[DOCID: f:hr564p1.110] From the House Reports Online via GPO Access [wais.access.gpo.gov] 110th Congress Rept. 110-564 HOUSE OF REPRESENTATIVES 2d Session Part 1 ====================================================================== INDIAN HEALTH CARE IMPROVEMENT ACT AMENDMENTS OF 2007 _______ April 4, 2008.--Ordered to be printed _______ Mr. Rahall, from the Committee on Natural Resources, submitted the following R E P O R T [To accompany H.R. 1328] [Including cost estimate of the Congressional Budget Office] The Committee on Natural Resources, to whom was referred the bill (H.R. 1328) to amend the Indian Health Care Improvement Act to revise and extend that Act, having considered the same, report favorably thereon with an amendment and recommend that the bill as amended do pass. The amendment is as follows: Strike all after the enacting clause and insert the following: SECTION 1. SHORT TITLE; TABLE OF CONTENTS. (a) Short Title.--This Act may be cited as the ``Indian Health Care Improvement Act Amendments of 2007''. (b) Table of Contents.--The table of contents of this Act is as follows: Sec. 1. Short title; table of contents. TITLE I--AMENDMENTS TO INDIAN LAWS Sec. 101. Indian Health Care Improvement Act amended. Sec. 102. Soboba sanitation facilities. Sec. 103. Native American Health and Wellness Foundation. TITLE II--IMPROVEMENT OF INDIAN HEALTH CARE PROVIDED UNDER THE SOCIAL SECURITY ACT Sec. 201. Expansion of payments under Medicare, Medicaid, and SCHIP for all covered services furnished by Indian Health Programs. Sec. 202. Increased outreach to Indians under Medicaid and SCHIP and improved cooperation in the provision of items and services to Indians under Social Security Act health benefit programs. Sec. 203. Additional provisions to increase outreach to, and enrollment of, Indians in SCHIP and Medicaid. Sec. 204. Premiums and cost sharing protections under Medicaid, eligibility determinations under Medicaid and SCHIP, and protection of certain Indian property from Medicaid estate recovery. Sec. 205. Nondiscrimination in qualifications for payment for services under Federal health care programs. Sec. 206. Consultation on Medicaid, SCHIP, and other health care programs funded under the Social Security Act involving Indian Health Programs and Urban Indian Organizations. Sec. 207. Exclusion waiver authority for affected Indian Health Programs and safe harbor transactions under the Social Security Act. Sec. 208. Rules applicable under Medicaid and SCHIP to managed care entities with respect to Indian enrollees and Indian health care providers and Indian managed care entities. Sec. 209. Annual report on Indians served by Social Security Act health benefit programs. SEC. 2. REPORT ON THIRD-PARTY PAYMENT COLLECTIONS. (a) Study.--The Secretary of Health and Human Services shall conduct a thorough study of the system of third-party payment collections for items and services furnished through the Indian Health Service. (b) Report.--Not later than 6 months after the date of the enactment of this Act, the Secretary shall submit to each House of Congress a report on such study. Such report shall include such recommendations on how to improve such third-party payment collections as the Secretary determines appropriate. TITLE I--AMENDMENTS TO INDIAN LAWS SEC. 101. INDIAN HEALTH CARE IMPROVEMENT ACT AMENDED. (a) In General.--The Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.) is amended to read as follows: ``SECTION 1. SHORT TITLE; TABLE OF CONTENTS. ``(a) Short Title.--This Act may be cited as the `Indian Health Care Improvement Act'. ``(b) Table of Contents.--The table of contents for this Act is as follows: ``Sec. 1. Short title; table of contents. ``Sec. 2. Findings. ``Sec. 3. Declaration of national Indian health policy. ``Sec. 4. Definitions. ``TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT ``Sec. 101. Purpose. ``Sec. 102. Health professions recruitment program for Indians. ``Sec. 103. Health professions preparatory scholarship program for Indians. ``Sec. 104. Indian health professions scholarships. ``Sec. 105. American Indians Into Psychology Program. ``Sec. 106. Scholarship programs for Indian Tribes. ``Sec. 107. Indian Health Service extern programs. ``Sec. 108. Continuing education allowances. ``Sec. 109. Community Health Representative Program. ``Sec. 110. Indian Health Service Loan Repayment Program. ``Sec. 111. Scholarship and Loan Repayment Recovery Fund. ``Sec. 112. Recruitment activities. ``Sec. 113. Indian recruitment and retention program. ``Sec. 114. Advanced training and research. ``Sec. 115. Quentin N. Burdick American Indians Into Nursing Program. ``Sec. 116. Tribal cultural orientation. ``Sec. 117. INMED Program. ``Sec. 118. Health training programs of community colleges. ``Sec. 119. Retention bonus. ``Sec. 120. Nursing residency program. ``Sec. 121. Community Health Aide Program. ``Sec. 122. Tribal Health Program administration. ``Sec. 123. Health professional chronic shortage demonstration programs. ``Sec. 124. National Health Service Corps. ``Sec. 125. Substance abuse counselor educational curricula demonstration programs. ``Sec. 126. Behavioral health training and community education programs. ``Sec. 127. Authorization of appropriations. ``TITLE II--HEALTH SERVICES ``Sec. 201. Indian Health Care Improvement Fund. ``Sec. 202. Catastrophic Health Emergency Fund. ``Sec. 203. Health promotion and disease prevention services. ``Sec. 204. Diabetes prevention, treatment, and control. ``Sec. 205. Shared services for long-term care. ``Sec. 206. Health services research. ``Sec. 207. Mammography and other cancer screening. ``Sec. 208. Patient travel costs. ``Sec. 209. Epidemiology centers. ``Sec. 210. Comprehensive school health education programs. ``Sec. 211. Indian youth program. ``Sec. 212. Prevention, control, and elimination of communicable and infectious diseases. ``Sec. 213. Authority for provision of other services. ``Sec. 214. Indian women's health care. ``Sec. 215. Environmental and nuclear health hazards. ``Sec. 216. Arizona as a contract health service delivery area. ``Sec. 217. North Dakota and South Dakota as contract health service delivery area. ``Sec. 218. California contract health services program. ``Sec. 219. California as a contract health service delivery area. ``Sec. 220. Contract health services for the Trenton Service Area. ``Sec. 221. Programs operated by Indian Tribes and Tribal Organizations. ``Sec. 222. Licensing. ``Sec. 223. Notification of provision of emergency contract health services. ``Sec. 224. Prompt action on payment of claims. ``Sec. 225. Liability for payment. ``Sec. 226. Office of Indian Men's Health. ``Sec. 227. Authorization of appropriations. ``TITLE III--FACILITIES ``Sec. 301. Consultation; construction and renovation of facilities; reports. ``Sec. 302. Sanitation facilities. ``Sec. 303. Preference to Indians and Indian firms. ``Sec. 304. Expenditure of non-Service funds for renovation. ``Sec. 305. Funding for the construction, expansion, and modernization of small ambulatory care facilities. ``Sec. 306. Indian health care delivery demonstration project. ``Sec. 307. Land transfer. ``Sec. 308. Leases, contracts, and other agreements. ``Sec. 309. Study on loans, loan guarantees, and loan repayment. ``Sec. 310. Tribal leasing. ``Sec. 311. Indian Health Service/tribal facilities joint venture program. ``Sec. 312. Location of facilities. ``Sec. 313. Maintenance and improvement of health care facilities. ``Sec. 314. Tribal management of federally-owned quarters. ``Sec. 315. Applicability of Buy American Act requirement. ``Sec. 316. Other funding for facilities. ``Sec. 317. Authorization of appropriations. ``TITLE IV--ACCESS TO HEALTH SERVICES ``Sec. 401. Treatment of payments under Social Security Act health benefits programs. ``Sec. 402. Grants to and contracts with the Service, Indian Tribes, Tribal Organizations, and Urban Indian Organizations to facilitate outreach, enrollment, and coverage of Indians under Social Security Act health benefit programs and other health benefits programs. ``Sec. 403. Reimbursement from certain third parties of costs of health services. ``Sec. 404. Crediting of reimbursements. ``Sec. 405. Purchasing health care coverage. ``Sec. 406. Sharing arrangements with Federal agencies. ``Sec. 407. Payor of last resort. ``Sec. 408. Nondiscrimination under Federal health care programs in qualifications for reimbursement for services. ``Sec. 409. Consultation. ``Sec. 410. State Children's Health Insurance Program (SCHIP). ``Sec. 411. Exclusion waiver authority for affected Indian Health Programs and safe harbor transactions under the Social Security Act. ``Sec. 412. Premium and cost sharing protections and eligibility determinations under Medicaid and SCHIP and protection of certain Indian property from Medicaid estate recovery. ``Sec. 413. Treatment under Medicaid and SCHIP managed care. ``Sec. 414. Navajo Nation Medicaid Agency feasibility study. ``Sec. 415. General exceptions. ``Sec. 416. 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. Division 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. Urban youth treatment center demonstration. ``Sec. 516. Grants for diabetes prevention, treatment, and control. ``Sec. 517. Community health representatives. ``Sec. 518. Effective date. ``Sec. 519. Eligibility for services. ``Sec. 520. Authorization of appropriations. ``TITLE VI--ORGANIZATIONAL IMPROVEMENTS ``Sec. 601. Establishment of the Indian Health Service as an agency of the Public Health Service. ``Sec. 602. Automated management information system. ``Sec. 603. Authorization of appropriations. ``TITLE VII--BEHAVIORAL HEALTH PROGRAMS ``Sec. 701. Behavioral health prevention and treatment services. ``Sec. 702. Memoranda of agreement with the Department of the Interior. ``Sec. 703. Comprehensive behavioral health prevention and treatment program. ``Sec. 704. Mental health technician program. ``Sec. 705. Licensing requirement for mental health care workers. ``Sec. 706. Indian women treatment programs. ``Sec. 707. Indian youth program. ``Sec. 708. Indian youth telemental health demonstration project. ``Sec. 709. Inpatient and community-based mental health facilities design, construction, and staffing. ``Sec. 710. Training and community education. ``Sec. 711. Behavioral health program. ``Sec. 712. Fetal alcohol disorder programs. ``Sec. 713. Child sexual abuse and prevention treatment programs. ``Sec. 714. Behavioral health research. ``Sec. 715. Definitions. ``Sec. 716. 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 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. Severability provisions. ``Sec. 813. Establishment of National Bipartisan Commission on Indian Health Care. ``Sec. 814. Confidentiality of medical quality assurance records; qualified immunity for participants. ``Sec. 815. Appropriations; availability. ``Sec. 816. Authorization of appropriations. ``SEC. 2. FINDINGS. ``Congress makes the following findings: ``(1) Federal health services 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, and resulting responsibility to, the American Indian people. ``(2) 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 to be raised to the highest possible level and to encourage the maximum participation of Indians in the planning and management of those services. ``(3) Federal health services to Indians have resulted in a reduction in the prevalence and incidence of preventable illnesses among, and unnecessary and premature deaths of, Indians. ``(4) Despite such services, the unmet health needs of the American Indian people are severe and the health status of the Indians is far below that of the general population of the United States. ``SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POLICY. ``Congress declares that it is the policy of this Nation, in fulfillment of its special trust responsibilities and legal obligations to Indians-- ``(1) to assure the highest possible health status for Indians and Urban Indians and to provide all resources necessary to effect that policy; ``(2) to raise the health status of Indians and Urban Indians to at least the levels set forth in the goals contained within the Healthy People 2010 or successor objectives; ``(3) to the greatest extent possible, to allow Indians to set their own health care priorities and establish goals that reflect their unmet needs; ``(4) to increase the proportion of all degrees in the health professions and allied and associated health professions awarded to Indians so that the proportion of Indian health professionals in each Service Area is raised to at least the level of that of the general population; ``(5) to require meaningful consultation with Indian Tribes, Tribal Organizations, and Urban Indian Organizations to implement this Act and the national policy of Indian self- determination; and ``(6) to provide funding for programs and facilities operated by Indian Tribes and Tribal Organizations in amounts that are not less than the amounts provided to programs and facilities operated directly by the Service. ``SEC. 4. DEFINITIONS. ``For purposes of this Act: ``(1) The term `accredited and accessible' means on or near a reservation and accredited by a national or regional organization with accrediting authority. ``(2) The term `Area Office' means an administrative entity, including a program office, within the Service through which services and funds are provided to the Service Units within a defined geographic area. ``(3) The term `Assistant Secretary' means the Assistant Secretary of Indian Health. ``(4)(A) The term `behavioral health' means the blending of substance (alcohol, drugs, inhalants, and tobacco) abuse and mental health prevention and treatment, for the purpose of providing comprehensive services. ``(B) The term `behavioral health' includes the joint development of substance abuse and mental health treatment planning and coordinated case management using a multidisciplinary approach. ``(5) The term `California Indians' means those Indians who are eligible for health services of the Service pursuant to section 806. ``(6) The term `community college' means-- ``(A) a tribal college or university, or ``(B) a junior or community college. ``(7) The term `contract health service' means health services provided at the expense of the Service or a Tribal Health Program by public or private medical providers or hospitals, other than the Service Unit or the Tribal Health Program at whose expense the services are provided. ``(8) The term `Department' means, unless otherwise designated, the Department of Health and Human Services. ``(9) The term `disease prevention' means the reduction, limitation, and prevention of disease and its complications and reduction in the consequences of disease, including-- ``(A) controlling-- ``(i) the development of diabetes; ``(ii) high blood pressure; ``(iii) infectious agents; ``(iv) injuries; ``(v) occupational hazards and disabilities; ``(vi) sexually transmittable diseases; and ``(vii) toxic agents; and ``(B) providing-- ``(i) fluoridation of water; and ``(ii) immunizations. ``(10) The term `health profession' means allopathic medicine, family medicine, internal medicine, pediatrics, geriatric medicine, obstetrics and gynecology, podiatric medicine, nursing, public health nursing, dentistry, psychiatry, osteopathy, optometry, pharmacy, psychology, public health, social work, marriage and family therapy, chiropractic medicine, environmental health and engineering, allied health professions, naturopathic medicine, and any other health profession. ``(11) The term `health promotion' means-- ``(A) fostering social, economic, environmental, and personal factors conducive to health, including raising public awareness about health matters and enabling the people to cope with health problems by increasing their knowledge and providing them with valid information; ``(B) encouraging adequate and appropriate diet, exercise, and sleep; ``(C) promoting education and work in conformity with physical and mental capacity; ``(D) making available safe water and sanitary facilities; ``(E) improving the physical, economic, cultural, psychological, and social environment; ``(F) promoting culturally competent care; and ``(G) providing adequate and appropriate programs, which may include-- ``(i) abuse prevention (mental and physical); ``(ii) community health; ``(iii) community safety; ``(iv) consumer health education; ``(v) diet and nutrition; ``(vi) immunization and other prevention of communicable diseases, including HIV/AIDS; ``(vii) environmental health; ``(viii) exercise and physical fitness; ``(ix) avoidance of fetal alcohol disorders; ``(x) first aid and CPR education; ``(xi) human growth and development; ``(xii) injury prevention and personal safety; ``(xiii) behavioral health; ``(xiv) monitoring of disease indicators between health care provider visits, through appropriate means, including Internet-based health care management systems; ``(xv) personal health and wellness practices; ``(xvi) personal capacity building; ``(xvii) prenatal, pregnancy, and infant care; ``(xviii) psychological well-being; ``(xix) reproductive health and family planning; ``(xx) safe and adequate water; ``(xxi) healthy work environments; ``(xxii) elimination, reduction, and prevention of contaminants that create unhealthy household conditions (including mold and other allergens); ``(xxiii) stress control; ``(xxiv) substance abuse; ``(xxv) sanitary facilities; ``(xxvi) sudden infant death syndrome prevention; ``(xxvii) tobacco use cessation and reduction; ``(xxviii) violence prevention; and ``(xxix) such other activities identified by the Service, a Tribal Health Program, or an Urban Indian Organization, to promote achievement of any of the objectives described in section 3(2). ``(12) The term `Indian', unless otherwise designated, means any person who is a member of an Indian Tribe or is eligible for health services under section 806, except that, for the purpose of sections 102 and 103, the term also means any individual who-- ``(A)(i) irrespective of whether the individual lives on or near a reservation, is a member of a tribe, band, or other organized group of Indians, including those tribes, bands, or groups terminated since 1940 and those recognized now or in the future by the State in which they reside; or ``(ii) is a descendant, in the first or second degree, of any such member; ``(B) is an Eskimo or Aleut or other Alaska 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. ``(13) The term `Indian Health Program' means-- ``(A) any health program administered directly by the Service; ``(B) any Tribal Health Program; or ``(C) any Indian Tribe or Tribal Organization to which the Secretary provides funding pursuant to section 23 of the Act of June 25, 1910 (25 U.S.C. 47) (commonly known as the `Buy Indian Act'). ``(14) The term `Indian Tribe' has the meaning given the term in the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.). ``(15) The term `junior or community college' has the meaning given the term by section 312(e) of the Higher Education Act of 1965 (20 U.S.C. 1058(e)). ``(16) The term `reservation' means any federally recognized Indian Tribe's reservation, Pueblo, or colony, including former reservations in Oklahoma, Indian allotments, and Alaska Native Regions established pursuant to the Alaska Native Claims Settlement Act (43 U.S.C. 1601 et seq.). ``(17) The term `Secretary', unless otherwise designated, means the Secretary of Health and Human Services. ``(18) The term `Service' means the Indian Health Service. ``(19) The term `Service Area' means the geographical area served by each Area Office. ``(20) The term `Service Unit' means an administrative entity of the Service, or a Tribal Health Program through which services are provided, directly or by contract, to eligible Indians within a defined geographic area. ``(21) The term `telehealth' has the meaning given the term in section 330K(a) of the Public Health Service Act (42 U.S.C. 254c-16(a)). ``(22) The term `telemedicine' means a telecommunications link to an end user through the use of eligible equipment that electronically links health professionals or patients and health professionals at separate sites in order to exchange health care information in audio, video, graphic, or other format for the purpose of providing improved health care services. ``(23) The term `tribal college or university' has the meaning given the term in section 316(b)(3) of the Higher Education Act (20 U.S.C. 1059c(b)(3)). ``(24) The term `Tribal Health Program' means an Indian Tribe or Tribal Organization that operates any health program, service, function, activity, or facility funded, in whole or part, by the Service through, or provided for in, a contract or compact with the Service under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.). ``(25) The term `Tribal Organization' has the meaning given the term in the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.). ``(26) The term `Urban Center' means any community which has a sufficient Urban Indian population with unmet health needs to warrant assistance under title V of this Act, as determined by the Secretary. ``(27) The term `Urban Indian' means any individual who resides in an Urban Center and who meets 1 or more of the following criteria: ``(A) Irrespective of whether the individual lives on or near a reservation, the individual is a member of a tribe, band, or other organized group of Indians, including those tribes, bands, or groups terminated since 1940 and those tribes, bands, or groups that are recognized by the States in which they reside, or who is a descendant in the first or second degree of any such member. ``(B) The individual is an Eskimo, Aleut, or other Alaska Native. ``(C) The individual is considered by the Secretary of the Interior to be an Indian for any purpose. ``(D) The individual is determined to be an Indian under regulations promulgated by the Secretary. ``(28) The term `Urban Indian Organization' means a nonprofit corporate body that (A) is situated in an Urban Center; (B) is governed by an Urban Indian-controlled board of directors; (C) provides for the participation of all interested Indian groups and individuals; and (D) is capable of legally cooperating with other public and private entities for the purpose of performing the activities described in section 503(a). ``TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT ``SEC. 101. PURPOSE. ``The purpose of this title is to increase, to the maximum extent feasible, the number of Indians entering the health professions and providing health services, and to assure an optimum supply of health professionals to the Indian Health Programs and Urban Indian Organizations involved in the provision of health services to Indians. ``SEC. 102. HEALTH PROFESSIONS RECRUITMENT PROGRAM FOR INDIANS. ``(a) In General.--The Secretary, acting through the Service, shall make grants to public or nonprofit private health or educational entities, Tribal Health Programs, or Urban Indian Organizations to assist such entities in meeting the costs of-- ``(1) identifying Indians with a potential for education or training in the health professions and encouraging and assisting them-- ``(A) to enroll in courses of study in such health professions; or ``(B) if they are not qualified to enroll in any such courses of study, to undertake such postsecondary education or training as may be required to qualify them for enrollment; ``(2) publicizing existing sources of financial aid available to Indians enrolled in any course of study referred to in paragraph (1) or who are undertaking training necessary to qualify them to enroll in any such course of study; or ``(3) establishing other programs which the Secretary determines will enhance and facilitate the enrollment of Indians in, and the subsequent pursuit and completion by them of, courses of study referred to in paragraph (1). ``(b) Grants.-- ``(1) Application.--The Secretary shall not make a grant under this section unless an application has been submitted to, and approved by, the Secretary. Such application shall be in such form, submitted in such manner, and contain such information, as the Secretary shall by regulation prescribe pursuant to this Act. The Secretary shall give a preference to applications submitted by Tribal Health Programs or Urban Indian Organizations. ``(2) Amount of grants; payment.--The amount of a grant under this section shall be determined by the Secretary. Payments pursuant to this section may be made in advance or by way of reimbursement, and at such intervals and on such conditions as provided for in regulations issued pursuant to this Act. To the extent not otherwise prohibited by law, grants shall be for 3 years, as provided in regulations issued pursuant to this Act. ``SEC. 103. HEALTH PROFESSIONS PREPARATORY SCHOLARSHIP PROGRAM FOR INDIANS. ``(a) Scholarships Authorized.--The Secretary, acting through the Service, shall provide scholarship grants to Indians who-- ``(1) have successfully completed their high school education or high school equivalency; and ``(2) have demonstrated the potential to successfully complete courses of study in the health professions. ``(b) Purposes.--Scholarship grants provided pursuant to this section shall be for the following purposes: ``(1) Compensatory preprofessional education of any recipient, such scholarship not to exceed 2 years on a full- time basis (or the part-time equivalent thereof, as determined by the Secretary pursuant to regulations issued under this Act). ``(2) Pregraduate education of any recipient leading to a baccalaureate degree in an approved course of study preparatory to a field of study in a health profession, such scholarship not to exceed 4 years. An extension of up to 2 years (or the part-time equivalent thereof, as determined by the Secretary pursuant to regulations issued pursuant to this Act) may be approved. ``(c) Other Conditions.--Scholarships under this section-- ``(1) may cover costs of tuition, books, transportation, board, and other necessary related expenses of a recipient while attending school; ``(2) shall not be denied solely on the basis of the applicant's scholastic achievement if such applicant has been admitted to, or maintained good standing at, an accredited institution; and ``(3) shall not be denied solely by reason of such applicant's eligibility for assistance or benefits under any other Federal program. ``SEC. 104. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS. ``(a) In General.-- ``(1) Authority.--The Secretary, acting through the Service, shall make scholarship grants to Indians who are enrolled full or part time in accredited schools pursuing courses of study in the health professions. Such scholarships shall be designated Indian Health Scholarships and shall be made in accordance with section 338A of the Public Health Services Act (42 U.S.C. 254l), except as provided in subsection (b) of this section. ``(2) Determinations by secretary.--The Secretary, acting through the Service, shall determine-- ``(A) who shall receive scholarship grants under subsection (a); and ``(B) the distribution of the scholarships among health professions on the basis of the relative needs of Indians for additional service in the health professions. ``(3) Certain delegation not allowed.--The administration of this section shall be a responsibility of the Assistant Secretary and shall not be delegated in a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.). ``(b) Active Duty Service Obligation.-- ``(1) Obligation met.--The active duty service obligation under a written contract with the Secretary under this section that an Indian has entered into shall, if that individual is a recipient of an Indian Health Scholarship, be met in full-time practice equal to 1 year for each school year for which the participant receives a scholarship award under this part, or 2 years, whichever is greater, by service in 1 or more of the following: ``(A) In an Indian Health Program. ``(B) In a program assisted under title V of this Act. ``(C) In the private practice of the applicable profession if, as determined by the Secretary, in accordance with guidelines promulgated by the Secretary, such practice is situated in a physician or other health professional shortage area and addresses the health care needs of a substantial number of Indians. ``(D) In a teaching capacity in a tribal college or university nursing program (or a related health profession program) if, as determined by the Secretary, the health service provided to Indians would not decrease. ``(2) Obligation deferred.--At the request of any individual who has entered into a contract referred to in paragraph (1) and who receives a degree in medicine (including osteopathic or allopathic medicine), dentistry, optometry, podiatry, or pharmacy, the Secretary shall defer the active duty service obligation of that individual under that contract, in order that such individual may complete any internship, residency, or other advanced clinical training that is required for the practice of that health profession, for an appropriate period (in years, as determined by the Secretary), subject to the following conditions: ``(A) No period of internship, residency, or other advanced clinical training shall be counted as satisfying any period of obligated service under this subsection. ``(B) The active duty service obligation of that individual shall commence not later than 90 days after the completion of that advanced clinical training (or by a date specified by the Secretary). ``(C) The active duty service obligation will be served in the health profession of that individual in a manner consistent with paragraph (1). ``(D) A recipient of a scholarship under this section may, at the election of the recipient, meet the active duty service obligation described in paragraph (1) by service in a program specified under that paragraph that-- ``(i) is located on the reservation of the Indian Tribe in which the recipient is enrolled; or ``(ii) serves the Indian Tribe in which the recipient is enrolled. ``(3) Priority when making assignments.--Subject to paragraph (2), the Secretary, in making assignments of Indian Health Scholarship recipients required to meet the active duty service obligation described in paragraph (1), shall give priority to assigning individuals to service in those programs specified in paragraph (1) that have a need for health professionals to provide health care services as a result of individuals having breached contracts entered into under this section. ``(c) Part-Time Students.--In the case of an individual receiving a scholarship under this section who is enrolled part time in an approved course of study-- ``(1) such scholarship shall be for a period of years not to exceed the part-time equivalent of 4 years, as determined by the Secretary; ``(2) the period of obligated service described in subsection (b)(1) shall be equal to the greater of-- ``(A) the part-time equivalent of 1 year for each year for which the individual was provided a scholarship (as determined by the Secretary); or ``(B) 2 years; and ``(3) the amount of the monthly stipend specified in section 338A(g)(1)(B) of the Public Health Service Act (42 U.S.C. 254l(g)(1)(B)) shall be reduced pro rata (as determined by the Secretary) based on the number of hours such student is enrolled. ``(d) Breach of Contract.-- ``(1) Specified breaches.--An individual shall be liable to the United States for the amount which has been paid to the individual, or on behalf of the individual, under a contract entered into with the Secretary under this section on or after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007 if that individual-- ``(A) fails to maintain an acceptable level of academic standing in the educational institution in which he or she is enrolled (such level determined by the educational institution under regulations of the Secretary); ``(B) is dismissed from such educational institution for disciplinary reasons; ``(C) voluntarily terminates the training in such an educational institution for which he or she is provided a scholarship under such contract before the completion of such training; or ``(D) fails to accept payment, or instructs the educational institution in which he or she is enrolled not to accept payment, in whole or in part, of a scholarship under such contract, in lieu of any service obligation arising under such contract. ``(2) Other breaches.--If for any reason not specified in paragraph (1) an individual breaches a written contract by failing either to begin such individual's service obligation required under such contract or to complete such service obligation, the United States shall be entitled to recover from the individual an amount determined in accordance with the formula specified in subsection (l) of section 110 in the manner provided for in such subsection. ``(3) Cancellation upon death of recipient.--Upon the death of an individual who receives an Indian Health Scholarship, any outstanding obligation of that individual for service or payment that relates to that scholarship shall be canceled. ``(4) Waivers and suspensions.-- ``(A) In general.--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 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. ``(B) Factors for consideration.--Before waiving or suspending an obligation of service or payment under subparagraph (A), the Secretary shall consult with the affected Area Office, Indian Tribes, Tribal Organizations, or Urban Indian Organizations, and may take into consideration whether the obligation may be satisfied in a teaching capacity at a tribal college or university nursing program under subsection (b)(1)(D). ``(5) Extreme hardship.--Notwithstanding any other provision of law, in any case of extreme hardship or for other good cause shown, the Secretary may waive, in whole or in part, the right of the United States to recover funds made available under this section. ``(6) Bankruptcy.--Notwithstanding any other provision of law, with respect to a recipient of an Indian Health Scholarship, no obligation for payment may be released by a discharge in bankruptcy under title 11, United States Code, unless that discharge is granted after the expiration of the 5- year period beginning on the initial date on which that payment is due, and only if the bankruptcy court finds that the nondischarge of the obligation would be unconscionable. ``SEC. 105. AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM. ``(a) Grants Authorized.--The Secretary, acting through the Service, shall make grants of not more than $300,000 to each of 9 colleges and universities for the purpose of developing and maintaining Indian psychology career recruitment programs as a means of encouraging Indians to enter the behavioral health field. These programs shall be located at various locations throughout the country to maximize their availability to Indian students and new programs shall be established in different locations from time to time. ``(b) Quentin N. Burdick Program Grant.--The Secretary shall provide a grant authorized under subsection (a) to develop and maintain a program at the University of North Dakota to be known as the `Quentin N. Burdick American Indians Into Psychology Program'. Such program shall, to the maximum extent feasible, coordinate with the Quentin N. Burdick Indian Health Programs authorized under section 117(b), the Quentin N. Burdick American Indians Into Nursing Program authorized under section 115(e), and existing university research and communications networks. ``(c) Regulations.--The Secretary shall issue regulations pursuant to this Act for the competitive awarding of grants provided under this section. ``(d) Conditions of Grant.--Applicants under this section shall agree to provide a program which, at a minimum-- ``(1) provides outreach and recruitment for health professions to Indian communities including elementary, secondary, and accredited and accessible community colleges that will be served by the program; ``(2) incorporates a program advisory board comprised of representatives from the tribes and communities that will be served by the program; ``(3) provides summer enrichment programs to expose Indian students to the various fields of psychology through research, clinical, and experimental activities; ``(4) provides stipends to undergraduate and graduate students to pursue a career in psychology; ``(5) develops affiliation agreements with tribal colleges and universities, the Service, university affiliated programs, and other appropriate accredited and accessible entities to enhance the education of Indian students; ``(6) to the maximum extent feasible, uses existing university tutoring, counseling, and student support services; and ``(7) to the maximum extent feasible, employs qualified Indians in the program. ``(e) Active Duty Service Requirement.--The active duty service obligation prescribed under section 338C of the Public Health Service Act (42 U.S.C. 254m) shall be met by each graduate who receives a stipend described in subsection (d)(4) that is funded under this section. Such obligation shall be met by service-- ``(1) in an Indian Health Program; ``(2) in a program assisted under title V of this Act; or ``(3) in the private practice of psychology if, as determined by the Secretary, in accordance with guidelines promulgated by the Secretary, such practice is situated in a physician or other health professional shortage area and addresses the health care needs of a substantial number of Indians. ``(f) Authorization of Appropriations.--There is authorized to be appropriated to carry out this section $2,700,000 for each of fiscal years 2008 through 2017. ``SEC. 106. SCHOLARSHIP PROGRAMS FOR INDIAN TRIBES. ``(a) In General.-- ``(1) Grants authorized.--The Secretary, acting through the Service, shall make grants to Tribal Health Programs for the purpose of providing scholarships for Indians to serve as health professionals in Indian communities. ``(2) Amount.--Amounts available under paragraph (1) for any fiscal year shall not exceed 5 percent of the amounts available for each fiscal year for Indian Health Scholarships under section 104. ``(3) Application.--An application for a grant under paragraph (1) shall be in such form and contain such agreements, assurances, and information as consistent with this section. ``(b) Requirements.-- ``(1) In general.--A Tribal Health Program receiving a grant under subsection (a) shall provide scholarships to Indians in accordance with the requirements of this section. ``(2) Costs.--With respect to costs of providing any scholarship pursuant to subsection (a)-- ``(A) 80 percent of the costs of the scholarship shall be paid from the funds made available pursuant to subsection (a)(1) provided to the Tribal Health Program; and ``(B) 20 percent of such costs may be paid from any other source of funds. ``(c) Course of Study.--A Tribal Health Program shall provide scholarships under this section only to Indians enrolled or accepted for enrollment in a course of study (approved by the Secretary) in 1 of the health professions contemplated by this Act. ``(d) Contract.-- ``(1) In general.--In providing scholarships under subsection (b), the Secretary and the Tribal Health Program shall enter into a written contract with each recipient of such scholarship. ``(2) Requirements.--Such contract shall-- ``(A) obligate such recipient to provide service in an Indian Health Program or Urban Indian Organization, in the same Service Area where the Tribal Health Program providing the scholarship is located, for-- ``(i) a number of years for which the scholarship is provided (or the part-time equivalent thereof, as determined by the Secretary), or for a period of 2 years, whichever period is greater; or ``(ii) such greater period of time as the recipient and the Tribal Health Program may agree; ``(B) provide that the amount of 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)), with such amount to be reduced pro rata (as determined by the Secretary) based on the number of hours such student is enrolled, and not to exceed, for any year of attendance for which the scholarship is provided, the total amount required for the year for the purposes authorized in this clause; and ``(ii) may not exceed, for any year of attendance for which the scholarship is provided, the total amount required for the year for the purposes authorized in 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 each health profession. ``(3) Service in other service areas.--The contract may allow the recipient to serve in another Service Area, provided the Tribal Health Program and Secretary approve and services are not diminished to Indians in the Service Area where the Tribal Health Program providing the scholarship is located. ``(e) Breach of Contract.-- ``(1) Specific breaches.--An individual who has entered into a written contract with the Secretary and a Tribal Health Program under subsection (d) shall be liable to the United States for the Federal share of the amount which has been paid to him or her, or on his or her behalf, under the contract if that individual-- ``(A) fails to maintain an acceptable level of academic standing in the educational institution in which he or she is enrolled (such level as determined by the educational institution under regulations of the Secretary); ``(B) is dismissed from such educational institution for disciplinary reasons; ``(C) voluntarily terminates the training in such an educational institution for which he or she is provided a scholarship under such contract before the completion of such training; or ``(D) fails to accept payment, or instructs the educational institution in which he or she is enrolled not to accept payment, in whole or in part, of a scholarship under such contract, in lieu of any service obligation arising under such contract. ``(2) Other breaches.--If for any reason not specified in paragraph (1), an individual breaches a written contract by failing to either begin such individual's service obligation required under such contract or to complete such service obligation, the United States shall be entitled to recover from the individual an amount determined in accordance with the formula specified in subsection (l) of section 110 in the manner provided for in such subsection. ``(3) Cancellation upon death of recipient.--Upon the death of an individual who receives an Indian Health Scholarship, any outstanding obligation of that individual for service or payment that relates to that scholarship shall be canceled. ``(4) Information.--The Secretary may carry out this subsection on the basis of information received from Tribal Health Programs involved or on the basis of information collected through such other means as the Secretary deems appropriate. ``(f) Relation to Social Security Act.--The recipient of a scholarship under this section shall agree, in providing health care pursuant to the requirements herein-- ``(1) not to discriminate against an individual seeking care on the basis of the ability of the individual to pay for such care or on the basis that payment for such care will be made pursuant to a program established in title XVIII of the Social Security Act or pursuant to the programs established in title XIX or title XXI of such Act; and ``(2) to accept assignment under section 1842(b)(3)(B)(ii) of the Social Security Act for all services for which payment may be made under part B of title XVIII of such Act, and to enter into an appropriate agreement with the State agency that administers the State plan for medical assistance under title XIX, or the State child health plan under title XXI, of such Act to provide service to individuals entitled to medical assistance or child health assistance, respectively, under the plan. ``(g) Continuance of Funding.--The Secretary shall make payments under this section to a Tribal Health Program for any fiscal year subsequent to the first fiscal year of such payments unless the Secretary determines that, for the immediately preceding fiscal year, the Tribal Health Program has not complied with the requirements of this section. ``SEC. 107. INDIAN HEALTH SERVICE EXTERN PROGRAMS. ``(a) Employment Preference.--Any individual who receives a scholarship pursuant to section 104 or 106 shall be given preference for employment in the Service, or may be employed by a Tribal Health Program or an Urban Indian Organization, or other agencies of the Department as available, during any nonacademic period of the year. ``(b) Not Counted Toward Active Duty Service Obligation.--Periods of employment pursuant to this subsection shall not be counted in determining fulfillment of the service obligation incurred as a condition of the scholarship. ``(c) Timing; Length of Employment.--Any individual enrolled in a program, including a high school program, authorized under section 102(a) may be employed by the Service or by a Tribal Health Program or an Urban Indian Organization during any nonacademic period of the year. Any such employment shall not exceed 120 days during any calendar year. ``(d) Nonapplicability of Competitive Personnel System.--Any employment pursuant to this section shall be made without regard to any competitive personnel system or agency personnel limitation and to a position which will enable the individual so employed to receive practical experience in the health profession in which he or she is engaged in study. Any individual so employed shall receive payment for his or her services comparable to the salary he or she would receive if he or she were employed in the competitive system. Any individual so employed shall not be counted against any employment ceiling affecting the Service or the Department. ``SEC. 108. CONTINUING EDUCATION ALLOWANCES. ``In order to encourage scholarship and stipend recipients under sections 104, 105, 106, and 115 and health professionals, including community health representatives and emergency medical technicians, to join or continue in an Indian Health Program and to provide their services in the rural and remote areas where a significant portion of Indians reside, the Secretary, acting through the Service, may-- ``(1) provide programs or allowances to transition into an Indian Health Program, including licensing, board or certification examination assistance, and technical assistance in fulfilling service obligations under sections 104, 105, 106, and 115; and ``(2) provide programs or allowances to health professionals employed in an Indian Health Program to enable them for a period of time each year prescribed by regulation of the Secretary to take leave of their duty stations for professional consultation, management, leadership, and refresher training courses. ``SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PROGRAM. ``(a) In General.--Under the authority of the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'), the Secretary, acting through the Service, shall maintain a Community Health Representative Program under which Indian Health Programs-- ``(1) provide for the training of Indians as community health representatives; and ``(2) use such community health representatives in the provision of health care, health promotion, and disease prevention services to Indian communities. ``(b) Duties.--The Community Health Representative Program of the Service, shall-- ``(1) provide a high standard of training for community health representatives to ensure that the community health representatives provide quality health care, health promotion, and disease prevention services to the Indian communities served by the Program; ``(2) in order to provide such training, develop and maintain a curriculum that-- ``(A) combines education in the theory of health care with supervised practical experience in the provision of health care; and ``(B) provides instruction and practical experience in health promotion and disease prevention activities, with appropriate consideration given to lifestyle factors that have an impact on Indian health status, such as alcoholism, family dysfunction, and poverty; ``(3) maintain a system which identifies the needs of community health representatives for continuing education in health care, health promotion, and disease prevention and develop programs that meet the needs for continuing education; ``(4) maintain a system that provides close supervision of Community Health Representatives; ``(5) maintain a system under which the work of Community Health Representatives is reviewed and evaluated; and ``(6) promote traditional health care practices of the Indian Tribes served consistent with the Service standards for the provision of health care, health promotion, and disease prevention. ``SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT PROGRAM. ``(a) Establishment.--The Secretary, acting through the Service, shall establish and administer a program to be known as the Service Loan Repayment Program (hereinafter referred to as the `Loan Repayment Program') in order to ensure an adequate supply of trained health professionals necessary to maintain accreditation of, and provide health care services to Indians through, Indian Health Programs and Urban Indian Organizations. ``(b) Eligible Individuals.--To be eligible to participate in the Loan Repayment Program, an individual must-- ``(1)(A) be enrolled-- ``(i) in a course of study or program in an accredited educational institution (as determined by the Secretary under section 338B(b)(1)(c)(i) of the Public Health Service Act (42 U.S.C. 254l- 1(b)(1)(c)(i))) and be scheduled to complete such course of study in the same year such individual applies to participate in such program; or ``(ii) in an approved graduate training program in a health profession; or ``(B) have-- ``(i) a degree in a health profession; and ``(ii) a license to practice a health profession; ``(2)(A) be eligible for, or hold, an appointment as a commissioned officer in the Regular or Reserve Corps of the Public Health Service; ``(B) be eligible for selection for civilian service in the Regular or Reserve Corps of the Public Health Service; ``(C) meet the professional standards for civil service employment in the Service; or ``(D) be employed in an Indian Health Program or Urban Indian Organization without a service obligation; and ``(3) submit to the Secretary an application for a contract described in subsection (e). ``(c) Application.-- ``(1) Information to be included with forms.--In disseminating application forms and contract forms to individuals desiring to participate in the Loan Repayment Program, the Secretary shall include with such forms a fair summary of the rights and liabilities of an individual whose application is approved (and whose contract is accepted) by the Secretary, including in the summary a clear explanation of the damages to which the United States is entitled under subsection (l) in the case of the individual's breach of contract. The Secretary shall provide such individuals with sufficient information regarding the advantages and disadvantages of service as a commissioned officer in the Regular or Reserve Corps of the Public Health Service or a civilian employee of the Service to enable the individual to make a decision on an informed basis. ``(2) Clear language.--The application form, contract form, and all other information furnished by the Secretary under this section shall be written in a manner calculated to be understood by the average individual applying to participate in the Loan Repayment Program. ``(3) Timely availability of forms.--The Secretary shall make such application forms, contract forms, and other information available to individuals desiring to participate in the Loan Repayment Program on a date sufficiently early to ensure that such individuals have adequate time to carefully review and evaluate such forms and information. ``(d) Priorities.-- ``(1) List.--Consistent with subsection (k), the Secretary shall annually-- ``(A) identify the positions in each Indian Health Program or Urban Indian Organization for which there is a need or a vacancy; and ``(B) rank those positions in order of priority. ``(2) Approvals.--Notwithstanding the priority determined under paragraph (1), the Secretary, in determining which applications under the Loan Repayment Program to approve (and which contracts to accept), shall-- ``(A) give first priority to applications made by individual Indians; and ``(B) after making determinations on all applications submitted by individual Indians as required under subparagraph (A), give priority to-- ``(i) individuals recruited through the efforts of an Indian Health Program or Urban Indian Organization; and ``(ii) other individuals based on the priority rankings under paragraph (1). ``(e) Recipient Contracts.-- ``(1) Contract required.--An individual becomes a participant in the Loan Repayment Program only upon the Secretary and the individual entering into a written contract described in paragraph (2). ``(2) Contents of contract.--The written contract referred to in this section between the Secretary and an individual shall contain-- ``(A) an agreement under which-- ``(i) subject to subparagraph (C), the Secretary agrees-- ``(I) to pay loans on behalf of the individual in accordance with the provisions of this section; and ``(II) to accept (subject to the availability of appropriated funds for carrying out this section) the individual into the Service or place the individual with a Tribal Health Program or Urban Indian Organization as provided in clause (ii)(III); and ``(ii) subject to subparagraph (C), the individual agrees-- ``(I) to accept loan payments on behalf of the individual; ``(II) in the case of an individual described in subsection (b)(1)-- ``(aa) to maintain enrollment in a course of study or training described in subsection (b)(1)(A) until the individual completes the course of study or training; and ``(bb) while enrolled in such course of study or training, to maintain an acceptable level of academic standing (as determined under regulations of the Secretary by the educational institution offering such course of study or training); and ``(III) to serve for a time period (hereinafter in this section referred to as the `period of obligated service') equal to 2 years or such longer period as the individual may agree to serve in the full-time clinical practice of such individual's profession in an Indian Health Program or Urban Indian Organization to which the individual may be assigned by the Secretary; ``(B) a provision permitting the Secretary to extend for such longer additional periods, as the individual may agree to, the period of obligated service agreed to by the individual under subparagraph (A)(ii)(III); ``(C) a provision that any financial obligation of the United States arising out of a contract entered into under this section and any obligation of the individual which is conditioned thereon is contingent upon funds being appropriated for loan repayments under this section; ``(D) a statement of the damages to which the United States is entitled under subsection (l) for the individual's breach of the contract; and ``(E) such other statements of the rights and liabilities of the Secretary and of the individual, not inconsistent with this section. ``(f) Deadline for Decision on Application.--The Secretary shall provide written notice to an individual within 21 days on-- ``(1) the Secretary's approving, under subsection (e)(1), of the individual's participation in the Loan Repayment Program, including extensions resulting in an aggregate period of obligated service in excess of 4 years; or ``(2) the Secretary's disapproving an individual's participation in such Program. ``(g) Payments.-- ``(1) In general.--A loan repayment provided for an individual under a written contract under the Loan Repayment Program shall consist of payment, in accordance with paragraph (2), on behalf of the individual of the principal, interest, and related expenses on government and commercial loans received by the individual regarding the undergraduate or graduate education of the individual (or both), which loans were made for-- ``(A) tuition expenses; ``(B) all other reasonable educational expenses, including fees, books, and laboratory expenses, incurred by the individual; and ``(C) reasonable living expenses as determined by the Secretary. ``(2) Amount.--For each year of obligated service that an individual contracts to serve under subsection (e), the Secretary may pay up to $35,000 or an amount equal to the amount specified in section 338B(g)(2)(A) of the Public Health Service Act, whichever is more, on behalf of the individual for loans described in paragraph (1). In making a determination of the amount to pay for a year of such service by an individual, the Secretary shall consider the extent to which each such determination-- ``(A) affects the ability of the Secretary to maximize the number of contracts that can be provided under the Loan Repayment Program from the amounts appropriated for such contracts; ``(B) provides an incentive to serve in Indian Health Programs and Urban Indian Organizations with the greatest shortages of health professionals; and ``(C) provides an incentive with respect to the health professional involved remaining in an Indian Health Program or Urban Indian Organization with such a health professional shortage, and continuing to provide primary health services, after the completion of the period of obligated service under the Loan Repayment Program. ``(3) Timing.--Any arrangement made by the Secretary for the making of loan repayments in accordance with this subsection shall provide that any repayments for a year of obligated service shall be made no later than the end of the fiscal year in which the individual completes such year of service. ``(4) Reimbursements for tax liability.--For the purpose of providing reimbursements for tax liability resulting from a payment under paragraph (2) on behalf of an individual, the Secretary-- ``(A) in addition to such payments, may make payments to the individual in an amount equal to not less than 20 percent and not more than 39 percent of the total amount of loan repayments made for the taxable year involved; and ``(B) may make such additional payments as the Secretary determines to be appropriate with respect to such purpose. ``(5) Payment schedule.--The Secretary may enter into an agreement with the holder of any loan for which payments are made under the Loan Repayment Program to establish a schedule for the making of such payments. ``(h) Employment Ceiling.--Notwithstanding any other provision of law, individuals who have entered into written contracts with the Secretary under this section shall not be counted against any employment ceiling affecting the Department while those individuals are undergoing academic training. ``(i) Recruitment.--The Secretary shall conduct recruiting programs for the Loan Repayment Program and other manpower programs of the Service at educational institutions training health professionals or specialists identified in subsection (a). ``(j) Applicability of Law.--Section 214 of the Public Health Service Act (42 U.S.C. 215) shall not apply to individuals during their period of obligated service under the Loan Repayment Program. ``(k) Assignment of Individuals.--The Secretary, in assigning individuals to serve in Indian Health Programs or Urban Indian Organizations pursuant to contracts entered into under this section, shall-- ``(1) ensure that the staffing needs of Tribal Health Programs and Urban Indian Organizations receive consideration on an equal basis with programs that are administered directly by the Service; and ``(2) give priority to assigning individuals to Indian Health Programs and Urban Indian Organizations that have a need for health professionals to provide health care services as a result of individuals having breached contracts entered into under this section. ``(l) Breach of Contract.-- ``(1) Specific breaches.--An individual who has entered into a written contract with the Secretary under this section and has not received a waiver under subsection (m) shall be liable, in lieu of any service obligation arising under such contract, to the United States for the amount which has been paid on such individual's behalf under the contract if that individual-- ``(A) is enrolled in the final year of a course of study and-- ``(i) fails to maintain an acceptable level of academic standing in the educational institution in which he or she is enrolled (such level determined by the educational institution under regulations of the Secretary); ``(ii) voluntarily terminates such enrollment; or ``(iii) is dismissed from such educational institution before completion of such course of study; or ``(B) is enrolled in a graduate training program and fails to complete such training program. ``(2) Other breaches; formula for amount owed.--If, for any reason not specified in paragraph (1), an individual breaches his or her written contract under this section by failing either to begin, or complete, such individual's period of obligated service in accordance with subsection (e)(2), the United States shall be entitled to recover from such individual an amount to be determined in accordance with the following formula: A=3Z(t-s/t) in which-- ``(A) `A' is the amount the United States is entitled to recover; ``(B) `Z' is the sum of the amounts paid under this section to, or on behalf of, the individual and the interest on such amounts which would be payable if, at the time the amounts were paid, they were loans bearing interest at the maximum legal prevailing rate, as determined by the Secretary of the Treasury; ``(C) `t' is the total number of months in the individual's period of obligated service in accordance with subsection (f); and ``(D) `s' is the number of months of such period served by such individual in accordance with this section. ``(3) Deductions in medicare payments.--Amounts not paid within such period shall be subject to collection through deductions in Medicare payments pursuant to section 1892 of the Social Security Act. ``(4) Time period for repayment.--Any amount of damages which the United States is entitled to recover under this subsection shall be paid to the United States within the 1-year period beginning on the date of the breach or such longer period beginning on such date as shall be specified by the Secretary. ``(5) Recovery of delinquency.-- ``(A) In general.--If damages described in paragraph (4) are delinquent for 3 months, the Secretary shall, for the purpose of recovering such damages-- ``(i) use collection agencies contracted with by the Administrator of General Services; or ``(ii) enter into contracts for the recovery of such damages with collection agencies selected by the Secretary. ``(B) Report.--Each contract for recovering damages pursuant to this subsection shall provide that the contractor will, not less than once each 6 months, submit to the Secretary a status report on the success of the contractor in collecting such damages. Section 3718 of title 31, United States Code, shall apply to any such contract to the extent not inconsistent with this subsection. ``(m) Waiver or Suspension of Obligation.-- ``(1) In general.--The Secretary shall by regulation provide for the partial or total waiver or suspension of any obligation of service or payment by an individual under the Loan Repayment Program whenever compliance by the individual is impossible or would involve extreme hardship to the individual and if enforcement of such obligation with respect to any individual would be unconscionable. ``(2) Canceled upon death.--Any obligation of an individual under the Loan Repayment Program for service or payment of damages shall be canceled upon the death of the individual. ``(3) Hardship waiver.--The Secretary may waive, in whole or in part, the rights of the United States to recover amounts under this section in any case of extreme hardship or other good cause shown, as determined by the Secretary. ``(4) Bankruptcy.--Any obligation of an individual under the Loan Repayment Program for payment of damages may be released by a discharge in bankruptcy under title 11 of the United States Code only if such discharge is granted after the expiration of the 5-year period beginning on the first date that payment of such damages is required, and only if the bankruptcy court finds that nondischarge of the obligation would be unconscionable. ``(n) Report.--The Secretary shall submit to the President, for inclusion in the report required to be submitted to Congress under section 801, a report concerning the previous fiscal year which sets forth by Service Area the following: ``(1) A list of the health professional positions maintained by Indian Health Programs and Urban Indian Organizations for which recruitment or retention is difficult. ``(2) The number of Loan Repayment Program applications filed with respect to each type of health profession. ``(3) The number of contracts described in subsection (e) that are entered into with respect to each health profession. ``(4) The amount of loan payments made under this section, in total and by health profession. ``(5) The number of scholarships that are provided under sections 104 and 106 with respect to each health profession. ``(6) The amount of scholarship grants provided under section 104 and 106, in total and by health profession. ``(7) The number of providers of health care that will be needed by Indian Health Programs and Urban Indian Organizations, by location and profession, during the 3 fiscal years beginning after the date the report is filed. ``(8) The measures the Secretary plans to take to fill the health professional positions maintained by Indian Health Programs or Urban Indian Organizations for which recruitment or retention is difficult. ``SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOVERY FUND. ``(a) Establishment.--There is established in the Treasury of the United States a fund to be known as the Indian Health Scholarship and Loan Repayment Recovery Fund (hereafter in this section referred to as the `LRRF'). The LRRF shall consist of such amounts as may be collected from individuals under section 104(d), section 106(e), and section 110(l) for breach of contract, such funds as may be appropriated to the LRRF, and interest earned on amounts in the LRRF. All amounts collected, appropriated, or earned relative to the LRRF shall remain available until expended. ``(b) Use of Funds.-- ``(1) By secretary.--Amounts in the LRRF may be expended by the Secretary, acting through the Service, to make payments to an Indian Health Program-- ``(A) to which a scholarship recipient under section 104 and 106 or a loan repayment program participant under section 110 has been assigned to meet the obligated service requirements pursuant to such sections; and ``(B) that has a need for a health professional to provide health care services as a result of such recipient or participant having breached the contract entered into under section 104, 106, or section 110. ``(2) By tribal health programs.--A Tribal Health Program receiving payments pursuant to paragraph (1) may expend the payments to provide scholarships or recruit and employ, directly or by contract, health professionals to provide health care services. ``(c) Investment of Funds.--The Secretary of the Treasury shall invest such amounts of the LRRF as the Secretary of Health and Human Services determines are not required to meet current withdrawals from the LRRF. Such investments may be made only in interest bearing obligations of the United States. For such purpose, such obligations may be acquired on original issue at the issue price, or by purchase of outstanding obligations at the market price. ``(d) Sale of Obligations.--Any obligation acquired by the LRRF may be sold by the Secretary of the Treasury at the market price. ``SEC. 112. RECRUITMENT ACTIVITIES. ``(a) Reimbursement for Travel.--The Secretary, acting through the Service, may reimburse health professionals seeking positions with Indian Health Programs or Urban Indian Organizations, including individuals considering entering into a contract under section 110 and their spouses, for actual and reasonable expenses incurred in traveling to and from their places of residence to an area in which they may be assigned for the purpose of evaluating such area with respect to such assignment. ``(b) Recruitment Personnel.--The Secretary, acting through the Service, shall assign 1 individual in each Area Office to be responsible on a full-time basis for recruitment activities. ``SEC. 113. INDIAN RECRUITMENT AND RETENTION PROGRAM. ``(a) In General.--The Secretary, acting through the Service, shall fund, on a competitive basis, innovative demonstration projects for a period not to exceed 3 years to enable Tribal Health Programs and Urban Indian Organizations to recruit, place, and retain health professionals to meet their staffing needs. ``(b) Eligible Entities; Application.--Any Tribal Health Program or Urban Indian Organization may submit an application for funding of a project pursuant to this section. ``SEC. 114. ADVANCED TRAINING AND RESEARCH. ``(a) Demonstration Program.--The Secretary, acting through the Service, shall establish a demonstration project to enable health professionals who have worked in an Indian Health Program or Urban Indian Organization for a substantial period of time to pursue advanced training or research areas of study for which the Secretary determines a need exists. ``(b) Service Obligation.--An individual who participates in a program under subsection (a), where the educational costs are borne by the Service, shall incur an obligation to serve in an Indian Health Program or Urban Indian Organization for a period of obligated service equal to at least the period of time during which the individual participates in such program. In the event that the individual fails to complete such obligated service, the individual shall be liable to the United States for the period of service remaining. In such event, with respect to individuals entering the program after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the United States shall be entitled to recover from such individual an amount to be determined in accordance with the formula specified in subsection (l) of section 110 in the manner provided for in such subsection. ``(c) Equal Opportunity for Participation.--Health professionals from Tribal Health Programs and Urban Indian Organizations shall be given an equal opportunity to participate in the program under subsection (a). ``SEC. 115. QUENTIN N. BURDICK AMERICAN INDIANS INTO NURSING PROGRAM. ``(a) Grants Authorized.--For the purpose of increasing the number of nurses, nurse midwives, and nurse practitioners who deliver health care services to Indians, the Secretary, acting through the Service, shall provide grants to the following: ``(1) Public or private schools of nursing. ``(2) Tribal colleges or universities. ``(3) Nurse midwife programs and advanced practice nurse programs that are provided by any tribal college or university accredited nursing program, or in the absence of such, any other public or private institutions. ``(b) Use of Grants.--Grants provided under subsection (a) may be used for 1 or more of the following: ``(1) To recruit individuals for programs which train individuals to be nurses, nurse midwives, or advanced practice nurses. ``(2) To provide scholarships to Indians enrolled in such programs that may pay the tuition charged for such program and other expenses incurred in connection with such program, including books, fees, room and board, and stipends for living expenses. ``(3) To provide a program that encourages nurses, nurse midwives, and advanced practice nurses to provide, or continue to provide, health care services to Indians. ``(4) To provide a program that increases the skills of, and provides continuing education to, nurses, nurse midwives, and advanced practice nurses. ``(5) To provide any program that is designed to achieve the purpose described in subsection (a). ``(c) Applications.--Each application for a grant under subsection (a) shall include such information as the Secretary may require to establish the connection between the program of the applicant and a health care facility that primarily serves Indians. ``(d) Preferences for Grant Recipients.--In providing grants under subsection (a), the Secretary shall extend a preference to the following: ``(1) Programs that provide a preference to Indians. ``(2) Programs that train nurse midwives or advanced practice nurses. ``(3) Programs that are interdisciplinary. ``(4) Programs that are conducted in cooperation with a program for gifted and talented Indian students. ``(5) Programs conducted by tribal colleges and universities. ``(e) Quentin N. Burdick Program Grant.--The Secretary shall provide 1 of the grants authorized under subsection (a) to establish and maintain a program at the University of North Dakota to be known as the `Quentin N. Burdick American Indians Into Nursing Program'. Such program shall, to the maximum extent feasible, coordinate with the Quentin N. Burdick Indian Health Programs established under section 117(b) and the Quentin N. Burdick American Indians Into Psychology Program established under section 105(b). ``(f) Active Duty Service Obligation.--The active duty service obligation prescribed under section 338C of the Public Health Service Act (42 U.S.C. 254m) shall be met by each individual who receives training or assistance described in paragraph (1) or (2) of subsection (b) that is funded by a grant provided under subsection (a). Such obligation shall be met by service-- ``(1) in the Service; ``(2) in a program of an Indian Tribe or Tribal Organization conducted under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) (including programs under agreements with the Bureau of Indian Affairs); ``(3) in a program assisted under title V of this Act; ``(4) in the private practice of nursing if, as determined by the Secretary, in accordance with guidelines promulgated by the Secretary, such practice is situated in a physician or other health shortage area and addresses the health care needs of a substantial number of Indians; or ``(5) in a teaching capacity in a tribal college or university nursing program (or a related health profession program) if, as determined by the Secretary, health services provided to Indians would not decrease. ``SEC. 116. TRIBAL CULTURAL ORIENTATION. ``(a) Cultural Education of Employees.--The Secretary, acting through the Service, shall require that appropriate employees of the Service who serve Indian Tribes in each Service Area receive educational instruction in the history and culture of such Indian Tribes and their relationship to the Service. ``(b) Program.--In carrying out subsection (a), the Secretary shall establish a program which shall, to the extent feasible-- ``(1) be developed in consultation with the affected Indian Tribes, Tribal Organizations, and Urban Indian Organizations; ``(2) be carried out through tribal colleges or universities; ``(3) include instruction in American Indian studies; and ``(4) describe the use and place of traditional health care practices of the Indian Tribes in the Service Area. ``SEC. 117. INMED PROGRAM. ``(a) Grants Authorized.--The Secretary, acting through the Service, is authorized to provide grants to colleges and universities for the purpose of maintaining and expanding the Indian health careers recruitment program known as the `Indians Into Medicine Program' (hereinafter in this section referred to as `INMED') as a means of encouraging Indians to enter the health professions. ``(b) Quentin N. Burdick Grant.--The Secretary shall provide 1 of the grants authorized under subsection (a) to maintain the INMED program at the University of North Dakota, to be known as the `Quentin N. Burdick Indian Health Programs', unless the Secretary makes a determination, based upon program reviews, that the program is not meeting the purposes of this section. Such program shall, to the maximum extent feasible, coordinate with the Quentin N. Burdick American Indians Into Psychology Program established under section 105(b) and the Quentin N. Burdick American Indians Into Nursing Program established under section 115. ``(c) Regulations.--The Secretary, pursuant to this Act, shall develop regulations to govern grants pursuant to this section. ``(d) Requirements.--Applicants for grants provided under this section shall agree to provide a program which-- ``(1) provides outreach and recruitment for health professions to Indian communities including elementary and secondary schools and community colleges located on reservations which will be served by the program; ``(2) incorporates a program advisory board comprised of representatives from the Indian Tribes and Indian communities which will be served by the program; ``(3) provides summer preparatory programs for Indian students who need enrichment in the subjects of math and science in order to pursue training in the health professions; ``(4) provides tutoring, counseling, and support to students who are enrolled in a health career program of study at the respective college or university; and ``(5) to the maximum extent feasible, employs qualified Indians in the program. ``SEC. 118. HEALTH TRAINING PROGRAMS OF COMMUNITY COLLEGES. ``(a) Grants to Establish Programs.-- ``(1) In general.--The Secretary, acting through the Service, shall award grants to accredited and accessible community colleges for the purpose of assisting such community colleges in the establishment of programs which provide education in a health profession leading to a degree or diploma in a health profession for individuals who desire to practice such profession on or near a reservation or in an Indian Health Program. ``(2) Amount of grants.--The amount of any grant awarded to a community college under paragraph (1) for the first year in which such a grant is provided to the community college shall not exceed $250,000. ``(b) Grants for Maintenance and Recruiting.-- ``(1) In general.--The Secretary, acting through the Service, shall award grants to accredited and accessible community colleges that have established a program described in subsection (a)(1) for the purpose of maintaining the program and recruiting students for the program. ``(2) Requirements.--Grants may only be made under this section to a community college which-- ``(A) is accredited; ``(B) has a relationship with a hospital facility, Service facility, or hospital that could provide training of nurses or health professionals; ``(C) has entered into an agreement with an accredited college or university medical school, the terms of which-- ``(i) provide a program that enhances the transition and recruitment of students into advanced baccalaureate or graduate programs that train health professionals; and ``(ii) stipulate certifications necessary to approve internship and field placement opportunities at Indian Health Programs; ``(D) has a qualified staff which has the appropriate certifications; ``(E) is capable of obtaining State or regional accreditation of the program described in subsection (a)(1); and ``(F) agrees to provide for Indian preference for applicants for programs under this section. ``(c) Technical Assistance.--The Secretary shall encourage community colleges described in subsection (b)(2) to establish and maintain programs described in subsection (a)(1) by-- ``(1) entering into agreements with such colleges for the provision of qualified personnel of the Service to teach courses of study in such programs; and ``(2) providing technical assistance and support to such colleges. ``(d) Advanced Training.-- ``(1) Required.--Any program receiving assistance under this section that is conducted with respect to a health profession shall also offer courses of study which provide advanced training for any health professional who-- ``(A) has already received a degree or diploma in such health profession; and ``(B) provides clinical services on or near a reservation or for an Indian Health Program. ``(2) May be offered at alternate site.--Such courses of study may be offered in conjunction with the college or university with which the community college has entered into the agreement required under subsection (b)(2)(C). ``(e) Priority.--Where the requirements of subsection (b) are met, grant award priority shall be provided to tribal colleges and universities in Service Areas where they exist. ``SEC. 119. RETENTION BONUS. ``(a) Bonus Authorized.--The Secretary may pay a retention bonus to any health professional employed by, or assigned to, and serving in, an Indian Health Program or Urban Indian Organization either as a civilian employee or as a commissioned officer in the Regular or Reserve Corps of the Public Health Service who-- ``(1) is assigned to, and serving in, a position for which recruitment or retention of personnel is difficult; ``(2) the Secretary determines is needed by Indian Health Programs and Urban Indian Organizations; ``(3) has-- ``(A) completed 2 years of employment with an Indian Health Program or Urban Indian Organization; or ``(B) completed any service obligations incurred as a requirement of-- ``(i) any Federal scholarship program; or ``(ii) any Federal education loan repayment program; and ``(4) enters into an agreement with an Indian Health Program or Urban Indian Organization for continued employment for a period of not less than 1 year. ``(b) Rates.--The Secretary may establish rates for the retention bonus which shall provide for a higher annual rate for multiyear agreements than for single year agreements referred to in subsection (a)(4), but in no event shall the annual rate be more than $25,000 per annum. ``(c) Default of Retention Agreement.--Any health professional failing to complete the agreed upon term of service, except where such failure is through no fault of the individual, shall be obligated to refund to the Government the full amount of the retention bonus for the period covered by the agreement, plus interest as determined by the Secretary in accordance with section 110(l)(2)(B). ``(d) Other Retention Bonus.--The Secretary may pay a retention bonus to any health professional employed by a Tribal Health Program if such health professional is serving in a position which the Secretary determines is-- ``(1) a position for which recruitment or retention is difficult; and ``(2) necessary for providing health care services to Indians. ``SEC. 120. NURSING RESIDENCY PROGRAM. ``(a) Establishment of Program.--The Secretary, acting through the Service, shall establish a program to enable Indians who are licensed practical nurses, licensed vocational nurses, and registered nurses who are working in an Indian Health Program or Urban Indian Organization, and have done so for a period of not less than 1 year, to pursue advanced training. Such program shall include a combination of education and work study in an Indian Health Program or Urban Indian Organization leading to an associate or bachelor's degree (in the case of a licensed practical nurse or licensed vocational nurse), a bachelor's degree (in the case of a registered nurse), or advanced degrees or certifications in nursing and public health. ``(b) Service Obligation.--An individual who participates in a program under subsection (a), where the educational costs are paid by the Service, shall incur an obligation to serve in an Indian Health Program or Urban Indian Organization for a period of obligated service equal to 1 year for every year that nonprofessional employee (licensed practical nurses, licensed vocational nurses, nursing assistants, and various health care technicals), or 2 years for every year that professional nurse (associate degree and bachelor-prepared registered nurses), 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. ``(a) General Purposes of Program.--Under the authority of the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'), the Secretary, acting through the Service, shall develop and operate a Community Health Aide Program in Alaska under which the Service-- ``(1) provides for the training of Alaska Natives as health aides or community health practitioners; ``(2) uses such aides or practitioners in the provision of health care, health promotion, and disease prevention services to Alaska Natives living in villages in rural Alaska; and ``(3) provides for the establishment of teleconferencing capacity in health clinics located in or near such villages for use by community health aides or community health practitioners. ``(b) Specific Program Requirements.--The Secretary, acting through the Community Health Aide Program of the Service, shall-- ``(1) using trainers accredited by the Program, provide a high standard of training to community health aides and community health practitioners to ensure that such aides and practitioners provide quality health care, health promotion, and disease prevention services to the villages served by the Program; ``(2) in order to provide such training, develop a curriculum that-- ``(A) combines education in the theory of health care with supervised practical experience in the provision of health care; ``(B) provides instruction and practical experience in the provision of acute care, emergency care, health promotion, disease prevention, and the efficient and effective management of clinic pharmacies, supplies, equipment, and facilities; and ``(C) promotes the achievement of the health status objectives specified in section 3(2); ``(3) establish and maintain a Community Health Aide Certification Board to certify as community health aides or community health practitioners individuals who have successfully completed the training described in paragraph (1) or can demonstrate equivalent experience; ``(4) develop and maintain a system which identifies the needs of community health aides and community health practitioners for continuing education in the provision of health care, including the areas described in paragraph (2)(B), and develop programs that meet the needs for such continuing education; ``(5) develop and maintain a system that provides close supervision of community health aides and community health practitioners; ``(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; and ``(7) ensure that pulpal therapy (not including pulpotomies on deciduous teeth) or extraction of adult teeth can be performed by a dental health aide therapist only after consultation with a licensed dentist who determines that the procedure is a medical emergency that cannot be resolved with palliative treatment, and further that dental health aide therapists are strictly prohibited from performing all other oral or jaw surgeries, provided that uncomplicated extractions shall not be considered oral surgery under this section. ``(c) Program Review.-- ``(1) Neutral panel.-- ``(A) Establishment.--The Secretary, acting through the Service, shall establish a neutral panel to carry out the study under paragraph (2). ``(B) Membership.--Members of the neutral panel shall be appointed by the Secretary from among clinicians, economists, community practitioners, oral epidemiologists, and Alaska Natives. ``(2) Study.-- ``(A) In general.--The neutral panel established under paragraph (1) shall conduct a study of the dental health aide therapist services provided by the Community Health Aide Program under this section to ensure that the quality of care provided through those services is adequate and appropriate. ``(B) Parameters of study.--The Secretary, in consultation with interested parties, including professional dental organizations, shall develop the parameters of the study. ``(C) Inclusions.--The study shall include a determination by the neutral panel with respect to-- ``(i) the ability of the dental health aide therapist services under this section to address the dental care needs of Alaska Natives; ``(ii) the quality of care provided through those services, including any training, improvement, or additional oversight required to improve the quality of care; and ``(iii) whether safer and less costly alternatives to the dental health aide therapist services exist. ``(D) Consultation.--In carrying out the study under this paragraph, the neutral panel shall consult with Alaska Tribal Organizations with respect to the adequacy and accuracy of the study. ``(3) Report.--The neutral panel shall submit to the Secretary, the Committee on Indian Affairs of the Senate, and the Committee on Natural Resources of the House of Representatives a report describing the results of the study under paragraph (2), including a description of-- ``(A) any determination of the neutral panel under paragraph (2)(C); and ``(B) any comments received from an Alaska Tribal Organization under paragraph (2)(D). ``(d) Nationalization of Program.-- ``(1) In general.--Except as provided in paragraph (2), the Secretary, acting through the Service, may establish a national Community Health Aide Program in accordance with the program under this section, as the Secretary determines to be appropriate. ``(2) Exception.--The national Community Health Aide Program under paragraph (1) shall not include dental health aide therapist services. ``(3) Requirement.--In establishing a national program under paragraph (1), the Secretary shall not reduce the amount of funds provided for the Community Health Aide Program described in subsections (a) and (b). ``SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION. ``The Secretary, acting through the Service, shall, by contract or otherwise, provide training for Indians in the administration and planning of Tribal Health Programs. ``SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE DEMONSTRATION PROGRAMS. ``(a) Demonstration Programs Authorized.--The Secretary, acting through the Service, may fund demonstration programs for Tribal Health Programs to address the chronic shortages of health professionals. ``(b) Purposes of Programs.--The purposes of demonstration programs funded under subsection (a) shall be-- ``(1) to provide direct clinical and practical experience at a Service Unit to health profession students and residents from medical schools; ``(2) to improve the quality of health care for Indians by assuring access to qualified health care professionals; and ``(3) to provide academic and scholarly opportunities for health professionals serving Indians by identifying all academic and scholarly resources of the region. ``(c) Advisory Board.--The demonstration programs established pursuant to subsection (a) shall incorporate a program advisory board composed of representatives from the Indian Tribes and Indian communities in the area which will be served by the program. ``SEC. 124. NATIONAL HEALTH SERVICE CORPS. ``(a) No Reduction in Services.--The Secretary shall not-- ``(1) remove a member of the National Health Service Corps from an Indian Health Program or Urban Indian Organization; or ``(2) withdraw funding used to support such member, unless the Secretary, acting through the Service, has ensured that the Indians receiving services from such member will experience no reduction in services. ``(b) Exemption From Limitations.--National Health Service Corps scholars qualifying for the Commissioned Corps in the Public Health Service shall be exempt from the full-time equivalent limitations of the National Health Service Corps and the Service when serving as a commissioned corps officer in a Tribal Health Program or an Urban Indian Organization. ``SEC. 125. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL CURRICULA DEMONSTRATION PROGRAMS. ``(a) Contracts and Grants.--The Secretary, acting through the Service, may enter into contracts with, or make grants to, accredited tribal colleges and universities and eligible accredited and accessible community colleges to establish demonstration programs to develop educational curricula for substance abuse counseling. ``(b) Use of Funds.--Funds provided under this section shall be used only for developing and providing educational curriculum for substance abuse counseling (including paying salaries for instructors). Such curricula may be provided through satellite campus programs. ``(c) Time Period of Assistance; Renewal.--A contract entered into or a grant provided under this section shall be for a period of 3 years. Such contract or grant may be renewed for an additional 2-year period upon the approval of the Secretary. ``(d) Criteria for Review and Approval of Applications.--Not later than 180 days after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary, after consultation with Indian Tribes and administrators of tribal colleges and universities and eligible accredited and accessible community colleges, shall develop and issue criteria for the review and approval of applications for funding (including applications for renewals of funding) under this section. Such criteria shall ensure that demonstration programs established under this section promote the development of the capacity of such entities to educate substance abuse counselors. ``(e) Assistance.--The Secretary shall provide such technical and other assistance as may be necessary to enable grant recipients to comply with the provisions of this section. ``(f) Report.--Each fiscal year, the Secretary shall submit to the President, for inclusion in the report which is required to be submitted under section 801 for that fiscal year, a report on the findings and conclusions derived from the demonstration programs conducted under this section during that fiscal year. ``(g) Definition.--For the purposes of this section, the term `educational curriculum' means 1 or more of the following: ``(1) Classroom education. ``(2) Clinical work experience. ``(3) Continuing education workshops. ``SEC. 126. BEHAVIORAL HEALTH TRAINING AND COMMUNITY EDUCATION PROGRAMS. ``(a) Study; List.--The Secretary, acting through the Service, and the Secretary of the Interior, in consultation with Indian Tribes and Tribal Organizations, shall conduct a study and compile a list of the types of staff positions specified in subsection (b) whose qualifications include, or should include, training in the identification, prevention, education, referral, or treatment of mental illness, or dysfunctional and self destructive behavior. ``(b) Positions.--The positions referred to in subsection (a) are-- ``(1) staff positions within the Bureau of Indian Affairs, including existing positions, in the fields of-- ``(A) elementary and secondary education; ``(B) social services and family and child welfare; ``(C) law enforcement and judicial services; and ``(D) alcohol and substance abuse; ``(2) staff positions within the Service; and ``(3) staff positions similar to those identified in paragraphs (1) and (2) established and maintained by Indian Tribes, Tribal Organizations (without regard to the funding source), and Urban Indian Organizations. ``(c) Training Criteria.-- ``(1) In general.--The appropriate Secretary shall provide training criteria appropriate to each type of position identified in subsection (b)(1) and (b)(2) and ensure that appropriate training has been, or shall be provided to any individual in any such position. With respect to any such individual in a position identified pursuant to subsection (b)(3), the respective Secretaries shall provide appropriate training to, or provide funds to, an Indian Tribe, Tribal Organization, or Urban Indian Organization for training of appropriate individuals. In the case of positions funded under a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), the appropriate Secretary shall ensure that such training costs are included in the contract or compact, as the Secretary determines necessary. ``(2) Position specific training criteria.--Position specific training criteria shall be culturally relevant to Indians and Indian Tribes and shall ensure that appropriate information regarding traditional health care practices is provided. ``(d) Community Education on Mental Illness.--The Service shall develop and implement, on request of an Indian Tribe, Tribal Organization, or Urban Indian Organization, or assist the Indian Tribe, Tribal Organization, or Urban Indian Organization to develop and implement, a program of community education on mental illness. In carrying out this subsection, the Service shall, upon request of an Indian Tribe, Tribal Organization, or Urban Indian Organization, provide technical assistance to the Indian Tribe, Tribal Organization, or Urban Indian Organization to obtain and develop community educational materials on the identification, prevention, referral, and treatment of mental illness and dysfunctional and self-destructive behavior. ``(e) Plan.--Not later than 90 days after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary shall develop a plan under which the Service will increase the health care staff providing behavioral health services by at least 500 positions within 5 years after the date of enactment of this section, with at least 200 of such positions devoted to child, adolescent, and family services. The plan developed under this subsection shall be implemented under the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'). ``SEC. 127. AUTHORIZATION OF APPROPRIATIONS. ``There are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2017 to carry out this title. ``TITLE II--HEALTH SERVICES ``SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND. ``(a) Use of Funds.--The Secretary, acting through the Service, is authorized to expend funds, directly or under the authority of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), which are appropriated under the authority of this section, for the purposes of-- ``(1) eliminating the deficiencies in health status and health resources of all Indian Tribes; ``(2) eliminating backlogs in the provision of health care services to Indians; ``(3) meeting the health needs of Indians in an efficient and equitable manner, including the use of telehealth and telemedicine when appropriate; ``(4) eliminating inequities in funding for both direct care and contract health service programs; and ``(5) augmenting the ability of the Service to meet the following health service responsibilities with respect to those Indian Tribes with the highest levels of health status deficiencies and resource deficiencies: ``(A) Clinical care, including inpatient care, outpatient care (including audiology, clinical eye, and vision care), primary care, secondary and tertiary care, and long-term care. ``(B) Preventive health, including mammography and other cancer screening in accordance with section 207. ``(C) Dental care. ``(D) Mental health, including community mental health services, inpatient mental health services, dormitory mental health services, therapeutic and residential treatment centers, and training of traditional health care practitioners. ``(E) Emergency medical services. ``(F) Treatment and control of, and rehabilitative care related to, alcoholism and drug abuse (including fetal alcohol syndrome) among Indians. ``(G) Injury prevention programs, including data collection and evaluation, demonstration projects, training, and capacity building. ``(H) Home health care. ``(I) Community health representatives. ``(J) Maintenance and improvement. ``(b) No Offset or Limitation.--Any funds appropriated under the authority of this section shall not be used to offset or limit any other appropriations made to the Service under this Act or the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'), or any other provision of law. ``(c) Allocation; Use.-- ``(1) In general.--Funds appropriated under the authority of this section shall be allocated to Service Units, Indian Tribes, or Tribal Organizations. The funds allocated to each Indian Tribe, Tribal Organization, or Service Unit under this paragraph shall be used by the Indian Tribe, Tribal Organization, or Service Unit under this paragraph to improve the health status and reduce the resource deficiency of each Indian Tribe served by such Service Unit, Indian Tribe, or Tribal Organization. ``(2) Apportionment of allocated funds.--The apportionment of funds allocated to a Service Unit, Indian Tribe, or Tribal Organization under paragraph (1) among the health service responsibilities described in subsection (a)(5) shall be determined by the Service in consultation with, and with the active participation of, the affected Indian Tribes and Tribal Organizations. ``(d) Provisions Relating to Health Status and Resource Deficiencies.--For the purposes of this section, the following definitions apply: ``(1) Definition.--The term `health status and resource deficiency' means the extent to which-- ``(A) the health status objectives set forth in section 3(2) are not being achieved; and ``(B) the Indian Tribe or Tribal Organization does not have available to it the health resources it needs, taking into account the actual cost of providing health care services given local geographic, climatic, rural, or other circumstances. ``(2) Available resources.--The health resources available to an Indian Tribe or Tribal Organization include health resources provided by the Service as well as health resources used by the Indian Tribe or Tribal Organization, including services and financing systems provided by any Federal programs, private insurance, and programs of State or local governments. ``(3) Process for review of determinations.--The Secretary shall establish procedures which allow any Indian Tribe or Tribal Organization to petition the Secretary for a review of any determination of the extent of the health status and resource deficiency of such Indian Tribe or Tribal Organization. ``(e) Eligibility for Funds.--Tribal Health Programs shall be eligible for funds appropriated under the authority of this section on an equal basis with programs that are administered directly by the Service. ``(f) Report.--By no later than the date that is 3 years after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary shall submit to Congress the current health status and resource deficiency report of the Service for each Service Unit, including newly recognized or acknowledged Indian Tribes. Such report shall set out-- ``(1) the methodology then in use by the Service for determining Tribal health status and resource deficiencies, as well as the most recent application of that methodology; ``(2) the extent of the health status and resource deficiency of each Indian Tribe served by the Service or a Tribal Health Program; ``(3) the amount of funds necessary to eliminate the health status and resource deficiencies of all Indian Tribes served by the Service or a Tribal Health Program; and ``(4) an estimate of-- ``(A) the amount of health service funds appropriated under the authority of this Act, or any other Act, including the amount of any funds transferred to the Service for the preceding fiscal year which is allocated to each Service Unit, Indian Tribe, or Tribal Organization; ``(B) the number of Indians eligible for health services in each Service Unit or Indian Tribe or Tribal Organization; and ``(C) the number of Indians using the Service resources made available to each Service Unit, Indian Tribe or Tribal Organization, and, to the extent available, information on the waiting lists and number of Indians turned away for services due to lack of resources. ``(g) Inclusion in Base Budget.--Funds appropriated under this section for any fiscal year shall be included in the base budget of the Service for the purpose of determining appropriations under this section in subsequent fiscal years. ``(h) Clarification.--Nothing in this section is intended to diminish the primary responsibility of the Service to eliminate existing backlogs in unmet health care needs, nor are the provisions of this section intended to discourage the Service from undertaking additional efforts to achieve equity among Indian Tribes and Tribal Organizations. ``(i) Funding Designation.--Any funds appropriated under the authority of this section shall be designated as the `Indian Health Care Improvement Fund'. ``SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND. ``(a) Establishment.--There is established an Indian Catastrophic Health Emergency Fund (hereafter in this section referred to as the `CHEF') consisting of-- ``(1) the amounts deposited under subsection (f); and ``(2) the amounts appropriated to CHEF under this section. ``(b) Administration.--CHEF shall be administered by the Secretary, acting through the headquarters of the Service, solely for the purpose of meeting the extraordinary medical costs associated with the treatment of victims of disasters or catastrophic illnesses who are within the responsibility of the Service. ``(c) Conditions on Use of Fund.--No part of CHEF or its administration shall be subject to contract or grant under any law, including the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), nor shall CHEF funds be allocated, apportioned, or delegated on an Area Office, Service Unit, or other similar basis. ``(d) Regulations.--The Secretary shall promulgate regulations consistent with the provisions of this section to-- ``(1) establish a definition of disasters and catastrophic illnesses for which the cost of the treatment provided under contract would qualify for payment from CHEF; ``(2) provide that a Service Unit shall not be eligible for reimbursement for the cost of treatment from CHEF until its cost of treating any victim of such catastrophic illness or disaster has reached a certain threshold cost which the Secretary shall establish at-- ``(A) the 2000 level of $19,000; and ``(B) for any subsequent year, not less than the threshold cost of the previous year increased by the percentage increase in the medical care expenditure category of the consumer price index for all urban consumers (United States city average) for the 12-month period ending with December of the previous year; ``(3) establish a procedure for the reimbursement of the portion of the costs that exceeds such threshold cost incurred by-- ``(A) Service Units; or ``(B) whenever otherwise authorized by the Service, non-Service facilities or providers; ``(4) establish a procedure for payment from CHEF in cases in which the exigencies of the medical circumstances warrant treatment prior to the authorization of such treatment by the Service; and ``(5) establish a procedure that will ensure that no payment shall be made from CHEF to any provider of treatment to the extent that such provider is eligible to receive payment for the treatment from any other Federal, State, local, or private source of reimbursement for which the patient is eligible. ``(e) No Offset or Limitation.--Amounts appropriated to CHEF under this section shall not be used to offset or limit appropriations made to the Service under the authority of the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'), or any other law. ``(f) Deposit of Reimbursement Funds.--There shall be deposited into CHEF all reimbursements to which the Service is entitled from any Federal, State, local, or private source (including third party insurance) by reason of treatment rendered to any victim of a disaster or catastrophic illness the cost of which was paid from CHEF. ``SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION SERVICES. ``(a) Findings.--Congress finds that health promotion and disease prevention activities-- ``(1) improve the health and well-being of Indians; and ``(2) reduce the expenses for health care of Indians. ``(b) Provision of Services.--The Secretary, acting through the Service and Tribal Health Programs, shall provide health promotion and disease prevention services to Indians to achieve the health status objectives set forth in section 3(2). ``(c) Evaluation.--The Secretary, after obtaining input from the affected Tribal Health Programs, shall submit to the President for inclusion in the report which is required to be submitted to Congress under section 801 an evaluation of-- ``(1) the health promotion and disease prevention needs of Indians; ``(2) the health promotion and disease prevention activities which would best meet such needs; ``(3) the internal capacity of the Service and Tribal Health Programs to meet such needs; and ``(4) the resources which would be required to enable the Service and Tribal Health Programs to undertake the health promotion and disease prevention activities necessary to meet such needs. ``SEC. 204. DIABETES PREVENTION, TREATMENT, AND CONTROL. ``(a) Determinations Regarding Diabetes.--The Secretary, acting through the Service, and in consultation with Indian Tribes and Tribal Organizations, shall determine-- ``(1) by Indian Tribe and by Service Unit, the incidence of, and the types of complications resulting from, diabetes among Indians; and ``(2) based on the determinations made pursuant to paragraph (1), the measures (including patient education and effective ongoing monitoring of disease indicators) each Service Unit should take to reduce the incidence of, and prevent, treat, and control the complications resulting from, diabetes among Indian Tribes within that Service Unit. ``(b) Diabetes Screening.--To the extent medically indicated and with informed consent, the Secretary shall screen each Indian who receives services from the Service for diabetes and for conditions which indicate a high risk that the individual will become diabetic and establish a cost-effective approach to ensure ongoing monitoring of disease indicators. Such screening and monitoring may be conducted by a Tribal Health Program and may be conducted through appropriate Internet-based health care management programs. ``(c) Diabetes Projects.--The Secretary shall continue to maintain each model diabetes project in existence on the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, any such other diabetes programs operated by the Service or Tribal Health Programs, and any additional diabetes projects, such as the Medical Vanguard program provided for in title IV of Public Law 108-87, as implemented to serve Indian Tribes. Tribal Health Programs shall receive recurring funding for the diabetes projects that they operate pursuant to this section, both at the date of enactment of the Indian Health Care Improvement Act Amendments of 2007 and for projects which are added and funded thereafter. ``(d) Dialysis Programs.--The Secretary is authorized to provide, through the Service, Indian Tribes, and Tribal Organizations, dialysis programs, including the purchase of dialysis equipment and the provision of necessary staffing. ``(e) Other Duties of the Secretary.-- ``(1) In general.--The Secretary shall, to the extent funding is available-- ``(A) in each Area Office, consult with Indian Tribes and Tribal Organizations regarding programs for the prevention, treatment, and control of diabetes; ``(B) establish in each Area Office a registry of patients with diabetes to track the incidence of diabetes and the complications from diabetes in that area; and ``(C) ensure that data collected in each Area Office regarding diabetes and related complications among Indians are disseminated to all other Area Offices, subject to applicable patient privacy laws. ``(2) Diabetes control officers.-- ``(A) In general.--The Secretary may establish and maintain in each Area Office a position of diabetes control officer to coordinate and manage any activity of that Area Office relating to the prevention, treatment, or control of diabetes to assist the Secretary in carrying out a program under this section or section 330C of the Public Health Service Act (42 U.S.C. 254c-3). ``(B) Certain activities.--Any activity carried out by a diabetes control officer under subparagraph (A) that is the subject of a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), and any funds made available to carry out such an activity, shall not be divisible for purposes of that Act. ``SEC. 205. SHARED SERVICES FOR LONG-TERM CARE. ``(a) Long-Term Care.--Notwithstanding any other provision of law, the Secretary, acting through the Service, is authorized to provide directly, or enter into contracts or compacts under the Indian Self- Determination and Education Assistance Act (25 U.S.C. 450 et seq.) with Indian Tribes or Tribal Organizations for, the delivery of long-term care (including health care services associated with long-term care) provided in a facility to Indians. Such agreements shall provide for the sharing of staff or other services between the Service or a Tribal Health Program and a long-term care or related facility owned and operated (directly or through a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.)) by such Indian Tribe or Tribal Organization. ``(b) Contents of Agreements.--An agreement entered into pursuant to subsection (a)-- ``(1) may, at the request of the Indian Tribe or Tribal Organization, delegate to such Indian Tribe or Tribal Organization such powers of supervision and control over Service employees as the Secretary deems necessary to carry out the purposes of this section; ``(2) shall provide that expenses (including salaries) relating to services that are shared between the Service and the Tribal Health Program be allocated proportionately between the Service and the Indian Tribe or Tribal Organization; and ``(3) may authorize such Indian Tribe or Tribal Organization to construct, renovate, or expand a long-term care or other similar facility (including the construction of a facility attached to a Service facility). ``(c) Minimum Requirement.--Any nursing facility provided for under this section shall meet the requirements for nursing facilities under section 1919 of the Social Security Act. ``(d) Other Assistance.--The Secretary shall provide such technical and other assistance as may be necessary to enable applicants to comply with the provisions of this section. ``(e) Use of Existing or Underused Facilities.--The Secretary shall encourage the use of existing facilities that are underused or allow the use of swing beds for long-term or similar care. ``SEC. 206. HEALTH SERVICES RESEARCH. ``(a) In General.--The Secretary, acting through the Service, shall make funding available for research to further the performance of the health service responsibilities of Indian Health Programs. ``(b) Coordination of Resources and Activities.--The Secretary shall also, to the maximum extent practicable, coordinate departmental research resources and activities to address relevant Indian Health Program research needs. ``(c) Availability.--Tribal Health Programs shall be given an equal opportunity to compete for, and receive, research funds under this section. ``(d) Use of Funds.--This funding may be used for both clinical and nonclinical research. ``(e) Evaluation and Dissemination.--The Secretary shall periodically-- ``(1) evaluate the impact of research conducted under this section; and ``(2) disseminate to Tribal Health Programs information regarding that research as the Secretary determines to be appropriate. ``SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREENING. ``The Secretary, acting through the Service or Tribal Health Programs, shall provide for screening as follows: ``(1) Screening mammography (as defined in section 1861(jj) of the Social Security Act) for Indian women at a frequency appropriate to such women under accepted and appropriate national standards, and under such terms and conditions as are consistent with standards established by the Secretary to ensure the safety and accuracy of screening mammography under part B of title XVIII of such Act. ``(2) Other cancer screening that receives an A or B rating as recommended by the United States Preventive Services Task Force established under section 915(a)(1) of the Public Health Service Act (42 U.S.C. 299b-4(a)(1)). The Secretary shall ensure that screening provided for under this paragraph complies with the recommendations of the Task Force with respect to-- ``(A) frequency; ``(B) the population to be served; ``(C) the procedure or technology to be used; ``(D) evidence of effectiveness; and ``(E) other matters that the Secretary determines appropriate. ``SEC. 208. PATIENT TRAVEL COSTS. ``(a) Definition of Qualified Escort.--In this section, the term `qualified escort' means-- ``(1) an adult escort (including a parent, guardian, or other family member) who is required because of the physical or mental condition, or age, of the applicable patient; ``(2) a health professional for the purpose of providing necessary medical care during travel by the applicable patient; or ``(3) other escorts, as the Secretary or applicable Indian Health Program determines to be appropriate. ``(b) Provision of Funds.--The Secretary, acting through the Service and Tribal Health Programs, is authorized to provide funds for the following patient travel costs, including qualified escorts, associated with receiving health care services provided (either through direct or contract care or through a contract or compact under the Indian Self- Determination and Education Assistance Act (25 U.S.C. 450 et seq.)) under this Act-- ``(1) emergency air transportation and non-emergency air transportation where ground transportation is infeasible; ``(2) transportation by private vehicle (where no other means of transportation is available), specially equipped vehicle, and ambulance; and ``(3) transportation by such other means as may be available and required when air or motor vehicle transportation is not available. ``SEC. 209. EPIDEMIOLOGY CENTERS. ``(a) Establishment of Centers.--The Secretary shall establish an epidemiology center in each Service Area to carry out the functions described in subsection (b). Any new center established after the date of the enactment of the Indian Health Care Improvement Act Amendments of 2007 may be operated under a grant authorized by subsection (d), but funding under such a grant shall not be divisible. ``(b) Functions of Centers.--In consultation with and upon the request of Indian Tribes, Tribal Organizations, and Urban Indian Organizations, each Service Area epidemiology center established under this subsection shall, with respect to such Service Area-- ``(1) collect data relating to, and monitor progress made toward meeting, each of the health status objectives of the Service, the Indian Tribes, Tribal Organizations, and Urban Indian Organizations in the Service Area; ``(2) evaluate existing delivery systems, data systems, and other systems that impact the improvement of Indian health; ``(3) assist Indian Tribes, Tribal Organizations, and Urban Indian Organizations in identifying their highest priority health status objectives and the services needed to achieve such objectives, based on epidemiological data; ``(4) make recommendations for the targeting of services needed by the populations served; ``(5) make recommendations to improve health care delivery systems for Indians and Urban Indians; ``(6) provide requested technical assistance to Indian Tribes, Tribal Organizations, and Urban Indian Organizations in the development of local health service priorities and incidence and prevalence rates of disease and other illness in the community; and ``(7) provide disease surveillance and assist Indian Tribes, Tribal Organizations, and Urban Indian Organizations to promote public health. ``(c) Technical Assistance.--The Director of the Centers for Disease Control and Prevention shall provide technical assistance to the centers in carrying out the requirements of this subsection. ``(d) Grants for Studies.-- ``(1) In general.--The Secretary may make grants to Indian Tribes, Tribal Organizations, Urban Indian Organizations, and eligible intertribal consortia to conduct epidemiological studies of Indian communities. ``(2) Eligible intertribal consortia.--An intertribal consortium is eligible to receive a grant under this subsection if-- ``(A) the intertribal consortium is incorporated for the primary purpose of improving Indian health; and ``(B) the intertribal consortium is representative of the Indian Tribes or urban Indian communities in which the intertribal consortium is located. ``(3) Applications.--An application for a grant under this subsection shall be submitted in such manner and at such time as the Secretary shall prescribe. ``(4) Requirements.--An applicant for a grant under this subsection shall-- ``(A) demonstrate the technical, administrative, and financial expertise necessary to carry out the functions described in paragraph (5); ``(B) consult and cooperate with providers of related health and social services in order to avoid duplication of existing services; and ``(C) demonstrate cooperation from Indian tribes or Urban Indian Organizations in the area to be served. ``(5) Use of funds.--A grant awarded under paragraph (1) may be used-- ``(A) to carry out the functions described in subsection (b); ``(B) to provide information to and consult with tribal leaders, urban Indian community leaders, and related health staff on health care and health service management issues; and ``(C) in collaboration with Indian Tribes, Tribal Organizations, and urban Indian communities, to provide the Service with information regarding ways to improve the health status of Indians. ``(e) Access to Information.--An epidemiology center operated by a grantee pursuant to a grant awarded under subsection (d) shall be treated as a public health authority for purposes of the Health Insurance Portability and Accountability Act of 1996 (Public Law 104- 191; 110 Stat. 2033), as such entities are defined in part 164.501 of title 45, Code of Federal Regulations (or a successor regulation). The Secretary shall grant such grantees access to and use of data, data sets, monitoring systems, delivery systems, and other protected health information in the possession of the Secretary. ``SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION PROGRAMS. ``(a) Funding for Development of Programs.--In addition to carrying out any other program for health promotion or disease prevention, the Secretary, acting through the Service, is authorized to award grants to Indian Tribes, Tribal Organizations, and Urban Indian Organizations to develop comprehensive school health education programs for children from pre-school through grade 12 in schools for the benefit of Indian and Urban Indian children. ``(b) Use of Grant Funds.--A grant awarded under this section may be used for purposes which may include, but are not limited to, the following: ``(1) Developing health education materials both for regular school programs and afterschool programs. ``(2) Training teachers in comprehensive school health education materials. ``(3) Integrating school-based, community-based, and other public and private health promotion efforts. ``(4) Encouraging healthy, tobacco-free school environments. ``(5) Coordinating school-based health programs with existing services and programs available in the community. ``(6) Developing school programs on nutrition education, personal health, oral health, and fitness. ``(7) Developing behavioral health wellness programs. ``(8) Developing chronic disease prevention programs. ``(9) Developing substance abuse prevention programs. ``(10) Developing injury prevention and safety education programs. ``(11) Developing activities for the prevention and control of communicable diseases. ``(12) Developing community and environmental health education programs that include traditional health care practitioners. ``(13) Violence prevention. ``(14) Such other health issues as are appropriate. ``(c) Technical Assistance.--Upon request, the Secretary, acting through the Service, shall provide technical assistance to Indian Tribes, Tribal Organizations, and Urban Indian Organizations in the development of comprehensive health education plans and the dissemination of comprehensive health education materials and information on existing health programs and resources. ``(d) Criteria for Review and Approval of Applications.--The Secretary, acting through the Service, and in consultation with Indian Tribes, Tribal Organizations, and Urban Indian Organizations, shall establish criteria for the review and approval of applications for grants awarded under this section. ``(e) Development of Program for BIA-Funded Schools.-- ``(1) In general.--The Secretary of the Interior, acting through the Bureau of Indian Affairs and in cooperation with the Secretary, acting through the Service, and affected Indian Tribes and Tribal Organizations, shall develop a comprehensive school health education program for children from preschool through grade 12 in schools for which support is provided by the Bureau of Indian Affairs. ``(2) Requirements for programs.--Such programs shall include-- ``(A) school programs on nutrition education, personal health, oral health, and fitness; ``(B) behavioral health wellness programs; ``(C) chronic disease prevention programs; ``(D) substance abuse prevention programs; ``(E) injury prevention and safety education programs; and ``(F) activities for the prevention and control of communicable diseases. ``(3) Duties of the secretary.--The Secretary of the Interior shall-- ``(A) provide training to teachers in comprehensive school health education materials; ``(B) ensure the integration and coordination of school-based programs with existing services and health programs available in the community; and ``(C) encourage healthy, tobacco-free school environments. ``SEC. 211. INDIAN YOUTH PROGRAM. ``(a) Program Authorized.--The Secretary, acting through the Service, is authorized to establish and administer a program to provide grants to Indian Tribes, Tribal Organizations, and Urban Indian Organizations for innovative mental and physical disease prevention and health promotion and treatment programs for Indian and Urban Indian preadolescent and adolescent youths. ``(b) Use of Funds.-- ``(1) Allowable uses.--Funds made available under this section may be used to-- ``(A) develop prevention and treatment programs for Indian youth which promote mental and physical health and incorporate cultural values, community and family involvement, and traditional health care practitioners; and ``(B) develop and provide community training and education. ``(2) Prohibited use.--Funds made available under this section may not be used to provide services described in section 707(c). ``(c) Duties of the Secretary.--The Secretary shall-- ``(1) disseminate to Indian Tribes, Tribal Organizations, and Urban Indian Organizations information regarding models for the delivery of comprehensive health care services to Indian and Urban Indian adolescents; ``(2) encourage the implementation of such models; and ``(3) at the request of an Indian Tribe, Tribal Organization, or Urban Indian Organization, provide technical assistance in the implementation of such models. ``(d) Criteria for Review and Approval of Applications.--The Secretary, in consultation with Indian Tribes, Tribal Organizations, and Urban Indian Organizations, shall establish criteria for the review and approval of applications or proposals under this section. ``SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF COMMUNICABLE AND INFECTIOUS DISEASES. ``(a) Grants Authorized.--The Secretary, acting through the Service, and after consultation with the Centers for Disease Control and Prevention, may make grants available to Indian Tribes, Tribal Organizations, and Urban Indian Organizations for the following: ``(1) Projects for the prevention, control, and elimination of communicable and infectious diseases, including tuberculosis, hepatitis, HIV, respiratory syncytial virus, hanta virus, sexually transmitted diseases, and H. Pylori. ``(2) Public information and education programs for the prevention, control, and elimination of communicable and infectious diseases. ``(3) Education, training, and clinical skills improvement activities in the prevention, control, and elimination of communicable and infectious diseases for health professionals, including allied health professionals. ``(4) Demonstration projects for the screening, treatment, and prevention of hepatitis C virus (HCV). ``(b) Application Required.--The Secretary may provide funding under subsection (a) only if an application or proposal for funding is submitted to the Secretary. ``(c) Coordination With Health Agencies.--Indian Tribes, Tribal Organizations, and Urban Indian Organizations receiving funding under this section are encouraged to coordinate their activities with the Centers for Disease Control and Prevention and State and local health agencies. ``(d) Technical Assistance; Report.--In carrying out this section, the Secretary-- ``(1) may, at the request of an Indian Tribe, Tribal Organization, or Urban Indian Organization, provide technical assistance; and ``(2) shall prepare and submit a report to Congress biennially on the use of funds under this section and on the progress made toward the prevention, control, and elimination of communicable and infectious diseases among Indians and Urban Indians. ``SEC. 213. AUTHORITY FOR PROVISION OF OTHER SERVICES. ``(a) Funding Authorized.--The Secretary, acting through the Service, Indian Tribes, and Tribal Organizations, may provide funding under this Act to meet the objectives set forth in section 3 through health care- related services and programs not otherwise described in this Act, including-- ``(1) hospice care; ``(2) assisted living; ``(3) long-term care; and ``(4) home- and community-based services. ``(b) Terms and Conditions.-- ``(1) In general.--Any service provided under this section shall be in accordance with such terms and conditions as are consistent with accepted and appropriate standards relating to the service, including any licensing term or condition under this Act. ``(2) Standards.-- ``(A) In general.--The Secretary may establish, by regulation, the standards for a service provided under this section, provided that such standards shall not be more stringent than the standards required by the State in which the service is provided. ``(B) Use of state standards.--If the Secretary does not, by regulation, establish standards for a service provided under this section, the standards required by the State in which the service is or will be provided shall apply to such service. ``(C) Indian tribes.--If a service under this section is provided by an Indian Tribe or Tribal Organization pursuant to the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), the verification by the Secretary that the service meets any standards required by the State in which the service is or will be provided shall be considered to meet the terms and conditions required under this subsection. ``(3) Eligibility.--The following individuals shall be eligible to receive long-term care under this section: ``(A) Individuals who are unable to perform a certain number of activities of daily living without assistance. ``(B) Individuals with a mental impairment, such as dementia, Alzheimer's disease, or another disabling mental illness, who may be able to perform activities of daily living under supervision. ``(C) Such other individuals as an applicable Indian Health Program determines to be appropriate. ``(c) Definitions.--For the purposes of this section, the following definitions shall apply: ``(1) The term `home- and community-based services' means 1 or more of the services specified in paragraphs (1) through (9) of section 1929(a) of the Social Security Act (42 U.S.C. 1396t(a)) (whether provided by the Service or by an Indian Tribe or Tribal Organization pursuant to the Indian Self- Determination and Education Assistance Act (25 U.S.C. 450 et seq.)) that are or will be provided in accordance with the standards described in subsection (b). ``(2) The term `hospice care' means the items and services specified in subparagraphs (A) through (H) of section 1861(dd)(1) of the Social Security Act (42 U.S.C. 1395x(dd)(1)), and such other services which an Indian Tribe or Tribal Organization determines are necessary and appropriate to provide in furtherance of this care. ``SEC. 214. INDIAN WOMEN'S HEALTH CARE. ``The Secretary, acting through the Service and Indian Tribes, Tribal Organizations, and Urban Indian Organizations, shall monitor and improve the quality of health care for Indian women of all ages through the planning and delivery of programs administered by the Service, in order to improve and enhance the treatment models of care for Indian women. ``SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH HAZARDS. ``(a) Studies and Monitoring.--The Secretary and the Service shall conduct, in conjunction with other appropriate Federal agencies and in consultation with concerned Indian Tribes and Tribal Organizations, studies and ongoing monitoring programs to determine trends in the health hazards to Indian miners and to Indians on or near reservations and Indian communities as a result of environmental hazards which may result in chronic or life threatening health problems, such as nuclear resource development, petroleum contamination, and contamination of water source and of the food chain. Such studies shall include-- ``(1) an evaluation of the nature and extent of health problems caused by environmental hazards currently exhibited among Indians and the causes of such health problems; ``(2) an analysis of the potential effect of ongoing and future environmental resource development on or near reservations and Indian communities, including the cumulative effect over time on health; ``(3) an evaluation of the types and nature of activities, practices, and conditions causing or affecting such health problems, including uranium mining and milling, uranium mine tailing deposits, nuclear power plant operation and construction, and nuclear waste disposal; oil and gas production or transportation on or near reservations or Indian communities; and other development that could affect the health of Indians and their water supply and food chain; ``(4) a summary of any findings and recommendations provided in Federal and State studies, reports, investigations, and inspections during the 5 years prior to the date of enactment of the Indian Health Care Improvement Act Amendments of 2007 that directly or indirectly relate to the activities, practices, and conditions affecting the health or safety of such Indians; and ``(5) the efforts that have been made by Federal and State agencies and resource and economic development companies to effectively carry out an education program for such Indians regarding the health and safety hazards of such development. ``(b) Health Care Plans.--Upon completion of such studies, the Secretary and the Service shall take into account the results of such studies and develop health care plans to address the health problems studied under subsection (a). The plans shall include-- ``(1) methods for diagnosing and treating Indians currently exhibiting such health problems; ``(2) preventive care and testing for Indians who may be exposed to such health hazards, including the monitoring of the health of individuals who have or may have been exposed to excessive amounts of radiation or affected by other activities that have had or could have a serious impact upon the health of such individuals; and ``(3) a program of education for Indians who, by reason of their work or geographic proximity to such nuclear or other development activities, may experience health problems. ``(c) Submission of Report and Plan to Congress.--The Secretary and the Service shall submit to Congress the study prepared under subsection (a) no later than 18 months after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007. The health care plan prepared under subsection (b) shall be submitted in a report no later than 1 year after the study prepared under subsection (a) is submitted to Congress. Such report shall include recommended activities for the implementation of the plan, as well as an evaluation of any activities previously undertaken by the Service to address such health problems. ``(d) Intergovernmental Task Force.-- ``(1) Establishment; members.--There is established an Intergovernmental Task Force to be composed of the following individuals (or their designees): ``(A) The Secretary of Energy. ``(B) The Secretary of the Environmental Protection Agency. ``(C) The Director of the Bureau of Mines. ``(D) The Assistant Secretary for Occupational Safety and Health. ``(E) The Secretary of the Interior. ``(F) The Secretary of Health and Human Services. ``(G) The Director of the Indian Health Service. ``(2) Duties.--The Task Force shall-- ``(A) identify existing and potential operations related to nuclear resource development or other environmental hazards that affect or may affect the health of Indians on or near a reservation or in an Indian community; and ``(B) enter into activities to correct existing health hazards and ensure that current and future health problems resulting from nuclear resource or other development activities are minimized or reduced. ``(3) Chairman; meetings.--The Secretary of Health and Human Services shall be the Chairman of the Task Force. The Task Force shall meet at least twice each year. ``(e) Health Services to Certain Employees.--In the case of any Indian who-- ``(1) as a result of employment in or near a uranium mine or mill or near any other environmental hazard, suffers from a work-related illness or condition; ``(2) is eligible to receive diagnosis and treatment services from an Indian Health Program; and ``(3) by reason of such Indian's employment, is entitled to medical care at the expense of such mine or mill operator or entity responsible for the environmental hazard, the Indian Health Program shall, at the request of such Indian, render appropriate medical care to such Indian for such illness or condition and may be reimbursed for any medical care so rendered to which such Indian is entitled at the expense of such operator or entity from such operator or entity. Nothing in this subsection shall affect the rights of such Indian to recover damages other than such amounts paid to the Indian Health Program from the employer for providing medical care for such illness or condition. ``SEC. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DELIVERY AREA. ``(a) In General.--For fiscal years beginning with the fiscal year ending September 30, 1983, and ending with the fiscal year ending September 30, 2016, the State of Arizona shall be designated as a contract health service delivery area by the Service for the purpose of providing contract health care services to members of federally recognized Indian Tribes of Arizona. ``(b) Maintenance of Services.--The Service shall not curtail any health care services provided to Indians residing on reservations in the State of Arizona if such curtailment is due to the provision of contract services in such State pursuant to the designation of such State as a contract health service delivery area pursuant to subsection (a). ``SEC. 217. NORTH DAKOTA AND SOUTH DAKOTA AS CONTRACT HEALTH SERVICE DELIVERY AREA. ``(a) In General.--Beginning in fiscal year 2003, the States of North Dakota and South Dakota shall be designated as a contract health service delivery area by the Service for the purpose of providing contract health care services to members of federally recognized Indian Tribes of North Dakota and South Dakota. ``(b) Limitation.--The Service shall not curtail any health care services provided to Indians residing on any reservation, or in any county that has a common boundary with any reservation, in the State of North Dakota or South Dakota if such curtailment is due to the provision of contract services in such States pursuant to the designation of such States as a contract health service delivery area pursuant to subsection (a). ``SEC. 218. CALIFORNIA CONTRACT HEALTH SERVICES PROGRAM. ``(a) Funding Authorized.--The Secretary is authorized to fund a program using the California Rural Indian Health Board (hereafter in this section referred to as the `CRIHB') as a contract care intermediary to improve the accessibility of health services to California Indians. ``(b) Reimbursement Contract.--The Secretary shall enter into an agreement with the CRIHB to reimburse the CRIHB for costs (including reasonable administrative costs) incurred pursuant to this section, in providing medical treatment under contract to California Indians described in section 806(a) throughout the California contract health services delivery area described in section 218 with respect to high cost contract care cases. ``(c) Administrative Expenses.--Not more than 5 percent of the amounts provided to the CRIHB under this section for any fiscal year may be for reimbursement for administrative expenses incurred by the CRIHB during such fiscal year. ``(d) Limitation on Payment.--No payment may be made for treatment provided hereunder to the extent payment may be made for such treatment under the Indian Catastrophic Health Emergency Fund described in section 202 or from amounts appropriated or otherwise made available to the California contract health service delivery area for a fiscal year. ``(e) Advisory Board.--There is established an advisory board which shall advise the CRIHB in carrying out this section. The advisory board shall be composed of representatives, selected by the CRIHB, from not less than 8 Tribal Health Programs serving California Indians covered under this section at least \1/2\ of whom of whom are not affiliated with the CRIHB. ``SEC. 219. CALIFORNIA AS A CONTRACT HEALTH SERVICE DELIVERY AREA. ``The State of California, excluding the counties of Alameda, Contra Costa, Los Angeles, Marin, Orange, Sacramento, San Francisco, San Mateo, Santa Clara, Kern, Merced, Monterey, Napa, San Benito, San Joaquin, San Luis Obispo, Santa Cruz, Solano, Stanislaus, and Ventura, shall be designated as a contract health service delivery area by the Service for the purpose of providing contract health services to California Indians. However, any of the counties listed herein may only be included in the contract health services delivery area if funding is specifically provided by the Service for such services in those counties. ``SEC. 220. CONTRACT HEALTH SERVICES FOR THE TRENTON SERVICE AREA. ``(a) Authorization for Services.--The Secretary, acting through the Service, is directed to provide contract health services to members of the Turtle Mountain Band of Chippewa Indians that reside in the Trenton Service Area of Divide, McKenzie, and Williams counties in the State of North Dakota and the adjoining counties of Richland, Roosevelt, and Sheridan in the State of Montana. ``(b) No Expansion of Eligibility.--Nothing in this section may be construed as expanding the eligibility of members of the Turtle Mountain Band of Chippewa Indians for health services provided by the Service beyond the scope of eligibility for such health services that applied on May 1, 1986. ``SEC. 221. PROGRAMS OPERATED BY INDIAN TRIBES AND TRIBAL ORGANIZATIONS. ``The Service shall provide funds for health care programs and facilities operated by Tribal Health Programs on the same basis as such funds are provided to programs and facilities operated directly by the Service. ``SEC. 222. LICENSING. ``Health care professionals employed by a Tribal Health Program shall, if licensed in any State, be exempt from the licensing requirements of the State in which the Tribal Health Program performs the services described in its contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.). ``SEC. 223. NOTIFICATION OF PROVISION OF EMERGENCY CONTRACT HEALTH SERVICES. ``With respect to an elderly Indian or an Indian with a disability receiving emergency medical care or services from a non-Service provider or in a non-Service facility under the authority of this Act, the time limitation (as a condition of payment) for notifying the Service of such treatment or admission shall be 30 days. ``SEC. 224. PROMPT ACTION ON PAYMENT OF CLAIMS. ``(a) Deadline for Response.--The Service shall respond to a notification of a claim by a provider of a contract care service with either an individual purchase order or a denial of the claim within 5 working days after the receipt of such notification. ``(b) Effect of Untimely Response.--If the Service fails to respond to a notification of a claim in accordance with subsection (a), the Service shall accept as valid the claim submitted by the provider of a contract care service. ``(c) Deadline for Payment of Valid Claim.--The Service shall pay a valid contract care service claim within 30 days after the completion of the claim. ``SEC. 225. LIABILITY FOR PAYMENT. ``(a) No Patient Liability.--A patient who receives contract health care services that are authorized by the Service shall not be liable for the payment of any charges or costs associated with the provision of such services. ``(b) Notification.--The Secretary shall notify a contract care provider and any patient who receives contract health care services authorized by the Service that such patient is not liable for the payment of any charges or costs associated with the provision of such services not later than 5 business days after receipt of a notification of a claim by a provider of contract care services. ``(c) No Recourse.--Following receipt of the notice provided under subsection (b), or, if a claim has been deemed accepted under section 223(b), the provider shall have no further recourse against the patient who received the services. ``SEC. 226. OFFICE OF INDIAN MEN'S HEALTH. ``(a) Establishment.--The Secretary may establish within the Service an office to be known as the `Office of Indian Men's Health' (referred to in this section as the `Office'). ``(b) Director.-- ``(1) In general.--The Office shall be headed by a director, to be appointed by the Secretary. ``(2) Duties.--The director shall coordinate and promote the status of the health of Indian men in the United States. ``(c) Report.--Not later than 2 years after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary, acting through the director of the Office, shall submit to Congress a report describing-- ``(1) any activity carried out by the director as of the date on which the report is prepared; and ``(2) any finding of the director with respect to the health of Indian men. ``SEC. 227. AUTHORIZATION OF APPROPRIATIONS. ``There are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2017 to carry out this title. ``TITLE III--FACILITIES ``SEC. 301. CONSULTATION; CONSTRUCTION AND RENOVATION OF FACILITIES; REPORTS. ``(a) Prerequisites for Expenditure of Funds.--Prior to the expenditure of, or the making of any binding commitment to expend, any funds appropriated for the planning, design, construction, or renovation of facilities pursuant to the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'), the Secretary, acting through the Service, shall-- ``(1) consult with any Indian Tribe that would be significantly affected by such expenditure for the purpose of determining and, whenever practicable, honoring tribal preferences concerning size, location, type, and other characteristics of any facility on which such expenditure is to be made; and ``(2) ensure, whenever practicable and applicable, that such facility meets the construction standards of any accrediting body recognized by the Secretary for the purposes of the Medicare, Medicaid, and SCHIP programs under titles XVIII, XIX, and XXI of the Social Security Act by not later than 1 year after the date on which the construction or renovation of such facility is completed. ``(b) Closures.