Indian health care News

[mdenney]

Dorgan cites 'major breakthrough' on Indian health
Monday, December 21, 2009
Filed Under: Health | Politics

Sen. Byron Dorgan (D-North Dakota), the chairman of the Senate Indian Affairs Committee, announced a "major breakthrough" today on the Indian Health Care Improvement Act.

Dorgan said S.1790, a bill to permanently reauthorize the IHCIA, has been included in H.R.3590, the national health care reform package that's being considered in the Senate. Passage is expected before Christmas.

"Including the bill in the broader health reform package indicates that Senate leaders recognize the improvements for Indian Country are both important and urgent," Dorgan said. "American Indian and Alaska Natives are the only group of Americans which the federal government actually has a trust responsibility to provide health care for, and so it is important that any health reform package contains the Indian Health Care Improvement Act."

The House included the IHCIA in its version of the health reform bill. The two chambers will have to resolve any differences before it becomes law but this is the closest the IHCIA has come to final passage in 10 years.

According to Dorgan's office, IHCIA will:
* Permanently re-authorize all current Indian health care programs;
* Authorize programs to increase the recruitment and retention of health care professionals, such as updates to the scholarship program, demonstration programs which promote new, innovative models of health care, to improve access to health care for Indians and Alaska Natives;
* Authorize long-term care, including home health care, assisted living, and community based care. Current law provides for none of these forms of long-term care;
* Establish mental and behavioral health programs beyond alcohol and substance abuse, such as fetal alcohol spectrum disorders, and domestic violence prevention programs;
* Improve the youth suicide prevention programs available to Native Americans, including streamlining the process by which Indian tribes apply for youth suicide prevention grants;
* Establish demonstration projects that provide incentives to use innovative facility construction methods, such as modular component construction and mobile health stations, to save money and improve access to health care services;
* Require that the IHS budget account for medical inflation rates and population growth, in order to combat the dramatic underfunding of the Indian health system.

Indian Health Care Improvement Act:
S.1790 | H.R.2708

64.38.12.138/News/2009/017872.asp


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S.1790
Indian Health Care Improvement Reauthorization and Extension Act of 2009 (Introduced in Senate)

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TITLE I--INDIAN HEALTH CARE IMPROVEMENT ACT REAUTHORIZATION AND AMENDMENTS

SEC. 101. REAUTHORIZATION.

(a) In General- Section 825 of the Indian Health Care Improvement Act (25 U.S.C. 1680o) is amended to read as follows:

`SEC. 825. AUTHORIZATION OF APPROPRIATIONS.

`There are authorized to be appropriated such sums as are necessary to carry out this Act for fiscal year 2010 and each fiscal year thereafter, to remain available until expended.'.

(b) Repeals- The following provisions of the Indian Health Care Improvement Act are repealed:

(1) Section 123 (25 U.S.C. 1616p).

(2) Paragraph (6) of section 209(m) (25 U.S.C. 1621h(m)).

(3) Subsection (g) of section 211 (25 U.S.C. 1621j).

(4) Subsection (e) of section 216 (25 U.S.C. 1621o).

(5) Section 224 (25 U.S.C. 1621w).

(6) Section 309 (25 U.S.C. 1638a).

(7) Section 407 (25 U.S.C. 1647).

(8) Subsection (c) of section 512 (25 U.S.C. 1660b).

(9) Section 514 (25 U.S.C. 1660d).

(10) Section 603 (25 U.S.C. 1663).

(11) Section 805 (25 U.S.C. 1675).

(c) Conforming Amendments-

(1) Section 204(c)(1) of the Indian Health Care Improvement Act (25 U.S.C. 1621c(c)(1)) is amended by striking `through fiscal year 2000'.

(2) Section 213 of the Indian Health Care Improvement Act (25 U.S.C. 1621l) is amended by striking `(a) The Secretary' and inserting `The Secretary'.

(3) Section 310 of the Indian Health Care Improvement Act (25 U.S.C. 1638b) is amended by striking `funds provided pursuant to the authorization contained in section 309' each place it appears and inserting `funds made available to carry out this title'.

SEC. 102. FINDINGS.

Section 2 of the Indian Health Care Improvement Act (25 U.S.C. 1601) is amended--

(1) by redesignating subsections (a), (b), (c), and (d) as paragraphs (1), (3), (4), and (5), respectively, and indenting the paragraphs appropriately; and

(2) by inserting after paragraph (1) (as so redesignated) the following:

`(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.'.

SEC. 103. DECLARATION OF NATIONAL INDIAN HEALTH POLICY.

Section 3 of the Indian Health Care Improvement Act (25 U.S.C. 1602) is amended to read as follows:

`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 ensure 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 initiative 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. 104. DEFINITIONS.

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

(1) by striking the matter preceding subsection (a) and inserting `In this Act:';

(2) in each of subsections (c), (j), (k), and (l), by redesignating the paragraphs contained in the subsections as subparagraphs and indenting the subparagraphs appropriately;

(3) by redesignating subsections (a) through (q) as paragraphs (17), (18), (13), (14), (26), (28), (27), (29), (1), (20), (11), (7), (19), (10), (21), (8), and (9), respectively, indenting the paragraphs appropriately, and moving the paragraphs so as to appear in numerical order;

(4) in each paragraph (as so redesignated), by inserting a heading the text of which is comprised of the term defined in the paragraph;

(5) by inserting `The term' after each paragraph heading;

(6) by inserting after paragraph (1) (as redesignated by paragraph (3)) the following:

`(2) BEHAVIORAL HEALTH-

`(A) IN GENERAL- 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) INCLUSIONS- The term `behavioral health' includes the joint development of substance abuse and mental health treatment planning and coordinated case management using a multidisciplinary approach.

`(3) CALIFORNIA INDIAN- The term `California Indian' means any Indian who is eligible for health services provided by the Service pursuant to section 809.

`(4) COMMUNITY COLLEGE- The term `community college' means--

`(A) a tribal college or university; or

`(B) a junior or community college.

`(5) CONTRACT HEALTH SERVICE- The term `contract health service' means any health service that is--

`(A) delivered based on a referral by, or at the expense of, an Indian health program; and

`(B) provided by a public or private medical provider or hospital that is not a provider or hospital of the Indian health program.

`(6) DEPARTMENT- The term `Department', unless otherwise designated, means the Department of Health and Human Services.';

(7) by striking paragraph (7) (as redesignated by paragraph (3)) and inserting the following:

`(7) DISEASE PREVENTION-

`(A) IN GENERAL- The term `disease prevention' means any activity for--

`(i) the reduction, limitation, and prevention of--

`(I) disease; and

`(II) complications of disease; and

`(ii) the reduction of consequences of disease.

`(B) INCLUSIONS- The term `disease prevention' includes an activity for--

`(i) controlling--

`(I) the development of diabetes;

`(II) high blood pressure;

`(III) infectious agents;

`(IV) injuries;

`(V) occupational hazards and disabilities;

`(VI) sexually transmittable diseases; or

`(VII) toxic agents; or

`(ii) providing--

`(I) fluoridation of water; or

`(II) immunizations.';

(8) by striking paragraph (9) (as redesignated by paragraph (3)) and inserting the following:

`(9) FAS- The term `fetal alcohol syndrome' or `FAS' means a syndrome in which, with a history of maternal alcohol consumption during pregnancy, the following criteria are met:

`(A) Central nervous system involvement such as mental retardation, developmental delay, intellectual deficit, microencephaly, or neurologic abnormalities.

`(B) Craniofacial abnormalities with at least 2 of the following: microophthalmia, short palpebral fissures, poorly developed philtrum, thin upper lip, flat nasal bridge, and short upturned nose.

`(C) Prenatal or postnatal growth delay.';

(9) by striking paragraphs (11) and (12) (as redesignated by paragraph (3)) and inserting the following:

`(11) HEALTH PROMOTION- The term `health promotion' means any activity for--

`(A) fostering social, economic, environmental, and personal factors conducive to health, including raising public awareness regarding health matters and enabling individuals to cope with health problems by increasing knowledge and providing valid information;

`(B) encouraging adequate and appropriate diet, exercise, and sleep;

`(C) promoting education and work in accordance 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, including programs for--

`(i) abuse prevention (mental and physical);

`(ii) community health;

`(iii) community safety;

`(iv) consumer health education;

`(v) diet and nutrition;

`(vi) immunization and other methods of 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) reproductive health and family planning;

`(xx) safe and adequate water;

`(xxi) healthy work environments;

`(xxii) elimination, reduction, and prevention of contaminants that create unhealthy household conditions (including mold and other allergens);

`(xxiii) stress control;

`(xxiv) substance abuse;

`(xxv) sanitary facilities;

`(xxvi) sudden infant death syndrome prevention;

`(xxvii) tobacco use cessation and reduction;

`(xxviii) violence prevention; and

`(xxix) such other activities identified by the Service, a tribal health program, or an urban Indian organization to promote achievement of any of the objectives referred to in section 3(2).

`(12) INDIAN HEALTH PROGRAM- The term `Indian health program' means--

`(A) any health program administered directly by the Service;

`(B) any tribal health program; and

`(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').';

(10) by inserting after paragraph (14) (as redesignated by paragraph (3)) the following:

`(15) JUNIOR OR COMMUNITY COLLEGE- The term `junior or community college' has the meaning given the term in section 312(e) of the Higher Education Act of 1965 (20 U.S.C. 1058(e)).

`(16) RESERVATION-

`(A) IN GENERAL- The term `reservation' means a reservation, Pueblo, or colony of any Indian tribe.

`(B) INCLUSIONS- The term `reservation' includes--

`(i) former reservations in Oklahoma;

`(ii) Indian allotments; and

`(iii) Alaska Native Regions established pursuant to the Alaska Native Claims Settlement Act (43 U.S.C. 1601 et seq.).';

(11) by striking paragraph (20) (as redesignated by paragraph (3)) and inserting the following:

`(20) SERVICE UNIT- 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.';

(12) by inserting after paragraph (21) (as redesignated by paragraph (3)) the following:

`(22) TELEHEALTH- 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)).

`(23) TELEMEDICINE- 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.

`(24) TRIBAL COLLEGE OR UNIVERSITY- The term `tribal college or university' has the meaning given the term in section 316(b) of the Higher Education Act of 1965 (20 U.S.C. 1059c(b)).

`(25) TRIBAL HEALTH PROGRAM- 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.).'; and

(13) by striking paragraph (26) (as redesignated by paragraph (3)) and inserting the following:

`(26) TRIBAL ORGANIZATION- The term `tribal organization' has the meaning given the term in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b).'.

Subtitle A--Indian Health Manpower

SEC. 111. COMMUNITY HEALTH AIDE PROGRAM.

Section 119 of the Indian Health Care Improvement Act (25 U.S.C. 1616l) is amended to read as follows:

`SEC. 119. COMMUNITY HEALTH AIDE PROGRAM.

`(a) General Purposes of Program- 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 develop and operate a Community Health Aide Program in the State of Alaska under which the Service--

`(1) provides for the training of Alaska Natives as health aides or community health practitioners;

`(2) uses those 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 those 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 those 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 regarding 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 that 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 ensure the provision of quality health care, health promotion, and disease prevention services; and

`(7) ensure that--

`(A) 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

`(B) dental health aide therapists are strictly prohibited from performing all other oral or jaw surgeries, subject to the condition 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 Alaska tribal organizations 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) REQUIREMENT- In establishing a national program under paragraph (1), the Secretary shall not reduce the amounts provided for the Community Health Aide Program described in subsections (a) and (b).'.

thomas.loc.gov/cgi-bin/query/F?c111:1:./temp/~c1115fsEUj:e8252:

[mdenney]

H.R.2708
Indian Health Care Improvement Act Amendments of 2009 (Introduced in House)


On the link below you have to ( Highlight it and copy paste the link to your internet address bar ok ) -


thomas.loc.gov/cgi-bin/query/z?c111:H.R.2708:


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H.R.2708
Title: To amend the Indian Health Care Improvement Act to revise and extend that Act, and for other purposes.
Sponsor: Rep Pallone, Frank, Jr. [NJ-6] (introduced 6/4/2009) Cosponsors (30)
Latest Major Action: 10/20/2009 House committee/subcommittee actions. Status: Subcommittee Hearings Held.
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SUMMARY AS OF:
6/4/2009--Introduced.

Indian Health Care Improvement Act Amendments of 2009 - Amends the Indian Health Care Improvement Act to revise requirements for health care programs and services for Indians, Indian tribes, tribal organizations, and urban Indian organizations.

Replaces the Urban Health Programs Branch with a Division of Urban Indian Health.

Authorizes grants to urban Indian organizations for health information technology, telemedicine services development, and related infrastructure.

Directs the Secretary of Health and Human Services, acting through the Indian Health Service, to provide programs of comprehensive behavioral health, prevention, and treatment.

