[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 556 Reported in Senate (RS)]
Calendar No. 802
108th CONGRESS
2d Session
S. 556
[Report No. 108-411]
To amend the Indian Health Care Improvement Act to revise and extend
that Act.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 6, 2003
Mr. Campbell (for himself, Mr. Inouye, Mr. McCain, Mr. Johnson, Mrs.
Murray, Mr. Daschle, Mr. Bingaman, Mr. Dorgan, Ms. Murkowski, and Ms.
Cantwell) introduced the following bill; which was read twice and
referred to the Committee on Indian Affairs
November 16, 2004
Reported by Mr. Campbell, with an amendment
[Strike out all after the enacting clause and insert the part printed
in italic]
_______________________________________________________________________
A BILL
To amend the Indian Health Care Improvement Act to revise and extend
that Act.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
<DELETED>SECTION 1. SHORT TITLE; TABLE OF CONTENTS.</DELETED>
<DELETED> (a) Short Title.--This Act may be cited as the ``Indian
Health Care Improvement Act Reauthorization of 2003''.</DELETED>
<DELETED> (b) Table of Contents.--The table of contents for this Act
is as follows:</DELETED>
<DELETED>Sec. 1. Short title.
<DELETED>TITLE I--REAUTHORIZATION AND REVISIONS OF THE INDIAN HEALTH
CARE IMPROVEMENT ACT
<DELETED>Sec. 101. Amendment to the Indian Health Care Improvement Act.
<DELETED>TITLE II--CONFORMING AMENDMENTS TO THE SOCIAL SECURITY ACT
<DELETED>Subtitle A--Medicare
<DELETED>Sec. 201. Limitations on charges.
<DELETED>Sec. 202. Qualified Indian health program.
<DELETED>Subtitle B--Medicaid
<DELETED>Sec. 211. State consultation with Indian health programs.
<DELETED>Sec. 212. FMAP for services provided by Indian health
programs.
<DELETED>Sec. 213. Indian Health Service programs.
<DELETED>Subtitle C--State Children's Health Insurance Program
<DELETED>Sec. 221. Enhanced FMAP for State children's health insurance
program.
<DELETED>Sec. 222. Direct funding of State children's health insurance
program.
<DELETED>Subtitle D--Authorization of Appropriations
<DELETED>Sec. 231. Authorization of appropriations.
<DELETED>TITLE III--MISCELLANEOUS PROVISIONS
<DELETED>Sec. 301. Repeals.
<DELETED>Sec. 302. Severability provisions.
<DELETED>Sec. 303. Effective date.
<DELETED>TITLE I--REAUTHORIZATION AND REVISIONS OF THE INDIAN HEALTH
CARE IMPROVEMENT ACT</DELETED>
<DELETED>SEC. 101. AMENDMENT TO THE INDIAN HEALTH CARE IMPROVEMENT
ACT.</DELETED>
<DELETED> The Indian Health Care Improvement Act (25 U.S.C. 1601 et
seq.) is amended to read as follows:</DELETED>
<DELETED>``SECTION 1. SHORT TITLE; TABLE OF CONTENTS.</DELETED>
<DELETED> ``(a) Short Title.--This Act may be cited as the `Indian
Health Care Improvement Act'.</DELETED>
<DELETED> ``(b) Table of Contents.--The table of contents for this
Act is as follows:</DELETED>
<DELETED>``Sec. 1. Short title; table of contents.
<DELETED>``Sec. 2. Findings.
<DELETED>``Sec. 3. Declaration of health objectives.
<DELETED>``Sec. 4. Definitions.
<DELETED>``TITLE I--INDIAN HEALTH, HUMAN RESOURCES AND DEVELOPMENT
<DELETED>``Sec. 101. Purpose.
<DELETED>``Sec. 102. General requirements.
<DELETED>``Sec. 103. Health professions recruitment program for
Indians.
<DELETED>``Sec. 104. Health professions preparatory scholarship
program for Indians.
<DELETED>``Sec. 105. Indian health professions scholarships.
<DELETED>``Sec. 106. American Indians into psychology program.
<DELETED>``Sec. 107. Indian Health Service extern programs.
<DELETED>``Sec. 108. Continuing education allowances.
<DELETED>``Sec. 109. Community health representative program.
<DELETED>``Sec. 110. Indian Health Service loan repayment
program.
<DELETED>``Sec. 111. Scholarship and loan repayment recovery
fund.
<DELETED>``Sec. 112. Recruitment activities.
<DELETED>``Sec. 113. Tribal recruitment and retention program.
<DELETED>``Sec. 114. Advanced training and research.
<DELETED>``Sec. 115. Nursing programs; Quentin N. Burdick
American Indians into Nursing Program.
<DELETED>``Sec. 116. Tribal culture and history.
<DELETED>``Sec. 117. INMED program.
<DELETED>``Sec. 118. Health training programs of community
colleges.
<DELETED>``Sec. 119. Retention bonus.
<DELETED>``Sec. 120. Nursing residency program.
<DELETED>``Sec. 121. Community health aide program for Alaska.
<DELETED>``Sec. 122. Tribal health program administration.
<DELETED>``Sec. 123. Health professional chronic shortage
demonstration project.
<DELETED>``Sec. 124. Scholarships.
<DELETED>``Sec. 125. National Health Service Corps.
<DELETED>``Sec. 126. Substance abuse counselor education
demonstration project.
<DELETED>``Sec. 127. Mental health training and community
education.
<DELETED>``Sec. 128. Authorization of appropriations.
<DELETED>``TITLE II--HEALTH SERVICES
<DELETED>``Sec. 201. Indian Health Care Improvement Fund.
<DELETED>``Sec. 202. Catastrophic Health Emergency Fund.
<DELETED>``Sec. 203. Health promotion and disease prevention
services.
<DELETED>``Sec. 204. Diabetes prevention, treatment, and
control.
<DELETED>``Sec. 205. Shared services.
<DELETED>``Sec. 206. Health services research.
<DELETED>``Sec. 207. Mammography and other cancer screening.
<DELETED>``Sec. 208. Patient travel costs.
<DELETED>``Sec. 209. Epidemiology centers.
<DELETED>``Sec. 210. Comprehensive school health education
programs.
<DELETED>``Sec. 211. Indian youth program.
<DELETED>``Sec. 212. Prevention, control, and elimination of
communicable and infectious diseases.
<DELETED>``Sec. 213. Authority for provision of other services.
<DELETED>``Sec. 214. Indian women's health care.
<DELETED>``Sec. 215. Environmental and nuclear health hazards.
<DELETED>``Sec. 216. Arizona as a contract health service
delivery area.
<DELETED>``Sec. 216A. North Dakota as a contract health service
delivery area.
<DELETED>``Sec. 216B. South Dakota as a contract health service
delivery area.
<DELETED>``Sec. 217. California contract health services
demonstration program.
<DELETED>``Sec. 218. California as a contract health service
delivery area.
<DELETED>``Sec. 219. Contract health services for the Trenton
service area.
<DELETED>``Sec. 220. Programs operated by Indian tribes and
tribal organizations.
<DELETED>``Sec. 221. Licensing.
<DELETED>``Sec. 222. Authorization for emergency contract
health services.
<DELETED>``Sec. 223. Prompt action on payment of claims.
<DELETED>``Sec. 224. Liability for payment.
<DELETED>``Sec. 225. Authorization of appropriations.
<DELETED>``TITLE III--FACILITIES
<DELETED>``Sec. 301. Consultation, construction and renovation
of facilities; reports.
<DELETED>``Sec. 302. Safe water and sanitary waste disposal
facilities.
<DELETED>``Sec. 303. Preference to Indians and Indian firms.
<DELETED>``Sec. 304. Soboba sanitation facilities.
<DELETED>``Sec. 305. Expenditure of nonservice funds for
renovation.
<DELETED>``Sec. 306. Funding for the construction, expansion,
and modernization of small ambulatory care
facilities.
<DELETED>``Sec. 307. Indian health care delivery demonstration
project.
<DELETED>``Sec. 308. Land transfer.
<DELETED>``Sec. 309. Leases.
<DELETED>``Sec. 310. Loans, loan guarantees and loan repayment.
<DELETED>``Sec. 311. Tribal leasing.
<DELETED>``Sec. 312. Indian Health Service/tribal facilities
joint venture program.
<DELETED>``Sec. 313. Location of facilities.
<DELETED>``Sec. 314. Maintenance and improvement of health care
facilities.
<DELETED>``Sec. 315. Tribal management of federally-owned
quarters.
<DELETED>``Sec. 316. Applicability of buy American requirement.
<DELETED>``Sec. 317. Other funding for facilities.
<DELETED>``Sec. 318. Authorization of appropriations.
<DELETED>``TITLE IV--ACCESS TO HEALTH SERVICES
<DELETED>``Sec. 401. Treatment of payments under medicare
program.
<DELETED>``Sec. 402. Treatment of payments under medicaid
program.
<DELETED>``Sec. 403. Report.
<DELETED>``Sec. 404. Grants to and funding agreements with the
service, Indian tribes or tribal
organizations, and urban Indian
organizations.
<DELETED>``Sec. 405. Direct billing and reimbursement of
medicare, medicaid, and other third party
payors.
<DELETED>``Sec. 406. Reimbursement from certain third parties
of costs of health services.
<DELETED>``Sec. 407. Crediting of reimbursements.
<DELETED>``Sec. 408. Purchasing health care coverage.
<DELETED>``Sec. 409. Indian Health Service, Department of
Veteran's Affairs, and other Federal agency
health facilities and services sharing.
<DELETED>``Sec. 410. Payor of last resort.
<DELETED>``Sec. 411. Right to recover from Federal health care
programs.
<DELETED>``Sec. 412. Tuba City demonstration project.
<DELETED>``Sec. 413. Access to Federal insurance.
<DELETED>``Sec. 414. Consultation and rulemaking.
<DELETED>``Sec. 415. Limitations on charges.
<DELETED>``Sec. 416. Limitation on Secretary's waiver
authority.
<DELETED>``Sec. 417. Waiver of medicare and medicaid sanctions.
<DELETED>``Sec. 418. Meaning of `remuneration' for purposes of
safe harbor provisions; antitrust immunity.
<DELETED>``Sec. 419. Co-insurance, co-payments, deductibles and
premiums.
<DELETED>``Sec. 420. Inclusion of income and resources for
purposes of medically needy medicaid
eligibility.
<DELETED>``Sec. 421. Estate recovery provisions.
<DELETED>``Sec. 422. Medical child support.
<DELETED>``Sec. 423. Provisions relating to managed care.
<DELETED>``Sec. 424. Navajo Nation medicaid agency.
<DELETED>``Sec. 425. Indian advisory committees.
<DELETED>``Sec. 426. Authorization of appropriations.
<DELETED>``TITLE V--HEALTH SERVICES FOR URBAN INDIANS
<DELETED>``Sec. 501. Purpose.
<DELETED>``Sec. 502. Contracts with, and grants to, urban
Indian organizations.
<DELETED>``Sec. 503. Contracts and grants for the provision of
health care and referral services.
<DELETED>``Sec. 504. Contracts and grants for the determination
of unmet health care needs.
<DELETED>``Sec. 505. Evaluations; renewals.
<DELETED>``Sec. 506. Other contract and grant requirements.
<DELETED>``Sec. 507. Reports and records.
<DELETED>``Sec. 508. Limitation on contract authority.
<DELETED>``Sec. 509. Facilities.
<DELETED>``Sec. 510. Office of Urban Indian Health.
<DELETED>``Sec. 511. Grants for alcohol and substance abuse
related services.
<DELETED>``Sec. 512. Treatment of certain demonstration
projects.
<DELETED>``Sec. 513. Urban NIAAA transferred programs.
<DELETED>``Sec. 514. Consultation with urban Indian
organizations.
<DELETED>``Sec. 515. Federal Tort Claims Act coverage.
<DELETED>``Sec. 516. Urban youth treatment center
demonstration.
<DELETED>``Sec. 517. Use of Federal government facilities and
sources of supply.
<DELETED>``Sec. 518. Grants for diabetes prevention, treatment
and control.
<DELETED>``Sec. 519. Community health representatives.
<DELETED>``Sec. 520. Regulations.
<DELETED>``Sec. 521. Authorization of appropriations.
<DELETED>``TITLE VI--ORGANIZATIONAL IMPROVEMENTS
<DELETED>``Sec. 601. Establishment of the Indian Health Service
as an agency of the Public Health Service.
<DELETED>``Sec. 602. Automated management information system.
<DELETED>``Sec. 603. Authorization of appropriations.
<DELETED>``TITLE VII--BEHAVIORAL HEALTH PROGRAMS
<DELETED>``Sec. 701. Behavioral health prevention and treatment
services.
<DELETED>``Sec. 702. Memorandum of agreement with the
Department of the Interior.
<DELETED>``Sec. 703. Comprehensive behavioral health prevention
and treatment program.
<DELETED>``Sec. 704. Mental health technician program.
<DELETED>``Sec. 705. Licensing requirement for mental health
care workers.
<DELETED>``Sec. 706. Indian women treatment programs.
<DELETED>``Sec. 707. Indian youth program.
<DELETED>``Sec. 708. Inpatient and community-based mental
health facilities design, construction and
staffing assessment.
<DELETED>``Sec. 709. Training and community education.
<DELETED>``Sec. 710. Behavioral health program.
<DELETED>``Sec. 711. Fetal alcohol disorder funding.
<DELETED>``Sec. 712. Child sexual abuse and prevention
treatment programs.
<DELETED>``Sec. 713. Behavioral mental health research.
<DELETED>``Sec. 714. Definitions.
<DELETED>``Sec. 715. Authorization of appropriations.
<DELETED>``TITLE VIII--MISCELLANEOUS
<DELETED>``Sec. 801. Reports.
<DELETED>``Sec. 802. Regulations.
<DELETED>``Sec. 803. Plan of implementation.
<DELETED>``Sec. 804. Availability of funds.
<DELETED>``Sec. 805. Limitation on use of funds appropriated to
the Indian Health Service.
<DELETED>``Sec. 806. Eligibility of California Indians.
<DELETED>``Sec. 807. Health services for ineligible persons.
<DELETED>``Sec. 808. Reallocation of base resources.
<DELETED>``Sec. 809. Results of demonstration projects.
<DELETED>``Sec. 810. Provision of services in Montana.
<DELETED>``Sec. 811. Moratorium.
<DELETED>``Sec. 812. Tribal employment.
<DELETED>``Sec. 813. Prime vendor.
<DELETED>``Sec. 814. National Bi-Partisan Commission on Indian
Health Care Entitlement.
<DELETED>``Sec. 815. Appropriations; availability.
<DELETED>``Sec. 816. Authorization of appropriations.
<DELETED>``SEC. 2. FINDINGS.</DELETED>
<DELETED> ``Congress makes the following findings:</DELETED>
<DELETED> ``(1) Federal delivery of health services and
funding of tribal and urban Indian health programs to maintain
and improve the health of the Indians are consonant with and
required by the Federal Government's historical and unique
legal relationship with the American Indian people, as
reflected in the Constitution, treaties, Federal laws, and the
course of dealings of the United States with Indian tribes, and
the United States' resulting government to government and trust
responsibility and obligations to the American Indian
people.</DELETED>
<DELETED> ``(2) From the time of European occupation and
colonization through the 20th century, the policies and
practices of the United States caused or contributed to the
severe health conditions of Indians.</DELETED>
<DELETED> ``(3) Indian tribes have, 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
secured a de facto contract that entitles Indians to health
care in perpetuity, based on the moral, legal, and historic
obligation of the United States.</DELETED>
<DELETED> ``(4) The population growth of the Indian people
that began in the later part of the 20th century increases the
need for Federal health care services.</DELETED>
<DELETED> ``(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, a level
that is not 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 services.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(7) Despite such services, the unmet health
needs of the American Indian people remain alarmingly severe,
and even continue to increase, and the health status of the
Indians is far below the health status of the general
population of the United States.</DELETED>
<DELETED> ``(8) The disparity in health status that is to be
addressed is formidable. In death rates for example, Indian
people suffer a death rate for diabetes mellitus that is 249
percent higher than the death rate for all races in the United
States, a pneumonia and influenza death rate that is 71 percent
higher, a tuberculosis death rate that is 533 percent higher,
and a death rate from alcoholism that is 627 percent
higher.</DELETED>
<DELETED>``SEC. 3. DECLARATION OF HEALTH OBJECTIVES.</DELETED>
<DELETED> ``Congress hereby declares that it is the policy of the
United States, in fulfillment of its special trust responsibilities and
legal obligations to the American Indian people--</DELETED>
<DELETED> ``(1) to assure the highest possible health status
for Indians and to provide all resources necessary to effect
that policy;</DELETED>
<DELETED> ``(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 any successor
standards thereto;</DELETED>
<DELETED> ``(3) in order to raise the health status of
Indian people to at least the levels set forth in the goals
contained within the Healthy People 2010, or any successor
standards thereto, to permit Indian tribes and tribal
organizations to set their own health care priorities and
establish goals that reflect their unmet needs;</DELETED>
<DELETED> ``(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 geographic service area is raised
to at least the level of that of the general
population;</DELETED>
<DELETED> ``(5) to require meaningful, active consultation
with Indian tribes, Indian organizations, and urban Indian
organizations to implement this Act and the national policy of Indian
self-determination; and</DELETED>
<DELETED> ``(6) that funds for health care programs and
facilities operated by tribes and tribal organizations be
provided in amounts that are not less than the funds that are
provided to programs and facilities operated directly by the
Service.</DELETED>
<DELETED>``SEC. 4. DEFINITIONS.</DELETED>
<DELETED> ``In this Act:</DELETED>
<DELETED> ``(1) Accredited and accessible.--The term
`accredited and accessible', with respect to an entity, means a
community college or other appropriate entity that is on or
near a reservation and accredited by a national or regional
organization with accrediting authority.</DELETED>
<DELETED> ``(2) Area office.--The term `area office' means
an administrative entity including a program office, within the
Indian Health Service through which services and funds are
provided to the service units within a defined geographic
area.</DELETED>
<DELETED> ``(3) Assistant secretary.--The term `Assistant
Secretary' means the Assistant Secretary of the Indian Health
as established under section 601.</DELETED>
<DELETED> ``(4) Contract health service.--The term `contract
health service' means a health service that is provided at the
expense of the Service, Indian tribe, or tribal organization by a
public or private medical provider or hospital, other than a service
funded under the Indian Self-Determination and Education Assistance Act
or under this Act.</DELETED>
<DELETED> ``(5) Department.--The term `Department', unless
specifically provided otherwise, means the Department of Health
and Human Services.</DELETED>
<DELETED> ``(6) Fund.--The terms `fund' or `funding' mean
the transfer of monies from the Department to any eligible
entity or individual under this Act by any legal means,
including funding agreements, contracts, memoranda of
understanding, Buy Indian Act contracts, or
otherwise.</DELETED>
<DELETED> ``(7) Funding agreement.--The term `funding
agreement' means any agreement to transfer funds for the
planning, conduct, and administration of programs, functions,
services and activities to tribes and tribal organizations from
the Secretary under the authority of the Indian Self-
Determination and Education Assistance Act.</DELETED>
<DELETED> ``(8) Health profession.--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, and allied health professions, or any other health
profession.</DELETED>
<DELETED> ``(9) Health promotion; disease prevention.--The
terms `health promotion' and `disease prevention' shall have
the meanings given such terms in paragraphs (1) and (2) of
section 203(c).</DELETED>
<DELETED> ``(10) Indian.--The term `Indian' and `Indians'
shall have meanings given such terms for purposes of the Indian
Self-Determination and Education Assistance Act.</DELETED>
<DELETED> ``(11) Indian health program.--The term `Indian
health program' shall have the meaning given such term in
section 110(a)(2)(A).</DELETED>
<DELETED> ``(12) Indian tribe.--The term `Indian tribe'
shall have the meaning given such term in section 4(e) of the
Indian Self Determination and Education Assistance
Act.</DELETED>
<DELETED> ``(13) Reservation.--The term `reservation' means
any federally recognized Indian tribe's reservation, Pueblo or
colony, including former reservations in Oklahoma, Alaska
Native Regions established pursuant to the Alaska Native Claims
Settlement Act, and Indian allotments.</DELETED>
<DELETED> ``(14) Secretary.--The term `Secretary', unless
specifically provided otherwise, means the Secretary of Health
and Human Services.</DELETED>
<DELETED> ``(15) Service.--The term `Service' means the
Indian Health Service.</DELETED>
<DELETED> ``(16) Service area.--The term `service area'
means the geographical area served by each area
office.</DELETED>
<DELETED> ``(17) Service unit.--The term `service unit'
means--</DELETED>
<DELETED> ``(A) an administrative entity within the
Indian Health Service; or</DELETED>
<DELETED> ``(B) a tribe or tribal organization
operating health care programs or facilities with funds
from the Service under the Indian Self-Determination
and Education Assistance Act, through which services
are provided, directly or by contract, to the eligible
Indian population within a defined geographic
area.</DELETED>
<DELETED> ``(18) Traditional health care practices.--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 embodies the influences or forces of innate
tribal discovery, history, description, explanation and
knowledge of the states of wellness and illness and which calls
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.</DELETED>
<DELETED> ``(19) Tribal organization.--The term `tribal
organization' shall have the meaning given such term in section
4(l) of the Indian Self Determination and Education Assistance
Act.</DELETED>
<DELETED> ``(20) Tribally controlled community college.--The
term `tribally controlled community college' shall have the
meaning given such term in section 126 (g)(2).</DELETED>
<DELETED> ``(21) Urban center.--The term `urban center'
means any community that has a sufficient urban Indian
population with unmet health needs to warrant assistance under
title V, as determined by the Secretary.</DELETED>
<DELETED> ``(22) Urban indian.--The term `urban Indian'
means any individual who resides in an urban center and who--
</DELETED>
<DELETED> ``(A) for purposes of title V and
regardless of whether such individual lives on or near
a reservation, is a member of a tribe, band or other
organized group of Indians, including those tribes,
bands or groups terminated since 1940 and those 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;</DELETED>
<DELETED> ``(B) is an Eskimo or Aleut or other
Alaskan Native;</DELETED>
<DELETED> ``(C) is considered by the Secretary of
the Interior to be an Indian for any purpose;
or</DELETED>
<DELETED> ``(D) is determined to be an Indian under
regulations promulgated by the Secretary.</DELETED>
<DELETED> ``(23) Urban indian organization.--The term `urban
Indian organization' means a nonprofit corporate body situated
in an urban center, governed by an urban Indian controlled
board of directors, and providing for the participation of all
interested Indian groups and individuals, and which is capable
of legally cooperating with other public and private entities
for the purpose of performing the activities described in
section 503(a).</DELETED>
<DELETED>``TITLE I--INDIAN HEALTH, HUMAN RESOURCES AND
DEVELOPMENT</DELETED>
<DELETED>``SEC. 101. PURPOSE.</DELETED>
<DELETED> ``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 Service, Indian tribes, tribal
organizations, and urban Indian organizations involved in the provision
of health services to Indian people.</DELETED>
<DELETED>``SEC. 102. GENERAL REQUIREMENTS.</DELETED>
<DELETED> ``(a) Service Area Priorities.--Unless specifically
provided otherwise, amounts appropriated for each fiscal year to carry
out each program authorized under this title shall be allocated by the
Secretary to the area office of each service area using a formula--
</DELETED>
<DELETED> ``(1) to be developed in consultation with Indian
tribes, tribal organizations and urban Indian
organizations;</DELETED>
<DELETED> ``(2) that takes into account the human resource
and development needs in each such service area; and</DELETED>
<DELETED> ``(3) that weighs the allocation of amounts
appropriated in favor of those service areas where the health
status of Indians within the area, as measured by life
expectancy based upon the most recent data available, is
significantly lower than the average health status for Indians
in all service areas, except that amounts allocated to each
such area using such a weighted allocation formula shall not be
less than the amounts allocated to each such area in the
previous fiscal year.</DELETED>
<DELETED> ``(b) Consultation.--Each area office receiving funds
under this title shall actively and continuously consult with
representatives of Indian tribes, tribal organizations, and urban
Indian organizations to prioritize the utilization of funds provided
under this title within the service area.</DELETED>
<DELETED> ``(c) Reallocation.--Unless specifically prohibited, an
area office may reallocate funds provided to the office under this
title among the programs authorized by this title, except that
scholarship and loan repayment funds shall not be used for
administrative functions or expenses.</DELETED>
<DELETED> ``(d) Limitation.--This section shall not apply with
respect to individual recipients of scholarships, loans or other funds
provided under this title (as this title existed 1 day prior to the
date of enactment of this Act) until such time as the individual
completes the course of study that is supported through the use of such
funds.</DELETED>
<DELETED>``SEC. 103. HEALTH PROFESSIONS RECRUITMENT PROGRAM FOR
INDIANS.</DELETED>
<DELETED> ``(a) In General.--The Secretary, acting through the
Service, shall make funds available through the area office to public
or nonprofit private health entities, or Indian tribes or tribal
organizations to assist such entities in meeting the costs of--
</DELETED>
<DELETED> ``(1) identifying Indians with a potential for
education or training in the health professions and encouraging
and assisting them--</DELETED>
<DELETED> ``(A) to enroll in courses of study in
such health professions; or</DELETED>
<DELETED> ``(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;</DELETED>
<DELETED> ``(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</DELETED>
<DELETED> ``(3) establishing other programs which the area
office 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).</DELETED>
<DELETED> ``(b) Administrative Provisions.--</DELETED>
<DELETED> ``(1) Application.--To be eligible to receive
funds under this section an entity described in subsection (a)
shall submit to the Secretary, through the appropriate area
office, and have approved, an application in such form,
submitted in such manner, and containing such information as
the Secretary shall by regulation prescribe.</DELETED>
<DELETED> ``(2) Preference.--In awarding funds under this
section, the area office shall give a preference to
applications submitted by Indian tribes, tribal organizations,
or urban Indian organizations.</DELETED>
<DELETED> ``(3) Amount.--The amount of funds to be provided
to an eligible entity under this section shall be determined by
the area office. Payments under 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 promulgated
pursuant to this Act.</DELETED>
<DELETED> ``(4) Terms.--A funding commitment under this
section shall, to the extent not otherwise prohibited by law,
be for a term of 3 years, as provided for in regulations
promulgated pursuant to this Act.</DELETED>
<DELETED> ``(c) Definition.--For purposes of this section and
sections 104 and 105, the terms `Indian' and `Indians' shall, in
addition to the definition provided for in section 4, mean any
individual who--</DELETED>
<DELETED> ``(1) irrespective of whether such individual
lives on or near a reservation, is a member of a tribe, band,
or other organized group of Indians, including those tribes,
bands, or groups terminated since 1940;</DELETED>
<DELETED> ``(2) is an Eskimo or Aleut or other Alaska
Native;</DELETED>
<DELETED> ``(3) is considered by the Secretary of the
Interior to be an Indian for any purpose; or</DELETED>
<DELETED> ``(4) is determined to be an Indian under
regulations promulgated by the Secretary.</DELETED>
<DELETED>``SEC. 104. HEALTH PROFESSIONS PREPARATORY SCHOLARSHIP PROGRAM
FOR INDIANS.</DELETED>
<DELETED> ``(a) In General.--The Secretary, acting through the
Service, shall provide scholarships through the area offices to Indians
who--</DELETED>
<DELETED> ``(1) have successfully completed their high
school education or high school equivalency; and</DELETED>
<DELETED> ``(2) have demonstrated the capability to
successfully complete courses of study in the health
professions.</DELETED>
<DELETED> ``(b) Purpose.--Scholarships provided under this section
shall be for the following purposes:</DELETED>
<DELETED> ``(1) Compensatory preprofessional education of
any recipient. Such scholarship shall not exceed 2 years on a
full-time basis (or the part-time equivalent thereof, as
determined by the area office pursuant to regulations
promulgated under this Act).</DELETED>
<DELETED> ``(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 (or the part-time
equivalent thereof, as determined by the area office pursuant
to regulations promulgated under this Act) except that an
extension of up to 2 years may be approved by the
Secretary.</DELETED>
<DELETED> ``(c) Use of Scholarship.--Scholarships made under this
section may be used to cover costs of tuition, books, transportation,
board, and other necessary related expenses of a recipient while
attending school.</DELETED>
<DELETED> ``(d) Limitations.--Scholarship assistance to an eligible
applicant under this section shall not be denied solely on the basis
of--</DELETED>
<DELETED> ``(1) the applicant's scholastic achievement if
such applicant has been admitted to, or maintained good
standing at, an accredited institution; or</DELETED>
<DELETED> ``(2) the applicant's eligibility for assistance
or benefits under any other Federal program.</DELETED>
<DELETED>``SEC. 105. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.</DELETED>
<DELETED> ``(a) Scholarships.--</DELETED>
<DELETED> ``(1) In general.--In order to meet the needs of
Indians, Indian tribes, tribal organizations, and urban Indian
organizations for health professionals, the Secretary, acting
through the Service and in accordance with this section, shall
provide scholarships through the area offices to Indians who
are enrolled full or part time in accredited schools and
pursuing courses of study in the health professions. Such
scholarships shall be designated Indian Health Scholarships and
shall, except as provided in subsection (b), be made in
accordance with section 338A of the Public Health Service Act
(42 U.S.C. 254l).</DELETED>
<DELETED> ``(2) No delegation.--The Director of the Service
shall administer this section and shall not delegate any
administrative functions under a funding agreement pursuant to
the Indian Self-Determination and Education Assistance
Act.</DELETED>
<DELETED> ``(b) Eligibility.--</DELETED>
<DELETED> ``(1) Enrollment.--An Indian shall be eligible for
a scholarship under subsection (a) in any year in which such
individual is enrolled full or part time in a course of study referred
to in subsection (a)(1).</DELETED>
<DELETED> ``(2) Service obligation.--</DELETED>
<DELETED> ``(A) Public health service act.--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--
</DELETED>
<DELETED> ``(i) in the Indian Health
Service;</DELETED>
<DELETED> ``(ii) in a program conducted
under a funding agreement entered into under
the Indian Self-Determination and Education
Assistance Act;</DELETED>
<DELETED> ``(iii) in a program assisted
under title V; or</DELETED>
<DELETED> ``(iv) 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.</DELETED>
<DELETED> ``(B) Deferring active service.--At the
request of any Indian who has entered into a contract
referred to in subparagraph (A) 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:</DELETED>
<DELETED> ``(i) No period of internship,
residency, or other advanced clinical training
shall be counted as satisfying any period of
obligated service that is required under this
section.</DELETED>
<DELETED> ``(ii) 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).</DELETED>
<DELETED> ``(iii) The active duty service
obligation will be served in the health
profession of that individual, in a manner
consistent with clauses (i) through (iv) of
subparagraph (A).</DELETED>
<DELETED> ``(C) New scholarship recipients.--A
recipient of an Indian Health Scholarship that is
awarded after December 31, 2003, shall meet the active
duty service obligation under such scholarship by
providing service within the service area from which
the scholarship was awarded. In placing the recipient
for active duty the area office shall give priority to
the program that funded the recipient, except that in
cases of special circumstances, a recipient may be
placed in a different service area pursuant to an
agreement between the areas or programs
involved.</DELETED>
<DELETED> ``(D) Priority in assignment.--Subject to
subparagraph (C), the area office, in making
assignments of Indian Health Scholarship recipients
required to meet the active duty service obligation
described in subparagraph (A), shall give priority to
assigning individuals to service in those programs
specified in subparagraph (A) 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.</DELETED>
<DELETED> ``(3) Part-time enrollment.--In the case of an
Indian receiving a scholarship under this section who is
enrolled part time in an approved course of study--</DELETED>
<DELETED> ``(A) such scholarship shall be for a
period of years not to exceed the part-time equivalent
of 4 years, as determined by the appropriate area
office;</DELETED>
<DELETED> ``(B) the period of obligated service
described in paragraph (2)(A) shall be equal to the
greater of--</DELETED>
<DELETED> ``(i) 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</DELETED>
<DELETED> ``(ii) two years; and</DELETED>
<DELETED> ``(C) 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.</DELETED>
<DELETED> ``(4) Breach of contract.--</DELETED>
<DELETED> ``(A) In general.--An Indian who has, on
or after the date of the enactment of this paragraph,
entered into a written contract with the area office
pursuant to a scholarship under this section and who--
</DELETED>
<DELETED> ``(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);</DELETED>
<DELETED> ``(ii) is dismissed from such
educational institution for disciplinary
reasons;</DELETED>
<DELETED> ``(iii) 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</DELETED>
<DELETED> ``(iv) 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;</DELETED>
<DELETED>in lieu of any service obligation arising
under such contract, shall be liable to the United
States for the amount which has been paid to him or
her, or on his or her behalf, under the
contract.</DELETED>
<DELETED> ``(B) Failure to perform service
obligation.--If for any reason not specified in
subparagraph (A) an individual breaches his or her
written contract by failing either to begin such
individual's service obligation under this section 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.</DELETED>
<DELETED> ``(C) Death.--Upon the death of an
individual who receives an Indian Health Scholarship,
any obligation of that individual for service or
payment that relates to that scholarship shall be
canceled.</DELETED>
<DELETED> ``(D) Waiver.--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 appropriate area office, Indian
tribe, tribal organization, and urban Indian
organization, determines that--</DELETED>
<DELETED> ``(i) it is not possible for the
recipient to meet that obligation or make that
payment;</DELETED>
<DELETED> ``(ii) requiring that recipient to
meet that obligation or make that payment would
result in extreme hardship to the recipient;
or</DELETED>
<DELETED> ``(iii) the enforcement of the
requirement to meet the obligation or make the
payment would be unconscionable.</DELETED>
<DELETED> ``(E) Hardship or good cause.--
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.</DELETED>
<DELETED> ``(F) 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.</DELETED>
<DELETED> ``(c) Funding for Tribes for Scholarship Programs.--
</DELETED>
<DELETED> ``(1) Provision of funds.--</DELETED>
<DELETED> ``(A) In general.--The Secretary shall
make funds available, through area offices, to Indian
tribes and tribal organizations for the purpose of
assisting such tribes and tribal organizations in
educating Indians to serve as health professionals in
Indian communities.</DELETED>
<DELETED> ``(B) Limitation.--The Secretary shall
ensure that amounts available for grants under
subparagraph (A) for any fiscal year shall not exceed
an amount equal to 5 percent of the amount available
for each fiscal year for Indian Health Scholarships
under this section.</DELETED>
<DELETED> ``(C) Application.--An application for
funds under subparagraph (A) shall be in such form and
contain such agreements, assurances and information as consistent with
this section.</DELETED>
<DELETED> ``(2) Requirements.--</DELETED>
<DELETED> ``(A) In general.--An Indian tribe or
tribal organization receiving funds under paragraph (1)
shall agree to provide scholarships to Indians in
accordance with the requirements of this
subsection.</DELETED>
<DELETED> ``(B) Matching requirement.--With respect
to the costs of providing any scholarship pursuant to
subparagraph (A)--</DELETED>
<DELETED> ``(i) 80 percent of the costs of
the scholarship shall be paid from the funds
provided under paragraph (1) to the Indian
tribe or tribal organization; and</DELETED>
<DELETED> ``(ii) 20 percent of such costs
shall be paid from any other source of
funds.</DELETED>
<DELETED> ``(3) Eligibility.--An Indian tribe or tribal
organization shall provide scholarships under this subsection
only to Indians who are enrolled or accepted for enrollment in
a course of study (approved by the Secretary) in one of the
health professions described in this Act.</DELETED>
<DELETED> ``(4) Contracts.--In providing scholarships under
paragraph (1), the Secretary and the Indian tribe or tribal
organization shall enter into a written contract with each
recipient of such scholarship. Such contract shall--</DELETED>
<DELETED> ``(A) obligate such recipient to provide
service in an Indian health program (as defined in
section 110(a)(2)(A)) in the same service area where
the Indian tribe or tribal organization providing the
scholarship is located, for--</DELETED>
<DELETED> ``(i) a number of years equal to
the 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</DELETED>
<DELETED> ``(ii) such greater period of time
as the recipient and the Indian tribe or tribal
organization may agree;</DELETED>
<DELETED> ``(B) provide that the scholarship--
</DELETED>
<DELETED> ``(i) may only be expended for--
</DELETED>
<DELETED> ``(I) tuition expenses,
other reasonable educational expenses,
and reasonable living expenses incurred
in attendance at the educational
institution; and</DELETED>
<DELETED> ``(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
which the scholarship is provided, the
total amount required for the year for
the purposes authorized in this clause;
and</DELETED>
<DELETED> ``(ii) may not exceed, for any
year of attendance which the scholarship is
provided, the total amount required for the
year for the purposes authorized in clause
(i);</DELETED>
<DELETED> ``(C) require the recipient of such
scholarship to maintain an acceptable level of academic
standing as determined by the educational institution
in accordance with regulations issued pursuant to this
Act; and</DELETED>
<DELETED> ``(D) require the recipient of such
scholarship to meet the educational and licensure
requirements appropriate to the health profession
involved.</DELETED>
<DELETED> ``(5) Breach of contract.--</DELETED>
<DELETED> ``(A) In general.--An individual who has
entered into a written contract with the Secretary and
an Indian tribe or tribal organization under this
subsection and who--</DELETED>
<DELETED> ``(i) fails to maintain an
acceptable level of academic standing in the
education institution in which he or she is
enrolled (such level determined by the
educational institution under regulations of
the Secretary);</DELETED>
<DELETED> ``(ii) is dismissed from such
education for disciplinary reasons;</DELETED>
<DELETED> ``(iii) voluntarily terminates the
training in such an educational institution for
which he or she has been provided a scholarship
under such contract before the completion of
such training; or</DELETED>
<DELETED> ``(iv) 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;</DELETED>
<DELETED>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.</DELETED>
<DELETED> ``(B) Failure to perform service
obligation.--If for any reason not specified in
subparagraph (A), an individual breaches his or her
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.</DELETED>
<DELETED> ``(C) Information.--The Secretary may
carry out this subsection on the basis of information
received from Indian tribes or tribal organizations
involved, or on the basis of information collected
through such other means as the Secretary deems
appropriate.</DELETED>
<DELETED> ``(6) Required agreements.--The recipient of a
scholarship under paragraph (1) shall agree, in providing
health care pursuant to the requirements of this subsection--
</DELETED>
<DELETED> ``(A) 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 the
program established in title XVIII of the Social
Security Act or pursuant to the programs established in
title XIX of such Act; and</DELETED>
<DELETED> ``(B) 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 of such Act to provide service to individuals
entitled to medical assistance under the
plan.</DELETED>
<DELETED> ``(7) Payments.--The Secretary, through the area
office, shall make payments under this subsection to an Indian
tribe or tribal organization for any fiscal year subsequent to
the first fiscal year of such payments unless the Secretary or
area office determines that, for the immediately preceding fiscal year,
the Indian tribe or tribal organization has not complied with the
requirements of this subsection.</DELETED>
<DELETED>``SEC. 106. AMERICAN INDIANS INTO PSYCHOLOGY
PROGRAM.</DELETED>
<DELETED> ``(a) In General.--Notwithstanding section 102, the
Secretary shall provide funds to at least 3 colleges and universities
for the purpose of developing and maintaining American Indian
psychology career recruitment programs as a means of encouraging
Indians to enter the mental health field. These programs shall be
located at various colleges and universities throughout the country to
maximize their availability to Indian students and new programs shall
be established in different locations from time to time.</DELETED>
<DELETED> ``(b) Quentin N. Burdick American Indians Into Psychology
Program.--The Secretary shall provide funds 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 American Indians Into Nursing
Program authorized under section 115, the Quentin N. Burdick Indians
into Health Program authorized under section 117, and existing
university research and communications networks.</DELETED>
<DELETED> ``(c) Requirements.--</DELETED>
<DELETED> ``(1) Regulations.--The Secretary shall promulgate
regulations pursuant to this Act for the competitive awarding
of funds under this section.</DELETED>
<DELETED> ``(2) Program.--Applicants for funds under this
section shall agree to provide a program which, at a minimum--
</DELETED>
<DELETED> ``(A) 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;</DELETED>
<DELETED> ``(B) incorporates a program advisory
board comprised of representatives from the tribes and
communities that will be served by the
program;</DELETED>
<DELETED> ``(C) provides summer enrichment programs
to expose Indian students to the various fields of
psychology through research, clinical, and experimental
activities;</DELETED>
<DELETED> ``(D) provides stipends to undergraduate
and graduate students to pursue a career in
psychology;</DELETED>
<DELETED> ``(E) develops affiliation agreements with
tribal community colleges, the Service, university
affiliated programs, and other appropriate accredited
and accessible entities to enhance the education of
Indian students;</DELETED>
<DELETED> ``(F) utilizes, to the maximum extent
feasible, existing university tutoring, counseling and
student support services; and</DELETED>
<DELETED> ``(G) employs, to the maximum extent
feasible, qualified Indians in the program.</DELETED>
<DELETED> ``(d) Active Duty 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 graduate who receives a
stipend described in subsection (c)(2)(C) that is funded under this
section. Such obligation shall be met by service--</DELETED>
<DELETED> ``(1) in the Indian Health Service;</DELETED>
<DELETED> ``(2) in a program conducted under a funding
agreement contract entered into under the Indian Self-
Determination and Education Assistance Act;</DELETED>
<DELETED> ``(3) in a program assisted under title V;
or</DELETED>
<DELETED> ``(4) 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.</DELETED>
<DELETED>``SEC. 107. INDIAN HEALTH SERVICE EXTERN PROGRAMS.</DELETED>
<DELETED> ``(a) In General.--Any individual who receives a
scholarship pursuant to section 105 shall be entitled to employment in
the Service, or may be employed by a program of an Indian tribe, tribal
organization, or urban Indian organization, or other agency of the
Department as may be appropriate and available, during any nonacademic
period of the year. Periods of employment pursuant to this subsection
shall not be counted in determining the fulfillment of the service
obligation incurred as a condition of the scholarship.</DELETED>
<DELETED> ``(b) Enrollees in Course of Study.--Any individual who is
enrolled in a course of study in the health professions may be employed
by the Service or by an Indian tribe, tribal organization, or urban
Indian organization, during any nonacademic period of the year. Any
such employment shall not exceed 120 days during any calendar
year.</DELETED>
<DELETED> ``(c) High School Programs.--Any individual who is in a
high school program authorized under section 103(a) may be employed by
the Service, or by a Indian tribe, tribal organization, or urban Indian
organization, during any nonacademic period of the year. Any such
employment shall not exceed 120 days during any calendar
year.</DELETED>
<DELETED> ``(d) Administrative Provisions.--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.</DELETED>
<DELETED>``SEC. 108. CONTINUING EDUCATION ALLOWANCES.</DELETED>
<DELETED> ``In order to encourage health professionals, including
for purposes of this section, community health representatives and
emergency medical technicians, to join or continue in the Service or in
any program of an Indian tribe, tribal organization, or urban Indian
organization and to provide their services in the rural and remote
areas where a significant portion of the Indian people reside, the
Secretary, acting through the area offices, may provide allowances to
health professionals employed in the Service or such a program to
enable such professionals to take leave of their duty stations for a
period of time each year (as prescribed by regulations of the
Secretary) for professional consultation and refresher training
courses.</DELETED>
<DELETED>``SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PROGRAM.</DELETED>
<DELETED> ``(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 maintain a Community Health Representative Program
under which the Service, Indian tribes and tribal organizations--
</DELETED>
<DELETED> ``(1) provide for the training of Indians as
community health representatives; and</DELETED>
<DELETED> ``(2) use such community health representatives in
the provision of health care, health promotion, and disease
prevention services to Indian communities.</DELETED>
<DELETED> ``(b) Activities.--The Secretary, acting through the
Community Health Representative Program, shall--</DELETED>
<DELETED> ``(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 such Program;</DELETED>
<DELETED> ``(2) in order to provide such training, develop
and maintain a curriculum that--</DELETED>
<DELETED> ``(A) combines education in the theory of
health care with supervised practical experience in the
provision of health care; and</DELETED>
<DELETED> ``(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;</DELETED>
<DELETED> ``(3) maintain a system which identifies the needs
of community health representatives for continuing education in
health care, health promotion, and disease prevention and
maintain programs that meet the needs for such continuing
education;</DELETED>
<DELETED> ``(4) maintain a system that provides close
supervision of community health representatives;</DELETED>
<DELETED> ``(5) maintain a system under which the work of
community health representatives is reviewed and evaluated;
and</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED>``SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT
PROGRAM.</DELETED>
<DELETED> ``(a) Establishment.--</DELETED>
<DELETED> ``(1) In general.--The Secretary, acting through
the Service, shall establish a program to be known as the
Indian Health Service Loan Repayment Program (referred to in