-- ``(1) Evaluation required.--Notwithstanding any other provision of law, no facility operated by the Service, or any portion of such facility, may be closed if the Secretary has not submitted to Congress, not less than 1 year and not more than 2 years before the date of the proposed closure, an evaluation, completed not more than 2 years before such submission, of the impact of the proposed closure that specifies, in addition to other considerations-- ``(A) the accessibility of alternative health care resources for the population served by such facility; ``(B) the cost-effectiveness of such closure; ``(C) the quality of health care to be provided to the population served by such facility after such closure; ``(D) the availability of contract health care funds to maintain existing levels of service; ``(E) the views of the Indian Tribes served by such facility concerning such closure; ``(F) the level of use of such facility by all eligible Indians; and ``(G) the distance between such facility and the nearest operating Service hospital. ``(2) Exception for certain temporary closures.--Paragraph (1) shall not apply to any temporary closure of a facility or any portion of a facility if such closure is necessary for medical, environmental, or construction safety reasons. ``(c) Health Care Facility Priority System.-- ``(1) In general.-- ``(A) Priority system.--The Secretary, acting through the Service, shall maintain a health care facility priority system, which-- ``(i) shall be developed in consultation with Indian Tribes and Tribal Organizations; ``(ii) shall give Indian Tribes' needs the highest priority; ``(iii)(I) may include the lists required in paragraph (2)(B)(ii); and ``(II) shall include the methodology required in paragraph (2)(B)(v); and ``(III) may include such other facilities, and such renovation or expansion needs of any health care facility, as the Service, Indian Tribes, and Tribal Organizations may identify; and ``(iv) shall provide an opportunity for the nomination of planning, design, and construction projects by the Service, Indian Tribes, and Tribal Organizations for consideration under the priority system at least once every 3 years, or more frequently as the Secretary determines to be appropriate. ``(B) Needs of facilities under isdeaa agreements.-- The Secretary shall ensure that the planning, design, construction, renovation, and expansion needs of Service and non-Service facilities operated under contracts or compacts in accordance with the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) are fully and equitably integrated into the health care facility priority system. ``(C) Criteria for evaluating needs.--For purposes of this subsection, the Secretary, in evaluating the needs of facilities operated under a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), shall use the criteria used by the Secretary in evaluating the needs of facilities operated directly by the Service. ``(D) Priority of certain projects protected.--The priority of any project established under the construction priority system in effect on the date of enactment of the Indian Health Care Improvement Act Amendments of 2007 shall not be affected by any change in the construction priority system taking place after that date if the project-- ``(i) was identified in the fiscal year 2008 Service budget justification as-- ``(I) 1 of the 10 top-priority inpatient projects; ``(II) 1 of the 10 top-priority outpatient projects; ``(III) 1 of the 10 top-priority staff quarters developments; or ``(IV) 1 of the 10 top-priority Youth Regional Treatment Centers; ``(ii) had completed both Phase I and Phase II of the construction priority system in effect on the date of enactment of such Act; or ``(iii) is not included in clause (i) or (ii) and is selected, as determined by the Secretary-- ``(I) on the initiative of the Secretary; or ``(II) pursuant to a request of an Indian Tribe or Tribal Organization. ``(2) Report; contents.-- ``(A) Initial comprehensive report.-- ``(i) Definitions.--In this subparagraph: ``(I) Facilities appropriation advisory board.--The term `Facilities Appropriation Advisory Board' means the advisory board, comprised of 12 members representing Indian tribes and 2 members representing the Service, established at the discretion of the Assistant Secretary-- ``(aa) to provide advice and recommendations for policies and procedures of the programs funded pursuant to facilities appropriations; and ``(bb) to address other facilities issues. ``(II) Facilities needs assessment workgroup.--The term `Facilities Needs Assessment Workgroup' means the workgroup established at the discretion of the Assistant Secretary-- ``(aa) to review the health care facilities construction priority system; and ``(bb) to make recommendations to the Facilities Appropriation Advisory Board for revising the priority system. ``(ii) Initial report.-- ``(I) In general.--Not later than 1 year after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary shall submit to the Committee on Indian Affairs of the Senate and the Committee on Natural Resources of the House of Representatives a report that describes the comprehensive, national, ranked list of all health care facilities needs for the Service, Indian Tribes, and Tribal Organizations (including inpatient health care facilities, outpatient health care facilities, specialized health care facilities (such as for long-term care and alcohol and drug abuse treatment), wellness centers, staff quarters and hostels associated with health care facilities, and the renovation and expansion needs, if any, of such facilities) developed by the Service, Indian Tribes, and Tribal Organizations for the Facilities Needs Assessment Workgroup and the Facilities Appropriation Advisory Board. ``(II) Inclusions.--The initial report shall include-- ``(aa) the methodology and criteria used by the Service in determining the needs and establishing the ranking of the facilities needs; and ``(bb) such other information as the Secretary determines to be appropriate. ``(iii) Updates of report.--Beginning in calendar year 2011, the Secretary shall-- ``(I) update the report under clause (ii) not less frequently that once every 5 years; and ``(II) include the updated report in the appropriate annual report under subparagraph (B) for submission to Congress under section 801. ``(B) Annual reports.--The Secretary shall submit to the President, for inclusion in the report required to be transmitted to Congress under section 801, a report which sets forth the following: ``(i) A description of the health care facility priority system of the Service established under paragraph (1). ``(ii) Health care facilities lists, which may include-- ``(I) the 10 top-priority inpatient health care facilities; ``(II) the 10 top-priority outpatient health care facilities; ``(III) the 10 top-priority specialized health care facilities (such as long-term care and alcohol and drug abuse treatment); ``(IV) the 10 top-priority staff quarters developments associated with health care facilities; and ``(V) the 10 top-priority hostels associated with health care facilities. ``(iii) The justification for such order of priority. ``(iv) The projected cost of such projects. ``(v) The methodology adopted by the Service in establishing priorities under its health care facility priority system. ``(3) Requirements for preparation of reports.--In preparing the report required under paragraph (2), the Secretary shall-- ``(A) consult with and obtain information on all health care facilities needs from Indian Tribes, Tribal Organizations, and Urban Indian Organizations; and ``(B) review the total unmet needs of all Indian Tribes, Tribal Organizations, and Urban Indian Organizations for health care facilities (including hostels and staff quarters), including needs for renovation and expansion of existing facilities. ``(d) Review of Methodology Used for Health Facilities Construction Priority System.-- ``(1) In general.--Not later than 1 year after the establishment of the priority system under subsection (c)(1)(A), the Comptroller General of the United States shall prepare and finalize a report reviewing the methodologies applied, and the processes followed, by the Service in making each assessment of needs for the list under subsection (c)(2)(A)(ii) and developing the priority system under subsection (c)(1), including a review of-- ``(A) the recommendations of the Facilities Appropriation Advisory Board and the Facilities Needs Assessment Workgroup (as those terms are defined in subsection (c)(2)(A)(i)); and ``(B) the relevant criteria used in ranking or prioritizing facilities other than hospitals or clinics. ``(2) Submission to congress.--The Comptroller General of the United States shall submit the report under paragraph (1) to-- ``(A) the Committees on Indian Affairs and Appropriations of the Senate; ``(B) the Committees on Natural Resources and Appropriations of the House of Representatives; and ``(C) the Secretary. ``(e) Funding Condition.--All funds appropriated under the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'), for the planning, design, construction, or renovation of health facilities for the benefit of 1 or more Indian Tribes shall be subject to the provisions of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.). ``(f) Development of Innovative Approaches.--The Secretary shall consult and cooperate with Indian Tribes, Tribal Organizations, and Urban Indian Organizations in developing innovative approaches to address all or part of the total unmet need for construction of health facilities, including those provided for in other sections of this title and other approaches. ``SEC. 302. SANITATION FACILITIES. ``(a) Findings.--Congress finds the following: ``(1) The provision of sanitation facilities is primarily a health consideration and function. ``(2) Indian people suffer an inordinately high incidence of disease, injury, and illness directly attributable to the absence or inadequacy of sanitation facilities. ``(3) The long-term cost to the United States of treating and curing such disease, injury, and illness is substantially greater than the short-term cost of providing sanitation facilities and other preventive health measures. ``(4) Many Indian homes and Indian communities still lack sanitation facilities. ``(5) It is in the interest of the United States, and it is the policy of the United States, that all Indian communities and Indian homes, new and existing, be provided with sanitation facilities. ``(b) Facilities and Services.--In furtherance of the findings made in subsection (a), Congress reaffirms the primary responsibility and authority of the Service to provide the necessary sanitation facilities and services as provided in section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a). Under such authority, the Secretary, acting through the Service, is authorized to provide the following: ``(1) Financial and technical assistance to Indian Tribes, Tribal Organizations, and Indian communities in the establishment, training, and equipping of utility organizations to operate and maintain sanitation facilities, including the provision of existing plans, standard details, and specifications available in the Department, to be used at the option of the Indian Tribe, Tribal Organization, or Indian community. ``(2) Ongoing technical assistance and training to Indian Tribes, Tribal Organizations, and Indian communities in the management of utility organizations which operate and maintain sanitation facilities. ``(3) Priority funding for operation and maintenance assistance for, and emergency repairs to, sanitation facilities operated by an Indian Tribe, Tribal Organization or Indian community when necessary to avoid an imminent health threat or to protect the investment in sanitation facilities and the investment in the health benefits gained through the provision of sanitation facilities. ``(c) Funding.--Notwithstanding any other provision of law-- ``(1) the Secretary of Housing and Urban Development is authorized to transfer funds appropriated under the Native American Housing Assistance and Self-Determination Act of 1996 (25 U.S.C. 4101 et seq.) to the Secretary of Health and Human Services; ``(2) the Secretary of Health and Human Services is authorized to accept and use such funds for the purpose of providing sanitation facilities and services for Indians under section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a); ``(3) unless specifically authorized when funds are appropriated, the Secretary shall not use funds appropriated under section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), to provide sanitation facilities to new homes constructed using funds provided by the Department of Housing and Urban Development; ``(4) the Secretary of Health and Human Services is authorized to accept from any source, including Federal and State agencies, funds for the purpose of providing sanitation facilities and services and place these funds into contracts or compacts under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.); ``(5) except as otherwise prohibited by this section, the Secretary may use funds appropriated under the authority of section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), to fund up to 100 percent of the amount of an Indian Tribe's loan obtained under any Federal program for new projects to construct eligible sanitation facilities to serve Indian homes; ``(6) except as otherwise prohibited by this section, the Secretary may use funds appropriated under the authority of section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a) to meet matching or cost participation requirements under other Federal and non-Federal programs for new projects to construct eligible sanitation facilities; ``(7) all Federal agencies are authorized to transfer to the Secretary funds identified, granted, loaned, or appropriated whereby the Department's applicable policies, rules, and regulations shall apply in the implementation of such projects; ``(8) the Secretary of Health and Human Services shall enter into interagency agreements with Federal and State agencies for the purpose of providing financial assistance for sanitation facilities and services under this Act; ``(9) the Secretary of Health and Human Services shall, by regulation, establish standards applicable to the planning, design, and construction of sanitation facilities funded under this Act; and ``(10) the Secretary of Health and Human Services is authorized to accept payments for goods and services furnished by the Service from appropriate public authorities, nonprofit organizations or agencies, or Indian Tribes, as contributions by that authority, organization, agency, or tribe to agreements made under section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), and such payments shall be credited to the same or subsequent appropriation account as funds appropriated under the authority of section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a). ``(d) Certain Capabilities Not Prerequisite.--The financial and technical capability of an Indian Tribe, Tribal Organization, or Indian community to safely operate, manage, and maintain a sanitation facility shall not be a prerequisite to the provision or construction of sanitation facilities by the Secretary. ``(e) Financial Assistance.--The Secretary is authorized to provide financial assistance to Indian Tribes, Tribal Organizations, and Indian communities for operation, management, and maintenance of their sanitation facilities. ``(f) Operation, Management, and Maintenance of Facilities.--The Indian Tribe has the primary responsibility to establish, collect, and use reasonable user fees, or otherwise set aside funding, for the purpose of operating, managing, and maintaining sanitation facilities. If a sanitation facility serving a community that is operated by an Indian Tribe or Tribal Organization is threatened with imminent failure and such operator lacks capacity to maintain the integrity or the health benefits of the sanitation facility, then the Secretary is authorized to assist the Indian Tribe, Tribal Organization, or Indian community in the resolution of the problem on a short-term basis through cooperation with the emergency coordinator or by providing operation, management, and maintenance service. ``(g) ISDEAA Program Funded on Equal Basis.--Tribal Health Programs shall be eligible (on an equal basis with programs that are administered directly by the Service) for-- ``(1) any funds appropriated pursuant to this section; and ``(2) any funds appropriated for the purpose of providing sanitation facilities. ``(h) Report.-- ``(1) Required; contents.--The Secretary, in consultation with the Secretary of Housing and Urban Development, Indian Tribes, Tribal Organizations, and tribally designated housing entities (as defined in section 4 of the Native American Housing Assistance and Self-Determination Act of 1996 (25 U.S.C. 4103)) shall submit to the President, for inclusion in the report required to be transmitted to Congress under section 801, a report which sets forth-- ``(A) the current Indian sanitation facility priority system of the Service; ``(B) the methodology for determining sanitation deficiencies and needs; ``(C) the criteria on which the deficiencies and needs will be evaluated; ``(D) the level of initial and final sanitation deficiency for each type of sanitation facility for each project of each Indian Tribe or Indian community; ``(E) the amount and most effective use of funds, derived from whatever source, necessary to accommodate the sanitation facilities needs of new homes assisted with funds under the Native American Housing Assistance and Self-Determination Act (25 U.S.C. 4101 et seq.), and to reduce the identified sanitation deficiency levels of all Indian Tribes and Indian communities to level I sanitation deficiency as defined in paragraph (3)(A); and ``(F) a 10-year plan to provide sanitation facilities to serve existing Indian homes and Indian communities and new and renovated Indian homes. ``(2) Uniform methodology.--The methodology used by the Secretary in determining, preparing cost estimates for, and reporting sanitation deficiencies for purposes of paragraph (1) shall be applied uniformly to all Indian Tribes and Indian communities. ``(3) Sanitation deficiency levels.--For purposes of this subsection, the sanitation deficiency levels for an individual, Indian Tribe, or Indian community sanitation facility to serve Indian homes are determined as follows: ``(A) A level I deficiency exists if a sanitation facility serving an individual, Indian Tribe, or Indian community-- ``(i) complies with all applicable water supply, pollution control, and solid waste disposal laws; and ``(ii) deficiencies relate to routine replacement, repair, or maintenance needs. ``(B) A level II deficiency exists if a sanitation facility serving an individual, Indian Tribe, or Indian community substantially or recently complied with all applicable water supply, pollution control, and solid waste laws and any deficiencies relate to-- ``(i) small or minor capital improvements needed to bring the facility back into compliance; ``(ii) capital improvements that are necessary to enlarge or improve the facilities in order to meet the current needs for domestic sanitation facilities; or ``(iii) the lack of equipment or training by an Indian Tribe, Tribal Organization, or an Indian community to properly operate and maintain the sanitation facilities. ``(C) A level III deficiency exists if a sanitation facility serving an individual, Indian Tribe or Indian community meets 1 or more of the following conditions-- ``(i) water or sewer service in the home is provided by a haul system with holding tanks and interior plumbing; ``(ii) major significant interruptions to water supply or sewage disposal occur frequently, requiring major capital improvements to correct the deficiencies; or ``(iii) there is no access to or no approved or permitted solid waste facility available. ``(D) A level IV deficiency exists-- ``(i) if a sanitation facility for an individual home, an Indian Tribe, or an Indian community exists but-- ``(I) lacks-- ``(aa) a safe water supply system; or ``(bb) a waste disposal system; ``(II) contains no piped water or sewer facilities; or ``(III) has become inoperable due to a major component failure; or ``(ii) if only a washeteria or central facility exists in the community. ``(E) A level V deficiency exists in the absence of a sanitation facility, where individual homes do not have access to safe drinking water or adequate wastewater (including sewage) disposal. ``(i) Definitions.--For purposes of this section, the following terms apply: ``(1) Indian community.--The term `Indian community' means a geographic area, a significant proportion of whose inhabitants are Indians and which is served by or capable of being served by a facility described in this section. ``(2) Sanitation facilities.--The terms `sanitation facility' and `sanitation facilities' mean safe and adequate water supply systems, sanitary sewage disposal systems, and sanitary solid waste systems (and all related equipment and support infrastructure). ``SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS. ``(a) Buy Indian Act.--The Secretary, acting through the Service, may use the negotiating authority of section 23 of the Act of June 25, 1910 (25 U.S.C. 47, commonly known as the `Buy Indian Act'), to give preference to any Indian or any enterprise, partnership, corporation, or other type of business organization owned and controlled by an Indian or Indians including former or currently federally recognized Indian Tribes in the State of New York (hereinafter referred to as an `Indian firm') in the construction and renovation of Service facilities pursuant to section 301 and in the construction of sanitation facilities pursuant to section 302. Such preference may be accorded by the Secretary unless the Secretary finds, pursuant to regulations, that the project or function to be contracted for will not be satisfactory or such project or function cannot be properly completed or maintained under the proposed contract. The Secretary, in arriving at such a finding, shall consider whether the Indian or Indian firm will be deficient with respect to-- ``(1) ownership and control by Indians; ``(2) equipment; ``(3) bookkeeping and accounting procedures; ``(4) substantive knowledge of the project or function to be contracted for; ``(5) adequately trained personnel; or ``(6) other necessary components of contract performance. ``(b) Labor Standards.--For the purposes of implementing the provisions of this title, contracts for the construction or renovation of health care facilities, staff quarters, and sanitation facilities, and related support infrastructure, funded in whole or in part with funds made available pursuant to this title, shall contain a provision requiring compliance with subchapter IV of chapter 31 of title 40, United States Code (commonly known as the `Davis-Bacon Act'). ``SEC. 304. EXPENDITURE OF NON-SERVICE FUNDS FOR RENOVATION. ``(a) In General.--Notwithstanding any other provision of law, if the requirements of subsection (c) are met, the Secretary, acting through the Service, is authorized to accept any major expansion, renovation, or modernization by any Indian Tribe or Tribal Organization of any Service facility or of any other Indian health facility operated pursuant to a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), including-- ``(1) any plans or designs for such expansion, renovation, or modernization; and ``(2) any expansion, renovation, or modernization for which funds appropriated under any Federal law were lawfully expended. ``(b) Priority List.-- ``(1) In general.--The Secretary shall maintain a separate priority list to address the needs for increased operating expenses, personnel, or equipment for such facilities. The methodology for establishing priorities shall be developed through regulations. The list of priority facilities will be revised annually in consultation with Indian Tribes and Tribal Organizations. ``(2) Report.--The Secretary shall submit to the President, for inclusion in the report required to be transmitted to Congress under section 801, the priority list maintained pursuant to paragraph (1). ``(c) Requirements.--The requirements of this subsection are met with respect to any expansion, renovation, or modernization if-- ``(1) the Indian Tribe or Tribal Organization-- ``(A) provides notice to the Secretary of its intent to expand, renovate, or modernize; and ``(B) applies to the Secretary to be placed on a separate priority list to address the needs of such new facilities for increased operating expenses, personnel, or equipment; and ``(2) the expansion, renovation, or modernization-- ``(A) is approved by the appropriate area director of the Service for Federal facilities; and ``(B) is administered by the Indian Tribe or Tribal Organization in accordance with any applicable regulations prescribed by the Secretary with respect to construction or renovation of Service facilities. ``(d) Additional Requirement for Expansion.--In addition to the requirements under subsection (c), for any expansion, the Indian Tribe or Tribal Organization shall provide to the Secretary additional information pursuant to regulations, including additional staffing, equipment, and other costs associated with the expansion. ``(e) Closure or Conversion of Facilities.--If any Service facility which has been expanded, renovated, or modernized by an Indian Tribe or Tribal Organization under this section ceases to be used as a Service facility during the 20-year period beginning on the date such expansion, renovation, or modernization is completed, such Indian Tribe or Tribal Organization shall be entitled to recover from the United States an amount which bears the same ratio to the value of such facility at the time of such cessation as the value of such expansion, renovation, or modernization (less the total amount of any funds provided specifically for such facility under any Federal program that were expended for such expansion, renovation, or modernization) bore to the value of such facility at the time of the completion of such expansion, renovation, or modernization. ``SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, AND MODERNIZATION OF SMALL AMBULATORY CARE FACILITIES. ``(a) Grants.-- ``(1) In general.--The Secretary, acting through the Service, shall make grants to Indian Tribes and Tribal Organizations for the construction, expansion, or modernization of facilities for the provision of ambulatory care services to eligible Indians (and noneligible persons pursuant to subsections (b)(2) and (c)(1)(C)). A grant made under this section may cover up to 100 percent of the costs of such construction, expansion, or modernization. For the purposes of this section, the term `construction' includes the replacement of an existing facility. ``(2) Grant agreement required.--A grant under paragraph (1) may only be made available to a Tribal Health Program operating an Indian health facility (other than a facility owned or constructed by the Service, including a facility originally owned or constructed by the Service and transferred to an Indian Tribe or Tribal Organization). ``(b) Use of Grant Funds.-- ``(1) Allowable uses.--A grant awarded under this section may be used for the construction, expansion, or modernization (including the planning and design of such construction, expansion, or modernization) of an ambulatory care facility-- ``(A) located apart from a hospital; ``(B) not funded under section 301 or section 306; and ``(C) which, upon completion of such construction or modernization will-- ``(i) have a total capacity appropriate to its projected service population; ``(ii) provide annually no fewer than 150 patient visits by eligible Indians and other users who are eligible for services in such facility in accordance with section 807(c)(2); and ``(iii) provide ambulatory care in a Service Area (specified in the contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.)) with a population of no fewer than 1,500 eligible Indians and other users who are eligible for services in such facility in accordance with section 807(c)(2). ``(2) Additional allowable use.--The Secretary may also reserve a portion of the funding provided under this section and use those reserved funds to reduce an outstanding debt incurred by Indian Tribes or Tribal Organizations for the construction, expansion, or modernization of an ambulatory care facility that meets the requirements under paragraph (1). The provisions of this section shall apply, except that such applications for funding under this paragraph shall be considered separately from applications for funding under paragraph (1). ``(3) Use only for certain portion of costs.--A grant provided under this section may be used only for the cost of that portion of a construction, expansion, or modernization project that benefits the Service population identified above in subsection (b)(1)(C) (ii) and (iii). The requirements of clauses (ii) and (iii) of paragraph (1)(C) shall not apply to an Indian Tribe or Tribal Organization applying for a grant under this section for a health care facility located or to be constructed on an island or when such facility is not located on a road system providing direct access to an inpatient hospital where care is available to the Service population. ``(c) Grants.-- ``(1) Application.--No grant may be made under this section unless an application or proposal for the grant has been approved by the Secretary in accordance with applicable regulations and has set forth reasonable assurance by the applicant that, at all times after the construction, expansion, or modernization of a facility carried out using a grant 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 grants under this section, the Secretary shall give priority to Indian Tribes and Tribal Organizations that demonstrate-- ``(A) a need for increased ambulatory care services; and ``(B) insufficient capacity to deliver such services. ``(3) Peer review panels.--The Secretary may provide for the establishment of peer review panels, as necessary, to review and evaluate applications and proposals and to advise the Secretary regarding such applications using the criteria developed pursuant to subsection (a)(1). ``(d) Reversion of Facilities.--If any facility (or portion thereof) with respect to which funds have been paid under this section, ceases, at any time after completion of the construction, expansion, or modernization carried out with such funds, to be used for the purposes of providing health care services to eligible Indians, all of the right, title, and interest in and to such facility (or portion thereof) shall transfer to the United States unless otherwise negotiated by the Service and the Indian Tribe or Tribal Organization. ``(e) Funding Nonrecurring.--Funding provided under this section shall be nonrecurring and shall not be available for inclusion in any individual Indian Tribe's tribal share for an award under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) or for reallocation or redesign thereunder. ``SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRATION PROJECT. ``(a) Health Care Demonstration Projects.--The Secretary, acting through the Service, is authorized to enter into contracts under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) with Indian Tribes or Tribal Organizations for the purpose of carrying out a health care delivery demonstration project to test alternative means of delivering health care and services to Indians through facilities. ``(b) Use of Funds.--The Secretary, in approving projects pursuant to this section, may authorize such contracts for the construction and renovation of hospitals, health centers, health stations, and other facilities to deliver health care services and is authorized to-- ``(1) waive any leasing prohibition; ``(2) permit carryover of funds appropriated for the provision of health care services; ``(3) permit the use of other available funds; ``(4) permit the use of funds or property donated from any source for project purposes; ``(5) provide for the reversion of donated real or personal property to the donor; and ``(6) permit the use of Service funds to match other funds, including Federal funds. ``(c) Regulations.--The Secretary shall develop and promulgate regulations, not later than 1 year after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, for the review and approval of applications submitted under this section. ``(d) Criteria.--The Secretary may approve projects that meet the following criteria: ``(1) There is a need for a new facility or program or the reorientation of an existing facility or program. ``(2) A significant number of Indians, including those with low health status, will be served by the project. ``(3) The project has the potential to deliver services in an efficient and effective manner. ``(4) The project is economically viable. ``(5) The Indian Tribe or Tribal Organization has the administrative and financial capability to administer the project. ``(6) The project is integrated with providers of related health and social services and is coordinated with, and avoids duplication of, existing services. ``(e) Peer Review Panels.--The Secretary may provide for the establishment of peer review panels, as necessary, to review and evaluate applications using the criteria developed pursuant to subsection (d). ``(f) Priority.--The Secretary shall give priority to applications for demonstration projects in each of the following Service Units to the extent that such applications are timely filed and meet the criteria specified in subsection (d): ``(1) Cass Lake, Minnesota. ``(2) Mescalero, New Mexico. ``(3) Owyhee, Nevada. ``(4) Schurz, Nevada. ``(5) Ft. Yuma, California. ``(g) Technical Assistance.--The Secretary shall provide such technical and other assistance as may be necessary to enable applicants to comply with the provisions of this section. ``(h) Service to Ineligible Persons.--Subject to section 807, the authority to provide services to persons otherwise ineligible for the health care benefits of the Service and the authority to extend hospital privileges in Service facilities to non-Service health practitioners as provided in section 807 may be included, subject to the terms of such section, in any demonstration project approved pursuant to this section. ``(i) Equitable Treatment.--For purposes of subsection (d)(1), the Secretary shall, in evaluating facilities operated under any contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), use the same criteria that the Secretary uses in evaluating facilities operated directly by the Service. ``(j) Equitable Integration of Facilities.--The Secretary shall ensure that the planning, design, construction, renovation, and expansion needs of Service and non-Service facilities which are the subject of a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) for health services are fully and equitably integrated into the implementation of the health care delivery demonstration projects under this section. ``SEC. 307. LAND TRANSFER. ``Notwithstanding any other provision of law, the Bureau of Indian Affairs and all other agencies and departments of the United States are authorized to transfer, at no cost, land and improvements to the Service for the provision of health care services. The Secretary is authorized to accept such land and improvements for such purposes. ``SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS. ``The Secretary, acting through the Service, may enter into leases, contracts, and other agreements with Indian Tribes and Tribal Organizations which hold (1) title to, (2) a leasehold interest in, or (3) a beneficial interest in (when title is held by the United States in trust for the benefit of an Indian Tribe) facilities used or to be used for the administration and delivery of health services by an Indian Health Program. Such leases, contracts, or agreements may include provisions for construction or renovation and provide for compensation to the Indian Tribe or Tribal Organization of rental and other costs consistent with section 105(l) of the Indian Self- Determination and Education Assistance Act (25 U.S.C. 450j(l)) and regulations thereunder. ``SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND LOAN REPAYMENT. ``(a) In General.--The Secretary, in consultation with the Secretary of the Treasury, Indian Tribes, and Tribal Organizations, shall carry out a study to determine the feasibility of establishing a loan fund to provide to Indian Tribes and Tribal Organizations direct loans or guarantees for loans for the construction of health care facilities, including-- ``(1) inpatient facilities; ``(2) outpatient facilities; ``(3) staff quarters; ``(4) hostels; and ``(5) specialized care facilities, such as behavioral health and elder care facilities. ``(b) Determinations.--In carrying out the study under subsection (a), the Secretary shall determine-- ``(1) the maximum principal amount of a loan or loan guarantee that should be offered to a recipient from the loan fund; ``(2) the percentage of eligible costs, not to exceed 100 percent, that may be covered by a loan or loan guarantee from the loan fund (including costs relating to planning, design, financing, site land development, construction, rehabilitation, renovation, conversion, improvements, medical equipment and furnishings, and other facility-related costs and capital purchase (but excluding staffing)); ``(3) the cumulative total of the principal of direct loans and loan guarantees, respectively, that may be outstanding at any 1 time; ``(4) the maximum term of a loan or loan guarantee that may be made for a facility from the loan fund; ``(5) the maximum percentage of funds from the loan fund that should be allocated for payment of costs associated with planning and applying for a loan or loan guarantee; ``(6) whether acceptance by the Secretary of an assignment of the revenue of an Indian Tribe or Tribal Organization as security for any direct loan or loan guarantee from the loan fund would be appropriate; ``(7) whether, in the planning and design of health facilities under this section, users eligible under section 807(c) may be included in any projection of patient population; ``(8) whether funds of the Service provided through loans or loan guarantees from the loan fund should be eligible for use in matching other Federal funds under other programs; ``(9) the appropriateness of, and best methods for, coordinating the loan fund with the health care priority system of the Service under section 301; and ``(10) any legislative or regulatory changes required to implement recommendations of the Secretary based on results of the study. ``(c) Report.--Not later than September 30, 2009, the Secretary shall submit to the Committee on Indian Affairs of the Senate and the Committee on Natural Resources and the Committee on Energy and Commerce of the House of Representatives a report that describes-- ``(1) the manner of consultation made as required by subsection (a); and ``(2) the results of the study, including any recommendations of the Secretary based on results of the study. ``SEC. 310. TRIBAL LEASING. ``A Tribal Health Program may lease permanent structures for the purpose of providing health care services without obtaining advance approval in appropriation Acts. ``SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES JOINT VENTURE PROGRAM. ``(a) In General.--The Secretary, acting through the Service, shall make arrangements with Indian Tribes and Tribal Organizations to establish joint venture demonstration projects under which an Indian Tribe or Tribal Organization shall expend tribal, private, or other available funds, for the acquisition or construction of a health facility for a minimum of 10 years, under a no-cost lease, in exchange for agreement by the Service to provide the equipment, supplies, and staffing for the operation and maintenance of such a health facility. An Indian Tribe or Tribal Organization may use tribal funds, private sector, or other available resources, including loan guarantees, to fulfill its commitment under a joint venture entered into under this subsection. An Indian Tribe or Tribal Organization shall be eligible to establish a joint venture project if, when it submits a letter of intent, it-- ``(1) has begun but not completed the process of acquisition or construction of a health facility to be used in the joint venture project; or ``(2) has not begun the process of acquisition or construction of a health facility for use in the joint venture project. ``(b) Requirements.--The Secretary shall make such an arrangement with an Indian Tribe or Tribal Organization only if-- ``(1) the Secretary first determines that the Indian Tribe or Tribal Organization has the administrative and financial capabilities necessary to complete the timely acquisition or construction of the relevant health facility; and ``(2) the Indian Tribe or Tribal Organization meets the need criteria determined using the criteria developed under the health care facility priority system under section 301, unless the Secretary determines, pursuant to regulations, that other criteria will result in a more cost-effective and efficient method of facilitating and completing construction of health care facilities. ``(c) Continued Operation.--The Secretary shall negotiate an agreement with the Indian Tribe or Tribal Organization regarding the continued operation of the facility at the end of the initial 10 year no-cost lease period. ``(d) Breach of Agreement.--An Indian Tribe or Tribal Organization that has entered into a written agreement with the Secretary under this section, and that breaches or terminates without cause such agreement, shall be liable to the United States for the amount that has been paid to the Indian Tribe or Tribal Organization, or paid to a third party on the Indian Tribe's or Tribal Organization's behalf, under the agreement. The Secretary has the right to recover tangible property (including supplies) and equipment, less depreciation, and any funds expended for operations and maintenance under this section. The preceding sentence does not apply to any funds expended for the delivery of health care services, personnel, or staffing. ``(e) Recovery for Nonuse.--An Indian Tribe or Tribal Organization that has entered into a written agreement with the Secretary under this subsection shall be entitled to recover from the United States an amount that is proportional to the value of such facility if, at any time within the 10-year term of the agreement, the Service ceases to use the facility or otherwise breaches the agreement. ``(f) Definition.--For the purposes of this section, the term `health facility' or `health facilities' includes quarters needed to provide housing for staff of the relevant Tribal Health Program. ``SEC. 312. LOCATION OF FACILITIES. ``(a) In General.--In all matters involving the reorganization or development of Service facilities or in the establishment of related employment projects to address unemployment conditions in economically depressed areas, the Bureau of Indian Affairs and the Service shall give priority to locating such facilities and projects on Indian lands, or lands in Alaska owned by any Alaska Native village, or village or regional corporation under the Alaska Native Claims Settlement Act (43 U.S.C. 1601 et seq.), or any land allotted to any Alaska Native, if requested by the Indian owner and the Indian Tribe with jurisdiction over such lands or other lands owned or leased by the Indian Tribe or Tribal Organization. Top priority shall be given to Indian land owned by 1 or more Indian Tribes. ``(b) Definition.--For purposes of this section, the term `Indian lands' means-- ``(1) all lands within the exterior boundaries of any reservation; and ``(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. ``SEC. 313. MAINTENANCE AND IMPROVEMENT OF HEALTH CARE FACILITIES. ``(a) Report.--The Secretary shall submit to the President, for inclusion in the report required to be transmitted to Congress under section 801, a report which identifies the backlog of maintenance and repair work required at both Service and tribal health care facilities, including new health care facilities expected to be in operation in the next fiscal year. The report shall also identify the need for renovation and expansion of existing facilities to support the growth of health care programs. ``(b) Maintenance of Newly Constructed Space.--The Secretary, acting through the Service, is authorized to expend maintenance and improvement funds to support maintenance of newly constructed space only if such space falls within the approved supportable space allocation for the Indian Tribe or Tribal Organization. Supportable space allocation shall be defined through the health care facility priority system under section 301(c). ``(c) Replacement Facilities.--In addition to using maintenance and improvement funds for renovation, modernization, and expansion of facilities, an Indian Tribe or Tribal Organization may use maintenance and improvement funds for construction of a replacement facility if the costs of renovation of such facility would exceed a maximum renovation cost threshold. The maximum renovation cost threshold shall be determined through the negotiated rulemaking process provided for under section 802. ``SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY-OWNED QUARTERS. ``(a) Rental Rates.-- ``(1) Establishment.--Notwithstanding any other provision of law, a Tribal Health Program which operates a hospital or other health facility and the federally-owned quarters associated therewith pursuant to a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) shall have the authority to establish the rental rates charged to the occupants of such quarters by providing notice to the Secretary of its election to exercise such authority. ``(2) Objectives.--In establishing rental rates pursuant to authority of this subsection, a Tribal Health Program shall endeavor to achieve the following objectives: ``(A) To base such rental rates on the reasonable value of the quarters to the occupants thereof. ``(B) To generate sufficient funds to prudently provide for the operation and maintenance of the quarters, and subject to the discretion of the Tribal Health Program, to supply reserve funds for capital repairs and replacement of the quarters. ``(3) Equitable funding.--Any quarters whose rental rates are established by a Tribal Health Program pursuant to this subsection shall remain eligible for quarters improvement and repair funds to the same extent as all federally-owned quarters used to house personnel in Services-supported programs. ``(4) Notice of rate change.--A Tribal Health Program which exercises the authority provided under this subsection shall provide occupants with no less than 60 days notice of any change in rental rates. ``(b) Direct Collection of Rent.-- ``(1) In general.--Notwithstanding any other provision of law, and subject to paragraph (2), a Tribal Health Program shall have the authority to collect rents directly from Federal employees who occupy such quarters in accordance with the following: ``(A) The Tribal Health Program shall notify the Secretary and the subject Federal employees of its election to exercise its authority to collect rents directly from such Federal employees. ``(B) Upon receipt of a notice described in subparagraph (A), the Federal employees shall pay rents for occupancy of such quarters directly to the Tribal Health Program and the Secretary shall have no further authority to collect rents from such employees through payroll deduction or otherwise. ``(C) Such rent payments shall be retained by the Tribal Health Program and shall not be made payable to or otherwise be deposited with the United States. ``(D) Such rent payments shall be deposited into a separate account which shall be used by the Tribal Health Program for the maintenance (including capital repairs and replacement) and operation of the quarters and facilities as the Tribal Health Program shall determine. ``(2) Retrocession of authority.--If a Tribal Health Program which has made an election under paragraph (1) requests retrocession of its authority to directly collect rents from Federal employees occupying federally-owned quarters, such retrocession shall become effective on the earlier of-- ``(A) the first day of the month that begins no less than 180 days after the Tribal Health Program notifies the Secretary of its desire to retrocede; or ``(B) such other date as may be mutually agreed by the Secretary and the Tribal Health Program. ``(c) Rates in Alaska.--To the extent that a Tribal Health Program, pursuant to authority granted in subsection (a), establishes rental rates for federally-owned quarters provided to a Federal employee in Alaska, such rents may be based on the cost of comparable private rental housing in the nearest established community with a year-round population of 1,500 or more individuals. ``SEC. 315. APPLICABILITY OF BUY AMERICAN ACT REQUIREMENT. ``(a) Applicability.--The Secretary shall ensure that the requirements of the Buy American Act apply to all procurements made with funds provided pursuant to section 317. Indian Tribes and Tribal Organizations shall be exempt from these requirements. ``(b) Effect of Violation.--If it has been finally determined by a court or Federal agency that any person intentionally affixed a label bearing a `Made in America' inscription or any inscription with the same meaning, to any product sold in or shipped to the United States that is not made in the United States, such person shall be ineligible to receive any contract or subcontract made with funds provided pursuant to section 317, pursuant to the debarment, suspension, and ineligibility procedures described in sections 9.400 through 9.409 of title 48, Code of Federal Regulations. ``(c) Definitions.--For purposes of this section, the term `Buy American Act' means title III of the Act entitled `An Act making appropriations for the Treasury and Post Office Departments for the fiscal year ending June 30, 1934, and for other purposes', approved March 3, 1933 (41 U.S.C. 10a et seq.). ``SEC. 316. OTHER FUNDING FOR FACILITIES. ``(a) Authority To Accept Funds.--The Secretary is authorized to accept from any source, including Federal and State agencies, funds that are available for the construction of health care facilities and use such funds to plan, design, and construct health care facilities for Indians and to place such funds into a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.). Receipt of such funds shall have no effect on the priorities established pursuant to section 301. ``(b) Interagency Agreements.--The Secretary is authorized to enter into interagency agreements with other Federal agencies or State agencies and other entities and to accept funds from such Federal or State agencies or other sources to provide for the planning, design, and construction of health care facilities to be administered by Indian Health Programs in order to carry out the purposes of this Act and the purposes for which the funds were appropriated or for which the funds were otherwise provided. ``(c) Establishment of Standards.--The Secretary, through the Service, shall establish standards by regulation for the planning, design, and construction of health care facilities serving Indians under this Act. ``SEC. 317. AUTHORIZATION OF APPROPRIATIONS. ``There are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2017 to carry out this title. ``TITLE IV--ACCESS TO HEALTH SERVICES ``SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SECURITY ACT HEALTH BENEFITS PROGRAMS. ``(a) Disregard of Medicare, Medicaid, and SCHIP Payments in Determining Appropriations.--Any payments received by an Indian Health Program or by an Urban Indian Organization under title XVIII, XIX, or XXI of the Social Security Act for services provided to Indians eligible for benefits under such respective titles shall not be considered in determining appropriations for the provision of health care and services to Indians. ``(b) Nonpreferential Treatment.--Nothing in this Act authorizes the Secretary to provide services to an Indian with coverage under title XVIII, XIX, or XXI of the Social Security Act in preference to an Indian without such coverage. ``(c) Use of Funds.-- ``(1) Special fund.-- ``(A) 100 percent pass-through of payments due to facilities.--Notwithstanding any other provision of law, but subject to paragraph (2), payments to which a facility of the Service is entitled by reason of a provision of the Social Security Act shall be placed in a special fund to be held by the Secretary. In making payments from such fund, the Secretary shall ensure that each Service Unit of the Service receives 100 percent of the amount to which the facilities of the Service, for which such Service Unit makes collections, are entitled by reason of a provision of the Social Security Act. ``(B) Use of funds.--Amounts received by a facility of the Service under subparagraph (A) shall first be 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 operated by or through such facility which may be necessary to achieve or maintain compliance with the applicable conditions and requirements of titles XVIII and XIX of the Social Security Act. Any amounts so received that are in excess of the amount necessary to achieve or maintain such conditions and requirements shall, subject to consultation with the Indian Tribes being served by the Service Unit, be used for reducing the health resource deficiencies (as determined under section 201(d)) of such Indian Tribes. ``(2) Direct payment option.--Paragraph (1) shall not apply to a Tribal Health Program upon the election of such Program under subsection (d) to receive payments directly. No payment may be made out of the special fund described in such paragraph with respect to reimbursement made for services provided by such Program during the period of such election. ``(d) Direct Billing.-- ``(1) In general.--Subject to complying with the requirements of paragraph (2), a Tribal Health Program may elect to directly bill for, and receive payment for, health care items and services provided by such Program for which payment is made under title XVIII or XIX of the Social Security Act or from any other third party payor. ``(2) Direct reimbursement.-- ``(A) Use of funds.--Each Tribal Health Program making the election described in paragraph (1) with respect to a program under a title of the Social Security Act shall be reimbursed directly by that program for items and services furnished without regard to subsection (c)(1), but all amounts so reimbursed shall be used by the Tribal Health Program for the purpose of making any improvements in facilities of the Tribal Health Program that may be necessary to achieve or maintain compliance with the conditions and requirements applicable generally to such items and services under the program under such title and to provide additional health care services, improvements in health care facilities and Tribal Health Programs, any health care related purpose, or otherwise to achieve the objectives provided in section 3 of this Act. ``(B) Audits.--The amounts paid to a Tribal Health Program making the election described in paragraph (1) with respect to a program under a title of the Social Security Act shall be subject to all auditing requirements applicable to the program under such title, as well as all auditing requirements applicable to programs administered by an Indian Health Program. Nothing in the preceding sentence shall be construed as limiting the application of auditing requirements applicable to amounts paid under title XVIII, XIX, or XXI of the Social Security Act. ``(C) Identification of source of payments.--Any Tribal Health Program that receives reimbursements or payments under title XVIII, XIX, or XXI of the Social Security Act, shall provide to the Service a list of each provider enrollment number (or other identifier) under which such Program receives such reimbursements or payments. ``(3) Examination and implementation of changes.-- ``(A) In general.--The Secretary, acting through the Service and with the assistance of the Administrator of the Centers for Medicare & Medicaid Services, shall examine on an ongoing basis and implement any administrative changes that may be necessary to facilitate direct billing and reimbursement under the program established under this subsection, including any agreements with States that may be necessary to provide for direct billing under a program under a title of the Social Security Act. ``(B) Coordination of information.--The Service shall provide the Administrator of the Centers for Medicare & Medicaid Services with copies of the lists submitted to the Service under paragraph (2)(C), enrollment data regarding patients served by the Service (and by Tribal Health Programs, to the extent such data is available to the Service), and such other information as the Administrator may require for purposes of administering title XVIII, XIX, or XXI of the Social Security Act. ``(4) Withdrawal from program.--A Tribal Health Program that bills directly under the program established under this subsection may withdraw from participation in the same manner and under the same conditions that an Indian Tribe or Tribal Organization may retrocede a contracted program to the Secretary under the authority of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.). All cost accounting and billing authority under the program established under this subsection shall be returned to the Secretary upon the Secretary's acceptance of the withdrawal of participation in this program. ``(5) Termination for failure to comply with requirements.-- The Secretary may terminate the participation of a Tribal Health Program or in the direct billing program established under this subsection if the Secretary determines that the Program has failed to comply with the requirements of paragraph (2). The Secretary shall provide a Tribal Health Program with notice of a determination that the Program has failed to comply with any such requirement and a reasonable opportunity to correct such noncompliance prior to terminating the Program's participation in the direct billing program established under this subsection. ``(e) Related Provisions Under the Social Security Act.--For provisions related to subsections (c) and (d), see sections 1880, 1911, and 2107(e)(1)(D) of the Social Security Act. ``SEC. 402. GRANTS TO AND CONTRACTS WITH THE SERVICE, INDIAN TRIBES, TRIBAL ORGANIZATIONS, AND URBAN INDIAN ORGANIZATIONS TO FACILITATE OUTREACH, ENROLLMENT, AND COVERAGE OF INDIANS UNDER SOCIAL SECURITY ACT HEALTH BENEFIT PROGRAMS AND OTHER HEALTH BENEFITS PROGRAMS. ``(a) Indian Tribes and Tribal Organizations.--From funds appropriated to carry out this title in accordance with section 416, the Secretary, acting through the Service, shall make grants to or enter into contracts with Indian Tribes and Tribal Organizations to assist such Tribes and Tribal Organizations in establishing and administering programs on or near reservations and trust lands to assist individual Indians-- ``(1) to enroll for benefits under a program established under title XVIII, XIX, or XXI of the Social Security Act and other health benefits programs; and ``(2) with respect to such programs for which the charging of premiums and cost sharing is not prohibited under such programs, to pay premiums or cost sharing for coverage for such benefits, which may be based on financial need (as determined by the Indian Tribe or Tribes or Tribal Organizations being served based on a schedule of income levels developed or implemented by such Tribe, Tribes, or Tribal Organizations). ``(b) Conditions.--The Secretary, acting through the Service, shall place conditions as deemed necessary to effect the purpose of this section in any grant or contract which the Secretary makes with any Indian Tribe or Tribal Organization pursuant to this section. Such conditions shall include requirements that the Indian Tribe or Tribal Organization successfully undertake-- ``(1) to determine the population of Indians eligible for the benefits described in subsection (a); ``(2) to educate Indians with respect to the benefits available under the respective programs; ``(3) to provide transportation for such individual Indians to the appropriate offices for enrollment or applications for such benefits; and ``(4) to develop and implement methods of improving the participation of Indians in receiving benefits under such programs. ``(c) Application to Urban Indian Organizations.-- ``(1) In general.--The provisions of subsection (a) shall apply with respect to grants and other funding to Urban Indian Organizations with respect to populations served by such organizations in the same manner they apply to grants and contracts with Indian Tribes and Tribal Organizations with respect to programs on or near reservations. ``(2) Requirements.--The Secretary shall include in the grants or contracts made or provided under paragraph (1) requirements that are-- ``(A) consistent with the requirements imposed by the Secretary under subsection (b); ``(B) appropriate to Urban Indian Organizations and Urban Indians; and ``(C) necessary to effect the purposes of this section. ``(d) Facilitating Cooperation.--The Secretary, acting through the Centers for Medicare & Medicaid Services, shall take such steps as are necessary to facilitate cooperation with, and agreements between, States and the Service, Indian Tribes, Tribal Organizations, or Urban Indian Organizations with respect to the provision of health care items and services to Indians under the programs established under title XVIII, XIX, or XXI of the Social Security Act. ``(e) Agreements Relating To Improving Enrollment of Indians Under Social Security Act Health Benefits Programs.--For provisions relating to agreements between the Secretary, acting through the Service, and Indian Tribes, Tribal Organizations, and Urban Indian Organizations for the collection, preparation, and submission of applications by Indians for assistance under the Medicaid and State children's health insurance programs established under titles XIX and XXI of the Social Security Act, and benefits under the Medicare program established under title XVIII of such Act, see subsections (a) and (b) of section 1139 of the Social Security Act. ``(f) Definition of Premiums and Cost Sharing.--In this section: ``(1) Premium.--The term `premium' includes any enrollment fee or similar charge. ``(2) Cost sharing.--The term `cost sharing' includes any deduction, deductible, copayment, coinsurance, or similar charge. ``SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS OF HEALTH SERVICES. ``(a) Right of Recovery.--Except as provided in subsection (f), the United States, an Indian Tribe, or Tribal Organization shall have the right to recover from an insurance company, health maintenance organization, employee benefit plan, third-party tortfeasor, or any other responsible or liable third party (including a political subdivision or local governmental entity of a State) the reasonable charges billed by the Secretary, an Indian Tribe, or Tribal Organization in providing health services through the Service, an Indian Tribe, or Tribal Organization to any individual to the same extent that such individual, or any nongovernmental provider of such services, would be eligible to receive damages, reimbursement, or indemnification for such charges or expenses if-- ``(1) such services had been provided by a nongovernmental provider; and ``(2) such individual had been required to pay such charges or expenses and did pay such charges or expenses. ``(b) Limitations on Recoveries From States.--Subsection (a) shall provide a right of recovery against any State, only if the injury, illness, or disability for which health services were provided is covered under-- ``(1) workers' compensation laws; or ``(2) a no-fault automobile accident insurance plan or program. ``(c) Nonapplication of Other Laws.--No law of any State, or of any political subdivision of a State and no provision of any contract, insurance or health maintenance organization policy, employee benefit plan, self-insurance plan, managed care plan, or other health care plan or program entered into or renewed after the date of the enactment of the Indian Health Care Amendments of 1988, shall prevent or hinder the right of recovery of the United States, an Indian Tribe, or Tribal Organization under subsection (a). ``(d) No Effect on Private Rights of Action.--No action taken by the United States, an Indian Tribe, or Tribal Organization to enforce the right of recovery provided under this section shall operate to deny to the injured person the recovery for that portion of the person's damage not covered hereunder. ``(e) Enforcement.-- ``(1) In general.--The United States, an Indian Tribe, or Tribal Organization may enforce the right of recovery provided under subsection (a) by-- ``(A) intervening or joining in any civil action or proceeding brought-- ``(i) by the individual for whom health services were provided by the Secretary, an Indian Tribe, or Tribal Organization; or ``(ii) by any representative or heirs of such individual, or ``(B) instituting a civil action, including a civil action for injunctive relief and other relief and including, with respect to a political subdivision or local governmental entity of a State, such an action against an official thereof. ``(2) Notice.--All reasonable efforts shall be made to provide notice of action instituted under paragraph (1)(B) to the individual to whom health services were provided, either before or during the pendency of such action. ``(3) Recovery from tortfeasors.-- ``(A) In general.--In any case in which an Indian Tribe or Tribal Organization that is authorized or required under a compact or contract issued pursuant to the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) to furnish or pay for health services to a person who is injured or suffers a disease on or after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007 under circumstances that establish grounds for a claim of liability against the tortfeasor with respect to the injury or disease, the Indian Tribe or Tribal Organization shall have a right to recover from the tortfeasor (or an insurer of the tortfeasor) the reasonable value of the health services so furnished, paid for, or to be paid for, in accordance with the Federal Medical Care Recovery Act (42 U.S.C. 2651 et seq.), to the same extent and under the same circumstances as the United States may recover under that Act. ``(B) Treatment.--The right of an Indian Tribe or Tribal Organization to recover under subparagraph (A) shall be independent of the rights of the injured or diseased person served by the Indian Tribe or Tribal Organization. ``(f) Limitation.--Absent specific written authorization by the governing body of an Indian Tribe for the period of such authorization (which may not be for a period of more than 1 year and which may be revoked at any time upon written notice by the governing body to the Service), the United States shall not have a right of recovery under this section if the injury, illness, or disability for which health services were provided is covered under a self-insurance plan funded by an Indian Tribe, Tribal Organization, or Urban Indian Organization. Where such authorization is provided, the Service may receive and expend such amounts for the provision of additional health services consistent with such authorization. ``(g) Costs and Attorneys' Fees.--In any action brought to enforce the provisions of this section, a prevailing plaintiff shall be awarded its reasonable attorneys' fees and costs of litigation. ``(h) Nonapplication of Claims Filing Requirements.--An insurance company, health maintenance organization, self-insurance plan, managed care plan, or other health care plan or program (under the Social Security Act or otherwise) may not deny a claim for benefits submitted by the Service or by an Indian Tribe or Tribal Organization based on the format in which the claim is submitted if such format complies with the format required for submission of claims under title XVIII of the Social Security Act or recognized under section 1175 of such Act. ``(i) Application to Urban Indian Organizations.--The previous provisions of this section shall apply to Urban Indian Organizations with respect to populations served by such Organizations in the same manner they apply to Indian Tribes and Tribal Organizations with respect to populations served by such Indian Tribes and Tribal Organizations. ``(j) Statute of Limitations.--The provisions of section 2415 of title 28, United States Code, shall apply to all actions commenced under this section, and the references therein to the United States are deemed to include Indian Tribes, Tribal Organizations, and Urban Indian Organizations. ``(k) Savings.--Nothing in this section shall be construed to limit any right of recovery available to the United States, an Indian Tribe, or Tribal Organization under the provisions of any applicable, Federal, State, or Tribal law, including medical lien laws. ``SEC. 404. CREDITING OF REIMBURSEMENTS. ``(a) Use of Amounts.-- ``(1) Retention by program.--Except as provided in section 202(f) (relating to the Catastrophic Health Emergency Fund) and section 807 (relating to health services for ineligible persons), all reimbursements received or recovered under any of the programs described in paragraph (2), including under section 807, by reason of the provision of health services by the Service, by an Indian Tribe or Tribal Organization, or by an Urban Indian Organization, shall be credited to the Service, such Indian Tribe or Tribal Organization, or such Urban Indian Organization, respectively, and may be used as provided in section 401. In the case of such a service provided by or through a Service Unit, such amounts shall be credited to such unit and used for such purposes. ``(2) Programs covered.--The programs referred to in paragraph (1) are the following: ``(A) Titles XVIII, XIX, and XXI of the Social Security Act. ``(B) This Act, including section 807. ``(C) Public Law 87-693. ``(D) Any other provision of law. ``(b) No Offset of Amounts.--The Service may not offset or limit any amount obligated to any Service Unit or entity receiving funding from the Service because of the receipt of reimbursements under subsection (a). ``SEC. 405. PURCHASING HEALTH CARE COVERAGE. ``(a) In General.--Insofar as amounts are made available under law (including a provision of the Social Security Act, the Indian Self- Determination and Education Assistance Act (25 U.S.C. 450 et seq.), or other law, other than under section 402) to Indian Tribes, Tribal Organizations, and Urban Indian Organizations for health benefits for Service beneficiaries, Indian Tribes, Tribal Organizations, and Urban Indian Organizations may use such amounts to purchase health benefits coverage for such beneficiaries in any manner, including through-- ``(1) a tribally owned and operated health care plan; ``(2) a State or locally authorized or licensed health care plan; ``(3) a health insurance provider or managed care organization; or ``(4) a self-insured plan. The purchase of such coverage by an Indian Tribe, Tribal Organization, or Urban Indian Organization may be based on the financial needs of such beneficiaries (as determined by the Indian Tribe or Tribes being served based on a schedule of income levels developed or implemented by such Indian Tribe or Tribes). ``(b) Expenses for Self-Insured Plan.--In the case of a self-insured plan under subsection (a)(4), the amounts may be used for expenses of operating the plan, including administration and insurance to limit the financial risks to the entity offering the plan. ``(c) Construction.--Nothing in this section shall be construed as affecting the use of any amounts not referred to in subsection (a). ``SEC. 406. SHARING ARRANGEMENTS WITH FEDERAL AGENCIES. ``(a) Authority.-- ``(1) In general.--The Secretary may enter into (or expand) arrangements for the sharing of medical facilities and services between the Service, Indian Tribes, and Tribal Organizations and the Department of Veterans Affairs and the Department of Defense. ``(2) Consultation by secretary required.--The Secretary may not finalize any arrangement between the Service and a Department described in paragraph (1) without first consulting with the Indian Tribes which will be significantly affected by the arrangement. ``(b) Limitations.--The Secretary shall not take any action under this section or under subchapter IV of chapter 81 of title 38, United States Code, which would impair-- ``(1) the priority access of any Indian to health care services provided through the Service and the eligibility of any Indian to receive health services through the Service; ``(2) the quality of health care services provided to any Indian through the Service; ``(3) the priority access of any veteran to health care services provided by the Department of Veterans Affairs; ``(4) the quality of health care services provided by the Department of Veterans Affairs or the Department of Defense; or ``(5) the eligibility of any Indian who is a veteran to receive health services through the Department of Veterans Affairs. ``(c) Reimbursement.--The Service, Indian Tribe, or Tribal Organization shall be reimbursed by the Department of Veterans Affairs or the Department of Defense (as the case may be) where services are provided through the Service, an Indian Tribe, or a Tribal Organization to beneficiaries eligible for services from either such Department, notwithstanding any other provision of law. ``(d) Construction.--Nothing in this section may be construed as creating any right of a non-Indian veteran to obtain health services from the Service. ``SEC. 407. PAYOR OF LAST RESORT. ``Indian Health Programs and health care programs operated by Urban Indian Organizations shall be the payor of last resort for services provided to persons eligible for services from Indian Health Programs and Urban Indian Organizations, notwithstanding any Federal, State, or local law to the contrary. ``SEC. 408. NONDISCRIMINATION UNDER FEDERAL HEALTH CARE PROGRAMS IN QUALIFICATIONS FOR REIMBURSEMENT FOR SERVICES. ``(a) Requirement To Satisfy Generally Applicable Participation Requirements.-- ``(1) In general.--A Federal health care program must accept an entity that is operated by the Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization as a provider eligible to receive payment under the program for health care services furnished to an Indian on the same basis as any other provider qualified to participate as a provider of health care services under the program if the entity meets generally applicable State or other requirements for participation as a provider of health care services under the program. ``(2) Satisfaction of state or local licensure or recognition requirements.--Any requirement for participation as a provider of health care services under a Federal health care program that an entity be licensed or recognized under the State or local law where the entity is located to furnish health care services shall be deemed to have been met in the case of an entity operated by the Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization if the entity meets all the applicable standards for such licensure or recognition, regardless of whether the entity obtains a license or other documentation under such State or local law. In accordance with section 221, the absence of the licensure of a health care professional employed by such an entity under the State or local law where the entity is located shall not be taken into account for purposes of determining whether the entity meets such standards, if the professional is licensed in another State. ``(b) Application of Exclusion From Participation in Federal Health Care Programs.-- ``(1) Excluded entities.--No entity operated by the Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization that has been excluded from participation in any Federal health care program or for which a license is under suspension or has been revoked by the State where the entity is located shall be eligible to receive payment or reimbursement under any such program for health care services furnished to an Indian. ``(2) Excluded individuals.--No individual who has been excluded from participation in any Federal health care program or whose State license is under suspension shall be eligible to receive payment or reimbursement under any such program for health care services furnished by that individual, directly or through an entity that is otherwise eligible to receive payment for health care services, to an Indian. ``(3) Federal health care program defined.--In this subsection, the term, `Federal health care program' has the meaning given that term in section 1128B(f) of the Social Security Act (42 U.S.C. 1320a-7b(f)), except that, for purposes of this subsection, such term shall include the health insurance program under chapter 89 of title 5, United States Code. ``(c) Related Provisions.--For provisions related to nondiscrimination against providers operated by the Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization, see section 1139(c) of the Social Security Act (42 U.S.C. 1320b-9(c)). ``SEC. 409. CONSULTATION. ``For provisions related to consultation with representatives of Indian Health Programs and Urban Indian Organizations with respect to the health care programs established under titles XVIII, XIX, and XXI of the Social Security Act, see section 1139(d) of the Social Security Act (42 U.S.C. 1320b-9(d)). ``SEC. 410. STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP). ``For provisions relating to-- ``(1) outreach to families of Indian children likely to be eligible for child health assistance under the State children's health insurance program established under title XXI of the Social Security Act, see sections 2105(c)(2)(C) and 1139(a) of such Act (42 U.S.C. 1397ee(c)(2), 1320b-9); and ``(2) ensuring that child health assistance is provided under such program to targeted low-income children who are Indians and that payments are made under such program to Indian Health Programs and Urban Indian Organizations operating in the State that provide such assistance, see sections 2102(b)(3)(D) and 2105(c)(6)(B) of such Act (42 U.S.C. 1397bb(b)(3)(D), 1397ee(c)(6)(B)). ``SEC. 411. EXCLUSION WAIVER AUTHORITY FOR AFFECTED INDIAN HEALTH PROGRAMS AND SAFE HARBOR TRANSACTIONS UNDER THE SOCIAL SECURITY ACT. ``For provisions relating to-- ``(1) exclusion waiver authority for affected Indian Health Programs under the Social Security Act, see section 1128(k) of the Social Security Act (42 U.S.C. 1320a-7(k)); and ``(2) certain transactions involving Indian Health Programs deemed to be in safe harbors under that Act, see section 1128B(b)(4) of the Social Security Act (42 U.S.C. 1320a- 7b(b)(4)). ``SEC. 412. PREMIUM AND COST SHARING PROTECTIONS AND ELIGIBILITY DETERMINATIONS UNDER MEDICAID AND SCHIP AND PROTECTION OF CERTAIN INDIAN PROPERTY FROM MEDICAID ESTATE RECOVERY. ``For provisions relating to-- ``(1) premiums or cost sharing protections for Indians furnished items or services directly by Indian Health Programs or through referral under the contract health service under the Medicaid program established under title XIX of the Social Security Act, see sections 1916(j) and 1916A(a)(1) of the Social Security Act (42 U.S.C. 1396o(j), 1396o-1(a)(1)); ``(2) rules regarding the treatment of certain property for purposes of determining eligibility under such programs, see sections 1902(e)(13) and 2107(e)(1)(B) of such Act (42 U.S.C. 1396a(e)(13), 1397gg(e)(1)(B)); and ``(3) the protection of certain property from estate recovery provisions under the Medicaid program, see section 1917(b)(3)(B) of such Act (42 U.S.C. 1396p(b)(3)(B)). ``SEC. 413. TREATMENT UNDER MEDICAID AND SCHIP MANAGED CARE. ``For provisions relating to the treatment of Indians enrolled in a managed care entity under the Medicaid program under title XIX of the Social Security Act and Indian Health Programs and Urban Indian Organizations that are providers of items or services to such Indian enrollees, see sections 1932(h) and 2107(e)(1)(H) of the Social Security Act (42 U.S.C. 1396u-2(h), 1397gg(e)(1)(H)). ``SEC. 414. NAVAJO NATION MEDICAID AGENCY FEASIBILITY STUDY. ``(a) Study.--The Secretary shall conduct a study to determine the feasibility of treating the Navajo Nation as a State for the purposes of title XIX of the Social Security Act, to provide services to Indians living within the boundaries of the Navajo Nation through an entity established having the same authority and performing the same functions as single-State medicaid agencies responsible for the administration of the State plan under title XIX of the Social Security Act. ``(b) Considerations.--In conducting the study, the Secretary shall consider the feasibility of-- ``(1) assigning and paying all expenditures for the provision of services and related administration funds, under title XIX of the Social Security Act, to Indians living within the boundaries of the Navajo Nation that are currently paid to or would otherwise be paid to the State of Arizona, New Mexico, or Utah; ``(2) providing assistance to the Navajo Nation in the development and implementation of such entity for the administration, eligibility, payment, and delivery of medical assistance under title XIX of the Social Security Act; ``(3) providing an appropriate level of matching funds for Federal medical assistance with respect to amounts such entity expends for medical assistance for services and related administrative costs; and ``(4) authorizing the Secretary, at the option of the Navajo Nation, to treat the Navajo Nation as a State for the purposes of title XIX of the Social Security Act (relating to the State children's health insurance program) under terms equivalent to those described in paragraphs (2) through (4). ``(c) Report.--Not later then 3 years after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary shall submit to the Committee on Indian Affairs and Committee on Finance of the Senate and the Committee on Natural Resources and Committee on Energy and Commerce of the House of Representatives a report that includes-- ``(1) the results of the study under this section; ``(2) a summary of any consultation that occurred between the Secretary and the Navajo Nation, other Indian Tribes, the States of Arizona, New Mexico, and Utah, counties which include Navajo Lands, and other interested parties, in conducting this study; ``(3) projected costs or savings associated with establishment of such entity, and any estimated impact on services provided as described in this section in relation to probable costs or savings; and ``(4) legislative actions that would be required to authorize the establishment of such entity if such entity is determined by the Secretary to be feasible. ``SEC. 415. GENERAL EXCEPTIONS. ``The requirements of this title shall not apply to any excepted benefits described in paragraph (1)(A) or (3) of section 2791(c) of the Public Health Service Act (42 U.S.C. 300gg-91). ``SEC. 416. AUTHORIZATION OF APPROPRIATIONS. ``There are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2017 to carry out this title. ``TITLE V--HEALTH SERVICES FOR URBAN INDIANS ``SEC. 501. PURPOSE. ``The purpose of this title is to establish and maintain programs in Urban Centers to make health services more accessible and available to Urban Indians. ``SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN INDIAN ORGANIZATIONS. ``Under authority of the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'), the Secretary, acting through the Service, shall enter into contracts with, or make grants to, Urban Indian Organizations to assist such organizations in the establishment and administration, within Urban Centers, of programs which meet the requirements set forth in this title. Subject to section 506, the Secretary, acting through the Service, shall include such conditions as the Secretary considers necessary to effect the purpose of this title in any contract into which the Secretary enters with, or in any grant the Secretary makes to, any Urban Indian Organization pursuant to this title. ``SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION OF HEALTH CARE AND REFERRAL SERVICES. ``(a) Requirements for Grants and Contracts.--Under authority of the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'), the Secretary, acting through the Service, shall enter into contracts with, 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, 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, or under any current public health service project funded in a manner other than pursuant to this title; ``(4) the capability of an Urban Indian Organization to perform the activities set forth in subsection (a) and to enter into a contract with the Secretary or to meet the requirements for receiving a grant under this section; ``(5) the satisfactory performance and successful completion by an Urban Indian Organization of other contracts with the Secretary under this title; ``(6) the appropriateness and likely effectiveness of conducting the activities set forth in subsection (a) in an Urban Center or centers; and ``(7) the extent of existing or likely future participation in the activities set forth in subsection (a) by appropriate health and health-related Federal, State, local, and other agencies. ``(c) Access to Health Promotion and Disease Prevention Programs.-- The Secretary, acting through the Service, shall facilitate access to or provide health promotion and disease prevention services for Urban Indians through grants made to Urban Indian Organizations administering contracts entered into or receiving grants under subsection (a). ``(d) Immunization Services.-- ``(1) Access or services provided.--The Secretary, acting through the Service, shall facilitate access to, or provide, immunization services for Urban Indians through grants made to Urban Indian Organizations administering contracts entered into or receiving grants under this section. ``(2) Definition.--For purposes of this subsection, the term `immunization services' means services to provide without charge immunizations against vaccine-preventable diseases. ``(e) Behavioral Health Services.-- ``(1) Access or services provided.--The Secretary, acting through the Service, shall facilitate access to, or provide, behavioral health services for Urban Indians through grants made to Urban Indian Organizations administering contracts entered into or receiving grants under subsection (a). ``(2) Assessment required.--Except as provided by paragraph (3)(A), a grant may not be made under this subsection to an Urban Indian Organization until that organization has prepared, and the Service has approved, an assessment of the following: ``(A) The behavioral health needs of the Urban Indian population concerned. ``(B) The behavioral health services and other related resources available to that population. ``(C) The barriers to obtaining those services and resources. ``(D) The needs that are unmet by such services and resources. ``(3) Purposes of grants.--Grants may be made under this subsection for the following: ``(A) To prepare assessments required under paragraph (2). ``(B) To provide outreach, educational, and referral services to Urban Indians regarding the availability of direct behavioral health services, to educate Urban Indians about behavioral health issues and services, and effect coordination with existing behavioral health providers in order to improve services to Urban Indians. ``(C) To provide outpatient behavioral health services to Urban Indians, including the identification and assessment of illness, therapeutic treatments, case management, support groups, family treatment, and other treatment. ``(D) To develop innovative behavioral health service delivery models which incorporate Indian cultural support systems and resources. ``(f) Prevention of Child Abuse.-- ``(1) Access or services provided.--The Secretary, acting through the Service, shall facilitate access to or provide services for Urban Indians through grants to Urban Indian Organizations administering contracts entered into or receiving grants under subsection (a) to prevent and treat child abuse (including sexual abuse) among Urban Indians. ``(2) Evaluation required.--Except as provided by paragraph (3)(A), a grant may not be made under this subsection to an Urban Indian Organization until that organization has prepared, and the Service has approved, an assessment that documents the prevalence of child abuse in the Urban Indian population concerned and specifies the services and programs (which may not duplicate existing services and programs) for which the grant is requested. ``(3) Purposes of grants.--Grants may be made under this subsection for the following: ``(A) To prepare assessments required under paragraph (2). ``(B) For the development of prevention, training, and education programs for Urban Indians, including child education, parent education, provider training on identification and intervention, education on reporting requirements, prevention campaigns, and establishing service networks of all those involved in Indian child protection. ``(C) To provide direct outpatient treatment services (including individual treatment, family treatment, group therapy, and support groups) to Urban Indians who are child victims of abuse (including sexual abuse) or adult survivors of child sexual abuse, to the families of such child victims, and to Urban Indian perpetrators of child abuse (including sexual abuse). ``(4) Considerations when making grants.--In making grants to carry out this subsection, the Secretary shall take into consideration-- ``(A) the support for the Urban Indian Organization demonstrated by the child protection authorities in the area, including committees or other services funded under the Indian Child Welfare Act of 1978 (25 U.S.C. 1901 et seq.), if any; ``(B) the capability and expertise demonstrated by the Urban Indian Organization to address the complex problem of child sexual abuse in the community; and ``(C) the assessment required under paragraph (2). ``(g) Other Grants.--The Secretary, acting through the Service, may enter into a contract with or make grants to an Urban Indian Organization that provides or arranges for the provision of health care services (through satellite facilities, provider networks, or otherwise) to Urban Indians in more than 1 Urban Center. ``SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINATION OF UNMET HEALTH CARE NEEDS. ``(a) Grants and Contracts Authorized.--Under authority of the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'), the Secretary, acting through the Service, may enter into contracts with or make grants to Urban Indian Organizations situated in Urban Centers for which contracts have not been entered into or grants have not been made under section 503. ``(b) Purpose.--The purpose of a contract or grant made under this section shall be the determination of the matters described in subsection (c)(1) in order to assist the Secretary in assessing the health status and health care needs of Urban Indians in the Urban Center involved and determining whether the Secretary should enter into a contract or make a grant under section 503 with respect to the Urban Indian Organization which the Secretary has entered into a contract with, or made a grant to, under this section. ``(c) Grant and Contract Requirements.--Any contract entered into, or grant made, by the Secretary under this section shall include requirements that-- ``(1) the Urban Indian Organization successfully undertakes to-- ``(A) document the health care status and unmet health care needs of Urban Indians in the Urban Center involved; and ``(B) with respect to Urban Indians in the Urban Center involved, determine the matters described in paragraphs (2), (3), (4), and (7) of section 503(b); and ``(2) the Urban Indian Organization complete performance of the contract, or carry out the requirements of the grant, within 1 year after the date on which the Secretary and such organization enter into such contract, or within 1 year after such organization receives such grant, whichever is applicable. ``(d) No Renewals.--The Secretary may not renew any contract entered into or grant made under this section. ``SEC. 505. EVALUATIONS; RENEWALS. ``(a) Procedures for Evaluations.--The Secretary, acting through the Service, shall develop procedures to evaluate compliance with grant requirements and compliance with and performance of contracts entered into by Urban Indian Organizations under this title. Such procedures shall include provisions for carrying out the requirements of this section. ``(b) Evaluations.--The Secretary, acting through the Service, shall evaluate the compliance of each Urban Indian Organization which has entered into a contract or received a grant under section 503 with the terms of such contract or grant. For purposes of this evaluation, the Secretary shall-- ``(1) acting through the Service, conduct an annual onsite evaluation of the organization; or ``(2) accept in lieu of such onsite evaluation evidence of the organization's provisional or full accreditation by a private independent entity recognized by the Secretary for purposes of conducting quality reviews of providers participating in the Medicare program under title XVIII of the Social Security Act. ``(c) Noncompliance; Unsatisfactory Performance.--If, as a result of the evaluations conducted under this section, the Secretary determines that an Urban Indian Organization has not complied with the requirements of a grant or complied with or satisfactorily performed a contract under section 503, the Secretary shall, prior to renewing such contract or grant, attempt to resolve with the organization the areas of noncompliance or unsatisfactory performance and modify the contract or grant to prevent future occurrences of noncompliance or unsatisfactory performance. If the Secretary determines that the noncompliance or unsatisfactory performance cannot be resolved and prevented in the future, the Secretary shall not renew the contract or grant with the organization and is authorized to enter into a contract or make a grant under section 503 with another Urban Indian Organization which is situated in the same Urban Center as the Urban Indian Organization whose contract or grant is not renewed under this section. ``(d) Considerations for Renewals.--In determining whether to renew a contract or grant with an Urban Indian Organization under section 503 which has completed performance of a contract or grant under section 504, the Secretary shall review the records of the Urban Indian Organization, the reports submitted under section 507, and shall consider the results of the onsite evaluations or accreditations under subsection (b). ``SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS. ``(a) Procurement.--Contracts with Urban Indian Organizations entered into pursuant to this title shall be in accordance with all Federal contracting laws and regulations relating to procurement except that in the discretion of the Secretary, such contracts may be negotiated without advertising and need not conform to the provisions of sections 1304 and 3131 through 3133 of title 40, United States Code. ``(b) Payments Under Contracts or Grants.-- ``(1) In general.--Payments under any contracts or grants pursuant to this title, notwithstanding any term or condition of such contract or grant-- ``(A) may be made in a single advance payment by the Secretary to the Urban Indian Organization by no later than the end of the first 30 days of the funding period with respect to which the payments apply, unless the Secretary determines through an evaluation under section 505 that the organization is not capable of administering such a single advance payment; and ``(B) if any portion thereof is unexpended by the Urban Indian Organization during the funding period with respect to which the payments initially apply, shall be carried forward for expenditure with respect to allowable or reimbursable costs incurred by the organization during 1 or more subsequent funding periods without additional justification or documentation by the organization as a condition of carrying forward the availability for expenditure of such funds. ``(2) Semiannual and quarterly payments and reimbursements.-- If the Secretary determines under paragraph (1)(A) that an Urban Indian Organization is not capable of administering an entire single advance payment, on request of the Urban Indian Organization, the payments may be made-- ``(A) in semiannual or quarterly payments by not later than 30 days after the date on which the funding period with respect to which the payments apply begins; or ``(B) by way of reimbursement. ``(c) Revision or Amendment of Contracts.--Notwithstanding any provision of law to the contrary, the Secretary may, at the request and consent of an Urban Indian Organization, revise or amend any contract entered into by the Secretary with such organization under this title as necessary to carry out the purposes of this title. ``(d) Fair and Uniform Services and Assistance.--Contracts with or grants to Urban Indian Organizations and regulations adopted pursuant to this title shall include provisions to assure the fair and uniform provision to Urban Indians of services and assistance under such contracts or grants by such organizations. ``SEC. 507. REPORTS AND RECORDS. ``(a) Reports.-- ``(1) In general.--For each fiscal year during which an Urban Indian Organization receives or expends funds pursuant to a contract entered into or a grant received pursuant to this title, such Urban Indian Organization shall submit to the Secretary not more frequently than every 6 months, a report that includes the following: ``(A) In the case of a contract or grant under section 503, recommendations pursuant to section 503(a)(5). ``(B) Information on activities conducted by the organization pursuant to the contract or grant. ``(C) An accounting of the amounts and purpose for which Federal funds were expended. ``(D) A minimum set of data, using uniformly defined elements, as specified by the Secretary after consultation with Urban Indian Organizations. ``(2) Health status and services.-- ``(A) In general.--Not later than 18 months after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary, acting through the Service, shall submit to Congress a report evaluating-- ``(i) the health status of Urban Indians; ``(ii) the services provided to Indians pursuant to this title; and ``(iii) areas of unmet needs in the delivery of health services to Urban Indians. ``(B) Consultation and contracts.--In preparing the report under paragraph (1), the Secretary-- ``(i) shall consult with Urban Indian Organizations; and ``(ii) may enter into a contract with a national organization representing Urban Indian Organizations to conduct any aspect of the report. ``(b) Audit.--The reports and records of the Urban Indian Organization with respect to a contract or grant under this title shall be subject to audit by the Secretary and the Comptroller General of the United States. ``(c) Costs of Audits.--The Secretary shall allow as a cost of any contract or grant entered into or awarded under section 502 or 503 the cost of an annual independent financial audit conducted by-- ``(1) a certified public accountant; or ``(2) a certified public accounting firm qualified to conduct Federal compliance audits. ``SEC. 508. LIMITATION ON CONTRACT AUTHORITY. ``The authority of the Secretary to enter into contracts or to award grants under this title shall be to the extent, and in an amount, provided for in appropriation Acts. ``SEC. 509. FACILITIES. ``(a) Grants.--The Secretary, acting through the Service, may make grants to contractors or grant recipients under this title for the lease, purchase, renovation, construction, or expansion of facilities, including leased facilities, in order to assist such contractors or grant recipients in complying with applicable licensure or certification requirements. ``(b) Loan Fund Study.--The Secretary, acting through the Service, may carry out a study to determine the feasibility of establishing a loan fund to provide to Urban Indian Organizations direct loans or guarantees for loans for the construction of health care facilities in a manner consistent with section 309, including by submitting a report in accordance with subsection (c) of that section. ``SEC. 510. DIVISION OF URBAN INDIAN HEALTH. ``There is established within the Service a Division of Urban Indian Health, which shall be responsible for-- ``(1) carrying out the provisions of this title; ``(2) providing central oversight of the programs and services authorized under this title; and ``(3) providing technical assistance to Urban Indian Organizations. ``SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE-RELATED SERVICES. ``(a) Grants Authorized.--The Secretary, acting through the Service, may make grants for the provision of health-related services in prevention of, treatment of, rehabilitation of, or school- and community-based education regarding, alcohol and substance abuse in Urban Centers to those Urban Indian Organizations with which the Secretary has entered into a contract under this title or under section 201. ``(b) Goals.--Each grant made pursuant to subsection (a) shall set forth the goals to be accomplished pursuant to the grant. The goals shall be specific to each grant as agreed to between the Secretary and the grantee. ``(c) Criteria.--The Secretary shall establish criteria for the grants made under subsection (a), including criteria relating to the following: ``(1) The size of the Urban Indian population. ``(2) Capability of the organization to adequately perform the activities required under the grant. ``(3) Satisfactory performance standards for the organization in meeting the goals set forth in such grant. The standards shall be negotiated and agreed to between the Secretary and the grantee on a grant-by-grant basis. ``(4) Identification of the need for services. ``(d) Allocation of Grants.--The Secretary shall develop a methodology for allocating grants made pursuant to this section based on the criteria established pursuant to subsection (c). ``(e) Grants Subject to Criteria.--Any grant received by an Urban Indian Organization under this Act for substance abuse prevention, treatment, and rehabilitation shall be subject to the criteria set forth in subsection (c). ``SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION PROJECTS. ``Notwithstanding any other provision of law, the Tulsa Clinic and Oklahoma City Clinic demonstration projects shall-- ``(1) be permanent programs within the Service's direct care program; ``(2) continue to be treated as Service Units and Operating Units in the allocation of resources and coordination of care; and ``(3) continue to meet the requirements and definitions of an Urban Indian Organization in this Act, and shall not be subject to the provisions of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.). ``SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS. ``(a) Grants and Contracts.--The Secretary, through the Division of Urban Indian Health, shall make grants or enter into contracts with Urban Indian Organizations, to take effect not later than September 30, 2010, for the administration of Urban Indian alcohol programs that were originally established under the National Institute on Alcoholism and Alcohol Abuse (hereafter in this section referred to as `NIAAA') and transferred to the Service. ``(b) Use of Funds.--Grants provided or contracts entered into under this section shall be used to provide support for the continuation of alcohol prevention and treatment services for Urban Indian populations and such other objectives as are agreed upon between the Service and a recipient of a grant or contract under this section. ``(c) Eligibility.--Urban Indian Organizations that operate Indian alcohol programs originally funded under the NIAAA and subsequently transferred to the Service are eligible for grants or contracts under this section. ``(d) Report.--The Secretary shall evaluate and report to Congress on the activities of programs funded under this section not less than every 5 years. ``SEC. 514. CONSULTATION WITH URBAN INDIAN ORGANIZATIONS. ``(a) In General.--The Secretary shall ensure that the Service consults, to the greatest extent practicable, with Urban Indian Organizations. ``(b) Definition of Consultation.--For purposes of subsection (a), consultation is the open and free exchange of information and opinions which leads to mutual understanding and comprehension and which emphasizes trust, respect, and shared responsibility. ``SEC. 515. URBAN YOUTH TREATMENT CENTER DEMONSTRATION. ``(a) Construction and Operation.--The Secretary, acting through the Service, through grant or contract, is authorized to fund the construction and operation of at least 2 residential treatment centers in each State described in subsection (b) to demonstrate the provision of alcohol and substance abuse treatment services to Urban Indian youth in a culturally competent residential setting. ``(b) Definition of State.--A State described in this subsection is a State in which-- ``(1) there resides Urban Indian youth with need for alcohol and substance abuse treatment services in a residential setting; and ``(2) there is a significant shortage of culturally competent residential treatment services for Urban Indian youth. ``SEC. 516. GRANTS FOR DIABETES PREVENTION, TREATMENT, AND CONTROL. ``(a) Grants Authorized.--The Secretary may make grants to those Urban Indian Organizations that have entered into a contract or have received a grant under this title for the provision of services for the prevention and treatment of, and control of the complications resulting from, diabetes among Urban Indians. ``(b) Goals.--Each grant made pursuant to subsection (a) shall set forth the goals to be accomplished under the grant. The goals shall be specific to each grant as agreed to between the Secretary and the grantee. ``(c) Establishment of Criteria.--The Secretary shall establish criteria for the grants made under subsection (a) relating to-- ``(1) the size and location of the Urban Indian population to be served; ``(2) the need for prevention of and treatment of, and control of the complications resulting from, diabetes among the Urban Indian population to be served; ``(3) performance standards for the organization in meeting the goals set forth in such grant that are negotiated and agreed to by the Secretary and the grantee; ``(4) the capability of the organization to adequately perform the activities required under the grant; and ``(5) the willingness of the organization to collaborate with the registry, if any, established by the Secretary under section 204(e) in the Area Office of the Service in which the organization is located. ``(d) Funds Subject to Criteria.--Any funds received by an Urban Indian Organization under this Act for the prevention, treatment, and control of diabetes among Urban Indians shall be subject to the criteria developed by the Secretary under subsection (c). ``SEC. 517. COMMUNITY HEALTH REPRESENTATIVES. ``The Secretary, acting through the Service, may enter into contracts with, and make grants to, Urban Indian Organizations for the employment of Indians trained as health service providers through the Community Health Representatives Program under section 109 in the provision of health care, health promotion, and disease prevention services to Urban Indians. ``SEC. 518. EFFECTIVE DATE. ``The amendments made by the Indian Health Care Improvement Act Amendments of 2007 to this title shall take effect beginning on the date of enactment of that Act, regardless of whether the Secretary has promulgated regulations implementing such amendments. ``SEC. 519. ELIGIBILITY FOR SERVICES. ``Urban Indians shall be eligible for, and the ultimate beneficiaries of, health care or referral services provided pursuant to this title. ``SEC. 520. AUTHORIZATION OF APPROPRIATIONS. ``There are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2017 to carry out this title. ``TITLE VI--ORGANIZATIONAL IMPROVEMENTS ``SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERVICE AS AN AGENCY OF THE PUBLIC HEALTH SERVICE. ``(a) Establishment.-- ``(1) In general.--In order to more effectively and efficiently carry out the responsibilities, authorities, and functions of the United States to provide health care services to Indians and Indian Tribes, as are or may be hereafter provided by Federal statute or treaties, there is established within the Public Health Service of the Department the Indian Health Service. ``(2) Assistant secretary of indian health.--The Service shall be administered by an Assistant Secretary of Indian Health, who shall be appointed by the President, by and with the advice and consent of the Senate. The Assistant Secretary shall report to the Secretary. Effective with respect to an individual appointed by the President, by and with the advice and consent of the Senate, after January 1, 2007, the term of service of the Assistant Secretary shall be 4 years. An Assistant Secretary may serve more than 1 term. ``(3) Incumbent.--The individual serving in the position of Director of the Service on the day before the date of enactment of the Indian Health Care Improvement Act Amendments of 2007 shall serve as Assistant Secretary. ``(4) Advocacy and consultation.--The position of Assistant Secretary is established to, in a manner consistent with the government-to-government relationship between the United States and Indian Tribes-- ``(A) facilitate advocacy for the development of appropriate Indian health policy; and ``(B) promote consultation on matters relating to Indian health. ``(b) Agency.--The Service shall be an agency within the Public Health Service of the Department, and shall not be an office, component, or unit of any other agency of the Department. ``(c) Duties.--The Assistant Secretary shall-- ``(1) perform all functions that were, on the day before the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, carried out by or under the direction of the individual serving as Director of the Service on that day; ``(2) perform all functions of the Secretary relating to the maintenance and operation of hospital and health facilities for Indians and the planning for, and provision and utilization of, health services for Indians; ``(3) administer all health programs under which health care is provided to Indians based upon their status as Indians which are administered by the Secretary, including programs under-- ``(A) this Act; ``(B) the Act of November 2, 1921 (25 U.S.C. 13); ``(C) the Act of August 5, 1954 (42 U.S.C. 2001 et seq.); ``(D) the Act of August 16, 1957 (42 U.S.C. 2005 et seq.); and ``(E) the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.); ``(4) administer all scholarship and loan functions carried out under title I; ``(5) report directly to the Secretary concerning all policy- and budget-related matters affecting Indian health; ``(6) collaborate with the Assistant Secretary for Health concerning appropriate matters of Indian health that affect the agencies of the Public Health Service; ``(7) advise each Assistant Secretary of the Department concerning matters of Indian health with respect to which that Assistant Secretary has authority and responsibility; ``(8) advise the heads of other agencies and programs of the Department concerning matters of Indian health with respect to which those heads have authority and responsibility; ``(9) coordinate the activities of the Department concerning matters of Indian health; and ``(10) perform such other functions as the Secretary may designate. ``(d) Authority.-- ``(1) In general.--The Secretary, acting through the Assistant Secretary, shall have the authority-- ``(A) except to the extent provided for in paragraph (2), to appoint and compensate employees for the Service in accordance with title 5, United States Code; ``(B) to enter into contracts for the procurement of goods and services to carry out the functions of the Service; and ``(C) to manage, expend, and obligate all funds appropriated for the Service. ``(2) Personnel actions.--Notwithstanding any other provision of law, the provisions of section 12 of the Act of June 18, 1934 (48 Stat. 986; 25 U.S.C. 472), shall apply to all personnel actions taken with respect to new positions created within the Service as a result of its establishment under subsection (a). ``(e) References.--Any reference to the Director of the Indian Health Service in any other Federal law, Executive order, rule, regulation, or delegation of authority, or in any document of or relating to the Director of the Indian Health Service, shall be deemed to refer to the Assistant Secretary. ``SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM. ``(a) Establishment.-- ``(1) In general.--The Secretary shall establish an automated management information system for the Service. ``(2) Requirements of system.--The information system established under paragraph (1) shall include-- ``(A) a financial management system; ``(B) a patient care information system for each area served by the Service; ``(C) a privacy component that protects the privacy of patient information held by, or on behalf of, the Service; ``(D) a services-based cost accounting component that provides estimates of the costs associated with the provision of specific medical treatments or services in each Area office of the Service; ``(E) an interface mechanism for patient billing and accounts receivable system; and ``(F) a training component. ``(b) Provision of Systems to Tribes and Organizations.--The Secretary shall provide each Tribal Health Program automated management information systems which-- ``(1) meet the management information needs of such Tribal Health Program with respect to the treatment by the Tribal Health Program of patients of the Service; and ``(2) meet the management information needs of the Service. ``(c) Access to Records.--Notwithstanding any other provision of law, each patient shall have reasonable access to the medical or health records of such patient which are held by, or on behalf of, the Service. ``(d) Authority To Enhance Information Technology.--The Secretary, acting through the Assistant Secretary, shall have the authority to enter into contracts, agreements, or joint ventures with other Federal agencies, States, private and nonprofit organizations, for the purpose of enhancing information technology in Indian Health Programs and facilities. ``SEC. 603. AUTHORIZATION OF APPROPRIATIONS. ``There is authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2017 to carry out this title. ``TITLE VII--BEHAVIORAL HEALTH PROGRAMS ``SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREATMENT SERVICES. ``(a) Purposes.--The purposes of this section are as follows: ``(1) To authorize and direct the Secretary, acting through the Service, Indian Tribes, Tribal Organizations, and Urban Indian Organizations, to develop a comprehensive behavioral health prevention and treatment program which emphasizes collaboration among alcohol and substance abuse, social services, and mental health programs. ``(2) To provide information, direction, and guidance relating to mental illness and dysfunction and self-destructive behavior, including child abuse and family violence, to those Federal, tribal, State, and local agencies responsible for programs in Indian communities in areas of health care, education, social services, child and family welfare, alcohol and substance abuse, law enforcement, and judicial services. ``(3) To assist Indian Tribes to identify services and resources available to address mental illness and dysfunctional and self-destructive behavior. ``(4) To provide authority and opportunities for Indian Tribes and Tribal Organizations to develop, implement, and coordinate with community-based programs which include identification, prevention, education, referral, and treatment services, including through multidisciplinary resource teams. ``(5) To ensure that Indians, as citizens of the United States and of the States in which they reside, have the same access to behavioral health services to which all citizens have access. ``(6) To modify or supplement existing programs and authorities in the areas identified in paragraph (2). ``(b) Plans.-- ``(1) Development.--The Secretary, acting through the Service, Indian Tribes, Tribal Organizations, and Urban Indian Organizations, shall encourage Indian Tribes and Tribal Organizations to develop tribal plans, and Urban Indian Organizations to develop local plans, and for all such groups to participate in developing areawide plans for Indian Behavioral Health Services. The plans shall include, to the extent feasible, the following components: ``(A) An assessment of the scope of alcohol or other substance abuse, mental illness, and dysfunctional and self-destructive behavior, including suicide, child abuse, and family violence, among Indians, including-- ``(i) the number of Indians served who are directly or indirectly affected by such illness or behavior; or ``(ii) an estimate of the financial and human cost attributable to such illness or behavior. ``(B) An assessment of the existing and additional resources necessary for the prevention and treatment of such illness and behavior, including an assessment of the progress toward achieving the availability of the full continuum of care described in subsection (c). ``(C) An estimate of the additional funding needed by the Service, Indian Tribes, Tribal Organizations, and Urban Indian Organizations to meet their responsibilities under the plans. ``(2) National clearinghouse.--The Secretary, acting through the Service, shall coordinate with existing national clearinghouses and information centers to include at the clearinghouses and centers plans and reports on the outcomes of such plans developed by Indian Tribes, Tribal Organizations, Urban Indian Organizations, and Service Areas relating to behavioral health. The Secretary shall ensure access to these plans and outcomes by any Indian Tribe, Tribal Organization, Urban Indian Organization, or the Service. ``(3) Technical assistance.--The Secretary shall provide technical assistance to Indian Tribes, Tribal Organizations, and Urban Indian Organizations in preparation of plans under this section and in developing standards of care that may be used and adopted locally. ``(c) Programs.--The Secretary, acting through the Service, Indian Tribes, and Tribal Organizations, shall provide, to the extent feasible and if funding is available, programs including the following: ``(1) Comprehensive care.--A comprehensive continuum of behavioral health care which provides-- ``(A) community-based prevention, intervention, outpatient, and behavioral health aftercare; ``(B) detoxification (social and medical); ``(C) acute hospitalization; ``(D) intensive outpatient/day treatment; ``(E) residential treatment; ``(F) transitional living for those needing a temporary, stable living environment that is supportive of treatment and recovery goals; ``(G) emergency shelter; ``(H) intensive case management; and ``(I) diagnostic services. ``(2) Child care.--Behavioral health services for Indians from birth through age 17, including-- ``(A) preschool and school age fetal alcohol disorder services, including assessment and behavioral intervention; ``(B) mental health and substance abuse services (emotional, organic, alcohol, drug, inhalant, and tobacco); ``(C) identification and treatment of co-occurring disorders and comorbidity; ``(D) prevention of alcohol, drug, inhalant, and tobacco use; ``(E) early intervention, treatment, and aftercare; ``(F) promotion of healthy approaches to risk and safety issues; and ``(G) identification and treatment of neglect and physical, mental, and sexual abuse. ``(3) Adult care.--Behavioral health services for Indians from age 18 through 55, including-- ``(A) early intervention, treatment, and aftercare; ``(B) mental health and substance abuse services (emotional, alcohol, drug, inhalant, and tobacco), including sex specific services; ``(C) identification and treatment of co-occurring disorders (dual diagnosis) and comorbidity; ``(D) promotion of healthy approaches for risk- related behavior; ``(E) treatment services for women at risk of giving birth to a child with a fetal alcohol disorder; and ``(F) sex specific treatment for sexual assault and domestic violence. ``(4) Family care.--Behavioral health services for families, including-- ``(A) early intervention, treatment, and aftercare for affected families; ``(B) treatment for sexual assault and domestic violence; and ``(C) promotion of healthy approaches relating to parenting, domestic violence, and other abuse issues. ``(5) Elder care.--Behavioral health services for Indians 56 years of age and older, including-- ``(A) early intervention, treatment, and aftercare; ``(B) mental health and substance abuse services (emotional, alcohol, drug, inhalant, and tobacco), including sex specific services; ``(C) identification and treatment of co-occurring disorders (dual diagnosis) and comorbidity; ``(D) promotion of healthy approaches to managing conditions related to aging; ``(E) sex specific treatment for sexual assault, domestic violence, neglect, physical and mental abuse and exploitation; and ``(F) identification and treatment of dementias regardless of cause. ``(d) Community Behavioral Health Plan.-- ``(1) Establishment.--The governing body of any Indian Tribe, Tribal Organization, or Urban Indian Organization may adopt a resolution for the establishment of a community behavioral health plan providing for the identification and coordination of available resources and programs to identify, prevent, or treat substance abuse, mental illness, or dysfunctional and self-destructive behavior, including child abuse and family violence, among its members or its service population. This plan should include behavioral health services, social services, intensive outpatient services, and continuing aftercare. ``(2) Technical assistance.--At the request of an Indian Tribe, Tribal Organization, or Urban Indian Organization, the Bureau of Indian Affairs and the Service shall cooperate with and provide technical assistance to the Indian Tribe, Tribal Organization, or Urban Indian Organization in the development and implementation of such plan. ``(3) Funding.--The Secretary, acting through the Service, may make funding available to Indian Tribes and Tribal Organizations which adopt a resolution pursuant to paragraph (1) to obtain technical assistance for the development of a community behavioral health plan and to provide administrative support in the implementation of such plan. ``(e) Coordination for Availability of Services.--The Secretary, acting through the Service, Indian Tribes, Tribal Organizations, and Urban Indian Organizations, shall coordinate behavioral health planning, to the extent feasible, with other Federal agencies and with State agencies, to encourage comprehensive behavioral health services for Indians regardless of their place of residence. ``(f) Mental Health Care Need Assessment.--Not later than 1 year after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary, acting through the Service, shall make an assessment of the need for inpatient mental health care among Indians and the availability and cost of inpatient mental health facilities which can meet such need. In making such assessment, the Secretary shall consider the possible conversion of existing, underused Service hospital beds into psychiatric units to meet such need. ``SEC. 702. MEMORANDA OF AGREEMENT WITH THE DEPARTMENT OF THE INTERIOR. ``(a) Contents.--Not later than 12 months after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary, acting through the Service, and the Secretary of the Interior shall develop and enter into a memoranda of agreement, or review and update any existing memoranda of agreement, as required by section 4205 of the Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 2411) under which the Secretaries address the following: ``(1) The scope and nature of mental illness and dysfunctional and self-destructive behavior, including child abuse and family violence, among Indians. ``(2) The existing Federal, tribal, State, local, and private services, resources, and programs available to provide behavioral health services for Indians. ``(3) The unmet need for additional services, resources, and programs necessary to meet the needs identified pursuant to paragraph (1). ``(4)(A) The right of Indians, as citizens of the United States and of the States in which they reside, to have access to behavioral health services to which all citizens have access. ``(B) The right of Indians to participate in, and receive the benefit of, such services. ``(C) The actions necessary to protect the exercise of such right. ``(5) The responsibilities of the Bureau of Indian Affairs and the Service, including mental illness identification, prevention, education, referral, and treatment services (including services through multidisciplinary resource teams), at the central, area, and agency and Service Unit, Service Area, and headquarters levels to address the problems identified in paragraph (1). ``(6) A strategy for the comprehensive coordination of the behavioral health services provided by the Bureau of Indian Affairs and the Service to meet the problems identified pursuant to paragraph (1), including-- ``(A) the coordination of alcohol and substance abuse programs of the Service, the Bureau of Indian Affairs, and Indian Tribes and Tribal Organizations (developed under the Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 2401 et seq.)) with behavioral health initiatives pursuant to this Act, particularly with respect to the referral and treatment of dually diagnosed individuals requiring behavioral health and substance abuse treatment; and ``(B) ensuring that the Bureau of Indian Affairs and Service programs and services (including multidisciplinary resource teams) addressing child abuse and family violence are coordinated with such non-Federal programs and services. ``(7) Directing appropriate officials of the Bureau of Indian Affairs and the Service, particularly at the agency and Service Unit levels, to cooperate fully with tribal requests made pursuant to community behavioral health plans adopted under section 701(c) and section 4206 of the Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 2412). ``(8) Providing for an annual review of such agreement by the Secretaries which shall be provided to Congress and Indian Tribes and Tribal Organizations. ``(b) Specific Provisions Required.--The memoranda of agreement updated or entered into pursuant to subsection (a) shall include specific provisions pursuant to which the Service shall assume responsibility for-- ``(1) the determination of the scope of the problem of alcohol and substance abuse among Indians, including the number of Indians within the jurisdiction of the Service who are directly or indirectly affected by alcohol and substance abuse and the financial and human cost; ``(2) an assessment of the existing and needed resources necessary for the prevention of alcohol and substance abuse and the treatment of Indians affected by alcohol and substance abuse; and ``(3) an estimate of the funding necessary to adequately support a program of prevention of alcohol and substance abuse and treatment of Indians affected by alcohol and substance abuse. ``(c) Publication.--Each memorandum of agreement entered into or renewed (and amendments or modifications thereto) under subsection (a) shall be published in the Federal Register. At the same time as publication in the Federal Register, the Secretary shall provide a copy of such memoranda, amendment, or modification to each Indian Tribe, Tribal Organization, and Urban Indian Organization. ``SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PREVENTION AND TREATMENT PROGRAM. ``(a) Establishment.-- ``(1) In general.--The Secretary, acting through the Service, Indian Tribes, and Tribal Organizations, shall provide a program of comprehensive behavioral health, prevention, treatment, and aftercare, which shall include-- ``(A) prevention, through educational intervention, in Indian communities; ``(B) acute detoxification, psychiatric hospitalization, residential, and intensive outpatient treatment; ``(C) community-based rehabilitation and aftercare; ``(D) community education and involvement, including extensive training of health care, educational, and community-based personnel; ``(E) specialized residential treatment programs for high-risk populations, including pregnant and postpartum women and their children; and ``(F) diagnostic services. ``(2) Target populations.--The target population of such programs shall be members of Indian Tribes. Efforts to train and educate key members of the Indian community shall also target employees of health, education, judicial, law enforcement, legal, and social service programs. ``(b) Contract Health Services.-- ``(1) In general.--The Secretary, acting through the Service, Indian Tribes, and Tribal Organizations, may enter into contracts with public or private providers of behavioral health treatment services for the purpose of carrying out the program required under subsection (a). ``(2) Provision of assistance.--In carrying out this subsection, the Secretary shall provide assistance to Indian Tribes and Tribal Organizations to develop criteria for the certification of behavioral health service providers and accreditation of service facilities which meet minimum standards for such services and facilities. ``SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM. ``(a) In General.--Under the authority of the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'), the Secretary shall establish and maintain a mental health technician program within the Service which-- ``(1) provides for the training of Indians as mental health technicians; and ``(2) employs such technicians in the provision of community- based mental health care that includes identification, prevention, education, referral, and treatment services. ``(b) Paraprofessional Training.--In carrying out subsection (a), the Secretary, acting through the Service, Indian Tribes, and Tribal Organizations, shall provide high-standard paraprofessional training in mental health care necessary to provide quality care to the Indian communities to be served. Such training shall be based upon a curriculum developed or approved by the Secretary which combines education in the theory of mental health care with supervised practical experience in the provision of such care. ``(c) Supervision and Evaluation of Technicians.--The Secretary, acting through the Service, Indian Tribes, and Tribal Organizations, shall supervise and evaluate the mental health technicians in the training program. ``(d) Traditional Health Care Practices.--The Secretary, acting through the Service, shall ensure that the program established pursuant to this subsection involves the use and promotion of the traditional health care practices of the Indian Tribes to be served. ``SEC. 705. LICENSING REQUIREMENT FOR MENTAL HEALTH CARE WORKERS. ``(a) In General.--Subject to the provisions of section 221, and except as provided in subsection (b), any individual employed as a psychologist, social worker, or marriage and family therapist for the purpose of providing mental health care services to Indians in a clinical setting under this Act is required to be licensed as a psychologist, social worker, or marriage and family therapist, respectively. ``(b) Trainees.--An individual may be employed as a trainee in psychology, social work, or marriage and family therapy to provide mental health care services described in subsection (a) if such individual-- ``(1) works under the direct supervision of a licensed psychologist, social worker, or marriage and family therapist, respectively; ``(2) is enrolled in or has completed at least 2 years of course work at a post-secondary, accredited education program for psychology, social work, marriage and family therapy, or counseling; and ``(3) meets such other training, supervision, and quality review requirements as the Secretary may establish. ``SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS. ``(a) Grants.--The Secretary, consistent with section 701, may make grants to Indian Tribes, Tribal Organizations, and Urban Indian Organizations to develop and implement a comprehensive behavioral health program of prevention, intervention, treatment, and relapse prevention services that specifically addresses the cultural, historical, social, and child care needs of Indian women, regardless of age. ``(b) Use of Grant Funds.--A grant made pursuant to this section may be used to-- ``(1) develop and provide community training, education, and prevention programs for Indian women relating to behavioral health issues, including fetal alcohol disorders; ``(2) identify and provide psychological services, counseling, advocacy, support, and relapse prevention to Indian women and their families; and ``(3) develop prevention and intervention models for Indian women which incorporate traditional health care practices, cultural values, and community and family involvement. ``(c) Criteria.--The Secretary, in consultation with Indian Tribes and Tribal Organizations, shall establish criteria for the review and approval of applications and proposals for funding under this section. ``(d) Earmark of Certain Funds.--Twenty percent of the funds appropriated pursuant to this section shall be used to make grants to Urban Indian Organizations. ``SEC. 707. INDIAN YOUTH PROGRAM. ``(a) Detoxification and Rehabilitation.--The Secretary, acting through the Service, consistent with section 701, shall develop and implement a program for acute detoxification and treatment for Indian youths, including behavioral health services. The program shall include regional treatment centers designed to include detoxification and rehabilitation for both sexes on a referral basis and programs developed and implemented by Indian Tribes or Tribal Organizations at the local level under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.). Regional centers shall be integrated with the intake and rehabilitation programs based in the referring Indian community. ``(b) Alcohol and Substance Abuse Treatment Centers or Facilities.-- ``(1) Establishment.-- ``(A) In general.--The Secretary, acting through the Service, Indian Tribes, and Tribal Organizations, shall construct, renovate, or, as necessary, purchase, and appropriately staff and operate, at least 1 youth regional treatment center or treatment network in each area under the jurisdiction of an Area Office. ``(B) Area office in california.--For the purposes of this subsection, the Area Office in California shall be considered to be 2 Area Offices, 1 office whose jurisdiction shall be considered to encompass the northern area of the State of California, and 1 office whose jurisdiction shall be considered to encompass the remainder of the State of California for the purpose of implementing California treatment networks. ``(2) Funding.--For the purpose of staffing and operating such centers or facilities, funding shall be pursuant to the Act of November 2, 1921 (25 U.S.C. 13). ``(3) Location.--A youth treatment center constructed or purchased under this subsection shall be constructed or purchased at a location within the area described in paragraph (1) agreed upon (by appropriate tribal resolution) by a majority of the Indian Tribes to be served by such center. ``(4) Specific provision of funds.-- ``(A) In general.--Notwithstanding any other provision of this title, the Secretary may, from amounts authorized to be appropriated for the purposes of carrying out this section, make funds available to-- ``(i) the Tanana Chiefs Conference, Incorporated, for the purpose of leasing, constructing, renovating, operating, and maintaining a residential youth treatment facility in Fairbanks, Alaska; and ``(ii) the Southeast Alaska Regional Health Corporation to staff and operate a residential youth treatment facility without regard to the proviso set forth in section 4(l) of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b(l)). ``(B) Provision of services to eligible youths.-- Until additional residential youth treatment facilities are established in Alaska pursuant to this section, the facilities specified in subparagraph (A) shall make every effort to provide services to all eligible Indian youths residing in Alaska. ``(c) Intermediate Adolescent Behavioral Health Services.-- ``(1) In general.--The Secretary, acting through the Service, Indian Tribes, and Tribal Organizations, may provide intermediate behavioral health services to Indian children and adolescents, including-- ``(A) pretreatment assistance; ``(B) inpatient, outpatient, and aftercare services; ``(C) emergency care; ``(D) suicide prevention and crisis intervention; and ``(E) prevention and treatment of mental illness and dysfunctional and self-destructive behavior, including child abuse and family violence. ``(2) Use of funds.--Funds provided under this subsection may be used-- ``(A) to construct or renovate an existing health facility to provide intermediate behavioral health services; ``(B) to hire behavioral health professionals; ``(C) to staff, operate, and maintain an intermediate mental health facility, group home, sober housing, transitional housing or similar facilities, or youth shelter where intermediate behavioral health services are being provided; ``(D) to make renovations and hire appropriate staff to convert existing hospital beds into adolescent psychiatric units; and ``(E) for intensive home- and community-based services. ``(3) Criteria.--The Secretary, acting through the Service, shall, in consultation with Indian Tribes and Tribal Organizations, establish criteria for the review and approval of applications or proposals for funding made available pursuant to this subsection. ``(d) Federally-Owned Structures.-- ``(1) In general.--The Secretary, in consultation with Indian Tribes and Tribal Organizations, shall-- ``(A) identify and use, where appropriate, federally- owned structures suitable for local residential or regional behavioral health treatment for Indian youths; and ``(B) establish guidelines for determining the suitability of any such federally-owned structure to be used for local residential or regional behavioral health treatment for Indian youths. ``(2) Terms and conditions for use of structure.--Any structure described in paragraph (1) may be used under such terms and conditions as may be agreed upon by the Secretary and the agency having responsibility for the structure and any Indian Tribe or Tribal Organization operating the program. ``(e) Rehabilitation and Aftercare Services.-- ``(1) In general.--The Secretary, Indian Tribes, or Tribal Organizations, in cooperation with the Secretary of the Interior, shall develop and implement within each Service Unit, community-based rehabilitation and follow-up services for Indian youths who are having significant behavioral health problems, and require long-term treatment, community reintegration, and monitoring to support the Indian youths after their return to their home community. ``(2) Administration.--Services under paragraph (1) shall be provided by trained staff within the community who can assist the Indian youths in their continuing development of self- image, positive problem-solving skills, and nonalcohol or substance abusing behaviors. Such staff may include alcohol and substance abuse counselors, mental health professionals, and other health professionals and paraprofessionals, including community health representatives. ``(f) Inclusion of Family in Youth Treatment Program.--In providing the treatment and other services to Indian youths authorized by this section, the Secretary, acting through the Service, Indian Tribes, and Tribal Organizations, shall provide for the inclusion of family members of such youths in the treatment programs or other services as may be appropriate. Not less than 10 percent of the funds appropriated for the purposes of carrying out subsection (e) shall be used for outpatient care of adult family members related to the treatment of an Indian youth under that subsection. ``(g) Multidrug Abuse Program.--The Secretary, acting through the Service, Indian Tribes, Tribal Organizations, and Urban Indian Organizations, shall provide, consistent with section 701, programs and services to prevent and treat the abuse of multiple forms of substances, including alcohol, drugs, inhalants, and tobacco, among Indian youths residing in Indian communities, on or near reservations, and in urban areas and provide appropriate mental health services to address the incidence of mental illness among such youths. ``(h) Indian Youth Mental Health.--The Secretary, acting through the Service, shall collect data for the report under section 801 with respect to-- ``(1) the number of Indian youth who are being provided mental health services through the Service and Tribal Health Programs; ``(2) a description of, and costs associated with, the mental health services provided for Indian youth through the Service and Tribal Health Programs; ``(3) the number of youth referred to the Service or Tribal Health Programs for mental health services; ``(4) the number of Indian youth provided residential treatment for mental health and behavioral problems through the Service and Tribal Health Programs, reported separately for on- and off-reservation facilities; and ``(5) the costs of the services described in paragraph (4). ``SEC. 708. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRATION PROJECT. ``(a) Purpose.--The purpose of this section is to authorize the Secretary to carry out a demonstration project to test the use of telemental health services in suicide prevention, intervention and treatment of Indian youth, including through-- ``(1) the use of psychotherapy, psychiatric assessments, diagnostic interviews, therapies for mental health conditions predisposing to suicide, and alcohol and substance abuse treatment; ``(2) the provision of clinical expertise to, consultation services with, and medical advice and training for frontline health care providers working with Indian youth; ``(3) training and related support for community leaders, family members and health and education workers who work with Indian youth; ``(4) the development of culturally-relevant educational materials on suicide; and ``(5) data collection and reporting. ``(b) Definitions.--For the purpose of this section, the following definitions shall apply: ``(1) Demonstration project.--The term `demonstration project' means the Indian youth telemental health demonstration project authorized under subsection (c). ``(2) Telemental health.--The term `telemental health' means the use of electronic information and telecommunications technologies to support long distance mental health care, patient and professional-related education, public health, and health administration. ``(c) Authorization.-- ``(1) In general.--The Secretary is authorized to award grants under the demonstration project for the provision of telemental health services to Indian youth who-- ``(A) have expressed suicidal ideas; ``(B) have attempted suicide; or ``(C) have mental health conditions that increase or could increase the risk of suicide. ``(2) Eligibility for grants.--Such grants shall be awarded to Indian Tribes and Tribal Organizations that operate 1 or more facilities-- ``(A) located in Alaska and part of the Alaska Federal Health Care Access Network; ``(B) reporting active clinical telehealth capabilities; or ``(C) offering school-based telemental health services relating to psychiatry to Indian youth. ``(3) Grant period.--The Secretary shall award grants under this section for a period of up to 4 years. ``(4) Awarding of grants.--Not more than 5 grants shall be provided under paragraph (1), with priority consideration given to Indian Tribes and Tribal Organizations that-- ``(A) serve a particular community or geographic area where there is a demonstrated need to address Indian youth suicide; ``(B) enter in to collaborative partnerships with Indian Health Service or Tribal Health Programs or facilities to provide services under this demonstration project; ``(C) serve an isolated community or geographic area which has limited or no access to behavioral health services; or ``(D) operate a detention facility at which Indian youth are detained. ``(d) Use of Funds.-- ``(1) In general.--An Indian Tribe or Tribal Organization shall use a grant received under subsection (c) for the following purposes: ``(A) To provide telemental health services to Indian youth, including the provision of-- ``(i) psychotherapy; ``(ii) psychiatric assessments and diagnostic interviews, therapies for mental health conditions predisposing to suicide, and treatment; and ``(iii) alcohol and substance abuse treatment. ``(B) To provide clinician-interactive medical advice, guidance and training, assistance in diagnosis and interpretation, crisis counseling and intervention, and related assistance to Service, tribal, or urban clinicians and health services providers working with youth being served under this demonstration project. ``(C) To assist, educate and train community leaders, health education professionals and paraprofessionals, tribal outreach workers, and family members who work with the youth receiving telemental health services under this demonstration project, including with identification of suicidal tendencies, crisis intervention and suicide prevention, emergency skill development, and building and expanding networks among these individuals and with State and local health services providers. ``(D) To develop and distribute culturally appropriate community educational materials on-- ``(i) suicide prevention; ``(ii) suicide education; ``(iii) suicide screening; ``(iv) suicide intervention; and ``(v) ways to mobilize communities with respect to the identification of risk factors for suicide. ``(E) For data collection and reporting related to Indian youth suicide prevention efforts. ``(2) Traditional health care practices.