Indian Health Care Improvement Act Amendments of 2004

        [Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2440 Introduced in House (IH)]

108th CONGRESS
1st Session
H. R. 2440

To improve the implementation of the Federal responsibility for the
care and education of Indian people by improving the services and
facilities of Federal health programs for Indians and encouraging
maximum participation of Indians in such programs, and for other
purposes.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

June 11, 2003

Mr. Young of Alaska (for himself, Mr. Hayworth, Mr. Renzi, Mr. Cole,
Mr. Hunter, Mr. McKeon, Mr. Pallone, Mr. Rahall, Mr. George Miller of
California, Mr. Kildee, Mr. Dingell, Mr. Waxman, Mr. Rangel, Mr.
Conyers, Mr. Oberstar, Mr. Grijalva, Ms. Millender-McDonald, Mr. Frost,
Mr. Kennedy of Rhode Island, Mr. Frank of Massachusetts, Mr. Filner,
Mr. Honda, Mr. Carson of Oklahoma, Mr. Allen, Mr. Abercrombie, Ms. Lee,
Mrs. Napolitano, Mr. Faleomavaega, Ms. McCollum, Mr. Towns, Mr. Udall
of New Mexico, Mr. Udall of Colorado, Mr. Kind, Mr. Lantos, Mr. Inslee,
Mr. Stupak, Mr. Baca, Ms. Kilpatrick, Mrs. Christensen, Mr. Blumenauer,
and Ms. Norton) introduced the following bill; which was referred to
the Committee on Resources, and in addition to the Committees on Energy
and Commerce, and Ways and Means, for a period to be subsequently
determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned

_______________________________________________________________________

A BILL

To improve the implementation of the Federal responsibility for the
care and education of Indian people by improving the services and
facilities of Federal health programs for Indians and encouraging
maximum participation of Indians in such programs, and for other
purposes.

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

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Indian Health Care Improvement Act
Amendments of 2003''.

SEC. 2. INDIAN HEALTH CARE IMPROVEMENT ACT AMENDED.

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

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

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

Sec. 1. Short title.
Sec. 2. Indian Health Care Improvement Act amended.
``Sec. 1. Short title; table of contents.
``Sec. 2. Findings.
``Sec. 3. Declaration of National Indian health policy.
``Sec. 4. Definitions.
``TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT

``Sec. 101. Purpose.
``Sec. 102. Health Professions Recruitment Program for Indians.
``Sec. 103. Health Professions Preparatory Scholarship Program
for Indians.
``Sec. 104. Indian health professions scholarships.
``Sec. 105. American Indians into psychology program.
``Sec. 106. Funding for tribes for scholarship programs.
``Sec. 107. Indian Health Service extern programs.
``Sec. 108. Continuing education allowances.
``Sec. 109. Community Health Representative Program.
``Sec. 110. Indian Health Service Loan Repayment Program.
``Sec. 111. Scholarship and loan repayment recovery fund.
``Sec. 112. Recruitment activities.
``Sec. 113. Indian recruitment and retention program.
``Sec. 114. Advanced training and research.
``Sec. 115. Quentin N. Burdick American Indians into nursing
program.
``Sec. 116. Tribal cultural orientation.
``Sec. 117. Inmed program.
``Sec. 118. Health training programs of community colleges.
``Sec. 119. Retention bonus.
``Sec. 120. Nursing residency program.
``Sec. 121. Community Health Aide Program for Alaska.
``Sec. 122. Tribal health program administration.
``Sec. 123. Health professional chronic shortage demonstration
programs.
``Sec. 124. Treatment of scholarships for certain purposes.
``Sec. 125. National Health Service Corps.
``Sec. 126. Substance abuse counselor educational curricula
demonstration programs.
``Sec. 127. Mental health training and community education
programs.
``Sec. 128. Designation of shortage areas.
``Sec. 129. Authorization of appropriations.
``TITLE II--HEALTH SERVICES

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

``Sec. 301. Consultation; construction and renovation of
facilities; reports.
``Sec. 302. Sanitation facilities.
``Sec. 303. Preference to Indians and Indian firms.
``Sec. 304. Expenditure of nonservice funds for renovation.
``Sec. 305. Funding for the construction, expansion, and
modernization of small ambulatory care
facilities.
``Sec. 306. Indian Health Care Delivery Demonstration Project.
``Sec. 307. Land transfer.
``Sec. 308. Leases, contracts, and other agreements.
``Sec. 309. Loans, loan guarantees, and loan repayment.
``Sec. 310. Tribal leasing.
``Sec. 311. Indian Health Service/tribal facilities joint
venture program.
``Sec. 312. Location of facilities.
``Sec. 313. Maintenance and improvement of health care
facilities.
``Sec. 314. Tribal management of federally owned quarters.
``Sec. 315. Applicability of Buy American Act requirement.
``Sec. 316. Other funding for facilities.
``Sec. 317. Authorization of appropriations.
``TITLE IV--ACCESS TO HEALTH SERVICES

``Sec. 401. Treatment of payments under Social Security Act
health care programs.
``Sec. 402. Grants to and funding agreements with the Service,
Indian tribes, tribal organizations, and
urban Indian organizations.
``Sec. 403. Reimbursement from certain third parties of costs
of health services.
``Sec. 404. Crediting of reimbursements.
``Sec. 405. Purchasing health care coverage.
``Sec. 406. Sharing arrangements with Federal agencies.
``Sec. 407. Payor of last resort.
``Sec. 408. Nondiscrimination in qualifications for
reimbursement for services.
``Sec. 409. Consultation.
``Sec. 410. State children's health insurance program (SCHIP).
``Sec. 411. Social Security Act sanctions.
``Sec. 412. Cost sharing.
``Sec. 413. Treatment under medicaid managed care.
``Sec. 414. Navajo nation medicaid agency.
``Sec. 415. Authorization of appropriations.
``TITLE V--HEALTH SERVICES FOR URBAN INDIANS

``Sec. 501. Purpose.
``Sec. 502. Contracts with, and grants to, urban Indian
organizations.
``Sec. 503. Contracts and grants for the provision of health
care and referral services.
``Sec. 504. Contracts and grants for the determination of unmet
health care needs.
``Sec. 505. Evaluations; renewals.
``Sec. 506. Other contract and grant requirements.
``Sec. 507. Reports and records.
``Sec. 508. Limitation on contract authority.
``Sec. 509. Facilities.
``Sec. 510. Office of Urban Indian Health.
``Sec. 511. Grants for alcohol and substance abuse-related
services.
``Sec. 512. Treatment of certain demonstration projects.
``Sec. 513. Urban NIAAA transferred programs.
``Sec. 514. Consultation with urban Indian organizations.
``Sec. 515. Federal Tort Claims Act coverage.
``Sec. 516. Urban youth treatment center demonstration.
``Sec. 517. Use of Federal government facilities and sources of
supply.
``Sec. 518. Grants for diabetes prevention, treatment, and
control.
``Sec. 519. Community health representatives.
``Sec. 520. Regulations.
``Sec. 521. Eligibility for services.
``Sec. 522. Authorization of appropriations.
``TITLE VI--ORGANIZATIONAL IMPROVEMENTS

``Sec. 601. Establishment of the Indian Health Service as an
agency of the Public Health Service.
``Sec. 602. Automated management information system.
``Sec. 603. Authorization of appropriations.
``TITLE VII--BEHAVIORAL HEALTH PROGRAMS

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

``Sec. 801. Reports.
``Sec. 802. Regulations.
``Sec. 803. Plan of implementation.
``Sec. 804. Availability of funds.
``Sec. 805. Limitation on use of funds appropriated to the
Indian Health Service.
``Sec. 806. Eligibility of California Indians.
``Sec. 807. Health services for ineligible persons.
``Sec. 808. Reallocation of base resources.
``Sec. 809. Results of demonstration projects.
``Sec. 810. Provision of services in Montana.
``Sec. 811. Moratorium.
``Sec. 812. Tribal employment.
``Sec. 813. Prime vendor.
``Sec. 814. Severability provisions.
``Sec. 815. Establishment of National Bipartisan Commission on
Indian Health Care Entitlement.
``Sec. 816. Appropriations; availability.
``Sec. 817. Confidentiality of medical quality assurance
records: qualified immunity for
participants.
``Sec. 818. Authorization of appropriations.
Sec. 3. Soboba sanitation facilities.
Sec. 4. Amendments to medicare program.
Sec. 5. Amendments to medicaid program and State Children's Health
Insurance Program (SCHIP).

``SEC. 2. FINDINGS.

``Congress finds the following:
``(1) Federal delivery of health services and funding of
Indian and Urban Indian Health Programs to maintain and improve
the health of Indians are consonant with and required by the
Federal Government's historical and unique legal relationship
with Indians, as reflected in the Constitution, treaties,
Federal statutes and the course of dealings of the United
States with Indian Tribes and the United States' resulting
government-to-government relationship with Indian Tribes and
trust responsibilities and obligations to Indians.
``(2) From the time of European occupation and colonization
through the 20th century, policies and practices of the United
States caused and/or contributed to the severe health
conditions of Indians.
``(3) Through the cession of over 400,000,000 acres of land
to the United States in exchange for promises, often reflected
in treaties, of health care, Indian Tribes have secured a de
facto contract which entitles Indians to health care in
perpetuity, based on the moral, legal, and historic obligation
of the United States.
``(4) The population growth of Indians that began in the
later part of the 20th century increases the need for Federal
health care services.
``(5) A major national goal of the United States is to
provide the quantity and quality of health services which will
permit the health status of Indians regardless of where they
live to be raised to the highest possible level that is no less
than that of the general population and to provide for the
maximum participation of Indian Tribes, Tribal Organizations,
and Urban Indian Organizations in the planning, delivery and
management of those health services.
``(6) Federal health services to Indians have resulted in a
reduction in the prevalence and incidence of illnesses among,
and unnecessary and premature deaths of, Indians.
``(7) Despite such services, the unmet health needs of
Indians remain alarmingly severe and the health status of
Indians is far below the health status of the general
population of the United States.
``(8) The disparity to be addressed is formidable. For
example, Indians suffer a death rate for diabetes mellitus that
is 318 percent higher than the all races rate for the United
States, a pneumonia and influenza death rate 52 percent
greater, a tuberculosis death rate that is 650 percent greater,
and a death rate from alcoholism that is 670 percent higher
than that of the all races United States rate.

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

``Congress hereby declares that it is the policy of this Nation, in
fulfillment of its special trust responsibilities and legal obligations
to Indians--
``(1) to assure the highest possible health status for
Indians and to provide all resources necessary to effect that
policy;
``(2) to raise the health status of Indians by the year
2010 to at least the levels set forth in the goals contained
within the Healthy People 2010 or successor objectives;
``(3) to the greatest extent possible, to allow Indians to
set their own health care priorities and establish goals that
reflect their unmet needs;
``(4) to increase the proportion of all degrees in the
health professions and allied and associated health professions
awarded to Indians so that the proportion of Indian health
professionals in each Service Area is raised to at least the
level of that of the general population;
``(5) to require meaningful consultation with Indian
Tribes, Tribal Organizations, and Urban Indian Organizations to
implement this Act and the national policy of Indian self-
determination; and
``(6) to provide funding for programs and facilities
operated by Indian Tribes and Tribal Organizations in amounts
that are not less than the amounts provided to programs and
facilities operated directly by the Service.

``SEC. 4. DEFINITIONS.

``For purposes of this Act:
``(1) The term `accredited and accessible' means on or near
a reservation and accredited by a national or regional
organization with accrediting authority.
``(2) The term `Area Office' means an administrative entity
including a program office, within the Service through which
services and funds are provided to the Service Units within a
defined geographic area.
``(3) The term `California Indians' shall mean those
Indians who are eligible for health services of the Service
pursuant to section 806.
``(4) The term `community college' means--
``(A) a tribal college or university, or
``(B) a junior or community college.
``(5) The term `contract health service' means health
services provided at the expense of the Service or a Tribal
Health Program by public or private medical providers or
hospitals, other than the Service Unit or the Tribal Health
Program at whose expense the services are provided.
``(6) The term `Department' means, unless otherwise
designated, the Department of Health and Human Services.
``(7) The term `Director' means the Director of the Indian
Health Service.
``(8) The term `disease prevention' means the reduction,
limitation, and prevention of disease and its complications and
reduction in the consequences of disease, including, but not
limited to--
``(A) controlling--
``(i) development of diabetes;
``(ii) high blood pressure;
``(iii) infectious agents;
``(iv) injuries;
``(v) occupational hazards and
disabilities;
``(vi) sexually transmittable diseases; and
``(vii) toxic agents; and
``(B) providing--
``(i) fluoridation of water; and
``(ii) immunizations.
``(9) The term `fund' or `funding' means the transfer of
moneys from the Department to any eligible entity or individual
under this Act by any legal means, including Funding
Agreements, contracts, memoranda of understanding, contracts
pursuant to section 23 of the Act of April 20, 1908 (25 U.S.C.
47; popularly known as the `Buy Indian Act'), or otherwise.
``(10) The term `Funding Agreement' means any agreement to
transfer funds for the planning, conduct, and administration of
programs, services, functions, and activities to Indian Tribes
and Tribal Organizations from the Secretary under the Indian
Self-Determination and Education Assistance Act.
``(11) The term `health profession' means allopathic
medicine, family medicine, internal medicine, pediatrics,
geriatric medicine, obstetrics and gynecology, podiatric
medicine, nursing, public health nursing, dentistry,
psychiatry, osteopathy, optometry, pharmacy, psychology, public
health, social work, marriage and family therapy, chiropractic
medicine, environmental health and engineering, allied health
professions, and any other health profession.
``(12) The term `health promotion' means--
``(A) fostering social, economic, environmental,
and personal factors conducive to health, including
raising public awareness about health matters and
enabling the people to cope with health problems by
increasing their knowledge and providing them with
valid information;
``(B) encouraging adequate and appropriate diet,
exercise, and sleep;
``(C) promoting education and work in conformity
with physical and mental capacity;
``(D) making available suitable housing, safe
water, and sanitary facilities;
``(E) improving the physical, economic, cultural,
psychological, and social environment;
``(F) promoting adequate opportunity for spiritual,
religious, and Traditional Health Care Practices; and
``(G) providing adequate and appropriate programs,
including, but not limited to--
``(i) abuse prevention (mental and
physical);
``(ii) community health;
``(iii) community safety;
``(iv) consumer health education;
``(v) diet and nutrition;
``(vi) immunization and other prevention of
communicable diseases, including HIV/AIDS;
``(vii) environmental health;
``(viii) exercise and physical fitness;
``(ix) avoidance of fetal alcohol
disorders;
``(x) first aid and CPR education;
``(xi) human growth and development;
``(xii) injury prevention and personal
safety;
``(xiii) mental health;
``(xiv) personal health and wellness
practices;
``(xv) personal capacity building;
``(xvi) prenatal, pregnancy, and infant
care;
``(xvii) psychological well-being;
``(xviii) reproductive health and family
planning;
``(xix) safe and adequate water;
``(xx) safe housing;
``(xxi) safe work environments;
``(xxii) stress control;
``(xxiii) substance abuse;
``(xxiv) sanitary facilities;
``(xxv) tobacco use cessation and
reduction;
``(xxvi) violence prevention; and
``(xxvii) such other activities identified
by the Service, a Tribal Health Program, or an
Urban Indian Organization, to promote
achievement of any of the objectives described
in section 3(2).
``(13) The term `Indian' shall have the meaning given that
term in the Indian Self-Determination and Education Assistance
Act.
``(14) The term `Indian Health Program' means the
following--
``(A) any health program administered directly by
the Service;
``(B) any Tribal Health Program; or
``(C) any Indian Tribe or Tribal Organization to
which the Secretary provides funding pursuant to
section 23 of the Act of April 30, 1908 (25 U.S.C. 47),
popularly known as the `Buy Indian Act'.
``(15) The term `Indian Tribe' shall have the meaning given
that term in the Indian Self-Determination and Education
Assistance Act.
``(16) The term `junior or community college' has the
meaning given to such term by section 312(e) of the Higher
Education Act of 1965 (20 U.S.C. 1058(e)).
``(17) The term `reservation' means any federally
recognized Indian Tribe's reservation, Pueblo, or colony,
including former reservations in Oklahoma, Indian allotments,
and Alaska Native Regions established pursuant to the Alaska
Native Claims Settlement Act (25 U.S.C. 1601 et seq.).
``(18) The term `Secretary', unless otherwise designated,
means the Secretary of Health and Human Services.
``(19) The term `Service' means the Indian Health Service.
``(20) The term `Service Area' means the geographical area
served by each Area Office.
``(21) 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.
``(22) The term `Traditional Health Care Practices' means
the application by Native healing practitioners of the Native
healing sciences (as opposed or in contradistinction to Western
healing sciences) which embody the influences or forces of
innate Tribal discovery, history, description, explanation and
knowledge of the states of wellness and illness and which call
upon these influences or forces, including physical, mental,
and spiritual forces in the promotion, restoration,
preservation, and maintenance of health, well-being, and life's
harmony.
``(23) The term `tribal college or university' shall have
the meaning given that term in section 316(b)(3) of the Higher
Education Act (20 U.S.C. 1059c(b)(3)).
``(24) The term `Tribal Health Program' means an Indian
Tribe or Tribal Organization that operates any health program,
service, function, activity, or facility funded, in whole or
part, by the Service through, or provided for in, a Funding
Agreement with the Service under the Indian Self-Determination
and Education Assistance Act.
``(25) The term `Tribal Organization' shall have the
meaning given that term in the Indian Self-Determination and
Education Assistance Act.
``(26) The term `Urban Center' means any community which
has a sufficient Urban Indian population with unmet health
needs to warrant assistance under title V, as determined by the
Secretary.
``(27) The term `Urban Indian' means any individual who
resides in an Urban Center and who meets 1 or more of the
following criteria:
``(A) Irrespective of whether the individual lives
on or near a reservation, the individual is a member of
a tribe, band, or other organized group of Indians,
including those tribes, bands, or groups terminated
since 1940 and those tribes, bands, or groups that are
recognized by the States in which they reside, or who
is a descendant in the first or second degree of any
such member.
``(B) The individual is an Eskimo, Aleut, or other
Alaskan Native.
``(C) The individual is considered by the Secretary
of the Interior to be an Indian for any purpose.
``(D) The individual is determined to be an Indian
under regulations promulgated by the Secretary.
``(28) The term `Urban Indian Organization' means a
nonprofit corporate body that (A) is situated in an Urban
Center; (B) is governed by an Urban Indian-controlled board of
directors; (C) provides for the participation of all interested
Indian groups and individuals; and (D) is capable of legally
cooperating with other public and private entities for the
purpose of performing the activities described in section
503(a).

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

``SEC. 101. PURPOSE.

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

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

``(a) In General.--The Secretary, acting through the Service, shall
make funds available to public or nonprofit private health entities or
Tribal Health Programs to assist such entities in meeting the costs
of--
``(1) identifying Indians with a potential for education or
training in the health professions and encouraging and
assisting them--
``(A) to enroll in courses of study in such health
professions; or
``(B) if they are not qualified to enroll in any
such courses of study, to undertake such postsecondary
education or training as may be required to qualify
them for enrollment;
``(2) publicizing existing sources of financial aid
available to Indians enrolled in any course of study referred
to in paragraph (1) or who are undertaking training necessary
to qualify them to enroll in any such course of study; or
``(3) establishing other programs which the Secretary
determines will enhance and facilitate the enrollment of
Indians in, and the subsequent pursuit and completion by them
of, courses of study referred to in paragraph (1).
``(b) Funding.--
``(1) Application.--Funds under this section shall require
that an application has been submitted to, and approved by, the
Secretary. Such application shall be in such form, submitted in
such manner, and contain such information, as the Secretary
shall by regulation prescribe pursuant to this Act. The
Secretary shall give a preference to applications submitted by
Tribal Health Programs or Urban Indian Organizations.
``(2) Amount of funds; payment.--The amount of funds
provided to entities under this section shall be determined by
the Secretary. Payments pursuant to this section may be made in
advance or by way of reimbursement, and at such intervals and
on such conditions as provided for in regulations issued
pursuant to this Act. To the extent not otherwise prohibited by
law, funding commitments shall be for 3 years, as provided in
regulations published pursuant to this Act.
``(c) Definition of Indian.--For purposes of this section and
sections 103 and 104, the term `Indian' shall, in addition to the
meaning given that term in section 4, also mean any individual who is
an Urban Indian.

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

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

``SEC. 104. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.

``(a) In General.--
``(1) Authority.--The Secretary, acting through the
Service, shall make scholarships to Indians who are enrolled
full or part time in accredited schools pursuing courses of
study in the health professions. Such scholarships shall be
designated Indian Health Scholarships and shall be made in
accordance with section 338A of the Public Health Services Act
(42 U.S.C. 2541), except as provided in subsection (b) of this
section.
``(2) Allocation by formula.--Except as provided in
paragraph (3), the funding authorized by this section shall be
allocated by Service Area by a formula developed in
consultation with Indian Tribes, Tribal Organizations, and
Urban Indian Organizations. Such formula shall consider the
human resource development needs in each Service Area.
``(3) Continuity of prior scholarships.--Paragraph (2)
shall not apply with respect to individual recipients of
scholarships provided under this section (as in effect 1 day
prior to the date of the enactment of the Indian Health Care
Improvement Act Amendments of 2003) until such time as the
individual completes the course of study that is supported
through such scholarship.
``(4) Certain delegation not allowed.--The administration
of this section shall be a responsibility of the Director and
shall not be delegated in a Funding Agreement.
``(b) Active Duty Service Obligation.--
``(1) Obligation met.--The active duty service obligation
under a written contract with the Secretary under section 338A
of the Public Health Service Act (42 U.S.C. 254l) that an
Indian has entered into under that section shall, if that
individual is a recipient of an Indian Health Scholarship, be
met in full-time practice on an equivalent year-for-year
obligation, by service in one or more of the following:
``(A) In an Indian Health Program.
``(B) In a program assisted under title V.
``(C) In the private practice of the applicable
profession if, as determined by the Secretary, in
accordance with guidelines promulgated by the
Secretary, such practice is situated in a physician or
other health professional shortage area and addresses
the health care needs of a substantial number of
Indians.
``(2) Obligation deferred.--At the request of any
individual who has entered into a contract referred to in
paragraph (1) and who receives a degree in medicine (including
osteopathic or allopathic medicine), dentistry, optometry,
podiatry, or pharmacy, the Secretary shall defer the active
duty service obligation of that individual under that contract,
in order that such individual may complete any internship,
residency, or other advanced clinical training that is required
for the practice of that health profession, for an appropriate
period (in years, as determined by the Secretary), subject to
the following conditions:
``(A) No period of internship, residency, or other
advanced clinical training shall be counted as
satisfying any period of obligated service under this
subsection.
``(B) The active duty service obligation of that
individual shall commence not later than 90 days after
the completion of that advanced clinical training (or
by a date specified by the Secretary).
``(C) The active duty service obligation will be
served in the health profession of that individual in a
manner consistent with paragraph (1).
``(D) A recipient of a scholarship under this
section may, at the election of the recipient, meet the
active duty service obligation described in paragraph
(1) by service in a program specified under that
paragraph that--
``(i) is located on the reservation of the
Indian Tribe in which the recipient is
enrolled; or
``(ii) serves the Indian Tribe in which the
recipient is enrolled.
``(3) Priority when making assignments.--Subject to
paragraph (2), the Secretary, in making assignments of Indian
Health Scholarship recipients required to meet the active duty
service obligation described in paragraph (1), shall give
priority to assigning individuals to service in those programs
specified in paragraph (1) that have a need for health
professionals to provide health care services as a result of
individuals having breached contracts entered into under this
section.
``(c) Part-Time Students.--In the case of an individual receiving a
scholarship under this section who is enrolled part time in an approved
course of study--
``(1) such scholarship shall be for a period of years not
to exceed the part-time equivalent of 4 years, as determined by
the Area Office;
``(2) the period of obligated service described in
subsection (b)(1) shall be equal to the greater of--
``(A) the part-time equivalent of 1 year for each
year for which the individual was provided a
scholarship (as determined by the Area Office); or
``(B) 2 years; and
``(3) the amount of the monthly stipend specified in
section 338A(g)(1)(B) of the Public Health Service Act (42
U.S.C. 254l(g)(1)(B)) shall be reduced pro rata (as determined
by the Secretary) based on the number of hours such student is
enrolled.
``(d) Breach of Contract.--
``(1) Specified breaches.--An individual shall be liable to
the United States for the amount which has been paid to the
individual, or on behalf of the individual, under a contract
entered into with the Secretary under this section on or after
the date of the enactment of the Indian Health Care Improvement
Act Amendments of 2003 if that individual--
``(A) fails to maintain an acceptable level of
academic standing in the educational institution in
which he or she is enrolled (such level determined by
the educational institution under regulations of the
Secretary);
``(B) is dismissed from such educational
institution for disciplinary reasons;
``(C) voluntarily terminates the training in such
an educational institution for which he or she is
provided a scholarship under such contract before the
completion of such training; or
``(D) fails to accept payment, or instructs the
educational institution in which he or she is enrolled
not to accept payment, in whole or in part, of a
scholarship under such contract, in lieu of any service
obligation arising under such contract.
``(2) Other breaches.--If for any reason not specified in
paragraph (1) an individual breaches a written contract by
failing either to begin such individual's service obligation
required under such contract or to complete such service
obligation, the United States shall be entitled to recover from
the individual an amount determined in accordance with the
formula specified in subsection (l) of section 110 in the
manner provided for in such subsection.
``(3) Cancellation upon death of recipient.--Upon the death
of an individual who receives an Indian Health Scholarship, any
outstanding obligation of that individual for service or
payment that relates to that scholarship shall be canceled.
``(4) Waivers and suspensions.--The Secretary shall provide
for the partial or total waiver or suspension of any obligation
of service or payment of a recipient of an Indian Health
Scholarship if the Secretary, in consultation with the Area
Office, Indian Tribes, Tribal Organizations, and Urban Indian
Organizations, determines that--
``(A) it is not possible for the recipient to meet
that obligation or make that payment;
``(B) requiring that recipient to meet that
obligation or make that payment would result in extreme
hardship to the recipient; or
``(C) the enforcement of the requirement to meet
the obligation or make the payment would be
unconscionable.
``(5) Extreme hardship.--Notwithstanding any other
provision of law, in any case of extreme hardship or for other
good cause shown, the Secretary may waive, in whole or in part,
the right of the United States to recover funds made available
under this section.
``(6) Bankruptcy.--Notwithstanding any other provision of
law, with respect to a recipient of an Indian Health
Scholarship, no obligation for payment may be released by a
discharge in bankruptcy under title 11, United States Code,
unless that discharge is granted after the expiration of the 5-
year period beginning on the initial date on which that payment
is due, and only if the bankruptcy court finds that the
nondischarge of the obligation would be unconscionable.