Excludes from gross income: (1) services or benefits provided or purchased by the Service; and (2) services or benefits provided by a tribe or tribal organization, directly or through insurance. Declares that these provisions are not intended as an inference to the tax treatment of governmental benefits provided by tribes to Indians.

Reauthorizes the Indian Health Care Improvement Act.

Amends the Indian Self-Determination and Education Assistance Act to direct the Secretary to establish the Native American Health and Wellness Foundation.

Expands coverage for qualified Indians in the State Children's Health Insurance Program (CHIP, formerly known as SCHIP) under title XXI of the Social Security Act (SSA), as well as under Medicare (SSA title XVIII) and Medicaid (SSA title XIX). Authorizes related payments to Indian Health Programs operating in the state.

thomas.loc.gov/cgi-bin/bdquery/z?d111:HR02708:@@@d&summ2=m&

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Beginning
June 4, 2009

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
Sec. 1. Short title; table of contents.
TITLE I--AMENDMENTS TO INDIAN LAWS

SEC. 101. INDIAN HEALTH CARE IMPROVEMENT ACT AMENDED.
`SECTION 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. EXEMPTION FROM PAYMENT OF CERTAIN FEES.
`SEC. 128. AUTHORIZATION OF APPROPRIATIONS.
`TITLE II--HEALTH SERVICES

`SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND.
`SEC. 202. HEALTH PROMOTION AND DISEASE PREVENTION SERVICES.
`SEC. 203. DIABETES PREVENTION, TREATMENT, AND CONTROL.
`SEC. 204. SHARED SERVICES FOR LONG-TERM CARE.
`SEC. 205. HEALTH SERVICES RESEARCH.
`SEC. 206. MAMMOGRAPHY AND OTHER CANCER SCREENING.
`SEC. 207. PATIENT TRAVEL COSTS.
`SEC. 208. EPIDEMIOLOGY CENTERS.
`SEC. 209. COMPREHENSIVE SCHOOL HEALTH EDUCATION PROGRAMS.
`SEC. 210. INDIAN YOUTH PROGRAM.
`SEC. 211. PREVENTION, CONTROL, AND ELIMINATION OF COMMUNICABLE AND INFECTIOUS DISEASES.
`SEC. 212. OTHER AUTHORITY FOR PROVISION OF SERVICES.
`SEC. 213. INDIAN WOMEN'S HEALTH CARE.
`SEC. 214. ENVIRONMENTAL AND NUCLEAR HEALTH HAZARDS.
`SEC. 215. ARIZONA AS A CONTRACT HEALTH SERVICE DELIVERY AREA.
`SEC. 216. NORTH DAKOTA AND SOUTH DAKOTA AS 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 PROJECT.
`SEC. 307. LAND TRANSFER.
`SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS.
`SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND LOAN REPAYMENT.
`SEC. 310. TRIBAL LEASING.
`SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES JOINT VENTURE PROGRAM.
`SEC. 312. LOCATION OF FACILITIES.
`SEC. 313. MAINTENANCE AND IMPROVEMENT OF HEALTH CARE FACILITIES.
`SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY OWNED QUARTERS.
`SEC. 315. APPLICABILITY OF BUY AMERICAN ACT REQUIREMENT.
`SEC. 316. OTHER FUNDING FOR FACILITIES.
`SEC. 317. AUTHORIZATION OF APPROPRIATIONS.
`TITLE IV--ACCESS TO HEALTH SERVICES

`SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SECURITY ACT HEALTH BENEFITS PROGRAMS.
`SEC. 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. 414. TREATMENT UNDER MEDICAID AND SCHIP MANAGED CARE.
`SEC. 415. NAVAJO NATION MEDICAID AGENCY FEASIBILITY STUDY.
`SEC. 416. EXCEPTION FOR EXCEPTED BENEFITS.
`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. USE OF FEDERAL GOVERNMENT FACILITIES AND SOURCES OF SUPPLY.
`SEC. 505. CONTRACTS AND GRANTS FOR THE DETERMINATION OF UNMET HEALTH CARE NEEDS.
`SEC. 506. EVALUATIONS; RENEWALS.
`SEC. 507. OTHER CONTRACT AND GRANT REQUIREMENTS.
`SEC. 508. REPORTS AND RECORDS.
`SEC. 509. LIMITATION ON CONTRACT AUTHORITY.
`SEC. 510. FACILITIES.
`SEC. 511. DIVISION OF URBAN INDIAN HEALTH.
`SEC. 512. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE-RELATED SERVICES.
`SEC. 513. TREATMENT OF CERTAIN DEMONSTRATION PROJECTS.
`SEC. 514. URBAN NIAAA TRANSFERRED PROGRAMS.
`SEC. 515. CONFERRING WITH URBAN INDIAN ORGANIZATIONS.
`SEC. 516. URBAN YOUTH TREATMENT CENTER DEMONSTRATION.
`SEC. 517. GRANTS FOR DIABETES PREVENTION, TREATMENT, AND CONTROL.
`SEC. 518. COMMUNITY HEALTH REPRESENTATIVES.
`SEC. 519. EFFECTIVE DATE.
`SEC. 520. ELIGIBILITY FOR SERVICES.
`SEC. 521. AUTHORIZATION OF APPROPRIATIONS.
`SEC. 522. HEALTH INFORMATION TECHNOLOGY.
`TITLE VI--ORGANIZATIONAL IMPROVEMENTS

`SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERVICE AS AN AGENCY OF THE PUBLIC HEALTH SERVICE.
`SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM.
`SEC. 603. AUTHORIZATION OF APPROPRIATIONS.
`TITLE VII--BEHAVIORAL HEALTH PROGRAMS

`SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREATMENT SERVICES.
`SEC. 702. MEMORANDA OF AGREEMENT WITH THE DEPARTMENT OF THE INTERIOR.
`SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PREVENTION AND TREATMENT PROGRAM.
`SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM.
`SEC. 705. LICENSING REQUIREMENT FOR MENTAL HEALTH CARE WORKERS.
`SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.
`SEC. 707. INDIAN YOUTH PROGRAM.
`SEC. 708. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRATION PROJECT.
`SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL HEALTH FACILITIES DESIGN, CONSTRUCTION, AND STAFFING.
`SEC. 710. TRAINING AND COMMUNITY EDUCATION.
`SEC. 711. BEHAVIORAL HEALTH PROGRAM.
`SEC. 712. FETAL ALCOHOL DISORDER PROGRAMS.
`SEC. 713. CHILD SEXUAL ABUSE AND PREVENTION TREATMENT PROGRAMS.
`SEC. 714. DOMESTIC AND SEXUAL VIOLENCE PREVENTION AND TREATMENT.
`SEC. 715. BEHAVIORAL HEALTH RESEARCH.
`SEC. 716. DEFINITIONS.
`SEC. 717. AUTHORIZATION OF APPROPRIATIONS.
`TITLE VIII--MISCELLANEOUS

`SEC. 801. REPORTS.
`SEC. 802. REGULATIONS.
`SEC. 803. PLAN OF IMPLEMENTATION.
`SEC. 804. LIMITATION ON USE OF FUNDS APPROPRIATED TO INDIAN HEALTH SERVICE.
`SEC. 805. ELIGIBILITY OF CALIFORNIA INDIANS.
`SEC. 806. HEALTH SERVICES FOR INELIGIBLE PERSONS.
`SEC. 807. TREATMENT OF CERTAIN SERVICES AND BENEFITS.
`SEC. 808. REALLOCATION OF BASE RESOURCES.
`SEC. 809. RESULTS OF DEMONSTRATION PROJECTS.
`SEC. 810. PROVISION OF SERVICES IN MONTANA.
`SEC. 811. MORATORIUM.
`SEC. 812. SEVERABILITY PROVISIONS.
`SEC. 813. USE OF PATIENT SAFETY ORGANIZATIONS.
`SEC. 814. CONFIDENTIALITY OF MEDICAL QUALITY ASSURANCE RECORDS; QUALIFIED IMMUNITY FOR PARTICIPANTS.
`SEC. 815. CLAREMORE INDIAN HOSPITAL.
`SEC. 816. SENSE OF CONGRESS REGARDING LAW ENFORCEMENT AND METHAMPHETAMINE ISSUES IN INDIAN COUNTRY.
`SEC. 817. PERMITTING IMPLEMENTATION THROUGH CONTRACTS WITH TRIBAL HEALTH PROGRAMS.
`SEC. 818. AUTHORIZATION OF APPROPRIATIONS; AVAILABILITY.
`SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR INDIAN HEALTH.';
SEC. 102. SOBOBA SANITATION FACILITIES.
SEC. 103. NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION.
`TITLE VIII--NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION

`SEC. 801. DEFINITIONS.
`SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION.
`SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT.
SEC. 104. GAO STUDY AND REPORT ON PAYMENTS FOR CONTRACT HEALTH SERVICES.
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. 1911. INDIAN HEALTH PROGRAMS.';
`SEC. 1880. INDIAN HEALTH PROGRAMS.';
`SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, HEALTH CARE FOR INDIANS UNDER TITLES XVIII, XIX, AND XXI.
SEC. 203. ADDITIONAL PROVISIONS TO INCREASE OUTREACH TO, AND ENROLLMENT OF, INDIANS IN SCHIP AND MEDICAID.
SEC. 204. NONDISCRIMINATION IN QUALIFICATIONS FOR PAYMENT FOR SERVICES UNDER FEDERAL HEALTH CARE PROGRAMS.
SEC. 206. ANNUAL REPORT ON INDIANS SERVED BY SOCIAL SECURITY ACT HEALTH BENEFIT PROGRAMS.


You have to put the internet link below into the address bar on your computer to get link to work ok ..

link below -

thomas.loc.gov/cgi-bin/query/z?c111:H.R.2708:

[mdenney]

H.R.2708
Indian Health Care Improvement Act Amendments of 2009 (Introduced in House)

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H.R.2708
Indian Health Care Improvement Act Amendments of 2009 (Introduced in House)

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`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 2009, 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 2025 to carry out this title.

`TITLE III--FACILITIES

`SEC. 301. CONSULTATION; CONSTRUCTION AND RENOVATION OF FACILITIES; REPORTS.

`(a) Prerequisites for Expenditure of Funds- Prior to the expenditure of, or the making of any binding commitment to expend, any funds appropriated for the planning, design, construction, or renovation of facilities pursuant to the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'), the Secretary, acting through the Service, shall--

`(1) consult with any Indian Tribe that would be significantly affected by such expenditure for the purpose of determining and, whenever practicable, honoring tribal preferences concerning size, location, type, and other characteristics of any facility on which such expenditure is to be made; and

`(2) ensure, whenever practicable and applicable, that such facility meets the construction standards of any accrediting body recognized by the Secretary for the purposes of the Medicare, Medicaid, and SCHIP programs under titles XVIII, XIX, and XXI of the Social Security Act by not later than 1 year after the date on which the construction or renovation of such facility is completed.

`(b) Closures-

`(1) EVALUATION REQUIRED- Notwithstanding any other provision of law, no facility operated by the Service may be closed if the Secretary has not submitted to Congress, not less than 1 year and not more than 2 years before the date of the proposed closure, an evaluation, completed not more than 2 years before such submission, of the impact of the proposed closure that specifies, in addition to other considerations--

`(A) the accessibility of alternative health care resources for the population served by such facility;

`(B) the cost-effectiveness of such closure;

`(C) the quality of health care to be provided to the population served by such facility after such closure;

`(D) the availability of contract health care funds to maintain existing levels of service;

`(E) the views of the Indian Tribes served by such facility concerning such closure;

`(F) the level of use of such facility by all eligible Indians; and

`(G) the distance between such facility and the nearest operating Service hospital.

`(2) EXCEPTION FOR CERTAIN TEMPORARY CLOSURES- Paragraph (1) shall not apply to any temporary closure of a facility or any portion of a facility if such closure is necessary for medical, environmental, or construction safety reasons.

`(c) Health Care Facility Priority System-

`(1) IN GENERAL-

`(A) PRIORITY SYSTEM- The Secretary, acting through the Service, shall maintain a health care facility priority system, which--

`(i) shall be developed in consultation with Indian Tribes and Tribal Organizations;

`(ii) shall give Indian Tribes' needs the highest priority;

`(iii)(I) may include the lists required in paragraph (2)(B)(ii); and

`(II) shall include the methodology required in paragraph (2)(B)(v); and

`(III) may include such other facilities, and such renovation or expansion needs of any health care facility, as the Service, Indian Tribes, and Tribal Organizations may identify; and

`(iv) shall provide an opportunity for the nomination of planning, design, and construction projects by the Service, Indian Tribes, and Tribal Organizations for consideration under the priority system at least once every 3 years, or more frequently as the Secretary determines to be appropriate.

