health
resources provided by the Service as well as health resources
used by the Indian tribe or tribal organization, including
services and financing systems provided by any Federal
programs, private insurance, and programs of State or local
governments.
``(3) Process for review of determinations.--The Secretary
shall establish procedures which allow any Indian tribe or
tribal organization to petition the Secretary for a review of
any determination of the extent of the health status and
resource deficiency of such Indian tribe or tribal
organization.
``(e) Eligibility for Funds.--Tribal health programs shall
be eligible for funds appropriated under the authority of
this section on an equal basis with programs that are
administered directly by the Service.
``(f) Report.--By no later than the date that is 3 years
after the date of enactment of the Indian Health Care
Improvement Reauthorization and Extension Act of 2009, the
Secretary shall submit to Congress the current health status
and resource deficiency report of the Service for each
Service unit, including newly recognized or acknowledged
Indian tribes. Such report shall set out--
``(1) the methodology then in use by the Service for
determining tribal health status and resource deficiencies,
as well as the most recent application of that methodology;
``(2) the extent of the health status and resource
deficiency of each Indian tribe served by the Service or a
tribal health program;
``(3) the amount of funds necessary to eliminate the health
status and resource deficiencies of all Indian tribes served
by the Service or a tribal health program; and
``(4) an estimate of--
``(A) the amount of health service funds appropriated under
the authority of this Act, or any other Act, including the
amount of any funds transferred to the Service for the
preceding fiscal year which is allocated to each Service
unit, Indian tribe, or tribal organization;
``(B) the number of Indians eligible for health services in
each Service unit or Indian tribe or tribal organization; and
``(C) the number of Indians using the Service resources
made available to each Service unit, Indian tribe or tribal
organization, and, to the extent available, information on
the waiting lists and number of Indians turned away for
services due to lack of resources.
``(g) Inclusion in Base Budget.--Funds appropriated under
this section for any fiscal year shall be included in the
base budget of the Service for the purpose of determining
appropriations under this section in subsequent fiscal years.
``(h) Clarification.--Nothing in this section is intended
to diminish the primary responsibility of the Service to
eliminate existing backlogs in unmet health care needs, nor
are the provisions of this section intended to discourage the
Service from undertaking additional efforts to achieve equity
among Indian tribes and tribal organizations.
``(i) Funding Designation.--Any funds appropriated under
the authority of this section shall be designated as the
`Indian Health Care Improvement Fund'.''.

SEC. 122. CATASTROPHIC HEALTH EMERGENCY FUND.

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

``SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND.

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

SEC. 123. DIABETES PREVENTION, TREATMENT, AND CONTROL.

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

[[Page S12437]]

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

``(a) Determinations Regarding Diabetes.--The Secretary,
acting through the Service, and in consultation with Indian
tribes and tribal organizations, shall determine--
``(1) by Indian tribe and by Service unit, the incidence
of, and the types of complications resulting from, diabetes
among Indians; and
``(2) based on the determinations made pursuant to
paragraph (1), the measures (including patient education and
effective ongoing monitoring of disease indicators) each
Service unit should take to reduce the incidence of, and
prevent, treat, and control the complications resulting from,
diabetes among Indian tribes within that Service unit.
``(b) Diabetes Screening.--To the extent medically
indicated and with informed consent, the Secretary shall
screen each Indian who receives services from the Service for
diabetes and for conditions which indicate a high risk that
the individual will become diabetic and establish a cost-
effective approach to ensure ongoing monitoring of disease
indicators. Such screening and monitoring may be conducted by
a tribal health program and may be conducted through
appropriate Internet-based health care management programs.
``(c) Diabetes Projects.--The Secretary shall continue to
maintain each model diabetes project in existence on the date
of enactment of the Indian Health Care Improvement
Reauthorization and Extension Act of 2009, any such other
diabetes programs operated by the Service or tribal health
programs, and any additional diabetes projects, such as the
Medical Vanguard program provided for in title IV of Public
Law 108-87, as implemented to serve Indian tribes. tribal
health programs shall receive recurring funding for the
diabetes projects that they operate pursuant to this section,
both at the date of enactment of the Indian Health Care
Improvement Reauthorization and Extension Act of 2009 and for
projects which are added and funded thereafter.
``(d) Dialysis Programs.--The Secretary is authorized to
provide, through the Service, Indian tribes, and tribal
organizations, dialysis programs, including the purchase of
dialysis equipment and the provision of necessary staffing.
``(e) Other Duties of the Secretary.--
``(1) In general.--The Secretary shall, to the extent
funding is available--
``(A) in each area office, consult with Indian tribes and
tribal organizations regarding programs for the prevention,
treatment, and control of diabetes;
``(B) establish in each area office a registry of patients
with diabetes to track the incidence of diabetes and the
complications from diabetes in that area; and
``(C) ensure that data collected in each area office
regarding diabetes and related complications among Indians
are disseminated to all other area offices, subject to
applicable patient privacy laws.
``(2) Diabetes control officers.--
``(A) In general.--The Secretary may establish and maintain
in each area office a position of diabetes control officer to
coordinate and manage any activity of that area office
relating to the prevention, treatment, or control of diabetes
to assist the Secretary in carrying out a program under this
section or section 330C of the Public Health Service Act (42
U.S.C. 254c-3).
``(B) Certain activities.--Any activity carried out by a
diabetes control officer under subparagraph (A) that is the
subject of a contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.), and any funds made available to carry out such an
activity, shall not be divisible for purposes of that Act.''.

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

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

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

``(a) Definitions.--In this section:
``(1) Assisted living service.--The term `assisted living
service' means any service provided by an assisted living
facility (as defined in section 232(b) of the National
Housing Act (12 U.S.C. 1715w(b))), except that such an
assisted living facility--
``(A) shall not be required to obtain a license; but
``(B) shall meet all applicable standards for licensure.
``(2) Home- and community-based service.--The term `home-
and community-based service' means 1 or more of the services
specified in paragraphs (1) through (9) of section 1929(a) of
the Social Security Act (42 U.S.C. 1396t(a)) (whether
provided by the Service or by an Indian tribe or tribal
organization pursuant to the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.)) that are or
will be provided in accordance with applicable standards.
``(3) Hospice care.--The term `hospice care' means--
``(A) the items and services specified in subparagraphs (A)
through (H) of section 1861(dd)(1) of the Social Security Act
(42 U.S.C. 1395x(dd)(1)); and
``(B) such other services as an Indian tribe or tribal
organization determines are necessary and appropriate to
provide in furtherance of that care.
``(4) Long-term care services.--The term `long-term care
services' has the meaning given the term `qualified long-term
care services' in section 7702B(c) of the Internal Revenue
Code of 1986.
``(b) Funding Authorized.--The Secretary, acting through
the Service, Indian tribes, and tribal organizations, may
provide funding under this Act to meet the objectives set
forth in section 3 through health care-related services and
programs not otherwise described in this Act for the
following services:
``(1) Hospice care.
``(2) Assisted living services.
``(3) Long-term care services.
``(4) Home- and community-based services.
``(c) Eligibility.--The following individuals shall be
eligible to receive long-term care services under this
section:
``(1) Individuals who are unable to perform a certain
number of activities of daily living without assistance.
``(2) Individuals with a mental impairment, such as
dementia, Alzheimer's disease, or another disabling mental
illness, who may be able to perform activities of daily
living under supervision.
``(3) Such other individuals as an applicable tribal health
program determines to be appropriate.
``(d) Authorization of Convenient Care Services.--The
Secretary, acting through the Service, Indian tribes, and
tribal organizations, may also provide funding under this Act
to meet the objectives set forth in section 3 for convenient
care services programs pursuant to section 307(c)(2)(A).''.
(2) Repeal.--Section 821 of the Indian Health Care
Improvement Act (25 U.S.C. 1680k) is repealed.
(b) Shared Services for Long-Term Care.--Section 822 of the
Indian Health Care Improvement Act (25 U.S.C. 1680l) is
amended to read as follows:

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

``(a) Long-Term Care.--
``(1) In general.--Notwithstanding any other provision of
law, the Secretary, acting through the Service, is authorized
to provide directly, or enter into contracts or compacts
under the Indian Self-Determination and Education Assistance
Act (25 U.S.C. 450 et seq.) with Indian tribes or tribal
organizations for, the delivery of long-term care (including
health care services associated with long-term care) provided
in a facility to Indians.
``(2) Inclusions.--Each agreement under paragraph (1) shall
provide for the sharing of staff or other services between
the Service or a tribal health program and a long-term care
or related facility owned and operated (directly or through a
contract or compact under the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.)) by the
Indian tribe or tribal organization.
``(b) Contents of Agreements.--An agreement entered into
pursuant to subsection (a)--
``(1) may, at the request of the Indian tribe or tribal
organization, delegate to the Indian tribe or tribal
organization such powers of supervision and control over
Service employees as the Secretary determines to be necessary
to carry out the purposes of this section;
``(2) shall provide that expenses (including salaries)
relating to services that are shared between the Service and
the tribal health program be allocated proportionately
between the Service and the Indian tribe or tribal
organization; and
``(3) may authorize the Indian tribe or tribal organization
to construct, renovate, or expand a long-term care or other
similar facility (including the construction of a facility
attached to a Service facility).
``(c) Minimum Requirement.--Any nursing facility provided
for under this section shall meet the requirements for
nursing facilities under section 1919 of the Social Security
Act (42 U.S.C. 1396r).
``(d) Other Assistance.--The Secretary shall provide such
technical and other assistance as may be necessary to enable
applicants to comply with this section.
``(e) Use of Existing or Underused Facilities.--The
Secretary shall encourage the use of existing facilities that
are underused, or allow the use of swing beds, for long-term
or similar care.''.