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

``(a) Grants Authorized.--The Secretary, acting through the
Service, shall provide funding grants to at least 3 colleges and
universities for the purpose of developing and maintaining Indian
psychology career recruitment programs as a means of encouraging
Indians to enter the mental 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 funds provided under this
section.
``(d) Conditions of Grant.--Applicants under this section shall
agree to provide a program which, at a minimum--
``(1) provides outreach and recruitment for health
professions to Indian communities including elementary,
secondary, and accredited and accessible community colleges
that will be served by the program;
``(2) incorporates a program advisory board comprised of
representatives from the tribes and communities that will be
served by the program;
``(3) provides summer enrichment programs to expose Indian
students to the various fields of psychology through research,
clinical, and experimental activities;
``(4) provides stipends to undergraduate and graduate
students to pursue a career in psychology;
``(5) develops affiliation agreements with tribal colleges
and universities, the Service, university affiliated programs,
and other appropriate accredited and accessible entities to
enhance the education of Indian students;
``(6) to the maximum extent feasible, uses existing
university tutoring, counseling, and student support services;
and
``(7) to the maximum extent feasible, employs qualified
Indians in the program.
``(e) Active Duty Service Requirement.--The active duty service
obligation prescribed under section 338C of the Public Health Service
Act (42 U.S.C. 254m) shall be met by each graduate who receives a
stipend described in subsection (d)(4) that is funded under this
section. Such obligation shall be met by service--
``(1) in an Indian Health Program;
``(2) in a program assisted under title V; 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.

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

``(a) In General.--
``(1) Funding authorized.--The Secretary, acting through
the Service, shall make funds available to Tribal Health
Programs for the purpose of assisting such Tribal Health
Programs in educating Indians to serve as health professionals
in Indian communities.
``(2) Amount.--Amounts available under paragraph (1) for
any fiscal year shall not exceed 5 percent of the amounts
available for each fiscal year for Indian Health Scholarships
under section 104.
``(3) Application.--An application for funds under
paragraph (1) shall be in such form and contain such
agreements, assurances, and information as consistent with this
section.
``(b) Requirements.--
``(1) In general.--A Tribal Health Program receiving funds
under subsection (a) shall provide scholarships to Indians in
accordance with the requirements of this section.
``(2) Costs.--With respect to costs of providing any
scholarship pursuant to subsection (a)--
``(A) 80 percent of the costs of the scholarship
shall be paid from the funds made available pursuant to
subsection (a)(1) provided to the Tribal Health
Program; and
``(B) 20 percent of such costs may be paid from any
other source of funds.
``(c) Course of Study.--A Tribal Health Program shall provide
scholarships under this section only to Indians enrolled or accepted
for enrollment in a course of study (approved by the Secretary) in one
of the health professions contemplated by this Act.
``(d) Contract.--In providing scholarships under subsection (b),
the Secretary and the Tribal Health Program shall enter into a written
contract with each recipient of such scholarship. Such contract shall--
``(1) obligate such recipient to provide service in an
Indian Health Program or Urban Indian Organization, in the same
Service Area where the Tribal Health Program providing the
scholarship is located, for--
``(A) a number of years for which the scholarship
is provided (or the part-time equivalent thereof, as
determined by the Secretary), or for a period of 2
years, whichever period is greater; or
``(B) such greater period of time as the recipient
and the Tribal Health Program may agree;
``(2) provide that the amount of the scholarship--
``(A) may only be expended for--
``(i) tuition expenses, other reasonable
educational expenses, and reasonable
living expenses incurred in attendance at the educational institution;
and
``(ii) payment to the recipient of a
monthly stipend of not more than the amount
authorized by section 338(g)(1)(B) of the
Public Health Service Act (42 U.S.C.
254m(g)(1)(B)), such amount to be reduced pro
rata (as determined by the Secretary) based on
the number of hours such student is enrolled;
and may not exceed, for any year of attendance
for which the scholarship is provided, the
total amount required for the year for the
purposes authorized in this clause; and
``(B) may not exceed, for any year of attendance
for which the scholarship is provided, the total amount
required for the year for the purposes authorized in
subparagraph (A);
``(3) require the recipient of such scholarship to maintain
an acceptable level of academic standing as determined by the
educational institution in accordance with regulations issued
pursuant to this Act; and
``(4) require the recipient of such scholarship to meet the
educational and licensure requirements appropriate to each
health profession.
``(e) Breach of Contract.--
``(1) Specific breaches.--An individual who has entered
into a written contract with the Secretary and a Tribal Health
Program under subsection (d) shall be liable to the United
States for the Federal share of the amount which has been paid
to him or her, or on his or her behalf, under the contract if
that individual--
``(A) fails to maintain an acceptable level of
academic standing in the educational institution in
which he or she is enrolled (such level as determined
by the educational institution under regulations of the
Secretary);
``(B) is dismissed from such educational
institution for disciplinary reasons;
``(C) voluntarily terminates the training in such
an educational institution for which he or she is
provided a scholarship under such contract before the
completion of such training; or
``(D) fails to accept payment, or instructs the
educational institution in which he or she is enrolled
not to accept payment, in whole or in part, of a
scholarship under such contract, in lieu of any service
obligation arising under such contract.
``(2) Other breaches.--If for any reason not specified in
paragraph (1), an individual breaches a written contract by
failing to either begin such individual's service obligation
required under such contract or to complete such service
obligation, the United States shall be entitled to recover from
the individual an amount determined in accordance with the
formula specified in subsection (l) of section 110 in the
manner provided for in such subsection.
``(3) Cancellation upon death of recipient.--Upon the death
of an individual who receives an Indian Health Scholarship, any
outstanding obligation of that individual for service or
payment that relates to that scholarship shall be canceled.
``(4) Information.--The Secretary may carry out this
subsection on the basis of information received from Tribal
Health Programs involved or on the basis of information
collected through such other means as the Secretary deems
appropriate.
``(f) Relation to Social Security Act.--The recipient of a
scholarship under this section shall agree, in providing health care
pursuant to the requirements herein--
``(1) not to discriminate against an individual seeking
care on the basis of the ability of the individual to pay for
such care or on the basis that payment for such care will be
made pursuant to a program established in title XVIII of the
Social Security Act or pursuant to the programs established in
title XIX or title XXI of such Act; and
``(2) to accept assignment under section 1842(b)(3)(B)(ii)
of the Social Security Act for all services for which payment
may be made under part B of title XVIII of such Act, and to
enter into an appropriate agreement with the State agency that
administers the State plan for medical assistance under title
XIX, or the State child health plan under title XXI, of such
Act to provide service to individuals entitled to medical
assistance or child health assistance, respectively, under the
plan.
``(g) Continuance of Funding.--The Secretary shall make payments
under this section to a Tribal Health Program for any fiscal year
subsequent to the first fiscal year of such payments unless the
Secretary determines that, for the immediately preceding fiscal year,
the Tribal Health Program has not complied with the requirements of
this section.

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

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

``SEC. 108. CONTINUING EDUCATION ALLOWANCES.

``In order to encourage health professionals, including community
health representatives and emergency medical technicians, to join or
continue in an Indian Health Program or an Urban Indian Organization
and to provide their services in the rural and remote areas where a
significant portion of Indians reside, the Secretary, acting through
the Service Area, may provide allowances to health professionals
employed in an Indian Health Program or an Urban Indian Organization to
enable them for a period of time each year prescribed by regulation of
the Secretary to take leave of their duty stations for professional
consultation and refresher training courses.

``SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PROGRAM.

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

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

``(a) Establishment.--The Secretary, acting through the Service,
shall establish and administer a program to be known as the Service
Loan Repayment Program (hereinafter referred to as the `Loan Repayment
Program') in order to ensure an adequate supply of trained health
professionals necessary to maintain accreditation of, and provide
health care services to Indians through, Indian Health Programs and
Urban Indian Organizations.
``(b) Eligible Individuals.--To be eligible to participate in the
Loan Repayment Program, an individual must--
``(1)(A) be enrolled--
``(i) in a course of study or program in an
accredited educational institution (as determined by
the Secretary under section 338B(b)(1)(c)(i) of the
Public Health Service Act (42 U.S.C. 254l-
1(b)(1)(c)(i))) and be scheduled to complete such
course of study in the same year such individual
applies to participate in such program; or
``(ii) in an approved graduate training program in
a health profession; or
``(B) have--
``(i) a degree in a health profession; and
``(ii) a license to practice a health profession;
``(2)(A) be eligible for, or hold, an appointment as a
commissioned officer in the Regular or Reserve Corps of the
Public Health Service;
``(B) be eligible for selection for civilian service in the
Regular or Reserve Corps of the Public Health Service;
``(C) meet the professional standards for civil service
employment in the Service; or
``(D) be employed in an Indian Health Program or Urban
Indian Organization without a service obligation; and
``(3) submit to the Secretary an application for a contract
described in subsection (e).
``(c) Application.--
``(1) Information to be included with forms.--In
disseminating application forms and contract forms to
individuals desiring to participate in the Loan Repayment
Program, the Secretary shall include with such forms a fair
summary of the rights and liabilities of an individual whose
application is approved (and whose contract is accepted) by the
Secretary, including in the summary a clear explanation of the
damages to which the United States is entitled under subsection
(l) in the case of the individual's breach of contract. The
Secretary shall provide such individuals with sufficient
information regarding the advantages and disadvantages of
service as a commissioned officer in the Regular or Reserve
Corps of the Public Health Service or a civilian employee of
the Service to enable the individual to make a decision on an
informed basis.
``(2) Clear language.--The application form, contract form,
and all other information furnished by the Secretary under this
section shall be written in a manner calculated to be
understood by the average individual applying to participate in
the Loan Repayment Program.
``(3) Timely availability of forms.--The Secretary shall
make such application forms, contract forms, and other
information available to individuals desiring to participate in
the Loan Repayment Program on a date sufficiently early to
ensure that such individuals have adequate time to carefully
review and evaluate such forms and information.
``(d) Priorities.--
``(1) List.--Consistent with subsection (k), the Secretary
shall annually--
``(A) identify the positions in each Indian Health
Program or Urban Indian Organization for which there is
a need or a vacancy; and
``(B) rank those positions in order of priority.
``(2) Approvals.--Notwithstanding the priority determined
under paragraph (1), the Secretary, in determining which
applications under the Loan Repayment Program to approve (and
which contracts to accept), shall--
``(A) give first priority to applications made by
individual Indians; and
``(B) after making determinations on all
applications submitted by individual Indians as
required under subparagraph (A), give priority to--
``(i) individuals recruited through the
efforts of a Tribal Health Program or Urban
Indian Organization; and
``(ii) other individuals based on the
priority rankings under paragraph (1).
``(e) Recipient Contracts.--
``(1) Contract required.--An individual becomes a
participant in the Loan Repayment Program only upon the
Secretary and the individual entering into a written contract
described in paragraph (2).
``(2) Contents of contract.--The written contract referred
to in this section between the Secretary and an individual
shall contain--
``(A) an agreement under which--
``(i) subject to subparagraph (C), the
Secretary agrees--
``(I) to pay loans on behalf of the
individual in accordance with the
provisions of this section; and
``(II) to accept (subject to the
availability of appropriated funds for
carrying out this section) the
individual into the Service or place
the individual with a Tribal Health
Program or Urban Indian Organization as
provided in clause (ii)(III); and
``(ii) subject to subparagraph (C), the
individual agrees--
``(I) to accept loan payments on
behalf of the individual;
``(II) in the case of an individual
described in subsection (b)(1)--
``(aa) to maintain
enrollment in a course of study
or training described in
subsection (b)(1)(A) until the
individual completes the course of study or training; and
``(bb) while enrolled in
such course of study or
training, to maintain an
acceptable level of academic
standing (as determined under
regulations of the Secretary by
the educational institution
offering such course of study
or training); and
``(III) to serve for a time period
(hereinafter in this section referred
to as the `period of obligated
service') equal to 2 years or such
longer period as the individual may
agree to serve in the full-time
clinical practice of such individual's
profession in an Indian Health Program
or Urban Indian Organization to which
the individual may be assigned by the
Secretary;
``(B) a provision permitting the Secretary to
extend for such longer additional periods, as the
individual may agree to, the period of obligated
service agreed to by the individual under subparagraph
(A)(ii)(III);
``(C) a provision that any financial obligation of
the United States arising out of a contract entered
into under this section and any obligation of the
individual which is conditioned thereon is contingent
upon funds being appropriated for loan repayments under
this section;
``(D) a statement of the damages to which the
United States is entitled under subsection (l) for the
individual's breach of the contract; and
``(E) such other statements of the rights and
liabilities of the Secretary and of the individual, not
inconsistent with this section.
``(f) Deadline for Decision on Application.--The Secretary shall
provide written notice to an individual within 21 days on--
``(1) the Secretary's approving, under subsection (e)(1),
of the individual's participation in the Loan Repayment
Program, including extensions resulting in an aggregate period
of obligated service in excess of 4 years; or
``(2) the Secretary's disapproving an individual's
participation in such Program.
``(g) Payments.--
``(1) In general.--A loan repayment provided for an
individual under a written contract under the Loan Repayment
Program shall consist of payment, in accordance with paragraph
(2), on behalf of the individual of the principal, interest,
and related expenses on government and commercial loans
received by the individual regarding the undergraduate or
graduate education of the individual (or both), which loans
were made for--
``(A) tuition expenses;
``(B) all other reasonable educational expenses,
including fees, books, and laboratory expenses,
incurred by the individual; and
``(C) reasonable living expenses as determined by
the Secretary.
``(2) Amount.--For each year of obligated service that an
individual contracts to serve under subsection (e), the
Secretary may pay up to $35,000 or an amount equal to the
amount specified in section 338B(g)(2)(A) of the Public Health
Service Act, whichever is more, on behalf of the individual for
loans described in paragraph (1). In making a determination of
the amount to pay for a year of such service by an individual,
the Secretary shall consider the extent to which each such
determination--
``(A) affects the ability of the Secretary to
maximize the number of contracts that can be provided
under the Loan Repayment Program from the amounts
appropriated for such contracts;
``(B) provides an incentive to serve in Indian
Health Programs and Urban Indian Organizations with the
greatest shortages of health professionals; and
``(C) provides an incentive with respect to the
health professional involved remaining in an Indian
Health Program or Urban Indian Organization with such a
health professional shortage, and continuing to provide
primary health services, after the completion of the
period of obligated service under the Loan Repayment
Program.
``(3) Timing.--Any arrangement made by the Secretary for
the making of loan repayments in accordance with this
subsection shall provide that any repayments for a year of
obligated service shall be made no later than the end of the
fiscal year in which the individual completes such year of
service.
``(4) Payment schedule.--The Secretary may enter into an
agreement with the holder of any loan for which payments are
made under the Loan Repayment Program to establish a schedule
for the making of such payments.
``(h) Employment Ceiling.--Notwithstanding any other provision of
law, individuals who have entered into written contracts with the
Secretary under this section shall not be counted against any
employment ceiling affecting the Department while those individuals are
undergoing academic training.
``(i) Recruitment.--The Secretary shall conduct recruiting programs
for the Loan Repayment Program and other Service manpower programs of
the Service at educational institutions training health professionals
or specialists identified in subsection (a).
``(j) Applicability of Law.--Section 214 of the Public Health
Service Act (42 U.S.C. 215) shall not apply to individuals during their
period of obligated service under the Loan Repayment Program.
``(k) Assignment of Individuals.--The Secretary, in assigning
individuals to serve in Indian Health Programs or Urban Indian
Organizations pursuant to contracts entered into under this section,
shall--
``(1) ensure that the staffing needs of Tribal Health
Programs and Urban Indian Organizations receive consideration
on an equal basis with programs that are administered directly
by the Service; and
``(2) give priority to assigning individuals to Indian
Health Programs and Urban Indian Organizations that have a need
for health professionals to provide health care services as a
result of individuals having breached contracts entered into
under this section.
``(l) Breach of Contract.--
``(1) Specific breaches.--An individual who has entered
into a written contract with the Secretary under this section
and has not received a waiver under subsection (m) shall be
liable, in lieu of any service obligation arising under such
contract, to the United States for the amount which has been
paid on such individual's behalf under the contract if that
individual--
``(A) is enrolled in the final year of a course of
study and--
``(i) fails to maintain an acceptable level
of academic standing in the educational
institution in which he or she is enrolled
(such level determined by the educational
institution under regulations of the
Secretary);
``(ii) voluntarily terminates such
enrollment; or
``(iii) is dismissed from such educational
institution before completion of such course of
study; or
``(B) is enrolled in a graduate training program
and fails to complete such training program.
``(2) Other breaches; formula for amount owed.--If, for any
reason not specified in paragraph (1), an individual breaches
his or her written contract under this section by failing
either to begin, or complete, such individual's period of
obligated service in accordance with subsection (e)(2), the
United States shall be entitled to recover from such individual
an amount to be determined in accordance with the following
formula: A=3Z(t-s/t) in which--
``(A) `A' is the amount the United States is
entitled to recover;
``(B) `Z' is the sum of the amounts paid under this
section to, or on behalf of, the individual and the
interest on such amounts which would be payable if, at
the time the amounts were paid, they were loans bearing
interest at the maximum legal prevailing rate, as
determined by the Secretary of the Treasury;
``(C) `t' is the total number of months in the
individual's period of obligated service in accordance
with subsection (f); and
``(D) `s' is the number of months of such period
served by such individual in accordance with this
section.
``(3) Deductions in medicare payments.--Amounts not paid
within such period shall be subject to collection through
deductions in medicare payments pursuant to section 1892 of the
Social Security Act.
``(4) Time period for repayment.--Any amount of damages
which the United States is entitled to recover under this
subsection shall be paid to the United States within the 1-year
period beginning on the date of the breach or such longer
period beginning on such date as shall be specified by the
Secretary.
``(5) Recovery of delinquency.--
``(A) In general.--If damages described in
paragraph (4) are delinquent for 3 months, the
Secretary shall, for the purpose of recovering such
damages--
``(i) use collection agencies contracted
with by the Administrator of General Services;
or
``(ii) enter into contracts for the
recovery of such damages with collection
agencies selected by the Secretary.
``(B) Report.--Each contract for recovering damages
pursuant to this subsection shall provide that the
contractor will, not less than once each 6 months,
submit to the Secretary a status report on the success
of the contractor in collecting such damages. Section
3718 of title 31, United States Code, shall apply to
any such contract to the extent not inconsistent with
this subsection.
``(m) Waiver or Suspension of Obligation.--
``(1) In general.--The Secretary shall by regulation
provide for the partial or total waiver or suspension of any
obligation of service or payment by an individual under the
Loan Repayment Program whenever compliance by the individual is
impossible or would involve extreme hardship to the individual
and if enforcement of such obligation with respect to any
individual would be unconscionable.
``(2) Canceled upon death.--Any obligation of an individual
under the Loan Repayment Program for service or payment of
damages shall be canceled upon the death of the individual.
``(3) Hardship waiver.--The Secretary may waive, in whole
or in part, the rights of the United States to recover amounts
under this section in any case of extreme hardship or other
good cause shown, as determined by the Secretary.
``(4) Bankruptcy.--Any obligation of an individual under
the Loan Repayment Program for payment of damages may be
released by a discharge in bankruptcy under title 11 of the
United States Code only if such discharge is granted after the
expiration of the 5-year period beginning on the first date
that payment of such damages is required, and only if the
bankruptcy court finds that nondischarge of the obligation
would be unconscionable.
``(n) Report.--The Secretary shall submit to the President, for
inclusion in each report required to be submitted to Congress under
section 801, a report concerning the previous fiscal year which sets
forth by Service Area the following:
``(1) A list of the health professional positions
maintained by Indian Health Programs and Urban Indian
Organizations for which recruitment or retention is difficult.
``(2) The number of Loan Repayment Program applications
filed with respect to each type of health profession.
``(3) The number of contracts described in subsection (e)
that are entered into with respect to each health profession.
``(4) The amount of loan payments made under this section,
in total and by health profession.
``(5) The number of scholarships that are provided under
section 104 and 106 with respect to each health profession.
``(6) The amount of scholarship grants provided under
section 104 and 106, in total and by health profession.
``(7) The number of providers of health care that will be
needed by Indian Health Programs and Urban Indian
Organizations, by location and profession, during the 3 fiscal
years beginning after the date the report is filed.
``(8) The measures the Secretary plans to take to fill the
health professional positions maintained by Indian Health
Programs or Urban Indian Organizations for which recruitment or
retention is difficult.

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

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

``SEC. 112. RECRUITMENT ACTIVITIES.

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

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

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

``SEC. 114. ADVANCED TRAINING AND RESEARCH.

``(a) Demonstration Program.--The Secretary, acting through the
Service, shall establish a demonstration project to enable health
professionals who have worked in an Indian Health Program or Urban
Indian Organization for a substantial period of time to pursue advanced
training or research areas of study for which the Secretary determines
a need exists.
``(b) Service Obligation.--An individual who participates in a
program under subsection (a), where the educational costs are borne by
the Service, shall incur an obligation to serve in an Indian Health
Program or Urban Indian Organization for a period of obligated service
equal to at least the period of time during which the individual
participates in such program. In the event that the individual fails to
complete such obligated service, the individual shall be liable to the
United States for the period of service remaining. In such event, with
respect to individuals entering the program after the date of the
enactment of the Indian Health Care Improvement Act Amendments of 2003,
the United States shall be entitled to recover from such individual an
amount to be determined in accordance with the formula specified in
subsection (l) of section 110 in the manner provided for in such
subsection.
``(c) Equal Opportunity for Participation.--Health professionals
from Tribal Health Programs and Urban Indian Organizations shall be
given an equal opportunity to participate in the program under
subsection (a).

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

``(a) Grants Authorized.--For the purpose of increasing the number
of nurses, nurse midwives, and nurse practitioners who deliver health
care services to Indians, the Secretary, acting through the Service,
shall provide grants to the following:
``(1) Public or private schools of nursing.
``(2) Tribal colleges or universities.
``(3) Nurse midwife programs and advanced practice nurse
programs that are provided by any tribal college or university
accredited nursing program, or in the absence of such, any
other public or private institutions.
``(b) Use of Grants.--Grants provided under subsection (a) may be
used for one or more of the following:
``(1) To recruit individuals for programs which train
individuals to be nurses, nurse midwives, or advanced practice
nurses.
``(2) To provide scholarships to Indians enrolled in such
programs that may pay the tuition charged for such program and
other expenses incurred in connection with such program,
including books, fees, room and board, and stipends for living
expenses.
``(3) To provide a program that encourages nurses, nurse
midwives, and advanced practice nurses to provide, or continue
to provide, health care services to Indians.
``(4) To provide a program that increases the skills of,
and provides continuing education to, nurses, nurse midwives,
and advanced practice nurses.
``(5) To provide any program that is designed to achieve
the purpose described in subsection (a).
``(c) Applications.--Each application for funding under subsection
(a) shall include such information as the Secretary may require to
establish the connection between the program of the applicant and a
health care facility that primarily serves Indians.
``(d) Preferences for Grant Recipients.--In providing grants under
subsection (a), the Secretary shall extend a preference to the
following:
``(1) Programs that provide a preference to Indians.
``(2) Programs that train nurse midwives or advanced
practice nurses.
``(3) Programs that are interdisciplinary.
``(4) Programs that are conducted in cooperation with a
program for gifted and talented Indian students.
``(e) Quentin N. Burdick Program Grant.--The Secretary shall
provide one of the grants authorized under subsection (a) to establish
and maintain a program at the University of North Dakota to be known as
the `Quentin N. Burdick American Indians Into Nursing Program'. Such
program shall, to the maximum extent feasible, coordinate with the
Quentin N. Burdick Indian Health Programs established under section
117(b) and the Quentin N. Burdick American Indians Into Psychology
Program established under section 105(b).
``(f) Active Duty Service Obligation.--The active duty service
obligation prescribed under section 338C of the Public Health Service
Act (42 U.S.C. 254m) shall be met by each individual who receives
training or assistance described in paragraph (1) or (2) of subsection
(b) that is funded by a grant provided under subsection (a). Such
obligation shall be met by service--
``(1) in the Service;
``(2) in a program of an Indian Tribe or Tribal
Organization conducted under the Indian Self-Determination Act
(including programs under agreements with the Bureau of Indian
Affairs);
``(3) in a program assisted under title V of this Act; or
``(4) in the private practice of nursing if, as determined
by the Secretary, in accordance with guidelines promulgated by
the Secretary, such practice is situated in a physician or
other health shortage area and addresses the health care needs
of a substantial number of Indians.

``SEC. 116. TRIBAL CULTURAL ORIENTATION.

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

``SEC. 117. INMED PROGRAM.

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

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

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

``SEC. 119. RETENTION BONUS.

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

``SEC. 120. NURSING RESIDENCY PROGRAM.