`(B) NEEDS OF FACILITIES UNDER ISDEAA AGREEMENTS- The Secretary shall ensure that the planning, design, construction, renovation, and expansion needs of Service and non-Service facilities operated under contracts or compacts in accordance with the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) are fully and equitably integrated into the health care facility priority system.

`(C) CRITERIA FOR EVALUATING NEEDS- For purposes of this subsection, the Secretary, in evaluating the needs of facilities operated under a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), shall use the criteria used by the Secretary in evaluating the needs of facilities operated directly by the Service.

`(D) PRIORITY OF CERTAIN PROJECTS PROTECTED- The priority of any project established under the construction priority system in effect on the date of enactment of the Indian Health Care Improvement Act Amendments of 2009 shall not be affected by any change in the construction priority system taking place after that date if the project--

`(i) was identified in the fiscal year 2008 Service budget justification as--

`(I) 1 of the 10 top-priority inpatient projects;

`(II) 1 of the 10 top-priority outpatient projects;

`(III) 1 of the 10 top-priority staff quarters developments; or

`(IV) 1 of the 10 top-priority Youth Regional Treatment Centers;

`(ii) had completed both Phase I and Phase II of the construction priority system in effect on the date of enactment of such Act; or

`(iii) is not included in clause (i) or (ii) and is selected, as determined by the Secretary--

`(I) on the initiative of the Secretary; or

`(II) pursuant to a request of an Indian Tribe or Tribal Organization.

`(2) REPORT; CONTENTS-

`(A) INITIAL COMPREHENSIVE REPORT-

`(i) DEFINITIONS- In this subparagraph:

`(I) FACILITIES APPROPRIATION ADVISORY BOARD- The term `Facilities Appropriation Advisory Board' means the advisory board, comprised of 12 members representing Indian tribes and 2 members representing the Service, established at the discretion of the Assistant Secretary--
`(aa) to provide advice and recommendations for policies and procedures of the programs funded pursuant to facilities appropriations; and

`(bb) to address other facilities issues.


`(II) FACILITIES NEEDS ASSESSMENT WORKGROUP- The term `Facilities Needs Assessment Workgroup' means the workgroup established at the discretion of the Assistant Secretary--
`(aa) to review the health care facilities construction priority system; and

`(bb) to make recommendations to the Facilities Appropriation Advisory Board for revising the priority system.


`(ii) INITIAL REPORT-

`(I) IN GENERAL- Not later than 1 year after the date of enactment of the Indian Health Care Improvement Act Amendments of 2009, the Secretary shall submit to the Committee on Indian Affairs of the Senate and the Committee on Natural Resources of the House of Representatives a report that describes the comprehensive, national, ranked list of all health care facilities needs for the Service, Indian Tribes, and Tribal Organizations (including inpatient health care facilities, outpatient health care facilities, specialized health care facilities (such as for long-term care and alcohol and drug abuse treatment), wellness centers, staff quarters and hostels associated with health care facilities, and the renovation and expansion needs, if any, of such facilities) developed by the Service, Indian Tribes, and Tribal Organizations for the Facilities Needs Assessment Workgroup and the Facilities Appropriation Advisory Board.

`(II) INCLUSIONS- The initial report shall include--
`(aa) the methodology and criteria used by the Service in determining the needs and establishing the ranking of the facilities needs; and

`(bb) such other information as the Secretary determines to be appropriate.


`(iii) UPDATES OF REPORT- Beginning in calendar year 2011, the Secretary shall--

`(I) update the report under clause (ii) not less frequently that once every 5 years; and

`(II) include the updated report in the appropriate annual report under subparagraph (B) for submission to Congress under section 801.

`(B) ANNUAL REPORTS- The Secretary shall submit to the President, for inclusion in the report required to be transmitted to Congress under section 801, a report which sets forth the following:

`(i) A description of the health care facility priority system of the Service established under paragraph (1).

`(ii) Health care facilities lists, which may include--

`(I) the 10 top-priority inpatient health care facilities;

`(II) the 10 top-priority outpatient health care facilities;

`(III) the 10 top-priority specialized health care facilities (such as long-term care and alcohol and drug abuse treatment);

`(IV) the 10 top-priority staff quarters developments associated with health care facilities; and

`(V) the 10 top-priority hostels associated with health care facilities.

`(iii) The justification for such order of priority.

`(iv) The projected cost of such projects.

`(v) The methodology adopted by the Service in establishing priorities under its health care facility priority system.

`(3) REQUIREMENTS FOR PREPARATION OF REPORTS- In preparing the report required under paragraph (2), the Secretary shall--

`(A) consult with and obtain information on all health care facilities needs from Indian Tribes, Tribal Organizations, and urban Indian organizations; and

`(B) review the total unmet needs of all Indian Tribes, Tribal Organizations, and urban Indian organizations for health care facilities (including hostels and staff quarters), including needs for renovation and expansion of existing facilities.

`(d) Review of Methodology Used for Health Facilities Construction Priority System-

`(1) IN GENERAL- Not later than 1 year after the establishment of the priority system under subsection (c)(1)(A), the Comptroller General of the United States shall prepare and finalize a report reviewing the methodologies applied, and the processes followed, by the Service in making each assessment of needs for the list under subsection (c)(2)(A)(ii) and developing the priority system under subsection (c)(1), including a review of--

`(A) the recommendations of the Facilities Appropriation Advisory Board and the Facilities Needs Assessment Workgroup (as those terms are defined in subsection (c)(2)(A)(i)); and

`(B) the relevant criteria used in ranking or prioritizing facilities other than hospitals or clinics.

`(2) SUBMISSION TO CONGRESS- The Comptroller General of the United States shall submit the report under paragraph (1) to--

`(A) the Committees on Indian Affairs and Appropriations of the Senate;

`(B) the Committees on Natural Resources and Appropriations of the House of Representatives; and

`(C) the Secretary.

`(e) Funding Condition- All funds appropriated under the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'), for the planning, design, construction, or renovation of health facilities for the benefit of 1 or more Indian Tribes shall be subject to the provisions of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.).

`(f) Development of Innovative Approaches- The Secretary shall consult and cooperate with Indian Tribes, Tribal Organizations, and urban Indian organizations in developing innovative approaches to address all or part of the total unmet need for construction of health facilities, including those provided for in other sections of this title and other approaches.

`SEC. 302. SANITATION FACILITIES.

`(a) Findings- Congress finds the following:

`(1) The provision of sanitation facilities is primarily a health consideration and function.

`(2) Indian people suffer an inordinately high incidence of disease, injury, and illness directly attributable to the absence or inadequacy of sanitation facilities.

`(3) The long-term cost to the United States of treating and curing such disease, injury, and illness is substantially greater than the short-term cost of providing sanitation facilities and other preventive health measures.

`(4) Many Indian homes and Indian communities still lack sanitation facilities.

`(5) It is in the interest of the United States, and it is the policy of the United States, that all Indian communities and Indian homes, new and existing, be provided with sanitation facilities.

`(b) Facilities and Services- In furtherance of the findings made in subsection (a), Congress reaffirms the primary responsibility and authority of the Service to provide the necessary sanitation facilities and services as provided in section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a). Under such authority, the Secretary, acting through the Service, is authorized to provide the following:

`(1) Financial and technical assistance to Indian Tribes, Tribal Organizations, and Indian communities in the establishment, training, and equipping of utility organizations to operate and maintain sanitation facilities, including the provision of existing plans, standard details, and specifications available in the Department, to be used at the option of the Indian Tribe, Tribal Organization, or Indian community.

`(2) Ongoing technical assistance and training to Indian Tribes, Tribal Organizations, and Indian communities in the management of utility organizations which operate and maintain sanitation facilities.

`(3) Priority funding for operation and maintenance assistance for, and emergency repairs to, sanitation facilities operated by an Indian Tribe, Tribal Organization or Indian community when necessary to avoid an imminent health threat or to protect the investment in sanitation facilities and the investment in the health benefits gained through the provision of sanitation facilities.

`(c) Funding- Notwithstanding any other provision of law--

`(1) the Secretary of Housing and Urban Development is authorized to transfer funds appropriated under the Native American Housing Assistance and Self-Determination Act of 1996 (25 U.S.C. 4101 et seq.) to the Secretary of Health and Human Services;

`(2) the Secretary of Health and Human Services is authorized to accept and use such funds for the purpose of providing sanitation facilities and services for Indians under section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a);

`(3) unless specifically authorized when funds are appropriated, the Secretary shall not use funds appropriated under section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), to provide sanitation facilities to new homes constructed using funds provided by the Department of Housing and Urban Development;

`(4) the Secretary of Health and Human Services is authorized to accept from any source, including Federal and State agencies, funds for the purpose of providing sanitation facilities and services and place these funds into contracts or compacts under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.);

`(5) except as otherwise prohibited by this section, the Secretary may use funds appropriated under the authority of section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), to fund up to 100 percent of the amount of an Indian Tribe's loan obtained under any Federal program for new projects to construct eligible sanitation facilities to serve Indian homes;

`(6) except as otherwise prohibited by this section, the Secretary may use funds appropriated under the authority of section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), to meet matching or cost participation requirements under other Federal and non-Federal programs for new projects to construct eligible sanitation facilities;

`(7) all Federal agencies are authorized to transfer to the Secretary funds identified, granted, loaned, or appropriated whereby the Department's applicable policies, rules, and regulations shall apply in the implementation of such projects;

`(8) the Secretary of Health and Human Services shall enter into interagency agreements with Federal and State agencies for the purpose of providing financial assistance for sanitation facilities and services under this Act;

`(9) the Secretary of Health and Human Services shall, by regulation, establish standards applicable to the planning, design, and construction of sanitation facilities funded under this Act; and

`(10) the Secretary of Health and Human Services is authorized to accept payments for goods and services furnished by the Service from appropriate public authorities, nonprofit organizations or agencies, or Indian Tribes, as contributions by that authority, organization, agency, or tribe to agreements made under section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), and such payments shall be credited to the same or subsequent appropriation account as funds appropriated under the authority of section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a).

`(d) Certain Capabilities Not Prerequisite- The financial and technical capability of an Indian Tribe, Tribal Organization, or Indian community to safely operate, manage, and maintain a sanitation facility shall not be a prerequisite to the provision or construction of sanitation facilities by the Secretary.

`(e) Financial Assistance- The Secretary is authorized to provide financial assistance to Indian Tribes, Tribal Organizations, and Indian communities in an amount equal to the Federal share of the costs of operating, managing, and maintaining the facilities provided under the plan described in subsection (h)(1)(F).

`(f) Operation, Management, and Maintenance of Facilities- The Indian Tribe has the primary responsibility to establish, collect, and use reasonable user fees, or otherwise set aside funding, for the purpose of operating, managing, and maintaining sanitation facilities. If a sanitation facility serving a community that is operated by an Indian Tribe or Tribal Organization is threatened with imminent failure and such operator lacks capacity to maintain the integrity or the health benefits of the sanitation facility, then the Secretary is authorized to assist the Indian Tribe, Tribal Organization, or Indian community in the resolution of the problem on a short-term basis through cooperation with the emergency coordinator or by providing operation, management, and maintenance service.

`(g) ISDEAA Program Funded on Equal Basis- Tribal Health Programs shall be eligible (on an equal basis with programs that are administered directly by the Service) for--

`(1) any funds appropriated pursuant to this section; and

`(2) any funds appropriated for the purpose of providing sanitation facilities.

`(h) Report-

`(1) REQUIRED; CONTENTS- The Secretary, in consultation with the Secretary of Housing and Urban Development, Indian Tribes, Tribal Organizations, and tribally designated housing entities (as defined in section 4 of the Native American Housing Assistance and Self-Determination Act of 1996 (25 U.S.C. 4103)) shall submit to the President, for inclusion in the report required to be transmitted to Congress under section 801, a report which sets forth--

`(A) the current Indian sanitation facility priority system of the Service;

`(B) the methodology for determining sanitation deficiencies and needs;

`(C) the criteria on which the deficiencies and needs will be evaluated;

`(D) the level of initial and final sanitation deficiency for each type of sanitation facility for each project of each Indian Tribe or Indian community;

`(E) the amount and most effective use of funds, derived from whatever source, necessary to accommodate the sanitation facilities needs of new homes assisted with funds under the Native American Housing Assistance and Self-Determination Act (25 U.S.C. 4101 et seq.), and to reduce the identified sanitation deficiency levels of all Indian Tribes and Indian communities to level I sanitation deficiency as defined in paragraph (3)(A); and

`(F) a 10-year plan to provide sanitation facilities to serve existing Indian homes and Indian communities and new and renovated Indian homes.

`(2) UNIFORM METHODOLOGY- The methodology used by the Secretary in determining, preparing cost estimates for, and reporting sanitation deficiencies for purposes of paragraph (1) shall be applied uniformly to all Indian Tribes and Indian communities.

