S 2526 IS
106th CONGRESS
2d Session
S. 2526
To amend the Indian Health Care Improvement Act to revise and extend
such Act.
IN THE SENATE OF THE UNITED STATES
May 9, 2000
Mr. CAMPBELL (for himself and for Mr. INOUYE) introduced the following bill;
which was read twice and referred to the Committee on Indian Affairs
A BILL
To amend the Indian Health Care Improvement Act to revise and extend
such Act.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE- This Act may be cited as the `Indian Health Care
Improvement Act Reauthorization of 2000'.
(b) TABLE OF CONTENTS- The table of contents for this Act is as
follows:
TITLE I--REAUTHORIZATION AND REVISIONS OF THE INDIAN HEALTH CARE IMPROVEMENT
ACT
Sec. 101. Amendment to the Indian Health Care Improvement Act.
TITLE II--CONFORMING AMENDMENTS TO THE SOCIAL SECURITY ACT
Subtitle A--Medicare
Sec. 201. Limitations on charges.
Sec. 202. Indian health programs.
Sec. 203. Qualified Indian health program.
Subtitle B--Medicaid
Sec. 211. Payments to Federally-qualified health centers.
Sec. 212. State consultation with Indian health programs.
Sec. 213. Fmap for services provided by Indian health programs.
Sec. 214. Indian Health Service programs.
Subtitle C--State Children's Health Insurance Program
Sec. 221. Enhanced fmap for State children's health insurance
program.
Sec. 222. Direct funding of State children's health insurance
program.
`Sec. 2111. Direct funding of Indian health programs.
Subtitle D--Authorization of Appropriations
Sec. 231. Authorization of appropriations.
TITLE III--MISCELLANEOUS PROVISIONS
Sec. 302. Severability provisions.
TITLE I--REAUTHORIZATION AND REVISIONS OF THE INDIAN HEALTH CARE
IMPROVEMENT ACT
SEC. 101. AMENDMENT TO THE INDIAN HEALTH CARE IMPROVEMENT ACT.
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; table of contents.
`Sec. 2. Findings.
`Sec. 3. Declaration of health objectives.
`Sec. 4. Definitions.
`TITLE I--INDIAN HEALTH, HUMAN RESOURCES AND DEVELOPMENT
`Sec. 101. Purpose.
`Sec. 102. General requirements.
`Sec. 103. Health professions recruitment program for
Indians.
`Sec. 104. Health professions preparatory scholarship program for
Indians.
`Sec. 105. Indian health professions scholarships.
`Sec. 106. American Indians into psychology program.
`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. Tribal recruitment and retention program.
`Sec. 114. Advanced training and research.
`Sec. 115. Nursing programs; Quentin N. Burdick American Indians into
Nursing Program.
`Sec. 116. Tribal culture and history.
`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
project.
`Sec. 124. Scholarships.
`Sec. 125. National Health Service Corps.
`Sec. 126. Substance abuse counselor education demonstration
project.
`Sec. 127. Mental health training and community education.
`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.
`Sec. 206. Health services research.
`Sec. 207. Mammography and other cancer screening.
`Sec. 208. Patient travel costs.
`Sec. 209. Epidemiology centers.
`Sec. 210. Comprehensive school health education programs.
`Sec. 211. Indian youth program.
`Sec. 212. Prevention, control, and elimination of communicable and
infectious diseases.
`Sec. 213. Authority for provision of other services.
`Sec. 214. Indian women's health care.
`Sec. 215. Environmental and nuclear health hazards.
`Sec. 216. Arizona as a contract health service delivery
area.
`Sec. 217. California contract health services demonstration
program.
`Sec. 218. California as a contract health service delivery
area.
`Sec. 219. Contract health services for the Trenton service
area.
`Sec. 220. Programs operated by Indian tribes and tribal
organizations.
`Sec. 221. Licensing.
`Sec. 222. Authorization for 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. Safe water and sanitary waste disposal
facilities.
`Sec. 303. Preference to Indians and Indian firms.
`Sec. 304. Soboba sanitation facilities.
`Sec. 305. Expenditure of nonservice funds for renovation.
`Sec. 306. Funding for the construction, expansion, and modernization of
small ambulatory care facilities.
`Sec. 307. Indian health care delivery demonstration
project.
`Sec. 308. Land transfer.
`Sec. 309. Leases.
`Sec. 310. Loans, loan guarantees and loan repayment.
`Sec. 311. Tribal leasing.
`Sec. 312. Indian Health Service/tribal facilities joint venture
program.
`Sec. 313. Location of facilities.
`Sec. 314. Maintenance and improvement of health care
facilities.
`Sec. 315. Tribal management of Federally-owned quarters.
`Sec. 316. Applicability of buy American requirement.
`Sec. 317. Other funding for facilities.
`Sec. 318. Authorization of appropriations.
`TITLE IV--ACCESS TO HEALTH SERVICES
`Sec. 401. Treatment of payments under medicare program.
`Sec. 402. Treatment of payments under medicaid program.
`Sec. 403. Report.
`Sec. 404. Grants to and funding agreements with the service, Indian
tribes or tribal organizations, and urban Indian organizations.
`Sec. 405. Direct billing and reimbursement of medicare, medicaid, and
other third party payors.
`Sec. 406. Reimbursement from certain third parties of costs of health
services.
`Sec. 407. Crediting of reimbursements.
`Sec. 408. Purchasing health care coverage.
`Sec. 409. Indian Health Service, Department of Veteran's Affairs, and
other Federal agency health facilities and services sharing.
`Sec. 410. Payor of last resort.
`Sec. 411. Right to recover from Federal health care
programs.
`Sec. 412. Tuba city demonstration project.
`Sec. 413. Access to Federal insurance.
`Sec. 414. Consultation and rulemaking.
`Sec. 415. Limitations on charges.
`Sec. 416. Limitation on Secretary's waiver authority.
`Sec. 417. Waiver of medicare and medicaid sanctions.
`Sec. 418. Meaning of `remuneration' for purposes of safe harbor
provisions; antitrust immunity.
`Sec. 419. Co-insurance, co-payments, deductibles and
premiums.
`Sec. 420. Inclusion of income and resources for purposes of medically
needy medicaid eligibility.
`Sec. 421. Estate recovery provisions.
`Sec. 422. Medical child support.
`Sec. 423. Provisions relating to managed care.
`Sec. 424. Navajo Nation medicaid agency.
`Sec. 425. Indian advisory committees.
`Sec. 426. Authorization of appropriations.
`TITLE V--HEALTH SERVICES FOR URBAN INDIANS
`Sec. 501. Purpose.
`Sec. 502. Contracts with, and grants to, urban Indian
organizations.
`Sec. 503. Contracts and grants for the provision of health care and
referral services.
`Sec. 504. Contracts and grants for the determination of unmet health
care needs.
`Sec. 505. Evaluations; renewals.
`Sec. 506. Other contract and grant requirements.
`Sec. 507. Reports and records.
`Sec. 508. Limitation on contract authority.
`Sec. 509. Facilities.
`Sec. 510. Office of Urban Indian Health.
`Sec. 511. Grants for alcohol and substance abuse related
services.
`Sec. 512. Treatment of certain demonstration projects.
`Sec. 513. Urban NIAAA transferred programs.
`Sec. 514. Consultation with urban Indian organizations.
`Sec. 515. Federal Tort Claims Act coverage.
`Sec. 516. Urban youth treatment center demonstration.
`Sec. 517. Use of Federal government facilities and sources of
supply.
`Sec. 518. Grants for diabetes prevention, treatment and
control.
`Sec. 519. Community health representatives.
`Sec. 520. Regulations.
`Sec. 521. 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. Memorandum 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 assessment. --
`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 mental 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. National Bi-Partisan Commission on Indian Health Care
Entitlement.
`Sec. 815. Appropriations; availability.
`Sec. 816. Authorization of appropriations.
`SEC. 2. FINDINGS.
`Congress makes the following findings:
`(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.
`(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.
`(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.
`(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.
`(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.
`(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 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.
`(8) The disparity in health status that is to be addresses 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.
`SEC. 3. DECLARATION OF HEALTH OBJECTIVES.
`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--
`(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 2000,
or any successor standards thereto;
`(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 2000,
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;
`(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;
`(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
`(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.
`SEC. 4. DEFINITIONS.
`(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.
`(2) AREA OFFICE- The term `area office' mean 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.
`(3) ASSISTANT SECRETARY- The term `Assistant Secretary' means the
Assistant Secretary of the Indian Health as established under section
601.
`(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.
`(5) DEPARTMENT- The term `Department', unless specifically provided
otherwise, means the Department of Health and Human Services.
`(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.
`(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.
`(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.
`(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).
`(10) INDIAN- The term `Indian' and `Indians' shall have meanings given
such terms for purposes of the Indian Self-Determination and Education
Assistance Act.
`(11) INDIAN HEALTH PROGRAM- The term `Indian health program' shall have
the meaning given such term in section 110(a)(2)(A).
`(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.
`(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.
`(14) SECRETARY- The term `Secretary', unless specifically provided
otherwise, means the Secretary of Health and Human Services.
`(15) SERVICE- The term `Service' means the Indian Health Service.
`(16) SERVICE AREA- The term `service area' means the geographical area
served by each area office.
`(17) SERVICE UNIT- The term `service unit' means--
`(A) an administrative entity within the Indian Health Service;
or
`(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.
`(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.
`(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.
`(20) TRIBALLY CONTROLLED COMMUNITY COLLEGE- The term `tribally
controlled community college' shall have the meaning given such term in
section 126 (g)(2).
`(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.
`(22) URBAN INDIAN- The term `urban Indian' means any individual who
resides in an urban center and who--
`(A) 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;
`(B) is an Eskimo or Aleut or other Alaskan Native;
`(C) is considered by the Secretary of the Interior to be an Indian
for any purpose; or
`(D) is determined to be an Indian under regulations promulgated by
the Secretary.
`(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).
`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
Service, Indian tribes, tribal organizations, and urban Indian organizations
involved in the provision of health services to Indian people.
`SEC. 102. GENERAL REQUIREMENTS.
`(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--
`(1) to be developed in consultation with Indian Tribes, tribal
organizations and urban Indian organizations; and
`(2) that takes into account the human resource and development needs in
each such service area.
`(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.
`(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.
`(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.
`SEC. 103. HEALTH PROFESSIONS RECRUITMENT PROGRAM FOR INDIANS.
`(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--
`(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 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).
`(b) ADMINISTRATIVE PROVISIONS-
`(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.
`(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.
`(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.
`(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.
`(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--
`(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;
`(2) is an Eskimo or Aleut or other Alaska Native;
`(3) is considered by the Secretary of the Interior to be an Indian for
any purpose; or
`(4) is determined to be an Indian under regulations promulgated by the
Secretary.
`SEC. 104. HEALTH PROFESSIONS PREPARATORY SCHOLARSHIP PROGRAM FOR
INDIANS.
`(a) IN GENERAL- The Secretary, acting through the Service, shall provide
scholarships through the area offices to Indians who--
`(1) have successfully completed their high school education or high
school equivalency; and
`(2) have demonstrated the capability to successfully complete courses
of study in the health professions.