--In carrying out the purposes described in paragraph (1), an Indian Tribe or Tribal Organization may use and promote the traditional health care practices of the Indian Tribes of the youth to be served. ``(e) Applications.--To be eligible to receive a grant under subsection (c), an Indian Tribe or Tribal Organization shall prepare and submit to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require, including-- ``(1) a description of the project that the Indian Tribe or Tribal Organization will carry out using the funds provided under the grant; ``(2) a description of the manner in which the project funded under the grant would-- ``(A) meet the telemental health care needs of the Indian youth population to be served by the project; or ``(B) improve the access of the Indian youth population to be served to suicide prevention and treatment services; ``(3) evidence of support for the project from the local community to be served by the project; ``(4) a description of how the families and leadership of the communities or populations to be served by the project would be involved in the development and ongoing operations of the project; ``(5) a plan to involve the tribal community of the youth who are provided services by the project in planning and evaluating the mental health care and suicide prevention efforts provided, in order to ensure the integration of community, clinical, environmental, and cultural components of the treatment; and ``(6) a plan for sustaining the project after Federal assistance for the demonstration project has terminated. ``(f) Collaboration; Reporting to National Clearinghouse.-- ``(1) Collaboration.--The Secretary, acting through the Service, shall encourage Indian Tribes and Tribal Organizations receiving grants under this section to collaborate to enable comparisons about best practices across projects. ``(2) Reporting to national clearinghouse.--The Secretary, acting through the Service, shall also encourage Indian Tribes and Tribal Organizations receiving grants under this section to submit relevant, declassified project information to the national clearinghouse authorized under section 701(b)(2) in order to better facilitate program performance and improve suicide prevention, intervention, and treatment services. ``(g) Annual Report.--Each grant recipient shall submit to the Secretary an annual report that-- ``(1) describes the number of telemental health services provided; and ``(2) includes any other information that the Secretary may require. ``(h) Report to Congress.--Not later than 270 days after the termination of the demonstration project, the Secretary shall submit to the Committee on Indian Affairs of the Senate and the Committee on Natural Resources and Committee on Energy and Commerce of the House of Representatives a final report, based on the annual reports provided by grant recipients under subsection (h), that-- ``(1) describes the results of the projects funded by grants awarded under this section, including any data available which indicates the number of attempted suicides; ``(2) evaluates the impact of the telemental health services funded by the grants in reducing the number of completed suicides among Indian youth; ``(3) evaluates whether the demonstration project should be-- ``(A) expanded to provide more than 5 grants; and ``(B) designated a permanent program; and ``(4) evaluates the benefits of expanding the demonstration project to include Urban Indian Organizations. ``(i) Authorization of Appropriations.--There is authorized to be appropriated to carry out this section $1,500,000 for each of fiscal years 2008 through 2011. ``SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL HEALTH FACILITIES DESIGN, CONSTRUCTION, AND STAFFING. ``Not later than 1 year after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary, acting through the Service, Indian Tribes, and Tribal Organizations, may provide, in each area of the Service, not less than 1 inpatient mental health care facility, or the equivalent, for Indians with behavioral health problems. For the purposes of this subsection, California shall be considered to be 2 Area Offices, 1 office whose location shall be considered to encompass the northern area of the State of California and 1 office whose jurisdiction shall be considered to encompass the remainder of the State of California. The Secretary shall consider the possible conversion of existing, underused Service hospital beds into psychiatric units to meet such need. ``SEC. 710. TRAINING AND COMMUNITY EDUCATION. ``(a) Program.--The Secretary, in cooperation with the Secretary of the Interior, shall develop and implement or assist Indian Tribes and Tribal Organizations to develop and implement, within each Service Unit or tribal program, a program of community education and involvement which shall be designed to provide concise and timely information to the community leadership of each tribal community. Such program shall include education about behavioral health issues to political leaders, Tribal judges, law enforcement personnel, members of tribal health and education boards, health care providers including traditional practitioners, and other critical members of each tribal community. Such program may also include community-based training to develop local capacity and tribal community provider training for prevention, intervention, treatment, and aftercare. ``(b) Instruction.--The Secretary, acting through the Service, shall, either directly or through Indian Tribes and Tribal Organizations, provide instruction in the area of behavioral health issues, including instruction in crisis intervention and family relations in the context of alcohol and substance abuse, child sexual abuse, youth alcohol and substance abuse, and the causes and effects of fetal alcohol disorders to appropriate employees of the Bureau of Indian Affairs and the Service, and to personnel in schools or programs operated under any contract with the Bureau of Indian Affairs or the Service, including supervisors of emergency shelters and halfway houses described in section 4213 of the Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 2433). ``(c) Training Models.--In carrying out the education and training programs required by this section, the Secretary, in consultation with Indian Tribes, Tribal Organizations, Indian behavioral health experts, and Indian alcohol and substance abuse prevention experts, shall develop and provide community-based training models. Such models shall address-- ``(1) the elevated risk of alcohol and behavioral health problems faced by children of alcoholics; ``(2) the cultural, spiritual, and multigenerational aspects of behavioral health problem prevention and recovery; and ``(3) community-based and multidisciplinary strategies for preventing and treating behavioral health problems. ``SEC. 711. BEHAVIORAL HEALTH PROGRAM. ``(a) Innovative Programs.--The Secretary, acting through the Service, Indian Tribes, and Tribal Organizations, consistent with section 701, may plan, develop, implement, and carry out programs to deliver innovative community-based behavioral health services to Indians. ``(b) Awards; Criteria.--The Secretary may award a grant for a project under subsection (a) to an Indian Tribe or Tribal Organization and may consider the following criteria: ``(1) The project will address significant unmet behavioral health needs among Indians. ``(2) The project will serve a significant number of Indians. ``(3) The project has the potential to deliver services in an efficient and effective manner. ``(4) The Indian Tribe or Tribal Organization has the administrative and financial capability to administer the project. ``(5) The project may deliver services in a manner consistent with traditional health care practices. ``(6) The project is coordinated with, and avoids duplication of, existing services. ``(c) Equitable Treatment.--For purposes of this subsection, the Secretary shall, in evaluating project applications or proposals, use the same criteria that the Secretary uses in evaluating any other application or proposal for such funding. ``SEC. 712. FETAL ALCOHOL DISORDER PROGRAMS. ``(a) Programs.-- ``(1) Establishment.--The Secretary, consistent with section 701, acting through the Service, Indian Tribes, and Tribal Organizations, is authorized to establish and operate fetal alcohol disorder programs as provided in this section for the purposes of meeting the health status objectives specified in section 3. ``(2) Use of funds.-- ``(A) In general.--Funding provided pursuant to this section shall be used for the following: ``(i) To develop and provide for Indians community and in-school training, education, and prevention programs relating to fetal alcohol disorders. ``(ii) To identify and provide behavioral health treatment to high-risk Indian women and high-risk women pregnant with an Indian's child. ``(iii) To identify and provide appropriate psychological services, educational and vocational support, counseling, advocacy, and information to fetal alcohol disorder affected Indians and their families or caretakers. ``(iv) To develop and implement counseling and support programs in schools for fetal alcohol disorder affected Indian children. ``(v) To develop prevention and intervention models which incorporate practitioners of traditional health care practices, cultural values, and community involvement. ``(vi) To develop, print, and disseminate education and prevention materials on fetal alcohol disorder. ``(vii) To develop and implement, in consultation with Indian Tribes, Tribal Organizations, and Urban Indian Organizations, culturally sensitive assessment and diagnostic tools including dysmorphology clinics and multidisciplinary fetal alcohol disorder clinics for use in Indian communities and Urban Centers. ``(B) Additional uses.--In addition to any purpose under subparagraph (A), funding provided pursuant to this section may be used for 1 or more of the following: ``(i) Early childhood intervention projects from birth on to mitigate the effects of fetal alcohol disorder among Indians. ``(ii) Community-based support services for Indians and women pregnant with Indian children. ``(iii) Community-based housing for adult Indians with fetal alcohol disorder. ``(3) Criteria for applications.--The Secretary shall establish criteria for the review and approval of applications for funding under this section. ``(b) Services.--The Secretary, acting through the Service and Indian Tribes, Tribal Organizations, and Urban Indian Organizations, shall-- ``(1) develop and provide services for the prevention, intervention, treatment, and aftercare for those affected by fetal alcohol disorder in Indian communities; and ``(2) provide supportive services, including services to meet the special educational, vocational, school-to-work transition, and independent living needs of adolescent and adult Indians with fetal alcohol disorder. ``(c) Task Force.--The Secretary shall establish a task force to be known as the Fetal Alcohol Disorder Task Force to advise the Secretary in carrying out subsection (b). Such task force shall be composed of representatives from the following: ``(1) The National Institute on Drug Abuse. ``(2) The National Institute on Alcohol and Alcoholism. ``(3) The Office of Substance Abuse Prevention. ``(4) The National Institute of Mental Health. ``(5) The Service. ``(6) The Office of Minority Health of the Department of Health and Human Services. ``(7) The Administration for Native Americans. ``(8) The National Institute of Child Health and Human Development (NICHD). ``(9) The Centers for Disease Control and Prevention. ``(10) The Bureau of Indian Affairs. ``(11) Indian Tribes. ``(12) Tribal Organizations. ``(13) Urban Indian Organizations. ``(14) Indian fetal alcohol disorder experts. ``(d) Applied Research Projects.--The Secretary, acting through the Substance Abuse and Mental Health Services Administration, shall make grants to Indian Tribes, Tribal Organizations, and Urban Indian Organizations for applied research projects which propose to elevate the understanding of methods to prevent, intervene, treat, or provide rehabilitation and behavioral health aftercare for Indians and Urban Indians affected by fetal alcohol disorder. ``(e) Funding for Urban Indian Organizations.--Ten percent of the funds appropriated pursuant to this section shall be used to make grants to Urban Indian Organizations funded under title V. ``SEC. 713. CHILD SEXUAL ABUSE AND PREVENTION TREATMENT PROGRAMS. ``(a) Establishment.--The Secretary, acting through the Service, and the Secretary of the Interior, Indian Tribes, and Tribal Organizations, shall establish, consistent with section 701, in every Service Area, programs involving treatment for-- ``(1) victims of sexual abuse who are Indian children or children in an Indian household; and ``(2) perpetrators of child sexual abuse who are Indian or members of an Indian household. ``(b) Use of Funds.--Funding provided pursuant to this section shall be used for the following: ``(1) To develop and provide community education and prevention programs related to sexual abuse of Indian children or children in an Indian household. ``(2) To identify and provide behavioral health treatment to victims of sexual abuse who are Indian children or children in an Indian household, and to their family members who are affected by sexual abuse. ``(3) To develop prevention and intervention models which incorporate traditional health care practices, cultural values, and community involvement. ``(4) To develop and implement culturally sensitive assessment and diagnostic tools for use in Indian communities and Urban Centers. ``(5) To identify and provide behavioral health treatment to Indian perpetrators and perpetrators who are members of an Indian household-- ``(A) making efforts to begin offender and behavioral health treatment while the perpetrator is incarcerated or at the earliest possible date if the perpetrator is not incarcerated; and ``(B) providing treatment after the perpetrator is released, until it is determined that the perpetrator is not a threat to children. ``(c) Coordination.--The programs established under subsection (a) shall be carried out in coordination with programs and services authorized under the Indian Child Protection and Family Violence Prevention Act (25 U.S.C. 3201 et seq.). ``SEC. 714. BEHAVIORAL HEALTH RESEARCH. ``The Secretary, in consultation with appropriate Federal agencies, shall make grants to, or enter into contracts with, 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 multifactorial causes of Indian youth suicide, including-- ``(A) protective and risk factors and scientific data that identifies those factors; and ``(B) the effects of loss of cultural identity and the development of scientific data on those effects; ``(2) the interrelationship and interdependence of behavioral health problems with alcoholism and other substance abuse, suicide, homicides, other injuries, and the incidence of family violence; and ``(3) the development of models of prevention techniques. The effect of the interrelationships and interdependencies referred to in paragraph (2) on children, and the development of prevention techniques under paragraph (3) applicable to children, shall be emphasized. ``SEC. 715. DEFINITIONS. ``For the purpose of this title, the following definitions shall apply: ``(1) Assessment.--The term `assessment' means the systematic collection, analysis, and dissemination of information on health status, health needs, and health problems. ``(2) Alcohol-related neurodevelopmental disorders or arnd.-- The term `alcohol-related neurodevelopmental disorders' or `ARND' means, with a history of maternal alcohol consumption during pregnancy, central nervous system involvement such as developmental delay, intellectual deficit, or neurologic abnormalities. Behaviorally, there can be problems with irritability, and failure to thrive as infants. As children become older there will likely be hyperactivity, attention deficit, language dysfunction, and perceptual and judgment problems. ``(3) Behavioral health aftercare.--The term `behavioral health aftercare' includes those activities and resources used to support recovery following inpatient, residential, intensive substance abuse, or mental health outpatient or outpatient treatment. The purpose is to help prevent or deal with relapse by ensuring that by the time a client or patient is discharged from a level of care, such as outpatient treatment, an aftercare plan has been developed with the client. An aftercare plan may use such resources as a community-based therapeutic group, transitional living facilities, a 12-step sponsor, a local 12-step or other related support group, and other community-based providers. ``(4) Dual diagnosis.--The term `dual diagnosis' means coexisting substance abuse and mental illness conditions or diagnosis. Such clients are sometimes referred to as mentally ill chemical abusers (MICAs). ``(5) Fetal alcohol disorders.--The term `fetal alcohol disorders' means fetal alcohol syndrome, partial fetal alcohol syndrome and alcohol related neurodevelopmental disorder (ARND). ``(6) Fetal alcohol syndrome or fas.--The term `fetal alcohol syndrome' or `FAS' means a syndrome in which, with a history of maternal alcohol consumption during pregnancy, the following criteria are met: ``(A) Central nervous system involvement such as developmental delay, intellectual deficit, microencephaly, or neurologic abnormalities. ``(B) Craniofacial abnormalities with at least 2 of the following: microophthalmia, short palpebral fissures, poorly developed philtrum, thin upper lip, flat nasal bridge, and short upturned nose. ``(C) Prenatal or postnatal growth delay. ``(7) Partial fas.--The term `partial FAS' means, with a history of maternal alcohol consumption during pregnancy, having most of the criteria of FAS, though not meeting a minimum of at least 2 of the following: microophthalmia, short palpebral fissures, poorly developed philtrum, thin upper lip, flat nasal bridge, and short upturned nose. ``(8) Rehabilitation.--The term `rehabilitation' means to restore the ability or capacity to engage in usual and customary life activities through education and therapy. ``(9) Substance abuse.--The term `substance abuse' includes inhalant abuse. ``SEC. 716. AUTHORIZATION OF APPROPRIATIONS. ``There is authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2017 to carry out the provisions of this title. ``TITLE VIII--MISCELLANEOUS ``SEC. 801. REPORTS. ``For each fiscal year following the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary shall transmit to Congress a report containing the following: ``(1) A report on the progress made in meeting the objectives of this Act, including a review of programs established or assisted pursuant to this Act and assessments and recommendations of additional programs or additional assistance necessary to, at a minimum, provide health services to Indians and ensure a health status for Indians, which are at a parity with the health services available to and the health status of the general population. ``(2) A report on whether, and to what extent, new national health care programs, benefits, initiatives, or financing systems have had an impact on the purposes of this Act and any steps that the Secretary may have taken to consult with Indian Tribes, Tribal Organizations, and Urban Indian Organizations to address such impact, including a report on proposed changes in allocation of funding pursuant to section 808. ``(3) A report on the use of health services by Indians-- ``(A) on a national and area or other relevant geographical basis; ``(B) by gender and age; ``(C) by source of payment and type of service; ``(D) comparing such rates of use with rates of use among comparable non-Indian populations; and ``(E) provided under contracts. ``(4) A report of contractors to the Secretary on Health Care Educational Loan Repayments every 6 months required by section 110. ``(5) A general audit report of the Secretary on the Health Care Educational Loan Repayment Program as required by section 110(n). ``(6) A report of the findings and conclusions of demonstration programs on development of educational curricula for substance abuse counseling as required in section 125(f). ``(7) A separate statement which specifies the amount of funds requested to carry out the provisions of section 201. ``(8) A report of the evaluations of health promotion and disease prevention as required in section 203(c). ``(9) A biennial report to Congress on infectious diseases as required by section 212. ``(10) A report on environmental and nuclear health hazards as required by section 215. ``(11) An annual report on the status of all health care facilities needs as required by section 301(c)(2)(B) and 301(d). ``(12) Reports on safe water and sanitary waste disposal facilities as required by section 302(h). ``(13) An annual report on the expenditure of non-Service funds for renovation as required by sections 304(b)(2). ``(14) A report identifying the backlog of maintenance and repair required at Service and tribal facilities required by section 313(a). ``(15) A report providing an accounting of reimbursement funds made available to the Secretary under titles XVIII, XIX, and XXI of the Social Security Act. ``(16) A report on any arrangements for the sharing of medical facilities or services, as authorized by section 406. ``(17) A report on evaluation and renewal of Urban Indian programs under section 505. ``(18) A report on the evaluation of programs as required by section 513(d). ``(19) A report on alcohol and substance abuse as required by section 701(f). ``(20) A report on Indian youth mental health services as required by section 707(h). ``(21) A report on the reallocation of base resources if required by section 808. ``(22) Report regarding patient movement.--A report on the movement of patients between Service Units, including-- ``(A) a list of those Service Units that have a net increase and those that have a net decrease of patients due to patients assigned to one Service Unit voluntarily choosing to receive service at another Service Unit; ``(B) an analysis of the effect of patient movement on the quality of services for those Service Units experiencing an increase in the number of patients served; and ``(C) what funding changes are necessary to maintain a consistent quality of service at Service Units that have an increase in the number of patients served. ``SEC. 802. REGULATIONS. ``(a) Deadlines.-- ``(1) Procedures.--Not later than 90 days after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary shall initiate procedures under subchapter III of chapter 5 of title 5, United States Code, to negotiate and promulgate such regulations or amendments thereto that are necessary to carry out titles II (except section 202) and VII, the sections of title III for which negotiated rulemaking is specifically required, and section 807. Unless otherwise required, the Secretary may promulgate regulations to carry out titles I, III, IV, and V, and section 202, using the procedures required by chapter V of title 5, United States Code (commonly known as the `Administrative Procedure Act'). ``(2) Proposed regulations.--Proposed regulations to implement this Act shall be published in the Federal Register by the Secretary no later than 2 years after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007 and shall have no less than a 120-day comment period. ``(3) Final regulations.--The Secretary shall publish in the Federal Register final regulations to implement this Act by not later than 3 years after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007. ``(b) Committee.--A negotiated rulemaking committee established pursuant to section 565 of title 5, United States Code, to carry out this section shall have as its members only representatives of the Federal Government and representatives of Indian Tribes, and Tribal Organizations, a majority of whom shall be nominated by and be representatives of Indian Tribes and Tribal Organizations from each Service Area. ``(c) Adaptation of Procedures.--The Secretary shall adapt the negotiated rulemaking procedures to the unique context of self- governance and the government-to-government relationship between the United States and Indian Tribes. ``(d) Lack of Regulations.--The lack of promulgated regulations shall not limit the effect of this Act. ``(e) Inconsistent Regulations.--The provisions of this Act shall supersede any conflicting provisions of law in effect on the day before the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, and the Secretary is authorized to repeal any regulation inconsistent with the provisions of this Act. ``SEC. 803. PLAN OF IMPLEMENTATION. ``Not later than 9 months after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary, in consultation with Indian Tribes, Tribal Organizations, and Urban Indian Organizations, shall submit to Congress a plan explaining the manner and schedule, by title and section, by which the Secretary will implement the provisions of this Act. This consultation may be conducted jointly with the annual budget consultation pursuant to the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq). ``SEC. 804. AVAILABILITY OF FUNDS. ``The funds appropriated pursuant to this Act shall remain available until expended. ``SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED TO INDIAN HEALTH SERVICE. ``Any limitation on the use of funds contained in an Act providing appropriations for the Department for a period with respect to the performance of abortions shall apply for that period with respect to the performance of abortions using funds contained in an Act providing appropriations for the Service. ``SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS. ``(a) In General.--The following California Indians shall be eligible for health services provided by the Service: ``(1) Any member of a federally recognized Indian Tribe. ``(2) Any descendant of an Indian who was residing in California on June 1, 1852, if such descendant-- ``(A) is a member of the Indian community served by a local program of the Service; and ``(B) is regarded as an Indian by the community in which such descendant lives. ``(3) Any Indian who holds trust interests in public domain, national forest, or reservation allotments in California. ``(4) Any Indian in California who is listed on the plans for distribution of the assets of rancherias and reservations located within the State of California under the Act of August 18, 1958 (72 Stat. 619), and any descendant of such an Indian. ``(b) Clarification.--Nothing in this section may be construed as expanding the eligibility of California Indians for health services provided by the Service beyond the scope of eligibility for such health services that applied on May 1, 1986. ``SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS. ``(a) Children.--Any individual who-- ``(1) has not attained 19 years of age; ``(2) is the natural or adopted child, stepchild, foster child, legal ward, or orphan of an eligible Indian; and ``(3) is not otherwise eligible for health services provided by the Service, shall be eligible for all health services provided by the Service on the same basis and subject to the same rules that apply to eligible Indians until such individual attains 19 years of age. The existing and potential health needs of all such individuals shall be taken into consideration by the Service in determining the need for, or the allocation of, the health resources of the Service. If such an individual has been determined to be legally incompetent prior to attaining 19 years of age, such individual shall remain eligible for such services until 1 year after the date of a determination of competency. ``(b) Spouses.--Any spouse of an eligible Indian who is not an Indian, or who is of Indian descent but is not otherwise eligible for the health services provided by the Service, shall be eligible for such health services if all such spouses or spouses who are married to members of each 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. ``(c) Provision of Services to Other Individuals.-- ``(1) In general.--The Secretary is authorized to provide health services under this subsection through health programs operated directly by the Service to individuals who reside within the Service Unit and who are not otherwise eligible for such health services if-- ``(A) the Indian Tribes served by such Service Unit request such provision of health services to such individuals; and ``(B) the Secretary and the served Indian Tribes have jointly determined that-- ``(i) the provision of such health services will not result in a denial or diminution of health services to eligible Indians; and ``(ii) there is no reasonable alternative health facilities or services, within or without the Service Unit, available to meet the health needs of such individuals. ``(2) ISDEAA programs.--In the case of health programs and facilities operated under a contract or compact entered into under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), the governing body of the Indian Tribe or Tribal Organization providing health services under such contract or compact is authorized to determine whether health services should be provided under such contract 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 paragraph (1)(B). ``(3) Payment for services.-- ``(A) In general.--Persons receiving health services provided by the Service under this subsection shall be liable for payment of such health services under a schedule of charges prescribed by the Secretary which, in the judgment of the Secretary, results in reimbursement in an amount not less than the actual cost of providing the health services. Notwithstanding section 404 of this Act or any other provision of law, amounts collected under this subsection, including Medicare, Medicaid, or SCHIP reimbursements under titles XVIII, XIX, and XXI of the Social Security Act, shall be credited to the account of the program providing the service and shall be used for the purposes listed in section 401(d)(2) and amounts collected under this subsection shall be available for expenditure within such program. ``(B) Indigent people.--Health services may be provided by the Secretary through the Service under this subsection to an indigent individual who would not be otherwise eligible for such health services but for the provisions of paragraph (1) only if an agreement has been entered into with a State or local government under which the State or local government agrees to reimburse the Service for the expenses incurred by the Service in providing such health services to such indigent individual. ``(4) Revocation of consent for services.-- ``(A) Single tribe service area.--In the case of a Service Area which serves only 1 Indian Tribe, the authority of the Secretary to provide health services under paragraph (1) shall terminate at the end of the fiscal year succeeding the fiscal year in which the governing body of the Indian Tribe revokes its concurrence to the provision of such health services. ``(B) Multitribal service area.--In the case of a multitribal Service Area, the authority of the Secretary to provide health services under paragraph (1) shall terminate at the end of the fiscal year succeeding the fiscal year in which at least 51 percent of the number of Indian Tribes in the Service Area revoke their concurrence to the provisions of such health services. ``(d) Other Services.--The Service may provide health services under this subsection to individuals who are not eligible for health services provided by the Service under any other provision of law in order to-- ``(1) achieve stability in a medical emergency; ``(2) prevent the spread of a communicable disease or otherwise deal with a public health hazard; ``(3) provide care to non-Indian women pregnant with an eligible Indian's child for the duration of the pregnancy through postpartum; or ``(4) provide care to immediate family members of an eligible individual if such care is directly related to the treatment of the eligible individual. ``(e) Hospital Privileges for Practitioners.--Hospital privileges in health facilities operated and maintained by the Service or operated under a contract or compact pursuant to the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) may be extended to non-Service health care practitioners who provide services to individuals described in subsection (a), (b), (c), or (d). Such non- Service health care practitioners may, as part of the privileging process, be designated as employees of the Federal Government for purposes of section 1346(b) and chapter 171 of title 28, United States Code (relating to Federal tort claims) only with respect to acts or omissions which occur in the course of providing services to eligible individuals as a part of the conditions under which such hospital privileges are extended. ``(f) Eligible Indian.--For purposes of this section, the term `eligible Indian' means any Indian who is eligible for health services provided by the Service without regard to the provisions of this section. ``SEC. 808. REALLOCATION OF BASE RESOURCES. ``(a) Report Required.--Notwithstanding any other provision of law, any allocation of Service funds for a fiscal year that reduces by 5 percent or more from the previous fiscal year the funding for any recurring program, project, or activity of a Service Unit may be implemented only after the Secretary has submitted to Congress, under section 801, a report on the proposed change in allocation of funding, including the reasons for the change and its likely effects. ``(b) Exception.--Subsection (a) shall not apply if the total amount appropriated to the Service for a fiscal year is at least 5 percent less than the amount appropriated to the Service for the previous fiscal year. ``SEC. 809. RESULTS OF DEMONSTRATION PROJECTS. ``The Secretary shall provide for the dissemination to Indian Tribes, Tribal Organizations, and Urban Indian Organizations of the findings and results of demonstration projects conducted under this Act. ``SEC. 810. PROVISION OF SERVICES IN MONTANA. ``(a) Consistent With Court Decision.--The Secretary, acting through the Service, shall provide services and benefits for Indians in Montana in a manner consistent with the decision of the United States Court of Appeals for the Ninth Circuit in McNabb for McNabb v. Bowen, 829 F.2d 787 (9th Cir. 1987). ``(b) Clarification.--The provisions of subsection (a) shall not be construed to be an expression of the sense of Congress on the application of the decision described in subsection (a) with respect to the provision of services or benefits for Indians living in any State other than Montana. ``SEC. 811. MORATORIUM. ``During the period of the moratorium imposed on implementation of the final rule published in the Federal Register on September 16, 1987, by the Department of Health and Human Services, relating to eligibility for the health care services of the Indian Health Service, the Indian Health Service shall provide services pursuant to the criteria for eligibility for such services that were in effect on September 15, 1987, subject to the provisions of sections 806 and 807, until the Service has submitted to the Committees on Appropriations of the Senate and the House of Representatives a budget request reflecting the increased costs associated with the proposed final rule, and the request has been included in an appropriations Act and enacted into law. ``SEC. 812. SEVERABILITY PROVISIONS. ``If any provision of this Act, any amendment made by the Act, or the application of such provision or amendment to any person or circumstances is held to be invalid, the remainder of this Act, the remaining amendments made by this Act, and the application of such provisions to persons or circumstances other than those to which it is held invalid, shall not be affected thereby. ``SEC. 813. ESTABLISHMENT OF NATIONAL BIPARTISAN COMMISSION ON INDIAN HEALTH CARE. ``(a) Establishment.--There is established the National Bipartisan Indian Health Care Commission (the `Commission'). ``(b) Duties of Commission.--The duties of the Commission are the following: ``(1) To establish a study committee composed of those members of the Commission appointed by the Director of the Service and at least 4 members of Congress from among the members of the Commission, the duties of which shall be the following: ``(A) To the extent necessary to carry out its duties, collect and compile data necessary to understand the extent of Indian needs with regard to the provision of health services, regardless of the location of Indians, including holding hearings and soliciting the views of Indians, Indian Tribes, Tribal Organizations, and Urban Indian Organizations, which may include authorizing and making funds available for feasibility studies of various models for providing and funding health services for all Indian beneficiaries, including those who live outside of a reservation, temporarily or permanently. ``(B) To make legislative recommendations to the Commission regarding the delivery of Federal health care services to Indians. Such recommendations shall include those related to issues of eligibility, benefits, the range of service providers, the cost of such services, financing such services, and the optimal manner in which to provide such services. ``(C) To determine the effect of the enactment of such recommendations on (i) the existing system of delivery of health services for Indians, and (ii) the sovereign status of Indian Tribes. ``(D) Not later than 12 months after the appointment of all members of the Commission, to submit a written report of its findings and recommendations to the full Commission. The report shall include a statement of the minority and majority position of the Committee and shall be disseminated, at a minimum, to every Indian Tribe, Tribal Organization, and Urban Indian Organization for comment to the Commission. ``(E) To report regularly to the full Commission regarding the findings and recommendations developed by the study committee in the course of carrying out its duties under this section. ``(2) To review and analyze the recommendations of the report of the study committee. ``(3) To make legislative recommendations to Congress regarding the delivery of Federal health care services to Indians. Such recommendations shall include those related to issues of eligibility, benefits, the range of service providers, the cost of such services, financing such services, and the optimal manner in which to provide such services. ``(4) Not later than 18 months following the date of appointment of all members of the Commission, submit a written report to Congress regarding the delivery of Federal health care services to Indians. Such recommendations shall include those related to issues of eligibility, benefits, the range of service providers, the cost of such services, financing such services, and the optimal manner in which to provide such services. ``(c) Members.-- ``(1) Appointment.--The Commission shall be composed of 25 members, appointed as follows: ``(A) Ten members of Congress, including 3 from the House of Representatives and 2 from the Senate, appointed by their respective majority leaders, and 3 from the House of Representatives and 2 from the Senate, appointed by their respective minority leaders, and who shall be members of the standing committees of Congress that consider legislation affecting health care to Indians. ``(B) Twelve persons chosen by the congressional members of the Commission, 1 from each Service Area as currently designated by the Director of the Service to be chosen from among 3 nominees from each Service Area put forward by the Indian Tribes within the area, with due regard being given to the experience and expertise of the nominees in the provision of health care to Indians and to a reasonable representation on the commission of members who are familiar with various health care delivery modes and who represent Indian Tribes of various size populations. ``(C) Three persons appointed by the Director who are knowledgeable about the provision of health care to Indians, at least 1 of whom shall be appointed from among 3 nominees put forward by those programs whose funds are provided in whole or in part by the Service primarily or exclusively for the benefit of Urban Indians. ``(D) All those persons chosen by the congressional members of the Commission and by the Director shall be members of federally recognized Indian Tribes. ``(2) Chair; vice chair.--The Chair and Vice Chair of the Commission shall be selected by the congressional members of the Commission. ``(3) Terms.--The terms of members of the Commission shall be for the life of the Commission. ``(4) Deadline for appointments.--Congressional members of the Commission shall be appointed not later than 180 days after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, and the remaining members of the Commission shall be appointed not later than 60 days following the appointment of the congressional members. ``(5) Vacancy.--A vacancy in the Commission shall be filled in the manner in which the original appointment was made. ``(d) Compensation.-- ``(1) Congressional members.--Each congressional member of the Commission shall receive no additional pay, allowances, or benefits by reason of their service on the Commission and shall receive travel expenses and per diem in lieu of subsistence in accordance with sections 5702 and 5703 of title 5, United States Code. ``(2) Other members.--Remaining members of the Commission, while serving on the business of the Commission (including travel time), shall be entitled to receive compensation at the per diem equivalent of the rate provided for level IV of the Executive Schedule under section 5315 of title 5, United States Code, and while so serving away from home and the member's regular place of business, a member may be allowed travel expenses, as authorized by the Chairman of the Commission. For purpose of pay (other than pay of members of the Commission) and employment benefits, rights, and privileges, all personnel of the Commission shall be treated as if they were employees of the United States Senate. ``(e) Meetings.--The Commission shall meet at the call of the Chair. ``(f) Quorum.--A quorum of the Commission shall consist of not less than 15 members, provided that no less than 6 of the members of Congress who are Commission members are present and no less than 9 of the members who are Indians are present. ``(g) Executive Director; Staff; Facilities.-- ``(1) Appointment; pay.--The Commission shall appoint an executive director of the Commission. The executive director shall be paid the rate of basic pay for level V of the Executive Schedule. ``(2) Staff appointment.--With the approval of the Commission, the executive director may appoint such personnel as the executive director deems appropriate. ``(3) Staff pay.--The staff of the Commission shall be appointed without regard to the provisions of title 5, United States Code, governing appointments in the competitive service, and shall be paid without regard to the provisions of chapter 51 and subchapter III of chapter 53 of such title (relating to classification and General Schedule pay rates). ``(4) Temporary services.--With the approval of the Commission, the executive director may procure temporary and intermittent services under section 3109(b) of title 5, United States Code. ``(5) Facilities.--The Administrator of General Services shall locate suitable office space for the operation of the Commission. The facilities shall serve as the headquarters of the Commission and shall include all necessary equipment and incidentals required for the proper functioning of the Commission. ``(h) Hearings.--(1) For the purpose of carrying out its duties, the Commission may hold such hearings and undertake such other activities as the Commission determines to be necessary to carry out its duties, provided that at least 6 regional hearings are held in different areas of the United States in which large numbers of Indians are present. Such hearings are to be held to solicit the views of Indians regarding the delivery of health care services to them. To constitute a hearing under this subsection, at least 5 members of the Commission, including at least 1 member of Congress, must be present. Hearings held by the study committee established in this section may count toward the number of regional hearings required by this subsection. ``(2) Upon request of the Commission, the Comptroller General shall conduct such studies or investigations as the Commission determines to be necessary to carry out its duties. ``(3)(A) The Director of the Congressional Budget Office or the Chief Actuary of the Centers for Medicare & Medicaid Services, or both, shall provide to the Commission, upon the request of the Commission, such cost estimates as the Commission determines to be necessary to carry out its duties. ``(B) The Commission shall reimburse the Director of the Congressional Budget Office for expenses relating to the employment in the office of that Director of such additional staff as may be necessary for the Director to comply with requests by the Commission under subparagraph (A). ``(4) Upon the request of the Commission, the head of any Federal agency is authorized to detail, without reimbursement, any of the personnel of such agency to the Commission to assist the Commission in carrying out its duties. Any such detail shall not interrupt or otherwise affect the civil service status or privileges of the Federal employee. ``(5) Upon the request of the Commission, the head of a Federal agency shall provide such technical assistance to the Commission as the Commission determines to be necessary to carry out its duties. ``(6) The Commission may use the United States mails in the same manner and under the same conditions as Federal agencies and shall, for purposes of the frank, be considered a commission of Congress as described in section 3215 of title 39, United States Code. ``(7) The Commission may secure directly from any Federal agency information necessary to enable it to carry out its duties, if the information may be disclosed under section 552 of title 4, United States Code. Upon request of the Chairman of the Commission, the head of such agency shall furnish such information to the Commission. ``(8) Upon the request of the Commission, the Administrator of General Services shall provide to the Commission on a reimbursable basis such administrative support services as the Commission may request. ``(9) For purposes of costs relating to printing and binding, including the cost of personnel detailed from the Government Printing Office, the Commission shall be deemed to be a committee of Congress. ``(i) Authorization of Appropriations.--There is authorized to be appropriated $4,000,000 to carry out the provisions of this section, which sum shall not be deducted from or affect any other appropriation for health care for Indian persons. ``(j) Nonapplicability of FACA.--The Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to the Commission. ``SEC. 814. CONFIDENTIALITY OF MEDICAL QUALITY ASSURANCE RECORDS; QUALIFIED IMMUNITY FOR PARTICIPANTS. ``(a) Confidentiality of Records.--Medical quality assurance records created by or for any Indian Health Program or a health program of an Urban Indian Organization as part of a medical quality assurance program are confidential and privileged. Such records may not be disclosed to any person or entity, except as provided in subsection (c). ``(b) Prohibition on Disclosure and Testimony.-- ``(1) In general.--No part of any medical quality assurance record described in subsection (a) may be subject to discovery or admitted into evidence in any judicial or administrative proceeding, except as provided in subsection (c). ``(2) Testimony.--A person who reviews or creates medical quality assurance records for any Indian Health Program or Urban Indian Organization who participates in any proceeding that reviews or creates such records may not be permitted or required to testify in any judicial or administrative proceeding with respect to such records or with respect to any finding, recommendation, evaluation, opinion, or action taken by such person or body in connection with such records except as provided in this section. ``(c) Authorized Disclosure and Testimony.-- ``(1) In general.--Subject to paragraph (2), a medical quality assurance record described in subsection (a) may be disclosed, and a person referred to in subsection (b) may give testimony in connection with such a record, only as follows: ``(A) To a Federal executive agency or private organization, if such medical quality assurance record or testimony is needed by such agency or organization to perform licensing or accreditation functions related to any Indian Health Program or to a health program of an Urban Indian Organization to perform monitoring, required by law, of such program or organization. ``(B) To an administrative or judicial proceeding commenced by a present or former Indian Health Program or Urban Indian Organization provider concerning the termination, suspension, or limitation of clinical privileges of such health care provider. ``(C) To a governmental board or agency or to a professional health care society or organization, if such medical quality assurance record or testimony is needed by such board, agency, society, or organization to perform licensing, credentialing, or the monitoring of professional standards with respect to any health care provider who is or was an employee of any Indian Health Program or Urban Indian Organization. ``(D) To a hospital, medical center, or other institution that provides health care services, if such medical quality assurance record or testimony is needed by such institution to assess the professional qualifications of any health care provider who is or was an employee of any Indian Health Program or Urban Indian Organization and who has applied for or been granted authority or employment to provide health care services in or on behalf of such program or organization. ``(E) To an officer, employee, or contractor of the Indian Health Program or Urban Indian Organization that created the records or for which the records were created. If that officer, employee, or contractor has a need for such record or testimony to perform official duties. ``(F) To a criminal or civil law enforcement agency or instrumentality charged under applicable law with the protection of the public health or safety, if a qualified representative of such agency or instrumentality makes a written request that such record or testimony be provided for a purpose authorized by law. ``(G) In an administrative or judicial proceeding commenced by a criminal or civil law enforcement agency or instrumentality referred to in subparagraph (F), but only with respect to the subject of such proceeding. ``(2) Identity of participants.--With the exception of the subject of a quality assurance action, the identity of any person receiving health care services from any Indian Health Program or Urban Indian Organization or the identity of any other person associated with such program or organization for purposes of a medical quality assurance program that is disclosed in a medical quality assurance record described in subsection (a) shall be deleted from that record or document before any disclosure of such record is made outside such program or organization. Such requirement does not apply to the release of information pursuant to section 552a of title 5. ``(d) Disclosure for Certain Purposes.-- ``(1) In general.--Nothing in this section shall be construed as authorizing or requiring the withholding from any person or entity aggregate statistical information regarding the results of any Indian Health Program or Urban Indian Organizations's medical quality assurance programs. ``(2) Withholding from congress.--Nothing in this section shall be construed as authority to withhold any medical quality assurance record from a committee of either House of Congress, any joint committee of Congress, or the Government Accountability Office if such record pertains to any matter within their respective jurisdictions. ``(e) Prohibition on Disclosure of Record or Testimony.--A person or entity having possession of or access to a record or testimony described by this section may not disclose the contents of such record or testimony in any manner or for any purpose except as provided in this section. ``(f) Exemption From Freedom of Information Act.--Medical quality assurance records described in subsection (a) may not be made available to any person under section 552 of title 5. ``(g) Limitation on Civil Liability.--A person who participates in or provides information to a person or body that reviews or creates medical quality assurance records described in subsection (a) shall not be civilly liable for such participation or for providing such information if the participation or provision of information was in good faith based on prevailing professional standards at the time the medical quality assurance program activity took place. ``(h) Application to Information in Certain Other Records.--Nothing in this section shall be construed as limiting access to the information in a record created and maintained outside a medical quality assurance program, including a patient's medical records, on the grounds that the information was presented during meetings of a review body that are part of a medical quality assurance program. ``(i) Regulations.--The Secretary, acting through the Service, shall promulgate regulations pursuant to section 802. ``(j) Definitions.--In this section: ``(1) The term `health care provider' means any health care professional, including community health aides and practitioners certified under section 121, who are granted clinical practice privileges or employed to provide health care services in an Indian Health Program or health program of an Urban Indian Organization, who is licensed or certified to perform health care services by a governmental board or agency or professional health care society or organization. ``(2) The term `medical quality assurance program' means any activity carried out before, on, or after the date of enactment of this Act by or for any Indian Health Program or Urban Indian Organization to assess the quality of medical care, including activities conducted by or on behalf of individuals, Indian Health Program or Urban Indian Organization medical or dental treatment review committees, or other review bodies responsible for quality assurance, credentials, infection control, patient safety, patient care assessment (including treatment procedures, blood, drugs, and therapeutics), medical records, health resources management review and identification and prevention of medical or dental incidents and risks. ``(3) The term `medical quality assurance record' means the proceedings, records, minutes, and reports that emanate from quality assurance program activities described in paragraph (2) and are produced or compiled by or for an Indian Health Program or Urban Indian Organization as part of a medical quality assurance program. ``SEC. 815. APPROPRIATIONS; AVAILABILITY. ``Any new spending authority (described in subparagraph (A) or (B) of section 401(c)(2) of the Congressional Budget Act of 1974 (Public Law 93-344; 88 Stat. 317)) 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 are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2017 to carry out this title.''. (b) Rate of Pay.-- (1) Positions at level iv.--Section 5315 of title 5, United States Code, is amended by striking ``Assistant Secretaries of Health and Human Services (6)'' and inserting ``Assistant Secretaries of Health and Human Services (7)''. (2) Positions at level v.--Section 5316 of title 5, United States Code, is amended by striking ``Director, Indian Health Service, Department of Health and Human Services''. (c) Amendments to Other Provisions of Law.-- (1) Section 3307(b)(1)(C) of the Children's Health Act of 2000 (25 U.S.C. 1671 note; Public Law 106-310) is amended by striking ``Director of the Indian Health Service'' and inserting ``Assistant Secretary for Indian Health''. (2) The Indian Lands Open Dump Cleanup Act of 1994 is amended-- (A) in section 3 (25 U.S.C. 3902)-- (i) by striking paragraph (2); (ii) by redesignating paragraphs (1), (3), (4), (5), and (6) as paragraphs (4), (5), (2), (6), and (1), respectively, and moving those paragraphs so as to appear in numerical order; and (iii) by inserting before paragraph (4) (as redesignated by clause (ii)) the following: ``(3) Assistant secretary.--The term `Assistant Secretary' means the Assistant Secretary for Indian Health.''; (B) in section 5 (25 U.S.C. 3904), by striking the section designation and heading and inserting the following: ``SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR INDIAN HEALTH.''; (C) in section 6(a) (25 U.S.C. 3905(a)), in the subsection heading, by striking ``Director'' and inserting ``Assistant Secretary''; (D) in section 9(a) (25 U.S.C. 3908(a)), in the subsection heading, by striking ``Director'' and inserting ``Assistant Secretary''; and (E) by striking ``Director'' each place it appears and inserting ``Assistant Secretary''. (3) Section 5504(d)(2) of the Augustus F. Hawkins-Robert T. Stafford Elementary and Secondary School Improvement Amendments of 1988 (25 U.S.C. 2001 note; Public Law 100-297) is amended by striking ``Director of the Indian Health Service'' and inserting ``Assistant Secretary for Indian Health''. (4) Section 203(a)(1) of the Rehabilitation Act of 1973 (29 U.S.C. 763(a)(1)) is amended by striking ``Director of the Indian Health Service'' and inserting ``Assistant Secretary for Indian Health''. (5) Subsections (b) and (e) of section 518 of the Federal Water Pollution Control Act (33 U.S.C. 1377) are amended by striking ``Director of the Indian Health Service'' each place it appears and inserting ``Assistant Secretary for Indian Health''. (6) Section 317M(b) of the Public Health Service Act (42 U.S.C. 247b-14(b)) is amended-- (A) by striking ``Director of the Indian Health Service'' each place it appears and inserting ``Assistant Secretary for Indian Health''; and (B) in paragraph (2)(A), by striking ``the Directors referred to in such paragraph'' and inserting ``the Director of the Centers for Disease Control and Prevention and the Assistant Secretary for Indian Health''. (7) Section 417C(b) of the Public Health Service Act (42 U.S.C. 285-9(b)) is amended by striking ``Director of the Indian Health Service'' and inserting ``Assistant Secretary for Indian Health''. (8) Section 1452(i) of the Safe Drinking Water Act (42 U.S.C. 300j-12(i)) is amended by striking ``Director of the Indian Health Service'' each place it appears and inserting ``Assistant Secretary for Indian Health''. (9) Section 803B(d)(1) of the Native American Programs Act of 1974 (42 U.S.C. 2991b-2(d)(1)) is amended in the last sentence by striking ``Director of the Indian Health Service'' and inserting ``Assistant Secretary for Indian Health''. (10) Section 203(b) of the Michigan Indian Land Claims Settlement Act (Public Law 105-143; 111 Stat. 2666) is amended by striking ``Director of the Indian Health Service'' and inserting ``Assistant Secretary for Indian Health''. SEC. 102. SOBOBA SANITATION FACILITIES. The Act of December 17, 1970 (84 Stat. 1465), is amended by adding at the end the following: ``Sec. 9. Nothing in this Act shall preclude the Soboba Band of Mission Indians and the Soboba Indian Reservation from being provided with sanitation facilities and services under the authority of section 7 of the Act of August 5, 1954 (68 Stat. 674), as amended by the Act of July 31, 1959 (73 Stat. 267).''. SEC. 103. NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION. (a) In General.--The Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) is amended by adding at the end the following: ``TITLE VIII--NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION ``SEC. 801. DEFINITIONS. ``In this title: ``(1) Board.--The term `Board' means the Board of Directors of the Foundation. ``(2) Committee.--The term `Committee' means the Committee for the Establishment of Native American Health and Wellness Foundation established under section 802(f). ``(3) Foundation.--The term `Foundation' means the Native American Health and Wellness Foundation established under section 802. ``(4) Secretary.--The term `Secretary' means the Secretary of Health and Human Services. ``(5) Service.--The term `Service' means the Indian Health Service of the Department of Health and Human Services. ``SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION. ``(a) Establishment.-- ``(1) In general.--As soon as practicable after the date of enactment of this title, the Secretary shall establish, under the laws of the District of Columbia and in accordance with this title, the Native American Health and Wellness Foundation. ``(2) Funding determinations.--No funds, gift, property, or other item of value (including any interest accrued on such an item) acquired by the Foundation shall-- ``(A) be taken into consideration for purposes of determining Federal appropriations relating to the provision of health care and services to Indians; or ``(B) otherwise limit, diminish, or affect the Federal responsibility for the provision of health care and services to Indians. ``(b) Perpetual Existence.--The Foundation shall have perpetual existence. ``(c) Nature of Corporation.--The Foundation-- ``(1) shall be a charitable and nonprofit federally chartered corporation; and ``(2) shall not be an agency or instrumentality of the United States. ``(d) Place of Incorporation and Domicile.--The Foundation shall be incorporated and domiciled in the District of Columbia. ``(e) Duties.--The Foundation shall-- ``(1) encourage, accept, and administer private gifts of real and personal property, and any income from or interest in such gifts, for the benefit of, or in support of, the mission of the Service; ``(2) undertake and conduct such other activities as will further the health and wellness activities and opportunities of Native Americans; and ``(3) participate with and assist Federal, State, and tribal governments, agencies, entities, and individuals in undertaking and conducting activities that will further the health and wellness activities and opportunities of Native Americans. ``(f) Committee for the Establishment of Native American Health and Wellness Foundation.-- ``(1) In general.--The Secretary shall establish the Committee for the Establishment of Native American Health and Wellness Foundation to assist the Secretary in establishing the Foundation. ``(2) Duties.--Not later than 180 days after the date of enactment of this section, the Committee shall-- ``(A) carry out such activities as are necessary to incorporate the Foundation under the laws of the District of Columbia, including acting as incorporators of the Foundation; ``(B) ensure that the Foundation qualifies for and maintains the status required to carry out this section, until the Board is established; ``(C) establish the constitution and initial bylaws of the Foundation; ``(D) provide for the initial operation of the Foundation, including providing for temporary or interim quarters, equipment, and staff; and ``(E) appoint the initial members of the Board in accordance with the constitution and initial bylaws of the Foundation. ``(g) Board of Directors.-- ``(1) In general.--The Board of Directors shall be the governing body of the Foundation. ``(2) Powers.--The Board may exercise, or provide for the exercise of, the powers of the Foundation. ``(3) Selection.-- ``(A) In general.--Subject to subparagraph (B), the number of members of the Board, the manner of selection of the members (including the filling of vacancies), and the terms of office of the members shall be as provided in the constitution and bylaws of the Foundation. ``(B) Requirements.-- ``(i) Number of members.--The Board shall have at least 11 members, who shall have staggered terms. ``(ii) Initial voting members.--The initial voting members of the Board-- ``(I) shall be appointed by the Committee not later than 180 days after the date on which the Foundation is established; and ``(II) shall have staggered terms. ``(iii) Qualification.--The members of the Board shall be United States citizens who are knowledgeable or experienced in Native American health care and related matters. ``(C) Compensation.--A member of the Board shall not receive compensation for service as a member, but shall be reimbursed for actual and necessary travel and subsistence expenses incurred in the performance of the duties of the Foundation. ``(h) Officers.-- ``(1) In general.--The officers of the Foundation shall be-- ``(A) a secretary, elected from among the members of the Board; and ``(B) any other officers provided for in the constitution and bylaws of the Foundation. ``(2) Chief operating officer.--The secretary of the Foundation may serve, at the direction of the Board, as the chief operating officer of the Foundation, or the Board may appoint a chief operating officer, who shall serve at the direction of the Board. ``(3) Election.--The manner of election, term of office, and duties of the officers of the Foundation shall be as provided in the constitution and bylaws of the Foundation. ``(i) Powers.--The Foundation-- ``(1) shall adopt a constitution and bylaws for the management of the property of the Foundation and the regulation of the affairs of the Foundation; ``(2) may adopt and alter a corporate seal; ``(3) may enter into contracts; ``(4) may acquire (through a gift or otherwise), own, lease, encumber, and transfer real or personal property as necessary or convenient to carry out the purposes of the Foundation; ``(5) may sue and be sued; and ``(6) may perform any other act necessary and proper to carry out the purposes of the Foundation. ``(j) Principal Office.-- ``(1) In general.--The principal office of the Foundation shall be in the District of Columbia. ``(2) Activities; offices.--The activities of the Foundation may be conducted, and offices may be maintained, throughout the United States in accordance with the constitution and bylaws of the Foundation. ``(k) Service of Process.--The Foundation shall comply with the law on service of process of each State in which the Foundation is incorporated and of each State in which the Foundation carries on activities. ``(l) Liability of Officers, Employees, and Agents.-- ``(1) In general.--The Foundation shall be liable for the acts of the officers, employees, and agents of the Foundation acting within the scope of their authority. ``(2) Personal liability.--A member of the Board shall be personally liable only for gross negligence in the performance of the duties of the member. ``(m) Restrictions.-- ``(1) Limitation on spending.--Beginning with the fiscal year following the first full fiscal year during which the Foundation is in operation, the administrative costs of the Foundation shall not exceed the percentage described in paragraph (2) of the sum of-- ``(A) the amounts transferred to the Foundation under subsection (o) during the preceding fiscal year; and ``(B) donations received from private sources during the preceding fiscal year. ``(2) Percentages.--The percentages referred to in paragraph (1) are-- ``(A) for the first fiscal year described in that paragraph, 20 percent; ``(B) for the following fiscal year, 15 percent; and ``(C) for each fiscal year thereafter, 10 percent. ``(3) Appointment and hiring.--The appointment of officers and employees of the Foundation shall be subject to the availability of funds. ``(4) Status.--A member of the Board or officer, employee, or agent of the Foundation shall not by reason of association with the Foundation be considered to be an officer, employee, or agent of the United States. ``(n) Audits.--The Foundation shall comply with section 10101 of title 36, United States Code, as if the Foundation were a corporation under part B of subtitle II of that title. ``(o) Funding.-- ``(1) Authorization of appropriations.--There is authorized to be appropriated to carry out subsection (e)(1) $500,000 for each fiscal year, as adjusted to reflect changes in the Consumer Price Index for all-urban consumers published by the Department of Labor. ``(2) Transfer of donated funds.--The Secretary shall transfer to the Foundation funds held by the Department of Health and Human Services under the Act of August 5, 1954 (42 U.S.C. 2001 et seq.), if the transfer or use of the funds is not prohibited by any term under which the funds were donated. ``SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT. ``(a) Provision of Support by Secretary.--Subject to subsection (b), during the 5-year period beginning on the date on which the Foundation is established, the Secretary-- ``(1) may provide personnel, facilities, and other administrative support services to the Foundation; ``(2) may provide funds for initial operating costs and to reimburse the travel expenses of the members of the Board; and ``(3) shall require and accept reimbursements from the Foundation for-- ``(A) services provided under paragraph (1); and ``(B) funds provided under paragraph (2). ``(b) Reimbursement.--Reimbursements accepted under subsection (a)(3)-- ``(1) shall be deposited in the Treasury of the United States to the credit of the applicable appropriations account; and ``(2) shall be chargeable for the cost of providing services described in subsection (a)(1) and travel expenses described in subsection (a)(2). ``(c) Continuation of Certain Services.--The Secretary may continue to provide facilities and necessary support services to the Foundation after the termination of the 5-year period specified in subsection (a) if the facilities and services-- ``(1) are available; and ``(2) are provided on reimbursable cost basis.''. (b) Technical Amendments.--The Indian Self-Determination and Education Assistance Act is amended-- (1) by redesignating the second title V (25 U.S.C. 458bbb et seq.) as title VII; (2) by redesignating sections 501, 502, and 503 (25 U.S.C. 458bbb, 458bbb-1, 458bbb-2) as sections 701, 702, and 703, respectively; and (3) in subsection (a)(2) of section 702 and paragraph (2) of section 703 (as redesignated by paragraph (2)), by striking ``section 501'' and inserting ``section 701''. TITLE II--IMPROVEMENT OF INDIAN HEALTH CARE PROVIDED UNDER THE SOCIAL SECURITY ACT SEC. 201. EXPANSION OF PAYMENTS UNDER MEDICARE, MEDICAID, AND SCHIP FOR ALL COVERED SERVICES FURNISHED BY INDIAN HEALTH PROGRAMS. (a) Medicaid.-- (1) Expansion to all covered services.--Section 1911 of the Social Security Act (42 U.S.C. 1396j) is amended-- (A) by amending the section designation and heading to read as follows: ``SEC. 1911. INDIAN HEALTH PROGRAMS.''; AND (B) by amending subsection (a) to read as follows: ``(a) Eligibility for Payment for Medical Assistance.--The Indian Health Service and an Indian Tribe, Tribal Organization, or an Urban Indian Organization shall be eligible for payment for medical assistance provided under a State plan or under waiver authority with respect to items and services furnished by the Indian Health Service, Indian Tribe, Tribal Organization, or Urban Indian Organization if the furnishing of such services meets all the conditions and requirements which are applicable generally to the furnishing of items and services under this title and under such plan or waiver authority.''. (2) Compliance with conditions and requirements.--Subsection (b) of such section is amended to read as follows: ``(b) Compliance With Conditions and Requirements.--A facility of the Indian Health Service or an Indian Tribe, Tribal Organization, or an Urban Indian Organization which is eligible for payment under subsection (a) with respect to the furnishing of items and services, but which does not meet all of the conditions and requirements of this title and under a State plan or waiver authority which are applicable generally to such facility, shall make such improvements as are necessary to achieve or maintain compliance with such conditions and requirements in accordance with a plan submitted to and accepted by the Secretary for achieving or maintaining compliance with such conditions and requirements, and shall be deemed to meet such conditions and requirements (and to be eligible for payment under this title), without regard to the extent of its actual compliance with such conditions and requirements, during the first 12 months after the month in which such plan is submitted.''. (3) Revision of authority to enter into agreements.-- Subsection (c) of such section is amended to read as follows: ``(c) Authority To Enter Into Agreements.--The Secretary may enter into an agreement with a State for the purpose of reimbursing the State for medical assistance provided by the Indian Health Service, an Indian Tribe, Tribal Organization, or an Urban Indian Organization (as so defined), directly, through referral, or under contracts or other arrangements between the Indian Health Service, an Indian Tribe, Tribal Organization, or an Urban Indian Organization and another health care provider to Indians who are eligible for medical assistance under the State plan or under waiver authority.''. (4) Cross-references to special fund for improvement of ihs facilities; direct billing option; definitions.--Such section is further amended by striking subsection (d) and adding at the end the following new subsections: ``(d) Special Fund for Improvement of IHS Facilities.--For provisions relating to the authority of the Secretary to place payments to which a facility of the Indian Health Service is eligible for payment under this title into a special fund established under section 401(c)(1) of the Indian Health Care Improvement Act, and the requirement to use amounts paid from such fund for making improvements in accordance with subsection (b), see subparagraphs (A) and (B) of section 401(c)(1) of such Act. ``(e) Direct Billing.--For provisions relating to the authority of a Tribal Health Program or an Urban Indian Organization to elect to directly bill for, and receive payment for, health care items and services provided by such Program or Organization for which payment is made under this title, see section 401(d) of the Indian Health Care Improvement Act. ``(f) Definitions.--In this section, the terms `Indian Health Program', `Indian Tribe', `Tribal Health Program', `Tribal Organization', and `Urban Indian Organization' have the meanings given those terms in section 4 of the Indian Health Care Improvement Act.''. (b) Medicare.-- (1) Expansion to all covered services.--Section 1880 of such Act (42 U.S.C. 1395qq) is amended-- (A) by amending the section designation and heading to read as follows: ``SEC. 1880. INDIAN HEALTH PROGRAMS.''; AND (B) by amending subsection (a) to read as follows: ``(a) Eligibility for Payments.--Subject to subsection (e), the Indian Health Service and an Indian Tribe, Tribal Organization, or an Urban Indian Organization shall be eligible for payments under this title with respect to items and services furnished by the Indian Health Service, Indian Tribe, Tribal Organization, or Urban Indian Organization if the furnishing of such services meets all the conditions and requirements which are applicable generally to the furnishing of items and services under this title.''. (2) Compliance with conditions and requirements.--Subsection (b) of such section is amended to read as follows: ``(b) Compliance With Conditions and Requirements.--Subject to subsection (e), a facility of the Indian Health Service or an Indian Tribe, Tribal Organization, or an Urban Indian Organization which is eligible for payment under subsection (a) with respect to the furnishing of items and services, but which does not meet all of the conditions and requirements of this title which are applicable generally to such facility, shall make such improvements as are necessary to achieve or maintain compliance with such conditions and requirements in accordance with a plan submitted to and accepted by the Secretary for achieving or maintaining compliance with such conditions and requirements, and shall be deemed to meet such conditions and requirements (and to be eligible for payment under this title), without regard to the extent of its actual compliance with such conditions and requirements, during the first 12 months after the month in which such plan is submitted.''. (3) Cross-references to special fund for improvement of ihs facilities; direct billing option; definitions.-- (A) In general.--Such section is further amended by striking subsections (c) and (d) and inserting the following new subsections: ``(c) Special Fund for Improvement of IHS Facilities.--For provisions relating to the authority of the Secretary to place payments to which a facility of the Indian Health Service is eligible for payment under this title into a special fund established under section 401(c)(1) of the Indian Health Care Improvement Act, and the requirement to use amounts paid from such fund for making improvements in accordance with subsection (b), see subparagraphs (A) and (B) of section 401(c)(1) of such Act. ``(d) Direct Billing.--For provisions relating to the authority of a Tribal Health Program or an Urban Indian Organization to elect to directly bill for, and receive payment for, health care items and services provided by such Program or Organization for which payment is made under this title, see section 401(d) of the Indian Health Care Improvement Act.''. (B) Conforming amendment.--Paragraph (3) of section 1880(e) of such Act (42 U.S.C. 1395qq(e)) is amended by inserting ``and section 401(c)(1) of the Indian Health Care Improvement Act'' after ``Subsection (c)''. (4) Definitions.--Such section is further amended by amending subsection (f) to read as follows: ``(f) Definitions.--In this section, the terms `Indian Health Program', `Indian Tribe', `Service Unit', `Tribal Health Program', `Tribal Organization', and `Urban Indian Organization' have the meanings given those terms in section 4 of the Indian Health Care Improvement Act.''. (c) Application to SCHIP.--Section 2107(e)(1) of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended-- (1) by redesignating subparagraph (D) as subparagraph (E); and (2) by inserting after subparagraph (C), the following new subparagraph: ``(D) Section 1911 (relating to Indian Health Programs, other than subsection (d) of such section).''. SEC. 202. INCREASED OUTREACH TO INDIANS UNDER MEDICAID AND SCHIP AND IMPROVED COOPERATION IN THE PROVISION OF ITEMS AND SERVICES TO INDIANS UNDER SOCIAL SECURITY ACT HEALTH BENEFIT PROGRAMS. Section 1139 of the Social Security Act (42 U.S.C. 1320b-9) is amended to read as follows: ``SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, HEALTH CARE FOR INDIANS UNDER TITLES XVIII, XIX, AND XXI. ``(a) Agreements With States for Medicaid and SCHIP Outreach on or Near Reservations To Increase the Enrollment of Indians in Those Programs.-- ``(1) In general.--In order to improve the access of Indians residing on or near a reservation to obtain benefits under the Medicaid and State children's health insurance programs established under titles XIX and XXI, the Secretary shall encourage the State to take steps to provide for enrollment on or near the reservation. Such steps may include outreach efforts such as the outstationing of eligibility workers, entering into agreements with the Indian Health Service, Indian Tribes, Tribal Organizations, and Urban Indian Organizations to provide outreach, education regarding eligibility and benefits, enrollment, and translation services when such services are appropriate. ``(2) Construction.--Nothing in subparagraph (A) shall be construed as affecting arrangements entered into between States and the Indian Health Service, Indian Tribes, Tribal Organizations, or Urban Indian Organizations for such Service, Tribes, or Organizations to conduct administrative activities under such titles. ``(b) Requirement To Facilitate Cooperation.--The Secretary, acting through the Centers for Medicare & Medicaid Services, shall take such steps as are necessary to facilitate cooperation with, and agreements between, States and the Indian Health Service, Indian Tribes, Tribal Organizations, or Urban Indian Organizations with respect to the provision of health care items and services to Indians under the programs established under title XVIII, XIX, or XXI. ``(c) Definition of Indian; Indian Tribe; Indian Health Program; Tribal Organization; Urban Indian Organization.--In this section, the terms `Indian', `Indian Tribe', `Indian Health Program', `Tribal Organization', and `Urban Indian Organization' have the meanings given those terms in section 4 of the Indian Health Care Improvement Act.''. SEC. 203. ADDITIONAL PROVISIONS TO INCREASE OUTREACH TO, AND ENROLLMENT OF, INDIANS IN SCHIP AND MEDICAID. (a) Nonapplication of 10 Percent Limit on Outreach and Certain Other Expenditures.--Section 2105(c)(2) of the Social Security Act (42 U.S.C. 1397ee(c)(2)) is amended by adding at the end the following new subparagraph: ``(C) Nonapplication to expenditures for outreach to increase the enrollment of indian children under this title and title xix.--The limitation under subparagraph (A) on expenditures for items described in subsection (a)(1)(D) shall not apply in the case of expenditures for outreach activities to families of Indian children likely to be eligible for child health assistance under the plan or medical assistance under the State plan under title XIX (or under a waiver of such plan), to inform such families of the availability of, and to assist them in enrolling their children in, such plans, including such activities conducted under grants, contracts, or agreements entered into under section 1139(a).''. (b) Assurance of Payments to Indian Health Care Providers for Child Health Assistance.--Section 2102(b)(3)(D) of such Act (42 U.S.C. 1397bb(b)(3)(D)) is amended by striking ``(as defined in section 4(c) of the Indian Health Care Improvement Act, 25 U.S.C. 1603(c))'' and inserting ``, including how the State will ensure that payments are made to Indian Health Programs and Urban Indian Organizations operating in the State for the provision of such assistance''. (c) Inclusion of Other Indian Financed Health Care Programs in Exemption From Prohibition on Certain Payments.--Section 2105(c)(6)(B) of such Act (42 U.S.C. 1397ee(c)(6)(B)) is amended by striking ``insurance program, other than an insurance program operated or financed by the Indian Health Service'' and inserting ``program, other than a health care program operated or financed by the Indian Health Service or by an Indian Tribe, Tribal Organization, or Urban Indian Organization''. (d) Satisfaction of Medicaid Documentation Requirements.-- (1) In general.--Section 1903(x)(3)(B) of the Social Security Act (42 U.S.C. 1396b(x)(3)(B)) is amended-- (A) by redesignating clause (v) as clause (vi); and (B) by inserting after clause (iv), the following new clause: ``(v)(I) Except as provided in subclause (II), a document issued by a federally-recognized Indian tribe evidencing membership or enrollment in, or affiliation with, such tribe. ``(II) With respect to those federally-recognized Indian tribes located within States having an international border whose membership includes individuals who are not citizens of the United States, the Secretary shall, after consulting with such tribes, issue regulations authorizing the presentation of such other forms of documentation (including tribal documentation, if appropriate) that the Secretary determines to be satisfactory documentary evidence of citizenship or nationality for purposes of satisfying the requirement of this subsection.''. (2) Transition rule.--During the period that begins on July 1, 2006, and ends on the effective date of final regulations issued under subclause (II) of section 1903(x)(3)(B)(v) of the Social Security Act (42 U.S.C. 1396b(x)(3)(B)(v)) (as added by paragraph (1)), an individual who is a member of a federally- recognized Indian tribe described in subclause (II) of that section who presents a document described in subclause (I) of such section that is issued by such Indian tribe, shall be deemed to have presented satisfactory evidence of citizenship or nationality for purposes of satisfying the requirement of subsection (x) of section 1903 of such Act. (e) Definitions.--Section 2110(c) of such Act (42 U.S.C. 1397jj(c)) is amended by adding at the end the following new paragraph: ``(9) Indian; indian health program; indian tribe; etc.--The terms `Indian', `Indian Health Program', `Indian Tribe', `Tribal Organization', and `Urban Indian Organization' have the meanings given those terms in section 4 of the Indian Health Care Improvement Act.''. SEC. 204. PREMIUMS AND COST SHARING PROTECTIONS UNDER MEDICAID, ELIGIBILITY DETERMINATIONS UNDER MEDICAID AND SCHIP, AND PROTECTION OF CERTAIN INDIAN PROPERTY FROM MEDICAID ESTATE RECOVERY. (a) Premiums and Cost Sharing Protection Under Medicaid.-- (1) In general.--Section 1916 of the Social Security Act (42 U.S.C. 1396o) is amended-- (A) in subsection (a), in the matter preceding paragraph (1), by striking ``and (i)'' and inserting ``, (i), and (j)''; and (B) by adding at the end the following new subsection: ``(j) No Premiums or Cost Sharing for Indians Furnished Items or Services Directly by Indian Health Programs or Through Referral Under the Contract Health Service.-- ``(1) No cost sharing for items or services furnished to indians through indian health programs.-- ``(A) In general.--No enrollment fee, premium, or similar charge, and no deduction, copayment, cost sharing, or similar charge shall be imposed against an Indian who is furnished an item or service directly by the Indian Health Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization or through referral under the contract health service for which payment may be made under this title. ``(B) No reduction in amount of payment to indian health providers.--Payment due under this title to the Indian Health Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization, or a health care provider through referral under the contract health service for the furnishing of an item or service to an Indian who is eligible for assistance under such title, may not be reduced by the amount of any enrollment fee, premium, or similar charge, or any deduction, copayment, cost sharing, or similar charge that would be due from the Indian but for the operation of subparagraph (A). ``(2) Rule of construction.--Nothing in this subsection shall be construed as restricting the application of any other limitations on the imposition of premiums or cost sharing that may apply to an individual receiving medical assistance under this title who is an Indian. ``(3) Definitions.--In this subsection, the terms `contract health service', `Indian', `Indian Tribe', `Tribal Organization', and `Urban Indian Organization' have the meanings given those terms in section 4 of the Indian Health Care Improvement Act.''. (2) Conforming amendment.--Section 1916A (a)(1) of such Act (42 U.S.C. 1396o-1(a)(1)) is amended by striking ``section 1916(g)'' and inserting ``subsections (g), (i), or (j) of section 1916''. (b) Treatment of Certain Property for Medicaid and SCHIP Eligibility.-- (1) Medicaid.--Section 1902(e) of the Social Security Act (42 U.S.C. 1396a) is amended by adding at the end the following new paragraph: ``(13) Notwithstanding any other requirement of this title or any other provision of Federal or State law, a State shall disregard the following property for purposes of determining the eligibility of an individual who is an Indian (as defined in section 4 of the Indian Health Care Improvement Act) for medical assistance under this title: ``(A) Property, including real property and improvements, that is held in trust, subject to Federal restrictions, or otherwise under the supervision of the Secretary of the Interior, located on a reservation, including any federally recognized Indian Tribe's reservation, pueblo, or colony, including former reservations in Oklahoma, Alaska Native regions established by the Alaska Native Claims Settlement Act, and Indian allotments on or near a reservation as designated and approved by the Bureau of Indian Affairs of the Department of the Interior. ``(B) For any federally recognized Tribe not described in subparagraph (A), property located within the most recent boundaries of a prior Federal reservation. ``(C) Ownership interests in rents, leases, royalties, or usage rights related to natural resources (including extraction of natural resources or harvesting of timber, other plants and plant products, animals, fish, and shellfish) resulting from the exercise of federally protected rights. ``(D) Ownership interests in or usage rights to items not covered by subparagraphs (A) through (C) that have unique religious, spiritual, traditional, or cultural significance or rights that support subsistence or a traditional lifestyle according to applicable tribal law or custom.''. (2) Application to schip.--Section 2107(e)(1) of such Act (42 U.S.C. 1397gg(e)(1)), as amended by section 201(c), is amended-- (A) by redesignating subparagraphs (B) through (E), as subparagraphs (C) through (F), respectively; and (B) by inserting after subparagraph (A), the following new subparagraph: ``(B) Section 1902(e)(13) (relating to disregard of certain property for purposes of making eligibility determinations).''. (c) Continuation of Current Law Protections of Certain Indian Property From Medicaid Estate Recovery.--Section 1917(b)(3) of the Social Security Act (42 U.S.C. 1396p(b)(3)) is amended-- (1) by inserting ``(A)'' after ``(3)''; and (2) by adding at the end the following new subparagraph: ``(B) The standards specified by the Secretary under subparagraph (A) shall require that the procedures established by the State agency under subparagraph (A) exempt income, resources, and property that are exempt from the application of this subsection as of April 1, 2003, under manual instructions issued to carry out this subsection (as in effect on such date) because of the Federal responsibility for Indian Tribes and Alaska Native Villages. Nothing in this subparagraph shall be construed as preventing the Secretary from providing additional estate recovery exemptions under this title for Indians.''. SEC. 205. NONDISCRIMINATION IN QUALIFICATIONS FOR PAYMENT FOR SERVICES UNDER FEDERAL HEALTH CARE PROGRAMS. Section 1139 of the Social Security Act (42 U.S.C. 1320b-9), as amended by section 202, is amended by redesignating subsection (c) as subsection (d), and inserting after subsection (b) the following new subsection: ``(c) Nondiscrimination in Qualifications for Payment for Services Under Federal Health Care Programs.-- ``(1) Requirement to satisfy generally applicable participation requirements.-- ``(A) In general.--A Federal health care program must accept an entity that is operated by the Indian Health Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization as a provider eligible to receive payment under the program for health care services furnished to an Indian on the same basis as any other provider qualified to participate as a provider of health care services under the program if the entity meets generally applicable State or other requirements for participation as a provider of health care services under the program. ``(B) Satisfaction of state or local licensure or recognition requirements.--Any requirement for participation as a provider of health care services under a Federal health care program that an entity be licensed or recognized under the State or local law where the entity is located to furnish health care services shall be deemed to have been met in the case of an entity operated by the Indian Health Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization if the entity meets all the applicable standards for such licensure or recognition, regardless of whether the entity obtains a license or other documentation under such State or local law. In accordance with section 221 of the Indian Health Care Improvement Act, the absence of the licensure of a health care professional employed by such an entity under the State or local law where the entity is located shall not be taken into account for purposes of determining whether the entity meets such standards, if the professional is licensed in another State. ``(2) Prohibition on federal payments to entities or individuals excluded from participation in federal health care programs or whose state licenses are under suspension or have been revoked.-- ``(A) Excluded entities.--No entity operated by the Indian Health Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization that has been excluded from participation in any Federal health care program or for which a license is under suspension or has been revoked by the State where the entity is located shall be eligible to receive payment under any such program for health care services furnished to an Indian. ``(B) Excluded individuals.--No individual who has been excluded from participation in any Federal health care program or whose State license is under suspension or has been revoked shall be eligible to receive payment under any such program for health care services furnished by that individual, directly or through an entity that is otherwise eligible to receive payment for health care services, to an Indian. ``(C) Federal health care program defined.--In this subsection, the term, `Federal health care program' has the meaning given that term in section 1128B(f), except that, for purposes of this subsection, such term shall include the health insurance program under chapter 89 of title 5, United States Code.''. SEC. 206. CONSULTATION ON MEDICAID, SCHIP, AND OTHER HEALTH CARE PROGRAMS FUNDED UNDER THE SOCIAL SECURITY ACT INVOLVING INDIAN HEALTH PROGRAMS AND URBAN INDIAN ORGANIZATIONS. (a) In General.--Section 1139 of the Social Security Act (42 U.S.C. 1320b-9), as amended by sections 202 and 205, is amended by redesignating subsection (d) as subsection (e), and inserting after subsection (c) the following new subsection: ``(d) Consultation With Tribal Technical Advisory Group (TTAG).--The Secretary shall maintain within the Centers for Medicaid & Medicare Services (CMS) a Tribal Technical Advisory Group, established in accordance with requirements of the charter dated September 30, 2003, and in such group shall include a representative of the Urban Indian Organizations and the Service. The representative of the Urban Indian Organization shall be deemed to be an elected officer of a tribal government for purposes of applying section 204(b) of the Unfunded Mandates Reform Act of 1995 (2 U.S.C. 1534(b)).''. (b) Solicitation of Advice Under Medicaid and SCHIP.-- (1) Medicaid state plan amendment.--Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)) is amended-- (A) in paragraph (69), by striking ``and'' at the end; (B) in paragraph (70)(B)(iv), by striking the period at the end and inserting ``; and''; and (C) by inserting after paragraph (70)(B)(iv), the following new paragraph: ``(71) in the case of any State in which the Indian Health Service operates or funds health care programs, or in which 1 or more Indian Health Programs or Urban Indian Organizations (as such terms are defined in section 4 of the Indian Health Care Improvement Act) provide health care in the State for which medical assistance is available under such title, provide for a process under which the State seeks advice on a regular, ongoing basis from designees of such Indian Health Programs and Urban Indian Organizations on matters relating to the application of this title that are likely to have a direct effect on such Indian Health Programs and Urban Indian Organizations and that-- ``(A) shall include solicitation of advice prior to submission of any plan amendments, waiver requests, and proposals for demonstration projects likely to have a direct effect on Indians, Indian Health Programs, or Urban Indian Organizations; and ``(B) may include appointment of an advisory committee and of a designee of such Indian Health Programs and Urban Indian Organizations to the medical care advisory committee advising the State on its State plan under this title.''. (2) Application to schip.--Section 2107(e)(1) of such Act (42 U.S.C. 1397gg(e)(1)), as amended by section 204(b)(2), is amended-- (A) by redesignating subparagraphs (B) through (F) as subparagraphs (C) through (G), respectively; and (B) by inserting after subparagraph (A), the following new subparagraph: ``(B) Section 1902(a)(71) (relating to the option of certain States to seek advice from designees of Indian Health Programs and Urban Indian Organizations).''. (c) Rule of Construction.--Nothing in the amendments made by this section shall be construed as superseding existing advisory committees, working groups, guidance, or other advisory procedures established by the Secretary of Health and Human Services or by any State with respect to the provision of health care to Indians. SEC. 207. EXCLUSION WAIVER AUTHORITY FOR AFFECTED INDIAN HEALTH PROGRAMS AND SAFE HARBOR TRANSACTIONS UNDER THE SOCIAL SECURITY ACT. (a) Exclusion Waiver Authority.--Section 1128 of the Social Security Act (42 U.S.C. 1320a-7) is amended by adding at the end the following new subsection: ``(k) Additional Exclusion Waiver Authority for Affected Indian Health Programs.--In addition to the authority granted the Secretary under subsections (c)(3)(B) and (d)(3)(B) to waive an exclusion under subsection (a)(1), (a)(3), (a)(4), or (b), the Secretary may, in the case of an Indian Health Program, waive such an exclusion upon the request of the administrator of an affected Indian Health Program (as defined in section 4 of the Indian Health Care Improvement Act) who determines that the exclusion would impose a hardship on individuals entitled to benefits under or enrolled in a Federal health care program.''. (b) Certain Transactions Involving Indian Health Care Programs Deemed To Be in Safe Harbors.--Section 1128B(b) of the Social Security Act (42 U.S.C. 1320a-7b(b)) is amended by adding at the end the following new paragraph: ``(4) Subject to such conditions as the Secretary may promulgate from time to time as necessary to prevent fraud and abuse, for purposes of paragraphs (1) and (2) and section 1128A(a), the following transfers shall not be treated as remuneration: ``(A) Transfers between indian health programs, indian tribes, tribal organizations, and urban indian organizations.-- Transfers of anything of value between or among an Indian Health Program, Indian Tribe, Tribal Organization, or Urban Indian Organization, that are made for the purpose of providing necessary health care items and services to any patient served by such Program, Tribe, or Organization and that consist of-- ``(i) services in connection with the collection, transport, analysis, or interpretation of diagnostic specimens or test data; ``(ii) inventory or supplies; ``(iii) staff; or ``(iv) a waiver of all or part of premiums or cost sharing. ``(B) Transfers between indian health programs, indian tribes, tribal organizations, or urban indian organizations and patients.--Transfers of anything of value between an Indian Health Program, Indian Tribe, Tribal Organization, or Urban Indian Organization and any patient served or eligible for service from an Indian Health Program, Indian Tribe, Tribal Organization, or Urban Indian Organization, including any patient served or eligible for service pursuant to section 807 of the Indian Health Care Improvement Act, but only if such transfers-- ``(i) consist of expenditures related to providing transportation for the patient for the provision of necessary health care items or services, provided that the provision of such transportation is not advertised, nor an incentive of which the value is disproportionately large in relationship to the value of the health care item or service (with respect to the value of the item or service itself or, for preventative items or services, the future health care costs reasonably expected to be avoided); ``(ii) consist of expenditures related to providing housing to the patient (including a pregnant patient) and immediate family members or an escort necessary to assuring the timely provision of health care items and services to the patient, provided that the provision of such housing is not advertised nor an incentive of which the value is disproportionately large in relationship to the value of the health care item or service (with respect to the value of the item or service itself or, for preventative items or services, the future health care costs reasonably expected to be avoided); or ``(iii) are for the purpose of paying premiums or cost sharing on behalf of such a patient, provided that the making of such payment is not subject to conditions other than conditions agreed to under a contract for the delivery of contract health services. ``(C) Contract health services.--A transfer of anything of value negotiated as part of a contract entered into between an Indian Health Program, Indian Tribe, Tribal Organization, Urban Indian Organization, or the Indian Health Service and a contract care provider for the delivery of contract health services authorized by the Indian Health Service, provided that-- ``(i) such a transfer is not tied to volume or value of referrals or other business generated by the parties; and ``(ii) any such transfer is limited to the fair market value of the health care items or services provided or, in the case of a transfer of items or services related to preventative care, the value of the future health care costs reasonably expected to be avoided. ``(D) Other transfers.--Any other transfer of anything of value involving an Indian Health Program, Indian Tribe, Tribal Organization, or Urban Indian Organization, or a patient served or eligible for service from an Indian Health Program, Indian Tribe, Tribal Organization, or Urban Indian Organization, that the Secretary, in consultation with the Attorney General, determines is appropriate, taking into account the special circumstances of such Indian Health Programs, Indian Tribes, Tribal Organizations, and Urban Indian Organizations, and of patients served by such Programs, Tribes, and Organizations.''. SEC. 208. RULES APPLICABLE UNDER MEDICAID AND SCHIP TO MANAGED CARE ENTITIES WITH RESPECT TO INDIAN ENROLLEES AND INDIAN HEALTH CARE PROVIDERS AND INDIAN MANAGED CARE ENTITIES. (a) In General.--Section 1932 of the Social Security Act (42 U.S.C. 1396u-2) is amended by adding at the end the following new subsection: ``(h) Special Rules With Respect to Indian Enrollees, Indian Health Care Providers, and Indian Managed Care Entities.-- ``(1) Enrollee option to select an indian health care provider as primary care provider.--In the case of a non-Indian Medicaid managed care entity that-- ``(A) has an Indian enrolled with the entity; and ``(B) has an Indian health care provider that is participating as a primary care provider within the network of the entity, insofar as the Indian is otherwise eligible to receive services from such Indian health care provider and the Indian health care provider has the capacity to provide primary care services to such Indian, the contract with the entity under section 1903(m) or under section 1905(t)(3) shall require, as a condition of receiving payment under such contract, that the Indian shall be allowed to choose such Indian health care provider as the Indian's primary care provider under the entity. ``(2) Assurance of payment to indian health care providers for provision of covered services.--Each contract with a managed care entity under section 1903(m) or under section 1905(t)(3) shall require any such entity that has a significant percentage of Indian enrollees (as determined by the Secretary), as a condition of receiving payment under such contract to satisfy the following requirements: ``(A) Demonstration of participating indian health care providers or application of alternative payment arrangements.--Subject to subparagraph (E), to-- ``(i) demonstrate that the number of Indian health care providers that are participating providers with respect to such entity are sufficient to ensure timely access to covered Medicaid managed care services for those enrollees who are eligible to receive services from such providers; or ``(ii) agree to pay Indian health care providers who are not participating providers with the entity for covered Medicaid managed care services provided to those enrollees who are eligible to receive services from such providers at a rate equal to the rate negotiated between such entity and the provider involved or, if such a rate has not been negotiated, at a rate that is not less than the level and amount of payment which the entity would make for the services if the services were furnished by a participating provider which is not an Indian health care provider. ``(B) Prompt payment.--To agree to make prompt payment (in accordance with rules applicable to managed care entities) to Indian health care providers that are participating providers with respect to such entity or, in the case of an entity to which subparagraph (A)(ii) or (E) applies, that the entity is required to pay in accordance with that subparagraph. ``(C) Satisfaction of claim requirement.--To deem any requirement for the submission of a claim or other documentation for services covered under subparagraph (A) by the enrollee to be satisfied through the submission of a claim or other documentation by an Indian health care provider that is consistent with section 403(h) of the Indian Health Care Improvement Act. ``(D) Compliance with generally applicable requirements.-- ``(i) In general.--Subject to clause (ii), as a condition of payment under subparagraph (A), an Indian health care provider shall comply with the generally applicable requirements of this title, the State plan, and such entity with respect to covered Medicaid managed care services provided by the Indian health care provider to the same extent that non-Indian providers participating with the entity must comply with such requirements. ``(ii) Limitations on compliance with managed care entity generally applicable requirements.--An Indian health care provider-- ``(I) shall not be required to comply with a generally applicable requirement of a managed care entity described in clause (i) as a condition of payment under subparagraph (A) if such compliance would conflict with any other statutory or regulatory requirements applicable to the Indian health care provider; and ``(II) shall only need to comply with those generally applicable requirements of a managed care entity described in clause (i) as a condition of payment under subparagraph (A) that are necessary for the entity's compliance with the State plan, such as those related to care management, quality assurance, and utilization management. ``(E) Application of special payment requirements for federally-qualified health centers and encounter rate for services provided by certain indian health care providers.-- ``(i) Federally-qualified health centers.-- ``(I) Managed care entity payment requirement.--To agree to pay any Indian health care provider that is a federally-qualified health center but not a participating provider with respect to the entity, for the provision of covered Medicaid managed care services by such provider to an Indian enrollee of the entity at a rate equal to the amount of payment that the entity would pay a federally-qualified health center that is a participating provider with respect to the entity but is not an Indian health care provider for such services. ``(II) Continued application of state requirement to make supplemental payment.--Nothing in subclause (I) or subparagraph (A) or (B) shall be construed as waiving the application of section 1902(bb)(5) regarding the State plan requirement to make any supplemental payment due under such section to a federally-qualified health center for services furnished by such center to an enrollee of a managed care entity (regardless of whether the federally-qualified health center is or is not a participating provider with the entity). ``(ii) Continued application of encounter rate for services provided by certain indian health care providers.--If the amount paid by a managed care entity to an Indian health care provider that is not a federally-qualified health center and that has elected to receive payment under this title as an Indian Health Service provider under the July 11, 1996, Memorandum of Agreement between the Health Care Financing Administration (now the Centers for Medicare & Medicaid Services) and the Indian Health Service for services provided by such provider to an Indian enrollee with the managed care entity is less than the encounter rate that applies to the provision of such services under such memorandum, the State plan shall provide for payment to the Indian health care provider of the difference between the applicable encounter rate under such memorandum and the amount paid by the managed care entity to the provider for such services. ``(F) Construction.--Nothing in this paragraph shall be construed as waiving the application of section 1902(a)(30)(A) (relating to application of standards to assure that payments are consistent with efficiency, economy, and quality of care). ``(3) Offering of managed care through indian medicaid managed care entities.--If-- ``(A) a State elects to provide services through Medicaid managed care entities under its Medicaid managed care program; and ``(B) an Indian health care provider that is funded in whole or in part by the Indian Health Service, or a consortium composed of 1 or more Tribes, Tribal Organizations, or Urban Indian Organizations, and which also may include the Indian Health Service, has established an Indian Medicaid managed care entity in the State that meets generally applicable standards required of such an entity under such Medicaid managed care program, the State shall offer to enter into an agreement with the entity to serve as a Medicaid managed care entity with respect to eligible Indians served by such entity under such program. ``(4) Special rules for indian managed care entities.--The following are special rules regarding the application of a Medicaid managed care program to Indian Medicaid managed care entities: ``(A) Enrollment.-- ``(i) Limitation to indians.--An Indian Medicaid managed care entity may restrict enrollment under such program to Indians and to members of specific Tribes in the same manner as Indian Health Programs may restrict the delivery of services to such Indians and tribal members. ``(ii) No less choice of plans.--Under such program the State may not limit the choice of an Indian among Medicaid managed care entities only to Indian Medicaid managed care entities or to be more restrictive than the choice of managed care entities offered to individuals who are not Indians. ``(iii) Default enrollment.-- ``(I) In general.--If such program of a State requires the enrollment of Indians in a Medicaid managed care entity in order to receive benefits, the State, taking into consideration the criteria specified in subsection (a)(4)(D)(ii)(I), shall provide for the enrollment of Indians described in subclause (II) who are not otherwise enrolled with such an entity in an Indian Medicaid managed care entity described in such clause. ``(II) Indian described.--An Indian described in this subclause, with respect to an Indian Medicaid managed care entity, is an Indian who, based upon the service area and capacity of the entity, is eligible to be enrolled with the entity consistent with subparagraph (A). ``(iv) Exception to state lock-in.--A request by an Indian who is enrolled under such program with a non-Indian Medicaid managed care entity to change enrollment with that entity to enrollment with an Indian Medicaid managed care entity shall be considered cause for granting such request under procedures specified by the Secretary. ``(B) Flexibility in application of solvency.--In applying section 1903(m)(1) to an Indian Medicaid managed care entity-- ``(i) any reference to a `State' in subparagraph (A)(ii) of that section shall be deemed to be a reference to the `Secretary'; and ``(ii) the entity shall be deemed to be a public entity described in subparagraph (C)(ii) of that section. ``(C) Exceptions to advance directives.--The Secretary may modify or waive the requirements of section 1902(w) (relating to provision of written materials on advance directives) insofar as the Secretary finds that the requirements otherwise imposed are not an appropriate or effective way of communicating the information to Indians. ``(D) Flexibility in information and marketing.-- ``(i) Materials.--The Secretary may modify requirements under subsection (a)(5) to ensure that information described in that subsection is provided to enrollees and potential enrollees of Indian Medicaid managed care entities in a culturally appropriate and understandable manner that clearly communicates to such enrollees and potential enrollees their rights, protections, and benefits. ``(ii) Distribution of marketing materials.-- The provisions of subsection (d)(2)(B) requiring the distribution of marketing materials to an entire service area shall be deemed satisfied in the case of an Indian Medicaid managed care entity that distributes appropriate materials only to those Indians who are potentially eligible to enroll with the entity in the service area. ``(5) Malpractice insurance.--Insofar as, under a Medicaid managed care program, a health care provider is required to have medical malpractice insurance coverage as a condition of contracting as a provider with a Medicaid managed care entity, an Indian health care provider that is-- ``(A) a federally-qualified health center that is covered under the Federal Tort Claims Act (28 U.S.C. 1346(b), 2671 et seq.); ``(B) providing health care services pursuant to a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) that are covered under the Federal Tort Claims Act (28 U.S.C. 1346(b), 2671 et seq.); or ``(C) the Indian Health Service providing health care services that are covered under the Federal Tort Claims Act (28 U.S.C. 1346(b), 2671 et seq.); are deemed to satisfy such requirement. ``(6) Definitions.--For purposes of this subsection: ``(A) Indian health care provider.--The term `Indian health care provider' means an Indian Health Program or an Urban Indian Organization. ``(B) Indian; indian health program; service; tribe; tribal organization; urban indian organization.--The terms `Indian', `Indian Health Program', `Service', `Tribe', `tribal organization', `Urban Indian Organization' have the meanings given such terms in section 4 of the Indian Health Care Improvement Act. ``(C) Indian medicaid managed care entity.--The term `Indian Medicaid managed care entity' means a managed care entity that is controlled (within the meaning of the last sentence of section 1903(m)(1)(C)) by the Indian Health Service, a Tribe, Tribal Organization, or Urban Indian Organization, or a consortium, which may be composed of 1 or more Tribes, Tribal Organizations, or Urban Indian Organizations, and which also may include the Service. ``(D) Non-indian medicaid managed care entity.--The term `non-Indian Medicaid managed care entity' means a managed care entity that is not an Indian Medicaid managed care entity. ``(E) Covered medicaid managed care services.--The term `covered Medicaid managed care services' means, with respect to an individual enrolled with a managed care entity, items and services that are within the scope of items and services for which benefits are available with respect to the individual under the contract between the entity and the State involved. ``(F) Medicaid managed care program.--The term `Medicaid managed care program' means a program under sections 1903(m) and 1932 and includes a managed care program operating under a waiver under section 1915(b) or 1115 or otherwise.''. (b) Application to SCHIP.--Section 2107(e)(1) of such Act (42 U.S.C. 1397gg(1)), as amended by section 206(b)(2), is amended by adding at the end the following new subparagraph: ``(H) Subsections (a)(2)(C) and (h) of section 1932.''. SEC. 209. ANNUAL REPORT ON INDIANS SERVED BY SOCIAL SECURITY ACT HEALTH BENEFIT PROGRAMS. Section 1139 of the Social Security Act (42 U.S.C. 1320b-9), as amended by the sections 202, 205, and 206, is amended by redesignating subsection (e) as subsection (f), and inserting after subsection (d) the following new subsection: ``(e) Annual Report on Indians Served by Health Benefit Programs Funded Under This Act.--Beginning January 1, 2007, and annually thereafter, the Secretary, acting through the Administrator of the Centers for Medicare & Medicaid Services and the Director of the Indian Health Service, shall submit a report to Congress regarding the enrollment and health status of Indians receiving items or services under health benefit programs funded under this Act during the preceding year. Each such report shall include the following: ``(1) The total number of Indians enrolled in, or receiving items or services under, such programs, disaggregated with respect to each such program. ``(2) The number of Indians described in paragraph (1) that also received health benefits under programs funded by the Indian Health Service. ``(3) General information regarding the health status of the Indians described in paragraph (1), disaggregated with respect to specific diseases or conditions and presented in a manner that is consistent with protections for privacy of individually identifiable health information under section 264(c) of the Health Insurance Portability and Accountability Act of 1996. ``(4) A detailed statement of the status of facilities of the Indian Health Service or an Indian Tribe, Tribal Organization, or an Urban Indian Organization with respect to such facilities' compliance with the applicable conditions and requirements of titles XVIII, XIX, and XXI, and, in the case of title XIX or XXI, under a State plan under such title or under waiver authority, and of the progress being made by such facilities (under plans submitted under section 1880(b), 1911(b) or otherwise) toward the achievement and maintenance of such compliance. ``(5) Such other information as the Secretary determines is appropriate.''. Purpose of the Bill The purpose of H.R. 1328 is to amend the Indian Health Care Improvement Act to revise and extend that Act. Background and Need for Legislation According to Indian Health Service (IHS) figures, the mortality rates for Native Americans from tuberculosis and alcoholism are more than six times the U.S. general population rate and mortality rates from diabetes are nearly three times as high as in the rest of the United States population. American Indian and Alaska Native death rates for unintentional injuries and motor vehicle crashes are two and one-half to three times higher than the national rates. Suicide and homicide rates are nearly twice as high in the Indian population. In addition, a new report from the Substance Abuse and Mental Health Services Administration (SAMHSA)\1\ found that American Indians and Alaska Natives continue to have higher rates of substance use disorders than other racial groups within the United States. Almost 11% percent of American Indians and Alaska Natives reported having a past-year alcohol use disorder compared with 7.6% of other racial groups, and 5% of American Indians and Alaska Natives had a past-year illicit drug use disorder compared with 2.9% of other racial groups.\2\ American Indians and Alaska Natives also had higher rates than members of other racial groups for past-year marijuana use (13.5% versus 10.6%), cocaine use (3.5% versus 2.4%), and disorders involving hallucinogen use (2.7% versus 1.7%).\3\ IHS reported that the number of patient services related to amphetamine abuse went from about 3,000 contacts in 2000 to over 7,000 contacts in 2005, an increase of almost 250% over 5 years.\4\ Modernizing and improving the health care system that serves these communities is essential. This legislation does that by upgrading and updating health care for Native Americans. --------------------------------------------------------------------------- \1\National Survey on Drug Use and Health: Substance Use and Substance Use Disorders Among American Indians and Alaska Natives, Office of Applied Studies, Substance Abuse and Mental Health Services Administration, January, 2007. \2\Id. \3\Id. \4\Testimony of Robert McSwain, Deputy Director, Indian Health Service to the Senate Committee on Indian Affairs, April 5, 2006 (109th Congress). --------------------------------------------------------------------------- INDIAN HEALTH CARE IMPROVEMENT ACT--PUBLIC LAW 94-437 The Indian Health Care Improvement Act (IHCIA) is the keystone federal law that directs the delivery of health services to American Indian and Alaska Native people. The Indian health care network--comprised of reservation and traditional homeland-based hospitals, clinics, school health centers; health stations in very remote areas; and urban Indian health programs in major cities--is the primary source of medical care for over 1.9 million American Indians and Alaska Natives. IHS administers this comprehensive health care network largely in partnership with Indian tribes, which have assumed an increasingly greater role in operating health programs vital to the well-being of their members. First enacted in 1976, the IHCIA presented a more organized and comprehensive approach to the delivery of medical care to Indian people, many of whom live in isolated, sparsely- populated and under-served areas of our country. Subsequent reauthorizations--the IHCIA has been reauthorized three times with substantial amendments, the last occurring in 1992-- amended the Act to reflect advancements in health care delivery, enabled tribes to exercise greater responsibility over programs, and targeted the high incidence of certain diseases that have plagued the Native American population. The National Steering Committee on the Reauthorization of the IHCIA was established by tribal and health care representatives in the summer of 1999 to review and reconcile differences in recommendations from various areas of Indian country. The Steering Committee then drafted legislation that reflected the final recommendations and has remained involved throughout the process. URBAN INDIANS For 40 years, the United States has provided health care to Urban Indians. Although appropriations for specific urban health care programs began in 1967, Congress formally authorized urban Indian health programs in 1976. In April 2004, the Supreme Court reaffirmed Congress' plenary power to legislate over matters relating to Indians.\5\ The Court acknowledged that Congress' plenary authority includes the power to recognize, terminate and restore the tribal status of Indian tribes.\6\ While Congress cannot arbitrarily call a community of people an Indian tribe,\7\ the Supreme Court has acknowledged that ``in respect of distinctly Indian communities, whether, to what extent and, for what time they shall be recognized and dealt with as dependent tribes requiring the guardianship and protection of the United States is to be determined by Congress''\8\ Congress' plenary authority over Indian tribes also includes the power to define who is an Indian.\9\ --------------------------------------------------------------------------- \5\United States v. Lara, 541 U.S. 193 (2004) (noting that the power of Congress in Indian affairs derives not only from the Indian Commerce Clause, U.S. Const., Art. I, Sec. 8, cl. 3, and the Treaty Clause, Art II, Sec. 2, cl. 2, but rests also ``upon the Constitution's adoption of preconstitutional powers necessarily inherent in any Federal Government, namely powers that [the U.S. Supreme] Court has described as `necessary concomitants of nationality.''') \6\Id. See, also the court's observations in U.S. v. John, 437 U.S. 634 (1978): (stating ``[n]either the fact that the Choctaws in Mississippi are merely a remnant of a larger group of Indians, long ago removed from Mississippi, nor the fact that federal supervision over them has not been continuous, destroys the federal power to deal with them.'' Id., at 652-3. \7\United States v. Sandoval, 231 U.S. 28, 46 (1913). \8\Id. \9\U.S. Const. Art. I, Sec. 8, cl. 3; Cohen, Felix, Handbook of Federal Indian Law, at 23, 1982 ed.; United States v. Holliday, 70 U.S. 407, 417 (1865) (Congress' broad power includes dealings with individual Indians). --------------------------------------------------------------------------- As noted, this is not the first time that Congress has exercised its authority over individual urban Indians. The Supreme Court has stated that ``[t]he overriding duty of our federal government to deal fairly with Indians wherever located has been recognized by this Court many times.''\10\ As early as 1921, Congress enacted the Snyder Act to authorize health care funding for Indians throughout the United States.\11\ The Snyder Act has never been held to be limited to Indians who are members of federally recognized tribes or limited to reservation Indians.\12\ --------------------------------------------------------------------------- \10\Morton v. Ruiz, (415 U.S. 199, 236, (1974). \11\25 U.S.C. Sec. 13 (emphasis added). \12\See, e.g., Morton v. Ruiz, 415 U.S. 199 (1974) (upholding general assistance benefits authorized under the Snyder Act for individual Indians located off the reservation). --------------------------------------------------------------------------- Historically, the United States treated tribes differently--entering into treaties with some tribes while ignoring others. Various federal policies also impacted Indian tribes differently. For instance, the former federal policy of ``termination'' was intended to assimilate individual Indians by ending the government-to-government relationship with some Indian tribes but not others. Terminating the political relationship, however, did not result in the individual Indians no longer being Indian. To the contrary, the Supreme Court has upheld the exercise of treaty rights by individual Indians despite the fact that Congress has terminated the federal relationship.\13\ Consequently, Congress has recognized the need to continue providing health care and certain other federal services to such individuals.\14\ --------------------------------------------------------------------------- \13\Menominee Tribe of Indians v. U.S., 391 U.S. 404 (1968). \14\See, e.g., No Child Left Behind Act, Pub. L. 107-110. --------------------------------------------------------------------------- Another former federal policy--relocation\15\--is largely responsible for Indians moving to urban locations. Depressed reservation economies have also contributed to urban migration. Even though urban Indians no longer reside on reservations, they suffer from high rates of diseases and have health statistics similar to reservation Indians.\16\ To address this situation, Congress began providing health care services for urban Indians in 1967. --------------------------------------------------------------------------- \15\Many Indians were relocated to urban areas as a result of federal policy that began in 1931 as an attempt to assimilate Indians. Although the initial purpose of the relocation programs was to end Federal services, Congress has always indicated that health care programs for Indians does not stop at reservation borders. \16\For instance, the sudden infant death syndrome is 157% higher, alcoholism is 178%, chronic liver disease and cirrhosis is 126% higher. Without urban Indian health programs urban Indians are less likely to seek medical attention causing higher costs later. --------------------------------------------------------------------------- The history and various policies of the United States also resulted in some tribes entering into treaties with state governments. Many of these tribes continue to have political relationships with state governments. In short, Congress' plenary authority over Indians is more than broad enough to encompass the provisions of this Act. Providing health care to urban Indians is consistent with federal policy and with Congress' moral obligations to Indians. TRADITIONAL HEALTH CARE PRACTICES For centuries, the United States employed various policies, such as assimilation and termination, to prevent Native Americans from using traditional health care practices. In furtherance of the current policy of self-governance, Congress recognized the importance and continued practice of traditional health care for Native Americans in the enactment of the Indian Health Care Improvement Act in 1976. Current law continues to recognize this importance and authorizes Federal funds to be used for traditional health care purposes, thus ensuring that health care for Native Americans is culturally appropriate. In 1990, Congress extended the Federal Tort Claims Act (FTCA) coverage to tribes and tribal organizations providing health care services under a contract or compact pursuant to the Indian Self-Determination and Education Assistance Act. While some concern has been expressed about FTCA's applicability to traditional health care practices, these concerns are unfounded for several reasons. First, a traditional healer is used when requested by an individual under the care of an IHS facility. In most instances, the traditional healer is not a Federal or tribal employee nor even paid with Federal funds. In fact, the traditional healer often does not accept any payment. Second, under the FTCA, liability is determined ``in accordance with the law of the place where the act or omission occurred.''\17\ In order for a claim to proceed then, state or tribal law must specify a standard of care for the traditional healing act performed. If no such standard is defined, there is no cause of action on which a claim for relief may be granted. Without such cause of action, the United States cannot be held liable under the FTCA. --------------------------------------------------------------------------- \17\28 U.S.C. Sec. Sec. 1346(b) & 2672. --------------------------------------------------------------------------- Finally, it should be noted that there is no record of a FTCA claim arising from traditional health care practices ever being filed.\18\ --------------------------------------------------------------------------- \18\S. Hrg. 100-53 at 14 (March 8, 2007) (Statement of C. Frederick Beckner III, Deputy Assistant Attorney General, Civil Division, Department of Justice). --------------------------------------------------------------------------- H.R. 1328 This legislation's primary objective is to improve access to quality medical care for American Indians and Alaska Natives. Currently, over half of the IHS budget is distributed directly to Indian tribes who provide health care delivery services pursuant to Indian Self-Determination and Education Assistance Act (ISDEAA) contracts or compacts. In many areas of Indian country, IHS programs are the only source of available health care. The basic framework of the IHCIA has been retained in H.R. 1328, including provisions that target diseases for which Indian Country reflects astonishingly high rates, such as diabetes, tuberculosis, infant mortality, alcoholism, accidents, homicide and substance abuse. H.R. 1328 would reauthorize the IHCIA through 2017 and provide funding for the recruitment and retention of Indian health professionals through scholarships, extern programs, continuing education programs, and retention bonuses. It would make permanent current programs for diabetes, andestablish a Catastrophic Health Emergency Fund administered for victims of disasters or catastrophic illness. In addition, the bill would require the Secretary to provide for mammography and other cancer screening consistent with national standards. Additionally, this legislation would authorize the Secretary to establish an Indian youth program for the purpose of providing innovative mental and physical disease prevention programs. Funding would also be authorized for activities such as assisted living, hospice care, long-term health care, home and community-based services, and traditional healing practices. H.R. 1328 would replace the current Urban Health Programs Branch with a Division of Urban Health that would continue to service urban Indian clinics. The bill would require agreements be made with Indian health care organizations to assist in enrolling qualified Indians into Medicare, Medicaid, and State Children's Health Insurance Program (SCHIP). It would further promote taking steps to provide for Medicaid enrollment on Indian reservations and seek input from Indian tribes on impacts encountered through changes in State plans. In addition, the bill would reorganize current substance abuse programs under a new Behavioral Health program to combine and integrate substance abuse, mental health, and social service programs. It would elevate the current position of Director of Indian Health Service to that of Assistant Secretary. This initiative would provide the Assistant Secretary with greater control over budget issues. Finally, this legislation would place greater emphasis on negotiated rulemaking with Indian tribes in order to provide the service population with ongoing input into how the IHCIA would be implemented. LEGISLATIVE HISTORY Similar legislation was introduced in the 106th (by Rep. George Miller), 107th (by Rep. Rahall), 108th and 109th Congresses (both by Rep. Don Young). The Committee reported H.R. 2440 in the 108th Congress (House Report 108-791--Part I) and H.R. 5312 the 109th Congress (House Report 109-661--Part I). Also in the 109th Congress, the Senate companion bill (S. 1057) was reported by the Senate Committee on Indian Affairs on March 16, 2006 (Senate Report 109-222). Committee Action H.R. 1328 was introduced on March 6, 2007 by Representative Frank Pallone (D-NJ), along with thirty-four original cosponsors, including both Chairman Rahall and Ranking Member Don Young. The bill was referred to the Committee on Natural Resources. On March 14, 2007, the Committee on Natural Resources held a hearing on the bill. On April 25, 2007, the Full Natural Resources Committee met to consider the bill. Representative Abercrombie (D-HI) offered an en bloc amendment to include ``Urban Indians'' in the goals of the bill, correct typographical errors, reinsert provisions in existing law that were inadvertently omitted, add naturopathic medicine within the definition of ``health profession,'' and make other clarifying changes. It was adopted by voice vote. Rep. Pearce (R-NM) offered an amendment to distribute funds based on actual population needs rather than historic funding levels. It was withdrawn after discussion. Rep. Pearce (R-NM) offered an amendment requiring the Secretary of Health and Human Services to conduct a study of the third-party payment collections system for items and services furnished through the Indian Health Service and requires the Secretary to submit such report to Congress within 6 months after date of enactment of the Act. It was adopted by voice vote. Rep. Boren (D-OK) offered an amendment to correct an alleged criminal jurisdiction void at the Claremore Indian Hospital. It was withdrawn by unanimous consent. Rep. Inslee (D-WA) offered an amendment to create an Area Distribution Fund formula to distribute health care construction facilities funds. It was withdrawn after discussion. Rep. Pearce (R-NM) offered an amendment requiring a report on the movement of patients between Service Units. It was adopted by voice vote. The bill, as amended, was then ordered favorably reported to the House of Representatives by voice vote. Section-by-Section Analysis Section 1. Short title; Table of contents Section 1 provides the short title of the bill as the ``Indian Health Care Improvement Act Amendments of 2007'' and sets forth the Table of Contents. Section 2. Report on third-party payment collections Section 2 requires the Secretary of Health and Human Services to conduct a study of the third-party payment collections system for items and services furnished through the Indian Health Service and requires the Secretary to submit such report to Congress within 6 months after date of enactment of the Act. Title I--Amendments to Indian Laws Section 101. Indian Health Care Improvement Act amended Section 101 amends the Indian Health Care Improvement Act to read as follows: Section 1. Short title; Table of contents Section 1 provides that this Act may be cited as the ``Indian Health Care Improvement Act'' and sets forth an amended Table of Contents. Section 2. Findings Section 2 sets forth findings indicating that federal health services are required by the historical and unique legal relationship between the United States and Indians; that improving the quantity and quality of health services for Indians is a goal of the United States; that federal health services to Indians have resulted in a reduction in the prevalence and incidence of preventable illness and premature deaths of Indians; and that despite such services, the health status of Indians is still far below the general United States population. Section 3. Declaration of national Indian health policy Section 3 sets forth a national policy of the United States, in fulfillment of its trust responsibility and legal obligations, to assure the highest possible health status of Indians and Urban Indians; to raise the health status of Indians and Urban Indians; to allow Indians to set their own health care priorities; to increase the number of degrees in health professions awarded to Indians; to require consultation with tribes, tribal organizations and urban Indian organizations; and to fund programs and facilities operated by tribes and tribal organizations at the same level as Indian Health Service (Service) programs and facilities are funded. Section 4. Definitions Section 4 defines terms used in this Act, including definitions for the following new terms: ``accredited and accessible,'' ``Assistant Secretary,'' ``behavioral health,'' ``California Indians,'' ``community college,'' ``contract health service,'' ``Department,'' ``disease prevention,'' ``Indian Health Program,'' ``junior or community college,'' ``reservation,'' ``telehealth,'' ``telemedicine,'' ``tribal college or university,'' and ``Tribal Health Program.'' ``Urban Indian'' includes members of federally-recognized Indian tribes, members of State-recognized Indian tribes, members of tribes whose relationship with the federal government has been terminated, and individuals who are descendants in the first or second degree of any such member. The Committee believes that there is adequate authority and precedent for this definition, especially since Congress has already done so for other purposes.