`(3) SANITATION DEFICIENCY LEVELS- For purposes of this subsection, the sanitation deficiency levels for an individual, Indian Tribe, or Indian community sanitation facility to serve Indian homes are determined as follows:

`(A) A level I deficiency exists if a sanitation facility serving an individual, Indian Tribe, or Indian community--

`(i) complies with all applicable water supply, pollution control, and solid waste disposal laws; and

`(ii) deficiencies relate to routine replacement, repair, or maintenance needs.

`(B) A level II deficiency exists if a sanitation facility serving an individual, Indian Tribe, or Indian community substantially or recently complied with all applicable water supply, pollution control, and solid waste laws and any deficiencies relate to--

`(i) small or minor capital improvements needed to bring the facility back into compliance;

`(ii) capital improvements that are necessary to enlarge or improve the facilities in order to meet the current needs for domestic sanitation facilities; or

`(iii) the lack of equipment or training by an Indian Tribe, Tribal Organization, or an Indian community to properly operate and maintain the sanitation facilities.

`(C) A level III deficiency exists if a sanitation facility serving an individual, Indian Tribe or Indian community meets 1 or more of the following conditions--

`(i) water or sewer service in the home is provided by a haul system with holding tanks and interior plumbing;

`(ii) major significant interruptions to water supply or sewage disposal occur frequently, requiring major capital improvements to correct the deficiencies; or

`(iii) there is no access to or no approved or permitted solid waste facility available.

`(D) A level IV deficiency exists--

`(i) if a sanitation facility for an individual home, an Indian Tribe, or an Indian community exists but--

`(I) lacks--
`(aa) a safe water supply system; or

`(bb) a waste disposal system;


`(II) contains no piped water or sewer facilities; or

`(III) has become inoperable due to a major component failure; or

`(ii) if only a washeteria or central facility exists in the community.

`(E) A level V deficiency exists in the absence of a sanitation facility, where individual homes do not have access to safe drinking water or adequate wastewater (including sewage) disposal.

`(i) Definitions- For purposes of this section, the following terms apply:

`(1) INDIAN COMMUNITY- The term `Indian community' means a geographic area, a significant proportion of whose inhabitants are Indians and which is served by or capable of being served by a facility described in this section.

`(2) SANITATION FACILITIES- The terms `sanitation facility' and `sanitation facilities' mean safe and adequate water supply systems, sanitary sewage disposal systems, and sanitary solid waste systems (and all related equipment and support infrastructure).

`SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS.

`(a) Buy Indian Act- The Secretary, acting through the Service, may use the negotiating authority of section 23 of the Act of June 25, 1910 (25 U.S.C. 47, commonly known as the `Buy Indian Act'), to give preference to any Indian or any enterprise, partnership, corporation, or other type of business organization owned and controlled by an Indian or Indians including former or currently federally recognized Indian Tribes in the State of New York (hereinafter referred to as an `Indian firm') in the construction and renovation of Service facilities pursuant to section 301 and in the construction of sanitation facilities pursuant to section 302. Such preference may be accorded by the Secretary unless the Secretary finds, pursuant to regulations, that the project or function to be contracted for will not be satisfactory or such project or function cannot be properly completed or maintained under the proposed contract. The Secretary, in arriving at such a finding, shall consider whether the Indian or Indian firm will be deficient with respect to--

`(1) ownership and control by Indians;

`(2) equipment;

`(3) bookkeeping and accounting procedures;

`(4) substantive knowledge of the project or function to be contracted for;

`(5) adequately trained personnel; or

`(6) other necessary components of contract performance.

`(b) Pay Rates- For the purposes of implementing the provisions of this title, the Secretary shall assure that the rates of pay for personnel engaged in the construction or renovation of facilities constructed or renovated in whole or in part by funds made available pursuant to this title are not less than the prevailing local wage rates for similar work as determined in accordance with the Act of March 3, 1931 (40 U.S.C. 276a-276a-5, known as the Davis-Bacon Act).

`(c) Labor Standards- For the purposes of implementing the provisions of this title, contracts for the construction or renovation of health care facilities, staff quarters, and sanitation facilities, and related support infrastructure, funded in whole or in part with funds made available pursuant to this title, shall contain a provision requiring compliance with subchapter IV of chapter 31 of title 40, United States Code (commonly known as the `Davis-Bacon Act').

`SEC. 304. EXPENDITURE OF NON-SERVICE FUNDS FOR RENOVATION.

`(a) In General- Notwithstanding any other provision of law, if the requirements of subsection (c) are met, the Secretary, acting through the Service, is authorized to accept any major expansion, renovation, or modernization by any Indian Tribe or Tribal Organization of any Service facility or of any other Indian health facility operated pursuant to a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), including--

`(1) any plans or designs for such expansion, renovation, or modernization; and

`(2) any expansion, renovation, or modernization for which funds appropriated under any Federal law were lawfully expended.

`(b) Priority List-

`(1) IN GENERAL- The Secretary shall maintain a separate priority list to address the needs for increased operating expenses, personnel, or equipment for such facilities. The methodology for establishing priorities shall be developed through regulations. The list of priority facilities will be revised annually in consultation with Indian Tribes and Tribal Organizations.

`(2) REPORT- The Secretary shall submit to the President, for inclusion in the report required to be transmitted to Congress under section 801, the priority list maintained pursuant to paragraph (1).

`(c) Requirements- The requirements of this subsection are met with respect to any expansion, renovation, or modernization if--

`(1) the Indian Tribe or Tribal Organization--

`(A) provides notice to the Secretary of its intent to expand, renovate, or modernize; and

`(B) applies to the Secretary to be placed on a separate priority list to address the needs of such new facilities for increased operating expenses, personnel, or equipment; and

`(2) the expansion, renovation, or modernization--

`(A) is approved by the appropriate area director of the Service for Federal facilities; and

`(B) is administered by the Indian Tribe or Tribal Organization in accordance with any applicable regulations prescribed by the Secretary with respect to construction or renovation of Service facilities.

`(d) Additional Requirement for Expansion- In addition to the requirements under subsection (c), for any expansion, the Indian Tribe or Tribal Organization shall provide to the Secretary additional information pursuant to regulations, including additional staffing, equipment, and other costs associated with the expansion.

`(e) Closure or Conversion of Facilities- If any Service facility which has been expanded, renovated, or modernized by an Indian Tribe or Tribal Organization under this section ceases to be used as a Service facility during the 20-year period beginning on the date such expansion, renovation, or modernization is completed, such Indian Tribe or Tribal Organization shall be entitled to recover from the United States an amount which bears the same ratio to the value of such facility at the time of such cessation as the value of such expansion, renovation, or modernization (less the total amount of any funds provided specifically for such facility under any Federal program that were expended for such expansion, renovation, or modernization) bore to the value of such facility at the time of the completion of such expansion, renovation, or modernization.

`SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, AND MODERNIZATION OF SMALL AMBULATORY CARE FACILITIES.

`(a) Grants-

`(1) IN GENERAL- The Secretary, acting through the Service, shall make grants to Indian Tribes and Tribal Organizations for the construction, expansion, or modernization of facilities for the provision of ambulatory care services to eligible Indians (and noneligible persons pursuant to subsections (b)(2) and (c)(1)(C)). A grant made under this section may cover up to 100 percent of the costs of such construction, expansion, or modernization. For the purposes of this section, the term `construction' includes the replacement of an existing facility.

`(2) GRANT AGREEMENT REQUIRED- A grant under paragraph (1) may only be made available to a Tribal Health Program operating an Indian health facility (other than a facility owned or constructed by the Service, including a facility originally owned or constructed by the Service and transferred to an Indian Tribe or Tribal Organization).

`(b) Use of Grant Funds-

`(1) ALLOWABLE USES- A grant awarded under this section may be used for the construction, expansion, or modernization (including the planning and design of such construction, expansion, or modernization) of an ambulatory care facility--

`(A) located apart from a hospital;

`(B) not funded under section 301 or section 306; and

`(C) which, upon completion of such construction or modernization will--

`(i) have a total capacity appropriate to its projected service population;

`(ii) provide annually no fewer than 150 patient visits by eligible Indians and other users who are eligible for services in such facility in accordance with section 807(c)(2); and

`(iii) provide ambulatory care in a Service Area (specified in the contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.)) with a population of no fewer than 1,500 eligible Indians and other users who are eligible for services in such facility in accordance with section 807(c)(2).

`(2) ADDITIONAL ALLOWABLE USE- The Secretary may also reserve a portion of the funding provided under this section and use those reserved funds to reduce an outstanding debt incurred by Indian Tribes or Tribal Organizations for the construction, expansion, or modernization of an ambulatory care facility that meets the requirements under paragraph (1). The provisions of this section shall apply, except that such applications for funding under this paragraph shall be considered separately from applications for funding under paragraph (1).

`(3) USE ONLY FOR CERTAIN PORTION OF COSTS- A grant provided under this section may be used only for the cost of that portion of a construction, expansion, or modernization project that benefits the Service population identified above in subsection (b)(1)(C) (ii) and (iii). The requirements of clauses (ii) and (iii) of paragraph (1)(C) shall not apply to an Indian Tribe or Tribal Organization applying for a grant under this section for a health care facility located or to be constructed on an island or when such facility is not located on a road system providing direct access to an inpatient hospital where care is available to the Service population.

`(c) Grants-

`(1) APPLICATION- No grant may be made under this section unless an application or proposal for the grant has been approved by the Secretary in accordance with applicable regulations and has set forth reasonable assurance by the applicant that, at all times after the construction, expansion, or modernization of a facility carried out using a grant received under this section--

`(A) adequate financial support will be available for the provision of services at such facility;

`(B) such facility will be available to eligible Indians without regard to ability to pay or source of payment; and

`(C) such facility will, as feasible without diminishing the quality or quantity of services provided to eligible Indians, serve noneligible persons on a cost basis.

`(2) PRIORITY- In awarding grants under this section, the Secretary shall give priority to Indian Tribes and Tribal Organizations that demonstrate--

`(A) a need for increased ambulatory care services; and

`(B) insufficient capacity to deliver such services.

`(3) PEER REVIEW PANELS- The Secretary may provide for the establishment of peer review panels, as necessary, to review and evaluate applications and proposals and to advise the Secretary regarding such applications using the criteria developed pursuant to subsection (a)(1).

`(d) Reversion of Facilities- If any facility (or portion thereof) with respect to which funds have been paid under this section, ceases, at any time after completion of the construction, expansion, or modernization carried out with such funds, to be used for the purposes of providing health care services to eligible Indians, all of the right, title, and interest in and to such facility (or portion thereof) shall transfer to the United States unless otherwise negotiated by the Service and the Indian Tribe or Tribal Organization.

`(e) Funding Nonrecurring- Funding provided under this section shall be nonrecurring and shall not be available for inclusion in any individual Indian Tribe's tribal share for an award under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) or for reallocation or redesign thereunder.

`SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRATION PROJECT.

`(a) Health Care Demonstration Projects- The Secretary, acting through the Service, is authorized to make grants to, and enter into construction contracts or construction project agreements with, Indian Tribes or Tribal Organizations under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) for the purpose of carrying out a health care delivery demonstration project to test alternative means of delivering health care and services to Indians through facilities.

`(b) Use of Funds- The Secretary, in approving projects pursuant to this section, may authorize such contracts for the construction and renovation of hospitals, health centers, health stations, and other facilities to deliver health care services and is authorized to--

`(1) waive any leasing prohibition;

`(2) permit carryover of funds appropriated for the provision of health care services;

`(3) permit the use of other available funds;

`(4) permit the use of funds or property donated from any source for project purposes;

`(5) provide for the reversion of donated real or personal property to the donor; and

`(6) permit the use of Service funds to match other funds, including Federal funds.

`(c) Regulations- The Secretary shall develop and promulgate regulations, not later than 1 year after the date of enactment of the Indian Health Care Improvement Act Amendments of 2009, for the review and approval of applications submitted under this section.

`(d) Criteria- The Secretary may approve projects that meet the following criteria:

`(1) There is a need for a new facility or program or the reorientation of an existing facility or program.

`(2) A significant number of Indians, including those with low health status, will be served by the project.

`(3) The project has the potential to deliver services in an efficient and effective manner.

`(4) The project is economically viable.

`(5) The Indian Tribe or Tribal Organization has the administrative and financial capability to administer the project.

`(6) The project is integrated with providers of related health and social services and is coordinated with, and avoids duplication of, existing services.

`(e) Peer Review Panels- The Secretary may provide for the establishment of peer review panels, as necessary, to review and evaluate applications using the criteria developed pursuant to subsection (d).

`(f) Priority- The Secretary shall give priority to applications for demonstration projects in each of the following Service Units to the extent that such applications are timely filed and meet the criteria specified in subsection (d):

`(1) Cass Lake, Minnesota.

`(2) Mescalero, New Mexico.

`(3) Owyhee, Nevada.

`(4) Schurz, Nevada.