this Act as the `Loan Repayment Program') in order to assure an
adequate supply of trained health professionals necessary to
maintain accreditation of, and provide health care services to
Indians through, Indian health programs.</DELETED>
<DELETED> ``(2) Definitions.--In this section:</DELETED>
<DELETED> ``(A) Indian health program.--The term
`Indian health program' means any health program or
facility funded, in whole or part, by the Service for
the benefit of Indians and administered--</DELETED>
<DELETED> ``(i) directly by the
Service;</DELETED>
<DELETED> ``(ii) by any Indian tribe or
tribal or Indian organization pursuant to a
funding agreement under--</DELETED>
<DELETED> ``(I) the Indian Self-
Determination and Educational
Assistance Act; or</DELETED>
<DELETED> ``(II) section 23 of the
Act of April 30, 1908 (25 U.S.C. 47)
(commonly known as the `Buy-Indian
Act'); or</DELETED>
<DELETED> ``(iii) by an urban Indian
organization pursuant to title V.</DELETED>
<DELETED> ``(B) State.--The term `State' has the
same meaning given such term in section 331(i)(4) of
the Public Health Service Act.</DELETED>
<DELETED> ``(b) Eligibility.--To be eligible to participate in the
Loan Repayment Program, an individual must--</DELETED>
<DELETED> ``(1)(A) be enrolled--</DELETED>
<DELETED> ``(i) in a course of study or program in
an accredited institution, as determined by the
Secretary, within any State and be scheduled to
complete such course of study in the same year such
individual applies to participate in such program;
or</DELETED>
<DELETED> ``(ii) in an approved graduate training
program in a health profession; or</DELETED>
<DELETED> ``(B) have--</DELETED>
<DELETED> ``(i) a degree in a health profession;
and</DELETED>
<DELETED> ``(ii) a license to practice a health
profession in a State;</DELETED>
<DELETED> ``(2)(A) be eligible for, or hold, an appointment
as a commissioned officer in the Regular or Reserve Corps of
the Public Health Service;</DELETED>
<DELETED> ``(B) be eligible for selection for civilian
service in the Regular or Reserve Corps of the Public Health
Service;</DELETED>
<DELETED> ``(C) meet the professional standards for civil
service employment in the Indian Health Service; or</DELETED>
<DELETED> ``(D) be employed in an Indian health program
without a service obligation; and</DELETED>
<DELETED> ``(3) submit to the Secretary an application for a
contract described in subsection (f).</DELETED>
<DELETED> ``(c) Forms.--</DELETED>
<DELETED> ``(1) In general.--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 the 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 Indian Health Service to enable the
individual to make a decision on an informed basis.</DELETED>
<DELETED> ``(2) Forms to be understandable.--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.</DELETED>
<DELETED> ``(3) Availability.--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.</DELETED>
<DELETED> ``(d) Priority.--</DELETED>
<DELETED> ``(1) Annual determinations.--The Secretary,
acting through the Service and in accordance with subsection
(k), shall annually--</DELETED>
<DELETED> ``(A) identify the positions in each
Indian health program for which there is a need or a
vacancy; and</DELETED>
<DELETED> ``(B) rank those positions in order of
priority.</DELETED>
<DELETED> ``(2) Priority in approval.--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--</DELETED>
<DELETED> ``(A) give first priority to applications
made by individual Indians; and</DELETED>
<DELETED> ``(B) after making determinations on all
applications submitted by individual Indians as
required under subparagraph (A), give priority to--
</DELETED>
<DELETED> ``(i) individuals recruited
through the efforts an Indian tribe, tribal
organization, or urban Indian organization;
and</DELETED>
<DELETED> ``(ii) other individuals based on
the priority rankings under paragraph
(1).</DELETED>
<DELETED> ``(e) Contracts.--</DELETED>
<DELETED> ``(1) In general.--An individual becomes a
participant in the Loan Repayment Program only upon the
Secretary and the individual entering into a written contract
described in subsection (f).</DELETED>
<DELETED> ``(2) Notice.--Not later than 21 days after
considering an individual for participation in the Loan
Repayment Program under paragraph (1), the Secretary shall
provide written notice to the individual of--</DELETED>
<DELETED> ``(A) the Secretary's approving 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</DELETED>
<DELETED> ``(B) the Secretary's disapproving an
individual's participation in such Program.</DELETED>
<DELETED> ``(f) Written Contract.--The written contract referred to
in this section between the Secretary and an individual shall contain--
</DELETED>
<DELETED> ``(1) an agreement under which--</DELETED>
<DELETED> ``(A) subject to paragraph (3), the
Secretary agrees--</DELETED>
<DELETED> ``(i) to pay loans on behalf of
the individual in accordance with the
provisions of this section; and</DELETED>
<DELETED> ``(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 tribe,
tribal organization, or urban Indian
organization as provided in subparagraph
(B)(iii); and</DELETED>
<DELETED> ``(B) subject to paragraph (3), the
individual agrees--</DELETED>
<DELETED> ``(i) to accept loan payments on
behalf of the individual;</DELETED>
<DELETED> ``(ii) in the case of an
individual described in subsection (b)(1)--
</DELETED>
<DELETED> ``(I) 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</DELETED>
<DELETED> ``(II) 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);</DELETED>
<DELETED> ``(iii) to serve for a time period
(referred to in this section 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 to which the
individual may be assigned by the Secretary;</DELETED>
<DELETED> ``(2) 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 paragraph (1)(B)(iii);</DELETED>
<DELETED> ``(3) 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;</DELETED>
<DELETED> ``(4) a statement of the damages to which the
United States is entitled under subsection (l) for the
individual's breach of the contract; and</DELETED>
<DELETED> ``(5) such other statements of the rights and
liabilities of the Secretary and of the individual, not
inconsistent with this section.</DELETED>
<DELETED> ``(g) Loan Repayments.--</DELETED>
<DELETED> ``(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--</DELETED>
<DELETED> ``(A) tuition expenses;</DELETED>
<DELETED> ``(B) all other reasonable educational
expenses, including fees, books, and laboratory
expenses, incurred by the individual; and</DELETED>
<DELETED> ``(C) reasonable living expenses as
determined by the Secretary.</DELETED>
<DELETED> ``(2) Amount of payment.--</DELETED>
<DELETED> ``(A) In general.--For each year of
obligated service that an individual contracts to serve
under subsection (f) 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)
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--</DELETED>
<DELETED> ``(i) 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;</DELETED>
<DELETED> ``(ii) provides an incentive to
serve in Indian health programs with the
greatest shortages of health professionals;
and</DELETED>
<DELETED> ``(iii) provides an incentive with
respect to the health professional involved
remaining in an Indian health program 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.</DELETED>
<DELETED> ``(B) Time for payment.--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 not later than the end of the fiscal year in which
the individual completes such year of
service.</DELETED>
<DELETED> ``(3) Schedule for payments.--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.</DELETED>
<DELETED> ``(h) Counting of Individuals.--Notwithstanding any other
provision of law, individuals who have entered into written contracts
with the Secretary under this section, while undergoing academic
training, shall not be counted against any employment ceiling affecting
the Department.</DELETED>
<DELETED> ``(i) Recruiting Programs.--The Secretary shall conduct
recruiting programs for the Loan Repayment Program and other health
professional programs of the Service at educational institutions
training health professionals or specialists identified in subsection
(a).</DELETED>
<DELETED> ``(j) Nonapplication of Certain Provision.--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.</DELETED>
<DELETED> ``(k) Assignment of Individuals.--The Secretary, in
assigning individuals to serve in Indian health programs pursuant to
contracts entered into under this section, shall--</DELETED>
<DELETED> ``(1) ensure that the staffing needs of Indian
health programs administered by an Indian tribe or tribal or
health organization receive consideration on an equal basis
with programs that are administered directly by the Service;
and</DELETED>
<DELETED> ``(2) give priority to assigning individuals to
Indian health programs 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.</DELETED>
<DELETED> ``(l) Breach of Contract.--</DELETED>
<DELETED> ``(1) In general.--An individual who has entered
into a written contract with the Secretary under this section
and who--</DELETED>
<DELETED> ``(A) is enrolled in the final year of a
course of study and who--</DELETED>
<DELETED> ``(i) fails to maintain an
acceptable level of academic standing in the
educational institution in which he is enrolled
(such level determined by the educational
institution under regulations of the
Secretary);</DELETED>
<DELETED> ``(ii) voluntarily terminates such
enrollment; or</DELETED>
<DELETED> ``(iii) is dismissed from such
educational institution before completion of
such course of study; or</DELETED>
<DELETED> ``(B) is enrolled in a graduate training
program, and who fails to complete such training
program, and does not receive a waiver from the
Secretary under subsection (b)(1)(B)(ii),</DELETED>
<DELETED>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.</DELETED>
<DELETED> ``(2) Amount of recovery.--If, for any reason not
specified in paragraph (1), an individual breaches his written
contract under this section by failing either to begin, or
complete, such individual's period of obligated service in
accordance with subsection (f), the United States shall be
entitled to recover from such individual an amount to be
determined in accordance with the following formula:</DELETED>
<DELETED>A=3Z(t-s/t)</DELETED>
<DELETED>in which--</DELETED>
<DELETED> ``(A) `A' is the amount the United States
is entitled to recover;</DELETED>
<DELETED> ``(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 Treasurer of the United States;</DELETED>
<DELETED> ``(C) `t' is the total number of months in
the individual's period of obligated service in
accordance with subsection (f); and</DELETED>
<DELETED> ``(D) `s' is the number of months of such
period served by such individual in accordance with
this section.</DELETED>
<DELETED>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.</DELETED>
<DELETED> ``(3) Damages.--</DELETED>
<DELETED> ``(A) Time for payment.--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 of contract or such longer period
beginning on such date as shall be specified by the
Secretary.</DELETED>
<DELETED> ``(B) Delinquencies.--If damages described
in subparagraph (A) are delinquent for 3 months, the
Secretary shall, for the purpose of recovering such
damages--</DELETED>
<DELETED> ``(i) utilize collection agencies
contracted with by the Administrator of the
General Services Administration; or</DELETED>
<DELETED> ``(ii) enter into contracts for
the recovery of such damages with collection
agencies selected by the Secretary.</DELETED>
<DELETED> ``(C) Contracts for recovery of damages.--
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.</DELETED>
<DELETED> ``(m) Cancellation, Waiver or Release.--</DELETED>
<DELETED> ``(1) Cancellation.--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.</DELETED>
<DELETED> ``(2) Waiver of service obligation.--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.</DELETED>
<DELETED> ``(3) Waiver of rights of united states.--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.</DELETED>
<DELETED> ``(4) Release.--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.</DELETED>
<DELETED> ``(n) Report.--The Secretary shall submit to the
President, for inclusion in each report required to be submitted to the
Congress under section 801, a report concerning the previous fiscal
year which sets forth--</DELETED>
<DELETED> ``(1) the health professional positions maintained
by the Service or by tribal or Indian organizations for which
recruitment or retention is difficult;</DELETED>
<DELETED> ``(2) the number of Loan Repayment Program
applications filed with respect to each type of health
profession;</DELETED>
<DELETED> ``(3) the number of contracts described in
subsection (f) that are entered into with respect to each
health profession;</DELETED>
<DELETED> ``(4) the amount of loan payments made under this
section, in total and by health profession;</DELETED>
<DELETED> ``(5) the number of scholarship grants that are
provided under section 105 with respect to each health
profession;</DELETED>
<DELETED> ``(6) the amount of scholarship grants provided
under section 105, in total and by health profession;</DELETED>
<DELETED> ``(7) the number of providers of health care that
will be needed by Indian health programs, by location and
profession, during the 3 fiscal years beginning after the date
the report is filed; and</DELETED>
<DELETED> ``(8) the measures the Secretary plans to take to
fill the health professional positions maintained by the
Service or by tribes, tribal organizations, or urban Indian
organizations for which recruitment or retention is
difficult.</DELETED>
<DELETED>``SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOVERY
FUND.</DELETED>
<DELETED> ``(a) Establishment.--Notwithstanding section 102, 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
(referred to in this section as the `LRRF'). The LRRF Fund shall
consist of--</DELETED>
<DELETED> ``(1) such amounts as may be collected from
individuals under subparagraphs (A) and (B) of section
105(b)(4) and section 110(l) for breach of contract;</DELETED>
<DELETED> ``(2) such funds as may be appropriated to the
LRRF;</DELETED>
<DELETED> ``(3) such interest earned on amounts in the LRRF;
and</DELETED>
<DELETED> ``(4) such additional amounts as may be collected,
appropriated, or earned relative to the LRRF.</DELETED>
<DELETED> Amounts appropriated to the LRRF shall remain available until
expended.</DELETED>
<DELETED> ``(b) Use of LRRF.--</DELETED>
<DELETED> ``(1) In general.--Amounts in the LRRF may be
expended by the Secretary, subject to section 102, acting
through the Service, to make payments to the Service or to an
Indian tribe or tribal organization administering a health care
program pursuant to a funding agreement entered into under the
Indian Self-Determination and Education Assistance Act--
</DELETED>
<DELETED> ``(A) to which a scholarship recipient
under section 105 or a loan repayment program
participant under section 110 has been assigned to meet
the obligated service requirements pursuant to
sections; and</DELETED>
<DELETED> ``(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 105 or section
110.</DELETED>
<DELETED> ``(2) Scholarships and recruiting.--An Indian
tribe or tribal organization receiving payments pursuant to
paragraph (1) may expend the payments to provide scholarships
or to recruit and employ, directly or by contract, health
professionals to provide health care services.</DELETED>
<DELETED> ``(c) Investing of Fund.--</DELETED>
<DELETED> ``(1) In general.--The Secretary of the Treasury
shall invest such amounts of the LRRF as the Secretary
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.</DELETED>
<DELETED> ``(2) Sale price.--Any obligation acquired by the
LRRF may be sold by the Secretary of the Treasury at the market
price.</DELETED>
<DELETED>``SEC. 112. RECRUITMENT ACTIVITIES.</DELETED>
<DELETED> ``(a) Reimbursement of Expenses.--The Secretary may
reimburse health professionals seeking positions in the Service, Indian
tribes, tribal organizations, 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.</DELETED>
<DELETED> ``(b) Assignment of 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.</DELETED>
<DELETED>``SEC. 113. TRIBAL RECRUITMENT AND RETENTION
PROGRAM.</DELETED>
<DELETED> ``(a) Funding of Projects.--The Secretary, acting through
the Service, shall fund innovative projects for a period not to exceed
3 years to enable Indian tribes, tribal organizations, and urban Indian
organizations to recruit, place, and retain health professionals to
meet the staffing needs of Indian health programs (as defined in
section 110(a)(2)(A)).</DELETED>
<DELETED> ``(b) Eligibility.--Any Indian tribe, tribal organization,
or urban Indian organization may submit an application for funding of a
project pursuant to this section.</DELETED>
<DELETED>``SEC. 114. ADVANCED TRAINING AND RESEARCH.</DELETED>
<DELETED> ``(a) Demonstration Project.--The Secretary, acting
through the Service, shall establish a demonstration project to enable
health professionals who have worked in an Indian health program (as
defined in section 110) for a substantial period of time to pursue
advanced training or research in areas of study for which the Secretary
determines a need exists.</DELETED>
<DELETED> ``(b) Service Obligation.--</DELETED>
<DELETED> ``(1) In general.--An individual who participates
in the project under subsection (a), where the educational
costs are borne by the Service, shall incur an obligation to
serve in an Indian health program for a period of obligated
service equal to at least the period of time during which the
individual participates in such project.</DELETED>
<DELETED> ``(2) Failure to complete service.--In the event
that an individual fails to complete a period of obligated
service under paragraph (1), the individual shall be liable to
the United States for the period of service remaining. In such
event, with respect to individuals entering the project after
the date of the enactment of this Act, 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.</DELETED>
<DELETED> ``(c) Opportunity To Participate.--Health professionals
from Indian tribes, tribal organizations, and urban Indian
organizations under the authority of the Indian Self-Determination and
Education Assistance Act shall be given an equal opportunity to
participate in the program under subsection (a).</DELETED>
<DELETED>``SEC. 115. NURSING PROGRAMS; QUENTIN N. BURDICK AMERICAN
INDIANS INTO NURSING PROGRAM.</DELETED>
<DELETED> ``(a) Grants.--Notwithstanding section 102, the Secretary,
acting through the Service, shall provide funds to--</DELETED>
<DELETED> ``(1) public or private schools of
nursing;</DELETED>
<DELETED> ``(2) tribally controlled community colleges and
tribally controlled postsecondary vocational institutions (as
defined in section 390(2) of the Tribally Controlled Vocational
Institutions Support Act of 1990 (20 U.S.C. 2397h(2));
and</DELETED>
<DELETED> ``(3) nurse midwife programs, and advance practice
nurse programs, that are provided by any tribal college
accredited nursing program, or in the absence of such, any
other public or private institution,</DELETED>
<DELETED>for the purpose of increasing the number of nurses, nurse
midwives, and nurse practitioners who deliver health care services to
Indians.</DELETED>
<DELETED> ``(b) Use of Grants.--Funds provided under subsection (a)
may be used to--</DELETED>
<DELETED> ``(1) recruit individuals for programs which train
individuals to be nurses, nurse midwives, or advanced practice
nurses;</DELETED>
<DELETED> ``(2) provide scholarships to Indian individuals
enrolled in such programs that may be used to pay the tuition
charged for such program and for other expenses incurred in
connection with such program, including books, fees, room and
board, and stipends for living expenses;</DELETED>
<DELETED> ``(3) provide a program that encourages nurses,
nurse midwives, and advanced practice nurses to provide, or
continue to provide, health care services to Indians;</DELETED>
<DELETED> ``(4) provide a program that increases the skills
of, and provides continuing education to, nurses, nurse
midwives, and advanced practice nurses; or</DELETED>
<DELETED> ``(5) provide any program that is designed to
achieve the purpose described in subsection (a).</DELETED>
<DELETED> ``(c) Applications.--Each application for funds 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.</DELETED>
<DELETED> ``(d) Preferences.--In providing funds under subsection
(a), the Secretary shall extend a preference to--</DELETED>
<DELETED> ``(1) programs that provide a preference to
Indians;</DELETED>
<DELETED> ``(2) programs that train nurse midwives or
advanced practice nurses;</DELETED>
<DELETED> ``(3) programs that are interdisciplinary;
and</DELETED>
<DELETED> ``(4) programs that are conducted in cooperation
with a center for gifted and talented Indian students
established under section 5324(a) of the Indian Education Act
of 1988.</DELETED>
<DELETED> ``(e) Quentin N. Burdick American Indians Into Nursing
Program.--The Secretary shall ensure that a portion of the funds
authorized under subsection (a) is made available 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 American Indians Into Psychology Program established
under section 106(b) and the Quentin N. Burdick Indian Health Programs
established under section 117(b).</DELETED>
<DELETED> ``(f) 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 under subsection (a). Such obligation shall be met
by service--</DELETED>
<DELETED> ``(1) in the Indian Health Service;</DELETED>
<DELETED> ``(2) in a program conducted under a contract
entered into under the Indian Self-Determination and Education
Assistance Act;</DELETED>
<DELETED> ``(3) in a program assisted under title V;
or</DELETED>
<DELETED> ``(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 professional shortage area and
addresses the health care needs of a substantial number of
Indians.</DELETED>
<DELETED>``SEC. 116. TRIBAL CULTURE AND HISTORY.</DELETED>
<DELETED> ``(a) In General.--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 tribes and their
relationship to the Service.</DELETED>
<DELETED> ``(b) Requirements.--To the extent feasible, the
educational instruction to be provided under subsection (a) shall--
</DELETED>
<DELETED> ``(1) be provided in consultation with the
affected tribal governments, tribal organizations, and urban
Indian organizations;</DELETED>
<DELETED> ``(2) be provided through tribally-controlled
community colleges (within the meaning of section 2(4) of the
Tribally Controlled Community College Assistance Act of 1978)
and tribally controlled postsecondary vocational institutions
(as defined in section 390(2) of the Tribally Controlled
Vocational Institutions Support Act of 1990 (20 U.S.C.
2397h(2)); and</DELETED>
<DELETED> ``(3) include instruction in Native American
studies.</DELETED>
<DELETED>``SEC. 117. INMED PROGRAM.</DELETED>
<DELETED> ``(a) Grants.--The Secretary may provide grants to 3
colleges and universities for the purpose of maintaining and expanding
the Native American health careers recruitment program known as the
`Indians into Medicine Program' (referred to in this section as
`INMED') as a means of encouraging Indians to enter the health
professions.</DELETED>
<DELETED> ``(b) Quentin N. Burdick Indian Health Program.--The
Secretary shall provide 1 of the grants under subsection (a) to
maintain the INMED program at the University of North Dakota, to be
known as the `Quentin N. Burdick Indian Health Program', 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 106(b) and the Quentin N. Burdick American Indians Into Nursing
Program established under section 115.</DELETED>
<DELETED> ``(c) Requirements.--</DELETED>
<DELETED> ``(1) In general.--The Secretary shall develop
regulations to govern grants under to this section.</DELETED>
<DELETED> ``(2) Program requirements.--Applicants for grants
provided under this section shall agree to provide a program
that--</DELETED>
<DELETED> ``(A) provides outreach and recruitment
for health professions to Indian communities including
elementary, secondary and community colleges located on
Indian reservations which will be served by the
program;</DELETED>
<DELETED> ``(B) incorporates a program advisory
board comprised of representatives from the tribes and
communities which will be served by the
program;</DELETED>
<DELETED> ``(C) 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;</DELETED>
<DELETED> ``(D) provides tutoring, counseling and
support to students who are enrolled in a health career
program of study at the respective college or
university; and</DELETED>
<DELETED> ``(E) to the maximum extent feasible,
employs qualified Indians in the program.</DELETED>
<DELETED>``SEC. 118. HEALTH TRAINING PROGRAMS OF COMMUNITY
COLLEGES.</DELETED>
<DELETED> ``(a) Establishment Grants.--</DELETED>
<DELETED> ``(1) In general.--The Secretary, acting through
the Service, shall award grants to accredited and accessible
community colleges for the purpose of assisting such 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 an Indian reservation, in the Service, or in a
tribal health program.</DELETED>
<DELETED> ``(2) Amount.--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.</DELETED>
<DELETED> ``(b) Continuation Grants.--</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(2) Eligibility.--Grants may only be made under
this subsection to a community college that--</DELETED>
<DELETED> ``(A) is accredited;</DELETED>
<DELETED> ``(B) has a relationship with a hospital
facility, Service facility, or hospital that could
provide training of nurses or health
professionals;</DELETED>
<DELETED> ``(C) has entered into an agreement with
an accredited college or university medical school, the
terms of which--</DELETED>
<DELETED> ``(i) provide a program that
enhances the transition and recruitment of
students into advanced baccalaureate or
graduate programs which train health
professionals; and</DELETED>
<DELETED> ``(ii) stipulate certifications
necessary to approve internship and field
placement opportunities at health programs of
the Service or at tribal health
programs;</DELETED>
<DELETED> ``(D) has a qualified staff which has the
appropriate certifications;</DELETED>
<DELETED> ``(E) is capable of obtaining State or
regional accreditation of the program described in
subsection (a)(1); and</DELETED>
<DELETED> ``(F) agrees to provide for Indian
preference for applicants for programs under this
section.</DELETED>
<DELETED> ``(c) Service Personnel and Technical Assistance.--The
Secretary shall encourage community colleges described in subsection
(b)(2) to establish and maintain programs described in subsection
(a)(1) by--</DELETED>
<DELETED> ``(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</DELETED>
<DELETED> ``(2) providing technical assistance and support
to such colleges.</DELETED>
<DELETED> ``(d) Specified Courses of Study.--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--</DELETED>
<DELETED> ``(1) has already received a degree or diploma in
such health profession; and</DELETED>
<DELETED> ``(2) provides clinical services on an Indian
reservation, at a Service facility, or at a tribal
clinic.</DELETED>
<DELETED>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).</DELETED>
<DELETED> ``(e) Priority.--Priority shall be provided under this
section to tribally controlled colleges in service areas that meet the
requirements of subsection (b).</DELETED>
<DELETED> ``(f) Definitions.--In this section:</DELETED>
<DELETED> ``(1) Community college.--The term `community
college' means--</DELETED>
<DELETED> ``(A) a tribally controlled community
college; or</DELETED>
<DELETED> ``(B) a junior or community
college.</DELETED>
<DELETED> ``(2) Junior or community college.--The term
`junior or community college' has the meaning given such term
by section 312(e) of the Higher Education Act of 1965 (20
U.S.C. 1058(e)).</DELETED>
<DELETED> ``(3) Tribally controlled college.--The term
`tribally controlled college' has the meaning given the term
`tribally controlled community college' by section 2(4) of the
Tribally Controlled Community College Assistance Act of
1978.</DELETED>
<DELETED>``SEC. 119. RETENTION BONUS.</DELETED>
<DELETED> ``(a) In General.--The Secretary may pay a retention bonus
to any health professional employed by, or assigned to, and serving in,
the Service, an Indian tribe, a tribal organization, or an 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--
</DELETED>
<DELETED> ``(1) is assigned to, and serving in, a position
for which recruitment or retention of personnel is
difficult;</DELETED>
<DELETED> ``(2) the Secretary determines is needed by the
Service, tribe, tribal organization, or urban
organization;</DELETED>
<DELETED> ``(3) has--</DELETED>
<DELETED> ``(A) completed 3 years of employment with
the Service; tribe, tribal organization, or urban
organization; or</DELETED>
<DELETED> ``(B) completed any service obligations
incurred as a requirement of--</DELETED>
<DELETED> ``(i) any Federal scholarship
program; or</DELETED>
<DELETED> ``(ii) any Federal education loan
repayment program; and</DELETED>
<DELETED> ``(4) enters into an agreement with the Service,
Indian tribe, tribal organization, or urban Indian organization
for continued employment for a period of not less than 1
year.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(c) Failure To Complete Term of Service.--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).</DELETED>
<DELETED> ``(d) Funding Agreement.--The Secretary may pay a
retention bonus to any health professional employed by an organization
providing health care services to Indians pursuant to a funding
agreement under the Indian Self-Determination and Education Assistance
Act if such health professional is serving in a position which the
Secretary determines is--</DELETED>
<DELETED> ``(1) a position for which recruitment or
retention is difficult; and</DELETED>
<DELETED> ``(2) necessary for providing health care services
to Indians.</DELETED>
<DELETED>``SEC. 120. NURSING RESIDENCY PROGRAM.</DELETED>
<DELETED> ``(a) Establishment.--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 (as defined in section
110(a)(2)(A)), and have done so for a period of not less than 1 year,
to pursue advanced training.</DELETED>
<DELETED> ``(b) Requirement.--The program established under
subsection (a) shall include a combination of education and work study
in an Indian health program (as defined in section 110(a)(2)(A))
leading to an associate or bachelor's degree (in the case of a licensed
practical nurse or licensed vocational nurse) or a bachelor's degree
(in the case of a registered nurse) or an advanced degree in nursing
and public health.</DELETED>
<DELETED> ``(c) 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 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.</DELETED>
<DELETED>``SEC. 121. COMMUNITY HEALTH AIDE PROGRAM FOR
ALASKA.</DELETED>
<DELETED> ``(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 maintain a Community Health Aide Program in Alaska
under which the Service--</DELETED>
<DELETED> ``(1) provides for the training of Alaska Natives
as health aides or community health practitioners;</DELETED>
<DELETED> ``(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</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(b) Activities.--The Secretary, acting through the
Community Health Aide Program under subsection (a), shall--</DELETED>
<DELETED> ``(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;</DELETED>
<DELETED> ``(2) in order to provide such training, develop a
curriculum that--</DELETED>
<DELETED> ``(A) combines education in the theory of
health care with supervised practical experience in the
provision of health care;</DELETED>
<DELETED> ``(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</DELETED>
<DELETED> ``(C) promotes the achievement of the
health status objective specified in section
3(b);</DELETED>
<DELETED> ``(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 who can demonstrate equivalent experience;</DELETED>
<DELETED> ``(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;</DELETED>
<DELETED> ``(5) develop and maintain a system that provides
close supervision of community health aides and community
health practitioners; and</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED>``SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION.</DELETED>
<DELETED> ``Subject to Section 102, the Secretary, acting through
the Service, shall, through a funding agreement or otherwise, provide
training for Indians in the administration and planning of tribal
health programs.</DELETED>
<DELETED>``SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE DEMONSTRATION
PROJECT.</DELETED>
<DELETED> ``(a) Pilot Programs.--The Secretary may, through area
offices, fund pilot programs for tribes and tribal organizations to
address chronic shortages of health professionals.</DELETED>
<DELETED> ``(b) Purpose.--It is the purpose of the health
professions demonstration project under this section to--</DELETED>
<DELETED> ``(1) provide direct clinical and practical
experience in a service area to health professions students and
residents from medical schools;</DELETED>
<DELETED> ``(2) improve the quality of health care for
Indians by assuring access to qualified health care
professionals; and</DELETED>
<DELETED> ``(3) provide academic and scholarly opportunities
for health professionals serving Indian people by identifying
and utilizing all academic and scholarly resources of the
region.</DELETED>
<DELETED> ``(c) Advisory Board.--A pilot program established under
subsection (a) shall incorporate a program advisory board that shall be
composed of representatives from the tribes and communities in the
service area that will be served by the program.</DELETED>
<DELETED>``SEC. 124. SCHOLARSHIPS.</DELETED>
<DELETED> ``Scholarships and loan reimbursements provided to
individuals pursuant to this title shall be treated as `qualified
scholarships' for purposes of section 117 of the Internal Revenue Code
of 1986.</DELETED>
<DELETED>``SEC. 125. NATIONAL HEALTH SERVICE CORPS.</DELETED>
<DELETED> ``(a) Limitations.--The Secretary shall not--</DELETED>
<DELETED> ``(1) remove a member of the National Health
Services Corps from a health program operated by Indian Health
Service or by a tribe or tribal organization under a funding
agreement with the Service under the Indian Self-Determination
and Education Assistance Act, or by urban Indian organizations;
or</DELETED>
<DELETED> ``(2) withdraw the funding used to support such a
member;</DELETED>
<DELETED>unless the Secretary, acting through the Service, tribes or
tribal organization, has ensured that the Indians receiving services
from such member will experience no reduction in services.</DELETED>
<DELETED> ``(b) Designation of Service Areas as Health Professional
Shortage Areas.--All service areas served by programs operated by the
Service or by a tribe or tribal organization under the Indian Self-
Determination and Education Assistance Act, or by an urban Indian
organization, shall be designated under section 332 of the Public
Health Service Act (42 U.S.C. 254e) as Health Professional Shortage
Areas.</DELETED>
<DELETED> ``(c) Full Time Equivalent.--National Health Service Corps
scholars that qualify for the commissioned corps in the Public Health
Service shall be exempt from the full time equivalent limitations of
the National Health Service Corps and the Service when such scholars
serve as commissioned corps officers in a health program operated by an
Indian tribe or tribal organization under the Indian Self-Determination
and Education Assistance Act or by an urban Indian
organization.</DELETED>
<DELETED>``SEC. 126. SUBSTANCE ABUSE COUNSELOR EDUCATION DEMONSTRATION
PROJECT.</DELETED>
<DELETED> ``(a) Demonstration Projects.--The Secretary, acting
through the Service, may enter into contracts with, or make grants to,
accredited tribally controlled community colleges, tribally controlled
postsecondary vocational institutions, and eligible accredited and
accessible community colleges to establish demonstration projects to
develop educational curricula for substance abuse counseling.</DELETED>
<DELETED> ``(b) Use of Funds.--Funds provided under this section
shall be used only for developing and providing educational curricula
for substance abuse counseling (including paying salaries for
instructors). Such curricula may be provided through satellite campus
programs.</DELETED>
<DELETED> ``(c) Term of Grant.--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.</DELETED>
<DELETED> ``(d) Review of Applications.--Not later than 180 days
after the date of the enactment of this Act, the Secretary, after
consultation with Indian tribes and administrators of accredited
tribally controlled community colleges, tribally controlled
postsecondary vocational institutions, 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 projects established under this section promote the
development of the capacity of such entities to educate substance abuse
counselors.</DELETED>
<DELETED> ``(e) Technical 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.</DELETED>
<DELETED> ``(f) Report.--The Secretary shall submit to the
President, for inclusion in the report required to be submitted under
section 801 for fiscal year 1999, a report on the findings and
conclusions derived from the demonstration projects conducted under
this section.</DELETED>
<DELETED> ``(g) Definitions.--In this section:</DELETED>
<DELETED> ``(1) Educational curriculum.--The term
`educational curriculum' means 1 or more of the
following:</DELETED>
<DELETED> ``(A) Classroom education.</DELETED>
<DELETED> ``(B) Clinical work experience.</DELETED>
<DELETED> ``(C) Continuing education
workshops.</DELETED>
<DELETED> ``(2) Tribally controlled community college.--The
term `tribally controlled community college' has the meaning
given such term in section 2(a)(4) of the Tribally Controlled
Community College Assistance Act of 1978 (25 U.S.C.
1801(a)(4)).</DELETED>
<DELETED> ``(3) Tribally controlled postsecondary vocational
institution.--The term `tribally controlled postsecondary
vocational institution' has the meaning given such term in
section 390(2) of the Tribally Controlled Vocational
Institutions Support Act of 1990 (20 U.S.C.
2397h(2)).</DELETED>
<DELETED>``SEC. 127. MENTAL HEALTH TRAINING AND COMMUNITY
EDUCATION.</DELETED>
<DELETED> ``(a) Study and List.--</DELETED>
<DELETED> ``(1) In general.--The Secretary 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, dysfunctional or self-destructive
behavior.</DELETED>
<DELETED> ``(2) Positions.--The positions referred to in
paragraph (1) are--</DELETED>
<DELETED> ``(A) staff positions within the Bureau of
Indian Affairs, including existing positions, in the
fields of--</DELETED>
<DELETED> ``(i) elementary and secondary
education;</DELETED>
<DELETED> ``(ii) social services, family and
child welfare;</DELETED>
<DELETED> ``(iii) law enforcement and
judicial services; and</DELETED>
<DELETED> ``(iv) alcohol and substance
abuse;</DELETED>
<DELETED> ``(B) staff positions within the Service;
and</DELETED>
<DELETED> ``(C) staff positions similar to those
specified in subsection (b) and established and
maintained by Indian tribes, tribal organizations, and
urban Indian organizations, including positions
established pursuant to funding agreements under the
Indian Self-determination and Education Assistance Act,
and this Act.</DELETED>
<DELETED> ``(3) Training criteria.--</DELETED>
<DELETED> ``(A) In general.--The appropriate
Secretary shall provide training criteria appropriate
to each type of position specified in subsection (b)(1)
and ensure that appropriate training has been or will
be provided to any individual in any such
position.</DELETED>
<DELETED> ``(B) Training.--With respect to any such
individual in a position specified pursuant to
subsection (b)(3), the respective Secretaries shall
provide appropriate training or provide funds to an
Indian tribe, tribal organization, or urban Indian
organization for the training of appropriate
individuals. In the case of a funding agreement, the
appropriate Secretary shall ensure that such training
costs are included in the funding agreement, if
necessary.</DELETED>
<DELETED> ``(4) Cultural relevancy.--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.</DELETED>
<DELETED> ``(5) Community education.--</DELETED>
<DELETED> ``(A) Development.--The Service shall
develop and implement, or on request of an Indian tribe
or tribal organization, assist an Indian tribe or
tribal organization, in developing and implementing a
program of community education on mental
illness.</DELETED>
<DELETED> ``(B) Technical assistance.--In carrying
out this paragraph, the Service shall, upon the 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,
dysfunctional and self-destructive behavior.</DELETED>
<DELETED> ``(b) Staffing.--</DELETED>
<DELETED> ``(1) In general.--Not later than 90 days after
the date of enactment of the Act, the Director of the Service
shall develop a plan under which the Service will increase the
number of health care staff that are providing mental health
services by at least 500 positions within 5 years after such
date of enactment, with at least 200 of such positions devoted
to child, adolescent, and family services. The allocation of
such positions shall be subject to the provisions of section
102(a).</DELETED>
<DELETED> ``(2) Implementation.--The plan developed under
paragraph (1) shall be implemented under the Act of November 2,
1921 (25 U.S.C. 13) (commonly know as the `Snyder
Act').</DELETED>
<DELETED>``SEC. 128. AUTHORIZATION OF APPROPRIATIONS.</DELETED>
<DELETED> ``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.</DELETED>
<DELETED>``TITLE II--HEALTH SERVICES</DELETED>
<DELETED>``SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND.</DELETED>
<DELETED> ``(a) In General.--The Secretary may expend funds,
directly or under the authority of the Indian Self-Determination and
Education Assistance Act, that are appropriated under the authority of
this section, for the purposes of--</DELETED>
<DELETED> ``(1) eliminating the deficiencies in the health
status and resources of all Indian tribes;</DELETED>
<DELETED> ``(2) eliminating backlogs in the provision of
health care services to Indians;</DELETED>
<DELETED> ``(3) meeting the health needs of Indians in an
efficient and equitable manner;</DELETED>
<DELETED> ``(4) eliminating inequities in funding for both
direct care and contract health service programs; and</DELETED>
<DELETED> ``(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
and resource deficiencies:</DELETED>
<DELETED> ``(A) clinical care, including inpatient
care, outpatient care (including audiology, clinical
eye and vision care), primary care, secondary and
tertiary care, and long term care;</DELETED>
<DELETED> ``(B) preventive health, including
mammography and other cancer screening in accordance
with section 207;</DELETED>
<DELETED> ``(C) dental care;</DELETED>
<DELETED> ``(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;</DELETED>
<DELETED> ``(E) emergency medical
services;</DELETED>
<DELETED> ``(F) treatment and control of, and
rehabilitative care related to, alcoholism and drug
abuse (including fetal alcohol syndrome) among
Indians;</DELETED>
<DELETED> ``(G) accident prevention
programs;</DELETED>
<DELETED> ``(H) home health care;</DELETED>
<DELETED> ``(I) community health
representatives;</DELETED>
<DELETED> ``(J) maintenance and repair;
and</DELETED>
<DELETED> ``(K) traditional health care
practices.</DELETED>
<DELETED> ``(b) Use of Funds.--</DELETED>
<DELETED> ``(1) 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, the Act of November 2, 1921 (25 U.S.C. 13) (commonly known
as the `Snyder Act'), or any other provision of law.</DELETED>
<DELETED> ``(2) Allocation.--</DELETED>
<DELETED> ``(A) In general.--Funds appropriated
under the authority of this section shall be allocated
to service units or Indian tribes or tribal
organizations. The funds allocated to each tribe,
tribal organization, or service unit under this
subparagraph shall be used to improve the health status
and reduce the resource deficiency of each tribe served
by such service unit, tribe or tribal organization.
Such allocation shall weigh the amounts appropriated in
favor of those service areas where the health status of
Indians within the area, as measured by life expectancy
based upon the most recent data available, is
significantly lower than the average health status for
Indians for all service areas, except that amounts
allocated to each such area using such a weighted
allocation formula shall not be less than the amounts
allocated to each such area in the previous fiscal
year.</DELETED>
<DELETED> ``(B) Apportionment.--The apportionment of
funds allocated to a service unit, tribe or tribal
organization under subparagraph (A) among the health
service responsibilities described in subsection (a)(4)
shall be determined by the Service in consultation
with, and with the active participation of, the
affected Indian tribes in accordance with this section
and such rules as may be established under title
VIII.</DELETED>
<DELETED> ``(c) Health Status and Resource Deficiency.--In this
section:</DELETED>
<DELETED> ``(1) Definition.--The term `health status and
resource deficiency' means the extent to which--</DELETED>
<DELETED> ``(A) the health status objective set
forth in section 3(2) is not being achieved;
and</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(2) Resources.--The health resources available
to an Indian tribe or tribal organization shall 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.</DELETED>
<DELETED> ``(3) Review of determination.--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 tribe or tribal
organization.</DELETED>
<DELETED> ``(d) Eligibility.--Programs administered by any Indian
tribe or tribal organization under the authority of the Indian Self-
Determination and Education Assistance Act 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.</DELETED>
<DELETED> ``(e) Report.--Not later than the date that is 3 years
after the date of enactment of this Act, the Secretary shall submit to
the Congress the current health status and resource deficiency report
of the Service for each Indian tribe or service unit, including newly
recognized or acknowledged tribes. Such report shall set out--
</DELETED>
<DELETED> ``(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;</DELETED>
<DELETED> ``(2) the extent of the health status and resource
deficiency of each Indian tribe served by the
Service;</DELETED>
<DELETED> ``(3) the amount of funds necessary to eliminate
the health status and resource deficiencies of all Indian
tribes served by the Service; and</DELETED>
<DELETED> ``(4) an estimate of--</DELETED>
<DELETED> ``(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 comparable entity;</DELETED>
<DELETED> ``(B) the number of Indians eligible for
health services in each service unit or Indian tribe or
tribal organization; and</DELETED>
<DELETED> ``(C) the number of Indians using the
Service resources made available to each service unit
or 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.</DELETED>
<DELETED> ``(f) Budgetary Rule.--Funds appropriated under the
authority of 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.</DELETED>
<DELETED> ``(g) Rule of Construction.--Nothing in this section shall
be construed to diminish the primary responsibility of the Service to
eliminate existing backlogs in unmet health care needs or to discourage
the Service from undertaking additional efforts to achieve equity among
Indian tribes and tribal organizations.</DELETED>
<DELETED> ``(h) Designation.--Any funds appropriated under the
authority of this section shall be designated as the `Indian Health
Care Improvement Fund'.</DELETED>
<DELETED>``SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND.</DELETED>
<DELETED> ``(a) Establishment.--</DELETED>
<DELETED> ``(1) In general.--There is hereby established an
Indian Catastrophic Health Emergency Fund (referred to in this
section as the `CHEF') consisting of--</DELETED>
<DELETED> ``(A) the amounts deposited under
subsection (d); and</DELETED>
<DELETED> ``(B) any amounts appropriated to the CHEF
under this Act.</DELETED>
<DELETED> ``(2) Administration.--The CHEF shall be
administered by the Secretary 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.</DELETED>
<DELETED> ``(3) Equitable allocation.--The CHEF shall be
equitably allocated, apportioned or delegated on a service unit
or area office basis, based upon a formula to be developed by
the Secretary in consultation with the Indian tribes and tribal
organizations through negotiated rulemaking under title VIII.