\19\ --------------------------------------------------------------------------- \19\See e.g. Indian Arts and Crafts Act, Pub. L. 101-644. --------------------------------------------------------------------------- Title I--Indian Health, Human Resources, and Development Section 101. Purpose Section 101 provides that the purpose of this title is to increase the number of Indians entering health professions and providing health services as well as to assure a supply of health professions to provide health services to Indians. Section 102. Health professions recruitment program for Indians Section 102 requires the Secretary to award grants to specified entities to assist with various activities associated with recruiting Indians for health professions. Terms addressing the application process, amount of grants, and payments are also set forth in this section. Section 103. Health professions preparatory scholarship program for Indians Section 103 requires the Secretary to provide scholarships to Indians for compensatory pre-professional education and pre- graduate education. This section also specifies the uses of the scholarships and prohibits denial based solely on the applicant's scholastic achievement if the applicant has been admitted to or maintained good standing at an accredited institution or based solely on the applicant's eligibility for other federal assistance or benefits. Section 104. Indian health professions scholarships Section 104 requires the Secretary to award Indian Health Scholarships to Indians pursuing courses of study in the health professions. The section specifies how the scholarships shall be distributed, how the scholarship program shall be administered, as well as active duty service requirements for recipients. Terms covering breach of contract are specified as are the right of recovery and the recovery terms used by the United States in the event of a breach of contract. The Secretary shall provide a partial or total waiver of the obligation of service or the repayment in certain specified conditions. A repayment obligation may not be discharged in bankruptcy. Section 105. American Indians into psychology program Section 105 requires the Secretary to award competitive grants of no more than $300,000 to nine colleges and universities to develop and maintain Indian psychology career recruitment programs. One of these grants shall be provided to develop and maintain the Quentin N. Burdick American Indians into Psychology Program at the University of North Dakota. Grant conditions are also set forth. Each graduate who receives a stipend from this program is required to meet the active duty service requirement. Section 106. Scholarship programs for Indian tribes Section 106 requires the Secretary to make grants to Tribal Health Programs for the purpose of providing scholarships for Indians to serve as health professionals in Indian communities. Grant amounts and requirements, contract terms, breach of contract terms, the relationship of the scholarship to the Social Security Act and continuance of funding terms are also set forth. Section 107. Indian Health Service extern programs Section 107 grants an employment preference at the Indian Health Service during the nonacademic period of the year for Section 104 and Section 106 scholarship recipients. Scholarship recipients may also be employed by a Tribal Health Program or an Urban Indian Organization during the nonacademic period of the year. Employment during this period does not count towards the recipient's active duty service obligation and may not exceed 120 days during any calendar year. The recipient shall be compensated for his or her services and shall be employed in a health profession in which he or she is studying. Such employment shall not be counted against any employment ceiling affecting the Service or the Department. Section 108. Continuing education allowances Section 108 authorizes the Secretary to provide programs or allowances to participants under Section 104, 105, 106, and 115 in order to transition into an Indian Health Program or to take leave, in accordance with regulations, for professional consultation, management, leadership, and refresher training courses. Section 109. Community Health Representative Program Section 109 directs the Secretary to maintain a Community Health Representative Program to provide training to Indians as community health representatives and to use community health representatives in the provision of health care, health promotion and disease prevention services to Indian communities. Program requirements are also set forth. Section 110. Indian Health Service Loan Repayment Program Section 110 requires the Secretary to establish and administer a Service Loan Repayment Program in which to pay an individual's student loans in return for the individual providing health care services to Indians. Eligibility, application information, decision deadlines, priorities, contract requirements, and loan payment terms are set forth. Individuals with written contracts under this section shall not count towards any employment ceiling affecting the Department. The Secretary shall conduct recruiting programs and section 214 of the Public Health Service Act shall not apply to individuals during their obligated service period. Terms governing assignment of individuals, breach of contract, and waiver or suspension of obligation are specified. The Secretary must submit a report to Congress providing data on program implementation on an annual basis. Section 111. Scholarship and Loan Repayment Recovery Fund Section 111 establishes an Indian Health Scholarship and Loan Repayment Recovery Fund in the United States Treasury. The Fund shall consist of amounts collected under sections 104(d), 106(e), and 110(l), any funds appropriated to the Fund, and interest earned on amounts in the Fund. Amounts in the Fund may be used to make payments to specified Indian Health Programs, may only be invested in interest bearing obligations of the United States, and such obligations may be sold by the Secretary of the Treasury at market price. Section 112. Recruitment activities Section 112 allows the Secretary to reimburse health professionals seeking positions with Indian Health Programs or Urban Indian Organizations for certain travel expenses. Individuals considering entering into a contract under section 110 and their spouses may also be reimbursed for such expenses. One individual from each Area Office shall be assigned by the Secretary to be responsible on a full-time basis for recruitment activities. Section 113. Indian recruitment and retention program Section 113 requires the Secretary to fund, on a competitive basis, innovative demonstration projects to enable Tribal Health Programs and Urban Indian Organizations to recruit, place, and retain health professionals to meet their staffing needs. Section 114. Advanced training and research Section 114 requires the Secretary to establish a demonstration project to enable health professionals who have worked in an Indian Health Program or Urban Indian Organization to pursue advanced training or research areas of study for which there is a need. Participating individuals must perform an active duty service obligation in an Indian Health Program or Urban Indian Organization and shall be liable to the United States for failure to complete such service obligation. Section 115. Quentin N. Burdick American Indians Into Nursing Program Section 115 requires the Secretary to provide grants to public or private schools of nursing, tribal colleges or universities, nurse midwife programs and advanced practice nurse programs to increase the number of nurses, nurse midwives, and nurse practitioners who deliver health care services to Indians. Use of grants and grant recipient priorities are specified. One grant shall be provided to the Quentin N. Burdick American Indians Into Nursing Program at the University of North Dakota. Individuals receiving training pursuant to this section shall incur an active duty service obligation. Section 116. Tribal cultural orientation Section 116 requires the Secretary to mandate that employees of the Service serving Indian Tribes in each Service Area receive educational instruction in the history and culture of Indian Tribes and their relationship to the Service. Details of the program are also set forth. Section 117. Inmed Program Section 117 authorizes the Secretary to provide grants to colleges and universities to maintain and expand the Indian health careers recruitment program known as the ``Indians Into Medicine Program'' to encourage Indians to enter the health professions. One grant shall be provided to the University of North Dakota. The Secretary shall develop regulations governing grants and applicants must meet specified criteria. Section 118. Health training programs of community colleges Section 118 requires the Secretary to award grants to community colleges to assist such colleges in establishing or maintaining programs leading to a degree or diploma in a health profession for individuals who desire to practice such profession on or near a reservation or in an Indian Health Program. The Secretary shall enter into agreements with the community colleges to provide qualified Service personnel to teach in the colleges and to provide technical assistance and support to such colleges. Any program receiving funding under this section must offer advanced training for certain health professionals. Tribal colleges and universities in the Service Areas shall be given priority. Section 119. Retention bonus Section 119 authorizes the Secretary to pay a retention bonus to certain health professionals employed by, or assigned to, and serving in, an Indian Health Program or Urban Indian Organization either as a civilian employee or as a commissioned officer in the Regular or Reserve Corps of the Public Health Service. The Secretary may establish retention bonus rates for multiyear agreements. In the event of default, the retention bonus plus interest must be repaid. Section 120. Nursing residency program Section 120 requires the Secretary to establish a program to enable Indian nurses working in an Indian Health Program or Urban Indian Organization to pursue advanced training. Program participants are obligated to serve in an Indian Health Program or Urban Indian Organization. Section 121. Community Health Aide Program Section 121 requires the Secretary to develop and operate a Community Health Aide Program in Alaska. Specific program requirements are set forth. A neutral panel, established by the Secretary, shall conduct a study of the dental health aide therapist services provided by the Community Health Aide Program to ensure that the quality of care provided through those services is adequate and appropriate. If the Secretary determines it is appropriate, the Secretary may establish a national Community Health Aide Program. The report shall be submitted to the specified Congressional committees. The Community Health Aide Program (CHAP), except for dental health aide therapists' certification, may expand nationally. The Dental Health Aide Therapist program will be limited to Alaska only and the therapists' scope of practice will be limited to the procedures as stated in the January 31, 2005, Community Health Aide Program Certification Board's Standards and Procedures. The Committee believes the importance of the dental health aide program as part of a comprehensive oral health care delivery system led by licensed dentists should not be understated. This program provides an important extension of the community health aide program because dental health aides will work and live in the villages helping to establish disease prevention and health education programs that can break the dental disease cycle affecting many American Indians and Alaska Natives. With the emphasis on prevention, the amount of new active disease can be reduced and treatment of any new active disease can be more easily managed. The Committee crafted this language with input from other concerned Members, after consideration of the endorsement of the dental health aide therapist program by national Indian organizations and public health organizations, and with the assistance of the American Dental Association to ensure safety and continued quality care in the larger CHAP program by imposing certain limitations on the practice of dental health aide therapists found in paragraph (b)(7). To help ensure the continued quality of the dental health aides certified by the Federal Community Health Aide Program Certification Board in Alaska, the board should include at least one dentist from outside the tribal community, who has actively practiced dentistry and who has expertise in setting quality standards for evaluating competence in education and practice. In paragraph (b)(7), ``medical emergency'' is defined as an injury or illness, including infection, that poses an immediate threat to a person's well being, health or life. Also in paragraph (b)(7), deciduous teeth are defined as primary teeth and adult teeth are defined as permanent teeth. The amended provision also provides for the Secretary to establish a neutral panel to conduct a study of the dental health aide therapist services and the services of other mid-level providers, such as the Community Dental Health Coordinator, as developed by the American Dental Association. Section 122. Tribal Health Program administration Section 122 requires the Secretary to provide training for Indians in the administration and planning of Tribal Health Programs. Section 123. Health professional chronic shortage demonstration programs Section 123 authorizes the Secretary to fund demonstration programs for Tribal Health Programs to address the chronic shortages of health professionals. Demonstration programs must be established for the purposes identified and must incorporate a program advisory board composed of representatives from Indian tribes and Indian communities in the area to be served. Section 124. National Health Service Corps Section 124 prohibits the Secretary from removing a member of the National Health Service Corps from an Indian Health Program or Urban Indian Organization or withdrawing funding used to support such member unless the Secretary has ensured that the Indians receiving services from such member will experience no reduction in services. Certain National Health Service Corps scholars are exempt from the full-time equivalent limitations of the National Health Service Corps and the Service when serving as a commissioned corps officer in a Tribal Health Program or an Urban Indian Organization. Section 125. Substance abuse counselor educational curricula demonstration programs Section 125 permits the Secretary to enter into three year contracts with, or make three year grants to, tribal colleges and universities and community colleges to establish demonstration programs to develop educational curricula for substance abuse counseling. The Secretary is required to develop and issue criteria for the review and approval of funding applications and must submit a report to the President on the findings and conclusions from the demonstration programs. Terms for use of funds, duration of grants and renewal are set forth. Section 126. Behavioral health training and community education programs Section 126 requires the Secretary, and the Secretary of the Interior, to consult with Indian tribes and tribal organizations in conducting a study and compiling a list of the types of staff positions within the Indian Health Service, Bureau of Indian Affairs and Indian tribes, Tribal Organizations and Urban Indian Organizations whose qualifications include, or should include, training in the identification, prevention, education, referral, or treatment of mental illness, or dysfunctional and self destructive behavior. The appropriate Secretary is required to provide training, or ensure that training is provided, appropriate to the staff position. Upon request of an Indian Tribe, Tribal Organization, or Urban Indian Organization, the Indian Health Service is required to develop and implement, or assist in the development and implementation of, a community education program on mental illness. No later than 90 days after date of enactment of this measure, the Secretary is required to develop a plan to increase the health care staff providing behavioral health services by at least 500 positions within five years. Section 127. Authorization of appropriations Section 127 authorizes such sums as may be necessary to carry out Title I. Title II--Health Services Section 201. Indian health care improvement funds Section 201 authorizes the Secretary to expend funds to fulfill the purposes specified in this section, such as eliminating the deficiencies in the health status and health resources of all Indian tribes, meeting the health needs of Indians, and training of traditional health care practitioners. Funds appropriated under this section may not be used to offset or limit any other appropriated funds. Funds appropriated pursuant to this section shall be used to improve the health status and reduce the resource deficiency of each Indian Tribe. The term ``health status and resource deficiency'' is definedfor purposes of this section and the health resources available to an Indian Tribe or Tribal Organization is clarified. The Secretary is also required to establish procedures for a review of any determination of the extent of the health status and resource deficiency of an Indian Tribe or Tribal Organization. The Secretary must submit a report to Congress on the current health status and resource deficiency of the Service for each Service Unit. Funds appropriated pursuant to this section shall be designated as the ``Indian Health Care Improvement Fund.'' The funds shall be included in the base budget of the Service. While the Administration has raised concerns about extending FTCA liability for services provided by traditional health care practitioners, this provision, as well as many of the other provisions, are existing law. The Committee believes that the policy of self-governance should be furthered and that there should be no regression from existing law. The Committee also believes that the Administration's concern is unfounded and that the federal government is adequately protected. Section 202. Catastrophic Health Emergency Fund Section 202 establishes an Indian Catastrophic Health Emergency Fund to 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 Service's responsibility. Neither these funds nor their administration shall be subject to a contract or grant, nor shall such funds be allocated, apportioned, or delegated to an Area Office, Service Unit, or other similar basis. The Secretary is required to promulgate regulations in accordance with this section. Funds under this section may not be used to offset or limit appropriations made under any other law. All reimbursements from any other source by reason of treatment rendered to any victim of a disaster or catastrophic illness shall be deposited to this Fund. Section 203. Health promotion and disease prevention services Section 203 finds that health promotion and disease prevention activities improve the health and well-being of Indians and reduces health care expenses of Indians. The Secretary is required to provide health promotion and disease prevention services to Indians. After receiving input from the affected Tribal Health Programs, the Secretary shall submit a report to Congress on the health promotion and disease prevention needs of Indians and the best activities to meet such needs. Section 204. Diabetes prevention, treatment, and control Section 204 requires the Secretary, in consultation with Indian Tribes and Tribal Organizations, to determine the incidence of, and the type of complications resulting from diabetes among Indians and the measures required to reduce the incidence of diabetes. To the extent medically indicated and with informed consent, the Secretary must screen each Indian who receives diabetes services from the Service. The Secretary shall also maintain any model diabetes project and other specified projects in existence on the date of enactment of this Act. The Secretary may provide dialysis programs. To the extent funding is available, the Secretary shall undertake other specified duties related to diabetes. Section 205. Shared services for long-term care Section 205 authorizes the Secretary to provide, either directly or through grants or contracts, long-term care services to Indians. Agreements between the Service and Tribal Health Programs, Indian Tribes or Tribal Organizations must provide for the sharing of staff or other services. Nursing facilities must meet the requirements of Section 1919 of the Social Security Act. The Secretary is required to provide technical assistance to enable applicants to comply with the provisions of this section and shall encourage the use of existing underused facilities. Section 206. Health services research Section 206 requires the Secretary to fund research to further the performance of the health service responsibilities of Indian Health Programs. To the extent practicable, the Secretary must coordinate departmental research resources and activities to address relevant Indian Health Program research needs. Tribal Health Programs shall have an equal opportunity to compete for, and receive research funds under this section. Use of funds are specified. The Secretary shall evaluate the research and disseminate to the Tribal Health Programs information regarding the research under this section. Section 207. Mammography and other cancer screening Section 207 requires the Secretary to provide mammography and other cancer screening as recommended by the United States Preventive Services Task Force. Section 208. Patient travel costs Section 208 defines the term ``qualified escort'' for purposes of this section and authorizes the Secretary to fund certain patient travel costs, including qualified escorts, associated with receiving health care services. Section 209. Epidemiology centers Section 209 requires the Secretary to establish an epidemiology center in each Service Area to carry out specified functions. The Director of the Centers for Disease Control and Prevention shall provide technical assistance to the centers. Grants may be made by the Secretary to tribes, tribal organizations, eligible intertribal consortia, and Urban Indian Organizations to conduct epidemiological studies of Indian communities. Epidemiology centers operated under such grants shall be treated as public health authorities for purposes of the Health Insurance Portability and Accountability Act of 1968. Eligible intertribal consortia is defined for purposes of this section. Section 210. Comprehensive school health education programs Section 210 authorizes the Secretary to award grants to Indian Tribes, Tribal Organizations, and Urban Indian Organizations to develop comprehensive school health education programs for children from pre-school through grade 12 in schools for the benefit of Indian and Urban Indian children. Upon request, the Secretary shall provide technical assistance to a Tribe, Tribal Organization or Urban Indian Organization. The Secretary shall also establish criteria for the review and approval of grant applications under this section and shall develop a comprehensive school health education program in schools funded by the Bureau of Indian Affairs. Section 211. Indian youth program Section 211 authorizes the Secretary to establish and administer a grant program to be awarded 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 youth. The allowable and prohibited uses of the funds as well as the Secretary's duties are set forth. Section 212. Prevention, control, and elimination of communicable and infectious diseases Section 212 authorizes the Secretary to make grants available to Indian Tribes, Tribal Organizations, and Urban Indian Organizations for the prevention, control, and elimination of communicable and infectious diseases, and other specified related activities. Grant recipients are encouraged to coordinate their activities with the Centers for Disease Control and Prevention and State and local health agencies. Upon request of an Indian Tribe, Tribal Organization, or Urban Indian Organization, the Secretary may provide technical assistance. The Secretary must prepare and submit a report to Congress on the use of funds and the progress made toward preventing, controlling, and eliminating communicable and infectious diseases amongst Indians. Section 213. Authority for provision of other services Section 213 allows the Secretary to provide funding to meet the Declaration of National Indian Health Policy objectives set forth in Section 3 through health care-related services and programs not otherwise described in this bill. Any service provided shall meet the terms and conditions set forth. This section also provides definitions for ``home- and community- based services'' and ``hospice care'' for purposes of this section. Section 214. Indian women's health care Section 214 requires the Secretary to monitor and improve the quality of Indian women's health care through the planning and delivery of programs. Section 215. Environmental and nuclear health hazards Section 215 requires the Secretary, along with other federal agencies, to conduct studies and ongoing monitoring programs to determine trends in the health hazards to Indian miners and to other Indians as a result of environmental hazards which may result in chronic or life threatening health problems. Upon completion of such studies, the Secretary shall develop health care plans to address the studied health problems. The studies shall be submitted to Congress. An Intergovernmental Task Force, composed of various federal agencies, is established to identify existing and potential operations related to nuclear resource development or other environmental hazards that affect or may affect the health of Indians and to undertake activities to correct existing health hazards and ensure that current and future health problems are minimized or reduced. The Indian Health Service shall provide appropriate medical care to Indians who suffer from a work- related illness as a result of employment in or near an environmental hazard. Section 216. Arizona as a contract health service delivery area Section 216 designates the State of Arizona as a contract health service delivery area through the fiscal year ending September 30, 2016 for the purpose of providing contract health care services to members of federally recognized Indian Tribes of Arizona. The Service may not curtail any health care services as a result of this provision. Section 216A. North Dakota and South Dakota as contract health service delivery area Section 216A provides that beginning in fiscal year 2003, the States of North Dakota and South Dakota are designated as a contract health service delivery area for the purpose of providing contract health care services to members of federally recognized Indian Tribes of North Dakota and South Dakota. Section 217. California contract health services program Section 217 authorizes the Secretary to fund a program using the California Rural Indian Health Board as a contract care intermediary to improve the accessibility of health services to California Indians. The Board shall be reimbursed for costs incurred pursuant to this section, however, not more than five percent of the reimbursed amounts may be used for administrative expenses. Payment shall not be made for treatment that may be paid for under the Indian Catastrophic Health Emergency Fund. An advisory board, consisting of not less than eight Tribal Health Programs serving California Indians, shall advise the California Rural Indian Health Board. Section 218. California as a contract health service delivery area Section 218 designates the State of California, excluding specified counties, as a contract health service delivery area for the purpose of providing contract health care services to California Indians. Excluded counties may only be included in the contract health services delivery area if funding is specifically provided by the Service for such services in those counties. Section 219. Contract health services for the Trenton Service Area Section 219 directs the Secretary to provide contract health care services to Turtle Mountain Band members residing in specified counties of the Trenton Service Area. Nothing in this section expands the eligibility of Band members for health services beyond the scope of eligibility for such health services that applied on May 1, 1986. Section 220. Programs operated by Indian tribes and tribal organizations Section 220 requires the Indian Health Service to provide funding to Tribal Health Programs on the same basis as funding is provided to programs and facilities operated directly by the Service. Section 221. Licensing Section 221 exempts Tribal Health Program health care professionals from State licensing requirements for the State in which the Tribal Health Program performs its services pursuant to its contract or compact. Section 222. Notification of provision of emergency contract health services Section 222 provides that elderly or disabled Indians receiving emergency medical care or services from a non-Service provider or in a non-Service facility shall have 30 days to notify the Service of such treatment or admission. Section 223. Prompt action on payment of claims Section 223 establishes a time frame for the Service to respond to a notification of a claim by a contract care service provider. Failure to respond within the time established requires the Service to accept the claim as valid. Payment on valid contract care service claims shall be made within 30 days after completion of the claim. Section 224. Liability for payment Section 224 exempts patients receiving authorized contract health care services from liability for payment of such costs associated with the provision of such services. The Secretary shall notify the contract care provider and the patient that the patient is not liable for payment. Upon receipt of a notice that the claim is accepted or that the patient is not liable, the provider shall have no further recourse against the patient. Section 225. Office of Indian Men's Health Section 225 permits the Secretary to establish an Office of Indian Men's Health within the Service. A Director, appointed by the Secretary, shall head the Office and shall coordinate and promote the health status of Indian men. Not later than two years after enactment of this bill, the Secretary shall submit a report to Congress describing the activities carried out by the Director and any findings by the Director with respect to the health of Indian men. Section 226. Authorization of appropriations Section 226 authorizes appropriations in such sums as necessary for each fiscal year through fiscal year 2017. Title III--Facilities Section 301. Consultation; Construction and renovation of facilities; Reports Section 301 requires the Secretary to take certain actions before expending or committing appropriated funds for facilities planning, design, construction, or renovation. Notwithstanding any other provision of law, the Secretary may not close a facility if the Secretary has not submitted an evaluation report to Congress that addresses the impact of the proposed closure and other specified considerations. The Secretary must maintain a health care priority system. Not later than one year after establishing the priority system, the Comptroller General of the United States shall prepare and finalize a report reviewing the methodologies applied, and the processes followed, by the Service in assessing the needs and developing the priority system. All funds appropriated for the planning, design, construction, or renovation of health care facilities shall be subject to the provisions of the Indian Self-Determination and Education Assistance Act. 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. Section 302. Sanitation facilities Section 302 sets forth findings relating to the need for sanitation facilities and reaffirms that the Service has primary responsibility and authority to provide necessary sanitation facilities and services. Funding sources and terms and conditions on the use of such funding are set forth. The financial and technical capability of an Indian Tribe, Tribal Organization, or Indian community to safely operate, manage, and maintain a sanitation facility shall not be a prerequisite to the provision or construction of sanitation facilities. Financial assistance may be provided to tribes, tribal organizations, and Indian communities for the operation, management, and maintenance of their sanitation facility. Reasonable user fees shall be established, collected, and used as determined by the Tribe. Tribal Health Programs shall be eligible for funding on an equal basis as programs administered by the Service. A report, in accordance with this section, shall be submitted by the Secretary as part of the reporting requirements under section 801. The terms ``Indian community,'' ``Sanitation facility,'' and ``Sanitation facilities'' are defined for purposes of this section. Section 303. Preference to Indians and Indian firms Section 303 authorizes the Secretary to utilize the Buy Indian Act, 25 U.S.C. Sec. 47, in the construction and renovation of Service facilities pursuant to Section 301, and in the construction of sanitation facilities pursuant to Section 302. With regard to subchapter IV of chapter 31 of title 40 of the Act commonly known as the ``Davis-Bacon Act,'' it is the intention of the Committee to maintain current law. When Indian health facilities are constructed or renovated, Davis-Bacon prevailing wage rates apply. However, pursuant to current federal law and longstanding policy of the Department of Labor, Indian Health Service, and Bureau of Indian Affairs, when Indian tribes and tribal organization construct or renovate federally-funded Indian health facilities using their own employees, Davis-Bacon prevailing wage rates do not apply. The intention of the Committee is to maintain the status quo of current law and policy pursuant to the Davis-Bacon Act and the Indian Self-Determination and Education Assistance Act in this regard. Section 304. Expenditure of non-service funds for renovation Section 304 permits the Secretary, if specified requirements are met, to accept any major expansion, renovation, or modernization by any Indian Tribe or Tribal Organization of any Service facility or of any other Indian health facility operated pursuant to a contract or compact. A separate priority list to address the increased operating expenses of expanded, renovated or modernized facilities shall be developed and maintained by the Secretary. The report shall be transmitted to Congress under section 801. Section 305. Funding for the construction, expansion, and modernization of small ambulatory care facilities Section 305 requires the Secretary to make grants to Indian Tribes and Tribal Organizations for the construction, expansion, and modernization of small ambulatory care facilities. Funds may be used as specified in this section. Grants must be approved by the Secretary in accordance with regulations. If grant funds are used on a facility that later is no longer used for the delivery of such health care services, all right, title, and interest in and to the facility shall transfer to the United States unless otherwise negotiated. Grant funds are nonrecurring and may not be included in an ISDEAA award. Section 306. Indian Health Care delivery demonstration project Section 306 authorizes the Secretary to enter into ISDEAA contracts for the purpose of carrying out health care delivery demonstration projects to test alternative means of delivering health care and services to Indians. Funds may be used for the construction and renovation of hospitals, health centers, health stations, and other facilities to deliver health care services. Regulations shall be developed for the review and approval of applications. Projects meeting specified criteria may be approved. Peer review panels may be used to review and evaluate applications. The Secretary may provide technical and other assistance to enable applicants to comply with this section. Priority shall be given to demonstration projects in the following Service Units: Cass Lake, Minnesota; Mescalero, New Mexico; Owyhee, Nevada; Schurz, Nevada; and Fort Yuma, California. The authority to provide services to otherwise ineligible persons and to extend hospital privileges in Service facilities to non-Service health practitioners may be included in a demonstration project. Facilities operated under a contract or compact shall be evaluated under the same criteria that the Secretary uses in evaluating facilities operated directly by the Service. Facilities subject to a contract or compact shall be fully and equitably integrated into the implementation of the health care delivery demonstration projects. Section 307. Land transfer Section 307 authorizes the Bureau of Indian Affairs and all federal agencies and departments to transfer, at no cost, land and improvements to the Service for the provision of health care services. Section 308. Leases, contracts, and other agreements Section 308 authorizes the Secretary to enter into leases, contracts, and other agreements with Indian tribes and Tribal Organizations for facilities used or to be used in the administration and delivery of health services by an Indian Health Program. Section 309. Study on loans, loan guarantees, and loan repayment Section 309 requires the Secretary to study feasibility of establishing a loan fund to provide direct loans and loan guarantees to Indian Tribes and Tribal Organizations for the construction of health care facilities. The study must include certain specified information and be submitted to Congress no later than September 30, 2009. Section 310. Tribal leasing Section 310 authorizes a Tribal Health Program to lease permanent structures for the purpose of providing health care services without obtaining advance approval in appropriations acts. Section 311. Indian Health Service/Tribal Facilities Joint Venture Program Section 311 requires the Secretary to make arrangements with Indian Tribes and Tribal Organizations to establish joint venture demonstration projects, under which an Indian Tribe or Tribal Organization must expend tribal, private, or other available funds to acquire or construct a health facility for a minimum of 10 years, under a no-cost lease. In exchange, the Service would provide the equipment, supplies, and staffing for the operation and maintenance of such health facility. The Secretary is required to make such an arrangement in specified instances and to continue the agreement at the end of the lease period. The Indian Tribe or Tribal Organization shall be liable to the United States for breach of the agreement and the Indian Tribe or Tribal Organization may recover from the United States if the Service breaches the agreement. The terms ``health facility'' or ``health facilities'' are defined for purposes of this section. Section 312. Location of facilities Section 312 requires the Bureau of Indian Affairs and the Service to give priority to locating Service facilities and projects on Indian lands or certain lands in Alaska. The term ``Indian lands'' is defined for purposes of this section. Section 313. Maintenance and improvement of health care facilities Section 313 requires the Secretary to submit to the President, for inclusion in the report required to be transmitted to Congress under section 801, a report on the backlog of maintenance and repair work required at Service and tribal health care facilities and the need for renovation and expansion at existing facilities. The Secretary may provide funds to support maintenance of newly constructed space. An Indian Tribe or Tribal Organization may use maintenance and improvement funds to construct a replacement facility if the costs of renovation exceed a maximum renovation cost threshold. Section 314. Tribal management of Federally-owned quarters Section 314 authorizes a Tribal Health Program operating a health facility and the federally-owned quarters associated with it pursuant to a contract or compact to establish the rental rates charged to the occupants of the such quarters. A Tribal Health Program shall endeavor to achieve specified objectives, and may collect rents directly from federal employees occupying such quarters. Specific provisions govern rental rates for federal employees in Alaska. Section 315. Applicability of Buy American Act requirements Section 315 requires the Secretary to comply with the Buy American Act on all procurements made under section 317. Indian Tribes and Tribal Organizations, however, are exempt from this requirement. Any person who violates the Buy American Act shall be subject to the penalties specified in this section. Section 316. Other funding for facilities Section 316 authorizes the Secretary to accept health care facilities construction funds from any source and to use such funds to plan, design, and construct health care facilities for Indians. In addition, the Secretary may enter into interagency agreements with other federal or state agencies, or other entities and to accept funds to the planning, design, and construction of health care facilities. Standards for the planning, design, and construction of health care facilities serving Indians shall be established by regulation. Section 317. Authorization of appropriations Section 317 authorizes such sums as may be necessary to be appropriated through fiscal year 2017. Title IV--Access to Health Services Section 401. Treatment of payments under Social Security Act health benefits programs Section 401 provides that payments received by an Indian Health Program or by an Urban Indian Organization under title XVIII, XIX, and XXI of the Social Security Act for services provided to Indians shall not be considered in determining appropriations for the provision of health care and services to Indians. Nothing in this Act authorizes the Secretary to provide services to an Indian with coverage under title XVIII, XIX, or XXI of the Social Security Act in preference to an Indian without such coverage. Social Security payments to which a Service facility is entitled shall be placed in a special fund held by the Secretary and used as specified. A Tribal Health Program may elect to directly bill for, and receive Social Security payments for, health care items and services provided. This section cross-references other provisions of the Social Security Act. Section 402. Grants to and contracts with the Service, Indian Tribes, Tribal Organizations, and Urban Indian Organizations to facilitate outreach, enrollment, and coverage of Indians under Social Security Act health benefit programs and other health benefits programs Section 402 requires the Secretary to make grants to or enter into contracts with Indian Tribes and Tribal Organizations to assist such entities in establishing and administering programs on or near reservations and trust lands to assist individual Indians with activities specified in this section. The Secretary shall place any necessary conditions and requirements on the grants or contracts. Urban Indian Organizations may also receive grants and other funding as specified. The Secretary is directed to take such steps as are necessary to facilitate cooperation with, and agreements between, States and the Service, Indian tribes, tribal organizations and Urban Indian Organizations. This section cross-references to other provisions of the Social Security Act. The terms ``Premium'' and ``Cost Sharing'' are defined for purposes of this section. Section 403. Reimbursement from certain third parties of costs of health services Section 403 provides the United States, an Indian Tribe, or Tribal Organization with the right to recovery, in accordance with this section, from an insurance company, health maintenance organization, employee benefit plan, third-party tortfeasor, or any other responsible or liable third party the reasonable charges billed by the Secretary, an Indian Tribe, or Tribal Organization for the provision of health services to any individual to the same extent that such individual would be eligible to receive damages, reimbursement or indemnification for such charges or expenses. With respect to the right of recovery against a State, this section only applies if the injury, illness, or disability is covered under workers' compensation laws or a no-fault automobile accident insurance plan. No state law and no contract provision, insurance policy, or other health care plan or program entered into or renewed after the date of enactment of this Act shall prevent or hinder the right of recovery under this section. Any right of recovery exercised pursuant to this section shall not deny the injured person the right of recovery for that portion of the person's damages not covered under this section. Provisions governing enforcement of the right of recovery are provided. Absent specific written authorization by a Tribal government, the United States shall not have a right of recovery under this section for an injury, illness, or disability covered by a self-insurance plan funded by an Indian Tribe, Tribal Organization, or Urban Indian Organization. A prevailing plaintiff shall be awarded reasonable attorney's fees and costs of litigation. A claim for benefits from specified entities may not be denied based on the format in which the claim is submitted. This section also applies to Urban Indian Organizations. Section 2415 of title 18, United States Code, applies to all actions commenced under this section. Nothing in this section shall be construed to limit any right of recovery available to the United States, an Indian Tribe, or Tribal Organization under the provisions of any applicable federal, state or tribal law. Section 404. Crediting of reimbursements Section 404 provides that, except as provided in section 202(f) and section 807, all reimbursements received or recovered under specified programs shall be credited to the Service, Indian tribe, Tribal Organization or Urban Indian Organization and used as provided in section 401. The Service may not offset or limit any amount obligated to any Service Unit or entity because of reimbursements under this section. Section 405. Purchasing health care coverage Section 405 authorizes Indian Tribes, Tribal Organizations, and Urban Indian Organizations to use funds provided for health benefits under any provision of law, other than those made available under section 402, to purchase health benefits coverages for beneficiaries. The amounts may also be used for the expenses of operating a self-insured plan. Section 406. Sharing arrangements with Federal agencies Section 406 authorizes the Secretary to enter into or expand arrangements for the sharing of medical facilities and services between the Service, Indian Tribes, and Tribal Organizations and the Department of Veterans Affairs and the Department of Defense. The Secretary is prohibited from taking certain actions that would: (1) Impair the priority access of any Indian to health care services provided through the Service and the eligibility of any Indian to receive health services through the Service; (2) the quality of health care services provided to any Indian through the Service; (3) the priority access of any veteran to health care services provided by the Department of Veterans Affairs; (4) the quality of health care services provided by the Department of Veterans Affairs or the Department of Defense; or (5) the eligibility of any Indian who is a veteran to receive health services through the Department of Veterans Affairs. The Department of Defense or the Department of Veterans Affairs shall reimburse the Service, Indian tribe, or Tribal Organization for services provided to beneficiaries eligible for services from either Department. Section 407. Payor of last resort Section 407 mandates that, notwithstanding any federal, state, or local law to the contrary, the Indian Health Programs and health care programs operated by Urban Indian Organizations are the payor of last resort for services provided to eligible persons. Section 408. Nondiscrimination under Federal health care programs in qualifications for reimbursement for services Section 408 requires a federal health care program to accept an entity operated by the Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization as an eligible provider for payment under the program for health care services furnished to an Indian on the same basis as any other provider qualified to participate as a health care services provider under the program. A health care services entity operated by the Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization shall be deemed to have met any State or local licensure or recognition requirements for purposes of participating as a health care services provider in specified circumstances. Certain entities that have been excluded from participating in a federal health care program and certain entities and individuals who have had their license suspended or revoked by a State may not receive payment or reimbursement under the federal health care program. The term ``federal health care program'' is defined for purposes of this section. This section cross-references certain provisions of the Social Security Act. Section 409. Consultation Section 409 cross-references section 1139(d) of the Social Security Act for provisions related to consultation with representatives of Indian Health Programs and Urban Indian Organizations with respect to the health care programs established under Titles XVIII, XIX, and XXI of the Social Security Act. Section 410. State Children's Health Insurance Program (SCHIP) Section 410 cross-references sections of the Social Security Act related to outreach to families of Indian children likely to be eligible for child health assistance under SCHIP and related to ensuring that child health assistance is provided under such program and that payments are made to Indian Health Programs and Urban Indian Organizations. Section 411. Exclusion waiver authority for affected Indian health programs and safe harbor transactions under the Social Security Act Section 411 cross-references the Social Security Act for provisions relating to exclusion waiver authority for affected Indian Health Programs and relating to certain transactions involving Indian Health Programs deemed to be in safe harbors. Section 412. Premium and cost sharing protections and eligibility determinations under Medicaid and SCHIP and protection of certain Indian property from Medicaid estate recovery Section 412 cross-references the Social Security Act for provisions relating to premiums or cost sharing protections for Indians furnished items or services directly by Indian Health Programs or through referral under the contract health service under the Medicaid program; relating rules regarding the treatment of certain property for purposes of determining eligibility; and relating to the protection of certain property from estate recovery provisions under the Medicaid program. Section 413. Treatment under Medicaid and SCHIP managed care Section 413 cross-references the Social Security Act for provisions relating to the treatment of Indians enrolled in a managed care entity under the Medicaid program and Indian Health Programs and Urban Indian Organizations that are providers of items or services to such Indian enrollees. Section 414. Navajo Nation Medicaid Agency feasibility study Section 414 requires the Secretary to study the feasibility of treating the Navajo Nation as a State for purposes of title XIX of the Social Security Act. The study must include certain considerations. A report of the feasibility study must be provided to Congress. Section 415. General exceptions Section 415 provides that the requirements of this Title shall not apply to any excepted benefits described in certain paragraphs of the Public Health Service Act. Section 416. Authorization of appropriations Section 416 authorizes appropriations of such sums as may be necessary for each fiscal year through fiscal year 2017. Title--Health Services for Urban Indians Section 501. Purpose Section 501 states that the purpose of this title is to establish and maintain programs in Urban Centers to make health services more accessible and available to Urban Indians. Section 502. Contracts with, and grants to, urban Indian organizations Section 502 requires the Secretary to enter into contracts with, or make grants to, Urban Indian Organizations to assist in the establishment and administration of programs in Urban Centers that meet the requirements specified in this Title. Section 503. Contracts and grants for the provision of health care and referral services Section 503 requires the Secretary to enter into contracts with, and make grants to, Urban Indian Organizations for the provision of health care and referral services for Urban Indians. Urban Indian Organizations will be selected using criteria prescribed by regulations and that includes certain specified factors. The Secretary shall facilitate access to or provide health promotion, disease prevention services, immunization services, behavioral health services, and child abuse prevention and treatment programs for Urban Indians. Other grants or contracts may be entered into between the Secretary and Urban Indian Organizations to provide or arrange for health care services to Urban Indians. Section 504. Contracts and grants for the determination of unmet health care needs Section 504 authorizes the Secretary to enter into contracts with, or make grants to, Urban Indian Organizations for which there were no contracts or grants entered into under section 503. The purpose of the grants or contracts shall be to assist the Secretary in assessing the health status and health care needs of Urban Indians. Any grant or contract entered into shall include certain requirements. Grants and contracts under this section may not be renewed. Section 505. Evaluations; renewals Section 505 requires the Secretary to develop procedures to evaluate compliance with contract and grant requirements entered into under this Title. Compliance evaluations shall be conducted by the Secretary as set forth in this section. In the event of noncompliance with the requirements, the Secretary shall attempt to resolve with the organization any areas of noncompliance or unsatisfactory performance. If the noncompliance or unsatisfactory performance cannot be resolved and prevented in the future, the Secretary shall not renew the contract or grant with the organization. Section 506. Other contract and grant requirements Section 506 requires that contracts with Urban Indian Organizations entered into pursuant to this title comply with all federal contracting laws and regulations relating to procurement except that in the discretion of the Secretary, contracts may be negotiated without advertising and need not conform to other specified provisions of law. The Secretary is authorized to make contract or grant payments in a single advance payment, in a semiannual or quarterly payment or by reimbursement. Contract provisions may be amended by the Secretary at the request of an Urban Indian Organization. Contracts or grants must assure the fair and uniform provision of services and assistance to Urban Indians. Section 507. Reports and records Section 507 requires each Urban Indian Organization to submit to the Secretary a report containing specified information for each fiscal year that funds are received. Not later than 18 months after the date of enactment of this Act, the Secretary shall submit a report to Congress regarding the health status of, and services provided to, Urban Indians. The contract and grant reports and records of Urban Indian Organizations shall be subject to audit by the Secretary and the Comptroller General of the United States. Annual independent financial audits shall be an allowable cost of any contract or grant under sections 502 and 503. Section 508. Limitation on contract authority Section 508 limits the Secretary's authority to enter into contracts with or award grants to the extent, and in the amount, provided for in appropriations acts. Section 509. Facilities Section 509 authorizes the Secretary to make grants to contractors or grant recipients under this title for the lease, purchase, renovation, construction or expansion of facilities in order to assist contractors or grant recipients in complying with applicable licensure or certification requirements. The Secretary may conduct a study to determine the feasibility of establishing a loan fund to provide direct loans or loan guarantees to Urban Indian Organizations. Section 510. Division of Urban Indian Health Section 510 establishes the Division of Urban Indian Health within the Service to carry out the provisions of this title, provide central oversight of the programs and services authorized under this title, and provide technical assistance to Urban Indian Organizations. Section. 511. Grants for alcohol and substance abuse related services Section 511 authorizes the Secretary to make grants for the provision of health-related services in prevention of, treatment of, rehabilitation of, or school- and community-based education regarding alcohol and substance abuse in urban centers. Each grant shall have specific goals which must be set forth in the grant. The Secretary shall establish the grant criteria and develop a methodology for distributing grants. Section 512. Treatment of certain demonstration projects Section 512 provides that the Tulsa Clinic and Oklahoma City Clinic demonstration projects shall be permanent programs, continue to be treated as Service Units and Operating Units with respect to resource allocation and coordination of care, continue to meet the requirements and definitions of an Urban Indian Organization, and shall not be subject to the ISDEAA. Section 513. Urban NIAAA transferred programs Section 513 requires the Secretary to make grants to, or enter into contracts with, Urban Indian Organizations for the administration of Urban Indian alcohol programs originally established under the National Institute on Alcoholism and Alcohol Abuse. Contracts and grants shall be used to provide support for the continuation of alcohol prevention and treatment services for Urban Indians. The Secretary must evaluate and report to Congress on the activities of these programs not less than every five years. Section 514. Consultation with Urban Indian Organizations Section 514 requires the Secretary to ensure that the Service consults with Urban Indian Organizations. ``Consultation'' is defined for purposes of this section. Section 515. Urban youth treatment center demonstration Section 515 authorizes the Secretary to fund the construction and operation of at least two residential treatment centers in each State meeting specified criteria. Section 516. Grants for diabetes prevention, treatment, and control Section 516 permits the Secretary to make grants to certain Urban Indian Organizations for the provision of services for the prevention and treatment of, and control of the complications resulting from, diabetes among Urban Indians. Each grant must specify the goals to be accomplished under the grant. The Secretary must establish criteria for the grants. Any funds received by an Urban Indian Organization under this Act for the prevention, treatment, and control of diabetes shall be subject to these criteria. Section 517. Community health representatives This section authorizes the Secretary to enter into contracts with, or award grants to, Urban Indian Organizations to employ Indians trained as health service providers through the Community Health Representatives Program. Section 518. Effective date This section mandates that the amendments made pursuant to this title shall become effective on the date of enactment of this Act regardless of whether the Secretary has promulgated implementing regulations. Section 519. Eligibility for services This section mandates that Urban Indians are eligible for, and the ultimate beneficiaries of, health care and referral services provided pursuant to this title. Section 520. Authorization of appropriations This section authorizes appropriations of such sums as may be necessary through fiscal year 2017. Title VI--Organizational Improvements Section 601. Establishment of the Indian Health Service as an Agency of the Public Health Service This section establishes the Indian Health Service within the Public Health Service of the Department of Health and Human Services. An Assistant Secretary of Indian Health shall be appointed by the President, by and with the advice and consent of the Senate, to administer the Service. The duties and authorities of the Assistant Secretary are set forth. Any reference to the Director of the Service in any other federal law, Executive Order, rule, regulation, or delegation of authority or in any document of or relating to the Director of the Service, shall be deemed to refer to the Assistant Secretary. Section 602. Automated management information system This section requires the Secretary to establish an automated management information system for the Service that meets specified requirements. Each Tribal Health Program must be provided with an automated management information system that meets the management information needs of each Program and the Service. Each patient shall have reasonable access to his or her medical or health records held by or on behalf of the Service. The Secretary may enter into contracts, agreements, or joint ventures to enhance information technology in Indian Health Programs and facilities. Section 603. Authorization of appropriations This section authorizes appropriations of such sums as may be necessary through fiscal year 2017. Title VII--Behavioral Health Programs Section 701. Behavioral health prevention and treatment services This section sets forth a number of purposes, plans, and programs for behavioral health prevention and treatment services. The Secretary must encourage Indian Tribes, Tribal Organizations, and Urban Indian Organizations to develop tribal or local plans for Indian Behavioral Health Services. To the extent feasible and if funding is available, the Secretary must provide a comprehensive continuum of behavioral health care and behavioral health services for Indians with services varying by the age of the Indian. An Indian tribe, Tribal Organization, or Urban Indian Organization may establish a community behavioral health plan to identify and coordinate resources and programs. The Secretary shall coordinate behavioral health planning with state and federal agencies. Not later than one year after the date of enactment of the bill, the Secretary shall assess the need for inpatient mental health care among Indians and the availability and cost of such inpatient mental health facilities. Section 702. Memoranda of agreement with the Department of the Interior This section requires the Secretary and the Secretary of the Interior to enter into a memoranda of agreement or to update any existing memoranda of agreement required by the Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 to address specified issues. The agreement must also contain specified provisions. Each memoranda of agreement must be published in the Federal Register. Section 703. Comprehensive behavioral health prevention and treatment program This section requires the Secretary to provide comprehensive behavioral health, prevention, treatment and aftercare programs. Such programs may be provided pursuant to contracts with public and private behavioral health treatment programs. Section 704. Mental health technician program This section requires the Secretary to establish and maintain a mental health technician program to train Indians as mental health technicians and to employ such technicians in the provision of community-based mental health care. High-standard training in mental health care shall be provided to paraprofessionals based on a curriculum developed or approved by the Secretary. The Secretary shall supervise and evaluate the mental health technicians in the training program and shall ensure that the program uses and promotes traditional health care practices of the Indian tribes being served. Section 705. Licensing requirement for mental health care workers This section requires any psychologist, social worker, or marriage and family therapist providing mental health care services to Indians in a clinical setting be licensed in the respective field. In specified situations, a trainee in psychology, social work, or marriage and family therapy may provide mental health care services. Section 706. Indian women treatment programs This section allows the Secretary to make grants to Indian tribes, Tribal Organizations, and Urban Indian Organizations to develop and implement a comprehensive behavioral health prevention, intervention, treatment, and relapse prevention program that specifically addresses the cultural, historical, social, and child care needs of Indian women. Terms governing use of funds are specified. The Secretary shall establish criteria for the review and approval of applications and proposals for funding under this section. Twenty percent of the funds appropriated under this section shall be for grants to Urban Indian Organizations. Section 707. Indian youth program This section requires the Secretary to develop and implement a program for acute detoxification and treatment for Indian youths. The Secretary must construct, renovate, or, as necessary, purchase and appropriately staff and operate at least one youth regional treatment center or treatment network in each area under the jurisdiction of an Area Office. The Secretary may provide intermediate technical behavioral health services to Indian children and adolescents. Federally-owned structures suitable for local residential or regional behavioral health treatment for Indian youths shall be identified and used by the Secretary for such purposes. Guidelines must be established by the Secretary for determining the suitability of any such federally-owned structure for such purposes. The Secretary, Indian Tribes, or Tribal Organizations, in cooperation with the Secretary of the Interior, shall develop and implement in each Service Unit, community-based rehabilitation and follow-up services for Indian youths who are having significant behavioral problems and need long-term treatment after their return to their home community. If appropriate, family members shall be included in the treatment programs provided to Indian youths. The Secretary shall provide programs and services to prevent and treat substance abuse among Indian youths. Data shall be collected by the Secretary with respect to mental health services provided to Indian youth. Section 708. Indian youth telemental health demonstration project This section sets forth the purpose of this section and definitions specific to this section. The Secretary may award grants through demonstration projects to provide telemental health services to Indian youth. The use of funds and priority for awarding funds and eligibility criteria are set forth. The Secretary shall encourage grant recipients to collaborate to enable comparisons about best practices across projects and to submit relevant, declassified project information to the national clearinghouse. Each grant recipient must submit an annual report to the Secretary. At the termination of a demonstration project, the Secretary must submit to Congress a final report containing specified information. This section authorizes $1,500,000 for each of fiscal years 2008 through 2011. Section 709. Inpatient and community-based mental health facilities design, construction, and staffing This section authorizes the Secretary to provide in each Service area, no less than one inpatient mental health care facility, or the equivalent, for Indians with behavioral health problems. The Secretary shall consider the possible conversion of existing, underused Service hospital beds into psychiatric units to meet such need. Section 710. Training and community education This section requires the Secretary to develop and implement or assist Indian Tribes and Tribal Organizations to develop and implement, with each Service Unit or tribal program, a program of community education and behavioral health issues. The Secretary must provide instruction in the area of behavioral health issues to appropriate Bureau of Indian Affairs and Indian Health Service employees and personnel in schools or programs operated under any contract with either the Bureau of Indian Affairs or the Service. In carrying out the education and training programs, the Secretary must develop and provide community-based training models. Section 711. Behavioral health program This section authorizes the Secretary to plan, develop, implement, and carry out programs to deliver innovative community-based behavioral health services to Indians. A grant may be awarded by the Secretary to an Indian Tribe or Tribal Organization to carry out the program. The Secretary may consider specified criteria and shall use the same criteria in evaluating the applications or proposals as used to evaluate other applications or proposals for funding. Section 712. Fetal alcohol disorder programs This section authorizes the Secretary to establish and operate fetal alcohol disorder programs. The Secretary must develop and provide specified services. A Fetal Alcohol Disorder Task Force, consisting of specified entities must be established by the Secretary to advise the Secretary in developing and providing specified services. The Secretary must make grants 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 affected by fetal alcohol disorder. Ten percent of the appropriated funds under this section shall be used for grants to Urban Indian Organizations. Section 713. Child sexual abuse and prevention treatment programs This section requires the Secretary to establish treatment programs for victims of sexual abuse who are Indian children or children in an Indian household, and perpetrators of child sexual abuse who are Indian or members of an Indian household. Funding under this section shall be used for specified purposes. Programs established under this section shall be carried out in coordination with programs and services authorized under the Indian Child Protection and Family Violence Prevention Act. Section 714. Behavioral health research This section requires the Secretary to make grants to, or enter into contracts with, Indian Tribes, Tribal Organizations, Urban Indian Organizations, or appropriate institutions to conduct research on the incidence and prevalence of behavioral health problems among Indians. Research priorities are specified. Section 715. Definitions This section sets forth definitions for purposes of this title. Section 716. Authorization of appropriations This section authorizes such sums as may be necessary to carry out this title. Title VIII--Miscellaneous Section 801. Reports This section requires the Secretary to submit to Congress 21 different reports on specified topics for each fiscal year following enactment of this measure. Section 802. Regulations This section requires the Secretary to initiate procedures to negotiate and promulgate regulations or amendments to regulations necessary to carry out specified titles of this Act. A negotiated rulemaking committee to carry out this section may only include representatives of the United States, Indian Tribes, and Tribal Organizations, a majority of whom shall be nominated by and be representatives of Indian Tribes and Tribal Organizations from each Service Area. The negotiated rulemaking procedures shall be adapted to the unique context of self-governance and the government-to-government relationship between the United States and Indian Tribes. The lack of regulations shall not limit the effect of this Act. The Secretary may repeal any inconsistent regulations. The provisions of this Act shall supersede any conflicting provisions of law in effect on the day before the date of enactment of this Act. The Committee understands the importance of negotiated rulemaking for these titles and sections. Negotiated rulemaking was authorized in 1990 and is now part of the Administrative Procedures Act. Many federal agencies use negotiated rulemaking and one agency has noted several advantages of using negotiated rulemaking.\20\ Negotiated rulemaking will enable Tribal leaders to provide advice and input in the development of regulations throughout the process, which, under the general regulations process, is limited. Given that the regulations will impact the daily lives of tribal members directly, it is important that Indian tribes have input in developing regulations during the entire process. This will result in regulations that are less costly, less burdensome, more efficient to implement, and more likely to address tribal concerns. --------------------------------------------------------------------------- \20\http://www.epa.gov/brownfields/aai/negregfs.html (as of December 18, 2007). --------------------------------------------------------------------------- Section 803. Plan of implementation This section requires the Secretary to submit to Congress a plan explaining the manner and schedule by which the Secretary will implement this Act. Section 804. Availability of funds This section provides that funds made available pursuant to this Act shall remain available until expended. Section 805. Limitation on use of funds appropriated to Indian Health Service This section provides that any limitation on the use of funds contained in an Appropriations bill for the Department for a period with respect to the performance of abortions shall apply for that period contained in the Appropriations bill for the Service. Section 806. Eligibility of California Indians This section sets forth the eligibility criteria for California Indians for health services provided by the Service. Nothing in this section expands 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. Section 807. Health services for ineligible persons This section sets forth the eligibility criteria for health services provided by the Service for individuals who would otherwise be ineligible for such services. For purposes of this section, the term ``eligible Indian'' means any Indian who is eligible for health services provided by the Service without regard to the provisions of this section. Section 808. Reallocation of base resources This section provides that any allocation of Service funds for a fiscal year that reduces by five 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 Congress a report on the proposed changes in allocation of funding. This provision does not apply if the amount appropriated to the Service for a fiscal year is at least five percent less than the amount appropriated to the Service for the previous fiscal year. Section 809. Results of demonstration projects This section requires that the Secretary disseminate to Indian Tribes, Tribal Organizations, and Urban Indian Organizations the findings and results of demonstration projects conducted under this Act. Section 810. Provision of services in Montana This section provides that the Secretary 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 a case titled McNabb for McNabb v. Bowen, 829 F.2d 787 (9th Cir. 1987). Application of this decision in Montana shall not be construed as expressing Congress' intent to require the provision of services consistent with that case in any other State. Section 811. Moratorium This section requires the Indian Health Service to provide services during the period of the moratorium imposed on the implementation of the final rule published in the Federal Register on September 16, 1987 by the Department of Health and Human Services pursuant to the eligibility criteria in effect on September 15, 1987 until the Service has submitted to Congress a budget request reflecting the increased costs associated with the proposed final rule and the request is included in an appropriations act. Section 812. Severability provisions This section provides that 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 shall remain and the application of such provisions to persons or circumstances other than those to which it is held invalid, shall not be affected thereby. Section 813. Establishment of National Bipartisan Commission on Indian Health Care This section establishes the National Bipartisan Indian Health Care Commission. Composition, staffing, meeting and hearing requirements, duties, and compensation of the Commission are set forth. Appropriations are authorized to carry out this section. The Federal Advisory Committee Act shall not apply to the Commission. Section 814. Confidentiality of medical quality assurance records; Qualified immunity for participants This section declares that the medical quality assurance records created by or for any Indian Health Program or a health program of an Urban Indian Organization as part of a medical quality assurance program are confidential and privileged and may not be disclosed to any person or entity, except as provided in this section. The civil liability of a person who releases such records in good faith is limited. The Secretary must promulgate regulations. Definitions for purposes of this section are set forth. Section 815. Appropriations; availability This section provides that any new spending authority, 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. Section 816. Authorization of appropriations This section authorizes such sums as may be necessary to be appropriated for each fiscal year though fiscal year 2017 to carry out this title. Conforming amendments are made to other laws. Section 102. Soboba sanitation facilities This section amends the Act of December 17, 1970 to provide that nothing in this Act precludes the Soboba Indian Reservation from being provided with sanitation facilities and services. Section 103 This section amends the Indian Self-Determination and Education Assistance Act to add a new Title VIII--Native American Health and Wellness Foundation. This new Title VIII provides definitions specific to that title and requires the Secretary to establish a Native American Health and Wellness Foundation. The organic structure of the Foundation is set forth as are the powers and duties of the Foundation. A Committee for the Establishment of Native American Health and Wellness Foundation shall be established by the Secretary to assist the Secretary in establishing the Foundation. The duties of the Committee are set forth in this section. There are authorized to be appropriated $500,000 for each fiscal year and the Secretary is required to transfer to the Foundation funds held by the Department of Health and Human Services under the Act of August 5, 1954, if the transfer or use of the funds is not prohibited by any term under which the funds were donated. Title II--Improvement of Indian Health Care Provided Under the Social Security Act Title II amends specified provisions of the Social Security Act. Section 201. Expansion of payments under Medicare, Medicaid, and SCHIP for all covered services furnished by Indian health programs This section authorizes the Indian Health Service and an Indian Tribe, Tribal Organization, or an Urban Indian Organization to be reimbursed for Medicaid, if applicable conditions and requirements are met. Indian Health Services, tribes, and Tribal and Urban Indian Organizations, which do not meet all applicable conditions and requirements, must make necessary improvements to achieve or maintain compliance with applicable conditions and requirements. The Secretary may enter into an agreement with a State to reimburse a State for Medicaid services provided by the Service, tribal or Urban Indian Organizations. Medicare payments may be made to the Service, Indian tribes, Tribal Organizations, or Urban Indian Organizations, if applicable conditions and requirements are met. If a Service, tribal, or urban Indian organization facility does not meet applicable conditions and requirements, such facility shall make necessary improvements to achieve or maintain compliance. Definitions for terms used in this section are provided. This section cross-references certain provisions of the Social Security Act relating to a special fund and direct billing for both Medicare and Medicaid by a Tribal Health Program or an Urban Indian Organization. Section 202. Increased outreach to Indians under Medicaid and SCHIP and improved cooperation in the provision of items and services to Indians under Social Security Act health benefit programs This section requires the Secretary to encourage States to enroll Indians in the Medicaid and SCHIP programs. The Secretary is also required to take such steps as are necessary to facilitate cooperation with, and agreements between, States and the Service, Indian Tribes, Tribal Organizations, and Urban Indian Organizations with respect to the provision of health care items and services. Definitions for terms used in this section are provided. Section 203. Additional provisions to increase outreach to, and enrollments of, Indians in SCHIP and Medicaid This section exempts outreach activities and enrollment assistance to families of Indian children from the cap on SCHIP payments. Section 204. Premiums and cost sharing protections under Medicaid, eligibility determinations under Medicaid and SCHIP, and protection of certain Indian property from Medicaid estate recovery Section 204 prohibits enrollment fees, premiums, and cost- sharing from being imposed on Indians served at Service, tribal, or Urban Indian health programs or through the referrals to contract health. It also prohibits the reduction of the reimbursement of the Service, tribal, or Urban Indian health program for the fees or cost-sharing. Certain Indian property is exempted from Medicaid estate recovery. Section 205. Nondiscrimination in qualifications for payment for services under Federal health care programs Section 205 permits the Service, an Indian Tribe, Tribal Organization or Urban Indian Organization to be eligible on the same basis as other qualified providers for reimbursement. Payments may not be made to programs excluded from any other federal health care program and if any state licenses were suspended or revoked. Section 206. Consultation on Medicaid, SCHIP, and other health care programs funded under the Social Security Act involving Indian health programs and urban Indian organizations Section 206 maintains the Tribal Technical Advisory Group within the Centers for Medicaid and Medicare Services to provide the Centers with technical assistance and advice. States must establish a process for consultation with tribal and urban health programs on matters relating to Medicaid which are likely to have a direct effect on Indians or Indian health programs. Section 207. Exclusion waiver authority for affected Indian health programs and safe harbor transactions under the Social Security Act Section 207 authorizes the Secretary to waive an exclusion under the Social Security Act for an Indian health program upon the request of the Indian health program. Certain transactions between the Indian health programs or patients may not be considered remuneration under Section 1128B of the Social Security Act. Section 208. Rules applicable under Medicaid and SCHIP to managed care entities with respect to Indian enrollees and Indian health care providers and Indian managed care entities Section 208 permits Indians, enrolled in a non-Indian managed care entity with an Indian health program participating in the network, to choose the Indian health program as the primary care provider. Non-Indian managed care entities with significant Indian enrollees must meet certain requirements. The Indian health programs are required to comply with all generally applicable Medicaid requirements to the extent the requirements do not conflict with other federal statutes applicable to the Indian health programs. Special rules are applicable to Indian managed care entities. In regard to Medicaid managed care program, if a health care provider is required to have medical malpractice insurance as a condition of contracting with a Medicaid managed care entity, an Indian health care provider would be deemed to satisfy such a requirement in specified instances. Section 209. Annual Report on Indians served by Social Security Act health benefit programs Section 209 requires the Secretary to submit annual reports to Congress regarding the enrollment and health status of Indians receiving items or services under health benefit programs funded under this Act. Committee Oversight Findings and Recommendations Regarding clause 2(b)(1) of rule X and clause 3(c)(1) of rule XIII of the Rules of the House of Representatives, the Committee on Natural Resources' oversight findings and recommendations are reflected in the body of this report. Constitutional Authority Statement Article I, section 8, clause 3 of the Constitution of the United States grants Congress the authority to enact this bill. Compliance With House Rule XIII 1. Cost of Legislation. Clause 3(d)(2) of rule XIII of the Rules of the House of Representatives requires an estimate and a comparison by the Committee of the costs which would be incurred in carrying out this bill. However, clause 3(d)(3)(B) of that rule provides that this requirement does not apply when the Committee has included in its report a timely submitted cost estimate of the bill prepared by the Director of the Congressional Budget Office under section 402 of the Congressional Budget Act of 1974. 2. Congressional Budget Act. As required by clause 3(c)(2) of rule XIII of the Rules of the House of Representatives and section 308(a) of the Congressional Budget Act of 1974, this bill contains several provisions, primarily related to the Medicaid program, that would increase direct spending. 3. General Performance Goals and Objectives. As required by clause 3(c)(4) of rule XIII, the general performance goal or objective of this bill is to amend the Indian Health Care Improvement Act to revise and extend that Act. 4. Congressional Budget Office Cost Estimate. Under clause 3(c)(3) of rule XIII of the Rules of the House of Representatives and section 403 of the Congressional Budget Act of 1974, the Committee has received the following cost estimate for this bill from the Director of the Congressional Budget Office: H.R. 1328--Indian Health Care Improvement Act Amendments of 2007 Summary: H.R. 1328 would authorize the appropriation of such sums as necessary through 2017 for activities under the Indian Health Care Improvement Act, the primary authorizing legislation for the Indian Health Service (IHS). The bill also contains specific authorizations for a program to encourage Indians to pursue careers related to behavioral health, a demonstration project to provide suicide prevention services, a commission on Indian health care, and administrative costs for a new nonprofit corporation. Enacting the bill also would affect direct spending, primarily through provisions affecting the Medicaid program. CBO estimates that implementing H.R. 1328 would cost $2.7 billion in 2008, about $16 billion over the 2008-2012 period, and about $35 billion over the 2008-2017 period, assuming appropriation of the necessary amounts. We also estimate that enacting the bill would increase direct spending by $10 million in 2008, $57 million over the 2008-2012 period, and $137 million over the 2008-2017 period. H.R. 1328 would preempt state licensing laws in certain cases, and this preemption would be an intergovernmental mandate as defined in the Unfunded Mandates Reform Act (UMRA); however, CBO estimates that the costs of that mandate would be small and would not approach the threshold established in UMRA ($66 million in 2007, adjusted annually for inflation). The bill also would place new requirements on Medicaid and the State Children's Health Insurance Program (SCHIP) that would result in additional spending of about $85 million over the 2008-2017 period. Those requirements, however, would not be intergovernmental mandates as defined by UMRA. Other provisions of the bill would benefit tribal governments by establishing new or expanding existing programs for Indian health care. This bill contains no private-sector mandates as defined in UMRA. Estimated Cost to the Federal Government: The estimated budgetary impact of H.R. 1328 is summarized in Table 1. The costs of this legislation fall within budget function 550 (health). TABLE 1.--ESTIMATED BUDGETARY EFFECTS OF H.R. 1328 ------------------------------------------------------------------------ By fiscal year, in millions of dollars-- --------------------------------------- 2008 2009 2010 2011 2012 ------------------------------------------------------------------------ CHANGES IN SPENDING SUBJECT TO APPROPRIATION Estimated Authorization Level... 3,257 3,326 3,402 3,481 3,558 Estimated Outlays............... 2,682 3,141 3,310 3,449 3,534 CHANGES IN DIRECT SPENDING\1\ Estimated Budget Authority...... 9 10 12 12 13 Estimated Outlays............... 10 10 12 12 13 ------------------------------------------------------------------------ \1\Direct spending changes through 2017 are shown in Table 3. Basis of estimate: For the purpose of this estimate, CBO assumes that H.R. 1328 will be enacted near the start of fiscal year 2008 and that the necessary amounts will be appropriated for each year. Spending Subject to Appropriation The estimated effects of H.R. 1328 on spending subject to appropriation for the next five years are detailed in Table 2. Implementing the legislation would result in discretionary costs of about $16 billion over the 2008-2012 period. Because the bill would authorize funding through 2017, such discretionary cost would continue, with an estimated cost of about $35 billion over the 2008-2017 period. TABLE 2.--ESTIMATED EFFECTS OF H.R. 1328 ON DISCRETIONARY SPENDING ---------------------------------------------------------------------------------------------------------------- By fiscal year, in millions of dollars-- ----------------------------------------------- 2007 2008 2009 2010 2011 2012 ---------------------------------------------------------------------------------------------------------------- SPENDING SUBJECT TO APPROPRIATION IHS Spending Under Current Law:\1\ Budget Authority............................................ 3,169 0 0 0 0 0 Estimated Outlays........................................... 3,203 553 164 72 12 2 Proposed Changes: Existing Indian Health Service Activities: Estimated Authorization Level........................... 0 3,247 3,320 3,396 3,475 3,554 Estimated Outlays....................................... 0 2,679 3,134 3,303 3,443 3,529 Recruitment Program for Behavioral Health Careers: Authorization Level..................................... 0 3 3 3 3 3 Estimated Outlays....................................... 0 2 3 3 3 3 Mental Health Demonstration Project: Authorization Level..................................... 0 2 2 2 2 0 Estimated Outlays....................................... 0 * 1 2 2 1 Commission on Indian Health Care: Authorization Level..................................... 0 4 0 0 0 0 Estimated Outlays....................................... 0 1 2 1 0 0 Native American Health and Wellness Foundation: Authorization Level..................................... 0 1 1 1 1 1 Estimated Outlays....................................... 0 * 1 1 1 1 Total Changes: Estimated Authorization Level........................... 0 3257 3,326 3,402 3,481 3,558 Estimated Outlays....................................... 0 2,682 3,141 3,310 3,449 3,534 Spending Under S. 1200: Estimated Authorization Level\1\............................ 3,169 3,257 3,326 3,402 3,481 3,558 Estimated Outlays........................................... 3,203 3,235 3,305 3,382 3,461 3,536 ---------------------------------------------------------------------------------------------------------------- Note: * = less than $500,000. \1\The 2007 level is the amount appropriated for that year for IHS. Existing Indian Health Service Activities. H.R. 1328 would authorize the appropriation of such sums as necessary for the Indian Health Service through 2017. The agency's responsibilities under the bill would be broadly similar to those in current law. In 2007, the agency received an appropriation of $3.2 billion. CBO's estimate of the authorized level for IHS programs is the appropriated amount for 2007 adjusted for inflation in later years. (That level would grow to nearly $4 billion by 2017.) The estimated outlays reflect historical spending patterns for IHS activities. Recruitment Program for Behavioral Health Careers. Section 105 of the bill would authorize the appropriation of $2.7 million annually through 2017 for grants to develop and maintain programs that encourage Indians to pursue careers in a field related to behavioral health. Assuming the appropriation of the authorized amounts, CBO estimates that implementing this provision would cost $2 million in 2008, $13 million over the 2008-2012 period, and $26 million over the 2008-2017 period. Mental Health Demonstration Project. Section 708 would authorize the appropriation of $1.5 million annually for fiscal years 2008 through 2011 for grants to examine the feasibility of using telecommunication technology to provide suicide prevention services to Indians. Assuming the appropriation of the authorized amounts, CBO estimates that implementing this provision would cost less than $500,000 in 2008 and about $6 million over the 2008-2012 period. Commission on Indian Health Care. Section 813 would authorize the appropriation of $4 million for a commission that would examine how the federal government provides health care services to Indians. The members of the commission would have to be appointed within eight months of the bill's enactment and would be required to submit a final report to the Congress no later than 18 months after that. Assuming the appropriation of the authorized amount, CBO estimates that implementing this provision would cost $1 million in 2008, $2 million in 2009, and $1 million in 2010. Native American Health and Wellness Foundation. H.R. 1328 would establish a charitable and nonprofit corporation called the Native American Health and Wellness Foundation to assist federal, state, tribal, and other entities in efforts to further health and wellness activities and opportunities for Indians. The bill would authorize the appropriation of $500,000 annually for the foundation's administrative expenses; this amount would be adjusted in later years for inflation. Assuming the appropriation of the authorized amounts, CBO estimates that implementing this provision would cost less than $500,000 in 2008 and about $2 million over the 2008-2012 period. Direct spending H.R. 1328 contains several provisions, primarily related to the Medicaid program, that would affect direct spending. The bill's estimated effects on direct spending are shown in Table 3. Overall, CBO estimates that enacting the bill would increase direct spending by $10 million in 2008 and $137 million over the 2008-2017 period. TABLE 3.--ESTIMATED EFFECTS OF H.R. 1328 ON DIRECT SPENDING -------------------------------------------------------------------------------------------------------------------------------------------------------- By fiscal year, in millions of dollars-- ------------------------------------------------------------------------------------------- 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2008-2012 2008-2017 -------------------------------------------------------------------------------------------------------------------------------------------------------- CHANGES IN DIRECT SPENDING Exemption from Cost Sharing and Premiums: Medicaid: Estimated Budget Authority.......................... 6 6 7 7 8 9 9 9 10 11 34 82 Estimated Outlays................................... 6 6 7 7 8 9 9 9 10 11 34 82 SCHIP: Budget Authority.................................... 0 0 0 0 0 0 0 0 0 0 0 0 Estimated Outlays................................... 1 * * * * -1 * * * * 2 * Consultation with Indian Health Programs: Estimated Budget Authority.............................. * * 1 1 1 1 1 1 1 1 3 7 Estimated Outlays....................................... * * 1 1 1 1 1 1 1 1 3 7 Medicaid Managed Care Provisions: Estimated Budget Authority.............................. 3 3 4 4 4 5 5 5 6 6 18 45 Estimated Outlays....................................... 3 3 4 4 4 5 5 5 6 6 18 45 Scholarship and Loan Repayment Recovery Fund: Estimated Budget Authority.............................. * * * * * * * * * * 2 4 Estimated Outlays....................................... * * * * * * * * * * 2 4 Total Changes: Estimated Budget Authority.............................. 9 10 12 12 13 15 15 16 17 18 56 137 Estimated Outlays....................................... 10 10 12 12 13 14 15 16 17 18 57 137 -------------------------------------------------------------------------------------------------------------------------------------------------------- Notes: Components may not sum to totals because of rounding. SCHIP is the State Children's Health Insurance Program. *= costs or savings of less than $500,000. IHS-funded health programs are commonly divided into three groups: Those operated directly by the Indian Health Service, those operated by tribes and tribal organizations under self- governance agreements, and those operated by urban Indian organizations. For this estimate, they are referred to collectively as Indian health programs. Exemption from Cost Sharing and Premiums. Section 204 would prohibit Medicaid and SCHIP programs from charging premiums or other cost-sharing payments to Indians for services that are provided directly or upon referral by Indian health programs. The provision also would prohibit states from reducing payments to providers for those services by the amount of cost sharing that Indians otherwise would pay. Medicaid. CBO anticipates that this provision's budgetary effect would stem largely from eliminating cost sharing for referral services. Current law already prohibits Indian health programs from charging cost sharing to Indians who use their services. In addition, Medicaid pays almost all facilities operated by IHS and tribes based on an all-inclusive rate that is not reduced to account for any cost sharing that Indians would otherwise have to pay. Finally, very few states charge premiums to their Medicaid enrollees. Using Medicaid administrative data, CBO estimates that about 280,000 Indians are Medicaid recipients who also use IHS, and that federal Medicaid spending on affected services would be about $225 per person annually in 2008. The amount of affected spending would be relatively low because Medicaid already prohibits cost sharing in many instances, such as long- term care services, emergency services, and services for many children and pregnant women. For the affected spending, CBO assumes that cost-sharing payments by individuals equal 2 percent of total spending--Medicaid law limits the extent to which states can impose cost sharing--and that eliminating cost sharing would increase total spending by about 5 percent as individuals consume more services. Overall, CBO estimates that the provision would increase federal Medicaid spending by $6 million in 2008 and by $82 million over the 2008-2017 period. State Children's Health Insurance Program. SCHIP regulations already prohibit states from charging cost sharing or premiums to Indian children enrolled in the program. As a result, the provision's impact on SCHIP spending largely reflects higher payments to Indian health programs and the use of additional services by adult enrollees that a handful of states cover in waiver programs. The provision's effects would be limited in later years because total funding for the program is capped. On balance, CBO estimates that the additional spending would total less than $500,000 over the 2008-2017 period. Consultation with Indian Health Programs. Section 206 would encourage state Medicaid programs to consult regularly with Indian health programs on outstanding Medicaid issues by allowing states to receive federal matching funds for the cost of those consultations. Those costs would be treated as an administrative expense under Medicaid and divided equally between the federal government and the states. CBO anticipates that a small number of states would take advantage of this provision, increasing federal Medicaid spending by less than $500,000 in 2008 and by $7 million over the 2008-2017 period. Medicaid Managed Care Provisions. Section 208 would make several changes to improve the ability of Indian health programs to receive payments for Indians who receive Medicaid benefits through managed care arrangements. Those changes include: <bullet> Managed care organizations (MCOs) would have to pay Indian health programs at least the rates used for non- preferred providers. States also would have the option of making those payments directly to Indian health programs. <bullet> MCOs would have to accept claims submitted by Indian health programs instead of requiring enrollees to submit claims personally. <bullet> Some requirements that MCOs must now meet to participate in Medicaid would be waived or modified for Indian health programs that seek to operate as MCOs. (For example, MCOs run by Indian health programs would be able to limit enrollment to Indians only.) <bullet> States would be required to offer contracts to Indian health programs seeking to operate their own MCOs. Based on administrative data on Medicaid enrollment and spending for Indians who receive benefits via managed care, CBO estimates that those provisions would increase federal Medicaid spending by $3 million in 2008 and $45 million over the 2008- 2017 period. We anticipate that the additional costs would be relatively modest because some states already use similar rules in their Medicaid managed care programs and Indian health programs would have a limited interest in participating as MCOs. Scholarship and Loan Repayment Recovery Fund. H.R. 1328 would allow the Secretary of Health and Human Services to spend amounts collected for breach of contract from recipients of certain IHS scholarships. Under current law, those funds are deposited in the Treasury and not spent. Because the Secretary's ability to spend those funds would not be subject to appropriation, the provision would increase direct spending. Based on historical information from IHS, CBO estimates that the provision would increase spending by less than $500,000 a year, but would total about $4 million over the 2008-2017 period. Estimated impact on state, local, and tribal governments: Intergovernmental mandates H.R. 1328 would preempt state licensing laws in cases where a health care professional is licensed in one state but is performing services in another state under a contract or compact with a tribal health program. This preemption would be an intergovernmental mandate as defined in the UMRA; however, CBO estimates that the loss of any licensing fees resulting from the mandate would be small and would not approach the threshold established in UMRA ($66 million in 2007, adjusted annually for inflation). Other impacts H.R. 1328 would reauthorize and expand grant and assistance programs available to Indian tribes, tribal organizations, and urban Indian organizations for a range of health care programs, including prevention, treatment, and ongoing care. The bill also would allow IHS and tribal entities to share facilities, and it would authorize joint ventures between IHS and Indian tribes or tribal organizations for the construction and operation of health facilities. The bill would authorize funding for a variety of health services including hospice care, long-term care, public health services, and home and community-based services. The bill would prohibit states from charging cost sharing or premiums in the Medicaid or SCHIP programs to Indians who receive services or benefits through an Indian health program. CBO estimates that the new requirements in the bill would result in additional spending by states of about $85 million over the 2008-2017 period. Those requirements, however, would not be intergovernmental mandates as defined by UMRA because Medicaid and SCHIP provide states with significant flexibility to make programmatic adjustments to accommodate the changes. Some tribal entities, particularly those operating managed care systems, may realize some savings as a result of these provisions. Estimated impact on the private sector: This bill contains no private-sector mandates as defined in UMRA. Previous CBO estimate: On June 8, 2007, CBO issued an estimate for H.R. 1328, the Indian Health Care Improvement Act Amendments of 2007, as ordered reported by the Senate Committee on Indian Affairs on May 10, 2007. There are only minor differences between the two bills, and CBO's estimates for them are identical. Estimate prepared by: Federal Costs: Eric Rollins, Impact on State, Local, and Tribal Governments: Leo Lex, Impact on the Private Sector: Paige Shevlin. Estimate approved by: Peter H. Fontaine, Deputy Assistant Director for Budget Analysis. Compliance With Public Law 104-4 This bill would preempt state licensing laws in certain cases, which would be an intergovernmental mandate, however the Congressional Budget Office estimates that the costs of this mandate would be small and would not approach the threshold established in the Unfunded Mandates Reform Act. Earmark Statement H.R. 1328 does not contain any congressional earmarks, limited tax benefits, or limited tariff benefits as defined in clause 9(d), 9(e) or 9(f) of rule XXI. Preemption of State, Local or Tribal Law This bill would preempt state licensing laws where a health care professional is licensed in one state but is performing services in another state under a contract or compact with a tribal health program. This bill does not preempt local or tribal law. Changes in Existing Law Made by the Bill, as Reported In compliance with clause 3(e) of rule XIII of the Rules of the House of Representatives, changes in existing law made by the bill, as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italic, existing law in which no change is proposed is shown in roman): INDIAN HEALTH CARE IMPROVEMENT ACT AN ACT To implement the Federal responsibility for the care and education of the Indian people by improving the services and facilities of Federal Indian health programs and encouraging maximum participation of Indians in such programs, and for other purposes. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, [That this Act may be cited as the ``Indian Health Care Improvement Act''. [findings [Sec. 2. The Congress finds the following: [(a) Federal health services 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, and resulting responsibility to, the American Indian people. [(b) 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 to be raised to the highest possible level and to encourage the maximum participation of Indians in the planning and management of those services. [(c) Federal health services to Indians have resulted in a reduction in the prevalence and incidence of preventable illnesses among, and unnecessary and premature deaths of, Indians. [(d) Despite such services, the unmet health needs of the American Indian people are severe and the health status of the Indians is far below that of the general population of the United States. [declaration of health objectives [Sec. 3. (a) The Congress hereby declares that it is the policy of this Nation, in fulfillment of its special responsibilities and legal obligation to the American Indian people, to assure the highest possible health status for Indians and urban Indians and to provide all resources necessary to effect that policy. [(b) It is the intent of the Congress that the Nation meet the following health status objectives with respect to Indians and urban Indians by the year 2000: [(1) Reduce coronary heart disease deaths to a level of no more than 100 per 100,000. [(2) Reduce the prevalence of overweight individuals to no more than 30 percent. [(3) Reduce the prevalence of anemia to less than 10 percent among children aged 1 through 5. [(4) Reduce the level of cancer deaths to a rate of no more than 130 per 100,000. [(5) Reduce the level of lung cancer deaths to a rate of no more than 42 per 100,000. [(6) Reduce the level of chronic obstructive pulmonary disease related deaths to a rate of no more than 25 per 100,000. [(7) Reduce deaths among men caused by alcohol- related motor vehicle crashes to no more than 44.8 per 100,000. [(8) Reduce cirrhosis deaths to no more than 13 per 100,000. [(9) Reduce drug-related deaths to no more than 3 per 100,000. [(10) Reduce pregnancies among girls aged 17 and younger to no more than 50 per 1,000 adolescents. [(11) Reduce suicide among men to no more than 12.8 per 100,000. [(12) Reduce by 15 percent the incidence of injurious suicide attempts among adolescents aged 14 through 17. [(13) Reduce to less than 10 percent the prevalence of mental disorders among children and adolescents. [(14) Reduce the incidence of child abuse or neglect to less than 25.2 per 1,000 children under age 18. [(15) Reduce physical abuse directed at women by male partners to no more than 27 per 1,000 couples. [(16) Increase years of healthy life to at least 65 years. [(17) Reduce deaths caused by unintentional injuries to no more than 66.1 per 100,000. [(18) Reduce deaths caused by motor vehicle crashes to no more than 39.2 per 100,000. [(19) Among children aged 6 months through 5 years, reduce the prevalence of blood lead levels exceeding15ug/dl and reduce to zero the prevalence of blood lead levels exceeding 25 ug/dl. [(20) Reduce dental caries (cavities) so that the proportion of children with one or more caries (in permanent or primary teeth) is no more than 45 percent among children aged 6 through 8 and no more than 60 percent among adolescents aged 15. [(21) Reduce untreated dental caries so that the proportion of children with untreated caries (in permanent or primary teeth) is no more than 20 percent among children aged 6 through 8 and no more than 40 percent among adolescents aged 15. [(22) Reduce to no more than 20 percent the proportion of individuals aged 65 and older who have lost all of their natural teeth. [(23) Increase to at least 45 percent the proportion of individuals aged 35 to 44 who have never lost a permanent tooth due to dental caries or periodontal disease. [(24) Reduce destructive periodontal disease to a prevalence of no more than 15 percent among individuals aged 35 to 44. [(25) Increase to at least 50 percent the proportion of children who have received protective sealants on the occlusal (chewing) surfaces of permanent molar teeth. [(26) Reduce the prevalence of gingivitis among individuals aged 35 to 44 to no more than 50 percent. [(27) Reduce the infant mortality rate to no more than 8.5 per 1,000 live births. [(28) Reduce the fetal death rate (20 or more weeks of gestation) to no more than 4 per 1,000 live births plus fetal deaths. [(29) Reduce the maternal mortality rate to no more than 3.3 per 100,000 live births. [(30) Reduce the incidence of fetal alcohol syndrome to no more than 2 per 1,000 live births. [(31) Reduce stroke deaths to no more than 20 per 100,000. [(32) Reverse the increase in end-stage renal disease (requiring maintenance dialysis or transplantation) to attain an incidence of no more than 13 per 100,000. [(33) Reduce breast cancer deaths to no more than 20.6 per 100,000 women. [(34) Reduce deaths from cancer of the uterine cervix to no more than 1.3 per 100,000 women. [(35) Reduce colorectal cancer deaths to no more than 13.2 per 100,000. [(36) Reduce to no more than 11 percent the proportion of individuals who experience a limitation in major activity due to chronic conditions. [(37) Reduce significant hearing impairment to a prevalence of no more than 82 per 1,000. [(38) Reduce significant visual impairment to a prevalence of no more than 30 per 1,000. [(39) Reduce diabetes-related deaths to no more than 48 per 100,000. [(40) Reduce diabetes to an incidence of no more than 2.5 per 1,000 and a prevalence of no more than 62 per 1,000. [(41) Reduce the most severe complications of diabetes as follows: [(A) End-stage renal disease, 1.9 per 1,000. [(B) Blindness, 1.4 per 1,000. [(C) Lower extremity amputation, 4.9 per 1,000. [(D) Perinatal mortality, 2 percent. [(E) Major congenital malformations, 4 percent. [(42) Confine annual incidence of diagnosed AIDS cases to no more than 1,000 cases. [(43) Confine the prevalence of HIV infection to no more than 100 per 100,000. [(44) Reduce gonorrhea to an incidence of no more than 225 cases per 100,000. [(45) Reduce chlamydia trachomatis infections, as measured by a decrease in the incidence of nongonococcal urethritis to no more than 170 cases per 100,000. [(46) Reduce primary and secondary syphilis to an incidence of no more than 10 cases per 100,000. [(47) Reduce the incidence of pelvic inflammatory disease, as measured by a reduction in hospitalization for pelvic inflammatory disease to no more than 250 per 100,000 women aged 15 through 44. [(48) Reduce viral hepatitis B infection to no more than 40 per 100,000 cases. [(49) Reduce indigenous cases of vaccine-preventable diseases as follows: [(A) Diphtheria among individuals aged 25 and younger, 0. [(B) Tetanus among individuals aged 25 and younger, 0. [(C) Polio (wild-type virus), 0. [(D) Measles, 0. [(E) Rubella, 0. [(F) Congenital Rubella Syndrome, 0. [(G) Mumps, 500. [(H) Pertussis, 1,000. [(50) Reduce epidemic-related pneumonia and influenza deaths among individuals aged 65 and older to no more than 7.3 per 100,000. [(51) Reduce the number of new carriers of viral hepatitis B among Alaska Natives to no more than 1 case. [(52) Reduce tuberculosis to an incidence of no more than 5 cases per 100,000. [(53) Reduce bacterial meningitis to no more than 8 cases per 100,000. [(54) Reduce infectious diarrhea by at least 25 percent among children. [(55) Reduce acute middle ear infections among children aged 4 and younger, as measured by days of restricted activity or school absenteeism, to no more than 105 days per 100 children. [(56) Reduce cigarette smoking to a prevalence of no more than 20 percent. [(57) Reduce smokeless tobacco use by youth to a prevalence of no more than 10 percent. [(58) Increase to at least 65 percent the proportion of parents and caregivers who use feeding practices that prevent baby bottle tooth decay. [(59) Increase to at least 75 percent the proportion of mothers who breast feed their babies in the early postpartum period, and to at least 50 percent the proportion who continue breast feeding until their babies are 5 to 6 months old. [(60) Increase to at least 90 percent the proportion of pregnant women who receive prenatal care in the first trimester of pregnancy. [(61) Increase to at least 70 percent the proportion of individuals who have received, as a minimum within the appropriate interval, all of the screening and immunization services and at least one of the counseling services appropriate for their age and gender as recommended by the United States Preventive Services Task Force. [(c) It is the intent of the Congress that the Nation increase the proportion of all degrees in the health professions and allied and associated health profession fields awarded to Indians to 0.6 percent. [(d) The Secretary shall submit to the President, for inclusion in each report required to be transmitted to the Congress under section 801, a report on the progress made in each area of the Service toward meeting each of the objectives described in subsection (b). [definitions [Sec. 4. For purposes of this Act-- [(a) ``Secretary'', unless otherwise designated, means the Secretary of Health and Human Services. [(b) ``Service'' means the Indian Health Service. [(c) ``Indians'' or ``Indian'', unless otherwise designated, means any person who is a member of an Indian tribe, as defined in subsection (d) hereof, except that, for the purpose of sections 102 and 103, such terms shall mean any individual who (1), irrespective of whether he or she lives on or near a reservation, is a member of a tribe, band, or other organized group of Indians, including those tribes, bands, or groups terminated since 1940 and those recognized now or in the future by the State in which they reside, or who is a descendant, in the first or second degree, of any such member, or (2) is an Eskimo or Aleut or other Alaska Native, or (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. [(d) ``Indian tribe'' means any Indian tribe, band, nation, or other organized group or community, including any Alaska Native village or group or regional or village corporation as defined in or established pursuant to the Alaska Native Claims Settlement Act (85 Stat. 688), which is recognized as eligible for the special programs and services provided by the United States to Indians because of their status as Indians. [(e) ``Tribal organization'' means the elected governing body of any Indian tribe or any legally established organization of Indians which is controlled by one or more such bodies or by a board of directors elected or selected by one or more such bodies (or elected by the Indian population to be served by such organization) and which includes the maximum participation of Indians in all phases of its activities. [(f) ``Urban Indian'' means any individual who resides in an urban center, as defined in subsection (g) hereof, and who meets one or more of the four criteria in subsection (c)(1) through (4) of this section. [(g) ``Urban center'' means any community which has a sufficient urban Indian population with unmet health needs to warrant assistance under title V, as determined by the Secretary. [(h) ``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 maximum participation of all interested Indian groups and individuals, which body is capable of legally cooperating with other public and private entities for the purpose of performing the activities described in section 503(a). [(i) ``Area office'' means an administrative entity including a program office, within the Indian Health Service through which services and funds are provided to the service units within a defined geographic area. [(j) ``Service unit'' means-- [(1) an administrative entity within the Indian Health Service, or [(2) a tribe or tribal organization operating health care programs or facilities with funds from the Service under the Indian Self-Determination Act, through which services are provided, directly or by contract, to the eligible Indian population within a defined geographic area. [(k) ``Health promotion'' includes-- [(1) cessation of tobacco smoking, [(2) reduction in the misuse of alcohol and drugs, [(3) improvement of nutrition, [(4) improvement in physical fitness, [(5) family planning, [(6) control of stress, and [(7) pregnancy and infant care (including prevention of fetal alcohol syndrome). [(l) ``Disease prevention'' includes-- [(1) immunizations, [(2) control of high blood pressure, [(3) control of sexually transmittable diseases, [(4) prevention and control of diabetes, [(5) control of toxic agents, [(6) occupational safety and health, [(7) accident prevention, [(8) fluoridation of water, and [(9) control of infectious agents. [(m) ``Service area'' means the geographical area served by each area office. [(n) ``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, an allied health profession, or any other health profession. [(o) ``Substance abuse'' includes inhalant abuse. [(p) ``FAE'' means fetal alcohol effect. [(q) ``FAS'' means fetal alcohol syndrome. TITLE I--INDIAN HEALTH MANPOWER [purpose [Sec. 101. The purpose of this title is to increase the number of Indians entering the health professions and to assure an adequate supply of health professionals to the Service, Indian tribes, tribal organizations, and urban Indian organizations involved in the provision of health care to Indian people. [health professions recruitment program for indians [Sec. 102. (a) The Secretary, acting through the Service, shall make grants to public or nonprofit private health, or educational 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) of this subsection or who are undertaking training necessary to quality them to enroll in any such course of study; or [(3) establishing other programs which the Secretary determines will enhance and facilitate the enrollment of Indians in, and the subsequent pursuit and completion by them of, courses of study referred to in paragraph (1) of this subsection. [(b)(1) No grant may be made under this section unless an application therefor has been submitted to, and approved by, the Secretary. Such application shall be in such form, submitted in such manner, and contain such information, as the Secretary shall by regulation prescribe. The Secretary shall give a preference to applications submitted by Indian tribes or tribal organizations. [(2) The amount of any grant under this section shall be determined by the Secretary. Payments pursuant to grants under this section may be made in advance or by way of reimbursement, and at such intervals and on such conditions as the Secretary finds necessary. [health professions preparatory scholarship program for indians [Sec. 103. (a) The Secretary, acting through the Service, shall make scholarship grants 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) Scholarship grants made pursuant to this section shall be for the following purposes: [(1) Compensatory preprofessional education of any grantee, such scholarship not to exceed two years on a full-time basis (or the part-time equivalent thereof, as determined by the Secretary). [(2) Pregraduate education of any grantee 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 Secretary). [(c) Scholarship grants made under this section may cover costs of tuition, books, transportation, board, and other necessary related expenses of a grantee while attending school. [(d) The Secretary shall not deny scholarship assistance to an eligible applicant under this section solely on the basis of the applicant's scholastic achievement if such applicant has been admitted to, or maintained good standing at, an accredited institution. [(e) The Secretary shall not deny scholarship assistance to an eligible applicant under this section solely by reason of such applicant's eligibility for assistance or benefits under any other Federal program. [indian health professions scholarships [Sec. 104. (a) In order to provide health professionals to Indians, Indian tribes, tribal organizations, and urban Indian organizations, the Secretary, acting through the Service and in accordance with this section, shall make scholarship grants to Indians who are enrolled full or part time in appropriately accredited schools and pursuing courses of study in the health professions. Such scholarships shall be designated Indian Health Scholarships and shall be made in accordance with section 338A of the Public Health Service Act (42 U.S.C. 254l), except as provided in subsection (b) of this section. [(b)(1) The Secretary, acting through the Service, shall determine who shall receive scholarships under subsection (a) and shall determine the distribution of such scholarships among such health professions on the basis of the relative needs of Indians for additional service in such health professions. [(2) An individual 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). [(3)(A) 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 individual has entered into under that section shall, if that individual is a recipient of an Indian Health Scholarship, be met in full-time practice, by service-- [(i) in the Indian Health Service; [(ii) in a program conducted under a contract entered into under the Indian Self-Determination Act; [(iii) in a program assisted under title V of this Act; [(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; or [(B) At the request of any individual 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 (v) of subparagraph (A). [(C) A recipient of an Indian Health Scholarship may, at the election of the recipient, meet the active duty service obligation described in subparagraph (A) by service in a program specified in that subparagraph that-- [(i) is located on the reservation of the tribe in which the recipient is enrolled; or [(ii) serves the tribe in which the recipient is enrolled. [(D) Subject to subparagraph (C), the Secretary, 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. [(4) In the case of an individual 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 Secretary; [(B) the period of obligated service described in paragraph (3)(A) shall be equal to the greater of-- [(i) the part-time equivalent of one year for each year for which the individual was provided a scholarship (as determined by the Secretary); or [(ii) two years; and [(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. [(5)(A) An individual who has, on or after the date of the enactment of this paragraph, entered into a written contract with the Secretary under this section 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) is dismissed from such educational institution for disciplinary reasons, [(iii) voluntarily terminates the training in such an educational institution for which he 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 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 on his behalf, under the contract. [(B) If for any reason not specified in subparagraph (A) an individual breaches his 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 108 in the manner provided for in such subsection. [(C) 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) 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 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) 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) 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) The Secretary shall, acting through the Service, establish a Placement Office to develop and implement a national policy for the placement, to available vacancies within the Service, of Indian Health Scholarship recipients required to meet the active duty service obligation prescribed under section 338C of the Public Health Service Act (42 U.S.C. 254m) without regard to any competitive personnel system, agency personnel limitation, or Indian preference policy. [indian health service extern programs [Sec. 105. (a) Any individual who receives a scholarship grant pursuant to section 104 shall be entitled to employment in the service 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 grant. [(b) Any individual enrolled in a course of study in the health professions may be employed by the Service during any nonacademic period of the year. Any such employment shall not exceed one hundred and twenty days during any calendar year. [(c) 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 of Health and Human Services. [continuing education allowances [Sec. 106. (a) In order to encourage physicians, dentists, nurses, and other health professionals to join or continue in the Service and to provide their services in the rural and remote areas where a significant portion of the Indian people resides, the Secretary, acting through the Service, may provide allowances to health professionals employed in the Service to enable them for a period of time each year prescribed by regulation of the Secretary to take leave of their duty stations for professional consultation and refresher training courses. [(b) Of amounts appropriated under the authority of this title for each fiscal year to be used to carry out this section, not more than $1,000,000 may be used to establish postdoctoral training programs for health professionals. [community health representative program [Sec. 107. (a) Under the authority of the Act of November 2, 1921 (25 U.S.C. 13), popularly known as the Snyder Act, the Secretary shall maintain a Community Health Representative Program under which the Service-- [(1) provides for the training of Indians as health paraprofessionals, and [(2) uses such paraprofessionals in the provision of health care, health promotion, and disease prevention services to Indian communities. [(b) The Secretary, acting through the Community Health Representative Program of the Service, shall-- [(1) provide a high standard of training for paraprofessionals to 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. [indian health service loan repayment program [Sec. 108. (a)(1) The Secretary, acting through the Service, shall establish a program to be known as the Indian Health Service Loan Repayment Program (hereinafter referred to 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) For the purposes of this section-- [(A) 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 contract under-- [(I) the Indian Self-Determination Act, or [(II) section 23 of the Act of April 30, 1908 (25 U.S.C. 47), popularly known as the ``Buy-Indian'' Act; or [(iii) by an urban Indian organization pursuant to title V of this Act; and [(B) the term ``State'' has the same meaning given such term in section 331(i)(4) of the Public Health Service Act. [(b) To be eligible to participate in the Loan Repayment Program, an individual must-- [(1)(A) be enrolled-- [(i) in a course of study or program in an accredited 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 [(B) have-- [(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). [(c)(1) 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) 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) The Secretary shall make such application forms, contract forms, and other information available to individuals desiring to participate in the Loan Repayment Program on a date sufficiently early to ensure that such individuals have adequate time to carefully review and evaluate such forms and information. [(d)(1) Consistent with paragraph (3), 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) 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-- [(A) Indians; and [(B) individuals recruited through the efforts of Indian tribes or tribal or Indian organizations. [(3)(A) Subject to subparagraph (B), of the total amounts appropriated for each of the fiscal years 1993, 1994, and 1995 for loan repayment contracts under this section, the Secretary shall provide that-- [(i) not less than 25 percent be provided to applicants who are nurses, nurse practitioners, or nurse midwives; and [(ii) not less than 10 percent be provided to applicants who are mental health professionals (other than applicants described in clause (i)). [(B) The requirements specified in clause (i) or clause (ii) of subparagraph (A) shall not apply if the Secretary does not receive the number of applications from the individuals described in clause (i) or clause (ii), respectively, necessary to meet such requirements. [(e)(1) 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) The Secretary shall provide written notice to an individual promptly on-- [(A) the Secretary's approving, under paragraph (1), of the individual's participation in the Loan Repayment Program, including extensions resulting in an aggregate period of obligated service in excess of 4 years; or [(B) the Secretary's disapproving an individual's participation in such Program. [(f) 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 or 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 (hereinafter in this section referred to as the ``period of obligated service'') equal to 2 years or such longer period as the individual may agree to serve in the full-time clinical practice of such individual's profession in an Indian health program 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. [(g)(1) A loan repayment provided for an individual under a written contract under the Loan Repayment Program shall consist of payment, in accordance with paragraph (2), on behalf of the individual of the principal, interest, and related expenses on government and commercial loans received by the individual regarding the undergraduate or graduate education of the individual (or both), which loans were made for-- [(A) tuition expenses; [(B) all other reasonable educational expenses, including fees, books, and laboratory expenses, incurred by the individual; and [(C) reasonable living expenses as determined by the Secretary. [(2)(A) 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) Any arrangement made by the Secretary for the making of loan repayments in accordance with this subsection shall provide that any repayments for a year of obligated service shall be made no later than the end of the fiscal year in which the individual completes such year of service. [(3) For the purpose of providing reimbursements for tax liability resulting from payments under paragraph (2) on behalf of an individual, the Secretary-- [(A) in addition to such payments, may make payments to the individual in an amount not less than 20 percent and not more than 39 percent of the total amount of loan repayments made for the taxable year involved; and [(B) may make such additional payments as the Secretary determines to be appropriate with respect to such purpose. [(4) 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) 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 of Health and Human Services. [(i) 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) 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) 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. [(l)(1) 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, 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) 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) in which-- [(A) ``A'' is the amount the United States is entitled to recover; [(B) ``Z'' is the sum of the amounts paid under this section to, or on behalf of, the individual and the interest on such amounts which would be payable if, at the time the amounts were paid, they were loans bearing interest at the maximum legal prevailing rate, as determined by the 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. [(3)(A) Any amount of damages which the United States is entitled to recover under this subsection shall be paid to the United States within the 1-year period beginning on the date of the breach or such longer period beginning on such date as shall be specified by the Secretary. [(B) 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) 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)(1) 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) 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) 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) 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) 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 104 with respect to each health profession; [(6) the amount of scholarship grants provided under section 104, 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 three 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 or tribal or Indian organizations for which recruitment or retention is difficult. [scholarship and loan repayment recovery fund [Sec. 108A. (a) There is established in the Treasury of the United States a fund to be known as the Indian Health Scholarship and Loan Repayment Recovery Fund (hereafter in this section referred to as the ``Fund''). The Fund shall consist of such amounts as may be appropriated to the Fund under subsection (b). Amounts appropriated for the Fund shall remain available until expended. [(b) For each fiscal year, there is authorized to be appropriated to the Fund an amount equal to the sum of-- [(1) the amount collected during the preceding fiscal year by the Federal Government pursuant to-- [(A) the liability of individuals under subparagraph (A) or (B) of section 104(b)(5) for the breach of contracts entered into under section 104; and [(B) the liability of individuals under section 108(l) for the breach of contracts entered into under section 108; and [(2) the aggregate amount of interest accruing during the preceding fiscal year on obligations held in the Fund pursuant to subsection (d) and the amount of proceeds from the sale or redemption of such obligations during such fiscal year. [(c)(1) Amounts in the Fund and available pursuant to appropriation Acts may be expended by the Secretary, acting through the Service, to make payments to an Indian tribe or tribal organization administering a health care program pursuant to a contract entered into under the Indian Self- Determination Act-- [(A) to which a scholarship recipient under section 104 or a loan repayment program participant under section 108 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 104 or section 108. [(2) An Indian tribe or tribal organization receiving payments pursuant to paragraph (1) may expend the payments to recruit and employ, directly or by contract, health professionals to provide health care services. [(d)(1) The Secretary of the Treasury shall invest such amounts of the Fund as such Secretary determines are not required to meet current withdrawals from the Fund. 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) Any obligation acquired by the Fund may be sold by the Secretary of the Treasury at the market price. [recruitment activities [Sec. 109. (a) The Secretary may reimburse health professionals seeking positions in the Service, including individuals considering entering into a contract under section 108, 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) 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. [tribal recruitment and retention program [Sec. 110. (a) The Secretary, acting through the Service, shall fund, on a competitive basis, projects to enable Indian tribes and tribal and Indian organizations to recruit, place, and retain health professionals to meet the staffing needs of Indian health programs (as defined in section 108(a)(2)). [(b)(1) Any Indian tribe or tribal or Indian organization may submit an application for funding of a project pursuant to this section. [(2) Indian tribes and tribal and Indian organizations under the authority of the Indian Self-Determination Act shall be given an equal opportunity with programs that are administered directly by the Service to compete for, and receive, grants under subsection (a) for such projects. [advanced training and research [Sec. 111. (a) The Secretary, acting through the Service, shall establish a program to enable health professionals to pursue advanced training or research in areas of study for which the Secretary determines a need exists. In selecting participants for a program established under this subsection, the Secretary, acting through the Service, shall give priority to applicants who are employed by the Indian Health Service, Indian tribes, tribal organizations, and urban Indian organizations, at the time of the submission of the applications. [(b) An individual who participates in a program under subsection (a), where the educational costs are borne by the Service, shall incur an obligation to serve in an Indian health program (as defined in section 108(a)(2)) for a period of obligated service equal to at least the period of time during which the individual participates in such program. In the event that the individual fails to complete such obligated service, the individual shall be liable to the United States for the period of service remaining. In such event, with respect to individuals entering the program after the date of the enactment of the Indian Health Amendments of 1992, 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 108 in the manner provided for in such subsection. [(c) Health professionals from Indian tribes and tribal and Indian organizations under the authority of the Indian Self- Determination Act shall be given an equal opportunity to participate in the program under subsection (a). [nursing program [Sec. 112. (a) The Secretary, acting through the Service, shall provide grants 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 nurse practitioner programs, that are provided by any 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) Grants provided under subsection (a) may be used to-- [(1) recruit individuals for programs which train individuals to be nurses, nurse midwives, or nurse practitioners, [(2) provide scholarships to individuals enrolled in such programs that may pay the tuition charged for such program and other expenses incurred in connection with such program, including books, fees, room and board, and stipends for living expenses, [(3) provide a program that encourages nurses, nurse midwives, and nurse practitioners 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 nurse practitioners, or [(5) provide any program that is designed to achieve the purpose described in subsection (a). [(c) Each application for a grant 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) In providing grants 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 nurse practitioners, [(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) The Secretary shall provide one of the grants authorized under subsection (a) to establish and maintain a program at the University of North Dakota to be known as the ``Quentin N. Burdick American Indians Into Nursing Program''. Such program shall, to the maximum extent feasible, coordinate with the Quentin N. Burdick Indian Health Programs established under section 114(b) and the Quentin N. Burdick American Indians Into Psychology Program established under section 217(b). [(f) The active duty service obligation prescribed under section 338C of the Public Health Service Act (42 U.S.C. 254m) shall be met by each individual who receives training or assistance described in paragraph (1) or (2) of subsection (b) that is funded by a grant provided under subsection (a). Such obligation shall be met by service-- [(A) in the Indian Health Service; [(B) in a program conducted under a contract entered into under the Indian Self-Determination Act; [(C) in a program assisted under title V of this Act; or [(D) 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. [(g) Beginning with fiscal year 1993, of the amounts appropriated under the authority of this title for each fiscal year to be used to carry out this section, not less than $1,000,000 shall be used to provide grants under subsection (a) for the training of nurse midwives, nurse anesthetists, and nurse practitioners. [nursing school clinics [Sec. 112A. (a) Grants.--In addition to the authority of the Secretary under section 112(a)(1), the Secretary, acting through the Service, is authorized to provide grants to public or private schools of nursing for the purpose of establishing, developing, operating, and administering clinics to address the health care needs of Indians, and to provide primary health care services to Indians who reside on or within 50 miles of Indian country, as defined in section 1151 of title 18, United States Code. [(b) Purposes.--Grants provided under subsection (a) may be used to-- [(1) establish clinics, to be run and staffed by the faculty and students of a grantee school, to provide primary care services in areas in or within 50 miles of Indian country (as defined in section 1151 of title 18, United States Code); [(2) provide clinical training, program development, faculty enhancement, and student scholarships in a manner that would benefit such clinics; and [(3) carry out any other activities determined appropriate by the Secretary. [(c) Amount and Conditions.--The Secretary may award grants under this section in such amounts and subject to such conditions as the Secretary deems appropriate. [(d) Design.--The clinics established under this section shall be designed to provide nursing students with a structured clinical experience that is similar in nature to that provided by residency training programs for physicians. [(e) Regulations.--The Secretary shall prescribe such regulations as may be necessary to carry out the provisions of this section. [(f) Authorization To Use Amounts.