`(5) Ft. Yuma, California.

`(g) Technical Assistance- The Secretary shall provide such technical and other assistance as may be necessary to enable applicants to comply with the provisions of this section.

`(h) Service to Ineligible Persons- Subject to section 806, 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 806 may be included, subject to the terms of such section, in any demonstration project approved pursuant to this section.

`(i) Equitable Treatment- For purposes of subsection (d)(1), the Secretary shall, in evaluating facilities operated under any contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), use the same criteria that the Secretary uses in evaluating facilities operated directly by the Service.

`(j) Equitable Integration of Facilities- The Secretary shall ensure that the planning, design, construction, renovation, and expansion needs of Service and non-Service facilities which are the subject of a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) for health services are fully and equitably integrated into the implementation of the health care delivery demonstration projects under this section.

`SEC. 307. LAND TRANSFER.

`Notwithstanding any other provision of law, the Bureau of Indian Affairs and all other agencies and departments of the United States are authorized to transfer, at no cost, land and improvements to the Service for the provision of health care services. The Secretary is authorized to accept such land and improvements for such purposes.

`SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS.

`The Secretary, acting through the Service, may enter into leases, contracts, and other agreements with Indian Tribes and Tribal Organizations which hold (1) title to, (2) a leasehold interest in, or (3) a beneficial interest in (when title is held by the United States in trust for the benefit of an Indian Tribe) facilities used or to be used for the administration and delivery of health services by an Indian Health Program. Such leases, contracts, or agreements may include provisions for construction or renovation and provide for compensation to the Indian Tribe or Tribal Organization of rental and other costs consistent with section 105(l) of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450j(l)) and regulations thereunder.

`SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND LOAN REPAYMENT.

`(a) In General- The Secretary, in consultation with the Secretary of the Treasury, Indian Tribes, and Tribal Organizations, shall carry out a study to determine the feasibility of establishing a loan fund to provide to Indian Tribes and Tribal Organizations direct loans or guarantees for loans for the construction of health care facilities, including--

`(1) inpatient facilities;

`(2) outpatient facilities;

`(3) staff quarters;

`(4) hostels; and

`(5) specialized care facilities, such as behavioral health and elder care facilities.

`(b) Determinations- In carrying out the study under subsection (a), the Secretary shall determine--

`(1) the maximum principal amount of a loan or loan guarantee that should be offered to a recipient from the loan fund;

`(2) the percentage of eligible costs, not to exceed 100 percent, that may be covered by a loan or loan guarantee from the loan fund (including costs relating to planning, design, financing, site land development, construction, rehabilitation, renovation, conversion, improvements, medical equipment and furnishings, and other facility-related costs and capital purchase (but excluding staffing));

`(3) the cumulative total of the principal of direct loans and loan guarantees, respectively, that may be outstanding at any 1 time;

`(4) the maximum term of a loan or loan guarantee that may be made for a facility from the loan fund;

`(5) the maximum percentage of funds from the loan fund that should be allocated for payment of costs associated with planning and applying for a loan or loan guarantee;

`(6) whether acceptance by the Secretary of an assignment of the revenue of an Indian Tribe or Tribal Organization as security for any direct loan or loan guarantee from the loan fund would be appropriate;

`(7) whether, in the planning and design of health facilities under this section, users eligible under section 806(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, 2010, 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.

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`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;

`(2) has not begun the process of acquisition or construction of a health facility for use in the joint venture project; or

`(3) in its application for a joint venture agreement, agrees--

`(A) to construct a facility for the joint venture which complies with the size and space criteria established by the Service; or

`(B) if the facility it proposes for the joint venture is already in existence or under construction, that only the portion of such facility which complies with the size and space criteria of the Service will be eligible for the joint venture agreement.

`(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 Secretary shall consult with Indian Tribes and Tribal Organizations in determining the maximum renovation cost threshold.

`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) Transferred Funds- Any Federal agency to which funds for the construction of health care facilities are appropriated is authorized to transfer such funds to the Secretary for the construction of health care facilities to carry out the purposes of this Act as well as the purposes for which such funds are appropriated to such other Federal agency.

`(d) 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 2025 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 title XVIII or XIX 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 either such title.

`(B) USE OF FUNDS- Amounts received by a facility of the Service under subparagraph (A) by reason of a provision of title XVIII or XIX of the Social Security Act 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 such respective title. 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 increasing the facility's capacity to provide, or improving the quality or accessibility of, services.

`(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, XIX, or XXI of the Social Security Act.

`(2) DIRECT REIMBURSEMENT-

`(A) USE OF FUNDS- Each Tribal Health Program making the election described in paragraph (1) with respect to a program under title XVIII, XIX, or XXI 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 same purposes with respect to such Program for which payment under subparagraph (A) of subsection (c)(1) to a facility of the Service may be used pursuant to subparagraph (B) of such subsection with respect to the Service.

`(B) AUDITS- The amounts paid to a Tribal Health Program making the election described in paragraph (1) with respect to a program under title XVIII, XIX, or XXI 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 title XIX or XXI 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.

`(a) Indian Tribes and Tribal Organizations- From funds appropriated to carry out this title in accordance with section 414, 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

`(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 in Enrollment and Retention- The Secretary, acting through the Centers for Medicare & Medicaid Services, shall consult with States, the Service, Indian Tribes, Tribal Organizations, and urban Indian organizations to develop and disseminate best practices with respect to facilitating agreements between the States and Indian Tribes, Tribal Organizations, and urban Indian organizations relating to enrollment and retention of Indians in programs established under titles XVIII, XIX, and XXI of the Social Security Act.

`(e) Agreements To Improve Enrollment of Indians Under Social Security Act Health Benefits Programs- For provisions relating to agreements between the Secretary and the Service, Indian Tribes, Tribal Organizations, and urban Indian organizations for the collection, preparation, and submission of applications by Indians for assistance under the Medicaid and 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) Definitions- 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.

`(3) BENEFITS- The term `benefits' means, with respect to--

`(A) title XVIII of the Social Security Act, benefits under such title;

`(B) title XIX of such Act, medical assistance under such title; and

`(C) title XXI of such Act, assistance under such title.

`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, or, if higher, the highest amount the third party would pay for care and services furnished by providers other than governmental entities, 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 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 2009 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) Retention of Amounts for Use by Program- Except as provided in section 202(f) (relating to the Catastrophic Health Emergency Fund) and section 806 (relating to health services for ineligible persons), all reimbursements received or recovered, including under section 806, 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.

`(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) Purchasing Coverage-

`(1) 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 that qualifies as creditable coverage under section 2701(c)(1) of the Public Health Service Act for such beneficiaries, including, subject to paragraph (2), through--

`(A) a tribally owned and operated health care plan;

`(B) a State or locally authorized or licensed health care plan;

`(C) a health insurance provider or managed care organization; or

`(D) a self-insured plan.

`(2) EXCEPTION- The coverage provided under paragraph (1) may not include coverage consisting of--

`(A) benefits provided under a health flexible spending arrangement (as defined in section 106(c)(2) of the Internal Revenue Code of 1986); or

`(B) a high deductible health plan (as defined in section 223(c)(2) of such Code), without regard to whether the plan is purchased in conjunction with a health savings account (as defined under section 223(d) of such Code).

`(3) PERMITTING PURCHASE OF COVERAGE BASED ON FINANCIAL NEED- The purchase of coverage by an Indian Tribe, Tribal Organization, or urban Indian organization under this subsection may be based on the financial needs of 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 than 3 years after the date of enactment of the Indian Health Care Improvement Act Amendments of 2009, 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. EXCEPTION FOR EXCEPTED BENEFITS.

`The previous provisions of this title shall not apply to the provision of 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(c)).

`SEC. 417. AUTHORIZATION OF APPROPRIATIONS.

`There are authorized to be appropriated such sums as may be necessary 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.

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`SEC. 504. USE OF FEDERAL GOVERNMENT FACILITIES AND SOURCES OF SUPPLY.

`(a) In General- The Secretary may permit an urban Indian organization that has entered into a contract or received a grant pursuant to this title, in carrying out such contract or grant, to use existing facilities and all equipment therein or pertaining thereto and other personal property owned by the Federal Government within the Secretary's jurisdiction under such terms and conditions as may be agreed upon for their use and maintenance.

`(b) Donations- Subject to subsection (d), the Secretary may donate to an urban Indian organization that has entered into a contract or received a grant pursuant to this title any personal or real property determined to be excess to the needs of the Indian Health Service or the General Services Administration for the purposes of carrying out the contract or grant.

`(c) Acquisition of Property- The Secretary may acquire excess or surplus government personal or real property for donation, subject to subsection (d) to an urban Indian organization that has entered into a contract or received a grant pursuant to this title if the Secretary determines that the property is appropriate for use by the urban Indian organization for a purpose for which a contract or grant is authorized under this title.

`(d) Priority- In the event that the Secretary receives a request for a specific item of personal or real property described in subsections (b) or (c) from an urban Indian organization and from an Indian Tribe or Tribal Organization, the Secretary shall give priority to the request for donation to the Indian Tribe or Tribal Organization if the Secretary receives the request from the Indian Tribe or Tribal Organization before the date the Secretary transfers title to the property or, if earlier, the date the Secretary transfers the property physically, to the urban Indian organization.

`(e) Executive Agency Status- For purposes of section 201(a) of the Federal Property and Administrative Services Act of 1949 (40 U.S.C 481(a)) (relating to Federal sources of supply), an urban Indian organization that has entered into a contract or received a grant pursuant to this title may be deemed to be an executive agency when carrying out such contract or grant.

`SEC. 505. 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. 506. 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. 507. 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. 508. 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 2009, the Secretary, acting through the Service, shall submit to Congress a report evaluating--

`(i) the health status of urban Indians;

`(ii) the services provided to Indians pursuant to this title; and

`(iii) areas of unmet needs in the delivery of health services to urban Indians.

`(B) CONSULTATION AND CONTRACTS- In preparing the report under paragraph (1), the Secretary--

`(i) shall consult with urban Indian organizations; and

`(ii) may enter into a contract with a national organization representing urban Indian organizations to conduct any aspect of the report.

`(b) Audit- The reports and records of the urban Indian organization with respect to a contract or grant under this title shall be subject to audit by the Secretary and the Comptroller General of the United States.

`(c) Costs of Audits- The Secretary shall allow as a cost of any contract or grant entered into or awarded under section 502 or 503 the cost of an annual independent financial audit conducted by--

`(1) a certified public accountant; or

`(2) a certified public accounting firm qualified to conduct Federal compliance audits.

`SEC. 509. 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. 510. 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. 511. DIVISION OF URBAN INDIAN HEALTH.

`There is established within the Service a Division of Urban Indian Health, which shall be responsible for--

`(1) carrying out the provisions of this title;

`(2) providing central oversight of the programs and services authorized under this title; and

`(3) providing technical assistance to urban Indian organizations.

`SEC. 512. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE-RELATED SERVICES.

`(a) Grants Authorized- The Secretary, acting through the Service, may make grants for the provision of health-related services in prevention of, treatment of, rehabilitation of, or school- and community-based education regarding, alcohol and substance abuse in Urban Centers to those urban Indian organizations with which the Secretary has entered into a contract under this title or under section 201.

`(b) Goals- Each grant made pursuant to subsection (a) shall set forth the goals to be accomplished pursuant to the grant. The goals shall be specific to each grant as agreed to between the Secretary and the grantee.

`(c) Criteria- The Secretary shall establish criteria for the grants made under subsection (a), including criteria relating to the following:

`(1) The size of the urban Indian population.

`(2) Capability of the organization to adequately perform the activities required under the grant.

`(3) Satisfactory performance standards for the organization in meeting the goals set forth in such grant. The standards shall be negotiated and agreed to between the Secretary and the grantee on a grant-by-grant basis.

`(4) Identification of the need for services.

`(d) Allocation of Grants- The Secretary shall develop a methodology for allocating grants made pursuant to this section based on the criteria established pursuant to subsection (c).

`(e) Grants Subject to Criteria- Any grant received by an urban Indian organization under this Act for substance abuse prevention, treatment, and rehabilitation shall be subject to the criteria set forth in subsection (c).

`SEC. 513. 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. 514. URBAN NIAAA TRANSFERRED PROGRAMS.

`(a) Grants and Contracts- The Secretary, through the Division of Urban Indian Health, shall make grants or enter into contracts with urban Indian organizations, to take effect not later than September 30, 2010, for the administration of urban Indian alcohol programs that were originally established under the National Institute on Alcoholism and Alcohol Abuse (hereafter in this section referred to as `NIAAA') and transferred to the Service.

`(b) Use of Funds- Grants provided or contracts entered into under this section shall be used to provide support for the continuation of alcohol prevention and treatment services for urban Indian populations and such other objectives as are agreed upon between the Service and a recipient of a grant or contract under this section.

