[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 1200 Referred in House (RFH)]
110th CONGRESS
2d Session
S. 1200
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 28, 2008
Referred to the Committee on Natural Resources, and in addition to the
Committee on Energy and Commerce and Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
AN ACT
To amend the Indian Health Care Improvement Act to revise and extend
that Act.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Indian Health Care
Improvement Act Amendments of 2008''.
(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.
Sec. 104. Modification of term.
Sec. 105. GAO study and report on payments for contract health
services.
Sec. 106. GAO study of membership criteria for federally recognized
Indian tribes.
Sec. 107. GAO study of tribal justice systems.
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. 210. Development of recommendations to improve interstate
coordination of Medicaid and SCHIP coverage
of Indian children and other children who
are outside of their State of residency
because of educational or other needs.
Sec. 211. Establishment of National Child Welfare Resource Center for
Tribes.
Sec. 212. Adjustment to the Medicare Advantage stabilization fund.
Sec. 213. Moratorium on implementation of changes to case management
and targeted case management payment
requirements under Medicaid.
Sec. 214. Increased civil money penalties and criminal fines for
Medicare fraud and abuse.
Sec. 215. Increased sentences for felonies involving Medicare fraud and
abuse.
TITLE III--MISCELLANEOUS
Sec. 301. Resolution of apology to Native Peoples of United States.
TITLE I--AMENDMENTS TO INDIAN LAWS
SEC. 101. INDIAN HEALTH CARE IMPROVEMENT ACT AMENDED.
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. Other authority for provision of services.
``Sec. 214. Indian women's health care.
``Sec. 215. Environmental and nuclear health hazards.
``Sec. 216. Arizona as a contract health service delivery area.
``Sec. 216A. North Dakota and South Dakota as a contract health service
delivery area.
``Sec. 217. California contract health services program.
``Sec. 218. California as a contract health service delivery area.
``Sec. 219. Contract health services for the Trenton service area.
``Sec. 220. Programs operated by Indian Tribes and Tribal
Organizations.
``Sec. 221. Licensing.
``Sec. 222. Notification of provision of emergency contract health
services.
``Sec. 223. Prompt action on payment of claims.
``Sec. 224. Liability for payment.
``Sec. 225. Office of Indian Men's Health.
``Sec. 226. 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 projects.
``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. Eligible Indian veteran services.
``Sec. 408. Payor of last resort.
``Sec. 409. Nondiscrimination under Federal health care programs in
qualifications for reimbursement for
services.
``Sec. 410. Consultation.
``Sec. 411. State Children's Health Insurance Program (SCHIP).
``Sec. 412. Exclusion waiver authority for affected Indian Health
Programs and safe harbor transactions under
the Social Security Act.
``Sec. 413. Premium and cost sharing protections and eligibility
determinations under Medicaid and SCHIP and
protection of certain Indian property from
Medicaid estate recovery.
``Sec. 414. Treatment under Medicaid and SCHIP managed care.
``Sec. 415. Navajo Nation Medicaid Agency feasibility study.
``Sec. 416. General exceptions.
``Sec. 417. 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. Conferring 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 spectrum disorders programs.
``Sec. 713. Child sexual abuse and prevention treatment programs.
``Sec. 714. Domestic and sexual violence prevention and treatment.
``Sec. 715. Testimony by service employees in cases of rape and sexual
assault.
``Sec. 716. Behavioral health research.
``Sec. 717. Definitions.
``Sec. 718. 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 relating to abortion.
``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. Tribal employment.
``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. Sense of Congress regarding law enforcement and
methamphetamine issues in Indian Country.
``Sec. 816. Tribal Health Program option for cost sharing.
``Sec. 817. Testing for sexually transmitted diseases in cases of
sexual violence.
``Sec. 818. Study on tobacco-related disease and disproportionate
health effects on tribal populations.
``Sec. 819. Appropriations; availability.
``Sec. 820. GAO report on coordination of services.
``Sec. 821. 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 resources, processes, and structure that will
enable Indian Tribes and tribal members to obtain the quantity
and quality of health care services and opportunities that will
eradicate the health disparities between Indians and the
general population of the United States.
``(3) 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.
``(4) 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.
``(5) 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 ensure maximum Indian participation in the
direction of health care services so as to render the persons
administering such services and the services themselves more
responsive to the needs and desires of Indian communities;
``(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 that all actions under this Act shall be
carried out with active and meaningful consultation with Indian
Tribes and Tribal Organizations, and conference with Urban
Indian Organizations, to implement this Act and the national
policy of Indian self-determination;
``(6) to ensure that the United States and Indian Tribes
work in a government-to-government relationship to ensure
quality health care for all tribal members; and
``(7) 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)(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.
``(4) The term `California Indians' means those Indians who
are eligible for health services of the Service pursuant to
section 806.
``(5) The term `community college' means--
``(A) a tribal college or university, or
``(B) a junior or community college.
``(6) 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.
``(7) The term `Department' means, unless otherwise
designated, the Department of Health and Human Services.
``(8) The term `Director' means the Director of the
Service.
``(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, 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 spectrum
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) 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 Director 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 2008 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, or Tribal
Organizations, or confer with the affected 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, in the case of nurses, to
obtain training and certification as sexual assault nurse examiners,
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, refresher
training courses, and, in the case of nurses, additional
clinical sexual assault nurse examiner experience to maintain
competency or certification.
``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.
``(e) Effective Date.--This section takes effect on October 1,
2009.
``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 2008, 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.
``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.
``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 2008, 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 and Tribal Organizations (without regard to the funding
source).
``(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 or Tribal
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 2008, 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 spectrum disorders) among Indians.
``(G) Injury prevention programs, including
training.
``(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 2008, 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 2008, 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 2008 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 enactment of the Indian Health Care Improvement Act Amendments of
2008 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
communities, each Service Area epidemiology center established under
this section 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 communities 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 communities 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 section.
``(d) Grants for Studies.--
``(1) In general.--The Secretary may make grants to Indian
Tribes, Tribal Organizations, Indian organizations, and
eligible intertribal consortia to conduct epidemiological
studies of Indian communities.
``(2) Eligible intertribal consortia.--An intertribal
consortium or Indian organization 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.--The Secretary shall grant
epidemiology centers operated by a grantee pursuant to a grant awarded
under subsection (d) access to use of the data, data sets, monitoring
systems, delivery systems, and other protected health information in
the possession of the Secretary. Such activities shall be for the
purposes of research and for preventing and controlling disease,
injury, or disability for purposes of the Health Insurance Portability
and Accountability Act of 1996 (Public Law 104-191; 110 Stat. 2033), as
such activities are described in part 164.512 of title 45, Code of
Federal regulations (or a successor regulation).
``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 and Tribal 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 and Tribal 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 and Tribal 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 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 and Tribal 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 or Tribal
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 and Tribal Organizations,
and in conference with 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 and Tribal
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 and Tribal
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 or Tribal
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. OTHER AUTHORITY FOR PROVISION OF 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 of this
Act through health care-related services and programs not otherwise
described in this Act for the following services:
``(1) Hospice care.
``(2) Assisted living services.
``(3) Long-term care services.
``(4) Home- and community-based services.
``(b) Eligibility.--The following individuals shall be eligible to
receive long-term care under this section:
``(1) Individuals who are unable to perform a certain
number of activities of daily living without assistance.
``(2) 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.
``(3) 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 `assisted living services' means any service
provided by an assisted living facility (as defined in section
232(b) of the National Housing Act (12 U.S.C. 1715w(b))),
except that such an assisted living facility--
``(A) shall not be required to obtain a license;
but
``(B) shall meet all applicable standards for
licensure.
``(2) 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
applicable standards.
``(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)), and such other services which an Indian Tribe or
Tribal Organization determines are necessary and appropriate to
provide in furtherance of this care.