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

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

``(a) General Purposes of Program.--Under the authority of the Act
of November 2, 1921 (25 U.S.C. 13; popularly known as the Snyder Act),
the Secretary, acting through the Service, shall develop and operate a
Community Health Aide Program in Alaska under which the Service--
``(1) provides for the training of Alaska Natives as health
aides or community health practitioners;
``(2) uses such aides or practitioners in the provision of
health care, health promotion, and disease prevention services
to Alaska Natives living in villages in rural Alaska; and
``(3) provides for the establishment of teleconferencing
capacity in health clinics located in or near such villages for
use by community health aides or community health
practitioners.
``(b) Specific Program Requirements.--The Secretary, acting through
the Community Health Aide Program of the Service, shall--
``(1) using trainers accredited by the Program, provide a
high standard of training to community health aides and
community health practitioners to ensure that such aides and
practitioners provide quality health care, health promotion,
and disease prevention services to the villages served by the
Program;
``(2) in order to provide such training, develop a
curriculum that--
``(A) combines education in the theory of health
care with supervised practical experience in the
provision of health care;
``(B) provides instruction and practical experience
in the provision of acute care, emergency care, health
promotion, disease prevention, and the efficient and
effective management of clinic pharmacies, supplies,
equipment, and facilities; and
``(C) promotes the achievement of the health status
objectives specified in section 3(2);
``(3) establish and maintain a Community Health Aide
Certification Board to certify as community health aides or
community health practitioners individuals who have
successfully completed the training described in paragraph (1)
or can demonstrate equivalent experience;
``(4) develop and maintain a system which identifies the
needs of community health aides and community health
practitioners for continuing education in the provision of
health care, including the areas described in paragraph (2)(B),
and develop programs that meet the needs for such continuing
education;
``(5) develop and maintain a system that provides close
supervision of community health aides and community health
practitioners; and
``(6) develop a system under which the work of community
health aides and community health practitioners is reviewed and
evaluated to assure the provision of quality health care,
health promotion, and disease prevention services.
``(c) National Community Health Aide Program.--The Secretary,
acting through the Service, shall develop and operate a national
Community Health Aide Program consistent with the requirements of this
section without reducing funds for the Community Health Aide Program
for Alaska.

``SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION.

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

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

``(a) Demonstration Programs Authorized.-- The Secretary, acting
through the Service, may fund demonstration programs for Tribal Health
Programs to address the chronic shortages of health professionals.
``(b) Purposes of Programs.--The purposes of demonstration programs
funded under subsection (a) shall be--
``(1) to provide direct clinical and practical experience
at a Service Unit to health profession students and residents
from medical schools;
``(2) to improve the quality of health care for Indians by
assuring access to qualified health care professionals; and
``(3) to provide academic and scholarly opportunities for
health professionals serving Indians by identifying all
academic and scholarly resources of the region.
``(c) Advisory Board.--The demonstration programs established
pursuant to subsection (a) shall incorporate a program advisory board
composed of representatives from the Indian Tribes and Indian
communities in the area which will be served by the program.

``SEC. 124. TREATMENT OF SCHOLARSHIPS FOR CERTAIN PURPOSES.

``Scholarships provided to individuals pursuant to this title shall
be deemed `qualified Scholarships' for purposes of section 11 of the
Internal Revenue Code of 1986.

``SEC. 125. NATIONAL HEALTH SERVICE CORPS.

``(a) No Reduction in Services.--The Secretary shall not--
``(1) remove a member of the National Health Service Corps
from an Indian Health Program or Urban Indian Organization; or
``(2) withdraw funding used to support such member, unless
the Secretary, acting through the Service, Indian Tribes, or
Tribal Organizations, has ensured that the Indians receiving
services from such member will experience no reduction in
services.
``(b) Exemption From Limitations.--National Health Service Corps
scholars qualifying for the Commissioned Corps in the United States
Public Health Service shall be exempt from the full-time equivalent
limitations of the National Health Service Corps and the Service when
serving as a commissioned corps officer in a Tribal Health Program or
an Urban Indian Organization.

``SEC. 126. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL CURRICULA
DEMONSTRATION PROGRAMS.

``(a) Grants and Contracts.--The Secretary, acting through the
Service, may enter into contracts with, or make grants to, accredited
tribal colleges and universities and eligible accredited and accessible
community colleges to establish demonstration programs to develop
educational curricula for substance abuse counseling.
``(b) Use of Funds.--Funds provided under this section shall be
used only for developing and providing educational curriculum for
substance abuse counseling (including paying salaries for instructors).
Such curricula may be provided through satellite campus programs.
``(c) Time Period of Assistance; Renewal.--A contract entered into
or a grant provided under this section shall be for a period of 1 year.
Such contract or grant may be renewed for an additional 1-year period
upon the approval of the Secretary.
``(d) Criteria for Review and Approval of Applications.--Not later
than 180 days after the date of the enactment of the Indian Health Care
Improvement Act Amendments of 2003, the Secretary, after consultation
with Indian Tribes and administrators of tribal colleges and
universities and eligible accredited and accessible community colleges,
shall develop and issue criteria for the review and approval of
applications for funding (including applications for renewals of
funding) under this section. Such criteria shall ensure that
demonstration programs established under this section promote the
development of the capacity of such entities to educate substance abuse
counselors.
``(e) Assistance.--The Secretary shall provide such technical and
other assistance as may be necessary to enable grant recipients to
comply with the provisions of this section.
``(f) Report.--Each fiscal year, the Secretary shall submit to the
President, for inclusion in the report which is required to be
submitted under section 801 for that fiscal year, a report on the
findings and conclusions derived from the demonstration programs
conducted under this section during that fiscal year.
``(g) Definition.--For the purposes of this section the term
`educational curriculum' means 1 or more of the following--
``(1) classroom education;
``(2) clinical work experience; and
``(3) continuing education workshops.

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

``(a) Study; List.--The Secretary, acting through the Service, and
the Secretary of the Interior, in consultation with Indian Tribes and
Tribal Organizations, shall conduct a study and compile a list of the
types of staff positions specified in subsection (b) whose
qualifications include, or should include, training in the
identification, prevention, education, referral, or treatment of mental
illness, or dysfunctional and self destructive behavior.
``(b) Positions.--The positions referred to in subsection (a) are--
``(1) staff positions within the Bureau of Indian Affairs,
including existing positions, in the fields of--
``(A) elementary and secondary education;
``(B) social services and family and child welfare;
``(C) law enforcement and judicial services; and
``(D) alcohol and substance abuse;
``(2) staff positions within the Service; and
``(3) staff positions similar to those identified in
paragraphs (1) and (2) established and maintained by Indian
Tribes, Tribal Organizations, (without regard to the funding
source) and Urban Indian Organizations.
``(c) Training Criteria.--
``(1) In general.--The appropriate Secretary shall provide
training criteria appropriate to each type of position
identified in subsection (b)(1) and (b)(2) and ensure that
appropriate training has been, or shall be provided to any
individual in any such position. With respect to any such
individual in a position identified pursuant to subsection
(b)(3), the respective Secretaries shall provide appropriate
training to, or provide funds to, an Indian Tribe, Tribal
Organization, or Urban Indian Organization for training of
appropriate individuals. In the case of positions funded under
a funding agreement, the appropriate Secretary shall ensure
that funds to cover the costs of such training costs are
included in the funding agreement.
``(2) Position specific training criteria.--Position
specific training criteria shall be culturally relevant to
Indians and Indian Tribes and shall ensure that appropriate
information regarding Traditional Health Care Practices is
provided.
``(d) Community Education on Mental Illness.--The Service shall
develop and implement, on request of an Indian Tribe or Tribal
Organization, or assist the Indian Tribe or Tribal Organization to
develop and implement a program of community education on mental
illness. In carrying out this subsection, the Service shall, upon
request of an Indian Tribe or Tribal Organization, provide technical
assistance to the Indian Tribe or Tribal Organization to obtain and
develop community educational materials on the identification,
prevention, referral, and treatment of mental illness and dysfunctional
and self-destructive behavior.
``(e) Plan.--Not later than 90 days after the date of the enactment
of the Indian Health Care Improvement Act Amendments of 2003, the
Secretary shall develop a plan under which the Service will increase
the health care staff providing mental health services by at least 500
positions within 5 years after the date of the enactment of this
section, with at least 200 of such positions devoted to child,
adolescent, and family services. The plan developed under this
subsection shall be implemented under the Act of November 2, 1921 (25
U.S.C. 13, popularly known as the Snyder Act).

``SEC. 128. DESIGNATION OF SHORTAGE AREAS.

``A Service Area served by an Indian Health Program or Urban Indian
Organization shall be designated under the Public Health Services Act
(42 U.S.C. 250 et seq.) as a shortage area immediately upon request of
an Indian Health Program without further evaluation by the Secretary.

``SEC. 129. AUTHORIZATION OF APPROPRIATIONS.

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

``TITLE II--HEALTH SERVICES

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

``(a) Use of Funds.--The Secretary, acting through the Service, is
authorized to expend funds, directly or under the authority of the
Indian Self-Determination and Education Assistance Act, 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;
``(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, but not limited to,
inpatient care, outpatient care (including audiology,
clinical eye, and vision care), primary care, secondary
and tertiary care, and long-term care.
``(B) Preventive health, including mammography and
other cancer screening in accordance with section 207.
``(C) Dental care.
``(D) Mental health, including community mental
health services, inpatient mental health services,
dormitory mental health services, therapeutic and
residential treatment centers, and training of
traditional health care practitioners.
``(E) Emergency medical services.
``(F) Treatment and control of, and rehabilitative
care related to, alcoholism and drug abuse (including
fetal alcohol syndrome) among Indians.
``(G) Accident prevention programs.
``(H) Home health care.
``(I) Community health representatives.
``(J) Maintenance and repair.
``(K) Traditional Health Care Practices.
``(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, popularly 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
section 3(2) are not being achieved; and
``(B) the Indian Tribe or Tribal Organization does
not have available to it the health resources it needs,
taking into account the actual cost of providing health
care services given local geographic, climatic, rural,
or other circumstances.
``(2) Available resources.--The health resources available
to an Indian Tribe or Tribal Organization include health
resources provided by the Service as well as health resources
used by the Indian Tribe or Tribal Organization, including
services and financing systems provided by any Federal
programs, private insurance, and programs of State or local
governments.
``(3) Process for review of determinations.--The Secretary
shall establish procedures which allow any Indian Tribe or
Tribal Organization to petition the Secretary for a review of
any determination of the extent of the health status and
resource deficiency of such Indian Tribe or Tribal
Organization.
``(e) Eligibility for Funds.--Tribal Health Programs shall be
eligible for funds appropriated under the authority of this section on
an equal basis with programs that are administered directly by the
Service.
``(f) Report.--By no later than the date that is 3 years after the
date of the enactment of the Indian Health Care Improvement Act
Amendments of 2003, the Secretary shall submit to Congress the current
health status and resource deficiency report of the Service for each
Service Unit, including newly recognized or acknowledged Indian Tribes.
Such report shall set out--
``(1) the methodology then in use by the Service for
determining Tribal health status and resource deficiencies, as
well as the most recent application of that methodology;
``(2) the extent of the health status and resource
deficiency of each Indian Tribe served by the Service or a
Tribal Health Program;
``(3) the amount of funds necessary to eliminate the health
status and resource deficiencies of all Indian Tribes served by
the Service or a Tribal Health Program; and
``(4) an estimate of--
``(A) the amount of health service funds
appropriated under the authority of this Act, or any
other Act, including the amount of any funds
transferred to the Service for the preceding fiscal
year which is allocated to each Service Unit, Indian
Tribe, or Tribal Organization;
``(B) the number of Indians eligible for health
services in each Service Unit or Indian Tribe or Tribal
Organization; and
``(C) the number of Indians using the Service
resources made available to each Service Unit, Indian
Tribe or Tribal Organization, and, to the extent
available, information on the waiting lists and number
of Indians turned away for services due to lack of
resources.
``(g) Inclusion in Base Budget.--Funds appropriated under this
section for any fiscal year shall be included in the base budget of the
Service for the purpose of determining appropriations under this
section in subsequent fiscal years.
``(h) Clarification.--Nothing in this section is intended to
diminish the primary responsibility of the Service to eliminate
existing backlogs in unmet health care needs, nor are the provisions of
this section intended to discourage the Service from undertaking
additional efforts to achieve equity among Indian Tribes and Tribal
Organizations.
``(i) Funding Designation.--Any funds appropriated under the
authority of this section shall be designated as the `Indian Health
Care Improvement Fund'.

``SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND.

``(a) Establishment.--There is hereby 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 central office 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 Act, nor shall CHEF funds be
allocated, apportioned, or delegated on an Area Office, Service Unit,
or other similar basis.
``(d) Regulations.--The Secretary shall, through the negotiated
rulemaking process under title VIII, 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; and
``(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, popularly known as the Snyder Act), or any other law.
``(f) Deposit of Reimbursement Funds.--There shall be deposited
into CHEF all reimbursements to which the Service is entitled from any
Federal, State, local, or private source (including third party
insurance) by reason of treatment rendered to any victim of a disaster
or catastrophic illness the cost of which was paid from CHEF.

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

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

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

``(a) Determinations Regarding Diabetes.--The Secretary, acting
through the Service, and in consultation with Indian Tribes and Tribal
Organizations, shall determine--
``(1) by an Indian Tribe, Tribal Organization, 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) 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.
Such screening may be done by a Tribal Health Program.
``(c) Funding for Diabetes.--The Secretary shall continue to fund
each model diabetes project in existence on the date of the enactment
of the Indian Health Amendments Care Improvement Act of 2003, any such
other diabetes programs operated by the Service or Tribal Health
Programs, and any additional diabetes projects. Tribal Health Programs
shall receive recurring funding for the diabetes projects that they
operate pursuant to this section, both at the date of enactment of the
Indian Health Care Improvement Act Amendments of 2003 and for projects
which are added and funded thereafter.
``(d) Funding for Dialysis Programs.--The Secretary shall provide
funding through the Service, Indian Tribes, and Tribal Organizations to
establish dialysis programs, including funding to purchase dialysis
equipment and provide necessary staffing.
``(e) Other Duties of the Secretary.--The Secretary shall, to the
extent funding is available--
``(1) in each Area Office, consult with Indian Tribes and
Tribal Organizations regarding programs for the prevention,
treatment, and control of diabetes;
``(2) 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
``(3) ensure that data collected in each Area Office
regarding diabetes and related complications among Indians is
disseminated to all other Area Offices.

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

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

``SEC. 206. HEALTH SERVICES RESEARCH.

``The Secretary, acting through the Service, shall make funding
available for research to further the performance of the health service
responsibilities of Indian Health Programs and shall coordinate the
activities of other agencies within the Department to address these
research needs. The funding shall be divided equitably among the Area
Offices. Then each Area Office shall award the funds competitively
within that Area. The Secretary shall consult with Indian Tribes and
Tribal Organizations in developing the methodology used to allocate
these funds among Area Offices for competitive awards. Tribal Health
Programs shall be given an equal opportunity to compete for, and
receive, research funds under this section. This funding may be used
for both clinical and nonclinical research.

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

``The Secretary, acting through the Service or Tribal Health
Programs, shall provide for screening as follows:
``(1) Screening mammography (as defined in section 1861(jj)
of the Social Security Act) for Indian women at a frequency
appropriate to such women under national standards, such as
those of the National Cancer Institute for the National
Institutes for Health, and under such terms and conditions as
are consistent with standards established by the Secretary to
ensure the safety and accuracy of screening mammography under
part B of title XVIII of such Act.
``(2) Other cancer screening meeting national standards,
such as those of the National Cancer Institute.

``SEC. 208. PATIENT TRAVEL COSTS.

``The Secretary, acting through the Service and Tribal Health
Programs, shall provide funds for the following patient travel costs,
including appropriate and necessary qualified escorts, associated with
receiving health care services provided (either through direct or
contract care or through Funding Agreements) under this Act--
``(1) emergency air transportation and non-emergency air
transportation where ground transportation is infeasible;
``(2) transportation by private vehicle, specially equipped
vehicle, and ambulance; and
``(3) transportation by such other means as may be
available and required when air or motor vehicle transportation
is not available.

``SEC. 209. EPIDEMIOLOGY CENTERS.

``(a) Additional Centers.--In addition to those epidemiology
centers already established at the time of enactment of this Act,
(including those for which funding is currently being provided in
Funding Agreements), and without reducing the funding levels for such
centers, not later than 180 days after the date of the enactment of the
Indian Health Care Improvement Act Amendments of 2003, the Secretary,
acting through the Service, shall establish and fund an epidemiology
center in each Service Area which does not yet have one to carry out
the functions described in subsection (b). Any new centers so
established may be operated by Tribal Health Programs, but such funding
shall not be divisible.
``(b) Functions of Centers.--In consultation with and upon the
request of Indian Tribes, Tribal Organizations, and Urban Indian
Organizations, each Service Area epidemiology center established under
this subsection shall, with respect to such Service Area--
``(1) collect data relating to, and monitor progress made
toward meeting, each of the health status objectives of the
Service, the Indian Tribes, Tribal Organizations, and Urban
Indian 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 their highest priority
health status objectives and the services needed to achieve
such objectives, based on epidemiological data;
``(4) make recommendations for the targeting of services
needed by the populations served;
``(5) make recommendations to improve health care delivery
systems for Indians and Urban Indians;
``(6) provide requested technical assistance to Indian
Tribes, Tribal Organizations, and Urban Indian Organizations in
the development of local health service priorities and
incidence and prevalence rates of disease and other illness in
the community; and
``(7) provide disease surveillance and assist Indian
Tribes, Tribal Organizations, and Urban Indian Organizations to
promote public health.
``(c) Technical Assistance.--The Director of the Centers for
Disease Control and Prevention shall provide technical assistance to
the centers in carrying out the requirements of this subsection.
``(d) Funding for Studies.--The Secretary may make funding
available to Indian Tribes, Tribal Organizations, and Urban Indian
Organizations to conduct epidemiological studies of Indian communities.

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

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

``SEC. 211. INDIAN YOUTH PROGRAM.

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

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

``(a) Funding Authorized.--The Secretary, acting through the
Service, and after consultation with Indian Tribes, Tribal
Organizations, Urban Indian Organizations, and the Centers for Disease
Control and Prevention, may make funding available to Indian Tribes and
Tribal Organizations for the following:
``(1) Projects for the prevention, control, and elimination
of communicable and infectious diseases including, but not
limited to, tuberculosis, hepatitis, HIV, respiratory syncitial
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. 213. AUTHORITY FOR PROVISION OF OTHER SERVICES.

``(a) Funding Authorized.--The Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, may provide funding
under this Act to meet the objectives set forth in section 3 through
health care-related services and programs not otherwise described in
this Act, which shall include, but not be limited to--
``(1) hospice care and assisted living;
``(2) long-term health care;
``(3) home- and community-based services;
``(4) public health functions; and
``(5) Traditional Health Care Practices.
``(b) Services to Otherwise Ineligible Persons.--At the discretion
of the Service, Indian Tribes, or Tribal Organizations, services
provided for hospice care, home health care, home- and community-based
care, assisted living, and long-term care may be provided (subject to
reimbursement of reasonable charges) to persons otherwise ineligible
for the health care benefits of the Service. Any funds received under
this subsection shall not be used to offset or limit the funding
allocated to an Indian Tribe or Tribal Organization.
``(c) Definitions.--For the purposes of this section, the following
definitions shall apply:
``(1) The term `home- and community-based services' means 1
or more of the following:
``(A) Homemaker/home health aide services.
``(B) Chore services.
``(C) Personal care services.
``(D) Nursing care services provided outside of a
nursing facility by, or under the supervision of, a
registered nurse.
``(E) Respite care.
``(F) Training for family members.
``(G) Adult day care.
``(H) Such other home- and community-based services
as the Secretary, an Indian Tribe, or Tribal
Organization may approve.
``(2) The term `hospice care' means the items and services
specified in subparagraphs (A) through (H) of section
1861(dd)(1) of the Social Security Act (42 U.S.C.
1395x(dd)(1)), and such other services which an Indian Tribe or
Tribal Organization determines are necessary and appropriate to
provide in furtherance of this care.
``(3) The term `public health functions' means the
provision of public health-related programs, functions, and
services including, but not limited to, assessment, assurance,
and policy development which Indian Tribes and Tribal
Organizations are authorized and encouraged, in those
circumstances where it meets their needs, to do by forming
collaborative relationships with all levels of local, State,
and Federal Government.

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

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

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

``(a) Studies and Monitoring.--The Secretary and the Service shall
conduct, in conjunction with other appropriate Federal agencies and in
consultation with concerned Indian Tribes and Tribal Organizations,
studies and ongoing monitoring programs to determine trends in the
health hazards to Indian miners and to Indians on or near reservations
and Indian communities as a result of environmental hazards which may
result in chronic or life threatening health problems, such as nuclear
resource development, petroleum contamination, and contamination of
water source and of the food chain. Such studies shall include--
``(1) an evaluation of the nature and extent of health
problems caused by environmental hazards currently exhibited
among Indians and the causes of such health problems;
``(2) an analysis of the potential effect of ongoing and
future environmental resource development on or near
reservations and Indian communities, including the cumulative
effect over time on health;
``(3) an evaluation of the types and nature of activities,
practices, and conditions causing or affecting such health
problems including, but not limited to, uranium mining and
milling, uranium mine tailing deposits, nuclear power plant
operation and construction, and nuclear waste disposal; oil and
gas production or transportation on or near reservations or
Indian communities; and other development that could affect the
health of Indians and their water supply and food chain;
``(4) a summary of any findings and recommendations
provided in Federal and State studies, reports, investigations,
and inspections during the 5 years prior to the date of the
enactment of the Indian Health Care Improvement Act Amendments
of 2003 that directly or indirectly relate to the activities,
practices, and conditions affecting the health or safety of
such Indians; and
``(5) the efforts that have been made by Federal and State
agencies and resource and economic development companies to
effectively carry out an education program for such Indians
regarding the health and safety hazards of such development.
``(b) Health Care Plans.--Upon completion of such studies, the
Secretary and the Service shall take into account the results of such
studies and, in consultation with Indian Tribes and Tribal
Organizations, develop health care plans to address the health problems
studied under subsection (a). The plans shall include--
``(1) methods for diagnosing and treating Indians currently
exhibiting such health problems;
``(2) preventive care and testing for Indians who may be
exposed to such health hazards, including the monitoring of the
health of individuals who have or may have been exposed to
excessive amounts of radiation or affected by other activities
that have had or could have a serious impact upon the health of
such individuals; and
``(3) a program of education for Indians who, by reason of
their work or geographic proximity to such nuclear or other
development activities, may experience health problems.
``(c) Submission of Report and Plan to Congress.--The Secretary and
the Service shall submit to Congress the study prepared under
subsection (a) no later than 18 months after the date of the enactment
of the Indian Health Care Improvement Act Amendments of 2003. The
health care plan prepared under subsection (b) shall be submitted in a
report no later than 1 year after the study prepared under subsection
(a) is submitted to Congress. Such report shall include recommended
activities for the implementation of the plan, as well as an evaluation
of any activities previously undertaken by the Service to address such
health problems.
``(d) Intergovernmental Task Force.--
``(1) Establishment; members.--There is established an
Intergovernmental Task Force to be composed of the following
individuals (or their designees):
``(A) The Secretary of Energy.
``(B) The Secretary of the Environmental Protection
Agency.
``(C) The Director of the Bureau of Mines.
``(D) The Assistant Secretary for Occupational
Safety and Health.
``(E) The Secretary of the Interior.
``(F) The Secretary of Health and Human Services.
``(G) The Director of the Indian Health Service.
``(2) Duties.--The Task Force shall--
``(A) identify existing and potential operations
related to nuclear resource development or other
environmental hazards that affect or may affect the
health of Indians on or near a reservation or in an
Indian community; and
``(B) enter into activities to correct existing
health hazards and ensure that current and future
health problems resulting from nuclear resource or
other development activities are minimized or reduced.
``(3) Chairman; meetings.--The Secretary of Health and
Human Services shall be the Chairman of the Task Force. The
Task Force shall meet at least twice each year.
``(e) Health Services to Certain Employees.--In the case of any
Indian who--
``(1) as a result of employment in or near a uranium mine
or mill or near any other environmental hazard, suffers from a
work-related illness or condition;
``(2) is eligible to receive diagnosis and treatment
services from an Indian Health Program; and
``(3) by reason of such Indian's employment, is entitled to
medical care at the expense of such mine or mill operator or
entity responsible for the environmental hazard, the Indian
Health Program shall, at the request of such Indian, render
appropriate medical care to such Indian for such illness or
condition and may be reimbursed for any medical care so
rendered to which such Indian is entitled at the expense of
such operator or entity from such operator or entity. Nothing
in this subsection shall affect the rights of such Indian to
recover damages other than such amounts paid to the Indian
Health Program from the employer for providing medical care for
such illness or condition.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

``SEC. 221. LICENSING.

``Health care professionals employed by a Tribal Health Program
shall, if licensed in any State, be exempt from the licensing
requirements of the State in which the Tribal Health Program performs
the services described in its Funding Agreement.

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

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

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

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

``SEC. 224. LIABILITY FOR PAYMENT.

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

``SEC. 225. AUTHORIZATION OF APPROPRIATIONS.