`(c) Eligibility- Urban Indian organizations that operate Indian alcohol programs originally funded under the NIAAA and subsequently transferred to the Service are eligible for grants or contracts under this section.

`(d) Report- The Secretary shall evaluate and report to Congress on the activities of programs funded under this section not less than every 5 years.

`SEC. 515. 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. 516. 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. 517. 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. 518. 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. 519. EFFECTIVE DATE.

`The amendments made by the Indian Health Care Improvement Act Amendments of 2009 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. 520. 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. 521. AUTHORIZATION OF APPROPRIATIONS.

`(a) In General- There are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2025 to carry out this title.

`(b) Urban Indian Organizations- The Secretary, acting through the Service, is authorized to establish programs, including programs for the awarding of grants, for urban Indian organizations that are identical to any programs established pursuant to section 126 (behavioral health training), section 210 (school health education), section 212 (prevention of communicable diseases), section 701 (behavioral health prevention and treatment services), and section 707(g) (multidrug abuse program).

`SEC. 522. HEALTH INFORMATION TECHNOLOGY.

`The Secretary, acting through the Service, may make grants to urban Indian organizations under this title for the development, adoption, and implementation of health information technology (as defined in section 3000(5) of the American Recovery and Reinvestment Act), telemedicine services development, and related infrastructure.

`TITLE VI--ORGANIZATIONAL IMPROVEMENTS

`SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERVICE AS AN AGENCY OF THE PUBLIC HEALTH SERVICE.

`(a) Establishment-

`(1) IN GENERAL- In order to more effectively and efficiently carry out the responsibilities, authorities, and functions of the United States to provide health care services to Indians and Indian Tribes, as are or may be hereafter provided by Federal statute or treaties, there is established within the Public Health Service of the Department the Indian Health Service.

`(2) ASSISTANT SECRETARY OF INDIAN HEALTH- The Service shall be administered by an Assistant Secretary of Indian Health, who shall be appointed by the President, by and with the advice and consent of the Senate. The Assistant Secretary shall report to the Secretary. Effective with respect to an individual appointed by the President, by and with the advice and consent of the Senate, after January 1, 2010, the term of service of the Assistant Secretary shall be 4 years. An Assistant Secretary may serve more than 1 term.

`(3) INCUMBENT- The individual serving in the position of Director of the Service on the day before the date of enactment of the Indian Health Care Improvement Act Amendments of 2009 shall serve as Assistant Secretary.

`(4) ADVOCACY AND CONSULTATION- The position of Assistant Secretary is established to, in a manner consistent with the government-to-government relationship between the United States and Indian Tribes--

`(A) facilitate advocacy for the development of appropriate Indian health policy; and

`(B) promote consultation on matters relating to Indian health.

`(b) Agency- The Service shall be an agency within the Public Health Service of the Department, and shall not be an office, component, or unit of any other agency of the Department.

`(c) Duties- The Assistant Secretary shall--

`(1) perform all functions that were, on the day before the date of enactment of the Indian Health Care Improvement Act Amendments of 2009, carried out by or under the direction of the individual serving as Director of the Service on that day;

`(2) perform all functions of the Secretary relating to the maintenance and operation of hospital and health facilities for Indians and the planning for, and provision and utilization of, health services for Indians;

`(3) administer all health programs under which health care is provided to Indians based upon their status as Indians which are administered by the Secretary, including programs under--

`(A) this Act;

`(B) the Act of November 2, 1921 (25 U.S.C. 13);

`(C) the Act of August 5, 1954 (42 U.S.C. 2001 et seq.);

`(D) the Act of August 16, 1957 (42 U.S.C. 2005 et seq.); and

`(E) the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.);

`(4) administer all scholarship and loan functions carried out under title I;

`(5) report directly to the Secretary concerning all policy- and budget-related matters affecting Indian health;

`(6) collaborate with the Assistant Secretary for Health concerning appropriate matters of Indian health that affect the agencies of the Public Health Service;

`(7) advise each Assistant Secretary of the Department concerning matters of Indian health with respect to which that Assistant Secretary has authority and responsibility;

`(8) advise the heads of other agencies and programs of the Department concerning matters of Indian health with respect to which those heads have authority and responsibility;

`(9) coordinate the activities of the Department concerning matters of Indian health; and

`(10) perform such other functions as the Secretary may designate.

`(d) Authority-

`(1) IN GENERAL- The Secretary, acting through the Assistant Secretary, shall have the authority--

`(A) except to the extent provided for in paragraph (2), to appoint and compensate employees for the Service in accordance with title 5, United States Code;

`(B) to enter into contracts for the procurement of goods and services to carry out the functions of the Service; and

`(C) to manage, expend, and obligate all funds appropriated for the Service.

`(2) PERSONNEL ACTIONS- Notwithstanding any other provision of law, the provisions of section 12 of the Act of June 18, 1934 (48 Stat. 986; 25 U.S.C. 472), shall apply to all personnel actions taken with respect to new positions created within the Service as a result of its establishment under subsection (a).

`(e) References- Any reference to the Director of the Indian Health Service in any other Federal law, Executive order, rule, regulation, or delegation of authority, or in any document of or relating to the Director of the Indian Health Service, shall be deemed to refer to the Assistant Secretary.

`SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM.

`(a) Establishment-

`(1) IN GENERAL- The Secretary shall establish an automated management information system for the Service.

`(2) REQUIREMENTS OF SYSTEM- The information system established under paragraph (1) shall include--

`(A) a financial management system;

`(B) a patient care information system for each area served by the Service;

`(C) privacy protections consistent with the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 or, to the extent consistent with such regulations, other Federal rules applicable to privacy of automated management information systems of a Federal agency;

`(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- The Service shall provide access of patients to their medical or health records which are held by, or on behalf of, the Service in accordance with the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 or, to the extent consistent with such regulations, other Federal rules applicable to access to health care records.

`(d) Authority To Enhance Information Technology- The Secretary, acting through the Assistant Secretary, shall have the authority to enter into contracts, agreements, or joint ventures with other Federal agencies, States, private and nonprofit organizations, for the purpose of enhancing information technology in Indian Health Programs and facilities.

`SEC. 603. AUTHORIZATION OF APPROPRIATIONS.

`There is authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2025 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, 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, shall encourage Indian Tribes and Tribal Organizations to develop tribal plans, and urban Indian organizations to develop local plans, and for all such groups to participate in developing areawide plans for Indian Behavioral Health Services. The plans shall include, to the extent feasible, the following components:

`(A) An assessment of the scope of alcohol or other substance abuse, mental illness, and dysfunctional and self-destructive behavior, including suicide, child abuse, and family violence, among Indians, including--

`(i) the number of Indians served who are directly or indirectly affected by such illness or behavior; or

`(ii) an estimate of the financial and human cost attributable to such illness or behavior.

`(B) An assessment of the existing and additional resources necessary for the prevention and treatment of such illness and behavior, including an assessment of the progress toward achieving the availability of the full continuum of care described in subsection (c).

`(C) An estimate of the additional funding needed by the Service, Indian Tribes, Tribal Organizations, and urban Indian organizations to meet their responsibilities under the plans.

`(2) NATIONAL CLEARINGHOUSE- The Secretary, acting through the Service, shall coordinate with existing national clearinghouses and information centers to include at the clearinghouses and centers plans and reports on the outcomes of such plans developed by Indian Tribes, Tribal Organizations, urban Indian organizations, and Service Areas relating to behavioral health. The Secretary shall ensure access to these plans and outcomes by any Indian Tribe, Tribal Organization, urban Indian organization, or the Service.

`(3) TECHNICAL ASSISTANCE- The Secretary shall provide technical assistance to Indian Tribes, Tribal Organizations, and urban Indian organizations in preparation of plans under this section and in developing standards of care that may be used and adopted locally.

`(c) Programs- The Secretary, acting through the Service, shall provide, to the extent feasible and if funding is available, programs including the following:

`(1) COMPREHENSIVE CARE- A comprehensive continuum of behavioral health care which provides--

`(A) community-based prevention, intervention, outpatient, and behavioral health aftercare;

`(B) detoxification (social and medical);

`(C) acute hospitalization;

`(D) intensive outpatient/day treatment;

`(E) residential treatment;

`(F) transitional living for those needing a temporary, stable living environment that is supportive of treatment and recovery goals;

`(G) emergency shelter;

`(H) intensive case management; and

`(I) diagnostic services.

`(2) CHILD CARE- Behavioral health services for Indians from birth through age 17, including--

`(A) preschool and school age fetal alcohol disorder services, including assessment and behavioral intervention;

`(B) mental health and substance abuse services (emotional, organic, alcohol, drug, inhalant, and tobacco);

`(C) identification and treatment of co-occurring disorders and comorbidity;

`(D) prevention of alcohol, drug, inhalant, and tobacco use;

`(E) early intervention, treatment, and aftercare;

`(F) promotion of healthy approaches to risk and safety issues; and

`(G) identification and treatment of neglect and physical, mental, and sexual abuse.

`(3) ADULT CARE- Behavioral health services for Indians from age 18 through 55, including--

`(A) early intervention, treatment, and aftercare;

`(B) mental health and substance abuse services (emotional, alcohol, drug, inhalant, and tobacco), including sex specific services;

`(C) identification and treatment of co-occurring disorders (dual diagnosis) and comorbidity;

`(D) promotion of healthy approaches for risk-related behavior;

`(E) treatment services for women at risk of giving birth to a child with a fetal alcohol disorder; and

`(F) sex specific treatment for sexual assault and domestic violence.

`(4) FAMILY CARE- Behavioral health services for families, including--

`(A) early intervention, treatment, and aftercare for affected families;

`(B) treatment for sexual assault and domestic violence; and

`(C) promotion of healthy approaches relating to parenting, domestic violence, and other abuse issues.

`(5) ELDER CARE- Behavioral health services for Indians 56 years of age and older, including--

`(A) early intervention, treatment, and aftercare;

`(B) mental health and substance abuse services (emotional, alcohol, drug, inhalant, and tobacco), including sex specific services;

`(C) identification and treatment of co-occurring disorders (dual diagnosis) and comorbidity;

`(D) promotion of healthy approaches to managing conditions related to aging;

`(E) sex specific treatment for sexual assault, domestic violence, neglect, physical and mental abuse and exploitation; and

`(F) identification and treatment of dementias regardless of cause.

`(d) Community Behavioral Health Plan-

`(1) ESTABLISHMENT- The governing body of any Indian Tribe, Tribal Organization, or urban Indian organization may adopt a resolution for the establishment of a community behavioral health plan providing for the identification and coordination of available resources and programs to identify, prevent, or treat substance abuse, mental illness, or dysfunctional and self-destructive behavior, including child abuse and family violence, among its members or its service population. This plan should include behavioral health services, social services, intensive outpatient services, and continuing aftercare.

`(2) TECHNICAL ASSISTANCE- At the request of an Indian Tribe, Tribal Organization, or urban Indian organization, the Bureau of Indian Affairs and the Service shall cooperate with and provide technical assistance to the Indian Tribe, Tribal Organization, or urban Indian organization in the development and implementation of such plan.

`(3) FUNDING- The Secretary, acting through the Service, may make funding available to Indian Tribes and Tribal Organizations which adopt a resolution pursuant to paragraph (1) to obtain technical assistance for the development of a community behavioral health plan and to provide administrative support in the implementation of such plan.

`(e) Coordination for Availability of Services- The Secretary, acting through the Service, 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 2009, 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 2009, 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, shall provide a program of comprehensive behavioral health, prevention, treatment, and aftercare, including Systems of Care, 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, 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, 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, shall supervise and evaluate the mental health technicians in the training program.

`(d) Traditional Health Care Practices- The Secretary, acting through the Service, shall ensure that the program established pursuant to this subsection involves the use and promotion of the traditional health care practices of the Indian Tribes to be served.

`SEC. 705. LICENSING REQUIREMENT FOR MENTAL HEALTH CARE WORKERS.

`(a) In General- Subject to the provisions of section 221, and except as provided in subsection (b), any individual employed as a psychologist, social worker, or marriage and family therapist for the purpose of providing mental health care services to Indians in a clinical setting under this Act is required to be licensed as a psychologist, social worker, or marriage and family therapist, respectively.

`(b) Trainees- An individual may be employed as a trainee in psychology, social work, or marriage and family therapy to provide mental health care services described in subsection (a) if such individual--

`(1) works under the direct supervision of a licensed psychologist, social worker, or marriage and family therapist, respectively;

`(2) is enrolled in or has completed at least 2 years of course work at a post-secondary, accredited education program for psychology, social work, marriage and family therapy, or counseling; and

`(3) meets such other training, supervision, and quality review requirements as the Secretary may establish.

`SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.

`(a) Grants- The Secretary, consistent with section 701, may make grants to Indian Tribes, Tribal Organizations, and urban Indian organizations to develop and implement a comprehensive behavioral health program of prevention, intervention, treatment, and relapse prevention services that specifically addresses the cultural, historical, social, and child care needs of Indian women, regardless of age.