``(4) The term `long-term care services' has the meaning
given the term `qualified long-term care services' in section
7702B(c) of the Internal Revenue Code of 1986.
``(d) Authorization of Convenient Care Services.--The Secretary,
acting through the Service, Indian Tribes, and Tribal Organizations,
may also provide funding under this Act to meet the objectives set
forth in section 3 of this Act for convenient care services programs
pursuant to section 306(c)(2)(A).
``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 sources 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 2008 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 2008. 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.
``(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. 216A. NORTH DAKOTA AND SOUTH DAKOTA AS A 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. 217. CALIFORNIA CONTRACT HEALTH SERVICES PROGRAM.
``(a) Funding Authorized.--The Secretary is authorized to fund a
program using the California Rural Indian Health Board (hereafter in
this section referred to as the `CRIHB') as a contract care
intermediary to improve the accessibility of health services to
California Indians.
``(b) Reimbursement Contract.--The Secretary shall enter into an
agreement with the CRIHB to reimburse the CRIHB for costs (including
reasonable administrative costs) incurred pursuant to this section, in
providing medical treatment under contract to California Indians
described in section 806(a) throughout the California contract health
services delivery area described in section 218 with respect to high
cost contract care cases.
``(c) Administrative Expenses.--Not more than 5 percent of the
amounts provided to the CRIHB under this section for any fiscal year
may be for reimbursement for administrative expenses incurred by the
CRIHB during such fiscal year.
``(d) Limitation on Payment.--No payment may be made for treatment
provided hereunder to the extent payment may be made for such treatment
under the Indian Catastrophic Health Emergency Fund described in
section 202 or from amounts appropriated or otherwise made available to
the California contract health service delivery area for a fiscal year.
``(e) Advisory Board.--There is 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. 218. CALIFORNIA AS A CONTRACT HEALTH SERVICE DELIVERY AREA.
``The State of California, excluding the counties of Alameda,
Contra Costa, Los Angeles, Marin, Orange, Sacramento, San Francisco,
San Mateo, Santa Clara, Kern, Merced, Monterey, Napa, San Benito, San
Joaquin, San Luis Obispo, Santa Cruz, Solano, Stanislaus, and Ventura,
shall be designated as a contract health service delivery area by the
Service for the purpose of providing contract health services to
California Indians. However, any of the counties listed herein may only
be included in the contract health services delivery area if funding is
specifically provided by the Service for such services in those
counties.
``SEC. 219. CONTRACT HEALTH SERVICES FOR THE TRENTON SERVICE AREA.
``(a) Authorization for Services.--The Secretary, acting through
the Service, is directed to provide contract health services to members
of the Turtle Mountain Band of Chippewa Indians that reside in the
Trenton Service Area of Divide, McKenzie, and Williams counties in the
State of North Dakota and the adjoining counties of Richland,
Roosevelt, and Sheridan in the State of Montana.
``(b) No Expansion of Eligibility.--Nothing in this section may be
construed as expanding the eligibility of members of the Turtle
Mountain Band of Chippewa Indians for health services provided by the
Service beyond the scope of eligibility for such health services that
applied on May 1, 1986.
``SEC. 220. PROGRAMS OPERATED BY INDIAN TRIBES AND TRIBAL
ORGANIZATIONS.
``The Service shall provide funds for health care programs and
facilities operated by Tribal Health Programs on the same basis as such
funds are provided to programs and facilities operated directly by the
Service.
``SEC. 221. LICENSING.
``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. 222. NOTIFICATION OF PROVISION OF EMERGENCY CONTRACT HEALTH
SERVICES.
``With respect to an elderly Indian or an Indian with a disability
receiving emergency medical care or services from a non-Service
provider or in a non-Service facility under the authority of this Act,
the time limitation (as a condition of payment) for notifying the
Service of such treatment or admission shall be 30 days.
``SEC. 223. PROMPT ACTION ON PAYMENT OF CLAIMS.
``(a) Deadline for Response.--The Service shall respond to a
notification of a claim by a provider of a contract care service with
either an individual purchase order or a denial of the claim within 5
working days after the receipt of such notification.
``(b) Effect of Untimely Response.--If the Service fails to respond
to a notification of a claim in accordance with subsection (a), the
Service shall accept as valid the claim submitted by the provider of a
contract care service.
``(c) Deadline for Payment of Valid Claim.--The Service shall pay a
valid contract care service claim within 30 days after the completion
of the claim.
``SEC. 224. LIABILITY FOR PAYMENT.
``(a) No Patient Liability.--A patient who receives contract health
care services that are authorized by the Service shall not be liable
for the payment of any charges or costs associated with the provision
of such services.
``(b) Notification.--The Secretary shall notify a contract care
provider and any patient who receives contract health care services
authorized by the Service that such patient is not liable for the
payment of any charges or costs associated with the provision of such
services not later than 5 business days after receipt of a notification
of a claim by a provider of contract care services.
``(c) No Recourse.--Following receipt of the notice provided under
subsection (b), or, if a claim has been deemed accepted under section
223(b), the provider shall have no further recourse against the patient
who received the services.
``SEC. 225. 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 2008, 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. 226. 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 and Reductions in Hours of Service.--
``(1) Evaluation required.--Notwithstanding any other
provision of law, no facility operated by the Service, or any
portion of such facility, may be closed or have the hours of
service of the facility reduced 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 or reduction in
hours of service an evaluation, completed not more than 2 years
before the submission, of the impact of the proposed closure or
reduction in hours of service 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 or
reduction in hours of service;
``(C) the quality of health care to be provided to
the population served by such facility after such
closure or reduction in hours of service;
``(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 or reduction in hours
of service;
``(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 and
reductions.--Paragraph (1) shall not apply to any temporary
closure or reduction in hours of service of a facility or any
portion of a facility if such closure or reduction in hours of
service 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 health care
facilities, and such renovation or expansion
needs of any health care facility, as the
Service 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 2008 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
Director--
``(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 Director--
``(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 2008, 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, and staff quarters, 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); and
``(IV) the 10 top-priority staff
quarters developments 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 and
Tribal Organizations; and
``(B) review the total unmet needs of all Indian
Tribes and Tribal Organizations for health care
facilities (including 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 section 102 of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450f) or sections 504 and 505 of
that Act (25 U.S.C. 458aaa-3, 458aaa-4).
``(f) Development of Innovative Approaches.--The Secretary shall
consult and cooperate with Indian Tribes and Tribal Organizations, and
confer with Urban Indian Organizations, in developing innovative
approaches to address all or part of the total unmet need for
construction of health facilities, that may include--
``(1) the establishment of an area distribution fund in
which a portion of health facility construction funding could
be devoted to all Service Areas;
``(2) approaches provided for in other provisions of this
title; and
``(3) other approaches, as the Secretary determines to be
appropriate.
``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) the Secretary is authorized to establish a program
under which the Secretary may, in accordance with this
subsection and with paragraphs (2), (3), (4), and (5) of
section 330(d) of the Public Health Service Act (42 U.S.C.
254b(d)) related to a loan guarantee program, guarantee the
principal and interest on loans made by lenders to Indian
Tribes for new projects to construct eligible sanitation
facilities to serve Indian homes, but only to the extent that
appropriations are provided in advance specifically for such
program, and without reducing funds made available for the
provision of domestic and community sanitation facilities for
Indians, as authorized by section 7 of the Act of August 5,
1954 (42 U.S.C. 2004a), the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.), and this Act;
``(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) Discretionary Authority; Covered Activities.--The Secretary,
acting through the Service, may utilize the negotiating authority of
section 23 of the Act of June 25, 1910 (25 U.S.C. 47), to give
preference to any Indian or any enterprise, partnership, corporation,
or other type of business organization owned and controlled by an
Indian or Indians including former or currently federally recognized
Indian Tribes in the State of New York (hereinafter referred to as an
`Indian firm') in the construction and renovation of Service facilities
pursuant to section 301 and in the construction of safe water and
sanitary waste disposal facilities pursuant to section 302. Such
preference may be accorded by the Secretary unless the Secretary finds,
pursuant to rules and regulations promulgated by the Secretary, that
the project or function to be contracted for will not be satisfactory
or that the 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) Pay Rates.--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 sections 3141
through 3144, 3146, and 3147 of title 40, United States Code.