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

``TITLE III--FACILITIES

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

``(a) Prerequisites for Expenditure of Funds.--Prior to the
expenditure of, or the making of any binding commitment to expend, any
funds appropriated for the planning, design, construction, or
renovation of facilities pursuant to the Act of November 2, 1921 (25
U.S.C. 13; popularly known as the Snyder Act), the Secretary, acting
through the Service, shall--
``(1) consult with any Indian Tribe that would be
significantly affected by such expenditure for the purpose of
determining and, whenever practicable, honoring tribal
preferences concerning size, location, type, and other
characteristics of any facility on which such expenditure is to
be made; and
``(2) ensure, whenever practicable and applicable, that
such facility meets the construction standards of any
accrediting body recognized by the Secretary for the purposes
of the medicare, medicaid, and SCHIP programs under title
XVIII, XIX, and XXI of the Social Security Act by not later
than 1 year after the date on which the construction or
renovation of such facility is completed.
``(b) Closures.--
``(1) Evaluation required.--Notwithstanding any other
provision of law, no facility operated by the Service may be
closed if the Secretary has not submitted to Congress at least
1 year prior to the date of the proposed closure an evaluation
of the impact of the proposed closure which specifies, in
addition to other considerations the following:
``(A) The accessibility of alternative health care
resources for the population served by such facility.
``(B) The cost-effectiveness of such closure.
``(C) The quality of health care to be provided to
the population served by such facility after such
closure.
``(D) The availability of contract health care
funds to maintain existing levels of service.
``(E) The views of the Indian Tribes served by such
facility concerning such closure.
``(F) The level of use of such facility by all
eligible Indians.
``(G) The distance between such facility and the
nearest operating Service hospital.
``(2) Exception for certain temporary closures.--Paragraph
(1) shall not apply to any temporary closure of a facility or
any portion of a facility if such closure is necessary for
medical, environmental, or construction safety reasons.
``(c) Health Care Facility Priority System.--
``(1) In general.--
``(A) Establishment.--The Secretary, acting through
the Service, shall establish a health care facility
priority system, which shall--
``(i) be developed with Indian Tribes and
Tribal Organizations through negotiated
rulemaking under section 802;
``(ii) give Indian Tribes' needs the
highest priority; and
``(iii) at a minimum, include the lists
required in paragraph (2)(B) and the
methodology required in paragraph (2)(E).
``(B) Priority of certain projects protected.--The
priority of any project established under the
construction priority system in effect on the date of
the Indian Health Care Improvement Act Amendments of
2003 shall not be affected by any change in the
construction priority system taking place thereafter if
the project was identified as 1 of the 10 top-priority
inpatient projects, 1 of the 10 top-priority outpatient
projects, 1 of the 10 top-priority staff quarters
developments, or 1 of the 10 top-priority Youth
Regional Treatment Centers in the fiscal year 2004
Indian Health Service budget justification, or if the
project had completed both Phase I and Phase II of the
construction priority system in effect on the date of
the enactment of such Act.
``(2) Report; contents.--The Secretary shall submit to the
President, for inclusion in each report required to be
transmitted to Congress under section 801, a report which sets
forth the following:
``(A) A description of the health care facility
priority system of the Service, established under
paragraph (1).
``(B) Health care facilities lists, including but
not limited to--
``(i) the total health care facilities
planning, design, construction, and renovation
needs for Indians, identified by national and
Service Area priorities;
``(ii) the 10 top-priority inpatient health
care facilities;
``(iii) the 10 top-priority outpatient
health care facilities;
``(iv) the 10 top-priority specialized
health care facilities (such as long-term care
and alcohol and drug abuse treatment);
``(v) the 10 top-priority staff quarters
developments associated with health care
facilities; and
``(vi) the 10 top-priority hostels
associated with health care facilities.
``(C) The justification for such order of priority.
``(D) The projected cost of such projects.
``(E) The methodology adopted by the Service in
establishing priorities under its health care facility
priority system.
``(3) Requirements for preparation of reports.--In
preparing each report required under paragraph (2) (other than
the initial report), the Secretary shall annually--
``(A) consult with and obtain information on all
health care facilities needs from Indian Tribes, Tribal
Organizations, and Urban Indian Organizations; and
``(B) review the total unmet needs of all Indian
Tribes and Tribal Organizations for health care
facilities (including hostels and staff quarters),
including needs for renovation and expansion of
existing facilities.
``(4) Criteria for evaluating needs.--For purposes of this
subsection, the Secretary shall, in evaluating the needs of
facilities operated under any Funding Agreement use the same
criteria that the Secretary uses in evaluating the needs of
facilities operated directly by the Service.
``(5) Needs of facilities under isdeaa agreements.--The
Secretary shall ensure that the planning, design, construction,
and renovation needs of Service and non-Service facilities
operated under funding agreements in accordance with the Indian
Self-Determination and Education Assistance Act are fully and
equitably integrated into the health care facility priority
system.
``(d) Review of Need for Facilities.--
``(1) Initial report.--In the year 2005, the General
Accounting Office shall prepare and finalize a report which
sets forth the needs of the Service, Indian Tribes, Tribal
Organizations, and Urban Indian Organizations, for the
facilities listed under subsection (c)(2)(B), including the
needs for renovation and expansion of existing facilities. The
General Accounting Office shall submit the report to the
appropriate authorizing and appropriations committees of the Congress
and to the Secretary.
``(2) Beginning in the year 2006, the Secretary shall
annually update the report required under paragraph (1).
``(3) The Comptroller General and the Secretary shall
consult with Indian Tribes, Tribal Organizations, and Urban
Indian Organizations. In preparing the reports required by
paragraphs (1) and (2), the Secretary shall submit the report
to the President for inclusion in the report required to be
transmitted to the Congress under section 801.
``(4) For purposes of this subsection, the reports shall,
regarding the needs of facilities operated under any Funding
Agreement be based on the same criteria that the Secretary uses
in evaluating the needs of facilities operated directly by the
Service.
``(5) The planning, design, construction, and renovation
needs of facilities operated under Funding Agreements shall be
fully and equitably integrated into the development of the
health facility priority system.
``(6) Beginning in the year 2006 and each fiscal year
thereafter, the Secretary shall provide an opportunity for
nomination of planning, design, and construction projects by
the Service, Indian Tribes, and Tribal Organizations for
consideration under the health care facility priority system.
``(e) Funding Condition.--All funds appropriated under the Act of
November 2, 1921 (25 U.S.C. 13), for the planning, design,
construction, or renovation of health facilities for the benefit of 1
or more Indian Tribes shall be subject to the provisions of the Indian
Self-Determination and Education Assistance Act.
``(f) Development of Innovative Approaches.--The Secretary shall
consult and cooperate with Indian Tribes, Tribal Organizations, and
Urban Indian Organizations in developing innovative approaches to
address all or part of the total unmet need for construction of health
facilities, including those provided for in other sections of this
title and other approaches.

``SEC. 302. SANITATION FACILITIES.

``(a) Findings.--Congress finds the following:
``(1) The provision of sanitation facilities is primarily a
health consideration and function.
``(2) Indian people suffer an inordinately high incidence
of disease, injury, and illness directly attributable to the
absence or inadequacy of sanitation facilities.
``(3) The long-term cost to the United States of treating
and curing such disease, injury, and illness is substantially
greater than the short-term cost of providing sanitation
facilities and other preventive health measures.
``(4) Many Indian homes and Indian communities still lack
sanitation facilities.
``(5) It is in the interest of the United States, and it is
the policy of the United States, that all Indian communities
and Indian homes, new and existing, be provided with sanitation
facilities.
``(b) Facilities and Services.--In furtherance of the findings made
in subsection (a), Congress reaffirms the primary responsibility and
authority of the Service to provide the necessary sanitation facilities
and services as provided in section 7 of the Act of August 5, 1954 (42
U.S.C. 2004a). Under such authority, the Secretary, acting through the
Service, shall provide the following:
``(1) Financial and technical assistance to Indian Tribes,
Tribal Organizations, and Indian communities in the
establishment, training, and equipping of utility organizations
to operate and maintain sanitation facilities, including the
provision of existing plans, standard details, and
specifications available in the Department, to be used at the
option of the Indian Tribe, Tribal Organization, or Indian
community.
``(2) Ongoing technical assistance and training to Indian
Tribes, Tribal Organizations, and Indian communities in the
management of utility organizations which operate and maintain
sanitation facilities.
``(3) Priority funding for operation and maintenance
assistance for, and emergency repairs to, sanitation facilities
operated by an Indian Tribe, Tribal Organization or Indian
community when necessary to avoid an imminent health threat or
to protect the investment in sanitation facilities and the
investment in the health benefits gained through the provision
of sanitation facilities.
``(c) Funding.--Notwithstanding any other provision of law--
``(1) the Secretary of Housing and Urban Development is
authorized to transfer funds appropriated under the Native
American Housing Assistance and Self-Determination Act of 1996
to the Secretary of Health and Human Services;
``(2) the Secretary of Health and Human Services is
authorized to accept and use such funds for the purpose of
providing sanitation facilities and services for Indians under
section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a);
``(3) unless specifically authorized otherwise when funds
are appropriated, the Secretary of Health and Human Services
shall use funds appropriated under section 7 of the Act of
August 5, 1954 (42 U.S.C. 2004a), to provide additional
priority of sanitation facilities assistance to eligible new
and existing Indian homes other than the following--
``(A) new homes constructed using housing funds
provided by the Department of Housing and Urban
Development; and
``(B) existing homes owned or managed by a tribally
designated housing entity (as that term is defined in
section 4(21) of the Native American Housing Assistance
and Self-Determination Act of 1996 (25 U.S.C. 4103(21))
that were constructed using housing funds provided by
the Department of Housing and Urban Development;
``(4) the Secretary of Health and Human Services is
authorized to accept from any source, including Federal and
State agencies, funds for the purpose of providing sanitation
facilities and services and place these funds into Funding
Agreements;
``(5) funds appropriated under the authority of section 7
of the Act of August 5, 1954 (42 U.S.C. 2004a) may be used to
fund up to 100 percent of the amount of an Indian Tribe's loan
obtained under any Federal program for new projects to
construct eligible sanitation facilities to serve Indian homes;
``(6) funds appropriated under the authority of section 7
of the Act of August 5, 1954 (42 U.S.C. 2004a) may be used to
meet matching or cost participation requirements under other
Federal and non-Federal programs for new projects to construct
eligible sanitation facilities;
``(7) all Federal agencies are authorized to transfer to
the Secretary funds identified, granted, loaned, or
appropriated whereby the Department's applicable policies,
rules, and regulations shall apply in the implementation of
such projects;
``(8) the Secretary of Health and Human Services shall
enter into interagency agreements with Federal and State
agencies for the purpose of providing financial assistance for
sanitation facilities and services under this Act; and
``(9) the Secretary of Health and Human Services shall, by
regulation developed through rulemaking under section 802,
establish standards applicable to the planning, design, and
construction of sanitation facilities funded under this Act.
``(d) Funding Plan.--The Secretary, acting through the Service, and
in consultation with Indian Tribes and Tribal Organizations, shall
develop and begin implementation of a 10-year funding plan to provide
sanitation facilities to serve existing Indian homes and Indian
communities and new and renovated Indian homes.
``(e) Certain Capabilities Not Prerequisite.--The financial and
technical capability of an Indian Tribe, Tribal Organization, or Indian
community to safely operate, manage, and maintain a sanitation facility
shall not be a prerequisite to the provision or construction of
sanitation facilities by the Secretary.
``(f) Financial Assistance.--The Secretary is authorized to provide
financial assistance to Indian Tribes, Tribal Organizations, and Indian
communities for operation, management, and maintenance of their
sanitation facilities.
``(g) Operation, Management, and Maintenance of Facilities.--The
Indian Tribe, Tribal Organization, Indian family, or Indian community
has the primary responsibility to establish, collect, and use
reasonable user fees, or otherwise set aside funding, for the purpose
of operating, managing, and maintaining sanitation facilities. If a
sanitation facility serving a community that is operated by an Indian
Tribe, Tribal Organization, or Indian community is threatened with
imminent failure and such operator lacks capacity to maintain the
integrity or the health benefits of the sanitation facility, then the
Secretary is authorized to assist the Indian Tribe, Tribal
Organization, or Indian community in the resolution of the problem on a
short-term basis through cooperation with the emergency coordinator or
by providing operation, management, and maintenance service.
``(h) ISDEAA Program Funded on Equal Basis.--Tribal Health Programs
shall be eligible (on an equal basis with programs that are
administered directly by the Service) for--
``(1) any funds appropriated pursuant to this section; and
``(2) any funds appropriated for the purpose of providing
sanitation facilities.
``(i) Report.--
``(1) Required; contents.--The Secretary shall submit to
the President, for inclusion in each report required to be
transmitted to Congress under section 801, a report which sets
forth--
``(A) the current Indian sanitation facility
priority system of the Service;
``(B) the methodology for determining sanitation
deficiencies;
``(C) the level of initial and final sanitation
deficiency for each type of sanitation facility for
each project of each Indian Tribe or Indian community;
and
``(D) the amount of funds necessary to reduce the
identified sanitation deficiency levels of all Indian
Tribes and Indian communities to level I sanitation
deficiency as defined in paragraph (4)(A).
``(2) Consultation.--In preparing each report required
under paragraph (1), the Secretary shall consult with Indian
Tribes and Tribal Organizations to determine the sanitation
facility needs of each Indian Tribe. The criteria on which the
needs will be evaluated shall be developed through negotiated
rulemaking pursuant to section 802.
``(3) Uniform methodology.--The methodology used by the
Secretary in determining, preparing cost estimates for, and
reporting sanitation deficiencies for purposes of paragraph (1)
shall be applied uniformly to all Indian Tribes and Indian
communities.
``(4) Sanitation deficiency levels.--For purposes of this
subsection, the sanitation deficiency levels for an individual,
Indian Tribe or Indian community sanitation facility to serve
Indian homes are determined as follows:
``(A) A level I deficiency exists if a sanitation
facility serving an individual, Indian Tribe, or Indian
community--
``(i) complies with all applicable water
supply, pollution control, and solid waste
disposal laws; and
``(ii) deficiencies relate to routine
replacement, repair, or maintenance needs.
``(B) A level II deficiency exists if a sanitation
facility serving an individual, Indian Tribe, or Indian
community substantially or recently complied with all
applicable water supply, pollution control, and solid
waste laws and any deficiencies relate to--
``(i) small or minor capital improvements
needed to bring the facility back into
compliance;
``(ii) capital improvements that are
necessary to enlarge or improve the facilities
in order to meet the current needs for domestic
sanitation facilities; or
``(iii) the lack of equipment or training
by an Indian Tribe, Tribal Organization, or an
Indian community to properly operate and
maintain the sanitation facilities.
``(C) A level III deficiency exists if a sanitation
facility serving an individual, Indian Tribe or Indian
community meets one or more of the following
conditions--
``(i) water or sewer service in the home is
provided by a haul system with holding tanks
and interior plumbing;
``(ii) major significant interruptions to
water supply or sewage disposal occur
frequently, requiring major capital
improvements to correct the deficiencies; or
``(iii) there is no access to or no
approved or permitted solid waste facility
available.
``(D) A level IV deficiency exists if--
``(i) a sanitation facility of an
individual, Indian Tribe, Tribal Organization,
or Indian community has no piped water or sewer
facilities in the home or the facility has
become inoperable due to major component
failure; or
``(ii) where only a washeteria or central
facility exists in the community.
``(E) A level V deficiency exists in the absence of
a sanitation facility, where individual homes do not
have access to safe drinking water or adequate
wastewater (including sewage) disposal.
``(j) Definitions.--For purposes of this section, the following
terms apply:
``(1) Indian community.--The term `Indian community' means
a geographic area, a significant proportion of whose
inhabitants are Indians and which is served by or capable of
being served by a facility described in this section.
``(2) Sanitation facilities.--The terms `sanitation
facility' and `sanitation facilities' mean safe and adequate
water supply systems, sanitary sewage disposal systems, and
sanitary solid waste systems (and all related equipment and
support infrastructure).

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

``(a) Buy Indian Act.--The Secretary, acting through the Service,
may use the negotiating authority of section 23 of the Act of June 25,
1910 (25 U.S.C. 47, commonly known as the `Buy Indian Act'), to give
preference to any Indian or any enterprise, partnership, corporation,
or other type of business organization owned and controlled by an
Indian or Indians including former or currently federally recognized
Indian Tribes in the State of New York (hereinafter referred to as an
`Indian firm') in the construction and renovation of Service facilities
pursuant to section 301 and in the construction of sanitation
facilities pursuant to section 302. Such preference may be accorded by
the Secretary unless the Secretary finds, pursuant to regulations
adopted pursuant to section 802, that the project or function to be
contracted for will not be satisfactory or such project or function
cannot be properly completed or maintained under the proposed contract.
The Secretary, in arriving at such a finding, shall consider whether
the Indian or Indian firm will be deficient with respect to--
``(1) ownership and control by Indians;
``(2) equipment;
``(3) bookkeeping and accounting procedures;
``(4) substantive knowledge of the project or function to
be contracted for;
``(5) adequately trained personnel; or
``(6) other necessary components of contract performance.
``(b) Labor Standards.--
``(1) In general.--For the purposes of implementing the
provisions of this title, contracts for the construction or
renovation of health care facilities, staff quarters, and
sanitation facilities, and related support infrastructure,
funded in whole or in part with funds made available pursuant
to this title, shall contain a provision requiring compliance
with the Act of March 3, 1931 (40 U.S.C. 276a--276a-5, known as
the Davis-Bacon Act), unless such construction or renovation--
``(A) is performed by a contractor pursuant to a
contract with an Indian Tribe or Tribal Organization
with funds supplied through a contract, compact or
funding agreement authorized by the Indian Self-
Determination and Education Assistance Act, or other
statutory authority; and
``(B) is subject to prevailing wage rates for
similar construction or renovation in the locality as
determined by the Indian Tribes or Tribal Organizations
to be served by the construction or renovation.
``(2) Exception.--This subsection shall not apply to
construction or renovation carried out by an Indian Tribe or
Tribal Organization with its own employees.

``SEC. 304. EXPENDITURE OF NONSERVICE FUNDS FOR RENOVATION.

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

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

``(a) Funding.--
``(1) In general.--The Secretary, acting through the
Service, in consultation with Indian Tribes and Tribal
Organizations, shall make funding available to Indian Tribes
and Tribal Organizations for the construction, expansion, or
modernization of facilities for the provision of ambulatory
care services to eligible Indians (and noneligible persons
pursuant to subsections (b)(2) and (c)(1)(C)). Funding made
under this section may cover up to 100 percent of the costs of
such construction, expansion, or modernization. For the
purposes of this section, the term `construction' includes the
replacement of an existing facility.
``(2) Funding agreement required.--Funding under paragraph
(1) may only be made available to a Tribal Health Program
operating an Indian health facility (other than a facility
owned or constructed by the Service, including a facility
originally owned or constructed by the Service and transferred
to an Indian Tribe or Tribal Organization).
``(b) Use of Funds.--
``(1) Allowable uses.--Funding provided under this section
may be used only for debt reduction or the construction,
expansion, or modernization (including the planning and design
of such construction, expansion, or modernization) of an
ambulatory care facility--
``(A) located apart from a hospital;
``(B) not funded under section 301 or section 307;
and
``(C) which, upon completion of such construction
or modernization will--
``(i) have a total capacity appropriate to
its projected service population;
``(ii) provide annually no fewer than 500
patient visits by eligible Indians and other
users who are eligible for services in such
facility in accordance with section 807(c)(2);
and
``(iii) provide ambulatory care in a
Service Area (specified in the Funding
Agreement) with a population of no fewer than
1,500 eligible Indians and other users who are
eligible for services in such facility in
accordance with section 807(c)(2).
``(2) Use only for certain portion of costs.--Funding
provided under this section may be used only for the cost of
that portion of a construction, expansion, or modernization
project that benefits the Service population identified above
in subsection (b)(1)(C)(ii) and (iii). The requirements of
clauses (ii) and (iii) of paragraph (1)(C) shall not apply to
an Indian Tribe or Tribal Organization applying for funding
under this section whose principal office for health care
administration is located on an island or when such office is
not located on a road system providing direct access to an
inpatient hospital where care is available to the Service
population.
``(c) Funding.--
``(1) Application.--No funding may be made available under
this section unless an application or proposal for such funding
has been approved by the Secretary in accordance with
applicable regulations and has forth reasonable assurance by
the applicant that, at all times after the construction,
expansion, or modernization of a facility carried out pursuant
to funding received under this section--
``(A) adequate financial support will be available
for the provision of services at such facility;
``(B) such facility will be available to eligible
Indians without regard to ability to pay or source of
payment; and
``(C) such facility will, as feasible without
diminishing the quality or quantity of services
provided to eligible Indians, serve noneligible persons
on a cost basis.
``(2) Priority.--In awarding funding under this section,
the Secretary shall give priority to Indian Tribes and Tribal
Organizations that demonstrate--
``(A) a need for increased ambulatory care
services; and
``(B) insufficient capacity to deliver such
services.
``(3) Peer review panels.--The Secretary may provide for
the establishment of peer review panels, as necessary, to
review and evaluate applications and proposals and to advise
the Secretary regarding such applications using the criteria
developed during consultations pursuant to subsection (a)(1).
``(d) Reversion of Facilities.--If any facility (or portion
thereof) with respect to which funds have been paid under this section,
ceases, within 5 years after completion of the construction, expansion,
or modernization carried out with such funds, to be used for the
purposes of providing health care services to eligible Indians, all of
the right, title, and interest in and to such facility (or portion
thereof) shall transfer to the United States unless otherwise
negotiated by the Service and the Indian Tribe or Tribal Organization.
``(e) Funding Nonrecurring.--Funding provided under this section
shall be nonrecurring and shall not be available for inclusion in any
individual Indian Tribe's tribal share for an award under the Indian
Self-Determination and Education Assistance Act or for reallocation or
redesign thereunder.

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

``(a) Health Care Demonstration Projects.--The Secretary, acting
through the Service, and in consultation with Indian Tribes and Tribal
Organizations, is authorized to enter into Funding Agreements with, or
make grants or loan guarantees to, Indian Tribes or Tribal
Organizations for the purpose of carrying out a health care delivery
demonstration project to test alternative means of delivering health
care and services to Indians through facilities, including but not
limited to hospice, traditional Indian health, and child care
facilities.
``(b) Use of Funds.--The Secretary, in approving projects pursuant
to this section, may authorize funding for the construction and
renovation of hospitals, health centers, health stations, and other
facilities to deliver health care services and is authorized to--
``(1) waive any leasing prohibition;
``(2) permit carryover of funds appropriated for the
provision of health care services;
``(3) permit the use of other available funds;
``(4) permit the use of funds or property donated from any
source for project purposes;
``(5) provide for the reversion of donated real or personal
property to the donor; and
``(6) permit the use of Service funds to match other funds,
including Federal funds.
``(c) Regulations.--The Secretary shall develop and publish
regulations, through rulemaking under section 802, for the review and
approval of applications submitted under this section.
``(d) Criteria.--The Secretary may enter into a contract or Funding
Agreement or award a grant under this section for projects which meet
the following criteria:
``(1) There is a need for a new facility or program or the
reorientation of an existing facility or program.
``(2) A significant number of Indians, including those with
low health status, will be served by the project.
``(3) The project has the potential to deliver services in
an efficient and effective manner.
``(4) The project is economically viable.
``(5) The Indian Tribe or Tribal Organization has the
administrative and financial capability to administer the
project.
``(6) The project is integrated with providers of related
health and social services and is coordinated with, and avoids
duplication of, existing services.
``(e) Peer Review Panels.--The Secretary may provide for the
establishment of peer review panels, as necessary, to review and
evaluate applications using the criteria developed pursuant to
subsection (d).
``(f) Priority.--The Secretary shall give priority to applications
for demonstration projects in each of the following Service Units to
the extent that such applications are timely filed and meet the
criteria specified in subsection (d):
``(1) Cass Lake, Minnesota.
``(2) Clinton, Oklahoma.
``(3) Harlem, Montana.
``(4) Mescalero, New Mexico.
``(5) Owyhee, Nevada.
``(6) Parker, Arizona.
``(7) Schurz, Nevada.
``(8) Winnebago, Nebraska.
``(9) Ft. Yuma, California.
``(g) Technical Assistance.--The Secretary shall provide such
technical and other assistance as may be necessary to enable applicants
to comply with the provisions of this section.
``(h) Service to Ineligible Persons.--The authority to provide
services to persons otherwise ineligible for the health care benefits
of the Service and the authority to extend hospital privileges in
Service facilities to non-Service health practitioners as provided in
section 807 may be included, subject to the terms of such section, in
any demonstration project approved pursuant to this section.
``(i) Equitable Treatment.--For purposes of subsection (d)(1), the
Secretary shall, in evaluating facilities operated under any Funding
Agreement, use the same criteria that the Secretary uses in evaluating
facilities operated directly by the Service.
``(j) Equitable Integration of Facilities.--The Secretary shall
ensure that the planning, design, construction, renovation, and
expansion needs of Service and non-Service facilities which are the
subject of a Funding Agreement for health services are fully and
equitably integrated into the implementation of the health care
delivery demonstration projects under this section.

``SEC. 307. LAND TRANSFER.

``(a) Chemawa Indian School.--The Bureau of Indian Affairs is
authorized to transfer, at no cost, up to 5 acres of land at the
Chemawa Indian School, Salem, Oregon, to the Service for the provision
of health care services. The land authorized to be transferred by this
section is that land adjacent to land under the jurisdiction of the
Service and occupied by the Chemawa Indian Health Center.
``(b) Federal Land to the Service.--Notwithstanding any other
provision of law, the Bureau of Indian Affairs and all other agencies
and departments of the United States are authorized to transfer, at no
cost, land and improvements to the Service for the provision of health
care services. The Secretary is authorized to accept such land and
improvements for such purposes.

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

``The Secretary, acting through the Service, may enter into leases,
contracts, and other agreements with Indian Tribes and Tribal
Organizations which hold (1) title to, (2) a leasehold interest in, or
(3) a beneficial interest in (when title is held by the United States
in trust for the benefit of an Indian Tribe) facilities used or to be
used for the administration and delivery of health services by an
Indian Health Program. Such leases, contracts, or agreements may
include provisions for construction or renovation and provide for
compensation to the Indian Tribe or Tribal Organization of rental and
other costs consistent with section 105(l) of the Indian Self-
Determination Act and regulations thereunder. Notwithstanding any other
provision of law, such leases, contracts, or other agreements shall be
considered as operating leases for the purpose of scoring under the
Budget Enforcement Act.

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

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

``SEC. 310. TRIBAL LEASING.