Such formula shall take into account the added needs of service
areas which are contract health service dependent.</DELETED>
<DELETED> ``(4) Not subject to contract or grant.--No part
of the CHEF or its administration shall be subject to contract
or grant under any law, including the Indian Self-Determination
and Education Assistance Act.</DELETED>
<DELETED> ``(5) Administration.--Amounts provided from the
CHEF shall be administered by the area offices based upon
priorities determined by the Indian tribes and tribal
organizations within each service area, including a
consideration of the needs of Indian tribes and tribal
organizations which are contract health service-
dependent.</DELETED>
<DELETED> ``(b) Requirements.--The Secretary shall, through the
negotiated rulemaking process under title VIII, promulgate regulations
consistent with the provisions of this section--</DELETED>
<DELETED> ``(1) establish a definition of disasters and
catastrophic illnesses for which the cost of treatment provided
under contract would qualify for payment from the
CHEF;</DELETED>
<DELETED> ``(2) provide that a service unit, Indian tribe,
or tribal organization shall not be eligible for reimbursement
for the cost of treatment from the CHEF until its cost of
treatment for any victim of such a catastrophic illness or
disaster has reached a certain threshold cost which the
Secretary shall establish at--</DELETED>
<DELETED> ``(A) for 1999, not less than $19,000;
and</DELETED>
<DELETED> ``(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;</DELETED>
<DELETED> ``(3) establish a procedure for the reimbursement
of the portion of the costs incurred by--</DELETED>
<DELETED> ``(A) service units, Indian tribes, or
tribal organizations, or facilities of the Service;
or</DELETED>
<DELETED> ``(B) non-Service facilities or providers
whenever otherwise authorized by the Service;</DELETED>
<DELETED>in rendering treatment that exceeds threshold cost
described in paragraph (2);</DELETED>
<DELETED> ``(4) establish a procedure for payment from the
CHEF in cases in which the exigencies of the medical
circumstances warrant treatment prior to the authorization of
such treatment by the Service; and</DELETED>
<DELETED> ``(5) establish a procedure that will ensure that
no payment shall be made from the 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.</DELETED>
<DELETED> ``(c) Limitation.--Amounts appropriated to the CHEF under
this section shall not be used to offset or limit appropriations made
to the Service under the authority of the Act of November 2, 1921 (25
U.S.C. 13) (commonly known as the Snyder Act) or any other
law.</DELETED>
<DELETED> ``(d) Deposits.--There shall be deposited into the 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 the
CHEF.</DELETED>
<DELETED>``SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION
SERVICES.</DELETED>
<DELETED> ``(a) Findings.--Congress finds that health promotion and
disease prevention activities will--</DELETED>
<DELETED> ``(1) improve the health and well-being of
Indians; and</DELETED>
<DELETED> ``(2) reduce the expenses for health care of
Indians.</DELETED>
<DELETED> ``(b) Provision of Services.--The Secretary, acting
through the Service and through Indian tribes and tribal organizations,
shall provide health promotion and disease prevention services to
Indians so as to achieve the health status objective set forth in
section 3(b).</DELETED>
<DELETED> ``(c) Disease Prevention and Health Promotion.--In this
section:</DELETED>
<DELETED> ``(1) Disease prevention.--The term `disease
prevention' means the reduction, limitation, and prevention of
disease and its complications, and the reduction in the
consequences of such diseases, including--</DELETED>
<DELETED> ``(A) controlling--</DELETED>
<DELETED> ``(i) diabetes;</DELETED>
<DELETED> ``(ii) high blood
pressure;</DELETED>
<DELETED> ``(iii) infectious
agents;</DELETED>
<DELETED> ``(iv) injuries;</DELETED>
<DELETED> ``(v) occupational hazards and
disabilities;</DELETED>
<DELETED> ``(vi) sexually transmittable
diseases; and</DELETED>
<DELETED> ``(vii) toxic agents;
and</DELETED>
<DELETED> ``(B) providing--</DELETED>
<DELETED> ``(i) for the fluoridation of
water; and</DELETED>
<DELETED> ``(ii) immunizations.</DELETED>
<DELETED> ``(2) Health promotion.--The term `health
promotion' means fostering social, economic, environmental, and
personal factors conducive to health, including--</DELETED>
<DELETED> ``(A) raising people's awareness about
health matters and enabling them to cope with health
problems by increasing their knowledge and providing
them with valid information;</DELETED>
<DELETED> ``(B) encouraging adequate and appropriate
diet, exercise, and sleep;</DELETED>
<DELETED> ``(C) promoting education and work in
conformity with physical and mental capacity;</DELETED>
<DELETED> ``(D) making available suitable housing,
safe water, and sanitary facilities;</DELETED>
<DELETED> ``(E) improving the physical economic,
cultural, psychological, and social
environment;</DELETED>
<DELETED> ``(F) promoting adequate opportunity for
spiritual, religious, and traditional practices;
and</DELETED>
<DELETED> ``(G) adequate and appropriate programs
including--</DELETED>
<DELETED> ``(i) abuse prevention (mental and
physical);</DELETED>
<DELETED> ``(ii) community health;</DELETED>
<DELETED> ``(iii) community
safety;</DELETED>
<DELETED> ``(iv) consumer health
education;</DELETED>
<DELETED> ``(v) diet and
nutrition;</DELETED>
<DELETED> ``(vi) disease prevention
(communicable, immunizations, HIV/
AIDS);</DELETED>
<DELETED> ``(vii) environmental
health;</DELETED>
<DELETED> ``(viii) exercise and physical
fitness;</DELETED>
<DELETED> ``(ix) fetal alcohol
disorders;</DELETED>
<DELETED> ``(x) first aid and CPR
education;</DELETED>
<DELETED> ``(xi) human growth and
development;</DELETED>
<DELETED> ``(xii) injury prevention and
personal safety;</DELETED>
<DELETED> ``(xiii) mental health (emotional,
self-worth);</DELETED>
<DELETED> ``(xiv) personal health and
wellness practices;</DELETED>
<DELETED> ``(xv) personal capacity
building;</DELETED>
<DELETED> ``(xvi) prenatal, pregnancy, and
infant care;</DELETED>
<DELETED> ``(xvii) psychological well
being;</DELETED>
<DELETED> ``(xiii) reproductive health
(family planning);</DELETED>
<DELETED> ``(xix) safe and adequate
water;</DELETED>
<DELETED> ``(xx) safe housing;</DELETED>
<DELETED> ``(xxi) safe work
environments;</DELETED>
<DELETED> ``(xxii) stress control;</DELETED>
<DELETED> ``(xxiii) substance
abuse;</DELETED>
<DELETED> ``(xxiv) sanitary
facilities;</DELETED>
<DELETED> ``(xxv) tobacco use cessation and
reduction;</DELETED>
<DELETED> ``(xxvi) violence prevention;
and</DELETED>
<DELETED> ``(xxvii) such other activities
identified by the Service, an Indian tribe or
tribal organization, to promote the achievement
of the objective described in section
3(b).</DELETED>
<DELETED> ``(d) Evaluation.--The Secretary, after obtaining input
from affected Indian tribes and tribal organizations, shall submit to
the President for inclusion in each statement which is required to be
submitted to Congress under section 801 an evaluation of--</DELETED>
<DELETED> ``(1) the health promotion and disease prevention
needs of Indians;</DELETED>
<DELETED> ``(2) the health promotion and disease prevention
activities which would best meet such needs;</DELETED>
<DELETED> ``(3) the internal capacity of the Service to meet
such needs; and</DELETED>
<DELETED> ``(4) the resources which would be required to
enable the Service to undertake the health promotion and
disease prevention activities necessary to meet such
needs.</DELETED>
<DELETED>``SEC. 204. DIABETES PREVENTION, TREATMENT, AND
CONTROL.</DELETED>
<DELETED> ``(a) Determination.--The Secretary, in consultation with
Indian tribes and tribal organizations, shall determine--</DELETED>
<DELETED> ``(1) by tribe, tribal organization, and service
unit of the Service, the prevalence of, and the types of
complications resulting from, diabetes among Indians;
and</DELETED>
<DELETED> ``(2) based on paragraph (1), the measures
(including patient education) each service unit should take to
reduce the prevalence of, and prevent, treat, and control the
complications resulting from, diabetes among Indian tribes
within that service unit.</DELETED>
<DELETED> ``(b) Screening.--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 an Indian tribe or tribal organization
operating health care programs or facilities with funds from the
Service under the Indian Self-Determination and Education Assistance
Act.</DELETED>
<DELETED> ``(c) Continued Funding.--The Secretary shall continue to
fund, through fiscal year 2015, each effective model diabetes project
in existence on the date of the enactment of this Act and such other
diabetes programs operated by the Secretary or by Indian tribes and
tribal organizations and any additional programs added to meet existing
diabetes needs. Indian tribes and tribal organizations shall receive
recurring funding for the diabetes programs which they operate pursuant
to this section. Model diabetes projects shall consult, on a regular
basis, with tribes and tribal organizations in their regions regarding
diabetes needs and provide technical expertise as needed.</DELETED>
<DELETED> ``(d) Dialysis Programs.--The Secretary shall provide
funding through the Service, Indian tribes and tribal organizations to
establish dialysis programs, including funds to purchase dialysis
equipment and provide necessary staffing.</DELETED>
<DELETED> ``(e) Other Activities.--The Secretary shall, to the
extent funding is available--</DELETED>
<DELETED> ``(1) in each area office of the Service, consult
with Indian tribes and tribal organizations regarding programs
for the prevention, treatment, and control of
diabetes;</DELETED>
<DELETED> ``(2) establish in each area office of the Service
a registry of patients with diabetes to track the prevalence of
diabetes and the complications from diabetes in that area;
and</DELETED>
<DELETED> ``(3) ensure that data collected in each area
office regarding diabetes and related complications among
Indians is disseminated to tribes, tribal organizations, and
all other area offices.</DELETED>
<DELETED>``SEC. 205. SHARED SERVICES.</DELETED>
<DELETED> ``(a) In General.--The Secretary, acting through the
Service and notwithstanding any other provision of law, 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 projects shall provide for the
sharing of staff or other services between a Service or tribal facility
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.</DELETED>
<DELETED> ``(b) Requirements.--A funding agreement or other
arrangement entered into pursuant to subsection (a)--</DELETED>
<DELETED> ``(1) may, at the request of the Indian tribe or
tribal organization, delegate to such 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;</DELETED>
<DELETED> ``(2) shall provide that expenses (including
salaries) relating to services that are shared between the
Service and the tribal facility be allocated proportionately
between the Service and the tribe or tribal organization;
and</DELETED>
<DELETED> ``(3) may authorize such 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).</DELETED>
<DELETED> ``(c) 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.</DELETED>
<DELETED> ``(d) Use of Existing Facilities.--The Secretary shall
encourage the use for long-term or similar care of existing facilities
that are under-utilized or allow the use of swing beds for such
purposes.</DELETED>
<DELETED>``SEC. 206. HEALTH SERVICES RESEARCH.</DELETED>
<DELETED> ``(a) Funding.--The Secretary shall make funding available
for research to further the performance of the health service
responsibilities of the Service, Indian tribes, and tribal
organizations and shall coordinate the activities of other Agencies
within the Department to address these research needs.</DELETED>
<DELETED> ``(b) Allocation.--Funding under subsection (a) shall be
allocated equitably among the area offices. Each area office shall
award such funds competitively within that area.</DELETED>
<DELETED> ``(c) Eligibility for Funds.--Indian tribes and tribal
organizations receiving funding from the Service under the authority of
the Indian Self-Determination and Education Assistance Act shall be
given an equal opportunity to compete for, and receive, research funds
under this section.</DELETED>
<DELETED> ``(d) Use.--Funds received under this section may be used
for both clinical and non-clinical research by Indian tribes and tribal
organizations and shall be distributed to the area offices. Such area
offices may make grants using such funds within each area.</DELETED>
<DELETED>``SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREENING.</DELETED>
<DELETED> ``The Secretary, through the Service or through Indian
tribes or tribal organizations, shall provide for the following
screening:</DELETED>
<DELETED> ``(1) 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, and under
such terms and conditions as are consistent with standards
established by the Secretary to assure the safety and accuracy
of screening mammography under part B of title XVIII of the
Social Security Act.</DELETED>
<DELETED> ``(2) Other cancer screening meeting national
standards.</DELETED>
<DELETED>``SEC. 208. PATIENT TRAVEL COSTS.</DELETED>
<DELETED> ``The Secretary, acting through the Service, Indian tribes
and tribal organizations 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 entered into
pursuant to the Indian Self-Determination and Education Assistance Act)
under this Act:</DELETED>
<DELETED> ``(1) Emergency air transportation and
nonemergency air transportation where ground transportation is
infeasible.</DELETED>
<DELETED> ``(2) Transportation by private vehicle, specially
equipped vehicle and ambulance.</DELETED>
<DELETED> ``(3) Transportation by such other means as may be
available and required when air or motor vehicle transportation
is not available.</DELETED>
<DELETED>``SEC. 209. EPIDEMIOLOGY CENTERS.</DELETED>
<DELETED> ``(a) Establishment.--</DELETED>
<DELETED> ``(1) In general.--In addition to those centers
operating 1 day prior to the date of enactment of this Act,
(including those centers for which funding is currently being
provided through funding agreements under the Indian Self-
Determination and Education Assistance Act), the Secretary
shall, not later than 180 days after such date of enactment,
establish and fund an epidemiology center in each service area
which does not have such a center to carry out the functions
described in paragraph (2). Any centers established under the
preceding sentence may be operated by Indian tribes or tribal
organizations pursuant to funding agreements under the Indian
Self-Determination and Education Assistance Act, but funding under such
agreements may not be divisible.</DELETED>
<DELETED> ``(2) Functions.--In consultation with and upon
the request of Indian tribes, tribal organizations and urban
Indian organizations, each area epidemiology center established
under this subsection shall, with respect to such area shall--
</DELETED>
<DELETED> ``(A) collect data related to the health
status objective described in section 3(b), and monitor
the progress that the Service, Indian tribes, tribal
organizations, and urban Indian organizations have made
in meeting such health status objective;</DELETED>
<DELETED> ``(B) evaluate existing delivery systems,
data systems, and other systems that impact the
improvement of Indian health;</DELETED>
<DELETED> ``(C) 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;</DELETED>
<DELETED> ``(D) make recommendations for the
targeting of services needed by tribal, urban, and
other Indian communities;</DELETED>
<DELETED> ``(E) make recommendations to improve
health care delivery systems for Indians and urban
Indians;</DELETED>
<DELETED> ``(F) provide requested technical
assistance to Indian tribes 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</DELETED>
<DELETED> ``(G) provide disease surveillance and
assist Indian tribes, tribal organizations, and urban
Indian organizations to promote public
health.</DELETED>
<DELETED> ``(3) 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.</DELETED>
<DELETED> ``(b) Funding.--The Secretary may make funding available
to Indian tribes, tribal organizations, and eligible intertribal
consortia or urban Indian organizations to conduct epidemiological
studies of Indian communities.</DELETED>
<DELETED>``SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION
PROGRAMS.</DELETED>
<DELETED> ``(a) In General.--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 preschool through grade 12 in
schools for the benefit of Indian and urban Indian children.</DELETED>
<DELETED> ``(b) Use of Funds.--Funds awarded under this section may
be used to--</DELETED>
<DELETED> ``(1) develop and implement health education
curricula both for regular school programs and after school
programs;</DELETED>
<DELETED> ``(2) train teachers in comprehensive school
health education curricula;</DELETED>
<DELETED> ``(3) integrate school-based, community-based, and
other public and private health promotion efforts;</DELETED>
<DELETED> ``(4) encourage healthy, tobacco-free school
environments;</DELETED>
<DELETED> ``(5) coordinate school-based health programs with
existing services and programs available in the
community;</DELETED>
<DELETED> ``(6) develop school programs on nutrition
education, personal health, oral health, and fitness;</DELETED>
<DELETED> ``(7) develop mental health wellness
programs;</DELETED>
<DELETED> ``(8) develop chronic disease prevention
programs;</DELETED>
<DELETED> ``(9) develop substance abuse prevention
programs;</DELETED>
<DELETED> ``(10) develop injury prevention and safety
education programs;</DELETED>
<DELETED> ``(11) develop activities for the prevention and
control of communicable diseases;</DELETED>
<DELETED> ``(12) develop community and environmental health
education programs that include traditional health care
practitioners;</DELETED>
<DELETED> ``(13) carry out violence prevention activities;
and</DELETED>
<DELETED> ``(14) carry out activities relating to such other
health issues as are appropriate.</DELETED>
<DELETED> ``(c) Technical Assistance.--The Secretary shall, upon
request, 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.</DELETED>
<DELETED> ``(d) Criteria.--The Secretary, in consultation with
Indian tribes, tribal organizations, and urban Indian organizations
shall establish criteria for the review and approval of applications
for funding under this section.</DELETED>
<DELETED> ``(e) Comprehensive School Health Education Program.--
</DELETED>
<DELETED> ``(1) Development.--The Secretary of the Interior,
acting through the Bureau of Indian Affairs and in cooperation
with the Secretary and affected Indian tribes and tribal
organizations, shall develop a comprehensive school health
education program for children from preschool through grade 12
for use in schools operated by the Bureau of Indian
Affairs.</DELETED>
<DELETED> ``(2) Requirements.--The program developed under
paragraph (1) shall include--</DELETED>
<DELETED> ``(A) school programs on nutrition
education, personal health, oral health, and
fitness;</DELETED>
<DELETED> ``(B) mental health wellness
programs;</DELETED>
<DELETED> ``(C) chronic disease prevention
programs;</DELETED>
<DELETED> ``(D) substance abuse prevention
programs;</DELETED>
<DELETED> ``(E) injury prevention and safety
education programs; and</DELETED>
<DELETED> ``(F) activities for the prevention and
control of communicable diseases.</DELETED>
<DELETED> ``(3) Training and coordination.--The Secretary of
the Interior shall--</DELETED>
<DELETED> ``(A) provide training to teachers in
comprehensive school health education
curricula;</DELETED>
<DELETED> ``(B) ensure the integration and
coordination of school-based programs with
existing services and health programs available in the community;
and</DELETED>
<DELETED> ``(C) encourage healthy, tobacco-free
school environments.</DELETED>
<DELETED>``SEC. 211. INDIAN YOUTH PROGRAM.</DELETED>
<DELETED> ``(a) In General.--The Secretary, acting through the
Service, is authorized 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.</DELETED>
<DELETED> ``(b) Use of Funds.--</DELETED>
<DELETED> ``(1) In general.--Funds made available under this
section may be used to--</DELETED>
<DELETED> ``(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</DELETED>
<DELETED> ``(B) develop and provide community
training and education.</DELETED>
<DELETED> ``(2) Limitation.--Funds made available under this
section may not be used to provide services described in
section 707(c).</DELETED>
<DELETED> ``(c) Requirements.--The Secretary shall--</DELETED>
<DELETED> ``(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;</DELETED>
<DELETED> ``(2) encourage the implementation of such models;
and</DELETED>
<DELETED> ``(3) at the request of an Indian tribe, tribal
organization, or urban Indian organization, provide technical
assistance in the implementation of such models.</DELETED>
<DELETED> ``(d) Criteria.--The Secretary, in consultation with
Indian tribes, tribal organization, and urban Indian organizations,
shall establish criteria for the review and approval of applications
under this section.</DELETED>
<DELETED>``SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF
COMMUNICABLE AND INFECTIOUS DISEASES.</DELETED>
<DELETED> ``(a) In General.--The Secretary, acting through the
Service 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--</DELETED>
<DELETED> ``(1) projects for the prevention, control, and
elimination of communicable and infectious diseases, including
tuberculosis, hepatitis, HIV, respiratory syncitial virus,
hanta virus, sexually transmitted diseases, and H. Pylori,
which projects may include screening, testing and treatment for
HCV and other infectious and communicable diseases;</DELETED>
<DELETED> ``(2) public information and education programs
for the prevention, control, and elimination of communicable
and infectious diseases;</DELETED>
<DELETED> ``(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;
and</DELETED>
<DELETED> ``(4) a demonstration project that studies the
seroprevalence of the Hepatitis C virus among a random sample
of American Indian and Alaskan Native populations and
identifies prevalence rates among a variety of tribes and
geographic regions.</DELETED>
<DELETED> ``(b) Requirement of Application.--The Secretary may
provide funds under subsection (a) only if an application or proposal
for such funds is submitted.</DELETED>
<DELETED> ``(c) Technical Assistance and Report.--In carrying out
this section, the Secretary--</DELETED>
<DELETED> ``(1) may, at the request of an Indian tribe or
tribal organization, provide technical assistance;
and</DELETED>
<DELETED> ``(2) shall prepare and submit, biennially, a
report to Congress 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.</DELETED>
<DELETED>``SEC. 213. AUTHORITY FOR PROVISION OF OTHER
SERVICES.</DELETED>
<DELETED> ``(a) In General.--The Secretary, acting through the
Service, Indian tribes, and tribal organizations, may provide funding
under this Act to meet the objective set forth in section 3 through
health care related services and programs not otherwise described in
this Act. Such services and programs shall include services and
programs related to--</DELETED>
<DELETED> ``(1) hospice care and assisted living;</DELETED>
<DELETED> ``(2) long-term health care;</DELETED>
<DELETED> ``(3) home- and community-based
services;</DELETED>
<DELETED> ``(4) public health functions; and</DELETED>
<DELETED> ``(5) traditional health care practices.</DELETED>
<DELETED> ``(b) Availability of Services for Certain Individuals.--
At the discretion of the Service, Indian tribe, or tribal organization,
services hospice care, home health care (under section 201), home- and
community-based care, assisted living, and long term care may be
provided (on a cost basis) to individuals 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 a tribe or tribal organization.</DELETED>
<DELETED> ``(c) Definitions.--In this section:</DELETED>
<DELETED> ``(1) Home- and community-based services.--The
term `home- and community-based services' means 1 or more of
the following:</DELETED>
<DELETED> ``(A) Homemaker/home health aide
services.</DELETED>
<DELETED> ``(B) Chore services.</DELETED>
<DELETED> ``(C) Personal care services.</DELETED>
<DELETED> ``(D) Nursing care services provided
outside of a nursing facility by, or under the
supervision of, a registered nurse.</DELETED>
<DELETED> ``(E) Training for family
members.</DELETED>
<DELETED> ``(F) Adult day care.</DELETED>
<DELETED> ``(G) Such other home- and community-based
services as the Secretary or a tribe or tribal
organization may approve.</DELETED>
<DELETED> ``(2) Hospice care.--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 such care.</DELETED>
<DELETED> ``(3) Public health functions.--The term `public
health functions' means public health related programs,
functions, and services including assessments, assurances, and
policy development that Indian tribes and tribal organizations
are authorized and encouraged, in those circumstances where it
meets their needs, to carry out by forming collaborative
relationships with all levels of local, State, and Federal
governments.</DELETED>
<DELETED>``SEC. 214. INDIAN WOMEN'S HEALTH CARE.</DELETED>
<DELETED> ``The Secretary acting through the Service, 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.</DELETED>
<DELETED>``SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH
HAZARDS.</DELETED>
<DELETED> ``(a) Study and Monitoring Programs.--The Secretary and
the Service shall, in conjunction with other appropriate Federal
agencies and in consultation with concerned Indian tribes and tribal
organizations, conduct a study and carry out ongoing monitoring
programs to determine the trends that exist in the health hazards posed
to Indian miners and to Indians on or near Indian reservations and in
Indian communities as a result of environmental hazards that may result
in chronic or life-threatening health problems. Such hazards include
nuclear resource development, petroleum contamination, and
contamination of the water source or of the food chain. Such study (and
any reports with respect to such study) shall include--</DELETED>
<DELETED> ``(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;</DELETED>
<DELETED> ``(2) an analysis of the potential effect of
ongoing and future environmental resource development on or
near Indian reservations and communities including the
cumulative effect of such development over time on
health;</DELETED>
<DELETED> ``(3) an evaluation of the types and nature of
activities, practices, and conditions causing or affecting such
health problems including uranium mining and milling, uranium
mine tailing deposits, nuclear power plant operation and
construction, and nuclear waste disposal, oil and gas
production or transportation on or near Indian reservations or
communities, and other development that could affect the health
of Indians and their water supply and food chain;</DELETED>
<DELETED> ``(4) a summary of any findings or recommendations
provided in Federal and State studies, reports, investigations,
and inspections during the 5 years prior to the date of the
enactment of this Act that directly or indirectly relate to the
activities, practices, and conditions affecting the health or
safety of such Indians; and</DELETED>
<DELETED> ``(5) a description of 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.</DELETED>
<DELETED> ``(b) Development of Health Care Plans.--Upon the
completion of the study under subsection (a), the Secretary and the
Service shall take into account the results of such study and, in
consultation with Indian tribes and tribal organizations, develop a
health care plan to address the health problems that were the subject
of such study. The plans shall include--</DELETED>
<DELETED> ``(1) methods for diagnosing and treating Indians
currently exhibiting such health problems;</DELETED>
<DELETED> ``(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</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(c) Submission to Congress.--</DELETED>
<DELETED> ``(1) General report.--Not later than 18 months
after the date of enactment of this Act, the Secretary and the
Service shall submit to Congress a report concerning the study
conducted under subsection (a).</DELETED>
<DELETED> ``(2) Health care plan report.--Not later than 1
year after the date on which the report under paragraph (1) is
submitted to Congress, the Secretary and the Service shall
submit to Congress the health care plan prepared under
subsection (b). Such plan 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 the
health problems involved.</DELETED>
<DELETED> ``(d) Task Force.--</DELETED>
<DELETED> ``(1) Established.--There is hereby established an
Intergovernmental Task Force (referred to in this section as
the `task force') that shall be composed of the following
individuals (or their designees):</DELETED>
<DELETED> ``(A) The Secretary of Energy.</DELETED>
<DELETED> ``(B) The Administrator of the
Environmental Protection Agency.</DELETED>
<DELETED> ``(C) The Director of the Bureau of
Mines.</DELETED>
<DELETED> ``(D) The Assistant Secretary for
Occupational Safety and Health.</DELETED>
<DELETED> ``(E) The Secretary of the
Interior.</DELETED>
<DELETED> ``(2) Duties.--The Task Force shall 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 an Indian reservation
or in an Indian community, and 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.</DELETED>
<DELETED> ``(3) Administrative provisions.--The Secretary
shall serve as the chairperson of the Task Force. The Task
Force shall meet at least twice each year. Each member of the
Task Force shall furnish necessary assistance to the Task
Force.</DELETED>
<DELETED> ``(e) Provision of Appropriate Medical Care.--In the case
of any Indian who--</DELETED>
<DELETED> ``(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;</DELETED>
<DELETED> ``(2) is eligible to receive diagnosis and
treatment services from a Service facility; and</DELETED>
<DELETED> ``(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;</DELETED>
<DELETED>the Service shall, at the request of such Indian, render
appropriate medical care to such Indian for such illness or condition
and may recover the costs of 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 costs paid to the
Service from the employer for such illness or condition.</DELETED>
<DELETED>``SEC. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DELIVERY
AREA.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(b) Limitation.--The Service shall not curtail any
health care services provided to Indians residing on Federal
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).</DELETED>
<DELETED>``SEC. 216A. NORTH DAKOTA AS A CONTRACT HEALTH SERVICE
DELIVERY AREA.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(b) Limitation.--The Service shall not curtail any
health care services provided to Indians residing on Federal
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).</DELETED>
<DELETED>``SEC. 216B. SOUTH DAKOTA AS A CONTRACT HEALTH SERVICE
DELIVERY AREA.</DELETED>
<DELETED> ``(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 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.</DELETED>
<DELETED> ``(b) Limitation.--The Service shall not curtail any
health care services provided to Indians residing on Federal
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).</DELETED>
<DELETED>``SEC. 217. CALIFORNIA CONTRACT HEALTH SERVICES DEMONSTRATION
PROGRAM.</DELETED>
<DELETED> ``(a) In General.--The Secretary may fund a program that
utilizes the California Rural Indian Health Board as a contract care
intermediary to improve the accessibility of health services to
California Indians.</DELETED>
<DELETED> ``(b) Reimbursement of Board.--</DELETED>
<DELETED> ``(1) Agreement.--The Secretary shall enter into
an agreement with the California Rural Indian Health Board to
reimburse the Board for costs (including reasonable
administrative costs) incurred pursuant to this section in
providing medical treatment under contract to California
Indians described in section 809(b) throughout the California
contract health services delivery area described in section 218
with respect to high-cost contract care cases.</DELETED>
<DELETED> ``(2) Administration.--Not more than 5 percent of
the amounts provided to the Board under this section for any
fiscal year may be used for reimbursement for administrative
expenses incurred by the Board during such fiscal
year.</DELETED>
<DELETED> ``(3) Limitation.--No payment may be made for
treatment provided under this section to the extent that
payment may be made for such treatment under the 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.</DELETED>
<DELETED> ``(c) Advisory Board.--There is hereby established an
advisory board that shall advise the California Rural Indian Health
Board in carrying out this section. The advisory board shall be
composed of representatives, selected by the California Rural Indian
Health Board, from not less than 8 tribal health programs serving
California Indians covered under this section, at least 50 percent of
whom are not affiliated with the California Rural Indian Health
Board.</DELETED>
<DELETED>``SEC. 218. CALIFORNIA AS A CONTRACT HEALTH SERVICE DELIVERY
AREA.</DELETED>
<DELETED> ``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 Indians in such State, except that any of the counties
described in this section may be included in the contract health
services delivery area if funding is specifically provided by the
Service for such services in those counties.</DELETED>
<DELETED>``SEC. 219. CONTRACT HEALTH SERVICES FOR THE TRENTON SERVICE
AREA.</DELETED>
<DELETED> ``(a) In General.--The Secretary, acting through the
Service, shall 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.</DELETED>
<DELETED> ``(b) Rule of Construction.--Nothing in this section shall
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.</DELETED>
<DELETED>``SEC. 220. PROGRAMS OPERATED BY INDIAN TRIBES AND TRIBAL
ORGANIZATIONS.</DELETED>
<DELETED> ``The Service shall provide funds for health care programs
and facilities operated by Indian tribes and tribal organizations under
funding agreements with the Service entered into under the Indian Self-
Determination and Education Assistance Act on the same basis as such
funds are provided to programs and facilities operated directly by the
Service.</DELETED>
<DELETED>``SEC. 221. LICENSING.</DELETED>
<DELETED> ``Health care professionals employed by Indian tribes and
tribal organizations to carry out agreements under the Indian Self-
Determination and Education Assistance Act, shall, if licensed in any
State, be exempt from the licensing requirements of the State in which
the agreement is performed.</DELETED>
<DELETED>``SEC. 222. AUTHORIZATION FOR EMERGENCY CONTRACT HEALTH
SERVICES.</DELETED>
<DELETED> ``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.</DELETED>
<DELETED>``SEC. 223. PROMPT ACTION ON PAYMENT OF CLAIMS.</DELETED>
<DELETED> ``(a) Requirement.--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.</DELETED>
<DELETED> ``(b) Failure To Respond.--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.</DELETED>
<DELETED> ``(c) Payment.--The Service shall pay a valid contract
care service claim within 30 days after the completion of the
claim.</DELETED>
<DELETED>``SEC. 224. LIABILITY FOR PAYMENT.</DELETED>
<DELETED> ``(a) No 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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(c) Limitation.--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 involved.</DELETED>
<DELETED>``SEC. 225. AUTHORIZATION OF APPROPRIATIONS.</DELETED>
<DELETED> ``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.</DELETED>
<DELETED>``TITLE III--FACILITIES</DELETED>
<DELETED>``SEC. 301. CONSULTATION, CONSTRUCTION AND RENOVATION OF
FACILITIES; REPORTS.</DELETED>
<DELETED> ``(a) Consultation.--Prior to the expenditure of, or the
making of any firm commitment to expend, any funds appropriated for the
planning, design, construction, or renovation of facilities pursuant to
the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the
Snyder Act), the Secretary, acting through the Service, shall--
</DELETED>
<DELETED> ``(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</DELETED>
<DELETED> ``(2) ensure, whenever practicable, that such
facility meets the construction standards of any nationally
recognized accrediting body by not later than 1 year after the
date on which the construction or renovation of such facility
is completed.</DELETED>
<DELETED> ``(b) Closure of Facilities.--</DELETED>
<DELETED> ``(1) In general.--Notwithstanding any provision
of law other than this subsection, no Service hospital or
outpatient health care facility or any inpatient service or
special care facility operated by the Service, may be closed if
the Secretary has not submitted to the Congress at least 1 year
prior to the date such proposed closure an evaluation of the
impact of such proposed closure which specifies, in addition to
other considerations--</DELETED>
<DELETED> ``(A) the accessibility of alternative
health care resources for the population served by such
hospital or facility;</DELETED>
<DELETED> ``(B) the cost effectiveness of such
closure;</DELETED>
<DELETED> ``(C) the quality of health care to be
provided to the population served by such hospital or
facility after such closure;</DELETED>
<DELETED> ``(D) the availability of contract health
care funds to maintain existing levels of
service;</DELETED>
<DELETED> ``(E) the views of the Indian tribes
served by such hospital or facility concerning such
closure;</DELETED>
<DELETED> ``(F) the level of utilization of such
hospital or facility by all eligible Indians;
and</DELETED>
<DELETED> ``(G) the distance between such hospital
or facility and the nearest operating Service
hospital.</DELETED>
<DELETED> ``(2) Temporary closure.--Paragraph (1) shall not
apply to any temporary closure of a facility or of any portion
of a facility if such closure is necessary for medical, environmental,
or safety reasons.</DELETED>
<DELETED> ``(c) Priority System.--</DELETED>
<DELETED> ``(1) Establishment.--The Secretary shall
establish a health care facility priority system, that shall--
</DELETED>
<DELETED> ``(A) be developed with Indian tribes and
tribal organizations through negotiated rulemaking
under section 802;</DELETED>
<DELETED> ``(B) give the needs of Indian tribes the
highest priority, with additional priority being given
to those service areas where the health status of
Indians within the area, as measured by life expectancy
based upon the most recent data available, is
significantly lower than the average health status for
Indians in all service areas; and</DELETED>
<DELETED> ``(C) at a minimum, include the lists
required in paragraph (2)(B) and the methodology
required in paragraph (2)(E);</DELETED>
<DELETED>except that the priority of any project established
under the construction priority system in effect on the date of
this Act shall not be affected by any change in the
construction priority system taking place thereafter if the
project was identified as one of the top 10 priority inpatient
projects or one of the top 10 outpatient projects in the Indian
Health Service budget justification for fiscal year 2003, or if the
project had completed both Phase I and Phase II of the construction
priority system in effect on the date of this Act.</DELETED>
<DELETED> ``(2) Report.--The Secretary shall submit to the
President, for inclusion in each report required to be
transmitted to the Congress under section 801, a report that
includes--</DELETED>
<DELETED> ``(A) a description of the health care
facility priority system of the Service, as established
under paragraph (1);</DELETED>
<DELETED> ``(B) health care facility lists,
including--</DELETED>
<DELETED> ``(i) the total health care
facility planning, design, construction and
renovation needs for Indians;</DELETED>
<DELETED> ``(ii) the 10 top-priority
inpatient care facilities;</DELETED>
<DELETED> ``(iii) the 10 top-priority
outpatient care facilities;</DELETED>
<DELETED> ``(iv) the 10 top-priority
specialized care facilities (such as long-term
care and alcohol and drug abuse treatment);
and</DELETED>
<DELETED> ``(v) any staff quarters
associated with such prioritized
facilities;</DELETED>
<DELETED> ``(C) the justification for the order of
priority among facilities;</DELETED>
<DELETED> ``(D) the projected cost of the projects
involved; and</DELETED>
<DELETED> ``(E) the methodology adopted by the
Service in establishing priorities under its health
care facility priority system.</DELETED>
<DELETED> ``(3) Consultation.--In preparing each report
required under paragraph (2) (other than the initial report)
the Secretary shall annually--</DELETED>
<DELETED> ``(A) consult with, and obtain information
on all health care facilities needs from, Indian tribes
and tribal organizations including those tribes or
tribal organizations operating health programs or
facilities under any funding agreement entered into
with the Service under the Indian Self-Determination
and Education Assistance Act; and</DELETED>
<DELETED> ``(B) review the total unmet needs of all
tribes and tribal organizations for health care
facilities (including staff quarters), including needs
for renovation and expansion of existing
facilities.</DELETED>
<DELETED> ``(4) Criteria.--For purposes of this subsection,
the Secretary shall, in evaluating the needs of facilities
operated under any funding agreement entered into with the
Service under the Indian Self-Determination and Education
Assistance Act, use the same criteria that the Secretary uses
in evaluating the needs of facilities operated directly by the
Service.</DELETED>
<DELETED> ``(5) Equitable integration.--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.</DELETED>
<DELETED> ``(d) Review of Need for Facilities.--</DELETED>
<DELETED> ``(1) Report.--Beginning in 2004, the Secretary
shall annually submit to the President, for inclusion in the
report required to be transmitted to Congress under section 801
of this Act, a report which sets forth the needs of the Service
and all Indian tribes and tribal organizations, including urban
Indian organizations, for inpatient, outpatient and specialized
care facilities, including the needs for renovation and
expansion of existing facilities.</DELETED>
<DELETED> ``(2) Consultation.--In preparing each report
required under paragraph (1) (other than the initial report),
the Secretary shall consult with Indian tribes and tribal
organizations including those tribes or tribal organizations
operating health programs or facilities under any funding
agreement entered into with the Service under the Indian Self-
Determination and Education Assistance Act, and with urban
Indian organizations.</DELETED>
<DELETED> ``(3) Criteria.--For purposes of this subsection,
the Secretary shall, in evaluating the needs of facilities
operated under any funding agreement entered into with the
Service under the Indian Self-Determination and Education
Assistance Act, use the same criteria that the Secretary uses
in evaluating the needs of facilities operated directly by the
Service.</DELETED>
<DELETED> ``(4) Equitable integration.--The Secretary shall
ensure that the planning, design, construction, and renovation
needs of facilities operated under funding agreements, in
accordance with the Indian Self-Determination and Education
Assistance Act, are fully and equitably integrated into the
development of the health facility priority system.</DELETED>
<DELETED> ``(5) Annual nominations.--Each year the Secretary
shall provide an opportunity for the nomination of planning,
design, and construction projects by the Service and all Indian
tribes and tribal organizations for consideration under the
health care facility priority system.</DELETED>
<DELETED> ``(e) Inclusion of Certain Programs.--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 an Indian tribe or tribes shall be subject to the
provisions of section 102 of the Indian Self-Determination and
Education Assistance Act.</DELETED>
<DELETED> ``(f) 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.</DELETED>
<DELETED>``SEC. 302. SAFE WATER AND SANITARY WASTE DISPOSAL
FACILITIES.</DELETED>
<DELETED> ``(a) Findings.--Congress finds and declares that--
</DELETED>
<DELETED> ``(1) the provision of safe water supply
facilities and sanitary sewage and solid waste disposal
facilities is primarily a health consideration and
function;</DELETED>
<DELETED> ``(2) Indian people suffer an inordinately high
incidence of disease, injury, and illness directly attributable
to the absence or inadequacy of such facilities;</DELETED>
<DELETED> ``(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
such facilities and other preventive health measures;</DELETED>
<DELETED> ``(4) many Indian homes and communities still lack
safe water supply facilities and sanitary sewage and solid
waste disposal facilities; and</DELETED>
<DELETED> ``(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 safe and adequate water supply facilities and sanitary
sewage waste disposal facilities as soon as possible.</DELETED>
<DELETED> ``(b) Provision of Facilities and Services.--</DELETED>
<DELETED> ``(1) In general.--In furtherance of the findings
and declarations 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).</DELETED>
<DELETED> ``(2) Assistance.--The Secretary, acting through
the Service, is authorized to provide under section 7 of the
Act of August 5, 1954 (42 U.S.C. 2004a)--</DELETED>
<DELETED> ``(A) 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 Indian sanitation facilities, including the
provision of existing plans, standard details, and
specifications available in the Department, to be used
at the option of the tribe or tribal
organization;</DELETED>
<DELETED> ``(B) ongoing technical assistance and
training in the management of utility organizations
which operate and maintain sanitation facilities;
and</DELETED>
<DELETED> ``(C) priority funding for the operation,
and maintenance assistance for, and emergency repairs
to, tribal sanitation facilities 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.</DELETED>
<DELETED> ``(3) Provisions relating to funding.--
Notwithstanding any other provision of law--</DELETED>
<DELETED> ``(A) 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;</DELETED>
<DELETED> ``(B) 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);</DELETED>
<DELETED> ``(C) unless specifically authorized when
funds are appropriated, the Secretary of Health and
Human Services shall not use funds appropriated under
section 7 of the Act of August 5, 1954 (42 U.S.C.
2004a) to provide sanitation facilities to new homes
constructed using funds provided by the Department of
Housing and Urban Development;</DELETED>
<DELETED> ``(D) the Secretary of Health and Human
Services is authorized to accept all Federal funds that
are available for the purpose of providing sanitation
facilities and related services and place those funds
into funding agreements, authorized under the Indian
Self-Determination and Education Assistance Act,
between the Secretary and Indian tribes and tribal
organizations;</DELETED>
<DELETED> ``(E) the Secretary may permit funds
appropriated under the authority of section 4 of the
Act of August 5, 1954 (42 U.S.C. 2004) to be used to
fund up to 100 percent of the amount of a tribe's loan
obtained under any Federal program for new projects to
construct eligible sanitation facilities to serve
Indian homes;</DELETED>
<DELETED> ``(F) the Secretary may permit funds
appropriated under the authority of section 4 of the
Act of August 5, 1954 (42 U.S.C. 2004) to be used to
meet matching or cost participation requirements under
other Federal and non-Federal programs for new projects
to construct eligible sanitation facilities;</DELETED>
<DELETED> ``(G) all Federal agencies are authorized
to transfer to the Secretary funds identified, granted,
loaned or appropriated and thereafter the Department's
applicable policies, rules, regulations shall apply in
the implementation of such projects;</DELETED>
<DELETED> ``(H) the Secretary of Health and Human
Services shall enter into inter-agency agreements with
the Bureau of Indian Affairs, the Department of Housing
and Urban Development, the Department of Agriculture,
the Environmental Protection Agency and other
appropriate Federal agencies, for the purpose of
providing financial assistance for safe water supply
and sanitary sewage disposal facilities under this Act;
and</DELETED>
<DELETED> ``(I) 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
water supply and sanitary sewage and solid waste
disposal facilities funded under this Act.</DELETED>
<DELETED> ``(c) 10-Year Funding Plan.--The Secretary, acting through
the Service and in consultation with Indian tribes and tribal
organizations, shall develop and implement a 10-year funding plan to
provide safe water supply and sanitary sewage and solid waste disposal
facilities serving existing Indian homes and communities, and to new
and renovated Indian homes.</DELETED>
<DELETED> ``(d) Capability of Tribe or Community.--The financial and
technical capability of an Indian tribe or community to safely operate
and maintain a sanitation facility shall not be a prerequisite to the
provision or construction of sanitation facilities by the
Secretary.</DELETED>
<DELETED> ``(e) Financial Assistance.--The Secretary may provide
financial assistance to Indian tribes, tribal organizations and
communities for the operation, management, and maintenance of their
sanitation facilities.</DELETED>
<DELETED> ``(f) Responsibility for Fees for Operation and
Maintenance.--The Indian family, community or tribe involved shall have
the primary responsibility to establish, collect, and use reasonable
user fees, or otherwise set aside funding, for the purpose of operating
and maintaining sanitation facilities. If a community facility is
threatened with imminent failure and there is a lack of tribal capacity
to maintain the integrity or the health benefit of the facility, the
Secretary may assist the tribe in the resolution of the problem on a
short term basis through cooperation with the emergency coordinator or
by providing operation and maintenance service.</DELETED>
<DELETED> ``(g) Eligibility of Certain Tribes or Organizations.--
Programs administered by Indian tribes or tribal organizations under
the authority of the Indian Self-Determination and Education Assistance
Act shall be eligible for--</DELETED>
<DELETED> ``(1) any funds appropriated pursuant to this
section; and</DELETED>
<DELETED> ``(2) any funds appropriated for the purpose of
providing water supply, sewage disposal, or solid waste
facilities;</DELETED>
<DELETED>on an equal basis with programs that are administered directly
by the Service.</DELETED>
<DELETED> ``(h) Report.--</DELETED>
<DELETED> ``(1) In general.--The Secretary shall submit to
the President, for inclusion in each report required to be
transmitted to the Congress under section 801, a report which
sets forth--</DELETED>
<DELETED> ``(A) the current Indian sanitation
facility priority system of the Service;</DELETED>
<DELETED> ``(B) the methodology for determining
sanitation deficiencies;</DELETED>
<DELETED> ``(C) the level of initial and final
sanitation deficiency for each type sanitation facility
for each project of each Indian tribe or community;
and</DELETED>
<DELETED> ``(D) the amount of funds necessary to
reduce the identified sanitation deficiency levels of
all Indian tribes and communities to a level I
sanitation deficiency as described in paragraph
(4)(A).</DELETED>
<DELETED> ``(2) Consultation.--In preparing each report
required under paragraph (1), the Secretary shall consult with
Indian tribes and tribal organizations (including those tribes
or tribal organizations operating health care programs or
facilities under any funding agreements entered into with the
Service under the Indian Self-Determination and Education
Assistance Act) to determine the sanitation needs of each tribe
and in developing the criteria on which the needs will be
evaluated through a process of negotiated rulemaking.</DELETED>
<DELETED> ``(3) 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
communities.</DELETED>
<DELETED> ``(4) Sanitation deficiency levels.--For purposes
of this subsection, the sanitation deficiency levels for an
individual or community sanitation facility serving Indian
homes are as follows:</DELETED>
<DELETED> ``(A) A level I deficiency is a sanitation
facility serving an individual or community--</DELETED>
<DELETED> ``(i) which complies with all
applicable water supply, pollution control and
solid waste disposal laws; and</DELETED>
<DELETED> ``(ii) in which the deficiencies
relate to routine replacement, repair, or
maintenance needs.</DELETED>
<DELETED> ``(B) A level II deficiency is a
sanitation facility serving an individual or
community--</DELETED>
<DELETED> ``(i) which substantially or
recently complied with all applicable water
supply, pollution control and solid waste laws,
in which the deficiencies relate to small or
minor capital improvements needed to bring the
facility back into compliance;</DELETED>
<DELETED> ``(ii) in which the deficiencies
relate to capital improvements that are
necessary to enlarge or improve the facilities
in order to meet the current needs for domestic
sanitation facilities; or</DELETED>
<DELETED> ``(iii) in which the deficiencies
relate to the lack of equipment or training by
an Indian tribe or community to properly
operate and maintain the sanitation facilities.</DELETED>
<DELETED> ``(C) A level III deficiency is an
individual or community facility with water or sewer
service in the home, piped services or a haul system
with holding tanks and interior plumbing, or where
major significant interruptions to water supply or
sewage disposal occur frequently, requiring major
capital improvements to correct the deficiencies. There
is no access to or no approved or permitted solid waste
facility available.</DELETED>
<DELETED> ``(D) A level IV deficiency is an
individual or community facility where there are no
piped water or sewer facilities in the home or the
facility has become inoperable due to major component
failure or where only a washeteria or central facility
exists.</DELETED>
<DELETED> ``(E) A level V deficiency is the absence
of a sanitation facility, where individual homes do not
have access to safe drinking water or adequate
wastewater disposal.</DELETED>
<DELETED> ``(i) Definitions.--In this section:</DELETED>
<DELETED> ``(1) Facility.--The terms `facility' or
`facilities' shall have the same meaning as the terms `system'
or `systems' unless the context requires otherwise.</DELETED>
<DELETED> ``(2) 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.</DELETED>
<DELETED>``SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS.</DELETED>
<DELETED> ``(a) In General.--The Secretary, acting through the
Service, may utilize the negotiating authority of the Act of June 25,
1910 (25 U.S.C. 47), to give preference to any Indian or any
enterprise, partnership, corporation, or other type of business
organization owned and controlled by an Indian or Indians including
former or currently federally recognized Indian tribes in the State of
New York (hereinafter referred to as an `Indian firm') in the
construction and renovation of Service facilities pursuant to section
301 and in the construction of safe water and sanitary waste disposal
facilities pursuant to section 302. Such preference may be accorded by
the Secretary unless the Secretary finds, pursuant to rules and
regulations promulgated by the Secretary, that the project or function
to be contracted for will not be satisfactory or such project or
function cannot be properly completed or maintained under the proposed
contract. The Secretary, in arriving at such finding, shall consider
whether the Indian or Indian firm will be deficient with respect to--
</DELETED>
<DELETED> ``(1) ownership and control by Indians;</DELETED>
<DELETED> ``(2) equipment;</DELETED>
<DELETED> ``(3) bookkeeping and accounting
procedures;</DELETED>
<DELETED> ``(4) substantive knowledge of the project or
function to be contracted for;</DELETED>
<DELETED> ``(5) adequately trained personnel; or</DELETED>
<DELETED> ``(6) other necessary components of contract
performance.</DELETED>
<DELETED> ``(b) Exemption From Davis-Bacon.--For the purpose of
implementing the provisions of this title, construction or renovation
of facilities constructed or renovated in whole or in part by funds
made available pursuant to this title are exempt from the Act of March
3, 1931 (40 U.S.C. 276a--276a-5, known as the Davis-Bacon Act). For all
health facilities, staff quarters and sanitation facilities,
construction and renovation subcontractors shall be paid wages at rates
that are not less than the prevailing wage rates for similar
construction in the locality involved, as determined by the Indian
tribe, tribes, or tribal organizations served by such
facilities.</DELETED>
<DELETED>``SEC. 304. SOBOBA SANITATION FACILITIES.</DELETED>
<DELETED> ``Nothing in the Act of December 17, 1970 (84 Stat. 1465)
shall be construed to 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).</DELETED>
<DELETED>``SEC. 305. EXPENDITURE OF NONSERVICE FUNDS FOR
RENOVATION.</DELETED>
<DELETED> ``(a) Permissibility.--</DELETED>
<DELETED> ``(1) In general.--Notwithstanding any other
provision of law, the Secretary is authorized to accept any
major expansion, renovation or modernization by any Indian
tribe of any Service facility, or of any other Indian health
facility operated pursuant to a funding agreement entered into
under the Indian Self-Determination and Education Assistance
Act, including--</DELETED>
<DELETED> ``(A) any plans or designs for such
expansion, renovation or modernization; and</DELETED>
<DELETED> ``(B) any expansion, renovation or
modernization for which funds appropriated under any
Federal law were lawfully expended;</DELETED>
<DELETED>but only if the requirements of subsection (b) are
met.</DELETED>
<DELETED> ``(2) Priority list.--The Secretary shall maintain
a separate priority list to address the need for increased
operating expenses, personnel or equipment for such facilities
described in paragraph (1). The methodology for establishing
priorities shall be developed by negotiated rulemaking under
section 802. The list of priority facilities will be revised
annually in consultation with Indian tribes and tribal
organizations.</DELETED>
<DELETED> ``(3) Report.--The Secretary shall submit to the
President, for inclusion in each report required to be
transmitted to the Congress under section 801, the priority
list maintained pursuant to paragraph (2).</DELETED>