``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
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 PROJECTS.
``(a) In General.--The Secretary, acting through the Service, is
authorized to carry out, or to enter into construction agreements under
the Indian Self-Determination and Education Assistance Act (25 U.S.C.
450 et seq.) with Indian Tribes or Tribal Organizations to carry 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 construction agreements 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) Health Care Demonstration Projects.--
``(1) General projects.--
``(A) Criteria.--The Secretary may approve under
this section demonstration projects that meet the
following criteria:
``(i) There is a need for a new facility or
program, such as a program for convenient care
services, or the reorientation of an existing
facility or program.
``(ii) A significant number of Indians,
including Indians with low health status, will
be served by the project.
``(iii) The project has the potential to
deliver services in an efficient and effective
manner.
``(iv) The project is economically viable.
``(v) For projects carried out by an Indian
Tribe or Tribal Organization, the Indian Tribe
or Tribal Organization has the administrative
and financial capability to administer the
project.
``(vi) The project is integrated with
providers of related health and social services
and is coordinated with, and avoids duplication
of, existing services in order to expand the
availability of services.
``(B) Priority.--In approving demonstration
projects under this paragraph, the Secretary shall give
priority to demonstration projects, to the extent the
projects meet the criteria described in subparagraph
(A), located in any of the following Service Units:
``(i) Cass Lake, Minnesota.
``(ii) Mescalero, New Mexico.
``(iii) Owyhee, Nevada.
``(iv) Schurz, Nevada.
``(v) Ft. Yuma, California.
``(2) Convenient care service projects.--
``(A) Definition of convenient care service.--In
this paragraph, the term `convenient care service'
means any primary health care service, such as urgent
care services, nonemergent care services, prevention
services and screenings, and any service authorized by
sections 203 or 213(d), that is--
``(i) provided outside the regular hours of
operation of a health care facility; or
``(ii) offered at an alternative setting,
including through telehealth.
``(B) Approval.--In addition to projects described
in paragraph (1), in any fiscal year, the Secretary is
authorized to approve not more than 10 applications for
health care delivery demonstration projects that--
``(i) include a convenient care services
program as an alternative means of delivering
health care services to Indians; and
``(ii) meet the criteria described in
subparagraph (C).
``(C) Criteria.--The Secretary shall approve under
subparagraph (B) demonstration projects that meet all
of the following criteria:
``(i) The criteria set forth in paragraph
(1)(A).
``(ii) There is a lack of access to health
care services at existing health care
facilities, which may be due to limited hours
of operation at those facilities or other
factors.
``(iii) The project--
``(I) expands the availability of
services; or
``(II) reduces--
``(aa) the burden on
Contract Health Services; or
``(bb) the need for
emergency room visits.
``(d) Peer Review Panels.--The Secretary may provide for the
establishment of peer review panels, as necessary, to review and
evaluate applications using the criteria described in paragraphs (1)(A)
and (2)(C) of subsection (c).
``(e) Technical Assistance.--The Secretary shall provide such
technical and other assistance as may be necessary to enable applicants
to comply with this section.
``(f) 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 that section, in any demonstration project approved
pursuant to this section.
``(g) Equitable Treatment.--For purposes of subsection (c), the
Secretary, 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.), shall use the same criteria that the
Secretary uses in evaluating facilities operated directly by the
Service.
``(h) Equitable Integration of Facilities.--The Secretary shall
ensure that the planning, design, construction, renovation, and
expansion needs of Service and non-Service facilities that 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; and
``(4) 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 417,
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,
including programs to provide outreach and enrollment through video,
electronic delivery methods, or telecommunication devices that allow
real-time or time-delayed communication between individual Indians and
the benefit program, 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 develop and disseminate
best practices that will serve 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 2008 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;
``(4) a self-insured plan; or
``(5) a high deductible or health savings account 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. ELIGIBLE INDIAN VETERAN SERVICES.
``(a) Findings; Purpose.--
``(1) Findings.--Congress finds that--
``(A) collaborations between the Secretary and the
Secretary of Veterans Affairs regarding the treatment
of Indian veterans at facilities of the Service should
be encouraged to the maximum extent practicable; and
``(B) increased enrollment for services of the
Department of Veterans Affairs by veterans who are
members of Indian tribes should be encouraged to the
maximum extent practicable.
``(2) Purpose.--The purpose of this section is to reaffirm
the goals stated in the document entitled `Memorandum of
Understanding Between the VA/Veterans Health Administration And
HHS/Indian Health Service' and dated February 25, 2003
(relating to cooperation and resource sharing between the
Veterans Health Administration and Service).
``(b) Definitions.--In this section:
``(1) Eligible indian veteran.--The term `eligible Indian
veteran' means an Indian or Alaska Native veteran who receives
any medical service that is--
``(A) authorized under the laws administered by the
Secretary of Veterans Affairs; and
``(B) administered at a facility of the Service
(including a facility operated by an Indian tribe or
tribal organization through a contract or compact with
the Service under the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.))
pursuant to a local memorandum of understanding.
``(2) Local memorandum of understanding.--The term `local
memorandum of understanding' means a memorandum of
understanding between the Secretary (or a designee, including
the director of any Area Office of the Service) and the
Secretary of Veterans Affairs (or a designee) to implement the
document entitled `Memorandum of Understanding Between the VA/
Veterans Health Administration And HHS/Indian Health Service'
and dated February 25, 2003 (relating to cooperation and
resource sharing between the Veterans Health Administration and
Indian Health Service).
``(c) Eligible Indian Veterans' Expenses.--
``(1) In general.--Notwithstanding any other provision of
law, the Secretary shall provide for veteran-related expenses
incurred by eligible Indian veterans as described in subsection
(b)(1)(B).
``(2) Method of payment.--The Secretary shall establish
such guidelines as the Secretary determines to be appropriate
regarding the method of payments to the Secretary of Veterans
Affairs under paragraph (1).
``(d) Tribal Approval of Memoranda.--In negotiating a local
memorandum of understanding with the Secretary of Veterans Affairs
regarding the provision of services to eligible Indian veterans, the
Secretary shall consult with each Indian tribe that would be affected
by the local memorandum of understanding.
``(e) Funding.--
``(1) Treatment.--Expenses incurred by the Secretary in
carrying out subsection (c)(1) shall not be considered to be
Contract Health Service expenses.
``(2) Use of funds.--Of funds made available to the
Secretary in appropriations Acts for the Service (excluding
funds made available for facilities, Contract Health Services,
or contract support costs), the Secretary shall use such sums
as are necessary to carry out this section.
``SEC. 408. 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. 409. 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. 410. 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. 411. 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. 412. 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. 413. 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. 414. 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. 415. 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 2008, 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. 416. 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. 417. 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 2008, the Secretary,
acting through the Service and working with a national
membership-based consortium of Urban Indian
Organizations, 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,
including unmet health care facilities needs.
``(B) Consultation and contracts.--In preparing the
report under paragraph (1), the Secretary--
``(i) shall confer 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 working with a national membership-based
consortium of 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,
including fetal alcohol spectrum disorders, 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 to, 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. CONFERRING WITH URBAN INDIAN ORGANIZATIONS.
``(a) In General.--The Secretary shall ensure that the Service
confers or conferences, to the greatest extent practicable, with Urban
Indian Organizations.
``(b) Definition of Confer; Conference.--In this section, the terms
`confer' and `conference' mean an open and free exchange of information
and opinions that--
``(1) leads to mutual understanding and comprehension; and
``(2) emphasizes trust, respect, and shared responsibility.