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

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

``(a) In General.--The Secretary, acting through the Service, shall
make arrangements with Indian Tribes and Tribal Organizations to
establish joint venture demonstration projects under which an Indian
Tribe or Tribal Organization shall expend tribal, private, or other
available funds, for the acquisition or construction of a health
facility for a minimum of 10 years, under a no-cost lease, in exchange
for agreement by the Service to provide the equipment, supplies, and
staffing for the operation and maintenance of such a health facility.
An Indian Tribe or Tribal Organization may use tribal funds, private
sector, or other available resources, including loan guarantees, to
fulfill its commitment under a joint venture entered into under this
subsection. An Indian Tribe or Tribal Organization shall be eligible to
establish a joint venture project if, when it submits a letter of
intent, it--
``(1) has begun but not completed the process of
acquisition or construction of a health facility to be used in
the joint venture project; or
``(2) has not begun the process of acquisition or
construction of a health facility for use in the joint venture
project.
``(b) Requirements.--The Secretary shall make such an arrangement
with an Indian Tribe or Tribal Organization only if--
``(1) the Secretary first determines that the Indian Tribe
or Tribal Organization has the administrative and financial
capabilities necessary to complete the timely acquisition or
construction of the relevant health facility; and
``(2) the Indian Tribe or Tribal Organization meets the
need criteria which shall be developed through the negotiated
rulemaking process provided for under section 802.
``(c) Continued Operation.--The Secretary shall negotiate an
agreement with the Indian Tribe or Tribal Organization regarding the
continued operation of the facility at the end of the initial 10 year
no-cost lease period.
``(d) Breach of Agreement.--An Indian Tribe or Tribal Organization
that has entered into a written agreement with the Secretary under this
section, and that breaches or terminates without cause such agreement,
shall be liable to the United States for the amount that has been paid
to the Indian Tribe or Tribal Organization, or paid to a third party on
the Indian Tribe's or Tribal Organization's behalf, under the
agreement. The Secretary has the right to recover tangible property
(including supplies) and equipment, less depreciation, and any funds
expended for operations and maintenance under this section. The
preceding sentence does not apply to any funds expended for the
delivery of health care services, personnel, or staffing.
``(e) Recovery for Nonuse.--An Indian Tribe or Tribal Organization
that has entered into a written agreement with the Secretary under this
subsection shall be entitled to recover from the United States an
amount that is proportional to the value of such facility if, at any
time within the 10-year term of the agreement, the Service ceases to
use the facility or otherwise breaches the agreement.
``(f) Definition.--For the purposes of this section, the term
`health facility' or `health facilities' includes quarters needed to
provide housing for staff of the relevant Tribal Health Program.

``SEC. 312. LOCATION OF FACILITIES.

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

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

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

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

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

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

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

``SEC. 316. OTHER FUNDING FOR FACILITIES.

``(a) Authority To Accept Funds.--The Secretary is authorized to
accept from any source, including Federal and State agencies, funds
that are available for the construction of health care facilities and
use such funds to plan, design, and construct health care facilities
for Indians and to place such funds into Funding Agreements. Receipt of
such funds shall have no effect on the priorities established pursuant
to section 301.
``(b) Interagency Agreements.--The Secretary is authorized to enter
into interagency agreements with other Federal agencies or State
agencies and other entities and to accept funds from such Federal or
State agencies or other sources to provide for the planning, design,
and construction of health care facilities to be administered by Indian
Health Programs in order to carry out the purposes of this Act and the
purposes for which the funds were appropriated or for which the funds
were otherwise provided.
``(c) Transferred Funds.--Any Federal agency to which funds for the
construction of health care facilities are appropriated is authorized
to transfer such funds to the Secretary for the construction of health
care facilities to carry out the purposes of this Act as well as the
purposes for which such funds are appropriated to such other Federal
agency.
``(d) Establishment of Standards.--The Secretary, through the
Service, shall establish standards by regulation, developed by
rulemaking under section 802, for the planning, design, and
construction of health care facilities serving Indians under this Act.

``SEC. 317. AUTHORIZATION OF APPROPRIATIONS.

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

``TITLE IV--ACCESS TO HEALTH SERVICES

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

``(a) Disregard of Medicare, Medicaid, and SCHIP Payments in
Determining Appropriations.--Any payments received by an Indian Health
Program or by an Urban Indian Organization made under title XVIII, XIX,
or XXI of the Social Security Act for services provided to Indians
eligible for benefits under such respective titles shall not be
considered in determining appropriations for the provision of health
care and services to Indians.
``(b) Nonpreferential Treatment.--Nothing in this Act authorizes
the Secretary to provide services to an Indian with coverage under
title XVIII, XIX, or XXI of the Social Security Act in preference to an
Indian without such coverage.
``(c) Use of Funds.--
``(1) Special fund.--Notwithstanding any other provision of
law, but subject to paragraph (2), payments to which a facility of the
Service is entitled by reason of a provision of the Social Security Act
shall be placed in a special fund to be held by the Secretary and first
used (to such extent or in such amounts as are provided in
appropriation Acts) for the purpose of making any improvements in the
programs of the Service which may be necessary to achieve or maintain
compliance with the applicable conditions and requirements of titles
XVIII, XIX, and XXI of the Social Security Act. Any amounts to be
reimbursed that are in excess of the amount necessary to achieve or
maintain such conditions and requirements shall, subject to the
consultation with Indian Tribes being served by the Service Unit, be
used for reducing the health resource deficiencies of the Indian
Tribes. In making payments from such fund, the Secretary shall ensure
that each Service Unit of the Service receives 100 percent of the
amount to which the facilities of the Service, for which such Service
Unit makes collections, are entitled by reason of a provision of the
Social Security Act.
``(2) Direct payment option.--Paragraph (1) shall not apply
upon the election of a Tribal Health 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 during the period of
such election.
``(d) Direct Billing.--
``(1) In general.--A Tribal Health Program may directly
bill for, and receive payment for, health care items and
services provided by such Indian tribe or organization 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
exercising the option 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 any other provision of law, but all amounts so
reimbursed shall be used by the Tribal Health Program
for the purpose of making any improvements in Tribal
facilities or Tribal Health Programs that may be
necessary to achieve or maintain compliance with the
conditions and requirements applicable generally to
such items and services under the program under such
title and to provide additional health care services,
improvements in health care facilities and Tribal
Health Programs, any health care-related purpose, or
otherwise to achieve the objectives provided in section
3 of this Act.
``(B) Audits.--The amounts paid to an Indian Tribe
or Tribal Organization exercising the option described
in paragraph (1) with respect to a program under a
title of the Social Security Act shall be subject to
all auditing requirements applicable to programs
administered by an Indian Health Program.
``(3) Examination and implementation of changes.--The
Secretary, acting through the Service and with the assistance
of the Administrator of the Centers for Medicare & Medicaid
Services, shall examine on an ongoing basis and implement any
administrative changes that may be necessary to facilitate
direct billing and reimbursement under the program established
under this subsection, including any agreements with States
that may be necessary to provide for direct billing under a
program under a title of the Social Security Act.
``(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.

``SEC. 402. GRANTS TO AND FUNDING AGREEMENTS WITH THE SERVICE, INDIAN
TRIBES, TRIBAL ORGANIZATIONS, AND URBAN INDIAN
ORGANIZATIONS.

``(a) Indian Tribes and Tribal Organizations.--The Secretary,
acting through the Service, shall make grants to or enter into Funding
Agreements 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 to assist individual
Indians--
``(1) to enroll for benefits under title XVIII, XIX, or XXI
of the Social Security Act and other health benefits programs;
and
``(2) to pay premiums for coverage for such benefits, which
may be based on financial need (as determined by the Indian
Tribe or Tribes being served based on a schedule of income
levels developed or implemented by such Tribe or Tribes).
``(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 Funding Agreement 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 to 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 the benefits provided
under titles XVIII, XIX, and XXI of the Social Security Act.
``(c) Agreements Relating to Improving Enrollment of Indians Under
Social Security Act Programs.--
``(1) Agreements with secretary to improve receipt and
processing of applications.--
``(A) Authorization.--The Secretary, acting through
the Service, may enter into an agreement with an Indian
Tribe, Tribal Organization, or Urban Indian
Organization which provides for the receipt and
processing of applications by Indians for assistance
under titles XIX and XXI of the Social Security Act,
and benefits under title XVIII of such Act, by an
Indian Health Program or Urban Indian Organization.
``(B) Reimbursement of costs.--Such agreements may
provide for reimbursement of costs of outreach,
education regarding eligibility and benefits, and
translation when such services are provided. The
reimbursement may, as appropriate, be added to the
applicable rate per encounter or be provided as a
separate fee-for-service payment to the Indian Tribe or
Tribal Organization.
``(C) Processing clarified.--In this paragraph, the
term `processing' does not include a final
determination of eligibility.
``(2) Agreements with states for outreach on or near
reservation.--
``(A) In general.--In order to improve the access
of Indians residing on or near a reservation to obtain
benefits under title XIX or XXI of the Social Security
Act, as a condition of continuing approval of a State
plan under such title, the State shall take steps as to
provide for enrollment on or near the reservation. Such
steps may include outreach efforts such as the
outstationing of eligibility workers, entering into
agreements with Indian Tribes and Tribal Organizations
to provide outreach, education regarding eligibility
and benefits, enrollment, and translation services when
such services are provided.
``(B) Construction.--Nothing in subparagraph (A)
shall be construed as affecting arrangements entered
into between States and Indian Tribes and Tribal
Organizations for such Indian Tribes and Tribal
Organizations to conduct administrative activities
under such titles.
``(d) Facilitating Cooperation.--The Secretary, acting through the
Centers for Medicare & Medicaid Services, shall take such steps as are
necessary to facilitate cooperation with, and agreements between,
States and the Service, Indian Tribes, Tribal Organizations, or Urban
Indian Organizations.
``(e) 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
Funding Agreements with Indian tribes and Tribal Organizations
with respect to programs on or near reservations.
``(2) Requirements.--The Secretary shall include in the
grants or Funding Agreements 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.

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

``(a) Right of Recovery.--Except as provided in subsection (f), the
United States, an Indian Tribe, or Tribal Organization shall have the
right to recover from an insurance company, health maintenance
organization, employee benefit plan, third-party tortfeasor, or any
other responsible or liable third party (including a political
subdivision or local governmental entity of a State) the reasonable
charges billed (or, if charges are not billed, the operational,
administrative, and other expenses incurred) by the Secretary, an
Indian Tribe, or Tribal Organization in providing health services,
through the Service, an Indian Tribe, or Tribal Organization to any
individual to the same extent that such individual, or any
nongovernmental provider of such services, would be eligible to receive
damages, reimbursement, or indemnification for such charges or expenses
if--
``(1) such services had been provided by a nongovernmental
provider; and
``(2) such individual had been required to pay such charges
or expenses and did pay such charges or expenses.
``(b) Limitations on Recoveries From States.--Subsection (a) shall
provide a right of recovery against any State, only if the injury,
illness, or disability for which health services were provided is
covered under--
``(1) workers' compensation laws; or
``(2) a no-fault automobile accident insurance plan or
program.
``(c) Nonapplication of Other Laws.--No law of any State, or of any
political subdivision of a State and no provision of any contract,
insurance or health maintenance organization policy, employee benefit
plan, self-insurance plan, managed care plan, or other health care plan
or program entered into or renewed after the date of the enactment of
the Indian Health Care Amendments of 1988, shall prevent or hinder the
right of recovery of the United States, an Indian Tribe, or Tribal
Organization under subsection (a).
``(d) No Effect on Private Rights of Action.--No action taken by
the United States, an Indian Tribe, or Tribal Organization to enforce
the right of recovery provided under subsection (a) shall operate to
deny to the injured person the recovery for that portion of the
person's damage not covered hereunder.
``(e) Enforcement.--
``(1) In general.--The United States, an Indian Tribe, or
Tribal Organization may enforce the right of recovery provided
under subsection (a) by--
``(A) intervening or joining in any civil action or
proceeding brought--
``(i) by the individual for whom health
services were provided by the Secretary, an
Indian Tribe, or Tribal Organization; or
``(ii) by any representative or heirs of
such individual, or
``(B) instituting a civil action, including a civil
action for injunctive relief and other relief and
including, with respect to a political subdivision or
local governmental entity of a State, such an action
against an official thereof.
``(2) Notice.--All reasonable efforts shall be made to
provide notice of action instituted under paragraph (1)(B) to
the individual to whom health services were provided, either
before or during the pendency of such action.
``(f) Limitation.--Absent specific written authorization by the
governing body of an Indian Tribe for the period of such authorization
(which may not be for a period of more than 1 year and which may be
revoked at any time upon written notice by the governing body to the
Service), the United States shall not have a right of recovery under
this section if the injury, illness, or disability for which health
services were provided is covered under a self-insurance plan funded by
an Indian Tribe, Tribal Organization, or Urban Indian Organization.
Where such authorization is provided, the Service may receive and
expend such amounts for the provision of additional health services
consistent with such authorization.
``(g) Costs and Attorneys' Fees.--In any action brought to enforce
the provisions of this section, a prevailing plaintiff shall be awarded
its reasonable attorneys' fees and costs of litigation.
``(h) Right of Action Against Insurers, HMOs, Employee Benefit
Plans, Self-Insurance Plans, and Other Health Care Plans or Programs.--
Where an insurance company, health maintenance organization, employee
benefit plan, self-insurance plan, managed care plan, or other health
care plan or program fails or refuses to pay the amount due under
subsection (a) for services provided to an individual who is a
beneficiary, participant, or insured of such company, organization,
plan, or program, the United States, Indian Tribe, or Tribal
Organization shall have a right to assert and pursue all the claims and
remedies against such company, organization, plan, or program and
against the fiduciaries of such company, organization, plan, or program
that the individual could assert or pursue under the terms of the
contract, program, or plan or applicable Federal, State, or Tribal law.
``(i) Nonapplication of Claims Filing Requirements.--An insurance
company, health maintenance organization, self-insurance plan, managed
care plan, or other health care plan or program (under the Social
Security Act or otherwise) may not deny a claim for benefits submitted
by the Service or by an Indian Tribe or Tribal Organization based on
the format in which the claim is submitted if such format complies with
the format required for submission of claims under title XVIII of the
Social Security Act or recognized under section 1175 of such Act.
``(j) 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.
``(k) 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.
``(l) 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 and the Federal
Medical Care Recovery Act (42 U.S.C. 2651 et seq.).

``SEC. 404. CREDITING OF REIMBURSEMENTS.

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

``SEC. 405. PURCHASING HEALTH CARE COVERAGE.

``(a) In General.--Insofar as amounts are made available under law
(including a provision of the Social Security Act, the Indian Self-
Determination and Education Assistance Act, or other law, other than
under section 402) to Indian Tribes, Tribal Organizations, and Urban
Indian Organizations for health benefits for Service beneficiaries,
Indian Tribes, Tribal Organizations, and Urban Indian Organizations may
use such amounts to purchase health benefits coverage for such
beneficiaries in any manner, including through--
``(1) a tribally owned and operated health care plan;
``(2) a State or locally authorized or licensed health care
plan;
``(3) a health insurance provider or managed care
organization; or
``(4) a self-insured plan.
The purchase of such coverage by an Indian Tribe, Tribal Organization,
or Urban Indian Organization may be based on the financial needs of
such beneficiaries (as determined by the Indian Tribe or Tribes being
served based on a schedule of income levels developed or implemented by
such Indian Tribe or Tribes).
``(b) Expenses for Self-Insured Plan.--In the case of a self-
insured plan under subsection (a)(4), the amounts may be used for
expenses of operating the plan, including administration and insurance
to limit the financial risks to the entity offering the plan.
``(c) Construction.--Nothing in this section shall be construed as
affecting the use of any amounts not referred to in subsection (a).

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

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

``SEC. 407. PAYOR OF LAST RESORT.

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

``SEC. 408. NONDISCRIMINATION IN QUALIFICATIONS FOR REIMBURSEMENT FOR
SERVICES.

``For purposes of determining the eligibility of an entity that is
operated by the Service, an Indian Tribe, Tribal Organization, or Urban
Indian Organization to receive payment or reimbursement from any
federally funded health care program for health care services it
furnishes to an Indian, any requirement that the entity be licensed or
recognized under State or local law to furnish such services shall be
deemed to have been met if the entity meets quality requirements for
the furnishing of such services recognized by the Secretary.

``SEC. 409. CONSULTATION.

``(a) National Indian Technical Advisory Group (TAG).--
``(1) Establishment and membership.--The Secretary shall
establish a National Indian Technical Advisory Group (in this
subsection referred to as the `Advisory Group') which shall
have no fewer than 14 members including at least 1 member
designated by the Indian Tribes and Tribal Organizations in
each Service Area, 1 Urban Indian Organization representative,
and 1 member representing the Service. The Secretary may
appoint additional members upon the recommendation of the Advisory
Group.
``(2) Duties.--
``(A) Identification of issues.--The Advisory Group
shall assist the Secretary in identifying and
addressing issues regarding the health care programs
under the Social Security Act (including medicare,
medicaid, and SCHIP) that have implications for Indian
Health Programs or Urban Indian Organizations. The
Advisory Group shall provide advice to the Secretary
with respect to those issues and with respect to the
need for the Secretary to engage in consultation with
Indian Tribes, Tribal Organizations, and Urban Indian
Organizations.
``(B) Construction.--Nothing in subparagraph (A)
shall be construed as affecting any requirement under
any applicable Executive order for the Secretary to
consult with Indian Tribes in cases of health care
policies that have implications for Indian Health
Programs or Urban Indian Organizations.
``(3) Funding.--The Secretary shall pay the expenses of the
Advisory Group using the general administrative funds of the
Centers for Medicare & Medicaid Services.
``(4) Nonapplication of federal advisory committee act.--
The Federal Advisory Committee Act (5 U.S.C. App.) shall not
apply to the Advisory Group.
``(5) Meetings.--The Secretary shall convene meetings of
the Advisory Group no less frequently than quarterly.
``(b) Solicitation of Medicaid Advice.--
``(1) In general.--As a requirement for payment under title
XIX of the Social Security Act to a State in which the Service
operates or funds health care programs or in which 1 or more
Indian Health Programs or Urban Indian Organizations provide
health care in the State for which medical assistance is
available under such title, the State shall establish a process
under which the State seeks advice on a regular, ongoing basis
(at least on a quarterly basis) from designees of such Indian
Health Programs and Urban Indian Organizations on matters
relating to the application of such title to such Indian Health
Programs and Urban Indian Organizations.
``(2) Manner of advice.--Such process shall be in addition
to (and not in lieu of) any consultation otherwise required by
law and shall apply before the submittal of plan amendments,
waiver requests, and proposals for demonstration projects. Such
process may include appointment of an advisory committee and of
a designee of such Indian Health Programs and Urban Indian
Organizations to the medical care advisory committee advising
the State on its medicaid plan.
``(3) Payment of expenses.--Expenses in carrying out this
subsection shall be treated as reasonable administrative
expenses for which reimbursement may be made under section
1903(a) of the Social Security Act.
``(c) Construction.--Nothing in this section shall be construed as
superseding existing advisory committees, working groups, or other
advisory procedures established by the Secretary or by any State.

``SEC. 410. STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP).

``(a) Authorization for Arrangements.--Notwithstanding any other
provision of law, insofar as the State health plan of a State under
title XXI of the Social Security Act may provide (whether through its
medicaid plan under title XIX of such Act or otherwise) child or other
health assistance to individuals who are otherwise served by the
Service or by an Indian Tribe or Tribal Organization, the Secretary may
enter into an arrangement with the State and with the Service or 1 or
more Indian Tribes and Tribal Organizations in the State under which a
portion of the funds otherwise made available to the State under such
title with respect to such individuals is provided to the Service,
Indian Tribe, or Tribal Organization, respectively, for the purpose of
providing such assistance to such individuals consistent with the
purposes of such title.
``(b) Entering Into Arrangements.--
``(1) In general.--Notwithstanding any other provision of
law, in the case of a State which has an unexpended allotment
amount described in paragraph (2) for a fiscal year, before
effecting any reallotment of such amount to other States, at
the request of the Service or 1 or more Indian Tribes or Tribal
Organizations that operate in the State with respect to
individuals who are served by such Service, Indian Tribes, or
Tribal Organizations, the Secretary shall enter into an
arrangement with the Service, Indian Tribes, or Tribal
Organizations under which the Indian child proportion (as
defined in paragraph (3)) for such Service, Indian Tribes, or
Tribal Organizations of such unexpended allotment amount is made
available to the Service or such Indian Tribes or Tribal Organizations
for the purpose of providing child health or other assistance to
individuals who are otherwise served by the Service or by such Indian
Tribes or Tribal Organizations consistent with the purposes of title
XXI of the Social Security Act. Insofar as amounts are made available
under the preceding sentence, such amounts shall be treated (for
purposes of title XXI of the Social Security Act) as if they had been
expended during the period referred to in paragraph (2).
``(2) Unexpended allotment amount.--For purposes of this
subsection, the term `unexpended allotment amount' means, with
respect to an allotment to a State under section 2104 of the
Social Security Act for a fiscal year, the portion of such
allotment which was not expended by the State during the period
in which such allotment is available for expenditure by the
State and which would, but for this subsection, be realloted to
other States.
``(3) Indian child proportion.--For purposes of this
subsection, the term `Indian child proportion' means, with
respect to an unexpended allotment amount for a State and an
arrangement under paragraph (1) with the Service or Indian
Tribes or Tribal Organizations, the proportion of targeted low-
income children in the State (as defined in section 2110(b) of
the Social Security Act) who are Indians who would be served
under an arrangement with the Service or such Indian Tribes or
Tribal Organizations under such paragraph, as estimated by the
Secretary of Health and Human Services based upon the best
available data before a portion of the unexpended allotment
amount is made available under this subsection.

``SEC. 411. SOCIAL SECURITY ACT SANCTIONS.

``(a) Requests for Waiver of Sanctions.--For purposes of applying
any authority under a provision of title XI, XVIII, XIX, or XXI of the
Social Security Act to seek a waiver of a sanction imposed against a
health care provider insofar as that provider provides services to
individuals through an Indian Health Program, any requirement that a
State request such a waiver shall be deemed to be met if such Indian
Health Program requests such a waiver.
``(b) Safe Harbor for Transactions Between and Among Indian Health
Care Programs.--For purposes of applying section 1128B(b) of the Social
Security Act, the exchange of anything of value between or among the
following shall not be treated as remuneration if the exchange arises
from or relates to any of the following health programs:
``(1) An exchange between or among the following:
``(A) Any Indian Health Program.
``(B) Any Urban Indian Organization.
``(2) An exchange between an Indian Tribe, Tribal
Organization, or an Urban Indian Organization and any patient
served or eligible for service from an Indian Tribe, Tribal
Organization, or Urban Indian Organization, including patients
served or eligible for service pursuant to section 807, but
only if such exchange--
``(A) is for the purpose of transporting the
patient for the provision of health care items or
services;
``(B) is for the purpose of providing housing to
the patient (including a pregnant patient) and
immediate family members or an escort incidental to
assuring the timely provision of health care items and
services to the patient;
``(C) is for the purpose of paying premiums,
copayments, deductibles, or other cost-sharing on
behalf of patients; or
``(D) consists of an item or service of small value
that is provided as a reasonable incentive to secure
timely and necessary preventive and other items and
services.
``(3) Such other exchanges involving an Indian Health
Program, an Urban Indian Organization, or an Indian Tribe or
Tribal Organization as meet such standards as the Secretary of
Health and Human Services, in consultation with the Attorney
General, determines is appropriate, taking into account the
special circumstances of such Indian Health Programs, Urban
Indian Organizations, Indian Tribes, and Tribal Organizations
and of patients served by Indian Health Programs, Urban Indian
Organizations, Indian Tribes, and Tribal Organizations.

``SEC. 412. COST SHARING.

``(a) Coinsurance, Copayments, and Deductibles.--Notwithstanding
any other provision of Federal or State law--
``(1) Protection for eligible indians under social security
act health programs.--No Indian who is furnished an item or
service for which payment may be made under title XVIII, XIX,
or XXI of the Social Security Act may be charged a deductible,
copayment, or coinsurance if the item or service is furnished
by, or upon referral made by, the Service, an Indian Tribe,
Tribal Organization, or Urban Indian Organization.
``(2) Protection for indians.--No Indian who is furnished
an item or service by the Service may be charged a deductible,
copayment, or coinsurance.
``(3) No reduction in amount of payment to indian health
providers.--The payment or reimbursement due to the Service,
Indian Tribe, Tribal Organization, or Urban Indian Organization
under title XVIII, XIX, or XXI of the Social Security Act may
not be reduced by the amount of the deductible, copayment, or
coinsurance that would be due from the Indian but for the
operation of this section.
``(b) Exemption From Medicaid and SCHIP Premiums.--Notwithstanding
any other provision of Federal or State law, no Indian who is otherwise
eligible for services under title XIX of the Social Security Act
(relating to the medicaid program) or title XXI of such Act (relating
to the State children's health insurance program) may be charged a
premium as a condition of receiving benefits under the program under
the respective title.
``(c) Medically Needy Program Spend-Down.--For the purposes of
determining the eligibility of an Indian for medical assistance under
any medically needy option under a State's medicaid plan under title
XIX of the Social Security Act, the cost of providing services to an
Indian in a health program of the Service, an Indian Tribe, Tribal
Organization, or Urban Indian Organization shall be deemed to have been
an expenditure for health care by the Indian.
``(d) Limitation on Medical Child Support Recovery.--
Notwithstanding any other provision of law, a parent (whether or not an
Indian) of an Indian child shall not be responsible for reimbursing a
State or the Federal Government under title XIX or XXI of the Social
Security Act for the cost of medical services relating to the child
(including childbirth and including, where such child is a minor
parent, any child of such minor parent) under circumstances in which
payment would have been made under the contract health services program
of an Indian Health Program but for the child's (or, in the case of
medical services relating to childbirth, mother's, or grandchild's, as
the case may be) eligibility under title XIX or XXI of the Social
Security Act.
``(e) Treatment of Certain Property for Medicaid Eligibility.--
Notwithstanding any other provision of Federal or State law, the
following property may not be included when determining eligibility for
services under title XIX of the Social Security Act:
``(1) Property, including interests in real property
currently or formerly held in trust by the Federal Government
which is protected under applicable Federal, State, or Tribal
law or custom from recourse and including public domain
allotments.
``(2) Property that has unique religious or cultural
significance or that supports subsistence or traditional
lifestyle according to applicable Tribal law or custom.
``(f) Continuation of Current Law Protections of Certain Indian
Property From Medicaid Estate Recovery.--Income, resources, and
property that are exempt from medicaid estate recovery under title XIX
of the Social Security Act as of April 1, 2003, under manual
instructions issued to carry out section 1917(b)(3) of such Act because
of Federal responsibility for Indian Tribes and Alaska Native Villages
shall remain so exempt. Nothing in this subsection shall be construed
as preventing the Secretary from providing additional medicaid estate
recovery exemptions for Indians.

``SEC. 413. TREATMENT UNDER MEDICAID MANAGED CARE.

