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S.2526
Indian Health Care Improvement Act Reauthorization of 2000
(Introduced in Senate)
`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:
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