``SEC. 515. URBAN YOUTH TREATMENT CENTER DEMONSTRATION.
``(a) Construction and Operation.--
``(1) In general.--The Secretary, acting through the
Service, through grant or contract, shall fund the construction
and operation of at least 1 residential treatment center in
each Service Area that meets the eligibility requirements set
forth in subsection (b) to demonstrate the provision of alcohol
and substance abuse treatment services to Urban Indian youth in
a culturally competent residential setting.
``(2) Treatment.--Each residential treatment center
described in paragraph (1) shall be in addition to any
facilities constructed under section 707(b).
``(b) Eligibility Requirements.--To be eligible to obtain a
facility under subsection (a)(1), a Service Area shall meet the
following requirements:
``(1) There is an Urban Indian Organization in the Service
Area.
``(2) There reside in the Service Area Urban Indian youth
with need for alcohol and substance abuse treatment services in
a residential setting.
``(3) There is a significant shortage of culturally
competent residential treatment services for Urban Indian youth
in the Service Area.
``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 2008 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) Director.--The 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 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, 2008, the term of service of
the Director shall be 4 years. A Director 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 2008
shall serve as Director.
``(4) Advocacy and consultation.--The position of Director
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 Director shall--
``(1) perform all functions that were, on the day before
the date of enactment of the Indian Health Care Improvement Act
Amendments of 2008, 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) directly advise the Secretary concerning the
development of 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
Director, shall have the authority--
``(A) except to the extent provided for in
paragraph (2), to appoint and compensate employees for
the Service in accordance with title 5, United States
Code;
``(B) to enter into contracts for the procurement
of goods and services to carry out the functions of the
Service; and
``(C) to manage, expend, and obligate all funds
appropriated for the Service.
``(2) Personnel actions.--Notwithstanding any other
provision of law, the provisions of section 12 of the Act of
June 18, 1934 (48 Stat. 986; 25 U.S.C. 472), shall apply to all
personnel actions taken with respect to new positions created
within the Service as a result of its establishment under
subsection (a).
``SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM.
``(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 Director, 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 and Tribal 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, and Tribal Organizations, shall
encourage Indian Tribes and Tribal Organizations to develop
tribal plans and 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, and Tribal Organizations
to meet their responsibilities under the plans.
``(2) Coordination with national clearinghouses and
information centers.--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, and Service
Areas relating to behavioral health. The Secretary shall ensure
access to these plans and outcomes by any Indian Tribe, Tribal
Organization, or the Service.
``(3) Technical assistance.--The Secretary shall provide
technical assistance to Indian Tribes and Tribal Organizations
in preparation of plans under this section and in developing
standards of care that may be used and adopted locally.
``(c) Programs.--The Secretary, acting through the Service, Indian
Tribes, and Tribal Organizations, shall provide, to the extent feasible
and if funding is available, programs including the following:
``(1) Comprehensive care.--A comprehensive continuum of
behavioral health care which provides--
``(A) community-based prevention, intervention,
outpatient, and behavioral health aftercare;
``(B) detoxification (social and medical);
``(C) acute hospitalization;
``(D) intensive outpatient/day treatment;
``(E) residential treatment;
``(F) transitional living for those needing a
temporary, stable living environment that is supportive
of treatment and recovery goals;
``(G) emergency shelter;
``(H) intensive case management;
``(I) diagnostic services; and
``(J) promotion of healthy approaches to risk and
safety issues, including injury prevention.
``(2) Child care.--Behavioral health services for Indians
from birth through age 17, including--
``(A) preschool and school age fetal alcohol
spectrum 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;
and
``(F) 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 a
fetal alcohol-exposed pregnancy; 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 or Tribal 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 or Tribal Organization, the Bureau of Indian Affairs and
the Service shall cooperate with and provide technical
assistance to the Indian Tribe or Tribal Organization in the
development 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, and Tribal 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 2008, 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 2008,
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 spectrum 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) Allocation 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, and Tribal 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 2008, 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 spectrum 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 SPECTRUM DISORDERS 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 spectrum disorders 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 spectrum 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 spectrum
disorders-affected Indians and their families
or caretakers.
``(iv) To develop and implement counseling
and support programs in schools for fetal
alcohol spectrum disorders-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 spectrum disorders.
``(vii) To develop and implement, in
consultation with Indian Tribes and Tribal
Organizations, and in conference with Urban
Indian Organizations, culturally sensitive
assessment and diagnostic tools including
dysmorphology clinics and multidisciplinary
fetal alcohol spectrum disorders 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 spectrum disorders 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 spectrum disorders.
``(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, Indian
Tribes, and Tribal Organizations, shall--
``(1) develop and provide services for the prevention,
intervention, treatment, and aftercare for those affected by
fetal alcohol spectrum disorders 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 spectrum disorders.
``(c) Task Force.--The Secretary shall establish a task force to be
known as the Fetal Alcohol Spectrum Disorders 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 communities.
``(14) Indian fetal alcohol spectrum disorders 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 spectrum disorders.
``(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 PREVENTION AND 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 victims of sexual abuse
who are Indian children or children in 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. DOMESTIC AND SEXUAL VIOLENCE PREVENTION AND TREATMENT.
``(a) In General.--The Secretary, in accordance with section 701,
is authorized to establish in each Service Area programs involving the
prevention and treatment of--
``(1) Indian victims of domestic violence or sexual abuse;
and
``(2) perpetrators of domestic violence or sexual abuse who
are Indian or members of an Indian household.
``(b) Use of Funds.--Funds made available to carry out this section
shall be used--
``(1) to develop and implement prevention programs and
community education programs relating to domestic violence and
sexual abuse;
``(2) to provide behavioral health services, including
victim support services, and medical treatment (including
examinations performed by sexual assault nurse examiners) to
Indian victims of domestic violence or sexual abuse;
``(3) to purchase rape kits,
``(4) to develop prevention and intervention models, which
may incorporate traditional health care practices; and
``(5) to identify and provide behavioral health treatment
to perpetrators who are Indian or members of an Indian
household.
``(c) Training and Certification.--
``(1) In general.--Not later than 1 year after the date of
enactment of the Indian Health Care Improvement Act Amendments
of 2008, the Secretary shall establish appropriate protocols,
policies, procedures, standards of practice, and, if not
available elsewhere, training curricula and training and
certification requirements for services for victims of domestic
violence and sexual abuse.
``(2) Report.--Not later than 18 months after the date of
enactment of the Indian Health Care Improvement Act Amendments
of 2008, 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 means
and extent to which the Secretary has carried out paragraph
(1).
``(d) Coordination.--
``(1) In general.--The Secretary, in coordination with the
Attorney General, Federal and tribal law enforcement agencies,
Indian Health Programs, and domestic violence or sexual assault
victim organizations, shall develop appropriate victim services
and victim advocate training programs--
``(A) to improve domestic violence or sexual abuse
responses;
``(B) to improve forensic examinations and
collection;
``(C) to identify problems or obstacles in the
prosecution of domestic violence or sexual abuse; and
``(D) to meet other needs or carry out other
activities required to prevent, treat, and improve
prosecutions of domestic violence and sexual abuse.
``(2) Report.--Not later than 2 years after the date of
enactment of the Indian Health Care Improvement Act Amendments
of 2008, 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, with
respect to the matters described in paragraph (1), the
improvements made and needed, problems or obstacles identified,
and costs necessary to address the problems or obstacles, and
any other recommendations that the Secretary determines to be
appropriate.
``SEC. 715. TESTIMONY BY SERVICE EMPLOYEES IN CASES OF RAPE AND SEXUAL
ASSAULT.
``(a) Approval by Director.--
``(1) In general.--The Director shall approve or
disapprove, in writing, any request or subpoena for a sexual
assault nurse examiner employed by the Service to provide
testimony in a deposition, trial, or other similar proceeding
regarding information obtained in carrying out the official
duties of the nurse examiner.