``(a) Payment for Services Furnished to Indians.--In the case of an
Indian who is enrolled with a managed care entity under section 1932 of
the Social Security Act (or otherwise under a waiver under title XIX of
such Act) and who receives covered services from an Indian Health
Program or an Urban Indian Organization, either--
``(1) the entity shall make payment to the Indian Health
Program or Urban Indian Organization at a rate established by
the entity for such services that is not less than the rate for
preferred providers (or at such other rate as may be negotiated
between the entity and such Indian Health Program or Urban
Indian Organization) and shall not require submittal of a claim
by the enrollee as a condition of payment to the Indian Health
Program or Urban Indian Organization; or
``(2) the State shall provide for payment to the Indian
Health Program or Urban Indian Organization under its State
plan under title XIX of such Act at the rate otherwise
applicable and shall provide for an appropriate adjustment of
the capitation payment made to the entity to take into account
such payment.
``(b) Offering of Managed Care.--If--
``(1) a State elects under its State plan under title XIX
of the Social Security Act to provide services through medicaid
managed care organizations or through primary care case
managers under section 1932 or under a waiver under such title;
and
``(2) the Indian Health Program or Urban Indian
Organization that is funded in whole or in part by the Service,
or a consortium thereof, has established a medicaid managed
care organization or a primary care case manager that meets
quality standards equivalent to those required of such an
organization or manager under such section or waiver,
the State shall enter into an agreement under such section with the
Service, Indian Tribe, Tribal Organization, or Urban Indian
Organization, or such consortium, to serve as a medicaid managed care
organization or a primary care case manager, respectively with respect
to Indians served by such entity. In carrying out this subsection, the
Secretary and the State may waive requirements regarding enrollment,
capitalization, and such other matters that might otherwise prevent the
application of the previous sentence.

``SEC. 414. NAVAJO NATION MEDICAID AGENCY.

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

``SEC. 415. AUTHORIZATION OF APPROPRIATIONS.

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

``TITLE V--HEALTH SERVICES FOR URBAN INDIANS

``SEC. 501. PURPOSE.

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

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

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

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

``(a) Requirements for Grants and Contracts.--Under authority of
the Act of November 2, 1921 (25 U.S.C. 13; popularly known as the
Snyder Act), the Secretary, acting through the Service, shall enter
into contracts with, and make grants to, Urban Indian Organizations for
the provision of health care and referral services for Urban Indians.
Any such contract or grant shall include requirements that the Urban
Indian Organization successfully undertake to--
``(1) estimate the population of Urban Indians residing in
the Urban Center or centers that the organization proposes to
serve who are or could be recipients of health care or referral
services;
``(2) estimate the current health status of Urban Indians
residing in such Urban Center or centers;
``(3) estimate the current health care needs of Urban
Indians residing in such Urban Center or centers;
``(4) provide basic health education, including health
promotion and disease prevention education, to Urban Indians;
``(5) make recommendations to the Secretary and Federal,
State, local, and other resource agencies on methods of
improving health service programs to meet the needs of Urban
Indians; and
``(6) where necessary, provide, or enter into contracts for
the provision of, health care services for Urban Indians.
``(b) Criteria.--The Secretary, acting through the Service, shall
by regulation adopted pursuant to section 520 prescribe the criteria
for selecting Urban Indian Organizations to enter into contracts or
receive grants under this section. Such criteria shall, among other
factors, include--
``(1) the extent of unmet health care needs of Urban
Indians in the Urban Center or centers involved;
``(2) the size of the Urban Indian population in the Urban
Center or centers involved;
``(3) the extent, if any, to which the activities set forth
in subsection (a) would duplicate any project funded under this
title;
``(4) the capability of an Urban Indian Organization to
perform the activities set forth in subsection (a) and to enter
into a contract with the Secretary or to meet the requirements
for receiving a grant under this section;
``(5) the satisfactory performance and successful
completion by an Urban Indian Organization of other contracts
with the Secretary under this title;
``(6) the appropriateness and likely effectiveness of
conducting the activities set forth in subsection (a) in an
Urban Center or centers; and
``(7) the extent of existing or likely future participation
in the activities set forth in subsection (a) by appropriate
health and health-related Federal, State, local, and other
agencies.
``(c) Access to Health Promotion and Disease Prevention Programs.--
The Secretary, acting through the Service, shall facilitate access to
or provide health promotion and disease prevention services for Urban
Indians through grants made to Urban Indian Organizations administering
contracts entered into or receiving grants under subsection (a).
``(d) Immunization Services.--
``(1) Access or services provided.--The Secretary, acting
through the Service, shall facilitate access to, or provide,
immunization services for Urban Indians through grants made to
Urban Indian Organizations administering contracts entered into
or receiving grants under this section.
``(2) Definition.--For purposes of this subsection, the
term `immunization services' means services to provide without
charge immunizations against vaccine-preventable diseases.
``(e) Mental Health Services.--
``(1) Access or services provided.--The Secretary, acting
through the Service, shall facilitate access to, or provide,
mental health services for Urban Indians through grants made to
Urban Indian Organizations administering contracts entered into
or receiving grants under subsection (a).
``(2) Assessment required.--Except as provided by paragraph
(3)(A), a grant may not be made under this subsection to an
Urban Indian Organization until that organization has prepared,
and the Service has approved, an assessment of the following:
``(A) The mental health needs of the Urban Indian
population concerned.
``(B) The mental health services and other related
resources available to that population.
``(C) The barriers to obtaining those services and
resources.
``(D) The needs that are unmet by such services and
resources.
``(3) Purposes of grants.--Grants may be made under this
subsection for the following:
``(A) To prepare assessments required under
paragraph (2).
``(B) To provide outreach, educational, and
referral services to Urban Indians regarding the
availability of direct behavioral health services, to
educate Urban Indians about behavioral health issues
and services, and effect coordination with existing
behavioral health providers in order to improve
services to Urban Indians.
``(C) To provide outpatient behavioral health
services to Urban Indians, including the identification
and assessment of illness, therapeutic treatments, case
management, support groups, family treatment, and other
treatment.
``(D) To develop innovative behavioral health
service delivery models which incorporate Indian
cultural support systems and resources.
``(f) Prevention of Child Abuse.--
``(1) Access or services provided.--The Secretary, acting
through the Service, shall facilitate access to or provide
services for Urban Indians through grants to Urban Indian
Organizations administering contracts entered into or receiving
grants under subsection (a) to prevent and treat child abuse
(including sexual abuse) among Urban Indians.
``(2) Evaluation required.--Except as provided by paragraph
(3)(A), a grant may not be made under this subsection to an
Urban Indian Organization until that organization has prepared,
and the Service has approved, an assessment that documents the
prevalence of child abuse in the Urban Indian population
concerned and specifies the services and programs (which may
not duplicate existing services and programs) for which the
grant is requested.
``(3) Purposes of grants.--Grants may be made under this
subsection for the following:
``(A) To prepare assessments required under
paragraph (2).
``(B) For the development of prevention, training,
and education programs for Urban Indians, including
child education, parent education, provider training on
identification and intervention, education on reporting
requirements, prevention campaigns, and establishing
service networks of all those involved in Indian child
protection.
``(C) To provide direct outpatient treatment
services (including individual treatment, family
treatment, group therapy, and support groups) to Urban
Indians who are child victims of abuse (including
sexual abuse) or adult survivors of child sexual abuse,
to the families of such child victims, and to Urban
Indian perpetrators of child abuse (including sexual
abuse).
``(4) Considerations when making grants.--In making grants
to carry out this subsection, the Secretary shall take into
consideration--
``(A) the support for the Urban Indian Organization
demonstrated by the child protection authorities in the
area, including committees or other services funded
under the Indian Child Welfare Act of 1978 (25 U.S.C.
1901 et seq.), if any;
``(B) the capability and expertise demonstrated by
the Urban Indian Organization to address the complex
problem of child sexual abuse in the community; and
``(C) the assessment required under paragraph (2).
``(g) Other Grants.--The Secretary, acting through the Service, may
enter into a contract with or make grants to an Urban Indian
Organization that provides or arranges for the provision of health care
services (through satellite facilities, provider networks, or
otherwise) to Urban Indians in more than 1 Urban Center.

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

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

``SEC. 505. EVALUATIONS; RENEWALS.

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

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

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

``SEC. 507. REPORTS AND RECORDS.

``(a) Reports.--For each fiscal year during which an Urban Indian
Organization receives or expends funds pursuant to a contract entered
into or a grant received pursuant to this title, such Urban Indian
Organization shall submit to the Secretary not more frequently than
every 6 months, a report that includes the following:
``(1) In the case of a contract or grant under section 503,
recommendations pursuant to section 503(a)(5).
``(2) Information on activities conducted by the
organization pursuant to the contract or grant.
``(3) An accounting of the amounts and purpose for which
Federal funds were expended.
``(4) A minimum set of data, using uniformly defined
elements, that is specified by the Secretary in consultation,
consistent with section 514, with Urban Indian Organizations.
``(b) Audit.--The reports and records of the Urban Indian
Organization with respect to a contract or grant under this title shall
be subject to audit by the Secretary and the Comptroller General of the
United States.
``(c) Costs of Audits.--The Secretary shall allow as a cost of any
contract or grant entered into or awarded under section 502 or 503 the
cost of an annual independent financial audit conducted by--
``(1) a certified public accountant; or
``(2) a certified public accounting firm qualified to
conduct Federal compliance audits.

``SEC. 508. LIMITATION ON CONTRACT AUTHORITY.

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

``SEC. 509. FACILITIES.

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

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

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

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

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

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

``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 in the
allocation of resources and coordination of care; and
``(3) shall be subject to the provisions of the Indian
Self-Determination and Education Assistance Act, except that
the programs shall not be divisible.

``SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS.

``(a) Grants and Contracts.--The Secretary, through the Office of
Urban Indian Health, shall make grants or enter into contracts with
Urban Indian Organizations for the administration of Urban Indian
alcohol programs that were originally established under the National
Institute on Alcoholism and Alcohol Abuse (hereafter in this section
referred to as `NIAAA') and transferred to the Service. Such grants and
contracts shall become effective no later than September 30, 2004.
``(b) Use of Funds.--Grants provided or contracts entered into
under this section shall be used to provide support for the
continuation of alcohol prevention and treatment services for Urban
Indian populations and such other objectives as are agreed upon between
the Service and a recipient of a grant or contract under this section.
``(c) Eligibility.--Urban Indian Organizations that operate Indian
alcohol programs originally funded under the NIAAA and subsequently
transferred to the Service are eligible for grants or contracts under
this section.
``(d) Report.--The Secretary shall evaluate and report to Congress
on the activities of programs funded under this section not less than
every 5 years.

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

``(a) In General.--The Secretary shall ensure that the Service, the
Centers for Medicare & Medicaid Services, and other operating divisions
and staff divisions of the Department consult, to the greatest extent
practicable, with Urban Indian Organizations prior to taking any
action, or approving Federal financial assistance for any action of a
State, that may affect Urban Indians or Urban Indian Organizations.
``(b) Definition of Consultation.--For purposes of subsection (a),
consultation is the open and free exchange of information and opinion
among Urban Indian Organizations and the operating and staff divisions
of the Department which leads to mutual understanding and comprehension
and which emphasizes trust, respect, and shared responsibility.

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

``(a) In General.--With respect to claims resulting from the
performance of functions during fiscal year 2004 and thereafter, or
claims asserted after September 30, 2003, but resulting from the
performance of functions prior to fiscal year 2004, under a contract,
grant agreement, or any other agreement authorized under this title, an
Urban Indian Organization is deemed hereafter to be part of the Service
in the Department of Health and Human Services while carrying out any
such contract or agreement and its employees are deemed employees of
the Service while acting within the scope of their employment in
carrying out the contract or agreement. After September 30, 2003, any
civil action or proceeding involving such claims brought hereafter
against any Urban Indian Organization or any employee of such Urban
Indian Organization covered by this provision shall be deemed to be an
action against the United States and will be defended by the Attorney
General and be afforded the full protection and coverage of the Federal
Tort Claims Act (28 U.S.C. 1346(b), 2671 et seq.).
``(b) Claims Resulting From Performance of Contract or Grant.--
Beginning with the fiscal year ending September 30, 2003, and
thereafter, the appropriate Secretary shall request through annual
appropriations funds sufficient to reimburse the Treasury for any
claims paid in the prior fiscal year pursuant to the foregoing
provisions.
``(c) Effect on ISDEAA.--Nothing in this section shall in any way
affect the provisions of section 102(d) of the Indian Self-
Determination and Education Assistance Act of 1975 (25 U.S.C. 450f(d)).

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

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

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

``(a) Authorization for Use.--The Secretary, acting through the
Service, shall allow an Urban Indian Organization that has entered into
a contract or received a grant pursuant to this title, in carrying out
such contract or grant, to use existing facilities and all equipment
therein or pertaining thereto and other personal property owned by the
Federal Government within the Secretary's jurisdiction under such terms
and conditions as may be agreed upon for their use and maintenance.
``(b) 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 purposes of carrying out the
contract or grant.
``(c) Acquisition of Property for Donation.--The Secretary may
acquire excess or surplus government personal or real property for
donation (subject to subsection (d)), to an Urban Indian Organization
that has entered into a contract or received a grant pursuant to this
title if the Secretary determines that the property is appropriate for
use by the Urban Indian Organization for a purpose for which a contract
or grant is authorized under this title.
``(d) Priority.--In the event that the Secretary receives a request
for donation of a specific item of personal or real property described
in subsection (b) or (c) from both an Urban Indian Organization and
from an Indian Tribe or Tribal Organization, the Secretary shall give
priority to the request for donation of the Indian Tribe or Tribal
Organization if the Secretary receives the request from the Indian
Tribe or Tribal Organization before the date the Secretary transfers
title to the property or, if earlier, the date the Secretary transfers
the property physically to the Urban Indian Organization.
``(e) Urban Indian Organizations Deemed Executive Agency for
Certain Purposes.--For purposes of section 501 of title 40, United
States Code, (relating to Federal sources of supply, including lodging
providers, airlines, and other transportation providers), an Urban
Indian Organization that has entered into a contract or received a
grant pursuant to this title shall be deemed an executive agency when
carrying out such contract or grant, and the employees of the Urban
Indian Organization shall be eligible to have access to such sources of
supply on the same basis as employees of an executive agency have such
access.

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

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

``SEC. 519. COMMUNITY HEALTH REPRESENTATIVES.

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

``SEC. 520. REGULATIONS.

``(a) Requirements for Regulations.--The Secretary may promulgate
regulations to implement the provisions of this title in accordance
with the following:
``(1) Proposed regulations to implement this Act shall be
published in the Federal Register by the Secretary no later
than 9 months after the date of the enactment of this Act and
shall have no less than a 4-month comment period.
``(2) The authority to promulgate regulations under this
Act shall expire 18 months from the date of the enactment of
this Act.
``(b) Effective Date of Title.--The amendments to this title made
by the Indian Health Care Improvement Act Amendments of 2003 shall be
effective on the date of the enactment of such amendments, regardless
of whether the Secretary has promulgated regulations implementing such
amendments have been promulgated.

``SEC. 521. ELIGIBILITY FOR SERVICES.

``Urban Indians shall be eligible for health care or referral
services provided pursuant to this title.

``SEC. 522. AUTHORIZATION OF APPROPRIATIONS.

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

``TITLE VI--ORGANIZATIONAL IMPROVEMENTS

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

``(a) Establishment.--In order to more effectively and efficiently
carry out the responsibilities, authorities, and functions of the
United States to provide health care services provided under Federal
statute or treaties to Indians and Indian Tribes, there was established
within the Public Health Service of the Department the Indian Health
Service.
``(b) Director.--The Indian Health Service is 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. The Indian
Health 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 of the Indian Health Service shall report to the
Secretary through the Assistant Secretary for Health of the Department
of Health and Human Services. Effective with respect to an individual
appointed by the President, by and with the advice and consent of the
Senate, after January 1, 1993, the term of service of the Director
shall be 4 years. A Director may serve more than 1 term.
``(c) Duties.--The Secretary shall carry out through the Director
of the Indian Health Service--
``(1) all functions which were, on the day before the date
of the enactment of the Indian Health Care Amendments of 1988,
carried out by or under the direction of the individual serving
as Director of the Indian Health Service on such day;
``(2) all functions of the Secretary relating to the
maintenance and operation of hospital and health facilities for
Indians and the planning for, and provision and use of, health
services for Indians;
``(3) all health programs under which health care is
provided to Indians based upon their status as Indians which
are administered by the Secretary, including but not limited to
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.); and
``(4) all scholarship and loan functions carried out under
title I.
``(d) Authorities.--(1) The Director shall have the authority--
``(A) except to the extent provided 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) Notwithstanding any other law, the provisions of section 12
of the Act of June 18, 1934 (48 Stat. 986; 25 U.S.C. 472), shall apply
to all personnel actions taken with respect to new positions created
within the Service as a result of its establishment under subsection
(a).

``SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM.

``(a)(1) The Secretary shall establish an automated management
information system for the Service.
``(2) The information system established under paragraph (1) shall
include--
``(A) a financial management system;
``(B) a patient care information system for each area
served by the Service;
``(C) a privacy component that protects the privacy of
patient information held by, or on behalf of, the Service;
``(D) a services-based cost accounting component that
provides estimates of the costs associated with the provision
of specific medical treatments or services in each Area Office
of the Service;
``(E) an interface mechanism for patient billing and
accounts receivable system; and
``(F) a training component.
``(b) The Secretary shall provide each Tribal Health Program
automated management information systems which--
``(1) meet the management information needs of such Tribal
Health Program with respect to the treatment by the Tribal
Health Program of patients of the Service; and
``(2) meet the management information needs of the Service.
``(c) Notwithstanding any other provision of law, each patient
shall have reasonable access to the medical or health records of such
patient which are held by, or on behalf of, the Service.
``(d) The Director shall have the authority to enter into
contracts, agreements, or joint ventures with other Federal agencies,
States, private and nonprofit organizations, for the purpose of
enhancing information technology in Indian Health Programs and
facilities.

``SEC. 603. AUTHORIZATION OF APPROPRIATIONS.

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

``TITLE VII--BEHAVIORAL HEALTH PROGRAMS

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

``(a) Purposes.--The purposes of this section are as follows:
``(1) To authorize and direct the Secretary, acting through
the Service, Indian Tribes, Tribal Organizations, and Urban
Indian Organizations, to develop a comprehensive behavioral
health prevention and treatment program which emphasizes
collaboration among alcohol and substance abuse, social
services, and mental health programs.
``(2) 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, Tribal Organizations, and Urban Indian
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.
``(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 establish a national clearinghouse
of 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, Indian
Tribes, and Tribal Organizations, 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; and
``(I) Traditional Health Care Practices.
``(2) Child care.--Behavioral health services for Indians
from birth through age 17, including the following:
``(A) Preschool and school age fetal alcohol
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 choices and lifestyle
(related to sexually transmitted diseases, domestic
violence, sexual abuse, suicide, teen pregnancy,
obesity, and other risk/safety issues).
``(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 the following:
``(A) Early intervention, treatment, and aftercare.
``(B) Mental health and substance abuse services
(emotional, alcohol, drug, inhalant, and tobacco),
including gender specific services.
``(C) Identification and treatment of co-occurring
disorders (dual diagnosis) and comorbidity.
``(D) Promotion of gender specific healthy choices
and lifestyle (related to parenting, partners, domestic
violence, sexual abuse, suicide, obesity, and other
risk-related behavior).
``(E) Treatment services for women at risk of
giving birth to a child with a fetal alcohol disorder.
``(F) Gender specific treatment for sexual assault
and domestic violence.
``(4) Family care.--Behavioral health services for
families, including the following:
``(A) Early intervention, treatment, and aftercare
for affected families.
``(B) Treatment for sexual assault and domestic
violence.
``(C) Promotion of healthy choices and lifestyle
(related to parenting, partners, domestic violence, and
other abuse issues).
``(5) Elder care.--Behavioral health services for Indians
56 years of age and older, including the following:
``(A) Early intervention, treatment, and aftercare.
``(B) Mental health and substance abuse services
(emotional, alcohol, drug, inhalant, and tobacco),
including gender specific services.
``(C) Identification and treatment of co-occurring
disorders (dual diagnosis) and comorbidity.
``(D) Promotion of healthy choices and lifestyle
(managing conditions related to aging).
``(E) Gender specific treatment for sexual assault,
domestic violence, neglect, physical and mental abuse
and exploitation.
``(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,
may make funding available to Indian Tribes and Tribal
Organizations which adopt a resolution pursuant to paragraph
(1) to obtain technical assistance for the development of a
community behavioral health plan and to provide administrative
support in the implementation of such plan.
``(e) Coordination for Availability of Services.--The Secretary,
acting through the Service, Indian Tribes, Tribal Organizations, and
Urban Indian Organizations, shall coordinate behavioral health
planning, to the extent feasible, with other Federal agencies and with
State agencies, to encourage comprehensive behavioral health services
for Indians regardless of their place of residence.
``(f) Mental Health Care Need Assessment.--Not later than 1 year
after the date of the enactment of the Indian Health Care Improvement
Act Amendments of 2003, the Secretary, acting through the Service,
shall make an assessment of the need for inpatient mental health care
among Indians and the availability and cost of inpatient mental health
facilities which can meet such need. In making such assessment, the
Secretary shall consider the possible conversion of existing, underused
Service hospital beds into psychiatric units to meet such need.

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

``(a) Contents.--Not later than 12 months after the date of the
enactment of the Indian Health Care Improvement Act Amendments of 2003,
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
mental health services for Indians.
``(3) The unmet need for additional services, resources,
and programs necessary to meet the needs identified pursuant to
paragraph (1).
``(4)(A) The right of Indians, as citizens of the United
States and of the States in which they reside, to have access
to mental health services to which all citizens have access.
``(B) The right of Indians to participate in, and receive
the benefit of, such services.
``(C) The actions necessary to protect the exercise of such
right.
``(5) The responsibilities of the Bureau of Indian Affairs
and the Service, including mental health identification,
prevention, education, referral, and treatment services
(including services through multidisciplinary resource teams),
at the central, area, and agency and Service Unit, Service
Area, and headquarters levels to address the problems
identified in paragraph (1).
``(6) A strategy for the comprehensive coordination of the
mental health services provided by the Bureau of Indian Affairs
and the Service to meet the 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) with mental
health initiatives pursuant to this Act, particularly
with respect to the referral and treatment of dually
diagnosed individuals requiring mental health and
substance abuse treatment; and
``(B) ensuring that the Bureau of Indian Affairs
and Service programs and services (including
multidisciplinary resource teams) addressing child
abuse and family violence are coordinated with such
non-Federal programs and services.
``(7) Directing appropriate officials of the Bureau of
Indian Affairs and the Service, particularly at the agency and
Service Unit levels, to cooperate fully with tribal requests
made pursuant to community behavioral health plans adopted
under section 701(c) and section 4206 of the Indian Alcohol and
Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C.
2412).
``(8) Providing for an annual review of such agreement by
the Secretaries which shall be provided to Congress and Indian
Tribes and Tribal Organizations.
``(b) Specific Provisions Required.--The memoranda of agreement
updated or entered into pursuant to subsection (a) shall include
specific provisions pursuant to which the Service shall assume
responsibility for--
``(1) the determination of the scope of the problem of
alcohol and substance abuse among Indians, including the number
of Indians within the jurisdiction of the Service who are
directly or indirectly affected by alcohol and substance abuse
and the financial and human cost;
``(2) an assessment of the existing and needed resources
necessary for the prevention of alcohol and substance abuse and
the treatment of Indians affected by alcohol and substance
abuse; and
``(3) an estimate of the funding necessary to adequately
support a program of prevention of alcohol and substance abuse
and treatment of Indians affected by alcohol and substance
abuse.
``(c) Consultation.--The Secretary, acting through the Service, and
the Secretary of the Interior shall, in developing the memoranda of
agreement under subsection (a), consult with and solicit the comments
from--
``(1) Indian Tribes and Tribal Organizations;
``(2) Indians;
``(3) Urban Indian Organizations and other Indian
organizations; and
``(4) behavioral health service providers.
``(d) Publication.--Each memorandum of agreement entered into or
renewed (and amendments or modifications thereto) under subsection (a)
shall be published in the Federal Register. At the same time as
publication in the Federal Register, the Secretary shall provide a copy
of such memoranda, amendment, or modification to each Indian Tribe,
Tribal Organization, and Urban Indian Organization.

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

``(a) Establishment.--
``(1) In general.--The Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, shall provide
a program of comprehensive behavioral health, prevention,
treatment, and aftercare, including Traditional Health Care Practices,
which shall include--
``(A) prevention, through educational intervention,
in Indian communities;
``(B) acute detoxification, psychiatric
hospitalization, and 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; and
``(E) specialized residential treatment programs
for high-risk populations, including but not limited to
pregnant and postpartum women and their children.
``(2) Target populations.--The target population of such
program shall be members of Indian Tribes. Efforts to train and
educate key members of the Indian community shall target
employees of health, education, judicial, law enforcement,
legal, and social service programs.
``(b) Contract Health Services.--
``(1) In general.--The Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, may enter
into contracts with public or private providers of behavioral
health treatment services for the purpose of carrying out the
program required under subsection (a).
``(2) Provision of assistance.--In carrying out this
subsection, the Secretary shall provide assistance to Indian
Tribes and Tribal Organizations to develop criteria for the
certification of behavioral health service providers and
accreditation of service facilities which meet minimum
standards for such services and facilities.

``SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM.

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

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

``Subject to the provisions of section 221, any person employed as
a psychologist, social worker, or marriage and family therapist for the
purpose of providing mental health care services to Indians in a
clinical setting under this Act or through a Funding Agreement shall,
in the case of a person employed as a psychologist, social worker, or
marriage and family therapist, be licensed as a clinical psychologist,
social worker, or marriage and family therapist, respectively, or
working under the direct supervision of a licensed clinical
psychologist, social worker, or marriage and family therapist,
respectively.

``SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.