`(b) PURPOSE- Scholarships provided under this section shall be for the
following purposes:
`(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).
`(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.
`(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.
`(d) LIMITATIONS- Scholarship assistance to an eligible applicant under
this section shall not be denied solely on the basis of--
`(1) the applicant's scholastic achievement if such applicant has been
admitted to, or maintained good standing at, an accredited institution;
or
`(2) the applicant's eligibility for assistance or benefits under any
other Federal program.
`SEC. 105. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.
`(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).
`(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.
`(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).
`(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--
`(i) in the Indian Health Service;
`(ii) in a program conducted under a funding agreement entered into
under the Indian Self-Determination and Education Assistance
Act;
`(iii) in a program assisted under title V; or
`(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.
`(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:
`(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.
`(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).
`(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).
`(C) NEW SCHOLARSHIP RECIPIENTS- A recipient of an Indian Health
Scholarship that is awarded after December 31, 2001, 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.
`(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.
`(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--
`(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;
`(B) the period of obligated service described in paragraph (2)(A)
shall be equal to the greater of--
`(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
`(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.
`(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--
`(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) is dismissed from such educational institution for
disciplinary reasons;
`(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
`(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, 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.
`(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.
`(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.
`(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--
`(i) it is not possible for the recipient to meet that obligation or
make that payment;
`(ii) requiring that recipient to meet that obligation or make that
payment would result in extreme hardship to the recipient;
or
`(iii) the enforcement of the requirement to meet the obligation or
make the payment would be unconscionable.
`(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.
`(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.
`(c) FUNDING FOR TRIBES FOR SCHOLARSHIP PROGRAMS-
`(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.
`(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.
`(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.
`(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.
`(B) MATCHING REQUIREMENT- With respect to the costs of providing any
scholarship pursuant to subparagraph (A)--
`(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
`(ii) 20 percent of such costs shall be paid from any other source
of funds.
`(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.
`(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--
`(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--
`(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
`(ii) such greater period of time as the recipient and the Indian
Tribe or tribal organization may agree;
`(B) provide that the scholarship--
`(i) 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 which the scholarship is provided, the total
amount required for the year for the purposes authorized in this clause; and
`(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);
`(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
`(D) require the recipient of such scholarship to meet the educational
and licensure requirements appropriate to the health profession
involved.
`(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--
`(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);
`(ii) is dismissed from such education for disciplinary
reasons;
`(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
`(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;
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.
`(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.
`(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.
`(6) REQUIRED AGREEMENTS- The recipient of a scholarship under paragraph
(1) shall agree, in providing health care pursuant to the requirements of
this subsection--
`(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
`(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.
`(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.
`SEC. 106. AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM.
`(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.
`(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.
`(1) REGULATIONS- The Secretary shall promulgate regulations pursuant to
this Act for the competitive awarding of funds under this section.
`(2) PROGRAM- Applicants for funds under this section shall agree to
provide a program which, at a minimum--
`(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;
`(B) incorporates a program advisory board comprised of
representatives from the Tribes and communities that will be served by the
program;
`(C) provides summer enrichment programs to expose Indian students to
the various fields of psychology through research, clinical, and
experimental activities;
`(D) provides stipends to undergraduate and graduate students to
pursue a career in psychology;
`(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;
`(F) utilizes, to the maximum extent feasible, existing university
tutoring, counseling and student support services; and
`(G) employs, to the maximum extent feasible, qualified Indians in the
program.
`(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--
`(1) in the Indian Health Service;
`(2) in a program conducted under a funding agreement contract entered
into under the Indian Self-Determination and Education Assistance Act;
`(3) in a program assisted under title V; or
`(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.
`SEC. 107. INDIAN HEALTH SERVICE EXTERN PROGRAMS.
`(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.
`(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.
`(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.
`(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.
`SEC. 108. CONTINUING EDUCATION ALLOWANCES.
`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.
`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 shall maintain a
Community Health Representative Program under which the Service, Indian tribes
and tribal organizations--
`(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) ACTIVITIES- The Secretary, acting through the Community Health
Representative Program, 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 such 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 maintain programs that meet the needs for such
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.
`(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.
`(2) DEFINITIONS- In this section:
`(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--
`(i) directly by the Service;
`(ii) by any Indian tribe or tribal or Indian organization pursuant
to a funding agreement under--
`(I) the Indian Self-Determination and Educational Assistance Act;
or
`(II) section 23 of the Act of April 30, 1908 (25 U.S.C. 47)
(commonly known as the `Buy-Indian Act'); or
`(iii) by an urban Indian organization pursuant to title
V.
`(B) STATE- The term `State' has the same meaning given such term in
section 331(i)(4) of the Public Health Service Act.
`(b) ELIGIBILITY- To be eligible to participate in the Loan Repayment
Program, an individual must--
`(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
`(ii) in an approved graduate training program in a health profession;
or
`(i) a degree in a health profession; and
`(ii) a license to practice a health profession in a State;
`(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
Indian Health Service; or
`(D) be employed in an Indian health program without a service
obligation; and
`(3) submit to the Secretary an application for a contract described in
subsection (f).
`(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.
`(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.
`(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.
`(1) ANNUAL DETERMINATIONS- The Secretary, acting through the Service
and in accordance with subsection (k), shall annually--
`(A) identify the positions in each Indian health program for which
there is a need or a vacancy; and
`(B) rank those positions in order of priority.
`(2) PRIORITY IN APPROVAL- Consistent with 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
give priority to applications made by--
`(B) individuals recruited through the efforts an Indian tribe, tribal
organization, or urban Indian organization.
`(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).
`(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--
`(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
`(B) the Secretary's disapproving an individual's participation in
such Program.
`(f) WRITTEN CONTRACT- The written contract referred to in this section
between the Secretary and an individual shall contain--
`(1) an agreement under which--
`(A) subject to paragraph (3), 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 tribe, tribal organization, or urban Indian
organization as provided in subparagraph (B)(iii); and
`(B) subject to paragraph (3), 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)--
`(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
`(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);
`(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;
`(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);
`(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;
`(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
`(5) such other statements of the rights and liabilities of the
Secretary and of the individual, not inconsistent with this section.
`(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--
`(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.
`(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--
`(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;
`(ii) provides an incentive to serve in Indian health programs with
the greatest shortages of health professionals; and
`(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.
`(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.
`(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.
`(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.
`(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).
`(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.
`(k) ASSIGNMENT OF INDIVIDUALS- The Secretary, in assigning individuals to
serve in Indian health programs pursuant to contracts entered into under this
section, shall--
`(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
`(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.
`(1) IN GENERAL- An individual who has entered into a written contract
with the Secretary under this section and who--
`(A) is enrolled in the final year of a course of study and
who--
`(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);
`(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 who fails to
complete such training program, and does not receive a waiver from the
Secretary under subsection (b)(1)(B)(ii),
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.
`(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:
A=3Z(t-s/t)
`(A) `A' is the amount the United States is entitled to
recover;
`(B) `Z' is the sum of the amounts paid under this section to, or on
behalf of, the individual and the interest on such amounts which would be
payable if, at the time the amounts were paid, they were loans bearing
interest at the maximum legal prevailing rate, as determined by the
Treasurer of the United States;
`(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.
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.
`(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.
`(B) DELINQUENCIES- If damages described in subparagraph (A) are
delinquent for 3 months, the Secretary shall, for the purpose of
recovering such damages--
`(i) utilize collection agencies contracted with by the
Administrator of the General Services Administration; or
`(ii) enter into contracts for the recovery of such damages with
collection agencies selected by the Secretary.
`(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.
`(m) CANCELLATION, WAIVER OR RELEASE-
`(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.
`(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.
`(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.
`(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.
`(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--
`(1) the health professional positions maintained by the Service or by
tribal or 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 (f) 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 scholarship grants that are provided under section
105 with respect to each health profession;
`(6) the amount of scholarship grants provided under section 105, in
total and by health profession;
`(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
`(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.
`SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOVERY FUND.
`(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--
`(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;
`(2) such funds as may be appropriated to the LRRF;
`(3) such interest earned on amounts in the LRRF; and
`(4) such additional amounts as may be collected, appropriated, or
earned relative to the LRRF.
Amounts appropriated to the LRRF shall remain available until expended.
`(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--
`(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
`(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.
`(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.
`(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.
`(2) SALE PRICE- 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 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.
`(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.
`SEC. 113. TRIBAL RECRUITMENT AND RETENTION PROGRAM.
`(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)).
`(b) ELIGIBILITY- Any Indian tribe, tribal organization, 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 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.
`(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.
`(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.
`(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).
`SEC. 115. NURSING PROGRAMS; QUENTIN N. BURDICK AMERICAN INDIANS INTO
NURSING PROGRAM.
`(a) GRANTS- Notwithstanding section 102, the Secretary, acting through
the Service, shall provide funds to--
`(1) public or private schools of nursing;
`(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
`(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,
for the purpose of increasing the number of nurses, nurse midwives, and
nurse practitioners who deliver health care services to Indians.
`(b) USE OF GRANTS- Funds provided under subsection (a) may be used
to--
`(1) recruit individuals for programs which train individuals to be
nurses, nurse midwives, or advanced practice nurses;
`(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;
`(3) provide a program that encourages nurses, nurse midwives, and
advanced practice nurses to provide, or continue to provide, health care
services to Indians;
`(4) provide a program that increases the skills of, and provides
continuing education to, nurses, nurse midwives, and advanced practice
nurses; or
`(5) provide any program that is designed to achieve the purpose
described in subsection (a).
`(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.
`(d) PREFERENCES- In providing funds under subsection (a), the Secretary
shall extend a preference to--
`(1) programs that provide a preference to Indians;
`(2) programs that train nurse midwives or advanced practice
nurses;
`(3) programs that are interdisciplinary; and
`(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.
`(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).
`(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--
`(1) in the Indian Health Service;
`(2) in a program conducted under a contract entered into under the
Indian Self-Determination and Education assistance Act;
`(3) in a program assisted under title V; 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 professional shortage
area and addresses the health care needs of a substantial number of
Indians.
`SEC. 116. TRIBAL CULTURE AND HISTORY.
`(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.
`(b) REQUIREMENTS- To the extent feasible, the educational instruction to
be provided under subsection (a) shall--
`(1) be provided in consultation with the affected tribal governments,
tribal organizations, and urban Indian organizations;
`(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
`(3) include instruction in Native American studies.
`SEC. 117. INMED PROGRAM.
`(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.
`(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.
`(1) IN GENERAL- The Secretary shall develop regulations to govern
grants under to this section.
`(2) PROGRAM REQUIREMENTS- Applicants for grants provided under this
section shall agree to provide a program that--
`(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;
`(B) incorporates a program advisory board comprised of
representatives from the tribes and communities which will be served by
the program;
`(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;
`(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
`(E) to the maximum extent feasible, employs qualified Indians in the
program.
`SEC. 118. HEALTH TRAINING PROGRAMS OF COMMUNITY COLLEGES.
`(a) ESTABLISHMENT GRANTS-
`(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.
`(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.