<DELETED> ``(b) Requirements.--The requirements of this subsection
are met with respect to any expansion, renovation or modernization if--
</DELETED>
<DELETED> ``(1) the tribe or tribal organization--</DELETED>
<DELETED> ``(A) provides notice to the Secretary of
its intent to expand, renovate or modernize;
and</DELETED>
<DELETED> ``(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</DELETED>
<DELETED> ``(2) the expansion renovation or modernization--
</DELETED>
<DELETED> ``(A) is approved by the appropriate area
director of the Service for Federal facilities;
and</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(c) Right of Tribe in Case of Failure of Facility To Be
Used as a Service Facility.--If any Service facility which has been
expanded, renovated or modernized by an Indian tribe 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 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.</DELETED>
<DELETED>``SEC. 306. FUNDING FOR THE CONSTRUCTION, EXPANSION, AND
MODERNIZATION OF SMALL AMBULATORY CARE
FACILITIES.</DELETED>
<DELETED> ``(a) Availability of Funding.--</DELETED>
<DELETED> ``(1) In general.--The Secretary, acting through
the Service and in consultation with Indian tribes and tribal
organization, shall make funding available to 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 as provided for in
subsections (b)(2) and (c)(1)(C)). Funding 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.</DELETED>
<DELETED> ``(2) Requirement.--Funding under paragraph (1)
may only be made available to an Indian tribe or tribal
organization 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) pursuant
to a funding agreement entered into under the Indian Self-
Determination and Education Assistance Act.</DELETED>
<DELETED> ``(b) Use of Funds.--</DELETED>
<DELETED> ``(1) In general.--Funds provided under this
section may be used only for the construction, expansion, or
modernization (including the planning and design of such
construction, expansion, or modernization) of an ambulatory
care facility--</DELETED>
<DELETED> ``(A) located apart from a
hospital;</DELETED>
<DELETED> ``(B) not funded under section 301 or
section 307; and</DELETED>
<DELETED> ``(C) which, upon completion of such
construction, expansion, or modernization will--
</DELETED>
<DELETED> ``(i) have a total capacity
appropriate to its projected service
population;</DELETED>
<DELETED> ``(ii) provide annually not less
than 500 patient visits by eligible Indians and
other users who are eligible for services in
such facility in accordance with section
807(b)(1)(B); and</DELETED>
<DELETED> ``(iii) provide ambulatory care in
a service area (specified in the funding
agreement entered into under the Indian Self-
Determination and Education Assistance Act)
with a population of not less than 1,500
eligible Indians and other users who are
eligible for services in such facility in
accordance with section 807(b)(1)(B).</DELETED>
<DELETED> ``(2) Limitation.--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 described in clauses (ii) and (iii) of
paragraph (1)(C). The requirements of such clauses (ii) and
(iii) shall not apply to a tribe or tribal organization
applying for funding under this section whose principal office
for health care administration is located on an island or where
such office is not located on a road system providing direct
access to an inpatient hospital where care is available to the
service population.</DELETED>
<DELETED> ``(c) Application and Priority.--</DELETED>
<DELETED> ``(1) Application.--No funding may be made
available under this section unless an application for such
funding has been submitted to and approved by the Secretary. An
application or proposal for funding under this section shall be
submitted in accordance with applicable regulations and shall
set 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--</DELETED>
<DELETED> ``(A) adequate financial support will be
available for the provision of services at such
facility;</DELETED>
<DELETED> ``(B) such facility will be available to
eligible Indians without regard to ability to pay or
source of payment; and</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(2) Priority.--In awarding funds under this
section, the Secretary shall give priority to tribes and tribal
organizations that demonstrate--</DELETED>
<DELETED> ``(A) a need for increased ambulatory care
services; and</DELETED>
<DELETED> ``(B) insufficient capacity to deliver
such services.</DELETED>
<DELETED> ``(d) Failure To Use Facility as Health Facility.--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 utilized 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.</DELETED>
<DELETED> ``(e) No Inclusion in Tribal Share.--Funding provided to
Indian tribes and tribal organizations under this section shall be non-
recurring and shall not be available for inclusion in any individual
tribe's tribal share for an award under the Indian Self-Determination
and Education Assistance Act or for reallocation or redesign
thereunder.</DELETED>
<DELETED>``SEC. 307. INDIAN HEALTH CARE DELIVERY DEMONSTRATION
PROJECT.</DELETED>
<DELETED> ``(a) Health Care Delivery Demonstration Projects.--The
Secretary, acting through the Service and in consultation with Indian
tribes and tribal organizations, may 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 through health facilities, including hospice,
traditional Indian health and child care facilities, to
Indians.</DELETED>
<DELETED> ``(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--
</DELETED>
<DELETED> ``(1) waive any leasing prohibition;</DELETED>
<DELETED> ``(2) permit carryover of funds appropriated for
the provision of health care services;</DELETED>
<DELETED> ``(3) permit the use of other available
funds;</DELETED>
<DELETED> ``(4) permit the use of funds or property donated
from any source for project purposes;</DELETED>
<DELETED> ``(5) provide for the reversion of donated real or
personal property to the donor; and</DELETED>
<DELETED> ``(6) permit the use of Service funds to match
other funds, including Federal funds.</DELETED>
<DELETED> ``(c) Criteria.--</DELETED>
<DELETED> ``(1) In general.--The Secretary shall develop and
publish regulations through rulemaking under section 802 for
the review and approval of applications submitted under this
section. The Secretary may enter into a contract, funding
agreement or award a grant under this section for projects
which meet the following criteria:</DELETED>
<DELETED> ``(A) There is a need for a new facility
or program or the reorientation of an existing facility
or program.</DELETED>
<DELETED> ``(B) A significant number of Indians,
including those with low health status, will be served
by the project.</DELETED>
<DELETED> ``(C) The project has the potential to
address the health needs of Indians in an innovative
manner.</DELETED>
<DELETED> ``(D) The project has the potential to
deliver services in an efficient and effective
manner.</DELETED>
<DELETED> ``(E) The project is economically
viable.</DELETED>
<DELETED> ``(F) The Indian tribe or tribal
organization has the administrative and financial
capability to administer the project.</DELETED>
<DELETED> ``(G) The project is integrated with
providers of related health and social services and is
coordinated with, and avoids duplication of, existing
services.</DELETED>
<DELETED> ``(2) Peer review panels.--The Secretary may
provide for the establishment of peer review panels, as
necessary, to review and evaluate applications and to advise
the Secretary regarding such applications using the criteria
developed pursuant to paragraph (1).</DELETED>
<DELETED> ``(3) Priority.--The Secretary shall give priority
to applications for demonstration projects under this section
in each of the following service units to the extent that such
applications are filed in a timely manner and otherwise meet
the criteria specified in paragraph (1):</DELETED>
<DELETED> ``(A) Cass Lake, Minnesota.</DELETED>
<DELETED> ``(B) Clinton, Oklahoma.</DELETED>
<DELETED> ``(C) Harlem, Montana.</DELETED>
<DELETED> ``(D) Mescalero, New Mexico.</DELETED>
<DELETED> ``(E) Owyhee, Nevada.</DELETED>
<DELETED> ``(F) Parker, Arizona.</DELETED>
<DELETED> ``(G) Schurz, Nevada.</DELETED>
<DELETED> ``(H) Winnebago, Nebraska.</DELETED>
<DELETED> ``(I) Ft. Yuma, California.</DELETED>
<DELETED> ``(d) 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.</DELETED>
<DELETED> ``(e) 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 care 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.</DELETED>
<DELETED> ``(f) Equitable Treatment.--For purposes of subsection
(c)(1)(A), the Secretary shall, in evaluating facilities operated under
any funding agreement entered into with the Service under the Indian
Self-Determination and Education Assistance Act, use the same criteria
that the Secretary uses in evaluating facilities operated directly by
the Service.</DELETED>
<DELETED> ``(g) 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 entered into with
the Service under the Indian Self-Determination and Education
Assistance Act, are fully and equitably integrated into the
implementation of the health care delivery demonstration projects under
this section.</DELETED>
<DELETED>``SEC. 308. LAND TRANSFER.</DELETED>
<DELETED> ``(a) General Authority for Transfers.--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.</DELETED>
<DELETED> ``(b) 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.</DELETED>
<DELETED>``SEC. 309. LEASES.</DELETED>
<DELETED> ``(a) In General.--Notwithstanding any other provision of
law, the Secretary is authorized, in carrying out the purposes of this
Act, to enter into leases with Indian tribes and tribal organizations
for periods not in excess of 20 years. Property leased by the Secretary
from an Indian tribe or tribal organization may be reconstructed or
renovated by the Secretary pursuant to an agreement with such Indian
tribe or tribal organization.</DELETED>
<DELETED> ``(b) Facilities for the Administration and Delivery of
Health Services.--The Secretary may enter into leases, contracts, and
other legal agreements with Indian tribes or tribal organizations which
hold--</DELETED>
<DELETED> ``(1) title to;</DELETED>
<DELETED> ``(2) a leasehold interest in; or</DELETED>
<DELETED> ``(3) a beneficial interest in (where title is
held by the United States in trust for the benefit of a
tribe);</DELETED>
<DELETED>facilities used for the administration and delivery of health
services by the Service or by programs operated by Indian tribes or
tribal organizations to compensate such Indian tribes or tribal
organizations for costs associated with the use of such facilities for
such purposes, and such leases shall be considered as operating leases
for the purposes of scoring under the Budget Enforcement Act,
notwithstanding any other provision of law. Such costs include rent,
depreciation based on the useful life of the building, principal and
interest paid or accrued, operation and maintenance expenses, and other
expenses determined by regulation to be allowable pursuant to
regulations under section 105(l) of the Indian Self-Determination and
Education Assistance Act.</DELETED>
<DELETED>``SEC. 310. LOANS, LOAN GUARANTEES AND LOAN
REPAYMENT.</DELETED>
<DELETED> ``(a) Health Care Facilities Loan Fund.--There is
established in the Treasury of the United States a fund to be known as
the `Health Care Facilities Loan Fund' (referred to in this Act as the
`HCFLF') to provide to Indian tribes and tribal organizations direct
loans, or guarantees for loans, for the construction of health care
facilities (including inpatient facilities, outpatient facilities,
associated staff quarters and specialized care facilities such as
behavioral health and elder care facilities).</DELETED>
<DELETED> ``(b) Standards and Procedures.--The Secretary may
promulgate regulations, developed through rulemaking as provided for in
section 802, to establish standards and procedures for governing loans
and loan guarantees under this section, subject to the following
conditions:</DELETED>
<DELETED> ``(1) The principal amount of a loan or loan
guarantee may cover up to 100 percent of eligible costs,
including costs for the 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).</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(3) In the discretion of the Secretary, the
program under this section may be administered by the Service
or the Health Resources and Services Administration (which
shall be specified by regulation).</DELETED>
<DELETED> ``(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 less.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(7) In the planning and design of health
facilities under this section, users eligible under section
807(b) may be included in any projection of patient
population.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(9) Service funds authorized under loans or loan
guarantees under this section may be used in matching other
Federal funds.</DELETED>
<DELETED> ``(c) Funding.--</DELETED>
<DELETED> ``(1) In general.--The HCFLF shall consist of--
</DELETED>
<DELETED> ``(A) such sums as may be initially
appropriated to the HCFLF and as may be subsequently
appropriated under paragraph (2);</DELETED>
<DELETED> ``(B) such amounts as may be collected
from borrowers; and</DELETED>
<DELETED> ``(C) all interest earned on amounts in
the HCFLF.</DELETED>
<DELETED> ``(2) Authorization of appropriations.--There is
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 on such amounts.</DELETED>
<DELETED> ``(3) Availability of funds.--Amounts
appropriated, collected or earned relative to the HCFLF shall
remain available until expended.</DELETED>
<DELETED> ``(d) Funding Agreements.--Amounts in the HCFLF and
available pursuant to appropriation Acts may be expended by the
Secretary, acting through the Service, to make loans under this section
to an Indian tribe or tribal organization pursuant to a funding
agreement entered into under the Indian Self-Determination and
Education Assistance Act.</DELETED>
<DELETED> ``(e) 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.</DELETED>
<DELETED> ``(f) Grants.--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,
associated staff quarters and specialized care facilities). Loans
eligible for such repayment grants shall include loans that have been
obtained under this section or otherwise.</DELETED>
<DELETED>``SEC. 311. TRIBAL LEASING.</DELETED>
<DELETED> ``Indian tribes and tribal organizations providing health
care services pursuant to a funding agreement contract entered into
under the Indian Self-Determination and Education Assistance Act may
lease permanent structures for the purpose of providing such health
care services without obtaining advance approval in appropriation
Acts.</DELETED>
<DELETED>``SEC. 312. INDIAN HEALTH SERVICE/TRIBAL FACILITIES JOINT
VENTURE PROGRAM.</DELETED>
<DELETED> ``(a) Authority.--</DELETED>
<DELETED> ``(1) 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.</DELETED>
<DELETED> ``(2) Use of resources.--A tribe or tribal
organization may utilize tribal funds, private sector, or other
available resources, including loan guarantees, to fulfill its
commitment under this subsection.</DELETED>
<DELETED> ``(3) Eligibility of certain entities.--A tribe
that has begun and substantially completed the process of
acquisition or construction of a health facility shall be eligible to
establish a joint venture project with the Service using such health
facility.</DELETED>
<DELETED> ``(b) Requirements.--</DELETED>
<DELETED> ``(1) In general.--The Secretary shall enter into
an arrangement under subsection (a)(1) with an Indian tribe or
tribal organization only if--</DELETED>
<DELETED> ``(A) 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
health facility described in subsection (a)(1);
and</DELETED>
<DELETED> ``(B) the Indian tribe or tribal
organization meets the needs criteria that shall be
developed through the negotiated rulemaking process
provided for under section 802.</DELETED>
<DELETED> ``(2) Continued operation of facility.--The
Secretary shall negotiate an agreement with the Indian tribe or
tribal organization regarding the continued operation of a
facility under this section at the end of the initial 10 year
no-cost lease period.</DELETED>
<DELETED> ``(3) Breach or termination 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 tribe or tribal organization, or paid to a third
party on the 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 shall
not apply to any funds expended for the delivery of health care
services, or for personnel or staffing.</DELETED>
<DELETED> ``(d) Recovery for Non-Use.--An Indian tribe or tribal
organization that has entered into a written agreement with the
Secretary under this section shall be entitled to recover from the
United States an amount that is proportional to the value of such
facility should at any time within 10 years the Service ceases to use
the facility or otherwise breaches the agreement.</DELETED>
<DELETED> ``(e) Definition.--In this section, the terms `health
facility' or `health facilities' include staff quarters needed to
provide housing for the staff of the tribal health program.</DELETED>
<DELETED>``SEC. 313. LOCATION OF FACILITIES.</DELETED>
<DELETED> ``(a) Priority.--The Bureau of Indian Affairs and the
Service shall, 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, 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 so long as priority is given to
Indian land owned by an Indian tribe or tribes.</DELETED>
<DELETED> ``(b) Definition.--In this section, the term `Indian
lands' means--</DELETED>
<DELETED> ``(1) all lands within the exterior boundaries of
any Indian reservation;</DELETED>
<DELETED> ``(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</DELETED>
<DELETED> ``(3) all lands in Alaska owned by any Alaska
Native village, or any village or regional corporation under
the Alaska Native Claims Settlement Act, or any land allotted
to any Alaska Native.</DELETED>
<DELETED>``SEC. 314. MAINTENANCE AND IMPROVEMENT OF HEALTH CARE
FACILITIES.</DELETED>
<DELETED> ``(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 that identifies the backlog of
maintenance and repair work required at both Service and tribal
facilities, including new facilities expected to be in operation in the
fiscal year after the year for which the report is being prepared. The
report shall identify the need for renovation and expansion of existing
facilities to support the growth of health care programs.</DELETED>
<DELETED> ``(b) Maintenance of Newly Constructed Space.--</DELETED>
<DELETED> ``(1) In general.--The Secretary may expend
maintenance and improvement funds to support the maintenance of
newly constructed space only if such space falls within the
approved supportable space allocation for the Indian tribe or
tribal organization.</DELETED>
<DELETED> ``(2) Definition.--For purposes of paragraph (1),
the term `supportable space allocation' shall be defined
through the negotiated rulemaking process provided for under
section 802.</DELETED>
<DELETED> ``(c) Construction of Replacement Facilities.--</DELETED>
<DELETED> ``(1) In general.--In addition to using
maintenance and improvement funds for the maintenance of
facilities under subsection (b)(1), an Indian tribe or tribal
organization may use such funds for the construction of a replacement
facility if the costs of the renovation of such facility would exceed a
maximum renovation cost threshold.</DELETED>
<DELETED> ``(2) Definition.--For purposes of paragraph (1),
the term `maximum renovation cost threshold' shall be defined
through the negotiated rulemaking process provided for under
section 802.</DELETED>
<DELETED>``SEC. 315. TRIBAL MANAGEMENT OF FEDERALLY-OWNED
QUARTERS.</DELETED>
<DELETED> ``(a) Establishment of Rental Rates.--</DELETED>
<DELETED> ``(1) In general.--Notwithstanding any other
provision of law, an Indian tribe or tribal organization which
operates a hospital or other health facility and the federally-
owned quarters associated therewith, pursuant to a funding
agreement under the Indian Self-Determination and Education
Assistance Act, may establish the rental rates charged to the
occupants of such quarters by providing notice to the Secretary
of its election to exercise such authority.</DELETED>
<DELETED> ``(2) Objectives.--In establishing rental rates
under paragraph (1), an Indian tribe or tribal organization
shall attempt to achieve the following objectives:</DELETED>
<DELETED> ``(A) The rental rates should be based on
the reasonable value of the quarters to the occupants
thereof.</DELETED>
<DELETED> ``(B) The rental rates should generate
sufficient funds to prudently provide for the operation
and maintenance of the quarters, and, subject to the
discretion of the Indian tribe or tribal organization,
to supply reserve funds for capital repairs and
replacement of the quarters.</DELETED>
<DELETED> ``(3) Eligibility for quarters improvement and
repair.--Any quarters whose rental rates are established by an
Indian tribe or tribal organization under this subsection shall
continue to be eligible for quarters improvement and repair
funds to the same extent as other federally-owned quarters that
are used to house personnel in Service-supported
programs.</DELETED>
<DELETED> ``(4) Notice of change in rates.--An Indian tribe
or tribal organization that exercises the authority provided
under this subsection shall provide occupants with not less
than 60 days notice of any change in rental rates.</DELETED>
<DELETED> ``(b) Collection of Rents.--</DELETED>
<DELETED> ``(1) In general.--Notwithstanding any other
provision of law, and subject to paragraph (2), an Indian tribe
or a tribal organization that operates federally-owned quarters
pursuant to a funding agreement under the Indian Self-
Determination and Education Assistance Act shall have the
authority to collect rents directly from Federal employees who
occupy such quarters in accordance with the
following:</DELETED>
<DELETED> ``(A) The Indian tribe or tribal
organization shall notify the Secretary and the Federal
employees involved of its election to exercise its
authority to collect rents directly from such Federal
employees.</DELETED>
<DELETED> ``(B) Upon the receipt of a notice
described in subparagraph (A), the Federal employees
involved shall pay rents for the occupancy of such
quarters directly to the Indian tribe or tribal
organization and the Secretary shall have no further
authority to collect rents from such employees through
payroll deduction or otherwise.</DELETED>
<DELETED> ``(C) Such rent payments shall be retained
by the Indian tribe or tribal organization and shall
not be made payable to or otherwise be deposited with
the United States.</DELETED>
<DELETED> ``(D) Such rent payments shall be
deposited into a separate account which shall be used
by the Indian tribe or tribal organization for the
maintenance (including capital repairs and replacement
expenses) and operation of the quarters and facilities
as the Indian tribe or tribal organization shall
determine appropriate.</DELETED>
<DELETED> ``(2) Retrocession.--If an Indian tribe or tribal
organization 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--</DELETED>
<DELETED> ``(A) the first day of the month that
begins not less than 180 days after the Indian tribe or
tribal organization notifies the Secretary of its
desire to retrocede; or</DELETED>
<DELETED> ``(B) such other date as may be mutually
agreed upon by the Secretary and the Indian tribe or
tribal organization.</DELETED>
<DELETED> ``(c) Rates.--To the extent that an Indian tribe or tribal
organization, 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.</DELETED>
<DELETED>``SEC. 316. APPLICABILITY OF BUY AMERICAN
REQUIREMENT.</DELETED>
<DELETED> ``(a) In General.--The Secretary shall ensure that the
requirements of the Buy American Act apply to all procurements made
with funds provided pursuant to the authorization contained in section
318, except that Indian tribes and tribal organizations shall be exempt
from such requirements.</DELETED>
<DELETED> ``(b) False or Misleading Labeling.--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 the authorization contained in
section 318, pursuant to the debarment, suspension, and ineligibility
procedures described in sections 9.400 through 9.409 of title 48, Code
of Federal Regulations.</DELETED>
<DELETED> ``(c) Definition.--In 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.).</DELETED>
<DELETED>``SEC. 317. OTHER FUNDING FOR FACILITIES.</DELETED>
<DELETED> ``Notwithstanding any other provision of law--</DELETED>
<DELETED> ``(1) the Secretary may 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
authorized under the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450f et seq.) between the Secretary
and an Indian tribe or tribal organization, except that the
receipt of such funds shall not have an effect on the
priorities established pursuant to section 301;</DELETED>
<DELETED> ``(2) the Secretary may enter into interagency
agreements with other Federal or State agencies and other
entities and to accept funds from such Federal or State
agencies or other entities to provide for the planning, design
and construction of health care facilities to be administered
by the Service or by Indian tribes or tribal organizations
under the Indian Self-Determination and Education Assistance
Act in order to carry out the purposes of this Act, together
with the purposes for which such funds are appropriated to such other
Federal or State agency or for which the funds were otherwise
provided;</DELETED>
<DELETED> ``(3) 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;
and</DELETED>
<DELETED> ``(4) the Secretary, acting through the Service,
shall establish standards under regulations developed through
rulemaking under section 802, for the planning, design and
construction of health care facilities serving Indians under
this Act.</DELETED>
<DELETED>``SEC. 318. AUTHORIZATION OF APPROPRIATIONS.</DELETED>
<DELETED> ``There is authorized to be appropriated such sums as may
be necessary for each fiscal year through fiscal year 2015 to carry out
this title.</DELETED>
<DELETED>``TITLE IV--ACCESS TO HEALTH SERVICES</DELETED>
<DELETED>``SEC. 401. TREATMENT OF PAYMENTS UNDER MEDICARE
PROGRAM.</DELETED>
<DELETED> ``(a) In General.--Any payments received by the Service,
by an Indian tribe or tribal organization pursuant to a funding
agreement under the Indian Self-Determination and Education Assistance
Act, or by an urban Indian organization pursuant to title V of this Act
for services provided to Indians eligible for benefits under title
XVIII of the Social Security Act shall not be considered in determining
appropriations for health care and services to Indians.</DELETED>
<DELETED> ``(b) Equal Treatment.--Nothing in this Act authorizes the
Secretary to provide services to an Indian beneficiary with coverage
under title XVIII of the Social Security Act in preference to an Indian
beneficiary without such coverage.</DELETED>
<DELETED> ``(c) Special Fund.--</DELETED>
<DELETED> ``(1) Use of funds.--Notwithstanding any other
provision of this title or of title XVIII of the Social
Security Act, payments to which any facility of the Service is
entitled by reason of this section 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
this title and of title XVIII of the Social Security Act. Any
funds to be reimbursed which are in excess of the amount
necessary to achieve or maintain such conditions and
requirements shall, subject to the consultation with tribes
being served by the service unit, be used for reducing the
health resource deficiencies of the Indian tribes.</DELETED>
<DELETED> ``(2) Nonapplication in case of election for
direct billing.--Paragraph (1) shall not apply upon the
election of an Indian tribe or tribal organization under
section 405 to receive direct payments for services provided to
Indians eligible for benefits under title XVIII of the Social
Security Act.</DELETED>
<DELETED>``SEC. 402. TREATMENT OF PAYMENTS UNDER MEDICAID
PROGRAM.</DELETED>
<DELETED> ``(a) Special Fund.--</DELETED>
<DELETED> ``(1) Use of funds.--Notwithstanding any other
provision of law, payments to which any facility of the Service
(including a hospital, nursing facility, intermediate care
facility for the mentally retarded, or any other type of
facility which provides services for which payment is available
under title XIX of the Social Security Act) is entitled under a
State plan by reason of section 1911 of such 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 facilities of such Service which may be necessary to
achieve or maintain compliance with the applicable conditions
and requirements of such title. Any payments which are in
excess of the amount necessary to achieve or maintain such
conditions and requirements shall, subject to the consultation
with 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 amounts to which the facilities of the Service, for which
such service unit makes collections, are entitled by reason of
section 1911 of the Social Security Act.</DELETED>
<DELETED> ``(2) Nonapplication in case of election for
direct billing.--Paragraph (1) shall not apply upon the
election of an Indian tribe or tribal organization under
section 405 to receive direct payments for services provided to Indians
eligible for medical assistance under title XIX of the Social Security
Act.</DELETED>
<DELETED> ``(b) Payments Disregarded for Appropriations.--Any
payments received under section 1911 of the Social Security Act for
services provided to Indians eligible for benefits under title XIX of
the Social Security Act shall not be considered in determining
appropriations for the provision of health care and services to
Indians.</DELETED>
<DELETED> ``(c) Direct Billing.--For provisions relating to the
authority of certain Indian tribes and tribal organizations to elect to
directly bill for, and receive payment for, health care services
provided by a hospital or clinic of such tribes or tribal organizations
and for which payment may be made under this title, see section
405.</DELETED>
<DELETED>``SEC. 403. REPORT.</DELETED>
<DELETED> ``(a) Inclusion in Annual Report.--The Secretary shall
submit to the President, for inclusion in the report required to be
transmitted to the Congress under section 801, an accounting on the
amount and use of funds made available to the Service pursuant to this
title as a result of reimbursements under titles XVIII and XIX of the
Social Security Act.</DELETED>
<DELETED> ``(b) Identification of Source of Payments.--If an Indian
tribe or tribal organization receives funding from the Service under
the Indian Self-Determination and Education Assistance Act or an urban
Indian organization receives funding from the Service under title V of
this Act and receives reimbursements or payments under title XVIII,
XIX, or XXI of the Social Security Act, such Indian tribe or tribal
organization, or urban Indian organization, shall provide to the
Service a list of each provider enrollment number (or other identifier)
under which it receives such reimbursements or payments.</DELETED>
<DELETED>``SEC. 404. GRANTS TO AND FUNDING AGREEMENTS WITH THE SERVICE,
INDIAN TRIBES OR TRIBAL ORGANIZATIONS, AND URBAN INDIAN
ORGANIZATIONS.</DELETED>
<DELETED> ``(a) In General.--The Secretary shall make grants to or
enter into funding agreements with Indian tribes and tribal
organizations to assist such organizations in establishing and
administering programs on or near Federal Indian reservations and trust
areas and in or near Alaska Native villages to assist individual
Indians to--</DELETED>
<DELETED> ``(1) enroll under sections 1818, 1836, and 1837
of the Social Security Act;</DELETED>
<DELETED> ``(2) pay premiums for health insurance coverage;
and</DELETED>
<DELETED> ``(3) apply for medical assistance provided
pursuant to titles XIX and XXI of the Social Security
Act.</DELETED>
<DELETED> ``(b) Conditions.--The Secretary shall place conditions as
deemed necessary to effect the purpose of this section in any funding
agreement or grant which the Secretary makes with any Indian tribe or
tribal organization pursuant to this section. Such conditions shall
include, but are not limited to, requirements that the organization
successfully undertake to--</DELETED>
<DELETED> ``(1) determine the population of Indians to be
served that are or could be recipients of benefits or
assistance under titles XVIII, XIX, and XXI of the Social
Security Act;</DELETED>
<DELETED> ``(2) assist individual Indians in becoming
familiar with and utilizing such benefits and
assistance;</DELETED>
<DELETED> ``(3) provide transportation to such individual
Indians to the appropriate offices for enrollment or
applications for such benefits and assistance;</DELETED>
<DELETED> ``(4) develop and implement--</DELETED>
<DELETED> ``(A) a schedule of income levels to
determine the extent of payments of premiums by such
organizations for health insurance coverage of needy
individuals; and</DELETED>
<DELETED> ``(B) methods of improving the
participation of Indians in receiving the benefits and
assistance provided under titles XVIII, XIX, and XXI of
the Social Security Act.</DELETED>
<DELETED> ``(c) Agreements for Receipt and Processing of
Applications.--The Secretary may enter into an agreement with an Indian
tribe or tribal organization, or an urban Indian organization, which
provides for the receipt and processing of applications for medical
assistance under title XIX of the Social Security Act, child health
assistance under title XXI of such Act and benefits under title XVIII
of such Act by a Service facility or a health care program administered
by such Indian tribe or tribal organization, or urban Indian
organization, pursuant to a funding agreement under the Indian Self-
Determination and Education Assistance Act or a grant or contract
entered into with an urban Indian organization under title V of this
Act. Notwithstanding any other provision of law, such agreements shall
provide for reimbursement of the cost of outreach, education regarding
eligibility and benefits, and translation when such services are
provided. The reimbursement may be included in an encounter rate or be
made on a fee-for-service basis as appropriate for the provider. When
necessary to carry out the terms of this section, the Secretary, acting
through the Health Care Financing Administration or the Service, may
enter into agreements with a State (or political subdivision thereof)
to facilitate cooperation between the State and the Service, an Indian
tribe or tribal organization, and an urban Indian
organization.</DELETED>
<DELETED> ``(d) Grants.--</DELETED>
<DELETED> ``(1) In general.--The Secretary shall make grants
or enter into contracts with urban Indian organizations to
assist such organizations in establishing and administering
programs to assist individual urban Indians to--</DELETED>
<DELETED> ``(A) enroll under sections 1818, 1836,
and 1837 of the Social Security Act;</DELETED>
<DELETED> ``(B) pay premiums on behalf of such
individuals for coverage under title XVIII of such Act;
and</DELETED>
<DELETED> ``(C) apply for medical assistance
provided under title XIX of such Act and for child
health assistance under title XXI of such
Act.</DELETED>
<DELETED> ``(2) Requirements.--The Secretary shall include
in the grants or contracts made or entered into under paragraph
(1) requirements that are--</DELETED>
<DELETED> ``(A) consistent with the conditions
imposed by the Secretary under subsection
(b);</DELETED>
<DELETED> ``(B) appropriate to urban Indian
organizations and urban Indians; and</DELETED>
<DELETED> ``(C) necessary to carry out the purposes
of this section.</DELETED>
<DELETED>``SEC. 405. DIRECT BILLING AND REIMBURSEMENT OF MEDICARE,
MEDICAID, AND OTHER THIRD PARTY PAYORS.</DELETED>
<DELETED> ``(a) Establishment of Direct Billing Program.--</DELETED>
<DELETED> ``(1) In general.--The Secretary shall establish a
program under which Indian tribes, tribal organizations, and
Alaska Native health organizations that contract or compact for
the operation of a hospital or clinic of the Service under the
Indian Self-Determination and Education Assistance Act may
elect to directly bill for, and receive payment for, health
care services provided by such hospital or clinic for which
payment is made under the medicare program established under
title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.), under the medicaid program established under title XIX
of the Social Security Act (42 U.S.C. 1396 et seq.), or from
any other third party payor.</DELETED>
<DELETED> ``(2) Application of 100 percent fmap.--The third
sentence of section 1905(b) of the Social Security Act (42
U.S.C. 1396d(b)) shall apply for purposes of reimbursement under title
XIX of the Social Security Act for health care services directly billed
under the program established under this section.</DELETED>
<DELETED> ``(b) Direct Reimbursement.--</DELETED>
<DELETED> ``(1) Use of funds.--Each hospital or clinic
participating in the program described in subsection (a) of
this section shall be reimbursed directly under titles XVIII
and XIX of the Social Security Act for services furnished,
without regard to the provisions of section 1880(c) of the
Social Security Act (42 U.S.C. 1395qq(c)) and sections 402(a)
and 807(b)(2)(A), but all funds so reimbursed shall first be
used by the hospital or clinic for the purpose of making any
improvements in the hospital or clinic that may be necessary to
achieve or maintain compliance with the conditions and
requirements applicable generally to facilities of such type
under title XVIII or XIX of the Social Security Act. Any funds
so reimbursed which are in excess of the amount necessary to
achieve or maintain such conditions shall be used--</DELETED>
<DELETED> ``(A) solely for improving the health
resources deficiency level of the Indian tribe;
and</DELETED>
<DELETED> ``(B) in accordance with the regulations
of the Service applicable to funds provided by the
Service under any contract entered into under the
Indian Self-Determination Act (25 U.S.C. 450f et
seq.).</DELETED>
<DELETED> ``(2) Audits.--The amounts paid to the hospitals
and clinics participating in the program established under this
section shall be subject to all auditing requirements
applicable to programs administered directly by the Service and
to facilities participating in the medicare and medicaid
programs under titles XVIII and XIX of the Social Security
Act.</DELETED>
<DELETED> ``(3) Secretarial oversight.--The Secretary shall
monitor the performance of hospitals and clinics participating
in the program established under this section, and shall
require such hospitals and clinics to submit reports on the
program to the Secretary on an annual basis.</DELETED>
<DELETED> ``(4) No payments from special funds.--
Notwithstanding section 1880(c) of the Social Security Act (42
U.S.C. 1395qq(c)) or section 402(a), no payment may be made out
of the special funds described in such sections for the benefit
of any hospital or clinic during the period that the hospital
or clinic participates in the program established under this
section.</DELETED>
<DELETED> ``(c) Requirements for Participation.--</DELETED>
<DELETED> ``(1) Application.--Except as provided in
paragraph (2)(B), in order to be eligible for participation in
the program established under this section, an Indian tribe,
tribal organization, or Alaska Native health organization shall
submit an application to the Secretary that establishes to the
satisfaction of the Secretary that--</DELETED>
<DELETED> ``(A) the Indian tribe, tribal
organization, or Alaska Native health organization
contracts or compacts for the operation of a facility
of the Service;</DELETED>
<DELETED> ``(B) the facility is eligible to
participate in the medicare or medicaid programs under
section 1880 or 1911 of the Social Security Act (42
U.S.C. 1395qq; 1396j);</DELETED>
<DELETED> ``(C) the facility meets the requirements
that apply to programs operated directly by the
Service; and</DELETED>
<DELETED> ``(D) the facility--</DELETED>
<DELETED> ``(i) is accredited by an
accrediting body as eligible for reimbursement
under the medicare or medicaid programs;
or</DELETED>
<DELETED> ``(ii) has submitted a plan, which
has been approved by the Secretary, for
achieving such accreditation.</DELETED>
<DELETED> ``(2) Approval.--</DELETED>
<DELETED> ``(A) In general.--The Secretary shall
review and approve a qualified application not later
than 90 days after the date the application is
submitted to the Secretary unless the Secretary
determines that any of the criteria set forth in
paragraph (1) are not met.</DELETED>
<DELETED> ``(B) Grandfather of demonstration program
participants.--Any participant in the demonstration
program authorized under this section as in effect on
the day before the date of enactment of the Alaska
Native and American Indian Direct Reimbursement Act of
2000 shall be deemed approved for participation in the
program established under this section and shall not be
required to submit an application in order to
participate in the program.</DELETED>
<DELETED> ``(C) Duration.--An approval by the
Secretary of a qualified application under subparagraph
(A), or a deemed approval of a demonstration program
under subparagraph (B), shall continue in effect as
long as the approved applicant or the deemed approved
demonstration program meets the requirements of this section.</DELETED>
<DELETED> ``(d) Examination and Implementation of Changes.--
</DELETED>
<DELETED> ``(1) In general.--The Secretary, acting through
the Service, and with the assistance of the Administrator of
the Health Care Financing Administration, shall examine on an
ongoing basis and implement--</DELETED>
<DELETED> ``(A) any administrative changes that may
be necessary to facilitate direct billing and
reimbursement under the program established under this
section, including any agreements with States that may
be necessary to provide for direct billing under title
XIX of the Social Security Act; and</DELETED>
<DELETED> ``(B) any changes that may be necessary to
enable participants in the program established under
this section to provide to the Service medical records
information on patients served under the program that
is consistent with the medical records information
system of the Service.</DELETED>
<DELETED> ``(2) Accounting information.--The accounting
information that a participant in the program established under
this section shall be required to report shall be the same as
the information required to be reported by participants in the
demonstration program authorized under this section as in
effect on the day before the date of enactment of the Alaska
Native and American Indian Direct Reimbursement Act of 2000.
The Secretary may from time to time, after consultation with
the program participants, change the accounting information
submission requirements.</DELETED>
<DELETED> ``(e) Withdrawal From Program.--A participant in the
program established under this section may withdraw from participation
in the same manner and under the same conditions that a tribe or tribal
organization may retrocede a contracted program to the Secretary under
authority of the Indian Self-Determination Act (25 U.S.C. 450 et seq.).
All cost accounting and billing authority under the program established
under this section shall be returned to the Secretary upon the
Secretary's acceptance of the withdrawal of participation in this
program.</DELETED>
<DELETED>``SEC. 406. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS
OF HEALTH SERVICES.</DELETED>
<DELETED> ``(a) Right of Recovery.--Except as provided in subsection
(g), the United States, an Indian tribe or tribal organization shall
have the right to recover the reasonable charges billed or expenses
incurred by the Secretary or an Indian tribe or tribal organization in
providing health services, through the Service or 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 reimbursement or indemnification for such charges
or expenses if--</DELETED>
<DELETED> ``(1) such services had been provided by a
nongovernmental provider; and</DELETED>
<DELETED> ``(2) such individual had been required to pay
such charges or expenses and did pay such expenses.</DELETED>
<DELETED> ``(b) Urban Indian Organizations.--Except as provided in
subsection (g), an urban Indian organization shall have the right to
recover the reasonable charges billed or expenses incurred by the
organization in providing health services to any individual to the same
extent that such individual, or any other nongovernmental provider of
such services, would be eligible to receive reimbursement or
indemnification for such charges or expenses if such individual had
been required to pay such charges or expenses and did pay such charges
or expenses.</DELETED>
<DELETED> ``(c) Limitations on Recoveries From States.--Subsections
(a) and (b) 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--</DELETED>
<DELETED> ``(1) workers' compensation laws; or</DELETED>
<DELETED> ``(2) a no-fault automobile accident insurance
plan or program.</DELETED>
<DELETED> ``(d) Nonapplication of Other Laws.--No law of any State,
or of any political subdivision of a State and no provision of any
contract entered into or renewed after the date of enactment of the
Indian Health Care Amendments of 1988, shall prevent or hinder the
right of recovery of the United States or an Indian tribe or tribal
organization under subsection (a), or an urban Indian organization
under subsection (b).</DELETED>
<DELETED> ``(e) No Effect on Private Rights of Action.--No action
taken by the United States or an Indian tribe or tribal organization to
enforce the right of recovery provided under subsection (a), or by an
urban Indian organization to enforce the right of recovery provided
under subsection (b), shall affect the right of any person to any
damages (other than damages for the cost of health services provided by
the Secretary through the Service).</DELETED>
<DELETED> ``(f) Methods of Enforcement.--</DELETED>
<DELETED> ``(1) In general.--The United States or an Indian
tribe or tribal organization may enforce the right of recovery
provided under subsection (a), and an urban Indian organization
may enforce the right of recovery provided under subsection
(b), by--</DELETED>
<DELETED> ``(A) intervening or joining in any civil
action or proceeding brought--</DELETED>
<DELETED> ``(i) by the individual for whom
health services were provided by the Secretary,
an Indian tribe or tribal organization, or
urban Indian organization; or</DELETED>
<DELETED> ``(ii) by any representative or
heirs of such individual; or</DELETED>
<DELETED> ``(B) instituting a civil
action.</DELETED>
<DELETED> ``(2) Notice.--All reasonable efforts shall be
made to provide notice of an action instituted in accordance
with paragraph (1)(B) to the individual to whom health services
were provided, either before or during the pendency of such
action.</DELETED>
<DELETED> ``(g) Limitation.--Notwithstanding this section, 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), neither the United States
through the Service, nor an Indian tribe or tribal organization under a
funding agreement pursuant to the Indian Self-Determination and
Education Assistance Act, nor an urban Indian organization funded under
title V, shall 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 or
tribal organization, or urban Indian organization. Where such tribal
authorization is provided, the Service may receive and expend such
funds for the provision of additional health services.</DELETED>
<DELETED> ``(h) Costs and Attorneys' Fees.--In any action brought to
enforce the provisions of this section, a prevailing plaintiff shall be
awarded reasonable attorneys' fees and costs of litigation.</DELETED>
<DELETED> ``(i) Right of Action Against Insurers and Employee
Benefit Plans.--</DELETED>
<DELETED> ``(1) In general.--Where an insurance company or
employee benefit plan 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 or
plan, the United States or an Indian tribe or tribal
organization shall have a right to assert and pursue all the
claims and remedies against such company or plan, and against
the fiduciaries of such company or plan, that the individual
could assert or pursue under applicable Federal, State or
tribal law.</DELETED>
<DELETED> ``(2) Urban indian organizations.--Where an
insurance company or employee benefit plan fails or refuses to
pay the amounts due under subsection (b) for health services
provided to an individual who is a beneficiary, participant, or
insured of such company or plan, the urban Indian organization
shall have a right to assert and pursue all the claims and
remedies against such company or plan, and against the
fiduciaries of such company or plan, that the individual could
assert or pursue under applicable Federal or State
law.</DELETED>
<DELETED> ``(j) Nonapplication of Claims Filing Requirements.--
Notwithstanding any other provision in law, the Service, an Indian
tribe or tribal organization, or an urban Indian organization shall
have a right of recovery for any otherwise reimbursable claim filed on
a current HCFA-1500 or UB-92 form, or the current NSF electronic
format, or their successors. No health plan shall deny payment because
a claim has not been submitted in a unique format that differs from
such forms.</DELETED>
<DELETED>``SEC. 407. CREDITING OF REIMBURSEMENTS.</DELETED>
<DELETED> ``(a) Retention of Funds.--Except as provided in section
202(d), this title, and section 807, all reimbursements received or
recovered under the authority of this Act, Public Law 87-693, or any
other provision of law, by reason of the provision of health services
by the Service or by an Indian tribe or tribal organization under a
funding agreement pursuant to the Indian Self-Determination and
Education Assistance Act, or by an urban Indian organization funded
under title V, shall be retained by the Service or that tribe or tribal
organization and shall be available for the facilities, and to carry
out the programs, of the Service or that tribe or tribal organization
to provide health care services to Indians.</DELETED>
<DELETED> ``(b) No Offset of Funds.--The Service may not offset or
limit the amount of funds obligated to any service unit or entity
receiving funding from the Service because of the receipt of
reimbursements under subsection (a).</DELETED>
<DELETED>``SEC. 408. PURCHASING HEALTH CARE COVERAGE.</DELETED>
<DELETED> ``An Indian tribe or tribal organization, and an urban
Indian organization may utilize funding from the Secretary under this
Act to purchase managed care coverage for Service beneficiaries
(including insurance to limit the financial risks of managed care
entities) from--</DELETED>
<DELETED> ``(1) a tribally owned and operated managed care
plan;</DELETED>
<DELETED> ``(2) a State or locally-authorized or licensed
managed care plan; or</DELETED>
<DELETED> ``(3) a health insurance provider.</DELETED>
<DELETED>``SEC. 409. INDIAN HEALTH SERVICE, DEPARTMENT OF VETERAN'S
AFFAIRS, AND OTHER FEDERAL AGENCY HEALTH FACILITIES AND
SERVICES SHARING.</DELETED>
<DELETED> ``(a) Examination of Feasibility of Arrangements.--
</DELETED>
<DELETED> ``(1) In general.--The Secretary shall examine the
feasibility of entering into arrangements or expanding existing
arrangements for the sharing of medical facilities and services
between the Service and the Veterans' Administration, and other
appropriate Federal agencies, including those within the
Department, and shall, in accordance with subsection (b),
prepare a report on the feasibility of such
arrangements.</DELETED>
<DELETED> ``(2) Submission of report.--Not later than
September 30, 2003, the Secretary shall submit the report
required under paragraph (1) to Congress.</DELETED>
<DELETED> ``(3) Consultation required.--The Secretary may
not finalize any arrangement described in paragraph (1) without
first consulting with the affected Indian tribes.</DELETED>
<DELETED> ``(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--</DELETED>
<DELETED> ``(1) the priority access of any Indian to health
care services provided through the Service;</DELETED>
<DELETED> ``(2) the quality of health care services provided
to any Indian through the Service;</DELETED>
<DELETED> ``(3) the priority access of any veteran to health
care services provided by the Veterans'
Administration;</DELETED>
<DELETED> ``(4) the quality of health care services provided
to any veteran by the Veteran's Administration;</DELETED>
<DELETED> ``(5) the eligibility of any Indian to receive
health services through the Service; or</DELETED>
<DELETED> ``(6) the eligibility of any Indian who is a
veteran to receive health services through the Veterans'
Administration provided, however, the Service or the Indian
tribe or tribal organization shall be reimbursed by the
Veterans' Administration where services are provided through
the Service or Indian tribes or tribal organizations to
beneficiaries eligible for services from the Veterans'
Administration, notwithstanding any other provision of
law.</DELETED>
<DELETED> ``(c) Agreements for Parity in Services.--The Service may
enter into agreements with other Federal agencies to assist in
achieving parity in services for Indians. Nothing in this section may
be construed as creating any right of a veteran to obtain health
services from the Service.</DELETED>
<DELETED>``SEC. 410. PAYOR OF LAST RESORT.</DELETED>
<DELETED> ``The Service, and programs operated by Indian tribes or
tribal organizations, or urban Indian organizations shall be the payor
of last resort for services provided to individuals eligible for
services from the Service and such programs, notwithstanding any
Federal, State or local law to the contrary, unless such law explicitly
provides otherwise.</DELETED>
<DELETED>``SEC. 411. RIGHT TO RECOVER FROM FEDERAL HEALTH CARE
PROGRAMS.</DELETED>
<DELETED> ``Notwithstanding any other provision of law, the Service,
Indian tribes or tribal organizations, and urban Indian organizations
(notwithstanding limitations on who is eligible to receive services
from such entities) shall be entitled to receive payment or
reimbursement for services provided by such entities from any federally
funded health care program, unless there is an explicit prohibition on
such payments in the applicable authorizing statute.</DELETED>
<DELETED>``SEC. 412. TUBA CITY DEMONSTRATION PROJECT.</DELETED>
<DELETED> ``(a) In General.--Notwithstanding any other provision of
law, including the Anti-Deficiency Act, provided the Indian tribes to
be served approve, the Service in the Tuba City Service Unit may--
</DELETED>
<DELETED> ``(1) enter into a demonstration project with the
State of Arizona under which the Service would provide certain
specified medicaid services to individuals dually eligible for
services from the Service and for medical assistance under
title XIX of the Social Security Act in return for payment on a
capitated basis from the State of Arizona; and</DELETED>
<DELETED> ``(2) purchase insurance to limit the financial
risks under the project.</DELETED>
<DELETED> ``(b) Extension of Project.--The demonstration project
authorized under subsection (a) may be extended to other service units
in Arizona, subject to the approval of the Indian tribes to be served
in such service units, the Service, and the State of Arizona.</DELETED>
<DELETED>``SEC. 413. ACCESS TO FEDERAL INSURANCE.</DELETED>
<DELETED> ``Notwithstanding the provisions of title 5, United States
Code, Executive Order, or administrative regulation, an Indian tribe or
tribal organization carrying out programs under the Indian Self-
Determination and Education Assistance Act or an urban Indian
organization carrying out programs under title V of this Act shall be
entitled to purchase coverage, rights and benefits for the employees of
such Indian tribe or tribal organization, or urban Indian organization,
under chapter 89 of title 5, United States Code, and chapter 87 of such
title if necessary employee deductions and agency contributions in
payment for the coverage, rights, and benefits for the period of
employment with such Indian tribe or tribal organization, or urban
Indian organization, are currently deposited in the applicable
Employee's Fund under such title.</DELETED>
<DELETED>``SEC. 414. CONSULTATION AND RULEMAKING.</DELETED>
<DELETED> ``(a) Consultation.--Prior to the adoption of any policy
or regulation by the Health Care Financing Administration, the
Secretary shall require the Administrator of that Administration to--
</DELETED>
<DELETED> ``(1) identify the impact such policy or
regulation may have on the Service, Indian tribes or tribal
organizations, and urban Indian organizations;</DELETED>
<DELETED> ``(2) provide to the Service, Indian tribes or
tribal organizations, and urban Indian organizations the
information described in paragraph (1);</DELETED>
<DELETED> ``(3) engage in consultation, consistent with the
requirements of Executive Order 13084 of May 14, 1998, with the
Service, Indian tribes or tribal organizations, and urban
Indian organizations prior to enacting any such policy or
regulation.</DELETED>
<DELETED> ``(b) Rulemaking.--The Administrator of the Health Care
Financing Administration shall participate in the negotiated rulemaking
provided for under title VIII with regard to any regulations necessary
to implement the provisions of this title that relate to the Social
Security Act.</DELETED>
<DELETED>``SEC. 415. LIMITATIONS ON CHARGES.</DELETED>
<DELETED> ``No provider of health services that is eligible to
receive payments or reimbursements under titles XVIII, XIX, or XXI of
the Social Security Act or from any federally funded (whether in whole
or part) health care program may seek to recover payment for services--
</DELETED>
<DELETED> ``(1) that are covered under and furnished to an
individual eligible for the contract health services program
operated by the Service, by an Indian tribe or tribal
organization, or furnished to an urban Indian eligible for
health services purchased by an urban Indian organization, in
an amount in excess of the lowest amount paid by any other
payor for comparable services; or</DELETED>
<DELETED> ``(2) for examinations or other diagnostic
procedures that are not medically necessary if such procedures
have already been performed by the referring Indian health
program and reported to the provider.</DELETED>
<DELETED>``SEC. 416. LIMITATION ON SECRETARY'S WAIVER
AUTHORITY.</DELETED>
<DELETED> ``Notwithstanding any other provision of law, the
Secretary may not waive the application of section 1902(a)(13)(D) of
the Social Security Act to any State plan under title XIX of the Social
Security Act.</DELETED>
<DELETED>``SEC. 417. WAIVER OF MEDICARE AND MEDICAID
SANCTIONS.</DELETED>
<DELETED> ``Notwithstanding any other provision of law, the Service
or an Indian tribe or tribal organization or an urban Indian