--Out of amounts appropriated to carry out this title for each of the fiscal years 1993 through 2000 not more than $5,000,000 may be used to carry out this section. [tribal culture and history [Sec. 113. (a) The Secretary, acting through the Service, shall establish a program under which appropriate employees of the Service who serve particular Indian tribes shall receive educational instruction in the history and culture of such tribes and in the history of the Service. [(b) To the extent feasible, the program established under subsection (a) shall-- [(1) be carried out 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)), [(2) be developed in consultation with the affected tribal government, and [(3) include instruction in Native American studies. [inmed program [Sec. 114. (a) The Secretary is authorized to provide grants to at least 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'' (hereinafter in this section referred to as ``INMED'') as a means of encouraging Indians to enter the health professions. [(b) The Secretary shall provide one of the grants authorized under subsection (a) to maintain the INMED program at the University of North Dakota, to be known as the ``Quentin N. Burdick Indian Health Programs'', unless the Secretary makes a determination, based upon program reviews, that the program is not meeting the purposes of this section. Such program shall, to the maximum extent feasible, coordinate with the Quentin N. Burdick American Indians Into Psychology Program established under section 217(b) and the Quentin N. Burdick American Indians Into Nursing Program established under section 112(e). [(c)(1) The Secretary shall develop regulations for the competitive awarding of the grants provided under this section. [(2) Applicants for grants provided under this section shall agree to provide a program which-- [(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. [(d) By no later than the date that is 3 years after the date of enactment of the Indian Health Care Amendments of 1988, the Secretary shall submit a report to the Congress on the program established under this section including recommendations for expansion or changes to the program. [health training programs of community colleges [Sec. 115. (a)(1) The Secretary, acting through the Service, shall award grants to community colleges for the purpose of assisting the community college 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 or in a tribal clinic. [(2) 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)(1) The Secretary, acting through the Service, shall award grants to 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) Grants may only be made under this section to a community college which-- [(A) is accredited, [(B) has access to 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 service unit facilities of the Service or at tribal health facilities, [(D) has a qualified staff which has the appropriate certifications, and [(E) is capable of obtaining State or regional accreditation of the program described in subsection (a)(1). [(c) 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) 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) For purposes of this section-- [(1) The term ``community college'' means-- [(A) a tribally controlled community college, or [(B) a junior or community college. [(2) The term ``tribally controlled community college'' has the meaning given to such term by section 2(4) of the Tribally Controlled Community College Assistance Act of 1978. [(3) The term ``junior or community college'' has the meaning given to such term by section 312(e) of the Higher Education Act of 1965 (20 U.S.C. 1058(e)). [additional incentives for health professionals [Sec. 116. (a) The Secretary may provide the incentive special pay authorized under section 302(b) of title 37, United States Code, to civilian medical officers of the Indian Health Service who are assigned to, and serving in, positions included in the list established under subsection (b)(1) for which recruitment or retention of personnel is difficult. [(b)(1) The Secretary shall establish and update on an annual basis a list of positions of health care professionals employed by, or assigned to, the Service for which recruitment or retention is difficult. [(2)(A) The Secretary may pay a bonus to any commissioned officer or civil service employee, other than a commissioned medical officer, dental officer, optometrist, and veterinarian, who is employed in or assigned to, and serving in, a position in the Service included in the list established by the Secretary under paragraph (1). [(B) The total amount of bonus payments made by the Secretary under this paragraph to any employee during any 1-year period shall not exceed $2,000. [(c) The Secretary may establish programs to allow the use of flexible work schedules, and compressed work schedules, in accordance with the provisions of subchapter II of chapter 61 of title 5, United States Code, for health professionals employed by, or assigned to, the Service. [retention bonus [Sec. 117. (a) The Secretary may pay a retention bonus to any physician or nurse employed by, or assigned to, and serving in, the Service 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 included in the list established under section 116(b)(1) for which recruitment or retention of personnel is difficult, [(2) the Secretary determines is needed by the Service, [(3) has-- [(A) completed 3 years of employment with the Service, 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 for continued employment for a period of not less than 1 year. [(b) Beginning with fiscal year 1993, not less than 25 percent of the retention bonuses awarded each year under subsection (a) shall be awarded to nurses. [(c) 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. [(d) The retention bonus for the entire period covered by the agreement described in subsection (a)(4) shall be paid at the beginning of the agreed upon term of service. [(e) Any physician or nurse 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 108(l)(2)(B). [(f) The Secretary may pay a retention bonus to any physician or nurse employed by an organization providing health care services to Indians pursuant to a contract under the Indian Self-Determination Act if such physician or nurse 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. [nursing residency program [Sec. 118. (a) The Secretary, acting through the Service, shall establish a program to enable licensed practical nurses, licensed vocational nurses, and registered nurses who are working in an Indian health program (as defined in section 108(a)(2)(A)), and have done so for a period of not less than one year, to pursue advanced training. [(b) Such program shall include a combination of education and work study in an Indian health program (as defined in section 108(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 a Master's degree. [(c) 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 at least three times the period of time during which the individual participates in such program. In the event that the individual fails to complete such obligated service, the United States shall be entitled to recover from such individual an amount determined in accordance with the formula specified in subsection (l) of section 108 in the manner provided for in such subsection. [community health aide program for alaska [Sec. 119. (a) Under the authority of the Act of November 2, 1921 (25 U.S.C. 13; popularly 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) The Secretary, acting through the Community Health Aide Program of the Service, shall-- [(1) using trainers accredited by the Program, provide a high standard of training to community health aides and community health practitioners to ensure that such aides and practitioners provide quality health care, health promotion, and disease prevention services to the villages served by the Program; [(2) in order to provide such training, develop a curriculum that-- [(A) combines education in the theory of health care with supervised practical experience in the provision of health care; [(B) provides instruction and practical experience in the provision of acute care, emergency care, health promotion, disease prevention, and the efficient and effective management of clinic pharmacies, supplies, equipment, and facilities; and [(C) promotes the achievement of the health status objectives specified in section 3(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 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. [matching grants to tribes for scholarship programs [Sec. 120. (a)(1) The Secretary shall make grants 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. [(2) Amounts available for grants under paragraph (1) for any fiscal year shall not exceed 5 percent of amounts available for such fiscal year for Indian Health Scholarships under section 104. [(3) An application for a grant under paragraph (1) shall be in such form and contain such agreements, assurances, and information as the Secretary determines are necessary to carry out this section. [(b)(1) An Indian tribe or tribal organization receiving a grant under subsection (a) shall agree to provide scholarships to Indians pursuing education in the health professions in accordance with the requirements of this section. [(2) With respect to the costs of providing any scholarship pursuant to paragraph (1)-- [(A) 80 percent of the costs of the scholarship shall be paid from the grant made under subsection (a) to the Indian tribe or tribal organization; and [(B) 20 percent of such costs shall be paid from non- Federal contributions by the Indian tribe or tribal organization through which the scholarship is provided. [(3) In determining the amount of non-Federal contributions that have been provided for purposes of subparagraph (B) of paragraph (2), any amounts provided by the Federal Government to the Indian tribe or tribal organization involved or to any other entity shall not be included. [(4) Non-Federal contributions required by subparagraph (B) of paragraph (2) may be provided directly by the Indian tribe or tribal organization involved or through donations from public and private entities. [(c) An Indian tribe or tribal organization shall provide scholarships under subsection (b) only to Indians enrolled or accepted for enrollment in a course of study (approved by the Secretary) in one of the health professions described in section 104(a). [(d) In providing scholarships under subsection (b), the Secretary and the Indian tribe or tribal organization shall enter into a written contract with each recipient of such scholarship. Such contract shall-- [(1) obligate such recipient to provide service in an Indian health program (as defined in section 108(a)(2)(A)), in the same service area where the Indian tribe or tribal organization providing the scholarship is located, for-- [(A) 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 [(B) such greater period of time as the recipient and the Indian tribe or tribal organization may agree; [(2) provide that the amount of such scholarship-- [(A) may be expended only 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 338A(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 [(B) may not exceed, for any year of attendance for which the scholarship is provided, the total amount required for the year for the purposes authorized in subparagraph (A); [(3) require the recipient of such scholarship to maintain an acceptable level of academic standing (as determined by the educational institution in accordance with regulations issued by the Secretary); and [(4) require the recipient of such scholarship to meet the educational and licensure requirements necessary to be a physician, certified nurse practitioner, certified nurse midwife, or physician assistant. [(e)(1) An individual who has entered into a written contract with the Secretary and an Indian tribe or tribal organization under subsection (d) and who-- [(A) 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), [(B) is dismissed from such educational institution for disciplinary reasons, [(C) voluntarily terminates the training in such an educational institution for which he is provided a scholarship under such contract before the completion of such training, or [(D) fails to accept payment, or instructs the educational institution in which he 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 on his behalf, under the contract. [(2) If for any reason not specified in paragraph (1), an individual breaches his written contract by failing either to begin such individual's service obligation required under such contract or to complete such service obligation, the United States shall be entitled to recover from the individual an amount determined in accordance with the formula specified in subsection (l) of section 108 in the manner provided for in such subsection. [(3) The Secretary may carry out this subsection on the basis of information submitted by the tribes or tribal organizations involved, or on the basis of information collected through such other means as the Secretary determines to be appropriate. [(f) The recipient of a scholarship under subsection (b) shall agree, in providing health care pursuant to the requirements of subsection (d)(1)-- [(1) not to discriminate against an individual seeking such 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 program established in title XIX of such Act; and [(2) to accept assignment under section 1842(b)(3)(B)(ii) of the Social Security Act for all services for which payment may be made under part B of title XVIII of such Act, and to enter into an appropriate agreement with the State agency that administers the State plan for medical assistance under title XIX of such Act to provide service to individuals entitled to medical assistance under the plan. [(g) The Secretary may not make any payments under subsection (a) to an Indian tribe or tribal organization for any fiscal year subsequent to the first fiscal year of such payments unless the Secretary determines that, for the immediately preceding fiscal year, the Indian tribe or tribal organization has complied with requirements of this section. [tribal health program administration [Sec. 121. The Secretary shall, by contract or otherwise, provide training for individuals in the administration and planning of tribal health programs. [university of south dakota pilot program [Sec. 122. (a) The Secretary may make a grant to the School of Medicine of the University of South Dakota (hereafter in this section referred to as ``USDSM'') to establish a pilot program on an Indian reservation at one or more service units in South Dakota to address the chronic manpower shortage in the Aberdeen Area of the Service. [(b) The purposes of the program established pursuant to a grant provided under subsection (a) are-- [(1) to provide direct clinical and practical experience at a service unit to medical students and residents from USDSM and other medical schools; [(2) to improve the quality of health care for Indians by assuring access to qualified health care professionals; and [(3) to provide academic and scholarly opportunities for physicians, physician assistants, nurse practitioners, nurses, and other allied health professionals serving Indian people by identifying and utilizing all academic and scholarly resources of the region. [(c) The pilot program established pursuant to a grant provided under subsection (a) shall-- [(1) incorporate a program advisory board composed of representatives from the tribes and communities in the area which will be served by the program; and [(2) shall be designated as an extension of the USDSM campus and program participants shall be under the direct supervision and instruction of qualified medical staff serving at the service unit who shall be members of the USDSM faculty. [(d) The USDSM shall coordinate the program established pursuant to a grant provided under subsection (a) with other medical schools in the region, nursing schools, tribal community colleges, and other health professional schools. [(e) The USDSM, in cooperation with the Service, shall develop additional professional opportunities for program participants on Indian reservations in order to improve the recruitment and retention of qualified health professionals in the Aberdeen Area of the Service. [authorization of appropriations [Sec. 123. There are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2000 to carry out this title. [TITLE II--HEALTH SERVICES [indian health care improvement fund [Sec. 201. (a) The Secretary is authorized to expend funds which are appropriated under the authority of this section, through the Service, for the purposes of-- [(1) eliminating the deficiencies in 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, and [(4) augmenting the ability of the Service to meet the following health service responsibilities, either through direct or contract care or through contracts entered into pursuant to the Indian Self-Determination Act, with respect to those Indian tribes with the highest levels of health status and resource deficiencies: [(A) clinical care (direct and indirect) including clinical eye and vision care; [(B) preventive health; [(C) dental care (direct and indirect); [(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 Indian practitioners; [(E) emergency medical services; [(F) treatment and control of, and rehabilitative care related to, alcoholism and drug abuse (including fetal alcohol syndrome) among Indians; [(G) accident prevention programs; [(H) home health care; [(I) community health representatives; and [(J) maintenance and repair. [(b)(1) Any funds appropriated under the authority of this section shall not be used to offset or limit any appropriations made to the Service under the Act of November 2, 1921 (25 U.S.C. 13), popularly known as the Snyder Act, or any other provision of law. [(2)(A) Funds appropriated under the authority of this section may be allocated on a service unit basis. The funds allocated to each service unit under this subparagraph shall be used by the service unit to reduce the health status and resource deficiency of each tribe served by such service unit. [(B) The apportionment of funds allocated to a service unit 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. [(c) For purposes of this section-- [(1) The term ``health status and resource deficiency'' means the extent to which-- [(A) the health status objectives set forth in section 3(b) are not being achieved; and [(B) the Indian tribe 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) The health resources available to an Indian tribe include health resources provided by the Service as well as health resources used by the Indian tribe, including services and financing systems provided by any Federal programs, private insurance, and programs of State or local governments. [(3) The Secretary shall establish procedures which allow any Indian tribe to petition the Secretary for a review of any determination of the extent of the health status and resource deficiency of such tribe. [(d)(1) Programs administered by any Indian tribe or tribal organization under the authority of the Indian Self- Determination 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. [(2) If any funds allocated to a tribe or service unit under the authority of this section are used for a contract entered into under the Indian Self-Determination Act, a reasonable portion of such funds may be used for health planning, training, technical assistance, and other administrative support functions. [(e) By no later than the date that is 3 years after the date of enactment of the Indian Health Amendments of 1992, 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 [(4) an estimate of-- [(A) the amount of health service funds appropriated under the authority of this Act, or any other Act, including the amount of any funds transferred to the Service, for the preceding fiscal year which is allocated to each service unit, Indian tribe, or comparable entity; [(B) the number of Indians eligible for health services in each service unit or Indian tribe; and [(C) the number of Indians using the Service resources made available to each service unit or Indian tribe. [(f) Funds appropriated under 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) Nothing in this section is intended to diminish the primary responsibility of the Service to eliminate existing backlogs in unmet health care needs, nor are the provisions of this section intended to discourage the Service from undertaking additional efforts to achieve parity among Indian tribes. [(h) Any funds appropriated under the authority of this section shall be designated as the ``Indian Health Care Improvement Fund''. [catastrophic health emergency fund [Sec. 202. (a)(1) There is hereby established an Indian Catastrophic Health Emergency Fund (hereafter in this section referred to as the ``Fund'') consisting of-- [(A) the amounts deposited under subsection (d), and [(B) the amounts appropriated to the Fund under this section. [(2) The Fund shall be administered by the Secretary, acting through the central office of the Service, solely for the purpose of meeting the extraordinary medical costs associated with the treatment of victims of disasters or catastrophic illnesses who are within the responsibility of the Service. [(3) The Fund shall not be allocated, apportioned, or delegated on a service unit, area office, or any other basis. [(4) No part of the Fund or its administration shall be subject to contract or grant under any law, including the Indian Self-Determination Act. [(b) The Secretary shall, through the promulgation of 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 Fund; [(2) provide that a service unit shall not be eligible for reimbursement for the cost of treatment from the Fund until its cost of treating any victim of such catastrophic illness or disaster has reached a certain threshold cost which the Secretary shall establish at-- [(A) for 1993, not less than $15,000 or not more than $25,000; 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 or facilities of the Service, or [(B) whenever otherwise authorized by the Service, non-Service facilities or providers, in rendering treatment that exceeds such threshold cost; [(4) establish a procedure for payment from the Fund 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 Fund 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) Amounts appropriated to the Fund under this section shall not be used to offset or limit appropriations made to the Service under authority of the Act of November 2, 1921 (25 U.S.C. 13), popularly known as the Snyder Act, or any other law. [(d) There shall be deposited into the Fund 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 Fund. [health promotion and disease prevention services [Sec. 203. (a) The Secretary, acting through the Service, shall provide health promotion and disease prevention services to Indians so as to achieve the health status objectives set forth in section 3(b). [(b) The Secretary shall submit to the President for inclusion in each statement which is required to be submitted to the 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. [diabetes prevention, treatment, and control [Sec. 204. (a) The Secretary, in consultation with the tribes, shall determine-- [(1) by tribe and by Service unit of the Service, the incidence 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 incidence of, and prevent, treat, and control the complications resulting from, diabetes among tribes within that Service unit. [(b) The Secretary shall screen each Indian who receives services from the Service for diabetes and for conditions which indicate a high risk that the individual will become diabetic. Such screening may be done by a tribe or tribal organization operating health care programs or facilities with funds from the Service under the Indian Self-Determination Act. [(c)(1) The Secretary shall continue to maintain through fiscal year 2000 each model diabetes project in existence on the date of the enactment of the Indian Health Amendments of 1992 and located-- [(A) at the Claremore Indian Hospital in Oklahoma; [(B) at the Fort Totten Health Center in North Dakota; [(C) at the Sacaton Indian Hospital in Arizona; [(D) at the Winnebago Indian Hospital in Nebraska; [(E) at the Albuquerque Indian Hospital in New Mexico; [(F) at the Perry, Princeton, and Old Town Health Centers in Maine; [(G) at the Bellingham Health Center in Washington; [(H) at the Fort Berthold Reservation; [(I) at the Navajo Reservation; [(J) at the Papago Reservation; [(K) at the Zuni Reservation; or [(L) in the States of Alaska, California, Minnesota, Montana, Oregon, or Utah. [(2) The Secretary may establish new model diabetes projects under this section taking into consideration applications received under this section from all service areas, except that the Secretary may not establish a greater number of such projects in one service area than in any other service area until there is an equal number of such projects established with respect to all service areas from which the Secretary receives qualified applications during the application period (as determined by the Secretary). [(d) The Secretary shall-- [(1) employ in each area office of the Service at least one diabetes control officer who shall coordinate and manage on a full-time basis activities within that area office 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 incidence of diabetes and the complications from diabetes in that area; [(3) ensure that data collected in each area office regarding diabetes and related complications among Indians is disseminated to all other area offices; and [(4) evaluate the effectiveness of services provided through model diabetes projects established under this section. [(e) Funds appropriated under this section in any fiscal year shall be in addition to base resources appropriated to the Service for that year. [hospice care feasibility study [Sec. 205. (a) The Secretary, acting through the Service and in consultation with representatives of Indian tribes, tribal organizations, Indian Health Service personnel, and hospice providers, shall conduct a study-- [(1) to assess the feasibility and desirability of furnishing hospice care to terminally ill Indians; and [(2) to determine the most efficient and effective means of furnishing such care. [(b) Such study shall-- [(1) assess the impact of Indian culture and beliefs concerning death and dying on the provision of hospice care to Indians; [(2) estimate the number of Indians for whom hospice care may be appropriate and determine the geographic distribution of such individuals; [(3) determine the most appropriate means to facilitate the participation of Indian tribes and tribal organizations in providing hospice care; [(4) identify and evaluate various means for providing hospice care, including-- [(A) the provision of such care by the personnel of a Service hospital pursuant to a hospice program established by the Secretary at such hospital; and [(B) the provision of such care by a community-based hospice program under contract to the Service; and [(5) identify and assess any difficulties in furnishing such care and the actions needed to resolve such difficulties. [(c) Not later than the date which is 12 months after the date of the enactment of this section, the Secretary shall transmit to the Congress a report containing-- [(1) a detailed description of the study conducted pursuant to this section; and [(2) a discussion of the findings and conclusions of such study. [(d) For the purposes of this section-- [(1) the term ``terminally ill'' means any Indian who has a medical prognosis (as certified by a physician) of a life expectancy of six months or less; and [(2) the term ``hospice program'' means any program which satisfies the requirements of section 1861(dd)(2) of the Social Security Act (42 U.S.C. 1395x(dd)(2)); and [(3) 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)). [reimbursement from certain third parties of costs of health services [Sec. 206. (a) Except as provided in subsection (f), the United States, an Indian tribe, or a tribal organization shall have the right to recover the reasonable expenses incurred by the Secretary, an Indian tribe, or a tribal organization in providing health services, through the Service, an Indian tribe, or a 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 expenses if-- [(1) such services had been provided by a nongovernmental provider, and [(2) such individual had been required to pay such expenses and did pay such expenses. [(b) Subsection (a) shall provide a right of recovery against any State only if the injury, illness, or disability for which health services were provided is covered under-- [(1) workers' compensation laws, or [(2) a no-fault automobile accident insurance plan or program. [(c) 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, an Indian tribe, or a tribal organization under subsection (a). [(d) No action taken by the United States, an Indian tribe, or a tribal organization to enforce the right of recovery provided under subsection (a) 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). [(e) The United States, an Indian tribe, or a tribal organization may enforce the right of recovery provided under subsection (a) by-- [(1) intervening or joining in any civil action or proceeding brought-- [(A) by the individual for whom health services were provided by the Secretary, an Indian tribe, or a tribal organization, or [(B) by any representative or heirs of such individual, or [(2) instituting a separate civil action, after providing to such individual, or to the representative or heirs of such individual, notice of the intention of the United States, an Indian tribe, or a tribal organization to institute a separate civil action. [(f) The United States shall not have a right of recovery under this section if the injury, illness, or disability for which health services were provided is covered under a self- insurance plan funded by an Indian tribe or tribal organization. [crediting of reimbursements [Sec. 207. (a) Except as provided in section 202(d), title IV, and section 813 of this Act, all reimbursements received or recovered, under authority of this Act, Public Law 87-693 (42 U.S.C. 2651, et seq.), or any other provision of law, by reason of the provision of health services by the Service or by a tribe or tribal organization under a contract pursuant to the Indian Self-Determination Act 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) The Service may not offset or limit the amount of funds obligated to any service unit or any entity under contract with the Service because of the receipt of reimbursements under subsection (a). [health services research [Sec. 208. Of the amounts appropriated for the Service in any fiscal year, other than amounts made available for the Indian Health Care Improvement Fund, not less than $200,000 shall be available only for research to further the performance of the health service responsibilities of the Service. Indian tribes and tribal organizations contracting with the Service under the authority of the Indian Self-Determination Act shall be given an equal opportunity to compete for, and receive, research funds under this section. [mental health prevention and treatment services [Sec. 209. (a) National Plan for Indian Mental Health Services.--(1) Not later than 120 days after the date of enactment of this section, the Secretary, acting through the Service, shall develop and publish in the Federal Register a final national plan for Indian Mental Health Services. The plan shall include-- [(A) an assessment of the scope of the problem of mental illness and dysfunctional and self-destructive behavior, including child abuse and family violence, among Indians, including-- [(i) the number of Indians served by the Service 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; and [(C) an estimate of the additional funding needed by the Service to meet its responsibilities under the plan. [(2) The Secretary shall submit a copy of the national plan to the Congress. [(b) Memorandum of Agreement.--Not later than 180 days after the date of enactment of this section, the Secretary and the Secretary of the Interior shall develop and enter into a memorandum of agreement under which the Secretaries shall, among other things-- [(1) determine and define the scope and nature of mental illness and dysfunctional and self-destructive behavior, including child abuse and family violence, among Indians; [(2) make an assessment of the existing Federal, tribal, State, local, and private services, resources, and programs available to provide mental health services for Indians; [(3) make an initial determination of the unmet need for additional services, resources, and programs necessary to meet the needs identified pursuant to paragraph (1); [(4)(A) ensure that Indians, as citizens of the United States and of the States in which they reside, have access to mental health services to which all citizens have access; [(B) determine the right of Indians to participate in, and receive the benefit of, such services; and [(C) take actions necessary to protect the exercise of such right; [(5) delineate 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) provide 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 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 subsection (d); and [(8) provide for an annual review of such agreement by the two Secretaries. [(c) Community Mental Health Plan.--(1) The governing body of any Indian tribe may, at its discretion, adopt a resolution for the establishment of a community mental health plan providing for the identification and coordination of available resources and programs to identify, prevent, or treat mental illness or dysfunctional and self-destructive behavior, including child abuse and family violence, among its members. [(2) 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 tribe in the development of such plan. Upon the establishment of such a plan and at the request of the tribe, such officials, as directed by the memorandum of agreement developed pursuant to subsection (c), shall cooperate with the tribe in the implementation of such plan. [(3) Two or more Indian tribes may form a coalition for the adoption of resolutions and the establishment and development of a joint community mental health plan under this subsection. [(4) The Secretary, acting through the Service, may make grants to Indian tribes adopting a resolution pursuant to paragraph (1) to obtain technical assistance for the development of a community mental health plan and to provide administrative support in the implementation of such plan. [(d) Mental Health Training and Community Education Programs.--(1) The Secretary and the Secretary of the Interior, in consultation with representatives of Indian tribes, shall conduct a study and compile a list, of the types of staff positions specified in paragraph (2) whose qualifications include, or should include, training in the identification, prevention, education, referral, or treatment of mental illness or dysfunctional and self-destructive behavior. [(2) 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 and family and child welfare; [(iii) law enforcement and judicial services; and [(iv) alcohol and substance abuse; [(B) staff positions with the Service; and [(C) staff positions similar to those identified in subparagraphs (A) and (B) established and maintained by Indian tribes, including positions established in contracts entered into under the Indian Self- Determination Act. [(3)(A) The appropriate Secretary shall provide training criteria appropriate to each type of position identified in paragraph (2)(A) and ensure that appropriate training has been, or will be, provided to any individual in any such position. With respect to any such individual in a position identified pursuant to paragraph (2)(C), the respective Secretaries shall provide appropriate training to, or provide funds to an Indian tribe for the training of, such individual. In the case of positions funded under a contract entered into under the Indian Self-Determination Act, the appropriate Secretary shall ensure that such training costs are included in the contract, if necessary. [(B) Funds authorized to be appropriated pursuant to this section may be used to provide training authorized by this paragraph for community education programs described in paragraph (5) if a plan adopted pursuant to subsection (d) identifies individuals or employment categories, other than those identified pursuant to paragraph (1), for which such training or community education is deemed necessary or desirable. [(4) Position-specific training criteria described in paragraph (3) shall be culturally relevant to Indians and Indian tribes and shall ensure that appropriate information regarding traditional Indian healing and treatment practices is provided. [(5) The Service shall develop and implement or, upon the request of an Indian tribe, assist such tribe to develop and implement, a program of community education on mental illness and dysfunctional and self-destructive behavior for individuals, as determined in a plan adopted pursuant to subsection (d). In carrying out this paragraph, the Service shall provide, upon the request of an Indian tribe, technical assistance to the Indian tribe to obtain or develop community education and training materials on the identification, prevention, referral, and treatment of mental illness and dysfunctional and self-destructive behavior. [(e) Staffing.--(1) Within 90 days after the date of enactment of this section, the Secretary shall develop a plan under which the Service will increase the health care staff providing mental health services by at least 500 positions within five years after the date of enactment of this section, with at least 200 of such positions devoted to child, adolescent, and family services. Such additional staff shall be primarily assigned to the service unit level for services which shall include outpatient, emergency, aftercare and follow-up, and prevention and education services. [(2) The plan developed under paragraph (1) shall be implemented under the Act of November 2, 1921 (25 U.S.C. 13) popularly known as the ``Snyder Act''. [(f) Staff Recruitment and Retention.--(1) The Secretary shall provide for the recruitment of the additional personnel required by subsection (f) and the retention of all Service personnel providing mental health services. In carrying out this subsection, the Secretary shall give priority to practitioners providing mental health services to children and adolescents with mental health problems. [(2) In carrying out paragraph (1), the Secretary shall develop a program providing for-- [(A) the payment of bonuses (which shall not be more favorable than those provided for under sections 116 and 117) for service in hardship posts; [(B) the repayment of loans (for which the provisions of repayment contracts shall not be more favorable than the repayment contracts under section 108) for health professions education as a recruitment incentive; and [(C) a system of postgraduate rotations as a retention incentive. [(3) This subsection shall be carried out in coordination with the recruitment and retention programs under title I. [(g) Mental Health Technician Program.--(1) Under the authority of the Snyder Act of November 2, 1921 (25 U.S.C. 13), the Secretary shall establish and maintain a Mental Health Technician program within the Service which-- [(A) provides for the training of Indians as mental health technicians; and [(B) employs such technicians in the provision of community-based mental health care that includes identification, prevention, education, referral, and treatment services. [(2) In carrying out paragraph (1)(A), 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. [(3) The Secretary shall supervise and evaluate the mental health technicians in the training program. [(4) The Secretary shall ensure that the program established pursuant to this subsection involves the utilization and promotion of the traditional Indian health care and treatment practices of the Indian tribes to be served. [(h) Mental Health Research.--The Secretary, acting through the Service and in consultation with the National Institute of Mental Health, shall enter into contracts with, or make grants to, appropriate institutions for the conduct of research on the incidence and prevalence of mental disorders among Indians on Indian reservations and in urban areas. Research priorities under this subsection shall include-- [(1) the inter-relationship and inter-dependence of mental disorders with alcoholism, suicide, homicides, accidents, and the incidence of family violence, and [(2) the development of models of prevention techniques. The effect of the inter-relationships and interdependencies referred to in paragraph (1) on children, and the development of prevention techniques under paragraph (2) applicable to children, shall be emphasized. [(i) Facilities Assessment.--Within one year after the date of enactment of this section, 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. [(j) Annual Report.--The Service shall develop methods for analyzing and evaluating the overall status of mental health programs and services for Indians and shall submit to the President, for inclusion in each report required to be transmitted to the Congress under section 801, a report on the mental health status of Indians which shall describe the progress being made to address mental health problems of Indian communities. [(k) Mental Health Demonstration Grant Program.--(1) The Secretary, acting through the Service, is authorized to make grants to Indian tribes and inter-tribal consortia to pay 75 percent of the cost of planning, developing, and implementing programs to deliver innovative community-based mental health services to Indians. The 25 percent tribal share of such cost may be provided in cash or through the provision of property or services. [(2) The Secretary may award a grant for a project under paragraph (1) to an Indian tribe or inter-tribal consortium which meets the following criteria: [(A) The project will address significant unmet mental health needs among Indians. [(B) The project will serve a significant number of Indians. [(C) The project has the potential to deliver services in an efficient and effective manner. [(D) The tribe or consortium has the administrative and financial capability to administer the project. [(E) The project will deliver services in a manner consistent with traditional Indian healing and treatment practices. [(F) The project is coordinated with, and avoids duplication of, existing services. [(3) For purposes of this subsection, the Secretary shall, in evaluating applications for grants for projects to be operated under any contract entered into with the Service under the Indian Self-Determination Act, use the same criteria that the Secretary uses in evaluating any other application for such a grant. [(4) The Secretary may only award one grant under this subsection with respect to a service area until the Secretary has awarded grants for all service areas with respect to which the Secretary receives applications during the application period, as determined by the Secretary, which meet the criteria specified in paragraph (2). [(5) Not later than 180 days after the close of the term of the last grant awarded pursuant to this subsection, the Secretary shall submit to the Congress a report evaluating the effectiveness of the innovative community-based projects demonstrated pursuant to this subsection. Such report shall include findings and recommendations, if any, relating to the reorganization of the programs of the Service for delivery of mental health services to Indians. [(6) Grants made pursuant to this section may be expended over a period of three years and no grant may exceed $1,000,000 for the fiscal years involved. [(l) Licensing Requirement for Mental Health Care Workers.-- 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 contract pursuant to the Indian Self-Determination Act shall-- [(1) in the case of a person employed as a psychologist, be licensed as a clinical psychologist or working under the direct supervision of a licensed clinical 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. [(m) Intermediate Adolescent Mental Health Services.--(1) The Secretary, acting through the Service, may make grants to Indian tribes and tribal organizations to provide intermediate mental health services to Indian children and adolescents, including-- [(A) inpatient and outpatient services; [(B) emergency care; [(C) suicide prevention and crisis intervention; and [(D) prevention and treatment of mental illness, and dysfunctional and self-destructive behavior, including child abuse and family violence. [(2) Funds provided under this subsection may be used-- [(A) to construct or renovate an existing health facility to provide intermediate mental health services; [(B) to hire mental health professionals; [(C) to staff, operate, and maintain an intermediate mental health facility, group home, or youth shelter where intermediate mental health services are being provided; and [(D) to make renovations and hire appropriate staff to convert existing hospital beds into adolescent psychiatric units. [(3) Funds provided under this subsection may not be used for the purposes described in section 216(b)(1). [(4) An Indian tribe or tribal organization receiving a grant under this subsection shall ensure that intermediate adolescent mental health services are coordinated with other tribal, Service, and Bureau of Indian Affairs mental health, alcohol and substance abuse, and social services programs on the reservation of such tribe or tribal organization. [(5) The Secretary shall establish criteria for the review and approval of applications for grants made pursuant to this subsection. [(6) There are authorized to be appropriated to carry out this section $10,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000. [managed care feasibility study [Sec. 210. (a) The Secretary, acting through the Service, shall conduct a study to assess the feasibility of allowing an Indian tribe to purchase, directly or through the Service, managed care coverage for all members of the tribe from-- [(1) a tribally owned and operated managed care plan; or [(2) a State licensed managed care plan. [(b) Not later than the date which is 12 months after the date of the enactment of this section, the Secretary shall transmit to the Congress a report containing-- [(1) a detailed description of the study conducted pursuant to this section; and [(2) a discussion of the findings and conclusions of such study. [california contract health services demonstration program [Sec. 211. (a) The Secretary shall establish a demonstration program to evaluate the use of a contract care intermediary to improve the accessibility of health services to California Indians. [(b)(1) In establishing such program, 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, during the period of the demonstration program, 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 810 with respect to high-cost contract care cases. [(2) Not more than 5 percent of the amounts provided to the Board under this section for any fiscal year may be for reimbursement for administrative expenses incurred by the Board during such fiscal year. [(3) No payment may be made for treatment provided under the demonstration program to the extent 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) There is hereby established an advisory board which shall advise the California Rural Indian Health Board in carrying out the demonstration pursuant to 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 such demonstration, at least one half of whom are not affiliated with the California Rural Indian Health Board. [(d) The demonstration program described in this section shall begin on January 1, 1993, and shall terminate on September 30, 1997. [(e) Not later than July 1, 1998, the California Rural Indian Health Board shall submit to the Secretary a report on the demonstration program carried out under this section, including a statement of its findings regarding the impact of using a contract care intermediary on-- [(1) access to needed health services; [(2) waiting periods for receiving such services; and [(3) the efficient management of high-cost contract care cases. [(f) For the purposes of this section, the term ``high-cost contract care cases'' means those cases in which the cost of the medical treatment provided to an individual-- [(1) would otherwise be eligible for reimbursement from the Catastrophic Health Emergency Fund established under section 202, except that the cost of such treatment does not meet the threshold cost requirement established pursuant to section 202(b)(2); and [(2) exceeds $1,000. [(g) There are authorized to be appropriated for each of the fiscal years 1996 through 2000, such sums as may be necessary to carry out the purposes of this section. [coverage of screening mammography [Sec. 212. The Secretary, through the Service, shall provide for screening mammography (as defined in section 1861(jj) of the Social Security Act) for Indian and urban Indian women 35 years of age or older at a frequency, determined by the Secretary (in consultation with the Director of the National Cancer Institute), appropriate to such women, 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. [patient travel costs [Sec. 213. (a) The Secretary, acting through the Service, shall provide funds for the following patient travel costs associated with receiving health care services provided (either through direct or contract care or through contracts entered into pursuant to the Indian Self-Determination Act) under this Act-- [(1) emergency air transportation; and [(2) nonemergency air transportation where ground transportation is infeasible. [(b) There are authorized to be appropriated to carry out this section $15,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000. [epidemiology centers [Sec. 214. (a)(1) The Secretary shall establish an epidemiology center in each Service area to carry out the functions described in paragraph (3). [(2) To assist such centers in carrying out such functions, the Secretary shall perform the following: [(A) In consultation with the Centers for Disease Control and Indian tribes, develop sets of data (which to the extent practicable, shall be consistent with the uniform data sets used by the States with respect to the year 2000 health objectives) for uniformly defining health status for purposes of the objectives specified in section 3(b). Such sets shall consist of one or more categories of information. The Secretary shall develop formats for the uniform collecting and reporting of information on such categories. [(B) Establish and maintain a system for monitoring the progress made toward meeting each of the health status objectives described in section 3(b). [(3) In consultation with Indian tribes and urban Indian communities, each area epidemiology center established under this subsection shall, with respect to such area-- [(A) collect data relating to, and monitor progress made toward meeting, each of the health status objectives described in section 3(b) using the data sets and monitoring system developed by the Secretary pursuant to paragraph (2); [(B) evaluate existing delivery systems, data systems, and other systems that impact the improvement of Indian health; [(C) assist tribes and urban Indian communities 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) work cooperatively with tribal providers of health and social services in order to avoid duplication of existing services; and [(G) provide 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. [(4) Epidemiology centers established under this subsection shall be subject to the provisions of the Indian Self- Determination Act (25 U.S.C. 450f et seq.). [(5) The director of the Centers for Disease Control shall provide technical assistance to the centers in carrying out the requirements of this subsection. [(6) The Service shall assign one epidemiologist from each of its area offices to each area epidemiology center to provide such center with technical assistance necessary to carry out this subsection. [(b)(1) The Secretary may make grants to Indian tribes, tribal organizations, and eligible intertribal consortia or Indian organizations to conduct epidemiological studies of Indian communities. [(2) An intertribal consortia or Indian organization is eligible to receive a grant under this subsection if-- [(A) it is incorporated for the primary purpose of improving Indian health; and [(B) it is representative of the tribes or urban Indian communities in which it is located. [(3) An application for a grant under this subsection shall be submitted in such manner and at such time as the Secretary shall prescribe. [(4) Applicants for grants under this subsection shall-- [(A) demonstrate the technical, administrative, and financial expertise necessary to carry out the functions described in paragraph (5); [(B) consult and cooperate with providers of related health and social services in order to avoid duplication of existing services; and [(C) demonstrate cooperation from Indian tribes or urban Indian organizations in the area to be served. [(5) A grant awarded under paragraph (1) may be used to-- [(A) carry out the functions described in subsection (a)(3); [(B) provide information to and consult with tribal leaders, urban Indian community leaders, and related health staff, on health care and health services management issues; and [(C) provide, in collaboration with tribes and urban Indian communities, the Service with information regarding ways to improve the health status of Indian people. [(6) There are authorized to be appropriated to carry out the purposes of this subsection not more than $12,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000. [comprehensive school health education programs [Sec. 215. (a) The Secretary, acting through the Service and in consultation with the Secretary of the Interior, may award grants to Indian tribes to develop comprehensive school health education programs for children from preschool through grade 12 in schools located on Indian reservations. [(b) Grants awarded under this section may be used to-- [(1) develop health education curricula; [(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, and fitness; [(7) develop mental health wellness programs; [(8) develop chronic disease prevention programs; [(9) develop substance abuse prevention programs; [(10) develop accident prevention and safety education programs; [(11) develop activities for the prevention and control of communicable diseases; and [(12) develop community and environmental health education programs. [(c) The Secretary shall provide technical assistance to Indian tribes in the development of health education plans, and the dissemination of health education materials and information on existing health programs and resources. [(d) The Secretary shall establish criteria for the review and approval of applications for grants made pursuant to this section. [(e) Recipients of grants under this section shall submit to the Secretary an annual report on activities undertaken with funds provided under this section. Such reports shall include a statement of-- [(1) the number of preschools, elementary schools, and secondary schools served; [(2) the number of students served; [(3) any new curricula established with funds provided under this section; [(4) the number of teachers trained in the health curricula; and [(5) the involvement of parents, members of the community, and community health workers in programs established with funds provided under this section. [(f)(1) The Secretary of the Interior, acting through the Bureau of Indian Affairs and in cooperation with the Secretary, shall develop a comprehensive school health education program for children from preschool through grade 12 in schools operated by the Bureau of Indian Affairs. [(2) Such program shall include-- [(A) school programs on nutrition education, personal health, and fitness; [(B) mental health wellness programs; [(C) chronic disease prevention programs; [(D) substance abuse prevention programs; [(E) accident prevention and safety education programs; and [(F) activities for the prevention and control of communicable diseases. [(3) 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. [(g) There are authorized to be appropriated to carry out this section $15,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000. [indian youth grant program [Sec. 216. (a) The Secretary, acting through the Service, is authorized to make grants to Indian tribes, tribal organizations, and urban Indian organizations for innovative mental and physical disease prevention and health promotion and treatment programs for Indian preadolescent and adolescent youths. [(b)(1) 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 healers; and [(B) develop and provide community training and education. [(2) Funds made available under this section may not be used to provide services described in section 209(m). [(c) The Secretary shall-- [(1) disseminate to Indian tribes 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, provide technical assistance in the implementation of such models. [(d) The Secretary shall establish criteria for the review and approval of applications under this section. [(e) There are authorized to be appropriated to carry out this section $5,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000. [american indians into psychology program [Sec. 217. (a) The Secretary may provide grants 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. [(b) The Secretary shall provide one of the grants authorized under subsection (a) to develop and maintain a program at the University of North Dakota to be known as the ``Quentin N. Burdick American Indians Into Psychology Program''. Such program shall, to the maximum extent feasible, coordinate with the Quentin N. Burdick Indian Health Programs authorized under section 114(b), the Quentin N. Burdick American Indians Into Nursing Program authorized under section 112(e), and existing university research and communications networks. [(c)(1) The Secretary shall issue regulations for the competitive awarding of the grants provided under this section. [(2) Applicants for grants 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 community colleges located on Indian reservations 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 varied fields of psychology through research, clinical, and experiential 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 entities to enhance the education of Indian students; [(F) to the maximum extent feasible, utilizes existing university tutoring, counseling and student support services; and [(G) to the maximum extent feasible, employs qualified Indians in the program. [(d) 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 student who receives a stipend described in subsection (c)(2)(D) that is funded by a grant provided under this section. 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 Act; [(3) in a program assisted under title V of this Act; 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. [prevention, control, and elimination of tuberculosis [Sec. 218. (a) The Secretary, acting through the Service after consultation with the Centers for Disease Control, may make grants to Indian tribes and tribal organizations for-- [(1) projects for the prevention, control, and elimination of tuberculosis; [(2) public information and education programs for the prevention, control, and elimination of tuberculosis; and [(3) education, training, and clinical skills improvement activities in the prevention, control, and elimination of tuberculosis for health professionals, including allied health professionals. [(b) The Secretary may make a grant under subsection (a) only if an application for the grant is submitted to the Secretary and the application is in such form, is made in such manner, and contains the assurances required by subsection (c) and such other agreements, assurances, and information as the Secretary may require. [(c) To be eligible for a grant under subsection (a), an applicant must provide assurances satisfactory to the Secretary that-- [(1) the applicant will coordinate its activities for the prevention, control, and elimination of tuberculosis with activities of the Centers for Disease Control\1\, and State and local health agencies; and [(2) the applicant will submit to the Secretary an annual report on its activities for the prevention, control, and elimination of tuberculosis. [(d) In carrying out this section, the Secretary-- [(1) shall establish criteria for the review and approval of applications for grants under subsection (a), including requirement of public health qualifications of applicants; [(2) shall, subject to available appropriations, make at least one grant under subsection (a) within each area office; [(3) may, at the request of an Indian tribe or tribal organization, provide technical assistance; and [(4) shall prepare and submit a report to the Committee on Energy and Commerce and the Committee on Natural Resources of the House and the Committee on Indian Affairs of the Senate not later than February 1, 1994, and biennially thereafter, on the use of funds under this section and on the progress made toward the prevention, control, and elimination of tuberculosis among Indian tribes and tribal organizations. [(e) The Secretary may, at the request of a recipient of a grant under subsection (a), reduce the amount of such grant by-- [(1) the fair market value of any supplies or equipment furnished the grant recipient; and [(2) the amount of the pay, allowances, and travel expenses of any officer or employee of the Government when detailed to the grant recipient and the amount of any other costs incurred in connection with the detail of such officer or employee, when the furnishing of such supplies or equipment or the detail of such an officer or employee is for the convenience of and at the request of such grant recipient and for the purpose of carrying out a program with respect to which the grant under subsection (a) is made. The amount by which any such grant is so reduced shall be available for payment by the Secretary of the costs incurred in furnishing the supplies or equipment, or in detailing the personnel, on which the reduction of such grant is based, and such amount shall be deemed as part of the grant and shall be deemed to have been paid to the grant recipient. [contract health services payment study [Sec. 219. (a) The Secretary, acting through the Service and in consultation with representatives of Indian tribes and tribal organizations operating contract health care programs under the Indian Self-Determination Act (25 U.S.C. 450f et seq.) or under self-governance compacts, Service personnel, private contract health services providers, the Indian Health Service Fiscal Intermediary, and other appropriate experts, shall conduct a study-- [(1) to assess and identify administrative barriers that hinder the timely payment for services delivered by private contract health services providers to individual Indians by the Service and the Indian Health Service Fiscal Intermediary; [(2) to assess and identify the impact of such delayed payments upon the personal credit histories of individual Indians who have been treated by such providers; and [(3) to determine the most efficient and effective means of improving the Service's contract health services payment system and ensuring the development of appropriate consumer protection policies to protect individual Indians who receive authorized services from private contract health services providers from billing and collection practices, including the development of materials and programs explaining patients' rights and responsibilities. [(b) The study required by subsection (a) shall-- [(1) assess the impact of the existing contract health services regulations and policies upon the ability of the Service and the Indian Health Service Fiscal Intermediary to process, on a timely and efficient basis, the payment of bills submitted by private contract health services providers; [(2) assess the financial and any other burdens imposed upon individual Indians and private contract health services providers by delayed payments; [(3) survey the policies and practices of collection agencies used by contract health services providers to collect payments for services rendered to individual Indians; [(4) identify appropriate changes in Federal policies, administrative procedures, and regulations, to eliminate the problems experienced by private contract health services providers and individual Indians as a result of delayed payments; and [(5) compare the Service's payment processing requirements with private insurance claims processing requirements to evaluate the systemic differences or similarities employed by the Service and private insurers. [(c) Not later than 12 months after the date of the enactment of this section, the Secretary shall transmit to the Congress a report that includes-- [(1) a detailed description of the study conducted pursuant to this section; and [(2) a discussion of the findings and conclusions of such study. [prompt action on payment of claims [Sec. 220. (a) 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) 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) The Service shall pay a completed contract care service claim within 30 days after completion of the claim. [demonstration of electronic claims processing [Sec. 221. (a) Not later than June 15, 1993, the Secretary shall develop and implement, directly or by contract, 2 projects to demonstrate in a pilot setting the use of claims processing technology to improve the accuracy and timeliness of the billing for, and payment of, contract health services. [(b) The Secretary shall conduct one of the projects authorized in subsection (a) in the Service area served by the area office located in Phoenix, Arizona. [liability for payment [Sec. 222. (a) 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) 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. [office of indian women's health care [Sec. 223. There is established within the Service an Office of Indian Women's Health Care to oversee efforts of the Service 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. [authorization of appropriations [Sec. 224. Except as provided in sections 209(m), 211, 213, 214(b)(5), 215, and 216, there are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2000 to carry out this title. [limitation on use of funds [Sec. 225. Amounts appropriated to carry out this title may not be used in a manner inconsistent with the Assisted Suicide Funding Restriction Act of 1997. [TITLE III--HEALTH FACILITIES [consultation; closure of facilities; reports [Sec. 301. (a) 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), popularly known as the Snyder Act, the Secretary, acting through the Service, shall-- [(1) consult with any Indian tribe that would be significantly affected by such expenditure for the purpose of determining and, whenever practicable, honoring tribal preferences concerning size, location, type, and other characteristics of any facility on which such expenditure is to be made, and [(2) ensure, whenever practicable, that such facility meets the standards of the Joint Commission on Accreditation of Health Care Organizations by not later than 1 year after the date on which the construction or renovation of such facility is completed. [(b)(1) Notwithstanding any provision of law other than this subsection, no Service hospital or outpatient health care facility of the Service, or any portion of such a hospital or facility, may be closed if the Secretary has not submitted to the Congress at least 1 year prior to the date such hospital or facility (or portion thereof) is proposed to be closed 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) 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. [(c)(1) 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 health facility priority system of the Service, [(B) the planning, design, construction, and renovation needs for the 10 top-priority inpatient care facilities and the 10 top-priority ambulatory care facilities (together with required staff quarters), [(C) the justification for such order of priority, [(D) the projected cost of such projects, and [(E) the methodology adopted by the Service in establishing priorities under its health facility priority system. [(2) In preparing each report required under paragraph (1) (other than the initial report), the Secretary shall-- [(A) consult with Indian tribes and tribal organizations including those tribes or tribal organizations operating health programs or facilities under any contract entered into with the Service under the Indian Self-Determination Act, and [(B) review the needs of such tribes and tribal organizations for inpatient and outpatient facilities, including their needs for renovation and expansion of existing facilities. [(3) For purposes of this subsection, the Secretary shall, in evaluating the needs of facilities operated under any contract entered into with the Service under the Indian Self- Determination Act, use the same criteria that the Secretary uses in evaluating the needs of facilities operated directly by the Service. [(4) The Secretary shall ensure that the planning, design, construction, and renovation needs of Service and non-Service facilities which are the subject of a contract for health services entered into with the Service under the Indian Self- Determination Act are fully and equitably integrated into the development of the health facility priority system. [(d) 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 Act. [safe water and sanitary waste disposal facilities [Sec. 302. (a) The Congress hereby finds and declares that-- [(1) the provision of safe water supply systems and sanitary sewage and solid waste disposal systems 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 systems; [(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 systems and other preventive health measures; [(4) many Indian homes and communities still lack safe water supply systems and sanitary sewage and solid waste disposal systems; 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 systems and sanitary sewage waste disposal systems as soon as possible. [(b)(1) 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) The Secretary, acting through the Service, is authorized to provide under section 7 of the Act of August 5, 1954\1\ (42 U.S.C. 2004a)-- [(A) financial and technical assistance to Indian tribes and communities in the establishment, training, and equipping of utility organizations to operate and maintain Indian sanitation facilities; [(B) ongoing technical assistance and training in the management of utility organizations which operate and maintain sanitation facilities; and [(C) operation and maintenance assistance for, and emergency repairs to, tribal sanitation facilities when necessary to avoid a health hazard or to protect the Federal investment in sanitation facilities. [(3) Notwithstanding any other provision of law-- [(A) the Secretary of Housing and Urban Affairs is authorized to transfer funds appropriated under the Housing and Community Development Act of 1974 (42 U.S.C. 5301, et seq.) to the Secretary of Health and Human Services, and [(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) Beginning in fiscal year 1990, the Secretary, acting through the Service, shall develop and begin implementation of a 10-year plan to provide safe water supply and sanitation sewage and solid waste disposal facilities to existing Indian homes and communities and to new and renovated Indian homes. [(d) 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)(1) The Secretary is authorized to provide financial assistance to Indian tribes and communities in an amount equal to the Federal share of the costs of operating, managing, and maintaining the facilities provided under the plan described in subsection (c). [(2) For the purposes of paragraph (1), the term ``Federal share'' means 80 percent of the costs described in paragraph (1). [(3) With respect to Indian tribes with fewer than 1,000 enrolled members, the non-Federal portion of the costs of operating, managing, and maintaining such facilities may be provided, in part, through cash donations or in kind property, fairly evaluated. [(f) Programs administered by Indian tribes or tribal organizations under the authority of the Indian Self- Determination 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 or sewage disposal services, on an equal basis with programs that are administered directly by the Service. [(g)(1) 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 sanitation deficiency for each sanitation facilities project of each Indian tribe or community; [(D) the amount of funds necessary to raise all Indian tribes and communities to a level I sanitation deficiency; and [(E) the amount of funds necessary to raise all Indian tribes and communities to zero sanitation deficiency. [(2) 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 care programs or facilities under any contract entered into with the Service under the Indian Self-Determination Act) to determine the sanitation needs of each tribe. [(3) The methodology used by the Secretary in determining sanitation deficiencies for purposes of paragraph (1) shall be applied uniformly to all Indian tribes and communities. [(4) For purposes of this subsection, the sanitation deficiency levels for an Indian tribe or community are as follows: [(A) level I is an Indian tribe or community with a sanitation system-- [(i) which complies with all applicable water supply and pollution control laws, and [(ii) in which the deficiencies relate to routine replacement, repair, or maintenance needs; [(B) level II is an Indian tribe or community with a sanitation system-- [(i) which complies with all applicable water supply and pollution control laws, and [(ii) in which the deficiencies relate to capital improvements that are necessary to improve the facilities in order to meet the needs of such tribe or community for domestic sanitation facilities; [(C) level III is an Indian tribe or community with a sanitation system which-- [(i) has an inadequate or partial water supply and a sewage disposal facility that does not comply with applicable water supply and pollution control laws, or [(ii) has no solid waste disposal facility; [(D) level IV is an Indian tribe or community with a sanitation system which lacks either a safe water supply system or a sewage disposal system; and [(E) level V is an Indian tribe or community that lacks a safe water supply and a sewage disposal system. [(5) For purposes of this subsection, any Indian tribe or community that lacks the operation and maintenance capability to enable its sanitation system to meet pollution control laws may not be treated as having a level I or II sanitation deficiency. [preference to indians and indian firms [Sec. 303. (a) 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 he finds, pursuant to rules and regulations promulgated by him, 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 his finding, shall consider whether the Indian or Indian firm will be deficient with respect to (1) ownership and control by Indians, (2) equipment, (3) bookkeeping and accounting procedures, (4) substantive knowledge of the project or function to be contracted for, (5) adequately trained personnel, or (6) other necessary components of contract performance. [(b) For the purpose of implementing the provisions of this title, the Secretary shall assure that the rates of pay for personnel engaged in the construction or renovation of facilities constructed or renovated in whole or in part by funds made available pursuant to this title are not less than the prevailing local wage rates for similar work as determined in accordance with the Act of March 3, 1931 (40 U.S.C. 276a-- 276a-5, known as the Davis-Bacon Act). [soboba sanitation facilities [Sec. 304. The Act of December 17, 1970 (84 Stat. 1465), is hereby amended by adding the following new section 9 at the end thereof: [``Sec. 9. Nothing in this Act shall preclude the Soboba Band of Mission Indians and the Soboba Indian Reservation from being provided with sanitation facilities and services under the authority of section 7 of the Act of August 5, 1954 (68 Stat 674), as amended by the Act of July 31, 1959 (73 Stat. 267).''. [expenditure of nonservice funds for renovation [Sec. 305. (a)(1) Notwithstanding any other provision of law, the Secretary is authorized to accept any major renovation or modernization by any Indian tribe of any Service facility, or of any other Indian health facility operated pursuant to a contract entered into under the Indian Self-Determination Act, including-- [(A) any plans or designs for such renovation or modernization; and [(B) any 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) The Secretary shall maintain a separate priority list to address the needs of such facilities for personnel or equipment. [(3) 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) The requirements of this subsection are met with respect to any renovation or modernization if-- [(1) the tribe or tribal organization-- [(A) provides notice to the Secretary of its intent to 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 personnel or equipment; and [(2) the renovation or modernization-- [(A) is approved by the appropriate area director of the Service; and [(B) is administered by the tribe in accordance with the rules and regulations prescribed by the Secretary with respect to construction or renovation of Service facilities. [(c) If any Service facility which has been 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 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 renovation or modernization (less the total amount of any funds provided specifically for such facility under any Federal program that were expended for such renovation or modernization) bore to the value of such facility at the time of the completion of such renovation or modernization. [grant program for the construction, expansion, and modernization of small ambulatory care facilities [Sec. 306. (a)(1) The Secretary, acting through the Service, shall make grants 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 in subsection (c)(1)(C)). A grant made under this section may cover up to 100 percent of the costs of such construction, expansion, or modernization. For the purposes of this section, the term ``construction'' includes the replacement of an existing facility. [(2) A grant under paragraph (1) may only be made to a 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 a tribe or tribal organization) pursuant to a contract entered into under the Indian Self- Determination Act. [(b)(1) A grant 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) serve no less than 500 eligible Indians annually; and [(iii) provide ambulatory care in a service area (specified in the contract entered into under the Indian Self-Determination Act) with a population of not less than 2,000 eligible Indians. [(2) The requirements of clauses (ii) and (iii) of paragraph (1)(C) shall not apply to a tribe or tribal organization applying for a grant under this section whose tribal government offices are located on an island. [(c)(1) No grant may be made under this section unless an application for such a grant has been submitted to and approved by the Secretary. An application for a grant under this section shall be submitted in such form and manner as the Secretary shall by regulation prescribe 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 a grant 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) In awarding grants 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) If any facility (or portion thereof) with respect to which funds have been paid under this section, ceases, at any time after completion of the construction, expansion, or modernization carried out with such funds, to be utilized for the purposes of providing ambulatory 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. [indian health care delivery demonstration project [Sec. 307. (a) Health Care Delivery Demonstration Projects.-- The Secretary, acting through the Service, is authorized to enter into contracts with, or make grants 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 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 non-Service Federal funds and non-Federal funds; [(4) permit the use of funds or property donated from any source for project purposes; and [(5) provide for the reversion of donated real or personal property to the donor. [(c) Criteria.--(1) Within 180 days after the date of enactment of this section, the Secretary, after consultation with Indian tribes and tribal organizations, shall develop and publish in the Federal Register criteria for the review and approval of applications submitted under this section. The Secretary may enter into a contract 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) 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)(A) On or before September 30, 1995, the Secretary shall enter into contracts or award grants under this section for a demonstration project in each of the following service units which meets the criteria specified in paragraph (1) and for which a completed application has been received by the Secretary: [(i) Cass Lake, Minnesota. [(ii) Clinton, Oklahoma. [(iii) Harlem, Montana. [(iv) Mescalero, New Mexico. [(v) Owyhee, Nevada. [(vi) Parker, Arizona. [(vii) Schurz, Nevada. [(viii) Winnebago, Nebraska. [(ix) Ft. Yuma, California. [(B) The Secretary may also enter into contracts or award grants under this section taking into consideration applications received under this section from all service areas. The Secretary may not award a greater number of such contracts or grants in one service area than in any other service area until there is an equal number of such contracts or grants awarded with respect to all service areas from which the Secretary receives applications during the application period (as determined by the Secretary) which meet the criteria specified in paragraph (1). [(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 813 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 contract entered into with the Service under the Indian Self-Determination 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, and renovation needs of Service and non-Service facilities which are the subject of a contract for health services entered into with the Service under the Indian Self-Determination Act, are fully and equitably integrated into the implementation of the health care delivery demonstration projects under this section. [(h)(1) The Secretary shall submit to the President, for inclusion in the report which is required to be submitted to the Congress under section 801 for fiscal year 1997, an interim report on the findings and conclusions derived from the demonstration projects established under this section. [(2) The Secretary shall submit to the President, for inclusion in the report which is required to be submitted to the Congress under section 801 for fiscal year 1999, a final report on the findings and conclusions derived from the demonstration projects established under this section, together with legislative recommendations. [land transfer [Sec. 308. 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. [authorization of appropriations [Sec. 309. There are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2000 to carry out this title. [applicability of buy american requirement [Sec. 310. (a) 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 309. [(b) The Secretary shall submit to the Congress a report on the amount of procurements from foreign entities made in fiscal years 1993 and 1994 with funds provided pursuant to the authorization contained in section 309. Such report shall separately indicate the dollar value of items procured with such funds for which the Buy American Act was waived pursuant to the Trade Agreement Act of 1979 or any international agreement to which the United States is a party. [(c) 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 309, pursuant to the debarment, suspension, and ineligibility procedures described in sections 9.400 through 9.409 of title 48, Code of Federal Regulations. [(d) For purposes of this section, the term ``Buy American Act'' means title III of the Act entitled ``An Act making appropriations for the Treasury and Post Office Departments for the fiscal year ending June 30, 1934, and for other purposes'', approved March 3, 1933 (41 U.S.C. 10a et seq.). [TITLE IV--ACCESS TO HEALTH SERVICES [treatment of payments under medicare program [Sec. 401. (a) Any payments received by a hospital or skilled nursing facility of the Service (whether operated by the Service or by an Indian tribe or tribal organization pursuant to a contract under the Indian Self-Determination 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) Nothing in this Act authorizes the Secretary to provide services to an Indian beneficiary with coverage under title XVIII of the Social Security Act, as amended, in preference to an Indian beneficiary without such coverage. [treatment of payments under medicaid program [Sec. 402. (a) 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 used by him (to such extent or in such amounts as are provided in appropriation Acts) exclusively for the purpose of making any improvements in the facilities of such Service which may be necessary to achieve compliance with the applicable conditions and requirements of such title. In making payments from such fund, the Secretary shall ensure that each service unit of the Service receives at least 80 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. [(b) Any payments received by such facility 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. [report [Sec. 403. 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 through title XVIII and XIX of the Social Security Act, as amended. [grants to and contracts with tribal organizations [Sec. 404. (a) The Secretary, acting through the Service, shall make grants to or enter into contracts with 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 section 1818 of part A and sections 1836 and 1837 of part B of title XVIII of the Social Security Act; [(2) pay monthly premiums for coverage due to financial need of such individual; and [(3) apply for medical assistance provided pursuant to title XIX of the Social Security Act. [(b) The Secretary, acting through the Service, shall place conditions as deemed necessary to effect the purpose of this section in any contract or grant which the Secretary makes with any 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 under titles XVIII and XIX of the Social Security Act; [(2) assist individual Indians in becoming familiar with and utilizing such benefits; [(3) provide transportation to such individual Indians to the appropriate offices for enrollment or application for medical assistance; [(4) develop and implement-- [(A) a schedule of income levels to determine the extent of payments of premiums by such organizations for coverage of needy individuals; and [(B) methods of improving the participation of Indians in receiving the benefits provided under titles XVIII and XIX of the Social Security Act. [(c) The Secretary, acting through the Service, may enter into an agreement with an Indian tribe, tribal organization, or urban Indian organization which provides for the receipt and processing of applications for medical assistance under title XIX of the Social Security Act and benefits under title XVIII of the Social Security Act at a Service facility or a health care facility administered by such tribe or organization pursuant to a contract under the Indian Self-Determination Act. [demonstration program for direct billing of medicare, medicaid, and other third party payorsi20 sec. 405. [(a) Establishment of Direct Billing Program.-- [(1) In general.--The Secretary shall establish a program under which Indian tribes, tribal organizations, and Alaska Native health organizations that contract or compact for the operation of a hospital or clinic of the Service under the Indian Self-Determination and Education Assistance Act may elect to directly bill for, and receive payment for, health care services provided by such hospital or clinic for which payment is made under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) (in this section referred to as the ``medicare program''), under a State plan for medical assistance approved under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) (in this section referred to as the ``medicaid program''), 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 (42 U.S.C. 1396d(b)) shall apply for purposes of reimbursement under the medicaid program for health care services directly billed under the program established under this section. [(b) Direct Reimbursement.-- [(1) Use of funds.--Each hospital or clinic participating in the program described in subsection (a) of this section shall be reimbursed directly under the medicare and medicaid programs for services furnished, without regard to the provisions of section 1880(c) of the Social Security Act (42 U.S.C. 1395qq(c)) and sections 402(a) and 813(b)(2)(A), but all funds so reimbursed shall first be used by the hospital or clinic for the purpose of making any improvements in the hospital or clinic that may be necessary to achieve or maintain compliance with the conditions and requirements applicable generally to facilities of such type under the medicare or medicaid programs. Any funds so reimbursed which are in excess of the amount necessary to achieve or maintain such conditions shall be used-- [(A) solely for improving the health resources deficiency level of the Indian tribe; and [(B) in accordance with the regulations of the Service applicable to funds provided by the Service under any contract entered into under the Indian Self-Determination Act (25 U.S.C. 450f et seq.). [(2) Audits.--The amounts paid to the hospitals and clinics participating in the program established under this section shall be subject to all auditing requirements applicable to programs administered directly by the Service and to facilities participating in the medicare and medicaid programs. [(3) Secretarial oversight.--The Secretary shall monitor the performance of hospitals and clinics participating in the program established under this section, and shall require such hospitals and clinics to submit reports on the program to the Secretary on an annual basis. [(4) No payments from special funds.--Notwithstanding section 1880(c) of the Social Security Act (42 U.S.C. 1395qq(c)) or section 402(a), no payment may be made out of the special funds described in such sections for the benefit of any hospital or clinic during the period that the hospital or clinic participates in the program established under this section. [(c) Requirements for Participation.-- [(1) Application.--Except as provided in paragraph (2)(B), in order to be eligible for participation in the program established under this section, an Indian tribe, tribal organization, or Alaska Native health organization shall submit an application to the Secretary that establishes to the satisfaction of the Secretary that-- [(A) the Indian tribe, tribal organization, or Alaska Native health organization contracts or compacts for the operation of a facility of the Service; [(B) the facility is eligible to participate in the medicare or medicaid programs under section 1880 or 1911 of the Social Security Act (42 U.S.C. 1395qq; 1396j); [(C) the facility meets the requirements that apply to programs operated directly by the Service; and [(D) the facility-- [(i) is accredited by an accrediting body as eligible for reimbursement under the medicare or medicaid programs; or [(ii) has submitted a plan, which has been approved by the Secretary, for achieving such accreditation. [(2) Approval.-- [(A) In general.--The Secretary shall review and approve a qualified application not later than 90 days after the date the application is submitted to the Secretary unless the Secretary determines that any of the criteria set forth in paragraph (1) are not met. [(B) Grandfather of demonstration program participants.--Any participant in the demonstration program authorized under this section as in effect on the day before the date of enactment of the Alaska Native and American Indian Direct Reimbursement Act of 1999 shall be deemed approved for participation in the program established under this section and shall not be required to submit an application in order to participate in the program. [(C) Duration.--An approval by the Secretary of a qualified application under subparagraph (A), or a deemed approval of a demonstration program under subparagraph (B), shall continue in effect as long as the approved applicant or the deemed approved demonstration program meets the requirements of this section. [(d) Examination and Implementation of Changes.-- [(1) In general.--The Secretary, acting through the Service, and with the assistance of the Administrator of the Centers for Medicare & Medicaid Services, shall examine on an ongoing basis and implement-- [(A) any administrative changes that may be necessary to facilitate direct billing and reimbursement under the program established under this section, including any agreements with States that may be necessary to provide for direct billing under the medicaid program; and [(B) any changes that may be necessary to enable participants in the program established under this section to provide to the Service medical records information on patients served under the program that is consistent with the medical records information system of the Service. [(2) Accounting information.--The accounting information that a participant in the program established under this section shall be required to report shall be the same as the information required to be reported by participants in the demonstration program authorized under this section as in effect on the day before the date of enactment of the Alaska Native and American Indian Direct Reimbursement Act of 1999. The Secretary may from time to time, after consultation with the program participants, change the accounting information submission requirements. [(e) Withdrawal From Program.--A participant in the program established under this section may withdraw from participation in the same manner and under the same conditions that a tribe or tribal organization may retrocede a contracted program to the Secretary under authority of the Indian Self-Determination Act (25 U.S.C. 450 et seq.). All cost accounting and billing authority under the program established under this section shall be returned to the Secretary upon the Secretary's acceptance of the withdrawal of participation in this program. [authorization for emergency contract health services [Sec. 406. With respect to an elderly or disabled Indian 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. [authorization of appropriations [Sec. 407. There are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2000 to carry out this title. [TITLE V--HEALTH SERVICES FOR URBAN INDIANS [purpose [Sec. 501. The purpose of this title is to establish programs in urban centers to make health services more accessible to urban Indians. [contracts with, and grants to, urban indian organizations [Sec. 502. Under authority of the Act of November 2, 1921 (25 U.S.C. 13), popularly 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 the urban centers in which such organizations are situated, of programs which meet the requirements set forth in this title. The Secretary, through the Service, 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. [contracts and grants for the provision of health care and referral services [Sec. 503. (a) Under authority of the Act of November 2, 1921 (25 U.S.C. 13), popularly known as the Snyder Act, the Secretary, through the Service, shall enter into contracts with, or make grants to, urban Indian organizations for the provision of health care and referral services for urban Indians residing in the urban centers in which such organizations are situated. 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 in which such organization is situated 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; [(3) estimate the current health care needs of urban Indians residing in such urban center; [(4) identify all public and private health services resources within such urban center which are or may be available to urban Indians; [(5) determine the use of public and health services resources by the urban Indians residing in such urban center; [(6) assist such health services resources in providing services to urban Indians; [(7) assist urban Indians in becoming familiar with and utilizing such health services resources; [(8) provide basic health education, including health promotion and disease prevention education, to urban Indians; [(9) establish and implement training programs to accomplish the referral and education tasks set forth in paragraphs (6) through (8) of this subsection; [(10) identify gaps between unmet health needs of urban Indians and the resources available to meet such needs; [(11) 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 [(12) where necessary, provide, or enter into contracts for the provision of, health care services for urban Indians. [(b) The Secretary, through the Service, shall by regulation 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 involved; [(2) the size of the urban Indian population in the urban center involved; [(3) the accessibility to, and utilization of, health care services (other than services provided under this title) by urban Indians in the urban center involved; [(4) the extent, if any, to which the activities set forth in subsection (a) would duplicate-- [(A) any previous or current public or private health services project in an urban center that was or is funded in a manner other than pursuant to this title; or [(B) any project funded under this title; [(5) 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; [(6) the satisfactory performance and successful completion by an urban Indian organization of other contracts with the Secretary under this title; [(7) the appropriateness and likely effectiveness of conducting the activities set forth in subsection (a) in an urban center; and [(8) 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) 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)(1) 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 pursuant to this section or receiving grants under subsection (a). [(2) In making any grant to carry out this subsection, the Secretary shall take into consideration-- [(A) the size of the urban Indian population to be served; [(B) the immunization levels of the urban Indian population, particularly the immunization levels of infants, children, and the elderly; [(C) the utilization by the urban Indians of alternative resources from State and local governments for no-cost or low-cost immunization services to the general population; and [(D) the capability of the urban Indian organization to carry out services pursuant to this subsection. [(3) For purposes of this subsection, the term ``immunization services'' means services to provide without charge immunizations against vaccine-preventable diseases. [(e)(1) 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 pursuant to this section or receiving grants under subsection (a). [(2) 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) 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 mental health services, to educate urban Indians about mental health issues and services, and effect coordination with existing mental health providers in order to improve services to urban Indians; [(C) to provide outpatient mental 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 mental health service delivery models which incorporate Indian cultural support systems and resources. [(f)(1) 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) 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) 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) 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). [contracts and grants for the determination of unmet health care needs [Sec. 504. (a) Under authority of the Act of November 2, 1921 (25 U.S.C. 13), popularly known as the Snyder Act, the Secretary, 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. 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) 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 clauses (2), (3), (4), and (8) of section 503(b); and [(2) the urban Indian organization complete performance of the contract, or carry out the requirements of the grant, within one year after the date on which the Secretary and such organization enter into such contract, or within one year after such organization receives such grant, whichever is applicable. [(c) The Secretary may not renew any contract entered into, or grant made, under this section. [evaluations; renewals [Sec. 505. (a) The Secretary, 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) The Secretary, through the Service, shall conduct an annual onsite evaluation of each urban Indian organization which has entered into a contract or received a grant under section 503 for purposes of determining the compliance of such organization with, and evaluating the performance of such organization under, such contract or the terms of such grant. [(c) 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. If the Secretary determines that such 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) 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 conducted under subsection (b). [other contract and grant requirements [Sec. 506. (a) Contracts with urban Indian organizations entered into pursuant to this title shall be in accordance with all Federal contracting laws and regulations 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 under any contracts or grants pursuant to this title may be made in advance or by way of reimbursement and in such installments and on such conditions as the Secretary deems necessary to carry out the purposes of this title. [(c) 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) In connection with any contract or grant entered into pursuant to this title, the Secretary may permit an urban Indian organization to utilize, in carrying out such contract or grant, existing facilities owned by the Federal Government within the Secretary's jurisdiction under such terms and conditions as may be agreed upon for the use and maintenance of such facilities. [(e) 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. [(f) Urban Indians, as defined in section 4(f) of this Act, shall be eligible for health care or referral services provided pursuant to this title. [reports and records [Sec. 507. (a) 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 a quarterly report including-- [(1) in the case of a contract or grant under section 503, information gathered pursuant to clauses (10) and (11) 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) such other information as the Secretary may request. [(b) 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) The Secretary shall allow as a cost of any contract or grant entered into under section 503 the cost of an annual private audit conducted by a certified public accountant. [(d)(1) The Secretary, acting through the Service, shall submit a report to the Congress not later than March 31, 1992, evaluating-- [(A) the health status of urban Indians; [(B) the services provided to Indians through this title; [(C) areas of unmet needs in urban areas served under this title; and [(D) areas of unmet needs in urban areas not served under this title. [(2) In preparing the report under paragraph (1), the Secretary shall consult with urban Indian health providers and may contract with a national organization representing urban Indian health concerns to conduct any aspect of the report. [(3) The Secretary and the Secretary of the Interior shall-- [(A) assess the status of the welfare of urban Indian children, including the volume of child protection cases, the prevalence of child sexual abuse, and the extent of urban Indian coordination with tribal authorities with respect to child sexual abuse; and [(B) submit a report on the assessment required under subparagraph (A), together with recommended legislation to improve Indian child protection in urban Indian populations, to the Congress no later than March 31, 1992. [limitation on contract authority [Sec. 508. The authority of the Secretary to enter into contracts under this title shall be to the extent, and in an amount, provided for in appropriation Acts. [facilities renovation [Sec. 509. The Secretary may make funds available to contractors or grant recipients under this title for minor renovations to facilities, including leased facilities, to assist such contractors or grant recipients in meeting or maintaining the Joint Commission for Accreditation of Health Care Organizations (JCAHO) standards. [urban health programs branch [Sec. 510. (a) Establishment.--There is hereby established within the Service a Branch of Urban Health Programs which shall be responsible for carrying out the provisions of this title and for providing central oversight of the programs and services authorized under this title. [(b) Staff, Services, and Equipment.--The Secretary shall appoint such employees to work in the branch, including a program director, and shall provide such services and equipment, as may be necessary for it to carry out its responsibilities. The Secretary shall also analyze the need to provide at least one urban health program analyst for each area office of the Indian Health Service and shall submit his findings to the Congress as a part of the Department's fiscal year 1993 budget request. [grants for alcohol and substance abuse related services [Sec. 511. (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) accessibility to, and utilization of, other health resources available to such population; [(3) duplication of existing Service or other Federal grants or contracts; [(4) capability of the organization to adequately perform the activities required under the grant; [(5) 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 [(6) 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). [treatment of certain demonstration projects [Sec. 512. (a) Notwithstanding any other provision of law, the Oklahoma City Clinic demonstration project and the Tulsa Clinic demonstration project shall be treated as service units in the allocation of resources and coordination of care and shall not be subject to the provisions of the Indian Self- Determination 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. [(b) The Secretary shall submit to the President, for inclusion in the report required to be submitted to the Congress under section 801 for fiscal year 1999, a report on the findings and conclusions derived from the demonstration projects specified in subsection (a). [(c) In addition to the amounts made available under section 514 to carry out this section through fiscal year 2000, there are authorized to be appropriated such sums as may be necessary to carry out this section for each of fiscal years 2001 and 2002. [urban niaaa transferred programs [Sec. 513. (a) The Secretary shall, within the Branch of Urban Health Programs of the Service, make grants or enter into contracts for the administration of urban Indian alcohol programs that were originally established under the National Institute on Alcoholism and Alcohol Abuse (hereafter in this section referred to as ``NIAAA'') and transferred to the Service. [(b) 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) 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) For the purpose of carrying out this section, the Secretary may combine NIAAA alcohol funds with other substance abuse funds currently administered through the Branch of Urban Health Programs of the Service. [(e) The Secretary shall evaluate and report to the Congress on the activities of programs funded under this section at least every 5 years. [authorization of appropriations [Sec. 514. There are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2000 to carry out this title. [TITLE VI--ORGANIZATIONAL IMPROVEMENTS [establishment of the indian health service as an agency of the public health service [Sec. 601. (a) 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 of Health and Human Services the Indian Health Service. The Indian Health Service shall be administered by a Director, who shall be appointed by the President, by and with the advice and consent of the Senate. The Director of the Indian Health Service shall report to the Secretary through the Assistant Secretary for Health of the Department of Health and Human Services. Effective with respect to an individual appointed by the President, by and with the advice and consent of the Senate, after January 1, 1993, the term of service of the Director shall be 4 years. A Director may serve more than 1 term. [(b) The Indian Health Service shall be an agency within the Public Health Service of the Department of Health and Human Services, and shall not be an office, component, or unit of any other agency of the Department. [(c) The Secretary shall carry out through the Director of the Indian Health Service-- [(1) all functions which were, on the day before the date of enactment of the Indian Health Care Amendments of 1988, carried out by or under the direction of the individual serving as Director of the Indian Health Service on such day; [(2) all functions of the Secretary relating to the maintenance and operation of hospital and health facilities for Indians and the planning for, and provision and 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 (but not limited to) programs under-- [(A) this Act; [(B) the Act of November 2, 1921 (25 U.S.C. 13); [(C) the Act of August 5, 1954 (42 U.S.C. 2001, et seq.); [(D) the Act of August 16, 1957 (42 U.S.C. 2005 et seq.); and [(E) the Indian Self-Determination Act (25 U.S.C. 450f, et seq.); and [(4) all scholarship and loan functions carried out under title I. [(d)(1) The Secretary, acting through the Director of the Indian Health Service, shall have the authority-- [(A) except to the extent provided in paragraph (2), to appoint and compensate employees for the Service in accordance with title 5, United States Code; [(B) to enter into contracts for the procurement of goods and services to carry out the functions of the Service; and [(C) to manage, expend, and obligate all funds appropriated for the Service. [(2) Notwithstanding any other law, the provisions of section 12 of the Act of June 18, 1934 (48 Stat. 986; 25 U.S.C. 472), shall apply to all personnel actions taken with respect to new positions created within the Service as a result of its establishment under subsection (a). [automated management information system [Sec. 602. (a)(1) The Secretary shall establish an automated management information system for the Service. [(2) The information system established under paragraph (1) shall include-- [(A) a financial management system, [(B) a patient care information system for each area served by the Service, [(C) a privacy component that protects the privacy of patient information held by, or on behalf of, the Service, and [(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. [(b)(1) 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-- [(A) 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 [(B) meet the management information needs of the Service. [(2) The Secretary shall reimburse each Indian tribe or tribal organization for the part of the cost of the operation of a system provided under paragraph (1) which is attributable to the treatment by such Indian tribe or tribal organization of patients of the Service. [(3) The Secretary shall provide systems under paragraph (1) to Indian tribes and tribal organizations providing health services in California by no later than September 30, 1990. [(c) Notwithstanding any other provision of law, each patient shall have reasonable access to the medical or health records of such patient which are held by, or on behalf of, the Service. [authorization of appropriations [Sec. 603. There are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2000 to carry out this title. [TITLE VII--SUBSTANCE ABUSE PROGRAMS [indian health service responsibilities [Sec. 701. The Memorandum of Agreement entered into pursuant to section 4205 of the Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 2411) 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. [indian health service program [Sec. 702. (a) Comprehensive Prevention and Treatment Program.--(1) The Secretary, acting through the Service, shall provide a program of comprehensive alcohol and substance abuse prevention and treatment which shall include-- [(A) prevention, through educational intervention, in Indian communities; [(B) acute detoxification and treatment; [(C) community-based rehabilitation; [(D) community education and involvement, including extensive training of health care, educational, and community-based personnel; and [(E) residential treatment programs for pregnant and post partum women and their children. [(2) The target population of such program shall be members of Indian tribes. Efforts to train and educate key members of the Indian community shall target employees of health, education, judicial, law enforcement, legal, and social service programs. [(b) Contract Health Services.--(1) The Secretary, acting through the Service, may enter into contracts with public or private providers of alcohol and substance abuse treatment services for the purpose of assisting the Service in carrying out the program required under subsection (a). [(2) In carrying out this subsection, the Secretary shall provide assistance to Indian tribes to develop criteria for the certification of alcohol and substance abuse service providers and accreditation of service facilities which meet minimum standards for such services and facilities as may be determined pursuant to section 4205(a)(3) of the Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 2411(a)(3)). [(c) Grants for Model Program.--(1) The Secretary, acting through the Service shall make a grant to the Standing Rock Sioux Tribe to develop a community-based demonstration project to reduce drug and alcohol abuse on the Standing Rock Sioux Reservation and to rehabilitate Indian families afflicted by such abuse. [(2) Funds shall be used by the Tribe to-- [(A) develop and coordinate community-based alcohol and substance abuse prevention and treatment services for Indian families; [(B) develop prevention and intervention models for Indian families; [(C) conduct community education on alcohol and substance abuse; and [(D) coordinate with existing Federal, State, and tribal services on the reservation to develop a comprehensive alcohol and substance abuse program that assists in the rehabilitation of Indian families that have been or are afflicted by alcoholism. [(3) The Secretary shall submit to the President for inclusion in the report to be transmitted to the Congress under section 801 for fiscal year 1995 an evaluation of the demonstration project established under paragraph (1). [indian women treatment programs [Sec. 703. (a) The Secretary may make grants to Indian tribes and tribal organizations to develop and implement a comprehensive alcohol and substance abuse program of prevention, intervention, treatment, and relapse prevention services that specifically addresses the cultural, historical, social, and child care needs of Indian women, regardless of age. [(b) Grants made pursuant to this section may be used to-- [(1) develop and provide community training, education, and prevention programs for Indian women relating to alcohol and substance abuse issues, including fetal alcohol syndrome and fetal alcohol effect; [(2) identify and provide appropriate 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 healers, cultural values, and community and family involvement. [(c) The Secretary shall establish criteria for the review and approval of applications for grants under this section. [(d)(1) There are authorized to be appropriated to carry out this section $10,000,000 for fiscal year 1993 and such sums as are necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000. [(2) Twenty percent of the funds appropriated pursuant to this subsection shall be used to make grants to urban Indian organizations funded under title V. [indian health service youth program [Sec. 704. (a) Detoxification and Rehabilitation.--The Secretary shall develop and implement a program for acute detoxification and treatment for Indian youth who are alcohol and substance abusers. The program shall include regional treatment centers designed to include detoxification and rehabilitation for both sexes on a referral basis. These regional centers shall be integrated with the intake and rehabilitation programs based in the referring Indian community. [(b) Treatment Centers or Facilities.--(1) The Secretary shall construct, renovate, or, as necessary, purchase, and appropriately staff and operate, a youth regional treatment center in each area under the jurisdiction of an area office. For the purposes of this subsection, the area offices of the Service in Tucson and Phoenix, Arizona, shall be considered one area office and the area office in California shall be considered to be two area offices, one office whose jurisdiction shall be considered to encompass the northern area of the State of California, and one office whose jurisdiction shall be considered to encompass the remainder of the State of California. [(2) For the purpose of staffing and operating such centers or facilities, funding shall be pursuant to the Act of November 2, 1921 (25 U.S.C. 13). [(3) A youth treatment center constructed or purchased under this subsection shall be constructed or purchased at a location within the area described in paragraph (1) agreed upon (by appropriate tribal resolution) by a majority of the tribes to be served by such center. [(4)(A) Notwithstanding any other provision of this title, the Secretary may, from amounts authorized to be appropriated for the purposes of carrying out this section, make funds available to-- [(i) the Tanana Chiefs Conference, Incorporated, for the purpose of leasing, constructing, renovating, operating and maintaining a residential youth treatment facility in Fairbanks, Alaska; and [(ii) the Southeast Alaska Regional Health Corporation to staff and operate a residential youth treatment facility without regard to the proviso set forth in section 4(l) of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b(l)). [(B) 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) Federally Owned Structures.-- [(1) The Secretary, acting through the Service, shall, in consultation with Indian tribes-- [(A) identify and use, where appropriate, federally owned structures suitable as local residential or regional alcohol and substance abuse treatment centers for Indian youth; and [(B) establish guidelines for determining the suitability of any such federally owned structure to be used as a local residential or regional alcohol and substance abuse treatment center for Indian youth. [(2) 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. [(d) Rehabilitation and Aftercare Services.-- [(1) The Secretary, in cooperation with the Secretary of the Interior, shall develop and implement within each Service service unit community-based rehabilitation and follow-up services for Indian youth who are alcohol or substance abusers which are designed to integrate long-term treatment and to monitor and support the Indian youth after their return to their home community. [(2) Services under paragraph (1) shall be administered within each service unit 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 shall include alcohol and substance abuse counselors, mental health professionals, and other health professionals and paraprofessionals, including community health representatives. [(e) Inclusion of Family in Youth Treatment Program.--In providing the treatment and other services to Indian youth authorized by this section, the Secretary 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 (d) shall be used for outpatient care of adult family members related to the treatment of an Indian youth under that subsection. [(f) Multidrug Abuse Study.--(1) The Secretary shall conduct a study to determine the incidence and prevalence of the abuse of multiple forms of drugs, including alcohol, among Indian youth residing on Indian reservations and in urban areas and the interrelationship of such abuse with the incidence of mental illness among such youth. [(2) The Secretary shall submit a report detailing the findings of such study, together with recommendations based on such findings, to the Congress no later than two years after the date of the enactment of this section. [training and community education [Sec. 705. (a) Community Education.--The Secretary, in cooperation with the Secretary of the Interior, shall develop and implement within each service unit a program of community education and involvement which shall be designed to provide concise and timely information to the community leadership of each tribal community. Such program shall include education in alcohol and substance abuse to political leaders, tribal judges, law enforcement personnel, members of tribal health and education boards, and other critical members of each tribal community. [(b) Training.--The Secretary shall, either directly or by contract, provide instruction in the area of alcohol and substance abuse, including instruction in crisis intervention and family relations in the context of alcohol and substance abuse, youth alcohol and substance abuse, and the causes and effects of fetal alcohol syndrome 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 tribes 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 substance abuse faced by children of alcoholics; [(2) the cultural and multigenerational aspects of alcohol and substance abuse prevention and recovery; and [(3) community-based and multidisciplinary strategies for preventing and treating alcohol and substance abuse. [gallup alcohol and substance abuse treatment center [Sec. 706. (a) Grants for Residential Treatment.--The Secretary shall make grants to the Navajo Nation for the purpose of providing residential treatment for alcohol and substance abuse for adult and adolescent members of the Navajo Nation and neighboring tribes. [(b) Purposes of Grants.--Grants made pursuant to this section shall (to the extent appropriations are made available) be used to-- [(1) provide at least 15 residential beds each year for adult long-term treatment, including beds for specialized services such as polydrug abusers, dual diagnosis, and specialized services for women with fetal alcohol syndrome children; [(2) establish clinical assessment teams consisting of a clinical psychologist, a part-time addictionologist, a master's level assessment counselor, and a certified medical records technician which shall be responsible for conducting individual assessments and matching Indian clients with the appropriate available treatment; [(3) provide at least 12 beds for an adolescent shelterbed program in the city of Gallup, New Mexico, which shall serve as a satellite facility to the Acoma/ Canoncito/Laguna Hospital and the adolescent center located in Shiprock, New Mexico, for emergency crisis services, assessment, and family intervention; [(4) develop a relapse program for the purposes of identifying sources of job training and job opportunity in the Gallup area and providing vocational training, job placement, and job retention services to recovering substance abusers; and [(5) provide continuing education and training of treatment staff in the areas of intensive outpatient services, development of family support systems, and case management in cooperation with regional colleges, community colleges, and universities. [(c) Contract for Residential Treatment.--The Navajo Nation, in carrying out the purposes of this section, shall enter into a contract with an institution in the Gallup, New Mexico, area which is accredited by the Joint Commission of the Accreditation of Health Care Organizations to provide comprehensive alcohol and drug treatment as authorized in subsection (b). [(d) Authorization of Appropriations.--There are authorized to be appropriated, for each of fiscal years 1996 through 2000, such sums as may be necessary to carry out subsection (b). [reports [Sec. 707. (a) Compilation of Data.--The Secretary, with respect to the administration of any health program by a service unit, directly or through contract, including a contract under the Indian Self-Determination Act, shall require the compilation of data relating to the number of cases or incidents in which any Service personnel or services were involved and which were related, either directly or indirectly, to alcohol or substance abuse. Such report shall include the type of assistance provided and the disposition of these cases. [(b) Referral of Data.--The data compiled under subsection (a) shall be provided annually to the affected Indian tribe and Tribal Coordinating Committee to assist them in developing or modifying a Tribal Action Plan under section 4206 of the Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 2471 et seq.). [(c) Comprehensive Report.--Each service unit director shall be responsible for assembling the data compiled under this section and section 4214 of the Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 2434) into an annual tribal comprehensive report. Such report shall be provided to the affected tribe and to the Director of the Service who shall develop and publish a biennial national report based on such tribal comprehensive reports. [fetal alcohol syndrome and fetal alcohol effect grants [Sec. 708. (a)(1) The Secretary may make grants to Indian tribes and tribal organizations to establish fetal alcohol syndrome and fetal alcohol effect programs as provided in this section for the purposes of meeting the health status objectives specified in section 3(b). [(2) Grants made pursuant to this section shall be used to-- [(A) develop and provide community and in-school training, education, and prevention programs relating to FAS and FAE; [(B) identify and provide alcohol and substance abuse treatment to high-risk women; [(C) identify and provide appropriate educational and vocational support, counseling, advocacy, and information to FAS and FAE affected persons and their families or caretakers; [(D) develop and implement counseling and support programs in schools for FAS and FAE affected children; [(E) develop prevention and intervention models which incorporate traditional healers, cultural values and community involvement; [(F) develop, print, and disseminate education and prevention materials on FAS and FAE; and [(G) develop and implement, through the tribal consultation process, culturally sensitive assessment and diagnostic tools for use in tribal and urban Indian communities. [(3) The Secretary shall establish criteria for the review and approval of applications for grants under this section. [(b) The Secretary, acting through the Service, shall-- [(1) develop an annual plan for the prevention, intervention, treatment, and aftercare for those affected by FAS and FAE in Indian communities; [(2) conduct a study, directly or by contract with any organization, entity, or institution of higher education with significant knowledge of FAS and FAE and Indian communities, of the special educational, vocational, school-to-work transition, and independent living needs of adolescent and adult Indians and Alaska Natives with FAS or FAE; and [(3) establish a national clearinghouse for prevention and educational materials and other information on FAS and FAE effect in Indian and Alaska Native communities and ensure access to clearinghouse materials by any Indian tribe or urban Indian organization. [(c) The Secretary shall establish a task force to be known as the FAS/FAE Task Force to advise the Secretary in carrying out subsection (b). Such task force 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 Bureau of Indian Affairs, Indian tribes, tribal organizations, urban Indian communities, and Indian FAS/ FAE experts. [(d) The Secretary, acting through the Substance Abuse and Mental Health Services Administration, shall make grants to Indian tribes, tribal organizations, universities working with Indian tribes on cooperative projects, and urban Indian organizations for applied research projects which propose to elevate the understanding of methods to prevent, intervene, treat, or provide aftercare for Indians and urban Indians affected by FAS or FAE. [(e)(1) The Secretary shall submit to the President, for inclusion in each report required to be transmitted to the Congress under section 801, a report on the status of FAS and FAE in the Indian population. Such report shall include, in addition to the information required under section (3)(d) with respect to the health status objective specified in section (3)(b)(27), the following: [(A) The progress of implementing a uniform assessment and diagnostic methodology in Service and tribally based service delivery systems. [(B) The incidence of FAS and FAE babies born for all births by reservation and urban-based sites. [(C) The prevalence of FAS and FAE affected Indian persons in Indian communities, their primary means of support, and recommendations to improve the support system for these individuals and their families or caretakers. [(D) The level of support received from the entities specified in subsection (c) in the area of FAS and FAE. [(E) The number of inpatient and outpatient substance abuse treatment resources which are specifically designed to meet the unique needs of Indian women, and the volume of care provided to Indian women through these means. [(F) Recommendations regarding the prevention, intervention, and appropriate vocational, educational and other support services for FAS and FAE affected individuals in Indian communities. [(2) The Secretary may contract the production of this report to a national organization specifically addressing FAS and FAE in Indian communities. [(f)(1) There are authorized to be appropriated to carry out this section $22,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000. [(2) Ten percent of the funds appropriated pursuant to this section shall be used to make grants to urban Indian organizations funded under title V. [pueblo substance abuse treatment project for san juan pueblo, new mexico [Sec. 709. The Secretary, acting through the Service, shall continue to make grants, through fiscal year 1995, to the 8 Northern Indian Pueblos Council, San Juan Pueblo, New Mexico, for the purpose of providing substance abuse treatment services to Indians in need of such services. [thunder child treatment center [Sec. 710. (a) The Secretary, acting through the Service, shall make a grant to the Intertribal Addictions Recovery Organization, Inc. (commonly known as the Thunder Child Treatment Center) at Sheridan, Wyoming, for the completion of construction of a multiple approach substance abuse treatment center which specializes in the treatment of alcohol and drug abuse of Indians. [(b) For the purposes of carrying out subsection (a), there are authorized to be appropriated $2,000,000 for fiscal years 1993 and 1994. No funding shall be available for staffing or operation of this facility. None of the funding appropriated to carry out subsection (a) shall be used for administrative purposes. [substance abuse counselor education demonstration project [Sec. 711. (a) 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 community colleges to establish demonstration projects to develop educational curricula for substance abuse counseling. [(b) 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) A contract entered into or a grant provided under this section shall be for a period of one year. Such contract or grant may be renewed for an additional one year period upon the approval of the Secretary. [(d) Not later than 180 days after the date of the enactment of this section, the Secretary, after consultation with Indian tribes and administrators of accredited tribally controlled community colleges, tribally controlled postsecondary vocational institutions, and eligible 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) 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) The Secretary shall submit to the President, for inclusion in the report which is 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) For the purposes of this section, the following definitions apply: [(1) The term ``educational curriculum'' means one or more of the following: [(A) Classroom education. [(B) Clinical work experience. [(C) Continuing education workshops. [(2) The term ``eligible community college'' means an accredited community college that-- [(i) is located on or near an Indian reservation; [(ii) has entered into a cooperative agreement with the governing body of such Indian reservation to carry out a demonstration project under this section; and [(iii) has a student enrollment of not less than 10 percent Indian. [(3) 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)). [(4) 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)). [(h) There are authorized to be appropriated for each of fiscal years 1996 through 2000, such sums as may be necessary to carry out the purposes of this section. Such sums shall remain available until expended. [gila river alcohol and substance abuse treatment facility [Sec. 712. (a) The Secretary, acting through the Service, shall establish a regional youth alcohol and substance abuse prevention and treatment center in Sacaton, Arizona, on the Gila River Indian Reservation. The center shall be established within facilities leased, with the consent of the Gila River Indian Community, by the Service from such Community. [(b) The center established pursuant to this section shall be known as the ``Regional Youth Alcohol and Substance Abuse Prevention and Treatment Center''. [(c) The Secretary, acting through the Service, shall establish, as a unit of the regional center, a youth alcohol and substance abuse prevention and treatment facility in Fallon, Nevada. [alaska native drug and alcohol abuse demonstration project [Sec. 713. (a) The Secretary, acting through the Service, shall make grants to the Alaska Native Health Board for the conduct of a two-part community-based demonstration project to reduce drug and alcohol abuse in Alaska Native villages and to rehabilitate families afflicted by such abuse. Sixty percent of such grant funds shall be used by the Health Board to stimulate coordinated community development programs in villages seeking to organize to combat alcohol and drug use. Forty percent of such grant funds shall be transferred to a qualified nonprofit corporation providing alcohol recovery services in the village of St. Mary's, Alaska, to enlarge and strengthen a family life demonstration program of rehabilitation for families that have been or are afflicted by alcoholism. [(b) 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 1995 an evaluation of the demonstration project established under subsection (a). [authorization of appropriations [Sec. 714. Except as provided in sections 703, 706, 708, 710, and 711, there are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2000 to carry out the provisions of this title. [TITLE VIII--MISCELLANEOUS [reports [Sec. 801. 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; [(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; [(3) a report on the use of health services by Indians-- [(A) on a national and area or other relevant geographical basis; [(B) by gender and age; [(C) by source of payment and type of service; and [(D) comparing such rates of use with rates of use among comparable non-Indian populations. [(4) a separate statement which specifies the amount of funds requested to carry out the provisions of section 201; [(5) a separate statement of the total amount obligated or expended in the most recently completed fiscal year to achieve each of the objectives described in section 814, relating to infant and maternal mortality and fetal alcohol syndrome; [(6) the reports required by sections 3(d), 108(n), 203(b), 209(j), 301(c), 302(g), 305(a)(3), 403, 708(e), and 817(a), and 822(f); [(7) for fiscal year 1995, the report required by sections 702(c)(3) and 713(b); [(8) for fiscal year 1997, the interim report required by section 307(h)(1); and [(9) for fiscal year 1999, the reports required by sections 307(h)(2), 512(b), 711(f), and 821(g). [regulations [Sec. 802. Prior to any revision of or amendment to rules or regulations promulgated pursuant to this Act, the Secretary shall consult with Indian tribes and appropriate national or regional Indian organizations and shall publish any proposed revision or amendment in the Federal Register not less than sixty days prior to the effective date of such revision or amendment in order to provide adequate notice to, and receive comments from, other interested parties. [leases with indian tribes [Sec. 804. (a) 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 for periods not in excess of twenty years. Property leased by the Secretary from an Indian tribe may be reconstructed or renovated by the Secretary pursuant to an agreement with such Indian tribe. [(b) The Secretary may enter into leases, contracts, and other legal agreements with Indian tribes or tribal organizations which hold-- [(1) title to; [(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. 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. [availability of funds [Sec. 805. The funds appropriated pursuant to this Act shall remain available until expended. [limitation on use of funds appropriated to the indian health service [Sec. 806. Any limitation on the use of funds contained in an Act providing appropriations for the Department of Health and Human Services 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 Indian Health Service. [nuclear resource development health hazards [Sec. 807. (a) The Secretary and the Service shall conduct, in conjunction with other appropriate Federal agencies and in consultation with concerned Indian tribes and organizations, a study of the health hazards to Indian communities as a result of nuclear resource development. Such study shall include-- [(1) an evaluation of the nature and extent of nuclear resource development related health problems currently exhibited among Indians and the causes of such health problems; [(2) an analysis of the potential effect of ongoing and future nuclear resource development on or near Indian reservations and communities; [(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 powerplant operation and construction, and nuclear waste disposal; [(4) a summary of any findings and recommendations provided in Federal and State studies, reports, investigations, and inspections during the five years prior to the date of the enactment of this section that directly or indirectly relate to the activities, practices, and conditions affecting the health or safety of such Indians; and [(5) the efforts that have been made by Federal and State agencies and mining and milling companies to effectively carry out an education program for such Indians regarding the health and safety hazards of such nuclear resource development. [(b) Upon completion of such study the Secretary and the Service shall take into account the results of such study and develop a health care plan to address the health problems studied under subsection (a). The plan shall include-- [(1) methods for diagnosing and treating Indians currently exhibiting such health problems; [(2) preventive care 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 radiations, or affected by other nuclear development 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 development activities, may experience health problems. [(c) The Secretary and the Service shall submit to Congress the study prepared under subsection (a) no later than the date eighteen months after the date of enactment of this section. The health care plan prepared under subsection (b) shall be submitted in a report no later than the date one year after the date that the study prepared under subsection (a) is submitted to Congress. Such report shall include recommended activities for the implementation of the plan, as well as an evaluation of any activities previously undertaken by the service to address such health problems. [(d)(1) There is established an Intergovernmental Task Force to be composed of the following individuals (or their designees): the Secretary of Energy, the Administrator of the Environmental Protection Agency, the Director of the Bureau of Mines, the Assistant Secretary for Occupational Safety and Health, and the Secretary of the Interior. [(2) The Task Force shall identify existing and potential operations related to nuclear resource development 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 insure that current and future health problems resulting from nuclear resource development activities are minimized or reduced. [(3) The Secretary shall be Chairman 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) In the case of any Indian who-- [(1) as a result of employment in or near a uranium mine or mill, 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; 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 from such operator. 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. [arizona as a contract health service delivery area [Sec. 808. (a) For the fiscal years beginning with the fiscal year ending September 30, 1982, and ending with the fiscal year ending September 30, 2000, 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) 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). [eligibility of california indians [Sec. 809. (a)(1) In order to provide the Congress with sufficient data to determine which Indians in the State of California should be eligible for health services provided by the Service, the Secretary shall, by no later than the date that is 3 years after the date of enactment of the Indian Health Care Amendments of 1988, prepare and submit to the Congress a report which sets forth-- [(A) a determination by the Secretary of the number of Indians described in subsection (b)(2), and the number of Indians described in subsection (b)(3), who are not members of an Indian tribe recognized by the Federal Government, [(B) the geographic location of such Indians, [(C) the Indian tribes of which such Indians are members, [(D) an assessment of the current health status, and health care needs, of such Indians, and [(E) an assessment of the actual availability and accessibility of alternative resources for the health care of such Indians that such Indians would have to rely on if the Service did not provide for the health care of such Indians. [(2) The report required under paragraph (1) shall be prepared by the Secretary-- [(A) in consultation with the Secretary of the Interior, and [(B) with the assistance of the tribal health programs providing services to the Indians described in paragraph (2) or (3) of subsection (b) who are not members of any Indian tribe recognized by the Federal Government. [(b) 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 living in California, [(B) is a member of the Indian community served by a local program of the Service, and [(C) 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. [(c) 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. [california as a contract health service delivery area [Sec. 810. 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. [contract health facilities [Sec. 811. The Service shall provide funds for health care programs and facilities operated by tribes and tribal organizations under contracts with the Service entered into under the Indian Self-Determination Act-- [(1) for the maintenance and repair of clinics owned or leased by such tribes or tribal organizations, [(2) for employee training, [(3) for cost-of-living increases for employees, and [(4) for any other expenses relating to the provision of health services, on the same basis as such funds are provided to programs and facilities operated directly by the Service. [national health service corps [Sec. 812. The Secretary of Health and Human Services shall not-- [(1) remove a member of the National Health Service Corps from a health facility operated by the Indian Health Service or by a tribe or tribal organization under contract with the Indian Health Service under the Indian Self-Determination Act, or [(2) withdraw funding used to support such member, unless the Secretary, acting through the Service, has ensured that the Indians receiving services from such member will experience no reduction in services. [health services for ineligible persons [Sec. 813. (a)(1) 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) 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 are made eligible, as a class, by an appropriate resolution of the governing body of the Indian tribe of the eligible Indian. 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)(1)(A) The Secretary is authorized to provide health services under this subsection through health facilities 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 facility or services, within or without the service area of such service unit, available to meet the health needs of such individuals. [(B) In the case of health facilities operated under a contract entered into under the Indian Self-Determination Act, the governing body of the Indian tribe or tribal organization providing health services under such contract is authorized to determine whether health services should be provided under such contract 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)(A) 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 facility providing the service and shall be used solely for the provision of health services within that facility. Amounts collected under this subsection shall be available for expenditure within such facility for not to exceed one fiscal year after the fiscal year in which collected. [(B) 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. [(3)(A) 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) 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) 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 in health facilities operated and maintained by the Service or operated under a contract entered into under the Indian Self-Determination 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) For purposes of this section, the term ``eligible Indian'' means any Indian who is eligible for health services provided by the Service without regard to the provisions of this section. [infant and maternal mortality; fetal alcohol syndrome [Sec. 814. By no later than January 1, 1990, the Secretary shall develop and begin implementation of a plan to achieve the following objectives by January 1, 1994: [(1) reduction of the rate of Indian infant mortality in each area office of the Service to the lower of-- [(A) twelve deaths per one thousand live births, or [(B) the rate of infant mortality applicable to the United States population as a whole; [(2) reduction of the rate of maternal mortality in each area office of the Service to the lower of-- [(A) five deaths per one hundred thousand live births, or [(B) the rate of maternal mortality applicable to the United States population as a whole; and [(3) reduction of the rate of fetal alcohol syndrome among Indians served by, or on behalf of, the Service to one per one thousand live births. [contract health services for the trenton service area [Sec. 815. (a) The Secretary, acting through the Service, is directed to provide contract health services to members of the Turtle Mountain Band of Chippewa Indians that reside in the Trenton Service Area of Divide, McKenzie, and Williams counties in the State of North Dakota and the adjoining counties of Richland, Roosevelt, and Sheridan in the State of Montana. [(b) Nothing in this section may be construed as expanding the eligibility of members of the Turtle Mountain Band of Chippewa Indians for health services provided by the Service beyond the scope of eligibility for such health services that applied on May 1, 1986. [indian health service and department of veterans affairs health facilities and services sharing [Sec. 816. (a) The Secretary shall examine the feasibility of entering into an arrangement for the sharing of medical facilities and services between the Indian Health Service and the Department of Veterans Affairs and shall, in accordance with subsection (b), prepare a report on the feasibility of such an arrangement and submit such report to the Congress by no later than September 30, 1990. [(b) 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 Indian Health Service; [(2) the quality of health care services provided to any Indian through the Indian Health Service; [(3) the priority access of any veteran to health care services provided by the Department of Veterans Affairs; [(4) the quality of health care services provided to any veteran by the Department of Veterans Affairs; [(5) the eligibility of any Indian to receive health services through the Indian Health Service; or [(6) the eligibility of any Indian who is a veteran to receive health services through the Department of Veterans Affairs. [(c)(1) Not later than December 23, 1988, the Director of the Indian Health Service and the Secretary of Veterans Affairs shall implement an agreement under which-- [(A) individuals in the vicinity of Roosevelt, Utah, who are eligible for health care from the Department of Veterans Affairs could obtain health care services at the facilities of the Indian Health Service located at Fort Duchesne, Utah; and [(B) individuals eligible for health care from the Indian Health Service at Fort Duchesne, Utah, could obtain health care services at the Department of Veterans Affairs medical center located in Salt Lake City, Utah. [(2) Not later than November 23, 1990, the Secretary and the Secretary of Veterans Affairs shall jointly submit a report to the Congress on the health care services provided as a result of paragraph (1). [(d) Nothing in this section may be construed as creating any right of a veteran to obtain health services from the Indian Health Service except as provided in an agreement under subsection (c). [reallocation of base resources [Sec. 817. (a) 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) 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. [demonstration projects for tribal management of health care services [Sec. 818. (a)(1) The Secretary, acting through the Service, shall make grants to Indian tribes to establish demonstration projects under which the Indian tribe will develop and test a phased approach to assumption by the Indian tribe of the health care delivery system of the Service for members of the Indian tribe living on or near the reservations of the Indian tribe through the use of Service, tribal, and private sector resources. [(2) A grant may be awarded to an Indian tribe under paragraph (1) only if the Secretary determines that the Indian tribe has the administrative and financial capabilities necessary to conduct a demonstration project described in paragraph (1). [(b) During the period in which a demonstration project established under subsection (a) is being conducted by an Indian tribe, the Secretary shall award all health care contracts, including community, behavioral, and preventive health care contracts, to the Indian tribe in the form of a single grant to which the regulations prescribed under part A of title XIX of the Public Health Service Act (as modified as necessary by any agreement entered into between the Secretary and the Indian tribe to achieve the purposes of the demonstration project established under subsection (a)) shall apply. [(c) The Secretary may waive such provisions of Federal procurement law as are necessary to enable any Indian tribe to develop and test administrative systems under the demonstration project established under subsection (a), but only if such waiver does not diminish or endanger the delivery of health care services to Indians. [(d)(1) The demonstration project established under subsection (a) shall terminate on September 30, 1993, or, in the case of a demonstration project for which a grant is made after September 30, 1990, three years after the date on which such grant is made. [(2) By no later than September 30, 1996, the Secretary shall evaluate the performance of each Indian tribe that has participated in a demonstration project established under subsection (a) and shall submit to the Congress a report on such evaluations and demonstration projects. [(e)(1) The Secretary, acting through the Service, shall make arrangements with Indian tribes to establish joint venture demonstration projects under which an Indian tribe shall expend tribal, private, or other available nontribal funds, for the acquisition or construction of a health facility for a minimum of 20 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. A tribe may utilize tribal funds, private sector, or other available resources, including loan guarantees, to fulfill its commitment under this subsection. [(2) The Secretary shall make such an arrangement with an Indian tribe only if the Secretary first determines that the Indian tribe has the administrative and financial capabilities necessary to complete the timely acquisition or construction of the health facility described in paragraph (1). [(3) An Indian tribe or tribal organization that has entered into a written agreement with the Secretary under this subsection, 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 paid to a third party on the tribe's behalf, under the agreement. The Secretary has the right to recover tangible property (including supplies), and equipment, less depreciation, and any funds expended for operations and maintenance under this section. The preceding sentence does not apply to any funds expended for the delivery of health care services, or for personnel or staffing, shall be recoverable. [child sexual abuse treatment programs [Sec. 819. (a) The Secretary and the Secretary of the Interior shall, for each fiscal year through fiscal year 1995, continue the demonstration programs involving treatment for child sexual abuse provided through the Hopi Tribe and the Assiniboine and Sioux Tribes of the Fort Peck Reservation. [(b) Beginning October 1, 1995, the Secretary and the Secretary of the Interior may establish, in any service area, demonstration programs involving treatment for child sexual abuse, except that the Secretaries may not establish a greater number of such programs in one service area than in any other service area until there is an equal number of such programs established with respect to all service areas from which the Secretary receives qualified applications during the application period (as determined by the Secretary). [tribal leasing [Sec. 820. Indian tribes providing health care services pursuant to a contract entered into under the Indian Self- Determination Act may lease permanent structures for the purpose of providing such health care services without obtaining advance approval in appropriation Acts. [home- and community-based care demonstration project [Sec. 821. (a) The Secretary, acting through the Service, is authorized to enter into contracts with, or make grants to, Indian tribes or tribal organizations providing health care services pursuant to a contract entered into under the Indian Self-Determination Act, to establish demonstration projects for the delivery of home- and community-based services to functionally disabled Indians. [(b)(1) Funds provided for a demonstration project under this section shall be used only for the delivery of home- and community-based services (including transportation services) to functionally disabled Indians. [(2) Such funds may not be used-- [(A) to make cash payments to functionally disabled Indians; [(B) to provide room and board for functionally disabled Indians; [(C) for the construction or renovation of facilities or the purchase of medical equipment; or [(D) for the provision of nursing facility services. [(c) Not later than 180 days after the date of the enactment of this section, the Secretary, after consultation with Indian tribes and tribal organizations, shall develop and issue criteria for the approval of applications submitted under this section. Such criteria shall ensure that demonstration projects established under this section promote the development of the capacity of tribes and tribal organizations to deliver, or arrange for the delivery of, high quality, culturally appropriate home- and community-based services to functionally disabled Indians; [(d) 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) At the discretion of the tribe or tribal organization, services provided under a demonstration project established under this section may be provided (on a cost basis) to persons otherwise ineligible for the health care benefits of the Service. [(f) The Secretary shall establish not more than 24 demonstration projects under this section. The Secretary may not establish a greater number of demonstration projects under this section in one service area than in any other service area until there is an equal number of such demonstration projects established with respect to all service areas from which the Secretary receives applications during the application period (as determined by the Secretary) which meet the criteria issued pursuant to subsection (c). [(g) The Secretary shall submit to the President, for inclusion in the report which is 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, together with legislative recommendations. [(h) For the purposes of this section, the following definitions shall apply: [(1) The term ``home- and community-based services'' means one or more of the following: [(A) Homemaker/home health aide services. [(B) Chore services. [(C) Personal care services. [(D) Nursing care services provided outside of a nursing facility by, or under the supervision of, a registered nurse. [(E) Respite care. [(F) Training for family members in managing a functionally disabled individual. [(G) Adult day care. [(H) Such other home- and community-based services as the Secretary may approve. [(2) The term ``functionally disabled'' means an individual who is determined to require home- and community-based services based on an assessment that uses criteria (including, at the discretion of the tribe or tribal organization, activities of daily living) developed by the tribe or tribal organization. [(i) There are authorized to be appropriated for each of the fiscal years 1996 through 2000 such sums as may be necessary to carry out this section. Such sums shall remain available until expended. [shared services demonstration project [Sec. 822. (a) The Secretary, acting through the Service and notwithstanding any other provision of law, is authorized to enter into contracts with Indian tribes or tribal organizations to establish not more than 6 shared services demonstration projects for the delivery of long-term care to Indians. Such projects shall provide for the sharing of staff or other services between a Service facility and a nursing facility owned and operated (directly or by contract) by such Indian tribe or tribal organization. [(b) A contract 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 facility 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 nursing facility (including the construction of a facility attached to a Service facility), except that no funds appropriated for the Service shall be obligated or expended for such purpose. [(c) To be eligible for a contract under this section, a tribe or tribal organization, shall, as of the date of the enactment of this Act-- [(1) own and operate (directly or by contract) a nursing facility; [(2) have entered into an agreement with a consultant to develop a plan for meeting the long-term needs of the tribe or tribal organization; or [(3) have adopted a tribal resolution providing for the construction of a nursing facility. [(d) Any nursing facility for which a contract is entered into under this section shall meet the requirements for nursing facilities under section 1919 of the Social Security Act. [(e) The Secretary shall provide such technical and other assistance as may be necessary to enable applicants to comply with the provisions of this section. [(f) The Secretary shall submit to the President, for inclusion in each report required to be transmitted to the Congress under section 801, a report on the findings and conclusions derived from the demonstration projects conducted under this section. [results of demonstration projects [Sec. 823. The Secretary shall provide for the dissemination to Indian tribes of the findings and results of demonstration projects conducted under this Act. [priority for indian reservations [Sec. 824. (a) Beginning on the date of the enactment of this section, 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 tribe with jurisdiction over such lands. [(b) For purposes of this section, the term ``Indian lands'' means-- [(1) all lands within the limits of any Indian reservation; and [(2) any lands title 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. [authorization of appropriations [Sec. 825. Except as provided in section 821, there are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2000 to carry out this title.] 