`(b) CONTINUATION GRANTS-
`(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) ELIGIBILITY- Grants may only be made under this subsection to a
community college that--
`(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 health programs of the Service or at
tribal 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) 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--
`(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) 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--
`(1) has already received a degree or diploma in such health profession;
and
`(2) provides clinical services on an Indian reservation, at a Service
facility, or at a tribal clinic.
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) PRIORITY- Priority shall be provided under this section to tribally
controlled colleges in service areas that meet the requirements of subsection
(b).
`(f) DEFINITIONS- In this section:
`(1) COMMUNITY COLLEGE- The term `community college' means--
`(A) a tribally controlled community college; or
`(B) a junior or community college.
`(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)).
`(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.
`SEC. 119. RETENTION BONUS.
`(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--
`(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 the Service, tribe, tribal
organization, or urban organization;
`(A) completed 3 years of employment with the Service; tribe, tribal
organization, or urban 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 the Service, Indian tribe, tribal
organization, 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) 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).
`(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--
`(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- 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.
`(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 degrees in nursing and public health.
`(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.
`SEC. 121. COMMUNITY HEALTH AIDE PROGRAM FOR ALASKA.
`(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--
`(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) ACTIVITIES- The Secretary, acting through the Community Health Aide
Program under subsection (a), 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 objective specified
in section 3(b);
`(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;
`(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.
`SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION.
`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.
`SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE DEMONSTRATION PROJECT.
`(a) PILOT PROGRAMS- The Secretary may, through area offices, fund pilot
programs for tribes and tribal organizations to address chronic shortages of
health professionals.
`(b) PURPOSE- It is the purpose of the health professions demonstration
project under this section to--
`(1) provide direct clinical and practical experience in a service area
to health professions students and residents from medical schools;
`(2) improve the quality of health care for Indians by assuring access
to qualified health care professionals; and
`(3) provide academic and scholarly opportunities for health
professionals serving Indian people by identifying and utilizing all
academic and scholarly resources of the region.
`(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.
`SEC. 124. SCHOLARSHIPS.
`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.
`SEC. 125. NATIONAL HEALTH SERVICE CORPS.
`(a) LIMITATIONS- The Secretary shall not--
`(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
`(2) withdraw the funding used to support such a member;
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.
`(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 sunder 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.
`(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.
`SEC. 126. SUBSTANCE ABUSE COUNSELOR EDUCATION DEMONSTRATION PROJECT.
`(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.
`(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.
`(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.
`(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.
`(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.
`(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.
`(g) DEFINITIONS- In this section:
`(1) EDUCATIONAL CURRICULUM- The term `educational curriculum' means 1
or more of the following:
`(A) Classroom education.
`(B) Clinical work experience.
`(C) Continuing education workshops.
`(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)).
`(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)).
`SEC. 127. MENTAL HEALTH TRAINING AND COMMUNITY EDUCATION.
`(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.
`(2) POSITIONS- The positions referred to in paragraph (1) are--
`(A) staff positions within the Bureau of Indian Affairs, including
existing positions, in the fields of--
`(i) elementary and secondary education;
`(ii) social services, family and child welfare;
`(iii) law enforcement and judicial services; and
`(iv) alcohol and substance abuse;
`(B) staff positions within the Service; and
`(C) staff positions similar to those 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.
`(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.
`(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.
`(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.
`(5) COMMUNITY EDUCATION-
`(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.
`(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.
`(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).
`(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').
`SEC. 128. AUTHORIZATION OF APPROPRIATIONS.
`There are authorized to be appropriated such sums as may be necessary for
each fiscal year through fiscal year 2012 to carry out this title.
`TITLE II--HEALTH SERVICES
`SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND.
`(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--
`(1) eliminating the deficiencies in the health status and resources of
all Indian tribes;
`(2) eliminating backlogs in the provision of health care services to
Indians;
`(3) meeting the health needs of Indians in an efficient and equitable
manner;
`(4) eliminating inequities in funding for both direct care and contract
health service programs; and -
`(5) augmenting the ability of the Service to meet the following health
service responsibilities with respect to those Indian tribes with the
highest levels of health status and resource deficiencies:
`(A) clinical care, including inpatient care, outpatient care
(including audiology, clinical eye and vision care), primary care,
secondary and tertiary care, and long term care;
`(B) preventive health, including mammography and other cancer
screening in accordance with section 207;
`(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;
`(I) community health representatives;
`(J) maintenance and repair; and
`(K) traditional health care practices.
`(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.
`(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.
`(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.
`(c) HEALTH STATUS AND RESOURCE DEFICIENCY- In this section:
`(1) DEFINITION- The term `health status and resource deficiency' means
the extent to which--
`(A) the health status objective set forth in section 3(2) is 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) 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.
`(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.
`(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.
`(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--
`(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;
`(3) the amount of funds necessary to eliminate the health status and
resource deficiencies of all Indian tribes served by the Service; and
`(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;
`(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 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.
`(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.
`(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.
`(h) 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.
`(1) IN GENERAL- There is hereby established an Indian Catastrophic
Health Emergency Fund (referred to in this section as the `CHEF') consisting
of--
`(A) the amounts deposited under subsection (d); and
`(B) any amounts appropriated to the CHEF under this Act.
`(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.
`(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.
`(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.
`(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.
`(b) REQUIREMENTS- The Secretary shall, through the negotiated rulemaking
process under title VIII, promulgate regulations consistent with the
provisions of this section--
`(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;
`(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--
`(A) for 1999, not less than $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 incurred by--
`(A) service units, Indian tribes, or tribal organizations, or
facilities of the Service; or
`(B) non-Service facilities or providers whenever otherwise authorized
by the Service;
in rendering treatment that exceeds threshold cost described in
paragraph (2);
`(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
`(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.
`(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.
`(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.
`SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION SERVICES.
`(a) FINDINGS- Congress finds that health promotion and disease prevention
activities will---
`(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
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).
`(c) DISEASE PREVENTION AND HEALTH PROMOTION- In this section:
`(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--
`(ii) high blood pressure;
`(iii) infectious agents;
`(v) occupational hazards and disabilities;
`(vi) sexually transmittable diseases; and
`(i) for the fluoridation of water; and
`(2) HEALTH PROMOTION- The term `health promotion' means fostering
social, economic, environmental, and personal factors conducive to health,
including--
`(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;
`(B) encouraging adequate and appropriate diet, exercise, and
sleep;
`(C) promoting education and work in conformity with physical and
mental capacity;
`(E) making available suitable housing, safe water, and sanitary
facilities;
`(F) improving the physical economic, cultural, psychological, and
social environment;
`(G) promoting adequate opportunity for spiritual, religious, and
traditional practices; and
`(H) adequate and appropriate programs including--
`(i) abuse prevention (mental and physical);
`(v) consumer health education;
`(vi) diet and nutrition;
`(vii) disease prevention (communicable, immunizations,
HIV/AIDS);
`(viii) environmental health;
`(ix) exercise and physical fitness;
`(x) fetal alcohol disorders;
`(xi) first aid and CPR education;
`(xii) human growth and development;
`(xiii) injury prevention and personal safety;
`(xiv) mental health (emotional, self-worth);
`(xv) personal health and wellness practices;
`(xvi) personal capacity building;
`(xvii) prenatal, pregnancy, and infant care;
`(xviii) psychological well being;
`(xix) reproductive health (family planning);
`(xx) safe and adequate water;
`(xxii) safe work environments;
`(xxv) sanitary facilities;
`(xxvi) tobacco use cessation and reduction;
`(xxvii) violence prevention; and
`(xxviii) 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).
`(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--
`(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 to meet such needs; and
`(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.
`SEC. 204. DIABETES PREVENTION, TREATMENT, AND CONTROL.
`(a) DETERMINATION- The Secretary, in consultation with Indian tribes and
tribal organizations, shall determine--
`(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
`(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.
`(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.
`(c) CONTINUED FUNDING- The Secretary shall continue to fund, through
fiscal year 2012, 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.
`(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.
`(e) OTHER ACTIVITIES- The Secretary shall, to the extent funding is
available--
`(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;
`(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
`(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.
`SEC. 205. SHARED SERVICES.
`(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.
`(b) REQUIREMENTS- 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 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 facility be
allocated proportionately between the Service and the tribe or tribal
organization; and
`(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).
`(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.
`(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.
`SEC. 206. HEALTH SERVICES RESEARCH.
`(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.
`(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.
`(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.
`(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.
`SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREENING.
`The Secretary, through the Service or through Indian tribes or tribal
organizations, shall provide for the following screening:
`(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.
`(2) Other cancer screening meeting national standards.
`SEC. 208. PATIENT TRAVEL COSTS.
`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:
`(1) Emergency air transportation and nonemergency air transportation
where ground transportation is infeasible.
`(2) Transportation by private vehicle, specially equipped vehicle and
ambulance.
`(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.
`(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.
`(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--
`(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;
`(B) evaluate existing delivery systems, data systems, and other
systems that impact the improvement of Indian health;
`(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;
`(D) make recommendations for the targeting of services needed by
tribal, urban, and other Indian communities;
`(E) make recommendations to improve health care delivery systems for
Indians and urban Indians;
`(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
`(G) provide disease surveillance and assist Indian tribes, tribal
organizations, and urban Indian organizations to promote public
health.
`(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.
`(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.
`SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION PROGRAMS.
`(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.
`(b) USE OF FUNDS- Funds awarded under this section may be used to--
`(1) develop and implement health education curricula both for regular
school programs and after school programs;
`(2) train teachers in comprehensive school health education
curricula;
`(3) integrate school-based, community-based, and other public and
private health promotion efforts;
`(4) encourage healthy, tobacco-free school environments;
`(5) coordinate school-based health programs with existing services and
programs available in the community;
`(6) develop school programs on nutrition education, personal health,
oral health, and fitness;
`(7) develop mental health wellness programs;
`(8) develop chronic disease prevention programs;
`(9) develop substance abuse prevention programs;
`(10) develop injury prevention and safety education programs;
`(11) develop activities for the prevention and control of communicable
diseases;
`(12) develop community and environmental health education programs that
include traditional health care practitioners;
`(13) carry out violence prevention activities; and
`(14) carry out activities relating to such other health issues as are
appropriate.
`(c) TECHNICAL ASSISTANCE- The Secretary shall, upon request, provide
technical assistance to Indian tribes, tribal organization 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- 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.
`(e) COMPREHENSIVE SCHOOL HEALTH EDUCATION PROGRAM-
`(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.
`(2) REQUIREMENTS- The program developed under paragraph (1) shall
include--
`(A) school programs on nutrition education, personal health, oral
health, and fitness;
`(B) mental health wellness programs;
`(C) chronic disease prevention programs;
`(D) substance abuse prevention programs;
`(E) injury prevention and safety education programs; and
`(F) activities for the prevention and control of communicable
diseases.
`(3) TRAINING AND COORDINATION- 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) 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.
`(1) IN GENERAL- 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) LIMITATION- Funds made available under this section may not be used
to provide services described in section 707(c).
`(c) REQUIREMENTS- 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- 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.
`SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF COMMUNICABLE AND
INFECTIOUS DISEASES.