SEC. 125. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS
OF HEALTH SERVICES.

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

``SEC. 206. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS
OF HEALTH SERVICES.

``(a) Right of Recovery.--Except as provided in subsection
(f), the United States, an Indian tribe, or tribal
organization shall have the right to recover from an
insurance company, health maintenance organization, employee
benefit plan, third-party tortfeasor, or any other
responsible or liable third party (including a political
subdivision or local governmental entity of a State) the
reasonable charges billed by the Secretary, an Indian tribe,
or tribal organization in providing health services through
the Service, an Indian tribe, or tribal organization, or, if
higher, the highest amount the third party would pay for care
and services furnished by providers other than governmental
entities, to any individual to the same extent that such
individual, or any nongovernmental provider of such services,
would be eligible

[[Page S12438]]

to receive damages, reimbursement, or indemnification for
such charges or expenses if--
``(1) such services had been provided by a nongovernmental
provider; and
``(2) such individual had been required to pay such charges
or expenses and did pay such charges or expenses.
``(b) Limitations on Recoveries From States.--Subsection
(a) shall provide a right of recovery against any State, only
if the injury, illness, or disability for which health
services were provided is covered under--
``(1) workers' compensation laws; or
``(2) a no-fault automobile accident insurance plan or
program.
``(c) Nonapplicability of Other Laws.--No law of any State,
or of any political subdivision of a State and no provision
of any contract, insurance or health maintenance organization
policy, employee benefit plan, self-insurance plan, managed
care plan, or other health care plan or program entered into
or renewed after the date of enactment of the Indian Health
Care Amendments of 1988, shall prevent or hinder the right of
recovery of the United States, an Indian tribe, or tribal
organization under subsection (a).
``(d) No Effect on Private Rights of Action.--No action
taken by the United States, an Indian tribe, or tribal
organization to enforce the right of recovery provided under
this section shall operate to deny to the injured person the
recovery for that portion of the person's damage not covered
hereunder.
``(e) Enforcement.--
``(1) In general.--The United States, an Indian tribe, or
tribal organization may enforce the right of recovery
provided under subsection (a) by--
``(A) intervening or joining in any civil action or
proceeding brought--
``(i) by the individual for whom health services were
provided by the Secretary, an Indian tribe, or tribal
organization; or
``(ii) by any representative or heirs of such individual,
or
``(B) instituting a separate civil action, including a
civil action for injunctive relief and other relief and
including, with respect to a political subdivision or local
governmental entity of a State, such an action against an
official thereof.
``(2) Notice.--All reasonable efforts shall be made to
provide notice of action instituted under paragraph (1)(B) to
the individual to whom health services were provided, either
before or during the pendency of such action.
``(3) Recovery from tortfeasors.--
``(A) In general.--In any case in which an Indian tribe or
tribal organization that is authorized or required under a
compact or contract issued pursuant to the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.) to furnish or pay for health services to a person who
is injured or suffers a disease on or after the date of
enactment of the Indian Health Care Improvement
Reauthorization and Extension Act of 2009 under circumstances
that establish grounds for a claim of liability against the
tortfeasor with respect to the injury or disease, the Indian
tribe or tribal organization shall have a right to recover
from the tortfeasor (or an insurer of the tortfeasor) the
reasonable value of the health services so furnished, paid
for, or to be paid for, in accordance with the Federal
Medical Care Recovery Act (42 U.S.C. 2651 et seq.), to the
same extent and under the same circumstances as the United
States may recover under that Act.
``(B) Treatment.--The right of an Indian tribe or tribal
organization to recover under subparagraph (A) shall be
independent of the rights of the injured or diseased person
served by the Indian tribe or tribal organization.
``(f) Limitation.--Absent specific written authorization by
the governing body of an Indian tribe for the period of such
authorization (which may not be for a period of more than 1
year and which may be revoked at any time upon written notice
by the governing body to the Service), the United States
shall not have a right of recovery under this section if the
injury, illness, or disability for which health services were
provided is covered under a self-insurance plan funded by an
Indian tribe, tribal organization, or urban Indian
organization. Where such authorization is provided, the
Service may receive and expend such amounts for the provision
of additional health services consistent with such
authorization.
``(g) Costs and Attorney's Fees.--In any action brought to
enforce the provisions of this section, a prevailing
plaintiff shall be awarded its reasonable attorney's fees and
costs of litigation.
``(h) Nonapplicability of Claims Filing Requirements.--An
insurance company, health maintenance organization, self-
insurance plan, managed care plan, or other health care plan
or program (under the Social Security Act or otherwise) may
not deny a claim for benefits submitted by the Service or by
an Indian tribe or tribal organization based on the format in
which the claim is submitted if such format complies with the
format required for submission of claims under title XVIII of
the Social Security Act or recognized under section 1175 of
such Act.
``(i) Application to Urban Indian Organizations.--The
previous provisions of this section shall apply to urban
Indian organizations with respect to populations served by
such Organizations in the same manner they apply to Indian
tribes and tribal organizations with respect to populations
served by such Indian tribes and tribal organizations.
``(j) Statute of Limitations.--The provisions of section
2415 of title 28, United States Code, shall apply to all
actions commenced under this section, and the references
therein to the United States are deemed to include Indian
tribes, tribal organizations, and urban Indian organizations.
``(k) Savings.--Nothing in this section shall be construed
to limit any right of recovery available to the United
States, an Indian tribe, or tribal organization under the
provisions of any applicable, Federal, State, or tribal law,
including medical lien laws.''.

SEC. 126. CREDITING OF REIMBURSEMENTS.

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

``SEC. 207. CREDITING OF REIMBURSEMENTS.

``(a) Use of Amounts.--
``(1) Retention by program.--Except as provided in sections
202(a)(2) and 813, all reimbursements received or recovered
under any of the programs described in paragraph (2),
including under section 813, by reason of the provision of
health services by the Service, by an Indian tribe or tribal
organization, or by an urban Indian organization, shall be
credited to the Service, such Indian tribe or tribal
organization, or such urban Indian organization,
respectively, and may be used as provided in section 401. In
the case of such a service provided by or through a Service
Unit, such amounts shall be credited to such unit and used
for such purposes.
``(2) Programs covered.--The programs referred to in
paragraph (1) are the following:
``(A) Titles XVIII, XIX, and XXI of the Social Security
Act.
``(B) This Act, including section 813.
``(C) Public Law 87-693.
``(D) Any other provision of law.
``(b) No Offset of Amounts.--The Service may not offset or
limit any amount obligated to any Service Unit or entity
receiving funding from the Service because of the receipt of
reimbursements under subsection (a).''.

SEC. 127. BEHAVIORAL HEALTH TRAINING AND COMMUNITY EDUCATION
PROGRAMS.

Section 209 of the Indian Health Care Improvement Act (25
U.S.C. 1621h) is amended by striking subsection (d) and
inserting the following:
``(d) Behavioral Health Training and Community Education
Programs.--
``(1) Study; list.--The Secretary, acting through the
Service, and the Secretary of the Interior, in consultation
with Indian tribes and tribal organizations, shall conduct a
study and compile a list of the types of staff positions
specified in paragraph (2) whose qualifications include, or
should include, training in the identification, prevention,
education, referral, or treatment of mental illness, or
dysfunctional and self destructive behavior.
``(2) Positions.--The positions referred to in paragraph
(1) are--
``(A) staff positions within the Bureau of Indian Affairs,
including existing positions, in the fields of--
``(i) elementary and secondary education;
``(ii) social services and family and child welfare;
``(iii) law enforcement and judicial services; and
``(iv) alcohol and substance abuse;
``(B) staff positions within the Service; and
``(C) staff positions similar to those identified in
subparagraphs (A) and (B) established and maintained by
Indian tribes and tribal organizations (without regard to the
funding source).
``(3) Training criteria.--
``(A) In general.--The appropriate Secretary shall provide
training criteria appropriate to each type of position
identified in paragraphs (2)(A) and (2)(B) and ensure that
appropriate training has been, or shall be provided to any
individual in any such position. With respect to any such
individual in a position identified pursuant to paragraph
(2)(C), the respective Secretaries shall provide appropriate
training to, or provide funds to, an Indian tribe or tribal
organization for training of appropriate individuals. In the
case of positions funded under a contract or compact under
the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450 et seq.), the appropriate Secretary shall
ensure that such training costs are included in the contract
or compact, as the Secretary determines necessary.
``(B) Position specific training criteria.--Position
specific training criteria shall be culturally relevant to
Indians and Indian tribes and shall ensure that appropriate
information regarding traditional health care practices is
provided.
``(4) Community education on mental illness.--The Service
shall develop and implement, on request of an Indian tribe,
tribal organization, or urban Indian organization, or assist
the Indian tribe, tribal organization, or urban Indian
organization to develop and implement, a program of community
education on mental illness. In carrying out this paragraph,
the Service shall, upon request of an Indian tribe, tribal
organization, or urban Indian organization, provide technical
assistance to the Indian tribe, tribal organization, or urban
Indian organization to obtain and develop community
educational materials on the identification, prevention,
referral, and treatment of mental illness and dysfunctional
and self-destructive behavior.
``(5) Plan.--Not later than 90 days after the date of
enactment of the Indian Health Care Improvement
Reauthorization and Extension

[[Page S12439]]

Act of 2009, the Secretary shall develop a plan under which
the Service will increase the health care staff providing
behavioral health services by at least 500 positions within 5
years after the date of enactment of that Act, with at least
200 of such positions devoted to child, adolescent, and
family services. The plan developed under this paragraph
shall be implemented under the Act of November 2, 1921 (25
U.S.C. 13) (commonly known as the `Snyder Act').''.