``(2) Requirement.--The Director shall approve a request or
subpoena under paragraph (1) if the request or subpoena does
not violate the policy of the Department to maintain strict
impartiality with respect to private causes of action.
``(3) Treatment.--If the Director fails to approve or
disapprove a request or subpoena by the date that is 30 days
after the date of receipt of the request or subpoena, the
request or subpoena shall be considered to be approved for
purposes of this subsection.
``(b) Policies and Protocol.--The Director, in coordination with
the Director of the Office on Violence Against Women of the Department
of Justice, in consultation with Indian Tribes and Tribal
Organizations, and in conference with Urban Indian Organizations, shall
develop standardized sexual assault policies and protocol for the
facilities of the Service.
``SEC. 716. 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. 717. 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 any 1 of a spectrum of effects that--
``(A) may occur when a woman drinks alcohol during
pregnancy; and
``(B) involves a central nervous system abnormality
that may be structural, neurological, or functional.
``(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 spectrum disorders.--
``(A) In general.--The term `fetal alcohol spectrum
disorders' includes a range of effects that can occur
in an individual whose mother drank alcohol during
pregnancy, including physical, mental, behavioral, and/
or learning disabilities with possible lifelong
implications.
``(B) Inclusions.--The term `fetal alcohol spectrum
disorders' may include--
``(i) fetal alcohol syndrome (FAS);
``(ii) fetal alcohol effect (FAE);
``(iii) alcohol-related birth defects; and
``(iv) alcohol-related neurodevelopmental
disorders (ARND).
``(6) Fetal alcohol syndrome or fas.--The term `fetal
alcohol syndrome' or `FAS' means any 1 of a spectrum of effects
that may occur when a woman drinks alcohol during pregnancy,
the diagnosis of which involves the confirmed presence of the
following 3 criteria:
``(A) Craniofacial abnormalities.
``(B) Growth deficits.
``(C) Central nervous system abnormalities.
``(7) Rehabilitation.--The term `rehabilitation' means to
restore the ability or capacity to engage in usual and
customary life activities through education and therapy.
``(8) Substance abuse.--The term `substance abuse' includes
inhalant abuse.
``SEC. 718. 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 2008, 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.
``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 2008, 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 2008 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 2008.
``(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 2008, 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 2008, the Secretary, in
consultation with Indian Tribes and Tribal Organizations, and in
conference with 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 RELATING TO ABORTION.
``(a) Definition of Health Benefits Coverage.--In this section, the
term `health benefits coverage' means a health-related service or group
of services provided pursuant to a contract, compact, grant, or other
agreement.
``(b) Limitation.--
``(1) In general.--Except as provided in paragraph (2), no
funds or facilities of the Service may be used--
``(A) to provide any abortion; or
``(B) to provide, or pay any administrative cost
of, any health benefits coverage that includes coverage
of an abortion.
``(2) Exceptions.--The limitation described in paragraph
(1) shall not apply in any case in which--
``(A) a pregnancy is the result of an act of rape,
or an act of incest against a minor; or
``(B) the woman suffers from a physical disorder,
physical injury, or physical illness that, as certified
by a physician, would place the woman in danger of
death unless an abortion is performed, including a
life-endangering physical condition caused by or
arising from the pregnancy itself.
``(c) Traditional Health Care Practices.--Although the Secretary
may promote traditional health care practices, consistent with the
Service standards for the provision of health care, health promotion,
and disease prevention under this Act, the United States is not liable
for any provision of traditional health care practices pursuant to this
Act that results in damage, injury, or death to a patient. Nothing in
this subsection shall be construed to alter any liability or other
obligation that the United States may otherwise have under the Indian
Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.)
or this Act.
``(d) Firearm Programs.--None of the funds made available to carry
out this Act may be used to carry out any antifirearm program, gun buy-
back program, or program to discourage or stigmatize the private
ownership of firearms for collecting, hunting, or self-defense
purposes.
``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. TRIBAL EMPLOYMENT.
``For purposes of section 2(2) of the Act of July 5, 1935 (49 Stat.
450, chapter 372), an Indian Tribe or Tribal Organization carrying out
a contract or compact pursuant to the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.) shall not be
considered an `employer'.
``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 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 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 2008, 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)(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).
``(3) 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.
``(4) 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.
``(5) 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.
``(6) 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.
``(7) 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.
``(8) 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.
``(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's or Urban Indian
Organization'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, is
authorized to 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 review of adverse incidents, claims,
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.
``(k) Relationship to Other Law.--This section shall continue in
force and effect, except as otherwise specifically provided in any
Federal law enacted after the date of enactment of the Indian Health
Care Improvement Act Amendments of 2008.
``SEC. 815. SENSE OF CONGRESS REGARDING LAW ENFORCEMENT AND
METHAMPHETAMINE ISSUES IN INDIAN COUNTRY.
``It is the sense of Congress that Congress encourages State,
local, and Indian tribal law enforcement agencies to enter into
memoranda of agreement between and among those agencies for purposes of
streamlining law enforcement activities and maximizing the use of
limited resources--
``(1) to improve law enforcement services provided to
Indian tribal communities; and
``(2) to increase the effectiveness of measures to address
problems relating to methamphetamine use in Indian Country (as
defined in section 1151 of title 18, United States Code).
``SEC. 816. TRIBAL HEALTH PROGRAM OPTION FOR COST SHARING.
``(a) In General.--Nothing in this Act limits the ability of a
Tribal Health Program operating any health program, service, function,
activity, or facility funded, in whole or part, by the Service through,
or provided for in, a compact with the Service pursuant to title V of
the Indian Self-Determination and Education Assistance Act (25 U.S.C.
458aaa et seq.) to charge an Indian for services provided by the Tribal
Health Program.
``(b) Service.--Nothing in this Act authorizes the Service--
``(1) to charge an Indian for services; or
``(2) to require any Tribal Health Program to charge an
Indian for services.
``SEC. 817. TESTING FOR SEXUALLY TRANSMITTED DISEASES IN CASES OF
SEXUAL VIOLENCE.
``The Attorney General shall ensure that, with respect to any
Federal criminal action involving a sexual assault, rape, or other
incident of sexual violence against an Indian--
``(1)(A) at the request of the victim, a defendant is
tested for the human immunodeficiency virus (HIV) and such
other sexually transmitted diseases as are requested by the
victim not later than 48 hours after the date on which the
applicable information or indictment is presented;
``(B) a notification of the test results is provided to the
victim or the parent or guardian of the victim and the
defendant as soon as practicable after the results are
generated; and
``(C) such follow-up tests for HIV and other sexually
transmitted diseases are provided as are medically appropriate,
with the test results made available in accordance with
subparagraph (B); and
``(2) pursuant to section 714(a), HIV and other sexually
transmitted disease testing, treatment, and counseling is
provided for victims of sexual abuse.
``SEC. 818. STUDY ON TOBACCO-RELATED DISEASE AND DISPROPORTIONATE
HEALTH EFFECTS ON TRIBAL POPULATIONS.
``Not later than 180 days after the date of enactment of the Indian
Health Care Improvement Act Amendments of 2008, the Secretary, in
consultation with appropriate Federal departments and agencies and
acting through the epidemiology centers established under section 209,
shall solicit from independent organizations bids to conduct, and shall
submit to Congress no later than 5 years after enactment a report
describing the results of, a study to determine possible causes for the
high prevalence of tobacco use among Indians.
``SEC. 819. 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. 820. GAO REPORT ON COORDINATION OF SERVICES.
``(a) Study and Evaluation.--The Comptroller General of the United
States shall conduct a study, and evaluate the effectiveness, of
coordination of health care services provided to Indians--
``(1) through Medicare, Medicaid, or SCHIP;
``(2) by the Service; or
``(3) using funds provided by--
``(A) State or local governments; or
``(B) Indian Tribes.