`(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--
`(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;
`(2) public information and education programs for the prevention,
control, and elimination of communicable and infectious diseases; and
`(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.
`(b) REQUIREMENT OF APPLICATION- The Secretary may provide funds under
subsection (a) only if an application or proposal for such funds is
submitted.
`(c) TECHNICAL ASSISTANCE AND REPORT- In carrying out this section, the
Secretary--
`(1) may, at the request of an Indian tribe or tribal organization,
provide technical assistance; and
`(2) shall prepare and submit, 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.
`SEC. 213. AUTHORITY FOR PROVISION OF OTHER SERVICES.
`(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--
`(1) hospice care and assisted living;
`(2) long-term health care;
`(3) home- and community-based services;
`(4) public health functions; and
`(5) traditional health care practices.
`(b) 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.
`(c) DEFINITIONS- In this section:
`(1) HOME- AND COMMUNITY-BASED SERVICES- The term `home- and
community-based services' means 1 or more of the following:
`(A) Homemaker/home health aide 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) Training for family members.
`(G) Such other home- and community-based services as the Secretary or
a tribe or tribal organization may approve.
`(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.
`(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.
`SEC. 214. INDIAN WOMEN'S HEALTH CARE.
`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.
`SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH HAZARDS.
`(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--
`(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 Indian reservations and
communities including the cumulative effect of such development over time on
health;
`(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;
`(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
`(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.
`(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--
`(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 TO CONGRESS-
`(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).
`(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.
`(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):
`(A) The Secretary of Energy.
`(B) The Administrator 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.
`(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.
`(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.
`(e) PROVISION OF APPROPRIATE MEDICAL CARE- 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 a
Service facility; 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 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.
`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, 2012,
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) 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).
`SEC. 217. CALIFORNIA CONTRACT HEALTH SERVICES DEMONSTRATION PROGRAM.
`(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.
`(b) REIMBURSEMENT OF BOARD-
`(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.
`(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.
`(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.
`(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.
`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 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.
`SEC. 219. CONTRACT HEALTH SERVICES FOR THE TRENTON SERVICE AREA.
`(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.
`(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.
`SEC. 220. PROGRAMS OPERATED BY INDIAN TRIBES AND TRIBAL ORGANIZATIONS.
`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.
`SEC. 221. LICENSING.
`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.
`SEC. 222. AUTHORIZATION FOR 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) 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.
`(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.
`(c) PAYMENT- 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 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.
`(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.
`SEC. 225. AUTHORIZATION OF APPROPRIATIONS.
`There are authorized to be appropriated such sums as may be necessary for
each fiscal year through fiscal year 2012 to carry out this title.
`TITLE III--FACILITIES
`SEC. 301. CONSULTATION, CONSTRUCTION AND RENOVATION OF FACILITIES;
REPORTS.
`(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--
`(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, 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.
`(b) CLOSURE OF FACILITIES-
`(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--
`(A) the accessibility of alternative health care resources for the
population served by such hospital or facility;
`(B) the cost effectiveness of such closure;
`(C) the quality of health care to be provided to the population
served by such hospital or 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 hospital or
facility concerning such closure;
`(F) the level of utilization of such hospital or facility by all
eligible Indians; and
`(G) the distance between such hospital or facility and the nearest
operating Service hospital.
`(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.
`(1) ESTABLISHMENT- The Secretary shall establish a health care facility
priority system, that shall--
`(A) be developed with Indian tribes and tribal organizations through
negotiated rulemaking under section 802;
`(B) give the needs of Indian tribes' the highest priority;
and
`(C) at a minimum, include the lists required in paragraph (2)(B) and
the methodology required in paragraph (2)(E);
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 2000, 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.
`(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--
`(A) a description of the health care facility priority system of the
Service, as established under paragraph (1);
`(B) health care facility lists, including--
`(i) the total health care facility planning, design, construction
and renovation needs for Indians;
`(ii) the 10 top-priority inpatient care facilities;
`(iii) the 10 top-priority outpatient care facilities;
`(iv) the 10 top-priority specialized care facilities (such as
long-term care and alcohol and drug abuse treatment); and
`(v) any staff quarters associated with such prioritized
facilities;
`(C) the justification for the order of priority among
facilities;
`(D) the projected cost of the projects involved; and
`(E) the methodology adopted by the Service in establishing priorities
under its health care facility priority system.
`(3) CONSULTATION- 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 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
`(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.
`(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.
`(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.
`(d) REVIEW OF NEED FOR FACILITIES-
`(1) REPORT- Beginning in 2001, 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 .
`(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.
`(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.
`(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.-
`(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.
`(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.
`(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.
`SEC. 302. SAFE WATER AND SANITARY WASTE DISPOSAL FACILITIES.
`(a) FINDINGS- Congress finds and declares that--
`(1) the provision of safe water supply facilities and sanitary sewage
and solid waste disposal 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
such 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 such facilities and other preventive health
measures;
`(4) many Indian homes and communities still lack safe water supply
facilities and sanitary sewage and solid waste disposal facilities;
and
`(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.
`(b) PROVISION OF FACILITIES AND SERVICES-
`(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).
`(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)--
`(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;
`(B) ongoing technical assistance and training in the management of
utility organizations which operate and maintain sanitation facilities;
and
`(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.
`(3) PROVISIONS RELATING TO FUNDING- Notwithstanding any other provision
of law--
`(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;
`(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);
`(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;
`(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;
`(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;
`(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;
`(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;
`(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
`(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.
`(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.
`(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.
`(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.
`(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.
`(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--
`(1) any funds appropriated pursuant to this section; and
`(2) any funds appropriated for the purpose of providing water supply,
sewage disposal, or solid waste facilities;
on an equal basis with programs that are administered directly by the
Service.
`(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--
`(A) the current Indian sanitation facility priority system of the
Service;
`(B) the methodology for determining sanitation deficiencies;
`(C) the level of initial and final sanitation deficiency for each
type sanitation facility for each project of each Indian tribe or
community; and
`(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).
`(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.
`(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.
`(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:
`(A) A level I deficiency is a sanitation facility serving and
individual or community--
`(i) which complies with all applicable water supply, pollution
control and solid waste disposal laws; and
`(ii) in which the deficiencies relate to routine replacement,
repair, or maintenance needs.
`(B) A level II deficiency is a sanitation facility serving and
individual or community--
`(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;
`(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
`(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.
`(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.
`(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.
`(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.
`(i) DEFINITIONS- In this section:
`(1) FACILITY- The terms `facility' or `facilities' shall have the same
meaning as the terms `system' or `systems' unless the context requires
otherwise.
`(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.
`SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS.
`(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--
`(1) ownership and control by Indians;
`(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) 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.
`SEC. 304. SOBOBA SANITATION FACILITIES.
`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).
`SEC. 305. EXPENDITURE OF NONSERVICE FUNDS FOR RENOVATION.
`(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--
`(A) any plans or designs for such expansion, renovation or
modernization; and
`(B) any expansion, renovation or modernization for which funds
appropriated under any Federal law were lawfully expended;
but only if the requirements of subsection (b) are met.
`(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.
`(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).
`(b) REQUIREMENTS- The requirements of this subsection are met with
respect to any expansion, renovation or modernization if--
`(1) the 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.
`(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.
`SEC. 306. FUNDING FOR THE CONSTRUCTION, EXPANSION, AND MODERNIZATION OF
SMALL AMBULATORY CARE FACILITIES.
`(a) AVAILABILITY OF FUNDING-
`(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.
`(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.
`(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--
`(A) located apart from a hospital;
`(B) not funded under section 301 or section 307; and
`(C) which, upon completion of such construction, expansion, or
modernization will--
`(i) have a total capacity appropriate to its projected service
population;
`(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
`(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).
`(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.
`(c) APPLICATION AND PRIORITY-
`(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--
`(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 funds under this section, the Secretary shall
give priority to tribes and tribal organizations that demonstrate--
`A) a need for increased ambulatory care services; and
`(B) insufficient capacity to deliver such services.
`(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.
`(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.
`SEC. 307. INDIAN HEALTH CARE DELIVERY DEMONSTRATION PROJECT.
`(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.
`(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.
`(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:
`(A) There is a need for a new facility or program or the
reorientation of an existing facility or program.
`(B) A significant number of Indians, including those with low health
status, will be served by the project.
`(C) The project has the potential to address the health needs of
Indians in an innovative manner.
`(D) The project has the potential to deliver services in an efficient
and effective manner.
`(E) The project is economically viable.
`(F) The Indian tribe or tribal organization has the administrative and
financial capability to administer the project.
`(G) The project is integrated with providers of related health and
social services and is coordinated with, and avoids duplication of,
existing services.
`(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).
`(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):
`(A) Cass Lake, Minnesota.
`(D) Mescalero, New Mexico.
`(H) Winnebago, Nebraska.
`(I) Ft. Yuma, California
`(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.
`(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.
`(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.
`(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.
`SEC. 308. LAND TRANSFER.
`(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.
`(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.
`SEC. 309. LEASES.
`(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.
`(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--
`(2) a leasehold interest in; or
`(3) a beneficial interest in (where title is held by the United States
in trust for the benefit of a tribe);
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.
`SEC. 310. LOANS, LOAN GUARANTEES AND LOAN REPAYMENT.
`(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).
`(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:
`(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).
`(2) The cumulative total of the principal of direct loans and loan
guarantees, respectively, outstanding at any one time shall not exceed such
limitations as may be specified in appropriation Acts.
`(3) In the discretion of the Secretary, the program under this section
may be administered by the Service or the Health Resources and Services
Administration (which shall be specified by regulation).
`(4) The Secretary may make or guarantee a loan with a term of the
useful estimated life of the facility, or 25 years, whichever is less.
`(5) The Secretary may allocate up to 100 percent of the funds available
for loans or loan guarantees in any year for the purpose of planning and
applying for a loan or loan guarantee.
`(6) The Secretary may accept an assignment of the revenue of an Indian
tribe or tribal organization as security for any direct loan or loan
guarantee under this section.
`(7) In the planning and design of health facilities under this section,
users eligible under section
807(b) may be included in any projection of patient population.
`(8) The Secretary shall not collect loan application, processing or
other similar fees from Indian tribes or tribal organizations applying for
direct loans or loan guarantees under this section.
`(9) Service funds authorized under loans or loan guarantees under this
section may be used in matching other Federal funds.
`(1) IN GENERAL- The HCFLF shall consist of--
`(A) such sums as may be initially appropriated to the HCFLF and as
may be subsequently appropriated under paragraph (2);
`(B) such amounts as may be collected from borrowers; and
`(C) all interest earned on amounts in the HCFLF.
`(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.
`(3) AVAILABILITY OF FUNDS- Amounts appropriated, collected or earned
relative to the HCFLF shall remain available until expended.
`(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.
`(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.
`(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.
`SEC. 311. TRIBAL LEASING.
`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.
`SEC. 312. INDIAN HEALTH SERVICE/TRIBAL FACILITIES JOINT VENTURE
PROGRAM.
`(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.
`(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.
`(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.
`(1) IN GENERAL- The Secretary shall enter into an arrangement under
subsection (a)(1) with an Indian tribe or tribal organization only
if--
`(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
`(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.