SEC. 128. CANCER SCREENINGS.

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

SEC. 129. PATIENT TRAVEL COSTS.

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

``SEC. 213. PATIENT TRAVEL COSTS.

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

SEC. 130. EPIDEMIOLOGY CENTERS.

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

``SEC. 214. EPIDEMIOLOGY CENTERS.

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

SEC. 131. INDIAN YOUTH GRANT PROGRAM.

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

SEC. 132. AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM.

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

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

``(a) Grants Authorized.--The Secretary, acting through the
Service, shall make grants of not more than $300,000 to each
of 9 colleges and universities for the purpose of developing
and maintaining Indian psychology career recruitment programs
as a means of encouraging Indians to enter the behavioral
health field. These programs shall be located at various
locations throughout the country to maximize their
availability to Indian students and new programs shall be
established in different locations from time to time.
``(b) Quentin N. Burdick Program Grant.--The Secretary
shall provide a grant authorized under subsection (a) to
develop and maintain a program at the University of North
Dakota to be known as the `Quentin N. Burdick American
Indians Into Psychology Program'. Such program shall, to the
maximum extent feasible, coordinate with the Quentin N.
Burdick Indian health programs authorized under section
117(b), the Quentin N. Burdick American Indians Into Nursing
Program authorized under section 115(e), and existing
university research and communications networks.
``(c) Regulations.--The Secretary shall issue regulations
pursuant to this Act for the competitive awarding of grants
provided under this section.
``(d) Conditions of Grant.--Applicants under this section
shall agree to provide a program which, at a minimum--
``(1) provides outreach and recruitment for health
professions to Indian communities including elementary,
secondary, and accredited and accessible community colleges
that will be served by the program;
``(2) incorporates a program advisory board comprised of
representatives from the tribes and communities that will be
served by the program;
``(3) provides summer enrichment programs to expose Indian
students to the various fields of psychology through
research, clinical, and experimental activities;
``(4) provides stipends to undergraduate and graduate
students to pursue a career in psychology;
``(5) develops affiliation agreements with tribal colleges
and universities, the Service, university affiliated
programs, and other appropriate accredited and accessible
entities to enhance the education of Indian students;

[[Page S12440]]

``(6) to the maximum extent feasible, uses existing
university tutoring, counseling, and student support
services; and
``(7) to the maximum extent feasible, employs qualified
Indians in the program.
``(e) Active Duty Service Requirement.--The active duty
service obligation prescribed under section 338C of the
Public Health Service Act (42 U.S.C. 254m) shall be met by
each graduate who receives a stipend described in subsection
(d)(4) that is funded under this section. Such obligation
shall be met by service--
``(1) in an Indian health program;
``(2) in a program assisted under title V; or
``(3) in the private practice of psychology if, as
determined by the Secretary, in accordance with guidelines
promulgated by the Secretary, such practice is situated in a
physician or other health professional shortage area and
addresses the health care needs of a substantial number of
Indians.
``(f) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section $2,700,000 for
fiscal year 2010 and each fiscal year thereafter.''.

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

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

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

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

SEC. 134. METHODS TO INCREASE CLINICIAN RECRUITMENT AND
RETENTION ISSUES.

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

``SEC. 221. LICENSING.

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

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

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

``SEC. 106. CONTINUING EDUCATION ALLOWANCES.

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

SEC. 135. LIABILITY FOR PAYMENT.

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

``SEC. 222. LIABILITY FOR PAYMENT.

``(a) No Patient Liability.--A patient who receives
contract health care services that are authorized by the
Service shall not be liable for the payment of any charges or
costs associated with the provision of such services.
``(b) Notification.--The Secretary shall notify a contract
care provider and any patient who receives contract health
care services authorized by the Service that such patient is
not liable for the payment of any charges or costs associated
with the provision of such services not later than 5 business
days after receipt of a notification of a claim by a provider
of contract care services.
``(c) No Recourse.--Following receipt of the notice
provided under subsection (b), or, if a claim has been deemed
accepted under section 220(b), the provider shall have no
further recourse against the patient who received the
services.''.

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

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

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

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

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

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

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

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

[[Page S12441]]

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

Subtitle C--Health Facilities

SEC. 141. HEALTH CARE FACILITY PRIORITY SYSTEM.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

SEC. 142. INDIAN HEALTH CARE DELIVERY DEMONSTRATION PROJECTS.

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

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

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

[[Page S12442]]

``(A) to test alternative means of delivering health care
and services to Indians through facilities; or
``(B) to use alternative or innovative methods or models of
delivering health care services to Indians (including primary
care services, contract health services, or any other program
or service authorized by this Act) through convenient care
services (as defined in subsection (c)), community health
centers, or cooperative agreements or arrangements with other
health care providers that share or coordinate the use of
facilities, funding, or other resources, or otherwise
coordinate or improve the coordination of activities of the
Service, Indian tribes, or tribal organizations, with those
of the other health care providers.
``(2) Authority.--The Secretary, acting through the
Service, is authorized to carry out, or to enter into
contracts or compacts under the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.) with Indian
tribes or tribal organizations to carry out, health care
delivery demonstration projects that--
``(A) test alternative means of delivering health care and
services to Indians through facilities; or
``(B) otherwise carry out the purposes of this section.
``(b) Use of Funds.--The Secretary, in approving projects
pursuant to this section--
``(1) may authorize such contracts for the construction and
renovation of hospitals, health centers, health stations, and
other facilities to deliver health care services; and
``(2) is authorized--
``(A) to waive any leasing prohibition;
``(B) to permit use and carryover of funds appropriated for
the provision of health care services under this Act
(including for the purchase of health benefits coverage, as
authorized by section 402(a));
``(C) to permit the use of other available funds, including
other Federal funds, funds from third-party collections in
accordance with sections 206, 207, and 401, and non-Federal
funds contributed by State or local governmental agencies or
facilities or private health care providers pursuant to
cooperative or other agreements with the Service, 1 or more
Indian tribes, or tribal organizations;
``(D) to permit the use of funds or property donated or
otherwise provided from any source for project purposes;
``(E) to provide for the reversion of donated real or
personal property to the donor; and
``(F) to permit the use of Service funds to match other
funds, including Federal funds.
``(c) Health Care Demonstration Projects.--
``(1) Definition of convenient care service.--In this
subsection, the term `convenient care service' means any
primary health care service, such as urgent care services,
nonemergent care services, prevention services and
screenings, and any service authorized by section 203 or
205(d), that is offered--
``(A) at an alternative setting; or
``(B) during hours other than regular working hours.
``(2) General projects.--
``(A) Criteria.--The Secretary may approve under this
section demonstration projects that meet the following
criteria:
``(i) There is a need for a new facility or program, such
as a program for convenient care services, or an improvement
in, increased efficiency at, or reorientation of an existing
facility or program.
``(ii) A significant number of Indians, including Indians
with low health status, will be served by the project.
``(iii) The project has the potential to deliver services
in an efficient and effective manner.
``(iv) The project is economically viable.
``(v) For projects carried out by an Indian tribe or tribal
organization, the Indian tribe or tribal organization has the
administrative and financial capability to administer the
project.
``(vi) The project is integrated with providers of related
health or social services (including State and local health
care agencies or other health care providers) and is
coordinated with, and avoids duplication of, existing
services in order to expand the availability of services.
``(B) Priority.--In approving demonstration projects under
this paragraph, the Secretary shall give priority to
demonstration projects, to the extent the projects meet the
criteria described in subparagraph (A), located in any of the
following Service units:
``(i) Cass Lake, Minnesota.
``(ii) Mescalero, New Mexico.
``(iii) Owyhee and Elko, Nevada.
``(iv) Schurz, Nevada.
``(v) Ft. Yuma, California.
``(3) Innovative health services delivery demonstration
project.--
``(A) Application or request.--On receipt of an application
or request from an Indian tribe, a consortium of Indian
tribes, or a tribal organization within a Service area, the
Secretary shall take into consideration alternative or
innovated methods to deliver health care services within the
Service area (or a portion of, or facility within, the
Service area) as described in the application or request,
including medical, dental, pharmaceutical, nursing, clinical
laboratory, contract health services, convenient care
services, community health centers, or any other health care
services delivery models designed to improve access to, or
efficiency or quality of, the health care, health promotion,
or disease prevention services and programs under this Act.
``(B) Approval.--In addition to projects described in
paragraph (2), in any fiscal year, the Secretary is
authorized under this paragraph to approve not more than 10
applications for health care delivery demonstration projects
that meet the criteria described in subparagraph (C).
``(C) Criteria.--The Secretary shall approve under
subparagraph (B) demonstration projects that meet all of the
following criteria:
``(i) The criteria set forth in paragraph (2)(A).
``(ii) There is a lack of access to health care services at
existing health care facilities, which may be due to limited
hours of operation at those facilities or other factors.
``(iii) The project--

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

``(aa) the burden on Contract Health Services; or
``(bb) the need for emergency room visits.
``(d) Technical Assistance.--On receipt of an application
or request from an Indian tribe, a consortium of Indian
tribes, or a tribal organization, the Secretary shall provide
such technical and other assistance as may be necessary to
enable applicants to comply with this section, including
information regarding the Service unit budget and available
funding for carrying out the proposed demonstration project.
``(e) Service to Ineligible Persons.--Subject to section
813, the authority to provide services to persons otherwise
ineligible for the health care benefits of the Service, and
the authority to extend hospital privileges in Service
facilities to non-Service health practitioners as provided in
section 813, may be included, subject to the terms of that
section, in any demonstration project approved pursuant to
this section.
``(f) Equitable Treatment.--For purposes of subsection (c),
the Secretary, in evaluating facilities operated under any
contract or compact under the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.), shall use
the same criteria that the Secretary uses in evaluating
facilities operated directly by the Service.
``(g) Equitable Integration of Facilities.--The Secretary
shall ensure that the planning, design, construction,
renovation, and expansion needs of Service and non-Service
facilities that are the subject of a contract or compact
under the Indian Self-Determination and Education Assistance
Act (25 U.S.C. 450 et seq.) for health services are fully and
equitably integrated into the implementation of the health
care delivery demonstration projects under this section.''.

