H.R. 4251House117th Congress (2021-2023)In Committee

Native Behavioral Health Access Improvement Act of 2021

Introduced June 30, 2021

AI-Generated Summary

Updated February 8, 2026 at 5:04 AM UTC

The Native Behavioral Health Access Improvement Act of 2021 amends the Indian Health Care Improvement Act to create a dedicated behavioral‑health program for American Indians, Alaska Natives, and urban Indian communities. It also expands the definition of “Indian” in the Affordable Care Act so more individuals qualify for health‑coverage benefits. The bill targets tribal health programs, Indian Health Service facilities, and urban Indian health organizations.

Key Provisions

  • Establishes a special behavioral‑health program under the Indian Health Care Improvement Act and defines eligible entities as IHS‑run programs, tribal health programs, and urban Indian health programs.
  • Authorizes formula‑based grants to eligible entities for mental‑health and substance‑use disorder services, with $200 million appropriated each fiscal year from 2022 through 2026.
  • Requires the IHS Director to provide technical assistance, collect and evaluate program data, and obligates grant recipients to submit regular reports and data as a condition of funding.
  • Updates the definition of “Indian” in the Affordable Care Act to include members of federally recognized tribes, eligible urban Indians, Alaska Natives, and others, and makes related conforming amendments to ACA provisions.

Legislative Activity

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3 earlier actions
HouseCommittee Latest Action

Referred to the Subcommittee for Indigenous Peoples of the United States.

July 24, 2021

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HouseIntro Referral

Introduced in House

June 30, 2021

HouseIntro Referral

Referred to the Committee on Energy and Commerce, and in addition to the Committee on Natural Resources, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

June 30, 2021

HouseCommittee

Referred to the Subcommittee on Health.

July 1, 2021

HouseCommittee

Referred to the Subcommittee for Indigenous Peoples of the United States.

July 24, 2021

Floor Debate

22 members

What members said about H.R. 4251 on the floor

14 Republicans8 Democrats
Jon Tester
Sen. Jon TesterD-MT · Apr 28, 2022

Mr. President, I could hardly hear you, but thank you very much for that recognition. I am about to talk about an issue that the man in the Chair, the good Senator from New Jersey, I know is…

John Cornyn
Sen. John CornynR-TX · Apr 28, 2022

Mr. President, let me start by expressing my gratitude to the Senator from Wyoming, Senator Barrasso, for laying out the nature of the border crisis that we are experiencing and have experienced at…

John Barrasso
Sen. John BarrassoR-WY · Apr 28, 2022

Mr. President, I come to the floor today to talk about the Biden border crisis. Right now, our Nation is facing a dangerous national security crisis at the border, and it is all because of the…

Charles E. Schumer
Sen. Charles E. SchumerD-NY · Apr 28, 2022

Mr. President, I ask unanimous consent that the order for the quorum call be rescinded. Mr. President, it has been a good week in the Senate because two important things happened. First, we finally…

John Thune
Sen. John ThuneR-SD · Apr 28, 2022

Madam President, from the beginning, the Biden administration has displayed a hostility to fossil fuels. President Biden set the tone on day 1 of his administration when he canceled the Keystone XL…

Show 8 more
Mitch McConnell
Sen. Mitch McConnellR-KY · Apr 28, 2022

Mr. President, I ask unanimous consent that the order for the quorum call be rescinded. Mr. President, runaway inflation is crushing working American families on Democrats' watch. The share of…

Maria Cantwell
Sen. Maria CantwellD-WA · Apr 28, 2022

Madam President, I ask unanimous consent that I be allowed to complete my remarks prior to the vote. If the Senator--first of all, I want to associate myself with the comments of the Senator from…

Virginia Foxx
Rep. Virginia FoxxR-NC-5 · Feb 4, 2022

Madam Speaker, I rise in opposition to the amendment. Madam Speaker, I yield myself such time as I may consume. Members on both sides of the aisle want more transparency and accountability in…

Joaquin Castro
Rep. Joaquin CastroD-TX-20 · Feb 4, 2022

Madam Speaker, I rise to oppose Representative Steel's amendment. Madam Speaker, I yield myself such time as I may consume. Representative Steel and I share a lot of the same concerns about China, in…