`(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.
`(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.
`(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.
`(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.
`SEC. 313. LOCATION OF FACILITIES.
`(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.
`(b) DEFINITION- In this section, the term `Indian lands' means--
`(1) all lands within the exterior boundaries of any Indian
reservation;
`(2) any lands title to which is held in trust by the United States for
the benefit of any Indian tribe or individual Indian, or held by any Indian
tribe or individual Indian subject to restriction by the United States
against alienation and over which an Indian tribe exercises governmental
power; and
`(3) all lands in Alaska owned by any Alaska Native village, or any
village or regional corporation under the Alaska Native Claims Settlement
Act, or any land allotted to any Alaska Native.
`SEC. 314. 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
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.
`(b) MAINTENANCE OF NEWLY CONSTRUCTED SPACE-
`(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.
`(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.
`(c) CONSTRUCTION OF REPLACEMENT FACILITIES-
`(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.
`(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.
`SEC. 315. TRIBAL MANAGEMENT OF FEDERALLY-OWNED QUARTERS.
`(a) ESTABLISHMENT OF RENTAL RATES-
`(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.
`(2) OBJECTIVES- In establishing rental rates under paragraph (1), an
Indian tribe or tribal organization shall attempt to achieve the following
objectives:
`(A) The rental rates should be based on the reasonable value of the
quarters to the occupants thereof.
`(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.
`(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.
`(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.
`(b) COLLECTION OF RENTS-
`(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:
`(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.
`(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.
`(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.
`(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.
`(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--
`(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
`(B) such other date as may be mutually agreed upon by the Secretary
and the Indian tribe or tribal organization.
`(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.-
`SEC. 316. APPLICABILITY OF BUY AMERICAN REQUIREMENT.
`(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.
`(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.
(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.).
`SEC. 317. OTHER FUNDING FOR FACILITIES.
`Notwithstanding any other provision of law--
`(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;
`(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;
`(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
`(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.
`SEC. 318. AUTHORIZATION OF APPROPRIATIONS.
`There is authorized to be appropriated such sums as may be necessary for
each fiscal year through fiscal year 2012 to carry out this title.
`TITLE IV--ACCESS TO HEALTH SERVICES
`SEC. 401. TREATMENT OF PAYMENTS UNDER MEDICARE PROGRAM.
`(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.
`(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.
`(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.
`(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.
`SEC. 402. TREATMENT OF PAYMENTS UNDER MEDICAID PROGRAM.
`(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.
`(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.
`(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.
`(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.
`SEC. 403. REPORT.
`(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.
`(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.
`SEC. 404. GRANTS TO AND FUNDING AGREEMENTS WITH THE SERVICE, INDIAN TRIBES
OR TRIBAL ORGANIZATIONS, AND URBAN INDIAN ORGANIZATIONS.
`(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--
`(1) enroll under sections 1818, 1836, and 1837 of the Social Security
Act;
`(2) pay premiums for health insurance coverage; and
`(3) apply for medical assistance provided pursuant to titles XIX and
XXI of the Social Security Act.
`(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--
`(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;
`(2) assist individual Indians in becoming familiar with and utilizing
such benefits and assistance;
`(3) provide transportation to such individual Indians to the
appropriate offices for enrollment or applications for such benefits and
assistance;
`(4) develop and implement--
`(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
`(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.
`(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.
`(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--
`(A) enroll under sections 1818, 1836, and 1837 of the Social Security
Act;
`(B) pay premiums on behalf of such individuals for coverage under
title XVIII of such Act; and
`(C) apply for medical assistance provided under title XIX of such Act
and for child health assistance under title XXI of such Act.
`(2) REQUIREMENTS- The Secretary shall include in the grants or
contracts made or entered into under paragraph (1) requirements that
are--
`(A) consistent with the conditions imposed by the Secretary under
subsection (b);
`(B) appropriate to urban Indian organizations and urban Indians;
and
`(C) necessary to carry out the purposes of this section.
`SEC. 405. DIRECT BILLING AND REIMBURSEMENT OF MEDICARE, MEDICAID, AND OTHER
THIRD PARTY PAYORS.
`(1) IN GENERAL- An Indian tribe or tribal organization may directly
bill for, and receive payment for, health care services provided by such
tribe or organization for which payment is made under title XVIII of the
Social Security Act, under a State plan for medical assistance approved
under title XIX of such Act, under a State child health plan approved under
title XXI of such Act, or from any other third party payor.
`(2) APPLICATION OF 100 PERCENT FMAP- The third sentence of section
1905(b) of the Social Security Act and section 2101(c) of such Act shall
apply for purposes of reimbursement under the medicaid or State children's
health insurance program for health care services directly billed under the
program established under this section.
`(b) DIRECT REIMBURSEMENT-
`(1) USE OF FUNDS- Each Indian tribe or tribal organization exercising
the option described in subsection (a) of this section shall be reimbursed
directly under the medicare, medicaid, and State children's health insurance
programs for services furnished, without regard to the provisions of
sections 1880(c) of the Social Security Act and section 402(a) of this Act,
but all funds so reimbursed shall first be used by the health program for
the purpose of making any improvements in the facility or health programs
that may be necessary to achieve or maintain compliance with the conditions
and requirements applicable generally to such health services under the
medicare, medicaid, or State children's health insurance program. Any funds
so reimbursed which are in excess of the amount necessary to achieve or
maintain such conditions or requirements shall be used to provide additional
health services, improvements in its health care facilities, or otherwise to
achieve the health objectives provided for under section 3 of this
Act.
`(2) AUDITS- The amounts paid to the health programs exercising the
option described in subsection (a) shall be subject to all auditing
requirements applicable to programs administered directly by the Service and
to facilities participating in the medicare, medicaid, and State children's
health insurance programs.
`(3) NO PAYMENTS FROM SPECIAL FUNDS- Notwithstanding section 401(c) or
section 402(a), no payment may be made out of the special fund described in
section 401(c) or 402(a), for the benefit of any health program exercising
the option described in subsection (a) of this section during the period of
such participation.
`(c) EXAMINATION AND IMPLEMENTATION OF CHANGES- 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 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 the medicaid or State children's health insurance
program.
`(d) 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 an Indian tribe or tribal organization may
retrocede a contracted program to the Secretary under authority of the Indian
Self-Determination and Education Assistance Act. 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.
`(e) 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.
`SEC. 406. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS OF HEALTH
SERVICES.
`(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--
`(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 expenses.
`(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.
`(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--
`(1) workers' compensation laws; or
`(2) a no-fault automobile accident insurance plan or program.
`(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).
`(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).
`(f) METHODS OF ENFORCEMENT-
`(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--
`(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 urban Indian
organization; or
`(ii) by any representative or heirs of such individual;
or
`(B) instituting a civil action.
`(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.
`(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.
`(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.
`(i) RIGHT OF ACTION AGAINST INSURERS AND EMPLOYEE BENEFIT PLANS-
`(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.
`(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.
`(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.
`SEC. 407. CREDITING OF REIMBURSEMENTS.
`(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.
`(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).
`SEC. 408. PURCHASING HEALTH CARE COVERAGE.
`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--
`(1) a tribally owned and operated managed care plan;
`(2) a State or locally-authorized or licensed managed care plan;
or
`(3) a health insurance provider.
`SEC. 409. INDIAN HEALTH SERVICE, DEPARTMENT OF VETERAN'S AFFAIRS, AND OTHER
FEDERAL AGENCY HEALTH FACILITIES AND SERVICES SHARING.
`(a) EXAMINATION OF FEASIBILITY OF ARRANGEMENTS-
`(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.
`(2) SUBMISSION OF REPORT- Not later than September 30, 2000, the
Secretary shall submit the report required under paragraph (1) to
Congress.
`(3) CONSULTATION REQUIRED- The Secretary may not finalize any
arrangement described in paragraph (1) without first consulting with the
affected Indian tribes.
`(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;
`(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 Veterans' Administration;
`(4) the quality of health care services provided to any veteran by the
Veteran's Administration;
`(5) the eligibility of any Indian to receive health services through
the Service; or
`(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.
`(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.
`SEC. 410. PAYOR OF LAST RESORT.
`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.
`SEC. 411. RIGHT TO RECOVER FROM FEDERAL HEALTH CARE PROGRAMS.
`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.
`SEC. 412. TUBA CITY DEMONSTRATION PROJECT.
`(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--
`(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
`(2) purchase insurance to limit the financial risks under the
project.
`(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.
`SEC. 413. ACCESS TO FEDERAL INSURANCE.
`Notwithstanding the provisions of title 5, United States Code, Executive
Order, or administrative regulation, an Indian tribe or tribal organization
carrying out programs under the Indian Self-Determination and Education
Assistance Act or an urban Indian organization carrying out programs under
title V of this Act shall be entitled to purchase coverage, rights and
benefits for the employees of such Indian tribe or tribal organization, or
urban Indian organization, under chapter 89 of title 5, United States Code,
and chapter 87 of such title if necessary employee deductions and agency
contributions in payment for the coverage, rights, and benefits for the period
of employment with such Indian tribe or tribal organization, or urban Indian
organization, are currently deposited in the applicable Employee's Fund under
such title.
`SEC. 414. CONSULTATION AND RULEMAKING.
`(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--
`(1) identify the impact such policy or regulation may have on the
Service, Indian tribes or tribal organizations, and urban Indian
organizations;
`(2) provide to the Service, Indian tribes or tribal organizations, and
urban Indian organizations the information described in paragraph (1);
`(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.
`(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.
`SEC. 415. LIMITATIONS ON CHARGES.
`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--
`(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
`(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.
`SEC. 416. LIMITATION ON SECRETARY'S WAIVER AUTHORITY.
`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.
`SEC. 417. WAIVER OF MEDICARE AND MEDICAID SANCTIONS.
`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.
`SEC. 418. MEANING OF `REMUNERATION' FOR PURPOSES OF SAFE HARBOR PROVISIONS;
ANTITRUST IMMUNITY.
`(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--
`(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;
`(2) any such Indian tribe or tribal organization or urban Indian
organization and the Service;
`(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
2000); or
`(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;
provided the exchange arises from or relates to such health programs.
`(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.
`SEC. 419. CO-INSURANCE, CO-PAYMENTS, DEDUCTIBLES AND PREMIUMS.
`(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.
`(b) EXEMPTION FROM PREMIUMS-
`(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 of XXI of such Act.
`(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.
`SEC. 420. INCLUSION OF INCOME AND RESOURCES FOR PURPOSES OF MEDICALLY NEEDY
MEDICAID ELIGIBILITY.
`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.
`SEC. 421. ESTATE RECOVERY PROVISIONS.
`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:
`(1) Income derived from rents, leases, or royalties of property held in
trust for individuals by the Federal Government.
`(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.
`(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.
`(4) Property that has unique religious or cultural significance or that
supports subsistence or traditional life style according to applicable
tribal law or custom.
`SEC. 422. MEDICAL CHILD SUPPORT.
`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.
`SEC. 423. PROVISIONS RELATING TO MANAGED CARE.
`(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.
`(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.
`(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.
`(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.
`(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.