SEC. 143. TRIBAL MANAGEMENT OF FEDERALLY OWNED QUARTERS.

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

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

``(a) Rental Rates.--
``(1) Establishment.--Notwithstanding any other provision
of law, a tribal health program that operates a hospital or
other health facility and the federally owned quarters
associated with such a facility pursuant to a contract or
compact under the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.) may establish the
rental rates charged to the occupants of those quarters, on
providing notice to the Secretary.
``(2) Objectives.--In establishing rental rates under this
subsection, a tribal health program shall attempt--
``(A) to base the rental rates on the reasonable value of
the quarters to the occupants of the quarters; and
``(B) to generate sufficient funds to prudently provide for
the operation and maintenance of the quarters, and at the
discretion of the tribal health program, to supply reserve
funds for capital repairs and replacement of the quarters.
``(3) Equitable funding.--A federally owned quarters the
rental rates for which are established by a tribal health
program under this subsection shall remain eligible to
receive improvement and repair funds to the same extent that
all federally owned quarters used to house personnel in
programs of the Service are eligible to receive those funds.
``(4) Notice of rate change.--A tribal health program that
establishes a rental rate under this subsection shall provide
occupants of the federally owned quarters a notice of any
change in the rental rate by not later than the date that is
60 days notice before the effective date of the change.
``(5) Rates in alaska.--A rental rate established by a
tribal health program under this section for a federally
owned quarters in the State of Alaska may be based on the
cost of comparable private rental housing in the nearest
established community with a year-round population of 1,500
or more individuals.
``(b) Direct Collection of Rent.--
``(1) In general.--Notwithstanding any other provision of
law, and subject to paragraph (2), a tribal health program
may collect rent directly from Federal employees who occupy
federally owned quarters if the tribal health program submits
to the Secretary and the employees a notice of the election
of the tribal health program to collect rents directly from
the employees.
``(2) Action by employees.--On receipt of a notice
described in paragraph (1)--

[[Page S12443]]

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

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

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

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

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

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

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

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

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

SEC. 146. MOBILE HEALTH STATIONS DEMONSTRATION PROGRAM.

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

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

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

[[Page S12444]]

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

Subtitle D--Access to Health Services

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

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

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

``(a) Disregard of Medicare, Medicaid, and CHIP Payments in
Determining Appropriations.--Any payments received by an
Indian health program or by an urban Indian organization
under title XVIII, XIX, or XXI of the Social Security Act for
services provided to Indians eligible for benefits under such
respective titles shall not be considered in determining
appropriations for the provision of health care and services
to Indians.
``(b) Nonpreferential Treatment.--Nothing in this Act
authorizes the Secretary to provide services to an Indian
with coverage under title XVIII, XIX, or XI of the Social
Security Act in preference to an Indian without such
coverage.
``(c) Use of Funds.--
``(1) Special fund.--
``(A) 100 percent pass-through of payments due to
facilities.--Notwithstanding any other provision of law, but
subject to paragraph (2), payments to which a facility of the
Service is entitled by reason of a provision of title XVIII
or XIX of the Social Security Act shall be placed in a
special fund to be held by the Secretary. In making payments
from such fund, the Secretary shall ensure that each Service
unit of the Service receives 100 percent of the amount to
which the facilities of the Service, for which such Service
unit makes collections, are entitled by reason of a provision
of either such title.
``(B) Use of funds.--Amounts received by a facility of the
Service under subparagraph (A) by reason of a provision of
title XVIII or XIX of the Social Security Act shall first be
used (to such extent or in such amounts as are provided in
appropriation Acts) for the purpose of making any
improvements in the programs of the Service operated by or
through such facility which may be necessary to achieve or
maintain compliance with the applicable conditions and
requirements of such respective title. Any amounts so
received that are in excess of the amount necessary to
achieve or maintain such conditions and requirements shall,
subject to consultation with the Indian tribes being served
by the Service unit, be used for reducing the health resource
deficiencies (as determined in section 201(c)) of such Indian
tribes, including the provision of services pursuant to
section 205.
``(2) Direct payment option.--Paragraph (1) shall not apply
to a tribal health program upon the election of such program
under subsection (d) to receive payments directly. No payment
may be made out of the special fund described in such
paragraph with respect to reimbursement made for services
provided by such program during the period of such election.
``(d) Direct Billing.--
``(1) In general.--Subject to complying with the
requirements of paragraph (2), a tribal health program may
elect to directly bill for, and receive payment for, health
care items and services provided by such program for which
payment is made under title XVIII, XIX, or XXI of the Social
Security Act or from any other third party payor.
``(2) Direct reimbursement.--
``(A) Use of funds.--Each tribal health program making the
election described in paragraph (1) with respect to a program
under a title of the Social Security Act shall be reimbursed
directly by that program for items and services furnished
without regard to subsection (c)(1), except that all amounts
so reimbursed shall be used by the tribal health program for
the purpose of making any improvements in facilities of the
tribal health program that may be necessary to achieve or
maintain compliance with the conditions and requirements
applicable generally to such items and services under the
program under such title and to provide additional health
care services, improvements in health care facilities and
tribal health programs, any health care-related purpose
(including coverage for a service or service within a
contract health service delivery area or any portion of a
contract health service delivery area that would otherwise be
provided as a contract health service), or otherwise to
achieve the objectives provided in section 3 of this Act.
``(B) Audits.--The amounts paid to a tribal health program
making the election described in paragraph (1) with respect
to a program under title XVIII, XIX, or XXI of the Social
Security Act shall be subject to all auditing requirements
applicable to the program under such title, as well as all
auditing requirements applicable to programs administered by
an Indian health program. Nothing in the preceding sentence
shall be construed as limiting the application of auditing
requirements applicable to amounts paid under title XVIII,
XIX, or XXI of the Social Security Act.
``(C) Identification of source of payments.--Any tribal
health program that receives reimbursements or payments under
title XVIII, XIX, or XXI of the Social Security Act shall
provide to the Service a list of each provider enrollment
number (or other identifier) under which such program
receives such reimbursements or payments.
``(3) Examination and implementation of changes.--
``(A) In general.--The Secretary, acting through the
Service and with the assistance of the Administrator of the
Centers for Medicare & Medicaid Services, shall examine on an
ongoing basis and implement any administrative changes that
may be necessary to facilitate direct billing and
reimbursement under the program established under this
subsection, including any agreements with States that may be
necessary to provide for direct billing under a program under
title XIX or XXI of the Social Security Act.
``(B) Coordination of information.--The Service shall
provide the Administrator of the Centers for Medicare &
Medicaid Services with copies of the lists submitted to the
Service under paragraph (2)(C), enrollment data regarding
patients served by the Service (and by tribal health
programs, to the extent such data is available to the
Service), and such other information as the Administrator may
require for purposes of administering title XVIII, XIX, or
XXI of the Social Security Act.
``(4) Withdrawal from program.--A tribal health program
that bills directly under the program established under this
subsection may withdraw from participation in the same manner
and under the same conditions that an Indian tribe or tribal
organization may retrocede a contracted program to the
Secretary under the authority of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.). All cost accounting and billing authority under the
program established under this subsection shall be returned
to the Secretary upon the Secretary's acceptance of the
withdrawal of participation in this program.
``(5) Termination for failure to comply with
requirements.--The Secretary may terminate the participation
of a tribal health program or in the direct billing program
established under this subsection if the Secretary determines
that the program has failed to comply with the requirements
of paragraph (2). The Secretary shall provide a tribal health
program with notice of a determination that the program has
failed to comply with any such requirement and a reasonable
opportunity to correct such noncompliance prior to
terminating the program's participation in the direct billing
program established under this subsection.
``(e) Related Provisions Under the Social Security Act.--
For provisions related to subsections (c) and (d), see
sections 1880, 1911, and 2107(e)(1)(D) of the Social Security
Act.''.

SEC. 152. PURCHASING HEALTH CARE COVERAGE.

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

``SEC. 402. PURCHASING HEALTH CARE COVERAGE.

``(a) In General.--Insofar as amounts are made available
under law (including a provision of the Social Security Act,
the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450 et seq.), or other law, other than under
section 404) to Indian tribes, tribal organizations, and
urban Indian organizations for health benefits for Service
beneficiaries, Indian tribes, tribal organizations, and urban
Indian organizations may use such amounts to purchase health
benefits coverage (including coverage for a service, or
service within a contract health service delivery area, or
any portion of a contract health service delivery area that
would otherwise be provided as a contract health service) for
such beneficiaries in any manner, including through--
``(1) a tribally owned and operated health care plan;

[[Page S12445]]

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

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

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

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

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

SEC. 154. SHARING ARRANGEMENTS WITH FEDERAL AGENCIES.

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

``SEC. 405. SHARING ARRANGEMENTS WITH FEDERAL AGENCIES.

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

SEC. 155. ELIGIBLE INDIAN VETERAN SERVICES.

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

``SEC. 407. ELIGIBLE INDIAN VETERAN SERVICES.

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

[[Page S12446]]

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

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

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

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

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

SEC. 157. ACCESS TO FEDERAL INSURANCE.

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

``SEC. 409. ACCESS TO FEDERAL INSURANCE.

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

SEC. 158. GENERAL EXCEPTIONS.