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 national Indian health policy. Sec. 4. Definitions. TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT Sec. 101. Purpose. Sec. 102. Health professions recruitment program for Indians. Sec. 103. Health professions preparatory scholarship program for Indians. Sec. 104. Indian health professions scholarships. Sec. 105. American Indians Into Psychology Program. Sec. 106. Scholarship programs for Indian Tribes. Sec. 107. Indian Health Service extern programs. Sec. 108. Continuing education allowances. Sec. 109. Community Health Representative Program. Sec. 110. Indian Health Service Loan Repayment Program. Sec. 111. Scholarship and Loan Repayment Recovery Fund. Sec. 112. Recruitment activities. Sec. 113. Indian recruitment and retention program. Sec. 114. Advanced training and research. Sec. 115. Quentin N. Burdick American Indians Into Nursing Program. Sec. 116. Tribal cultural orientation. Sec. 117. INMED Program. Sec. 118. Health training programs of community colleges. Sec. 119. Retention bonus. Sec. 120. Nursing residency program. Sec. 121. Community Health Aide Program. Sec. 122. Tribal Health Program administration. Sec. 123. Health professional chronic shortage demonstration programs. Sec. 124. National Health Service Corps. Sec. 125. Substance abuse counselor educational curricula demonstration programs. Sec. 126. Behavioral health training and community education programs. Sec. 127. Authorization of appropriations. TITLE II--HEALTH SERVICES Sec. 201. Indian Health Care Improvement Fund. Sec. 202. Catastrophic Health Emergency Fund. Sec. 203. Health promotion and disease prevention services. Sec. 204. Diabetes prevention, treatment, and control. Sec. 205. Shared services for long-term care. Sec. 206. Health services research. Sec. 207. Mammography and other cancer screening. Sec. 208. Patient travel costs. Sec. 209. Epidemiology centers. Sec. 210. Comprehensive school health education programs. Sec. 211. Indian youth program. Sec. 212. Prevention, control, and elimination of communicable and infectious diseases. Sec. 213. Authority for provision of other services. Sec. 214. Indian women's health care. Sec. 215. Environmental and nuclear health hazards. Sec. 216. Arizona as a contract health service delivery area. Sec. 217. North Dakota and South Dakota as contract health service delivery area. Sec. 218. California contract health services program. Sec. 219. California as a contract health service delivery area. Sec. 220. Contract health services for the Trenton Service Area. Sec. 221. Programs operated by Indian Tribes and Tribal Organizations. Sec. 222. Licensing. Sec. 223. Notification of provision of emergency contract health services. Sec. 224. Prompt action on payment of claims. Sec. 225. Liability for payment. Sec. 226. Office of Indian Men's Health. Sec. 227. Authorization of appropriations. TITLE III--FACILITIES Sec. 301. Consultation; construction and renovation of facilities; reports. Sec. 302. Sanitation facilities. Sec. 303. Preference to Indians and Indian firms. Sec. 304. Expenditure of non-Service funds for renovation. Sec. 305. Funding for the construction, expansion, and modernization of small ambulatory care facilities. Sec. 306. Indian health care delivery demonstration project. Sec. 307. Land transfer. Sec. 308. Leases, contracts, and other agreements. Sec. 309. Study on loans, loan guarantees, and loan repayment. Sec. 310. Tribal leasing. Sec. 311. Indian Health Service/tribal facilities joint venture program. Sec. 312. Location of facilities. Sec. 313. Maintenance and improvement of health care facilities. Sec. 314. Tribal management of federally-owned quarters. Sec. 315. Applicability of Buy American Act requirement. Sec. 316. Other funding for facilities. Sec. 317. Authorization of appropriations. TITLE IV--ACCESS TO HEALTH SERVICES Sec. 401. Treatment of payments under Social Security Act health benefits programs. Sec. 402. Grants to and contracts with the Service, Indian Tribes, Tribal Organizations, and Urban Indian Organizations to facilitate outreach, enrollment, and coverage of Indians under Social Security Act health benefit programs and other health benefits programs. Sec. 403. Reimbursement from certain third parties of costs of health services. Sec. 404. Crediting of reimbursements. Sec. 405. Purchasing health care coverage. Sec. 406. Sharing arrangements with Federal agencies. Sec. 407. Payor of last resort. Sec. 408. Nondiscrimination under Federal health care programs in qualifications for reimbursement for services. Sec. 409. Consultation. Sec. 410. State Children's Health Insurance Program (SCHIP). Sec. 411. Exclusion waiver authority for affected Indian Health Programs and safe harbor transactions under the Social Security Act. Sec. 412. Premium and cost sharing protections and eligibility determinations under Medicaid and SCHIP and protection of certain Indian property from Medicaid estate recovery. Sec. 413. Treatment under Medicaid and SCHIP managed care. Sec. 414. Navajo Nation Medicaid Agency feasibility study. Sec. 415. General exceptions. Sec. 416. 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. Division 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. Urban youth treatment center demonstration. Sec. 516. Grants for diabetes prevention, treatment, and control. Sec. 517. Community health representatives. Sec. 518. Effective date. Sec. 519. Eligibility for services. Sec. 520. Authorization of appropriations. TITLE VI--ORGANIZATIONAL IMPROVEMENTS Sec. 601. Establishment of the Indian Health Service as an agency of the Public Health Service. Sec. 602. Automated management information system. Sec. 603. Authorization of appropriations. TITLE VII--BEHAVIORAL HEALTH PROGRAMS Sec. 701. Behavioral health prevention and treatment services. Sec. 702. Memoranda of agreement with the Department of the Interior. Sec. 703. Comprehensive behavioral health prevention and treatment program. Sec. 704. Mental health technician program. Sec. 705. Licensing requirement for mental health care workers. Sec. 706. Indian women treatment programs. Sec. 707. Indian youth program. Sec. 708. Indian youth telemental health demonstration project. Sec. 709. Inpatient and community-based mental health facilities design, construction, and staffing. Sec. 710. Training and community education. Sec. 711. Behavioral health program. Sec. 712. Fetal alcohol disorder programs. Sec. 713. Child sexual abuse and prevention treatment programs. Sec. 714. Behavioral health research. Sec. 715. Definitions. Sec. 716. 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 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. Severability provisions. Sec. 813. Establishment of National Bipartisan Commission on Indian Health Care. Sec. 814. Confidentiality of medical quality assurance records; qualified immunity for participants. Sec. 815. Appropriations; availability. Sec. 816. Authorization of appropriations. SEC. 2. FINDINGS. Congress makes the following findings: (1) Federal health services 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, and resulting responsibility to, the American Indian people. (2) 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 to be raised to the highest possible level and to encourage the maximum participation of Indians in the planning and management of those services. (3) Federal health services to Indians have resulted in a reduction in the prevalence and incidence of preventable illnesses among, and unnecessary and premature deaths of, Indians. (4) Despite such services, the unmet health needs of the American Indian people are severe and the health status of the Indians is far below that of the general population of the United States. SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POLICY. Congress declares that it is the policy of this Nation, in fulfillment of its special trust responsibilities and legal obligations to Indians-- (1) to assure the highest possible health status for Indians and Urban Indians and to provide all resources necessary to effect that policy; (2) to raise the health status of Indians and Urban Indians to at least the levels set forth in the goals contained within the Healthy People 2010 or successor objectives; (3) to the greatest extent possible, to allow Indians to set their own health care priorities and establish goals that reflect their unmet needs; (4) to increase the proportion of all degrees in the health professions and allied and associated health professions awarded to Indians so that the proportion of Indian health professionals in each Service Area is raised to at least the level of that of the general population; (5) to require meaningful consultation with Indian Tribes, Tribal Organizations, and Urban Indian Organizations to implement this Act and the national policy of Indian self-determination; and (6) to provide funding for programs and facilities operated by Indian Tribes and Tribal Organizations in amounts that are not less than the amounts provided to programs and facilities operated directly by the Service. SEC. 4. DEFINITIONS. For purposes of this Act: (1) The term ``accredited and accessible'' means on or near a reservation and accredited by a national or regional organization with accrediting authority. (2) The term ``Area Office'' means an administrative entity, including a program office, within the Service through which services and funds are provided to the Service Units within a defined geographic area. (3) The term ``Assistant Secretary'' means the Assistant Secretary of Indian Health. (4)(A) The term ``behavioral health'' means the blending of substance (alcohol, drugs, inhalants, and tobacco) abuse and mental health prevention and treatment, for the purpose of providing comprehensive services. (B) The term ``behavioral health'' includes the joint development of substance abuse and mental health treatment planning and coordinated case management using a multidisciplinary approach. (5) The term ``California Indians'' means those Indians who are eligible for health services of the Service pursuant to section 806. (6) The term ``community college'' means-- (A) a tribal college or university, or (B) a junior or community college. (7) The term ``contract health service'' means health services provided at the expense of the Service or a Tribal Health Program by public or private medical providers or hospitals, other than the Service Unit or the Tribal Health Program at whose expense the services are provided. (8) The term ``Department'' means, unless otherwise designated, the Department of Health and Human Services. (9) The term ``disease prevention'' means the reduction, limitation, and prevention of disease and its complications and reduction in the consequences of disease, including-- (A) controlling-- (i) the development of diabetes; (ii) high blood pressure; (iii) infectious agents; (iv) injuries; (v) occupational hazards and disabilities; (vi) sexually transmittable diseases; and (vii) toxic agents; and (B) providing-- (i) fluoridation of water; and (ii) immunizations. (10) The term ``health profession'' means allopathic medicine, family medicine, internal medicine, pediatrics, geriatric medicine, obstetrics and gynecology, podiatric medicine, nursing, public health nursing, dentistry, psychiatry, osteopathy, optometry, pharmacy, psychology, public health, social work, marriage and family therapy, chiropractic medicine, environmental health and engineering, allied health professions, naturopathic medicine, and any other health profession. (11) The term ``health promotion'' means-- (A) fostering social, economic, environmental, and personal factors conducive to health, including raising public awareness about health matters and enabling the people to cope with health problems by increasing their knowledge and providing them with valid information; (B) encouraging adequate and appropriate diet, exercise, and sleep; (C) promoting education and work in conformity with physical and mental capacity; (D) making available safe water and sanitary facilities; (E) improving the physical, economic, cultural, psychological, and social environment; (F) promoting culturally competent care; and (G) providing adequate and appropriate programs, which may include-- (i) abuse prevention (mental and physical); (ii) community health; (iii) community safety; (iv) consumer health education; (v) diet and nutrition; (vi) immunization and other prevention of communicable diseases, including HIV/AIDS; (vii) environmental health; (viii) exercise and physical fitness; (ix) avoidance of fetal alcohol disorders; (x) first aid and CPR education; (xi) human growth and development; (xii) injury prevention and personal safety; (xiii) behavioral health; (xiv) monitoring of disease indicators between health care provider visits, through appropriate means, including Internet-based health care management systems; (xv) personal health and wellness practices; (xvi) personal capacity building; (xvii) prenatal, pregnancy, and infant care; (xviii) psychological well-being; (xix) reproductive health and family planning; (xx) safe and adequate water; (xxi) healthy work environments; (xxii) elimination, reduction, and prevention of contaminants that create unhealthy household conditions (including mold and other allergens); (xxiii) stress control; (xxiv) substance abuse; (xxv) sanitary facilities; (xxvi) sudden infant death syndrome prevention; (xxvii) tobacco use cessation and reduction; (xxviii) violence prevention; and (xxix) such other activities identified by the Service, a Tribal Health Program, or an Urban Indian Organization, to promote achievement of any of the objectives described in section 3(2). (12) The term ``Indian'', unless otherwise designated, means any person who is a member of an Indian Tribe or is eligible for health services under section 806, except that, for the purpose of sections 102 and 103, the term also means any individual who-- (A)(i) irrespective of whether the individual lives on or near a reservation, is a member of a tribe, band, or other organized group of Indians, including those tribes, bands, or groups terminated since 1940 and those recognized now or in the future by the State in which they reside; or (ii) is a descendant, in the first or second degree, of any such member; (B) is an Eskimo or Aleut or other Alaska 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. (13) The term ``Indian Health Program'' means-- (A) any health program administered directly by the Service; (B) any Tribal Health Program; or (C) any Indian Tribe or Tribal Organization to which the Secretary provides funding pursuant to section 23 of the Act of June 25, 1910 (25 U.S.C. 47) (commonly known as the ``Buy Indian Act''). (14) The term ``Indian Tribe'' has the meaning given the term in the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.). (15) The term ``junior or community college'' has the meaning given the term by section 312(e) of the Higher Education Act of 1965 (20 U.S.C. 1058(e)). (16) The term ``reservation'' means any federally recognized Indian Tribe's reservation, Pueblo, or colony, including former reservations in Oklahoma, Indian allotments, and Alaska Native Regions established pursuant to the Alaska Native Claims Settlement Act (43 U.S.C. 1601 et seq.). (17) The term ``Secretary'', unless otherwise designated, means the Secretary of Health and Human Services. (18) The term ``Service'' means the Indian Health Service. (19) The term ``Service Area'' means the geographical area served by each Area Office. (20) The term ``Service Unit'' means an administrative entity of the Service, or a Tribal Health Program through which services are provided, directly or by contract, to eligible Indians within a defined geographic area. (21) The term ``telehealth'' has the meaning given the term in section 330K(a) of the Public Health Service Act (42 U.S.C. 254c-16(a)). (22) The term ``telemedicine'' means a telecommunications link to an end user through the use of eligible equipment that electronically links health professionals or patients and health professionals at separate sites in order to exchange health care information in audio, video, graphic, or other format for the purpose of providing improved health care services. (23) The term ``tribal college or university'' has the meaning given the term in section 316(b)(3) of the Higher Education Act (20 U.S.C. 1059c(b)(3)). (24) The term ``Tribal Health Program'' means an Indian Tribe or Tribal Organization that operates any health program, service, function, activity, or facility funded, in whole or part, by the Service through, or provided for in, a contract or compact with the Service under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.). (25) The term ``Tribal Organization'' has the meaning given the term in the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.). (26) The term ``Urban Center'' means any community which has a sufficient Urban Indian population with unmet health needs to warrant assistance under title V of this Act, as determined by the Secretary. (27) The term ``Urban Indian'' means any individual who resides in an Urban Center and who meets 1 or more of the following criteria: (A) Irrespective of whether the individual lives on or near a reservation, the individual is a member of a tribe, band, or other organized group of Indians, including those tribes, bands, or groups terminated since 1940 and those tribes, bands, or groups that are recognized by the States in which they reside, or who is a descendant in the first or second degree of any such member. (B) The individual is an Eskimo, Aleut, or other Alaska Native. (C) The individual is considered by the Secretary of the Interior to be an Indian for any purpose. (D) The individual is determined to be an Indian under regulations promulgated by the Secretary. (28) The term ``Urban Indian Organization'' means a nonprofit corporate body that (A) is situated in an Urban Center; (B) is governed by an Urban Indian- controlled board of directors; (C) provides for the participation of all interested Indian groups and individuals; and (D) is capable of legally cooperating with other public and private entities for the purpose of performing the activities described in section 503(a). TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT SEC. 101. PURPOSE. The purpose of this title is to increase, to the maximum extent feasible, the number of Indians entering the health professions and providing health services, and to assure an optimum supply of health professionals to the Indian Health Programs and Urban Indian Organizations involved in the provision of health services to Indians. SEC. 102. HEALTH PROFESSIONS RECRUITMENT PROGRAM FOR INDIANS. (a) In General.--The Secretary, acting through the Service, shall make grants to public or nonprofit private health or educational entities, Tribal Health Programs, or Urban Indian Organizations to assist such entities in meeting the costs of-- (1) identifying Indians with a potential for education or training in the health professions and encouraging and assisting them-- (A) to enroll in courses of study in such health professions; or (B) if they are not qualified to enroll in any such courses of study, to undertake such postsecondary education or training as may be required to qualify them for enrollment; (2) publicizing existing sources of financial aid available to Indians enrolled in any course of study referred to in paragraph (1) or who are undertaking training necessary to qualify them to enroll in any such course of study; or (3) establishing other programs which the Secretary determines will enhance and facilitate the enrollment of Indians in, and the subsequent pursuit and completion by them of, courses of study referred to in paragraph (1). (b) Grants.-- (1) Application.--The Secretary shall not make a grant under this section unless an application has been submitted to, and approved by, the Secretary. Such application shall be in such form, submitted in such manner, and contain such information, as the Secretary shall by regulation prescribe pursuant to this Act. The Secretary shall give a preference to applications submitted by Tribal Health Programs or Urban Indian Organizations. (2) Amount of grants; payment.--The amount of a grant under this section shall be determined by the Secretary. Payments pursuant to this section may be made in advance or by way of reimbursement, and at such intervals and on such conditions as provided for in regulations issued pursuant to this Act. To the extent not otherwise prohibited by law, grants shall be for 3 years, as provided in regulations issued pursuant to this Act. SEC. 103. HEALTH PROFESSIONS PREPARATORY SCHOLARSHIP PROGRAM FOR INDIANS. (a) Scholarships Authorized.--The Secretary, acting through the Service, shall provide scholarship grants to Indians who-- (1) have successfully completed their high school education or high school equivalency; and (2) have demonstrated the potential to successfully complete courses of study in the health professions. (b) Purposes.--Scholarship grants provided pursuant to this section shall be for the following purposes: (1) Compensatory preprofessional education of any recipient, such scholarship not to exceed 2 years on a full-time basis (or the part-time equivalent thereof, as determined by the Secretary pursuant to regulations issued under this Act). (2) Pregraduate education of any recipient leading to a baccalaureate degree in an approved course of study preparatory to a field of study in a health profession, such scholarship not to exceed 4 years. An extension of up to 2 years (or the part-time equivalent thereof, as determined by the Secretary pursuant to regulations issued pursuant to this Act) may be approved. (c) Other Conditions.--Scholarships under this section-- (1) may cover costs of tuition, books, transportation, board, and other necessary related expenses of a recipient while attending school; (2) shall not be denied solely on the basis of the applicant's scholastic achievement if such applicant has been admitted to, or maintained good standing at, an accredited institution; and (3) shall not be denied solely by reason of such applicant's eligibility for assistance or benefits under any other Federal program. SEC. 104. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS. (a) In General.-- (1) Authority.--The Secretary, acting through the Service, shall make scholarship grants to Indians who are enrolled full or part time in accredited schools pursuing courses of study in the health professions. Such scholarships shall be designated Indian Health Scholarships and shall be made in accordance with section 338A of the Public Health Services Act (42 U.S.C. 254l), except as provided in subsection (b) of this section. (2) Determinations by secretary.--The Secretary, acting through the Service, shall determine-- (A) who shall receive scholarship grants under subsection (a); and (B) the distribution of the scholarships among health professions on the basis of the relative needs of Indians for additional service in the health professions. (3) Certain delegation not allowed.--The administration of this section shall be a responsibility of the Assistant Secretary and shall not be delegated in a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.). (b) Active Duty Service Obligation.-- (1) Obligation met.--The active duty service obligation under a written contract with the Secretary under this section that an Indian has entered into shall, if that individual is a recipient of an Indian Health Scholarship, be met in full-time practice equal to 1 year for each school year for which the participant receives a scholarship award under this part, or 2 years, whichever is greater, by service in 1 or more of the following: (A) In an Indian Health Program. (B) In a program assisted under title V of this Act. (C) In the private practice of the applicable profession if, as determined by the Secretary, in accordance with guidelines promulgated by the Secretary, such practice is situated in a physician or other health professional shortage area and addresses the health care needs of a substantial number of Indians. (D) In a teaching capacity in a tribal college or university nursing program (or a related health profession program) if, as determined by the Secretary, the health service provided to Indians would not decrease. (2) Obligation deferred.--At the request of any individual who has entered into a contract referred to in paragraph (1) and who receives a degree in medicine (including osteopathic or allopathic medicine), dentistry, optometry, podiatry, or pharmacy, the Secretary shall defer the active duty service obligation of that individual under that contract, in order that such individual may complete any internship, residency, or other advanced clinical training that is required for the practice of that health profession, for an appropriate period (in years, as determined by the Secretary), subject to the following conditions: (A) No period of internship, residency, or other advanced clinical training shall be counted as satisfying any period of obligated service under this subsection. (B) The active duty service obligation of that individual shall commence not later than 90 days after the completion of that advanced clinical training (or by a date specified by the Secretary). (C) The active duty service obligation will be served in the health profession of that individual in a manner consistent with paragraph (1). (D) A recipient of a scholarship under this section may, at the election of the recipient, meet the active duty service obligation described in paragraph (1) by service in a program specified under that paragraph that-- (i) is located on the reservation of the Indian Tribe in which the recipient is enrolled; or (ii) serves the Indian Tribe in which the recipient is enrolled. (3) Priority when making assignments.--Subject to paragraph (2), the Secretary, in making assignments of Indian Health Scholarship recipients required to meet the active duty service obligation described in paragraph (1), shall give priority to assigning individuals to service in those programs specified in paragraph (1) that have a need for health professionals to provide health care services as a result of individuals having breached contracts entered into under this section. (c) Part-Time Students.--In the case of an individual receiving a scholarship under this section who is enrolled part time in an approved course of study-- (1) such scholarship shall be for a period of years not to exceed the part-time equivalent of 4 years, as determined by the Secretary; (2) the period of obligated service described in subsection (b)(1) shall be equal to the greater of-- (A) the part-time equivalent of 1 year for each year for which the individual was provided a scholarship (as determined by the Secretary); or (B) 2 years; and (3) the amount of the monthly stipend specified in section 338A(g)(1)(B) of the Public Health Service Act (42 U.S.C. 254l(g)(1)(B)) shall be reduced pro rata (as determined by the Secretary) based on the number of hours such student is enrolled. (d) Breach of Contract.-- (1) Specified breaches.--An individual shall be liable to the United States for the amount which has been paid to the individual, or on behalf of the individual, under a contract entered into with the Secretary under this section on or after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007 if that individual-- (A) fails to maintain an acceptable level of academic standing in the educational institution in which he or she is enrolled (such level determined by the educational institution under regulations of the Secretary); (B) is dismissed from such educational institution for disciplinary reasons; (C) voluntarily terminates the training in such an educational institution for which he or she is provided a scholarship under such contract before the completion of such training; or (D) fails to accept payment, or instructs the educational institution in which he or she is enrolled not to accept payment, in whole or in part, of a scholarship under such contract, in lieu of any service obligation arising under such contract. (2) Other breaches.--If for any reason not specified in paragraph (1) an individual breaches a written contract by failing either to begin such individual's service obligation required under such contract or to complete such service obligation, the United States shall be entitled to recover from the individual an amount determined in accordance with the formula specified in subsection (l) of section 110 in the manner provided for in such subsection. (3) Cancellation upon death of recipient.--Upon the death of an individual who receives an Indian Health Scholarship, any outstanding obligation of that individual for service or payment that relates to that scholarship shall be canceled. (4) Waivers and suspensions.-- (A) In general.--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 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. (B) Factors for consideration.--Before waiving or suspending an obligation of service or payment under subparagraph (A), the Secretary shall consult with the affected Area Office, Indian Tribes, Tribal Organizations, or Urban Indian Organizations, and may take into consideration whether the obligation may be satisfied in a teaching capacity at a tribal college or university nursing program under subsection (b)(1)(D). (5) Extreme hardship.--Notwithstanding any other provision of law, in any case of extreme hardship or for other good cause shown, the Secretary may waive, in whole or in part, the right of the United States to recover funds made available under this section. (6) Bankruptcy.--Notwithstanding any other provision of law, with respect to a recipient of an Indian Health Scholarship, no obligation for payment may be released by a discharge in bankruptcy under title 11, United States Code, unless that discharge is granted after the expiration of the 5-year period beginning on the initial date on which that payment is due, and only if the bankruptcy court finds that the nondischarge of the obligation would be unconscionable. SEC. 105. AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM. (a) Grants Authorized.--The Secretary, acting through the Service, shall make grants of not more than $300,000 to each of 9 colleges and universities for the purpose of developing and maintaining Indian psychology career recruitment programs as a means of encouraging Indians to enter the behavioral health field. These programs shall be located at various locations throughout the country to maximize their availability to Indian students and new programs shall be established in different locations from time to time. (b) Quentin N. Burdick Program Grant.--The Secretary shall provide a grant authorized under subsection (a) to develop and maintain a program at the University of North Dakota to be known as the ``Quentin N. Burdick American Indians Into Psychology Program'. Such program shall, to the maximum extent feasible, coordinate with the Quentin N. Burdick Indian Health Programs authorized under section 117(b), the Quentin N. Burdick American Indians Into Nursing Program authorized under section 115(e), and existing university research and communications networks. (c) Regulations.--The Secretary shall issue regulations pursuant to this Act for the competitive awarding of grants provided under this section. (d) Conditions of Grant.--Applicants under this section shall agree to provide a program which, at a minimum-- (1) provides outreach and recruitment for health professions to Indian communities including elementary, secondary, and accredited and accessible community colleges that will be served by the program; (2) incorporates a program advisory board comprised of representatives from the tribes and communities that will be served by the program; (3) provides summer enrichment programs to expose Indian students to the various fields of psychology through research, clinical, and experimental activities; (4) provides stipends to undergraduate and graduate students to pursue a career in psychology; (5) develops affiliation agreements with tribal colleges and universities, the Service, university affiliated programs, and other appropriate accredited and accessible entities to enhance the education of Indian students; (6) to the maximum extent feasible, uses existing university tutoring, counseling, and student support services; and (7) to the maximum extent feasible, employs qualified Indians in the program. (e) Active Duty Service Requirement.--The active duty service obligation prescribed under section 338C of the Public Health Service Act (42 U.S.C. 254m) shall be met by each graduate who receives a stipend described in subsection (d)(4) that is funded under this section. Such obligation shall be met by service-- (1) in an Indian Health Program; (2) in a program assisted under title V of this Act; or (3) in the private practice of psychology if, as determined by the Secretary, in accordance with guidelines promulgated by the Secretary, such practice is situated in a physician or other health professional shortage area and addresses the health care needs of a substantial number of Indians. (f) Authorization of Appropriations.--There is authorized to be appropriated to carry out this section $2,700,000 for each of fiscal years 2008 through 2017. SEC. 106. SCHOLARSHIP PROGRAMS FOR INDIAN TRIBES. (a) In General.-- (1) Grants authorized.--The Secretary, acting through the Service, shall make grants to Tribal Health Programs for the purpose of providing scholarships for Indians to serve as health professionals in Indian communities. (2) Amount.--Amounts available under paragraph (1) for any fiscal year shall not exceed 5 percent of the amounts available for each fiscal year for Indian Health Scholarships under section 104. (3) Application.--An application for a grant under paragraph (1) shall be in such form and contain such agreements, assurances, and information as consistent with this section. (b) Requirements.-- (1) In general.--A Tribal Health Program receiving a grant under subsection (a) shall provide scholarships to Indians in accordance with the requirements of this section. (2) Costs.--With respect to costs of providing any scholarship pursuant to subsection (a)-- (A) 80 percent of the costs of the scholarship shall be paid from the funds made available pursuant to subsection (a)(1) provided to the Tribal Health Program; and (B) 20 percent of such costs may be paid from any other source of funds. (c) Course of Study.--A Tribal Health Program shall provide scholarships under this section only to Indians enrolled or accepted for enrollment in a course of study (approved by the Secretary) in 1 of the health professions contemplated by this Act. (d) Contract.-- (1) In general.--In providing scholarships under subsection (b), the Secretary and the Tribal Health Program shall enter into a written contract with each recipient of such scholarship. (2) Requirements.--Such contract shall-- (A) obligate such recipient to provide service in an Indian Health Program or Urban Indian Organization, in the same Service Area where the Tribal Health Program providing the scholarship is located, for-- (i) a number of years for which the scholarship is provided (or the part- time equivalent thereof, as determined by the Secretary), or for a period of 2 years, whichever period is greater; or (ii) such greater period of time as the recipient and the Tribal Health Program may agree; (B) provide that the amount of 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)), with such amount to be reduced pro rata (as determined by the Secretary) based on the number of hours such student is enrolled, and not to exceed, for any year of attendance for which the scholarship is provided, the total amount required for the year for the purposes authorized in this clause; and (ii) may not exceed, for any year of attendance for which the scholarship is provided, the total amount required for the year for the purposes authorized in 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 each health profession. (3) Service in other service areas.--The contract may allow the recipient to serve in another Service Area, provided the Tribal Health Program and Secretary approve and services are not diminished to Indians in the Service Area where the Tribal Health Program providing the scholarship is located. (e) Breach of Contract.-- (1) Specific breaches.--An individual who has entered into a written contract with the Secretary and a Tribal Health Program under subsection (d) shall be liable to the United States for the Federal share of the amount which has been paid to him or her, or on his or her behalf, under the contract if that individual-- (A) fails to maintain an acceptable level of academic standing in the educational institution in which he or she is enrolled (such level as determined by the educational institution under regulations of the Secretary); (B) is dismissed from such educational institution for disciplinary reasons; (C) voluntarily terminates the training in such an educational institution for which he or she is provided a scholarship under such contract before the completion of such training; or (D) fails to accept payment, or instructs the educational institution in which he or she is enrolled not to accept payment, in whole or in part, of a scholarship under such contract, in lieu of any service obligation arising under such contract. (2) Other breaches.--If for any reason not specified in paragraph (1), an individual breaches a written contract by failing to either begin such individual's service obligation required under such contract or to complete such service obligation, the United States shall be entitled to recover from the individual an amount determined in accordance with the formula specified in subsection (l) of section 110 in the manner provided for in such subsection. (3) Cancellation upon death of recipient.--Upon the death of an individual who receives an Indian Health Scholarship, any outstanding obligation of that individual for service or payment that relates to that scholarship shall be canceled. (4) Information.--The Secretary may carry out this subsection on the basis of information received from Tribal Health Programs involved or on the basis of information collected through such other means as the Secretary deems appropriate. (f) Relation to Social Security Act.--The recipient of a scholarship under this section shall agree, in providing health care pursuant to the requirements herein-- (1) not to discriminate against an individual seeking care on the basis of the ability of the individual to pay for such care or on the basis that payment for such care will be made pursuant to a program established in title XVIII of the Social Security Act or pursuant to the programs established in title XIX or title XXI of such Act; and (2) to accept assignment under section 1842(b)(3)(B)(ii) of the Social Security Act for all services for which payment may be made under part B of title XVIII of such Act, and to enter into an appropriate agreement with the State agency that administers the State plan for medical assistance under title XIX, or the State child health plan under title XXI, of such Act to provide service to individuals entitled to medical assistance or child health assistance, respectively, under the plan. (g) Continuance of Funding.--The Secretary shall make payments under this section to a Tribal Health Program for any fiscal year subsequent to the first fiscal year of such payments unless the Secretary determines that, for the immediately preceding fiscal year, the Tribal Health Program has not complied with the requirements of this section. SEC. 107. INDIAN HEALTH SERVICE EXTERN PROGRAMS. (a) Employment Preference.--Any individual who receives a scholarship pursuant to section 104 or 106 shall be given preference for employment in the Service, or may be employed by a Tribal Health Program or an Urban Indian Organization, or other agencies of the Department as available, during any nonacademic period of the year. (b) Not Counted Toward Active Duty Service Obligation.-- Periods of employment pursuant to this subsection shall not be counted in determining fulfillment of the service obligation incurred as a condition of the scholarship. (c) Timing; Length of Employment.--Any individual enrolled in a program, including a high school program, authorized under section 102(a) may be employed by the Service or by a Tribal Health Program or an Urban Indian Organization during any nonacademic period of the year. Any such employment shall not exceed 120 days during any calendar year. (d) Nonapplicability of Competitive Personnel System.--Any employment pursuant to this section shall be made without regard to any competitive personnel system or agency personnel limitation and to a position which will enable the individual so employed to receive practical experience in the health profession in which he or she is engaged in study. Any individual so employed shall receive payment for his or her services comparable to the salary he or she would receive if he or she were employed in the competitive system. Any individual so employed shall not be counted against any employment ceiling affecting the Service or the Department. SEC. 108. CONTINUING EDUCATION ALLOWANCES. In order to encourage scholarship and stipend recipients under sections 104, 105, 106, and 115 and health professionals, including community health representatives and emergency medical technicians, to join or continue in an Indian Health Program and to provide their services in the rural and remote areas where a significant portion of Indians reside, the Secretary, acting through the Service, may-- (1) provide programs or allowances to transition into an Indian Health Program, including licensing, board or certification examination assistance, and technical assistance in fulfilling service obligations under sections 104, 105, 106, and 115; and (2) provide programs or allowances to health professionals employed in an Indian Health Program to enable them for a period of time each year prescribed by regulation of the Secretary to take leave of their duty stations for professional consultation, management, leadership, and refresher training courses. SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PROGRAM. (a) In General.--Under the authority of the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the ``Snyder Act''), the Secretary, acting through the Service, shall maintain a Community Health Representative Program under which Indian Health Programs-- (1) provide for the training of Indians as community health representatives; and (2) use such community health representatives in the provision of health care, health promotion, and disease prevention services to Indian communities. (b) Duties.--The Community Health Representative Program of the Service, shall-- (1) provide a high standard of training for community health representatives to ensure that the community health representatives provide quality health care, health promotion, and disease prevention services to the Indian communities served by the Program; (2) in order to provide such training, develop and maintain a curriculum that-- (A) combines education in the theory of health care with supervised practical experience in the provision of health care; and (B) provides instruction and practical experience in health promotion and disease prevention activities, with appropriate consideration given to lifestyle factors that have an impact on Indian health status, such as alcoholism, family dysfunction, and poverty; (3) maintain a system which identifies the needs of community health representatives for continuing education in health care, health promotion, and disease prevention and develop programs that meet the needs for continuing education; (4) maintain a system that provides close supervision of Community Health Representatives; (5) maintain a system under which the work of Community Health Representatives is reviewed and evaluated; and (6) promote traditional health care practices of the Indian Tribes served consistent with the Service standards for the provision of health care, health promotion, and disease prevention. SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT PROGRAM. (a) Establishment.--The Secretary, acting through the Service, shall establish and administer a program to be known as the Service Loan Repayment Program (hereinafter referred to as the ``Loan Repayment Program'') in order to ensure an adequate supply of trained health professionals necessary to maintain accreditation of, and provide health care services to Indians through, Indian Health Programs and Urban Indian Organizations. (b) Eligible Individuals.--To be eligible to participate in the Loan Repayment Program, an individual must-- (1)(A) be enrolled-- (i) in a course of study or program in an accredited educational institution (as determined by the Secretary under section 338B(b)(1)(c)(i) of the Public Health Service Act (42 U.S.C. 254l-1(b)(1)(c)(i))) and be scheduled to complete such course of study in the same year such individual applies to participate in such program; or (ii) in an approved graduate training program in a health profession; or (B) have-- (i) a degree in a health profession; and (ii) a license to practice a health profession; (2)(A) be eligible for, or hold, an appointment as a commissioned officer in the Regular or Reserve Corps of the Public Health Service; (B) be eligible for selection for civilian service in the Regular or Reserve Corps of the Public Health Service; (C) meet the professional standards for civil service employment in the Service; or (D) be employed in an Indian Health Program or Urban Indian Organization without a service obligation; and (3) submit to the Secretary an application for a contract described in subsection (e). (c) Application.-- (1) Information to be included with forms.--In disseminating application forms and contract forms to individuals desiring to participate in the Loan Repayment Program, the Secretary shall include with such forms a fair summary of the rights and liabilities of an individual whose application is approved (and whose contract is accepted) by the Secretary, including in the summary a clear explanation of the damages to which the United States is entitled under subsection (l) in the case of the individual's breach of contract. The Secretary shall provide such individuals with sufficient information regarding the advantages and disadvantages of service as a commissioned officer in the Regular or Reserve Corps of the Public Health Service or a civilian employee of the Service to enable the individual to make a decision on an informed basis. (2) Clear language.--The application form, contract form, and all other information furnished by the Secretary under this section shall be written in a manner calculated to be understood by the average individual applying to participate in the Loan Repayment Program. (3) Timely availability of forms.--The Secretary shall make such application forms, contract forms, and other information available to individuals desiring to participate in the Loan Repayment Program on a date sufficiently early to ensure that such individuals have adequate time to carefully review and evaluate such forms and information. (d) Priorities.-- (1) List.--Consistent with subsection (k), the Secretary shall annually-- (A) identify the positions in each Indian Health Program or Urban Indian Organization for which there is a need or a vacancy; and (B) rank those positions in order of priority. (2) Approvals.--Notwithstanding the priority determined under paragraph (1), the Secretary, in determining which applications under the Loan Repayment Program to approve (and which contracts to accept), shall-- (A) give first priority to applications made by individual Indians; and (B) after making determinations on all applications submitted by individual Indians as required under subparagraph (A), give priority to-- (i) individuals recruited through the efforts of an Indian Health Program or Urban Indian Organization; and (ii) other individuals based on the priority rankings under paragraph (1). (e) Recipient Contracts.-- (1) Contract required.--An individual becomes a participant in the Loan Repayment Program only upon the Secretary and the individual entering into a written contract described in paragraph (2). (2) Contents of contract.--The written contract referred to in this section between the Secretary and an individual shall contain-- (A) an agreement under which-- (i) subject to subparagraph (C), the Secretary agrees-- (I) to pay loans on behalf of the individual in accordance with the provisions of this section; and (II) to accept (subject to the availability of appropriated funds for carrying out this section) the individual into the Service or place the individual with a Tribal Health Program or Urban Indian Organization as provided in clause (ii)(III); and (ii) subject to subparagraph (C), the individual agrees-- (I) to accept loan payments on behalf of the individual; (II) in the case of an individual described in subsection (b)(1)-- (aa) to maintain enrollment in a course of study or training described in subsection (b)(1)(A) until the individual completes the course of study or training; and (bb) while enrolled in such course of study or training, to maintain an acceptable level of academic standing (as determined under regulations of the Secretary by the educational institution offering such course of study or training); and (III) to serve for a time period (hereinafter in this section referred to as the ``period of obligated service'') equal to 2 years or such longer period as the individual may agree to serve in the full-time clinical practice of such individual's profession in an Indian Health Program or Urban Indian Organization to which the individual may be assigned by the Secretary; (B) a provision permitting the Secretary to extend for such longer additional periods, as the individual may agree to, the period of obligated service agreed to by the individual under subparagraph (A)(ii)(III); (C) a provision that any financial obligation of the United States arising out of a contract entered into under this section and any obligation of the individual which is conditioned thereon is contingent upon funds being appropriated for loan repayments under this section; (D) a statement of the damages to which the United States is entitled under subsection (l) for the individual's breach of the contract; and (E) such other statements of the rights and liabilities of the Secretary and of the individual, not inconsistent with this section. (f) Deadline for Decision on Application.--The Secretary shall provide written notice to an individual within 21 days on-- (1) the Secretary's approving, under subsection (e)(1), of the individual's participation in the Loan Repayment Program, including extensions resulting in an aggregate period of obligated service in excess of 4 years; or (2) the Secretary's disapproving an individual's participation in such Program. (g) Payments.-- (1) In general.--A loan repayment provided for an individual under a written contract under the Loan Repayment Program shall consist of payment, in accordance with paragraph (2), on behalf of the individual of the principal, interest, and related expenses on government and commercial loans received by the individual regarding the undergraduate or graduate education of the individual (or both), which loans were made for-- (A) tuition expenses; (B) all other reasonable educational expenses, including fees, books, and laboratory expenses, incurred by the individual; and (C) reasonable living expenses as determined by the Secretary. (2) Amount.--For each year of obligated service that an individual contracts to serve under subsection (e), the Secretary may pay up to $35,000 or an amount equal to the amount specified in section 338B(g)(2)(A) of the Public Health Service Act, whichever is more, on behalf of the individual for loans described in paragraph (1). In making a determination of the amount to pay for a year of such service by an individual, the Secretary shall consider the extent to which each such determination-- (A) affects the ability of the Secretary to maximize the number of contracts that can be provided under the Loan Repayment Program from the amounts appropriated for such contracts; (B) provides an incentive to serve in Indian Health Programs and Urban Indian Organizations with the greatest shortages of health professionals; and (C) provides an incentive with respect to the health professional involved remaining in an Indian Health Program or Urban Indian Organization with such a health professional shortage, and continuing to provide primary health services, after the completion of the period of obligated service under the Loan Repayment Program. (3) Timing.--Any arrangement made by the Secretary for the making of loan repayments in accordance with this subsection shall provide that any repayments for a year of obligated service shall be made no later than the end of the fiscal year in which the individual completes such year of service. (4) Reimbursements for tax liability.--For the purpose of providing reimbursements for tax liability resulting from a payment under paragraph (2) on behalf of an individual, the Secretary-- (A) in addition to such payments, may make payments to the individual in an amount equal to not less than 20 percent and not more than 39 percent of the total amount of loan repayments made for the taxable year involved; and (B) may make such additional payments as the Secretary determines to be appropriate with respect to such purpose. (5) Payment schedule.--The Secretary may enter into an agreement with the holder of any loan for which payments are made under the Loan Repayment Program to establish a schedule for the making of such payments. (h) Employment Ceiling.--Notwithstanding any other provision of law, individuals who have entered into written contracts with the Secretary under this section shall not be counted against any employment ceiling affecting the Department while those individuals are undergoing academic training. (i) Recruitment.--The Secretary shall conduct recruiting programs for the Loan Repayment Program and other manpower programs of the Service at educational institutions training health professionals or specialists identified in subsection (a). (j) Applicability of Law.--Section 214 of the Public Health Service Act (42 U.S.C. 215) shall not apply to individuals during their period of obligated service under the Loan Repayment Program. (k) Assignment of Individuals.--The Secretary, in assigning individuals to serve in Indian Health Programs or Urban Indian Organizations pursuant to contracts entered into under this section, shall-- (1) ensure that the staffing needs of Tribal Health Programs and Urban Indian Organizations receive consideration on an equal basis with programs that are administered directly by the Service; and (2) give priority to assigning individuals to Indian Health Programs and Urban Indian Organizations that have a need for health professionals to provide health care services as a result of individuals having breached contracts entered into under this section. (l) Breach of Contract.-- (1) Specific breaches.--An individual who has entered into a written contract with the Secretary under this section and has not received a waiver under subsection (m) shall be liable, in lieu of any service obligation arising under such contract, to the United States for the amount which has been paid on such individual's behalf under the contract if that individual-- (A) is enrolled in the final year of a course of study and-- (i) fails to maintain an acceptable level of academic standing in the educational institution in which he or she is enrolled (such level determined by the educational institution under regulations of the Secretary); (ii) voluntarily terminates such enrollment; or (iii) is dismissed from such educational institution before completion of such course of study; or (B) is enrolled in a graduate training program and fails to complete such training program. (2) Other breaches; formula for amount owed.--If, for any reason not specified in paragraph (1), an individual breaches his or her written contract under this section by failing either to begin, or complete, such individual's period of obligated service in accordance with subsection (e)(2), the United States shall be entitled to recover from such individual an amount to be determined in accordance with the following formula: A=3Z(t-s/t) in which-- (A) ``A'' is the amount the United States is entitled to recover; (B) ``Z'' is the sum of the amounts paid under this section to, or on behalf of, the individual and the interest on such amounts which would be payable if, at the time the amounts were paid, they were loans bearing interest at the maximum legal prevailing rate, as determined by the Secretary of the Treasury; (C) ``t'' is the total number of months in the individual's period of obligated service in accordance with subsection (f); and (D) ``s'' is the number of months of such period served by such individual in accordance with this section. (3) Deductions in medicare payments.--Amounts not paid within such period shall be subject to collection through deductions in Medicare payments pursuant to section 1892 of the Social Security Act. (4) Time period for repayment.--Any amount of damages which the United States is entitled to recover under this subsection shall be paid to the United States within the 1-year period beginning on the date of the breach or such longer period beginning on such date as shall be specified by the Secretary. (5) Recovery of delinquency.-- (A) In general.--If damages described in paragraph (4) are delinquent for 3 months, the Secretary shall, for the purpose of recovering such damages-- (i) use collection agencies contracted with by the Administrator of General Services; or (ii) enter into contracts for the recovery of such damages with collection agencies selected by the Secretary. (B) Report.--Each contract for recovering damages pursuant to this subsection shall provide that the contractor will, not less than once each 6 months, submit to the Secretary a status report on the success of the contractor in collecting such damages. Section 3718 of title 31, United States Code, shall apply to any such contract to the extent not inconsistent with this subsection. (m) Waiver or Suspension of Obligation.-- (1) In general.--The Secretary shall by regulation provide for the partial or total waiver or suspension of any obligation of service or payment by an individual under the Loan Repayment Program whenever compliance by the individual is impossible or would involve extreme hardship to the individual and if enforcement of such obligation with respect to any individual would be unconscionable. (2) Canceled upon death.--Any obligation of an individual under the Loan Repayment Program for service or payment of damages shall be canceled upon the death of the individual. (3) Hardship waiver.--The Secretary may waive, in whole or in part, the rights of the United States to recover amounts under this section in any case of extreme hardship or other good cause shown, as determined by the Secretary. (4) Bankruptcy.--Any obligation of an individual under the Loan Repayment Program for payment of damages may be released by a discharge in bankruptcy under title 11 of the United States Code only if such discharge is granted after the expiration of the 5-year period beginning on the first date that payment of such damages is required, and only if the bankruptcy court finds that nondischarge of the obligation would be unconscionable. (n) Report.--The Secretary shall submit to the President, for inclusion in the report required to be submitted to Congress under section 801, a report concerning the previous fiscal year which sets forth by Service Area the following: (1) A list of the health professional positions maintained by Indian Health Programs and Urban Indian Organizations for which recruitment or retention is difficult. (2) The number of Loan Repayment Program applications filed with respect to each type of health profession. (3) The number of contracts described in subsection (e) that are entered into with respect to each health profession. (4) The amount of loan payments made under this section, in total and by health profession. (5) The number of scholarships that are provided under sections 104 and 106 with respect to each health profession. (6) The amount of scholarship grants provided under section 104 and 106, in total and by health profession. (7) The number of providers of health care that will be needed by Indian Health Programs and Urban Indian Organizations, by location and profession, during the 3 fiscal years beginning after the date the report is filed. (8) The measures the Secretary plans to take to fill the health professional positions maintained by Indian Health Programs or Urban Indian Organizations for which recruitment or retention is difficult. SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOVERY FUND. (a) Establishment.--There is established in the Treasury of the United States a fund to be known as the Indian Health Scholarship and Loan Repayment Recovery Fund (hereafter in this section referred to as the ``LRRF''). The LRRF shall consist of such amounts as may be collected from individuals under section 104(d), section 106(e), and section 110(l) for breach of contract, such funds as may be appropriated to the LRRF, and interest earned on amounts in the LRRF. All amounts collected, appropriated, or earned relative to the LRRF shall remain available until expended. (b) Use of Funds.-- (1) By secretary.--Amounts in the LRRF may be expended by the Secretary, acting through the Service, to make payments to an Indian Health Program-- (A) to which a scholarship recipient under section 104 and 106 or a loan repayment program participant under section 110 has been assigned to meet the obligated service requirements pursuant to such sections; and (B) that has a need for a health professional to provide health care services as a result of such recipient or participant having breached the contract entered into under section 104, 106, or section 110. (2) By tribal health programs.--A Tribal Health Program receiving payments pursuant to paragraph (1) may expend the payments to provide scholarships or recruit and employ, directly or by contract, health professionals to provide health care services. (c) Investment of Funds.--The Secretary of the Treasury shall invest such amounts of the LRRF as the Secretary of Health and Human Services determines are not required to meet current withdrawals from the LRRF. Such investments may be made only in interest bearing obligations of the United States. For such purpose, such obligations may be acquired on original issue at the issue price, or by purchase of outstanding obligations at the market price. (d) Sale of Obligations.--Any obligation acquired by the LRRF may be sold by the Secretary of the Treasury at the market price. SEC. 112. RECRUITMENT ACTIVITIES. (a) Reimbursement for Travel.--The Secretary, acting through the Service, may reimburse health professionals seeking positions with Indian Health Programs or Urban Indian Organizations, including individuals considering entering into a contract under section 110 and their spouses, for actual and reasonable expenses incurred in traveling to and from their places of residence to an area in which they may be assigned for the purpose of evaluating such area with respect to such assignment. (b) Recruitment Personnel.--The Secretary, acting through the Service, shall assign 1 individual in each Area Office to be responsible on a full-time basis for recruitment activities. SEC. 113. INDIAN RECRUITMENT AND RETENTION PROGRAM. (a) In General.--The Secretary, acting through the Service, shall fund, on a competitive basis, innovative demonstration projects for a period not to exceed 3 years to enable Tribal Health Programs and Urban Indian Organizations to recruit, place, and retain health professionals to meet their staffing needs. (b) Eligible Entities; Application.--Any Tribal Health Program or Urban Indian Organization may submit an application for funding of a project pursuant to this section. SEC. 114. ADVANCED TRAINING AND RESEARCH. (a) Demonstration Program.--The Secretary, acting through the Service, shall establish a demonstration project to enable health professionals who have worked in an Indian Health Program or Urban Indian Organization for a substantial period of time to pursue advanced training or research areas of study for which the Secretary determines a need exists. (b) Service Obligation.--An individual who participates in a program under subsection (a), where the educational costs are borne by the Service, shall incur an obligation to serve in an Indian Health Program or Urban Indian Organization for a period of obligated service equal to at least the period of time during which the individual participates in such program. In the event that the individual fails to complete such obligated service, the individual shall be liable to the United States for the period of service remaining. In such event, with respect to individuals entering the program after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the United States shall be entitled to recover from such individual an amount to be determined in accordance with the formula specified in subsection (l) of section 110 in the manner provided for in such subsection. (c) Equal Opportunity for Participation.--Health professionals from Tribal Health Programs and Urban Indian Organizations shall be given an equal opportunity to participate in the program under subsection (a). SEC. 115. QUENTIN N. BURDICK AMERICAN INDIANS INTO NURSING PROGRAM. (a) Grants Authorized.--For the purpose of increasing the number of nurses, nurse midwives, and nurse practitioners who deliver health care services to Indians, the Secretary, acting through the Service, shall provide grants to the following: (1) Public or private schools of nursing. (2) Tribal colleges or universities. (3) Nurse midwife programs and advanced practice nurse programs that are provided by any tribal college or university accredited nursing program, or in the absence of such, any other public or private institutions. (b) Use of Grants.--Grants provided under subsection (a) may be used for 1 or more of the following: (1) To recruit individuals for programs which train individuals to be nurses, nurse midwives, or advanced practice nurses. (2) To provide scholarships to Indians enrolled in such programs that may pay the tuition charged for such program and other expenses incurred in connection with such program, including books, fees, room and board, and stipends for living expenses. (3) To provide a program that encourages nurses, nurse midwives, and advanced practice nurses to provide, or continue to provide, health care services to Indians. (4) To provide a program that increases the skills of, and provides continuing education to, nurses, nurse midwives, and advanced practice nurses. (5) To provide any program that is designed to achieve the purpose described in subsection (a). (c) Applications.--Each application for a grant under subsection (a) shall include such information as the Secretary may require to establish the connection between the program of the applicant and a health care facility that primarily serves Indians. (d) Preferences for Grant Recipients.--In providing grants under subsection (a), the Secretary shall extend a preference to the following: (1) Programs that provide a preference to Indians. (2) Programs that train nurse midwives or advanced practice nurses. (3) Programs that are interdisciplinary. (4) Programs that are conducted in cooperation with a program for gifted and talented Indian students. (5) Programs conducted by tribal colleges and universities. (e) Quentin N. Burdick Program Grant.--The Secretary shall provide 1 of the grants authorized under subsection (a) to establish and maintain a program at the University of North Dakota to be known as the ``Quentin N. Burdick American Indians Into Nursing Program''. Such program shall, to the maximum extent feasible, coordinate with the Quentin N. Burdick Indian Health Programs established under section 117(b) and the Quentin N. Burdick American Indians Into Psychology Program established under section 105(b). (f) Active Duty Service Obligation.--The active duty service obligation prescribed under section 338C of the Public Health Service Act (42 U.S.C. 254m) shall be met by each individual who receives training or assistance described in paragraph (1) or (2) of subsection (b) that is funded by a grant provided under subsection (a). Such obligation shall be met by service-- (1) in the Service; (2) in a program of an Indian Tribe or Tribal Organization conducted under the Indian Self- Determination and Education Assistance Act (25 U.S.C. 450 et seq.) (including programs under agreements with the Bureau of Indian Affairs); (3) in a program assisted under title V of this Act; (4) in the private practice of nursing if, as determined by the Secretary, in accordance with guidelines promulgated by the Secretary, such practice is situated in a physician or other health shortage area and addresses the health care needs of a substantial number of Indians; or (5) in a teaching capacity in a tribal college or university nursing program (or a related health profession program) if, as determined by the Secretary, health services provided to Indians would not decrease. SEC. 116. TRIBAL CULTURAL ORIENTATION. (a) Cultural Education of Employees.--The Secretary, acting through the Service, shall require that appropriate employees of the Service who serve Indian Tribes in each Service Area receive educational instruction in the history and culture of such Indian Tribes and their relationship to the Service. (b) Program.--In carrying out subsection (a), the Secretary shall establish a program which shall, to the extent feasible-- (1) be developed in consultation with the affected Indian Tribes, Tribal Organizations, and Urban Indian Organizations; (2) be carried out through tribal colleges or universities; (3) include instruction in American Indian studies; and (4) describe the use and place of traditional health care practices of the Indian Tribes in the Service Area. SEC. 117. INMED PROGRAM. (a) Grants Authorized.--The Secretary, acting through the Service, is authorized to provide grants to colleges and universities for the purpose of maintaining and expanding the Indian health careers recruitment program known as the ``Indians Into Medicine Program'' (hereinafter in this section referred to as ``INMED'') as a means of encouraging Indians to enter the health professions. (b) Quentin N. Burdick Grant.--The Secretary shall provide 1 of the grants authorized under subsection (a) to maintain the INMED program at the University of North Dakota, to be known as the ``Quentin N. Burdick Indian Health Programs'', unless the Secretary makes a determination, based upon program reviews, that the program is not meeting the purposes of this section. Such program shall, to the maximum extent feasible, coordinate with the Quentin N. Burdick American Indians Into Psychology Program established under section 105(b) and the Quentin N. Burdick American Indians Into Nursing Program established under section 115. (c) Regulations.--The Secretary, pursuant to this Act, shall develop regulations to govern grants pursuant to this section. (d) Requirements.--Applicants for grants provided under this section shall agree to provide a program which-- (1) provides outreach and recruitment for health professions to Indian communities including elementary and secondary schools and community colleges located on reservations which will be served by the program; (2) incorporates a program advisory board comprised of representatives from the Indian Tribes and Indian communities which will be served by the program; (3) provides summer preparatory programs for Indian students who need enrichment in the subjects of math and science in order to pursue training in the health professions; (4) provides tutoring, counseling, and support to students who are enrolled in a health career program of study at the respective college or university; and (5) to the maximum extent feasible, employs qualified Indians in the program. SEC. 118. HEALTH TRAINING PROGRAMS OF COMMUNITY COLLEGES. (a) Grants to Establish Programs.-- (1) In general.--The Secretary, acting through the Service, shall award grants to accredited and accessible community colleges for the purpose of assisting such community colleges in the establishment of programs which provide education in a health profession leading to a degree or diploma in a health profession for individuals who desire to practice such profession on or near a reservation or in an Indian Health Program. (2) Amount of grants.--The amount of any grant awarded to a community college under paragraph (1) for the first year in which such a grant is provided to the community college shall not exceed $250,000. (b) Grants for Maintenance and Recruiting.-- (1) In general.--The Secretary, acting through the Service, shall award grants to accredited and accessible community colleges that have established a program described in subsection (a)(1) for the purpose of maintaining the program and recruiting students for the program. (2) Requirements.--Grants may only be made under this section to a community college which-- (A) is accredited; (B) has a relationship with a hospital facility, Service facility, or hospital that could provide training of nurses or health professionals; (C) has entered into an agreement with an accredited college or university medical school, the terms of which-- (i) provide a program that enhances the transition and recruitment of students into advanced baccalaureate or graduate programs that train health professionals; and (ii) stipulate certifications necessary to approve internship and field placement opportunities at Indian Health Programs; (D) has a qualified staff which has the appropriate certifications; (E) is capable of obtaining State or regional accreditation of the program described in subsection (a)(1); and (F) agrees to provide for Indian preference for applicants for programs under this section. (c) Technical Assistance.--The Secretary shall encourage community colleges described in subsection (b)(2) to establish and maintain programs described in subsection (a)(1) by-- (1) entering into agreements with such colleges for the provision of qualified personnel of the Service to teach courses of study in such programs; and (2) providing technical assistance and support to such colleges. (d) Advanced Training.-- (1) Required.--Any program receiving assistance under this section that is conducted with respect to a health profession shall also offer courses of study which provide advanced training for any health professional who-- (A) has already received a degree or diploma in such health profession; and (B) provides clinical services on or near a reservation or for an Indian Health Program. (2) May be offered at alternate site.--Such courses of study may be offered in conjunction with the college or university with which the community college has entered into the agreement required under subsection (b)(2)(C). (e) Priority.--Where the requirements of subsection (b) are met, grant award priority shall be provided to tribal colleges and universities in Service Areas where they exist. SEC. 119. RETENTION BONUS. (a) Bonus Authorized.--The Secretary may pay a retention bonus to any health professional employed by, or assigned to, and serving in, an Indian Health Program or Urban Indian Organization either as a civilian employee or as a commissioned officer in the Regular or Reserve Corps of the Public Health Service who-- (1) is assigned to, and serving in, a position for which recruitment or retention of personnel is difficult; (2) the Secretary determines is needed by Indian Health Programs and Urban Indian Organizations; (3) has-- (A) completed 2 years of employment with an Indian Health Program or Urban Indian Organization; or (B) completed any service obligations incurred as a requirement of-- (i) any Federal scholarship program; or (ii) any Federal education loan repayment program; and (4) enters into an agreement with an Indian Health Program or Urban Indian Organization for continued employment for a period of not less than 1 year. (b) Rates.--The Secretary may establish rates for the retention bonus which shall provide for a higher annual rate for multiyear agreements than for single year agreements referred to in subsection (a)(4), but in no event shall the annual rate be more than $25,000 per annum. (c) Default of Retention Agreement.--Any health professional failing to complete the agreed upon term of service, except where such failure is through no fault of the individual, shall be obligated to refund to the Government the full amount of the retention bonus for the period covered by the agreement, plus interest as determined by the Secretary in accordance with section 110(l)(2)(B). (d) Other Retention Bonus.--The Secretary may pay a retention bonus to any health professional employed by a Tribal Health Program if such health professional is serving in a position which the Secretary determines is-- (1) a position for which recruitment or retention is difficult; and (2) necessary for providing health care services to Indians. SEC. 120. NURSING RESIDENCY PROGRAM. (a) Establishment of Program.--The Secretary, acting through the Service, shall establish a program to enable Indians who are licensed practical nurses, licensed vocational nurses, and registered nurses who are working in an Indian Health Program or Urban Indian Organization, and have done so for a period of not less than 1 year, to pursue advanced training. Such program shall include a combination of education and work study in an Indian Health Program or Urban Indian Organization leading to an associate or bachelor's degree (in the case of a licensed practical nurse or licensed vocational nurse), a bachelor's degree (in the case of a registered nurse), or advanced degrees or certifications in nursing and public health. (b) Service Obligation.--An individual who participates in a program under subsection (a), where the educational costs are paid by the Service, shall incur an obligation to serve in an Indian Health Program or Urban Indian Organization for a period of obligated service equal to 1 year for every year that nonprofessional employee (licensed practical nurses, licensed vocational nurses, nursing assistants, and various health care technicals), or 2 years for every year that professional nurse (associate degree and bachelor-prepared registered nurses), 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. (a) General Purposes of Program.--Under the authority of the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the ``Snyder Act''), the Secretary, acting through the Service, shall develop and operate a Community Health Aide Program in Alaska under which the Service-- (1) provides for the training of Alaska Natives as health aides or community health practitioners; (2) uses such aides or practitioners in the provision of health care, health promotion, and disease prevention services to Alaska Natives living in villages in rural Alaska; and (3) provides for the establishment of teleconferencing capacity in health clinics located in or near such villages for use by community health aides or community health practitioners. (b) Specific Program Requirements.--The Secretary, acting through the Community Health Aide Program of the Service, shall-- (1) using trainers accredited by the Program, provide a high standard of training to community health aides and community health practitioners to ensure that such aides and practitioners provide quality health care, health promotion, and disease prevention services to the villages served by the Program; (2) in order to provide such training, develop a curriculum that-- (A) combines education in the theory of health care with supervised practical experience in the provision of health care; (B) provides instruction and practical experience in the provision of acute care, emergency care, health promotion, disease prevention, and the efficient and effective management of clinic pharmacies, supplies, equipment, and facilities; and (C) promotes the achievement of the health status objectives specified in section 3(2); (3) establish and maintain a Community Health Aide Certification Board to certify as community health aides or community health practitioners individuals who have successfully completed the training described in paragraph (1) or can demonstrate equivalent experience; (4) develop and maintain a system which identifies the needs of community health aides and community health practitioners for continuing education in the provision of health care, including the areas described in paragraph (2)(B), and develop programs that meet the needs for such continuing education; (5) develop and maintain a system that provides close supervision of community health aides and community health practitioners; (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; and (7) ensure that pulpal therapy (not including pulpotomies on deciduous teeth) or extraction of adult teeth can be performed by a dental health aide therapist only after consultation with a licensed dentist who determines that the procedure is a medical emergency that cannot be resolved with palliative treatment, and further that dental health aide therapists are strictly prohibited from performing all other oral or jaw surgeries, provided that uncomplicated extractions shall not be considered oral surgery under this section. (c) Program Review.-- (1) Neutral panel.-- (A) Establishment.--The Secretary, acting through the Service, shall establish a neutral panel to carry out the study under paragraph (2). (B) Membership.--Members of the neutral panel shall be appointed by the Secretary from among clinicians, economists, community practitioners, oral epidemiologists, and Alaska Natives. (2) Study.-- (A) In general.--The neutral panel established under paragraph (1) shall conduct a study of the dental health aide therapist services provided by the Community Health Aide Program under this section to ensure that the quality of care provided through those services is adequate and appropriate. (B) Parameters of study.--The Secretary, in consultation with interested parties, including professional dental organizations, shall develop the parameters of the study. (C) Inclusions.--The study shall include a determination by the neutral panel with respect to-- (i) the ability of the dental health aide therapist services under this section to address the dental care needs of Alaska Natives; (ii) the quality of care provided through those services, including any training, improvement, or additional oversight required to improve the quality of care; and (iii) whether safer and less costly alternatives to the dental health aide therapist services exist. (D) Consultation.--In carrying out the study under this paragraph, the neutral panel shall consult with Alaska Tribal Organizations with respect to the adequacy and accuracy of the study. (3) Report.--The neutral panel shall submit to the Secretary, the Committee on Indian Affairs of the Senate, and the Committee on Natural Resources of the House of Representatives a report describing the results of the study under paragraph (2), including a description of-- (A) any determination of the neutral panel under paragraph (2)(C); and (B) any comments received from an Alaska Tribal Organization under paragraph (2)(D). (d) Nationalization of Program.-- (1) In general.--Except as provided in paragraph (2), the Secretary, acting through the Service, may establish a national Community Health Aide Program in accordance with the program under this section, as the Secretary determines to be appropriate. (2) Exception.--The national Community Health Aide Program under paragraph (1) shall not include dental health aide therapist services. (3) Requirement.--In establishing a national program under paragraph (1), the Secretary shall not reduce the amount of funds provided for the Community Health Aide Program described in subsections (a) and (b). SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION. The Secretary, acting through the Service, shall, by contract or otherwise, provide training for Indians in the administration and planning of Tribal Health Programs. SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE DEMONSTRATION PROGRAMS. (a) Demonstration Programs Authorized.--The Secretary, acting through the Service, may fund demonstration programs for Tribal Health Programs to address the chronic shortages of health professionals. (b) Purposes of Programs.--The purposes of demonstration programs funded under subsection (a) shall be-- (1) to provide direct clinical and practical experience at a Service Unit to health profession students and residents from medical schools; (2) to improve the quality of health care for Indians by assuring access to qualified health care professionals; and (3) to provide academic and scholarly opportunities for health professionals serving Indians by identifying all academic and scholarly resources of the region. (c) Advisory Board.--The demonstration programs established pursuant to subsection (a) shall incorporate a program advisory board composed of representatives from the Indian Tribes and Indian communities in the area which will be served by the program. SEC. 124. NATIONAL HEALTH SERVICE CORPS. (a) No Reduction in Services.--The Secretary shall not-- (1) remove a member of the National Health Service Corps from an Indian Health Program or Urban Indian Organization; or (2) withdraw funding used to support such member, unless the Secretary, acting through the Service, has ensured that the Indians receiving services from such member will experience no reduction in services. (b) Exemption From Limitations.--National Health Service Corps scholars qualifying for the Commissioned Corps in the Public Health Service shall be exempt from the full-time equivalent limitations of the National Health Service Corps and the Service when serving as a commissioned corps officer in a Tribal Health Program or an Urban Indian Organization. SEC. 125. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL CURRICULA DEMONSTRATION PROGRAMS. (a) Contracts and Grants.--The Secretary, acting through the Service, may enter into contracts with, or make grants to, accredited tribal colleges and universities and eligible accredited and accessible community colleges to establish demonstration programs to develop educational curricula for substance abuse counseling. (b) Use of Funds.--Funds provided under this section shall be used only for developing and providing educational curriculum for substance abuse counseling (including paying salaries for instructors). Such curricula may be provided through satellite campus programs. (c) Time Period of Assistance; Renewal.--A contract entered into or a grant provided under this section shall be for a period of 3 years. Such contract or grant may be renewed for an additional 2-year period upon the approval of the Secretary. (d) Criteria for Review and Approval of Applications.--Not later than 180 days after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary, after consultation with Indian Tribes and administrators of tribal colleges and universities and eligible accredited and accessible community colleges, shall develop and issue criteria for the review and approval of applications for funding (including applications for renewals of funding) under this section. Such criteria shall ensure that demonstration programs established under this section promote the development of the capacity of such entities to educate substance abuse counselors. (e) Assistance.--The Secretary shall provide such technical and other assistance as may be necessary to enable grant recipients to comply with the provisions of this section. (f) Report.--Each fiscal year, the Secretary shall submit to the President, for inclusion in the report which is required to be submitted under section 801 for that fiscal year, a report on the findings and conclusions derived from the demonstration programs conducted under this section during that fiscal year. (g) Definition.--For the purposes of this section, the term ``educational curriculum'' means 1 or more of the following: (1) Classroom education. (2) Clinical work experience. (3) Continuing education workshops. SEC. 126. BEHAVIORAL HEALTH TRAINING AND COMMUNITY EDUCATION PROGRAMS. (a) Study; List.--The Secretary, acting through the Service, and the Secretary of the Interior, in consultation with Indian Tribes and Tribal Organizations, shall conduct a study and compile a list of the types of staff positions specified in subsection (b) whose qualifications include, or should include, training in the identification, prevention, education, referral, or treatment of mental illness, or dysfunctional and self destructive behavior. (b) Positions.--The positions referred to in subsection (a) are-- (1) staff positions within the Bureau of Indian Affairs, including existing positions, in the fields of-- (A) elementary and secondary education; (B) social services and family and child welfare; (C) law enforcement and judicial services; and (D) alcohol and substance abuse; (2) staff positions within the Service; and (3) staff positions similar to those identified in paragraphs (1) and (2) established and maintained by Indian Tribes, Tribal Organizations (without regard to the funding source), and Urban Indian Organizations. (c) Training Criteria.-- (1) In general.--The appropriate Secretary shall provide training criteria appropriate to each type of position identified in subsection (b)(1) and (b)(2) and ensure that appropriate training has been, or shall be provided to any individual in any such position. With respect to any such individual in a position identified pursuant to subsection (b)(3), the respective Secretaries shall provide appropriate training to, or provide funds to, an Indian Tribe, Tribal Organization, or Urban Indian Organization for training of appropriate individuals. In the case of positions funded under a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), the appropriate Secretary shall ensure that such training costs are included in the contract or compact, as the Secretary determines necessary. (2) Position specific training criteria.--Position specific training criteria shall be culturally relevant to Indians and Indian Tribes and shall ensure that appropriate information regarding traditional health care practices is provided. (d) Community Education on Mental Illness.--The Service shall develop and implement, on request of an Indian Tribe, Tribal Organization, or Urban Indian Organization, or assist the Indian Tribe, Tribal Organization, or Urban Indian Organization to develop and implement, a program of community education on mental illness. In carrying out this subsection, the Service shall, upon request of an Indian Tribe, Tribal Organization, or Urban Indian Organization, provide technical assistance to the Indian Tribe, Tribal Organization, or Urban Indian Organization to obtain and develop community educational materials on the identification, prevention, referral, and treatment of mental illness and dysfunctional and self-destructive behavior. (e) Plan.--Not later than 90 days after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary shall develop a plan under which the Service will increase the health care staff providing behavioral health services by at least 500 positions within 5 years after the date of enactment of this section, with at least 200 of such positions devoted to child, adolescent, and family services. The plan developed under this subsection shall be implemented under the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the ``Snyder Act''). SEC. 127. AUTHORIZATION OF APPROPRIATIONS. There are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2017 to carry out this title. TITLE II--HEALTH SERVICES SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND. (a) Use of Funds.--The Secretary, acting through the Service, is authorized to expend funds, directly or under the authority of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), which are appropriated under the authority of this section, for the purposes of-- (1) eliminating the deficiencies in health status and health resources of all Indian Tribes; (2) eliminating backlogs in the provision of health care services to Indians; (3) meeting the health needs of Indians in an efficient and equitable manner, including the use of telehealth and telemedicine when appropriate; (4) eliminating inequities in funding for both direct care and contract health service programs; and (5) augmenting the ability of the Service to meet the following health service responsibilities with respect to those Indian Tribes with the highest levels of health status deficiencies and resource deficiencies: (A) Clinical care, including inpatient care, outpatient care (including audiology, clinical eye, and vision care), primary care, secondary and tertiary care, and long-term care. (B) Preventive health, including mammography and other cancer screening in accordance with section 207. (C) Dental care. (D) Mental health, including community mental health services, inpatient mental health services, dormitory mental health services, therapeutic and residential treatment centers, and training of traditional health care practitioners. (E) Emergency medical services. (F) Treatment and control of, and rehabilitative care related to, alcoholism and drug abuse (including fetal alcohol syndrome) among Indians. (G) Injury prevention programs, including data collection and evaluation, demonstration projects, training, and capacity building. (H) Home health care. (I) Community health representatives. (J) Maintenance and improvement. (b) No Offset or Limitation.--Any funds appropriated under the authority of this section shall not be used to offset or limit any other appropriations made to the Service under this Act or the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the ``Snyder Act''), or any other provision of law. (c) Allocation; Use.-- (1) In general.--Funds appropriated under the authority of this section shall be allocated to Service Units, Indian Tribes, or Tribal Organizations. The funds allocated to each Indian Tribe, Tribal Organization, or Service Unit under this paragraph shall be used by the Indian Tribe, Tribal Organization, or Service Unit under this paragraph to improve the health status and reduce the resource deficiency of each Indian Tribe served by such Service Unit, Indian Tribe, or Tribal Organization. (2) Apportionment of allocated funds.--The apportionment of funds allocated to a Service Unit, Indian Tribe, or Tribal Organization under paragraph (1) among the health service responsibilities described in subsection (a)(5) shall be determined by the Service in consultation with, and with the active participation of, the affected Indian Tribes and Tribal Organizations. (d) Provisions Relating to Health Status and Resource Deficiencies.--For the purposes of this section, the following definitions apply: (1) Definition.--The term ``health status and resource deficiency'' means the extent to which-- (A) the health status objectives set forth in section 3(2) are not being achieved; and (B) the Indian Tribe or Tribal Organization does not have available to it the health resources it needs, taking into account the actual cost of providing health care services given local geographic, climatic, rural, or other circumstances. (2) Available resources.--The health resources available to an Indian Tribe or Tribal Organization include health resources provided by the Service as well as health resources used by the Indian Tribe or Tribal Organization, including services and financing systems provided by any Federal programs, private insurance, and programs of State or local governments. (3) Process for review of determinations.--The Secretary shall establish procedures which allow any Indian Tribe or Tribal Organization to petition the Secretary for a review of any determination of the extent of the health status and resource deficiency of such Indian Tribe or Tribal Organization. (e) Eligibility for Funds.--Tribal Health Programs shall be eligible for funds appropriated under the authority of this section on an equal basis with programs that are administered directly by the Service. (f) Report.--By no later than the date that is 3 years after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary shall submit to Congress the current health status and resource deficiency report of the Service for each Service Unit, including newly recognized or acknowledged Indian Tribes. Such report shall set out-- (1) the methodology then in use by the Service for determining Tribal health status and resource deficiencies, as well as the most recent application of that methodology; (2) the extent of the health status and resource deficiency of each Indian Tribe served by the Service or a Tribal Health Program; (3) the amount of funds necessary to eliminate the health status and resource deficiencies of all Indian Tribes served by the Service or a Tribal Health Program; and (4) an estimate of-- (A) the amount of health service funds appropriated under the authority of this Act, or any other Act, including the amount of any funds transferred to the Service for the preceding fiscal year which is allocated to each Service Unit, Indian Tribe, or Tribal Organization; (B) the number of Indians eligible for health services in each Service Unit or Indian Tribe or Tribal Organization; and (C) the number of Indians using the Service resources made available to each Service Unit, Indian Tribe or Tribal Organization, and, to the extent available, information on the waiting lists and number of Indians turned away for services due to lack of resources. (g) Inclusion in Base Budget.--Funds appropriated under this section for any fiscal year shall be included in the base budget of the Service for the purpose of determining appropriations under this section in subsequent fiscal years. (h) Clarification.--Nothing in this section is intended to diminish the primary responsibility of the Service to eliminate existing backlogs in unmet health care needs, nor are the provisions of this section intended to discourage the Service from undertaking additional efforts to achieve equity among Indian Tribes and Tribal Organizations. (i) Funding Designation.--Any funds appropriated under the authority of this section shall be designated as the ``Indian Health Care Improvement Fund''. SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND. (a) Establishment.--There is established an Indian Catastrophic Health Emergency Fund (hereafter in this section referred to as the ``CHEF'') consisting of-- (1) the amounts deposited under subsection (f); and (2) the amounts appropriated to CHEF under this section. (b) Administration.--CHEF shall be administered by the Secretary, acting through the headquarters of the Service, solely for the purpose of meeting the extraordinary medical costs associated with the treatment of victims of disasters or catastrophic illnesses who are within the responsibility of the Service. (c) Conditions on Use of Fund.--No part of CHEF or its administration shall be subject to contract or grant under any law, including the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), nor shall CHEF funds be allocated, apportioned, or delegated on an Area Office, Service Unit, or other similar basis. (d) Regulations.--The Secretary shall promulgate regulations consistent with the provisions of this section to-- (1) establish a definition of disasters and catastrophic illnesses for which the cost of the treatment provided under contract would qualify for payment from CHEF; (2) provide that a Service Unit shall not be eligible for reimbursement for the cost of treatment from CHEF until its cost of treating any victim of such catastrophic illness or disaster has reached a certain threshold cost which the Secretary shall establish at-- (A) the 2000 level of $19,000; and (B) for any subsequent year, not less than the threshold cost of the previous year increased by the percentage increase in the medical care expenditure category of the consumer price index for all urban consumers (United States city average) for the 12-month period ending with December of the previous year; (3) establish a procedure for the reimbursement of the portion of the costs that exceeds such threshold cost incurred by-- (A) Service Units; or (B) whenever otherwise authorized by the Service, non-Service facilities or providers; (4) establish a procedure for payment from CHEF in cases in which the exigencies of the medical circumstances warrant treatment prior to the authorization of such treatment by the Service; and (5) establish a procedure that will ensure that no payment shall be made from CHEF to any provider of treatment to the extent that such provider is eligible to receive payment for the treatment from any other Federal, State, local, or private source of reimbursement for which the patient is eligible. (e) No Offset or Limitation.--Amounts appropriated to CHEF under this section shall not be used to offset or limit appropriations made to the Service under the authority of the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the ``Snyder Act''), or any other law. (f) Deposit of Reimbursement Funds.--There shall be deposited into CHEF all reimbursements to which the Service is entitled from any Federal, State, local, or private source (including third party insurance) by reason of treatment rendered to any victim of a disaster or catastrophic illness the cost of which was paid from CHEF. SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION SERVICES. (a) Findings.--Congress finds that health promotion and disease prevention activities-- (1) improve the health and well-being of Indians; and (2) reduce the expenses for health care of Indians. (b) Provision of Services.--The Secretary, acting through the Service and Tribal Health Programs, shall provide health promotion and disease prevention services to Indians to achieve the health status objectives set forth in section 3(2). (c) Evaluation.--The Secretary, after obtaining input from the affected Tribal Health Programs, shall submit to the President for inclusion in the report which is required to be submitted to Congress under section 801 an evaluation of-- (1) the health promotion and disease prevention needs of Indians; (2) the health promotion and disease prevention activities which would best meet such needs; (3) the internal capacity of the Service and Tribal Health Programs to meet such needs; and (4) the resources which would be required to enable the Service and Tribal Health Programs to undertake the health promotion and disease prevention activities necessary to meet such needs. SEC. 204. DIABETES PREVENTION, TREATMENT, AND CONTROL. (a) Determinations Regarding Diabetes.--The Secretary, acting through the Service, and in consultation with Indian Tribes and Tribal Organizations, shall determine-- (1) by Indian Tribe and by Service Unit, the incidence of, and the types of complications resulting from, diabetes among Indians; and (2) based on the determinations made pursuant to paragraph (1), the measures (including patient education and effective ongoing monitoring of disease indicators) each Service Unit should take to reduce the incidence of, and prevent, treat, and control the complications resulting from, diabetes among Indian Tribes within that Service Unit. (b) Diabetes Screening.--To the extent medically indicated and with informed consent, the Secretary shall screen each Indian who receives services from the Service for diabetes and for conditions which indicate a high risk that the individual will become diabetic and establish a cost-effective approach to ensure ongoing monitoring of disease indicators. Such screening and monitoring may be conducted by a Tribal Health Program and may be conducted through appropriate Internet-based health care management programs. (c) Diabetes Projects.--The Secretary shall continue to maintain each model diabetes project in existence on the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, any such other diabetes programs operated by the Service or Tribal Health Programs, and any additional diabetes projects, such as the Medical Vanguard program provided for in title IV of Public Law 108-87, as implemented to serve Indian Tribes. Tribal Health Programs shall receive recurring funding for the diabetes projects that they operate pursuant to this section, both at the date of enactment of the Indian Health Care Improvement Act Amendments of 2007 and for projects which are added and funded thereafter. (d) Dialysis Programs.--The Secretary is authorized to provide, through the Service, Indian Tribes, and Tribal Organizations, dialysis programs, including the purchase of dialysis equipment and the provision of necessary staffing. (e) Other Duties of the Secretary.-- (1) In general.--The Secretary shall, to the extent funding is available-- (A) in each Area Office, consult with Indian Tribes and Tribal Organizations regarding programs for the prevention, treatment, and control of diabetes; (B) establish in each Area Office a registry of patients with diabetes to track the incidence of diabetes and the complications from diabetes in that area; and (C) ensure that data collected in each Area Office regarding diabetes and related complications among Indians are disseminated to all other Area Offices, subject to applicable patient privacy laws. (2) Diabetes control officers.-- (A) In general.--The Secretary may establish and maintain in each Area Office a position of diabetes control officer to coordinate and manage any activity of that Area Office relating to the prevention, treatment, or control of diabetes to assist the Secretary in carrying out a program under this section or section 330C of the Public Health Service Act (42 U.S.C. 254c-3). (B) Certain activities.--Any activity carried out by a diabetes control officer under subparagraph (A) that is the subject of a contract or compact under the Indian Self- Determination and Education Assistance Act (25 U.S.C. 450 et seq.), and any funds made available to carry out such an activity, shall not be divisible for purposes of that Act. SEC. 205. SHARED SERVICES FOR LONG-TERM CARE. (a) Long-Term Care.--Notwithstanding any other provision of law, the Secretary, acting through the Service, is authorized to provide directly, or enter into contracts or compacts under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) with Indian Tribes or Tribal Organizations for, the delivery of long-term care (including health care services associated with long-term care) provided in a facility to Indians. Such agreements shall provide for the sharing of staff or other services between the Service or a Tribal Health Program and a long-term care or related facility owned and operated (directly or through a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.)) by such Indian Tribe or Tribal Organization. (b) Contents of Agreements.--An agreement entered into pursuant to subsection (a)-- (1) may, at the request of the Indian Tribe or Tribal Organization, delegate to such Indian Tribe or Tribal Organization such powers of supervision and control over Service employees as the Secretary deems necessary to carry out the purposes of this section; (2) shall provide that expenses (including salaries) relating to services that are shared between the Service and the Tribal Health Program be allocated proportionately between the Service and the Indian Tribe or Tribal Organization; and (3) may authorize such Indian Tribe or Tribal Organization to construct, renovate, or expand a long- term care or other similar facility (including the construction of a facility attached to a Service facility). (c) Minimum Requirement.--Any nursing facility provided for under this section shall meet the requirements for nursing facilities under section 1919 of the Social Security Act. (d) Other Assistance.--The Secretary shall provide such technical and other assistance as may be necessary to enable applicants to comply with the provisions of this section. (e) Use of Existing or Underused Facilities.--The Secretary shall encourage the use of existing facilities that are underused or allow the use of swing beds for long-term or similar care. SEC. 206. HEALTH SERVICES RESEARCH. (a) In General.--The Secretary, acting through the Service, shall make funding available for research to further the performance of the health service responsibilities of Indian Health Programs. (b) Coordination of Resources and Activities.--The Secretary shall also, to the maximum extent practicable, coordinate departmental research resources and activities to address relevant Indian Health Program research needs. (c) Availability.--Tribal Health Programs shall be given an equal opportunity to compete for, and receive, research funds under this section. (d) Use of Funds.--This funding may be used for both clinical and nonclinical research. (e) Evaluation and Dissemination.--The Secretary shall periodically-- (1) evaluate the impact of research conducted under this section; and (2) disseminate to Tribal Health Programs information regarding that research as the Secretary determines to be appropriate. SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREENING. The Secretary, acting through the Service or Tribal Health Programs, shall provide for screening as follows: (1) Screening mammography (as defined in section 1861(jj) of the Social Security Act) for Indian women at a frequency appropriate to such women under accepted and appropriate national standards, and under such terms and conditions as are consistent with standards established by the Secretary to ensure the safety and accuracy of screening mammography under part B of title XVIII of such Act. (2) Other cancer screening that receives an A or B rating as recommended by the United States Preventive Services Task Force established under section 915(a)(1) of the Public Health Service Act (42 U.S.C. 299b- 4(a)(1)). The Secretary shall ensure that screening provided for under this paragraph complies with the recommendations of the Task Force with respect to-- (A) frequency; (B) the population to be served; (C) the procedure or technology to be used; (D) evidence of effectiveness; and (E) other matters that the Secretary determines appropriate. SEC. 208. PATIENT TRAVEL COSTS. (a) Definition of Qualified Escort.--In this section, the term ``qualified escort'' means-- (1) an adult escort (including a parent, guardian, or other family member) who is required because of the physical or mental condition, or age, of the applicable patient; (2) a health professional for the purpose of providing necessary medical care during travel by the applicable patient; or (3) other escorts, as the Secretary or applicable Indian Health Program determines to be appropriate. (b) Provision of Funds.--The Secretary, acting through the Service and Tribal Health Programs, is authorized to provide funds for the following patient travel costs, including qualified escorts, associated with receiving health care services provided (either through direct or contract care or through a contract or compact under the Indian Self- Determination and Education Assistance Act (25 U.S.C. 450 et seq.)) under this Act-- (1) emergency air transportation and non-emergency air transportation where ground transportation is infeasible; (2) transportation by private vehicle (where no other means of transportation is available), specially equipped vehicle, and ambulance; and (3) transportation by such other means as may be available and required when air or motor vehicle transportation is not available. SEC. 209. EPIDEMIOLOGY CENTERS. (a) Establishment of Centers.--The Secretary shall establish an epidemiology center in each Service Area to carry out the functions described in subsection (b). Any new center established after the date of the enactment of the Indian Health Care Improvement Act Amendments of 2007 may be operated under a grant authorized by subsection (d), but funding under such a grant shall not be divisible. (b) Functions of Centers.--In consultation with and upon the request of Indian Tribes, Tribal Organizations, and Urban Indian Organizations, each Service Area epidemiology center established under this subsection shall, with respect to such Service Area-- (1) collect data relating to, and monitor progress made toward meeting, each of the health status objectives of the Service, the Indian Tribes, Tribal Organizations, and Urban Indian Organizations in the Service Area; (2) evaluate existing delivery systems, data systems, and other systems that impact the improvement of Indian health; (3) assist Indian Tribes, Tribal Organizations, and Urban Indian Organizations in identifying their highest priority health status objectives and the services needed to achieve such objectives, based on epidemiological data; (4) make recommendations for the targeting of services needed by the populations served; (5) make recommendations to improve health care delivery systems for Indians and Urban Indians; (6) provide requested technical assistance to Indian Tribes, Tribal Organizations, and Urban Indian Organizations in the development of local health service priorities and incidence and prevalence rates of disease and other illness in the community; and (7) provide disease surveillance and assist Indian Tribes, Tribal Organizations, and Urban Indian Organizations to promote public health. (c) Technical Assistance.--The Director of the Centers for Disease Control and Prevention shall provide technical assistance to the centers in carrying out the requirements of this subsection. (d) Grants for Studies.-- (1) In general.--The Secretary may make grants to Indian Tribes, Tribal Organizations, Urban Indian Organizations, and eligible intertribal consortia to conduct epidemiological studies of Indian communities. (2) Eligible intertribal consortia.--An intertribal consortium is eligible to receive a grant under this subsection if-- (A) the intertribal consortium is incorporated for the primary purpose of improving Indian health; and (B) the intertribal consortium is representative of the Indian Tribes or urban Indian communities in which the intertribal consortium is located. (3) Applications.--An application for a grant under this subsection shall be submitted in such manner and at such time as the Secretary shall prescribe. (4) Requirements.--An applicant for a grant under this subsection shall-- (A) demonstrate the technical, administrative, and financial expertise necessary to carry out the functions described in paragraph (5); (B) consult and cooperate with providers of related health and social services in order to avoid duplication of existing services; and (C) demonstrate cooperation from Indian tribes or Urban Indian Organizations in the area to be served. (5) Use of funds.--A grant awarded under paragraph (1) may be used-- (A) to carry out the functions described in subsection (b); (B) to provide information to and consult with tribal leaders, urban Indian community leaders, and related health staff on health care and health service management issues; and (C) in collaboration with Indian Tribes, Tribal Organizations, and urban Indian communities, to provide the Service with information regarding ways to improve the health status of Indians. (e) Access to Information.--An epidemiology center operated by a grantee pursuant to a grant awarded under subsection (d) shall be treated as a public health authority for purposes of the Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191; 110 Stat. 2033), as such entities are defined in part 164.501 of title 45, Code of Federal Regulations (or a successor regulation). The Secretary shall grant such grantees access to and use of data, data sets, monitoring systems, delivery systems, and other protected health information in the possession of the Secretary. SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION PROGRAMS. (a) Funding for Development of Programs.--In addition to carrying out any other program for health promotion or disease prevention, the Secretary, acting through the Service, is authorized to award grants to Indian Tribes, Tribal Organizations, and Urban Indian Organizations to develop comprehensive school health education programs for children from pre-school through grade 12 in schools for the benefit of Indian and Urban Indian children. (b) Use of Grant Funds.--A grant awarded under this section may be used for purposes which may include, but are not limited to, the following: (1) Developing health education materials both for regular school programs and afterschool programs. (2) Training teachers in comprehensive school health education materials. (3) Integrating school-based, community-based, and other public and private health promotion efforts. (4) Encouraging healthy, tobacco-free school environments. (5) Coordinating school-based health programs with existing services and programs available in the community. (6) Developing school programs on nutrition education, personal health, oral health, and fitness. (7) Developing behavioral health wellness programs. (8) Developing chronic disease prevention programs. (9) Developing substance abuse prevention programs. (10) Developing injury prevention and safety education programs. (11) Developing activities for the prevention and control of communicable diseases. (12) Developing community and environmental health education programs that include traditional health care practitioners. (13) Violence prevention. (14) Such other health issues as are appropriate. (c) Technical Assistance.--Upon request, the Secretary, acting through the Service, shall provide technical assistance to Indian Tribes, Tribal Organizations, and Urban Indian Organizations in the development of comprehensive health education plans and the dissemination of comprehensive health education materials and information on existing health programs and resources. (d) Criteria for Review and Approval of Applications.--The Secretary, acting through the Service, and in consultation with Indian Tribes, Tribal Organizations, and Urban Indian Organizations, shall establish criteria for the review and approval of applications for grants awarded under this section. (e) Development of Program for BIA-Funded Schools.-- (1) In general.--The Secretary of the Interior, acting through the Bureau of Indian Affairs and in cooperation with the Secretary, acting through the Service, and affected Indian Tribes and Tribal Organizations, shall develop a comprehensive school health education program for children from preschool through grade 12 in schools for which support is provided by the Bureau of Indian Affairs. (2) Requirements for programs.--Such programs shall include-- (A) school programs on nutrition education, personal health, oral health, and fitness; (B) behavioral health wellness programs; (C) chronic disease prevention programs; (D) substance abuse prevention programs; (E) injury prevention and safety education programs; and (F) activities for the prevention and control of communicable diseases. (3) Duties of the secretary.--The Secretary of the Interior shall-- (A) provide training to teachers in comprehensive school health education materials; (B) ensure the integration and coordination of school-based programs with existing services and health programs available in the community; and (C) encourage healthy, tobacco-free school environments. SEC. 211. INDIAN YOUTH PROGRAM. (a) Program Authorized.--The Secretary, acting through the Service, is authorized to establish and administer a program to provide grants to Indian Tribes, Tribal Organizations, and Urban Indian Organizations for innovative mental and physical disease prevention and health promotion and treatment programs for Indian and Urban Indian preadolescent and adolescent youths. (b) Use of Funds.-- (1) Allowable uses.--Funds made available under this section may be used to-- (A) develop prevention and treatment programs for Indian youth which promote mental and physical health and incorporate cultural values, community and family involvement, and traditional health care practitioners; and (B) develop and provide community training and education. (2) Prohibited use.--Funds made available under this section may not be used to provide services described in section 707(c). (c) Duties of the Secretary.--The Secretary shall-- (1) disseminate to Indian Tribes, Tribal Organizations, and Urban Indian Organizations information regarding models for the delivery of comprehensive health care services to Indian and Urban Indian adolescents; (2) encourage the implementation of such models; and (3) at the request of an Indian Tribe, Tribal Organization, or Urban Indian Organization, provide technical assistance in the implementation of such models. (d) Criteria for Review and Approval of Applications.--The Secretary, in consultation with Indian Tribes, Tribal Organizations, and Urban Indian Organizations, shall establish criteria for the review and approval of applications or proposals under this section. SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF COMMUNICABLE AND INFECTIOUS DISEASES. (a) Grants Authorized.--The Secretary, acting through the Service, and after consultation with the Centers for Disease Control and Prevention, may make grants available to Indian Tribes, Tribal Organizations, and Urban Indian Organizations for the following: (1) Projects for the prevention, control, and elimination of communicable and infectious diseases, including tuberculosis, hepatitis, HIV, respiratory syncytial virus, hanta virus, sexually transmitted diseases, and H. Pylori. (2) Public information and education programs for the prevention, control, and elimination of communicable and infectious diseases. (3) Education, training, and clinical skills improvement activities in the prevention, control, and elimination of communicable and infectious diseases for health professionals, including allied health professionals. (4) Demonstration projects for the screening, treatment, and prevention of hepatitis C virus (HCV). (b) Application Required.--The Secretary may provide funding under subsection (a) only if an application or proposal for funding is submitted to the Secretary. (c) Coordination With Health Agencies.--Indian Tribes, Tribal Organizations, and Urban Indian Organizations receiving funding under this section are encouraged to coordinate their activities with the Centers for Disease Control and Prevention and State and local health agencies. (d) Technical Assistance; Report.--In carrying out this section, the Secretary-- (1) may, at the request of an Indian Tribe, Tribal Organization, or Urban Indian Organization, provide technical assistance; and (2) shall prepare and submit a report to Congress biennially on the use of funds under this section and on the progress made toward the prevention, control, and elimination of communicable and infectious diseases among Indians and Urban Indians. SEC. 213. AUTHORITY FOR PROVISION OF OTHER SERVICES. (a) Funding Authorized.--The Secretary, acting through the Service, Indian Tribes, and Tribal Organizations, may provide funding under this Act to meet the objectives set forth in section 3 through health care-related services and programs not otherwise described in this Act, including-- (1) hospice care; (2) assisted living; (3) long-term care; and (4) home- and community-based services. (b) Terms and Conditions.-- (1) In general.--Any service provided under this section shall be in accordance with such terms and conditions as are consistent with accepted and appropriate standards relating to the service, including any licensing term or condition under this Act. (2) Standards.-- (A) In general.--The Secretary may establish, by regulation, the standards for a service provided under this section, provided that such standards shall not be more stringent than the standards required by the State in which the service is provided. (B) Use of state standards.--If the Secretary does not, by regulation, establish standards for a service provided under this section, the standards required by the State in which the service is or will be provided shall apply to such service. (C) Indian tribes.--If a service under this section is provided by an Indian Tribe or Tribal Organization pursuant to the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), the verification by the Secretary that the service meets any standards required by the State in which the service is or will be provided shall be considered to meet the terms and conditions required under this subsection. (3) Eligibility.--The following individuals shall be eligible to receive long-term care under this section: (A) Individuals who are unable to perform a certain number of activities of daily living without assistance. (B) Individuals with a mental impairment, such as dementia, Alzheimer's disease, or another disabling mental illness, who may be able to perform activities of daily living under supervision. (C) Such other individuals as an applicable Indian Health Program determines to be appropriate. (c) Definitions.--For the purposes of this section, the following definitions shall apply: (1) The term ``home- and community-based services'' means 1 or more of the services specified in paragraphs (1) through (9) of section 1929(a) of the Social Security Act (42 U.S.C. 1396t(a)) (whether provided by the Service or by an Indian Tribe or Tribal Organization pursuant to the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.)) that are or will be provided in accordance with the standards described in subsection (b). (2) The term ``hospice care'' means the items and services specified in subparagraphs (A) through (H) of section 1861(dd)(1) of the Social Security Act (42 U.S.C. 1395x(dd)(1)), and such other services which an Indian Tribe or Tribal Organization determines are necessary and appropriate to provide in furtherance of this care. SEC. 214. INDIAN WOMEN'S HEALTH CARE. The Secretary, acting through the Service and Indian Tribes, Tribal Organizations, and Urban Indian Organizations, shall monitor and improve the quality of health care for Indian women of all ages through the planning and delivery of programs administered by the Service, in order to improve and enhance the treatment models of care for Indian women. SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH HAZARDS. (a) Studies and Monitoring.--The Secretary and the Service shall conduct, in conjunction with other appropriate Federal agencies and in consultation with concerned Indian Tribes and Tribal Organizations, studies and ongoing monitoring programs to determine trends in the health hazards to Indian miners and to Indians on or near reservations and Indian communities as a result of environmental hazards which may result in chronic or life threatening health problems, such as nuclear resource development, petroleum contamination, and contamination of water source and of the food chain. Such studies shall include-- (1) an evaluation of the nature and extent of health problems caused by environmental hazards currently exhibited among Indians and the causes of such health problems; (2) an analysis of the potential effect of ongoing and future environmental resource development on or near reservations and Indian communities, including the cumulative effect over time on health; (3) an evaluation of the types and nature of activities, practices, and conditions causing or affecting such health problems, including uranium mining and milling, uranium mine tailing deposits, nuclear power plant operation and construction, and nuclear waste disposal; oil and gas production or transportation on or near reservations or Indian communities; and other development that could affect the health of Indians and their water supply and food chain; (4) a summary of any findings and recommendations provided in Federal and State studies, reports, investigations, and inspections during the 5 years prior to the date of enactment of the Indian Health Care Improvement Act Amendments of 2007 that directly or indirectly relate to the activities, practices, and conditions affecting the health or safety of such Indians; and (5) the efforts that have been made by Federal and State agencies and resource and economic development companies to effectively carry out an education program for such Indians regarding the health and safety hazards of such development. (b) Health Care Plans.--Upon completion of such studies, the Secretary and the Service shall take into account the results of such studies and develop health care plans to address the health problems studied under subsection (a). The plans shall include-- (1) methods for diagnosing and treating Indians currently exhibiting such health problems; (2) preventive care and testing for Indians who may be exposed to such health hazards, including the monitoring of the health of individuals who have or may have been exposed to excessive amounts of radiation or affected by other activities that have had or could have a serious impact upon the health of such individuals; and (3) a program of education for Indians who, by reason of their work or geographic proximity to such nuclear or other development activities, may experience health problems. (c) Submission of Report and Plan to Congress.--The Secretary and the Service shall submit to Congress the study prepared under subsection (a) no later than 18 months after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007. The health care plan prepared under subsection (b) shall be submitted in a report no later than 1 year after the study prepared under subsection (a) is submitted to Congress. Such report shall include recommended activities for the implementation of the plan, as well as an evaluation of any activities previously undertaken by the Service to address such health problems. (d) Intergovernmental Task Force.-- (1) Establishment; members.--There is established an Intergovernmental Task Force to be composed of the following individuals (or their designees): (A) The Secretary of Energy. (B) The Secretary of the Environmental Protection Agency. (C) The Director of the Bureau of Mines. (D) The Assistant Secretary for Occupational Safety and Health. (E) The Secretary of the Interior. (F) The Secretary of Health and Human Services. (G) The Director of the Indian Health Service. (2) Duties.--The Task Force shall-- (A) identify existing and potential operations related to nuclear resource development or other environmental hazards that affect or may affect the health of Indians on or near a reservation or in an Indian community; and (B) enter into activities to correct existing health hazards and ensure that current and future health problems resulting from nuclear resource or other development activities are minimized or reduced. (3) Chairman; meetings.--The Secretary of Health and Human Services shall be the Chairman of the Task Force. The Task Force shall meet at least twice each year. (e) Health Services to Certain Employees.--In the case of any Indian who-- (1) as a result of employment in or near a uranium mine or mill or near any other environmental hazard, suffers from a work-related illness or condition; (2) is eligible to receive diagnosis and treatment services from an Indian Health Program; and (3) by reason of such Indian's employment, is entitled to medical care at the expense of such mine or mill operator or entity responsible for the environmental hazard, the Indian Health Program shall, at the request of such Indian, render appropriate medical care to such Indian for such illness or condition and may be reimbursed for any medical care so rendered to which such Indian is entitled at the expense of such operator or entity from such operator or entity. Nothing in this subsection shall affect the rights of such Indian to recover damages other than such amounts paid to the Indian Health Program from the employer for providing medical care for such illness or condition. SEC. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DELIVERY AREA. (a) In General.--For fiscal years beginning with the fiscal year ending September 30, 1983, and ending with the fiscal year ending September 30, 2016, the State of Arizona shall be designated as a contract health service delivery area by the Service for the purpose of providing contract health care services to members of federally recognized Indian Tribes of Arizona. (b) Maintenance of Services.--The Service shall not curtail any health care services provided to Indians residing on reservations in the State of Arizona if such curtailment is due to the provision of contract services in such State pursuant to the designation of such State as a contract health service delivery area pursuant to subsection (a). SEC. 217. NORTH DAKOTA AND SOUTH DAKOTA AS CONTRACT HEALTH SERVICE DELIVERY AREA. (a) In General.--Beginning in fiscal year 2003, the States of North Dakota and South Dakota shall be designated as a contract health service delivery area by the Service for the purpose of providing contract health care services to members of federally recognized Indian Tribes of North Dakota and South Dakota. (b) Limitation.--The Service shall not curtail any health care services provided to Indians residing on any reservation, or in any county that has a common boundary with any reservation, in the State of North Dakota or South Dakota if such curtailment is due to the provision of contract services in such States pursuant to the designation of such States as a contract health service delivery area pursuant to subsection (a). SEC. 218. CALIFORNIA CONTRACT HEALTH SERVICES PROGRAM. (a) Funding Authorized.--The Secretary is authorized to fund a program using the California Rural Indian Health Board (hereafter in this section referred to as the ``CRIHB'') as a contract care intermediary to improve the accessibility of health services to California Indians. (b) Reimbursement Contract.--The Secretary shall enter into an agreement with the CRIHB to reimburse the CRIHB for costs (including reasonable administrative costs) incurred pursuant to this section, in providing medical treatment under contract to California Indians described in section 806(a) throughout the California contract health services delivery area described in section 218 with respect to high cost contract care cases. (c) Administrative Expenses.--Not more than 5 percent of the amounts provided to the CRIHB under this section for any fiscal year may be for reimbursement for administrative expenses incurred by the CRIHB during such fiscal year. (d) Limitation on Payment.--No payment may be made for treatment provided hereunder to the extent payment may be made for such treatment under the Indian Catastrophic Health Emergency Fund described in section 202 or from amounts appropriated or otherwise made available to the California contract health service delivery area for a fiscal year. (e) Advisory Board.--There is established an advisory board which shall advise the CRIHB in carrying out this section. The advisory board shall be composed of representatives, selected by the CRIHB, from not less than 8 Tribal Health Programs serving California Indians covered under this section at least \1/2\ of whom of whom are not affiliated with the CRIHB. SEC. 219. CALIFORNIA AS A CONTRACT HEALTH SERVICE DELIVERY AREA. The State of California, excluding the counties of Alameda, Contra Costa, Los Angeles, Marin, Orange, Sacramento, San Francisco, San Mateo, Santa Clara, Kern, Merced, Monterey, Napa, San Benito, San Joaquin, San Luis Obispo, Santa Cruz, Solano, Stanislaus, and Ventura, shall be designated as a contract health service delivery area by the Service for the purpose of providing contract health services to California Indians. However, any of the counties listed herein may only be included in the contract health services delivery area if funding is specifically provided by the Service for such services in those counties. SEC. 220. CONTRACT HEALTH SERVICES FOR THE TRENTON SERVICE AREA. (a) Authorization for Services.--The Secretary, acting through the Service, is directed to provide contract health services to members of the Turtle Mountain Band of Chippewa Indians that reside in the Trenton Service Area of Divide, McKenzie, and Williams counties in the State of North Dakota and the adjoining counties of Richland, Roosevelt, and Sheridan in the State of Montana. (b) No Expansion of Eligibility.--Nothing in this section may be construed as expanding the eligibility of members of the Turtle Mountain Band of Chippewa Indians for health services provided by the Service beyond the scope of eligibility for such health services that applied on May 1, 1986. SEC. 221. PROGRAMS OPERATED BY INDIAN TRIBES AND TRIBAL ORGANIZATIONS. The Service shall provide funds for health care programs and facilities operated by Tribal Health Programs on the same basis as such funds are provided to programs and facilities operated directly by the Service. SEC. 222. LICENSING. Health care professionals employed by a Tribal Health Program shall, if licensed in any State, be exempt from the licensing requirements of the State in which the Tribal Health Program performs the services described in its contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.). SEC. 223. NOTIFICATION OF PROVISION OF EMERGENCY CONTRACT HEALTH SERVICES. With respect to an elderly Indian or an Indian with a disability receiving emergency medical care or services from a non-Service provider or in a non-Service facility under the authority of this Act, the time limitation (as a condition of payment) for notifying the Service of such treatment or admission shall be 30 days. SEC. 224. PROMPT ACTION ON PAYMENT OF CLAIMS. (a) Deadline for Response.--The Service shall respond to a notification of a claim by a provider of a contract care service with either an individual purchase order or a denial of the claim within 5 working days after the receipt of such notification. (b) Effect of Untimely Response.--If the Service fails to respond to a notification of a claim in accordance with subsection (a), the Service shall accept as valid the claim submitted by the provider of a contract care service. (c) Deadline for Payment of Valid Claim.--The Service shall pay a valid contract care service claim within 30 days after the completion of the claim. SEC. 225. LIABILITY FOR PAYMENT. (a) No Patient Liability.--A patient who receives contract health care services that are authorized by the Service shall not be liable for the payment of any charges or costs associated with the provision of such services. (b) Notification.--The Secretary shall notify a contract care provider and any patient who receives contract health care services authorized by the Service that such patient is not liable for the payment of any charges or costs associated with the provision of such services not later than 5 business days after receipt of a notification of a claim by a provider of contract care services. (c) No Recourse.--Following receipt of the notice provided under subsection (b), or, if a claim has been deemed accepted under section 223(b), the provider shall have no further recourse against the patient who received the services. SEC. 226. OFFICE OF INDIAN MEN'S HEALTH. (a) Establishment.--The Secretary may establish within the Service an office to be known as the ``Office of Indian Men's Health'' (referred to in this section as the ``Office''). (b) Director.-- (1) In general.--The Office shall be headed by a director, to be appointed by the Secretary. (2) Duties.--The director shall coordinate and promote the status of the health of Indian men in the United States. (c) Report.--Not later than 2 years after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary, acting through the director of the Office, shall submit to Congress a report describing-- (1) any activity carried out by the director as of the date on which the report is prepared; and (2) any finding of the director with respect to the health of Indian men. SEC. 227. AUTHORIZATION OF APPROPRIATIONS. There are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2017 to carry out this title. TITLE III--FACILITIES SEC. 301. CONSULTATION; CONSTRUCTION AND RENOVATION OF FACILITIES; REPORTS. (a) Prerequisites for Expenditure of Funds.--Prior to the expenditure of, or the making of any binding commitment to expend, any funds appropriated for the planning, design, construction, or renovation of facilities pursuant to the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the ``Snyder Act''), the Secretary, acting through the Service, shall-- (1) consult with any Indian Tribe that would be significantly affected by such expenditure for the purpose of determining and, whenever practicable, honoring tribal preferences concerning size, location, type, and other characteristics of any facility on which such expenditure is to be made; and (2) ensure, whenever practicable and applicable, that such facility meets the construction standards of any accrediting body recognized by the Secretary for the purposes of the Medicare, Medicaid, and SCHIP programs under titles XVIII, XIX, and XXI of the Social Security Act by not later than 1 year after the date on which the construction or renovation of such facility is completed. (b) Closures.-- (1) Evaluation required.