organization operating a health program under the Indian Self-
Determination and Education Assistance Act shall be entitled to seek a
waiver of sanctions imposed under title XVIII, XIX, or XXI of the
Social Security Act as if such entity were directly responsible for
administering the State health care program.</DELETED>
<DELETED>``SEC. 418. MEANING OF `REMUNERATION' FOR PURPOSES OF SAFE
HARBOR PROVISIONS; ANTITRUST IMMUNITY.</DELETED>
<DELETED> ``(a) Meaning of Remuneration.--Notwithstanding any other
provision of law, the term `remuneration' as used in sections 1128A and
1128B of the Social Security Act shall not include any exchange of
anything of value between or among--</DELETED>
<DELETED> ``(1) any Indian tribe or tribal organization or
an urban Indian organization that administers health programs
under the authority of the Indian Self-Determination and Education
Assistance Act;</DELETED>
<DELETED> ``(2) any such Indian tribe or tribal organization
or urban Indian organization and the Service;</DELETED>
<DELETED> ``(3) any such Indian tribe or tribal organization
or urban Indian organization and any patient served or eligible
for service under such programs, including patients served or
eligible for service pursuant to section 813 of this Act (as in
effect on the day before the date of enactment of the Indian
Health Care Improvement Act Reauthorization of 2003);
or</DELETED>
<DELETED> ``(4) any such Indian tribe or tribal organization
or urban Indian organization and any third party required by
contract, section 206 or 207 of this Act (as so in effect), or
other applicable law, to pay or reimburse the reasonable health
care costs incurred by the United States or any such Indian
tribe or tribal organization or urban Indian
organization;</DELETED>
<DELETED>provided the exchange arises from or relates to such health
programs.</DELETED>
<DELETED> ``(b) Antitrust Immunity.--An Indian tribe or tribal
organization or an urban Indian organization that administers health
programs under the authority of the Indian Self-Determination and
Education Assistance Act or title V shall be deemed to be an agency of
the United States and immune from liability under the Acts commonly
known as the Sherman Act, the Clayton Act, the Robinson-Patman Anti-
Discrimination Act, the Federal Trade Commission Act, and any other
Federal, State, or local antitrust laws, with regard to any
transaction, agreement, or conduct that relates to such
programs.</DELETED>
<DELETED>``SEC. 419. CO-INSURANCE, CO-PAYMENTS, DEDUCTIBLES AND
PREMIUMS.</DELETED>
<DELETED> ``(a) Exemption From Cost-Sharing Requirements.--
Notwithstanding any other provision of Federal or State law, no Indian
who is eligible for services under title XVIII, XIX, or XXI of the
Social Security Act, or under any other Federally funded health care
programs, may be charged a deductible, co-payment, or co-insurance for
any service provided by or through the Service, an Indian tribe or
tribal organization or urban Indian organization, nor may the payment
or reimbursement due to the Service or an Indian tribe or tribal
organization or urban Indian organization be reduced by the amount of
the deductible, co-payment, or co-insurance that would be due from the
Indian but for the operation of this section. For the purposes of this
section, the term `through' shall include services provided directly,
by referral, or under contracts or other arrangements between the
Service, an Indian tribe or tribal organization or an urban Indian
organization and another health provider.</DELETED>
<DELETED> ``(b) Exemption From Premiums.--</DELETED>
<DELETED> ``(1) Medicaid and state children's health
insurance program.--Notwithstanding any other provision of
Federal or State law, no Indian who is otherwise eligible for
medical assistance under title XIX of the Social Security Act
or child health assistance under title XXI of such Act may be
charged a premium as a condition of receiving such assistance
under title XIX or XXI of such Act.</DELETED>
<DELETED> ``(2) Medicare enrollment premium penalties.--
Notwithstanding section 1839(b) of the Social Security Act or
any other provision of Federal or State law, no Indian who is
eligible for benefits under part B of title XVIII of the Social
Security Act, but for the payment of premiums, shall be charged
a penalty for enrolling in such part at a time later than the
Indian might otherwise have been first eligible to do so. The
preceding sentence applies whether an Indian pays for premiums
under such part directly or such premiums are paid by another
person or entity, including a State, the Service, an Indian
tribe or tribal organization, or an urban Indian
organization.</DELETED>
<DELETED>``SEC. 420. INCLUSION OF INCOME AND RESOURCES FOR PURPOSES OF
MEDICALLY NEEDY MEDICAID ELIGIBILITY.</DELETED>
<DELETED> ``For the purpose of determining the eligibility under
section 1902(a)(10)(A)(ii)(IV) of the Social Security Act of an Indian
for medical assistance under a State plan under title XIX of such Act,
the cost of providing services to an Indian in a health program of the
Service, an Indian tribe or tribal organization, or an urban Indian
organization shall be deemed to have been an expenditure for health
care by the Indian.</DELETED>
<DELETED>``SEC. 421. ESTATE RECOVERY PROVISIONS.</DELETED>
<DELETED> ``Notwithstanding any other provision of Federal or State
law, the following property may not be included when determining
eligibility for services or implementing estate recovery rights under
title XVIII, XIX, or XXI of the Social Security Act, or any other
health care programs funded in whole or part with Federal
funds:</DELETED>
<DELETED> ``(1) Income derived from rents, leases, or
royalties of property held in trust for individuals by the
Federal Government.</DELETED>
<DELETED> ``(2) Income derived from rents, leases,
royalties, or natural resources (including timber and fishing
activities) resulting from the exercise of federally protected
rights, whether collected by an individual or a tribal group
and distributed to individuals.</DELETED>
<DELETED> ``(3) 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, including public domain
allotments.</DELETED>
<DELETED> ``(4) Property that has unique religious or
cultural significance or that supports subsistence or
traditional life style according to applicable tribal law or
custom.</DELETED>
<DELETED>``SEC. 422. MEDICAL CHILD SUPPORT.</DELETED>
<DELETED> ``Notwithstanding any other provision of law, a parent
shall not be responsible for reimbursing the Federal Government or a
State for the cost of medical services provided to a child by or
through the Service, an Indian tribe or tribal organization or an urban
Indian organization. For the purposes of this subsection, the term
`through' includes services provided directly, by referral, or under
contracts or other arrangements between the Service, an Indian tribe or
tribal organization or an urban Indian organization and another health
provider.</DELETED>
<DELETED>``SEC. 423. PROVISIONS RELATING TO MANAGED CARE.</DELETED>
<DELETED> ``(a) Recovery From Managed Care Plans.--Notwithstanding
any other provision in law, the Service, an Indian tribe or tribal
organization or an urban Indian organization shall have a right of
recovery under section 408 from all private and public health plans or
programs, including the medicare, medicaid, and State children's health
insurance programs under titles XVIII, XIX, and XXI of the Social
Security Act, for the reasonable costs of delivering health services to
Indians entitled to receive services from the Service, an Indian tribe
or tribal organization or an urban Indian organization.</DELETED>
<DELETED> ``(b) Limitation.--No provision of law or regulation, or
of any contract, may be relied upon or interpreted to deny or reduce
payments otherwise due under subsection (a), except to the extent the
Service, an Indian tribe or tribal organization, or an urban Indian
organization has entered into an agreement with a managed care entity
regarding services to be provided to Indians or rates to be paid for
such services, provided that such an agreement may not be made a
prerequisite for such payments to be made.</DELETED>
<DELETED> ``(c) Parity.--Payments due under subsection (a) from a
managed care entity may not be paid at a rate that is less than the
rate paid to a `preferred provider' by the entity or, in the event
there is no such rate, the usual and customary fee for equivalent
services.</DELETED>
<DELETED> ``(d) No Claim Requirement.--A managed care entity may not
deny payment under subsection (a) because an enrollee with the entity
has not submitted a claim.</DELETED>
<DELETED> ``(e) Direct Billing.--Notwithstanding the preceding
subsections of this section, the Service, an Indian tribe or tribal
organization, or an urban Indian organization that provides a health
service to an Indian entitled to medical assistance under the State
plan under title XIX of the Social Security Act or enrolled in a child
health plan under title XXI of such Act shall have the right to be paid
directly by the State agency administering such plans notwithstanding
any agreements the State may have entered into with managed care
organizations or providers.</DELETED>
<DELETED> ``(f) Requirement for Medicaid Managed Care Entities.--A
managed care entity (as defined in section 1932(a)(1)(B) of the Social
Security Act shall, as a condition of participation in the State plan
under title XIX of such Act, offer a contract to health programs
administered by the Service, an Indian tribe or tribal organization or
an urban Indian organization that provides health services in the
geographic area served by the managed care entity and such contract (or
other provider participation agreement) shall contain terms and
conditions of participation and payment no more restrictive or onerous
than those provided for in this section.</DELETED>
<DELETED> ``(g) Prohibition.--Notwithstanding any other provision of
law or any waiver granted by the Secretary no Indian may be assigned
automatically or by default under any managed care entity participating
in a State plan under title XIX or XXI of the Social Security Act
unless the Indian had the option of enrolling in a managed care plan or
health program administered by the Service, an Indian tribe or tribal
organization, or an urban Indian organization.</DELETED>
<DELETED> ``(h) Indian Managed Care Plans.--Notwithstanding any
other provision of law, any State entering into agreements with one or
more managed care organizations to provide services under title XIX or
XXI of the Social Security Act shall enter into such an agreement with
the Service, an Indian tribe or tribal organization or an urban Indian
organization under which such an entity may provide services to Indians
who may be eligible or required to enroll with a managed care
organization through enrollment in an Indian managed care organization
that provides services similar to those offered by other managed care
organizations in the State. The Secretary and the State are hereby
authorized to waive requirements regarding discrimination,
capitalization, and other matters that might otherwise prevent an
Indian managed care organization or health program from meeting Federal
or State standards applicable to such organizations, provided such
Indian managed care organization or health program offers Indian
enrollees services of an equivalent quality to that required of other
managed care organizations.</DELETED>
<DELETED> ``(i) Advertising.--A managed care organization entering
into a contract to provide services to Indians on or near an Indian
reservation shall provide a certificate of coverage or similar type of
document that is written in the Indian language of the majority of the
Indian population residing on such reservation.</DELETED>
<DELETED>``SEC. 424. NAVAJO NATION MEDICAID AGENCY.</DELETED>
<DELETED> ``(a) In General.--Notwithstanding any other provision of
law, the Secretary may treat the Navajo Nation as a State under title
XIX of the Social Security Act for purposes of providing medical
assistance to Indians living within the boundaries of the Navajo
Nation.</DELETED>
<DELETED> ``(b) Assignment and Payment.--Notwithstanding any other
provision of law, the Secretary may assign and pay all expenditures
related to the provision of services to Indians living within the
boundaries of the Navajo Nation under title XIX of the Social Security
Act (including administrative expenditures) that 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.</DELETED>
<DELETED> ``(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
State agency responsible for the administration of the State plan under
title XIX of the Social Security Act.</DELETED>
<DELETED> ``(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. Such assistance may include providing funds for
demonstration projects conducted with such Nation.</DELETED>
<DELETED> ``(e) FMAP.--Notwithstanding section 1905(b) of the Social
Security Act, the Federal medical assistance percentage shall be 100
per cent with respect to amounts the Navajo Nation Medicaid agency
expends for medical assistance and related administrative
costs.</DELETED>
<DELETED> ``(f) 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.</DELETED>
<DELETED> ``(g) SCHIP.--At the option of the Navajo Nation, the
Secretary may treat the Navajo Nation as a State for purposes of title
XXI of the Social Security Act under terms equivalent to those
described in the preceding subsections of this section.</DELETED>
<DELETED>``SEC. 425. INDIAN ADVISORY COMMITTEES.</DELETED>
<DELETED> ``(a) National Indian Technical Advisory Group.--The
Administrator of the Health Care Financing Administration shall
establish and fund the expenses of a National Indian Technical 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 scope of the activities of such group
shall be established under section 802 provided that such scope shall
include providing comment on and advice regarding the programs funded
under titles XVIII, XIX, and XXI of the Social Security Act or
regarding any other health care program funded (in whole or part) by
the Health Care Financing Administration.</DELETED>
<DELETED> ``(b) Indian Medicaid Advisory Committees.--The
Administrator of the Health Care Financing Administration shall
establish and provide funding for a Indian Medicaid Advisory Committee
made up of designees of the Service, Indian tribes and tribal
organizations and urban Indian organizations in each State in which the
Service directly operates a health program or in which there is one or
more Indian tribe or tribal organization or urban Indian
organization.</DELETED>
<DELETED>``SEC. 426. AUTHORIZATION OF APPROPRIATIONS.</DELETED>
<DELETED> There is authorized to be appropriated such sums as may be
necessary for each of fiscal years 2004 through 2015 to carry out this
title.''.</DELETED>
<DELETED>``TITLE V--HEALTH SERVICES FOR URBAN INDIANS</DELETED>
<DELETED>``SEC. 501. PURPOSE.</DELETED>
<DELETED> ``The purpose of this title is to establish programs in
urban centers to make health services more accessible and available to
urban Indians.</DELETED>
<DELETED>``SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN INDIAN
ORGANIZATIONS.</DELETED>
<DELETED> ``Under the authority of the Act of November 2, 1921 (25
U.S.C. 13) (commonly known as the Snyder Act), the Secretary, 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. The Secretary, through the
Service, subject to section 506, shall include such conditions as the
Secretary considers necessary to effect the purpose of this title in
any contract which the Secretary enters into with, or in any grant the
Secretary makes to, any urban Indian organization pursuant to this
title.</DELETED>
<DELETED>``SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION OF HEALTH
CARE AND REFERRAL SERVICES.</DELETED>
<DELETED> ``(a) Authority.--Under the authority of the Act of
November 2, 1921 (25 U.S.C. 13) (commonly known as the Snyder Act), the
Secretary, acting through the Service, shall 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--</DELETED>
<DELETED> ``(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;</DELETED>
<DELETED> ``(2) estimate the current health status of urban
Indians residing in such urban center or centers;</DELETED>
<DELETED> ``(3) estimate the current health care needs of
urban Indians residing in such urban center or
centers;</DELETED>
<DELETED> ``(4) provide basic health education, including
health promotion and disease prevention education, to urban
Indians;</DELETED>
<DELETED> ``(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</DELETED>
<DELETED> ``(6) where necessary, provide, or enter into
contracts for the provision of, health care services for urban
Indians.</DELETED>
<DELETED> ``(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--</DELETED>
<DELETED> ``(1) the extent of unmet health care needs of
urban Indians in the urban center or centers
involved;</DELETED>
<DELETED> ``(2) the size of the urban Indian population in
the urban center or centers involved;</DELETED>
<DELETED> ``(3) the extent, if any, to which the activities
set forth in subsection (a) would duplicate any project funded
under this title;</DELETED>
<DELETED> ``(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;</DELETED>
<DELETED> ``(5) the satisfactory performance and successful
completion by an urban Indian organization of other contracts
with the Secretary under this title;</DELETED>
<DELETED> ``(6) the appropriateness and likely effectiveness
of conducting the activities set forth in subsection (a) in an
urban center or centers; and</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(c) Health Promotion and Disease Prevention.--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 pursuant to this section or receiving grants
under subsection (a).</DELETED>
<DELETED> ``(d) Immunization Services.--</DELETED>
<DELETED> ``(1) In general.--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.</DELETED>
<DELETED> ``(2) Definition.--In this section, the term
`immunization services' means services to provide without
charge immunizations against vaccine-preventable
diseases.</DELETED>
<DELETED> ``(e) Mental Health Services.--</DELETED>
<DELETED> ``(1) In general.--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 this section.</DELETED>
<DELETED> ``(2) Assessment.--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 mental health needs of the urban Indian
population concerned, the mental health services and other
related resources available to that population, the barriers to
obtaining those services and resources, and the needs that are
unmet by such services and resources.</DELETED>
<DELETED> ``(3) Use of funds.--Grants may be made under this
subsection--</DELETED>
<DELETED> ``(A) to prepare assessments required
under paragraph (2);</DELETED>
<DELETED> ``(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;</DELETED>
<DELETED> ``(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; and</DELETED>
<DELETED> ``(D) to develop innovative behavioral
health service delivery models which incorporate Indian
cultural support systems and resources.</DELETED>
<DELETED> ``(f) Child Abuse.--</DELETED>
<DELETED> ``(1) In general.--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 pursuant to this section
or receiving grants under subsection (a) to prevent and treat
child abuse (including sexual abuse) among urban
Indians.</DELETED>
<DELETED> ``(2) Assessment.--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.</DELETED>
<DELETED> ``(3) Use of funds.--Grants may be made under this
subsection--</DELETED>
<DELETED> ``(A) to prepare assessments required
under paragraph (2);</DELETED>
<DELETED> ``(B) for the development of prevention,
training, and education programs for urban Indian
populations, 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;
and</DELETED>
<DELETED> ``(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).</DELETED>
<DELETED> ``(4) Considerations.--In making grants to carry
out this subsection, the Secretary shall take into
consideration--</DELETED>
<DELETED> ``(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;</DELETED>
<DELETED> ``(B) the capability and expertise
demonstrated by the urban Indian organization to
address the complex problem of child sexual abuse in
the community; and</DELETED>
<DELETED> ``(C) the assessment required under
paragraph (2).</DELETED>
<DELETED> ``(g) Multiple Urban Centers.--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 one
urban center.</DELETED>
<DELETED>``SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINATION OF
UNMET HEALTH CARE NEEDS.</DELETED>
<DELETED> ``(a) Authority.--</DELETED>
<DELETED> ``(1) In general.--Under authority of the Act of
November 2, 1921 (25 U.S.C. 13) (commonly known as the Snyder
Act), the Secretary, acting through the Service, may enter into
contracts with, or make grants to, urban Indian organizations
situated in urban centers for which contracts have not been
entered into, or grants have not been made, under section
503.</DELETED>
<DELETED> ``(2) Purpose.--The purpose of a contract or grant
made under this section shall be the determination of the
matters described in subsection (b)(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.</DELETED>
<DELETED> ``(b) Requirements.--Any contract entered into, or grant
made, by the Secretary under this section shall include requirements
that--</DELETED>
<DELETED> ``(1) the urban Indian organization successfully
undertake to--</DELETED>
<DELETED> ``(A) document the health care status and
unmet health care needs of urban Indians in the urban
center involved; and</DELETED>
<DELETED> ``(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</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(c) Limitation on Renewal.--The Secretary may not renew
any contract entered into, or grant made, under this section.</DELETED>
<DELETED>``SEC. 505. EVALUATIONS; RENEWALS.</DELETED>
<DELETED> ``(a) Procedures.--The Secretary, acting through the
Service, shall develop procedures to evaluate compliance with grant
requirements under this title 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.</DELETED>
<DELETED> ``(b) Compliance With Terms.--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 an evaluation under this subsection, the Secretary, in
determining the capacity of an urban Indian organization to deliver
quality patient care shall, at the option of the organization--
</DELETED>
<DELETED> ``(1) conduct, through the Service, an annual
onsite evaluation of the organization; or</DELETED>
<DELETED> ``(2) accept, in lieu of an 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.</DELETED>
<DELETED> ``(c) Noncompliance.--</DELETED>
<DELETED> ``(1) In general.--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 such organization the areas of
noncompliance or unsatisfactory performance and modify such
contract or grant to prevent future occurrences of such
noncompliance or unsatisfactory performance.</DELETED>
<DELETED> ``(2) Nonrenewal.--If the Secretary determines,
under an evaluation under this section, that noncompliance or
unsatisfactory performance cannot be resolved and prevented in
the future, the Secretary shall not renew such contract or
grant with such 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.</DELETED>
<DELETED> ``(d) Determination of Renewal.--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, in
the case of a renewal of a contract or grant under section 503, shall
consider the results of the onsite evaluations or accreditation under
subsection (b).</DELETED>
<DELETED>``SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS.</DELETED>
<DELETED> ``(a) Application of Federal Law.--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 the Act of August 24, 1935 (40 U.S.C. 270a, et
seq.).</DELETED>
<DELETED> ``(b) Payments.--Payments under any contracts or grants
pursuant to this title shall, notwithstanding any term or condition of
such contract or grant--</DELETED>
<DELETED> ``(1) be made in their entirety by the Secretary
to the urban Indian organization by not 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</DELETED>
<DELETED> ``(2) if unexpended by the urban Indian
organization during the funding period with respect to which
the payments initially apply, 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 expenditure of such funds.</DELETED>
<DELETED> ``(c) Revising or Amending Contract.--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.</DELETED>
<DELETED> ``(d) Fair and Uniform Provision of Services.--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.</DELETED>
<DELETED> ``(e) Eligibility of Urban Indians.--Urban Indians, as
defined in section 4(f), shall be eligible for health care or referral
services provided pursuant to this title.</DELETED>
<DELETED>``SEC. 507. REPORTS AND RECORDS.</DELETED>
<DELETED> ``(a) Report.--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
organization shall submit to the Secretary, on a basis no more frequent
than every 6 months, a report including--</DELETED>
<DELETED> ``(1) in the case of a contract or grant under
section 503, information gathered pursuant to paragraph (5) of
subsection (a) of such section;</DELETED>
<DELETED> ``(2) information on activities conducted by the
organization pursuant to the contract or grant;</DELETED>
<DELETED> ``(3) an accounting of the amounts and purposes
for which Federal funds were expended; and</DELETED>
<DELETED> ``(4) a minimum set of data, using uniformly
defined elements, that is specified by the Secretary, after
consultations consistent with section 514, with urban Indian
organizations.</DELETED>
<DELETED> ``(b) Audits.--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.</DELETED>
<DELETED> ``(c) Cost of Audit.--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--
</DELETED>
<DELETED> ``(1) a certified public accountant; or</DELETED>
<DELETED> ``(2) a certified public accounting firm qualified
to conduct Federal compliance audits.</DELETED>
<DELETED>``SEC. 508. LIMITATION ON CONTRACT AUTHORITY.</DELETED>
<DELETED> ``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.</DELETED>
<DELETED>``SEC. 509. FACILITIES.</DELETED>
<DELETED> ``(a) Grants.--The Secretary 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.</DELETED>
<DELETED> ``(b) Loans or Loan Guarantees.--The Secretary, acting
through the Service or through the Health Resources and Services
Administration, may provide loans to contractors or grant recipients
under this title from the Urban Indian Health Care Facilities Revolving
Loan Fund (referred to in this section as the `URLF') described in
subsection (c), or guarantees for loans, for the construction,
renovation, expansion, or purchase of health care facilities, subject
to the following requirements:</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(2) The total amount of the principal of loans
and loan guarantees, respectively, outstanding at any one time
shall not exceed such limitations as may be specified in
appropriations Acts.</DELETED>
<DELETED> ``(3) The loan or loan guarantee may have a term
of the shorter of the estimated useful life of the facility, or
25 years.</DELETED>
<DELETED> ``(4) An urban Indian organization may assign, and
the Secretary may accept assignment of, the revenue of the
organization as security for a loan or loan guarantee under
this subsection.</DELETED>
<DELETED> ``(5) The Secretary shall not collect application,
processing, or similar fees from urban Indian organizations
applying for loans or loan guarantees under this
subsection.</DELETED>
<DELETED> ``(c) Urban Indian Health Care Facilities Revolving Loan
Fund.--</DELETED>
<DELETED> ``(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. The URLF
shall consist of--</DELETED>
<DELETED> ``(A) such amounts as may be appropriated
to the URLF;</DELETED>
<DELETED> ``(B) amounts received from urban Indian
organizations in repayment of loans made to such
organizations under paragraph (2); and</DELETED>
<DELETED> ``(C) interest earned on amounts in the
URLF under paragraph (3).</DELETED>
<DELETED> ``(2) Use of urlf.--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.</DELETED>
<DELETED> ``(3) Investments.--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.</DELETED>
<DELETED>``SEC. 510. OFFICE OF URBAN INDIAN HEALTH.</DELETED>
<DELETED> ``There is hereby established within the Service an Office
of Urban Indian Health which shall be responsible for--</DELETED>
<DELETED> ``(1) carrying out the provisions of this
title;</DELETED>
<DELETED> ``(2) providing central oversight of the programs
and services authorized under this title; and</DELETED>
<DELETED> ``(3) providing technical assistance to urban
Indian organizations.</DELETED>
<DELETED>``SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE RELATED
SERVICES.</DELETED>
<DELETED> ``(a) Grants.--The Secretary may make grants for the
provision of health-related services in prevention of, treatment of,
rehabilitation of, or school and community-based education in, alcohol
and substance abuse in urban centers to those urban Indian
organizations with whom the Secretary has entered into a contract under
this title or under section 201.</DELETED>
<DELETED> ``(b) Goals of Grant.--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.</DELETED>
<DELETED> ``(c) Criteria.--The Secretary shall establish criteria
for the grants made under subsection (a), including criteria relating
to the--</DELETED>
<DELETED> ``(1) size of the urban Indian
population;</DELETED>
<DELETED> ``(2) capability of the organization to adequately
perform the activities required under the grant;</DELETED>
<DELETED> ``(3) satisfactory performance standards for the
organization in meeting the goals set forth in such grant,
which standards shall be negotiated and agreed to between the
Secretary and the grantee on a grant-by-grant basis;
and</DELETED>
<DELETED> ``(4) identification of need for
services.</DELETED>
<DELETED>The Secretary shall develop a methodology for allocating
grants made pursuant to this section based on such criteria.</DELETED>
<DELETED> ``(d) Treatment of Funds Received by Urban Indian
Organizations.--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).</DELETED>
<DELETED>``SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION
PROJECTS.</DELETED>
<DELETED> ``(a) Tulsa and Oklahoma City Clinics.--Notwithstanding
any other provision of law, the Tulsa and Oklahoma City Clinic
demonstration projects shall become permanent programs within the
Service's direct care program and continue to be treated as service
units in the allocation of resources and coordination of care, and
shall continue to meet the requirements and definitions of an urban
Indian organization in this title, and as such will not be subject to
the provisions of the Indian Self-Determination and Education
Assistance Act.</DELETED>
<DELETED> ``(b) Report.--The Secretary shall submit to the
President, for inclusion in the report required to be submitted to the
Congress under section 801 for fiscal year 1999, a report on the
findings and conclusions derived from the demonstration projects
specified in subsection (a).</DELETED>
<DELETED>``SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS.</DELETED>
<DELETED> ``(a) Grants and Contracts.--The Secretary, acting through
the Office of Urban Indian Health of the Service, shall make grants or
enter into contracts, effective not later than September 30, 2004, 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 (referred to in this section
to as `NIAAA') and transferred to the Service.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(c) Eligibility.--Urban Indian organizations that
operate Indian alcohol programs originally funded under NIAAA and
subsequently transferred to the Service are eligible for grants or
contracts under this section.</DELETED>
<DELETED> ``(d) Evaluation and Report.--The Secretary shall evaluate
and report to the Congress on the activities of programs funded under
this section at least every 5 years.</DELETED>
<DELETED>``SEC. 514. CONSULTATION WITH URBAN INDIAN
ORGANIZATIONS.</DELETED>
<DELETED> ``(a) In General.--The Secretary shall ensure that the
Service, the Health Care Financing Administration, and other operating
divisions and staff divisions of the Department consult, to the maximum
extent practicable, with urban Indian organizations (as defined in
section 4) 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.</DELETED>
<DELETED> ``(b) Requirement.--In subsection (a), the term
`consultation' means 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.</DELETED>
<DELETED>``SEC. 515. FEDERAL TORT CLAIMS ACT COVERAGE.</DELETED>
<DELETED> ``For purposes of section 224 of the Public Health Service
Act (42 U.S.C. 233), with respect to claims by any person, initially
filed on or after October 1, 1999, whether or not such person is an
Indian or Alaska Native or is served on a fee basis or under other
circumstances as permitted by Federal law or regulations, for personal
injury (including death) resulting from the performance prior to,
including, or after October 1, 1999, of medical, surgical, dental, or
related functions, including the conduct of clinical studies or
investigations, or for purposes of section 2679 of title 28, United
States Code, with respect to claims by any such person, on or after
October 1, 1999, for personal injury (including death) resulting from
the operation of an emergency motor vehicle, an urban Indian
organization that has entered into a contract or received a grant
pursuant to this title is deemed to be part of the Public Health
Service while carrying out any such contract or grant and its employees
(including those acting on behalf of the organization as provided for
in section 2671 of title 28, United States Code, and including an
individual who provides health care services pursuant to a personal
services contract with an urban Indian organization for the provision
of services in any facility owned, operated, or constructed under the
jurisdiction of the Indian Health Service) are deemed employees of the
Service while acting within the scope of their employment in carrying
out the contract or grant, except that such employees shall be deemed
to be acting within the scope of their employment in carrying out the
contract or grant when they are required, by reason of their
employment, to perform medical, surgical, dental or related functions
at a facility other than a facility operated by the urban Indian
organization pursuant to such contract or grant, but only if such
employees are not compensated for the performance of such functions by
a person or entity other than the urban Indian organization.</DELETED>
<DELETED>``SEC. 516. URBAN YOUTH TREATMENT CENTER
DEMONSTRATION.</DELETED>
<DELETED> ``(a) Construction and Operation.--The Secretary, acting
through the Service, shall, through grants or contracts, 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.</DELETED>
<DELETED> ``(b) States.--A State described in this subsection is a
State in which--</DELETED>
<DELETED> ``(1) there reside urban Indian youth with a need
for alcohol and substance abuse treatment services in a
residential setting; and</DELETED>
<DELETED> ``(2) there is a significant shortage of
culturally competent residential treatment services for urban
Indian youth.</DELETED>
<DELETED>``SEC. 517. USE OF FEDERAL GOVERNMENT FACILITIES AND SOURCES
OF SUPPLY.</DELETED>
<DELETED> ``(a) In General.--The Secretary shall permit 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.</DELETED>
<DELETED> ``(b) Donation of Property.--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.</DELETED>
<DELETED> ``(c) Acquisition of Property.--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.</DELETED>
<DELETED> ``(d) Priority.--In the event that the Secretary receives
a request for a specific item of personal or real property described in
subsections (b) or (c) from an urban Indian organization and from an
Indian tribe or tribal organization, the Secretary shall give priority
to the request for donation to the Indian tribe or tribal organization
if the Secretary receives the request from the Indian tribe or tribal
organization before the date on which the Secretary transfers title to
the property or, if earlier, the date on which the Secretary transfers
the property physically, to the urban Indian organization.</DELETED>
<DELETED> ``(e) Relation to Federal Sources of Supply.--For purposes
of section 201(a) of the Federal Property and Administrative Services
Act of 1949 (40 U.S.C. 481(a)) (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.</DELETED>
<DELETED>``SEC. 518. GRANTS FOR DIABETES PREVENTION, TREATMENT AND
CONTROL.</DELETED>
<DELETED> ``(a) Authority.--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, treatment, and control of the complications resulting from,
diabetes among urban Indians.</DELETED>
<DELETED> ``(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 upon between the Secretary
and the grantee.</DELETED>
<DELETED> ``(c) Criteria.--The Secretary shall establish criteria
for the awarding of grants made under subsection (a) relating to--
</DELETED>
<DELETED> ``(1) the size and location of the urban Indian
population to be served;</DELETED>
<DELETED> ``(2) the need for the prevention of, treatment
of, and control of the complications resulting from diabetes
among the urban Indian population to be served;</DELETED>
<DELETED> ``(3) performance standards for the urban Indian
organization in meeting the goals set forth in such grant that
are negotiated and agreed to by the Secretary and the
grantee;</DELETED>
<DELETED> ``(4) the capability of the urban Indian
organization to adequately perform the activities required
under the grant; and</DELETED>
<DELETED> ``(5) the willingness of the urban Indian
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.</DELETED>
<DELETED> ``(d) Application of 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).</DELETED>
<DELETED>``SEC. 519. COMMUNITY HEALTH REPRESENTATIVES.</DELETED>
<DELETED> ``The Secretary, acting through the Service, may enter
into contracts with, and make grants to, urban Indian organizations for
the use of Indians trained as health service providers through the
Community Health Representatives Program under section 107(b) in the
provision of health care, health promotion, and disease prevention
services to urban Indians.</DELETED>
<DELETED>``SEC. 520. REGULATIONS.</DELETED>
<DELETED> ``(a) Effect of Title.--This title shall be effective on
the date of enactment of this Act regardless of whether the Secretary
has promulgated regulations implementing this title.</DELETED>
<DELETED> ``(b) Promulgation.--</DELETED>
<DELETED> ``(1) In general.--The Secretary may promulgate
regulations to implement the provisions of this
title.</DELETED>
<DELETED> ``(2) Publication.--Proposed regulations to
implement this title shall be published by the Secretary in the
Federal Register not later than 270 days after the date of
enactment of this Act and shall have a comment period of not
less than 120 days.</DELETED>
<DELETED> ``(3) Expiration of authority.--The authority to
promulgate regulations under this title shall expire on the
date that is 18 months after the date of enactment of this
Act.</DELETED>
<DELETED> ``(c) Negotiated Rulemaking Committee.--A negotiated
rulemaking committee shall be established pursuant to section 565 of
title 5, United States Code, to carry out this section and shall, in
addition to Federal representatives, have as the majority of its
members representatives of urban Indian organizations from each service
area.</DELETED>
<DELETED> ``(d) Adaption of Procedures.--The Secretary shall adapt
the negotiated rulemaking procedures to the unique context of this
Act.</DELETED>
<DELETED>``SEC. 521. AUTHORIZATION OF APPROPRIATIONS.</DELETED>
<DELETED> ``There is authorized to be appropriated such sums as may
be necessary for each fiscal year through fiscal year 2015 to carry out
this title.</DELETED>
<DELETED>``TITLE VI--ORGANIZATIONAL IMPROVEMENTS</DELETED>
<DELETED>``SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERVICE AS AN
AGENCY OF THE PUBLIC HEALTH SERVICE.</DELETED>
<DELETED> ``(a) Establishment.--</DELETED>
<DELETED> ``(1) In general.--In order to more effectively
and efficiently carry out the responsibilities, authorities,
and functions of the United States to provide health care
services to Indians and Indian tribes, as are or may be
hereafter provided by Federal statute or treaties, there is
established within the Public Health Service of the Department
the Indian Health Service.</DELETED>
<DELETED> ``(2) Assistant secretary of indian health.--The
Service shall be administered by an Assistance Secretary of
Indian Health, who shall be appointed by the President, by and
with the advice and consent of the Senate. The Assistant
Secretary shall report to the Secretary. Effective with respect
to an individual appointed by the President, by and with the
advice and consent of the Senate, after January 1, 1993, the
term of service of the Assistant Secretary shall be 4 years. An
Assistant Secretary may serve more than 1 term.</DELETED>
<DELETED> ``(b) Agency.--The Service shall be an agency within the
Public Health Service of the Department, and shall not be an office,
component, or unit of any other agency of the Department.</DELETED>
<DELETED> ``(c) Functions and Duties.--The Secretary shall carry out
through the Assistant Secretary of the Service--</DELETED>
<DELETED> ``(1) all functions which were, on the day before
the date of enactment of the Indian Health Care Amendments of
1988, carried out by or under the direction of the individual
serving as Director of the Service on such day;</DELETED>
<DELETED> ``(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 utilization
of, health services for Indians;</DELETED>
<DELETED> ``(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 programs under--
</DELETED>
<DELETED> ``(A) this Act;</DELETED>
<DELETED> ``(B) the Act of November 2, 1921 (25
U.S.C. 13);</DELETED>
<DELETED> ``(C) the Act of August 5, 1954 (42 U.S.C.
2001, et seq.);</DELETED>
<DELETED> ``(D) the Act of August 16, 1957 (42
U.S.C. 2005 et seq.); and</DELETED>
<DELETED> ``(E) the Indian Self-Determination Act
(25 U.S.C. 450f, et seq.); and</DELETED>
<DELETED> ``(4) all scholarship and loan functions carried
out under title I.</DELETED>
<DELETED> ``(d) Authority.--</DELETED>
<DELETED> ``(1) In general.--The Secretary, acting through
the Assistant Secretary, shall have the authority--</DELETED>
<DELETED> ``(A) except to the extent provided for in
paragraph (2), to appoint and compensate employees for
the Service in accordance with title 5, United States
Code;</DELETED>
<DELETED> ``(B) to enter into contracts for the
procurement of goods and services to carry out the
functions of the Service; and</DELETED>
<DELETED> ``(C) to manage, expend, and obligate all
funds appropriated for the Service.</DELETED>
<DELETED> ``(2) Personnel actions.--Notwithstanding any
other provision of law, the provisions of section 12 of the Act
of June 18, 1934 (48 Stat. 986; 25 U.S.C. 472), shall apply to all
personnel actions taken with respect to new positions created within
the Service as a result of its establishment under subsection
(a).</DELETED>
<DELETED>``SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM.</DELETED>
<DELETED> ``(a) Establishment.--</DELETED>
<DELETED> ``(1) In general.--The Secretary, in consultation
with tribes, tribal organizations, and urban Indian
organizations, shall establish an automated management
information system for the Service.</DELETED>
<DELETED> ``(2) Requirements of system.--The information
system established under paragraph (1) shall include--
</DELETED>
<DELETED> ``(A) a financial management
system;</DELETED>
<DELETED> ``(B) a patient care information
system;</DELETED>
<DELETED> ``(C) a privacy component that protects
the privacy of patient information;</DELETED>
<DELETED> ``(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;</DELETED>
<DELETED> ``(E) an interface mechanism for patient
billing and accounts receivable system; and</DELETED>
<DELETED> ``(F) a training component.</DELETED>
<DELETED> ``(b) Provision of Systems to Tribes and Organizations.--
The Secretary shall provide each Indian tribe and tribal organization
that provides health services under a contract entered into with the
Service under the Indian Self-Determination Act automated management
information systems which--</DELETED>
<DELETED> ``(1) meet the management information needs of
such Indian tribe or tribal organization with respect to the
treatment by the Indian tribe or tribal organization of
patients of the Service; and</DELETED>
<DELETED> ``(2) meet the management information needs of the
Service.</DELETED>
<DELETED> ``(c) Access to Records.--Notwithstanding any other
provision of law, each patient shall have reasonable access to the
medical or health records of such patient which are held by, or on
behalf of, the Service.</DELETED>
<DELETED> ``(d) Authority To Enhance Information Technology.--The
Secretary, acting through the Assistant Secretary, 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.</DELETED>
<DELETED>``SEC. 603. AUTHORIZATION OF APPROPRIATIONS.</DELETED>
<DELETED> ``There is authorized to be appropriated such sums as may
be necessary for each fiscal year through fiscal year 2015 to carry out
this title.</DELETED>
<DELETED>``TITLE VII--BEHAVIORAL HEALTH PROGRAMS</DELETED>
<DELETED>``SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREATMENT
SERVICES.</DELETED>
<DELETED> ``(a) Purposes.--It is the purpose of this section to--
</DELETED>
<DELETED> ``(1) 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;</DELETED>
<DELETED> ``(2) 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;</DELETED>
<DELETED> ``(3) assist Indian tribes to identify services
and resources available to address mental illness and
dysfunctional and self-destructive behavior;</DELETED>
<DELETED> ``(4) provide authority and opportunities for
Indian tribes to develop and implement, and coordinate with,
community-based programs which include identification,
prevention, education, referral, and treatment services,
including through multi-disciplinary resource teams;</DELETED>
<DELETED> ``(5) 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; and</DELETED>
<DELETED> ``(6) modify or supplement existing programs and
authorities in the areas identified in paragraph (2).</DELETED>
<DELETED> ``(b) Behavioral Health Planning.--</DELETED>
<DELETED> ``(1) Area-wide plans.--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, encourage urban
Indian organizations to develop local plans, and encourage all
such groups to participate in developing area-wide plans for
Indian Behavioral Health Services. The plans shall, to the
extent feasible, include--</DELETED>
<DELETED> ``(A) an assessment of the scope of the
problem of alcohol or other substance abuse, mental
illness, dysfunctional and self-destructive behavior,
including suicide, child abuse and family violence,
among Indians, including--</DELETED>
<DELETED> ``(i) the number of Indians served
who are directly or indirectly affected by such
illness or behavior; and</DELETED>
<DELETED> ``(ii) an estimate of the
financial and human cost attributable to such
illness or behavior;</DELETED>
<DELETED> ``(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); and</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(2) National clearinghouse.--The Secretary shall
establish a national clearinghouse of plans and reports on the
outcomes of such plans developed under this section by Indian
tribes, tribal organizations and by areas relating to
behavioral health. The Secretary shall ensure access to such
plans and outcomes by any Indian tribe, tribal organization,
urban Indian organization or the Service.</DELETED>
<DELETED> ``(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 utilized and adopted locally.</DELETED>
<DELETED> ``(c) Continuum of Care.--The Secretary, acting through
the Service, Indian tribes and tribal organizations, shall provide, to
the extent feasible and to the extent that funding is available, for
the implementation of programs including--</DELETED>
<DELETED> ``(1) a comprehensive continuum of behavioral
health care that provides for--</DELETED>
<DELETED> ``(A) community based prevention,
intervention, outpatient and behavioral health
aftercare;</DELETED>
<DELETED> ``(B) detoxification (social and
medical);</DELETED>
<DELETED> ``(C) acute hospitalization;</DELETED>
<DELETED> ``(D) intensive outpatient or day
treatment;</DELETED>
<DELETED> ``(E) residential treatment;</DELETED>
<DELETED> ``(F) transitional living for those
needing a temporary stable living environment that is
supportive of treatment or recovery goals;</DELETED>
<DELETED> ``(G) emergency shelter;</DELETED>
<DELETED> ``(H) intensive case management;</DELETED>
<DELETED> ``(I) traditional health care practices;
and</DELETED>
<DELETED> ``(J) diagnostic services, including the
utilization of neurological assessment technology;
and</DELETED>
<DELETED> ``(2) behavioral health services for particular
populations, including--</DELETED>
<DELETED> ``(A) for persons from birth through age
17, child behavioral health services, that include--
</DELETED>
<DELETED> ``(i) pre-school and school age
fetal alcohol disorder services, including
assessment and behavioral
intervention);</DELETED>
<DELETED> ``(ii) mental health or substance
abuse services (emotional, organic, alcohol,
drug, inhalant and tobacco);</DELETED>
<DELETED> ``(iii) services for co-occurring
disorders (multiple diagnosis);</DELETED>
<DELETED> ``(iv) prevention services that
are focused on individuals ages 5 years through
10 years (alcohol, drug, inhalant and
tobacco);</DELETED>
<DELETED> ``(v) early intervention,
treatment and aftercare services that are
focused on individuals ages 11 years through 17
years;</DELETED>
<DELETED> ``(vi) healthy choices or life
style services (related to STD's, domestic
violence, sexual abuse, suicide, teen
pregnancy, obesity, and other risk or safety
issues);</DELETED>
<DELETED> ``(vii) co-morbidity
services;</DELETED>
<DELETED> ``(B) for persons ages 18 years through 55
years, adult behavioral health services that include--
</DELETED>
<DELETED> ``(i) early intervention,
treatment and aftercare services;</DELETED>
<DELETED> ``(ii) mental health and substance
abuse services (emotional, alcohol, drug,
inhalant and tobacco);</DELETED>
<DELETED> ``(iii) services for co-occurring
disorders (dual diagnosis) and co-
morbidity;</DELETED>
<DELETED> ``(iv) healthy choices and life
style services (related to parenting, partners,
domestic violence, sexual abuse, suicide,
obesity, and other risk related
behavior);</DELETED>
<DELETED> ``(v) female specific treatment
services for--</DELETED>
<DELETED> ``(I) women at risk of
giving birth to a child with a fetal
alcohol disorder;</DELETED>
<DELETED> ``(II) substance abuse
requiring gender specific
services;</DELETED>
<DELETED> ``(III) sexual assault and
domestic violence; and</DELETED>
<DELETED> ``(IV) healthy choices and
life style (parenting, partners,
obesity, suicide and other related
behavioral risk); and</DELETED>
<DELETED> ``(vi) male specific treatment
services for--</DELETED>
<DELETED> ``(I) substance abuse
requiring gender specific
services;</DELETED>
<DELETED> ``(II) sexual assault and
domestic violence; and</DELETED>
<DELETED> ``(III) healthy choices
and life style (parenting, partners,
obesity, suicide and other risk related
behavior);</DELETED>
<DELETED> ``(C) family behavioral health services,
including--</DELETED>
<DELETED> ``(i) early intervention,
treatment and aftercare for affected
families;</DELETED>
<DELETED> ``(ii) treatment for sexual
assault and domestic violence; and</DELETED>
<DELETED> ``(iii) healthy choices and life
style (related to parenting, partners, domestic
violence and other abuse issues);</DELETED>
<DELETED> ``(D) for persons age 56 years and older,
elder behavioral health services including--</DELETED>
<DELETED> ``(i) early intervention,
treatment and aftercare services that include--
</DELETED>
<DELETED> ``(I) mental health and
substance abuse services (emotional,
alcohol, drug, inhalant and
tobacco);</DELETED>
<DELETED> ``(II) services for co-
occurring disorders (dual diagnosis)
and co-morbidity; and</DELETED>
<DELETED> ``(III) healthy choices
and life style services (managing
conditions related to aging);</DELETED>
<DELETED> ``(ii) elder women specific
services that include--</DELETED>
<DELETED> ``(I) treatment for
substance abuse requiring gender
specific services and</DELETED>
<DELETED> ``(II) treatment for
sexual assault, domestic violence and
neglect;</DELETED>
<DELETED> ``(iii) elder men specific
services that include--</DELETED>
<DELETED> ``(I) treatment for
substance abuse requiring gender
specific services; and</DELETED>
<DELETED> ``(II) treatment for
sexual assault, domestic violence and
neglect; and</DELETED>
<DELETED> ``(iv) services for dementia
regardless of cause.</DELETED>
<DELETED> ``(d) Community Behavioral Health Plan.--</DELETED>
<DELETED> ``(1) In general.--The governing body of any
Indian tribe or tribal organization or urban Indian
organization may, at its discretion, 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 alcohol and other
substance abuse, mental illness or dysfunctional and self-
destructive behavior, including child abuse and family
violence, among its members or its service population. Such
plan should include behavioral health services, social
services, intensive outpatient services, and continuing after
care.</DELETED>
<DELETED> ``(2) Technical assistance.--In furtherance of a
plan established pursuant to paragraph (1) and at the request
of a tribe, the appropriate agency, service unit, or other
officials of the Bureau of Indian Affairs and the Service shall
cooperate with, and provide technical assistance to, the Indian
tribe or tribal organization in the development of a plan under
paragraph (1). Upon the establishment of such a plan and at the
request of the Indian tribe or tribal organization, such
officials shall cooperate with the Indian tribe or tribal
organization in the implementation of such plan.</DELETED>
<DELETED> ``(3) Funding.--The Secretary, acting through the
Service, may make funding available to Indian tribes and tribal
organizations adopting 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.</DELETED>
<DELETED> ``(e) Coordinated Planning.--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 and State agencies, to ensure that
comprehensive behavioral health services are available to Indians
without regard to their place of residence.</DELETED>
<DELETED> ``(f) Facilities Assessment.--Not later than 1 year after
the date of enactment of this Act, 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, under-utilized service hospital beds into psychiatric units
to meet such need.</DELETED>
<DELETED>``SEC. 702. MEMORANDUM OF AGREEMENT WITH THE DEPARTMENT OF THE
INTERIOR.</DELETED>
<DELETED> ``(a) In General.--Not later than 1 year after the date of
enactment of this Act, the Secretary and the Secretary of the Interior
shall develop and enter into a memorandum of agreement, or review and
update any existing memoranda of agreement as required under section
4205 of the Indian Alcohol and Substance Abuse Prevention and
Treatment Act of 1986 (25 U.S.C. 2411), and under which the Secretaries
address--</DELETED>
<DELETED> ``(1) the scope and nature of mental illness and
dysfunctional and self-destructive behavior, including child
abuse and family violence, among Indians;</DELETED>
<DELETED> ``(2) the existing Federal, tribal, State, local,
and private services, resources, and programs available to
provide mental health services for Indians;</DELETED>
<DELETED> ``(3) the unmet need for additional services,
resources, and programs necessary to meet the needs identified
pursuant to paragraph (1);</DELETED>
<DELETED> ``(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;</DELETED>
<DELETED> ``(B) the right of Indians to participate in, and
receive the benefit of, such services; and</DELETED>
<DELETED> ``(C) the actions necessary to protect the
exercise of such right;</DELETED>
<DELETED> ``(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
levels to address the problems identified in paragraph
(1);</DELETED>
<DELETED> ``(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 needs
identified pursuant to paragraph (1), including--</DELETED>
<DELETED> ``(A) the coordination of alcohol and
substance abuse programs of the Service, the Bureau of
Indian Affairs, and the various Indian tribes
(developed under the Indian Alcohol and Substance Abuse
Prevention and Treatment Act of 1986) with the 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</DELETED>
<DELETED> ``(B) ensuring that 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;</DELETED>
<DELETED> ``(7) direct 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); and</DELETED>
<DELETED> ``(8) provide for an annual review of such
agreement by the 2 Secretaries and a report which shall be
submitted to Congress and made available to the Indian
tribes.</DELETED>
<DELETED> ``(b) Specific Provisions.--The memorandum of agreement
updated or entered into pursuant to subsection (a) shall include
specific provisions pursuant to which the Service shall assume
responsibility for--</DELETED>
<DELETED> ``(1) the determination of the scope of the
problem of alcohol and substance abuse among Indian people,
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;</DELETED>
<DELETED> ``(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</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(c) Consultation.--The Secretary and the Secretary of
the Interior shall, in developing the memorandum of agreement under
subsection (a), consult with and solicit the comments of--</DELETED>
<DELETED> ``(1) Indian tribes and tribal
organizations;</DELETED>
<DELETED> ``(2) Indian individuals;</DELETED>
<DELETED> ``(3) urban Indian organizations and other Indian
organizations;</DELETED>
<DELETED> ``(4) behavioral health service
providers.</DELETED>
<DELETED> ``(d) Publication.--The memorandum of agreement under
subsection (a) shall be published in the Federal Register. At the same
time as the publication of such agreement in the Federal Register, the
Secretary shall provide a copy of such memorandum to each Indian tribe,
tribal organization, and urban Indian organization.</DELETED>
<DELETED>``SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PREVENTION AND
TREATMENT PROGRAM.</DELETED>
<DELETED> ``(a) Establishment.--</DELETED>
<DELETED> ``(1) In general.--The Secretary, acting through
the Service, Indian tribes and tribal organizations consistent
with section 701, shall provide a program of comprehensive
behavioral health prevention and treatment and aftercare, including