`(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.
`(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.
`(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.
`(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.
`SEC. 424. NAVAJO NATION MEDICAID AGENCY.
`(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.
`(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.
`(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.
`(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.
`(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.
`(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.
`(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.
`SEC. 425. INDIAN ADVISORY COMMITTEES.
`(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.
`(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.
`SEC. 426. AUTHORIZATION OF APPROPRIATIONS.
There is authorized to be appropriated such sums as may be necessary for
each of fiscal years 2000 through 2012 to carry out this title.'.
`TITLE V--HEALTH SERVICES FOR URBAN INDIANS
`SEC. 501. PURPOSE.
`The purpose of this title is to establish programs in urban centers to
make health services more accessible and available to urban Indians.
`SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN INDIAN ORGANIZATIONS.
`Under 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.
`SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION OF HEALTH CARE AND
REFERRAL SERVICES.
`(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--
`(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) 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).
`(d) IMMUNIZATION SERVICES-
`(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.
`(3) DEFINITION- In this section, the term `immunization services' means
services to provide without charge immunizations against vaccine-preventable
diseases.
`(e) MENTAL HEALTH SERVICES-
`(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.
`(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.
`(3) USE OF FUNDS- Grants may be made under this subsection--
`(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; and
`(D) to develop innovative behavioral health service delivery models
which incorporate Indian cultural support systems and resources.
`(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.
`(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.
`(3) USE OF FUNDS- Grants may be made under this subsection--
`(A) to prepare assessments required under paragraph (2);
`(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
`(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- 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) 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.
`SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINATION OF UNMET HEALTH CARE
NEEDS.
`(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.
`(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.
`(b) REQUIREMENTS- Any contract entered into, or grant made, by the
Secretary under this section shall include requirements that--
`(1) the urban Indian organization successfully undertake 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.
`(c) LIMITATION ON RENEWAL- The Secretary may not renew any contract
entered into, or grant made, under this section.
`SEC. 505. EVALUATIONS; RENEWALS.
`(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.
`(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 of 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--
`(1) conduct, through the Service, an annual onsite evaluation of the
organization; or
`(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.
`(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.
`(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.
`(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).
`SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS.
`(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.).
`(b) PAYMENTS- 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 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
`(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.
`(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.
`(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.
`(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.
`SEC. 507. REPORTS AND RECORDS.
`(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--
`(1) in the case of a contract or grant under section 503, information
gathered pursuant to paragraph (5) of subsection (a) of such section;
`(2) information on activities conducted by the organization pursuant to
the contract or grant;
`(3) an accounting of the amounts and purposes for which Federal funds
were expended; and
`(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.
`(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.
`(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--
`(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 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 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:
`(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 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.
`(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 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) URBAN INDIAN HEALTH CARE FACILITIES REVOLVING LOAN 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. 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 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.
`(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.
`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- 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.
`(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.
`(c) CRITERIA- The Secretary shall establish criteria for the grants made
under subsection (a), including criteria relating to the--
`(1) 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, which standards shall be negotiated and
agreed to between the Secretary and the grantee on a grant-by-grant basis;
and
`(4) identification of need for services.
The Secretary shall develop a methodology for allocating grants made
pursuant to this section based on such criteria.
`(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).
`SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION PROJECTS.
`(a) OKLAHOMA CITY CLINIC-
`(1) IN GENERAL- Notwithstanding any other provision of law, the
Oklahoma City Clinic demonstration project shall be treated as a service
unit in the allocation of resources and coordination of care and shall not
be subject to the provisions of the Indian Self-Determination and Education
Assistance Act for the term of such projects. The Secretary shall provide
assistance to such projects in the development of resources and equipment
and facility needs.
`(2) 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 project specified in paragraph (1).
`(b) TULSA CLINIC- Notwithstanding any other provision of law, the Tulsa
Clinic demonstration project shall become a permanent program within the
Service's direct care program and continue to be treated as a service unit 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.
`SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS.
`(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, 2001, 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.
`(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 NIAAA and subsequently transferred to the
Service are eligible for grants or contracts under this section.
`(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.
`SEC. 514. CONSULTATION WITH URBAN INDIAN ORGANIZATIONS.
`(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.
`(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.
`SEC. 515. FEDERAL TORT CLAIMS ACT COVERAGE.
`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.
`SEC. 516. URBAN YOUTH TREATMENT CENTER DEMONSTRATION.
`(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.
`(b) STATES- A State described in this subsection is a State in which--
`(1) there reside urban Indian youth with a need for alcohol and
substance abuse treatment services in a residential setting; and
`(2) there is a significant shortage of culturally competent residential
treatment services for urban Indian youth.
`SEC. 517. USE OF FEDERAL GOVERNMENT FACILITIES AND SOURCES OF SUPPLY.
`(a) 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.
`(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.
`(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.
`(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.
`(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.
`SEC. 518. GRANTS FOR DIABETES PREVENTION, TREATMENT AND CONTROL.
`(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.
`(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.
`(c) CRITERIA- The Secretary shall establish criteria for the awarding of
grants made under subsection (a) relating to--
`(1) the size and location of the urban Indian population to be
served;
`(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;
`(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;
`(4) the capability of the urban Indian organization to adequately
perform the activities required under the grant; and
`(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.
`(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).
`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 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.
`SEC. 520. REGULATIONS.
`(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.
`(1) IN GENERAL- The Secretary may promulgate regulations to implement
the provisions of this title.
`(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.
`(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.
`(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.
`(d) ADAPTION OF PROCEDURES- The Secretary shall adapt the negotiated
rulemaking procedures to the unique context of this Act.
`SEC. 521. AUTHORIZATION OF APPROPRIATIONS.
`There is authorized to be appropriated such sums as may be necessary for
each fiscal year through fiscal year 2012 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.
`(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 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.
`(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) FUNCTIONS AND DUTIES- The Secretary shall carry out through the
Assistant Secretary of the Service--
`(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;
`(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;
`(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--
`(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 Act (25 U.S.C. 450f, et seq.);
and
`(4) all scholarship and loan functions carried out under title I.
`(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).
`SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM.
`(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.
`(2) REQUIREMENTS OF SYSTEM- The information system established under
paragraph (1) shall include--
`(A) a financial management system;
`(B) a patient care information system;
`(C) a privacy component that protects the privacy of patient
information;
`(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 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--
`(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
`(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 2012 to carry out this title.
`TITLE VII--BEHAVIORAL HEALTH PROGRAMS
`SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREATMENT SERVICES.
`(a) PURPOSES- It is the purpose of this section to--
`(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;
`(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;
`(3) assist Indian tribes to identify services and resources available
to address mental illness and dysfunctional and self-destructive
behavior;
`(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;
`(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
`(6) modify or supplement existing programs and authorities in the areas
identified in paragraph (2).
`(b) BEHAVIORAL HEALTH PLANNING-
`(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--
`(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--
`(i) the number of Indians served who are directly or indirectly
affected by such illness or behavior; and
`(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); and
`(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 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.
`(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.
`(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--
`(1) a comprehensive continuum of behavioral health care that provides
for--
`(A) community based prevention, intervention, outpatient and
behavioral health aftercare;
`(B) detoxification (social and medical);
`(C) acute hospitalization;
`(D) intensive outpatient or day treatment;
`(E) residential treatment;
`(F) transitional living for those needing a temporary stable living
environment that is supportive of treatment or recovery goals;
`(H) intensive case management; and
`(I) traditional health care practices; and
`(2) behavioral health services for particular populations,
including--
`(A) for persons from birth through age 17, child behavioral health
services, that include--
`(i) pre-school and school age fetal alcohol disorder services,
including assessment and behavioral intervention);
`(ii) mental health or substance abuse services (emotional, organic,
alcohol, drug, inhalant and tobacco);
`(iii) services for co-occurring disorders (multiple
diagnosis);
`(iv) prevention services that are focused on individuals ages 5
years through 10 years (alcohol, drug, inhalant and
tobacco);
`(v) early intervention, treatment and aftercare services that are
focused on individuals ages 11 years through 17 years;
`(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);
`(vii) co-morbidity services;
`(B) for persons ages 18 years through 55 years, adult behavioral
health services that include--
`(i) early intervention, treatment and aftercare
services;
`(ii) mental health and substance abuse services (emotional,
alcohol, drug, inhalant and tobacco);
`(iii) services for co-occurring disorders (dual diagnosis) and
co-morbidity;
`(iv) healthy choices and life style services (related to parenting,
partners, domestic violence, sexual abuse, suicide, obesity, and other
risk related behavior);
`(v) female specific treatment services for--
`(I) women at risk of giving birth to a child with a fetal alcohol
disorder;
`(II) substance abuse requiring gender specific
services;
`(III) sexual assault and domestic violence; and
`(IV) healthy choices and life style (parenting, partners,
obesity, suicide and other related behavioral risk);
and
`(vi) male specific treatment services for--
`(I) substance abuse requiring gender specific
services;
`(II) sexual assault and domestic violence; and
`(III) healthy choices and life style (parenting, partners,
obesity, suicide and other risk related behavior);
`(C) family behavioral health services, including--
`(i) early intervention, treatment and aftercare for affected
families;
`(ii) treatment for sexual assault and domestic violence;
and
`(iii) healthy choices and life style (related to parenting,
partners, domestic violence and other abuse issues);
`(D) for persons age 56 years and older, elder behavioral health
services including--
`(i) early intervention, treatment and aftercare services that
include--
`(I) mental health and substance abuse services (emotional,
alcohol, drug, inhalant and tobacco);
`(II) services for co-occurring disorders (dual diagnosis) and
co-morbidity; and
`(III) healthy choices and life style services (managing
conditions related to aging);
`(ii) elder women specific services that include--
`(I) treatment for substance abuse requiring gender specific
services and
`(II) treatment for sexual assault, domestic violence and
neglect;
`(iii) elder men specific services that include--
`(I) treatment for substance abuse requiring gender specific
services; and
`(II) treatment for sexual assault, domestic violence and neglect;
and
`(iv) services for dementia regardless of cause.
`(d) COMMUNITY BEHAVIORAL HEALTH PLAN-
`(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.
`(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.
`(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.
`(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.
`(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.
`SEC. 702. MEMORANDUM OF AGREEMENT WITH THE DEPARTMENT OF THE INTERIOR.
`(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--
`(1) the scope and nature of mental illness and dysfunctional and
self-destructive behavior, including child abuse and family violence, among
Indians;
`(2) the existing Federal, tribal, State, local, and private services,
resources, and programs available to provide mental health services for
Indians;
`(3) the unmet need for additional services, resources, and programs
necessary to meet the needs identified pursuant to paragraph (1);
`(4)(A) the right of Indians, as citizens of the United States and of
the States in which they reside, to have access to mental health services to
which all citizens have access;
`(B) the right of Indians to participate in, and receive the benefit of,
such services; and
`(C) the actions necessary to protect the exercise of such right;
`(5) the responsibilities of the Bureau of Indian Affairs and the
Service, including mental health identification, prevention, education,
referral, and treatment services (including services through
multidisciplinary resource teams), at the central, area, and agency and
service unit levels to address the problems identified in paragraph
(1);
`(6) a strategy for the comprehensive coordination of the mental health
services provided by the Bureau of Indian Affairs and the Service to meet
the needs identified pursuant to paragraph (1), including--
`(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
`(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;
`(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
`(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.