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

``SEC. 410. GENERAL EXCEPTIONS.

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

SEC. 159. NAVAJO NATION MEDICAID AGENCY FEASIBILITY STUDY.

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

``SEC. 411. NAVAJO NATION MEDICAID AGENCY FEASIBILITY STUDY.

``(a) Study.--The Secretary shall conduct a study to
determine the feasibility of treating the Navajo Nation as a
State for the purposes of title XIX of the Social Security
Act, to provide services to Indians living within the
boundaries of the Navajo Nation through an entity established
having the same authority and performing the same functions
as single-State medicaid agencies responsible for the
administration of the State plan under title XIX of the
Social Security Act.
``(b) Considerations.--In conducting the study, the
Secretary shall consider the feasibility of--
``(1) assigning and paying all expenditures for the
provision of services and related administration funds, under
title XIX of the Social Security Act, to Indians living
within the boundaries of the Navajo Nation that are currently
paid to or would otherwise be paid to the State of Arizona,
New Mexico, or Utah;
``(2) providing assistance to the Navajo Nation in the
development and implementation of such entity for the
administration, eligibility, payment, and delivery of medical
assistance under title XIX of the Social Security Act;
``(3) providing an appropriate level of matching funds for
Federal medical assistance with respect to amounts such
entity expends for medical assistance for services and
related administrative costs; and
``(4) authorizing the Secretary, at the option of the
Navajo Nation, to treat the Navajo Nation as a State for the
purposes of title XIX of the Social Security Act (relating to
the State children's health insurance program) under terms
equivalent to those described in paragraphs (2) through (4).
``(c) Report.--Not later then 3 years after the date of
enactment of the Indian Health Care Improvement
Reauthorization and Extension Act of 2009, the Secretary
shall submit to the Committee on Indian Affairs and Committee
on Finance of the Senate and the Committee on Natural
Resources and Committee on Energy and Commerce of the House
of Representatives a report that includes--
``(1) the results of the study under this section;
``(2) a summary of any consultation that occurred between
the Secretary and the Navajo Nation, other Indian Tribes, the
States of Arizona, New Mexico, and Utah, counties which
include Navajo Lands, and other interested parties, in
conducting this study;
``(3) projected costs or savings associated with
establishment of such entity, and any estimated impact on
services provided as described in this section in relation to
probable costs or savings; and
``(4) legislative actions that would be required to
authorize the establishment of such entity if such entity is
determined by the Secretary to be feasible.''.

Subtitle E--Health Services for Urban Indians

SEC. 161. FACILITIES RENOVATION.

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

SEC. 162. TREATMENT OF CERTAIN DEMONSTRATION PROJECTS.

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

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

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

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

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

[[Page S12447]]

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

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

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

``(a) In General.--Pursuant to the Act of November 2, 1921
(25 U.S.C. 13) (commonly known as the `Snyder Act'), the
Secretary, acting through the Service, shall enter into
contracts with, or make grants to, urban Indian organizations
to assist the urban Indian organizations in the establishment
and administration, within urban centers, of programs that
meet the requirements of this title.
``(b) Conditions.--Subject to section 506, the Secretary,
acting through the Service, shall include such conditions as
the Secretary considers necessary to effect the purpose of
this title in any contract into which the Secretary enters
with, or in any grant the Secretary makes to, any urban
Indian organization pursuant to this title.''.

SEC. 164. EXPANDED PROGRAM AUTHORITY FOR URBAN INDIAN
ORGANIZATIONS.

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

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

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

SEC. 165. COMMUNITY HEALTH REPRESENTATIVES.

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

``SEC. 516. COMMUNITY HEALTH REPRESENTATIVES.

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

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

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

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

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

``SEC. 518. HEALTH INFORMATION TECHNOLOGY.

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

Subtitle F--Organizational Improvements

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

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

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

``(a) Establishment.--
``(1) In general.--In order to more effectively and
efficiently carry out the responsibilities, authorities, and
functions of the United States to provide health care
services to Indians and Indian tribes, as are or may be
hereafter provided by Federal statute or treaties, there is
established within the Public Health Service of the
Department the Indian Health Service.
``(2) Director.--The Service shall be administered by a
Director, who shall be appointed by the President, by and
with the advice and consent of the Senate. The Director shall
report to the Secretary. Effective with respect to an
individual appointed by the President, by and with the advice
and consent of the Senate, after January 1, 2008, the term of
service of the Director shall be 4 years. A Director may
serve more than 1 term.
``(3) Incumbent.--The individual serving in the position of
Director of the Service on the day before the date of
enactment of the Indian Health Care Improvement
Reauthorization and Extension Act of 2009 shall serve as
Director.
``(4) Advocacy and consultation.--The position of Director
is established to, in a manner consistent with the
government-to-government relationship between the United
States and Indian Tribes--
``(A) facilitate advocacy for the development of
appropriate Indian health policy; and
``(B) promote consultation on matters relating to Indian
health.
``(b) Agency.--The Service shall be an agency within the
Public Health Service of the Department, and shall not be an
office, component, or unit of any other agency of the
Department.
``(c) Duties.--The Director shall--
``(1) perform all functions that were, on the day before
the date of enactment of the Indian Health Care Improvement
Reauthorization and Extension Act of 2009, carried out by or
under the direction of the individual serving as Director of
the Service on that day;
``(2) perform all functions of the Secretary relating to
the maintenance and operation of hospital and health
facilities for Indians and the planning for, and provision
and utilization of, health services for Indians, including by
ensuring that all agency directors, managers, and chief
executive officers have appropriate and adequate training,
experience, skill levels, knowledge, abilities, and education
(including continuing training requirements) to competently
fulfill the duties of the positions and the mission of the
Service;
``(3) administer all health programs under which health
care is provided to Indians based upon their status as
Indians which are administered by the Secretary, including
programs under--
``(A) this Act;
``(B) the Act of November 2, 1921 (25 U.S.C. 13);
``(C) the Act of August 5, 1954 (42 U.S.C. 2001 et seq.);
``(D) the Act of August 16, 1957 (42 U.S.C. 2005 et seq.);
and
``(E) the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.);
``(4) administer all scholarship and loan functions carried
out under title I;
``(5) directly advise the Secretary concerning the
development of all policy- and budget-related matters
affecting Indian health;
``(6) collaborate with the Assistant Secretary for Health
concerning appropriate matters of Indian health that affect
the agencies of the Public Health Service;
``(7) advise each Assistant Secretary of the Department
concerning matters of Indian health with respect to which
that Assistant Secretary has authority and responsibility;
``(8) advise the heads of other agencies and programs of
the Department concerning matters of Indian health with
respect to which those heads have authority and
responsibility;
``(9) coordinate the activities of the Department
concerning matters of Indian health; and
``(10) perform such other functions as the Secretary may
designate.
``(d) Authority.--
``(1) In general.--The Secretary, acting through the
Director, shall have the authority--

[[Page S12448]]

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

SEC. 172. OFFICE OF DIRECT SERVICE TRIBES.

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

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

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

SEC. 173. NEVADA AREA OFFICE.

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

``SEC. 604. NEVADA AREA OFFICE.

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

Subtitle G--Behavioral Health Programs

SEC. 181. BEHAVIORAL HEALTH PROGRAMS.

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

``TITLE VII--BEHAVIORAL HEALTH PROGRAMS

``Subtitle A--General Programs

``SEC. 701. DEFINITIONS.

``In this subtitle:
``(1) Alcohol-related neurodevelopmental disorders; arnd.--
The term `alcohol-related neurodevelopmental disorders' or
`ARND' means, with a history of maternal alcohol consumption
during pregnancy, central nervous system abnormalities, which
may range from minor intellectual deficits and developmental
delays to mental retardation. ARND children may have
behavioral problems, learning disabilities, problems with
executive functioning, and attention disorders. The
neurological defects of ARND may be as severe as FAS, but
facial anomalies and other physical characteristics are not
present in ARND, thus making diagnosis difficult.
``(2) Assessment.--The term `assessment' means the
systematic collection, analysis, and dissemination of
information on health status, health needs, and health
problems.
``(3) Behavioral health aftercare.--The term `behavioral
health aftercare' includes those activities and resources
used to support recovery following inpatient, residential,
intensive substance abuse, or mental health outpatient or
outpatient treatment. The purpose is to help prevent or deal
with relapse by ensuring that by the time a client or patient
is discharged from a level of care, such as outpatient
treatment, an aftercare plan has been developed with the
client. An aftercare plan may use such resources as a
community-based therapeutic group, transitional living
facilities, a 12-step sponsor, a local 12-step or other
related support group, and other community-based providers.
``(4) Dual diagnosis.--The term `dual diagnosis' means
coexisting substance abuse and mental illness conditions or
diagnosis. Such clients are sometimes referred to as mentally
ill chemical abusers (MICAs).
``(5) Fetal alcohol spectrum disorders.--
``(A) In general.--The term `fetal alcohol spectrum
disorders' includes a range of effects that can occur in an
individual whose mother drank alcohol during pregnancy,
including physical, mental, behavioral, and/or learning
disabilities with possible lifelong implications.
``(B) Inclusions.--The term `fetal alcohol spectrum
disorders' may include--
``(i) fetal alcohol syndrome (FAS);
``(ii) partial fetal alcohol syndrome (partial FAS);
``(iii) alcohol-related birth defects (ARBD); and
``(iv) alcohol-related neurodevelopmental disorders (ARND).
``(6) FAS or fetal alcohol syndrome.--The term `FAS' or
`fetal alcohol syndrome' means a syndrome in which, with a
history of maternal alcohol consumption during pregnancy, the
following criteria are met:
``(A) Central nervous system involvement, such as mental
retardation, developmental delay, intellectual deficit,
microencephaly, or neurological abnormalities.
``(B) Craniofacial abnormalities with at least 2 of the
following:
``(i) Microophthalmia.
``(ii) Short palpebral fissures.
``(iii) Poorly developed philtrum.
``(iv) Thin upper lip.
``(v) Flat nasal bridge.
``(vi) Short upturned nose.
``(C) Prenatal or postnatal growth delay.
``(7) Rehabilitation.--The term `rehabilitation' means
medical and health care services that--
``(A) are recommended by a physician or licensed
practitioner of the healing arts within the scope of their
practice under applicable law;
``(B) are furnished in a facility, home, or other setting
in accordance with applicable standards; and
``(C) have as their purpose any of the following:
``(i) The maximum attainment of physical, mental, and
developmental functioning.
``(ii) Averting deterioration in physical or mental
functional status.
``(iii) The maintenance of physical or mental health
functional status.
``(8) Substance abuse.--The term `substance abuse' includes
inhalant abuse.