Rep. Andy LevinD-MI-9 · Feb 4, 2022

Madam Speaker, I have an amendment at the desk. Madam Speaker, I yield myself such time as I may consume. I would like to begin by thanking Chair Eddie Bernice Johnson for her leadership on H.R.…

Michelle Steel
Rep. Michelle SteelR-CA-48 · Feb 4, 2022

Madam Speaker, I have an amendment at the desk. Madam Speaker, I yield myself 2 minutes. China has avoided accountability for their unfair trade practices, gross human rights violations, and…

Anthony Gonzalez
Rep. Anthony GonzalezR-OH-16 · Feb 4, 2022

Madam Speaker, I rise today in support of our bipartisan amendment that includes both the JOBS Act and the College Transparency Act. Since I first ran for Congress, the number one issue that I hear…

Raja Krishnamoorthi
Rep. Raja KrishnamoorthiD-IL-8 · Feb 4, 2022

Madam Speaker, I rise today in support of amendment 260 and in support of the America COMPETES Act. My amendment 260 contains the bipartisan College Transparency Act, which creates an extremely…

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Fred Keller
Rep. Fred KellerR-PA-12 · Feb 4, 2022

Madam Speaker, I thank Ranking Member Foxx for yielding. Madam Speaker, I rise in opposition to amendment No. 260 which excludes certain educational institutions from participating in Federal Pell…

Mariannette Miller-Meeks
Rep. Mariannette Miller-MeeksR-IA-2 · Feb 4, 2022

Madam Speaker, I thank my good friend, Congresswoman Steel, for offering her commonsense amendment. China is the world's leading producer of carbon emissions. For years, China has been one of the…

Mary E. Miller
Rep. Mary E. MillerR-IL-15 · Feb 4, 2022

Madam Speaker, I thank the gentlewoman for yielding. In a bill that professes to push back on the influence of China's authoritarian regime, this amendment runs the risk of putting the personal…

Robert C. "Bobby" Scott
Rep. Robert C. "Bobby" ScottD-VA-3 · Feb 4, 2022

Madam Speaker, this amendment would significantly strengthen how the America COMPETES Act will work by improving access to affordable high-quality higher education. First, the amendment includes the…

Troy Balderson
Rep. Troy BaldersonR-OH-12 · Feb 4, 2022

Madam Speaker, I rise in support of the amendment offered by Representative Steel. This amendment is simple. It demands that China, the world's worst producer of greenhouse gas emissions, meets the…

Richard J. Durbin
Sen. Richard J. DurbinD-IL · Apr 28, 2022

I announce that the Senator from Connecticut (Mr. Murphy) and the Senator from Oregon (Mr. Wyden) are necessarily absent.

Michael T. McCaul
Rep. Michael T. McCaulR-TX-10 · Feb 4, 2022

Madam Speaker, I have a motion to recommit at the desk. Madam Speaker, on that I demand the yeas and nays.

Mike Crapo
Sen. Mike CrapoR-ID · Apr 28, 2022

Mr. President, I yield back all time. Mr. President, I ask for the yeas and nays.

Brian Babin
Rep. Brian BabinR-TX-36 · Feb 4, 2022

Mr. Speaker, on that I demand the yeas and nays.

Bill Text

Latest available legislative text

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Introduced in HouseIssued June 30, 2021

I

117th CONGRESS

1st Session

H. R. 4251

IN THE HOUSE OF REPRESENTATIVES

June 30, 2021

Mr. Pallone (for himself and Mr. Ruiz) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Natural Resources, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

A BILL

To amend the Indian Health Care Improvement Act to authorize a special behavioral health program for Indians, and for other purposes.

1.

Short title

This Act may be cited as the Native Behavioral Health Access Improvement Act of 2021.

2.

Special behavioral health program for Indians

(a)

In general

Subtitle A of title VII of the Indian Health Care Improvement Act (25 U.S.C. 1665 et seq.) is amended by adding at the end the following:

716.

Special behavioral health program for Indians

(a)

Definition of eligible entity

In this section, the term eligible entity means—

(1)

any health program administered directly by the Service;

(2)

a tribal health program; and

(3)

an Urban Indian health program operated by an Urban Indian organization pursuant to a grant or contract with the Service under title V.