`(b) Use of Grant Funds- A grant made pursuant to this section may be used to--

`(1) develop and provide community training, education, and prevention programs for Indian women relating to behavioral health issues, including fetal alcohol disorders;

`(2) identify and provide psychological services, counseling, advocacy, support, and relapse prevention to Indian women and their families; and

`(3) develop prevention and intervention models for Indian women which incorporate traditional health care practices, cultural values, and community and family involvement.

`(c) Criteria- The Secretary, in consultation with Indian Tribes and Tribal Organizations, shall establish criteria for the review and approval of applications and proposals for funding under this section.

`(d) Allocation of Funds for Urban Indian Organizations- 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, 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, may provide intermediate behavioral health services, which may incorporate Systems of Care, 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.

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`(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, 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, 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 2010 through 2025.

`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 2009, the Secretary, acting through the Service, 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 provide instruction in the area of behavioral health issues, including instruction in crisis intervention and family relations in the context of alcohol and substance abuse, child sexual abuse, youth alcohol and substance abuse, and the causes and effects of fetal alcohol disorders to appropriate employees of the Bureau of Indian Affairs and the Service, and to personnel in schools or programs operated under any contract with the Bureau of Indian Affairs or the Service, including supervisors of emergency shelters and halfway houses described in section 4213 of the Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 2433).

`(c) Training Models- In carrying out the education and training programs required by this section, the Secretary, in consultation with Indian Tribes, Tribal Organizations, Indian behavioral health experts, and Indian alcohol and substance abuse prevention experts, shall develop and provide community-based training models. Such models shall address--

`(1) the elevated risk of alcohol and behavioral health problems faced by children of alcoholics;

`(2) the cultural, spiritual, and multigenerational aspects of behavioral health problem prevention and recovery; and

`(3) community-based and multidisciplinary strategies, including Systems of Care, for preventing and treating behavioral health problems.

`SEC. 711. BEHAVIORAL HEALTH PROGRAM.

`(a) Innovative Programs- The Secretary, acting through the Service, consistent with section 701, may plan, develop, implement, and carry out programs to deliver innovative community-based behavioral health services to Indians.

`(b) Awards; Criteria- The Secretary may award a grant for a project under subsection (a) to an Indian Tribe or Tribal Organization and may consider the following criteria:

`(1) The project will address significant unmet behavioral health needs among Indians.

`(2) The project will serve a significant number of Indians.

`(3) The project has the potential to deliver services in an efficient and effective manner.

`(4) The Indian Tribe or Tribal Organization has the administrative and financial capability to administer the project.

`(5) The project may deliver services in a manner consistent with traditional health care practices.

`(6) The project is coordinated with, and avoids duplication of, existing services.

`(c) Equitable Treatment- For purposes of this subsection, the Secretary shall, in evaluating project applications or proposals, use the same criteria that the Secretary uses in evaluating any other application or proposal for such funding.

`SEC. 712. FETAL ALCOHOL DISORDER PROGRAMS.

`(a) Programs-

`(1) ESTABLISHMENT- The Secretary, consistent with section 701 and acting through the Service, is authorized to establish and operate fetal alcohol disorder programs as provided in this section for the purposes of meeting the health status objectives specified in section 3.

`(2) USE OF FUNDS-

`(A) IN GENERAL- Funding provided pursuant to this section shall be used for the following:

`(i) To develop and provide for Indians community and in-school training, education, and prevention programs relating to fetal alcohol disorders.

`(ii) To identify and provide behavioral health treatment to high-risk Indian women and high-risk women pregnant with an Indian's child.

`(iii) To identify and provide appropriate psychological services, educational and vocational support, counseling, advocacy, and information to fetal alcohol disorder affected Indians and their families or caretakers.

`(iv) To develop and implement counseling and support programs in schools for fetal alcohol disorder affected Indian children.

`(v) To develop prevention and intervention models which incorporate practitioners of traditional health care practices, cultural values, and community involvement.

`(vi) To develop, print, and disseminate education and prevention materials on fetal alcohol disorder.

`(vii) To develop and implement, in consultation with Indian Tribes, Tribal Organizations, and urban Indian organizations, culturally sensitive assessment and diagnostic tools including dysmorphology clinics and multidisciplinary fetal alcohol disorder clinics for use in Indian communities and Urban Centers.

`(B) ADDITIONAL USES- In addition to any purpose under subparagraph (A), funding provided pursuant to this section may be used for 1 or more of the following:

`(i) Early childhood intervention projects from birth on to mitigate the effects of fetal alcohol disorder among Indians.

`(ii) Community-based support services for Indians and women pregnant with Indian children.

`(iii) Community-based housing for adult Indians with fetal alcohol disorder.

`(3) CRITERIA FOR APPLICATIONS- The Secretary shall establish criteria for the review and approval of applications for funding under this section.

`(b) Services- The Secretary, acting through the Service, shall--

`(1) develop and provide services for the prevention, intervention, treatment, and aftercare for those affected by fetal alcohol disorder in Indian communities; and

`(2) provide supportive services, including services to meet the special educational, vocational, school-to-work transition, and independent living needs of adolescent and adult Indians with fetal alcohol disorder.

`(c) Task Force- The Secretary shall establish a task force to be known as the Fetal Alcohol Disorder Task Force to advise the Secretary in carrying out subsection (b). Such task force shall be composed of representatives from the following:

`(1) The National Institute on Drug Abuse.

`(2) The National Institute on Alcohol and Alcoholism.

`(3) The Office of Substance Abuse Prevention.

`(4) The National Institute of Mental Health.

`(5) The Service.

`(6) The Office of Minority Health of the Department of Health and Human Services.

`(7) The Administration for Native Americans.

`(8) The National Institute of Child Health and Human Development (NICHD).

`(9) The Centers for Disease Control and Prevention.

`(10) The Bureau of Indian Affairs.

`(11) Indian Tribes.

`(12) Tribal Organizations.

`(13) urban Indian organizations.

`(14) Indian fetal alcohol 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 AND PREVENTION TREATMENT PROGRAMS.

`(a) Establishment- The Secretary, acting through the Service, shall establish, consistent with section 701, in every Service Area, programs involving treatment for--

`(1) victims of sexual abuse who are Indian children or children in an Indian household; and

`(2) perpetrators of child sexual abuse who are Indian or members of an Indian household.

`(b) Use of Funds- Funding provided pursuant to this section shall be used for the following:

`(1) To develop and provide community education and prevention programs related to sexual abuse of Indian children or children in an Indian household.

`(2) To identify and provide behavioral health treatment to victims of sexual abuse who are Indian children or children in an Indian household, and to their family members who are affected by sexual abuse.

`(3) To develop prevention and intervention models which incorporate traditional health care practices, cultural values, and community involvement.

`(4) To develop and implement culturally sensitive assessment and diagnostic tools for use in Indian communities and Urban Centers.

`(5) To identify and provide behavioral health treatment to Indian perpetrators and perpetrators who are members of an Indian household--

`(A) making efforts to begin offender and behavioral health treatment while the perpetrator is incarcerated or at the earliest possible date if the perpetrator is not incarcerated; and

`(B) providing treatment after the perpetrator is released, until it is determined that the perpetrator is not a threat to children.

`(c) Coordination- The programs established under subsection (a) shall be carried out in coordination with programs and services authorized under the Indian Child Protection and Family Violence Prevention Act (25 U.S.C. 3201 et seq.).

`SEC. 714. 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 2009, 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. 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. 716. DEFINITIONS.

`For the purpose of this title, the following definitions shall apply:

`(1) ASSESSMENT- The term `assessment' means the systematic collection, analysis, and dissemination of information on health status, health needs, and health problems.

`(2) ALCOHOL-RELATED NEURODEVELOPMENTAL DISORDERS OR ARND- The term `alcohol-related neurodevelopmental disorders' or `ARND' means, with a history of maternal alcohol consumption during pregnancy, central nervous system involvement such as developmental delay, intellectual deficit, or neurologic abnormalities. Behaviorally, there can be problems with irritability, and failure to thrive as infants. As children become older there will likely be hyperactivity, attention deficit, language dysfunction, and perceptual and judgment problems.

`(3) BEHAVIORAL HEALTH AFTERCARE- The term `behavioral health aftercare' includes those activities and resources used to support recovery following inpatient, residential, intensive substance abuse, or mental health outpatient or outpatient treatment. The purpose is to help prevent or deal with relapse by ensuring that by the time a client or patient is discharged from a level of care, such as outpatient treatment, an aftercare plan has been developed with the client. An aftercare plan may use such resources as a community-based therapeutic group, transitional living facilities, a 12-step sponsor, a local 12-step or other related support group, and other community-based providers.

`(4) DUAL DIAGNOSIS- The term `dual diagnosis' means coexisting substance abuse and mental illness conditions or diagnosis. Such clients are sometimes referred to as mentally ill chemical abusers (MICAs).

`(5) FETAL ALCOHOL 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 medical and health care services that--

`(A) are recommended by a physician or licensed practitioner of the healing arts within the scope of their practice under applicable law;

`(B) are furnished in a facility, home, or other setting in accordance with applicable standards; and

`(C) have as their purpose any of the following:

`(i) The maximum attainment of physical, mental, and developmental functioning.

`(ii) Averting deterioration in physical or mental functional status.

`(iii) The maintenance of physical or mental health functional status.

`(8) SUBSTANCE ABUSE- The term `substance abuse' includes inhalant abuse.

`(9) SYSTEMS OF CARE- The term `Systems of Care' means a system for delivering services to children and their families that is child-centered, family-focused and family-driven, community-based, and culturally competent and responsive to the needs of the children and families being served. The systems of care approach values prevention and early identification, smooth transitions for children and families, child and family participation and advocacy, comprehensive array of services, individualized service planning, services in the least restrictive environment, and integrated services with coordinated planning across the child-serving systems.

`SEC. 717. AUTHORIZATION OF APPROPRIATIONS.

`There is authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2025 to carry out the provisions of this title.

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`TITLE VIII--MISCELLANEOUS

`SEC. 801. REPORTS.

`For each fiscal year following the date of enactment of the Indian Health Care Improvement Act Amendments of 2009, 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 807.

`(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(m).

`(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 807.

`(22) A report on the movement of patients between Service Units, including--

`(A) a list of those Service Units that have a net increase and those that have a net decrease of patients due to patients assigned to one Service Unit voluntarily choosing to receive service at another Service Unit;

`(B) an analysis of the effect of patient movement on the quality of services for those Service Units experiencing an increase in the number of patients served; and

`(C) what funding changes are necessary to maintain a consistent quality of service at Service Units that have an increase in the number of patients served.

`(23) A report on the extent to which health care facilities of the Service, Indian Tribes, Tribal Organizations, and urban Indian organizations comply with credentialing requirements of the Service or licensure requirements of States.

`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 2009, the Secretary shall initiate procedures under subchapter III of chapter 5 of title 5, United States Code, to negotiate and promulgate such regulations or amendments thereto that are necessary to carry out this Act, except sections 105, 115, 117, 202, and 409 through 416. The Secretary may promulgate regulations to carry out such sections using the procedures required by chapter 5 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 2009 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 2009.

`(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.

`SEC. 803. PLAN OF IMPLEMENTATION.

`(a) In General- Not later than 1 year after the date of enactment of the Indian Health Care Improvement Act Amendments of 2009, the Secretary, in consultation with Indian Tribes, Tribal Organizations, and urban Indian organizations, shall submit to Congress a plan explaining the manner and schedule, by title and section, by which the Secretary will implement the provisions of this Act. This consultation may be conducted jointly with the annual budget consultation pursuant to the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.).

`(b) Lack of Plan- The lack of (or failure to submit) such a plan shall not limit the effect, or prevent the implementation, of this Act.

`SEC. 804. LIMITATION ON USE OF FUNDS APPROPRIATED TO INDIAN HEALTH SERVICE.

`Any limitation on the use of funds contained in an Act providing appropriations for the Department for a period with respect to the performance of abortions shall apply for that period with respect to the performance of abortions using funds contained in an Act providing appropriations for the Service.

`SEC. 805. 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. 806. 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 area of 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-

`(1) IN GENERAL- 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.

`(2) DEFINITION- For purposes of this subsection, the term `non-Service health care practitioner' means a practitioner who is not--

`(A) an employee of the Service; or

`(B) an employee of an Indian tribe or tribal organization operating a contract or compact under the Indian Self-Determination and Education Assistance Act or an individual who provides health care services pursuant to a personal services contract with such Indian tribe or tribal organization.

`(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. 807. TREATMENT OF CERTAIN SERVICES AND BENEFITS.