systems of care and traditional health care practices, which shall
include--</DELETED>
<DELETED> ``(A) prevention, through educational
intervention, in Indian communities;</DELETED>
<DELETED> ``(B) acute detoxification or psychiatric
hospitalization and treatment (residential and
intensive outpatient);</DELETED>
<DELETED> ``(C) community-based rehabilitation and
aftercare;</DELETED>
<DELETED> ``(D) community education and involvement,
including extensive training of health care,
educational, and community-based personnel;</DELETED>
<DELETED> ``(E) specialized residential treatment
programs for high risk populations including pregnant
and post partum women and their children;</DELETED>
<DELETED> ``(F) diagnostic services utilizing, when
appropriate, neuropsychiatric assessments which include
the use of the most advances technology available;
and</DELETED>
<DELETED> ``(G) a telepsychiatry program that uses
experts in the field of pediatric psychiatry, and that
incorporates assessment, diagnosis and treatment for
children, including those children with concurrent
neurological disorders.</DELETED>
<DELETED> ``(2) Target populations.--The target population
of the program under paragraph (1) 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.</DELETED>
<DELETED> ``(b) Contract Health Services.--</DELETED>
<DELETED> ``(1) In general.--The Secretary, acting through
the Service (with the consent of the Indian tribe to be
served), 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).</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED>``SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM.</DELETED>
<DELETED> ``(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--</DELETED>
<DELETED> ``(1) provides for the training of Indians as
mental health technicians; and</DELETED>
<DELETED> ``(2) employs such technicians in the provision of
community-based mental health care that includes
identification, prevention, education, referral, and treatment
services.</DELETED>
<DELETED> ``(b) Training.--In carrying out subsection (a)(1), the
Secretary 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.</DELETED>
<DELETED> ``(c) Supervision and Evaluation.--The Secretary shall
supervise and evaluate the mental health technicians in the training
program under this section.</DELETED>
<DELETED> ``(d) Traditional Care.--The Secretary shall ensure that
the program established pursuant to this section involves the
utilization and promotion of the traditional Indian health care and
treatment practices of the Indian tribes to be served.</DELETED>
<DELETED>``SEC. 705. LICENSING REQUIREMENT FOR MENTAL HEALTH CARE
WORKERS.</DELETED>
<DELETED> ``Subject to section 220, 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 the authority of this Act or through a funding
agreement pursuant to the Indian Self-Determination and Education
Assistance Act shall--</DELETED>
<DELETED> ``(1) in the case of a person employed as a
psychologist to provide health care services, be licensed as a
clinical or counseling psychologist, or working under the
direct supervision of a clinical or counseling
psychologist;</DELETED>
<DELETED> ``(2) in the case of a person employed as a social
worker, be licensed as a social worker or working under the
direct supervision of a licensed social worker; or</DELETED>
<DELETED> ``(3) in the case of a person employed as a
marriage and family therapist, be licensed as a marriage and
family therapist or working under the direct supervision of a
licensed marriage and family therapist.</DELETED>
<DELETED>``SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.</DELETED>
<DELETED> ``(a) Funding.--The Secretary, consistent with section
701, shall make funding available to Indian tribes, tribal
organizations and urban Indian organization 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.</DELETED>
<DELETED> ``(b) Use of Funds.--Funding provided pursuant to this
section may be used to--</DELETED>
<DELETED> ``(1) develop and provide community training,
education, and prevention programs for Indian women relating to
behavioral health issues, including fetal alcohol
disorders;</DELETED>
<DELETED> ``(2) identify and provide psychological services,
counseling, advocacy, support, and relapse prevention to Indian
women and their families; and</DELETED>
<DELETED> ``(3) develop prevention and intervention models
for Indian women which incorporate traditional health care
practices, cultural values, and community and family
involvement.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(d) Earmark of Certain Funds.--Twenty percent of the
amounts appropriated to carry out this section shall be used to make
grants to urban Indian organizations funded under title V.</DELETED>
<DELETED>``SEC. 707. INDIAN YOUTH PROGRAM.</DELETED>
<DELETED> ``(a) Detoxification and Rehabilitation.--The Secretary
shall, consistent with section 701, develop and implement a program for
acute detoxification and treatment for Indian youth that includes
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.</DELETED>
<DELETED> ``(b) Alcohol and Substance Abuse Treatment Centers or
Facilities.--</DELETED>
<DELETED> ``(1) Establishment.--</DELETED>
<DELETED> ``(A) In general.--The Secretary, acting
through the Service, Indian tribes, or 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.</DELETED>
<DELETED> ``(B) Area office in california.--For
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.</DELETED>
<DELETED> ``(2) Funding.--For the purpose of staffing and
operating centers or facilities under this subsection, funding
shall be made available pursuant to the Act of November 2, 1921
(25 U.S.C. 13) (commonly known as the Snyder Act).</DELETED>
<DELETED> ``(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) that is agreed upon (by appropriate
tribal resolution) by a majority of the tribes to be served by
such center.</DELETED>
<DELETED> ``(4) Specific provision of funds.--</DELETED>
<DELETED> ``(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--
</DELETED>
<DELETED> ``(i) the Tanana Chiefs
Conference, Incorporated, for the purpose of
leasing, constructing, renovating, operating
and maintaining a residential youth treatment
facility in Fairbanks, Alaska;</DELETED>
<DELETED> ``(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));</DELETED>
<DELETED> ``(iii) the Southern Indian Health
Council, for the purpose of staffing,
operating, and maintaining a residential youth
treatment facility in San Diego County,
California; and</DELETED>
<DELETED> ``(iv) the Navajo Nation, for the
staffing, operation, and maintenance of the
Four Corners Regional Adolescent Treatment
Center, a residential youth treatment facility
in New Mexico.</DELETED>
<DELETED> ``(B) Provision of services to eligible
youth.--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 youth residing in such State.</DELETED>
<DELETED> ``(c) Intermediate Adolescent Behavioral Health
Services.--</DELETED>
<DELETED> ``(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--</DELETED>
<DELETED> ``(A) pre-treatment assistance;</DELETED>
<DELETED> ``(B) inpatient, outpatient, and after-
care services;</DELETED>
<DELETED> ``(C) emergency care;</DELETED>
<DELETED> ``(D) suicide prevention and crisis
intervention; and</DELETED>
<DELETED> ``(E) prevention and treatment of mental
illness, and dysfunctional and self-destructive
behavior, including child abuse and family
violence.</DELETED>
<DELETED> ``(2) Use of funds.--Funds provided under this
subsection may be used--</DELETED>
<DELETED> ``(A) to construct or renovate an existing
health facility to provide intermediate behavioral
health services;</DELETED>
<DELETED> ``(B) to hire behavioral health
professionals;</DELETED>
<DELETED> ``(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; and</DELETED>
<DELETED> ``(D) to make renovations and hire
appropriate staff to convert existing hospital beds
into adolescent psychiatric units; and</DELETED>
<DELETED> ``(E) to provide intensive home- and
community-based services, including collaborative
systems of care.</DELETED>
<DELETED> ``(3) Criteria.--The Secretary 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.</DELETED>
<DELETED> ``(d) Federally Owned Structures.--</DELETED>
<DELETED> ``(1) In general.--The Secretary, acting through
the Service, shall, in consultation with Indian tribes and
tribal organizations--</DELETED>
<DELETED> ``(A) identify and use, where appropriate,
federally owned structures suitable for local
residential or regional behavioral health treatment for
Indian youth; and</DELETED>
<DELETED> ``(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 youth.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(e) Rehabilitation and Aftercare Services.--</DELETED>
<DELETED> ``(1) In general.--The Secretary, an Indian tribe
or tribal organization, 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 youth who have significant behavioral health problems,
and require long-term treatment, community reintegration, and
monitoring to support the Indian youth after their return to
their home community.</DELETED>
<DELETED> ``(2) Administration.--Services under paragraph
(1) shall be administered within each service unit or tribal
program by trained staff within the community who can assist
the Indian youth in 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.</DELETED>
<DELETED> ``(f) Inclusion of Family in Youth Treatment Program.--In
providing the treatment and other services to Indian youth authorized
by this section, the Secretary, an Indian tribe or tribal organization
shall provide for the inclusion of family members of such youth 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.</DELETED>
<DELETED> ``(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 alcohol, drugs, inhalants, and tobacco, among
Indian youth residing in Indian communities, on Indian reservations,
and in urban areas and provide appropriate mental health services to
address the incidence of mental illness among such youth.</DELETED>
<DELETED>``SEC. 708. INPATIENT AND COMMUNITY-BASED MENTAL HEALTH
FACILITIES DESIGN, CONSTRUCTION AND STAFFING
ASSESSMENT.</DELETED>
<DELETED> ``(a) In General.--Not later than 1 year after the date of
enactment of this section, 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.</DELETED>
<DELETED> ``(b) Treatment of California.--For purposes of this
section, California shall be considered to be 2 areas of the Service, 1
area whose location shall be considered to encompass the northern area
of the State of California and 1 area whose jurisdiction shall be
considered to encompass the remainder of the State of
California.</DELETED>
<DELETED> ``(c) Conversion of Certain Hospital Beds.--The Secretary
shall consider the possible conversion of existing, under-utilized
Service hospital beds into psychiatric units to meet needs under this
section.</DELETED>
<DELETED>``SEC. 709. TRAINING AND COMMUNITY EDUCATION.</DELETED>
<DELETED> ``(a) Community Education.--</DELETED>
<DELETED> ``(1) In general.--The Secretary, in cooperation
with the Secretary of the Interior, shall develop and
implement, or provide funding to enable Indian tribes and
tribal organization 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.</DELETED>
<DELETED> ``(2) Education.--A program under paragraph (1)
shall include education concerning behavioral health for
political leaders, tribal judges, law enforcement personnel,
members of tribal health and education boards, and other
critical members of each tribal community.</DELETED>
<DELETED> ``(3) Training.--Community-based training
(oriented toward local capacity development) under a program
under paragraph (1) shall include tribal community provider
training (designed for adult learners from the communities
receiving services for prevention, intervention, treatment and
aftercare).</DELETED>
<DELETED> ``(b) Training.--The Secretary shall, either directly or
through Indian tribes or tribal organization, 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).</DELETED>
<DELETED> ``(c) Community-Based Training Models.--In carrying out
the education and training programs required by this section, the
Secretary, acting through the Service and 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--</DELETED>
<DELETED> ``(1) the elevated risk of alcohol and behavioral
health problems faced by children of alcoholics;</DELETED>
<DELETED> ``(2) the cultural, spiritual, and
multigenerational aspects of behavioral health problem
prevention and recovery; and</DELETED>
<DELETED> ``(3) community-based and multidisciplinary
strategies for preventing and treating behavioral health
problems.</DELETED>
<DELETED>``SEC. 710. BEHAVIORAL HEALTH PROGRAM.</DELETED>
<DELETED> ``(a) Programs for Innovative Services.--The Secretary,
acting through the Service, Indian tribes or tribal organizations,
consistent with Section 701, may develop, implement, and carry out
programs to deliver innovative community-based behavioral health
services to Indians.</DELETED>
<DELETED> ``(b) Criteria.--The Secretary may award funding for a
project under subsection (a) to an Indian tribe or tribal organization
and may consider the following criteria:</DELETED>
<DELETED> ``(1) Whether the project will address significant
unmet behavioral health needs among Indians.</DELETED>
<DELETED> ``(2) Whether the project will serve a significant
number of Indians.</DELETED>
<DELETED> ``(3) Whether the project has the potential to
deliver services in an efficient and effective
manner.</DELETED>
<DELETED> ``(4) Whether the tribe or tribal organization has
the administrative and financial capability to administer the
project.</DELETED>
<DELETED> ``(5) Whether the project will deliver services in
a manner consistent with traditional health care.</DELETED>
<DELETED> ``(6) Whether the project is coordinated with, and
avoids duplication of, existing services.</DELETED>
<DELETED> ``(c) Funding Agreements.--For purposes of this
subsection, the Secretary shall, in evaluating applications or
proposals for funding for projects to be operated under any funding
agreement entered into with the Service under the Indian Self-
Determination Act and Education Assistance Act, use the same criteria
that the Secretary uses in evaluating any other application or proposal
for such funding.</DELETED>
<DELETED>``SEC. 711. FETAL ALCOHOL DISORDER FUNDING.</DELETED>
<DELETED> ``(a) Establishment of Program.--</DELETED>
<DELETED> ``(1) In general.--The Secretary, consistent with
Section 701, acting through Indian tribes, tribal
organizations, and urban Indian organizations, shall establish
and operate fetal alcohol disorders programs as provided for in
this section for the purposes of meeting the health status
objective specified in section 3(b).</DELETED>
<DELETED> ``(2) Use of funds.--Funding provided pursuant to
this section shall be used to--</DELETED>
<DELETED> ``(A) develop and provide community and
in-school training, education, and prevention programs
relating to fetal alcohol disorders;</DELETED>
<DELETED> ``(B) identify and provide behavioral
health treatment to high-risk women;</DELETED>
<DELETED> ``(C) identify and provide appropriate
educational and vocational support, counseling,
advocacy, and information to fetal alcohol disorder
affected persons and their families or
caretakers;</DELETED>
<DELETED> ``(D) develop and implement counseling and
support programs in schools for fetal alcohol disorder
affected children;</DELETED>
<DELETED> ``(E) develop prevention and intervention
models which incorporate traditional practitioners,
cultural and spiritual values and community
involvement;</DELETED>
<DELETED> ``(F) develop, print, and disseminate
education and prevention materials on fetal alcohol
disorders;</DELETED>
<DELETED> ``(G) 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 tribal and urban Indian
communities;</DELETED>
<DELETED> ``(H) develop early childhood intervention
projects from birth on to mitigate the effects of fetal
alcohol disorders; and</DELETED>
<DELETED> ``(I) develop and fund community-based
adult fetal alcohol disorder housing and support
services.</DELETED>
<DELETED> ``(3) Criteria.--The Secretary shall establish
criteria for the review and approval of applications for
funding under this section.</DELETED>
<DELETED> ``(b) Provision of Services.--The Secretary, acting
through the Service, Indian tribes, tribal organizations and urban
Indian organizations, shall--</DELETED>
<DELETED> ``(1) develop and provide services for the
prevention, intervention, treatment, and aftercare for those
affected by fetal alcohol disorders in Indian communities;
and</DELETED>
<DELETED> ``(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 disorders.</DELETED>
<DELETED> ``(c) Task Force.--</DELETED>
<DELETED> ``(1) In general.--The Secretary shall establish a
task force to be known as the Fetal Alcohol Disorders Task
Force to advise the Secretary in carrying out subsection
(b).</DELETED>
<DELETED> ``(2) Composition.--The task force under paragraph
(1) shall be composed of representatives from the National
Institute on Drug Abuse, the National Institute on Alcohol and
Alcoholism, the Office of Substance Abuse Prevention, the
National Institute of Mental Health, the Service, the Office of
Minority Health of the Department of Health and Human Services,
the Administration for Native Americans, the National Institute
of Child Health & Human Development, the Centers for Disease
Control and Prevention, the Bureau of Indian Affairs, Indian
tribes, tribal organizations, urban Indian communities, and
Indian fetal alcohol disorders experts.</DELETED>
<DELETED> ``(d) Applied Research.--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 disorders.</DELETED>
<DELETED> ``(e) Urban Indian Organizations.--The Secretary shall
ensure that 10 percent of the amounts appropriated to carry out this
section shall be used to make grants to urban Indian organizations
funded under title V.</DELETED>
<DELETED>``SEC. 712. CHILD SEXUAL ABUSE AND PREVENTION TREATMENT
PROGRAMS.</DELETED>
<DELETED> ``(a) Establishment.--The Secretary and the Secretary of
the Interior, acting through the Service, Indian tribes and tribal
organizations, shall establish, consistent with section 701, in each
service area, programs involving treatment for--</DELETED>
<DELETED> ``(1) victims of child sexual abuse; and</DELETED>
<DELETED> ``(2) perpetrators of child sexual
abuse.</DELETED>
<DELETED> ``(b) Use of Funds.--Funds provided under this section
shall be used to--</DELETED>
<DELETED> ``(1) develop and provide community education and
prevention programs related to child sexual abuse;</DELETED>
<DELETED> ``(2) identify and provide behavioral health
treatment to children who are victims of sexual abuse and to
their families who are affected by sexual abuse;</DELETED>
<DELETED> ``(3) develop prevention and intervention models
which incorporate traditional health care practitioners,
cultural and spiritual values, and community
involvement;</DELETED>
<DELETED> ``(4) develop and implement, though the tribal
consultation process, culturally sensitive assessment and
diagnostic tools for use in tribal and urban Indian
communities.</DELETED>
<DELETED> ``(5) identify and provide behavioral health
treatment to perpetrators of child sexual abuse with efforts
being made 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 to
provide treatment after release to the community until it is
determined that the perpetrator is not a threat to
children.</DELETED>
<DELETED>``SEC. 713. BEHAVIORAL MENTAL HEALTH RESEARCH.</DELETED>
<DELETED> ``(a) In General.--The Secretary, acting through the
Service and 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--
</DELETED>
<DELETED> ``(1) the inter-relationship and inter-dependence
of behavioral health problems with alcoholism and other
substance abuse, suicide, homicides, other injuries, and the
incidence of family violence; and</DELETED>
<DELETED> ``(2) the development of models of prevention
techniques.</DELETED>
<DELETED> ``(b) Special Emphasis.--The effect of the inter-
relationships and interdependencies referred to in subsection (a)(1) on
children, and the development of prevention techniques under subsection
(a)(2) applicable to children, shall be emphasized.</DELETED>
<DELETED>``SEC. 714. DEFINITIONS.</DELETED>
<DELETED> ``In this title:</DELETED>
<DELETED> ``(1) Assessment.--The term `assessment' means the
systematic collection, analysis and dissemination of
information on health status, health needs and health
problems.</DELETED>
<DELETED> ``(2) Alcohol related neurodevelopmental
disorders.--The term `alcohol related neurodevelopmental
disorders' or `ARND' with respect to an individual means the
individual has a history of maternal alcohol consumption during
pregnancy, central nervous system involvement such as
developmental delay, intellectual deficit, or neurologic
abnormalities, that behaviorally, there may be problems with
irritability, and failure to thrive as infants, and that as
children become older there will likely be hyperactivity,
attention deficit, language dysfunction and perceptual and
judgment problems.</DELETED>
<DELETED> ``(3) Behavioral health.--The term `behavioral
health' means the blending of substances (alcohol, drugs,
inhalants and tobacco) abuse and mental health prevention and
treatment, for the purpose of providing comprehensive services.
Such term includes the joint development of substance abuse and
mental health treatment planning and coordinated case
management using a multidisciplinary approach.</DELETED>
<DELETED> ``(4) Behavioral health aftercare.--</DELETED>
<DELETED> ``(A) In general.--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, to help prevent or
treat relapse, including the development of an
aftercare plan.</DELETED>
<DELETED> ``(B) Aftercare plan.--Prior to the time
at which an individual is discharged from a level of
care, such as outpatient treatment, an aftercare plan
shall have been developed for the individual. Such plan
may use such resources as community base therapeutic
group care, transitional living, a 12-step sponsor, a
local 12-step or other related support group, or other
community based providers (such as mental health
professionals, traditional health care practitioners,
community health aides, community health
representatives, mental health technicians, or
ministers).</DELETED>
<DELETED> ``(5) Dual diagnosis.--The term `dual diagnosis'
means coexisting substance abuse and mental illness conditions
or diagnosis. In individual with a dual diagnosis may be
referred to as a mentally ill chemical abuser.</DELETED>
<DELETED> ``(6) Fetal alcohol disorders.--The term `fetal
alcohol disorders' means fetal alcohol syndrome, partial fetal
alcohol syndrome, or alcohol related neural developmental
disorder.</DELETED>
<DELETED> ``(7) Fetal alcohol syndrome.--The term `fetal
alcohol syndrome' or `FAS' with respect to an individual means
a syndrome in which the individual has a history of maternal
alcohol consumption during pregnancy, and with respect to which
the following criteria should be met:</DELETED>
<DELETED> ``(A) Central nervous system involvement
such as developmental delay, intellectual deficit,
microencephaly, or neurologic abnormalities.</DELETED>
<DELETED> ``(B) Craniofacial abnormalities with at
least 2 of the following: microphthalmia, short
palpebral fissures, poorly developed philtrum, thin
upper lip, flat nasal bridge, and short upturned
nose.</DELETED>
<DELETED> ``(C) Prenatal or postnatal growth
delay.</DELETED>
<DELETED> ``(8) Partial fas.--The term `partial FAS' with
respect to an individual means 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: micro-ophthalmia, short palpebral fissures, poorly
developed philtrum, thin upper lip, flat nasal bridge, short
upturned nose.</DELETED>
<DELETED> ``(9) Rehabilitation.--The term `rehabilitation'
means to restore the ability or capacity to engage in usual and
customary life activities through education and
therapy.</DELETED>
<DELETED> ``(10) Substance abuse.--The term `substance
abuse' includes inhalant abuse.</DELETED>
<DELETED>``SEC. 715. AUTHORIZATION OF APPROPRIATIONS.</DELETED>
<DELETED> ``There is authorized to be appropriated such sums as may
be necessary for each fiscal year through fiscal year 2015 to carry out
this title.</DELETED>
<DELETED>``TITLE VIII--MISCELLANEOUS</DELETED>
<DELETED>``SEC. 801. REPORTS.</DELETED>
<DELETED> ``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 the Congress a report containing--</DELETED>
<DELETED> ``(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 an assessment
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;</DELETED>
<DELETED> ``(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 to address such impact, including a report
on proposed changes in the allocation of funding pursuant to
section 808;</DELETED>
<DELETED> ``(3) a report on the use of health services by
Indians--</DELETED>
<DELETED> ``(A) on a national and area or other
relevant geographical basis;</DELETED>
<DELETED> ``(B) by gender and age;</DELETED>
<DELETED> ``(C) by source of payment and type of
service;</DELETED>
<DELETED> ``(D) comparing such rates of use with
rates of use among comparable non-Indian populations;
and</DELETED>
<DELETED> ``(E) on the services provided under
funding agreements pursuant to the Indian Self-
Determination and Education Assistance Act;</DELETED>
<DELETED> ``(4) a report of contractors concerning health
care educational loan repayments under section 110;</DELETED>
<DELETED> ``(5) a general audit report on the health care
educational loan repayment program as required under section
110(n);</DELETED>
<DELETED> ``(6) a separate statement that specifies the
amount of funds requested to carry out the provisions of
section 201;</DELETED>
<DELETED> ``(7) a report on infectious diseases as required
under section 212;</DELETED>
<DELETED> ``(8) a report on environmental and nuclear health
hazards as required under section 214;</DELETED>
<DELETED> ``(9) a report on the status of all health care
facilities needs as required under sections 301(c)(2) and
301(d);</DELETED>
<DELETED> ``(10) a report on safe water and sanitary waste
disposal facilities as required under section
302(h)(1);</DELETED>
<DELETED> ``(11) a report on the expenditure of non-service
funds for renovation as required under sections 305(a)(2) and
305(a)(3);</DELETED>
<DELETED> ``(12) a report identifying the backlog of
maintenance and repair required at Service and tribal
facilities as required under section 314(a);</DELETED>
<DELETED> ``(13) a report providing an accounting of
reimbursement funds made available to the Secretary under
titles XVIII and XIX of the Social Security Act as required
under section 403(a);</DELETED>
<DELETED> ``(14) a report on services sharing of the
Service, the Department of Veteran's Affairs, and other Federal
agency health programs as required under section
412(c)(2);</DELETED>
<DELETED> ``(15) a report on the evaluation and renewal of
urban Indian programs as required under section 505;</DELETED>
<DELETED> ``(16) a report on the findings and conclusions
derived from the demonstration project as required under
section 512(a)(2);</DELETED>
<DELETED> ``(17) a report on the evaluation of programs as
required under section 513; and</DELETED>
<DELETED> ``(18) a report on alcohol and substance abuse as
required under section 701(f).</DELETED>
<DELETED>``SEC. 802. REGULATIONS.</DELETED>
<DELETED> ``(a) Initiation of Rulemaking Procedures.--</DELETED>
<DELETED> ``(1) In general.--Not later than 90 days after
the date of enactment of this Act, 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 this
Act.</DELETED>
<DELETED> ``(2) Publication.--Proposed regulations to
implement this Act shall be published in the Federal Register
by the Secretary not later than 270 days after the date of
enactment of this Act and shall have not less than a 120 day
comment period.</DELETED>
<DELETED> ``(3) Expiration of authority.--The authority to
promulgate regulations under this Act shall expire 18 months
from the date of enactment of this Act.</DELETED>
<DELETED> ``(b) Rulemaking 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.</DELETED>
<DELETED> ``(c) Adaption 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.</DELETED>
<DELETED> ``(d) Failure To Promulgate Regulations.--The lack of
promulgated regulations shall not limit the effect of this
Act.</DELETED>
<DELETED> ``(e) Supremacy of Provisions.--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
enactment of the Indian Self-Determination Contract Reform Act of 1994,
and the Secretary is authorized to repeal any regulation that is
inconsistent with the provisions of this Act.</DELETED>
<DELETED>``SEC. 803. PLAN OF IMPLEMENTATION.</DELETED>
<DELETED> ``Not later than 240 days after the date of enactment of
this Act, the Secretary, in consultation with Indian tribes, tribal
organizations, and urban Indian organizations, shall prepare and submit
to Congress a plan that shall explain the manner and schedule
(including a schedule of appropriate requests), by title and section,
by which the Secretary will implement the provisions of this
Act.</DELETED>
<DELETED>``SEC. 804. AVAILABILITY OF FUNDS.</DELETED>
<DELETED> ``Amounts appropriated under this Act shall remain
available until expended.</DELETED>
<DELETED>``SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED TO THE
INDIAN HEALTH SERVICE.</DELETED>
<DELETED> ``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.</DELETED>
<DELETED>``SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS.</DELETED>
<DELETED> ``(a) Eligibility.--</DELETED>
<DELETED> ``(1) In general.--Until such time as any
subsequent law may otherwise provide, the following California
Indians shall be eligible for health services provided by the
Service:</DELETED>
<DELETED> ``(A) Any member of a federally recognized
Indian tribe.</DELETED>
<DELETED> ``(B) Any descendant of an Indian who was
residing in California on June 1, 1852, but only if
such descendant--</DELETED>
<DELETED> ``(i) is a member of the Indian
community served by a local program of the
Service; and</DELETED>
<DELETED> ``(ii) is regarded as an Indian by
the community in which such descendant
lives.</DELETED>
<DELETED> ``(C) Any Indian who holds trust interests
in public domain, national forest, or Indian
reservation allotments in California.</DELETED>
<DELETED> ``(D) 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.</DELETED>
<DELETED> ``(b) Rule of Construction.--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.</DELETED>
<DELETED>``SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS.</DELETED>
<DELETED> ``(a) Ineligible Persons.--</DELETED>
<DELETED> ``(1) In general.--Any individual who--</DELETED>
<DELETED> ``(A) has not attained 19 years of
age;</DELETED>
<DELETED> ``(B) is the natural or adopted child,
step-child, foster-child, legal ward, or orphan of an
eligible Indian; and</DELETED>
<DELETED> ``(C) is not otherwise eligible for the
health services provided by the Service,</DELETED>
<DELETED>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
one year after the date such disability has been removed.</DELETED>
<DELETED> ``(2) 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 of
such spouses or spouses who are married to members of the
Indian tribe being served are made eligible, as a class, by an
appropriate resolution of the governing body of the Indian
tribe or tribal organization providing such services. The
health needs of persons made eligible under this paragraph
shall not be taken into consideration by the Service in
determining the need for, or allocation of, its health
resources.</DELETED>
<DELETED> ``(b) Programs and Services.--</DELETED>
<DELETED> ``(1) Programs.--</DELETED>
<DELETED> ``(A) In general.--The Secretary may
provide health services under this subsection through
health programs operated directly by the Service to
individuals who reside within the service area of a
service unit and who are not eligible for such health
services under any other subsection of this section or
under any other provision of law if--</DELETED>
<DELETED> ``(i) the Indian tribe (or, in the
case of a multi-tribal service area, all the
Indian tribes) served by such service unit
requests such provision of health services to
such individuals; and</DELETED>
<DELETED> ``(ii) the Secretary and the
Indian tribe or tribes have jointly determined
that--</DELETED>
<DELETED> ``(I) the provision of
such health services will not result in
a denial or diminution of health
services to eligible Indians;
and</DELETED>
<DELETED> ``(II) there is no
reasonable alternative health program
or services, within or without the
service area of such service unit,
available to meet the health needs of
such individuals.</DELETED>
<DELETED> ``(B) Funding agreements.--In the case of
health programs operated under a funding agreement
entered into under the Indian Self-Determination and
Educational Assistance Act, the governing body of the
Indian tribe or tribal organization providing health
services under such funding agreement is authorized to
determine whether health services should be provided
under such funding agreement to individuals who are not
eligible for such health services under any other
subsection of this section or under any other provision
of law. In making such determinations, the governing
body of the Indian tribe or tribal organization shall
take into account the considerations described in
subparagraph (A)(ii).</DELETED>
<DELETED> ``(2) Liability for payment.--</DELETED>
<DELETED> ``(A) In general.--Persons receiving
health services provided by the Service by reason 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 of the Social
Security Act, section 402(a) of this Act, or any other
provision of law, amounts collected under this
subsection, including medicare or medicaid
reimbursements under titles XVIII and XIX of the Social
Security Act, shall be credited to the account of the
program providing the service and shall be used solely
for the provision of health services within that
program. Amounts collected under this subsection shall
be available for expenditure within such program for
not to exceed 1 fiscal year after the fiscal year in
which collected.</DELETED>
<DELETED> ``(B) Services for indigent persons.--
Health services may be provided by the Secretary
through the Service under this subsection to an
indigent person who would not be 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 person.</DELETED>
<DELETED> ``(3) Service areas.--</DELETED>
<DELETED> ``(A) Service to only one tribe.--In the
case of a service area which serves only one Indian
tribe, the authority of the Secretary to provide health
services under paragraph (1)(A) 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.</DELETED>
<DELETED> ``(B) Multi-tribal areas.--In the case of
a multi-tribal service area, the authority of the
Secretary to provide health services under paragraph
(1)(A) 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 provision of such
health services.</DELETED>
<DELETED> ``(c) Purpose for Providing 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 subsection of this section or under any other provision of law in
order to--</DELETED>
<DELETED> ``(1) achieve stability in a medical
emergency;</DELETED>
<DELETED> ``(2) prevent the spread of a communicable disease
or otherwise deal with a public health hazard;</DELETED>
<DELETED> ``(3) provide care to non-Indian women pregnant
with an eligible Indian's child for the duration of the
pregnancy through post partum; or</DELETED>
<DELETED> ``(4) provide care to immediate family members of
an eligible person if such care is directly related to the
treatment of the eligible person.</DELETED>
<DELETED> ``(d) Hospital Privileges.--Hospital privileges in health
facilities operated and maintained by the Service or operated under a
contract entered into under the Indian Self-Determination Education
Assistance Act may be extended to non-Service health care practitioners
who provide services to persons described in subsection (a) or (b).
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.</DELETED>
<DELETED> ``(e) Definition.--In 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.</DELETED>
<DELETED>``SEC. 808. REALLOCATION OF BASE RESOURCES.</DELETED>
<DELETED> ``(a) Requirement of Report.--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 the Congress under section 801, a report on the proposed change in
allocation of funding, including the reasons for the change and its
likely effects.</DELETED>
<DELETED> ``(b) Nonapplication of Section.--Subsection (a) shall not
apply if the total amount appropriated to the Service for a fiscal year
is less than the amount appropriated to the Service for previous fiscal
year.</DELETED>
<DELETED>``SEC. 809. RESULTS OF DEMONSTRATION PROJECTS.</DELETED>
<DELETED> ``The Secretary shall provide for the dissemination to
Indian tribes of the findings and results of demonstration projects
conducted under this Act.</DELETED>
<DELETED>``SEC. 810. PROVISION OF SERVICES IN MONTANA.</DELETED>
<DELETED> ``(a) In General.--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 Cr. 1987).</DELETED>
<DELETED> ``(b) Rule of Construction.--The provisions of subsection
(a) shall not be construed to be an expression of the sense of the
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.</DELETED>
<DELETED>``SEC. 811. MORATORIUM.</DELETED>
<DELETED> ``During the period of the moratorium imposed by Public
Law 100-446 on implementation of the final rule published in the
Federal Register on September 16, 1987, by the Health Resources and
Services Administration, relating to eligibility for the health care
services of the Service, the 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.</DELETED>
<DELETED>``SEC. 812. TRIBAL EMPLOYMENT.</DELETED>
<DELETED> ``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 under the Self-Determination and
Education Assistance Act shall not be considered an employer.</DELETED>
<DELETED>``SEC. 813. PRIME VENDOR.</DELETED>
<DELETED> ``For purposes of section 4 of Public Law 102-585 (38
U.S.C. 812) Indian tribes and tribal organizations carrying out a
grant, cooperative agreement, or funding agreement under the Indian
Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.)
shall be deemed to be an executive agency and part of the Service and,
as such, may act as an ordering agent of the Service and the employees
of the tribe or tribal organization may order supplies on behalf
thereof on the same basis as employees of the Service.</DELETED>
<DELETED>``SEC. 814. NATIONAL BI-PARTISAN COMMISSION ON INDIAN HEALTH
CARE ENTITLEMENT.</DELETED>
<DELETED> ``(a) Establishment.--There is hereby established the
National Bi-Partisan Indian Health Care Entitlement Commission
(referred to in this Act as the `Commission').</DELETED>
<DELETED> ``(b) Membership.--The Commission shall be composed of 25
members, to be appointed as follows:</DELETED>
<DELETED> ``(1) Ten members of Congress, of which--
</DELETED>
<DELETED> ``(A) three members shall be from the
House of Representatives and shall be appointed by the
majority leader;</DELETED>
<DELETED> ``(B) three members shall be from the
House of Representatives and shall be appointed by the
minority leader;</DELETED>
<DELETED> ``(C) two members shall be from the Senate
and shall be appointed by the majority leader;
and</DELETED>
<DELETED> ``(D) two members shall be from the Senate
and shall be appointed by the minority
leader;</DELETED>
<DELETED>who shall each be members of the committees of
Congress that consider legislation affecting the provision of
health care to Indians and who shall elect the chairperson and
vice-chairperson of the Commission.</DELETED>
<DELETED> ``(2) Twelve individuals to be appointed by the
members of the Commission appointed under paragraph (1), of
which at least 1 shall be from each service area as currently
designated by the Director of the Service, to be chosen from
among 3 nominees from each such area as selected 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 with due regard being given to a
reasonable representation on the Commission of members who are
familiar with various health care delivery modes and who
represent tribes of various size populations.</DELETED>
<DELETED> ``(3) Three individuals shall be appointed by the
Director of the Service from among individual who are
knowledgeable about the provision of health care to Indians, at
least 1 of whom shall be appointed from among 3 nominees from
each program that is funded in whole or in part by the Service
primarily or exclusively for the benefit of urban
Indians.</DELETED>
<DELETED>All those persons appointed under paragraphs (2) and (3) shall
be members of Federally recognized Indian tribes.</DELETED>
<DELETED> ``(c) Terms.--</DELETED>
<DELETED> ``(1) In general.--Members of the Commission shall
serve for the life of the Commission.</DELETED>
<DELETED> ``(2) Appointment of members.--Members of the
Commission shall be appointed under subsection (b)(1) not later
than 90 days after the date of enactment of this Act, and the
remaining members of the Commission shall be appointed not
later than 60 days after the date on which the members are
appointed under such subsection.</DELETED>
<DELETED> ``(3) Vacancy.--A vacancy in the membership of the
Commission shall be filled in the manner in which the original
appointment was made.</DELETED>
<DELETED> ``(d) Duties of the Commission.--The Commission shall
carry out the following duties and functions:</DELETED>
<DELETED> ``(1) Review and analyze the recommendations of
the report of the study committee established under paragraph
(3) to the Commission.</DELETED>
<DELETED> ``(2) Make recommendations to Congress for
providing health services for Indian persons as an entitlement,
giving due regard to the effects of such a programs on existing
health care delivery systems for Indian persons and the effect
of such programs on the sovereign status of Indian
tribes;</DELETED>
<DELETED> ``(3) Establish a study committee to be composed
of those members of the Commission appointed by the Director of
the Service and at least 4 additional members of Congress from
among the members of the Commission which shall--</DELETED>
<DELETED> ``(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, and which
may include authorizing and funding 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;</DELETED>
<DELETED> ``(B) make recommendations to the
Commission for legislation that will provide for the
delivery of health services for Indians as an
entitlement, which shall, at a minimum, address 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 funding of the health services to be provided;</DELETED>
<DELETED> ``(C) determine the effect of the
enactment of such recommendations on the existing
system of the delivery of health services for
Indians;</DELETED>
<DELETED> ``(D) determine the effect of a health
services entitlement program for Indian persons on the
sovereign status of Indian tribes;</DELETED>
<DELETED> ``(E) not later than 12 months after the
appointment of all members of the Commission, make a
written report of its findings and recommendations to
the Commission, which report shall include a statement
of the minority and majority position of the committee
and which shall be disseminated, at a minimum, to each
federally recognized Indian tribe, tribal organization
and urban Indian organization for comment to the
Commission; and</DELETED>
<DELETED> ``(F) report regularly to the full
Commission regarding the findings and recommendations
developed by the committee in the course of carrying
out its duties under this section.</DELETED>
<DELETED> ``(4) Not later than 18 months after 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 the 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.</DELETED>
<DELETED> ``(e) Administrative Provisions.--</DELETED>
<DELETED> ``(1) Compensation and expenses.--</DELETED>
<DELETED> ``(A) Congressional members.--Each member
of the Commission appointed under subsection (b)(1)
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.</DELETED>
<DELETED> ``(B) Other members.--The members of the
Commission appointed under paragraphs (2) and (3) of
subsection (b), 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, be allowed travel expenses,
as authorized by the chairperson of the Commission. For
purposes 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.</DELETED>
<DELETED> ``(2) Meetings and quorum.--</DELETED>
<DELETED> ``(A) Meetings.--The Commission shall meet
at the call of the chairperson.</DELETED>
<DELETED> ``(B) Quorum.--A quorum of the Commission
shall consist of not less than 15 members, of which not
less than 6 of such members shall be appointees under
subsection (b)(1) and not less than 9 of such members
shall be Indians.</DELETED>
<DELETED> ``(3) Director and staff.--</DELETED>
<DELETED> ``(A) Executive director.--The members of
the Commission shall appoint an executive director of
the Commission. The executive director shall be paid
the rate of basic pay equal to that for level V of the
Executive Schedule.</DELETED>
<DELETED> ``(B) Staff.--With the approval of the
Commission, the executive director may appoint such
personnel as the executive director deems
appropriate.</DELETED>
<DELETED> ``(C) Applicability of civil service
laws.--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).</DELETED>
<DELETED> ``(D) Experts and consultants.--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.</DELETED>
<DELETED> ``(E) Facilities.--The Administrator of
the General Services Administration 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.</DELETED>
<DELETED> ``(f) Powers.--</DELETED>
<DELETED> ``(1) Hearings and other activities.--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,
except that at least 6 regional hearings shall be held in
different areas of the United States in which large numbers of
Indians are present. Such hearings shall be held to solicit the
views of Indians regarding the delivery of health care services
to them. To constitute a hearing under this paragraph, at least
5 members of the Commission, including at least 1 member of
Congress, must be present. Hearings held by the study committee
established under this section may be counted towards the
number of regional hearings required by this
paragraph.</DELETED>
<DELETED> ``(2) Studies by gao.--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.</DELETED>
<DELETED> ``(3) Cost estimates.--</DELETED>
<DELETED> ``(A) In general.--The Director of the
Congressional Budget Office or the Chief Actuary of the
Health Care Financing Administration, 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.</DELETED>
<DELETED> ``(B) Reimbursements.--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).</DELETED>
<DELETED> ``(4) Detail of federal employees.--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.</DELETED>
<DELETED> ``(5) Technical assistance.--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.</DELETED>
<DELETED> ``(6) Use of mails.--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.</DELETED>
<DELETED> ``(7) Obtaining information.--The Commission may
secure directly from the 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 chairperson of the
Commission, the head of such agency shall furnish such
information to the Commission.</DELETED>
<DELETED> ``(8) Support services.--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.</DELETED>
<DELETED> ``(9) Printing.--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 the Congress.</DELETED>
<DELETED> ``(g) Authorization of Appropriations.--There is
authorized to be appropriated $4,000,000 to carry out this section. The
amount appropriated under this subsection shall not be deducted from or
affect any other appropriation for health care for Indian
persons.</DELETED>
<DELETED>``SEC. 815. APPROPRIATIONS; AVAILABILITY.</DELETED>
<DELETED> ``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.</DELETED>
<DELETED>``SEC. 816. AUTHORIZATION OF APPROPRIATIONS.</DELETED>
<DELETED> ``There is authorized to be appropriated such sums as may
be necessary for each fiscal year through fiscal year 2015 to carry out
this title.''.</DELETED>
<DELETED>TITLE II--CONFORMING AMENDMENTS TO THE SOCIAL SECURITY
ACT</DELETED>
<DELETED>Subtitle A--Medicare</DELETED>
<DELETED>SEC. 201. LIMITATIONS ON CHARGES.</DELETED>
<DELETED> Section 1866(a)(1) of the Social Security Act (42 U.S.C.
1395cc(a)(1)) is amended--</DELETED>
<DELETED> (1) in subparagraph (R), by striking ``and'' at
the end;</DELETED>
<DELETED> (2) in subparagraph (S), by striking the period
and inserting ``, and''; and</DELETED>
<DELETED> (3) by adding at the end the following:</DELETED>
<DELETED> ``(T) in the case of hospitals and critical access
hospitals which provide inpatient hospital services for which
payment may be made under this title, to accept as payment in
full for services that are covered under and furnished to an
individual eligible for the contract health services program
operated by the Indian Health Service, by an Indian tribe or
tribal organization, or furnished to an urban Indian eligible
for health services purchased by an urban Indian organization
(as those terms are defined in section 4 of the Indian Health
Care Improvement Act), in accordance with such admission
practices and such payment methodology and amounts as are
prescribed under regulations issued by the
Secretary.''.</DELETED>
<DELETED>SEC. 202. QUALIFIED INDIAN HEALTH PROGRAM.</DELETED>
<DELETED> Title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.) is amended by inserting after section 1880 the
following:</DELETED>
<DELETED>``qualified indian health program</DELETED>
<DELETED> ``Sec. 1880A. (a) Definition of Qualified Indian Health
Program.--In this section:</DELETED>
<DELETED> ``(1) In general.--The term `qualified Indian
health program' means a health program operated by--</DELETED>
<DELETED> ``(A) the Indian Health Service;</DELETED>
<DELETED> ``(B) an Indian tribe or tribal
organization or an urban Indian organization (as those
terms are defined in section 4 of the Indian Health
Care Improvement Act) and which is funded in whole or
part by the Indian Health Service under the Indian Self
Determination and Education Assistance Act;
or</DELETED>
<DELETED> ``(C) an urban Indian organization (as so
defined) and which is funded in whole or in part under
title V of the Indian Health Care Improvement
Act.</DELETED>
<DELETED> ``(2) Included programs and entities.--Such term
may include 1 or more hospital, nursing home, home health
program, clinic, ambulance service or other health program that
provides a service for which payments may be made under this
title and which is covered in the cost report submitted under
this title or title XIX for the qualified Indian health
program.</DELETED>
<DELETED> ``(b) Eligibility for Payments.--A qualified Indian health
program shall be eligible for payments under this title,
notwithstanding sections 1814(c) and 1835(d), if and for so long as the
program meets all the conditions and requirements set forth in this
section.</DELETED>
<DELETED> ``(c) Determination of Payments.--</DELETED>
<DELETED> ``(1) In general.--Notwithstanding any other
provision in the law, a qualified Indian health program shall
be entitled to receive payment based on an all-inclusive rate
which shall be calculated to provide full cost recovery for the
cost of furnishing services provided under this
section.</DELETED>
<DELETED> ``(2) Definition of full cost recovery.--
</DELETED>
<DELETED> ``(A) In general.--Subject to subparagraph
(B), in this section, the term `full cost recovery'
means the sum of--</DELETED>
<DELETED> ``(i) the direct costs, which are
reasonable, adequate and related to the cost of
furnishing such services, taking into account
the unique nature, location, and service
population of the qualified Indian health
program, and which shall include direct
program, administrative, and overhead costs,
without regard to the customary or other charge
or any fee schedule that would otherwise be
applicable; and</DELETED>
<DELETED> ``(ii) indirect costs which, in
the case of a qualified Indian health program--
</DELETED>
<DELETED> ``(I) for which an
indirect cost rate (as that term is
defined in section 4(g) of the Indian
Self-Determination and Education
Assistance Act) has been established,
shall be not less than an amount
determined on the basis of the indirect
cost rate; or</DELETED>
<DELETED> ``(II) for which no such
rate has been established, shall be not
less than the administrative costs
specifically associated with the
delivery of the services being
provided.</DELETED>
<DELETED> ``(B) Limitation.--Notwithstanding any
other provision of law, the amount determined to be
payable as full cost recovery may not be reduced for
co-insurance, co-payments, or deductibles when the
service was provided to an Indian entitled under
Federal law to receive the service from the Indian
Health Service, an Indian tribe or tribal organization,
or an urban Indian organization or because of any
limitations on payment provided for in any managed care
plan.</DELETED>
<DELETED> ``(3) Outstationing costs.--In addition to full
cost recovery, a qualified Indian health program shall be
entitled to reasonable outstationing costs, which shall include
all administrative costs associated with outreach and
acceptance of eligibility applications for any Federal or State
health program including the programs established under this
title, title XIX, and XXI.</DELETED>
<DELETED> ``(4) Determination of all-inclusive encounter or
per diem amount.--</DELETED>
<DELETED> ``(A) In general.--Costs identified for
services addressed in a cost report submitted by a
qualified Indian health program shall be used to
determine an all-inclusive encounter or per diem
payment amount for such services.</DELETED>
<DELETED> ``(B) No single report requirement.--Not
all qualified Indian health programs provided or
administered by the Indian Health Service, an Indian
tribe or tribal organization, or an urban Indian
organization need be combined into a single cost
report.</DELETED>
<DELETED> ``(C) Payment for items not covered by a
cost report.--A full cost recovery payment for services
not covered by a cost report shall be made on a fee-
for-service, encounter, or per diem basis.</DELETED>
<DELETED> ``(5) Optional determination.--The full cost
recovery rate provided for in paragraphs (1) through (3) may be
determined, at the election of the qualified Indian health
program, by the Health Care Financing Administration or by the
State agency responsible for administering the State plan under
title XIX and shall be valid for reimbursements made under this
title, title XIX, and title XXI. The costs described in
paragraph (2)(A) shall be calculated under whatever methodology
yields the greatest aggregate payment for the cost reporting
period, provided that such methodology shall be adjusted to
include adjustments to such payment to take into account for
those qualified Indian health programs that include hospitals--
</DELETED>
<DELETED> ``(A) a significant decrease in
discharges;</DELETED>
<DELETED> ``(B) costs for graduate medical education
programs;</DELETED>
<DELETED> ``(C) additional payment as a
disproportionate share hospital with a payment
adjustment factor of 10; and</DELETED>
<DELETED> ``(D) payment for outlier cases.</DELETED>
<DELETED> ``(6) Election of payment.--A qualified Indian
health program may elect to receive payment for services
provided under this section--</DELETED>
<DELETED> ``(A) on the full cost recovery basis
provided in paragraphs (1) through (5);</DELETED>
<DELETED> ``(B) on the basis of the inpatient or
outpatient encounter rates established for Indian
Health Service facilities and published annually in the
Federal Register;</DELETED>
<DELETED> ``(C) on the same basis as other providers
are reimbursed under this title, provided that the
amounts determined under paragraph (c)(2)(B) shall be
added to any such amount;</DELETED>
<DELETED> ``(D) on the basis of any other rate or
methodology applicable to the Indian Health Service or
an Indian tribe or tribal organization; or</DELETED>
<DELETED> ``(E) on the basis of any rate or
methodology negotiated with the agency responsible for
making payment.</DELETED>
<DELETED> ``(d) Election of Reimbursement for Other Services.--
</DELETED>
<DELETED> ``(1) In general.--A qualified Indian health
program may elect to be reimbursed for any service the Indian
Health Service, an Indian tribe or tribal organization, or an
urban Indian organization may be reimbursed for under section
1880 and section 1911.</DELETED>
<DELETED> ``(2) Option to include additional services.--An
election under paragraph (1) may include, at the election of
the qualified Indian health program--</DELETED>
<DELETED> ``(A) any service when furnished by an
employee of the qualified Indian health program who is
licensed or certified to perform such a service to the
same extent that such service would be reimbursable if
performed by a physician and any service or supplies
furnished as incident to a physician's service as would
otherwise be covered if furnished by a physician or as
an incident to a physician's service;</DELETED>
<DELETED> ``(B) screening, diagnostic, and
therapeutic outpatient services including part-time or
intermittent screening, diagnostic, and therapeutic
skilled nursing care and related medical supplies
(other than drugs and biologicals), furnished by an
employee of the qualified Indian health program who is
licensed or certified to perform such a service for an
individual in the individual's home or in a community
health setting under a written plan of treatment
established and periodically reviewed by a physician,
when furnished to an individual as an outpatient of a
qualified Indian health program;</DELETED>
<DELETED> ``(C) preventive primary health services
as described under section 330 of the Public Health
Service Act, when provided by an employee of the
qualified Indian health program who is licensed or
certified to perform such a service, regardless of the
location in which the service is provided;</DELETED>
<DELETED> ``(D) with respect to services for
children, all services specified as part of the State
plan under title XIX, the State child health plan under
title XXI, and early and periodic screening,
diagnostic, and treatment services as described in
section 1905(r);</DELETED>
<DELETED> ``(E) influenza and pneumococcal
immunizations;</DELETED>
<DELETED> ``(F) other immunizations for prevention
of communicable diseases when targeted; and</DELETED>
<DELETED> ``(G) the cost of transportation for
providers or patients necessary to facilitate access
for patients.''.</DELETED>
<DELETED>Subtitle B--Medicaid</DELETED>
<DELETED>SEC. 211. STATE CONSULTATION WITH INDIAN HEALTH
PROGRAMS.</DELETED>
<DELETED> Section 1902(a) of the Social Security Act (42 U.S.C.