--Notwithstanding any other provision of law, no facility operated by the Service, or any portion of such facility, may be closed if the Secretary has not submitted to Congress, not less than 1 year and not more than 2 years before the date of the proposed closure, an evaluation, completed not more than 2 years before such submission, of the impact of the proposed closure that specifies, in addition to other considerations-- (A) the accessibility of alternative health care resources for the population served by such facility; (B) the cost-effectiveness of such closure; (C) the quality of health care to be provided to the population served by such facility after such closure; (D) the availability of contract health care funds to maintain existing levels of service; (E) the views of the Indian Tribes served by such facility concerning such closure; (F) the level of use of such facility by all eligible Indians; and (G) the distance between such facility and the nearest operating Service hospital. (2) Exception for certain temporary closures.-- Paragraph (1) shall not apply to any temporary closure of a facility or any portion of a facility if such closure is necessary for medical, environmental, or construction safety reasons. (c) Health Care Facility Priority System.-- (1) In general.-- (A) Priority system.--The Secretary, acting through the Service, shall maintain a health care facility priority system, which-- (i) shall be developed in consultation with Indian Tribes and Tribal Organizations; (ii) shall give Indian Tribes' needs the highest priority; (iii)(I) may include the lists required in paragraph (2)(B)(ii); and (II) shall include the methodology required in paragraph (2)(B)(v); and (III) may include such other facilities, and such renovation or expansion needs of any health care facility, as the Service, Indian Tribes, and Tribal Organizations may identify; and (iv) shall provide an opportunity for the nomination of planning, design, and construction projects by the Service, Indian Tribes, and Tribal Organizations for consideration under the priority system at least once every 3 years, or more frequently as the Secretary determines to be appropriate. (B) Needs of facilities under isdeaa agreements.--The Secretary shall ensure that the planning, design, construction, renovation, and expansion needs of Service and non-Service facilities operated under contracts or compacts in accordance with the Indian Self- Determination and Education Assistance Act (25 U.S.C. 450 et seq.) are fully and equitably integrated into the health care facility priority system. (C) Criteria for evaluating needs.--For purposes of this subsection, the Secretary, in evaluating the needs of facilities operated under a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), shall use the criteria used by the Secretary in evaluating the needs of facilities operated directly by the Service. (D) Priority of certain projects protected.-- The priority of any project established under the construction priority system in effect on the date of enactment of the Indian Health Care Improvement Act Amendments of 2007 shall not be affected by any change in the construction priority system taking place after that date if the project-- (i) was identified in the fiscal year 2008 Service budget justification as-- (I) 1 of the 10 top-priority inpatient projects; (II) 1 of the 10 top-priority outpatient projects; (III) 1 of the 10 top- priority staff quarters developments; or (IV) 1 of the 10 top-priority Youth Regional Treatment Centers; (ii) had completed both Phase I and Phase II of the construction priority system in effect on the date of enactment of such Act; or (iii) is not included in clause (i) or (ii) and is selected, as determined by the Secretary-- (I) on the initiative of the Secretary; or (II) pursuant to a request of an Indian Tribe or Tribal Organization. (2) Report; contents.-- (A) Initial comprehensive report.-- (i) Definitions.--In this subparagraph: (I) Facilities appropriation advisory board.--The term ``Facilities Appropriation Advisory Board'' means the advisory board, comprised of 12 members representing Indian tribes and 2 members representing the Service, established at the discretion of the Assistant Secretary-- (aa) to provide advice and recommendations for policies and procedures of the programs funded pursuant to facilities appropriations; and (bb) to address other facilities issues. (II) Facilities needs assessment workgroup.--The term ``Facilities Needs Assessment Workgroup'' means the workgroup established at the discretion of the Assistant Secretary-- (aa) to review the health care facilities construction priority system; and (bb) to make recommendations to the Facilities Appropriation Advisory Board for revising the priority system. (ii) Initial report.-- (I) In general.--Not later than 1 year after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary shall submit to the Committee on Indian Affairs of the Senate and the Committee on Natural Resources of the House of Representatives a report that describes the comprehensive, national, ranked list of all health care facilities needs for the Service, Indian Tribes, and Tribal Organizations (including inpatient health care facilities, outpatient health care facilities, specialized health care facilities (such as for long- term care and alcohol and drug abuse treatment), wellness centers, staff quarters and hostels associated with health care facilities, and the renovation and expansion needs, if any, of such facilities) developed by the Service, Indian Tribes, and Tribal Organizations for the Facilities Needs Assessment Workgroup and the Facilities Appropriation Advisory Board. (II) Inclusions.--The initial report shall include-- (aa) the methodology and criteria used by the Service in determining the needs and establishing the ranking of the facilities needs; and (bb) such other information as the Secretary determines to be appropriate. (iii) Updates of report.--Beginning in calendar year 2011, the Secretary shall-- (I) update the report under clause (ii) not less frequently that once every 5 years; and (II) include the updated report in the appropriate annual report under subparagraph (B) for submission to Congress under section 801. (B) Annual reports.--The Secretary shall submit to the President, for inclusion in the report required to be transmitted to Congress under section 801, a report which sets forth the following: (i) A description of the health care facility priority system of the Service established under paragraph (1). (ii) Health care facilities lists, which may include-- (I) the 10 top-priority inpatient health care facilities; (II) the 10 top-priority outpatient health care facilities; (III) the 10 top-priority specialized health care facilities (such as long-term care and alcohol and drug abuse treatment); (IV) the 10 top-priority staff quarters developments associated with health care facilities; and (V) the 10 top-priority hostels associated with health care facilities. (iii) The justification for such order of priority. (iv) The projected cost of such projects. (v) The methodology adopted by the Service in establishing priorities under its health care facility priority system. (3) Requirements for preparation of reports.--In preparing the report required under paragraph (2), the Secretary shall-- (A) consult with and obtain information on all health care facilities needs from Indian Tribes, Tribal Organizations, and Urban Indian Organizations; and (B) review the total unmet needs of all Indian Tribes, Tribal Organizations, and Urban Indian Organizations for health care facilities (including hostels and staff quarters), including needs for renovation and expansion of existing facilities. (d) Review of Methodology Used for Health Facilities Construction Priority System.-- (1) In general.--Not later than 1 year after the establishment of the priority system under subsection (c)(1)(A), the Comptroller General of the United States shall prepare and finalize a report reviewing the methodologies applied, and the processes followed, by the Service in making each assessment of needs for the list under subsection (c)(2)(A)(ii) and developing the priority system under subsection (c)(1), including a review of-- (A) the recommendations of the Facilities Appropriation Advisory Board and the Facilities Needs Assessment Workgroup (as those terms are defined in subsection (c)(2)(A)(i)); and (B) the relevant criteria used in ranking or prioritizing facilities other than hospitals or clinics. (2) Submission to congress.--The Comptroller General of the United States shall submit the report under paragraph (1) to-- (A) the Committees on Indian Affairs and Appropriations of the Senate; (B) the Committees on Natural Resources and Appropriations of the House of Representatives; and (C) the Secretary. (e) Funding Condition.--All funds appropriated under the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the ``Snyder Act''), for the planning, design, construction, or renovation of health facilities for the benefit of 1 or more Indian Tribes shall be subject to the provisions of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.). (f) Development of Innovative Approaches.--The Secretary shall consult and cooperate with Indian Tribes, Tribal Organizations, and Urban Indian Organizations in developing innovative approaches to address all or part of the total unmet need for construction of health facilities, including those provided for in other sections of this title and other approaches. SEC. 302. SANITATION FACILITIES. (a) Findings.--Congress finds the following: (1) The provision of sanitation facilities is primarily a health consideration and function. (2) Indian people suffer an inordinately high incidence of disease, injury, and illness directly attributable to the absence or inadequacy of sanitation facilities. (3) The long-term cost to the United States of treating and curing such disease, injury, and illness is substantially greater than the short-term cost of providing sanitation facilities and other preventive health measures. (4) Many Indian homes and Indian communities still lack sanitation facilities. (5) It is in the interest of the United States, and it is the policy of the United States, that all Indian communities and Indian homes, new and existing, be provided with sanitation facilities. (b) Facilities and Services.--In furtherance of the findings made in subsection (a), Congress reaffirms the primary responsibility and authority of the Service to provide the necessary sanitation facilities and services as provided in section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a). Under such authority, the Secretary, acting through the Service, is authorized to provide the following: (1) Financial and technical assistance to Indian Tribes, Tribal Organizations, and Indian communities in the establishment, training, and equipping of utility organizations to operate and maintain sanitation facilities, including the provision of existing plans, standard details, and specifications available in the Department, to be used at the option of the Indian Tribe, Tribal Organization, or Indian community. (2) Ongoing technical assistance and training to Indian Tribes, Tribal Organizations, and Indian communities in the management of utility organizations which operate and maintain sanitation facilities. (3) Priority funding for operation and maintenance assistance for, and emergency repairs to, sanitation facilities operated by an Indian Tribe, Tribal Organization or Indian community when necessary to avoid an imminent health threat or to protect the investment in sanitation facilities and the investment in the health benefits gained through the provision of sanitation facilities. (c) Funding.--Notwithstanding any other provision of law-- (1) the Secretary of Housing and Urban Development is authorized to transfer funds appropriated under the Native American Housing Assistance and Self- Determination Act of 1996 (25 U.S.C. 4101 et seq.) to the Secretary of Health and Human Services; (2) the Secretary of Health and Human Services is authorized to accept and use such funds for the purpose of providing sanitation facilities and services for Indians under section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a); (3) unless specifically authorized when funds are appropriated, the Secretary shall not use funds appropriated under section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), to provide sanitation facilities to new homes constructed using funds provided by the Department of Housing and Urban Development; (4) the Secretary of Health and Human Services is authorized to accept from any source, including Federal and State agencies, funds for the purpose of providing sanitation facilities and services and place these funds into contracts or compacts under the Indian Self- Determination and Education Assistance Act (25 U.S.C. 450 et seq.); (5) except as otherwise prohibited by this section, the Secretary may use funds appropriated under the authority of section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), to fund up to 100 percent of the amount of an Indian Tribe's loan obtained under any Federal program for new projects to construct eligible sanitation facilities to serve Indian homes; (6) except as otherwise prohibited by this section, the Secretary may use funds appropriated under the authority of section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a) to meet matching or cost participation requirements under other Federal and non-Federal programs for new projects to construct eligible sanitation facilities; (7) all Federal agencies are authorized to transfer to the Secretary funds identified, granted, loaned, or appropriated whereby the Department's applicable policies, rules, and regulations shall apply in the implementation of such projects; (8) the Secretary of Health and Human Services shall enter into interagency agreements with Federal and State agencies for the purpose of providing financial assistance for sanitation facilities and services under this Act; (9) the Secretary of Health and Human Services shall, by regulation, establish standards applicable to the planning, design, and construction of sanitation facilities funded under this Act; and (10) the Secretary of Health and Human Services is authorized to accept payments for goods and services furnished by the Service from appropriate public authorities, nonprofit organizations or agencies, or Indian Tribes, as contributions by that authority, organization, agency, or tribe to agreements made under section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), and such payments shall be credited to the same or subsequent appropriation account as funds appropriated under the authority of section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a). (d) Certain Capabilities Not Prerequisite.--The financial and technical capability of an Indian Tribe, Tribal Organization, or Indian community to safely operate, manage, and maintain a sanitation facility shall not be a prerequisite to the provision or construction of sanitation facilities by the Secretary. (e) Financial Assistance.--The Secretary is authorized to provide financial assistance to Indian Tribes, Tribal Organizations, and Indian communities for operation, management, and maintenance of their sanitation facilities. (f) Operation, Management, and Maintenance of Facilities.-- The Indian Tribe has the primary responsibility to establish, collect, and use reasonable user fees, or otherwise set aside funding, for the purpose of operating, managing, and maintaining sanitation facilities. If a sanitation facility serving a community that is operated by an Indian Tribe or Tribal Organization is threatened with imminent failure and such operator lacks capacity to maintain the integrity or the health benefits of the sanitation facility, then the Secretary is authorized to assist the Indian Tribe, Tribal Organization, or Indian community in the resolution of the problem on a short-term basis through cooperation with the emergency coordinator or by providing operation, management, and maintenance service. (g) ISDEAA Program Funded on Equal Basis.--Tribal Health Programs shall be eligible (on an equal basis with programs that are administered directly by the Service) for-- (1) any funds appropriated pursuant to this section; and (2) any funds appropriated for the purpose of providing sanitation facilities. (h) Report.-- (1) Required; contents.--The Secretary, in consultation with the Secretary of Housing and Urban Development, Indian Tribes, Tribal Organizations, and tribally designated housing entities (as defined in section 4 of the Native American Housing Assistance and Self-Determination Act of 1996 (25 U.S.C. 4103)) shall submit to the President, for inclusion in the report required to be transmitted to Congress under section 801, a report which sets forth-- (A) the current Indian sanitation facility priority system of the Service; (B) the methodology for determining sanitation deficiencies and needs; (C) the criteria on which the deficiencies and needs will be evaluated; (D) the level of initial and final sanitation deficiency for each type of sanitation facility for each project of each Indian Tribe or Indian community; (E) the amount and most effective use of funds, derived from whatever source, necessary to accommodate the sanitation facilities needs of new homes assisted with funds under the Native American Housing Assistance and Self- Determination Act (25 U.S.C. 4101 et seq.), and to reduce the identified sanitation deficiency levels of all Indian Tribes and Indian communities to level I sanitation deficiency as defined in paragraph (3)(A); and (F) a 10-year plan to provide sanitation facilities to serve existing Indian homes and Indian communities and new and renovated Indian homes. (2) Uniform methodology.--The methodology used by the Secretary in determining, preparing cost estimates for, and reporting sanitation deficiencies for purposes of paragraph (1) shall be applied uniformly to all Indian Tribes and Indian communities. (3) Sanitation deficiency levels.--For purposes of this subsection, the sanitation deficiency levels for an individual, Indian Tribe, or Indian community sanitation facility to serve Indian homes are determined as follows: (A) A level I deficiency exists if a sanitation facility serving an individual, Indian Tribe, or Indian community-- (i) complies with all applicable water supply, pollution control, and solid waste disposal laws; and (ii) deficiencies relate to routine replacement, repair, or maintenance needs. (B) A level II deficiency exists if a sanitation facility serving an individual, Indian Tribe, or Indian community substantially or recently complied with all applicable water supply, pollution control, and solid waste laws and any deficiencies relate to-- (i) small or minor capital improvements needed to bring the facility back into compliance; (ii) capital improvements that are necessary to enlarge or improve the facilities in order to meet the current needs for domestic sanitation facilities; or (iii) the lack of equipment or training by an Indian Tribe, Tribal Organization, or an Indian community to properly operate and maintain the sanitation facilities. (C) A level III deficiency exists if a sanitation facility serving an individual, Indian Tribe or Indian community meets 1 or more of the following conditions-- (i) water or sewer service in the home is provided by a haul system with holding tanks and interior plumbing; (ii) major significant interruptions to water supply or sewage disposal occur frequently, requiring major capital improvements to correct the deficiencies; or (iii) there is no access to or no approved or permitted solid waste facility available. (D) A level IV deficiency exists-- (i) if a sanitation facility for an individual home, an Indian Tribe, or an Indian community exists but-- (I) lacks-- (aa) a safe water supply system; or (bb) a waste disposal system; (II) contains no piped water or sewer facilities; or (III) has become inoperable due to a major component failure; or (ii) if only a washeteria or central facility exists in the community. (E) A level V deficiency exists in the absence of a sanitation facility, where individual homes do not have access to safe drinking water or adequate wastewater (including sewage) disposal. (i) Definitions.--For purposes of this section, the following terms apply: (1) Indian community.--The term ``Indian community'' means a geographic area, a significant proportion of whose inhabitants are Indians and which is served by or capable of being served by a facility described in this section. (2) Sanitation facilities.--The terms ``sanitation facility'' and ``sanitation facilities'' mean safe and adequate water supply systems, sanitary sewage disposal systems, and sanitary solid waste systems (and all related equipment and support infrastructure). SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS. (a) Buy Indian Act.--The Secretary, acting through the Service, may use the negotiating authority of section 23 of the Act of June 25, 1910 (25 U.S.C. 47, commonly known as the ``Buy Indian Act''), to give preference to any Indian or any enterprise, partnership, corporation, or other type of business organization owned and controlled by an Indian or Indians including former or currently federally recognized Indian Tribes in the State of New York (hereinafter referred to as an ``Indian firm'') in the construction and renovation of Service facilities pursuant to section 301 and in the construction of sanitation facilities pursuant to section 302. Such preference may be accorded by the Secretary unless the Secretary finds, pursuant to regulations, that the project or function to be contracted for will not be satisfactory or such project or function cannot be properly completed or maintained under the proposed contract. The Secretary, in arriving at such a finding, shall consider whether the Indian or Indian firm will be deficient with respect to-- (1) ownership and control by Indians; (2) equipment; (3) bookkeeping and accounting procedures; (4) substantive knowledge of the project or function to be contracted for; (5) adequately trained personnel; or (6) other necessary components of contract performance. (b) Labor Standards.--For the purposes of implementing the provisions of this title, contracts for the construction or renovation of health care facilities, staff quarters, and sanitation facilities, and related support infrastructure, funded in whole or in part with funds made available pursuant to this title, shall contain a provision requiring compliance with subchapter IV of chapter 31 of title 40, United States Code (commonly known as the ``Davis-Bacon Act''). SEC. 304. EXPENDITURE OF NON-SERVICE FUNDS FOR RENOVATION. (a) In General.--Notwithstanding any other provision of law, if the requirements of subsection (c) are met, the Secretary, acting through the Service, is authorized to accept any major expansion, renovation, or modernization by any Indian Tribe or Tribal Organization of any Service facility or of any other Indian health facility operated pursuant to a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), including-- (1) any plans or designs for such expansion, renovation, or modernization; and (2) any expansion, renovation, or modernization for which funds appropriated under any Federal law were lawfully expended. (b) Priority List.-- (1) In general.--The Secretary shall maintain a separate priority list to address the needs for increased operating expenses, personnel, or equipment for such facilities. The methodology for establishing priorities shall be developed through regulations. The list of priority facilities will be revised annually in consultation with Indian Tribes and Tribal Organizations. (2) Report.--The Secretary shall submit to the President, for inclusion in the report required to be transmitted to Congress under section 801, the priority list maintained pursuant to paragraph (1). (c) Requirements.--The requirements of this subsection are met with respect to any expansion, renovation, or modernization if-- (1) the Indian Tribe or Tribal Organization-- (A) provides notice to the Secretary of its intent to expand, renovate, or modernize; and (B) applies to the Secretary to be placed on a separate priority list to address the needs of such new facilities for increased operating expenses, personnel, or equipment; and (2) the expansion, renovation, or modernization-- (A) is approved by the appropriate area director of the Service for Federal facilities; and (B) is administered by the Indian Tribe or Tribal Organization in accordance with any applicable regulations prescribed by the Secretary with respect to construction or renovation of Service facilities. (d) Additional Requirement for Expansion.--In addition to the requirements under subsection (c), for any expansion, the Indian Tribe or Tribal Organization shall provide to the Secretary additional information pursuant to regulations, including additional staffing, equipment, and other costs associated with the expansion. (e) Closure or Conversion of Facilities.--If any Service facility which has been expanded, renovated, or modernized by an Indian Tribe or Tribal Organization under this section ceases to be used as a Service facility during the 20-year period beginning on the date such expansion, renovation, or modernization is completed, such Indian Tribe or Tribal Organization shall be entitled to recover from the United States an amount which bears the same ratio to the value of such facility at the time of such cessation as the value of such expansion, renovation, or modernization (less the total amount of any funds provided specifically for such facility under any Federal program that were expended for such expansion, renovation, or modernization) bore to the value of such facility at the time of the completion of such expansion, renovation, or modernization. SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, AND MODERNIZATION OF SMALL AMBULATORY CARE FACILITIES. (a) Grants.-- (1) In general.--The Secretary, acting through the Service, shall make grants to Indian Tribes and Tribal Organizations for the construction, expansion, or modernization of facilities for the provision of ambulatory care services to eligible Indians (and noneligible persons pursuant to subsections (b)(2) and (c)(1)(C)). A grant made under this section may cover up to 100 percent of the costs of such construction, expansion, or modernization. For the purposes of this section, the term ``construction'' includes the replacement of an existing facility. (2) Grant agreement required.--A grant under paragraph (1) may only be made available to a Tribal Health Program operating an Indian health facility (other than a facility owned or constructed by the Service, including a facility originally owned or constructed by the Service and transferred to an Indian Tribe or Tribal Organization). (b) Use of Grant Funds.-- (1) Allowable uses.--A grant awarded under this section may be used for the construction, expansion, or modernization (including the planning and design of such construction, expansion, or modernization) of an ambulatory care facility-- (A) located apart from a hospital; (B) not funded under section 301 or section 306; and (C) which, upon completion of such construction or modernization will-- (i) have a total capacity appropriate to its projected service population; (ii) provide annually no fewer than 150 patient visits by eligible Indians and other users who are eligible for services in such facility in accordance with section 807(c)(2); and (iii) provide ambulatory care in a Service Area (specified in the contract or compact under the Indian Self- Determination and Education Assistance Act (25 U.S.C. 450 et seq.)) with a population of no fewer than 1,500 eligible Indians and other users who are eligible for services in such facility in accordance with section 807(c)(2). (2) Additional allowable use.--The Secretary may also reserve a portion of the funding provided under this section and use those reserved funds to reduce an outstanding debt incurred by Indian Tribes or Tribal Organizations for the construction, expansion, or modernization of an ambulatory care facility that meets the requirements under paragraph (1). The provisions of this section shall apply, except that such applications for funding under this paragraph shall be considered separately from applications for funding under paragraph (1). (3) Use only for certain portion of costs.--A grant provided under this section may be used only for the cost of that portion of a construction, expansion, or modernization project that benefits the Service population identified above in subsection (b)(1)(C) (ii) and (iii). The requirements of clauses (ii) and (iii) of paragraph (1)(C) shall not apply to an Indian Tribe or Tribal Organization applying for a grant under this section for a health care facility located or to be constructed on an island or when such facility is not located on a road system providing direct access to an inpatient hospital where care is available to the Service population. (c) Grants.-- (1) Application.--No grant may be made under this section unless an application or proposal for the grant has been approved by the Secretary in accordance with applicable regulations and has set forth reasonable assurance by the applicant that, at all times after the construction, expansion, or modernization of a facility carried out using a grant 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 grants under this section, the Secretary shall give priority to Indian Tribes and Tribal Organizations that demonstrate-- (A) a need for increased ambulatory care services; and (B) insufficient capacity to deliver such services. (3) Peer review panels.--The Secretary may provide for the establishment of peer review panels, as necessary, to review and evaluate applications and proposals and to advise the Secretary regarding such applications using the criteria developed pursuant to subsection (a)(1). (d) Reversion of Facilities.--If any facility (or portion thereof) with respect to which funds have been paid under this section, ceases, at any time after completion of the construction, expansion, or modernization carried out with such funds, to be used for the purposes of providing health care services to eligible Indians, all of the right, title, and interest in and to such facility (or portion thereof) shall transfer to the United States unless otherwise negotiated by the Service and the Indian Tribe or Tribal Organization. (e) Funding Nonrecurring.--Funding provided under this section shall be nonrecurring and shall not be available for inclusion in any individual Indian Tribe's tribal share for an award under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) or for reallocation or redesign thereunder. SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRATION PROJECT. (a) Health Care Demonstration Projects.--The Secretary, acting through the Service, is authorized to enter into contracts under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) with Indian Tribes or Tribal Organizations for the purpose of carrying out a health care delivery demonstration project to test alternative means of delivering health care and services to Indians through facilities. (b) Use of Funds.--The Secretary, in approving projects pursuant to this section, may authorize such contracts for the construction and renovation of hospitals, health centers, health stations, and other facilities to deliver health care services and is authorized to-- (1) waive any leasing prohibition; (2) permit carryover of funds appropriated for the provision of health care services; (3) permit the use of other available funds; (4) permit the use of funds or property donated from any source for project purposes; (5) provide for the reversion of donated real or personal property to the donor; and (6) permit the use of Service funds to match other funds, including Federal funds. (c) Regulations.--The Secretary shall develop and promulgate regulations, not later than 1 year after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, for the review and approval of applications submitted under this section. (d) Criteria.--The Secretary may approve projects that meet the following criteria: (1) There is a need for a new facility or program or the reorientation of an existing facility or program. (2) A significant number of Indians, including those with low health status, will be served by the project. (3) The project has the potential to deliver services in an efficient and effective manner. (4) The project is economically viable. (5) The Indian Tribe or Tribal Organization has the administrative and financial capability to administer the project. (6) The project is integrated with providers of related health and social services and is coordinated with, and avoids duplication of, existing services. (e) Peer Review Panels.--The Secretary may provide for the establishment of peer review panels, as necessary, to review and evaluate applications using the criteria developed pursuant to subsection (d). (f) Priority.--The Secretary shall give priority to applications for demonstration projects in each of the following Service Units to the extent that such applications are timely filed and meet the criteria specified in subsection (d): (1) Cass Lake, Minnesota. (2) Mescalero, New Mexico. (3) Owyhee, Nevada. (4) Schurz, Nevada. (5) Ft. Yuma, California. (g) Technical Assistance.--The Secretary shall provide such technical and other assistance as may be necessary to enable applicants to comply with the provisions of this section. (h) Service to Ineligible Persons.--Subject to section 807, the authority to provide services to persons otherwise ineligible for the health care benefits of the Service and the authority to extend hospital privileges in Service facilities to non-Service health practitioners as provided in section 807 may be included, subject to the terms of such section, in any demonstration project approved pursuant to this section. (i) Equitable Treatment.--For purposes of subsection (d)(1), the Secretary shall, in evaluating facilities operated under any contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), use the same criteria that the Secretary uses in evaluating facilities operated directly by the Service. (j) Equitable Integration of Facilities.--The Secretary shall ensure that the planning, design, construction, renovation, and expansion needs of Service and non-Service facilities which are the subject of a contract or compact under the Indian Self- Determination and Education Assistance Act (25 U.S.C. 450 et seq.) for health services are fully and equitably integrated into the implementation of the health care delivery demonstration projects under this section. SEC. 307. LAND TRANSFER. Notwithstanding any other provision of law, the Bureau of Indian Affairs and all other agencies and departments of the United States are authorized to transfer, at no cost, land and improvements to the Service for the provision of health care services. The Secretary is authorized to accept such land and improvements for such purposes. SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS. The Secretary, acting through the Service, may enter into leases, contracts, and other agreements with Indian Tribes and Tribal Organizations which hold (1) title to, (2) a leasehold interest in, or (3) a beneficial interest in (when title is held by the United States in trust for the benefit of an Indian Tribe) facilities used or to be used for the administration and delivery of health services by an Indian Health Program. Such leases, contracts, or agreements may include provisions for construction or renovation and provide for compensation to the Indian Tribe or Tribal Organization of rental and other costs consistent with section 105(l) of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450j(l)) and regulations thereunder. SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND LOAN REPAYMENT. (a) In General.--The Secretary, in consultation with the Secretary of the Treasury, Indian Tribes, and Tribal Organizations, shall carry out a study to determine the feasibility of establishing a loan fund to provide to Indian Tribes and Tribal Organizations direct loans or guarantees for loans for the construction of health care facilities, including-- (1) inpatient facilities; (2) outpatient facilities; (3) staff quarters; (4) hostels; and (5) specialized care facilities, such as behavioral health and elder care facilities. (b) Determinations.--In carrying out the study under subsection (a), the Secretary shall determine-- (1) the maximum principal amount of a loan or loan guarantee that should be offered to a recipient from the loan fund; (2) the percentage of eligible costs, not to exceed 100 percent, that may be covered by a loan or loan guarantee from the loan fund (including costs relating to planning, design, financing, site land development, construction, rehabilitation, renovation, conversion, improvements, medical equipment and furnishings, and other facility-related costs and capital purchase (but excluding staffing)); (3) the cumulative total of the principal of direct loans and loan guarantees, respectively, that may be outstanding at any 1 time; (4) the maximum term of a loan or loan guarantee that may be made for a facility from the loan fund; (5) the maximum percentage of funds from the loan fund that should be allocated for payment of costs associated with planning and applying for a loan or loan guarantee; (6) whether acceptance by the Secretary of an assignment of the revenue of an Indian Tribe or Tribal Organization as security for any direct loan or loan guarantee from the loan fund would be appropriate; (7) whether, in the planning and design of health facilities under this section, users eligible under section 807(c) may be included in any projection of patient population; (8) whether funds of the Service provided through loans or loan guarantees from the loan fund should be eligible for use in matching other Federal funds under other programs; (9) the appropriateness of, and best methods for, coordinating the loan fund with the health care priority system of the Service under section 301; and (10) any legislative or regulatory changes required to implement recommendations of the Secretary based on results of the study. (c) Report.--Not later than September 30, 2009, the Secretary shall submit to the Committee on Indian Affairs of the Senate and the Committee on Natural Resources and the Committee on Energy and Commerce of the House of Representatives a report that describes-- (1) the manner of consultation made as required by subsection (a); and (2) the results of the study, including any recommendations of the Secretary based on results of the study. SEC. 310. TRIBAL LEASING. A Tribal Health Program may lease permanent structures for the purpose of providing health care services without obtaining advance approval in appropriation Acts. SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES JOINT VENTURE PROGRAM. (a) In General.--The Secretary, acting through the Service, shall make arrangements with Indian Tribes and Tribal Organizations to establish joint venture demonstration projects under which an Indian Tribe or Tribal Organization shall expend tribal, private, or other available funds, for the acquisition or construction of a health facility for a minimum of 10 years, under a no-cost lease, in exchange for agreement by the Service to provide the equipment, supplies, and staffing for the operation and maintenance of such a health facility. An Indian Tribe or Tribal Organization may use tribal funds, private sector, or other available resources, including loan guarantees, to fulfill its commitment under a joint venture entered into under this subsection. An Indian Tribe or Tribal Organization shall be eligible to establish a joint venture project if, when it submits a letter of intent, it-- (1) has begun but not completed the process of acquisition or construction of a health facility to be used in the joint venture project; or (2) has not begun the process of acquisition or construction of a health facility for use in the joint venture project. (b) Requirements.--The Secretary shall make such an arrangement with an Indian Tribe or Tribal Organization only if-- (1) the Secretary first determines that the Indian Tribe or Tribal Organization has the administrative and financial capabilities necessary to complete the timely acquisition or construction of the relevant health facility; and (2) the Indian Tribe or Tribal Organization meets the need criteria determined using the criteria developed under the health care facility priority system under section 301, unless the Secretary determines, pursuant to regulations, that other criteria will result in a more cost-effective and efficient method of facilitating and completing construction of health care facilities. (c) Continued Operation.--The Secretary shall negotiate an agreement with the Indian Tribe or Tribal Organization regarding the continued operation of the facility at the end of the initial 10 year no-cost lease period. (d) Breach of Agreement.--An Indian Tribe or Tribal Organization that has entered into a written agreement with the Secretary under this section, and that breaches or terminates without cause such agreement, shall be liable to the United States for the amount that has been paid to the Indian Tribe or Tribal Organization, or paid to a third party on the Indian Tribe's or Tribal Organization's behalf, under the agreement. The Secretary has the right to recover tangible property (including supplies) and equipment, less depreciation, and any funds expended for operations and maintenance under this section. The preceding sentence does not apply to any funds expended for the delivery of health care services, personnel, or staffing. (e) Recovery for Nonuse.--An Indian Tribe or Tribal Organization that has entered into a written agreement with the Secretary under this subsection shall be entitled to recover from the United States an amount that is proportional to the value of such facility if, at any time within the 10-year term of the agreement, the Service ceases to use the facility or otherwise breaches the agreement. (f) Definition.--For the purposes of this section, the term ``health facility'' or ``health facilities'' includes quarters needed to provide housing for staff of the relevant Tribal Health Program. SEC. 312. LOCATION OF FACILITIES. (a) In General.--In all matters involving the reorganization or development of Service facilities or in the establishment of related employment projects to address unemployment conditions in economically depressed areas, the Bureau of Indian Affairs and the Service shall give priority to locating such facilities and projects on Indian lands, or lands in Alaska owned by any Alaska Native village, or village or regional corporation under the Alaska Native Claims Settlement Act (43 U.S.C. 1601 et seq.), or any land allotted to any Alaska Native, if requested by the Indian owner and the Indian Tribe with jurisdiction over such lands or other lands owned or leased by the Indian Tribe or Tribal Organization. Top priority shall be given to Indian land owned by 1 or more Indian Tribes. (b) Definition.--For purposes of this section, the term ``Indian lands'' means-- (1) all lands within the exterior boundaries of any reservation; and (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. SEC. 313. MAINTENANCE AND IMPROVEMENT OF HEALTH CARE FACILITIES. (a) Report.--The Secretary shall submit to the President, for inclusion in the report required to be transmitted to Congress under section 801, a report which identifies the backlog of maintenance and repair work required at both Service and tribal health care facilities, including new health care facilities expected to be in operation in the next fiscal year. The report shall also identify the need for renovation and expansion of existing facilities to support the growth of health care programs. (b) Maintenance of Newly Constructed Space.--The Secretary, acting through the Service, is authorized to expend maintenance and improvement funds to support maintenance of newly constructed space only if such space falls within the approved supportable space allocation for the Indian Tribe or Tribal Organization. Supportable space allocation shall be defined through the health care facility priority system under section 301(c). (c) Replacement Facilities.--In addition to using maintenance and improvement funds for renovation, modernization, and expansion of facilities, an Indian Tribe or Tribal Organization may use maintenance and improvement funds for construction of a replacement facility if the costs of renovation of such facility would exceed a maximum renovation cost threshold. The maximum renovation cost threshold shall be determined through the negotiated rulemaking process provided for under section 802. SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY-OWNED QUARTERS. (a) Rental Rates.-- (1) Establishment.--Notwithstanding any other provision of law, a Tribal Health Program which operates a hospital or other health facility and the federally-owned quarters associated therewith pursuant to a contract or compact under the Indian Self- Determination and Education Assistance Act (25 U.S.C. 450 et seq.) shall have the authority to establish the rental rates charged to the occupants of such quarters by providing notice to the Secretary of its election to exercise such authority. (2) Objectives.--In establishing rental rates pursuant to authority of this subsection, a Tribal Health Program shall endeavor to achieve the following objectives: (A) To base such rental rates on the reasonable value of the quarters to the occupants thereof. (B) To generate sufficient funds to prudently provide for the operation and maintenance of the quarters, and subject to the discretion of the Tribal Health Program, to supply reserve funds for capital repairs and replacement of the quarters. (3) Equitable funding.--Any quarters whose rental rates are established by a Tribal Health Program pursuant to this subsection shall remain eligible for quarters improvement and repair funds to the same extent as all federally-owned quarters used to house personnel in Services-supported programs. (4) Notice of rate change.--A Tribal Health Program which exercises the authority provided under this subsection shall provide occupants with no less than 60 days notice of any change in rental rates. (b) Direct Collection of Rent.-- (1) In general.--Notwithstanding any other provision of law, and subject to paragraph (2), a Tribal Health Program shall have the authority to collect rents directly from Federal employees who occupy such quarters in accordance with the following: (A) The Tribal Health Program shall notify the Secretary and the subject Federal employees of its election to exercise its authority to collect rents directly from such Federal employees. (B) Upon receipt of a notice described in subparagraph (A), the Federal employees shall pay rents for occupancy of such quarters directly to the Tribal Health Program and the Secretary shall have no further authority to collect rents from such employees through payroll deduction or otherwise. (C) Such rent payments shall be retained by the Tribal Health Program and shall not be made payable to or otherwise be deposited with the United States. (D) Such rent payments shall be deposited into a separate account which shall be used by the Tribal Health Program for the maintenance (including capital repairs and replacement) and operation of the quarters and facilities as the Tribal Health Program shall determine. (2) Retrocession of authority.--If a Tribal Health Program which has made an election under paragraph (1) requests retrocession of its authority to directly collect rents from Federal employees occupying federally-owned quarters, such retrocession shall become effective on the earlier of-- (A) the first day of the month that begins no less than 180 days after the Tribal Health Program notifies the Secretary of its desire to retrocede; or (B) such other date as may be mutually agreed by the Secretary and the Tribal Health Program. (c) Rates in Alaska.--To the extent that a Tribal Health Program, pursuant to authority granted in subsection (a), establishes rental rates for federally-owned quarters provided to a Federal employee in Alaska, such rents may be based on the cost of comparable private rental housing in the nearest established community with a year-round population of 1,500 or more individuals. SEC. 315. APPLICABILITY OF BUY AMERICAN ACT REQUIREMENT. (a) Applicability.--The Secretary shall ensure that the requirements of the Buy American Act apply to all procurements made with funds provided pursuant to section 317. Indian Tribes and Tribal Organizations shall be exempt from these requirements. (b) Effect of Violation.--If it has been finally determined by a court or Federal agency that any person intentionally affixed a label bearing a ``Made in America'' inscription or any inscription with the same meaning, to any product sold in or shipped to the United States that is not made in the United States, such person shall be ineligible to receive any contract or subcontract made with funds provided pursuant to section 317, pursuant to the debarment, suspension, and ineligibility procedures described in sections 9.400 through 9.409 of title 48, Code of Federal Regulations. (c) Definitions.--For purposes of this section, the term ``Buy American Act'' means title III of the Act entitled ``An Act making appropriations for the Treasury and Post Office Departments for the fiscal year ending June 30, 1934, and for other purposes'', approved March 3, 1933 (41 U.S.C. 10a et seq.). SEC. 316. OTHER FUNDING FOR FACILITIES. (a) Authority To Accept Funds.--The Secretary is authorized to accept from any source, including Federal and State agencies, funds that are available for the construction of health care facilities and use such funds to plan, design, and construct health care facilities for Indians and to place such funds into a contract or compact under the Indian Self- Determination and Education Assistance Act (25 U.S.C. 450 et seq.). Receipt of such funds shall have no effect on the priorities established pursuant to section 301. (b) Interagency Agreements.--The Secretary is authorized to enter into interagency agreements with other Federal agencies or State agencies and other entities and to accept funds from such Federal or State agencies or other sources to provide for the planning, design, and construction of health care facilities to be administered by Indian Health Programs in order to carry out the purposes of this Act and the purposes for which the funds were appropriated or for which the funds were otherwise provided. (c) Establishment of Standards.--The Secretary, through the Service, shall establish standards by regulation for the planning, design, and construction of health care facilities serving Indians under this Act. SEC. 317. AUTHORIZATION OF APPROPRIATIONS. There are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2017 to carry out this title. TITLE IV--ACCESS TO HEALTH SERVICES SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SECURITY ACT HEALTH BENEFITS PROGRAMS. (a) Disregard of Medicare, Medicaid, and SCHIP Payments in Determining Appropriations.--Any payments received by an Indian Health Program or by an Urban Indian Organization under title XVIII, XIX, or XXI of the Social Security Act for services provided to Indians eligible for benefits under such respective titles shall not be considered in determining appropriations for the provision of health care and services to Indians. (b) Nonpreferential Treatment.--Nothing in this Act authorizes the Secretary to provide services to an Indian with coverage under title XVIII, XIX, or XXI of the Social Security Act in preference to an Indian without such coverage. (c) Use of Funds.-- (1) Special fund.-- (A) 100 percent pass-through of payments due to facilities.--Notwithstanding any other provision of law, but subject to paragraph (2), payments to which a facility of the Service is entitled by reason of a provision of the Social Security Act shall be placed in a special fund to be held by the Secretary. In making payments from such fund, the Secretary shall ensure that each Service Unit of the Service receives 100 percent of the amount to which the facilities of the Service, for which such Service Unit makes collections, are entitled by reason of a provision of the Social Security Act. (B) Use of funds.--Amounts received by a facility of the Service under subparagraph (A) shall first be 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 operated by or through such facility which may be necessary to achieve or maintain compliance with the applicable conditions and requirements of titles XVIII and XIX of the Social Security Act. Any amounts so received that are in excess of the amount necessary to achieve or maintain such conditions and requirements shall, subject to consultation with the Indian Tribes being served by the Service Unit, be used for reducing the health resource deficiencies (as determined under section 201(d)) of such Indian Tribes. (2) Direct payment option.--Paragraph (1) shall not apply to a Tribal Health Program upon the election of such Program under subsection (d) to receive payments directly. No payment may be made out of the special fund described in such paragraph with respect to reimbursement made for services provided by such Program during the period of such election. (d) Direct Billing.-- (1) In general.--Subject to complying with the requirements of paragraph (2), a Tribal Health Program may elect to directly bill for, and receive payment for, health care items and services provided by such Program for which payment is made under title XVIII or XIX of the Social Security Act or from any other third party payor. (2) Direct reimbursement.-- (A) Use of funds.--Each Tribal Health Program making the election described in paragraph (1) with respect to a program under a title of the Social Security Act shall be reimbursed directly by that program for items and services furnished without regard to subsection (c)(1), but all amounts so reimbursed shall be used by the Tribal Health Program for the purpose of making any improvements in facilities of the Tribal Health Program that may be necessary to achieve or maintain compliance with the conditions and requirements applicable generally to such items and services under the program under such title and to provide additional health care services, improvements in health care facilities and Tribal Health Programs, any health care related purpose, or otherwise to achieve the objectives provided in section 3 of this Act. (B) Audits.--The amounts paid to a Tribal Health Program making the election described in paragraph (1) with respect to a program under a title of the Social Security Act shall be subject to all auditing requirements applicable to the program under such title, as well as all auditing requirements applicable to programs administered by an Indian Health Program. Nothing in the preceding sentence shall be construed as limiting the application of auditing requirements applicable to amounts paid under title XVIII, XIX, or XXI of the Social Security Act. (C) Identification of source of payments.-- Any Tribal Health Program that receives reimbursements or payments under title XVIII, XIX, or XXI of the Social Security Act, shall provide to the Service a list of each provider enrollment number (or other identifier) under which such Program receives such reimbursements or payments. (3) Examination and implementation of changes.-- (A) In general.--The Secretary, acting through the Service and with the assistance of the Administrator of the Centers for Medicare & Medicaid Services, shall examine on an ongoing basis and implement any administrative changes that may be necessary to facilitate direct billing and reimbursement under the program established under this subsection, including any agreements with States that may be necessary to provide for direct billing under a program under a title of the Social Security Act. (B) Coordination of information.--The Service shall provide the Administrator of the Centers for Medicare & Medicaid Services with copies of the lists submitted to the Service under paragraph (2)(C), enrollment data regarding patients served by the Service (and by Tribal Health Programs, to the extent such data is available to the Service), and such other information as the Administrator may require for purposes of administering title XVIII, XIX, or XXI of the Social Security Act. (4) Withdrawal from program.--A Tribal Health Program that bills directly under the program established under this subsection may withdraw from participation in the same manner and under the same conditions that an Indian Tribe or Tribal Organization may retrocede a contracted program to the Secretary under the authority of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.). All cost accounting and billing authority under the program established under this subsection shall be returned to the Secretary upon the Secretary's acceptance of the withdrawal of participation in this program. (5) Termination for failure to comply with requirements.--The Secretary may terminate the participation of a Tribal Health Program or in the direct billing program established under this subsection if the Secretary determines that the Program has failed to comply with the requirements of paragraph (2). The Secretary shall provide a Tribal Health Program with notice of a determination that the Program has failed to comply with any such requirement and a reasonable opportunity to correct such noncompliance prior to terminating the Program's participation in the direct billing program established under this subsection. (e) Related Provisions Under the Social Security Act.--For provisions related to subsections (c) and (d), see sections 1880, 1911, and 2107(e)(1)(D) of the Social Security Act. SEC. 402. GRANTS TO AND CONTRACTS WITH THE SERVICE, INDIAN TRIBES, TRIBAL ORGANIZATIONS, AND URBAN INDIAN ORGANIZATIONS TO FACILITATE OUTREACH, ENROLLMENT, AND COVERAGE OF INDIANS UNDER SOCIAL SECURITY ACT HEALTH BENEFIT PROGRAMS AND OTHER HEALTH BENEFITS PROGRAMS. (a) Indian Tribes and Tribal Organizations.--From funds appropriated to carry out this title in accordance with section 416, the Secretary, acting through the Service, shall make grants to or enter into contracts with Indian Tribes and Tribal Organizations to assist such Tribes and Tribal Organizations in establishing and administering programs on or near reservations and trust lands to assist individual Indians-- (1) to enroll for benefits under a program established under title XVIII, XIX, or XXI of the Social Security Act and other health benefits programs; and (2) with respect to such programs for which the charging of premiums and cost sharing is not prohibited under such programs, to pay premiums or cost sharing for coverage for such benefits, which may be based on financial need (as determined by the Indian Tribe or Tribes or Tribal Organizations being served based on a schedule of income levels developed or implemented by such Tribe, Tribes, or Tribal Organizations). (b) Conditions.--The Secretary, acting through the Service, shall place conditions as deemed necessary to effect the purpose of this section in any grant or contract which the Secretary makes with any Indian Tribe or Tribal Organization pursuant to this section. Such conditions shall include requirements that the Indian Tribe or Tribal Organization successfully undertake-- (1) to determine the population of Indians eligible for the benefits described in subsection (a); (2) to educate Indians with respect to the benefits available under the respective programs; (3) to provide transportation for such individual Indians to the appropriate offices for enrollment or applications for such benefits; and (4) to develop and implement methods of improving the participation of Indians in receiving benefits under such programs. (c) Application to Urban Indian Organizations.-- (1) In general.--The provisions of subsection (a) shall apply with respect to grants and other funding to Urban Indian Organizations with respect to populations served by such organizations in the same manner they apply to grants and contracts with Indian Tribes and Tribal Organizations with respect to programs on or near reservations. (2) Requirements.--The Secretary shall include in the grants or contracts made or provided under paragraph (1) requirements that are-- (A) consistent with the requirements imposed by the Secretary under subsection (b); (B) appropriate to Urban Indian Organizations and Urban Indians; and (C) necessary to effect the purposes of this section. (d) Facilitating Cooperation.--The Secretary, acting through the Centers for Medicare & Medicaid Services, shall take such steps as are necessary to facilitate cooperation with, and agreements between, States and the Service, Indian Tribes, Tribal Organizations, or Urban Indian Organizations with respect to the provision of health care items and services to Indians under the programs established under title XVIII, XIX, or XXI of the Social Security Act. (e) Agreements Relating To Improving Enrollment of Indians Under Social Security Act Health Benefits Programs.--For provisions relating to agreements between the Secretary, acting through the Service, and Indian Tribes, Tribal Organizations, and Urban Indian Organizations for the collection, preparation, and submission of applications by Indians for assistance under the Medicaid and State children's health insurance programs established under titles XIX and XXI of the Social Security Act, and benefits under the Medicare program established under title XVIII of such Act, see subsections (a) and (b) of section 1139 of the Social Security Act. (f) Definition of Premiums and Cost Sharing.--In this section: (1) Premium.--The term ``premium'' includes any enrollment fee or similar charge. (2) Cost sharing.--The term ``cost sharing'' includes any deduction, deductible, copayment, coinsurance, or similar charge. SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS OF HEALTH SERVICES. (a) Right of Recovery.--Except as provided in subsection (f), the United States, an Indian Tribe, or Tribal Organization shall have the right to recover from an insurance company, health maintenance organization, employee benefit plan, third- party tortfeasor, or any other responsible or liable third party (including a political subdivision or local governmental entity of a State) the reasonable charges billed by the Secretary, an Indian Tribe, or Tribal Organization in providing health services through the Service, an Indian Tribe, or Tribal Organization to any individual to the same extent that such individual, or any nongovernmental provider of such services, would be eligible to receive damages, reimbursement, or indemnification for such charges or expenses if-- (1) such services had been provided by a nongovernmental provider; and (2) such individual had been required to pay such charges or expenses and did pay such charges or expenses. (b) Limitations on Recoveries From States.--Subsection (a) shall provide a right of recovery against any State, only if the injury, illness, or disability for which health services were provided is covered under-- (1) workers' compensation laws; or (2) a no-fault automobile accident insurance plan or program. (c) Nonapplication of Other Laws.--No law of any State, or of any political subdivision of a State and no provision of any contract, insurance or health maintenance organization policy, employee benefit plan, self-insurance plan, managed care plan, or other health care plan or program entered into or renewed after the date of the enactment of the Indian Health Care Amendments of 1988, shall prevent or hinder the right of recovery of the United States, an Indian Tribe, or Tribal Organization under subsection (a). (d) No Effect on Private Rights of Action.--No action taken by the United States, an Indian Tribe, or Tribal Organization to enforce the right of recovery provided under this section shall operate to deny to the injured person the recovery for that portion of the person's damage not covered hereunder. (e) Enforcement.-- (1) In general.--The United States, an Indian Tribe, or Tribal Organization may enforce the right of recovery provided under subsection (a) by-- (A) intervening or joining in any civil action or proceeding brought-- (i) by the individual for whom health services were provided by the Secretary, an Indian Tribe, or Tribal Organization; or (ii) by any representative or heirs of such individual, or (B) instituting a civil action, including a civil action for injunctive relief and other relief and including, with respect to a political subdivision or local governmental entity of a State, such an action against an official thereof. (2) Notice.--All reasonable efforts shall be made to provide notice of action instituted under paragraph (1)(B) to the individual to whom health services were provided, either before or during the pendency of such action. (3) Recovery from tortfeasors.-- (A) In general.--In any case in which an Indian Tribe or Tribal Organization that is authorized or required under a compact or contract issued pursuant to the Indian Self- Determination and Education Assistance Act (25 U.S.C. 450 et seq.) to furnish or pay for health services to a person who is injured or suffers a disease on or after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007 under circumstances that establish grounds for a claim of liability against the tortfeasor with respect to the injury or disease, the Indian Tribe or Tribal Organization shall have a right to recover from the tortfeasor (or an insurer of the tortfeasor) the reasonable value of the health services so furnished, paid for, or to be paid for, in accordance with the Federal Medical Care Recovery Act (42 U.S.C. 2651 et seq.), to the same extent and under the same circumstances as the United States may recover under that Act. (B) Treatment.--The right of an Indian Tribe or Tribal Organization to recover under subparagraph (A) shall be independent of the rights of the injured or diseased person served by the Indian Tribe or Tribal Organization. (f) Limitation.--Absent specific written authorization by the governing body of an Indian Tribe for the period of such authorization (which may not be for a period of more than 1 year and which may be revoked at any time upon written notice by the governing body to the Service), the United States shall not have a right of recovery under this section if the injury, illness, or disability for which health services were provided is covered under a self-insurance plan funded by an Indian Tribe, Tribal Organization, or Urban Indian Organization. Where such authorization is provided, the Service may receive and expend such amounts for the provision of additional health services consistent with such authorization. (g) Costs and Attorneys' Fees.--In any action brought to enforce the provisions of this section, a prevailing plaintiff shall be awarded its reasonable attorneys' fees and costs of litigation. (h) Nonapplication of Claims Filing Requirements.--An insurance company, health maintenance organization, self- insurance plan, managed care plan, or other health care plan or program (under the Social Security Act or otherwise) may not deny a claim for benefits submitted by the Service or by an Indian Tribe or Tribal Organization based on the format in which the claim is submitted if such format complies with the format required for submission of claims under title XVIII of the Social Security Act or recognized under section 1175 of such Act. (i) Application to Urban Indian Organizations.--The previous provisions of this section shall apply to Urban Indian Organizations with respect to populations served by such Organizations in the same manner they apply to Indian Tribes and Tribal Organizations with respect to populations served by such Indian Tribes and Tribal Organizations. (j) Statute of Limitations.--The provisions of section 2415 of title 28, United States Code, shall apply to all actions commenced under this section, and the references therein to the United States are deemed to include Indian Tribes, Tribal Organizations, and Urban Indian Organizations. (k) Savings.--Nothing in this section shall be construed to limit any right of recovery available to the United States, an Indian Tribe, or Tribal Organization under the provisions of any applicable, Federal, State, or Tribal law, including medical lien laws. SEC. 404. CREDITING OF REIMBURSEMENTS. (a) Use of Amounts.-- (1) Retention by program.--Except as provided in section 202(f) (relating to the Catastrophic Health Emergency Fund) and section 807 (relating to health services for ineligible persons), all reimbursements received or recovered under any of the programs described in paragraph (2), including under section 807, by reason of the provision of health services by the Service, by an Indian Tribe or Tribal Organization, or by an Urban Indian Organization, shall be credited to the Service, such Indian Tribe or Tribal Organization, or such Urban Indian Organization, respectively, and may be used as provided in section 401. In the case of such a service provided by or through a Service Unit, such amounts shall be credited to such unit and used for such purposes. (2) Programs covered.--The programs referred to in paragraph (1) are the following: (A) Titles XVIII, XIX, and XXI of the Social Security Act. (B) This Act, including section 807. (C) Public Law 87-693. (D) Any other provision of law. (b) No Offset of Amounts.--The Service may not offset or limit any amount obligated to any Service Unit or entity receiving funding from the Service because of the receipt of reimbursements under subsection (a). SEC. 405. PURCHASING HEALTH CARE COVERAGE. (a) In General.--Insofar as amounts are made available under law (including a provision of the Social Security Act, the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), or other law, other than under section 402) to Indian Tribes, Tribal Organizations, and Urban Indian Organizations for health benefits for Service beneficiaries, Indian Tribes, Tribal Organizations, and Urban Indian Organizations may use such amounts to purchase health benefits coverage for such beneficiaries in any manner, including through-- (1) a tribally owned and operated health care plan; (2) a State or locally authorized or licensed health care plan; (3) a health insurance provider or managed care organization; or (4) a self-insured plan. The purchase of such coverage by an Indian Tribe, Tribal Organization, or Urban Indian Organization may be based on the financial needs of such beneficiaries (as determined by the Indian Tribe or Tribes being served based on a schedule of income levels developed or implemented by such Indian Tribe or Tribes). (b) Expenses for Self-Insured Plan.--In the case of a self- insured plan under subsection (a)(4), the amounts may be used for expenses of operating the plan, including administration and insurance to limit the financial risks to the entity offering the plan. (c) Construction.--Nothing in this section shall be construed as affecting the use of any amounts not referred to in subsection (a). SEC. 406. SHARING ARRANGEMENTS WITH FEDERAL AGENCIES. (a) Authority.-- (1) In general.--The Secretary may enter into (or expand) arrangements for the sharing of medical facilities and services between the Service, Indian Tribes, and Tribal Organizations and the Department of Veterans Affairs and the Department of Defense. (2) Consultation by secretary required.--The Secretary may not finalize any arrangement between the Service and a Department described in paragraph (1) without first consulting with the Indian Tribes which will be significantly affected by the arrangement. (b) Limitations.--The Secretary shall not take any action under this section or under subchapter IV of chapter 81 of title 38, United States Code, which would impair-- (1) the priority access of any Indian to health care services provided through the Service and the eligibility of any Indian to receive health services through the Service; (2) the quality of health care services provided to any Indian through the Service; (3) the priority access of any veteran to health care services provided by the Department of Veterans Affairs; (4) the quality of health care services provided by the Department of Veterans Affairs or the Department of Defense; or (5) the eligibility of any Indian who is a veteran to receive health services through the Department of Veterans Affairs. (c) Reimbursement.--The Service, Indian Tribe, or Tribal Organization shall be reimbursed by the Department of Veterans Affairs or the Department of Defense (as the case may be) where services are provided through the Service, an Indian Tribe, or a Tribal Organization to beneficiaries eligible for services from either such Department, notwithstanding any other provision of law. (d) Construction.--Nothing in this section may be construed as creating any right of a non-Indian veteran to obtain health services from the Service. SEC. 407. PAYOR OF LAST RESORT. Indian Health Programs and health care programs operated by Urban Indian Organizations shall be the payor of last resort for services provided to persons eligible for services from Indian Health Programs and Urban Indian Organizations, notwithstanding any Federal, State, or local law to the contrary. SEC. 408. NONDISCRIMINATION UNDER FEDERAL HEALTH CARE PROGRAMS IN QUALIFICATIONS FOR REIMBURSEMENT FOR SERVICES. (a) Requirement To Satisfy Generally Applicable Participation Requirements.-- (1) In general.--A Federal health care program must accept an entity that is operated by the Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization as a provider eligible to receive payment under the program for health care services furnished to an Indian on the same basis as any other provider qualified to participate as a provider of health care services under the program if the entity meets generally applicable State or other requirements for participation as a provider of health care services under the program. (2) Satisfaction of state or local licensure or recognition requirements.--Any requirement for participation as a provider of health care services under a Federal health care program that an entity be licensed or recognized under the State or local law where the entity is located to furnish health care services shall be deemed to have been met in the case of an entity operated by the Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization if the entity meets all the applicable standards for such licensure or recognition, regardless of whether the entity obtains a license or other documentation under such State or local law. In accordance with section 221, the absence of the licensure of a health care professional employed by such an entity under the State or local law where the entity is located shall not be taken into account for purposes of determining whether the entity meets such standards, if the professional is licensed in another State. (b) Application of Exclusion From Participation in Federal Health Care Programs.-- (1) Excluded entities.--No entity operated by the Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization that has been excluded from participation in any Federal health care program or for which a license is under suspension or has been revoked by the State where the entity is located shall be eligible to receive payment or reimbursement under any such program for health care services furnished to an Indian. (2) Excluded individuals.--No individual who has been excluded from participation in any Federal health care program or whose State license is under suspension shall be eligible to receive payment or reimbursement under any such program for health care services furnished by that individual, directly or through an entity that is otherwise eligible to receive payment for health care services, to an Indian. (3) Federal health care program defined.--In this subsection, the term, ``Federal health care program'' has the meaning given that term in section 1128B(f) of the Social Security Act (42 U.S.C. 1320a-7b(f)), except that, for purposes of this subsection, such term shall include the health insurance program under chapter 89 of title 5, United States Code. (c) Related Provisions.--For provisions related to nondiscrimination against providers operated by the Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization, see section 1139(c) of the Social Security Act (42 U.S.C. 1320b-9(c)). SEC. 409. CONSULTATION. For provisions related to consultation with representatives of Indian Health Programs and Urban Indian Organizations with respect to the health care programs established under titles XVIII, XIX, and XXI of the Social Security Act, see section 1139(d) of the Social Security Act (42 U.S.C. 1320b-9(d)). SEC. 410. STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP). For provisions relating to-- (1) outreach to families of Indian children likely to be eligible for child health assistance under the State children's health insurance program established under title XXI of the Social Security Act, see sections 2105(c)(2)(C) and 1139(a) of such Act (42 U.S.C. 1397ee(c)(2), 1320b-9); and (2) ensuring that child health assistance is provided under such program to targeted low-income children who are Indians and that payments are made under such program to Indian Health Programs and Urban Indian Organizations operating in the State that provide such assistance, see sections 2102(b)(3)(D) and 2105(c)(6)(B) of such Act (42 U.S.C. 1397bb(b)(3)(D), 1397ee(c)(6)(B)). SEC. 411. EXCLUSION WAIVER AUTHORITY FOR AFFECTED INDIAN HEALTH PROGRAMS AND SAFE HARBOR TRANSACTIONS UNDER THE SOCIAL SECURITY ACT. For provisions relating to-- (1) exclusion waiver authority for affected Indian Health Programs under the Social Security Act, see section 1128(k) of the Social Security Act (42 U.S.C. 1320a-7(k)); and (2) certain transactions involving Indian Health Programs deemed to be in safe harbors under that Act, see section 1128B(b)(4) of the Social Security Act (42 U.S.C. 1320a-7b(b)(4)). SEC. 412. PREMIUM AND COST SHARING PROTECTIONS AND ELIGIBILITY DETERMINATIONS UNDER MEDICAID AND SCHIP AND PROTECTION OF CERTAIN INDIAN PROPERTY FROM MEDICAID ESTATE RECOVERY. For provisions relating to-- (1) premiums or cost sharing protections for Indians furnished items or services directly by Indian Health Programs or through referral under the contract health service under the Medicaid program established under title XIX of the Social Security Act, see sections 1916(j) and 1916A(a)(1) of the Social Security Act (42 U.S.C. 1396o(j), 1396o-1(a)(1)); (2) rules regarding the treatment of certain property for purposes of determining eligibility under such programs, see sections 1902(e)(13) and 2107(e)(1)(B) of such Act (42 U.S.C. 1396a(e)(13), 1397gg(e)(1)(B)); and (3) the protection of certain property from estate recovery provisions under the Medicaid program, see section 1917(b)(3)(B) of such Act (42 U.S.C. 1396p(b)(3)(B)). SEC. 413. TREATMENT UNDER MEDICAID AND SCHIP MANAGED CARE. For provisions relating to the treatment of Indians enrolled in a managed care entity under the Medicaid program under title XIX of the Social Security Act and Indian Health Programs and Urban Indian Organizations that are providers of items or services to such Indian enrollees, see sections 1932(h) and 2107(e)(1)(H) of the Social Security Act (42 U.S.C. 1396u-2(h), 1397gg(e)(1)(H)). SEC. 414. NAVAJO NATION MEDICAID AGENCY FEASIBILITY STUDY. (a) Study.--The Secretary shall conduct a study to determine the feasibility of treating the Navajo Nation as a State for the purposes of title XIX of the Social Security Act, to provide services to Indians living within the boundaries of the Navajo Nation through an entity established having the same authority and performing the same functions as single-State medicaid agencies responsible for the administration of the State plan under title XIX of the Social Security Act. (b) Considerations.--In conducting the study, the Secretary shall consider the feasibility of-- (1) assigning and paying all expenditures for the provision of services and related administration funds, under title XIX of the Social Security Act, to Indians living within the boundaries of the Navajo Nation that are currently paid to or would otherwise be paid to the State of Arizona, New Mexico, or Utah; (2) providing assistance to the Navajo Nation in the development and implementation of such entity for the administration, eligibility, payment, and delivery of medical assistance under title XIX of the Social Security Act; (3) providing an appropriate level of matching funds for Federal medical assistance with respect to amounts such entity expends for medical assistance for services and related administrative costs; and (4) authorizing the Secretary, at the option of the Navajo Nation, to treat the Navajo Nation as a State for the purposes of title XIX of the Social Security Act (relating to the State children's health insurance program) under terms equivalent to those described in paragraphs (2) through (4). (c) Report.--Not later then 3 years after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary shall submit to the Committee on Indian Affairs and Committee on Finance of the Senate and the Committee on Natural Resources and Committee on Energy and Commerce of the House of Representatives a report that includes-- (1) the results of the study under this section; (2) a summary of any consultation that occurred between the Secretary and the Navajo Nation, other Indian Tribes, the States of Arizona, New Mexico, and Utah, counties which include Navajo Lands, and other interested parties, in conducting this study; (3) projected costs or savings associated with establishment of such entity, and any estimated impact on services provided as described in this section in relation to probable costs or savings; and (4) legislative actions that would be required to authorize the establishment of such entity if such entity is determined by the Secretary to be feasible. SEC. 415. GENERAL EXCEPTIONS. The requirements of this title shall not apply to any excepted benefits described in paragraph (1)(A) or (3) of section 2791(c) of the Public Health Service Act (42 U.S.C. 300gg-91). SEC. 416. AUTHORIZATION OF APPROPRIATIONS. There are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2017 to carry out this title. TITLE V--HEALTH SERVICES FOR URBAN INDIANS SEC. 501. PURPOSE. The purpose of this title is to establish and maintain programs in Urban Centers to make health services more accessible and available to Urban Indians. SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN INDIAN ORGANIZATIONS. Under authority of the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the ``Snyder Act''), the Secretary, acting through the Service, shall enter into contracts with, or make grants to, Urban Indian Organizations to assist such organizations in the establishment and administration, within Urban Centers, of programs which meet the requirements set forth in this title. Subject to section 506, the Secretary, acting through the Service, shall include such conditions as the Secretary considers necessary to effect the purpose of this title in any contract into which the Secretary enters with, or in any grant the Secretary makes to, any Urban Indian Organization pursuant to this title. SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION OF HEALTH CARE AND REFERRAL SERVICES. (a) Requirements for Grants and Contracts.--Under authority of the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the ``Snyder Act''), the Secretary, acting through the Service, shall enter into contracts with, 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, 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, or under any current public health service project funded in a manner other than pursuant to this title; (4) the capability of an Urban Indian Organization to perform the activities set forth in subsection (a) and to enter into a contract with the Secretary or to meet the requirements for receiving a grant under this section; (5) the satisfactory performance and successful completion by an Urban Indian Organization of other contracts with the Secretary under this title; (6) the appropriateness and likely effectiveness of conducting the activities set forth in subsection (a) in an Urban Center or centers; and (7) the extent of existing or likely future participation in the activities set forth in subsection (a) by appropriate health and health-related Federal, State, local, and other agencies. (c) Access to Health Promotion and Disease Prevention Programs.--The Secretary, acting through the Service, shall facilitate access to or provide health promotion and disease prevention services for Urban Indians through grants made to Urban Indian Organizations administering contracts entered into or receiving grants under subsection (a). (d) Immunization Services.-- (1) Access or services provided.--The Secretary, acting through the Service, shall facilitate access to, or provide, immunization services for Urban Indians through grants made to Urban Indian Organizations administering contracts entered into or receiving grants under this section. (2) Definition.--For purposes of this subsection, the term ``immunization services'' means services to provide without charge immunizations against vaccine- preventable diseases. (e) Behavioral Health Services.-- (1) Access or services provided.--The Secretary, acting through the Service, shall facilitate access to, or provide, behavioral health services for Urban Indians through grants made to Urban Indian Organizations administering contracts entered into or receiving grants under subsection (a). (2) Assessment required.--Except as provided by paragraph (3)(A), a grant may not be made under this subsection to an Urban Indian Organization until that organization has prepared, and the Service has approved, an assessment of the following: (A) The behavioral health needs of the Urban Indian population concerned. (B) The behavioral health services and other related resources available to that population. (C) The barriers to obtaining those services and resources. (D) The needs that are unmet by such services and resources. (3) Purposes of grants.--Grants may be made under this subsection for the following: (A) To prepare assessments required under paragraph (2). (B) To provide outreach, educational, and referral services to Urban Indians regarding the availability of direct behavioral health services, to educate Urban Indians about behavioral health issues and services, and effect coordination with existing behavioral health providers in order to improve services to Urban Indians. (C) To provide outpatient behavioral health services to Urban Indians, including the identification and assessment of illness, therapeutic treatments, case management, support groups, family treatment, and other treatment. (D) To develop innovative behavioral health service delivery models which incorporate Indian cultural support systems and resources. (f) Prevention of Child Abuse.-- (1) Access or services provided.--The Secretary, acting through the Service, shall facilitate access to or provide services for Urban Indians through grants to Urban Indian Organizations administering contracts entered into or receiving grants under subsection (a) to prevent and treat child abuse (including sexual abuse) among Urban Indians. (2) Evaluation required.--Except as provided by paragraph (3)(A), a grant may not be made under this subsection to an Urban Indian Organization until that organization has prepared, and the Service has approved, an assessment that documents the prevalence of child abuse in the Urban Indian population concerned and specifies the services and programs (which may not duplicate existing services and programs) for which the grant is requested. (3) Purposes of grants.--Grants may be made under this subsection for the following: (A) To prepare assessments required under paragraph (2). (B) For the development of prevention, training, and education programs for Urban Indians, including child education, parent education, provider training on identification and intervention, education on reporting requirements, prevention campaigns, and establishing service networks of all those involved in Indian child protection. (C) To provide direct outpatient treatment services (including individual treatment, family treatment, group therapy, and support groups) to Urban Indians who are child victims of abuse (including sexual abuse) or adult survivors of child sexual abuse, to the families of such child victims, and to Urban Indian perpetrators of child abuse (including sexual abuse). (4) Considerations when making grants.--In making grants to carry out this subsection, the Secretary shall take into consideration-- (A) the support for the Urban Indian Organization demonstrated by the child protection authorities in the area, including committees or other services funded under the Indian Child Welfare Act of 1978 (25 U.S.C. 1901 et seq.), if any; (B) the capability and expertise demonstrated by the Urban Indian Organization to address the complex problem of child sexual abuse in the community; and (C) the assessment required under paragraph (2). (g) Other Grants.--The Secretary, acting through the Service, may enter into a contract with or make grants to an Urban Indian Organization that provides or arranges for the provision of health care services (through satellite facilities, provider networks, or otherwise) to Urban Indians in more than 1 Urban Center. SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINATION OF UNMET HEALTH CARE NEEDS. (a) Grants and Contracts Authorized.--Under authority of the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the ``Snyder Act''), the Secretary, acting through the Service, may enter into contracts with or make grants to Urban Indian Organizations situated in Urban Centers for which contracts have not been entered into or grants have not been made under section 503. (b) Purpose.--The purpose of a contract or grant made under this section shall be the determination of the matters described in subsection (c)(1) in order to assist the Secretary in assessing the health status and health care needs of Urban Indians in the Urban Center involved and determining whether the Secretary should enter into a contract or make a grant under section 503 with respect to the Urban Indian Organization which the Secretary has entered into a contract with, or made a grant to, under this section. (c) Grant and Contract Requirements.--Any contract entered into, or grant made, by the Secretary under this section shall include requirements that-- (1) the Urban Indian Organization successfully undertakes to-- (A) document the health care status and unmet health care needs of Urban Indians in the Urban Center involved; and (B) with respect to Urban Indians in the Urban Center involved, determine the matters described in paragraphs (2), (3), (4), and (7) of section 503(b); and (2) the Urban Indian Organization complete performance of the contract, or carry out the requirements of the grant, within 1 year after the date on which the Secretary and such organization enter into such contract, or within 1 year after such organization receives such grant, whichever is applicable. (d) No Renewals.--The Secretary may not renew any contract entered into or grant made under this section. SEC. 505. EVALUATIONS; RENEWALS. (a) Procedures for Evaluations.--The Secretary, acting through the Service, shall develop procedures to evaluate compliance with grant requirements and compliance with and performance of contracts entered into by Urban Indian Organizations under this title. Such procedures shall include provisions for carrying out the requirements of this section. (b) Evaluations.--The Secretary, acting through the Service, shall evaluate the compliance of each Urban Indian Organization which has entered into a contract or received a grant under section 503 with the terms of such contract or grant. For purposes of this evaluation, the Secretary shall-- (1) acting through the Service, conduct an annual onsite evaluation of the organization; or (2) accept in lieu of such onsite evaluation evidence of the organization's provisional or full accreditation by a private independent entity recognized by the Secretary for purposes of conducting quality reviews of providers participating in the Medicare program under title XVIII of the Social Security Act. (c) Noncompliance; Unsatisfactory Performance.--If, as a result of the evaluations conducted under this section, the Secretary determines that an Urban Indian Organization has not complied with the requirements of a grant or complied with or satisfactorily performed a contract under section 503, the Secretary shall, prior to renewing such contract or grant, attempt to resolve with the organization the areas of noncompliance or unsatisfactory performance and modify the contract or grant to prevent future occurrences of noncompliance or unsatisfactory performance. If the Secretary determines that the noncompliance or unsatisfactory performance cannot be resolved and prevented in the future, the Secretary shall not renew the contract or grant with the organization and is authorized to enter into a contract or make a grant under section 503 with another Urban Indian Organization which is situated in the same Urban Center as the Urban Indian Organization whose contract or grant is not renewed under this section. (d) Considerations for Renewals.--In determining whether to renew a contract or grant with an Urban Indian Organization under section 503 which has completed performance of a contract or grant under section 504, the Secretary shall review the records of the Urban Indian Organization, the reports submitted under section 507, and shall consider the results of the onsite evaluations or accreditations under subsection (b). SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS. (a) Procurement.--Contracts with Urban Indian Organizations entered into pursuant to this title shall be in accordance with all Federal contracting laws and regulations relating to procurement except that in the discretion of the Secretary, such contracts may be negotiated without advertising and need not conform to the provisions of sections 1304 and 3131 through 3133 of title 40, United States Code. (b) Payments Under Contracts or Grants.-- (1) In general.--Payments under any contracts or grants pursuant to this title, notwithstanding any term or condition of such contract or grant-- (A) may be made in a single advance payment by the Secretary to the Urban Indian Organization by no later than the end of the first 30 days of the funding period with respect to which the payments apply, unless the Secretary determines through an evaluation under section 505 that the organization is not capable of administering such a single advance payment; and (B) if any portion thereof is unexpended by the Urban Indian Organization during the funding period with respect to which the payments initially apply, shall be carried forward for expenditure with respect to allowable or reimbursable costs incurred by the organization during 1 or more subsequent funding periods without additional justification or documentation by the organization as a condition of carrying forward the availability for expenditure of such funds. (2) Semiannual and quarterly payments and reimbursements.--If the Secretary determines under paragraph (1)(A) that an Urban Indian Organization is not capable of administering an entire single advance payment, on request of the Urban Indian Organization, the payments may be made-- (A) in semiannual or quarterly payments by not later than 30 days after the date on which the funding period with respect to which the payments apply begins; or (B) by way of reimbursement. (c) Revision or Amendment of Contracts.--Notwithstanding any provision of law to the contrary, the Secretary may, at the request and consent of an Urban Indian Organization, revise or amend any contract entered into by the Secretary with such organization under this title as necessary to carry out the purposes of this title. (d) Fair and Uniform Services and Assistance.--Contracts with or grants to Urban Indian Organizations and regulations adopted pursuant to this title shall include provisions to assure the fair and uniform provision to Urban Indians of services and assistance under such contracts or grants by such organizations. SEC. 507. REPORTS AND RECORDS. (a) Reports.-- (1) In general.--For each fiscal year during which an Urban Indian Organization receives or expends funds pursuant to a contract entered into or a grant received pursuant to this title, such Urban Indian Organization shall submit to the Secretary not more frequently than every 6 months, a report that includes the following: (A) In the case of a contract or grant under section 503, recommendations pursuant to section 503(a)(5). (B) Information on activities conducted by the organization pursuant to the contract or grant. (C) An accounting of the amounts and purpose for which Federal funds were expended. (D) A minimum set of data, using uniformly defined elements, as specified by the Secretary after consultation with Urban Indian Organizations. (2) Health status and services.-- (A) In general.--Not later than 18 months after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary, acting through the Service, shall submit to Congress a report evaluating-- (i) the health status of Urban Indians; (ii) the services provided to Indians pursuant to this title; and (iii) areas of unmet needs in the delivery of health services to Urban Indians. (B) Consultation and contracts.--In preparing the report under paragraph (1), the Secretary-- (i) shall consult with Urban Indian Organizations; and (ii) may enter into a contract with a national organization representing Urban Indian Organizations to conduct any aspect of the report. (b) Audit.--The reports and records of the Urban Indian Organization with respect to a contract or grant under this title shall be subject to audit by the Secretary and the Comptroller General of the United States. (c) Costs of Audits.--The Secretary shall allow as a cost of any contract or grant entered into or awarded under section 502 or 503 the cost of an annual independent financial audit conducted by-- (1) a certified public accountant; or (2) a certified public accounting firm qualified to conduct Federal compliance audits. SEC. 508. LIMITATION ON CONTRACT AUTHORITY. The authority of the Secretary to enter into contracts or to award grants under this title shall be to the extent, and in an amount, provided for in appropriation Acts. SEC. 509. FACILITIES. (a) Grants.--The Secretary, acting through the Service, may make grants to contractors or grant recipients under this title for the lease, purchase, renovation, construction, or expansion of facilities, including leased facilities, in order to assist such contractors or grant recipients in complying with applicable licensure or certification requirements. (b) Loan Fund Study.--The Secretary, acting through the Service, may carry out a study to determine the feasibility of establishing a loan fund to provide to Urban Indian Organizations direct loans or guarantees for loans for the construction of health care facilities in a manner consistent with section 309, including by submitting a report in accordance with subsection (c) of that section. SEC. 510. DIVISION OF URBAN INDIAN HEALTH. There is established within the Service a Division of Urban Indian Health, which shall be responsible for-- (1) carrying out the provisions of this title; (2) providing central oversight of the programs and services authorized under this title; and (3) providing technical assistance to Urban Indian Organizations. SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE-RELATED SERVICES. (a) Grants Authorized.--The Secretary, acting through the Service, may make grants for the provision of health-related services in prevention of, treatment of, rehabilitation of, or school- and community-based education regarding, alcohol and substance abuse in Urban Centers to those Urban Indian Organizations with which the Secretary has entered into a contract under this title or under section 201. (b) Goals.--Each grant made pursuant to subsection (a) shall set forth the goals to be accomplished pursuant to the grant. The goals shall be specific to each grant as agreed to between the Secretary and the grantee. (c) Criteria.--The Secretary shall establish criteria for the grants made under subsection (a), including criteria relating to the following: (1) The size of the Urban Indian population. (2) Capability of the organization to adequately perform the activities required under the grant. (3) Satisfactory performance standards for the organization in meeting the goals set forth in such grant. The standards shall be negotiated and agreed to between the Secretary and the grantee on a grant-by- grant basis. (4) Identification of the need for services. (d) Allocation of Grants.--The Secretary shall develop a methodology for allocating grants made pursuant to this section based on the criteria established pursuant to subsection (c). (e) Grants Subject to Criteria.--Any grant received by an Urban Indian Organization under this Act for substance abuse prevention, treatment, and rehabilitation shall be subject to the criteria set forth in subsection (c). SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION PROJECTS. Notwithstanding any other provision of law, the Tulsa Clinic and Oklahoma City Clinic demonstration projects shall-- (1) be permanent programs within the Service's direct care program; (2) continue to be treated as Service Units and Operating Units in the allocation of resources and coordination of care; and (3) continue to meet the requirements and definitions of an Urban Indian Organization in this Act, and shall not be subject to the provisions of the Indian Self- Determination and Education Assistance Act (25 U.S.C. 450 et seq.). SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS. (a) Grants and Contracts.--The Secretary, through the Division of Urban Indian Health, shall make grants or enter into contracts with Urban Indian Organizations, to take effect not later than September 30, 2010, for the administration of Urban Indian alcohol programs that were originally established under the National Institute on Alcoholism and Alcohol Abuse (hereafter in this section referred to as ``NIAAA'') and transferred to the Service. (b) Use of Funds.--Grants provided or contracts entered into under this section shall be used to provide support for the continuation of alcohol prevention and treatment services for Urban Indian populations and such other objectives as are agreed upon between the Service and a recipient of a grant or contract under this section. (c) Eligibility.--Urban Indian Organizations that operate Indian alcohol programs originally funded under the NIAAA and subsequently transferred to the Service are eligible for grants or contracts under this section. (d) Report.--The Secretary shall evaluate and report to Congress on the activities of programs funded under this section not less than every 5 years. SEC. 514. CONSULTATION WITH URBAN INDIAN ORGANIZATIONS. (a) In General.--The Secretary shall ensure that the Service consults, to the greatest extent practicable, with Urban Indian Organizations. (b) Definition of Consultation.--For purposes of subsection (a), consultation is the open and free exchange of information and opinions which leads to mutual understanding and comprehension and which emphasizes trust, respect, and shared responsibility. SEC. 515. URBAN YOUTH TREATMENT CENTER DEMONSTRATION. (a) Construction and Operation.--The Secretary, acting through the Service, through grant or contract, is authorized to fund the construction and operation of at least 2 residential treatment centers in each State described in subsection (b) to demonstrate the provision of alcohol and substance abuse treatment services to Urban Indian youth in a culturally competent residential setting. (b) Definition of State.--A State described in this subsection is a State in which-- (1) there resides Urban Indian youth with need for alcohol and substance abuse treatment services in a residential setting; and (2) there is a significant shortage of culturally competent residential treatment services for Urban Indian youth. SEC. 516. GRANTS FOR DIABETES PREVENTION, TREATMENT, AND CONTROL. (a) Grants Authorized.--The Secretary may make grants to those Urban Indian Organizations that have entered into a contract or have received a grant under this title for the provision of services for the prevention and treatment of, and control of the complications resulting from, diabetes among Urban Indians. (b) Goals.--Each grant made pursuant to subsection (a) shall set forth the goals to be accomplished under the grant. The goals shall be specific to each grant as agreed to between the Secretary and the grantee. (c) Establishment of Criteria.--The Secretary shall establish criteria for the grants made under subsection (a) relating to-- (1) the size and location of the Urban Indian population to be served; (2) the need for prevention of and treatment of, and control of the complications resulting from, diabetes among the Urban Indian population to be served; (3) performance standards for the organization in meeting the goals set forth in such grant that are negotiated and agreed to by the Secretary and the grantee; (4) the capability of the organization to adequately perform the activities required under the grant; and (5) the willingness of the organization to collaborate with the registry, if any, established by the Secretary under section 204(e) in the Area Office of the Service in which the organization is located. (d) Funds Subject to Criteria.--Any funds received by an Urban Indian Organization under this Act for the prevention, treatment, and control of diabetes among Urban Indians shall be subject to the criteria developed by the Secretary under subsection (c). SEC. 517. COMMUNITY HEALTH REPRESENTATIVES. The Secretary, acting through the Service, may enter into contracts with, and make grants to, Urban Indian Organizations for the employment of Indians trained as health service providers through the Community Health Representatives Program under section 109 in the provision of health care, health promotion, and disease prevention services to Urban Indians. SEC. 518. EFFECTIVE DATE. The amendments made by the Indian Health Care Improvement Act Amendments of 2007 to this title shall take effect beginning on the date of enactment of that Act, regardless of whether the Secretary has promulgated regulations implementing such amendments. SEC. 519. ELIGIBILITY FOR SERVICES. Urban Indians shall be eligible for, and the ultimate beneficiaries of, health care or referral services provided pursuant to this title. SEC. 520. AUTHORIZATION OF APPROPRIATIONS. There are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2017 to carry out this title. TITLE VI--ORGANIZATIONAL IMPROVEMENTS SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERVICE AS AN AGENCY OF THE PUBLIC HEALTH SERVICE. (a) Establishment.-- (1) In general.--In order to more effectively and efficiently carry out the responsibilities, authorities, and functions of the United States to provide health care services to Indians and Indian Tribes, as are or may be hereafter provided by Federal statute or treaties, there is established within the Public Health Service of the Department the Indian Health Service. (2) Assistant secretary of indian health.--The Service shall be administered by an Assistant Secretary of Indian Health, who shall be appointed by the President, by and with the advice and consent of the Senate. The Assistant Secretary shall report to the Secretary. Effective with respect to an individual appointed by the President, by and with the advice and consent of the Senate, after January 1, 2007, the term of service of the Assistant Secretary shall be 4 years. An Assistant Secretary may serve more than 1 term. (3) Incumbent.--The individual serving in the position of Director of the Service on the day before the date of enactment of the Indian Health Care Improvement Act Amendments of 2007 shall serve as Assistant Secretary. (4) Advocacy and consultation.--The position of Assistant Secretary is established to, in a manner consistent with the government-to-government relationship between the United States and Indian Tribes-- (A) facilitate advocacy for the development of appropriate Indian health policy; and (B) promote consultation on matters relating to Indian health. (b) Agency.--The Service shall be an agency within the Public Health Service of the Department, and shall not be an office, component, or unit of any other agency of the Department. (c) Duties.--The Assistant Secretary shall-- (1) perform all functions that were, on the day before the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, carried out by or under the direction of the individual serving as Director of the Service on that day; (2) perform all functions of the Secretary relating to the maintenance and operation of hospital and health facilities for Indians and the planning for, and provision and utilization of, health services for Indians; (3) administer all health programs under which health care is provided to Indians based upon their status as Indians which are administered by the Secretary, including programs under-- (A) this Act; (B) the Act of November 2, 1921 (25 U.S.C. 13); (C) the Act of August 5, 1954 (42 U.S.C. 2001 et seq.); (D) the Act of August 16, 1957 (42 U.S.C. 2005 et seq.); and (E) the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.); (4) administer all scholarship and loan functions carried out under title I; (5) report directly to the Secretary concerning all policy- and budget-related matters affecting Indian health; (6) collaborate with the Assistant Secretary for Health concerning appropriate matters of Indian health that affect the agencies of the Public Health Service; (7) advise each Assistant Secretary of the Department concerning matters of Indian health with respect to which that Assistant Secretary has authority and responsibility; (8) advise the heads of other agencies and programs of the Department concerning matters of Indian health with respect to which those heads have authority and responsibility; (9) coordinate the activities of the Department concerning matters of Indian health; and (10) perform such other functions as the Secretary may designate. (d) Authority.-- (1) In general.--The Secretary, acting through the Assistant Secretary, shall have the authority-- (A) except to the extent provided for in paragraph (2), to appoint and compensate employees for the Service in accordance with title 5, United States Code; (B) to enter into contracts for the procurement of goods and services to carry out the functions of the Service; and (C) to manage, expend, and obligate all funds appropriated for the Service. (2) Personnel actions.--Notwithstanding any other provision of law, the provisions of section 12 of the Act of June 18, 1934 (48 Stat. 986; 25 U.S.C. 472), shall apply to all personnel actions taken with respect to new positions created within the Service as a result of its establishment under subsection (a). (e) References.--Any reference to the Director of the Indian Health Service in any other Federal law, Executive order, rule, regulation, or delegation of authority, or in any document of or relating to the Director of the Indian Health Service, shall be deemed to refer to the Assistant Secretary. SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM. (a) Establishment.-- (1) In general.--The Secretary shall establish an automated management information system for the Service. (2) Requirements of system.--The information system established under paragraph (1) shall include-- (A) a financial management system; (B) a patient care information system for each area served by the Service; (C) a privacy component that protects the privacy of patient information held by, or on behalf of, the Service; (D) a services-based cost accounting component that provides estimates of the costs associated with the provision of specific medical treatments or services in each Area office of the Service; (E) an interface mechanism for patient billing and accounts receivable system; and (F) a training component. (b) Provision of Systems to Tribes and Organizations.--The Secretary shall provide each Tribal Health Program automated management information systems which-- (1) meet the management information needs of such Tribal Health Program with respect to the treatment by the Tribal Health Program of patients of the Service; and (2) meet the management information needs of the Service. (c) Access to Records.--Notwithstanding any other provision of law, each patient shall have reasonable access to the medical or health records of such patient which are held by, or on behalf of, the Service. (d) Authority To Enhance Information Technology.--The Secretary, acting through the Assistant Secretary, shall have the authority to enter into contracts, agreements, or joint ventures with other Federal agencies, States, private and nonprofit organizations, for the purpose of enhancing information technology in Indian Health Programs and facilities. SEC. 603. AUTHORIZATION OF APPROPRIATIONS. There is authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2017 to carry out this title. TITLE VII--BEHAVIORAL HEALTH PROGRAMS SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREATMENT SERVICES. (a) Purposes.--The purposes of this section are as follows: (1) To authorize and direct the Secretary, acting through the Service, Indian Tribes, Tribal Organizations, and Urban Indian Organizations, to develop a comprehensive behavioral health prevention and treatment program which emphasizes collaboration among alcohol and substance abuse, social services, and mental health programs. (2) To provide information, direction, and guidance relating to mental illness and dysfunction and self- destructive behavior, including child abuse and family violence, to those Federal, tribal, State, and local agencies responsible for programs in Indian communities in areas of health care, education, social services, child and family welfare, alcohol and substance abuse, law enforcement, and judicial services. (3) To assist Indian Tribes to identify services and resources available to address mental illness and dysfunctional and self-destructive behavior. (4) To provide authority and opportunities for Indian Tribes and Tribal Organizations to develop, implement, and coordinate with community-based programs which include identification, prevention, education, referral, and treatment services, including through multidisciplinary resource teams. (5) To ensure that Indians, as citizens of the United States and of the States in which they reside, have the same access to behavioral health services to which all citizens have access. (6) To modify or supplement existing programs and authorities in the areas identified in paragraph (2). (b) Plans.-- (1) Development.--The Secretary, acting through the Service, Indian Tribes, Tribal Organizations, and Urban Indian Organizations, shall encourage Indian Tribes and Tribal Organizations to develop tribal plans, and Urban Indian Organizations to develop local plans, and for all such groups to participate in developing areawide plans for Indian Behavioral Health Services. The plans shall include, to the extent feasible, the following components: (A) An assessment of the scope of alcohol or other substance abuse, mental illness, and dysfunctional and self-destructive behavior, including suicide, child abuse, and family violence, among Indians, including-- (i) the number of Indians served who are directly or indirectly affected by such illness or behavior; or (ii) an estimate of the financial and human cost attributable to such illness or behavior. (B) An assessment of the existing and additional resources necessary for the prevention and treatment of such illness and behavior, including an assessment of the progress toward achieving the availability of the full continuum of care described in subsection (c). (C) An estimate of the additional funding needed by the Service, Indian Tribes, Tribal Organizations, and Urban Indian Organizations to meet their responsibilities under the plans. (2) National clearinghouse.--The Secretary, acting through the Service, shall coordinate with existing national clearinghouses and information centers to include at the clearinghouses and centers plans and reports on the outcomes of such plans developed by Indian Tribes, Tribal Organizations, Urban Indian Organizations, and Service Areas relating to behavioral health. The Secretary shall ensure access to these plans and outcomes by any Indian Tribe, Tribal Organization, Urban Indian Organization, or the Service. (3) Technical assistance.--The Secretary shall provide technical assistance to Indian Tribes, Tribal Organizations, and Urban Indian Organizations in preparation of plans under this section and in developing standards of care that may be used and adopted locally. (c) Programs.--The Secretary, acting through the Service, Indian Tribes, and Tribal Organizations, shall provide, to the extent feasible and if funding is available, programs including the following: (1) Comprehensive care.--A comprehensive continuum of behavioral health care which provides-- (A) community-based prevention, intervention, outpatient, and behavioral health aftercare; (B) detoxification (social and medical); (C) acute hospitalization; (D) intensive outpatient/day treatment; (E) residential treatment; (F) transitional living for those needing a temporary, stable living environment that is supportive of treatment and recovery goals; (G) emergency shelter; (H) intensive case management; and (I) diagnostic services. (2) Child care.--Behavioral health services for Indians from birth through age 17, including-- (A) preschool and school age fetal alcohol disorder services, including assessment and behavioral intervention; (B) mental health and substance abuse services (emotional, organic, alcohol, drug, inhalant, and tobacco); (C) identification and treatment of co- occurring disorders and comorbidity; (D) prevention of alcohol, drug, inhalant, and tobacco use; (E) early intervention, treatment, and aftercare; (F) promotion of healthy approaches to risk and safety issues; and (G) identification and treatment of neglect and physical, mental, and sexual abuse. (3) Adult care.--Behavioral health services for Indians from age 18 through 55, including-- (A) early intervention, treatment, and aftercare; (B) mental health and substance abuse services (emotional, alcohol, drug, inhalant, and tobacco), including sex specific services; (C) identification and treatment of co- occurring disorders (dual diagnosis) and comorbidity; (D) promotion of healthy approaches for risk- related behavior; (E) treatment services for women at risk of giving birth to a child with a fetal alcohol disorder; and (F) sex specific treatment for sexual assault and domestic violence. (4) Family care.--Behavioral health services for families, including-- (A) early intervention, treatment, and aftercare for affected families; (B) treatment for sexual assault and domestic violence; and (C) promotion of healthy approaches relating to parenting, domestic violence, and other abuse issues. (5) Elder care.--Behavioral health services for Indians 56 years of age and older, including-- (A) early intervention, treatment, and aftercare; (B) mental health and substance abuse services (emotional, alcohol, drug, inhalant, and tobacco), including sex specific services; (C) identification and treatment of co- occurring disorders (dual diagnosis) and comorbidity; (D) promotion of healthy approaches to managing conditions related to aging; (E) sex specific treatment for sexual assault, domestic violence, neglect, physical and mental abuse and exploitation; and (F) identification and treatment of dementias regardless of cause. (d) Community Behavioral Health Plan.-- (1) Establishment.--The governing body of any Indian Tribe, Tribal Organization, or Urban Indian Organization may adopt a resolution for the establishment of a community behavioral health plan providing for the identification and coordination of available resources and programs to identify, prevent, or treat substance abuse, mental illness, or dysfunctional and self-destructive behavior, including child abuse and family violence, among its members or its service population. This plan should include behavioral health services, social services, intensive outpatient services, and continuing aftercare. (2) Technical assistance.--At the request of an Indian Tribe, Tribal Organization, or Urban Indian Organization, the Bureau of Indian Affairs and the Service shall cooperate with and provide technical assistance to the Indian Tribe, Tribal Organization, or Urban Indian Organization in the development and implementation of such plan. (3) Funding.--The Secretary, acting through the Service, may make funding available to Indian Tribes and Tribal Organizations which adopt a resolution pursuant to paragraph (1) to obtain technical assistance for the development of a community behavioral health plan and to provide administrative support in the implementation of such plan. (e) Coordination for Availability of Services.--The Secretary, acting through the Service, Indian Tribes, Tribal Organizations, and Urban Indian Organizations, shall coordinate behavioral health planning, to the extent feasible, with other Federal agencies and with State agencies, to encourage comprehensive behavioral health services for Indians regardless of their place of residence. (f) Mental Health Care Need Assessment.--Not later than 1 year after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary, acting through the Service, shall make an assessment of the need for inpatient mental health care among Indians and the availability and cost of inpatient mental health facilities which can meet such need. In making such assessment, the Secretary shall consider the possible conversion of existing, underused Service hospital beds into psychiatric units to meet such need. SEC. 702. MEMORANDA OF AGREEMENT WITH THE DEPARTMENT OF THE INTERIOR. (a) Contents.--Not later than 12 months after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary, acting through the Service, and the Secretary of the Interior shall develop and enter into a memoranda of agreement, or review and update any existing memoranda of agreement, as required by section 4205 of the Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 2411) under which the Secretaries address the following: (1) The scope and nature of mental illness and dysfunctional and self-destructive behavior, including child abuse and family violence, among Indians. (2) The existing Federal, tribal, State, local, and private services, resources, and programs available to provide behavioral health services for Indians. (3) The unmet need for additional services, resources, and programs necessary to meet the needs identified pursuant to paragraph (1). (4)(A) The right of Indians, as citizens of the United States and of the States in which they reside, to have access to behavioral health services to which all citizens have access. (B) The right of Indians to participate in, and receive the benefit of, such services. (C) The actions necessary to protect the exercise of such right. (5) The responsibilities of the Bureau of Indian Affairs and the Service, including mental illness identification, prevention, education, referral, and treatment services (including services through multidisciplinary resource teams), at the central, area, and agency and Service Unit, Service Area, and headquarters levels to address the problems identified in paragraph (1). (6) A strategy for the comprehensive coordination of the behavioral health services provided by the Bureau of Indian Affairs and the Service to meet the problems identified pursuant to paragraph (1), including-- (A) the coordination of alcohol and substance abuse programs of the Service, the Bureau of Indian Affairs, and Indian Tribes and Tribal Organizations (developed under the Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 2401 et seq.)) with behavioral health initiatives pursuant to this Act, particularly with respect to the referral and treatment of dually diagnosed individuals requiring behavioral health and substance abuse treatment; and (B) ensuring that the Bureau of Indian Affairs and Service programs and services (including multidisciplinary resource teams) addressing child abuse and family violence are coordinated with such non-Federal programs and services. (7) Directing appropriate officials of the Bureau of Indian Affairs and the Service, particularly at the agency and Service Unit levels, to cooperate fully with tribal requests made pursuant to community behavioral health plans adopted under section 701(c) and section 4206 of the Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 2412). (8) Providing for an annual review of such agreement by the Secretaries which shall be provided to Congress and Indian Tribes and Tribal Organizations. (b) Specific Provisions Required.--The memoranda of agreement updated or entered into pursuant to subsection (a) shall include specific provisions pursuant to which the Service shall assume responsibility for-- (1) the determination of the scope of the problem of alcohol and substance abuse among Indians, including the number of Indians within the jurisdiction of the Service who are directly or indirectly affected by alcohol and substance abuse and the financial and human cost; (2) an assessment of the existing and needed resources necessary for the prevention of alcohol and substance abuse and the treatment of Indians affected by alcohol and substance abuse; and (3) an estimate of the funding necessary to adequately support a program of prevention of alcohol and substance abuse and treatment of Indians affected by alcohol and substance abuse. (c) Publication.--Each memorandum of agreement entered into or renewed (and amendments or modifications thereto) under subsection (a) shall be published in the Federal Register. At the same time as publication in the Federal Register, the Secretary shall provide a copy of such memoranda, amendment, or modification to each Indian Tribe, Tribal Organization, and Urban Indian Organization. SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PREVENTION AND TREATMENT PROGRAM. (a) Establishment.-- (1) In general.--The Secretary, acting through the Service, Indian Tribes, and Tribal Organizations, shall provide a program of comprehensive behavioral health, prevention, treatment, and aftercare, which shall include-- (A) prevention, through educational intervention, in Indian communities; (B) acute detoxification, psychiatric hospitalization, residential, and intensive outpatient treatment; (C) community-based rehabilitation and aftercare; (D) community education and involvement, including extensive training of health care, educational, and community-based personnel; (E) specialized residential treatment programs for high-risk populations, including pregnant and postpartum women and their children; and (F) diagnostic services. (2) Target populations.--The target population of such programs shall be members of Indian Tribes. Efforts to train and educate key members of the Indian community shall also target employees of health, education, judicial, law enforcement, legal, and social service programs. (b) Contract Health Services.-- (1) In general.--The Secretary, acting through the Service, Indian Tribes, and Tribal Organizations, may enter into contracts with public or private providers of behavioral health treatment services for the purpose of carrying out the program required under subsection (a). (2) Provision of assistance.--In carrying out this subsection, the Secretary shall provide assistance to Indian Tribes and Tribal Organizations to develop criteria for the certification of behavioral health service providers and accreditation of service facilities which meet minimum standards for such services and facilities. SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM. (a) In General.--Under the authority of the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the ``Snyder Act''), the Secretary shall establish and maintain a mental health technician program within the Service which-- (1) provides for the training of Indians as mental health technicians; and (2) employs such technicians in the provision of community-based mental health care that includes identification, prevention, education, referral, and treatment services. (b) Paraprofessional Training.--In carrying out subsection (a), the Secretary, acting through the Service, Indian Tribes, and Tribal Organizations, shall provide high-standard paraprofessional training in mental health care necessary to provide quality care to the Indian communities to be served. Such training shall be based upon a curriculum developed or approved by the Secretary which combines education in the theory of mental health care with supervised practical experience in the provision of such care. (c) Supervision and Evaluation of Technicians.--The Secretary, acting through the Service, Indian Tribes, and Tribal Organizations, shall supervise and evaluate the mental health technicians in the training program. (d) Traditional Health Care Practices.--The Secretary, acting through the Service, shall ensure that the program established pursuant to this subsection involves the use and promotion of the traditional health care practices of the Indian Tribes to be served. SEC. 705. LICENSING REQUIREMENT FOR MENTAL HEALTH CARE WORKERS. (a) In General.--Subject to the provisions of section 221, and except as provided in subsection (b), any individual employed as a psychologist, social worker, or marriage and family therapist for the purpose of providing mental health care services to Indians in a clinical setting under this Act is required to be licensed as a psychologist, social worker, or marriage and family therapist, respectively. (b) Trainees.--An individual may be employed as a trainee in psychology, social work, or marriage and family therapy to provide mental health care services described in subsection (a) if such individual-- (1) works under the direct supervision of a licensed psychologist, social worker, or marriage and family therapist, respectively; (2) is enrolled in or has completed at least 2 years of course work at a post-secondary, accredited education program for psychology, social work, marriage and family therapy, or counseling; and (3) meets such other training, supervision, and quality review requirements as the Secretary may establish. SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS. (a) Grants.--The Secretary, consistent with section 701, may make grants to Indian Tribes, Tribal Organizations, and Urban Indian Organizations to develop and implement a comprehensive behavioral health program of prevention, intervention, treatment, and relapse prevention services that specifically addresses the cultural, historical, social, and child care needs of Indian women, regardless of age. (b) Use of Grant Funds.--A grant made pursuant to this section may be used to-- (1) develop and provide community training, education, and prevention programs for Indian women relating to behavioral health issues, including fetal alcohol disorders; (2) identify and provide psychological services, counseling, advocacy, support, and relapse prevention to Indian women and their families; and (3) develop prevention and intervention models for Indian women which incorporate traditional health care practices, cultural values, and community and family involvement. (c) Criteria.--The Secretary, in consultation with Indian Tribes and Tribal Organizations, shall establish criteria for the review and approval of applications and proposals for funding under this section. (d) Earmark of Certain Funds.--Twenty percent of the funds appropriated pursuant to this section shall be used to make grants to Urban Indian Organizations. SEC. 707. INDIAN YOUTH PROGRAM. (a) Detoxification and Rehabilitation.--The Secretary, acting through the Service, consistent with section 701, shall develop and implement a program for acute detoxification and treatment for Indian youths, including behavioral health services. The program shall include regional treatment centers designed to include detoxification and rehabilitation for both sexes on a referral basis and programs developed and implemented by Indian Tribes or Tribal Organizations at the local level under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.). Regional centers shall be integrated with the intake and rehabilitation programs based in the referring Indian community. (b) Alcohol and Substance Abuse Treatment Centers or Facilities.-- (1) Establishment.-- (A) In general.--The Secretary, acting through the Service, Indian Tribes, and Tribal Organizations, shall construct, renovate, or, as necessary, purchase, and appropriately staff and operate, at least 1 youth regional treatment center or treatment network in each area under the jurisdiction of an Area Office. (B) Area office in california.--For the purposes of this subsection, the Area Office in California shall be considered to be 2 Area Offices, 1 office whose jurisdiction shall be considered to encompass the northern area of the State of California, and 1 office whose jurisdiction shall be considered to encompass the remainder of the State of California for the purpose of implementing California treatment networks. (2) Funding.--For the purpose of staffing and operating such centers or facilities, funding shall be pursuant to the Act of November 2, 1921 (25 U.S.C. 13). (3) Location.--A youth treatment center constructed or purchased under this subsection shall be constructed or purchased at a location within the area described in paragraph (1) agreed upon (by appropriate tribal resolution) by a majority of the Indian Tribes to be served by such center. (4) Specific provision of funds.-- (A) In general.--Notwithstanding any other provision of this title, the Secretary may, from amounts authorized to be appropriated for the purposes of carrying out this section, make funds available to-- (i) the Tanana Chiefs Conference, Incorporated, for the purpose of leasing, constructing, renovating, operating, and maintaining a residential youth treatment facility in Fairbanks, Alaska; and (ii) the Southeast Alaska Regional Health Corporation to staff and operate a residential youth treatment facility without regard to the proviso set forth in section 4(l) of the Indian Self- Determination and Education Assistance Act (25 U.S.C. 450b(l)). (B) Provision of services to eligible youths.--Until additional residential youth treatment facilities are established in Alaska pursuant to this section, the facilities specified in subparagraph (A) shall make every effort to provide services to all eligible Indian youths residing in Alaska. (c) Intermediate Adolescent Behavioral Health Services.-- (1) In general.--The Secretary, acting through the Service, Indian Tribes, and Tribal Organizations, may provide intermediate behavioral health services to Indian children and adolescents, including-- (A) pretreatment assistance; (B) inpatient, outpatient, and aftercare services; (C) emergency care; (D) suicide prevention and crisis intervention; and (E) prevention and treatment of mental illness and dysfunctional and self-destructive behavior, including child abuse and family violence. (2) Use of funds.--Funds provided under this subsection may be used-- (A) to construct or renovate an existing health facility to provide intermediate behavioral health services; (B) to hire behavioral health professionals; (C) to staff, operate, and maintain an intermediate mental health facility, group home, sober housing, transitional housing or similar facilities, or youth shelter where intermediate behavioral health services are being provided; (D) to make renovations and hire appropriate staff to convert existing hospital beds into adolescent psychiatric units; and (E) for intensive home- and community-based services. (3) Criteria.--The Secretary, acting through the Service, shall, in consultation with Indian Tribes and Tribal Organizations, establish criteria for the review and approval of applications or proposals for funding made available pursuant to this subsection. (d) Federally-Owned Structures.-- (1) In general.--The Secretary, in consultation with Indian Tribes and Tribal Organizations, shall-- (A) identify and use, where appropriate, federally-owned structures suitable for local residential or regional behavioral health treatment for Indian youths; and (B) establish guidelines for determining the suitability of any such federally-owned structure to be used for local residential or regional behavioral health treatment for Indian youths. (2) Terms and conditions for use of structure.--Any structure described in paragraph (1) may be used under such terms and conditions as may be agreed upon by the Secretary and the agency having responsibility for the structure and any Indian Tribe or Tribal Organization operating the program. (e) Rehabilitation and Aftercare Services.-- (1) In general.--The Secretary, Indian Tribes, or Tribal Organizations, in cooperation with the Secretary of the Interior, shall develop and implement within each Service Unit, community-based rehabilitation and follow-up services for Indian youths who are having significant behavioral health problems, and require long-term treatment, community reintegration, and monitoring to support the Indian youths after their return to their home community. (2) Administration.--Services under paragraph (1) shall be provided by trained staff within the community who can assist the Indian youths in their continuing development of self-image, positive problem-solving skills, and nonalcohol or substance abusing behaviors. Such staff may include alcohol and substance abuse counselors, mental health professionals, and other health professionals and paraprofessionals, including community health representatives. (f) Inclusion of Family in Youth Treatment Program.--In providing the treatment and other services to Indian youths authorized by this section, the Secretary, acting through the Service, Indian Tribes, and Tribal Organizations, shall provide for the inclusion of family members of such youths in the treatment programs or other services as may be appropriate. Not less than 10 percent of the funds appropriated for the purposes of carrying out subsection (e) shall be used for outpatient care of adult family members related to the treatment of an Indian youth under that subsection. (g) Multidrug Abuse Program.--The Secretary, acting through the Service, Indian Tribes, Tribal Organizations, and Urban Indian Organizations, shall provide, consistent with section 701, programs and services to prevent and treat the abuse of multiple forms of substances, including alcohol, drugs, inhalants, and tobacco, among Indian youths residing in Indian communities, on or near reservations, and in urban areas and provide appropriate mental health services to address the incidence of mental illness among such youths. (h) Indian Youth Mental Health.--The Secretary, acting through the Service, shall collect data for the report under section 801 with respect to-- (1) the number of Indian youth who are being provided mental health services through the Service and Tribal Health Programs; (2) a description of, and costs associated with, the mental health services provided for Indian youth through the Service and Tribal Health Programs; (3) the number of youth referred to the Service or Tribal Health Programs for mental health services; (4) the number of Indian youth provided residential treatment for mental health and behavioral problems through the Service and Tribal Health Programs, reported separately for on- and off-reservation facilities; and (5) the costs of the services described in paragraph (4). SEC. 708. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRATION PROJECT. (a) Purpose.--The purpose of this section is to authorize the Secretary to carry out a demonstration project to test the use of telemental health services in suicide prevention, intervention and treatment of Indian youth, including through-- (1) the use of psychotherapy, psychiatric assessments, diagnostic interviews, therapies for mental health conditions predisposing to suicide, and alcohol and substance abuse treatment; (2) the provision of clinical expertise to, consultation services with, and medical advice and training for frontline health care providers working with Indian youth; (3) training and related support for community leaders, family members and health and education workers who work with Indian youth; (4) the development of culturally-relevant educational materials on suicide; and (5) data collection and reporting. (b) Definitions.--For the purpose of this section, the following definitions shall apply: (1) Demonstration project.--The term ``demonstration project'' means the Indian youth telemental health demonstration project authorized under subsection (c). (2) Telemental health.--The term ``telemental health'' means the use of electronic information and telecommunications technologies to support long distance mental health care, patient and professional- related education, public health, and health administration. (c) Authorization.-- (1) In general.--The Secretary is authorized to award grants under the demonstration project for the provision of telemental health services to Indian youth who-- (A) have expressed suicidal ideas; (B) have attempted suicide; or (C) have mental health conditions that increase or could increase the risk of suicide. (2) Eligibility for grants.--Such grants shall be awarded to Indian Tribes and Tribal Organizations that operate 1 or more facilities-- (A) located in Alaska and part of the Alaska Federal Health Care Access Network; (B) reporting active clinical telehealth capabilities; or (C) offering school-based telemental health services relating to psychiatry to Indian youth. (3) Grant period.--The Secretary shall award grants under this section for a period of up to 4 years. (4) Awarding of grants.--Not more than 5 grants shall be provided under paragraph (1), with priority consideration given to Indian Tribes and Tribal Organizations that-- (A) serve a particular community or geographic area where there is a demonstrated need to address Indian youth suicide; (B) enter in to collaborative partnerships with Indian Health Service or Tribal Health Programs or facilities to provide services under this demonstration project; (C) serve an isolated community or geographic area which has limited or no access to behavioral health services; or (D) operate a detention facility at which Indian youth are detained. (d) Use of Funds.-- (1) In general.--An Indian Tribe or Tribal Organization shall use a grant received under subsection (c) for the following purposes: (A) To provide telemental health services to Indian youth, including the provision of-- (i) psychotherapy; (ii) psychiatric assessments and diagnostic interviews, therapies for mental health conditions predisposing to suicide, and treatment; and (iii) alcohol and substance abuse treatment. (B) To provide clinician-interactive medical advice, guidance and training, assistance in diagnosis and interpretation, crisis counseling and intervention, and related assistance to Service, tribal, or urban clinicians and health services providers working with youth being served under this demonstration project. (C) To assist, educate and train community leaders, health education professionals and paraprofessionals, tribal outreach workers, and family members who work with the youth receiving telemental health services under this demonstration project, including with identification of suicidal tendencies, crisis intervention and suicide prevention, emergency skill development, and building and expanding networks among these individuals and with State and local health services providers. (D) To develop and distribute culturally appropriate community educational materials on-- (i) suicide prevention; (ii) suicide education; (iii) suicide screening; (iv) suicide intervention; and (v) ways to mobilize communities with respect to the identification of risk factors for suicide. (E) For data collection and reporting related to Indian youth suicide prevention efforts. (2) Traditional health care practices.--In carrying out the purposes described in paragraph (1), an Indian Tribe or Tribal Organization may use and promote the traditional health care practices of the Indian Tribes of the youth to be served. (e) Applications.--To be eligible to receive a grant under subsection (c), an Indian Tribe or Tribal Organization shall prepare and submit to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require, including-- (1) a description of the project that the Indian Tribe or Tribal Organization will carry out using the funds provided under the grant; (2) a description of the manner in which the project funded under the grant would-- (A) meet the telemental health care needs of the Indian youth population to be served by the project; or (B) improve the access of the Indian youth population to be served to suicide prevention and treatment services; (3) evidence of support for the project from the local community to be served by the project; (4) a description of how the families and leadership of the communities or populations to be served by the project would be involved in the development and ongoing operations of the project; (5) a plan to involve the tribal community of the youth who are provided services by the project in planning and evaluating the mental health care and suicide prevention efforts provided, in order to ensure the integration of community, clinical, environmental, and cultural components of the treatment; and (6) a plan for sustaining the project after Federal assistance for the demonstration project has terminated. (f) Collaboration; Reporting to National Clearinghouse.-- (1) Collaboration.--The Secretary, acting through the Service, shall encourage Indian Tribes and Tribal Organizations receiving grants under this section to collaborate to enable comparisons about best practices across projects. (2) Reporting to national clearinghouse.