``SEC. 702. BEHAVIORAL HEALTH PREVENTION AND TREATMENT
SERVICES.

``(a) Purposes.--The purposes of this section are as
follows:
``(1) To authorize and direct the Secretary, acting through
the Service, Indian tribes, and tribal organizations, to
develop a comprehensive behavioral health prevention and
treatment program which emphasizes collaboration among
alcohol and substance abuse, social services, and mental
health programs.
``(2) To provide information, direction, and guidance
relating to mental illness and dysfunction and self-
destructive behavior, including child abuse and family
violence, to those Federal, tribal, State, and local agencies
responsible for programs in Indian communities in areas of
health care, education, social services, child and family
welfare, alcohol and substance abuse, law enforcement, and
judicial services.
``(3) To assist Indian tribes to identify services and
resources available to address mental illness and
dysfunctional and self-destructive behavior.
``(4) To provide authority and opportunities for Indian
tribes and tribal organizations to develop, implement, and
coordinate with community-based programs which include
identification, prevention, education, referral, and
treatment services, including through multidisciplinary
resource teams.
``(5) To ensure that Indians, as citizens of the United
States and of the States in which they reside, have the same
access to behavioral health services to which all citizens
have access.
``(6) To modify or supplement existing programs and
authorities in the areas identified in paragraph (2).
``(b) Plans.--
``(1) Development.--The Secretary, acting through the
Service, Indian tribes, and tribal organizations, shall
encourage Indian tribes and tribal organizations to develop
tribal plans, and urban Indian organizations to develop local
plans, and for all such groups to participate in developing
areawide plans for Indian Behavioral Health Services. The
plans shall include, to the extent feasible, the following
components:
``(A) An assessment of the scope of alcohol or other
substance abuse, mental illness, and dysfunctional and self-
destructive behavior, including suicide, child abuse, and
family violence, among Indians, including--
``(i) the number of Indians served who are directly or
indirectly affected by such illness or behavior; or
``(ii) an estimate of the financial and human cost
attributable to such illness or behavior.

[[Page S12449]]

``(B) An assessment of the existing and additional
resources necessary for the prevention and treatment of such
illness and behavior, including an assessment of the progress
toward achieving the availability of the full continuum of
care described in subsection (c).
``(C) An estimate of the additional funding needed by the
Service, Indian tribes, tribal organizations, and urban
Indian organizations to meet their responsibilities under the
plans.
``(2) National clearinghouse.--The Secretary, acting
through the Service, shall coordinate with existing national
clearinghouses and information centers to include at the
clearinghouses and centers plans and reports on the outcomes
of such plans developed by Indian tribes, tribal
organizations, urban Indian organizations, and Service areas
relating to behavioral health. The Secretary shall ensure
access to these plans and outcomes by any Indian tribe,
tribal organization, urban Indian organization, or the
Service.
``(3) Technical assistance.--The Secretary shall provide
technical assistance to Indian tribes, tribal organizations,
and urban Indian organizations in preparation of plans under
this section and in developing standards of care that may be
used and adopted locally.
``(c) Programs.--The Secretary, acting through the Service,
shall provide, to the extent feasible and if funding is
available, programs including the following:
``(1) Comprehensive care.--A comprehensive continuum of
behavioral health care which provides--
``(A) community-based prevention, intervention, outpatient,
and behavioral health aftercare;
``(B) detoxification (social and medical);
``(C) acute hospitalization;
``(D) intensive outpatient/day treatment;
``(E) residential treatment;
``(F) transitional living for those needing a temporary,
stable living environment that is supportive of treatment and
recovery goals;
``(G) emergency shelter;
``(H) intensive case management;
``(I) diagnostic services; and
``(J) promotion of healthy approaches to risk and safety
issues, including injury prevention.
``(2) Child care.--Behavioral health services for Indians
from birth through age 17, including--
``(A) preschool and school age fetal alcohol spectrum
disorder services, including assessment and behavioral
intervention;
``(B) mental health and substance abuse services
(emotional, organic, alcohol, drug, inhalant, and tobacco);
``(C) identification and treatment of co-occurring
disorders and comorbidity;
``(D) prevention of alcohol, drug, inhalant, and tobacco
use;
``(E) early intervention, treatment, and aftercare;
``(F) promotion of healthy approaches to risk and safety
issues; and
``(G) identification and treatment of neglect and physical,
mental, and sexual abuse.
``(3) Adult care.--Behavioral health services for Indians
from age 18 through 55, including--
``(A) early intervention, treatment, and aftercare;
``(B) mental health and substance abuse services
(emotional, alcohol, drug, inhalant, and tobacco), including
sex specific services;
``(C) identification and treatment of co-occurring
disorders (dual diagnosis) and comorbidity;
``(D) promotion of healthy approaches for risk-related
behavior;
``(E) treatment services for women at risk of giving birth
to a child with a fetal alcohol spectrum disorder; and
``(F) sex specific treatment for sexual assault and
domestic violence.
``(4) Family care.--Behavioral health services for
families, including--
``(A) early intervention, treatment, and aftercare for
affected families;
``(B) treatment for sexual assault and domestic violence;
and
``(C) promotion of healthy approaches relating to
parenting, domestic violence, and other abuse issues.
``(5) Elder care.--Behavioral health services for Indians
56 years of age and older, including--
``(A) early intervention, treatment, and aftercare;
``(B) mental health and substance abuse services
(emotional, alcohol, drug, inhalant, and tobacco), including
sex specific services;
``(C) identification and treatment of co-occurring
disorders (dual diagnosis) and comorbidity;
``(D) promotion of healthy approaches to managing
conditions related to aging;
``(E) sex specific treatment for sexual assault, domestic
violence, neglect, physical and mental abuse and
exploitation; and
``(F) identification and treatment of dementias regardless
of cause.
``(d) Community Behavioral Health Plan.--
``(1) Establishment.--The governing body of any Indian
tribe, tribal organization, or urban Indian organization may
adopt a resolution for the establishment of a community
behavioral health plan providing for the identification and
coordination of available resources and programs to identify,
prevent, or treat substance abuse, mental illness, or
dysfunctional and self-destructive behavior, including child
abuse and family violence, among its members or its service
population. This plan should include behavioral health
services, social services, intensive outpatient services, and
continuing aftercare.
``(2) Technical assistance.--At the request of an Indian
tribe, tribal organization, or urban Indian organization, the
Bureau of Indian Affairs and the Service shall cooperate with
and provide technical assistance to the Indian tribe, tribal
organization, or urban Indian organization in the development
and implementation of such plan.
``(3) Funding.--The Secretary, acting through the Service,
Indian tribes, and tribal organizations, may make funding
available to Indian tribes and tribal organizations which
adopt a resolution pursuant to paragraph (1) to obtain
technical assistance for the development of a community
behavioral health plan and to provide administrative support
in the implementation of such plan.
``(e) Coordination for Availability of Services.--The
Secretary, acting through the Service, shall coordinate
behavioral health planning, to the extent feasible, with
other Federal agencies and with State agencies, to encourage
comprehensive behavioral health services for Indians
regardless of their place of residence.
``(f) Mental Health Care Need Assessment.--Not later than 1
year after the date of enactment of the Indian Health Care
Improvement Reauthorization and Extension Act of 2009, the
Secretary, acting through the Service, shall make an
assessment of the need for inpatient mental health care among
Indians and the availability and cost of inpatient mental
health facilities which can meet such need. In making such
assessment, the Secretary shall consider the possible
conversion of existing, underused Service hospital beds into
psychiatric units to meet such need.

``SEC. 703. MEMORANDA OF AGREEMENT WITH THE DEPARTMENT OF
INTERIOR.