`(a) Gross income does not include (1) health services or benefits provided or purchased by the Indian Health Service, either directly or indirectly, through a grant to or a contract or compact with an Indian tribe or tribal organization, or grants to or other programs of third parties funded by the Indian Health Service; (2) health services, health benefits or other amounts for health care services, including preventive care and treatment of personal injuries or sickness and other health conditions, provided by an Indian tribe or tribal organization to an Indian either directly, through purchased services, or through accident or health insurance (or through an arrangement having the effect of accident or health insurance); (3) the value of health coverage provided or premiums paid by an Indian tribe or tribal organization to or on behalf of an Indian under an accident or health plan (or through an arrangement having the effect of accident or health insurance); or (4) any other benefit or service provided by an Indian tribe that supplements the programs and services provided by the Federal government to Indian tribes or Indians, or other general welfare benefits or services provided by Indian tribes to Indians.

`(b) Definitions- For the purposes of this section:

`(1) The terms `accident or health insurance' and `personal injuries and sickness' have the meaning given those terms in section 104 of the Internal Revenue Code of 1986.

`(2) The term `Indian tribe' has the meaning given that term in section 4(e) of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b(e)).

`(3) The term `Indians' and `Indian' means any person who--

`(A) is a member of an Indian tribe, as defined in paragraph (2); and

`(B)(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 by the State in which they reside;

`(ii) is a descendant, in the first or second degree, of any such member;

`(iii) is an Eskimo or Aleut or other Alaska Native;

`(iv) is otherwise eligible for services provided or funded by the Indian Health Service under applicable law; or

`(v) is considered by the Secretary of the Interior to be an Indian for any purpose.

`(4) The term `tribal organization' has the meaning given that term in section 4(l) of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b(l)).

`(c) No Inference- Nothing in this section is intended as an inference to the tax treatment of governmental benefits (including health care benefits not covered under this section) provided by Indian tribes to Indians after the date of the enactment of this section.

`SEC. 808. REALLOCATION OF BASE RESOURCES.

`(a) Report Required- Notwithstanding any other provision of law, any allocation of Service funds for a fiscal year that reduces by 5 percent or more from the previous fiscal year the funding for any recurring program, project, or activity of a Service Unit may be implemented only after the Secretary has submitted to Congress, under section 801, a report on the proposed change in allocation of funding, including the reasons for the change and its likely effects.

`(b) Exception- Subsection (a) shall not apply if the total amount appropriated to the Service for a fiscal year is at least 5 percent less than the amount appropriated to the Service for the previous fiscal year.

`SEC. 809. RESULTS OF DEMONSTRATION PROJECTS.

`The Secretary shall provide for the dissemination to Indian Tribes, Tribal Organizations, and urban Indian organizations of the findings and results of demonstration projects conducted under this Act.

`SEC. 810. PROVISION OF SERVICES IN MONTANA.

`(a) Consistent With Court Decision- The Secretary, acting through the Service, shall provide services and benefits for Indians in Montana in a manner consistent with the decision of the United States Court of Appeals for the Ninth Circuit in McNabb for McNabb v. Bowen, 829 F.2d 787 (9th Cir. 1987).

`(b) Clarification- The provisions of subsection (a) shall not be construed to be an expression of the sense of Congress on the application of the decision described in subsection (a) with respect to the provision of services or benefits for Indians living in any State other than Montana.

`SEC. 811. MORATORIUM.

`During the period of the moratorium imposed on implementation of the final rule published in the Federal Register on September 16, 1987, by the Department of Health and Human Services, relating to eligibility for the health care services of the Indian Health Service, the Indian Health Service shall provide services pursuant to the criteria for eligibility for such services that were in effect on September 15, 1987, subject to the provisions of sections 805 and 806, until the Service has submitted to the Committees on Appropriations of the Senate and the House of Representatives a budget request reflecting the increased costs associated with the proposed final rule, and the request has been included in an appropriations Act and enacted into law.

`SEC. 812. SEVERABILITY PROVISIONS.

`If any provision of this Act, any amendment made by the Act, or the application of such provision or amendment to any person or circumstances is held to be invalid, the remainder of this Act, the remaining amendments made by this Act, and the application of such provisions to persons or circumstances other than those to which it is held invalid, shall not be affected thereby.

`SEC. 813. USE OF PATIENT SAFETY ORGANIZATIONS.

`The Service, an Indian Tribe, Tribal Organization, or urban Indian organization may provide for quality assurance activities through the use of a patient safety organization in accordance with title IX of the Public Health Service Act.

`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 or Urban Indian Organizations's medical quality assurance programs.

`(2) WITHHOLDING FROM CONGRESS- Nothing in this section shall be construed as authority to withhold any medical quality assurance record from a committee of either House of Congress, any joint committee of Congress, or the Government Accountability Office if such record pertains to any matter within their respective jurisdictions.

`(e) Prohibition on Disclosure of Record or Testimony- A person or entity having possession of or access to a record or testimony described by this section may not disclose the contents of such record or testimony in any manner or for any purpose except as provided in this section.

`(f) Exemption From Freedom of Information Act- Medical quality assurance records described in subsection (a) may not be made available to any person under section 552 of title 5, United States Code.

`(g) Limitation on Civil Liability- A person who participates in or provides information to a person or body that reviews or creates medical quality assurance records described in subsection (a) shall not be civilly liable for such participation or for providing such information if the participation or provision of information was in good faith based on prevailing professional standards at the time the medical quality assurance program activity took place.

`(h) Application to Information in Certain Other Records- Nothing in this section shall be construed as limiting access to the information in a record created and maintained outside a medical quality assurance program, including a patient's medical records, on the grounds that the information was presented during meetings of a review body that are part of a medical quality assurance program.

`(i) Regulations- The Secretary, acting through the Service, shall promulgate regulations pursuant to section 802.

`(j) Definitions- In this section:

`(1) The term `health care provider' means any health care professional, including community health aides and practitioners certified under section 121, who are granted clinical practice privileges or employed to provide health care services in an Indian Health Program or health program of an Urban Indian Organization, who is licensed or certified to perform health care services by a governmental board or agency or professional health care society or organization.

`(2) The term `medical quality assurance program' means any activity carried out before, on, or after the date of enactment of this Act by or for any Indian Health Program or Urban Indian Organization to assess the quality of medical care, including activities conducted by or on behalf of individuals, Indian Health Program or Urban Indian Organization medical or dental treatment review committees, or other review bodies responsible for quality assurance, credentials, infection control, patient safety, patient care assessment (including treatment procedures, blood, drugs, and therapeutics), medical records, health resources management review and identification and prevention of medical or dental incidents and risks.

`(3) The term `medical quality assurance record' means the proceedings, records, minutes, and reports that emanate from quality assurance program activities described in paragraph (2) and are produced or compiled by or for an Indian Health Program or Urban Indian Organization as part of a medical quality assurance program.

`(k) Continued Protection- Disclosure under subsection (c) does not permit redisclosure except to the extent such further disclosure is authorized under subsection (c) or is otherwise authorized to be disclosed under this section.

`(l) Inconsistencies- To the extent that the protections under the Patient Safety and Quality Improvement Act of 2005 and this section are inconsistent, the provisions of whichever is more protective shall control.

`(m) Relationship to Other Law- This section shall continue in force and effect, except asotherwise specifically provided in any Federal law enacted after the date of enactment of the Indian Health Care Improvement Act Amendments of 2009.

`SEC. 815. CLAREMORE INDIAN HOSPITAL.

`The Claremore Indian Hospital shall be deemed to be a dependant Indian community for the purposes of section 1151 of title 18, United States Code.

`SEC. 816. 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. 817. PERMITTING IMPLEMENTATION THROUGH CONTRACTS WITH TRIBAL HEALTH PROGRAMS.

`Nothing in this Act shall be construed as preventing the Secretary from--

`(1) carrying out any section of this Act through contracts with Tribal Health Programs; and

`(2) carrying out sections through 214, 701(a)(1), 701(b)(1), 701(c), 707(g), and 712(b), through contracts with urban Indian organizations.

The previous sentence shall not affect the authority the Secretary may otherwise have to carry out other provisions of this Act through such contracts.

`SEC. 818. AUTHORIZATION OF APPROPRIATIONS; AVAILABILITY.

`(a) Authorization of Appropriations- There are authorized to be appropriated such sums as may be necessary to carry out this title.

`(b) Limitation on New Spending Authority- 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.

`(c) Availability- The funds appropriated pursuant to this Act shall remain available until expended.'.

(b) Rate of Pay-

(1) POSITIONS AT LEVEL IV- Section 5315 of title 5, United States Code, is amended by striking `Assistant Secretaries of Health and Human Services (6).' and inserting `Assistant Secretaries of Health and Human Services (7)'.

(2) POSITIONS AT LEVEL V- Section 5316 of title 5, United States Code, is amended by striking `Director, Indian Health Service, Department of Health and Human Services'.

(c) Amendments to Other Provisions of Law-

(1) Section 3307(b)(1)(C) of the Children's Health Act of 2000 (25 U.S.C. 1671 note; Public Law 106-310) is amended by striking `Director of the Indian Health Service' and inserting `Assistant Secretary for Indian Health'.

(2) The Indian Lands Open Dump Cleanup Act of 1994 is amended--

(A) in section 3 (25 U.S.C. 3902)--

(i) by striking paragraph (2);

(ii) by redesignating paragraphs (1), (3), (4), (5), and (6) as paragraphs (4), (5), (2), (6), and (1), respectively, and moving those paragraphs so as to appear in numerical order; and

(iii) by inserting before paragraph (4) (as redesignated by subclause (II)) the following:

`(3) ASSISTANT SECRETARY- The term `Assistant Secretary' means the Assistant Secretary for Indian Health.';

(B) in section 5 (25 U.S.C. 3904), by striking the section designation and heading and inserting the following:

`SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR INDIAN HEALTH.';

(C) in section 6(a) (25 U.S.C. 3905(a)), in the subsection heading, by striking `Director' and inserting `Assistant Secretary';

(D) in section 9(a) (25 U.S.C. 3908(a)), in the subsection heading, by striking `Director' and inserting `Assistant Secretary'; and

(E) by striking `Director' each place it appears and inserting `Assistant Secretary'.

(3) Section 5504(d)(2) of the Augustus F. Hawkins-Robert T. Stafford Elementary and Secondary School Improvement Amendments of 1988 (25 U.S.C. 2001 note; Public Law 100-297) is amended by striking `Director of the Indian Health Service' and inserting `Assistant Secretary for Indian Health'.

(4) Section 203(a)(1) of the Rehabilitation Act of 1973 (29 U.S.C. 763(a)(1)) is amended by striking `Director of the Indian Health Service' and inserting `Assistant Secretary for Indian Health'.

(5) Subsections (b) and (e) of section 518 of the Federal Water Pollution Control Act (33 U.S.C. 1377) are amended by striking `Director of the Indian Health Service' each place it appears and inserting `Assistant Secretary for Indian Health'.

(6) Section 317M(b) of the Public Health Service Act (42 U.S.C. 247b-14(b)) is amended--

(A) by striking `Director of the Indian Health Service' each place it appears and inserting `Assistant Secretary for Indian Health'; and

(B) in paragraph (2)(A), by striking `the Directors referred to in such paragraph' and inserting `the Director of the Centers for Disease Control and Prevention and the Assistant Secretary for Indian Health'.

(7) Section 417C(b) of the Public Health Service Act (42 U.S.C. 285-9(b)) is amended by striking `Director of the Indian Health Service' and inserting `Assistant Secretary for Indian Health'.

(8) Section 1452(i) of the Safe Drinking Water Act (42 U.S.C. 300j-12(i)) is amended by striking `Director of the Indian Health Service' each place it appears and inserting `Assistant Secretary for Indian Health'.

(9) Section 803B(d)(1) of the Native American Programs Act of 1974 (42 U.S.C. 2991b-2(d)(1)) is amended in the last sentence by striking `Director of the Indian Health Service' and inserting `Assistant Secretary for Indian Health'.

(10) Section 203(b) of the Michigan Indian Land Claims Settlement Act (Public Law 105-143; 111 Stat. 2666) is amended by striking `Director of the Indian Health Service' and inserting `Assistant Secretary for Indian Health'.

SEC. 102. SOBOBA SANITATION FACILITIES.

The Act of December 17, 1970 (84 Stat. 1465), is amended by adding at the end the following:

`Sec. 9.


copy the link below to your address bar ok to get it to work

thomas.loc.gov/cgi-bin/query/F?c111:1:./temp/~c111UI4QjG:e168166:

[mdenney]

Indian Health Care Improvement Act:

S.1790

64.38.12.138/my.asp?url=http://thomas.loc.gov/cgi-bin/bdquery/z?d111:s.01790:

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H.R.2708

64.38.12.138/my.asp?url=http://thomas.loc.gov/cgi-bin/bdquery/z?d111:h.r.02708:




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all this came from here

64.38.12.138/News/2009/017872.asp