`(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--
`(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;
`(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 and the Secretary of the Interior shall,
in developing the memorandum of agreement under subsection (a), consult with
and solicit the comments of--
`(1) Indian tribes and tribal organizations;
`(3) urban Indian organizations and other Indian organizations;
`(4) behavioral health service providers.
`(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.
`SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PREVENTION AND TREATMENT
PROGRAM.
`(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 traditional health care practices, which shall
include--
`(A) prevention, through educational intervention, in Indian
communities;
`(B) acute detoxification or psychiatric hospitalization and treatment
(residential and intensive outpatient);
`(C) community-based rehabilitation and aftercare;
`(D) community education and involvement, including extensive training
of health care, educational, and community-based personnel; and
`(E) specialized residential treatment programs for high risk
populations including pregnant and post partum women and their
children.
`(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.
`(b) CONTRACT HEALTH SERVICES-
`(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).
`(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) 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.
`(c) SUPERVISION AND EVALUATION- The Secretary shall supervise and
evaluate the mental health technicians in the training program under this
section.
`(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.-
`SEC. 705. LICENSING REQUIREMENT FOR MENTAL HEALTH CARE WORKERS.
`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--
`(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;
`(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
`(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.
`SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.
`(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.
`(b) USE OF FUNDS- Funding provided 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 amounts appropriated
to carry out this section shall be used to make grants to urban Indian
organizations funded under title V.
`SEC. 707. INDIAN YOUTH PROGRAM.
`(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.
`(b) ALCOHOL AND SUBSTANCE ABUSE TREATMENT CENTERS OR FACILITIES-
`(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.
`(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.
`(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).
`(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.
`(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;
`(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));
`(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
`(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.
`(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.
`(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) pre-treatment assistance;
`(B) inpatient, outpatient, and after-care services;
`(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; and
`(D) to make renovations and hire appropriate staff to convert
existing hospital beds into adolescent psychiatric units; and
`(E) intensive home and community based services.
`(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.
`(d) FEDERALLY OWNED STRUCTURES-
`(1) IN GENERAL- The Secretary, acting through the Service, shall, in
consultation with Indian tribes and tribal organizations--
`(A) identify and use, where appropriate, federally owned structures
suitable for local residential or regional behavioral health treatment for
Indian youth; 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 youth.
`(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, 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.
`(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.
`(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.
`(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.
`SEC. 708. INPATIENT AND COMMUNITY-BASED MENTAL HEALTH FACILITIES DESIGN,
CONSTRUCTION AND STAFFING ASSESSMENT. --
`(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.
`(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.
`(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.-
`SEC. 709. TRAINING AND COMMUNITY EDUCATION.
`(a) COMMUNITY EDUCATION-
`(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.
`(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.
`(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).
`(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).
`(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--
`(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) 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.
`(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:
`(1) Whether the project will address significant unmet behavioral
health needs among Indians.
`(2) Whether the project will serve a significant number of
Indians.
`(3) Whether the project has the potential to deliver services in an
efficient and effective manner.
`(4) Whether the tribe or tribal organization has the administrative and
financial capability to administer the project.
`(5) Whether the project will deliver services in a manner consistent
with traditional health care.
`(6) Whether the project is coordinated with, and avoids duplication of,
existing services.
`(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.
`SEC. 711. FETAL ALCOHOL DISORDER FUNDING.
`(a) ESTABLISHMENT OF PROGRAM-
`(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).
`(2) USE OF FUNDS- Funding provided pursuant to this section shall be
used to--
`(A) develop and provide community and in-school training, education,
and prevention programs relating to fetal alcohol disorders;
`(B) identify and provide behavioral health treatment to high-risk
women;
`(C) identify and provide appropriate educational and vocational
support, counseling, advocacy, and information to fetal alcohol disorder
affected persons and their families or caretakers;
`(D) develop and implement counseling and support programs in schools
for fetal alcohol disorder affected children;
`(E) develop prevention and intervention models which incorporate
traditional practitioners, cultural and spiritual values and community
involvement;
`(F) develop, print, and disseminate education and prevention
materials on fetal alcohol disorders;
`(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;
`(H) develop early childhood intervention projects from birth on to
mitigate the effects of fetal alcohol disorders; and
`(I) develop and fund community-based adult fetal alcohol disorder
housing and support services.
`(3) CRITERIA- The Secretary shall establish criteria for the review and
approval of applications for funding under this section.
`(b) PROVISION OF SERVICES- The Secretary, acting through the Service,
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 disorders 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
disorders.
`(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).
`(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.
`(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.
`(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.
`SEC. 712. CHILD SEXUAL ABUSE AND PREVENTION TREATMENT PROGRAMS.
`(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--
`(1) victims of child sexual abuse; and
`(2) perpetrators of child sexual abuse.
`(b) USE OF FUNDS- Funds provided under this section shall be used to--
`(1) develop and provide community education and prevention programs
related to child sexual abuse;
`(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;
`(3) develop prevention and intervention models which incorporate
traditional health care practitioners, cultural and spiritual values, and
community involvement;
`(4) develop and implement, though the tribal consultation process,
culturally sensitive assessment and diagnostic tools for use in tribal and
urban Indian communities.
`(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.
`SEC. 713. BEHAVIORAL MENTAL HEALTH RESEARCH.
`(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--
`(1) the inter-relationship and inter-dependance 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.
`(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.
`SEC. 714. DEFINITIONS.
`(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 NEURODEVELOP-MENTAL DISORDERS- The term `alcohol
related neurodevelop-mental 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.
`(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.
`(4) BEHAVIORAL HEALTH AFTERCARE-
`(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.
`(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).
`(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.-
`(6) FETAL ALCOHOL DISORDERS- The term `fetal alcohol disorders' means
fetal alcohol syndrome, partial fetal alcohol syndrome, or alcohol related
neural developmental disorder.
`(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:
`(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:
microphthalmia, short palpebral fissures, poorly developed philtrum, thin
upper lip, flat nasal bridge, and short upturned nose.
`(C) Prenatal or postnatal growth delay.
`(8) PARTIAL FAS- The term `partial FAS' 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.
`(9) REHABILITATION- The term `rehabilitation' means to restore the
ability or capacity to engage in usual and customary life activities through
education and therapy.-
`(10) SUBSTANCE ABUSE- The term `substance abuse' includes inhalant
abuse. --
`SEC. 715. AUTHORIZATION OF APPROPRIATIONS.
`There is authorized to be appropriated such sums as may be necessary for
each fiscal year through fiscal year 2012 to carry out 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 the
Congress a report containing--
`(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;
`(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;
`(3) a report on the use of health services by Indians--
`(A) on a national and area or other relevant geographical
basis;
`(C) by source of payment and type of service;
`(D) comparing such rates of use with rates of use among comparable
non-Indian populations; and
`(E) on the services provided under funding agreements pursuant to the
Indian Self-Determination and Education Assistance Act;
`(4) a report of contractors concerning health care educational loan
repayments under section 110;
`(5) a general audit report on the health care educational loan
repayment program as required under section 110(n);
`(6) a separate statement that specifies the amount of funds requested
to carry out the provisions of section 201;
`(7) a report on infectious diseases as required under section
212;
`(8) a report on environmental and nuclear health hazards as required
under section 214;
`(9) a report on the status of all health care facilities needs as
required under sections 301(c)(2) and 301(d);
`(10) a report on safe water and sanitary waste disposal facilities as
required under section 302(h)(1);
`(11) a report on the expenditure of non-service funds for renovation as
required under sections 305(a)(2) and 305(a)(3);
`(12) a report identifying the backlog of maintenance and repair
required at Service and tribal facilities as required under section
314(a);
`(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);
`(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);
`(15) a report on the evaluation and renewal of urban Indian programs as
required under section 505;
`(16) a report on the findings and conclusions derived from the
demonstration project as required under section 512(a)(2);
`(17) a report on the evaluation of programs as required under section
513; and
`(18) a report on alcohol and substance abuse as required under section
701(f).
`SEC. 802. REGULATIONS.
`(a) INITIATION OF RULEMAKING PROCEDURES-
`(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.
`(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.
`(3) EXPIRATION OF AUTHORITY- The authority to promulgate regulations
under this Act shall expire 18 months from the date of enactment of this
Act.
`(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.
`(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.
`(d) FAILURE TO PROMULGATE REGULATIONS- The lack of promulgated
regulations shall not limit the effect of this Act.
`(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.
`SEC. 803. PLAN OF IMPLEMENTATION.
`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.
`SEC. 804. AVAILABILITY OF FUNDS.
`Amounts appropriated under 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.
`(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:
`(1) Any member of a Federally recognized Indian tribe.
`(2) Any descendant of an Indian who was residing in California on
June 1, 1852, but only 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 Indian reservation allotments in California.
`(4) Any Indian in California who is listed on the plans for
distribution of the assets of California rancherias and reservations under
the Act of August 18, 1958 (72 Stat. 619), and any descendant of such an
Indian.
`(b) 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.
`SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS.
`(1) IN GENERAL- Any individual who--
`(A) has not attained 19 years of age;
`(B) is the natural or adopted child, step-child, foster-child, legal
ward, or orphan of an eligible Indian; and
`(C) is not otherwise eligible for the 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 one year after the date such
disability has been removed.
`(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.
`(b) PROGRAMS AND SERVICES-
`(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--
`(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
`(ii) the Secretary and the Indian tribe or 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 program or
services, within or without the service area of such service unit,
available to meet the health needs of such individuals.
`(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).
`(2) LIABILITY FOR PAYMENT-
`(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(c) 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.
`(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.
`(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.
`(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.
`(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--
`(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 post partum; or
`(4) provide care to immediate family members of an eligible person if
such care is directly related to the treatment of the eligible person.
`(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.
`(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.
`SEC. 808. REALLOCATION OF BASE RESOURCES.
`(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.
`(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.
`SEC. 809. RESULTS OF DEMONSTRATION PROJECTS.
`The Secretary shall provide for the dissemination to Indian tribes of the
findings and results of demonstration projects conducted under this Act.
`SEC. 810. PROVISION OF SERVICES IN MONTANA.
`(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).
`(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.
`SEC. 811. MORATORIUM.
`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.
`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 under the Self-Determination and Education Assistance Act shall not
be considered an employer.
`SEC. 813. PRIME VENDOR.
`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 in the 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.
`SEC. 814. NATIONAL BI-PARTISAN COMMISSION ON INDIAN HEALTH CARE
ENTITLEMENT.
`(a) ESTABLISHMENT- There is hereby established the National Bi-Partisan
Indian Health Care Entitlement Commission (referred to in this Act as the
`Commission').
`(b) MEMBERSHIP- The Commission shall be composed of 25 members, to be
appointed as follows:
`(1) Ten members of Congress, of which--
`(A) three members shall be from the House of Representatives and
shall be appointed by the majority leader;
`(B) three members shall be from the House of Representatives and
shall be appointed by the minority leader;
`(C) two members shall be from the Senate and shall be appointed by
the majority leader; and
`(D) two members shall be from the Senate and shall be appointed by
the minority leader;
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.