``(b) Report.--Not later than 18 months after the date of enactment
of the Indian Health Care Improvement Act Amendments of 2007, the
Comptroller General shall submit to Congress a report--
``(1) describing the results of the evaluation under
subsection (a); and
``(2) containing recommendations of the Comptroller General
regarding measures to support and increase coordination of the
provision of health care services to Indians as described in
subsection (a).
``SEC. 821. 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.''.
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 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''.
SEC. 104. MODIFICATION OF TERM.
(a) In General.--Except as provided in subsection (b), the Indian
Health Care Improvement Act (as amended by section 101) and each
provision of the Social Security Act amended by title II are amended
(as applicable)--
(1) by striking ``Urban Indian Organizations'' each place
it appears and inserting ``urban Indian organizations'';
(2) by striking ``Urban Indian Organization'' each place it
appears and inserting ``urban Indian organization'';
(3) by striking ``Urban Indians'' each place it appears and
inserting ``urban Indians'';
(4) by striking ``Urban Indian'' each place it appears and
inserting ``urban Indian'';
(5) by striking ``Urban Centers'' each place it appears and
inserting ``urban centers''; and
(6) by striking ``Urban Center'' each place it appears and
inserting ``urban center''.
(b) Exception.--The amendments made by subsection (a) shall not
apply with respect to--
(1) the matter preceding paragraph (1) of section 510 of
the Indian Health Care Improvement Act (as amended by section
101); and
(2) ``Urban Indian'' the first place it appears in section
513(a) of the Indian Health Care Improvement Act (as amended by
section 101).
(c) Modification of Definition.--Section 4 of the Indian Health
Care Improvement Act (as amended by section 101) is amended by striking
paragraph (27) and inserting the following:
``(27) The term `urban Indian' means any individual who
resides in an urban center and who meets 1 or more of the 4
criteria in subparagraphs (A) through (D) of paragraph (12).''.
SEC. 105. GAO STUDY AND REPORT ON PAYMENTS FOR CONTRACT HEALTH
SERVICES.
(a) Study.--
(1) In general.--The Comptroller General of the United
States (in this section referred to as the ``Comptroller
General'') shall conduct a study on the utilization of health
care furnished by health care providers under the contract
health services program funded by the Indian Health Service and
operated by the Indian Health Service, an Indian Tribe, or a
Tribal Organization (as those terms are defined in section 4 of
the Indian Health Care Improvement Act).
(2) Analysis.--The study conducted under paragraph (1)
shall include an analysis of--
(A) the amounts reimbursed under the contract
health services program described in paragraph (1) for
health care furnished by entities, individual
providers, and suppliers, including a comparison of
reimbursement for such health care through other public
programs and in the private sector;
(B) barriers to accessing care under such contract
health services program, including, but not limited to,
barriers relating to travel distances, cultural
differences, and public and private sector reluctance
to furnish care to patients under such program;
(C) the adequacy of existing Federal funding for
health care under such contract health services
program; and
(D) any other items determined appropriate by the
Comptroller General.
(b) Report.--Not later than 18 months after the date of enactment
of this Act, the Comptroller General shall submit to Congress a report
on the study conducted under subsection (a), together with
recommendations regarding--
(1) the appropriate level of Federal funding that should be
established for health care under the contract health services
program described in subsection (a)(1); and
(2) how to most efficiently utilize such funding.
(c) Consultation.--In conducting the study under subsection (a) and
preparing the report under subsection (b), the Comptroller General
shall consult with the Indian Health Service, Indian Tribes, and Tribal
Organizations.
SEC. 106. GAO STUDY OF MEMBERSHIP CRITERIA FOR FEDERALLY RECOGNIZED
INDIAN TRIBES.
Not later than 1 year after the date of enactment of this Act, the
Comptroller General of the United States shall conduct a study of
membership criteria for federally recognized Indian tribes, including--
(1) the number of federally recognized Indian tribes in
existence on the date on which the study is conducted;
(2) the number of those Indian tribes that use blood
quantum as a criterion for membership in the Indian tribe and
the importance assigned to that criterion;
(3) the percentage of members of federally recognized
Indian tribes that possesses degrees of Indian blood of--
(A) \1/4\;
(B) \1/8\; and
(C) \1/16\; and
(4) the variance in wait times and rationing of health care
services within the Service between federally recognized Indian
Tribes that use blood quantum as a criterion for membership and
those Indian Tribes that do not use blood quantum as such a
criterion.
SEC. 107. GAO STUDY OF TRIBAL JUSTICE SYSTEMS.
(a) In General.--Not later than 1 year after the date of enactment
of this Act, the Comptroller General of the United States shall
conduct, and submit to Congress a report describing the results of, a
study of the tribal justice systems of Indian tribes located in the
States of North Dakota and South Dakota.
(b) Inclusions.--The study under subsection (a) shall include, with
respect to the tribal system of each Indian tribe described in
subsection (a) and the tribal justice system as a whole--
(1)(A) a description of how the tribal justice systems
function, or are supposed to function; and
(B) a description of the components of the tribal justice
systems, such as tribal trial courts, courts of appeal,
applicable tribal law, judges, qualifications of judges, the
selection and removal of judges, turnover of judges, the
creation of precedent, the recording of precedent, the
jurisdictional authority of the tribal court system, and the
separation of powers between the tribal court system, the
tribal council, and the head of the tribal government;
(2) a review of the origins of the tribal justice systems,
such as the development of the systems pursuant to the Act of
June 18, 1934 (25 U.S.C. 461 et seq.) (commonly known as the
``Indian Reorganization Act''), which promoted tribal
constitutions and addressed the tribal court system;
(3) an analysis of the weaknesses of the tribal justice
systems, including the adequacy of law enforcement personnel
and detention facilities, in particular in relation to crime
rates; and
(4) an analysis of the measures that tribal officials
suggest could be carried out to improve the tribal justice
systems, including an analysis of how Federal law could improve
and stabilize the tribal court system.
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 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 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.--Section
1903(x)(3)(B) of the Social Security Act (42 U.S.C. 1396b(x)(3)(B)) is
amended--
(1) by redesignating clause (v) as clause (vii); and
(2) by inserting after clause (iv), the following new
clauses:
``(v) Except as provided in clause (vi), a document issued
by a federally recognized Indian tribe evidencing membership or
enrollment in, or affiliation with, such tribe (such as a
tribal enrollment card or certificate of degree of Indian
blood).
``(vi)(I) 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 documentation (including tribal
documentation, if appropriate) that the Secretary determines to
be satisfactory documentary evidence of United States
citizenship or nationality under the regulations adopted
pursuant to subclause (II).
``(II) Not later than 90 days after the date of enactment
of this subclause, the Secretary, in consultation with the
tribes referred to in subclause (I), shall promulgate interim
final regulations specifying the forms of documentation
(including tribal documentation, if appropriate) deemed to be
satisfactory evidence of the United States citizenship or
nationality of a member of any such Indian tribe for purposes
of satisfying the requirements of this subsection.
``(III) During the period that begins on the date of
enactment of this clause and ends on the effective date of the
interim final regulations promulgated under subclause (II), a
document issued by a federally recognized Indian tribe referred
to in subclause (I) evidencing membership or enrollment in, or
affiliation with, such tribe (such as a tribal enrollment card
or certificate of degree of Indian blood) accompanied by a
signed attestation that the individual is a citizen of the
United States and a certification by the appropriate officer or
agent of the Indian tribe that the membership or other records
maintained by the Indian tribe indicate that the individual was
born in the United States is deemed to be a document described
in this subparagraph for purposes of satisfying the
requirements of this subsection.''.
(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 indians furnished items or
services directly by or through indian health programs.--
``(A) No enrollment fees, premiums, or
copayments.--
``(i) 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, a
Tribal Organization, or an urban Indian
organization, or by a health care provider
through referral under the contract health
service for which payment may be made under
this title.