``(a) Funding.--The Secretary, consistent with section 701, shall
make funds available 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 spiritual,
cultural, historical, social, and child care needs of Indian women,
regardless of age.
``(b) Use of Funds.--Funds made available pursuant to this section
may be used to--
``(1) develop and provide community training, education,
and prevention programs for Indian women relating to behavioral
health issues, including fetal alcohol disorders;
``(2) identify and provide psychological services,
counseling, advocacy, support, and relapse prevention to Indian
women and their families; and
``(3) develop prevention and intervention models for Indian
women which incorporate Traditional Health Care Practices,
cultural values, and community and family involvement.
``(c) Criteria.--The Secretary, in consultation with Indian Tribes
and Tribal Organizations, shall establish criteria for the review and
approval of applications and proposals for funding under this section.
``(d) Earmark of Certain Funds.--Twenty percent of the funds
appropriated pursuant to this section shall be used to make grants to
Urban Indian Organizations.

``SEC. 707. INDIAN YOUTH PROGRAM.

``(a) Detoxification and Rehabilitation.--The Secretary, acting
through the Service, consistent with section 701, shall develop and
implement a program for acute detoxification and treatment for Indian
youths, including behavioral health services. The program shall include
regional treatment centers designed to include detoxification and
rehabilitation for both sexes on a referral basis and programs
developed and implemented by Indian Tribes or Tribal Organizations at
the local level under the Indian Self-Determination and Education
Assistance Act. Regional centers shall be integrated with the intake
and rehabilitation programs based in the referring Indian community.
``(b) Alcohol and Substance Abuse Treatment Centers or
Facilities.--
``(1) Establishment.--
``(A) In general.--The Secretary, acting through
the Service, Indian Tribes, and Tribal Organizations,
shall construct, renovate, or, as necessary, purchase,
and appropriately staff and operate, at least 1 youth
regional treatment center or treatment network in each
area under the jurisdiction of an Area Office.
``(B) Area office in california.--For the purposes
of this subsection, the Area Office in California shall
be considered to be 2 Area Offices, 1 office whose
jurisdiction shall be considered to encompass the
northern area of the State of California, and 1 office
whose jurisdiction shall be considered to encompass the
remainder of the State of California for the purpose of
implementing California treatment networks.
``(2) Funding.--For the purpose of staffing and operating
such centers or facilities, funding shall be pursuant to the
Act of November 2, 1921 (25 U.S.C. 13).
``(3) Location.--A youth treatment center constructed or
purchased under this subsection shall be constructed or
purchased at a location within the area described in paragraph
(1) agreed upon (by appropriate tribal resolution) by a
majority of the Indian Tribes to be served by such center.
``(4) Specific provision of funds.--
``(A) In general.--Notwithstanding any other
provision of this title, the Secretary may, from
amounts authorized to be appropriated for the purposes
of carrying out this section, make funds available to--
``(i) the Tanana Chiefs Conference,
Incorporated, for the purpose of leasing,
constructing, renovating, operating, and
maintaining a residential youth treatment
facility in Fairbanks, Alaska; and
``(ii) the Southeast Alaska Regional Health
Corporation to staff and operate a residential
youth treatment facility without regard to the
proviso set forth in section 4(l) of the Indian
Self-Determination and Education Assistance Act
(25 U.S.C. 450b(l)).
``(B) Provision of services to eligible youths.--
Until additional residential youth treatment facilities
are established in Alaska pursuant to this section, the
facilities specified in subparagraph (A) shall make
every effort to provide services to all eligible Indian
youths residing in such State.
``(c) Intermediate Adolescent Behavioral Health Services.--
``(1) In general.--The Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, may provide
intermediate behavioral health services, which may incorporate
Traditional Health Care Practices, to Indian children and
adolescents, including--
``(A) pretreatment assistance;
``(B) inpatient, outpatient, and aftercare
services;
``(C) emergency care;
``(D) suicide prevention and crisis intervention;
and
``(E) prevention and treatment of mental illness
and dysfunctional and self-destructive behavior,
including child abuse and family violence.
``(2) Use of funds.--Funds provided under this subsection
may be used--
``(A) to construct or renovate an existing health
facility to provide intermediate behavioral health
services;
``(B) to hire behavioral health professionals;
``(C) to staff, operate, and maintain an
intermediate mental health facility, group home, sober
housing, transitional housing or similar facilities, or
youth shelter where intermediate behavioral health
services are being provided;
``(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, in consultation with
Indian Tribes and Tribal Organizations, for determining
the suitability of any such federally owned structure
to be used for local residential or regional behavioral
health treatment for Indian youths.
``(2) Terms and conditions for use of structure.--Any
structure described in paragraph (1) may be used under such
terms and conditions as may be agreed upon by the Secretary and
the agency having responsibility for the structure and any
Indian Tribe or Tribal Organization operating the program.
``(e) Rehabilitation and Aftercare Services.--
``(1) In general.--The Secretary, Indian Tribes, or Tribal
Organizations, in cooperation with the Secretary of the
Interior, shall develop and implement within each Service Unit,
community-based rehabilitation and follow-up services for
Indian youths who are having significant behavioral health
problems, and require long-term treatment, community
reintegration, and monitoring to support the Indian youths
after their return to their home community.
``(2) Administration.--Services under paragraph (1) shall
be provided by trained staff within the community who can
assist the Indian youths in their continuing development of
self-image, positive problem-solving skills, and nonalcohol or
substance abusing behaviors. Such staff may include alcohol and
substance abuse counselors, mental health professionals, and
other health professionals and paraprofessionals, including
community health representatives.
``(f) Inclusion of Family in Youth Treatment Program.--In providing
the treatment and other services to Indian youths authorized by this
section, the Secretary, acting through the Service, Indian Tribes, and
Tribal Organizations, shall provide for the inclusion of family members
of such youths in the treatment programs or other services as may be
appropriate. Not less than 10 percent of the funds appropriated for the
purposes of carrying out subsection (e) shall be used for outpatient
care of adult family members related to the treatment of an Indian
youth under that subsection.
``(g) Multidrug Abuse Program.--The Secretary, acting through the
Service, Indian Tribes, Tribal Organizations, and Urban Indian
Organizations, shall provide, consistent with section 701, programs and
services to prevent and treat the abuse of multiple forms of
substances, including, but not limited to, 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.

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

``Not later than 1 year after the date of the enactment of the
Indian Health Care Improvement Act Amendments of 2003, the Secretary,
acting through the Service, Indian Tribes, and Tribal Organizations,
shall provide, in each area of the Service, not less than 1 inpatient
mental health care facility, or the equivalent, for Indians with
behavioral health problems. 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. 709. TRAINING AND COMMUNITY EDUCATION.

``(a) Program.--The Secretary, in cooperation with the Secretary of
the Interior, shall develop and implement or provide funding for 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. Community-based training (oriented toward local capacity
development) shall also include tribal community provider training
(designed for adult learners from the communities receiving services
for prevention, intervention, treatment, and aftercare).
``(b) Instruction.--The Secretary, acting through the Service,
shall, either directly or through Indian Tribes and Tribal
Organizations, provide instruction in the area of behavioral health
issues, including instruction in crisis intervention and family
relations in the context of alcohol and substance abuse, child sexual
abuse, youth alcohol and substance abuse, and the causes and effects of
fetal alcohol disorders to appropriate employees of the Bureau of
Indian Affairs and the Service, and to personnel in schools or programs
operated under any contract with the Bureau of Indian Affairs or the
Service, including supervisors of emergency shelters and halfway houses
described in section 4213 of the Indian Alcohol and Substance Abuse
Prevention and Treatment Act of 1986 (25 U.S.C. 2433).
``(c) Training Models.--In carrying out the education and training
programs required by this section, the Secretary, in consultation with
Indian Tribes, Tribal Organizations, Indian behavioral health experts,
and Indian alcohol and substance abuse prevention experts, shall
develop and provide community-based training models. Such models shall
address--
``(1) the elevated risk of alcohol and behavioral health
problems faced by children of alcoholics;
``(2) the cultural, spiritual, and multigenerational
aspects of behavioral health problem prevention and recovery;
and
``(3) community-based and multidisciplinary strategies for
preventing and treating behavioral health problems.

``SEC. 710. BEHAVIORAL HEALTH PROGRAM.

``(a) Innovative Programs.--The Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, consistent with
section 701, may plan, develop, implement, and carry out programs to
deliver innovative community-based behavioral health services to
Indians.
``(b) Funding; Criteria.--The Secretary may award such funding 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 applications or proposals for funding
for projects to be operated under any Funding Agreement, use the same
criteria that the Secretary uses in evaluating any other application or
proposal for such funding.

``SEC. 711. FETAL ALCOHOL DISORDER FUNDING.

``(a) Programs.--
``(1) Establishment.--The Secretary, consistent with
section 701, acting through Indian Tribes and Tribal
Organizations, shall establish and operate fetal alcohol
disorder programs as provided in this section for the purposes
of meeting the health status objectives specified in section 3.
``(2) Use of funds.--Funding provided pursuant to this
section shall be used for the following:
``(A) To develop and provide for Indians community
and in school training, education, and prevention
programs relating to fetal alcohol disorders.
``(B) To identify and provide behavioral health
treatment to high-risk Indian women and high-risk women
pregnant with an Indian's child.
``(C) To identify and provide appropriate
psychological services, educational and vocational
support, counseling, advocacy, and information to fetal
alcohol disorder affected Indians and their families or
caretakers.
``(D) To develop and implement counseling and
support programs in schools for fetal alcohol disorder
affected Indian children.
``(E) To develop prevention and intervention models
which incorporate practitioners of Traditional Health
Care Practices, cultural and spiritual values, and
community involvement.
``(F) To develop, print, and disseminate education
and prevention materials on fetal alcohol disorder.
``(G) To develop and implement, through the tribal
consultation process, culturally sensitive assessment
and diagnostic tools including dysmorphology clinics
and multidisciplinary fetal alcohol disorder clinics
for use in Indian communities and Urban Centers.
``(H) To develop early childhood intervention
projects from birth on to mitigate the effects of fetal
alcohol disorder among Indians.
``(I) To develop and fund community-based adult
fetal alcohol disorder housing and support services for
Indians and for women pregnant with an Indian's child.
``(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 and
Indian Tribes, Tribal Organizations, and Urban Indian Organizations,
shall--
``(1) develop and provide services for the prevention,
intervention, treatment, and aftercare for those affected by
fetal alcohol disorder in Indian communities; and
``(2) provide supportive services, directly or through an
Indian Tribe, Tribal Organization, or Urban Indian
Organization, including services to meet the special
educational, vocational, school-to-work transition, and
independent living needs of adolescent and adult Indians with
fetal alcohol disorder.
``(c) Task Force.--The Secretary shall establish a task force to be
known as the Fetal Alcohol Disorder Task Force to advise the Secretary
in carrying out subsection (b). Such task force shall be composed of
representatives from the following:
``(1) The National Institute on Drug Abuse.
``(2) The National Institute on Alcohol and Alcoholism.
``(3) The Office of Substance Abuse Prevention.
``(4) The National Institute of Mental Health.
``(5) The Service.
``(6) The Office of Minority Health of the Department of
Health and Human Services.
``(7) The Administration for Native Americans.
``(8) The National Institute of Child Health and Human
Development (NICHD).
``(9) The Centers for Disease Control and Prevention.
``(10) The Bureau of Indian Affairs.
``(11) Indian Tribes.
``(12) Tribal Organizations.
``(13) Urban Indian Organizations.
``(14) Indian fetal alcohol disorder experts.
``(d) Applied Research Projects.--The Secretary, acting through the
Substance Abuse and Mental Health Services Administration, shall make
funding available to Indian Tribes, Tribal Organizations, and Urban
Indian Organizations for applied research projects which propose to
elevate the understanding of methods to prevent, intervene, treat, or
provide rehabilitation and behavioral health aftercare for Indians and
Urban Indians affected by fetal alcohol disorder.
``(e) Funding for Urban Indian Organizations.--Ten percent of the
funds appropriated pursuant to this section shall be used to make
grants to Urban Indian Organizations funded under title V.

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

``(a) Establishment.--The Secretary, acting through the Service,
and the Secretary of the Interior, Indian Tribes, and Tribal
Organizations shall establish, consistent with section 701, in every
Service Area, programs involving treatment for--
``(1) victims of sexual abuse who are Indian children or
children in an Indian household; and
``(2) perpetrators of child sexual abuse who are Indian or
members of an Indian household.
``(b) Use of Funds.--Funding provided pursuant to this section
shall be used for the following:
``(1) To develop and provide community education and
prevention programs related to sexual abuse of Indian children
or children in an Indian household.
``(2) To identify and provide behavioral health treatment
to victims of sexual abuse who are Indian children or children
in an Indian household, and to their family members who are
affected by sexual abuse.
``(3) To develop prevention and intervention models which
incorporate Traditional Health Care Practices, cultural and
spiritual values, and community involvement.
``(4) To develop and implement, through the tribal
consultation process, culturally sensitive assessment and
diagnostic tools for use in Indian communities and Urban
Centers.
``(5) To identify and provide behavioral health treatment
to Indian perpetrators and perpetrators who are members of an
Indian household--
``(A) making efforts to begin offender and
behavioral health treatment while the perpetrator is
incarcerated or at the earliest possible date if the
perpetrator is not incarcerated; and
``(B) providing treatment after the perpetrator is
released, until it is determined that the perpetrator
is not a threat to children.

``SEC. 713. BEHAVIORAL HEALTH RESEARCH.

``The Secretary, in consultation with appropriate Federal agencies,
shall provide funding to Indian Tribes, Tribal Organizations, and Urban
Indian Organizations or enter into contracts with, or make grants to
appropriate institutions for, the conduct of research on the incidence
and prevalence of behavioral health problems among Indians served by
the Service, Indian Tribes, or Tribal Organizations and among Indians
in urban areas. Research priorities under this section shall include--
``(1) the interrelationship and interdependence of
behavioral health problems with alcoholism and other substance
abuse, suicide, homicides, other injuries, and the incidence of
family violence; and
``(2) the development of models of prevention techniques.
The effect of the interrelationships and interdependencies referred to
in paragraph (1) on children, and the development of prevention
techniques under paragraph (2) applicable to children, shall be
emphasized.

``SEC. 714. DEFINITIONS.

``For the purpose of this title, the following definitions shall
apply:
``(1) Assessment.--The term `assessment' means the
systematic collection, analysis, and dissemination of
information on health status, health needs, and health
problems.
``(2) Alcohol-related neurodevelopmental disorders or
arnd.--The term `alcohol-related neurodevelopmental disorders'
or `ARND' means, with a history of maternal alcohol consumption
during pregnancy, central nervous system involvement such as
developmental delay, intellectual deficit, or neurologic
abnormalities. Behaviorally, there can be problems with
irritability, and failure to thrive as infants. As children
become older there will likely be hyperactivity, attention
deficit, language dysfunction, and perceptual and judgment
problems.
``(3) Behavioral health.--The term `behavioral health'
means the blending of substance (alcohol, drugs, inhalants, and
tobacco) abuse and mental health prevention and treatment, for
the purpose of providing comprehensive services. This can
include the joint development of substance abuse and mental
health treatment planning and coordinated case management using
a multidisciplinary approach.
``(4) 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 a as 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 (mental health professionals,
traditional health care practitioners, community health aides,
community health representatives, mental health technicians,
ministers, etc.)
``(5) 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).
``(6) Fetal alcohol disorders.--The term `fetal alcohol
disorders' means fetal alcohol syndrome, partial fetal alcohol
syndrome and alcohol related neurodevelopmental disorder
(ARND).
``(7) Fetal alcohol syndrome or 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
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.
``(8) Partial fas.--The term `partial FAS' means, with a
history of maternal alcohol consumption during pregnancy,
having most of the criteria of FAS, though not meeting a
minimum of at least 2 of the following: microophthalmia, short
palpebral fissures, poorly developed philtrum, thin upper lip,
flat nasal bridge, and short upturned nose.
``(9) Rehabilitation.--The term `rehabilitation' means to
restore the ability or capacity to engage in usual and
customary life activities through education and therapy.
``(10) Substance abuse.--The term `substance abuse'
includes inhalant abuse.

``SEC. 715. AUTHORIZATION OF APPROPRIATIONS.

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

``TITLE VIII--MISCELLANEOUS

``SEC. 801. REPORTS.

``The President shall, at the time the budget is submitted under
section 1105 of title 31, United States Code, for each fiscal year
transmit to Congress a report containing the following:
``(1) A report on the progress made in meeting the
objectives of this Act, including a review of programs
established or assisted pursuant to this Act and assessments
and recommendations of additional programs or additional
assistance necessary to, at a minimum, provide health services
to Indians and ensure a health status for Indians, which are at
a parity with the health services available to and the health
status of the general population, including specific
comparisons of appropriations provided and those required for
such parity.
``(2) A report on whether, and to what extent, new national
health care programs, benefits, initiatives, or financing
systems have had an impact on the purposes of this Act and any
steps that the Secretary may have taken to consult with Indian
Tribes, Tribal Organizations, and Urban Indian Organizations to
address such impact, including a report on proposed changes in
allocation of funding pursuant to section 808.
``(3) A report on the use of health services by Indians--
``(A) on a national and area or other relevant
geographical basis;
``(B) by gender and age;
``(C) by source of payment and type of service;
``(D) comparing such rates of use with rates of use
among comparable non-Indian populations; and
``(E) on the services provided under Funding
Agreements.
``(4) A report of contractors to the Secretary on Health
Care Educational Loan Repayments every 6 months required by
section 110.
``(5) A general audit report of the Secretary on the Health
Care Educational Loan Repayment Program as required by section
110(n).
``(6) A report of the findings and conclusions of
demonstration programs on development of educational curricula
for substance abuse counseling as required in section 126(f).
``(7) A separate statement which specifies the amount of
funds requested to carry out the provisions of section 201.
``(8) A report of the evaluations of health promotion and
disease prevention as required in section 203(c).
``(9) A biennial report to Congress on infectious diseases
as required by section 212.
``(10) A report on environmental and nuclear health hazards
as required by section 215.
``(11) An annual report on the status of all health care
facilities needs as required by section 301(c)(2) and 301(d).
``(12) Reports on safe water and sanitary waste disposal
facilities as required by section 302(i).
``(13) An annual report on the expenditure of nonservice
funds for renovation as required by sections 304(b)(2).
``(14) A report identifying the backlog of maintenance and
repair required at Service and tribal facilities required by
section 313(a).
``(15) A report providing an accounting of reimbursement
funds made available to the Secretary under titles XVIII, XIX,
and XXI of the Social Security Act.
``(16) A report on any arrangements for the sharing of
medical facilities or services between the Service, Indian
Tribes, and Tribal Organizations, and the Department of
Veterans Affairs and the Department of Defense, as authorized
by section 406.
``(17) A report on evaluation and renewal of Urban Indian
programs under section 505.
``(18) A report on the evaluation of programs as required
by section 513(d).
``(19) A report on alcohol and substance abuse as required
by section 701(f).

``SEC. 802. REGULATIONS.

``(a) Deadlines.--
``(1) Procedures.--Not later than 90 days after the date of
the enactment of the Indian Health Care Improvement Act
Amendments of 2003, the Secretary shall initiate procedures
under subchapter III of chapter 5 of title 5, United States
Code, to negotiate and promulgate such regulations or
amendments thereto that are necessary to carry out titles I,
II, III, IV, and VII and section 817. The Secretary may
promulgate regulations to carry out sections 105, 115, 117, and
title V, using the procedures required by the Administrative
Procedures Act. The Secretary shall issue no regulations to
carry out titles VI and VIII, except as necessary to carry out
section 817.
``(2) Proposed regulations.--Proposed regulations to
implement this Act shall be published in the Federal Register
by the Secretary no later than 270 days after the date of the
enactment of the Indian Health Care Improvement Act Amendments
of 2003 and shall have no less than a 120-day comment period.
``(3) Expiration of authority.--The authority to promulgate
regulations under this Act shall expire 18 months from the date
of the enactment of this Act.
``(b) Committee.--A negotiated rulemaking committee established
pursuant to section 565 of title 5, United States Code, to carry out
this section shall have as its members only representatives of the
Federal Government and representatives of Indian Tribes and Tribal
Organizations, a majority of whom shall be nominated by and be
representatives of Indian Tribes, Tribal Organizations, and Urban
Indian Organizations from each Service Area.
``(c) Adaptation of Procedures.--The Secretary shall adapt the
negotiated rulemaking procedures to the unique context of self-
governance and the government-to-government relationship between the
United States and Indian Tribes.
``(d) Lack of Regulations.--The lack of promulgated regulations
shall not limit the effect of this Act.
``(e) Inconsistent Regulations.--The provisions of this Act shall
supersede any conflicting provisions of law (including any conflicting
regulations) in effect on the day before the date of the enactment of
the Indian Health Care Improvement Act Amendments of 2003, and the
Secretary is authorized to repeal any regulation inconsistent with the
provisions of this Act.

``SEC. 803. PLAN OF IMPLEMENTATION.

``Not later than 8 months after the date of the enactment of the
Indian Health Care Improvement Act Amendments of 2003, the Secretary in
consultation with Indian Tribes, Tribal Organizations, and Urban Indian
Organizations, shall submit to Congress a plan explaining the manner
and schedule (including a schedule of appropriation requests), by title
and section, by which the Secretary will implement the provisions of
this Act.

``SEC. 804. AVAILABILITY OF FUNDS.

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

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

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

``SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS.

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

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

``(a) Children.--Any individual who--
``(1) has not attained 19 years of age;
``(2) is the natural or adopted child, stepchild, foster
child, legal ward, or orphan of an eligible Indian; and
``(3) is not otherwise eligible for health services
provided by the Service,
shall be eligible for all health services provided by the Service on
the same basis and subject to the same rules that apply to eligible
Indians until such individual attains 19 years of age. The existing and
potential health needs of all such individuals shall be taken into
consideration by the Service in determining the need for, or the
allocation of, the health resources of the Service. If such an
individual has been determined to be legally incompetent prior to
attaining 19 years of age, such individual shall remain eligible for
such services until 1 year after the date of a determination of
competency.
``(b) Spouses.--Any spouse of an eligible Indian who is not an
Indian, or who is of Indian descent but 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 the Indian Tribe(s) being served are made eligible, as a
class, by an appropriate resolution of the governing body of the Indian
Tribe or Tribal Organization providing such services. The health needs
of persons made eligible under this paragraph shall not be taken into
consideration by the Service in determining the need for, or allocation
of, its health resources.
``(c) Provision of Services to Other Individuals.--
``(1) In general.--The Secretary is authorized to provide
health services under this subsection through health programs
operated directly by the Service to individuals who reside
within the Service Unit and who are not otherwise eligible for
such health services if--
``(A) the Indian Tribes served by such Service Unit
request such provision of health services to such
individuals; and
``(B) the Secretary and the served Indian Tribes
have jointly determined that--
``(i) the provision of such health services
will not result in a denial or diminution of
health services to eligible Indians; and
``(ii) there is no reasonable alternative
health facilities or services, within or
without the Service Unit, available to meet the
health needs of such individuals.
``(2) ISDEAA programs.--In the case of a Tribal Health
Program, the governing body of the Indian Tribe or Tribal
Organization providing health services under such Tribal Health
Program is authorized to determine whether health services
should be provided under its Funding Agreement to individuals
who are not otherwise eligible for such services. In making
such determination, the governing body shall take into account
the considerations described in clauses (i) and (ii) of
paragraph (1)(B).
``(3) Payment for services.--
``(A) In general.--Persons receiving health
services provided by the Service under of this
subsection shall be liable for payment of such health
services under a schedule of charges prescribed by the
Secretary which, in the judgment of the Secretary,
results in reimbursement in an amount not less than the
actual cost of providing the health services.
Notwithstanding section 1880(c) of the Social Security
Act, section 404 of this Act, or any other provision of
law, amounts collected under this subsection, including
medicare, medicaid, or SCHIP reimbursements under
titles XVIII, XIX, and XXI of the Social Security Act,
shall be credited to the account of the program
providing the service and shall be used for the
purposes listed in section 401(d)(2) and amounts
collected under this subsection shall be available for
expenditure within such program.
``(B) Indigent people.--Health services may be
provided by the Secretary through the Service under
this subsection to an indigent individual who would not
be otherwise eligible for such health services but for
the provisions of paragraph (1) only if an agreement
has been entered into with a State or local government
under which the State or local government agrees to
reimburse the Service for the expenses incurred by the
Service in providing such health services to such
indigent individual.
``(4) Revocation of consent for services.--
``(A) Single tribe service area.--In the case of a
Service Area which serves only 1 Indian Tribe, the
authority of the Secretary to provide health services
under paragraph (1) shall terminate at the end of the
fiscal year succeeding the fiscal year in which the
governing body of the Indian Tribe revokes its
concurrence to the provision of such health services.
``(B) Multitribal service area.--In the case of a
multitribal Service Area, the authority of the
Secretary to provide health services under paragraph
(1) shall terminate at the end of the fiscal year
succeeding the fiscal year in which at least 51 percent
of the number of Indian Tribes in the Service Area
revoke their concurrence to the provisions of such
health services.
``(d) Other Services.--The Service may provide health services
under this subsection to individuals who are not eligible for health
services provided by the Service under any other provision of law in
order to--
``(1) achieve stability in a medical emergency;
``(2) prevent the spread of a communicable disease or
otherwise deal with a public health hazard;
``(3) provide care to non-Indian women pregnant with an
eligible Indian's child for the duration of the pregnancy
through postpartum; or
``(4) provide care to immediate family members of an
eligible person if such care is directly related to the
treatment of the eligible individual.
``(e) Hospital Privileges for Practitioners.--Hospital privileges
in health facilities operated and maintained by the Service or operated
under a Funding Agreement 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 be regarded as employees of the Federal Government
for purposes of section 1346(b) and chapter 171 of title 28, United
States Code (relating to Federal tort claims) only with respect to acts
or omissions which occur in the course of providing services to
eligible persons as a part of the conditions under which such hospital
privileges are extended.
``(f) Eligible Indian.--For purposes of this section, the term
`eligible Indian' means any Indian who is eligible for health services
provided by the Service without regard to the provisions of this
section.

``SEC. 808. REALLOCATION OF BASE RESOURCES.

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

``SEC. 809. RESULTS OF DEMONSTRATION PROJECTS.

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

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

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

``SEC. 811. MORATORIUM.

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

``SEC. 812. TRIBAL EMPLOYMENT.

``For purposes of section 2(2) of the Act of July 5, 1935 (49 Stat.
450, chapter 372), an Indian Tribe or Tribal Organization carrying out
a Funding Agreement shall not be considered an `employer'.