1396a(a)) is amended--</DELETED>
<DELETED> (1) in paragraph (64), by striking ``and'' at the
end:</DELETED>
<DELETED> (2) in paragraph (65), by striking the period and
inserting ``; and''; and</DELETED>
<DELETED> (3) by inserting after paragraph (65), the
following:</DELETED>
<DELETED> ``(66) if the Indian Health Service operates or
funds health programs in the State or if there are Indian
tribes or tribal organizations or urban Indian organizations
(as those terms are defined in Section 4 of the Indian Health
Care Improvement Act) present in the State, provide for
meaningful consultation with such entities prior to the
submission of, and as a precondition of approval of, any
proposed amendment, waiver, demonstration project, or other
request that would have the effect of changing any aspect of
the State's administration of the State plan under this title,
so long as--</DELETED>
<DELETED> ``(A) the term `meaningful consultation'
is defined through the negotiated rulemaking process
provided for under section 802 of the Indian Health Care Improvement
Act; and</DELETED>
<DELETED> ``(B) such consultation is carried out in
collaboration with the Indian Medicaid Advisory
Committee established under section 415(a)(3) of that
Act.''.</DELETED>
<DELETED>SEC. 212. FMAP FOR SERVICES PROVIDED BY INDIAN HEALTH
PROGRAMS.</DELETED>
<DELETED> The third sentence of Section 1905(b) of the Social
Security Act (42 U.S.C. 1396d(b)) is amended to read as
follows:</DELETED>
<DELETED>``Notwithstanding the first sentence of this section, the
Federal medical assistance percentage shall be 100 per cent with
respect to amounts expended as medical assistance for services which
are received through the Indian Health Service, an Indian tribe or
tribal organization, or an urban Indian organization (as defined in
section 4 of the Indian Health Care Improvement Act) under section
1911, whether directly, by referral, or under contracts or other
arrangements between the Indian Health Service, Indian tribe or tribal
organization, or urban Indian organization and another health
provider.''.</DELETED>
<DELETED>SEC. 213. INDIAN HEALTH SERVICE PROGRAMS.</DELETED>
<DELETED> Section 1911 of the Social Security Act (42 U.S.C. 1396j)
is amended to read as follows:</DELETED>
<DELETED>``indian health service programs</DELETED>
<DELETED> ``Sec. 1911. (a) In General.--The Indian Health Service,
an Indian tribe or tribal organization, or an urban Indian 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 by such entities if and for so
long as the Service, Indian tribe or tribal organization, or urban
Indian organization provides services or provider types of a type
otherwise covered under the State plan and meets the conditions and
requirements which are applicable generally to the service for which it
seeks reimbursement under this title and for services provided by a
qualified Indian health program under section 1880A.</DELETED>
<DELETED> ``(b) Period for Billing.--Notwithstanding subsection (a),
if the Indian Health Service, an Indian tribe or tribal organization,
or an urban Indian organization which provides services of a type
otherwise covered under the State plan does not meet all of the
conditions and requirements of this title which are applicable
generally to such services submits to the Secretary within 6 months
after the date on which such reimbursement is first sought an
acceptable plan for achieving compliance with such conditions and
requirements, the Service, an Indian tribe or tribal organization, or
urban Indian organization shall be deemed to meet such conditions and
requirements (and to be eligible for reimbursement under this title),
without regard to the extent of actual compliance with such conditions
and requirements during the first 12 months after the month in which
such plan is submitted.</DELETED>
<DELETED> ``(c) Authority To Enter Into Agreements.--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 or tribal organizations, or urban
Indian organizations, 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.''.</DELETED>
<DELETED>Subtitle C--State Children's Health Insurance
Program</DELETED>
<DELETED>SEC. 221. ENHANCED FMAP FOR STATE CHILDREN'S HEALTH INSURANCE
PROGRAM.</DELETED>
<DELETED> (a) In General.--Section 2105(b) of the Social Security
Act (42 U.S.C. 1397ee(b)) is amended--</DELETED>
<DELETED> (1) by striking ``For purposes'' and inserting the
following:</DELETED>
<DELETED> ``(1) In general.--Subject to paragraph (2), for
purposes''; and</DELETED>
<DELETED> (2) by adding at the end the following:</DELETED>
<DELETED> ``(2) Services provided by indian programs.--
Without regard to which option a State chooses under section
2101(a), the `enhanced FMAP' for a State for a fiscal year
shall be 100 per cent with respect to expenditures for child
health assistance for services provided through a health
program operated by the Indian Health Service, an Indian tribe
or tribal organization, or an urban Indian organization (as
such terms are defined in section 4 of the Indian Health Care
Improvement Act).''.</DELETED>
<DELETED> (b) Conforming Amendment.--Section 2105(c)(6)(B) of such
Act (42 U.S.C. 1397ee(c)(6)(B)) is amended by inserting ``an Indian
tribe or tribal organization, or an urban Indian organization (as such
terms are defined in section 4 of the Indian Health Care Improvement
Act),'' after ``Service,''.</DELETED>
<DELETED>SEC. 222. DIRECT FUNDING OF STATE CHILDREN'S HEALTH INSURANCE
PROGRAM.</DELETED>
<DELETED> Title XXI of Social Security Act (42 U.S.C. 1397aa et
seq.) is amended by adding at the end the following:</DELETED>
<DELETED>``SEC. 2111. DIRECT FUNDING OF INDIAN HEALTH
PROGRAMS.</DELETED>
<DELETED> ``(a) In General.--The Secretary may enter into agreements
directly with the Indian Health Service, an Indian tribe or tribal
organization, or an urban Indian organization (as such terms are
defined in section 4 of the Indian Health Care Improvement Act) for
such entities to provide child health assistance to Indians who reside
in a service area on or near an Indian reservation. Such agreements may
provide for funding under a block grant or such other mechanism as is
agreed upon by the Secretary and the Indian Health Service, Indian
tribe or tribal organization, or urban Indian organization. Such
agreements may not be made contingent on the approval of the State in
which the Indians to be served reside.</DELETED>
<DELETED> ``(b) Transfer of Funds.--Notwithstanding any other
provision of law, a State may transfer funds to which it is, or would
otherwise be, entitled to under this title to the Indian Health
Service, an Indian tribe or tribal organization or an urban Indian
organization--</DELETED>
<DELETED> ``(1) to be administered by such entity to achieve
the purposes and objectives of this title under an agreement
between the State and the entity; or</DELETED>
<DELETED> ``(2) under an agreement entered into under
subsection (a) between the entity and the
Secretary.''.</DELETED>
<DELETED>Subtitle D--Authorization of Appropriations</DELETED>
<DELETED>SEC. 231. AUTHORIZATION OF APPROPRIATIONS.</DELETED>
<DELETED> There is authorized to be appropriated such sums as may be
necessary for each of fiscal years 2004 through 2015 to carry out this
title and the amendments by this title.</DELETED>
<DELETED>TITLE III--MISCELLANEOUS PROVISIONS</DELETED>
<DELETED>SEC. 301. REPEALS.</DELETED>
<DELETED> The following are repealed:</DELETED>
<DELETED> (1) Section 506 of Public Law 101-630 (25 U.S.C.
1653 note) is repealed.</DELETED>
<DELETED> (2) Section 712 of the Indian Health Care
Amendments of 1988 is repealed.</DELETED>
<DELETED>SEC. 302. SEVERABILITY PROVISIONS.</DELETED>
<DELETED> 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.</DELETED>
<DELETED>SEC. 303. EFFECTIVE DATE.</DELETED>
<DELETED> This Act and the amendments made by this Act take effect
on October 1, 2003.</DELETED>
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Indian Health Care Improvement Act
Amendments of 2004''.
SEC. 2. INDIAN HEALTH CARE IMPROVEMENT ACT AMENDED.
(a) In General.--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. 128. 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 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 or certification.
``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. Study on loans, loan guarantees, and loan
repayment.
``Sec. 310. Tribal leasing.
``Sec. 311. Indian Health Service/tribal facilities joint
venture program.
``Sec. 312. Location of facilities.
``Sec. 313. Maintenance and improvement of health care
facilities.
``Sec. 314. Tribal management of federally owned quarters.
``Sec. 315. Applicability of Buy American Act requirement.
``Sec. 316. Other funding for facilities.
``Sec. 317. Authorization of appropriations.
``TITLE IV--ACCESS TO HEALTH SERVICES
``Sec. 401. Treatment of payments under Social Security Act
health 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 feasibility study.
``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 property and supplies.
``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 the medicaid and State children's health
insurance programs.
``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 `Assistant Secretary' means the Assistant
Secretary of Indian Health.
``(4) The term `behavioral health' means the blending of
substance (alcohol, drugs, inhalants, and tobacco) abuse and
mental illness prevention and treatment, for the purpose of
providing comprehensive services. This definition can include
the joint development of substance abuse and mental illness
treatment planning and coordinated case management using a
multidisciplinary approach.
``(5) The term `California Indians' shall mean those
Indians who are eligible for health services of the Service
pursuant to section 806.
``(6) The term `community college' means--
``(A) a tribal college or university, or
``(B) a junior or community college.
``(7) 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.
``(8) The term `Department' means, unless otherwise
designated, the Department of Health and Human Services.
``(9) The term `disease prevention' means the reduction,
limitation, and prevention of disease and its complications and
reduction in the consequences of disease, including--
``(A) controlling--
``(i) 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.
``(10) 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, grants, memoranda of understanding,
contracts pursuant to section 23 of the Act of April 20, 1908
(25 U.S.C. 47; commonly known as the `Buy Indian Act'), or
otherwise. Any program administered as a grant program one day
before the date of enactment may continue to be administered as
a grant program. This definition does not otherwise modify
grant programs, except that upon request of the Indian Tribes
or Tribal Organizations, discretionary grants and all
categories of awarded nonrecurring funding shall be included in
the Funding Agreement. Discretionary grant funds shall be
governed by all the particular terms and conditions attached to
such funds, unless waived by the Secretary. All particular
terms and conditions attached to the discretionary grant funds
must be shown in the Funding Agreement. The use of such grant
funds shall be governed by the terms and conditions set forth
in the Funding Agreement and not the substantive provisions of
the Indian Self-Determination and Education Assistance Act (25
U.S.C. 450 et seq.).
``(11) 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 (25 U.S.C. 450
et seq.).
``(12) The term `health profession' means allopathic
medicine, family medicine, internal medicine, pediatrics,
geriatric medicine, obstetrics and gynecology, podiatric
medicine, nursing, public health nursing, advanced practice
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.
``(13) 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) behavioral health;
``(xiv) monitoring of disease indicators
between health care provider visits, through
appropriate means, including Internet-based
health care management systems;
``(xv) personal health and wellness
practices;
``(xvi) personal capacity building;
``(xvii) prenatal, pregnancy, and infant
care;
``(xviii) psychological well-being;
``(xix) reproductive health and family
planning;
``(xx) safe and adequate water;
``(xxi) safe housing relative to
eliminating, reducing, or preventing
contaminants which create unhealthy housing
conditions;
``(xxii) safe work environments;
``(xxiii) stress control;
``(xxiv) substance abuse;
``(xxv) sanitary facilities;
``(xxvi) sudden infant death syndrome
prevention;
``(xxvii) tobacco use cessation and
reduction;
``(xxviii) violence prevention; and
``(xxix) such other activities identified
by the Service, a Tribal Health Program, or an
Urban Indian Organization, to promote
achievement of any of the objectives described
in section 3(2).
``(14) The term `Indian' has the meaning given the term in
the Indian Self-Determination and Education Assistance Act (25
U.S.C. 450 et seq.).
``(15) The term `Indian Health Program' means--
``(A) any health program administered directly by
the Service;
``(B) any Tribal Health Program; or
``(C) any Indian Tribe or Tribal Organization to
which the Secretary provides funding pursuant to
section 23 of the Act of April 30, 1908 (25 U.S.C. 47),
commonly known as the `Buy Indian Act'.
``(16) The term `Indian Tribe' has the meaning given the
term in the Indian Self-Determination and Education Assistance
Act (25 U.S.C. 450 et seq.).
``(17) The term `junior or community college' has the
meaning given the term by section 312(e) of the Higher
Education Act of 1965 (20 U.S.C. 1058(e)).
``(18) 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.).
``(19) The term `Secretary', unless otherwise designated,
means the Secretary of Health and Human Services.
``(20) The term `Service' means the Indian Health Service.
``(21) The term `Service Area' means the geographical area
served by each Area Office.
``(22) 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.
``(23) The term `telehealth' has the meaning given the term
in section 330K(a) of the Public Health Service Act (42 U.S.C.
254c-16(a)).
``(24) The term `telemedicine' means a telecommunications
link to an end user through the use of eligible equipment that
electronically links health professionals or patients and
health professionals at separate sites in order to exchange
health care information in audio, video, graphic, or other
format for the purpose of providing improved health care
services.
``(25) 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.
``(26) The term `tribal college or university' has the
meaning given the term in section 316(b)(3) of the Higher
Education Act (20 U.S.C. 1059c(b)(3)).
``(27) 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 U.S.C. 450 et seq.).
``(28) The term `Tribal Organization' has the meaning given
the term in the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.).
``(29) The term `Urban Center' means any community which
has a sufficient Urban Indian population with unmet health
needs to warrant assistance under title V of this Act, as
determined by the Secretary.
``(30) 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.
``(31) 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 or
educational entities, Tribal Health Programs, or Urban Indian
Organizations to assist such entities in meeting the costs of--
``(1) identifying Indians with a potential for education or
training in the health professions and encouraging and
assisting them--
``(A) to enroll in courses of study in such health
professions; or
``(B) if they are not qualified to enroll in any
such courses of study, to undertake such postsecondary
education or training as may be required to qualify
them for enrollment;
``(2) publicizing existing sources of financial aid
available to Indians enrolled in any course of study referred
to in paragraph (1) or who are undertaking training necessary
to qualify them to enroll in any such course of study; or
``(3) establishing other programs which the Secretary
determines will enhance and facilitate the enrollment of
Indians in, and the subsequent pursuit and completion by them
of, courses of study referred to in paragraph (1).
``(b) 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 issued 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. 254l), 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 2004) 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 Assistant
Secretary 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 of this
Act.
``(C) In the private practice of the applicable
profession if, as determined by the Secretary, in
accordance with guidelines promulgated by the
Secretary, such practice is situated in a physician or
other health professional shortage area and addresses
the health care needs of a substantial number of
Indians.
``(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--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 2004 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 of this Act; or
``(3) in the private practice of psychology if, as
determined by the Secretary, in accordance with guidelines
promulgated by the Secretary, such practice is situated in a
physician or other health professional shortage area and
addresses the health care needs of a substantial number of
Indians.
``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 providing scholarships for Indians
to serve as health professionals in Indian communities.
``(2) Amount.--Amounts available under paragraph (1) for
any fiscal year shall not exceed 5 percent of the amounts
available for each fiscal year for Indian Health Scholarships
under section 104.
``(3) Application.--An application for 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 section 104 or 106 shall be given preference
for employment in the Service, or may be employed by a Tribal Health
Program or an Urban Indian Organization, or other agencies of the
Department as available, during any nonacademic period of the year.
``(b) Not Counted Toward Active Duty Service Obligation.--Periods
of employment pursuant to this subsection shall not be counted in
determining fulfillment of the service obligation incurred as a
condition of the scholarship.
``(c) Timing; Length of Employment.--Any individual enrolled in a
program, including a high school program, authorized under section
102(a) may be employed by the Service or by a Tribal Health Program or
an Urban Indian Organization during any nonacademic period of the year.
Any such employment shall not exceed 120 days during any calendar year.
``(d) Nonapplicability of Competitive Personnel System.--Any
employment pursuant to this section shall be made without regard to any
competitive personnel system or agency personnel limitation and to a
position which will enable the individual so employed to receive
practical experience in the health profession in which he or she is
engaged in study. Any individual so employed shall receive payment for
his or her services comparable to the salary he or she would receive if
he or she were employed in the competitive system. Any individual so
employed shall not be counted against any employment ceiling affecting
the Service or the Department.
``SEC. 108. CONTINUING EDUCATION ALLOWANCES.
``In order to encourage 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, 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) (commonly known as the `Snyder Act'), the
Secretary, acting through the Service, shall maintain a Community
Health Representative Program under which Indian Health Programs--
``(1) provide for the training of Indians as community
health representatives; and
``(2) use such community health representatives in the
provision of health care, health promotion, and disease
prevention services to Indian communities.
``(b) Duties.--The Community Health Representative Program of the
Service, shall--
``(1) provide a high standard of training for community
health representatives to ensure that the community health
representatives provide quality health care, health promotion,
and disease prevention services to the Indian communities
served by the Program;
``(2) in order to provide such training, develop and
maintain a curriculum that--
``(A) combines education in the theory of health
care with supervised practical experience in the
provision of health care; and
``(B) provides instruction and practical experience
in health promotion and disease prevention activities,
with appropriate consideration given to lifestyle
factors that have an impact on Indian health status,
such as alcoholism, family dysfunction, and poverty;
``(3) maintain a system which identifies the needs of
community health representatives for continuing education in
health care, health promotion, and disease prevention, and
develop programs that meet the needs for continuing education;
``(4) maintain a system that provides close supervision of
Community Health Representatives;
``(5) maintain a system under which the work of Community
Health Representatives is reviewed and evaluated; and
``(6) promote Traditional Health Care Practices of the
Indian Tribes served consistent with the Service standards for
the provision of health care, health promotion, and disease
prevention.
``SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT PROGRAM.
``(a) Establishment.--The Secretary, acting through the Service,
shall establish and administer a program to be known as the Service
Loan Repayment Program (hereinafter referred to as the `Loan Repayment
Program') in order to ensure an adequate supply of trained health
professionals necessary to maintain accreditation of, and provide
health care services to Indians through, Indian Health Programs and
Urban Indian Organizations.
``(b) Eligible Individuals.--To be eligible to participate in the
Loan Repayment Program, an individual must--
``(1)(A) be enrolled--
``(i) in a course of study or program in an
accredited educational institution (as determined by
the Secretary under section 338B(b)(1)(c)(i) of the
Public Health Service Act (42 U.S.C. 254l-
1(b)(1)(c)(i))) and be scheduled to complete such
course of study in the same year such individual
applies to participate in such program; or
``(ii) in an approved graduate training program in
a health profession; or
``(B) have--
``(i) a degree in a health profession; and
``(ii) a license to practice a health profession;
``(2)(A) be eligible for, or hold, an appointment as a
commissioned officer in the Regular or Reserve Corps of the
Public Health Service;
``(B) be eligible for selection for civilian service in the
Regular or Reserve Corps of the Public Health Service;
``(C) meet the professional standards for civil service
employment in the Service; or
``(D) be employed in an Indian Health Program or Urban
Indian Organization without a service obligation; and
``(3) submit to the Secretary an application for a contract
described in subsection (e).
``(c) Application.--
``(1) Information to be included with forms.--In
disseminating application forms and contract forms to
individuals desiring to participate in the Loan Repayment
Program, the Secretary shall include with such forms a fair
summary of the rights and liabilities of an individual whose
application is approved (and whose contract is accepted) by the
Secretary, including in the summary a clear explanation of the
damages to which the United States is entitled under subsection
(l) in the case of the individual's breach of contract. The
Secretary shall provide such individuals with sufficient
information regarding the advantages and disadvantages of
service as a commissioned officer in the Regular or Reserve
Corps of the Public Health Service or a civilian employee of
the Service to enable the individual to make a decision on an
informed basis.
``(2) Clear language.--The application form, contract form,
and all other information furnished by the Secretary under this
section shall be written in a manner calculated to be
understood by the average individual applying to participate in
the Loan Repayment Program.
``(3) Timely availability of forms.--The Secretary shall
make such application forms, contract forms, and other
information available to individuals desiring to participate in
the Loan Repayment Program on a date sufficiently early to
ensure that such individuals have adequate time to carefully
review and evaluate such forms and information.
``(d) Priorities.--
``(1) List.--Consistent with subsection (k), the Secretary
shall annually--
``(A) identify the positions in each Indian Health
Program or Urban Indian Organization for which there is
a need or a vacancy; and
``(B) rank those positions in order of priority.
``(2) Approvals.--Notwithstanding the priority determined
under paragraph (1), the Secretary, in determining which
applications under the Loan Repayment Program to approve (and
which contracts to accept), shall--
``(A) give first priority to applications made by
individual Indians; and
``(B) after making determinations on all
applications submitted by individual Indians as
required under subparagraph (A), give priority to--
``(i) individuals recruited through the
efforts of an Indian Health Program or Urban
Indian Organization; and
``(ii) other individuals based on the
priority rankings under paragraph (1).
``(e) Recipient Contracts.--
``(1) Contract required.--An individual becomes a
participant in the Loan Repayment Program only upon the
Secretary and the individual entering into a written contract
described in paragraph (2).
``(2) Contents of contract.--The written contract referred
to in this section between the Secretary and an individual
shall contain--
``(A) an agreement under which--
``(i) subject to subparagraph (C), the
Secretary agrees--
``(I) to pay loans on behalf of the
individual in accordance with the
provisions of this section; and
``(II) to accept (subject to the
availability of appropriated funds for
carrying out this section) the
individual into the Service or place
the individual with a Tribal Health
Program or Urban Indian Organization as
provided in clause (ii)(III); and
``(ii) subject to subparagraph (C), the
individual agrees--
``(I) to accept loan payments on
behalf of the individual;
``(II) in the case of an individual
described in subsection (b)(1)--
``(aa) to maintain
enrollment in a course of study
or training described in
subsection (b)(1)(A) until the
individual completes the course
of study or training; and
``(bb) while enrolled in
such course of study or
training, to maintain an
acceptable level of academic
standing (as determined under
regulations of the Secretary by
the educational institution
offering such course of study
or training); and
``(III) to serve for a time period
(hereinafter in this section referred
to as the `period of obligated
service') equal to 2 years or such
longer period as the individual may
agree to serve in the full-time
clinical practice of such individual's
profession in an Indian Health Program
or Urban Indian Organization to which
the individual may be assigned by the
Secretary;
``(B) a provision permitting the Secretary to
extend for such longer additional periods, as the
individual may agree to, the period of obligated
service agreed to by the individual under subparagraph
(A)(ii)(III);
``(C) a provision that any financial obligation of
the United States arising out of a contract entered
into under this section and any obligation of the
individual which is conditioned thereon is contingent
upon funds being appropriated for loan repayments under
this section;
``(D) a statement of the damages to which the
United States is entitled under subsection (l) for the
individual's breach of the contract; and
``(E) such other statements of the rights and
liabilities of the Secretary and of the individual, not
inconsistent with this section.
``(f) Deadline for Decision on Application.--The Secretary shall
provide written notice to an individual within 21 days on--
``(1) the Secretary's approving, under subsection (e)(1),
of the individual's participation in the Loan Repayment
Program, including extensions resulting in an aggregate period
of obligated service in excess of 4 years; or
``(2) the Secretary's disapproving an individual's
participation in such Program.
``(g) Payments.--
``(1) In general.--A loan repayment provided for an
individual under a written contract under the Loan Repayment
Program shall consist of payment, in accordance with paragraph
(2), on behalf of the individual of the principal, interest,
and related expenses on government and commercial loans
received by the individual regarding the undergraduate or
graduate education of the individual (or both), which loans
were made for--
``(A) tuition expenses;
``(B) all other reasonable educational expenses,
including fees, books, and laboratory expenses,
incurred by the individual; and
``(C) reasonable living expenses as determined by
the Secretary.
``(2) Amount.--For each year of obligated service that an
individual contracts to serve under subsection (e), the
Secretary may pay up to $35,000 or an amount equal to the
amount specified in section 338B(g)(2)(A) of the Public Health
Service Act, whichever is more, on behalf of the individual for
loans described in paragraph (1). In making a determination of
the amount to pay for a year of such service by an individual,
the Secretary shall consider the extent to which each such
determination--
``(A) affects the ability of the Secretary to
maximize the number of contracts that can be provided
under the Loan Repayment Program from the amounts
appropriated for such contracts;
``(B) provides an incentive to serve in Indian
Health Programs and Urban Indian Organizations with the
greatest shortages of health professionals; and
``(C) provides an incentive with respect to the
health professional involved remaining in an Indian
Health Program or Urban Indian Organization with such a
health professional shortage, and continuing to provide
primary health services, after the completion of the
period of obligated service under the Loan Repayment
Program.
``(3) Timing.--Any arrangement made by the Secretary for
the making of loan repayments in accordance with this
subsection shall provide that any repayments for a year of
obligated service shall be made no later than the end of the
fiscal year in which the individual completes such year of
service.
``(4) For the purpose of providing reimbursements for tax
liability resulting from payments under paragraph (2) on behalf
of an individual, the Secretary--
``(A) in addition to such payments, may make
payments to the individual in an amount not less than
20 percent and not more than 39 percent of the total
amount of loan repayments made for the taxable year
involved; and
``(B) may make such additional payments as the
Secretary determines to be appropriate with respect to
such purpose.
``(5) Payment schedule.--The Secretary may enter into an
agreement with the holder of any loan for which payments are
made under the Loan Repayment Program to establish a schedule
for the making of such payments.
``(h) Employment Ceiling.--Notwithstanding any other provision of
law, individuals who have entered into written contracts with the
Secretary under this section shall not be counted against any
employment ceiling affecting the Department while those individuals are
undergoing academic training.
``(i) Recruitment.--The Secretary shall conduct recruiting programs
for the Loan Repayment Program and other Service manpower programs 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 based on yields on appropriate marketable
Treasury securities;
``(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
sections 104 and 106 with respect to each health profession.
``(6) The amount of scholarship grants provided under
section 104 and 106, in total and by health profession.
``(7) The number of providers of health care that will be
needed by Indian Health Programs and Urban Indian
Organizations, by location and profession, during the 3 fiscal
years beginning after the date the report is filed.
``(8) The measures the Secretary plans to take to fill the
health professional positions maintained by Indian Health
Programs or Urban Indian Organizations for which recruitment or
retention is difficult.
``SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOVERY FUND.
``(a) Establishment.--There is established in the Treasury of the
United States a fund to be known as the Indian Health Scholarship and
Loan Repayment Recovery Fund (hereafter in this section referred to as
the `LRRF'). The LRRF shall consist of such amounts as may be collected
from individuals under section 104(d), section 106(e), and section
110(l) for breach of contract, such funds as may be appropriated to the
LRRF, and interest earned on amounts in the LRRF. All amounts
collected, appropriated, or earned relative to the LRRF shall remain
available until expended.
``(b) Use of Funds.--
``(1) By secretary.--Amounts in the LRRF may be expended by
the Secretary, acting through the Service, to make payments to
an Indian Health Program--
``(A) to which a scholarship recipient under
section 104 and 106 or a loan repayment program
participant under section 110 has been assigned to meet
the obligated service requirements pursuant to such
sections; and
``(B) that has a need for a health professional to
provide health care services as a result of such
recipient or participant having breached the contract
entered into under section 104, 106, or section 110.
``(2) By tribal health programs.--A Tribal Health Program
receiving payments pursuant to paragraph (1) may expend the
payments to provide scholarships or recruit and employ,
directly or by contract, health professionals to provide health
care services.
``(c) Investment of Funds.--The Secretary of the Treasury shall
invest such amounts of the LRRF, except for the appropriated funds, as
the Secretary 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 2004,
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 and
Education Assistance 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 or certification 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) (commonly known as the `Snyder
Act'), the Secretary, acting through the Service, shall develop and
operate a Community Health Aide Program in Alaska under which the
Service--
``(1) provides for the training of Alaska Natives as health
aides or community health practitioners;
``(2) uses such aides or practitioners in the provision of
health care, health promotion, and disease prevention services
to Alaska Natives living in villages in rural Alaska; and
``(3) provides for the establishment of teleconferencing
capacity in health clinics located in or near such villages for
use by community health aides or community health
practitioners.
``(b) Specific Program Requirements.--The Secretary, acting through
the Community Health Aide Program of the Service, shall--
``(1) using trainers accredited by the Program, provide a
high standard of training to community health aides and
community health practitioners to ensure that such aides and
practitioners provide quality health care, health promotion,
and disease prevention services to the villages served by the
Program;
``(2) in order to provide such training, develop a
curriculum that--
``(A) combines education in the theory of health
care with supervised practical experience in the
provision of health care;
``(B) provides instruction and practical experience
in the provision of acute care, emergency care, health
promotion, disease prevention, and the efficient and
effective management of clinic pharmacies, supplies,
equipment, and facilities; and
``(C) promotes the achievement of the health status
objectives specified in section 3(2);
``(3) establish and maintain a Community Health Aide
Certification Board to certify as community health aides or
community health practitioners individuals who have
successfully completed the training described in paragraph (1)
or can demonstrate equivalent experience;
``(4) develop and maintain a system which identifies the
needs of community health aides and community health
practitioners for continuing education in the provision of
health care, including the areas described in paragraph (2)(B),
and develop programs that meet the needs for such continuing
education;
``(5) develop and maintain a system that provides close
supervision of community health aides and community health
practitioners; 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 promulgate regulations to
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 2004, the Secretary, after consultation
with Indian Tribes and administrators of tribal colleges and
universities and eligible accredited and accessible community colleges,
shall develop and issue criteria for the review and approval of
applications for funding (including applications for renewals of
funding) under this section. Such criteria shall ensure that
demonstration programs established under this section promote the
development of the capacity of such entities to educate substance abuse
counselors.
``(e) Assistance.--The Secretary shall provide such technical and
other assistance as may be necessary to enable grant recipients to
comply with the provisions of this section.
``(f) Report.--Each fiscal year, the Secretary shall submit to the
President, for inclusion in the report which is required to be
submitted under section 801 for that fiscal year, a report on the
findings and conclusions derived from the demonstration programs
conducted under this section during that fiscal year.
``(g) Definition.--For the purposes of this section, the term
`educational curriculum' means 1 or more of the following:
``(1) Classroom education.
``(2) Clinical work experience.
``(3) Continuing education workshops.
``SEC. 127. BEHAVIORAL HEALTH TRAINING AND COMMUNITY EDUCATION
PROGRAMS.
``(a) Study; List.--The Secretary, acting through the Service, and
the Secretary of the Interior, in consultation with Indian Tribes and
Tribal Organizations, shall conduct a study and compile a list of the
types of staff positions specified in subsection (b) whose
qualifications include, or should include, training in the
identification, prevention, education, referral, or treatment of mental
illness, or dysfunctional and self destructive behavior.
``(b) Positions.--The positions referred to in subsection (a) are--
``(1) staff positions within the Bureau of Indian Affairs,
including existing positions, in the fields of--
``(A) elementary and secondary education;
``(B) social services and family and child welfare;
``(C) law enforcement and judicial services; and
``(D) alcohol and substance abuse;
``(2) staff positions within the Service; and
``(3) staff positions similar to those identified in
paragraphs (1) and (2) established and maintained by Indian
Tribes, 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, Tribal
Organization, or Urban Indian Organization, or assist the Indian Tribe,
Tribal Organization, or Urban Indian Organization to develop and
implement, a program of community education on mental illness. In
carrying out this subsection, the Service shall, upon request of an
Indian Tribe, Tribal Organization, or Urban Indian Organization,
provide technical assistance to the Indian Tribe, Tribal Organization,
or Urban Indian Organization to obtain and develop community
educational materials on the identification, prevention, referral, and
treatment of mental illness and dysfunctional and self-destructive
behavior.
``(e) Plan.--Not later than 90 days after the date of the enactment
of the Indian Health Care Improvement Act Amendments of 2004, the
Secretary shall develop a plan under which the Service will increase
the health care staff providing behavioral health services by at least
500 positions within 5 years after the date of 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) (commonly known as the `Snyder Act').
``SEC. 128. 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, including the use of telehealth and
telemedicine when appropriate;
``(4) eliminating inequities in funding for both direct
care and contract health service programs; and
``(5) augmenting the ability of the Service to meet the
following health service responsibilities with respect to those
Indian Tribes with the highest levels of health status
deficiencies and resource deficiencies:
``(A) Clinical care, including, 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) (commonly known as the `Snyder Act'),
or any other provision of law.
``(c) Allocation; Use.--
``(1) In general.--Funds appropriated under the authority
of this section shall be allocated to Service Units, Indian
Tribes, or Tribal Organizations. The funds allocated to each
Indian Tribe, Tribal Organization, or Service Unit under this
paragraph shall be used by the Indian Tribe, Tribal
Organization, or Service Unit under this paragraph to improve
the health status and reduce the resource deficiency of each
Indian Tribe served by such Service Unit, Indian Tribe, or
Tribal Organization.
``(2) Apportionment of allocated funds.--The apportionment
of funds allocated to a Service Unit, Indian Tribe, or Tribal
Organization under paragraph (1) among the health service
responsibilities described in subsection (a)(5) shall be
determined by the Service in consultation with, and with the
active participation of, the affected Indian Tribes and Tribal
Organizations.
``(d) Provisions Relating to Health Status and Resource
Deficiencies.--For the purposes of this section, the following
definitions apply:
``(1) Definition.--The term `health status and resource
deficiency' means the extent to which--
``(A) the health status objectives set forth in
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 2004, 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 and Education Assistance 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;
``(3) establish a procedure for the reimbursement of the
portion of the costs that exceeds such threshold cost incurred
by--
``(A) Service Units; or
``(B) whenever otherwise authorized by the Service,
non-Service facilities or providers;
``(4) establish a procedure for payment from CHEF in cases
in which the exigencies of the medical circumstances warrant
treatment prior to the authorization of such treatment by the
Service; and
``(5) establish a procedure that will ensure that no
payment shall be made from CHEF to any provider of treatment to
the extent that such provider is eligible to receive payment
for the treatment from any other Federal, State, local, or
private source of reimbursement for which the patient is
eligible.
``(e) No Offset or Limitation.--Amounts appropriated to CHEF under
this section shall not be used to offset or limit appropriations made
to the Service under the authority of the Act of November 2, 1921 (25
U.S.C. 13) (commonly known as the `Snyder Act'), or any other law.
``(f) Deposit of Reimbursement Funds.--There shall be deposited
into CHEF all reimbursements to which the Service is entitled from any
Federal, State, local, or private source (including third party
insurance) by reason of treatment rendered to any victim of a disaster
or catastrophic illness the cost of which was paid from CHEF.
``SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION SERVICES.
``(a) Findings.--Congress finds that health promotion and disease
prevention activities--
``(1) improve the health and well-being of Indians; and
``(2) reduce the expenses for health care of Indians.
``(b) Provision of Services.--The Secretary, acting through the
Service and Tribal Health Programs, shall provide health promotion and
disease prevention services to Indians to achieve the health status
objectives set forth in section 3(2).
``(c) Evaluation.--The Secretary, after obtaining input from the
affected Tribal Health Programs, shall submit to the President for
inclusion in 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 and
effective ongoing monitoring of disease indicators) each
Service Unit should take to reduce the incidence of, and
prevent, treat, and control the complications resulting from,
diabetes among Indian Tribes within that Service Unit.
``(b) Diabetes Screening.--To the extent medically indicated and
with informed consent, the Secretary shall screen each Indian who
receives services from the Service for diabetes and for conditions
which indicate a high risk that the individual will become diabetic
and, in consultation with Indian Tribes, Urban Indian Organizations,
and appropriate health care providers, establish a cost-effective
approach to ensure ongoing monitoring of disease indicators. Such
screening and monitoring may be conducted by a Tribal Health Program
and may be conducted through appropriate Internet-based health care
management programs.
``(c) 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 Care Improvement Amendments Act of 2004, any such
other diabetes programs operated by the Service or Tribal Health
Programs, and any additional diabetes projects, such as the Medical
Vanguard program provided for in title IV of Public Law 108-87, as
implemented to serve Indian Tribes. Tribal Health Programs shall
receive recurring funding for the diabetes projects that they operate
pursuant to this section, both at the date of enactment of the Indian
Health Care Improvement Act Amendments of 2004 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 are
disseminated to all other Area Offices, subject to applicable
patient privacy laws.
``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. 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 (where no other
means of transportation is available), specially equipped
vehicle, and ambulance; and
``(3) transportation by such other means as may be
available and required when air or motor vehicle transportation
is not available.
``SEC. 209. EPIDEMIOLOGY CENTERS.
``(a) 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 2004, 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 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 behavioral health wellness programs.
``(8) Developing chronic disease prevention programs.
``(9) Developing substance abuse prevention programs.
``(10) Developing injury prevention and safety education
programs.
``(11) Developing activities for the prevention and control
of communicable diseases.
``(12) Developing community and environmental health
education programs that include traditional health care
practitioners.
``(13) Violence prevention.
``(14) Such other health issues as are appropriate.
``(c) Technical Assistance.--Upon request, the Secretary, acting
through the Service, shall provide technical assistance to Indian
Tribes, 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--
``(A) school programs on nutrition education,
personal health, oral health, and fitness;
``(B) behavioral health wellness programs;
``(C) chronic disease prevention programs;
``(D) substance abuse prevention programs;
``(E) injury prevention and safety education
programs; and
``(F) activities for the prevention and control of
communicable diseases.
``(3) Duties of the secretary.--The Secretary of the
Interior shall--
``(A) provide training to teachers in comprehensive
school health education 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 Organizations,
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,
Tribal Organizations, and Urban Indian Organizations for the following:
``(1) Projects for the prevention, control, and elimination
of communicable and infectious diseases including, but not
limited to, tuberculosis, hepatitis, human immunodeficiency
virus, respiratory syncytial virus, hanta virus, sexually
transmitted diseases, and Helicobacter Pylori Infections.
``(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, Tribal
Organizations, and Urban Indian 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, Tribal
Organization, or Urban Indian 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;
``(2) assisted living;
``(3) long-term health care;
``(4) home- and community-based services;
``(5) public health functions; and
``(6) 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 2004 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 2004. 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 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 OR CERTIFICATION.
``Health care professionals employed by a Tribal Health Program
shall, if licensed or certified in any State, be exempt from the
licensing or certification 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) (commonly known as the `Snyder Act'), the Secretary, acting
through the Service, shall--
``(1) consult with any Indian Tribe that would be
significantly affected by such expenditure for the purpose of
determining and, whenever practicable, honoring tribal
preferences concerning size, location, type, and other
characteristics of any facility on which such expenditure is to
be made; and
``(2) ensure, whenever practicable and applicable, that
such facility meets the construction standards of any
accrediting body recognized by the Secretary for the purposes
of the medicare, medicaid, and SCHIP programs under titles
XVIII, XIX, and XXI of the Social Security Act by not later
than 1 year after the date on which the construction or
renovation of such facility is completed.
``(b) Closures.--
``(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--
``(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; and
``(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
2004 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 2005
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 10 top-priority inpatient health
care facilities;
``(ii) the 10 top-priority outpatient
health care facilities;
``(iii) the 10 top-priority specialized
health care facilities (such as long-term care
and alcohol and drug abuse treatment);
``(iv) the 10 top-priority staff quarters
developments associated with health care
facilities; and
``(v) the 10 top-priority patient 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, Tribal Organizations, and Urban Indian
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 (25 U.S.C. 450
et seq.) 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 Government
Accountability 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
Government Accountability Office shall submit the report to the
appropriate authorizing and appropriations committees of
Congress and to the Secretary.
``(2) Beginning in the year 2006, the Secretary shall
update the report required under paragraph (1) every 5 years.
``(3) The Comptroller General and the Secretary shall
consult with Indian Tribes, Tribal Organizations, and Urban
Indian Organizations. The Secretary shall submit the reports
required by paragraphs (1) and (2), to the President for
inclusion in the report required to be transmitted to 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) (commonly known as the `Snyder Act'),
for the planning, design, construction, or renovation of health
facilities for the benefit of 1 or more Indian Tribes shall be subject
to the provisions of the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.).
``(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, is authorized to provide the following:
``(1) Financial and technical assistance to Indian Tribes,
Tribal Organizations, and Indian communities in the
establishment, training, and equipping of utility organizations
to operate and maintain sanitation facilities, including the
provision of existing plans, standard details, and
specifications available in the Department, to be used at the
option of the Indian Tribe, Tribal Organization, or Indian
community.
``(2) Ongoing technical assistance and training to Indian
Tribes, Tribal Organizations, and Indian communities in the
management of utility organizations which operate and maintain
sanitation facilities.
``(3) Priority funding for operation and maintenance
assistance for, and emergency repairs to, sanitation facilities
operated by an Indian Tribe, Tribal Organization or Indian
community when necessary to avoid an imminent health threat or
to protect the investment in sanitation facilities and the
investment in the health benefits gained through the provision
of sanitation facilities.
``(c) Funding.--Notwithstanding any other provision of law--
``(1) the Secretary of Housing and Urban Development is
authorized to transfer funds appropriated under the Native
American Housing Assistance and Self-Determination Act of 1996
to the Secretary of Health and Human Services;
``(2) the Secretary of Health and Human Services is
authorized to accept and use such funds for the purpose of
providing sanitation facilities and services for Indians under
section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a);
``(3) unless specifically authorized when funds are
appropriated, the Secretary shall not use funds appropriated
under section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a),
to provide sanitation facilities to new homes constructed using
funds provided by the Department of Housing and Urban
Development;
``(4) the Secretary of Health and Human Services is
authorized to accept from any source, including Federal and
State agencies, funds for the purpose of providing sanitation
facilities and services and place these funds into Funding
Agreements;
``(5) except as otherwise prohibited by this section, the
Secretary may use funds appropriated under the authority of
section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a) to
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) except as otherwise prohibited by this section, the
Secretary may use funds appropriated under the authority of
section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a) to
meet matching or cost participation requirements under other
Federal and non-Federal programs for new projects to construct
eligible sanitation facilities;
``(7) all Federal agencies are authorized to transfer to
the Secretary funds identified, granted, loaned, or
appropriated whereby the Department's applicable policies,
rules, and regulations shall apply in the implementation of
such projects;
``(8) the Secretary of Health and Human Services shall
enter into interagency agreements with Federal and State
agencies for the purpose of providing financial assistance for
sanitation facilities and services under this Act; 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) Certain Capabilities Not Prerequisite.--The financial and
technical capability of an Indian Tribe, Tribal Organization, or Indian
community to safely operate, manage, and maintain a sanitation facility
shall not be a prerequisite to the provision or construction of
sanitation facilities by the Secretary.
``(e) Financial Assistance.--The Secretary is authorized to provide
financial assistance to Indian Tribes, Tribal Organizations, and Indian
communities for operation, management, and maintenance of their
sanitation facilities.
``(f) Operation, Management, and Maintenance of Facilities.--The
Indian Tribe, Tribal Organization, 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.
``(g) ISDEAA Program Funded on Equal Basis.--Tribal Health Programs
shall be eligible (on an equal basis with programs that are
administered directly by the Service) for--
``(1) any funds appropriated pursuant to this section; and
``(2) any funds appropriated for the purpose of providing
sanitation facilities.
``(h) Report.--
``(1) Required; contents.--The Secretary, in consultation
with the Secretary of Housing and Urban Development, Indian
Tribes, Tribal Organizations, and tribally designated housing
entities (as defined in section 4 of the Native American
Housing Assistance and Self-Determination Act of 1996 (25
U.S.C. 4103)) shall submit to the President, for inclusion in
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 and needs;
``(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;
``(D) the amount and most effective use of funds,
derived from whatever source, necessary to accommodate
the sanitation facilities needs of new homes assisted
with funds under the Native American Housing Assistance
and Self-Determination Act, and 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); and
``(E) a 10-year plan to provide sanitation
facilities to serve existing Indian homes and Indian
communities and new and renovated Indian homes.
``(2) Criteria.--The criteria on which the deficiencies and
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 subchapter IV of chapter 31 of title 40, United States
Code (commonly 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) Additional Requirement for Expansion.--In addition to the
requirements in subsection (c), for any expansions, the Indian Tribe or
Tribal Organization shall provide to the Secretary additional
information developed through negotiated rulemaking under section 802,
including additional staffing, equipment, and other costs associated
with the expansion.
``(e) Closure or Conversion of Facilities.--If any Service facility
which has been expanded, renovated, or modernized by an Indian Tribe or
Tribal Organization under this section ceases to be used as a Service
facility during the 20-year period beginning on the date such
expansion, renovation, or modernization is completed, such Indian Tribe
or Tribal Organization shall be entitled to recover from the United
States an amount which bears the same ratio to the value of such
facility at the time of such cessation as the value of such expansion,
renovation, or modernization (less the total amount of any funds
provided specifically for such facility under any Federal program that
were expended for such expansion, renovation, or modernization) bore to
the value of such facility at the time of the completion of such
expansion, renovation, or modernization.
``SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, AND MODERNIZATION
OF SMALL AMBULATORY CARE FACILITIES.
``(a) 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 for the construction, expansion, or modernization
(including the planning and design of such construction,
expansion, or modernization) of an ambulatory care facility--
``(A) located apart from a hospital;
``(B) not funded under section 301 or section 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 150
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) Additional allowable use.--The Secretary may also
reserve a portion of the funding provided under this section
and use those reserved funds to reduce an outstanding debt
incurred by Indian Tribes or Tribal Organizations for the
construction, expansion, or modernization of an ambulatory care
facility that meets the requirements under paragraph (1). The
provisions of this section shall apply, except that such
applications for funding under this paragraph shall be
considered separately from applications for funding under
paragraph (1).
``(3) Use only for certain portion of costs.--Funding
provided under this section may be used only for the cost of
that portion of a construction, expansion, or modernization
project or debt reduction that benefits the Service population
identified above in subsection (b)(1)(C) (ii) and (iii).
``(4) Applicability of requirements in the case of isolated
facilities.--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 for a
health care facility located or to be constructed on an island
or when such facility 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 provided 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 construction project
agreements and construction contracts under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et seq.) with
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 promulgate
regulations not later than 1 year after the date of enactment of the
Indian Health Care Improvement Act Amendments of 2004. If the Secretary
has not promulgated regulations by that date, 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 approve projects that 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.
``Notwithstanding any other provision of law, the Bureau of Indian
Affairs and all other agencies and departments of the United States are
authorized to transfer, at no cost, land and improvements to the
Service for the provision of health care services. The Secretary is
authorized to accept such land and improvements for such purposes.
``SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS.
``The Secretary, acting through the Service, may enter into leases,
contracts, and other agreements with Indian Tribes and Tribal
Organizations which hold (1) title to, (2) a leasehold interest in, or
(3) a beneficial interest in (when title is held by the United States
in trust for the benefit of an Indian Tribe) facilities used or to be
used for the administration and delivery of health services by an
Indian Health Program. Such leases, contracts, or agreements may
include provisions for construction or renovation and provide for
compensation to the Indian Tribe or Tribal Organization of rental and
other costs consistent with section 105(l) of the Indian Self-
Determination and Education Assistance Act 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 Balanced Budget and Emergency Deficit
Contol Act of 1985 (2 U.S.C. 901 et seq.)
``SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND LOAN REPAYMENT.
``(a) In General.--The Secretary, in consultation with the
Secretary of the Treasury, Indian Tribes, and Tribal Organizations,
shall carry out a study to determine the feasibility of establishing a
loan fund to provide to Indian Tribes and Tribal Organizations direct
loans or guarantees for loans for the construction of health care
facilities, including--
``(1) inpatient facilities;
``(2) outpatient facilities;
``(3) staff quarters;
``(4) hostels; and
``(5) specialized care facilities, such as behavioral
health and elder care facilities.