``(ii) Exception.--Clause (i) shall not
apply to an individual only eligible for the
programs or services under sections 102 and 103
or title V of the Indian Health Care
Improvement Act.
``(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''.
(3) Effective date.--The amendments made by this subsection
take effect on October 1, 2009.
(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)) 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.
(d) Effective Date.--This section and the amendments made by this
section take effect on October 1, 2009.
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.''.
(c) Effective Date.--This section and the amendments made by this
section take effect on October 1, 2009.
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, 2008, 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.''.
SEC. 210. DEVELOPMENT OF RECOMMENDATIONS TO IMPROVE INTERSTATE
COORDINATION OF MEDICAID AND SCHIP COVERAGE OF INDIAN
CHILDREN AND OTHER CHILDREN WHO ARE OUTSIDE OF THEIR
STATE OF RESIDENCY BECAUSE OF EDUCATIONAL OR OTHER NEEDS.
(a) Study.--The Secretary shall conduct a study to identify
barriers to interstate coordination of enrollment and coverage under
the Medicaid program under title XIX of the Social Security Act and the
State Children's Health Insurance Program under title XXI of such Act
of children who are eligible for medical assistance or child health
assistance under such programs and who, because of educational needs,
migration of families, emergency evacuations, or otherwise, frequently
change their State of residency or otherwise are temporarily present
outside of the State of their residency. Such study shall include an
examination of the enrollment and coverage coordination issues faced by
Indian children who are eligible for medical assistance or child health
assistance under such programs in their State of residence and who
temporarily reside in an out-of-State boarding school or peripheral
dormitory funded by the Bureau of Indian Affairs.
(b) Report.--Not later than 18 months after the date of enactment
of this Act, the Secretary, in consultation with directors of State
Medicaid programs under title XIX of the Social Security Act and
directors of State Children's Health Insurance Programs under title XXI
of such Act, shall submit a report to Congress that contains
recommendations for such legislative and administrative actions as the
Secretary determines appropriate to address the enrollment and coverage
coordination barriers identified through the study required under
subsection (a).
SEC. 211. ESTABLISHMENT OF NATIONAL CHILD WELFARE RESOURCE CENTER FOR
TRIBES.
(a) Establishment.--The Secretary of Health and Human Services
shall establish a National Child Welfare Resource Center for Tribes
that is--
(1) specifically and exclusively dedicated to meeting the
needs of Indian tribes and tribal organizations through the
provision of assistance described in subsection (b); and
(2) not part of any existing national child welfare
resource center.
(b) Assistance Provided.--
(1) In general.--The National Child Welfare Resource Center
for Tribes shall provide information, advice, educational
materials, and technical assistance to Indian tribes and tribal
organizations with respect to the types of services,
administrative functions, data collection, program management,
and reporting that are provided for under State plans under
parts B and E of title IV of the Social Security Act.
(2) Implementation authority.--The Secretary may provide
the assistance described in paragraph (1) either directly or
through grant or contract with public or private organizations
knowledgeable and experienced in the field of Indian tribal
affairs and child welfare.
(c) Appropriations.--There is appropriated to the Secretary of
Health and Human Services, out of any money in the Treasury of the
United States not otherwise appropriated, $1,000,000 for each of fiscal
years 2009 through 2013 to carry out the purposes of this section.
SEC. 212. ADJUSTMENT TO THE MEDICARE ADVANTAGE STABILIZATION FUND.
Section 1858(e)(2)(A)(i) of the Social Security Act (42 U.S.C.
1395w-27a(e)(2)(A)(i)), as amended by section 110 of the Medicare,
Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173), is
amended by striking ``$1,790,000,000'' and inserting
``$1,657,000,000''.
SEC. 213. MORATORIUM ON IMPLEMENTATION OF CHANGES TO CASE MANAGEMENT
AND TARGETED CASE MANAGEMENT PAYMENT REQUIREMENTS UNDER
MEDICAID.
(a) Moratorium.--
(1) Delayed implementation of december 4, 2007, interim
final rule.--The interim final rule published on December 4,
2007, at pages 68,077 through 68,093 of volume 72 of the
Federal Register (relating to parts 431, 440, and 441 of title
42 of the Code of Federal Regulations) shall not take effect
before April 1, 2009.
(2) Continuation of 2007 payment policies and practices.--
Notwithstanding any other provision of law, the Secretary of
Health and Human Services shall not, prior to April 1, 2009,
take any action (through promulgation of regulation, issuance
of regulatory guidance, use of Federal payment audit
procedures, or other administrative action, policy or practice,
including a Medical Assistance Manual transmittal or issuance
of a letter to State Medicaid directors) to restrict coverage
or payment under title XIX of the Social Security Act for case
management and targeted case management services if such action
is more restrictive than the administrative action, policy, or
practice that applies to coverage of, or payment for, such
services under title XIX of the Social Security Act on December
3, 2007. Any such action taken by the Secretary of Health and
Human Services during the period that begins on December 4,
2007, and ends on March 31, 2009, that is based in whole or in
part on the interim final rule described in subsection (a) is
null and void.
(b) Inclusion of Medicare Providers and Suppliers in Federal
Payment Levy and Administrative Offset Program.--
(1) In general.--Section 1874 of the Social Security Act
(42 U.S.C. 1395kk) is amended by adding at the end the
following new subsection:
``(d) Inclusion of Medicare Provider and Supplier Payments in
Federal Payment Levy Program.--
``(1) In general.--The Centers for Medicare & Medicaid
Services shall take all necessary steps to participate in the
Federal Payment Levy Program under section 6331(h) of the
Internal Revenue Code of 1986 as soon as possible and shall
ensure that--
``(A) at least 50 percent of all payments under
parts A and B are processed through such program
beginning within 1 year after the date of the enactment
of this section;
``(B) at least 75 percent of all payments under
parts A and B are processed through such program
beginning within 2 years after such date; and
``(C) all payments under parts A and B are
processed through such program beginning not later than
September 30, 2011.
``(2) Assistance.--The Financial Management Service and the
Internal Revenue Service shall provide assistance to the
Centers for Medicare & Medicaid Services to ensure that all
payments described in paragraph (1) are included in the Federal
Payment Levy Program by the deadlines specified in that
subsection.''.
(2) Application of administrative offset provisions to
medicare provider or supplier payments.--Section 3716 of title
31, United States Code, is amended--
(A) by inserting ``the Department of Health and
Human Services,'' after ``United States Postal
Service,'' in subsection (c)(1)(A); and
(B) by adding at the end of subsection (c)(3) the
following new subparagraph:
``(D) This section shall apply to payments made
after the date which is 90 days after the enactment of
this subparagraph (or such earlier date as designated
by the Secretary of Health and Human Services) with
respect to claims or debts, and to amounts payable,
under title XVIII of the Social Security Act.''.
(3) Effective date.--The amendments made by this subsection
shall take effect on the date of the enactment of this Act.
SEC. 214. INCREASED CIVIL MONEY PENALTIES AND CRIMINAL FINES FOR
MEDICARE FRAUD AND ABUSE.
(a) Increased Civil Money Penalties.--Section 1128A of the Social
Security Act (42 U.S.C. 1320a-7a) is amended--
(1) in subsection (a), in the flush matter following
paragraph (7)--
(A) by striking ``$10,000'' each place it appears
and inserting ``$20,000'';
(B) by striking ``$15,000'' and inserting
``$30,000''; and
(C) by striking ``$50,000'' and inserting
``$100,000''; and
(2) in subsection (b)--
(A) in paragraph (1), in the flush matter following
subparagraph (B), by striking ``$2,000'' and inserting
``$4,000'';
(B) in paragraph (2), by striking ``$2,000'' and
inserting ``$4,000''; and
(C) in paragraph (3)(A)(i), by striking ``$5,000''
and inserting ``$10,000''.