``(a) Contents.--Not later than 1 year after the date of
enactment of the Indian Health Care Improvement
Reauthorization and Extension Act of 2009, the Secretary,
acting through the Service, and the Secretary of the Interior
shall develop and enter into a memoranda of agreement, or
review and update any existing memoranda of agreement, as
required by section 4205 of the Indian Alcohol and Substance
Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 2411)
under which the Secretaries address the following:
``(1) The scope and nature of mental illness and
dysfunctional and self-destructive behavior, including child
abuse and family violence, among Indians.
``(2) The existing Federal, tribal, State, local, and
private services, resources, and programs available to
provide behavioral health services for Indians.
``(3) The unmet need for additional services, resources,
and programs necessary to meet the needs identified pursuant
to paragraph (1).
``(4)(A) The right of Indians, as citizens of the United
States and of the States in which they reside, to have access
to behavioral health services to which all citizens have
access.
``(B) The right of Indians to participate in, and receive
the benefit of, such services.
``(C) The actions necessary to protect the exercise of such
right.
``(5) The responsibilities of the Bureau of Indian Affairs
and the Service, including mental illness identification,
prevention, education, referral, and treatment services
(including services through multidisciplinary resource
teams), at the central, area, and agency and Service unit,
Service area, and headquarters levels to address the problems
identified in paragraph (1).
``(6) A strategy for the comprehensive coordination of the
behavioral health services provided by the Bureau of Indian
Affairs and the Service to meet the problems identified
pursuant to paragraph (1), including--
``(A) the coordination of alcohol and substance abuse
programs of the Service, the Bureau of Indian Affairs, and
Indian tribes and tribal organizations (developed under the
Indian Alcohol and Substance Abuse Prevention and Treatment
Act of 1986 (25 U.S.C. 2401 et seq.)) with behavioral health
initiatives pursuant to this Act, particularly with respect
to the referral and treatment of dually diagnosed individuals
requiring behavioral health and substance abuse treatment;
and
``(B) ensuring that the Bureau of Indian Affairs and
Service programs and services (including multidisciplinary
resource teams) addressing child abuse and family violence
are coordinated with such non-Federal programs and services.
``(7) Directing appropriate officials of the Bureau of
Indian Affairs and the Service, particularly at the agency
and Service unit levels, to cooperate fully with tribal
requests made pursuant to community behavioral health plans
adopted under section 702(c) and section 4206 of the Indian
Alcohol and Substance Abuse Prevention and Treatment Act of
1986 (25 U.S.C. 2412).
``(8) Providing for an annual review of such agreement by
the Secretaries which shall be provided to Congress and
Indian tribes and tribal organizations.
``(b) Specific Provisions Required.--The memoranda of
agreement updated or entered into pursuant to subsection (a)
shall include specific provisions pursuant to which the
Service shall assume responsibility for--
``(1) the determination of the scope of the problem of
alcohol and substance abuse

[[Page S12450]]

among Indians, including the number of Indians within the
jurisdiction of the Service who are directly or indirectly
affected by alcohol and substance abuse and the financial and
human cost;
``(2) an assessment of the existing and needed resources
necessary for the prevention of alcohol and substance abuse
and the treatment of Indians affected by alcohol and
substance abuse; and
``(3) an estimate of the funding necessary to adequately
support a program of prevention of alcohol and substance
abuse and treatment of Indians affected by alcohol and
substance abuse.
``(c) Publication.--Each memorandum of agreement entered
into or renewed (and amendments or modifications thereto)
under subsection (a) shall be published in the Federal
Register. At the same time as publication in the Federal
Register, the Secretary shall provide a copy of such
memoranda, amendment, or modification to each Indian tribe,
tribal organization, and urban Indian organization.

``SEC. 704. COMPREHENSIVE BEHAVIORAL HEALTH PREVENTION AND
TREATMENT PROGRAM.

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

``SEC. 705. MENTAL HEALTH TECHNICIAN PROGRAM.

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

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

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

``SEC. 707. INDIAN WOMEN TREATMENT PROGRAMS.

``(a) Grants.--The Secretary, consistent with section 702,
may make grants to Indian tribes, tribal organizations, and
urban Indian organizations to develop and implement a
comprehensive behavioral health program of prevention,
intervention, treatment, and relapse prevention services that
specifically addresses the cultural, historical, social, and
child care needs of Indian women, regardless of age.
``(b) Use of Grant Funds.--A grant made pursuant to this
section may be used--
``(1) to develop and provide community training, education,
and prevention programs for Indian women relating to
behavioral health issues, including fetal alcohol spectrum
disorders;
``(2) to identify and provide psychological services,
counseling, advocacy, support, and relapse prevention to
Indian women and their families; and
``(3) to develop prevention and intervention models for
Indian women which incorporate traditional health care
practices, cultural values, and community and family
involvement.
``(c) Criteria.--The Secretary, in consultation with Indian
tribes and tribal organizations, shall establish criteria for
the review and approval of applications and proposals for
funding under this section.
``(d) Allocation of Funds for Urban Indian Organizations.--
20 percent of the funds appropriated pursuant to this section
shall be used to make grants to urban Indian organizations.

``SEC. 708. INDIAN YOUTH PROGRAM.

``(a) Detoxification and Rehabilitation.--The Secretary,
acting through the Service, consistent with section 702,
shall develop and implement a program for acute
detoxification and treatment for Indian youths, including
behavioral health services. The program shall include
regional treatment centers designed to include detoxification
and rehabilitation for both sexes on a referral basis and
programs developed and implemented by Indian tribes or tribal
organizations at the local level under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.). Regional centers shall be integrated with the intake
and rehabilitation programs based in the referring Indian
community.
``(b) Alcohol and Substance Abuse Treatment Centers or
Facilities.--
``(1) Establishment.--
``(A) In general.--The Secretary, acting through the
Service, shall construct, renovate, or, as necessary,
purchase, and appropriately staff and operate, at least 1
youth regional treatment center or treatment network in each
area under the jurisdiction of an area office.
``(B) Area office in california.--For the purposes of this
subsection, the area office in California shall be considered
to be 2 area offices, 1 office whose jurisdiction shall be
considered to encompass the northern area of the State of
California, and 1 office whose jurisdiction shall be
considered to encompass the remainder of the State of
California for the purpose of implementing California
treatment networks.
``(2) Funding.--For the purpose of staffing and operating
such centers or facilities, funding shall be pursuant to the
Act of November 2, 1921 (25 U.S.C. 13).
``(3) Location.--A youth treatment center constructed or
purchased under this subsection shall be constructed or
purchased at a location within the area described in
paragraph (1) agreed upon (by appropriate tribal resolution)
by a majority of the Indian tribes to be served by such
center.
``(4) Specific provision of funds.--
``(A) In general.--Notwithstanding any other provision of
this title, the Secretary may, from amounts authorized to be
appropriated for the purposes of carrying out this section,
make funds available to--
``(i) the Tanana Chiefs Conference, Incorporated, for the
purpose of leasing, constructing, renovating, operating, and
maintaining a residential youth treatment facility in
Fairbanks, Alaska; and
``(ii) the Southeast Alaska Regional Health Corporation to
staff and operate a residential youth treatment facility
without regard to the proviso set forth in section 4(l) of
the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450b(l)).
``(B) Provision of services to eligible youths.--Until
additional residential youth treatment facilities are
established in Alaska pursuant to this section, the
facilities specified in subparagraph (A) shall make every
effort to provide services to all eligible Indian youths
residing in Alaska.
``(c) Intermediate Adolescent Behavioral Health Services.--
``(1) In general.--The Secretary, acting through the
Service, may provide intermediate behavioral health services,
which may, if feasible and appropriate, incorporate systems
of care, to Indian children and adolescents, including--
``(A) pretreatment assistance;
``(B) inpatient, outpatient, and aftercare services;
``(C) emergency care;
``(D) suicide prevention and crisis intervention; and

[[Page S12451]]

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

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

``Not later than 1 year after the date of enactment of the
Indian Health Care Improvement Reauthorization and Extension
Act of 2009, the Secretary, acting through the Service, may
provide, in each area of the Service, not less than 1
inpatient mental health care facility, or the equivalent, for
Indians with behavioral health problems. For the purposes of
this subsection, California shall be considered to be 2 area
offices, 1 office whose location shall be considered to
encompass the northern area of the State of California and 1
office whose jurisdiction shall be considered to encompass
the remainder of the State of California. The Secretary shall
consider the possible conversion of existing, underused
Service hospital beds into psychiatric units to meet such
need.

``SEC. 710. TRAINING AND COMMUNITY EDUCATION.

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

``SEC. 711. BEHAVIORAL HEALTH PROGRAM.

``(a) Innovative Programs.--The Secretary, acting through
the Service, consistent with section 702, may plan, develop,
implement, and carry out programs to deliver innovative
community-based behavioral health services to Indians.
``(b) Awards; Criteria.--The Secretary may award a grant
for a project under subsection (a) to an Indian tribe or
tribal organization and may consider the following criteria:
``(1) The project will address significant unmet behavioral
health needs among Indians.
``(2) The project will serve a significant number of
Indians.
``(3) The project has the potential to deliver services in
an efficient and effective manner.
``(4) The Indian tribe or tribal organization has the
administrative and financial capability to administer the
project.
``(5) The project may deliver services in a manner
consistent with traditional health care practices.
``(6) The project is coordinated with, and avoids
duplication of, existing services.
``(c) Equitable Treatment.--For purposes of this
subsection, the Secretary shall, in evaluating project
applications or proposals, use the same criteria that the
Secretary uses in evaluating any other application or
proposal for such funding.

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

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

[[Page S12452]]

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

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

``(a) Establishment.--The Secretary, acting through the
Service, shall establish, consistent with section 702, in
every Service area, programs involving treatment for--
``(1) victims of sexual abuse who are Indian children or
children in an Indian household; and
``(2) other members of the household or family of the
victims described in paragraph (1).
``(b) Use of Funds.--Funding provided pursuant to this
section shall be used for the following:
``(1) To develop and provide community education and
prevention programs related to sexual abuse of Indian
children or children in an Indian household.
``(2) To identify and provide behavioral health treatment
to victims of sexual abuse who are Indian children or
children in an Indian household, and to their family members
who are affected by sexual abuse.
``(3) To develop prevention and intervention models which
incorporate traditional health care practices, cultural
values, and community involvement.
``(4) To develop and implement culturally sensitive
assessment and diagnostic tools for use in Indian communities
and urban centers.
``(c) Coordination.--The programs established under
subsection (a) shall be carried out in coordination with
programs and services authorized under the Indian Child
Protection and Family Violence Prevention Act (25 U.S.C. 3201
et seq.).