(b)

Formula grants

(1)

In general

The Director of the Service (referred to in this section as the Director) shall award grants to eligible entities, in amounts determined pursuant to the formula described in paragraph (2), to be used by the eligible entity to provide services for the prevention of, treatment of, and recovery from mental health and substance use disorders.

(2)

Formula

The Director, in consultation with Indian tribes and Urban Indian organizations, shall develop a formula to determine the amount of a grant under paragraph (1).

(c)

Technical assistance and program evaluation

(1)

In general

The Director shall—

(A)

provide technical assistance to applicants and grantees under this section; and

(B)

collect and evaluate information on the program carried out under this section.

(2)

Consultation

The Director shall consult with eligible entities under this section for purposes of developing evaluation measures and data submission and reporting requirements for purposes of the collection and evaluation of information under paragraph (1)(B).

(3)

Data submission and reporting

As a condition on receipt of a grant under this section, an applicant shall agree to submit data and reports consistent with the data submission and reporting requirements developed under paragraph (2).

(d)

Funding

To carry out this section, there is authorized to be appropriated, and there is appropriated, out of any money in the Treasury not otherwise appropriated, $200,000,000 for each of fiscal years 2022 through 2026.

.

(b)

Technical amendment

Section 4(26) of the Indian Health Care Improvement Act (25 U.S.C. 1603(26)) is amended by striking (25 U.S.C. 450b) and inserting (25 U.S.C. 5304).

3.

Indian defined in PPACA

(a)

Indian defined in PPACA

(1)

In general

Section 1304 of the Patient Protection and Affordable Care Act (42 U.S.C. 18024) is amended by adding at the end the following new subsection:

(f)

Indian

(1)

In general

In this title, the term Indian means any individual—

(A)

described in paragraph (13) or (28) of section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603);

(B)

who is eligible for health services provided by the Indian Health Service under section 809 of the Indian Health Care Improvement Act (25 U.S.C. 1679);

(C)

who is of Indian descent and belongs to the Indian community served by the local facilities and program of the Indian Health Service; or

(D)

who is described in paragraph (2).

(2)

Included individuals

For purposes of this title, the following individuals shall be considered to be an Indian:

(A)

A member of a Federally recognized Indian tribe.

(B)

A resident of an urban center who meets one or more of the following four criteria:

(i)

Membership in a Tribe, band, or other organized group of Indians, including those Tribes, bands, or groups terminated since 1940 and those recognized by the State in which they reside, or being a descendant, in the first or second degree, of any such member.

(ii)

Is an Eskimo or Aleut or other Alaska Native.

(iii)

Is considered by the Secretary of the Interior to be an Indian for any purpose.

(iv)

Is determined to be an Indian under regulations promulgated by the Secretary.

(C)

An individual who is considered by the Secretary of the Interior to be an Indian for any purpose.

(D)

An individual who is considered by the Secretary to be an Indian for purposes of eligibility for Indian health care services, including as a California Indian, Eskimo, Aleut, or other Alaska Native.

.

(2)

Conforming amendments

(A)

Affordable choices health benefit plans

Section 1311(c)(6)(D) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(6)(D)) is amended by striking section 4 of the Indian Health Care Improvement Act and inserting section 1304(f).

(B)

Reduced cost-sharing for individuals enrolling in qualified health plans

Section 1402(d) of the Patient Protection and Affordable Care Act (42 U.S.C. 18071(d)) is amended—

(i)

in paragraph (1), in the matter preceding subparagraph (A), by striking section 4(d) of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b(d)) and inserting section 1304(f); and

(ii)

in paragraph (2), in the matter preceding subparagraph (A), by striking (as so defined) and inserting (as defined in section 1304(f)).

(3)

Effective date

The amendments made by this subsection shall apply with respect to plan years beginning on or after January 1, 2023.

(b)

Technical amendments

Section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603) is amended—

(1)

in paragraph (13), by striking as defined in subsection (d) hereof and inserting as defined in paragraph (14); and

(2)

in paragraph (28)—

(A)

by striking as defined in subsection (g) hereof and inserting as defined in paragraph (27); and

(B)

by striking subsection (c)(1) through (4) and inserting subparagraphs (A) through (D) of paragraph (13).