``(b) Determinations.--In carrying out the study under subsection
(a), the Secretary shall determine--
``(1) the maximum principal amount of a loan or loan
guarantee that should be offered to a recipient from the loan
fund;
``(2) the percentage of eligible costs, not to exceed 100
percent, that may be covered by a loan or loan guarantee from
the loan fund (including costs relating to planning, design,
financing, site land development, construction, rehabilitation,
renovation, conversion, improvements, medical equipment and
furnishings, and other facility-related costs and capital
purchase (but excluding staffing));
``(3) the cumulative total of the principal of direct loans
and loan guarantees, respectively, that may be outstanding at
any 1 time;
``(4) the maximum term of a loan or loan guarantee that may
be made for a facility from the loan fund;
``(5) the maximum percentage of funds from the loan fund
that should be allocated for payment of costs associated with
planning and applying for a loan or loan guarantee;
``(6) whether acceptance by the Secretary of an assignment
of the revenue of an Indian Tribe or Tribal Organization as
security for any direct loan or loan guarantee from the loan
fund would be appropriate;
``(7) whether, in the planning and design of health
facilities under this section, users eligible under section
807(c) may be included in any projection of patient population;
``(8) whether funds of the Service provided through loans
or loan guarantees from the loan fund should be eligible for
use in matching other Federal funds under other programs;
``(9) the appropriateness of, and best methods for,
coordinating the loan fund with the health care priority system
of the Service under section 301; and
``(10) any legislative or regulatory changes required to
implement recommendations of the Secretary based on results of
the study.
``(c) Report.--Not later than September 30, 2006, the Secretary
shall submit to the Committee on Indian Affairs of the Senate and the
Committee on Resources and the Committee on Energy and Commerce of the
House of Representatives a report that describes--
``(1) the manner of consultation made as required by
subsection (a); and
``(2) the results of the study, including any
recommendations of the Secretary based on results of the study.
``SEC. 310. TRIBAL LEASING.
``A Tribal Health Program may lease permanent structures for the
purpose of providing health care services without obtaining advance
approval in appropriation Acts.
``SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES JOINT VENTURE
PROGRAM.
``(a) In General.--The Secretary, acting through the Service, is
authorized to negotiate and enter into 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 under this section 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
``(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 transfer such funds to Indian Tribes or Tribal
Organizations through construction project agreements or construction
contracts under the Indian Self-Determination and Education Assistance
Act (25 U.S.C. 450 et seq.). Receipt of such funds shall have no effect
on the priorities established pursuant to section 301.
``(b) Interagency Agreements.--The Secretary is authorized to enter
into interagency agreements with other Federal agencies or State
agencies and other entities and to accept funds from such Federal or
State agencies or other sources to provide for the planning, design,
and construction of health care facilities to be administered by Indian
Health Programs in order to carry out the purposes of this Act and the
purposes for which the funds were appropriated or for which the funds
were otherwise provided.
``(c) 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 Tribal 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 section 401(c), 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.
``(C) Identification of source of payments.--If an
Indian Tribe or Tribal Organization receives funding
from the Service under the Indian Self-Determination
and Education Assistance Act or an Urban Indian
Organization receives funding from the Service under
title V of this Act and receives reimbursements or
payments under title XVIII, XIX, or XXI of the Social
Security Act, such Indian Tribe or Tribal Organization,
or Urban Indian Organization, shall provide to the
Service a list of each provider enrollment number (or
other identifier) under which it receives such
reimbursements or payments.
``(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 for such individual Indians
to the appropriate offices for enrollment or applications for
such benefits; and
``(4) to develop and implement methods of improving the
participation of Indians in receiving 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 this section shall operate to deny
to the injured person the recovery for that portion of the person's
damage not covered hereunder.
``(e) Enforcement.--
``(1) In general.--The United States, an Indian Tribe, or
Tribal Organization may enforce the right of recovery provided
under subsection (a) by--
``(A) intervening or joining in any civil action or
proceeding brought--
``(i) by the individual for whom health
services were provided by the Secretary, an
Indian Tribe, or Tribal Organization; or
``(ii) by any representative or heirs of
such individual, or
``(B) instituting a civil action, including a civil
action for injunctive relief and other relief and
including, with respect to a political subdivision or
local governmental entity of a State, such an action
against an official thereof.
``(2) Notice.--All reasonable efforts shall be made to
provide notice of action instituted under paragraph (1)(B) to
the individual to whom health services were provided, either
before or during the pendency of such action.
``(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 all the applicable
standards for such licensure, but the entity need not obtain a license.
In determining whether the entity meets such standards, the absence of
licensure of any staff member of the entity may not be taken into
account.
``SEC. 409. CONSULTATION.
``(a) National Indian Technical Advisory Group (TAG).--
``(1) Establishment and membership.--The Secretary shall
establish within the Centers for Medicare & Medicaid Services 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) Nonapplication of federal advisory committee act.--
The Federal Advisory Committee Act (5 U.S.C. App.) shall not
apply to the Advisory Group.
``(4) Meetings.--The Secretary is authorized to convene
meetings of the Advisory Group as often as needed to fulfill
the responsibilities under this section.
``(b) Solicitation of Medicaid Advice.--
``(1) In general.--As part of its plan 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 may establish a
process under which the State seeks advice on a regular,
ongoing basis from designees of such Indian Health Programs and
Urban Indian Organizations on matters relating to the
application of such title to and having a direct effect on such
Indian Health Programs and Urban Indian Organizations.
``(2) Manner of advice.--The process described in paragraph
(1) should include solicitation of advice prior to submission
of any 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).
``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 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.
``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) Other exchanges involving an Indian Health Program,
an Urban Indian Organization, or an Indian Tribe or Tribal
Organization that 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 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 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) 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.
``(d) 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.
``(e) 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.--
``(1) In general.--Subject to paragraph (2), 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 services,
covered by a managed care entity, from an Indian Health Program
or an Urban Indian Organization, either--
``(A) 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
``(B) 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.
``(2) Payment standards.--The payment provisions shall meet
the usual medicaid standards for economy, efficiency, and
access to quality care.
``(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 FEASIBILITY STUDY.
``(a) Study.--The Secretary shall conduct a study to determine the
feasibility of treating the Navajo Nation as a State for the purposes
of title XIX of the Social Security Act, to provide services to Indians
living within the boundaries of the Navajo Nation through an entity
established having the same authority and performing the same functions
as single-State medicaid agencies responsible for the administration of
the State plan under title XIX of the Social Security Act.
``(b) Considerations.--In conducting the study, the Secretary shall
consider the feasibility of--
``(1) assigning and paying all expenditures for the
provision of services and related administration funds, under
title XIX of the Social Security Act, to Indians living within
the boundaries of the Navajo Nation that are currently paid to
or would otherwise be paid to the State of Arizona, New Mexico,
or Utah;
``(2) providing assistance to the Navajo Nation in the
development and implementation of such entity for the
administration, eligibility, payment, and delivery of medical
assistance under title XIX of the Social Security Act;
``(3) providing an appropriate level of matching funds for
Federal medical assistance with respect to amounts such entity
expends for medical assistance for services and related
administrative costs; and
``(4) authorizing the Secretary, at the option of the
Navajo Nation, to treat the Navajo Nation as a State for the
purposes of title XIX of the Social Security Act (relating to
the State children's health insurance program) under terms
equivalent to those described in paragraphs (2) through (4).
``(c) Report.--Not later then 3 years after the date of enactment
of the Indian Health Act Improvement Act Amendments of 2004, the
Secretary shall submit to the Committee of Indian Affairs and Committee
on Finance of the Senate and the Committee on Resources and Committee
on Ways and Means on the House of Representatives a report that
includes--
``(1) the results of the study under this section;
``(2) a summary of any consultation that occurred between
the Secretary and the Navajo Nation, other Indian Tribes, the
States of Arizona, New Mexico, and Utah, counties which include
Navajo Lands, and other interested parties, in conducting this
study;
``(3) projected costs or savings associated with
establishment of such entity, and any estimated impact on
services provided as described in this section in relation to
probable costs or savings; and
``(4) legislative actions that would be required to
authorize the establishment of such entity if such entity is
determined by the Secretary to be feasible.
``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 and maintain programs
in Urban Centers to make health services more accessible and available
to Urban Indians.
``SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN INDIAN ORGANIZATIONS.
``Under authority of the Act of November 2, 1921 (25 U.S.C. 13)
(commonly known as the `Snyder Act'), the Secretary, acting through the
Service, shall enter into contracts with, or make grants to, Urban
Indian Organizations to assist such organizations in the establishment
and administration, within Urban Centers, of programs which meet the
requirements set forth in this title. Subject to section 506, the
Secretary, acting through the Service, shall include such conditions as
the Secretary considers necessary to effect the purpose of this title
in any contract into which the Secretary enters with, or in any grant
the Secretary makes to, any Urban Indian Organization pursuant to this
title.
``SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION OF HEALTH CARE AND
REFERRAL SERVICES.
``(a) Requirements for Grants and Contracts.--Under authority of
the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the
`Snyder Act'), the Secretary, acting through the Service, shall enter
into contracts with, or 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) Behavioral Health Services.--
``(1) Access or services provided.--The Secretary, acting
through the Service, shall facilitate access to, or provide,
behavioral health services for Urban Indians through grants
made to Urban Indian Organizations administering contracts
entered into or receiving grants under subsection (a).
``(2) Assessment required.--Except as provided by paragraph
(3)(A), a grant may not be made under this subsection to an
Urban Indian Organization until that organization has prepared,
and the Service has approved, an assessment of the following:
``(A) The behavioral health needs of the Urban
Indian population concerned.
``(B) The behavioral health services and other
related resources available to that population.
``(C) The barriers to obtaining those services and
resources.
``(D) The needs that are unmet by such services and
resources.
``(3) Purposes of grants.--Grants may be made under this
subsection for the following:
``(A) To prepare assessments required under
paragraph (2).
``(B) To provide outreach, educational, and
referral services to Urban Indians regarding the
availability of direct behavioral health services, to
educate Urban Indians about behavioral health issues
and services, and effect coordination with existing
behavioral health providers in order to improve
services to Urban Indians.
``(C) To provide outpatient behavioral health
services to Urban Indians, including the identification
and assessment of illness, therapeutic treatments, case
management, support groups, family treatment, and other
treatment.
``(D) To develop innovative behavioral health
service delivery models which incorporate Indian
cultural support systems and resources.
``(f) Prevention of Child Abuse.--
``(1) Access or services provided.--The Secretary, acting
through the Service, shall facilitate access to or provide
services for Urban Indians through grants to Urban Indian
Organizations administering contracts entered into or receiving
grants under subsection (a) to prevent and treat child abuse
(including sexual abuse) among Urban Indians.
``(2) Evaluation required.--Except as provided by paragraph
(3)(A), a grant may not be made under this subsection to an
Urban Indian Organization until that organization has prepared,
and the Service has approved, an assessment that documents the
prevalence of child abuse in the Urban Indian population
concerned and specifies the services and programs (which may
not duplicate existing services and programs) for which the
grant is requested.
``(3) Purposes of grants.--Grants may be made under this
subsection for the following:
``(A) To prepare assessments required under
paragraph (2).
``(B) For the development of prevention, training,
and education programs for Urban Indians, including
child education, parent education, provider training on
identification and intervention, education on reporting
requirements, prevention campaigns, and establishing
service networks of all those involved in Indian child
protection.
``(C) To provide direct outpatient treatment
services (including individual treatment, family
treatment, group therapy, and support groups) to Urban
Indians who are child victims of abuse (including
sexual abuse) or adult survivors of child sexual abuse,
to the families of such child victims, and to Urban
Indian perpetrators of child abuse (including sexual
abuse).
``(4) Considerations when making grants.--In making grants
to carry out this subsection, the Secretary shall take into
consideration--
``(A) the support for the Urban Indian Organization
demonstrated by the child protection authorities in the
area, including committees or other services funded
under the Indian Child Welfare Act of 1978 (25 U.S.C.
1901 et seq.), if any;
``(B) the capability and expertise demonstrated by
the Urban Indian Organization to address the complex
problem of child sexual abuse in the community; and
``(C) the assessment required under paragraph (2).
``(g) Other Grants.--The Secretary, acting through the Service, may
enter into a contract with or make grants to an Urban Indian
Organization that provides or arranges for the provision of health care
services (through satellite facilities, provider networks, or
otherwise) to Urban Indians in more than 1 Urban Center.
``SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINATION OF UNMET HEALTH
CARE NEEDS.
``(a) Grants and Contracts Authorized.--Under authority of the Act
of November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder
Act'), the Secretary, acting through the Service, may enter into
contracts with or make grants to Urban Indian Organizations situated in
Urban Centers for which contracts have not been entered into or grants
have not been made under section 503.
``(b) Purpose.--The purpose of a contract or grant made under this
section shall be the determination of the matters described in
subsection (c)(1) in order to assist the Secretary in assessing the
health status and health care needs of Urban Indians in the Urban
Center involved and determining whether the Secretary should enter into
a contract or make a grant under section 503 with respect to the Urban
Indian Organization which the Secretary has entered into a contract
with, or made a grant to, under this section.
``(c) Grant and Contract Requirements.--Any contract entered into,
or grant made, by the Secretary under this section shall include
requirements that--
``(1) the Urban Indian Organization successfully undertakes
to--
``(A) document the health care status and unmet
health care needs of Urban Indians in the Urban Center
involved; and
``(B) with respect to Urban Indians in the Urban
Center involved, determine the matters described in
paragraphs (2), (3), (4), and (7) of section 503(b);
and
``(2) the Urban Indian Organization complete performance of
the contract, or carry out the requirements of the grant,
within 1 year after the date on which the Secretary and such
organization enter into such contract, or within 1 year after
such organization receives such grant, whichever is applicable.
``(d) No Renewals.--The Secretary may not renew any contract
entered into or grant made under this section.
``SEC. 505. EVALUATIONS; RENEWALS.
``(a) Procedures for Evaluations.--The Secretary, acting through
the Service, shall develop procedures to evaluate compliance with grant
requirements and compliance with and performance of contracts entered
into by Urban Indian Organizations under this title. Such procedures
shall include provisions for carrying out the requirements of this
section.
``(b) Evaluations.--The Secretary, acting through the Service,
shall evaluate the compliance of each Urban Indian Organization which
has entered into a contract or received a grant under section 503 with
the terms of such contract or grant. For purposes of this evaluation,
in determining the capacity of an Urban Indian Organization to deliver
quality patient care the Secretary shall--
``(1) acting through the Service, conduct an annual onsite
evaluation of the organization; or
``(2) accept in lieu of such onsite evaluation evidence of
the organization's provisional or full accreditation by a
private independent entity recognized by the Secretary for
purposes of conducting quality reviews of providers
participating in the Medicare program under title XVIII of the
Social Security Act.
``(c) Noncompliance; Unsatisfactory Performance.--If, as a result
of the evaluations conducted under this section, the Secretary
determines that an Urban Indian Organization has not complied with the
requirements of a grant or complied with or satisfactorily performed a
contract under section 503, the Secretary shall, prior to renewing such
contract or grant, attempt to resolve with the organization the areas
of noncompliance or unsatisfactory performance and modify the contract
or grant to prevent future occurrences of noncompliance or
unsatisfactory performance. If the Secretary determines that the
noncompliance or unsatisfactory performance cannot be resolved and
prevented in the future, the Secretary shall not renew the contract or
grant with the organization and is authorized to enter into a contract
or make a grant under section 503 with another Urban Indian
Organization which is situated in the same Urban Center as the Urban
Indian Organization whose contract or grant is not renewed under this
section.
``(d) Considerations for Renewals.--In determining whether to renew
a contract or grant with an Urban Indian Organization under section 503
which has completed performance of a contract or grant under section
504, the Secretary shall review the records of the Urban Indian
Organization, the reports submitted under section 507, and shall
consider the results of the onsite evaluations or accreditations under
subsection (b).
``SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS.
``(a) Procurement.--Contracts with Urban Indian Organizations
entered into pursuant to this title shall be in accordance with all
Federal contracting laws and regulations relating to procurement except
that in the discretion of the Secretary, such contracts may be
negotiated without advertising and need not conform to the provisions
of sections 1304 and 3131 through 3133 of title 40, United States Code.
``(b) Payments Under Contracts or Grants.--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) continue to meet the requirements and definitions of
an urban Indian organization in this Act, and shall not be
subject to the provisions of the Indian Self-Determination and
Education Assistance Act.
``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, 2007.
``(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
consults, to the greatest extent practicable, with Urban Indian
Organizations.
``(b) Definition of Consultation.--For purposes of subsection (a),
consultation is the open and free exchange of information and opinions
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 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.
``SEC. 516. URBAN YOUTH TREATMENT CENTER DEMONSTRATION.
``(a) Construction and Operation.--The Secretary, acting through
the Service, through grant or contract, is authorized to fund 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 PROPERTY AND SUPPLIES.
``(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 real and 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--
``(1) the size and location of the Urban Indian population
to be served;
``(2) the need for prevention of and treatment of, and
control of the complications resulting from, diabetes among the
Urban Indian population to be served;
``(3) performance standards for the organization in meeting
the goals set forth in such grant that are negotiated and
agreed to by the Secretary and the grantee;
``(4) the capability of the organization to adequately
perform the activities required under the grant; and
``(5) the willingness of the organization to collaborate
with the registry, if any, established by the Secretary under
section 204(e) in the Area Office of the Service in which the
organization is located.
``(d) Funds Subject to Criteria.--Any funds received by an Urban
Indian Organization under this Act for the prevention, treatment, and
control of diabetes among Urban Indians shall be subject to the
criteria developed by the Secretary under subsection (c).
``SEC. 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 2004 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 and the ultimate beneficiaries
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.--
``(1) In general.--In order to more effectively and
efficiently carry out the responsibilities, authorities, and
functions of the United States to provide health care services
to Indians and Indian Tribes, as are or may be hereafter
provided by Federal statute or treaties, there is established
within the Public Health Service of the Department the Indian
Health Service.
``(2) Assistant secretary of indian health.--The Service
shall be administered by an Assistant Secretary of Indian
Health, who shall be appointed by the President, by and with
the advice and consent of the Senate. The Assistant Secretary
shall report to the Secretary. Effective with respect to an
individual appointed by the President, by and with the advice
and consent of the Senate, after January 1, 2005, the term of
service of the Assistant Secretary shall be 4 years. An
Assistant Secretary may serve more than 1 term.
``(3) Incumbent.--The individual serving in the position of
Director of the Indian Health Service on the day before the
date of enactment of the Indian Health Care Improvement Act
Amendments of 2004 shall serve as Assistant Secretary.
``(4) Advocacy and consultation.--The position of Assistant
Secretary is established to, in a manner consistent with the
government-to-government relationship between the United States
and Indian Tribes--
``(A) facilitate advocacy for the development of
appropriate Indian health policy; and
``(B) promote consultation on matters relating to
Indian health.
``(b) Agency.--The Service shall be an agency within the Public
Health Service of the Department, and shall not be an office,
component, or unit of any other agency of the Department.
``(c) Duties.--The Assistant Secretary of Indian Health shall--
``(1) perform all functions that were, on the day before
the date of enactment of the Indian Health Care Improvement Act
Amendments of 2004, carried out by or under the direction of
the individual serving as Director of the Service on that day;
``(2) perform all functions of the Secretary relating to
the maintenance and operation of hospital and health facilities
for Indians and the planning for, and provision and utilization
of, health services for Indians;
``(3) administer all health programs under which health
care is provided to Indians based upon their status as Indians
which are administered by the Secretary, including programs
under--
``(A) this Act;
``(B) the Act of November 2, 1921 (25 U.S.C. 13);
``(C) the Act of August 5, 1954 (42 U.S.C. 2001 et
seq.);
``(D) the Act of August 16, 1957 (42 U.S.C. 2005 et
seq.); and
``(E) the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.);
``(4) administer all scholarship and loan functions carried
out under title I;
``(5) report directly to the Secretary concerning all
policy- and budget-related matters affecting Indian health;
``(6) collaborate with the Assistant Secretary for Health
concerning appropriate matters of Indian health that affect the
agencies of the Public Health Service;
``(7) advise each Assistant Secretary of the Department
concerning matters of Indian health with respect to which that
Assistant Secretary has authority and responsibility;
``(8) advise the heads of other agencies and programs of
the Department concerning matters of Indian health with respect
to which those heads have authority and responsibility;
``(9) coordinate the activities of the Department
concerning matters of Indian health; and
``(10) perform such other functions as the Secretary may
designate.
``(d) Authority.--
``(1) In general.--The Secretary, acting through the
Assistant Secretary, shall have the authority--
``(A) except to the extent provided for in
paragraph (2), to appoint and compensate employees for
the Service in accordance with title 5, United States
Code;
``(B) to enter into contracts for the procurement
of goods and services to carry out the functions of the
Service; and
``(C) to manage, expend, and obligate all funds
appropriated for the Service.
``(2) Personnel actions.--Notwithstanding any other
provision of law, the provisions of section 12 of the Act of
June 18, 1934 (48 Stat. 986; 25 U.S.C. 472), shall apply to all
personnel actions taken with respect to new positions created
within the Service as a result of its establishment under
subsection (a).
``(e) References.--Any reference to the Director of the Indian
Health Service in any Federal law, Executive order, rule, regulation,
or delegation of authority, or in any document of or relating to the
Director of the Indian Health Service, shall be deemed to refer to the
Assistant Secretary.
``SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM.
``(a) Establishment.--
``(1) In general.--The Secretary shall establish an
automated management information system for the Service.
``(2) Requirements of system.--The information system
established under paragraph (1) shall include--
``(A) a financial management system;
``(B) a patient care information system for each
area served by the Service;
``(C) a privacy component that protects the privacy
of patient information held by, or on behalf of, the
Service;
``(D) a services-based cost accounting component
that provides estimates of the costs associated with
the provision of specific medical treatments or
services in each Area office of the Service;
``(E) an interface mechanism for patient billing
and accounts receivable system; and
``(F) a training component.
``(b) Provision of Systems to Tribes and Organizations.--The
Secretary shall provide each Tribal Health Program automated management
information systems which--
``(1) meet the management information needs of such Tribal
Health Program with respect to the treatment by the Tribal
Health Program of patients of the Service; and
``(2) meet the management information needs of the Service.
``(c) Access to Records.--Notwithstanding any other provision of
law, each patient shall have reasonable access to the medical or health
records of such patient which are held by, or on behalf of, the
Service.
``(d) Authority To Enhance Information Technology.--The Secretary,
acting through the Assistant Secretary, shall have the authority to
enter into contracts, agreements, or joint ventures with other Federal
agencies, States, private and nonprofit organizations, for the purpose
of enhancing information technology in Indian health programs and
facilities.
``SEC. 603. AUTHORIZATION OF APPROPRIATIONS.
``There is authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 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;
``(I) Traditional Health Care Practices; and
``(J) diagnostic services.
``(2) Child care.--Behavioral health services for Indians
from birth through age 17, including--
``(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); and
``(G) identification and treatment of neglect and
physical, mental, and sexual abuse.
``(3) Adult care.--Behavioral health services for Indians
from age 18 through 55, including--
``(A) early intervention, treatment, and aftercare;
``(B) mental health and substance abuse services
(emotional, alcohol, drug, inhalant, and tobacco),
including 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;
and
``(F) gender specific treatment for sexual assault
and domestic violence.
``(4) Family care.--Behavioral health services for
families, including--
``(A) early intervention, treatment, and aftercare
for affected families;
``(B) treatment for sexual assault and domestic
violence; and
``(C) promotion of healthy 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--
``(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; and
``(F) identification and treatment of dementias
regardless of cause.
``(d) Community Behavioral Health Plan.--
``(1) Establishment.--The governing body of any Indian
Tribe, Tribal Organization, or Urban Indian Organization may
adopt a resolution for the establishment of a community
behavioral health plan providing for the identification and
coordination of available resources and programs to identify,
prevent, or treat substance abuse, mental illness, or
dysfunctional and self-destructive behavior, including child
abuse and family violence, among its members or its service
population. This plan should include behavioral health
services, social services, intensive outpatient services, and
continuing aftercare.
``(2) Technical assistance.--At the request of an Indian
Tribe, Tribal Organization, or Urban Indian Organization, the
Bureau of Indian Affairs and the Service shall cooperate with
and provide technical assistance to the Indian Tribe, Tribal
Organization, or Urban Indian Organization in the development
and implementation of such plan.
``(3) Funding.--The Secretary, acting through the Service,
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 2004, 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 2004,
the Secretary, acting through the Service, and the Secretary of the
Interior shall develop and enter into a memoranda of agreement, or
review and update any existing memoranda of agreement, as required by
section 4205 of the Indian Alcohol and Substance Abuse Prevention and
Treatment Act of 1986 (25 U.S.C. 2411) under which the Secretaries
address the following:
``(1) The scope and nature of mental illness and
dysfunctional and self-destructive behavior, including child
abuse and family violence, among Indians.
``(2) The existing Federal, tribal, State, local, and
private services, resources, and programs available to provide
behavioral health services for Indians.
``(3) The unmet need for additional services, resources,
and programs necessary to meet the needs identified pursuant to
paragraph (1).
``(4)(A) The right of Indians, as citizens of the United
States and of the States in which they reside, to have access
to behavioral health services to which all citizens have
access.
``(B) The right of Indians to participate in, and receive
the benefit of, such services.
``(C) The actions necessary to protect the exercise of such
right.
``(5) The responsibilities of the Bureau of Indian Affairs
and the Service, including mental illness identification,
prevention, education, referral, and treatment services
(including services through multidisciplinary resource teams),
at the central, area, and agency and Service Unit, Service
Area, and headquarters levels to address the problems
identified in paragraph (1).
``(6) A strategy for the comprehensive coordination of the
behavioral health services provided by the Bureau of Indian
Affairs and the Service to meet the problems identified
pursuant to paragraph (1), including--
``(A) the coordination of alcohol and substance
abuse programs of the Service, the Bureau of Indian
Affairs, and Indian Tribes and Tribal Organizations
(developed under the Indian Alcohol and Substance Abuse
Prevention and Treatment Act of 1986) with behavioral
health initiatives pursuant to this Act, particularly
with respect to the referral and treatment of dually
diagnosed individuals requiring behavioral health and
substance abuse treatment; and
``(B) ensuring that the Bureau of Indian Affairs
and Service programs and services (including
multidisciplinary resource teams) addressing child
abuse and family violence are coordinated with such
non-Federal programs and services.
``(7) Directing appropriate officials of the Bureau of
Indian Affairs and the Service, particularly at the agency and
Service Unit levels, to cooperate fully with tribal requests
made pursuant to community behavioral health plans adopted
under section 701(c) and section 4206 of the Indian Alcohol and
Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C.
2412).
``(8) Providing for an annual review of such agreement by
the Secretaries which shall be provided to Congress and Indian
Tribes and Tribal Organizations.
``(b) Specific Provisions Required.--The memoranda of agreement
updated or entered into pursuant to subsection (a) shall include
specific provisions pursuant to which the Service shall assume
responsibility for--
``(1) the determination of the scope of the problem of
alcohol and substance abuse among Indians, including the number
of Indians within the jurisdiction of the Service who are
directly or indirectly affected by alcohol and substance abuse
and the financial and human cost;
``(2) an assessment of the existing and needed resources
necessary for the prevention of alcohol and substance abuse and
the treatment of Indians affected by alcohol and substance
abuse; and
``(3) an estimate of the funding necessary to adequately
support a program of prevention of alcohol and substance abuse
and treatment of Indians affected by alcohol and substance
abuse.
``(c) 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, residential, and intensive outpatient
treatment;
``(C) community-based rehabilitation and aftercare;
``(D) community education and involvement,
including extensive training of health care,
educational, and community-based personnel;
``(E) specialized residential treatment programs
for high-risk populations, including but not limited to
pregnant and postpartum women and their children; and
``(F) diagnostic services.
``(2) Target populations.--The target population of such
programs shall be members of Indian Tribes. Efforts to train
and educate key members of the Indian community shall also
target employees of health, education, judicial, law
enforcement, legal, and social service programs.
``(b) Contract Health Services.--
``(1) In general.--The Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, may enter
into contracts with public or private providers of behavioral
health treatment services for the purpose of carrying out the
program required under subsection (a).
``(2) Provision of assistance.--In carrying out this
subsection, the Secretary shall provide assistance to Indian
Tribes and Tribal Organizations to develop criteria for the
certification of behavioral health service providers and
accreditation of service facilities which meet minimum
standards for such services and facilities.
``SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM.
``(a) In General.--Under the authority of the Act of November 2,
1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'), the Secretary
shall establish and maintain a mental health technician program within
the Service which--
``(1) provides for the training of Indians as mental health
technicians; and
``(2) employs such technicians in the provision of
community-based mental health care that includes
identification, prevention, education, referral, and treatment
services.
``(b) Paraprofessional Training.--In carrying out subsection (a),
the Secretary, acting through the Service, Indian Tribes, and Tribal
Organizations, shall provide high-standard paraprofessional training in
mental health care necessary to provide quality care to the Indian
communities to be served. Such training shall be based upon a
curriculum developed or approved by the Secretary which combines
education in the theory of mental health care with supervised practical
experience in the provision of such care.
``(c) Supervision and Evaluation of Technicians.--The Secretary,
acting through the Service, Indian Tribes, and Tribal Organizations,
shall supervise and evaluate the mental health technicians in the
training program.
``(d) Traditional Health Care Practices.--The Secretary, acting
through the Service, shall ensure that the program established pursuant
to this subsection involves the use and promotion of the Traditional
Health Care Practices of the Indian Tribes to be served.
``SEC. 705. LICENSING REQUIREMENT FOR MENTAL HEALTH CARE WORKERS.
``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 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 Alaska.
``(c) Intermediate Adolescent Behavioral Health Services.--
``(1) In general.--The Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, may provide
intermediate behavioral health services, 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 2004, the Secretary,
acting through the Service, Indian Tribes, and Tribal Organizations,
may provide, in each area of the Service, not less than 1 inpatient
mental health care facility, or the equivalent, for Indians with
behavioral health problems. For the purposes of this subsection,
California shall be considered to be 2 Area Offices, 1 office whose
location shall be considered to encompass the northern area of the
State of California and 1 office whose jurisdiction shall be considered
to encompass the remainder of the State of California. The Secretary
shall consider the possible conversion of existing, underused Service
hospital beds into psychiatric units to meet such need.
``SEC. 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 the Service, 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 a central nervous system or behavioral
disorder, following a maternal history of alcohol consumption
during pregnancy, that may involve--
``(A) physical manifestations such as development
delay, intellectual deficit, neurologic abnormalities,
or failure to thrive as infants; or
``(B) behavioral manifestations such as
irritability, or for older children, hyperactivity,
attention deficit, language dysfunction, or perceptual
or judgment difficulties.
``(3) Behavioral health aftercare.--The term `behavioral
health aftercare' includes those activities and resources used
to support recovery following inpatient, residential, intensive
substance abuse, or mental health outpatient or outpatient
treatment. The purpose is to help prevent or deal with relapse
by ensuring that by the time a client or patient is discharged
from a level of care, such as outpatient treatment, an
aftercare plan has been developed with the client. An aftercare
plan may use such resources as a community-based therapeutic
group, transitional living facilities, a 12-step sponsor, a
local 12-step or other related support group, and other
community-based providers (mental health professionals,
traditional health care practitioners, community health aides,
community health representatives, mental health technicians,
ministers, etc.)
``(4) Dual diagnosis.--The term `dual diagnosis' means
coexisting substance abuse and mental illness conditions or
diagnosis. Such clients are sometimes referred to as mentally
ill chemical abusers (MICAs).
``(5) Fetal alcohol disorders.--The term `fetal alcohol
disorders' means fetal alcohol syndrome, partial fetal alcohol
syndrome and alcohol related neurodevelopmental disorder
(ARND).
``(6) 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.
``(7) 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.
``(8) Rehabilitation.--The term `rehabilitation' means to
restore the ability or capacity to engage in usual and
customary life activities through education and therapy.
``(9) 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) 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(h).
``(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 2004, 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, and VII and section 817. The Secretary may promulgate
regulations to carry out sections 105, 115, 117, and titles IV
and V, using the procedures required by chapter V of title 5,
United States Code (commonly known as the `Administrative
Procedure 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 2004 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 in effect on the day before
the date of the enactment of the Indian Health Care Improvement Act
Amendments of 2004, 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 2004, 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 rancherias and reservations
located within the State of California under the Act of August
18, 1958 (72 Stat. 619), and any descendant of such an Indian.
``(b) Clarification.--Nothing in this section may be construed as
expanding the eligibility of California Indians for health services
provided by the Service beyond the scope of eligibility for such health
services that applied on May 1, 1986.
``SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS.
``(a) Children.--Any individual who--
``(1) has not attained 19 years of age;
``(2) is the natural or adopted child, stepchild, foster
child, legal ward, or orphan of an eligible Indian; and
``(3) is not otherwise eligible for health services
provided by the Service,
shall be eligible for all health services provided by the Service on
the same basis and subject to the same rules that apply to eligible
Indians until such individual attains 19 years of age. The existing and
potential health needs of all such individuals shall be taken into
consideration by the Service in determining the need for, or the
allocation of, the health resources of the Service. If such an
individual has been determined to be legally incompetent prior to
attaining 19 years of age, such individual shall remain eligible for
such services until 1 year after the date of a determination of
competency.
``(b) Spouses.--Any spouse of an eligible Indian who is not an
Indian, or who is of Indian descent but 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 this subsection
shall be liable for payment of such health services
under a schedule of charges prescribed by the Secretary
which, in the judgment of the Secretary, results in
reimbursement in an amount not less than the actual
cost of providing the health services. Notwithstanding
section 404 of this Act or any other provision of law,
amounts collected under this subsection, including
medicare, medicaid, or SCHIP reimbursements under
titles XVIII, XIX, and XXI of the Social Security Act,
shall be credited to the account of the program
providing the service and shall be used for the
purposes listed in section 401(d)(2) and amounts
collected under this subsection shall be available for
expenditure within such program.
``(B) Indigent people.--Health services may be
provided by the Secretary through the Service under
this subsection to an indigent individual who would not
be otherwise eligible for such health services but for
the provisions of paragraph (1) only if an agreement
has been entered into with a State or local government
under which the State or local government agrees to
reimburse the Service for the expenses incurred by the
Service in providing such health services to such
indigent individual.
``(4) Revocation of consent for services.--
``(A) Single tribe service area.--In the case of a
Service Area which serves only 1 Indian Tribe, the
authority of the Secretary to provide health services
under paragraph (1) shall terminate at the end of the
fiscal year succeeding the fiscal year in which the
governing body of the Indian Tribe revokes its
concurrence to the provision of such health services.
``(B) Multitribal service area.--In the case of a
multitribal Service Area, the authority of the
Secretary to provide health services under paragraph
(1) shall terminate at the end of the fiscal year
succeeding the fiscal year in which at least 51 percent
of the number of Indian Tribes in the Service Area
revoke their concurrence to the provisions of such
health services.
``(d) Other Services.--The Service may provide health services
under this subsection to individuals who are not eligible for health
services provided by the Service under any other provision of law in
order to--
``(1) achieve stability in a medical emergency;
``(2) prevent the spread of a communicable disease or
otherwise deal with a public health hazard;
``(3) provide care to non-Indian women pregnant with an
eligible Indian's child for the duration of the pregnancy
through postpartum; or
``(4) provide care to immediate family members of an
eligible individual if such care is directly related to the
treatment of the eligible individual.
``(e) Hospital Privileges for Practitioners.--Hospital privileges
in health facilities operated and maintained by the Service or operated
under a 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, as part of the privileging process, be designated as
employees of the Federal Government for purposes of section 1346(b) and
chapter 171 of title 28, United States Code (relating to Federal tort
claims) only with respect to acts or omissions which occur in the
course of providing services to eligible individuals as a part of the
conditions under which such hospital privileges are extended.
``(f) Eligible Indian.--For purposes of this section, the term
`eligible Indian' means any Indian who is eligible for health services
provided by the Service without regard to the provisions of this
section.
``SEC. 808. REALLOCATION OF BASE RESOURCES.
``(a) Report Required.--Notwithstanding any other provision of law,
any allocation of Service funds for a fiscal year that reduces 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) IHS 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
House of Representatives and 2 from the Senate,
appointed by their respective majority leaders, and 3
from the House of Representatives and 2 from the
Senate, appointed by their respective minority leaders,
and who shall be members of the standing committees of
Congress that consider legislation affecting health
care to Indians.
``(B) Twelve persons chosen by the congressional
members of the Commission, 1 from each Service Area as
currently designated by the Director to be chosen from
among 3 nominees from each Service Area put forward by
the Indian Tribes within the area, with due regard
being given to the experience and expertise of the
nominees in the provision of health care to Indians and
to a reasonable representation on the commission of
members who are familiar with various health care
delivery modes and who represent Indian Tribes of
various size populations.
``(C) Three persons appointed by the Director who
are knowledgeable about the provision of health care to
Indians, at least 1 of whom shall be appointed from
among 3 nominees put forward by those programs whose
funds are provided in whole or in part by the Service
primarily or exclusively for the benefit of Urban
Indians.
``(D) All those persons chosen by the congressional
members of the Commission and by the Director shall be
members of federally recognized Indian Tribes.
``(2) Chair; vice chair.--The Chair and Vice Chair of the
Commission shall be selected by the congressional members of
the Commission.
``(3) Terms.--The terms of members of the Commission shall
be for the life of the Commission.
``(4) Deadline for appointments.--Congressional members of
the Commission shall be appointed not later than 90 days after
the date of the enactment of the Indian Health Care Improvement
Act Amendments of 2004, 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 toward 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 & 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 Urban Indian
Organization who participates in any proceeding that reviews or
creates such records may not be permitted or required to
testify in any judicial or administrative proceeding with
respect to such records or with respect to any finding,
recommendation, evaluation, opinion, or action taken by such
person or body in connection with such records except as
provided in this section.
``(c) Authorized Disclosure and Testimony.--
``(1) Subject to paragraph (2), a medical quality assurance
record described in subsection (a) may be disclosed, and a
person referred to in subsection (b) may give testimony in
connection with such a record, only as follows:
``(A) To a Federal executive agency or private
organization, if such medical quality assurance record
or testimony is needed by such agency or organization
to perform licensing or accreditation functions related
to any Indian Health Program or to a health program of
an Urban Indian Organization to perform monitoring,
required by law, of such program or organization.
``(B) To an administrative or judicial proceeding
commenced by a present or former Indian Health Program
or Urban Indian Organization provider concerning the
termination, suspension, or limitation of clinical
privileges of such health care provider.
``(C) To a governmental board or agency or to a
professional health care society or organization, if
such medical quality assurance record or testimony is
needed by such board, agency, society, or organization
to perform licensing, credentialing, or the monitoring
of professional standards with respect to any health
care provider who is or was an employee of any Indian
Health Program or Urban Indian Organization.
``(D) To a hospital, medical center, or other
institution that provides health care services, if such
medical quality assurance record or testimony is needed
by such institution to assess the professional
qualifications of any health care provider who is or
was an employee of any Indian Health Program or Urban
Indian Organization and who has applied for or been
granted authority or employment to provide health care
services in or on behalf of such program or
organization.
``(E) To an officer, employee, or contractor of the
Indian Health Program or Urban Indian Organization that
created the records or for which the records were
created. If that officer, employee, or contractor has a
need for such record or testimony to perform official
duties.
``(F) To a criminal or civil law enforcement agency
or instrumentality charged under applicable law with
the protection of the public health or safety, if a
qualified representative of such agency or
instrumentality makes a written request that such
record or testimony be provided for a purpose
authorized by law.
``(G) In an administrative or judicial proceeding
commenced by a criminal or civil law enforcement agency
or instrumentality referred to in subparagraph (F), but
only with respect to the subject of such proceeding.
``(2) 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 Government Accountability Office if such
record pertains to any matter within their respective
jurisdictions.
``(e) Prohibition on Disclosure of Record or Testimony.--A person
or entity having possession of or access to a record or testimony
described by this section may not disclose the contents of such record
or testimony in any manner or for any purpose except as provided in
this section.
``(f) Exemption From Freedom of Information Act.--Medical quality
assurance records described in subsection (a) may not be made available
to any person under section 552 of title 5.
``(g) Limitation on Civil Liability.--A person who participates in
or provides information to a person or body that reviews or creates
medical quality assurance records described in subsection (a) shall not
be civilly liable for such participation or for providing such
information if the participation or provision of information was in
good faith based on prevailing professional standards at the time the
medical quality assurance program activity took place.
``(h) Application to Information in Certain Other Records.--Nothing
in this section shall be construed as limiting access to the
information in a record created and maintained outside a medical
quality assurance program, including a patient's medical records, on
the grounds that the information was presented during meetings of a
review body that are part of a medical quality assurance program.
``(i) Regulations.--The Secretary, acting through the Service,
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 or on behalf of
individuals, Indian Health Program or Urban Indian Organization
medical or dental treatment review committees, or other review
bodies responsible for quality assurance, credentials,
infection control, patient 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 or for 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.
``(a) In General.--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.''.
(b) Rate of Pay.--
(1) Positions at level iv.--Section 5315 of title 5, United
States Code, is amended by striking ``Assistant Secretaries of
Health and Human Services (6).'' and inserting ``Assistant
Secretaries of Health and Human Services (7)''.
(2) Positions at level v.--Section 5316 of title 5, United
States Code, is amended by striking ``Director, Indian Health
Service, Department of Health and Human Services''.
(c) Three Affiliated Tribes Health Facility Compensation.--
(1) Findings.--Congress finds that--
(A) in 1949, the United States assumed jurisdiction
over more than 150,000 prime acres on the Fort Berthold
Indian Reservation, North Dakota, for the construction
of the Garrison Dam and Reservoir;
(B) the reservoir flooded and destroyed vital
infrastructure on the reservation, including a hospital
of the Indian Health Service;
(C) the United States made a commitment to the
Three Affiliated Tribes of the Fort Berthold Indian
Reservation to replace the lost infrastructure;
(D) on May 10, 1985, the Secretary of the Interior
established the Garrison Unit Joint Tribal Advisory
Committee to examine the effects of the Garrison Dam
and Reservoir on the Fort Berthold Indian Reservation;
(E) the final report of the Committee issued on May
23, 1986, acknowledged the obligation of the Federal
Government to replace the infrastructure destroyed by
the Federal action;
(F) the Committee on Indian Affairs of the Senate--
(i) acknowledged the recommendations of the
final report of the Committee in Senate Report
No. 102-250; and
(ii) stated that every effort should be
made by the Administration and Congress to
provide additional Federal funding to replace
the lost infrastructure; and
(G) on August 30, 2001, the Chairman of the Three
Affiliated Tribes testified before the Committee on
Indian Affairs of the Senate that the promise to
replace the lost infrastructure, particularly the
hospital, still had not been kept.
(2) Rural health care facility, fort berthold indian
reservation, north dakota.--The Three Affiliated Tribes and
Standing Rock Sioux Tribe Equitable Compensation Act is
amended--
(A) in section 3504 (106 Stat. 4732), by adding at
the end the following:
``(c) Authorization of Appropriations.--There are authorized to be
appropriated such sums as are necessary to carry out this section.'';
and
(B) by striking section 3511 (106 Stat. 4739) and
inserting the following:
``SEC. 3511. RURAL HEALTH CARE FACILITY, FORT BERTHOLD INDIAN
RESERVATION, NORTH DAKOTA.
``There are authorized to be appropriated to the Secretary of
Health and Human Services $20,000,000 for the construction of, and such
sums as are necessary for other expenses relating to, a rural health
care facility on the Fort Berthold Indian Reservation of the Three
Affiliated Tribes, North Dakota.''.
(c) Amendments to Other Provisions of Law.--
(1) Section 3307(b)(1)(C) of the Children's Health Act of
2000 (25 U.S.C. 1671 note; Public Law 106-310) is amended by
striking ``Director of the Indian Health Service'' and
inserting ``Assistant Secretary for Indian Health''.
(2) The Indian Lands Open Dump Cleanup Act of 1994 is
amended--
(A) in section 3 (25 U.S.C. 3902)--
(i) by striking paragraph (2);
(ii) by redesignating paragraphs (1), (3),
(4), (5), and (6) as paragraphs (4), (5), (2),
(6), and (1), respectively, and moving those
paragraphs so as to appear in numerical order;
and
(iii) by inserting before paragraph (4) (as
redesignated by subclause (II)) the following:
``(3) Assistant secretary.--The term `Assistant Secretary'
means the Assistant Secretary for Indian Health.'';
(B) in section 5 (25 U.S.C. 3904), by striking the
section heading and inserting the following:
``SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR INDIAN HEALTH.'';
(C) in section 6(a) (25 U.S.C. 3905(a)), in the
subsection heading, by striking ``Director'' and
inserting ``Assistant Secretary'';
(D) in section 9(a) (25 U.S.C. 3908(a)), in the
subsection heading, by striking ``Director'' and
inserting ``Assistant Secretary''; and
(E) by striking ``Director'' each place it appears
and inserting ``Assistant Secretary''.
(3) Section 5504(d)(2) of the Augustus F. Hawkins-Robert T.
Stafford Elementary and Secondary School Improvement Amendments
of 1988 (25 U.S.C. 2001 note; Public Law 100-297) is amended by
striking ``Director of the Indian Health Service'' and
inserting ``Assistant Secretary for Indian Health''.
(4) Section 203(a)(1) of the Rehabilitation Act of 1973 (29
U.S.C. 763(a)(1)) is amended by striking ``Director of the
Indian Health Service'' and inserting ``Assistant Secretary for
Indian Health''.
(5) Subsections (b) and (e) of section 518 of the Federal
Water Pollution Control Act (33 U.S.C. 1377) are amended by
striking ``Director of the Indian Health Service'' each place
it appears and inserting ``Assistant Secretary for Indian
Health''.
(6) Section 317M(b) of the Public Health Service Act (42
U.S.C. 247b-14(b)) is amended--
(A) by striking ``Director of the Indian Health
Service'' each place it appears and inserting
``Assistant Secretary for Indian Health''; and
(B) in paragraph (2)(A), by striking ``the
Directors referred to in such paragraph'' and inserting
``the Director of the Centers for Disease Control and
Prevention and the Assistant Secretary for Indian
Health''.
(7) Section 417C(b) of the Public Health Service Act (42
U.S.C. 285-9(b)) is amended by striking ``Director of the
Indian Health Service'' and inserting ``Assistant Secretary for
Indian Health''.
(8) Section 1452(i) of the Safe Drinking Water Act (42
U.S.C. 300j-12(i)) is amended by striking ``Director of the
Indian Health Service'' each place it appears and inserting
``Assistant Secretary for Indian Health''.
(9) Section 803B(d)(1) of the Native American Programs Act
of 1974 (42 U.S.C. 2991b-2(d)(1)) is amended in the last
sentence by striking ``Director of the Indian Health Service''
and inserting ``Assistant Secretary for Indian Health''.
(10) Section 203(b) of the Michigan Indian Land Claims
Settlement Act (Public Law 105-143; 111 Stat. 2666) is amended
by striking ``Director of the Indian Health Service'' and
inserting ``Assistant Secretary for Indian Health''.
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 THE MEDICAID AND STATE CHILDREN'S HEALTH
INSURANCE PROGRAMS.
(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) Eligibility for Reimbursement for Medical Assistance.--The
Indian Health Service and an Indian Tribe, Tribal Organization, or an
urban Indian Organization (as such 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 or
under waiver authority with respect to items and services furnished by
the Indian Health Service, Indian Tribe, Tribal Organization, or Urban
Indian Organization if the furnishing of such services meets all the
conditions and requirements which are applicable generally to the
furnishing of items and services under this title and under such plan
or waiver authority.''.
(2) 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) Authority To Enter Into Agreements.--The Secretary may enter
into an agreement with a State for the purpose of reimbursing the State
for medical assistance provided by the Indian Health Service, an Indian
Tribe, Tribal Organizations, or an Urban Indian Organization (as so
defined), directly, through referral, or under contracts or other
arrangements between the Indian Health Service, an Indian Tribe, Tribal
Organization, or an Urban Indian Organization and another health care
provider to Indians who are eligible for medical assistance under the
State plan or under waiver authority.''.
(4) Reference correction.--Subsection (d) of such section
is redesignated as subsection (c) and is amended--
(A) by striking ``For'' and inserting ``Direct
Billing.--For''; and
(B) by striking ``section 405'' and inserting
``section 401(d)''.
(b) 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 striking ``other than an
insurance program operated or financed by the Indian Health Service,''
and inserting ``other than a health program operated or financed by the
Indian Health Service 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)''.
Calendar No. 802
108th CONGRESS
2d Session
S. 556
[Report No. 108-411]
_______________________________________________________________________
A BILL
To amend the Indian Health Care Improvement Act to revise and extend
that Act.
_______________________________________________________________________
November 16, 2004
Reported with an amendment