(b) Increased Criminal Fines.--Section 1128B of the Social Security
Act (42 U.S.C. 1320a-7b) is amended--
(1) in subsection (a), in the flush matter following
paragraph (6)--
(A) by striking ``$25,000'' and inserting
``$100,000''; and
(B) by striking ``$10,000'' and inserting
``$20,000'';
(2) in subsection (b)--
(A) in paragraph (1), in the flush matter following
subparagraph (B), by striking ``$25,000'' and inserting
``$100,000''; and
(B) in paragraph (2), in the flush matter following
subparagraph (B), by striking ``$25,000'' and inserting
``$100,000'';
(3) in subsection (c), by striking ``$25,000'' and
inserting ``$100,000'';
(4) in subsection (d), in the second flush matter following
subparagraph (B), by striking ``$25,000'' and inserting
``$100,000''; and
(5) in subsection (e), by striking ``$2,000'' and inserting
``$4,000''.
(c) Effective Date.--The amendments made by this section shall
apply to civil money penalties and fines imposed for actions taken on
or after the date of enactment of this Act.
SEC. 215. INCREASED SENTENCES FOR FELONIES INVOLVING MEDICARE FRAUD AND
ABUSE.
(a) False Statements and Representations.--Section 1128B(a) of the
Social Security Act (42 U.S.C. 1320a-7b(a)) is amended, in clause (i)
of the flush matter following paragraph (6), by striking ``not more
than 5 years'' and inserting ``not more than 10 years''.
(b) Anti-Kickback.--Section 1128B(b) of the Social Security Act (42
U.S.C. 1320a-7b(b)) is amended--
(1) in paragraph (1), in the flush matter following
subparagraph (B), by striking ``not more than 5 years'' and
inserting ``not more than 10 years''; and
(2) in paragraph (2), in the flush matter following
subparagraph (B), by striking ``not more than 5 years'' and
inserting ``not more than 10 years''.
(c) False Statement or Representation With Respect to Conditions or
Operations of Facilities.--Section 1128B(c) of the Social Security Act
(42 U.S.C. 1320a-7b(c)) is amended by striking ``not more than 5
years'' and inserting ``not more than 10 years''.
(d) Excess Charges.--Section 1128B(d) of the Social Security Act
(42 U.S.C. 1320a-7b(d)) is amended, in the second flush matter
following subparagraph (B), by striking ``not more than 5 years'' and
inserting ``not more than 10 years''.
(e) Effective Date.--The amendments made by this section shall
apply to criminal penalties imposed for actions taken on or after the
date of enactment of this Act.
TITLE III--MISCELLANEOUS
SEC. 301. RESOLUTION OF APOLOGY TO NATIVE PEOPLES OF UNITED STATES.
(a) Findings.--Congress finds that--
(1) the ancestors of today's Native Peoples inhabited the
land of the present-day United States since time immemorial and
for thousands of years before the arrival of people of European
descent;
(2) for millennia, Native Peoples have honored, protected,
and stewarded this land we cherish;
(3) Native Peoples are spiritual people with a deep and
abiding belief in the Creator, and for millennia Native Peoples
have maintained a powerful spiritual connection to this land,
as evidenced by their customs and legends;
(4) the arrival of Europeans in North America opened a new
chapter in the history of Native Peoples;
(5) while establishment of permanent European settlements
in North America did stir conflict with nearby Indian tribes,
peaceful and mutually beneficial interactions also took place;
(6) the foundational English settlements in Jamestown,
Virginia, and Plymouth, Massachusetts, owed their survival in
large measure to the compassion and aid of Native Peoples in
the vicinities of the settlements;
(7) in the infancy of the United States, the founders of
the Republic expressed their desire for a just relationship
with the Indian tribes, as evidenced by the Northwest Ordinance
enacted by Congress in 1787, which begins with the phrase,
``The utmost good faith shall always be observed toward the
Indians'';
(8) Indian tribes provided great assistance to the
fledgling Republic as it strengthened and grew, including
invaluable help to Meriwether Lewis and William Clark on their
epic journey from St. Louis, Missouri, to the Pacific Coast;
(9) Native Peoples and non-Native settlers engaged in
numerous armed conflicts in which unfortunately, both took
innocent lives, including those of women and children;
(10) the Federal Government violated many of the treaties
ratified by Congress and other diplomatic agreements with
Indian tribes;
(11) the United States forced Indian tribes and their
citizens to move away from their traditional homelands and onto
federally established and controlled reservations, in
accordance with such Acts as the Act of May 28, 1830 (4 Stat.
411, chapter 148) (commonly known as the ``Indian Removal
Act'');
(12) many Native Peoples suffered and perished--
(A) during the execution of the official Federal
Government policy of forced removal, including the
infamous Trail of Tears and Long Walk;
(B) during bloody armed confrontations and
massacres, such as the Sand Creek Massacre in 1864 and
the Wounded Knee Massacre in 1890; and
(C) on numerous Indian reservations;
(13) the Federal Government condemned the traditions,
beliefs, and customs of Native Peoples and endeavored to
assimilate them by such policies as the redistribution of land
under the Act of February 8, 1887 (25 U.S.C. 331; 24 Stat. 388,
chapter 119) (commonly known as the ``General Allotment Act''),
and the forcible removal of Native children from their families
to faraway boarding schools where their Native practices and
languages were degraded and forbidden;
(14) officials of the Federal Government and private United
States citizens harmed Native Peoples by the unlawful
acquisition of recognized tribal land and the theft of tribal
resources and assets from recognized tribal land;
(15) the policies of the Federal Government toward Indian
tribes and the breaking of covenants with Indian tribes have
contributed to the severe social ills and economic troubles in
many Native communities today;
(16) despite the wrongs committed against Native Peoples by
the United States, Native Peoples have remained committed to
the protection of this great land, as evidenced by the fact
that, on a per capita basis, more Native Peoples have served in
the United States Armed Forces and placed themselves in harm's
way in defense of the United States in every major military
conflict than any other ethnic group;
(17) Indian tribes have actively influenced the public life
of the United States by continued cooperation with Congress and
the Department of the Interior, through the involvement of
Native individuals in official Federal Government positions,
and by leadership of their own sovereign Indian tribes;
(18) Indian tribes are resilient and determined to
preserve, develop, and transmit to future generations their
unique cultural identities;
(19) the National Museum of the American Indian was
established within the Smithsonian Institution as a living
memorial to Native Peoples and their traditions; and
(20) Native Peoples are endowed by their Creator with
certain unalienable rights, and among those are life, liberty,
and the pursuit of happiness.
(b) Acknowledgment and Apology.--The United States, acting through
Congress--
(1) recognizes the special legal and political relationship
Indian tribes have with the United States and the solemn
covenant with the land we share;
(2) commends and honors Native Peoples for the thousands of
years that they have stewarded and protected this land;
(3) recognizes that there have been years of official
depredations, ill-conceived policies, and the breaking of
covenants by the Federal Government regarding Indian tribes;
(4) apologizes on behalf of the people of the United States
to all Native Peoples for the many instances of violence,
maltreatment, and neglect inflicted on Native Peoples by
citizens of the United States;
(5) expresses its regret for the ramifications of former
wrongs and its commitment to build on the positive
relationships of the past and present to move toward a brighter
future where all the people of this land live reconciled as
brothers and sisters, and harmoniously steward and protect this
land together;
(6) urges the President to acknowledge the wrongs of the
United States against Indian tribes in the history of the
United States in order to bring healing to this land; and
(7) commends the State governments that have begun
reconciliation efforts with recognized Indian tribes located in
their boundaries and encourages all State governments similarly
to work toward reconciling relationships with Indian tribes
within their boundaries.
(c) Disclaimer.--Nothing in this section--
(1) authorizes or supports any claim against the United
States; or
(2) serves as a settlement of any claim against the United
States.
Passed the Senate February 26, 2008.
Attest:
NANCY ERICKSON,
Secretary.