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

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

``SEC. 715. BEHAVIORAL HEALTH RESEARCH.

``(a) In General.--The Secretary, in consultation with
appropriate Federal agencies, shall make grants to, or enter
into contracts with, Indian tribes, tribal organizations, and
urban Indian organizations or enter into contracts with, or
make grants to appropriate institutions for, the conduct of
research on the incidence and prevalence of behavioral health
problems among Indians served by the Service, Indian tribes,
or tribal organizations and among Indians in urban areas.
Research priorities under this section shall include--
``(1) the multifactorial causes of Indian youth suicide,
including--
``(A) protective and risk factors and scientific data that
identifies those factors; and
``(B) the effects of loss of cultural identity and the
development of scientific data on those effects;
``(2) the interrelationship and interdependence of
behavioral health problems with alcoholism and other
substance abuse, suicide, homicides, other injuries, and the
incidence of family violence; and
``(3) the development of models of prevention techniques.
``(b) Emphasis.--The effect of the interrelationships and
interdependencies referred to in subsection (a)(2) on
children, and the development of prevention techniques under
subsection (a)(3) applicable to children, shall be
emphasized.

``Subtitle B--Indian Youth Suicide Prevention

``SEC. 721. FINDINGS AND PURPOSE.

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

[[Page S12453]]

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

``SEC. 722. DEFINITIONS.

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

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

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

[[Page S12454]]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[[Page S12455]]

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

Subtitle H--Miscellaneous

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

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

[[Page S12456]]

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

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

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

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

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

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

``(a) In General.--The State of Arizona shall be designated
as a contract health service delivery area by the Service for
the purpose of providing contract health care services to
members of Indian tribes in the State of Arizona.
``(b) Maintenance of Services.--The Service shall not
curtail any health care services provided to Indians residing
on reservations in the State of Arizona if the curtailment is
due to the provision of contract services in that State
pursuant to the designation of the State as a contract health
service delivery area by subsection (a).'';
(2) by inserting after section 808 (25 U.S.C. 1678) the
following:

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

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

[[Page S12457]]

as a contract health service delivery area by the Service for
the purpose of providing contract health care services to
members of Indian tribes in the States of North Dakota and
South Dakota.
``(b) Maintenance of Services.--The Service shall not
curtail any health care services provided to Indians residing
on any reservation, or in any county that has a common
boundary with any reservation, in the State of North Dakota
or South Dakota if the curtailment is due to the provision of
contract services in those States pursuant to the designation
of the States as a contract health service delivery area by
subsection (a).''; and
(3) by striking section 809 (25 U.S.C. 1679) and inserting
the following:

``SEC. 809. ELIGIBILITY OF CALIFORNIA INDIANS.

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

SEC. 193. METHODS TO INCREASE ACCESS TO PROFESSIONALS OF
CERTAIN CORPS.

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

``SEC. 812. NATIONAL HEALTH SERVICE CORPS.

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

SEC. 194. HEALTH SERVICES FOR INELIGIBLE PERSONS.

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

``SEC. 813. HEALTH SERVICES FOR INELIGIBLE PERSONS.

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

shall be eligible for all health services provided by the
Service on the same basis and subject to the same rules that
apply to eligible Indians until such individual attains 19
years of age. The existing and potential health needs of all
such individuals shall be taken into consideration by the
Service in determining the need for, or the allocation of,
the health resources of the Service. If such an individual
has been determined to be legally incompetent prior to
attaining 19 years of age, such individual shall remain
eligible for such services until 1 year after the date of a
determination of competency.
``(b) Spouses.--Any spouse of an eligible Indian who is not
an Indian, or who is of Indian descent but is not otherwise
eligible for the health services provided by the Service,
shall be eligible for such health services if all such
spouses or spouses who are married to members of each Indian
tribe being served are made eligible, as a class, by an
appropriate resolution of the governing body of the Indian
tribe or tribal organization providing such services. The
health needs of persons made eligible under this paragraph
shall not be taken into consideration by the Service in
determining the need for, or allocation of, its health
resources.
``(c) Health Facilities Providing Health Services.--
``(1) In general.--The Secretary is authorized to provide
health services under this subsection through health
facilities operated directly by the Service to individuals
who reside within the Service unit and who are not otherwise
eligible for such health services if--
``(A) the Indian tribes served by such Service unit
requests such provision of health services to such
individuals, and
``(B) the Secretary and the served Indian tribes have
jointly determined that the provision of such health services
will not result in a denial or diminution of health services
to eligible Indians.
``(2) ISDEAA programs.--In the case of health facilities
operated under a contract or compact entered into under the
Indian Self-Determination and Education Assistance Act (25
U.S.C. 450 et seq.), the governing body of the Indian tribe
or tribal organization providing health services under such
contract or compact is authorized to determine whether health
services should be provided under such contract or compact to
individuals who are not eligible for such health services
under any other subsection of this section or under any other
provision of law. In making such determinations, the
governing body of the Indian tribe or tribal organization
shall take into account the consideration described in
paragraph (1)(B). Any services provided by the Indian tribe
or tribal organization pursuant to a determination made under
this subparagraph shall be deemed to be provided under the
agreement entered into by the Indian tribe or tribal
organization under the Indian Self-Determination and
Education Assistance Act. The provisions of section 314 of
Public Law 101-512 (104 Stat. 1959), as amended by section
308 of Public Law 103-138 (107 Stat. 1416), shall apply to
any services provided by the Indian tribe or tribal
organization pursuant to a determination made under this
subparagraph.
``(3) Payment for services.--
``(A) In general.--Persons receiving health services
provided by the Service under this subsection shall be liable
for payment of such health services under a schedule of
charges prescribed by the Secretary which, in the judgment of
the Secretary, results in reimbursement in an amount not less
than the actual cost of providing the health services.
Notwithstanding section 207 of this Act or any other
provision of law, amounts collected under this subsection,
including Medicare, Medicaid, or children's health insurance
program reimbursements under titles XVIII, XIX, and XXI of
the Social Security Act (42 U.S.C. 1395 et seq.), shall be
credited to the account of the program providing the service
and shall be used for the purposes listed in section
401(d)(2) and amounts collected under this subsection shall
be available for expenditure within such program.
``(B) Indigent people.--Health services may be provided by
the Secretary through the Service under this subsection to an
indigent individual who would not be otherwise eligible for
such health services but for the provisions of paragraph (1)
only if an agreement has been entered into with a State or
local government under which the State or local government
agrees to reimburse the Service for the expenses incurred by
the Service in providing such health services to such
indigent individual.
``(4) Revocation of consent for services.--
``(A) Single tribe service area.--In the case of a Service
Area which serves only 1 Indian tribe, the authority of the
Secretary to provide health services under paragraph (1)
shall terminate at the end of the fiscal year succeeding the
fiscal year in which the governing body of the Indian tribe
revokes its concurrence to the provision of such health
services.
``(B) Multitribal service area.--In the case of a
multitribal Service Area, the authority of the Secretary to
provide health services under paragraph (1) shall terminate
at the end of the fiscal year succeeding the fiscal year in
which at least 51 percent of the number of Indian tribes in
the Service Area revoke their concurrence to the provisions
of such health services.
``(d) Other Services.--The Service may provide health
services under this subsection to individuals who are not
eligible for health services provided by the Service under
any other provision of law in order to--
``(1) achieve stability in a medical emergency;
``(2) prevent the spread of a communicable disease or
otherwise deal with a public health hazard;
``(3) provide care to non-Indian women pregnant with an
eligible Indian's child for the duration of the pregnancy
through postpartum; or
``(4) provide care to immediate family members of an
eligible individual if such care is directly related to the
treatment of the eligible individual.
``(e) Hospital Privileges for Practitioners.--
``(1) In general.--Hospital privileges in health facilities
operated and maintained by the Service or operated under a
contract or compact pursuant to the Indian Self-Determination
and Education Assistance Act (25 U.S.C. 450 et seq.) may be
extended to non-Service health care practitioners who provide
services to individuals described in subsection (a), (b),
(c), or (d). Such non-Service health care practitioners may,
as part of the privileging process, be designated as
employees of the Federal Government for purposes of section
1346(b) and chapter 171 of title 28, United States Code
(relating to Federal tort claims) only with respect to acts
or omissions which occur in the course of providing services
to eligible individuals as a part of the conditions under
which such hospital privileges are extended.
``(2) Definition.--For purposes of this subsection, the
term `non-Service health care practitioner' means a
practitioner who is not--
``(A) an employee of the Service; or
``(B) an employee of an Indian tribe or tribal organization
operating a contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.) or an individual who provides health care services
pursuant to a personal services contract with such Indian
tribe or tribal organization.

[[Page S12458]]

``(f) Eligible Indian.--For purposes of this section, the
term `eligible Indian' means any Indian who is eligible for
health services provided by the Service without regard to the
provisions of this section.''.

SEC. 195. ANNUAL BUDGET SUBMISSION.

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

``SEC. 826. ANNUAL BUDGET SUBMISSION.

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

SEC. 196. PRESCRIPTION DRUG MONITORING.

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

``SEC. 827. PRESCRIPTION DRUG MONITORING.

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

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

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

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

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

SEC. 198. DISEASE AND INJURY PREVENTION REPORT.

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

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

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

SEC. 199. OTHER GAO REPORTS.

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

``SEC. 830. OTHER GAO REPORTS.

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

SEC. 199A. TRADITIONAL HEALTH CARE PRACTICES.

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

``SEC. 831. TRADITIONAL HEALTH CARE PRACTICES.

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

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

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

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

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

[[Page S12459]]

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

TITLE II--AMENDMENTS TO OTHER ACTS

SEC. 201. MEDICARE AMENDMENTS.

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

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

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

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