`(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.
`(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.
All those persons appointed under paragraphs (2) and (3) shall be members
of Federally recognized Indian Tribes.
`(1) IN GENERAL- Members of the Commission shall serve for the life of
the Commission.
`(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.
`(3) VACANCY- A vacancy in the membership of the Commission shall be
filled in the manner in which the original appointment was made.
`(d) DUTIES OF THE COMMISSION- The Commission shall carry out the
following duties and functions:
`(1) Review and analyze the recommendations of the report of the study
committee established under paragraph (3) to the Commission.
`(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;
`(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--
`(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;
`(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 provide,d and the cost, including mechanisms for
funding of the health services to be provided;
`(C) determine the effect of the enactment of such recommendations on
the existing system of the delivery of health services for
Indians;
`(D) determine the effect of a health services entitlement program for
Indian persons on the sovereign status of Indian tribes;
`(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
`(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.
`(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.
`(e) ADMINISTRATIVE PROVISIONS-
`(1) COMPENSATION AND EXPENSES-
`(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.
`(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.
`(2) MEETINGS AND QUORUM-
`(A) MEETINGS- The Commission shall meet at the call of the
chairperson.
`(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.
`(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.
`(B) STAFF- With the approval of the Commission, the executive
director may appoint such personnel as the executive director deems
appropriate.
`(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).
`(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.
`(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.
`(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.
`(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.
`(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.
`(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).
`(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.
`(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.
`(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.
`(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.
`(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.
`(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.
`(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.
`SEC. 815. 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. 816. AUTHORIZATION OF APPROPRIATIONS.
`There is authorized to be appropriated such sums as may be necessary for
each fiscal year through fiscal year 2012 to carry out this title.'.
TITLE II--CONFORMING AMENDMENTS TO THE SOCIAL SECURITY ACT
Subtitle A--Medicare
SEC. 201. LIMITATIONS ON CHARGES.
Section 1866(a)(1) of the Social Security Act (42 U.S.C. 1395cc(a)(1)) is
amended--
(1) in subparagraph (R), by adding a semicolon at the end;
(2) in subparagraph (S), by striking the period and inserting `; and';
and
(3) by adding at the end the following:
`(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.'.
SEC. 202. INDIAN HEALTH PROGRAMS.
Section 1880 of the Social Security Act (42 U.S.C. 1395qq) is amended to
read as follows:
`INDIAN HEALTH PROGRAMS
`SEC. 1880. (a) ELIGIBILITY FOR PAYMENTS- The Indian Health Service
(referred to in this section as the `Service') and 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
payments under this title, notwithstanding sections 1814(c) and 1835(d), if
and for so long as the Service, Indian tribe or tribal organization, or urban
Indian organization meets the conditions and requirements for such payments
which are applicable generally to the service or provider type for which the
Service, Indian tribe or tribal organization, or urban Indian organization
seeks payment under this title and for services and provider types provided by
a qualified Indian health program under section 1880A.
`(b) PERIOD FOR BILLING- Notwithstanding subsection (a), if the Service,
an Indian tribe or tribal organization, or urban Indian organization, does not
meet all of the conditions and requirements of this title which are applicable
generally to the service or provider type for which payment is sought, but
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.
`(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 of the Indian Health Care Improvement Act.
`(d) COMMUNITY HEALTH AIDES- The Service or an Indian Tribe or tribal
organization providing a service otherwise eligible for payment under this
section through the use of a community health aide or practitioner certified
under the provisions of section 121 of the Indian Health Care Improvement Act
shall be paid for such services on the same basis that such services are
reimbursed under State plans approved under title XIX.
`(e) TREATMENT OF CERTAIN PROGRAMS- Notwithstanding any other provision of
law, a health program operated by the Service or an Indian tribe or tribal
organization, which collaborates with a hospital operated by the Service or an
Indian tribe or tribal organization, shall, at the option of the Indian tribe
or tribal organization, be paid for services for which it would otherwise be
eligible for under this as if the health program were an outpatient department
of the hospital. In situations where the health program is on a separate
campus from the hospital, billing as an outpatient department of the hospital
shall not subject such a health program to the requirements of section
1867.
`(f) PAYMENT FOR CERTAIN NURSING SERVICES- The Service or an Indian tribe
or tribal organization providing visiting nurse services in a home health
agency shortage area shall be paid for such services on the same basis that
such services are reimbursed under this title for other primary care
providers.
`(g) ALTERNATIVE METHODS OF REIMBURSEMENT- Notwithstanding any other
provision of law, the Secretary may identify and implement alternative methods
of reimbursing Indian health programs for services reimbursable under this
title that are provided to Indians, so long as such methods--
`(1) allow an Indian tribe or tribal organization or urban Indian
organization to opt to receive reimbursement under reimbursement
methodologies applicable to other providers of similar services; and
`(2) provide that the amount of reimbursement resulting under any such
methodology shall not be less than 100 percent of the reasonable cost of the
service to which the methodology applies under section 1861(v).'.
SEC. 203. QUALIFIED INDIAN HEALTH PROGRAM.
Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended
by inserting after section 1880 the following:
`QUALIFIED INDIAN HEALTH PROGRAM
`SEC. 1880A. (a) DEFINITION OF QUALIFIED INDIAN HEALTH PROGRAM- In this
section:
`(1) IN GENERAL- The term `qualified Indian health program' means a
health program operated by--
`(A) the Indian Health Service;
`(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; and
`(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.
`(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.
`(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.
`(c) DETERMINATION OF PAYMENTS-
`(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.
`(2) DEFINITION OF FULL COST RECOVERY-
`(A) IN GENERAL- Subject to subparagraph (B), in this section, the
term `full cost recovery' means the sum of--
`(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
`(ii) indirect costs which, in the case of a qualified Indian health
program--
`(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
`(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.
`(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.
`(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.
`(4) DETERMINATION OF ALL-INCLUSIVE ENCOUNTER OR PER DIEM AMOUNT-
`(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.
`(B) NO SINGLE REPORT REQUIREMENT- Not all 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.
`(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.
`(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--
`(A) a significant decrease in discharges;
`(B) costs for graduate medical education programs;
`(C) additional payment as a disproportionate share hospital with a
payment adjustment factor of 10; and
`(D) payment for outlier cases.
`(6) ELECTION OF PAYMENT- A qualified Indian health program may elect to
receive payment for services provided under this section--
`(A) on the full cost recovery basis provided in paragraphs (1)
through (5);
`(B) on the basis of the inpatient or outpatient encounter rates
established for Indian Health Service facilities and published annually in
the Federal Register;
`(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;
`(D) on the basis of any other rate or methodology applicable to the
Indian Health Service or an Indian Tribe or tribal organization;
or
`(E) on the basis of any rate or methodology negotiated with the
agency responsible for making payment.
`(d) ELECTION OF REIMBURSEMENT FOR OTHER SERVICES-
`(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.
`(2) OPTION TO INCLUDE ADDITIONAL SERVICES- An election under paragraph
(1) may include, at the election of the qualified Indian health
program--
`(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;
`(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;
`(C) preventive primary health services as described under sections
329, 330, and 340 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;
`(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);
`(E) influenza and pneumococcal immunizations;
`(F) other immunizations for prevention of communicable diseases when
targeted; and
`(G) the cost of transportation for providers or patients necessary to
facilitate access for patients.'.
Subtitle B--Medicaid
SEC. 211. PAYMENTS TO FEDERALLY-QUALIFIED HEALTH CENTERS.
Section 1902(a)(13) of the Social Security Act (42 U.S.C. 1396a(a)(13)) is
amended--
(1) in subparagraph (B), by striking `and' at the end;
(2) in subparagraph (C), by adding `and' at the end; and
(3) by adding at the end the following:
`(D)(i) for payment for services described in section 1905(a)(2)(C)
under the plan furnished by an Indian tribe or tribal organization or an
urban Indian organization (as defined in section 4 of the Indian Health
Care Improvement Act) of 100 percent of costs which are reasonable and
related to the cost of furnishing such services or based on other tests of
reasonableness as the Secretary prescribes in regulations under section
1833(a)(3), or, in the case of services to which those regulations do not
apply, the same methodology used under section 1833(a)(3), and
`(ii) in the case of such services furnished pursuant to a contract
between a Federally-qualified health center and a medicaid managed care
organization under section 1903(m), for payment to the Federally-qualified
health center at least quarterly by the State of a supplemental payment
equal to the amount (if any) by which the amount determined under clause
(i) exceeds the amount of the payments provided under such
contract.'.
SEC. 212. STATE CONSULTATION WITH INDIAN HEALTH PROGRAMS.
Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)) is
amended--
(1) in paragraph (65), by striking the period; and
(2) by inserting after (65), the following:
`(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--
`(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
`(B) such consultation is carried out in collaboration with the Indian
Medicaid Advisory Committee established under section 415(a)(3) of that
Act.'.
SEC. 213. FMAP FOR SERVICES PROVIDED BY INDIAN HEALTH PROGRAMS.
The third sentence of Section 1905(b) of the Social Security Act (42
U.S.C. 1396d(b)) is amended to read as follows:
`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.'.
SEC. 214. INDIAN HEALTH SERVICE PROGRAMS.
Section 1911 of the Social Security Act (42 U.S.C. 1396j) is amended to
read as follows:
`INDIAN HEALTH SERVICE PROGRAMS
`SEC. 1911. (a) IN GENERAL- The Indian Health Service and 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
if and for so long as such 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.
`(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.
`(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 and 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.
Subtitle C--State Children's Health Insurance Program
SEC. 221. ENHANCED FMAP FOR STATE CHILDREN'S HEALTH INSURANCE PROGRAM.
(a) IN GENERAL- Section 2105(b) of the Social Security Act (42 U.S.C.
1397ee(b)) is amended--
(1) by striking `For purposes' and inserting the following:
`(1) IN GENERAL- Subject to paragraph (2), for purposes'; and
(2) by adding at the end the following:
`(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).'.
(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'.
SEC. 222. DIRECT FUNDING OF STATE CHILDREN'S HEALTH INSURANCE PROGRAM.
Title XXI of Social Security Act (42 U.S.C. 1397aa et seq.) is amended by
adding at the end the following:
`SEC. 2111. DIRECT FUNDING OF INDIAN HEALTH PROGRAMS.
`(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.
`(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--
`(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
`(2) under an agreement entered into under subsection (a) between the
entity and the Secretary.'.
Subtitle D--Authorization of Appropriations
SEC. 231. AUTHORIZATION OF APPROPRIATIONS.
There is authorized to be appropriated such sums as may be necessary for
each of fiscal years 2000 through 2012 to carry out this title and the
amendments by this title.
TITLE III--MISCELLANEOUS PROVISIONS
SEC. 301. REPEALS.
The following are repealed:
(1) Section 506 of Public Law 101-630 (25 U.S.C. 1653 note) is
repealed.
(2) Section 712 of the Indian Health Care Amendments of 1988 is
repealed.
SEC. 302. 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.
END