``SEC. 813. PRIME VENDOR.

``(a) Executive Agency Status.--For purposes of section 201(a) of
the Federal Property and Administrative Services Act (40 U.S.C. 481(a))
(relating to Federal sources of supply, including lodging providers,
airlines, and other transportation providers), a Tribal Health Program
shall be deemed an executive agency when carrying out a contract,
grant, cooperative agreement, or Funding Agreement with the Service and
shall have access to the Federal Supply Schedule and any other Federal
source of supply to which executive agencies have access.
``(b) HHS Status.--For purposes of section 4 of Public Law 102-585
(38 U.S.C. 8126), a Tribal Health Program shall have the status of the
Indian Health Service and shall have direct access to the Veterans
Administration prime vendor provided for in section 4 of Public Law
102-585.
``(c) Employee Status.--The employees of such Tribal Health
Programs may order supplies under such respective programs on the same
basis as employees of the Service.

``SEC. 814. SEVERABILITY PROVISIONS.

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

``SEC. 815. ESTABLISHMENT OF NATIONAL BIPARTISAN COMMISSION ON INDIAN
HEALTH CARE ENTITLEMENT.

``(a) Establishment.--There is hereby established the National
Bipartisan Indian Health Care Entitlement Commission (the
`Commission').
``(b) Duties of Commission.--The duties of the Commission are the
following:
``(1) To establish a study committee composed of those
members of the Commission appointed by the Director and at
least 4 members of Congress from among the members of the
Commission, the duties of which shall be the following:
``(A) To the extent necessary to carry out its
duties, collect and compile data necessary to
understand the extent of Indian needs with regard to
the provision of health services, regardless of the
location of Indians, including holding hearings and
soliciting the views of Indians, Indian Tribes, Tribal
Organizations, and Urban Indian Organizations, which
may include authorizing and making funds available for
feasibility studies of various models for providing and
funding health services for all Indian beneficiaries,
including those who live outside of a reservation,
temporarily or permanently.
``(B) To make recommendations to the Commission for
legislation that will provide for the delivery of
health services for Indians as an entitlement, which
will address, among other things, issues of
eligibility, benefits to be provided, including
recommendations regarding from whom such health
services are to be provided and the cost, including
mechanisms for making funds available for the health
services to be provided.
``(C) To determine the effect of the enactment of
such recommendations on (i) the existing system of
delivery of health services for Indians, and (ii) the
sovereign status of Indian Tribes.
``(D) Not later than 12 months after the
appointment of all members of the Commission, to submit
a written report of its findings and recommendations to
the full Commission. The report shall include a
statement of the minority and majority position of the
Committee and shall be disseminated, at a minimum, to
every Indian Tribe, Tribal Organization, and Urban
Indian Organization for comment to the Commission.
``(E) To report regularly to the full Commission
regarding the findings and recommendations developed by
the study committee in the course of carrying out its
duties under this section.
``(2) To review and analyze the recommendations of the
report of the study committee.
``(3) To make recommendations to Congress for providing
health services for Indians as an entitlement, giving due
regard to the effects of such a program on existing health care
delivery systems for Indians and the effect of such a program
on the sovereign status of Indian Tribes.
``(4) Not later than 18 months following the date of
appointment of all members of the Commission, submit a written
report to Congress containing a recommendation of policies and
legislation to implement a policy that would establish a health
care system for Indians based on delivery of health services as
an entitlement, together with a determination of the
implications of such an entitlement system on existing health
care delivery systems for Indians and on the sovereign status
of Indian Tribes.
``(c) Members.--
``(1) Appointment.--The Commission shall be composed of 25
members, appointed as follows:
``(A) Ten members of Congress, including 3 from the
United States House of Representatives and 2 from the
United States Senate, appointed by their respective
majority leaders, and 3 from the United States House of
Representatives and 2 from the United States Senate,
appointed by their respective minority leaders, and who
shall be members of the standing committees of Congress
that consider legislation affecting health care to
Indians.
``(B) Twelve persons chosen by the Congressional
members of the Commission, 1 from each Service Area as
currently designated by the Director to be chosen from
among 3 nominees from each Service Area put forward by
the Indian Tribes within the area, with due regard
being given to the experience and expertise of the
nominees in the provision of health care to Indians and
to a reasonable representation on the commission of
members who are familiar with various health care
delivery modes and who represent Indian Tribes of
various size populations.
``(C) Three persons appointed by the Director who
are knowledgeable about the provision of health care to
Indians, at least one of whom shall be appointed from
among 3 nominees put forward by those programs whose
funds are provided in whole or in part by the Service
primarily or exclusively for the benefit of Urban
Indians.
``(D) All those persons chosen by the Congressional
members of the Commission and by the Director shall be
members of federally recognized Indian Tribes.
``(2) Chair; vice chair.--The Chair and Vice Chair of the
Commission shall be selected by the Congressional members of
the Commission.
``(3) Terms.--The terms of members of the Commission shall
be for the life of the Commission.
``(4) Deadline for appointments.--Congressional members of
the Commission shall be appointed not later than 90 days after
the date of the enactment of the Indian Health Care Improvement
Act Amendments of 2003, and the remaining members of the
Commission shall be appointed not later than 60 days following
the appointment of the Congressional members.
``(5) Vacancy.--A vacancy in the Commission shall be filled
in the manner in which the original appointment was made.
``(d) Compensation.--
``(1) Congressional members.--Each Congressional member of
the Commission shall receive no additional pay, allowances, or
benefits by reason of their service on the Commission and shall
receive travel expenses and per diem in lieu of subsistence in
accordance with sections 5702 and 5703 of title 5, United
States Code.
``(2) Other members.--Remaining members of the Commission,
while serving on the business of the Commission (including
travel time), shall be entitled to receive compensation at the
per diem equivalent of the rate provided for level IV of the
Executive Schedule under section 5315 of title 5, United States
Code, and while so serving away from home and the member's
regular place of business, a member may be allowed travel
expenses, as authorized by the Chairman of the Commission. For
purpose of pay (other than pay of members of the Commission)
and employment benefits, rights, and privileges, all personnel
of the Commission shall be treated as if they were employees of
the United States Senate.
``(e) Meetings.--The Commission shall meet at the call of the
Chair.
``(f) Quorum.--A quorum of the Commission shall consist of not less
than 15 members, provided that no less than 6 of the members of
Congress who are Commission members are present and no less than 9 of
the members who are Indians are present.
``(g) Executive Director; Staff; Facilities.--
``(1) Appointment; pay.--The Commission shall appoint an
executive director of the Commission. The executive director
shall be paid the rate of basic pay for level V of the
Executive Schedule.
``(2) Staff appointment.--With the approval of the
Commission, the executive director may appoint such personnel
as the executive director deems appropriate.
``(3) Staff pay.--The staff of the Commission shall be
appointed without regard to the provisions of title 5, United
States Code, governing appointments in the competitive service,
and shall be paid without regard to the provisions of chapter
51 and subchapter III of chapter 53 of such title (relating to
classification and General Schedule pay rates).
``(4) Temporary services.--With the approval of the
Commission, the executive director may procure temporary and
intermittent services under section 3109(b) of title 5, United
States Code.
``(5) Facilities.--The Administrator of General Services
shall locate suitable office space for the operation of the
Commission. The facilities shall serve as the headquarters of
the Commission and shall include all necessary equipment and
incidentals required for the proper functioning of the
Commission.
``(h) Hearings.--(1) For the purpose of carrying out its duties,
the Commission may hold such hearings and undertake such other
activities as the Commission determines to be necessary to carry out
its duties, provided that at least 6 regional hearings are held in
different areas of the United States in which large numbers of Indians
are present. Such hearings are to be held to solicit the views of
Indians regarding the delivery of health care services to them. To
constitute a hearing under this subsection, at least 5 members of the
Commission, including at least 1 member of Congress, must be present.
Hearings held by the study committee established in this section may
count towards the number of regional hearings required by this
subsection.
``(2) Upon request of the Commission, the Comptroller General shall
conduct such studies or investigations as the Commission determines to
be necessary to carry out its duties.
``(3)(A) The Director of the Congressional Budget Office or the
Chief Actuary of the Centers for Medicare and Medicaid Services, or
both, shall provide to the Commission, upon the request of the
Commission, such cost estimates as the Commission determines to be
necessary to carry out its duties.
``(B) The Commission shall reimburse the Director of the
Congressional Budget Office for expenses relating to the employment in
the office of the Director of such additional staff as may be necessary
for the Director to comply with requests by the Commission under
subparagraph (A).
``(4) Upon the request of the Commission, the head of any Federal
agency is authorized to detail, without reimbursement, any of the
personnel of such agency to the Commission to assist the Commission in
carrying out its duties. Any such detail shall not interrupt or
otherwise affect the civil service status or privileges of the Federal
employee.
``(5) Upon the request of the Commission, the head of a Federal
agency shall provide such technical assistance to the Commission as the
Commission determines to be necessary to carry out its duties.
``(6) The Commission may use the United States mails in the same
manner and under the same conditions as Federal agencies and shall, for
purposes of the frank, be considered a commission of Congress as
described in section 3215 of title 39, United States Code.
``(7) The Commission may secure directly from any Federal agency
information necessary to enable it to carry out its duties, if the
information may be disclosed under section 552 of title 4, United
States Code. Upon request of the Chairman of the Commission, the head
of such agency shall furnish such information to the Commission.
``(8) Upon the request of the Commission, the Administrator of
General Services shall provide to the Commission on a reimbursable
basis such administrative support services as the Commission may
request.
``(9) For purposes of costs relating to printing and binding,
including the cost of personnel detailed from the Government Printing
Office, the Commission shall be deemed to be a committee of Congress.
``(i) Authorization of Appropriations.--There is authorized to be
appropriated $4,000,000 to carry out the provisions of this section,
which sum shall not be deducted from or affect any other appropriation
for health care for Indian persons.
``(j) FACA.--The Federal Advisory Committee Act (5 U.S.C. App.)
shall not apply to the Commission.

``SEC. 816. APPROPRIATIONS; AVAILABILITY.

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

``SEC. 817. CONFIDENTIALITY OF MEDICAL QUALITY ASSURANCE RECORDS:
QUALIFIED IMMUNITY FOR PARTICIPANTS.

``(a) Confidentiality of Records.--Medical quality assurance
records created by or for any Indian Health Program or a health program
of an Urban Indian Organization as part of a medical quality assurance
program are confidential and privileged. Such records may not be
disclosed to any person or entity, except as provided in subsection
(c).
``(b) Prohibition on Disclosure and Testimony.--
``(1) No part of any medical quality assurance record
described in subsection (a) may be subject to discovery or
admitted into evidence in any judicial or administrative
proceeding, except as provided in subsection (c).
``(2) A person who reviews or creates medical quality
assurance records for any Indian health program or who
participates in any proceeding that reviews or creates such
records may not be permitted or required to testify in any
judicial or administrative proceeding with respect to such
records or with respect to any finding, recommendation,
evaluation, opinion, or action taken by such person or body in
connection with such records except as provided in this section.
``(c) Authorized Disclosure and Testimony.--
``(1) Subject to paragraph (2), a medical quality assurance
record described in subsection (a) may be disclosed, and a
person referred to in subsection (b) may give testimony in
connection with such a record, only as follows:
``(A) To a Federal executive agency or private
organization, if such medical quality assurance record
or testimony is needed by such agency or organization
to perform licensing or accreditation functions related
to any Indian Health Program or to a health program of
an Urban Indian Organization to perform monitoring,
required by law, of such program or organization.
``(B) To an administrative or judicial proceeding
commenced by a present or former Indian Health Program
or Urban Indian Organization provider concerning the
termination, suspension, or limitation of clinical
privileges of such health care provider.
``(C) To a governmental board or agency or to a
professional health care society or organization, if
such medical quality assurance record or testimony is
needed by such board, agency, society, or organization
to perform licensing, credentialing, or the monitoring
of professional standards with respect to any health
care provider who is or was an employee of any Indian
Health Program or Urban Indian Organization.
``(D) To a hospital, medical center, or other
institution that provides health care services, if such
medical quality assurance record or testimony is needed
by such institution to assess the professional
qualifications of any health care provider who is or
was an employee of any Indian Health Program or Urban
Indian Organization and who has applied for or been
granted authority or employment to provide health care
services in or on behalf of such program or
organization.
``(E) To an officer, employee, or contractor of any
Indian Health Program or Urban Indian Organization who
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) With the exception of the subject of a quality
assurance action, the identity of any person receiving health
care services from any Indian Health Program or Urban Indian
Organization or the identity of any other person associated
with such program or organization for purposes of a medical
quality assurance program that is disclosed in a medical
quality assurance record described in subsection (a) shall be
deleted from that record or document before any disclosure of
such record is made outside such program or organization. Such
requirement does not apply to the release of information
pursuant to section 552a of title 5.
``(d) Disclosure for Certain Purposes.--
``(1) 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 Organizations's
medical quality assurance programs.
``(2) 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 General Accounting Office if such record
pertains to any matter within their respective jurisdictions.
``(e) Prohibition on Disclosure of Record or Testimony.--A person
or entity having possession of or access to a record or testimony
described by this section may not disclose the contents of such record
or testimony in any manner or for any purpose except as provided in
this section.
``(f) Exemption From Freedom of Information Act.--Medical quality
assurance records described in subsection (a) may not be made available
to any person under section 552 of title 5.
``(g) Limitation on Civil Liability.--A person who participates in
or provides information to a person or body that reviews or creates
medical quality assurance records described in subsection (a) shall not
be civilly liable for such participation or for providing such
information if the participation or provision of information was in
good faith based on prevailing professional standards at the time the
medical quality assurance program activity took place.
``(h) Application to Information in Certain Other Records.--Nothing
in this section shall be construed as limiting access to the
information in a record created and maintained outside a medical
quality assurance program, including a patient's medical records, on
the grounds that the information was presented during meetings of a
review body that are part of a medical quality assurance program.
``(i) Regulations.--The Secretary, acting through the Service,
shall promulgate regulations pursuant to section 802 of this title.
``(j) Definitions.--In this section:
``(1) The term `medical quality assurance program' means
any activity carried out before, on, or after the date of
enactment of this Act by or for any Indian Health Program or
Urban Indian Organization to assess the quality of medical
care, including activities conducted by individuals, military
medical or dental treatment facility committees, or other review bodies
responsible for quality assurance, credentials, infection control,
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.
``(2) The term `medical quality assurance record' means the
proceedings, records, minutes, and reports that emanate from
quality assurance program activities described in paragraph (1)
and are produced or compiled by an Indian Health Program or
Urban Indian Organization as part of a medical quality
assurance program.
``(3) The term `health care provider' means any health care
professional, including community health aides and
practitioners certified under section 121, who are granted
clinical practice privileges or employed to provide health care
services in an Indian Health Program or health program of an
Urban Indian Organization, who is licensed or certified to
perform health care services by a governmental board or agency
or professional health care society or organization.

``SEC. 818. AUTHORIZATION OF APPROPRIATIONS.

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

SEC. 3. SOBOBA SANITATION FACILITIES.

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

SEC. 4. AMENDMENTS TO MEDICARE PROGRAM.

(a) Expansion of Medicare Payment for All Covered Services
Furnished by Indian Health Programs.--
(1) Expansion to all covered services.--Section 1880 of the
Social Security Act (42 U.S.C. 1395qq) is amended--
(A) by amending the heading to read as follows:

``indian health programs'';

(B) by amending subsection (a) to read as follows:
``(a) An Indian Health Program (as that term is defined in section
4 of the Indian Health Care Improvement Act) shall be eligible for
payments under this title, notwithstanding sections 1814(c) and
1835(d), with respect to covered items and services it furnishes if
(subject to section 408 of such Act) it meets the conditions and
requirements for such payments which apply to the furnishing of such
items and services under this title.''; and
(C) by striking subsection (e).
(2) Elimination of temporary deeming provision, separate
fund requirement, and duplicative annual report.--Such section
is amended by striking subsections (b) through (d).
(3) Reference correction.--Subsection (f) of such section
is redesignated as subsection (b) and is amended by striking
``section 405'' and inserting ``section 401(d)''.
(b) Limitation on Charges for Hospital Contract Health Services
Provided to Indians by Medicare Participating Hospitals.--
(1) In general.--Section 1866(a)(1) of the Social Security
Act (42 U.S.C. 1395cc(a)(1)) is amended--
(A) in subparagraph (R), by striking ``and'' at the
end;
(B) in subparagraph (S), by striking the period and
inserting ``, and''; and
(C) by adding at the end the following new
subparagraph:
``(T) in the case of hospitals and critical access
hospitals which furnish services for which payment may
be made under this title to be a participating
provider--
``(i) under the contract health services
program operated by an Indian Health Program
(as those terms are defined in section 4 of the
Indian Health Care Improvement Act), with
respect to items and services that are covered
under and furnished to an individual eligible
for such program; and
``(ii) under a program funded by the Indian
Health Service and operated by an Urban Indian
Organization with respect to the purchase of
items and services for an eligible Urban Indian
(as those terms are defined in section 4 of the
Indian Health Care Improvement Act (25 U.S.C.
1603);
in accordance with regulations promulgated by the
Secretary regarding admission practices, payment
methodology, and rates of payment (including the
acceptance of not more than such payment rate as
payment in full for such items and services).''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply as of a date specified by the Secretary of Health
and Human Services (but in no case later than 6 months after
the date of the enactment of this Act) to medicare
participation agreements in effect (or entered into) on or
after such date.
(c) Medicare Coverage of Services of Community Health Aides or
Practitioners.--
(1) In general.--Section 1861 of such Act (42 U.S.C. 1395x)
is amended--
(A) in subsection (s)(2)(K)--
(i) in clause (ii), by adding ``and'' at
the end; and
(ii) by adding at the end the following new
clause:
``(iii) services which would be physicians' services if
furnished by a physician (as defined in subsection (r)(1)) and
which are performed by a community health aide or practitioner
which the aide or practitioner is legally authorized to
perform, and such services and supplies furnished as incident
to such services as would be covered under subparagraph (A) if
furnished incident to a physician's professional service but only if no
other provider charges or is paid any amounts with respect to the
professional fee for furnishing of such services (and, in the case of a
telehealth service described in section 1834(m), treating services at
the originating site and the distant site as separate services);''; and
(B) by adding at the end the following new
subsection:

``Community Health Aides or Practitioners

``(ww) The term `community health aides or practitioner' means such
an aide or practitioner who has been certified under the provisions of
section 121 of the Indian Health Care Improvement Act and who only
provides services as an employee of the Indian Health Service, an
Indian Tribe, or Tribal Organization.''.
(2) Payment.--
(A) Payment rate.--Section 1833(a)(1)(O) of such
Act (42 U.S.C. 1395l(a)(1)(O)) is amended--
(i) by striking ``or'' before ``(ii)''; and
(ii) by adding at the end the following:
``or (iii) in the case of services of a
community health aide or practitioner, the
lesser of the actual charge or 80 percent of
the fee schedule amount provided under section
1848,''.
(B) Limitation on balance billing.--Section
1842(b)(18)(C) of such Act (42 U.S.C. 1395u(b)(18)(C))
is amended by adding at the end the following new
clause:
``(vii) A community health aide or practitioner.''.
(3) Effective date.--The amendments made by this subsection
shall apply to services furnished on or after January 1, 2004.
(d) Continuation of Special Treatment for Collaborative
Arrangements Between Indian Health Programs and Hospital Outpatient
Departments.--Section 1833(t)(13) of the Social Security Act (42 U.S.C.
1395l(t)(13)) is amended by adding at the end the following new
subparagraph:
``(B) Extension of treatment of certain
collaborative arrangements.--With respect to the
treatment under this subsection of collaborative
arrangements between a health program operated by the
Indian Health Service, an Indian Tribe, or Tribal
Organization and a hospital operated by such Service or
such an Indian Tribe or Tribal Organization, the
Secretary shall reinstate treatment (as in effect on
January 1, 2000) and extend it to such collaborative
arrangements regardless of when they were entered
into.''.
(e) Coverage of Visiting Nurse Services of Tribal Clinics.--
(1) In general.--Section 1861(aa)(1) of the Social Security
Act (42 U.S.C. 1395x(aa)(1)) is amended by adding at the end
the following:
``For purposes of applying subparagraph (C) (relating to visiting nurse
services), an ambulatory care clinic or other outpatient program of the
Indian Health Service or of an Indian Tribe or a Tribal Organization
(as such terms are defined in section 4 of the Indian Health Care
Improvement Act) shall be treated as if it were a rural health clinic
located in an area described in such subparagraph, and nursing care and
supplies described in such subparagraph and furnished to an individual
as an outpatient of such a tribal clinic or program shall be
reimbursable under this title using the methodology specified in
section 4(f) of the Indian Health Care Improvement Act Amendments of
2003, and, for purposes of this sentence, any reference in such
subparagraph (C) to a licensed practical nurse is also deemed to
include a reference to a home health aide.''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply services furnished on or after January 1, 2004.
(f) Medicare Payment for Outpatient Clinics.--
(1) In general.--Notwithstanding any other provision of
law, for purposes of determining the rate of reimbursement
under title XVIII of the Social Security Act, any outpatient or
ambulatory care clinic (whether freestanding or provider-based)
operated by the Indian Health Service, by an Indian Tribe, or
by a Tribal Organization (as such terms are defined for
purposes of the Indian Health Care Improvement Act) shall, upon
the election of such clinic, be reimbursed on the same basis as
if such clinic were a hospital outpatient department of the
Indian Health Service.
(2) Effective date.--Paragraph (1) shall apply to payment
for services furnished on or after January 1, 2004.
(g) Review of Medicare and Medicaid Payment Systems.--
(1) Study.--
(A) In general.--The Secretary of Health and Human
Services shall conduct a review of the extent to which
the payment methodologies applicable under titles XVIII
and XIX of the Social Security Act (including under
section 1880 of such Act, as amended by this section,
section 1911 of such Act, as amended by section 5(a),
and including payment methodologies in effect at the
time the review is undertaken and payment methodologies
effected under this section or section 5) take into
account the unique or special circumstances of the
provision of covered services to Indians by the Indian
Health Service, Indian Tribes, Tribal Organizations,
and Urban Indian Organizations (as such terms are
defined in section 4 of the Indian Health Care
Improvement Act).
(B) Matters considered.--In particular, the
Secretary shall review the sufficiency of the payment
amounts under such methodologies in assuring access to
care and payment rates consistent with the payment
rates for most favored providers.
(C) Consultation.--In conducting the study, the
Secretary shall consult with the Indian Health Service,
Indian Tribes, Tribal Organizations, and Urban Indian
Organizations.
(2) Report.--Not later than 2 years after the date of
implementation of the amendments made by subsection (a) (or, if
later, the date of implementation of the amendments made by
section 5(a)), the Secretary shall submit to Congress a report
on the review under paragraph (1). Such report shall include
recommendations for such adjustments to such payment
methodologies as may be necessary to assure that payment
amounts under the medicare and medicaid programs to such
Service, Indian Tribes, Tribal Organizations, and Urban Indian
Organizations are sufficient to provide access to quality care.
(3) Retention of current payment methodology.--
Notwithstanding any other provision of law, the Secretary shall
retain the all-inclusive payment methodology for encounter
rates for the Indian Health Service, Indian Tribes, and Tribal
Organizations under titles XVIII and XIX of the Social Security
Act unless the use of such methodology is expressly prohibited
or otherwise superceded by Act of Congress.

SEC. 5. AMENDMENTS TO MEDICAID PROGRAM AND STATE CHILDREN'S HEALTH
INSURANCE PROGRAM (SCHIP).

(a) Expansion of Medicaid Payment for All Covered Services
Furnished by Indian Health Programs.--
(1) Expansion to all covered services.--Section 1911 of the
Social Security Act (42 U.S.C. 1396j) is amended--
(A) by amending the heading to read as follows:

``indian health programs''; and

(B) by amending subsection (a) to read as follows:
``(a) The Indian Health Service and an Indian Tribe or Tribal
Organization (as those terms are defined in section 4 of the Indian
Health Care Improvement Act) shall be eligible for reimbursement for
medical assistance provided under a State plan with respect to covered
items and services it furnishes if it meets all the conditions and
requirements which are applicable generally to the furnishing of such
items and services under this title.''.
(2) Elimination of temporary deeming provision--Such
section is amended by striking subsection (b).
(3) Revision of authority to enter into agreements.--
Subsection (c) of such section is redesignated as subsection
(b) and is amended to read as follows:
``(b) The Secretary may enter into agreements with the State agency
for the purpose of reimbursing such agency for health care and services
provided by the Indian Health Service, Indian Tribes, Tribal
Organizations, or Urban Indian Organizations (as such terms are defined
in section 4 of the Indian Health Care Improvement Act), directly,
through referral, or under contracts or other arrangements between the
Indian Health Service, an Indian Tribe or Tribal Organization, or an
Urban Indian Organization and another health care provider to Indians
who are eligible for medical assistance under the State plan.''.
(4) Reference correction.--Subsection (d) of such section
is redesignated as subsection (c) and is amended by striking
``section 405'' and inserting ``section 401(d)''.
(b) Seeking Advice From Indian Health Programs.--Section 1902(a) of
the Social Security Act (42 U.S.C. 1396a(a)) is amended--
(1) in paragraph (64), by striking ``and'' at the end;
(2) in paragraph (65), by striking the period and inserting
``; and''; and
(3) by inserting after paragraph (65), the following new
paragraph:
``(66) if the Indian Health Service operates or funds
health programs in the State or if there are Indian Tribes,
Tribal Organizations, or Urban Indian Organizations (as those
terms are defined in section 4 of the Indian Health Care
Improvement Act) providing health care in the State for which
medical assistance is available, provide for the establishment
and maintenance of the advisory process described in section
409(b) of such Act.''.
(c) SCHIP Treatment of Indian Tribes, Tribal Organizations, and
Urban Indian Organizations.--Section 2105(c)(6)(B) of such Act (42
U.S.C. 1397ee(c)(6)(B)) is amended by inserting ``or by an Indian
Tribe, Tribal Organization, or Urban Indian Organization (as such terms
are defined in section 4 of the Indian Health Care Improvement Act)''
after ``Service''.
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