--The Secretary, acting through the Service, shall also encourage Indian Tribes and Tribal Organizations receiving grants under this section to submit relevant, declassified project information to the national clearinghouse authorized under section 701(b)(2) in order to better facilitate program performance and improve suicide prevention, intervention, and treatment services. (g) Annual Report.--Each grant recipient shall submit to the Secretary an annual report that-- (1) describes the number of telemental health services provided; and (2) includes any other information that the Secretary may require. (h) Report to Congress.--Not later than 270 days after the termination of the demonstration project, the Secretary shall submit to the Committee on Indian Affairs of the Senate and the Committee on Natural Resources and Committee on Energy and Commerce of the House of Representatives a final report, based on the annual reports provided by grant recipients under subsection (h), that-- (1) describes the results of the projects funded by grants awarded under this section, including any data available which indicates the number of attempted suicides; (2) evaluates the impact of the telemental health services funded by the grants in reducing the number of completed suicides among Indian youth; (3) evaluates whether the demonstration project should be-- (A) expanded to provide more than 5 grants; and (B) designated a permanent program; and (4) evaluates the benefits of expanding the demonstration project to include Urban Indian Organizations. (i) Authorization of Appropriations.--There is authorized to be appropriated to carry out this section $1,500,000 for each of fiscal years 2008 through 2011. SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL HEALTH FACILITIES DESIGN, CONSTRUCTION, AND STAFFING. Not later than 1 year after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary, acting through the Service, Indian Tribes, and Tribal Organizations, may provide, in each area of the Service, not less than 1 inpatient mental health care facility, or the equivalent, for Indians with behavioral health problems. For the purposes of this subsection, California shall be considered to be 2 Area Offices, 1 office whose location shall be considered to encompass the northern area of the State of California and 1 office whose jurisdiction shall be considered to encompass the remainder of the State of California. The Secretary shall consider the possible conversion of existing, underused Service hospital beds into psychiatric units to meet such need. SEC. 710. TRAINING AND COMMUNITY EDUCATION. (a) Program.--The Secretary, in cooperation with the Secretary of the Interior, shall develop and implement or assist Indian Tribes and Tribal Organizations to develop and implement, within each Service Unit or tribal program, a program of community education and involvement which shall be designed to provide concise and timely information to the community leadership of each tribal community. Such program shall include education about behavioral health issues to political leaders, Tribal judges, law enforcement personnel, members of tribal health and education boards, health care providers including traditional practitioners, and other critical members of each tribal community. Such program may also include community-based training to develop local capacity and tribal community provider training for prevention, intervention, treatment, and aftercare. (b) Instruction.--The Secretary, acting through the Service, shall, either directly or through Indian Tribes and Tribal Organizations, provide instruction in the area of behavioral health issues, including instruction in crisis intervention and family relations in the context of alcohol and substance abuse, child sexual abuse, youth alcohol and substance abuse, and the causes and effects of fetal alcohol disorders to appropriate employees of the Bureau of Indian Affairs and the Service, and to personnel in schools or programs operated under any contract with the Bureau of Indian Affairs or the Service, including supervisors of emergency shelters and halfway houses described in section 4213 of the Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 2433). (c) Training Models.--In carrying out the education and training programs required by this section, the Secretary, in consultation with Indian Tribes, Tribal Organizations, Indian behavioral health experts, and Indian alcohol and substance abuse prevention experts, shall develop and provide community- based training models. Such models shall address-- (1) the elevated risk of alcohol and behavioral health problems faced by children of alcoholics; (2) the cultural, spiritual, and multigenerational aspects of behavioral health problem prevention and recovery; and (3) community-based and multidisciplinary strategies for preventing and treating behavioral health problems. SEC. 711. BEHAVIORAL HEALTH PROGRAM. (a) Innovative Programs.--The Secretary, acting through the Service, Indian Tribes, and Tribal Organizations, consistent with section 701, may plan, develop, implement, and carry out programs to deliver innovative community-based behavioral health services to Indians. (b) Awards; Criteria.--The Secretary may award a grant for a project under subsection (a) to an Indian Tribe or Tribal Organization and may consider the following criteria: (1) The project will address significant unmet behavioral health needs among Indians. (2) The project will serve a significant number of Indians. (3) The project has the potential to deliver services in an efficient and effective manner. (4) The Indian Tribe or Tribal Organization has the administrative and financial capability to administer the project. (5) The project may deliver services in a manner consistent with traditional health care practices. (6) The project is coordinated with, and avoids duplication of, existing services. (c) Equitable Treatment.--For purposes of this subsection, the Secretary shall, in evaluating project applications or proposals, use the same criteria that the Secretary uses in evaluating any other application or proposal for such funding. SEC. 712. FETAL ALCOHOL DISORDER PROGRAMS. (a) Programs.-- (1) Establishment.--The Secretary, consistent with section 701, acting through the Service, Indian Tribes, and Tribal Organizations, is authorized to establish and operate fetal alcohol disorder programs as provided in this section for the purposes of meeting the health status objectives specified in section 3. (2) Use of funds.-- (A) In general.--Funding provided pursuant to this section shall be used for the following: (i) To develop and provide for Indians community and in-school training, education, and prevention programs relating to fetal alcohol disorders. (ii) To identify and provide behavioral health treatment to high- risk Indian women and high-risk women pregnant with an Indian's child. (iii) To identify and provide appropriate psychological services, educational and vocational support, counseling, advocacy, and information to fetal alcohol disorder affected Indians and their families or caretakers. (iv) To develop and implement counseling and support programs in schools for fetal alcohol disorder affected Indian children. (v) To develop prevention and intervention models which incorporate practitioners of traditional health care practices, cultural values, and community involvement. (vi) To develop, print, and disseminate education and prevention materials on fetal alcohol disorder. (vii) To develop and implement, in consultation with Indian Tribes, Tribal Organizations, and Urban Indian Organizations, culturally sensitive assessment and diagnostic tools including dysmorphology clinics and multidisciplinary fetal alcohol disorder clinics for use in Indian communities and Urban Centers. (B) Additional uses.--In addition to any purpose under subparagraph (A), funding provided pursuant to this section may be used for 1 or more of the following: (i) Early childhood intervention projects from birth on to mitigate the effects of fetal alcohol disorder among Indians. (ii) Community-based support services for Indians and women pregnant with Indian children. (iii) Community-based housing for adult Indians with fetal alcohol disorder. (3) Criteria for applications.--The Secretary shall establish criteria for the review and approval of applications for funding under this section. (b) Services.--The Secretary, acting through the Service and Indian Tribes, Tribal Organizations, and Urban Indian Organizations, shall-- (1) develop and provide services for the prevention, intervention, treatment, and aftercare for those affected by fetal alcohol disorder in Indian communities; and (2) provide supportive services, including services to meet the special educational, vocational, school-to- work transition, and independent living needs of adolescent and adult Indians with fetal alcohol disorder. (c) Task Force.--The Secretary shall establish a task force to be known as the Fetal Alcohol Disorder Task Force to advise the Secretary in carrying out subsection (b). Such task force shall be composed of representatives from the following: (1) The National Institute on Drug Abuse. (2) The National Institute on Alcohol and Alcoholism. (3) The Office of Substance Abuse Prevention. (4) The National Institute of Mental Health. (5) The Service. (6) The Office of Minority Health of the Department of Health and Human Services. (7) The Administration for Native Americans. (8) The National Institute of Child Health and Human Development (NICHD). (9) The Centers for Disease Control and Prevention. (10) The Bureau of Indian Affairs. (11) Indian Tribes. (12) Tribal Organizations. (13) Urban Indian Organizations. (14) Indian fetal alcohol disorder experts. (d) Applied Research Projects.--The Secretary, acting through the Substance Abuse and Mental Health Services Administration, shall make grants to Indian Tribes, Tribal Organizations, and Urban Indian Organizations for applied research projects which propose to elevate the understanding of methods to prevent, intervene, treat, or provide rehabilitation and behavioral health aftercare for Indians and Urban Indians affected by fetal alcohol disorder. (e) Funding for Urban Indian Organizations.--Ten percent of the funds appropriated pursuant to this section shall be used to make grants to Urban Indian Organizations funded under title V. SEC. 713. CHILD SEXUAL ABUSE AND PREVENTION TREATMENT PROGRAMS. (a) Establishment.--The Secretary, acting through the Service, and the Secretary of the Interior, Indian Tribes, and Tribal Organizations, shall establish, consistent with section 701, in every Service Area, programs involving treatment for-- (1) victims of sexual abuse who are Indian children or children in an Indian household; and (2) perpetrators of child sexual abuse who are Indian or members of an Indian household. (b) Use of Funds.--Funding provided pursuant to this section shall be used for the following: (1) To develop and provide community education and prevention programs related to sexual abuse of Indian children or children in an Indian household. (2) To identify and provide behavioral health treatment to victims of sexual abuse who are Indian children or children in an Indian household, and to their family members who are affected by sexual abuse. (3) To develop prevention and intervention models which incorporate traditional health care practices, cultural values, and community involvement. (4) To develop and implement culturally sensitive assessment and diagnostic tools for use in Indian communities and Urban Centers. (5) To identify and provide behavioral health treatment to Indian perpetrators and perpetrators who are members of an Indian household-- (A) making efforts to begin offender and behavioral health treatment while the perpetrator is incarcerated or at the earliest possible date if the perpetrator is not incarcerated; and (B) providing treatment after the perpetrator is released, until it is determined that the perpetrator is not a threat to children. (c) Coordination.--The programs established under subsection (a) shall be carried out in coordination with programs and services authorized under the Indian Child Protection and Family Violence Prevention Act (25 U.S.C. 3201 et seq.). SEC. 714. BEHAVIORAL HEALTH RESEARCH. The Secretary, in consultation with appropriate Federal agencies, shall make grants to, or enter into contracts with, 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 multifactorial causes of Indian youth suicide, including-- (A) protective and risk factors and scientific data that identifies those factors; and (B) the effects of loss of cultural identity and the development of scientific data on those effects; (2) the interrelationship and interdependence of behavioral health problems with alcoholism and other substance abuse, suicide, homicides, other injuries, and the incidence of family violence; and (3) the development of models of prevention techniques. The effect of the interrelationships and interdependencies referred to in paragraph (2) on children, and the development of prevention techniques under paragraph (3) applicable to children, shall be emphasized. SEC. 715. DEFINITIONS. For the purpose of this title, the following definitions shall apply: (1) Assessment.--The term ``assessment'' means the systematic collection, analysis, and dissemination of information on health status, health needs, and health problems. (2) Alcohol-related neurodevelopmental disorders or arnd.--The term ``alcohol-related neurodevelopmental disorders'' or ``ARND'' means, with a history of maternal alcohol consumption during pregnancy, central nervous system involvement such as developmental delay, intellectual deficit, or neurologic abnormalities. Behaviorally, there can be problems with irritability, and failure to thrive as infants. As children become older there will likely be hyperactivity, attention deficit, language dysfunction, and perceptual and judgment problems. (3) Behavioral health aftercare.--The term ``behavioral health aftercare'' includes those activities and resources used to support recovery following inpatient, residential, intensive substance abuse, or mental health outpatient or outpatient treatment. The purpose is to help prevent or deal with relapse by ensuring that by the time a client or patient is discharged from a level of care, such as outpatient treatment, an aftercare plan has been developed with the client. An aftercare plan may use such resources as a community-based therapeutic group, transitional living facilities, a 12-step sponsor, a local 12-step or other related support group, and other community-based providers. (4) Dual diagnosis.--The term ``dual diagnosis'' means coexisting substance abuse and mental illness conditions or diagnosis. Such clients are sometimes referred to as mentally ill chemical abusers (MICAs). (5) Fetal alcohol disorders.--The term ``fetal alcohol disorders'' means fetal alcohol syndrome, partial fetal alcohol syndrome and alcohol related neurodevelopmental disorder (ARND). (6) Fetal alcohol syndrome or fas.--The term ``fetal alcohol syndrome'' or ``FAS'' means a syndrome in which, with a history of maternal alcohol consumption during pregnancy, the following criteria are met: (A) Central nervous system involvement such as developmental delay, intellectual deficit, microencephaly, or neurologic abnormalities. (B) Craniofacial abnormalities with at least 2 of the following: microophthalmia, short palpebral fissures, poorly developed philtrum, thin upper lip, flat nasal bridge, and short upturned nose. (C) Prenatal or postnatal growth delay. (7) Partial fas.--The term ``partial FAS'' means, with a history of maternal alcohol consumption during pregnancy, having most of the criteria of FAS, though not meeting a minimum of at least 2 of the following: microophthalmia, short palpebral fissures, poorly developed philtrum, thin upper lip, flat nasal bridge, and short upturned nose. (8) Rehabilitation.--The term ``rehabilitation'' means to restore the ability or capacity to engage in usual and customary life activities through education and therapy. (9) Substance abuse.--The term ``substance abuse'' includes inhalant abuse. SEC. 716. AUTHORIZATION OF APPROPRIATIONS. There is authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2017 to carry out the provisions of this title. TITLE VIII--MISCELLANEOUS SEC. 801. REPORTS. For each fiscal year following the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary shall transmit to Congress a report containing the following: (1) A report on the progress made in meeting the objectives of this Act, including a review of programs established or assisted pursuant to this Act and assessments and recommendations of additional programs or additional assistance necessary to, at a minimum, provide health services to Indians and ensure a health status for Indians, which are at a parity with the health services available to and the health status of the general population. (2) A report on whether, and to what extent, new national health care programs, benefits, initiatives, or financing systems have had an impact on the purposes of this Act and any steps that the Secretary may have taken to consult with Indian Tribes, Tribal Organizations, and Urban Indian Organizations to address such impact, including a report on proposed changes in allocation of funding pursuant to section 808. (3) A report on the use of health services by Indians-- (A) on a national and area or other relevant geographical basis; (B) by gender and age; (C) by source of payment and type of service; (D) comparing such rates of use with rates of use among comparable non-Indian populations; and (E) provided under contracts. (4) A report of contractors to the Secretary on Health Care Educational Loan Repayments every 6 months required by section 110. (5) A general audit report of the Secretary on the Health Care Educational Loan Repayment Program as required by section 110(n). (6) A report of the findings and conclusions of demonstration programs on development of educational curricula for substance abuse counseling as required in section 125(f). (7) A separate statement which specifies the amount of funds requested to carry out the provisions of section 201. (8) A report of the evaluations of health promotion and disease prevention as required in section 203(c). (9) A biennial report to Congress on infectious diseases as required by section 212. (10) A report on environmental and nuclear health hazards as required by section 215. (11) An annual report on the status of all health care facilities needs as required by section 301(c)(2)(B) and 301(d). (12) Reports on safe water and sanitary waste disposal facilities as required by section 302(h). (13) An annual report on the expenditure of non- Service funds for renovation as required by sections 304(b)(2). (14) A report identifying the backlog of maintenance and repair required at Service and tribal facilities required by section 313(a). (15) A report providing an accounting of reimbursement funds made available to the Secretary under titles XVIII, XIX, and XXI of the Social Security Act. (16) A report on any arrangements for the sharing of medical facilities or services, as authorized by section 406. (17) A report on evaluation and renewal of Urban Indian programs under section 505. (18) A report on the evaluation of programs as required by section 513(d). (19) A report on alcohol and substance abuse as required by section 701(f). (20) A report on Indian youth mental health services as required by section 707(h). (21) A report on the reallocation of base resources if required by section 808. (22) Report regarding patient movement.--A report on the movement of patients between Service Units, including-- (A) a list of those Service Units that have a net increase and those that have a net decrease of patients due to patients assigned to one Service Unit voluntarily choosing to receive service at another Service Unit; (B) an analysis of the effect of patient movement on the quality of services for those Service Units experiencing an increase in the number of patients served; and (C) what funding changes are necessary to maintain a consistent quality of service at Service Units that have an increase in the number of patients served. SEC. 802. REGULATIONS. (a) Deadlines.-- (1) Procedures.--Not later than 90 days after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary shall initiate procedures under subchapter III of chapter 5 of title 5, United States Code, to negotiate and promulgate such regulations or amendments thereto that are necessary to carry out titles II (except section 202) and VII, the sections of title III for which negotiated rulemaking is specifically required, and section 807. Unless otherwise required, the Secretary may promulgate regulations to carry out titles I, III, IV, and V, and section 202, using the procedures required by chapter V of title 5, United States Code (commonly known as the ``Administrative Procedure Act''). (2) Proposed regulations.--Proposed regulations to implement this Act shall be published in the Federal Register by the Secretary no later than 2 years after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007 and shall have no less than a 120-day comment period. (3) Final regulations.--The Secretary shall publish in the Federal Register final regulations to implement this Act by not later than 3 years after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007. (b) Committee.--A negotiated rulemaking committee established pursuant to section 565 of title 5, United States Code, to carry out this section shall have as its members only representatives of the Federal Government and representatives of Indian Tribes, and Tribal Organizations, a majority of whom shall be nominated by and be representatives of Indian Tribes and Tribal Organizations from each Service Area. (c) Adaptation of Procedures.--The Secretary shall adapt the negotiated rulemaking procedures to the unique context of self- governance and the government-to-government relationship between the United States and Indian Tribes. (d) Lack of Regulations.--The lack of promulgated regulations shall not limit the effect of this Act. (e) Inconsistent Regulations.--The provisions of this Act shall supersede any conflicting provisions of law in effect on the day before the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, and the Secretary is authorized to repeal any regulation inconsistent with the provisions of this Act. SEC. 803. PLAN OF IMPLEMENTATION. Not later than 9 months after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, the Secretary, in consultation with Indian Tribes, Tribal Organizations, and Urban Indian Organizations, shall submit to Congress a plan explaining the manner and schedule, by title and section, by which the Secretary will implement the provisions of this Act. This consultation may be conducted jointly with the annual budget consultation pursuant to the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq). SEC. 804. AVAILABILITY OF FUNDS. The funds appropriated pursuant to this Act shall remain available until expended. SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED TO INDIAN HEALTH SERVICE. Any limitation on the use of funds contained in an Act providing appropriations for the Department for a period with respect to the performance of abortions shall apply for that period with respect to the performance of abortions using funds contained in an Act providing appropriations for the Service. SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS. (a) In General.--The following California Indians shall be eligible for health services provided by the Service: (1) Any member of a federally recognized Indian Tribe. (2) Any descendant of an Indian who was residing in California on June 1, 1852, if such descendant-- (A) is a member of the Indian community served by a local program of the Service; and (B) is regarded as an Indian by the community in which such descendant lives. (3) Any Indian who holds trust interests in public domain, national forest, or reservation allotments in California. (4) Any Indian in California who is listed on the plans for distribution of the assets of rancherias and reservations located within the State of California under the Act of August 18, 1958 (72 Stat. 619), and any descendant of such an Indian. (b) Clarification.--Nothing in this section may be construed as expanding the eligibility of California Indians for health services provided by the Service beyond the scope of eligibility for such health services that applied on May 1, 1986. SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS. (a) Children.--Any individual who-- (1) has not attained 19 years of age; (2) is the natural or adopted child, stepchild, foster child, legal ward, or orphan of an eligible Indian; and (3) is not otherwise eligible for health services provided by the Service, shall be eligible for all health services provided by the Service on the same basis and subject to the same rules that apply to eligible Indians until such individual attains 19 years of age. The existing and potential health needs of all such individuals shall be taken into consideration by the Service in determining the need for, or the allocation of, the health resources of the Service. If such an individual has been determined to be legally incompetent prior to attaining 19 years of age, such individual shall remain eligible for such services until 1 year after the date of a determination of competency. (b) Spouses.--Any spouse of an eligible Indian who is not an Indian, or who is of Indian descent but is not otherwise eligible for the health services provided by the Service, shall be eligible for such health services if all such spouses or spouses who are married to members of each 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. (c) Provision of Services to Other Individuals.-- (1) In general.--The Secretary is authorized to provide health services under this subsection through health programs operated directly by the Service to individuals who reside within the Service Unit and who are not otherwise eligible for such health services if-- (A) the Indian Tribes served by such Service Unit request such provision of health services to such individuals; and (B) the Secretary and the served Indian Tribes have jointly determined that-- (i) the provision of such health services will not result in a denial or diminution of health services to eligible Indians; and (ii) there is no reasonable alternative health facilities or services, within or without the Service Unit, available to meet the health needs of such individuals. (2) ISDEAA programs.--In the case of health programs and facilities operated under a contract or compact entered into under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), the governing body of the Indian Tribe or Tribal Organization providing health services under such contract or compact is authorized to determine whether health services should be provided under such contract 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 paragraph (1)(B). (3) Payment for services.-- (A) In general.--Persons receiving health services provided by the Service under this subsection shall be liable for payment of such health services under a schedule of charges prescribed by the Secretary which, in the judgment of the Secretary, results in reimbursement in an amount not less than the actual cost of providing the health services. Notwithstanding section 404 of this Act or any other provision of law, amounts collected under this subsection, including Medicare, Medicaid, or SCHIP reimbursements under titles XVIII, XIX, and XXI of the Social Security Act, shall be credited to the account of the program providing the service and shall be used for the purposes listed in section 401(d)(2) and amounts collected under this subsection shall be available for expenditure within such program. (B) Indigent people.--Health services may be provided by the Secretary through the Service under this subsection to an indigent individual who would not be otherwise eligible for such health services but for the provisions of paragraph (1) only if an agreement has been entered into with a State or local government under which the State or local government agrees to reimburse the Service for the expenses incurred by the Service in providing such health services to such indigent individual. (4) Revocation of consent for services.-- (A) Single tribe service area.--In the case of a Service Area which serves only 1 Indian Tribe, the authority of the Secretary to provide health services under paragraph (1) shall terminate at the end of the fiscal year succeeding the fiscal year in which the governing body of the Indian Tribe revokes its concurrence to the provision of such health services. (B) Multitribal service area.--In the case of a multitribal Service Area, the authority of the Secretary to provide health services under paragraph (1) shall terminate at the end of the fiscal year succeeding the fiscal year in which at least 51 percent of the number of Indian Tribes in the Service Area revoke their concurrence to the provisions of such health services. (d) Other Services.--The Service may provide health services under this subsection to individuals who are not eligible for health services provided by the Service under any other provision of law in order to-- (1) achieve stability in a medical emergency; (2) prevent the spread of a communicable disease or otherwise deal with a public health hazard; (3) provide care to non-Indian women pregnant with an eligible Indian's child for the duration of the pregnancy through postpartum; or (4) provide care to immediate family members of an eligible individual if such care is directly related to the treatment of the eligible individual. (e) Hospital Privileges for Practitioners.--Hospital privileges in health facilities operated and maintained by the Service or operated under a contract or compact pursuant to the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) may be extended to non-Service health care practitioners who provide services to individuals described in subsection (a), (b), (c), or (d). Such non-Service health care practitioners may, as part of the privileging process, be designated as employees of the Federal Government for purposes of section 1346(b) and chapter 171 of title 28, United States Code (relating to Federal tort claims) only with respect to acts or omissions which occur in the course of providing services to eligible individuals as a part of the conditions under which such hospital privileges are extended. (f) Eligible Indian.--For purposes of this section, the term ``eligible Indian'' means any Indian who is eligible for health services provided by the Service without regard to the provisions of this section. SEC. 808. REALLOCATION OF BASE RESOURCES. (a) Report Required.--Notwithstanding any other provision of law, any allocation of Service funds for a fiscal year that reduces by 5 percent or more from the previous fiscal year the funding for any recurring program, project, or activity of a Service Unit may be implemented only after the Secretary has submitted to Congress, under section 801, a report on the proposed change in allocation of funding, including the reasons for the change and its likely effects. (b) Exception.--Subsection (a) shall not apply if the total amount appropriated to the Service for a fiscal year is at least 5 percent less than the amount appropriated to the Service for the previous fiscal year. SEC. 809. RESULTS OF DEMONSTRATION PROJECTS. The Secretary shall provide for the dissemination to Indian Tribes, Tribal Organizations, and Urban Indian Organizations of the findings and results of demonstration projects conducted under this Act. SEC. 810. PROVISION OF SERVICES IN MONTANA. (a) Consistent With Court Decision.--The Secretary, acting through the Service, shall provide services and benefits for Indians in Montana in a manner consistent with the decision of the United States Court of Appeals for the Ninth Circuit in McNabb for McNabb v. Bowen, 829 F.2d 787 (9th Cir. 1987). (b) Clarification.--The provisions of subsection (a) shall not be construed to be an expression of the sense of Congress on the application of the decision described in subsection (a) with respect to the provision of services or benefits for Indians living in any State other than Montana. SEC. 811. MORATORIUM. During the period of the moratorium imposed on implementation of the final rule published in the Federal Register on September 16, 1987, by the Department of Health and Human Services, relating to eligibility for the health care services of the Indian Health Service, the Indian Health Service shall provide services pursuant to the criteria for eligibility for such services that were in effect on September 15, 1987, subject to the provisions of sections 806 and 807, until the Service has submitted to the Committees on Appropriations of the Senate and the House of Representatives a budget request reflecting the increased costs associated with the proposed final rule, and the request has been included in an appropriations Act and enacted into law. SEC. 812. SEVERABILITY PROVISIONS. If any provision of this Act, any amendment made by the Act, or the application of such provision or amendment to any person or circumstances is held to be invalid, the remainder of this Act, the remaining amendments made by this Act, and the application of such provisions to persons or circumstances other than those to which it is held invalid, shall not be affected thereby. SEC. 813. ESTABLISHMENT OF NATIONAL BIPARTISAN COMMISSION ON INDIAN HEALTH CARE. (a) Establishment.--There is established the National Bipartisan Indian Health Care Commission (the ``Commission''). (b) Duties of Commission.--The duties of the Commission are the following: (1) To establish a study committee composed of those members of the Commission appointed by the Director of the Service and at least 4 members of Congress from among the members of the Commission, the duties of which shall be the following: (A) To the extent necessary to carry out its duties, collect and compile data necessary to understand the extent of Indian needs with regard to the provision of health services, regardless of the location of Indians, including holding hearings and soliciting the views of Indians, Indian Tribes, Tribal Organizations, and Urban Indian Organizations, which may include authorizing and making funds available for feasibility studies of various models for providing and funding health services for all Indian beneficiaries, including those who live outside of a reservation, temporarily or permanently. (B) To make legislative recommendations to the Commission regarding the delivery of Federal health care services to Indians. Such recommendations shall include those related to issues of eligibility, benefits, the range of service providers, the cost of such services, financing such services, and the optimal manner in which to provide such services. (C) To determine the effect of the enactment of such recommendations on (i) the existing system of delivery of health services for Indians, and (ii) the sovereign status of Indian Tribes. (D) Not later than 12 months after the appointment of all members of the Commission, to submit a written report of its findings and recommendations to the full Commission. The report shall include a statement of the minority and majority position of the Committee and shall be disseminated, at a minimum, to every Indian Tribe, Tribal Organization, and Urban Indian Organization for comment to the Commission. (E) To report regularly to the full Commission regarding the findings and recommendations developed by the study committee in the course of carrying out its duties under this section. (2) To review and analyze the recommendations of the report of the study committee. (3) To make legislative recommendations to Congress regarding the delivery of Federal health care services to Indians. Such recommendations shall include those related to issues of eligibility, benefits, the range of service providers, the cost of such services, financing such services, and the optimal manner in which to provide such services. (4) Not later than 18 months following the date of appointment of all members of the Commission, submit a written report to Congress regarding the delivery of Federal health care services to Indians. Such recommendations shall include those related to issues of eligibility, benefits, the range of service providers, the cost of such services, financing such services, and the optimal manner in which to provide such services. (c) Members.-- (1) Appointment.--The Commission shall be composed of 25 members, appointed as follows: (A) Ten members of Congress, including 3 from the House of Representatives and 2 from the Senate, appointed by their respective majority leaders, and 3 from the House of Representatives and 2 from the Senate, appointed by their respective minority leaders, and who shall be members of the standing committees of Congress that consider legislation affecting health care to Indians. (B) Twelve persons chosen by the congressional members of the Commission, 1 from each Service Area as currently designated by the Director of the Service to be chosen from among 3 nominees from each Service Area put forward by the Indian Tribes within the area, with due regard being given to the experience and expertise of the nominees in the provision of health care to Indians and to a reasonable representation on the commission of members who are familiar with various health care delivery modes and who represent Indian Tribes of various size populations. (C) Three persons appointed by the Director who are knowledgeable about the provision of health care to Indians, at least 1 of whom shall be appointed from among 3 nominees put forward by those programs whose funds are provided in whole or in part by the Service primarily or exclusively for the benefit of Urban Indians. (D) All those persons chosen by the congressional members of the Commission and by the Director shall be members of federally recognized Indian Tribes. (2) Chair; vice chair.--The Chair and Vice Chair of the Commission shall be selected by the congressional members of the Commission. (3) Terms.--The terms of members of the Commission shall be for the life of the Commission. (4) Deadline for appointments.--Congressional members of the Commission shall be appointed not later than 180 days after the date of enactment of the Indian Health Care Improvement Act Amendments of 2007, and the remaining members of the Commission shall be appointed not later than 60 days following the appointment of the congressional members. (5) Vacancy.--A vacancy in the Commission shall be filled in the manner in which the original appointment was made. (d) Compensation.-- (1) Congressional members.--Each congressional member of the Commission shall receive no additional pay, allowances, or benefits by reason of their service on the Commission and shall receive travel expenses and per diem in lieu of subsistence in accordance with sections 5702 and 5703 of title 5, United States Code. (2) Other members.--Remaining members of the Commission, while serving on the business of the Commission (including travel time), shall be entitled to receive compensation at the per diem equivalent of the rate provided for level IV of the Executive Schedule under section 5315 of title 5, United States Code, and while so serving away from home and the member's regular place of business, a member may be allowed travel expenses, as authorized by the Chairman of the Commission. For purpose of pay (other than pay of members of the Commission) and employment benefits, rights, and privileges, all personnel of the Commission shall be treated as if they were employees of the United States Senate. (e) Meetings.--The Commission shall meet at the call of the Chair. (f) Quorum.--A quorum of the Commission shall consist of not less than 15 members, provided that no less than 6 of the members of Congress who are Commission members are present and no less than 9 of the members who are Indians are present. (g) Executive Director; Staff; Facilities.-- (1) Appointment; pay.--The Commission shall appoint an executive director of the Commission. The executive director shall be paid the rate of basic pay for level V of the Executive Schedule. (2) Staff appointment.--With the approval of the Commission, the executive director may appoint such personnel as the executive director deems appropriate. (3) Staff pay.--The staff of the Commission shall be appointed without regard to the provisions of title 5, United States Code, governing appointments in the competitive service, and shall be paid without regard to the provisions of chapter 51 and subchapter III of chapter 53 of such title (relating to classification and General Schedule pay rates). (4) Temporary services.--With the approval of the Commission, the executive director may procure temporary and intermittent services under section 3109(b) of title 5, United States Code. (5) Facilities.--The Administrator of General Services shall locate suitable office space for the operation of the Commission. The facilities shall serve as the headquarters of the Commission and shall include all necessary equipment and incidentals required for the proper functioning of the Commission. (h) Hearings.--(1) For the purpose of carrying out its duties, the Commission may hold such hearings and undertake such other activities as the Commission determines to be necessary to carry out its duties, provided that at least 6 regional hearings are held in different areas of the United States in which large numbers of Indians are present. Such hearings are to be held to solicit the views of Indians regarding the delivery of health care services to them. To constitute a hearing under this subsection, at least 5 members of the Commission, including at least 1 member of Congress, must be present. Hearings held by the study committee established in this section may count toward the number of regional hearings required by this subsection. (2) Upon request of the Commission, the Comptroller General shall conduct such studies or investigations as the Commission determines to be necessary to carry out its duties. (3)(A) The Director of the Congressional Budget Office or the Chief Actuary of the Centers for Medicare & Medicaid Services, or both, shall provide to the Commission, upon the request of the Commission, such cost estimates as the Commission determines to be necessary to carry out its duties. (B) The Commission shall reimburse the Director of the Congressional Budget Office for expenses relating to the employment in the office of that Director of such additional staff as may be necessary for the Director to comply with requests by the Commission under subparagraph (A). (4) Upon the request of the Commission, the head of any Federal agency is authorized to detail, without reimbursement, any of the personnel of such agency to the Commission to assist the Commission in carrying out its duties. Any such detail shall not interrupt or otherwise affect the civil service status or privileges of the Federal employee. (5) Upon the request of the Commission, the head of a Federal agency shall provide such technical assistance to the Commission as the Commission determines to be necessary to carry out its duties. (6) The Commission may use the United States mails in the same manner and under the same conditions as Federal agencies and shall, for purposes of the frank, be considered a commission of Congress as described in section 3215 of title 39, United States Code. (7) The Commission may secure directly from any Federal agency information necessary to enable it to carry out its duties, if the information may be disclosed under section 552 of title 4, United States Code. Upon request of the Chairman of the Commission, the head of such agency shall furnish such information to the Commission. (8) Upon the request of the Commission, the Administrator of General Services shall provide to the Commission on a reimbursable basis such administrative support services as the Commission may request. (9) For purposes of costs relating to printing and binding, including the cost of personnel detailed from the Government Printing Office, the Commission shall be deemed to be a committee of Congress. (i) Authorization of Appropriations.--There is authorized to be appropriated $4,000,000 to carry out the provisions of this section, which sum shall not be deducted from or affect any other appropriation for health care for Indian persons. (j) Nonapplicability of FACA.--The Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to the Commission. SEC. 814. CONFIDENTIALITY OF MEDICAL QUALITY ASSURANCE RECORDS; QUALIFIED IMMUNITY FOR PARTICIPANTS. (a) Confidentiality of Records.--Medical quality assurance records created by or for any Indian Health Program or a health program of an Urban Indian Organization as part of a medical quality assurance program are confidential and privileged. Such records may not be disclosed to any person or entity, except as provided in subsection (c). (b) Prohibition on Disclosure and Testimony.-- (1) In general.--No part of any medical quality assurance record described in subsection (a) may be subject to discovery or admitted into evidence in any judicial or administrative proceeding, except as provided in subsection (c). (2) Testimony.--A person who reviews or creates medical quality assurance records for any Indian Health Program or Urban Indian Organization who participates in any proceeding that reviews or creates such records may not be permitted or required to testify in any judicial or administrative proceeding with respect to such records or with respect to any finding, recommendation, evaluation, opinion, or action taken by such person or body in connection with such records except as provided in this section. (c) Authorized Disclosure and Testimony.-- (1) In general.--Subject to paragraph (2), a medical quality assurance record described in subsection (a) may be disclosed, and a person referred to in subsection (b) may give testimony in connection with such a record, only as follows: (A) To a Federal executive agency or private organization, if such medical quality assurance record or testimony is needed by such agency or organization to perform licensing or accreditation functions related to any Indian Health Program or to a health program of an Urban Indian Organization to perform monitoring, required by law, of such program or organization. (B) To an administrative or judicial proceeding commenced by a present or former Indian Health Program or Urban Indian Organization provider concerning the termination, suspension, or limitation of clinical privileges of such health care provider. (C) To a governmental board or agency or to a professional health care society or organization, if such medical quality assurance record or testimony is needed by such board, agency, society, or organization to perform licensing, credentialing, or the monitoring of professional standards with respect to any health care provider who is or was an employee of any Indian Health Program or Urban Indian Organization. (D) To a hospital, medical center, or other institution that provides health care services, if such medical quality assurance record or testimony is needed by such institution to assess the professional qualifications of any health care provider who is or was an employee of any Indian Health Program or Urban Indian Organization and who has applied for or been granted authority or employment to provide health care services in or on behalf of such program or organization. (E) To an officer, employee, or contractor of the Indian Health Program or Urban Indian Organization that created the records or for which the records were created. If that officer, employee, or contractor has a need for such record or testimony to perform official duties. (F) To a criminal or civil law enforcement agency or instrumentality charged under applicable law with the protection of the public health or safety, if a qualified representative of such agency or instrumentality makes a written request that such record or testimony be provided for a purpose authorized by law. (G) In an administrative or judicial proceeding commenced by a criminal or civil law enforcement agency or instrumentality referred to in subparagraph (F), but only with respect to the subject of such proceeding. (2) Identity of participants.--With the exception of the subject of a quality assurance action, the identity of any person receiving health care services from any Indian Health Program or Urban Indian Organization or the identity of any other person associated with such program or organization for purposes of a medical quality assurance program that is disclosed in a medical quality assurance record described in subsection (a) shall be deleted from that record or document before any disclosure of such record is made outside such program or organization. Such requirement does not apply to the release of information pursuant to section 552a of title 5. (d) Disclosure for Certain Purposes.-- (1) In general.--Nothing in this section shall be construed as authorizing or requiring the withholding from any person or entity aggregate statistical information regarding the results of any Indian Health Program or Urban Indian Organizations's medical quality assurance programs. (2) Withholding from congress.--Nothing in this section shall be construed as authority to withhold any medical quality assurance record from a committee of either House of Congress, any joint committee of Congress, or the Government Accountability Office if such record pertains to any matter within their respective jurisdictions. (e) Prohibition on Disclosure of Record or Testimony.--A person or entity having possession of or access to a record or testimony described by this section may not disclose the contents of such record or testimony in any manner or for any purpose except as provided in this section. (f) Exemption From Freedom of Information Act.--Medical quality assurance records described in subsection (a) may not be made available to any person under section 552 of title 5. (g) Limitation on Civil Liability.--A person who participates in or provides information to a person or body that reviews or creates medical quality assurance records described in subsection (a) shall not be civilly liable for such participation or for providing such information if the participation or provision of information was in good faith based on prevailing professional standards at the time the medical quality assurance program activity took place. (h) Application to Information in Certain Other Records.-- Nothing in this section shall be construed as limiting access to the information in a record created and maintained outside a medical quality assurance program, including a patient's medical records, on the grounds that the information was presented during meetings of a review body that are part of a medical quality assurance program. (i) Regulations.--The Secretary, acting through the Service, shall promulgate regulations pursuant to section 802. (j) Definitions.--In this section: (1) The term ``health care provider'' means any health care professional, including community health aides and practitioners certified under section 121, who are granted clinical practice privileges or employed to provide health care services in an Indian Health Program or health program of an Urban Indian Organization, who is licensed or certified to perform health care services by a governmental board or agency or professional health care society or organization. (2) The term ``medical quality assurance program'' means any activity carried out before, on, or after the date of enactment of this Act by or for any Indian Health Program or Urban Indian Organization to assess the quality of medical care, including activities conducted by or on behalf of individuals, Indian Health Program or Urban Indian Organization medical or dental treatment review committees, or other review bodies responsible for quality assurance, credentials, infection control, patient safety, patient care assessment (including treatment procedures, blood, drugs, and therapeutics), medical records, health resources management review and identification and prevention of medical or dental incidents and risks. (3) The term ``medical quality assurance record'' means the proceedings, records, minutes, and reports that emanate from quality assurance program activities described in paragraph (2) and are produced or compiled by or for an Indian Health Program or Urban Indian Organization as part of a medical quality assurance program. SEC. 815. APPROPRIATIONS; AVAILABILITY. Any new spending authority (described in subparagraph (A) or (B) of section 401(c)(2) of the Congressional Budget Act of 1974 (Public Law 93-344; 88 Stat. 317)) 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 are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2017 to carry out this title. * * * * * * * ---------- - TITLE 5, UNITED STATES CODE - * * * * * * * PART III--EMPLOYEES * * * * * * * SUBPART D--PAY AND ALLOWANCES * * * * * * * CHAPTER 53--PAY RATES AND SYSTEMS * * * * * * * SUBCHAPTER II--EXECUTIVE SCHEDULE PAY RATES * * * * * * * Sec. 5315. Positions at level IV Level IV of the Executive Schedule applies to the following positions, for which the annual rate of basic pay shall be the rate determined with respect to such level under chapter 11 of title 2, as adjusted by section 5318 of this title: Deputy Administrator of General Services. * * * * * * * [Assistant Secretaries of Health and Human Services (6)] Assistant Secretaries of Health and Human Services (7). * * * * * * * Sec. 5316. Positions at level V Level V of the Executive Schedule applies to the following positions, for which the annual rate of basic pay shall be the rate determined with respect to such level under chapter 11 of title 2, as adjusted by section 5318 of this title: Administrator, Bonneville Power Administration, Department of the Interior. * * * * * * * [Director, Indian Health Service, Department of Health and Human Services.] * * * * * * * ---------- CHILDREN'S HEALTH ACT OF 2000 SEC. 3307. ESTABLISHMENT OF COMMISSION. (a) * * * (b) Membership.-- (1) In general.--The Commission established under subsection (a) shall consist of-- (A) * * * (C) the [Director of the Indian Health Service] Assistant Secretary for Indian Health and the Commissioner of Indian Affairs, who shall be nonvoting members. * * * * * * * ---------- INDIAN LANDS OPEN DUMP CLEANUP ACT OF 1994 * * * * * * * SEC. 3. DEFINITIONS. For the purposes of this Act, the following definitions shall apply: [(6)] (1) Alaska native entity.--The term ``Alaska Native entity'' includes native corporations established pursuant to the Alaska Native Claims Settlement Act (43 U.S.C. 1600 et seq.) and any Alaska Native village or municipal entity which owns Alaska Native land. [(2) Director.--The term ``Director'' means the Director of the Indian Health Service.] [(4)] (2) Alaska native land.--The term ``Alaska Native land'' means (A) land conveyed or to be conveyed pursuant to the Alaska Native Claims Settlement Act (43 U.S.C. 1600 et seq.), including any land reconveyed under section 14(c)(3) of that Act (43 U.S.C. 1613(c)(3)), and (B) land conveyed pursuant to the Act of November 2, 1966 (16 U.S.C. 1151 et seq.; commonly known as the ``Fur Seal Act of 1966''). (3) Assistant secretary.--The term ``Assistant Secretary'' means the Assistant Secretary for Indian Health. [(1)] (4) Closure or close.--The term ``closure or close'' means the termination of operations at open dumps on Indian land or Alaska Native land and bringing such dumps into compliance with applicable Federal standards and regulations, or standards promulgated by an Indian tribal government or Alaska Native entity, if such standards are more stringent than the Federal standards and regulations. [(3)] (5) Indian land.--The term ``Indian land'' means-- (A) land within the limits of any Indian reservation under the jurisdiction of the United States Government, notwithstanding the issuance of any patent, and including rights- of-way running through the reservation; (B) dependent Indian communities within the borders of the United States whether within the original or subsequently acquired territory thereof, and whether within or without the limits of a State; and (C) Indian allotments, the Indian titles to which have not been extinguished, including rights-of-way running through such allotments. [(5)] (6) Indian tribal government.--The term ``Indian tribal government'' means the governing body of any Indian tribe, band, nation, pueblo, or other organized group or community which is recognized as eligible for the special programs and services provided by the United States to Indians because of their status as Indians. * * * * * * * SEC. 4. INVENTORY OF OPEN DUMPS. (a) Study and Inventory.--Not later than 12 months after the date of enactment of this Act, the [Director] Assistant Secretary shall conduct a study and inventory of open dumps on Indian lands and Alaska Native lands. The inventory shall list the geographic location of all open dumps, an evaluation of the contents of each dump, and an assessment of the relative severity of the threat to public health and the environment posed by each dump. Such assessment shall be carried out cooperatively with the Administrator of the Environmental Protection Agency. The [Director] Assistant Secretary shall obtain the concurrence of the Administrator in the determination of relative severity made by any such assessment. (b) Annual Reports.--Upon completion of the study and inventory under subsection (a), the [Director] Assistant Secretary shall report to the Congress, and update such report annually-- (1) the current priority of Indian and Alaska Native solid waste deficiencies, (2) the methodology of determining the priority listing, (3) the level of funding needed to effectively close or bring into compliance all open dumps on Indian lands or Alaska Native lands, and (4) the progress made in addressing Indian and Alaska Native solid waste deficiencies. (c) 10-Year Plan.--The [Director] Assistant Secretary shall develop and begin implementation of a 10-year plan to address solid waste disposal needs on Indian lands and Alaska Native lands. This 10-year plan shall identify-- (1) * * * * * * * * * * [SEC. 5. AUTHORITY OF THE DIRECTOR OF THE INDIAN HEALTH SERVICE.] SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR INDIAN HEALTH. (a) Reservation Inventory.--(1) Upon request by an Indian tribal government or Alaska Native entity, the [Director] Assistant Secretary shall-- (A) * * * (B) determine the relative severity of the threat to public health and the environment posed by each dump based on information available to the [Director] Assistant Secretary and the Indian tribal government or Alaska Native entity unless the [Director] Assistant Secretary, in consultation with the Indian tribal government or Alaska Native entity, determines that additional actions such as soil testing or water monitoring would be appropriate in the circumstances; and * * * * * * * (2) The inventory and evaluation authorized under paragraph (1)(A) shall be carried out cooperatively with the Administrator of the Environmental Protection Agency. The [Director] Assistant Secretary shall obtain the concurrence of the Administrator in the determination of relative severity made under paragraph (1)(B). (b) Assistance.--Upon completion of the activities required to be performed pursuant to subsection (a), the [Director] Assistant Secretary shall, subject to subsection (c), provide financial and technical assistance to the Indian tribal government or Alaska Native entity to carry out the activities necessary to-- (1) * * * * * * * * * * (c) Conditions.--All assistance provided pursuant to subsection (b) shall be made available on a site-specific basis in accordance with priorities developed by the [Director] Assistant Secretary. Priorities on specific Indian lands or Alaska Native lands shall be developed in consultation with the Indian tribal government or Alaska Native entity. The priorities shall take into account the relative severity of the threat to public health and the environment posed by each open dump and the availability of funds necessary for closure and postclosure maintenance. SEC. 6. CONTRACT AUTHORITY. (a) Authority of [Director] Assistant Secretary.--To the maximum extent feasible, the [Director] Assistant Secretary shall carry out duties under this Act through contracts, compacts, or memoranda of agreement with Indian tribal governments or Alaska Native entities pursuant to the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), or section 302 of the Indian Health Care Improvement Act (25 U.S.C. 1632). (b) Cooperative Agreements.--The [Director] Assistant Secretary is authorized, for purposes of carrying out the duties of the [Director] Assistant Secretary under this Act, to contract with or enter into such cooperative agreements with such other Federal agencies as is considered necessary to provide cost-sharing for closure and postclosure activities, to obtain necessary technical and financial assistance and expertise, and for such other purposes as the [Director] Assistant Secretary considers necessary. SEC. 7. TRIBAL DEMONSTRATION PROJECT. (a) In General.--The [Director] Assistant Secretary may establish and carry out a program providing for demonstration projects involving open dumps on Indian land or Alaska Native land. It shall be the purpose of such projects to determine if there are unique cost factors involved in the cleanup and maintenance of open dumps on such land, and the extent to which advanced closure planning is necessary. Under the program, the [Director] Assistant Secretary is authorized to select no less than three Indian tribal governments or Alaska Native entities to participate in such demonstration projects. (b) Criteria.--Criteria established by the [Director] Assistant Secretary for the selection and participation of an Indian tribal government or Alaska Native entity in the demonstration project shall provide that in order to be eligible to participate, an Indian tribal government or Alaska Native entity must-- (1) * * * * * * * * * * SEC. 8. AUTHORIZATION OF APPROPRIATIONS. (a) * * * (b) Coordination.--The activities required to be performed by the [Director] Assistant Secretary under this Act shall be coordinated with activities related to solid waste and sanitation facilities funded pursuant to other authorizations. SEC. 9. DISCLAIMERS. (a) Authority of [Director] Assistant Secretary.--Nothing in this Act shall be construed to alter, diminish, repeal, or supersede any authority conferred on the [Director] Assistant Secretary pursuant to section 302 of the Indian Health Care Improvement Act (25 U.S.C. 1632), and section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a). * * * * * * * ---------- SECTION 5504 OF THE AUGUSTUS F. HAWKINS-ROBERT T. STAFFORD ELEMENTARY AND SECONDARY SCHOOL IMPROVEMENT AMENDMENTS OF 1988 SEC. 5504. ADMINISTRATIVE PROVISIONS. (a) * * * * * * * * * * (d) Federal Agency Cooperation and Assistance.-- (1) * * * (2) The Commissioner of the Administration for Native Americans of the Department of Health and Human Services and the [Director of the Indian Health Service] Assistant Secretary for Indian Health of the Department of Health and Human Services are authorized to detail personnel to the Task Force, upon request, to enable the Task Force to carry out its functions under this part. * * * * * * * ---------- - REHABILITATION ACT OF 1973 * * * * * * * TITLE II--RESEARCH AND TRAINING * * * * * * * INTERAGENCY COMMITTEE Sec. 203. (a)(1) In order to promote coordination and cooperation among Federal departments and agencies conducting rehabilitation research programs, including programs relating to assistive technology research and research that incorporates the principles of universal design, there is established within the Federal Government an Interagency Committee on Disability Research (hereinafter in this section referred to as the ``Committee''), chaired by the Director and comprised of such members as the President may designate, including the following (or their designees): the Director, the Commissioner of the Rehabilitation Services Administration, the Assistant Secretary for Special Education and Rehabilitative Services, the Secretary of Education, the Secretary of Veterans Affairs, the Director of the National Institutes of Health, the Director of the National Institute of Mental Health, the Administrator of the National Aeronautics and Space Administration, the Secretary of Transportation, the Assistant Secretary of the Interior for Indian Affairs, the [Director of the Indian Health Service] Assistant Secretary for Indian Health, and the Director of the National Science Foundation. * * * * * * * ---------- - SECTION 518 OF THE FEDERAL WATER POLLUTION CONTROL ACT SEC. 518. INDIAN TRIBES. (a) * * * (b) Assessment of Sewage Treatment Needs; Report.--The Administrator, in cooperation with the [Director of the Indian Health Service] Assistant Secretary for Indian Health, shall assess the need for sewage treatment works to serve Indian tribes, the degree to which such needs will be met through funds allotted to States under section 205 of this Act and priority lists under section 216 of this Act, and any obstacles which prevent such needs from being met. Not later than one year after the date of the enactment of this section, the Administrator shall submit a report to Congress on the assessment under this subsection, along with recommendations specifying (1) how the Administrator intends to provide assistance to Indian tribes to develop waste treatment management plans and to construct treatment works under this Act, and (2) methods by which the participation in and administration of programs under this Act by Indian tribes can be maximized. * * * * * * * (e) Treatment as States.--The Administrator is authorized to treat an Indian tribe as a State for purposes of title II and sections 104, 106, 303, 305, 308, 309, 314, 319, 401, 402, 404, and 406 of this Act to the degree necessary to carry out the objectives of this section, but only if-- (1) * * * * * * * * * * Such treatment as a State may include the direct provision of funds reserved under subsection (c) to the governing bodies of Indian tribes, and the determination of priorities by Indian tribes, where not determined by the Administrator in cooperation with the [Director of the Indian Health Service] Assistant Secretary for Indian Health. The Administrator, in cooperation with the [Director of the Indian Health Service] Assistant Secretary for Indian Health, is authorized to make grants under title II of this Act in an amount not to exceed 100 percent of the cost of a project. Not later than 18 months after the date of the enactment of this section, the Administrator shall, in consultation with Indian tribes, promulgate final regulations which specify how Indian tribes shall be treated as States for purposes of this Act. The Administrator shall, in promulgating such regulations, consult affected States sharing common water bodies and provide a mechanism for the resolution of any unreasonable consequences that may arise as a result of differing water quality standards that may be set by States and Indian tribes located on common bodies of water. Such mechanism shall provide for explicit consideration of relevant factors including, but not limited to, the effects of differing water quality permit requirements on upstream and downstream dischargers, economic impacts, and present and historical uses and quality of the waters subject to such standards. Such mechanism should provide for the avoidance of such unreasonable consequences in a manner consistent with the objective of this Act. * * * * * * * ---------- PUBLIC HEALTH SERVICE ACT * * * * * * * TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE * * * * * * * Part B--Federal-State Cooperation * * * * * * * ORAL HEALTH PROMOTION AND DISEASE PREVENTION Sec. 317M. (a) * * * (b) Community Water Fluoridation.-- (1) In general.--The Secretary, acting through the Director of the Centers for Disease Control and Prevention and in collaboration with the [Director of the Indian Health Service] Assistant Secretary for Indian Health, shall establish a demonstration project that is designed to assist rural water systems in successfully implementing the water fluoridation guidelines of the Centers for Disease Control and Prevention that are entitled ``Engineering and Administrative Recommendations for Water Fluoridation, 1995'' (referred to in this subsection as the ``EARWF''). (2) Requirements.-- (A) Collaboration.--In collaborating under paragraph (1), [the Directors referred to in such paragraph] the Director of the Centers for Disease Control and Prevention and the Assistant Secretary for Indian Health shall ensure that technical assistance and training are provided to tribal programs located in each of the 12 areas of the Indian Health Service. The [Director of the Indian Health Service] Assistant Secretary for Indian Health shall provide coordination and administrative support to tribes under this section. * * * * * * * TITLE IV--NATIONAL RESEARCH INSTITUTES * * * * * * * Part C--Specific Provisions Respecting National Research Institutes Subpart 1--National Cancer Institute * * * * * * * SEC. 417C. GRANTS FOR EDUCATION, PREVENTION, AND EARLY DETECTION OF RADIOGENIC CANCERS AND DISEASES. (a) * * * (b) In General.--The Secretary, acting through the Administrator of the Health Resources and Services Administration in consultation with the Director of the National Institutes of Health and the [Director of the Indian Health Service] Assistant Secretary for Indian Health, may make competitive grants to any entity for the purpose of carrying out programs to-- (1) * * * * * * * * * * ---------- - SAFE DRINKING WATER ACT -TITLE XIV--SAFETY OF PUBLIC WATER SYSTEMS * * * * * * * Part E--General Provisions * * * * * * * STATE REVOLVING LOAN FUNDS Sec. 1452. (a) * * * * * * * * * * (i) Indian Tribes.-- (1) * * * (2) Use of funds.--Funds reserved pursuant to paragraph (1) shall be used to address the most significant threats to public health associated with public water systems that serve Indian Tribes, as determined by the Administrator in consultation with the [Director of the Indian Health Service] Assistant Secretary for Indian Health and Indian Tribes. * * * * * * * (4) Needs assessment.--The Administrator, in consultation with the [Director of the Indian Health Service] Assistant Secretary for Indian Health and Indian Tribes, shall, in accordance with a schedule that is consistent with the needs surveys conducted pursuant to subsection (h), prepare surveys and assess the needs of drinking water treatment facilities to serve Indian Tribes, including an evaluation of the public water systems that pose the most significant threats to public health. * * * * * * * ---------- - NATIVE AMERICAN PROGRAMS ACT OF 1974 * * * * * * * TITLE VIII--NATIVE AMERICAN PROGRAMS * * * * * * * ESTABLISHMENT OF ADMINISTRATION FOR NATIVE AMERICANS Sec. 803B. (a) * * * * * * * * * * (d)(1) There is established in the Office of the Secretary the Intra-Departmental Council on Native American Affairs. The Commissioner shall be the chairperson of such Council and shall advise the Secretary on all matters affecting Native Americans that involve the Department. The [Director of the Indian Health Service] Assistant Secretary for Indian Health shall serve as vice chairperson of the Council. * * * * * * * ---------- SECTION 203 OF THE MICHIGAN INDIAN LAND CLAIMS SETTLEMENT ACT SEC. 203. LIMITATION. (a) * * * (b) Consideration.--In any case in which the Secretary, acting through the [Director of the Indian Health Service] Assistant Secretary for Indian Health, is required to select from more than 1 application for a contract or compact described in subsection (a), in awarding the contract or compact, the Secretary shall take into consideration-- (1) * * * * * * * * * * ---------- ACT OF DECEMBER 17, 1970 (Public Law 91-557) AN ACT To authorize the Secretary of the Interior to approve an agreement entered into by the Soboba Band of Mission Indians releasing a claim against the Metropolitan Water District of Southern California and Eastern Municipal Water District, California, and to provide for construction of a water distribution system and a water supply for the Soboba Indian Reservation; and to authorize long-term leases of land on the reservation. * * * * * * * Sec. 9. Nothing in this Act shall preclude the Soboba Band of Mission Indians and the Soboba Indian Reservation from being provided with sanitation facilities and services under the authority of section 7 of the Act of August 5, 1954 (68 Stat. 674), as amended by the Act of July 31, 1959 (73 Stat. 267). ---------- INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT * * * * * * * TITLE [V] VII--AMERICAN INDIAN EDUCATION FOUNDATION SEC. [501.] 701. AMERICAN INDIAN EDUCATION FOUNDATION. (a) * * * * * * * * * * SEC. [502.] 702. ADMINISTRATIVE SERVICES AND SUPPORT. (a) Provision of Support by Secretary.--Subject to subsection (b), during the 5-year period beginning on the date that the Foundation is established, the Secretary-- (1) * * * (2) may provide funds to reimburse the travel expenses of the members of the Board under [section 501] section 701; and * * * * * * * SEC. [503.] 703. DEFINITIONS. For the purposes of this title-- (1) the term ``Bureau funded school'' has the meaning given that term in title XI of the Education Amendments of 1978; (2) the term ``Foundation'' means the Foundation established by the Secretary pursuant to [section 501] section 701; and * * * * * * * TITLE VIII--NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION SEC. 801. DEFINITIONS. In this title: (1) Board.--The term ``Board'' means the Board of Directors of the Foundation. (2) Committee.--The term ``Committee'' means the Committee for the Establishment of Native American Health and Wellness Foundation established under section 802(f). (3) Foundation.--The term ``Foundation'' means the Native American Health and Wellness Foundation established under section 802. (4) Secretary.--The term ``Secretary'' means the Secretary of Health and Human Services. (5) Service.--The term ``Service'' means the Indian Health Service of the Department of Health and Human Services. SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION. (a) Establishment.-- (1) In general.--As soon as practicable after the date of enactment of this title, the Secretary shall establish, under the laws of the District of Columbia and in accordance with this title, the Native American Health and Wellness Foundation. (2) Funding determinations.--No funds, gift, property, or other item of value (including any interest accrued on such an item) acquired by the Foundation shall-- (A) be taken into consideration for purposes of determining Federal appropriations relating to the provision of health care and services to Indians; or (B) otherwise limit, diminish, or affect the Federal responsibility for the provision of health care and services to Indians. (b) Perpetual Existence.--The Foundation shall have perpetual existence. (c) Nature of Corporation.--The Foundation-- (1) shall be a charitable and nonprofit federally chartered corporation; and (2) shall not be an agency or instrumentality of the United States. (d) Place of Incorporation and Domicile.--The Foundation shall be incorporated and domiciled in the District of Columbia. (e) Duties.--The Foundation shall-- (1) encourage, accept, and administer private gifts of real and personal property, and any income from or interest in such gifts, for the benefit of, or in support of, the mission of the Service; (2) undertake and conduct such other activities as will further the health and wellness activities and opportunities of Native Americans; and (3) participate with and assist Federal, State, and tribal governments, agencies, entities, and individuals in undertaking and conducting activities that will further the health and wellness activities and opportunities of Native Americans. (f) Committee for the Establishment of Native American Health and Wellness Foundation.-- (1) In general.--The Secretary shall establish the Committee for the Establishment of Native American Health and Wellness Foundation to assist the Secretary in establishing the Foundation. (2) Duties.--Not later than 180 days after the date of enactment of this section, the Committee shall-- (A) carry out such activities as are necessary to incorporate the Foundation under the laws of the District of Columbia, including acting as incorporators of the Foundation; (B) ensure that the Foundation qualifies for and maintains the status required to carry out this section, until the Board is established; (C) establish the constitution and initial bylaws of the Foundation; (D) provide for the initial operation of the Foundation, including providing for temporary or interim quarters, equipment, and staff; and (E) appoint the initial members of the Board in accordance with the constitution and initial bylaws of the Foundation. (g) Board of Directors.-- (1) In general.--The Board of Directors shall be the governing body of the Foundation. (2) Powers.--The Board may exercise, or provide for the exercise of, the powers of the Foundation. (3) Selection.-- (A) In general.--Subject to subparagraph (B), the number of members of the Board, the manner of selection of the members (including the filling of vacancies), and the terms of office of the members shall be as provided in the constitution and bylaws of the Foundation. (B) Requirements.-- (i) Number of members.--The Board shall have at least 11 members, who shall have staggered terms. (ii) Initial voting members.--The initial voting members of the Board-- (I) shall be appointed by the Committee not later than 180 days after the date on which the Foundation is established; and (II) shall have staggered terms. (iii) Qualification.--The members of the Board shall be United States citizens who are knowledgeable or experienced in Native American health care and related matters. (C) Compensation.--A member of the Board shall not receive compensation for service as a member, but shall be reimbursed for actual and necessary travel and subsistence expenses incurred in the performance of the duties of the Foundation. (h) Officers.-- (1) In general.--The officers of the Foundation shall be-- (A) a secretary, elected from among the members of the Board; and (B) any other officers provided for in the constitution and bylaws of the Foundation. (2) Chief operating officer.--The secretary of the Foundation may serve, at the direction of the Board, as the chief operating officer of the Foundation, or the Board may appoint a chief operating officer, who shall serve at the direction of the Board. (3) Election.--The manner of election, term of office, and duties of the officers of the Foundation shall be as provided in the constitution and bylaws of the Foundation. (i) Powers.--The Foundation-- (1) shall adopt a constitution and bylaws for the management of the property of the Foundation and the regulation of the affairs of the Foundation; (2) may adopt and alter a corporate seal; (3) may enter into contracts; (4) may acquire (through a gift or otherwise), own, lease, encumber, and transfer real or personal property as necessary or convenient to carry out the purposes of the Foundation; (5) may sue and be sued; and (6) may perform any other act necessary and proper to carry out the purposes of the Foundation. (j) Principal Office.-- (1) In general.--The principal office of the Foundation shall be in the District of Columbia. (2) Activities; offices.--The activities of the Foundation may be conducted, and offices may be maintained, throughout the United States in accordance with the constitution and bylaws of the Foundation. (k) Service of Process.--The Foundation shall comply with the law on service of process of each State in which the Foundation is incorporated and of each State in which the Foundation carries on activities. (l) Liability of Officers, Employees, and Agents.-- (1) In general.--The Foundation shall be liable for the acts of the officers, employees, and agents of the Foundation acting within the scope of their authority. (2) Personal liability.--A member of the Board shall be personally liable only for gross negligence in the performance of the duties of the member. (m) Restrictions.-- (1) Limitation on spending.--Beginning with the fiscal year following the first full fiscal year during which the Foundation is in operation, the administrative costs of the Foundation shall not exceed the percentage described in paragraph (2) of the sum of-- (A) the amounts transferred to the Foundation under subsection (o) during the preceding fiscal year; and (B) donations received from private sources during the preceding fiscal year. (2) Percentages.--The percentages referred to in paragraph (1) are-- (A) for the first fiscal year described in that paragraph, 20 percent; (B) for the following fiscal year, 15 percent; and (C) for each fiscal year thereafter, 10 percent. (3) Appointment and hiring.--The appointment of officers and employees of the Foundation shall be subject to the availability of funds. (4) Status.--A member of the Board or officer, employee, or agent of the Foundation shall not by reason of association with the Foundation be considered to be an officer, employee, or agent of the United States. (n) Audits.--The Foundation shall comply with section 10101 of title 36, United States Code, as if the Foundation were a corporation under part B of subtitle II of that title. (o) Funding.-- (1) Authorization of appropriations.--There is authorized to be appropriated to carry out subsection (e)(1) $500,000 for each fiscal year, as adjusted to reflect changes in the Consumer Price Index for all- urban consumers published by the Department of Labor. (2) Transfer of donated funds.--The Secretary shall transfer to the Foundation funds held by the Department of Health and Human Services under the Act of August 5, 1954 (42 U.S.C. 2001 et seq.), if the transfer or use of the funds is not prohibited by any term under which the funds were donated. SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT. (a) Provision of Support by Secretary.--Subject to subsection (b), during the 5-year period beginning on the date on which the Foundation is established, the Secretary-- (1) may provide personnel, facilities, and other administrative support services to the Foundation; (2) may provide funds for initial operating costs and to reimburse the travel expenses of the members of the Board; and (3) shall require and accept reimbursements from the Foundation for-- (A) services provided under paragraph (1); and (B) funds provided under paragraph (2). (b) Reimbursement.--Reimbursements accepted under subsection (a)(3)-- (1) shall be deposited in the Treasury of the United States to the credit of the applicable appropriations account; and (2) shall be chargeable for the cost of providing services described in subsection (a)(1) and travel expenses described in subsection (a)(2). (c) Continuation of Certain Services.--The Secretary may continue to provide facilities and necessary support services to the Foundation after the termination of the 5-year period specified in subsection (a) if the facilities and services-- (1) are available; and (2) are provided on reimbursable cost basis. ---------- SOCIAL SECURITY ACT * * * * * * * TITLE XI--GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE SIMPLIFICATION Part A--General Provisions * * * * * * * EXCLUSION OF CERTAIN INDIVIDUALS AND ENTITIES FROM PARTICIPATION IN MEDICARE AND STATE HEALTH CARE PROGRAMS Sec. 1128. (a) * * * * * * * * * * (k) Additional Exclusion waiver authority for affected Indian Health Programs.--In addition to the authority granted the Secretary under subsections (c)(3)(B) and (d)(3)(B) to waive an exclusion under subsection (a)(1), (a)(3), (a)(4), or (b), the Secretary may, in the case of an Indian Health Program, waive such an exclusion upon the request of the administrator of an affected Indian Health Program (as defined in section 4 of the Indian Health Care Improvement Act) who determines that the exclusion would impose a hardship on individuals entitled to benefits under or enrolled in a Federal health care program. * * * * * * * CRIMINAL PENALTIES FOR ACTS INVOLVING FEDERAL HEALTH CARE PROGRAMS Sec. 1128B. (a) * * * (b)(1) * * * * * * * * * * (4) Subject to such conditions as the Secretary may promulgate from time to time as necessary to prevent fraud and abuse, for purposes of paragraphs (1) and (2) and section 1128A(a), the following transfers shall not be treated as remuneration: (A) Transfers between indian health programs, indian tribes, tribal organizations, and urban indian organizations.--Transfers of anything of value between or among an Indian Health Program, Indian Tribe, Tribal Organization, or Urban Indian Organization, that are made for the purpose of providing necessary health care items and services to any patient served by such Program, Tribe, or Organization and that consist of-- (i) services in connection with the collection, transport, analysis, or interpretation of diagnostic specimens or test data; (ii) inventory or supplies; (iii) staff; or (iv) a waiver of all or part of premiums or cost sharing. (B) Transfers between indian health programs, indian tribes, tribal organizations, or urban indian organizations and patients.--Transfers of anything of value between an Indian Health Program, Indian Tribe, Tribal Organization, or Urban Indian Organization and any patient served or eligible for service from an Indian Health Program, Indian Tribe, Tribal Organization, or Urban Indian Organization, including any patient served or eligible for service pursuant to section 807 of the Indian Health Care Improvement Act, but only if such transfers-- (i) consist of expenditures related to providing transportation for the patient for the provision of necessary health care items or services, provided that the provision of such transportation is not advertised, nor an incentive of which the value is disproportionately large in relationship to the value of the health care item or service (with respect to the value of the item or service itself or, for preventative items or services, the future health care costs reasonably expected to be avoided); (ii) consist of expenditures related to providing housing to the patient (including a pregnant patient) and immediate family members or an escort necessary to assuring the timely provision of health care items and services to the patient, provided that the provision of such housing is not advertised nor an incentive of which the value is disproportionately large in relationship to the value of the health care item or service (with respect to the value of the item or service itself or, for preventative items or services, the future health care costs reasonably expected to be avoided); or (iii) are for the purpose of paying premiums or cost sharing on behalf of such a patient, provided that the making of such payment is not subject to conditions other than conditions agreed to under a contract for the delivery of contract health services. (C) Contract health services.--A transfer of anything of value negotiated as part of a contract entered into between an Indian Health Program, Indian Tribe, Tribal Organization, Urban Indian Organization, or the Indian Health Service and a contract care provider for the delivery of contract health services authorized by the Indian Health Service, provided that-- (i) such a transfer is not tied to volume or value of referrals or other business generated by the parties; and (ii) any such transfer is limited to the fair market value of the health care items or services provided or, in the case of a transfer of items or services related to preventative care, the value of the future health care costs reasonably expected to be avoided. (D) Other transfers.--Any other transfer of anything of value involving an Indian Health Program, Indian Tribe, Tribal Organization, or Urban Indian Organization, or a patient served or eligible for service from an Indian Health Program, Indian Tribe, Tribal Organization, or Urban Indian Organization, that the Secretary, in consultation with the Attorney General, determines is appropriate, taking into account the special circumstances of such Indian Health Programs, Indian Tribes, Tribal Organizations, and Urban Indian Organizations, and of patients served by such Programs, Tribes, and Organizations. * * * * * * * [NATIONAL COMMISSION ON CHILDREN [Sec. 1139. [(a)(1) There is hereby established a commission to be known as the National Commission on Children (in this section referred to as the ``Commission''). [(b)(1) The Commission shall consist of-- [(A) 12 members to be appointed by the President, [(B) 12 members to be appointed by the Speaker of the House of Representatives, and [(C) 12 members to be appointed by the President pro tempore of the Senate. [(2) The President, the Speaker, and the President pro tempore shall each appoint as members of the Commission-- [(A) 4 individuals who-- [(i) are representatives of organizations providing services to children, [(ii) are involved in activities on behalf of children, or [(iii) have engaged in academic research with respect to the problems and needs of children, [(B) 4 individuals who are elected or appointed public officials (at the Federal, State, or local level) involved in issues and programs relating to children, and [(C) 4 individuals who are parents or representatives of parents or parents' organizations. [(3) The appointments made pursuant to subparagraphs (B) and (C) of paragraph (1) shall be made in consultation with the chairmen of committees of the House of Representatives and the Senate, respectively, having jurisdiction over relevant Federal programs. [(c)(1) It shall be the duty and function of the Commission to serve as a forum on behalf of the children of the Nation and to conduct the studies and issue the report required by subsection (d). [(2) The Commission (and any committees that it may form) shall conduct public hearings in different geographic areas of the country, both urban and rural, in order to receive the views of a broad spectrum of the public on the status of the Nation's children and on ways to safeguard and enhance the physical, mental, and emotional well-being of all of the children of the Nation, including those with physical or mental disabilities, and others whose circumstances deny them a full share of the opportunities that parents of the Nation may rightfully expect for their children. [(3) The Commission shall receive testimony from individuals, and from representatives of public and private organizations and institutions with an interest in the welfare of children, including educators, health care professionals, religious leaders, providers of social services, representatives of organizations with children as members, elected and appointed public officials, and from parents and children speaking in their own behalf. [(d) The Commission shall submit to the President, and to the Committees on Finance and Labor and Human Resources of the Senate and the Committees on Ways and Means, Education and Labor, and Energy and Commerce of the House of Representatives, an interim report no later than March 31, 1990, and a final report no later than March 31, 1991, setting forth recommendations with respect to the following subjects: [(1) Questions relating to the health of children that the Commission shall address include-- [(A) how to reduce infant mortality, [(B) how to reduce the number of low-birth- weight babies, [(C) how to reduce the number of children with chronic illnesses and disabilities, [(D) how to improve the nutrition of children, [(E) how to promote the physical fitness of children, [(F) how to ensure that pregnant women receive adequate prenatal care, [(G) how to ensure that all children have access to both preventive and acute care health services, and [(H) how to improve the quality and availability of health care for children. [(2) Questions relating to social and support services for children and their parents that the Commission shall address include-- [(A) how to prevent and treat child neglect and abuse, [(B) how to provide help to parents who seek assistance in meeting the problems of their children, [(C) how to provide counseling services for children, [(D) how to strengthen the family unit, [(E) how children can be assured of adequate care while their parents are working or participating in education or training programs, [(F) how to improve foster care and adoption services, [(G) how to reduce drug and alcohol abuse by children and youths, and [(H) how to reduce the incidence of teenage pregnancy. [(3) Questions relating to education that the Commission shall address include-- [(A) how to encourage academic excellence for all children at all levels of education, [(B) how to use preschool experiences to enhance educational achievement, [(C) how to improve the qualifications of teachers, [(D) how schools can better prepare the Nation's youth to compete in the labor market, [(E) how parents and schools can work together to help children achieve success at each step of the academic ladder, [(F) how to encourage teenagers to complete high school and remain in school to fulfill their academic potential, [(G) how to address the problems of drug and alcohol abuse by young people, [(H) how schools might lend support to efforts aimed at reducing the incidence of teenage pregnancy, and [(I) how schools might better meet the special needs of children who have physical or mental handicaps. [(4) Questions relating to income security that the Commission shall address include-- [(A) how to reduce poverty among children, [(B) how to ensure that parents support their children to the fullest extent possible through improved child support collection services, including services on behalf of children whose parents are unmarried, and [(C) how to ensure that cash assistance to needy children is adequate. [(5) Questions relating to tax policy that the Commission shall address include-- [(A) how to assure the equitable tax treatment of families with children, [(B) the effect of existing tax provisions, including the dependent care tax credit, the earned income tax credit, and the targeted jobs tax credit, on children living in poverty, [(C) whether the dependent care tax credit should be refundable and the effect of such a policy, [(D) whether the earned income tax credit should be adjusted for family size and the effect of such a policy, and [(E) whether there are other tax-related policies which would reduce poverty among children. [(6) In addition to addressing the questions specified in paragraphs (1) through (5), the Commission shall-- [(A) seek to identify ways in which public and private organizations and institutions can work together at the community level to identify deficiencies in existing services for families and children and to develop recommendations to ensure that the needs of families and children are met, using all available resources, in a coordinated and comprehensive manner, and [(B) assess the existing capacities of agencies to collect and analyze data on the status of children and on relevant programs, identify gaps in the data collection system, and recommend ways to improve the collection of data and the coordination among agencies in the collection and utilization of data. The reports required by this subsection shall be based upon the testimony received in the hearings conducted pursuant to subsection (c), and upon other data and findings developed by the Commission. [(e)(1)(A) Members of the Commission shall first be appointed not later than 60 days after the date of the enactment of this section, for terms ending on March 31, 1991. [(B) A vacancy in the Commission shall not affect its powers, but shall be filled in the same manner as the vacant position was first filled. [(2) The Commission shall elect one of its members to serve as Chairman of the Commission. The Chairman shall be a nonvoting member of the Commission. [(3) A majority of the members of the Commission shall constitute a quorum for the transaction of business. [(4)(A) The Commission shall meet at the call of the Chairman, or at the call of a majority of the members of the Commission. [(B) The Commission shall meet not less than 4 times during the period beginning with the date of the enactment of this section and ending with September 30, 1990. [(5) Decisions of the Commission shall be according to the vote of a simple majority of those present and voting at a properly called meeting. [(6) Members of the Commission shall serve without compensation, but shall be reimbursed for travel, subsistence, and other necessary expenses incurred in the performance of their duties as members of the Commission. [(f)(1) The Commission shall appoint an Executive Director of the Commission. In addition to the Executive Director, the Commission may appoint and fix the compensation of such personnel as it deems advisable. Such appointments and compensation may be made without regard to title 5, United States Code, that govern appointments in the competitive services, and the provisions of chapter 51 and subchapter III of chapter 53 of such title that relate to classifications and the General Schedule pay rates. [(2) The Commission may procure such temporary and intermittent services of consultants under section 3109(b) of title 5, United States Code, as the Commission determines to be necessary to carry out the duties of the Commission. [(g) In carrying out its duties, the Commission, or any duly organized committee thereof, is authorized to hold such hearings, sit and act at such times and places, and take such testimony, with respect to matters for which it has a responsibility under this section, as the Commission or committee may deem advisable. [(h)(1) The Commission may secure directly from any department or agency of the United States such data and information as may be necessary to carry out its responsibilities. [(2) Upon request of the Commission, any such department or agency shall furnish any such data or information. [(i) The General Services Administration shall provide to the Commission, on a reimbursable basis, such administrative support services as the Commission may request. [(j) There are authorized to be appropriated through fiscal year 1991, such sums as may be necessary to carry out this section for each of fiscal years 1989 and 1990. [(k)(1) The Commission is authorized to accept donations of money, property, or personal services. Funds received from donations shall be deposited in the Treasury in a separate fund created for this purpose. Funds appropriated for the Commission and donated funds may be expended for such purposes as official reception and representation expenses, public surveys, public service announcements, preparation of special papers, analyses, and documentaries, and for such other purposes as determined by the Commission to be in furtherance of its mission to review national issues affecting children. [(2) For purposes of Federal income, estate, and gift taxation, money and other property accepted under paragraph (1) of this subsection shall be considered as a gift or bequest to or for the use of the United States. [(3) Expenditure of appropriated and donated funds shall be subject to such rules and regulations as may be adopted by the Commission and shall not be subject to Federal procurement requirements. [(l) The Commission is authorized to conduct such public surveys as it deems necessary in support of its review of national issues affecting children and, in conducting such surveys, the Commission shall not be deemed to be an ``agency'' for the purpose of section 3502 of title 44, United States Code.] SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, HEALTH CARE FOR INDIANS UNDER TITLES XVIII, XIX, AND XXI. (a) Agreements with States for Medicaid and Schip Outreach on or Near Reservations To Increase the Enrollment of Indians in Those Programs.-- (1) In general.--In order to improve the access of Indians residing on or near a reservation to obtain benefits under the Medicaid and State children's health insurance programs established under titles XIX and XXI, the Secretary shall encourage the State to take steps to provide for enrollment on or near the reservation. Such steps may include outreach efforts such as the outstationing of eligibility workers, entering into agreements with the Indian Health Service, Indian Tribes, Tribal Organizations, and Urban Indian Organizations to provide outreach, education regarding eligibility and benefits, enrollment, and translation services when such services are appropriate. (2) Construction.--Nothing in subparagraph (A) shall be construed as affecting arrangements entered into between States and the Indian Health Service, Indian Tribes, Tribal Organizations, or Urban Indian Organizations for such Service, Tribes, or Organizations to conduct administrative activities under such titles. (b) Requirement To Facilitate Cooperation.--The Secretary, acting through the Centers for Medicare & Medicaid Services, shall take such steps as are necessary to facilitate cooperation with, and agreements between, States and the Indian Health Service, Indian Tribes, Tribal Organizations, or Urban Indian Organizations with respect to the provision of health care items and services to Indians under the programs established under title XVIII, XIX, or XXI. (c) Nondiscrimination in Qualifications for Payment for Services under Federal Health Care Programs.-- (1) Requirement to satisfy generally applicable participation requirements.-- (A) In general.--A Federal health care program must accept an entity that is operated by the Indian Health Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization as a provider eligible to receive payment under the program for health care services furnished to an Indian on the same basis as any other provider qualified to participate as a provider of health care services under the program if the entity meets generally applicable State or other requirements for participation as a provider of health care services under the program. (B) Satisfaction of state or local licensure or recognition requirements.--Any requirement for participation as a provider of health care services under a Federal health care program that an entity be licensed or recognized under the State or local law where the entity is located to furnish health care services shall be deemed to have been met in the case of an entity operated by the Indian Health Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization if the entity meets all the applicable standards for such licensure or recognition, regardless of whether the entity obtains a license or other documentation under such State or local law. In accordance with section 221 of the Indian Health Care Improvement Act, the absence of the licensure of a health care professional employed by such an entity under the State or local law where the entity is located shall not be taken into account for purposes of determining whether the entity meets such standards, if the professional is licensed in another State. (2) Prohibition on federal payments to entities or individuals excluded from participation in federal health care programs or whose State licenses are under suspension or have been revoked.-- (A) Excluded entities.--No entity operated by the Indian Health Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization that has been excluded from participation in any Federal health care program or for which a license is under suspension or has been revoked by the State where the entity is located shall be eligible to receive payment under any such program for health care services furnished to an Indian. (B) Excluded individuals.--No individual who has been excluded from participation in any Federal health care program or whose State license is under suspension or has been revoked shall be eligible to receive payment under any such program for health care services furnished by that individual, directly or through an entity that is otherwise eligible to receive payment for health care services, to an Indian. (C) Federal health care program defined.--In this subsection, the term, ``Federal health care program'' has the meaning given that term in section 1128B(f), except that, for purposes of this subsection, such term shall include the health insurance program under chapter 89 of title 5, United States Code. (d) Consultation With Tribal Technical Advisory Group (Ttag).--The Secretary shall maintain within the Centers for Medicaid & Medicare Services (CMS) a Tribal Technical Advisory Group, established in accordance with requirements of the charter dated September 30, 2003, and in such group shall include a representative of the Urban Indian Organizations and the Service. The representative of the Urban Indian Organization shall be deemed to be an elected officer of a tribal government for purposes of applying section 204(b) of the Unfunded Mandates Reform Act of 1995 (2 U.S.C. 1534(b)). (e) Annual Report on Indians Served by Health Benefit Programs Funded Under This Act.--Beginning January 1, 2007, and annually thereafter, the Secretary, acting through the Administrator of the Centers for Medicare & Medicaid Services and the Director of the Indian Health Service, shall submit a report to Congress regarding the enrollment and health status of Indians receiving items or services under health benefit programs funded under this Act during the preceding year. Each such report shall include the following: (1) The total number of Indians enrolled in, or receiving items or services under, such programs, disaggregated with respect to each such program. (2) The number of Indians described in paragraph (1) that also received health benefits under programs funded by the Indian Health Service. (3) General information regarding the health status of the Indians described in paragraph (1), disaggregated with respect to specific diseases or conditions and presented in a manner that is consistent with protections for privacy of individually identifiable health information under section 264(c) of the Health Insurance Portability and Accountability Act of 1996. (4) A detailed statement of the status of facilities of the Indian Health Service or an Indian Tribe, Tribal Organization, or an Urban Indian Organization with respect to such facilities' compliance with the applicable conditions and requirements of titles XVIII, XIX, and XXI, and, in the case of title XIX or XXI, under a State plan under such title or under waiver authority, and of the progress being made by such facilities (under plans submitted under section 1880(b), 1911(b) or otherwise) toward the achievement and maintenance of such compliance. (5) Such other information as the Secretary determines is appropriate. (f) Definition of Indian; Indian Tribe; Indian Health Program; Tribal Organization; Urban Indian Organization.--In this section, the terms ``Indian'', ``Indian Tribe'', ``Indian Health Program'', ``Tribal Organization'', and ``Urban Indian Organization'' have the meanings given those terms in section 4 of the Indian Health Care Improvement Act. * * * * * * * TITLE XVIII--HEALTH INSURANCE FOR THE AGED AND DISABLED * * * * * * * Part E--Miscellaneous Provisions * * * * * * * [INDIAN HEALTH SERVICE FACILITIES [Sec. 1880. [(a) A hospital or skilled nursing facility of the Indian Health Service, whether operated by such Service or by an Indian tribe or tribal organization (as those terms are defined in section 4 of the Indian Health Care Improvement Act), shall be eligible for payments under this title, notwithstanding sections 1814(c) and 1835(d), if and for so long as it meets all of the conditions and requirements for such payments which are applicable generally to hospitals or skilled nursing facilities (as the case may be) under this title. [(b) Notwithstanding subsection (a), a hospital or skilled nursing facility of the Indian Health Service which does not meet all of the conditions and requirements of this title which are applicable generally to hospitals or skilled nursing facilities (as the case may be), but which submits to the Secretary within six months after the date of the enactment of this section an acceptable plan for achieving compliance with such conditions and requirements, shall be deemed to meet such conditions and requirements (and to be eligible for payments under this title), without regard to the extent of its actual compliance with such conditions and requirements, during the first 12 months after the month in which such plan is submitted. [(c) Notwithstanding any other provision of this title, payments to which any hospital or skilled nursing facility of the Indian Health Service is entitled by reason of this section shall be placed in a special fund to be held by the Secretary and used by him (to such extent or in such amounts as are provided in appropriation Acts) exclusively for the purpose of making any improvements in the hospitals and skilled nursing facilities of such Service which may be necessary to achieve compliance with the applicable conditions and requirements of this title. The preceding sentence shall cease to apply when the Secretary determines and certifies that substantially all of the hospitals and skilled nursing facilities of such Service in the United States are in compliance with such conditions and requirements. [(d) The annual report of the Secretary which is required by section 701 of the Indian Health Care Improvement Act shall include (along with the matters specified in section 403 of such Act) a detailed statement of the status of the hospitals and skilled nursing facilities of the Service in terms of their compliance with the applicable conditions and requirements of this title and of the progress being made by such hospitals and facilities (under plans submitted under subsection (b) and otherwise) toward the achievement of such compliance.] SEC. 1880. INDIAN HEALTH PROGRAMS. (a) Eligibility for Payments.--Subject to subsection (e), the Indian Health Service and an Indian Tribe, Tribal Organization, or an Urban Indian Organization shall be eligible for payments under this title with respect to items and services furnished by the Indian Health Service, Indian Tribe, Tribal Organization, or Urban Indian Organization if the furnishing of such services meets all the conditions and requirements which are applicable generally to the furnishing of items and services under this title. (b) Compliance With Conditions and Requirements.--Subject to subsection (e), a facility of the Indian Health Service or an Indian Tribe, Tribal Organization, or an Urban Indian Organization which is eligible for payment under subsection (a) with respect to the furnishing of items and services, but which does not meet all of the conditions and requirements of this title which are applicable generally to such facility, shall make such improvements as are necessary to achieve or maintain compliance with such conditions and requirements in accordance with a plan submitted to and accepted by the Secretary for achieving or maintaining compliance with such conditions and requirements, and shall be deemed to meet such conditions and requirements (and to be eligible for payment under this title), without regard to the extent of its actual compliance with such conditions and requirements, during the first 12 months after the month in which such plan is submitted. (c) Special Fund for Improvement of IHS Facilities.--For provisions relating to the authority of the Secretary to place payments to which a facility of the Indian Health Service is eligible for payment under this title into a special fund established under section 401(c)(1) of the Indian Health Care Improvement Act, and the requirement to use amounts paid from such fund for making improvements in accordance with subsection (b), see subparagraphs (A) and (B) of section 401(c)(1) of such Act. (d) Direct Billing.--For provisions relating to the authority of a Tribal Health Program or an Urban Indian Organization to elect to directly bill for, and receive payment for, health care items and services provided by such Program or Organization for which payment is made under this title, see section 401(d) of the Indian Health Care Improvement Act. (e)(1) * * * * * * * * * * (3) Subsection (c) and section 401(c)(1) of the Indian Health Care Improvement Act shall not apply to payments made under this subsection. [(f) For provisions relating to the authority of certain Indian tribes, tribal organizations, and Alaska Native health organizations to elect to directly bill for, and receive payment for, health care services provided by a hospital or clinic of such tribes or organizations and for which payment may be made under this title, see section 405 of the Indian Health Care Improvement Act (25 U.S.C. 1645).] (f) Definitions.--In this section, the terms ``Indian Health Program'', ``Indian Tribe'', ``Service Unit'', ``Tribal Health Program'', ``Tribal Organization'', and ``Urban Indian Organization'' have the meanings given those terms in section 4 of the Indian Health Care Improvement Act. * * * * * * * TITLE XIX--GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS * * * * * * * STATE PLANS FOR MEDICAL ASSISTANCE Sec. 1902. (a) A State plan for medical assistance must-- (1) * * * * * * * * * * (69) provide that the State must comply with any requirements determined by the Secretary to be necessary for carrying out the Medicaid Integrity Program established under section 1936; [and] (70) at the option of the State and notwithstanding paragraphs (1), (10)(B), and (23), provide for the establishment of a non-emergency medical transportation brokerage program in order to more cost-effectively provide transportation for individuals eligible for medical assistance under the State plan who need access to medical care or services and have no other means of transportation which-- (A) * * * (B) may be conducted under contract with a broker who-- (i) * * * * * * * * * * (iv) complies with such requirements related to prohibitions on referrals and conflict of interest as the Secretary shall establish (based on the prohibitions on physician referrals under section 1877 and such other prohibitions and requirements as the Secretary determines to be appropriate)[.]; and (71) in the case of any State in which the Indian Health Service operates or funds health care programs, or in which 1 or more Indian Health Programs or Urban Indian Organizations (as such terms are defined in section 4 of the Indian Health Care Improvement Act) provide health care in the State for which medical assistance is available under such title, provide for a process under which the State seeks advice on a regular, ongoing basis from designees of such Indian Health Programs and Urban Indian Organizations on matters relating to the application of this title that are likely to have a direct effect on such Indian Health Programs and Urban Indian Organizations and that-- (A) shall include solicitation of advice prior to submission of any plan amendments, waiver requests, and proposals for demonstration projects likely to have a direct effect on Indians, Indian Health Programs, or Urban Indian Organizations; and (B) may include appointment of an advisory committee and of a designee of such Indian Health Programs and Urban Indian Organizations to the medical care advisory committee advising the State on its State plan under this title. Notwithstanding paragraph (5), if on January 1, 1965, and on the date on which a State submits its plan for approval under this title, the State agency which administered or supervised the administration of the plan of such State approved under title X (or title XVI, insofar as it relates to the blind) was different from the State agency which administered or supervised the administration of the State plan approved under title I (or title XVI, insofar as it relates to the aged), the State agency which administered or supervised the administration of such plan approved under title X (or title XVI, insofar as it relates to the blind) may be designated to administer or supervise the administration of the portion of the State plan for medical assistance which relates to blind individuals and a different State agency may be established or designated to administer or supervise the administration of the rest of the State plan for medical assistance; and in such case the part of the plan which each such agency administers, or the administration of which each such agency supervises, shall be regarded as a separate plan for purposes of this title (except for purposes of paragraph (10)). The provisions of paragraphs (9)(A), (31), and (33) and of section 1903(i)(4) shall not apply to a religious nonmedical health care institution (as defined in section 1861(ss)(1)). * * * * * * * (e)(1) * * * * * * * * * * (13) Notwithstanding any other requirement of this title or any other provision of Federal or State law, a State shall disregard the following property for purposes of determining the eligibility of an individual who is an Indian (as defined in section 4 of the Indian Health Care Improvement Act) for medical assistance under this title: (A) Property, including real property and improvements, that is held in trust, subject to Federal restrictions, or otherwise under the supervision of the Secretary of the Interior, located on a reservation, including any federally recognized Indian Tribe's reservation, pueblo, or colony, including former reservations in Oklahoma, Alaska Native regions established by the Alaska Native Claims Settlement Act, and Indian allotments on or near a reservation as designated and approved by the Bureau of Indian Affairs of the Department of the Interior. (B) For any federally recognized Tribe not described in subparagraph (A), property located within the most recent boundaries of a prior Federal reservation. (C) Ownership interests in rents, leases, royalties, or usage rights related to natural resources (including extraction of natural resources or harvesting of timber, other plants and plant products, animals, fish, and shellfish) resulting from the exercise of federally protected rights. (D) Ownership interests in or usage rights to items not covered by subparagraphs (A) through (C) that have unique religious, spiritual, traditional, or cultural significance or rights that support subsistence or a traditional lifestyle according to applicable tribal law or custom. * * * * * * * PAYMENT TO STATES Sec. 1903. (a) * * * * * * * * * * (x)(1) * * * * * * * * * * (3)(A) * * * (B) The following are documents described in this subparagraph: (i) * * * * * * * * * * (v)(I) Except as provided in subclause (II), a document issued by a federally-recognized Indian tribe evidencing membership or enrollment in, or affiliation with, such tribe. (II) With respect to those federally-recognized Indian tribes located within States having an international border whose membership includes individuals who are not citizens of the United States, the Secretary shall, after consulting with such tribes, issue regulations authorizing the presentation of such other forms of documentation (including tribal documentation, if appropriate) that the Secretary determines to be satisfactory documentary evidence of citizenship or nationality for purposes of satisfying the requirement of this subsection. [(v)] (vi) Such other document as the Secretary may specify, by regulation, that provides proof of United States citizenship or nationality and that provides a reliable means of documentation of personal identity. * * * * * * * [INDIAN HEALTH SERVICE FACILITIES [Sec. 1911. [(a) A facility of the Indian Health Service (including a hospital, nursing facility, or any other type of facility which provides services of a type otherwise covered under the State plan), whether operated by such Service or by an Indian tribe or tribal organization (as those terms are defined in section 4 of the Indian Health Care Improvement Act), shall be eligible for reimbursement for medical assistance provided under a State plan if and for so long as it meets all of the conditions and requirements which are applicable generally to such facilities under this title. [(b) Notwithstanding subsection (a), a facility of the Indian Health Service (including a hospital, nursing facility, or any other type of facility which provides services of a type otherwise covered under the State plan) which does not meet all of the conditions and requirements of this title which are applicable generally to such facility, but which submits to the Secretary within six months after the date of the enactment of this section an acceptable plan for achieving compliance with such conditions and requirements, shall be deemed to meet such conditions and requirements (and to be eligible for reimbursement under this title), without regard to the extent of its actual compliance with such conditions and requirements, during the first twelve months after the month in which such plan is submitted. [(c) The Secretary is authorized to enter into agreements with the State agency for the purpose of reimbursing such agency for health care and services provided in Indian Health Service facilities to Indians who are eligible for medical assistance under the State plan. [(d) For provisions relating to the authority of certain Indian tribes, tribal organizations, and Alaska Native health organizations to elect to directly bill for, and receive payment for, health care services provided by a hospital or clinic of such tribes or organizations and for which payment may be made under this title, see section 405 of the Indian Health Care Improvement Act (25 U.S.C. 1645).] SEC. 1911. INDIAN HEALTH PROGRAMS. (a) Eligibility for Payment for Medical Assistance.--The Indian Health Service and an Indian Tribe, Tribal Organization, or an Urban Indian Organization shall be eligible for payment for medical assistance provided under a State plan or under waiver authority with respect to items and services furnished by the Indian Health Service, Indian Tribe, Tribal Organization, or Urban Indian Organization if the furnishing of such services meets all the conditions and requirements which are applicable generally to the furnishing of items and services under this title and under such plan or waiver authority. (b) Compliance With Conditions and Requirements.--A facility of the Indian Health Service or an Indian Tribe, Tribal Organization, or an Urban Indian Organization which is eligible for payment under subsection (a) with respect to the furnishing of items and services, but which does not meet all of the conditions and requirements of this title and under a State plan or waiver authority which are applicable generally to such facility, shall make such improvements as are necessary to achieve or maintain compliance with such conditions and requirements in accordance with a plan submitted to and accepted by the Secretary for achieving or maintaining compliance with such conditions and requirements, and shall be deemed to meet such conditions and requirements (and to be eligible for payment under this title), without regard to the extent of its 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 an agreement with a State for the purpose of reimbursing the State for medical assistance provided by the Indian Health Service, an Indian Tribe, Tribal Organization, or an Urban Indian Organization (as so defined), directly, through referral, or under contracts or other arrangements between the Indian Health Service, an Indian Tribe, Tribal Organization, or an Urban Indian Organization and another health care provider to Indians who are eligible for medical assistance under the State plan or under waiver authority. (d) Special Fund for Improvement of IHS Facilities.--For provisions relating to the authority of the Secretary to place payments to which a facility of the Indian Health Service is eligible for payment under this title into a special fund established under section 401(c)(1) of the Indian Health Care Improvement Act, and the requirement to use amounts paid from such fund for making improvements in accordance with subsection (b), see subparagraphs (A) and (B) of section 401(c)(1) of such Act. (e) Direct Billing.--For provisions relating to the authority of a Tribal Health Program or an Urban Indian Organization to elect to directly bill for, and receive payment for, health care items and services provided by such Program or Organization for which payment is made under this title, see section 401(d) of the Indian Health Care Improvement Act. (f) Definitions.--In this section, the terms ``Indian Health Program'', ``Indian Tribe'', ``Tribal Health Program'', ``Tribal Organization'', and ``Urban Indian Organization'' have the meanings given those terms in section 4 of the Indian Health Care Improvement Act. * * * * * * * USE OF ENROLLMENT FEES, PREMIUMS, DEDUCTIONS, COST SHARING, AND SIMILAR CHARGES Sec. 1916. (a) Subject to subsections (g) [and (i)], (i), and (j), the State plan shall provide that in the case of individuals described in subparagraph (A) or (E)(i) of section 1902(a)(10) who are eligible under the plan-- (1) * * * * * * * * * * - (j) No Premiums or Cost Sharing for Indians Furnished Items or Services Directly by Indian Health Programs or through Referral under the Contract Health Service.-- (1) No cost sharing for items or services furnished to indians through indian health programs.-- (A) In general.--No enrollment fee, premium, or similar charge, and no deduction, copayment, cost sharing, or similar charge shall be imposed against an Indian who is furnished an item or service directly by the Indian Health Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization or through referral under the contract health service for which payment may be made under this title. (B) No reduction in amount of payment to Indian health providers.--Payment due under this title to the Indian Health Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization, or a health care provider through referral under the contract health service for the furnishing of an item or service to an Indian who is eligible for assistance under such title, may not be reduced by the amount of any enrollment fee, premium, or similar charge, or any deduction, copayment, cost sharing, or similar charge that would be due from the Indian but for the operation of subparagraph (A). (2) Rule of construction.--Nothing in this subsection shall be construed as restricting the application of any other limitations on the imposition of premiums or cost sharing that may apply to an individual receiving medical assistance under this title who is an Indian. (3) Definitions.--In this subsection, the terms ``contract health service'', ``Indian'', ``Indian Tribe'', ``Tribal Organization'', and ``Urban Indian Organization'' have the meanings given those terms in section 4 of the Indian Health Care Improvement Act. STATE OPTION FOR ALTERNATIVE PREMIUMS AND COST SHARING Sec. 1916A. (a) State Flexibility.-- (1) In general.--Notwithstanding sections 1916 and 1902(a)(10)(B), but subject to paragraph (2), a State, at its option and through a State plan amendment, may impose premiums and cost sharing for any group of individuals (as specified by the State) and for any type of services (other than drugs for which cost sharing may be imposed under subsection (c) and non- emergency services furnished in a hospital emergency department for which cost sharing may be imposed under subsection (e)), and may vary such premiums and cost sharing among such groups or types, consistent with the limitations established under this section. Nothing in this section shall be construed as superseding (or preventing the application of) [section 1916(g)] subsections (g), (i), or (j) of section 1916. * * * * * * * LIENS, ADJUSTMENTS AND RECOVERIES, AND TRANSFERS OF ASSETS Sec. 1917. (a) * * * (b)(1) * * * * * * * * * * (3)(A) The State agency shall establish procedures (in accordance with standards specified by the Secretary) under which the agency shall waive the application of this subsection (other than paragraph (1)(C)) if such application would work an undue hardship as determined on the basis of criteria established by the Secretary. (B) The standards specified by the Secretary under subparagraph (A) shall require that the procedures established by the State agency under subparagraph (A) exempt income, resources, and property that are exempt from the application of this subsection as of April 1, 2003, under manual instructions issued to carry out this subsection (as in effect on such date) because of the Federal responsibility for Indian Tribes and Alaska Native Villages. Nothing in this subparagraph shall be construed as preventing the Secretary from providing additional estate recovery exemptions under this title for Indians. * * * * * * * PROVISIONS RELATING TO MANAGED CARE Sec. 1932. (a) * * * * * * * * * * (h) Special Rules With Respect to Indian Enrollees, Indian Health Care Providers, and Indian Managed Care Entities.-- (1) Enrollee option to select an indian health care provider as primary care provider.--In the case of a non-Indian Medicaid managed care entity that-- (A) has an Indian enrolled with the entity; and (B) has an Indian health care provider that is participating as a primary care provider within the network of the entity, insofar as the Indian is otherwise eligible to receive services from such Indian health care provider and the Indian health care provider has the capacity to provide primary care services to such Indian, the contract with the entity under section 1903(m) or under section 1905(t)(3) shall require, as a condition of receiving payment under such contract, that the Indian shall be allowed to choose such Indian health care provider as the Indian's primary care provider under the entity. (2) Assurance of payment to indian health care providers for provision of covered services.--Each contract with a managed care entity under section 1903(m) or under section 1905(t)(3) shall require any such entity that has a significant percentage of Indian enrollees (as determined by the Secretary), as a condition of receiving payment under such contract to satisfy the following requirements: (A) Demonstration of participating indian health care providers or application of alternative payment arrangements.--Subject to subparagraph (E), to-- (i) demonstrate that the number of Indian health care providers that are participating providers with respect to such entity are sufficient to ensure timely access to covered Medicaid managed care services for those enrollees who are eligible to receive services from such providers; or (ii) agree to pay Indian health care providers who are not participating providers with the entity for covered Medicaid managed care services provided to those enrollees who are eligible to receive services from such providers at a rate equal to the rate negotiated between such entity and the provider involved or, if such a rate has not been negotiated, at a rate that is not less than the level and amount of payment which the entity would make for the services if the services were furnished by a participating provider which is not an Indian health care provider. (B) Prompt payment.--To agree to make prompt payment (in accordance with rules applicable to managed care entities) to Indian health care providers that are participating providers with respect to such entity or, in the case of an entity to which subparagraph (A)(ii) or (E) applies, that the entity is required to pay in accordance with that subparagraph. (C) Satisfaction of claim requirement.--To deem any requirement for the submission of a claim or other documentation for services covered under subparagraph (A) by the enrollee to be satisfied through the submission of a claim or other documentation by an Indian health care provider that is consistent with section 403(h) of the Indian Health Care Improvement Act. (D) Compliance with generally applicable requirements.-- (i) In general.--Subject to clause (ii), as a condition of payment under subparagraph (A), an Indian health care provider shall comply with the generally applicable requirements of this title, the State plan, and such entity with respect to covered Medicaid managed care services provided by the Indian health care provider to the same extent that non-Indian providers participating with the entity must comply with such requirements. (ii) Limitations on compliance with managed care entity generally applicable requirements.--An Indian health care provider-- (I) shall not be required to comply with a generally applicable requirement of a managed care entity described in clause (i) as a condition of payment under subparagraph (A) if such compliance would conflict with any other statutory or regulatory requirements applicable to the Indian health care provider; and (II) shall only need to comply with those generally applicable requirements of a managed care entity described in clause (i) as a condition of payment under subparagraph (A) that are necessary for the entity's compliance with the State plan, such as those related to care management, quality assurance, and utilization management. (E) Application of special payment requirements for federally-qualified health centers and encounter rate for services provided by certain indian health care providers.-- (i) Federally-qualified health centers.-- (I) Managed care entity payment requirement.--To agree to pay any Indian health care provider that is a federally- qualified health center but not a participating provider with respect to the entity, for the provision of covered Medicaid managed care services by such provider to an Indian enrollee of the entity at a rate equal to the amount of payment that the entity would pay a federally-qualified health center that is a participating provider with respect to the entity but is not an Indian health care provider for such services. (II) Continued application of state requirement to make supplemental payment.--Nothing in subclause (I) or subparagraph (A) or (B) shall be construed as waiving the application of section 1902(bb)(5) regarding the State plan requirement to make any supplemental payment due under such section to a federally- qualified health center for services furnished by such center to an enrollee of a managed care entity (regardless of whether the federally- qualified health center is or is not a participating provider with the entity). (ii) Continued application of encounter rate for services provided by certain indian health care providers.-- If the amount paid by a managed care entity to an Indian health care provider that is not a federally- qualified health center and that has elected to receive payment under this title as an Indian Health Service provider under the July 11, 1996, Memorandum of Agreement between the Health Care Financing Administration (now the Centers for Medicare & Medicaid Services) and the Indian Health Service for services provided by such provider to an Indian enrollee with the managed care entity is less than the encounter rate that applies to the provision of such services under such memorandum, the State plan shall provide for payment to the Indian health care provider of the difference between the applicable encounter rate under such memorandum and the amount paid by the managed care entity to the provider for such services. (F) Construction.--Nothing in this paragraph shall be construed as waiving the application of section 1902(a)(30)(A) (relating to application of standards to assure that payments are consistent with efficiency, economy, and quality of care). (3) Offering of managed care through indian medicaid managed care entities.--If-- (A) a State elects to provide services through Medicaid managed care entities under its Medicaid managed care program; and (B) an Indian health care provider that is funded in whole or in part by the Indian Health Service, or a consortium composed of 1 or more Tribes, Tribal Organizations, or Urban Indian Organizations, and which also may include the Indian Health Service, has established an Indian Medicaid managed care entity in the State that meets generally applicable standards required of such an entity under such Medicaid managed care program, the State shall offer to enter into an agreement with the entity to serve as a Medicaid managed care entity with respect to eligible Indians served by such entity under such program. (4) Special rules for indian managed care entities.-- The following are special rules regarding the application of a Medicaid managed care program to Indian Medicaid managed care entities: (A) Enrollment.-- (i) Limitation to indians.--An Indian Medicaid managed care entity may restrict enrollment under such program to Indians and to members of specific Tribes in the same manner as Indian Health Programs may restrict the delivery of services to such Indians and tribal members. (ii) No less choice of plans.--Under such program the State may not limit the choice of an Indian among Medicaid managed care entities only to Indian Medicaid managed care entities or to be more restrictive than the choice of managed care entities offered to individuals who are not Indians. (iii) Default enrollment.-- (I) In general.--If such program of a State requires the enrollment of Indians in a Medicaid managed care entity in order to receive benefits, the State, taking into consideration the criteria specified in subsection (a)(4)(D)(ii)(I), shall provide for the enrollment of Indians described in subclause (II) who are not otherwise enrolled with such an entity in an Indian Medicaid managed care entity described in such clause. (II) Indian described.--An Indian described in this subclause, with respect to an Indian Medicaid managed care entity, is an Indian who, based upon the service area and capacity of the entity, is eligible to be enrolled with the entity consistent with subparagraph (A). (iv) Exception to state lock-in.--A request by an Indian who is enrolled under such program with a non-Indian Medicaid managed care entity to change enrollment with that entity to enrollment with an Indian Medicaid managed care entity shall be considered cause for granting such request under procedures specified by the Secretary. (B) Flexibility in application of solvency.-- In applying section 1903(m)(1) to an Indian Medicaid managed care entity-- (i) any reference to a ``State'' in subparagraph (A)(ii) of that section shall be deemed to be a reference to the ``Secretary''; and (ii) the entity shall be deemed to be a public entity described in subparagraph (C)(ii) of that section. (C) Exceptions to advance directives.--The Secretary may modify or waive the requirements of section 1902(w) (relating to provision of written materials on advance directives) insofar as the Secretary finds that the requirements otherwise imposed are not an appropriate or effective way of communicating the information to Indians. (D) Flexibility in information and marketing.-- (i) Materials.--The Secretary may modify requirements under subsection (a)(5) to ensure that information described in that subsection is provided to enrollees and potential enrollees of Indian Medicaid managed care entities in a culturally appropriate and understandable manner that clearly communicates to such enrollees and potential enrollees their rights, protections, and benefits. (ii) Distribution of marketing materials.--The provisions of subsection (d)(2)(B) requiring the distribution of marketing materials to an entire service area shall be deemed satisfied in the case of an Indian Medicaid managed care entity that distributes appropriate materials only to those Indians who are potentially eligible to enroll with the entity in the service area. (5) Malpractice insurance.--Insofar as, under a Medicaid managed care program, a health care provider is required to have medical malpractice insurance coverage as a condition of contracting as a provider with a Medicaid managed care entity, an Indian health care provider that is-- (A) a federally-qualified health center that is covered under the Federal Tort Claims Act (28 U.S.C. 1346(b), 2671 et seq.); (B) providing health care services pursuant to a contract or compact under the Indian Self- Determination and Education Assistance Act (25 U.S.C. 450 et seq.) that are covered under the Federal Tort Claims Act (28 U.S.C. 1346(b), 2671 et seq.); or (C) the Indian Health Service providing health care services that are covered under the Federal Tort Claims Act (28 U.S.C. 1346(b), 2671 et seq.); are deemed to satisfy such requirement. (6) Definitions.--For purposes of this subsection: (A) Indian health care provider.--The term ``Indian health care provider'' means an Indian Health Program or an Urban Indian Organization. (B) Indian; indian health program; service; tribe; tribal organization; urban indian organization.--The terms ``Indian'', ``Indian Health Program'', ``Service'', ``Tribe'', ``tribal organization'', ``Urban Indian Organization'' have the meanings given such terms in section 4 of the Indian Health Care Improvement Act. (C) Indian medicaid managed care entity.--The term ``Indian Medicaid managed care entity'' means a managed care entity that is controlled (within the meaning of the last sentence of section 1903(m)(1)(C)) by the Indian Health Service, a Tribe, Tribal Organization, or Urban Indian Organization, or a consortium, which may be composed of 1 or more Tribes, Tribal Organizations, or Urban Indian Organizations, and which also may include the Service. (D) Non-indian medicaid managed care entity.--The term ``non-Indian Medicaid managed care entity'' means a managed care entity that is not an Indian Medicaid managed care entity. (E) Covered medicaid managed care services.-- The term ``covered Medicaid managed care services'' means, with respect to an individual enrolled with a managed care entity, items and services that are within the scope of items and services for which benefits are available with respect to the individual under the contract between the entity and the State involved. (F) Medicaid managed care program.--The term ``Medicaid managed care program'' means a program under sections 1903(m) and 1932 and includes a managed care program operating under a waiver under section 1915(b) or 1115 or otherwise. * * * * * * * TITLE XXI--STATE CHILDREN'S HEALTH INSURANCE PROGRAM * * * * * * * SEC. 2102. GENERAL CONTENTS OF STATE CHILD HEALTH PLAN; ELIGIBILITY; OUTREACH. (a) * * * (b) General Description of Eligibility Standards and Methodology.-- (1) * * * * * * * * * * (3) Eligibility screening; coordination with other health coverage programs.--The plan shall include a description of procedures to be used to ensure-- (A) * * * * * * * * * * (D) the provision of child health assistance to targeted low-income children in the State who are Indians [(as defined in section 4(c) of the Indian Health Care Improvement Act, 25 U.S.C. 1603(c))], including how the State will ensure that payments are made to Indian Health Programs and Urban Indian Organizations operating in the State for the provision of such assistance; and * * * * * * * SEC. 2105. PAYMENTS TO STATES. (a) * * * * * * * * * * (c) Limitation on Certain Payments for Certain Expenditures.-- (1) * * * (2) Limitation on expenditures not used for medicaid or health insurance assistance.-- (A) * * * * * * * * * * (C) Nonapplication to expenditures for outreach to increase the enrollment of indian children under this title and title xix.--The limitation under subparagraph (A) on expenditures for items described in subsection (a)(1)(D) shall not apply in the case of expenditures for outreach activities to families of Indian children likely to be eligible for child health assistance under the plan or medical assistance under the State plan under title XIX (or under a waiver of such plan), to inform such families of the availability of, and to assist them in enrolling their children in, such plans, including such activities conducted under grants, contracts, or agreements entered into under section 1139(a). * * * * * * * (6) Prevention of duplicative payments.-- (A) * * * (B) Other federal governmental programs.-- Except as provided in subparagraph (A) or (B) of subsection (a)(1) or any other provision of law, no payment shall be made to a State under this section for expenditures for child health assistance provided for a targeted low-income child under its plan to the extent that payment has been made or can reasonably be expected to be made promptly (as determined in accordance with regulations) under any other federally operated or financed health care [insurance program, other than an insurance program operated or financed by the Indian Health Service] program, other than a health care program operated or financed by the Indian Health Service or by an Indian Tribe, Tribal Organization, or Urban Indian Organization, as identified by the Secretary. For purposes of this paragraph, rules similar to the rules for overpayments under section 1903(d)(2) shall apply. * * * * * * * SEC. 2107. STRATEGIC OBJECTIVES AND PERFORMANCE GOALS; PLAN ADMINISTRATION. (a) * * * * * * * * * * (e) Application of Certain General Provisions.--The following sections of this Act shall apply to States under this title in the same manner as they apply to a State under title XIX: (1) Title xix provisions.-- (A) * * * (B) Section 1902(a)(71) (relating to the option of certain States to seek advice from designees of Indian Health Programs and Urban Indian Organizations). (C) Section 1902(e)(13) (relating to disregard of certain property for purposes of making eligibility determinations). [(B)] (D) Paragraphs (2), (16), and (17) of section 1903(i) (relating to limitations on payment). [(C)] (E) Section 1903(w) (relating to limitations on provider taxes and donations). (F) Section 1911 (relating to Indian Health Programs, other than subsection (d) of such section). [(D)] (G) Section 1920A (relating to presumptive eligibility for children). (H) Subsections (a)(2)(C) and (h) of section 1932. * * * * * * * SEC. 2110. DEFINITIONS. (a) * * * * * * * * * * (c) Additional Definitions.--For purposes of this title: (1) * * * * * * * * * * (9) Indian; indian health program; indian tribe; etc.--The terms ``Indian'', ``Indian Health Program'', ``Indian Tribe'', ``Tribal Organization'', and ``Urban Indian Organization'' have the meanings given those terms in section 4 of the Indian Health Care Improvement Act. * * * * * * * <all>