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S 1790 ISRSCommentsClose CommentsPermalink

111th CONGRESSCommentsClose CommentsPermalink

1st SessionCommentsClose CommentsPermalink

S. 1790CommentsClose CommentsPermalink

To amend the Indian Health Care Improvement Act to revise and extend that Act, and for other purposes.CommentsClose CommentsPermalink

IN THE SENATE OF THE UNITED STATESCommentsClose CommentsPermalink

October 15, 2009CommentsClose CommentsPermalink

Mr. DORGAN (for himself, Mr. REID, Ms. MURKOWSKI, Mr. UDALL of New Mexico, Mr. WHITEHOUSE, Mr. JOHNSON, Mr. TESTER, Mr. AKAKA, Mr. CONRAD, Mr. BEGICH, Mr. FRANKEN, Mr. BURRIS, Mr. INOUYE, Ms. STABENOW, Mr. UDALL of Colorado, and Ms. KLOBUCHAR, Mr. BENNET, Mr. CRAPO, Mrs. MURRAY, Ms. CANTWELL, Mr. MERKLEY, and Mr. DODD) introduced the following bill; which was read twice and referred to the Committee on Indian AffairsCommentsClose CommentsPermalink

A BILLCommentsClose CommentsPermalink

To amend the Indian Health Care Improvement Act to revise and extend that Act, and for other purposes.CommentsClose CommentsPermalink

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, CommentsClose CommentsPermalink

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title- This Act may be cited as the ‘Indian Health Care Improvement Reauthorization and Extension Act of 2009’.CommentsClose CommentsPermalink





(b) Table of Contents- The table of contents of this Act is as follows:CommentsClose CommentsPermalink





Sec. 1. Short title; table of contents.CommentsClose CommentsPermalink

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

Sec. 101. Reauthorization.CommentsClose CommentsPermalink





Sec. 102. Findings.CommentsClose CommentsPermalink





Sec. 103. Declaration of national Indian health policy.CommentsClose CommentsPermalink





Sec. 104. Definitions.CommentsClose CommentsPermalink

Subtitle A--Indian Health Manpower

Sec. 111. Community Health Aide Program.CommentsClose CommentsPermalink





Sec. 112. Health professional chronic shortage demonstration programs.CommentsClose CommentsPermalink





Sec. 113. Exemption from payment of certain fees.CommentsClose CommentsPermalink

Subtitle B--Health Services

Sec. 121. Indian Health Care Improvement Fund. CommentsClose CommentsPermalink





Sec. 122. Catastrophic Health Emergency Fund. CommentsClose CommentsPermalink





Sec. 123. Diabetes prevention, treatment, and control. CommentsClose CommentsPermalink





Sec. [Struck out->]121[<-Struck out] 124. Other authority for provision of services; shared services for long-term care.CommentsClose CommentsPermalink





Sec. 122 [Struck out->]122[<-Struck out] 125. Reimbursement from certain third parties of costs of health services.CommentsClose CommentsPermalink





Sec. 123 [Struck out->]123[<-Struck out] 126. Crediting of reimbursements.CommentsClose CommentsPermalink





Sec. 124 [Struck out->]124[<-Struck out] 127. Behavioral health training and community education programs.CommentsClose CommentsPermalink





Sec. 125. Mammography and other cancer screening.Sec. 1268. Cancer screenings. CommentsClose CommentsPermalink





Sec. [Struck out->]126[<-Struck out] 129. Patient travel costs.CommentsClose CommentsPermalink





Sec. 127 [Struck out->]127[<-Struck out] 130. Epidemiology centers.CommentsClose CommentsPermalink





Sec. 12831. Indian youth grant program. CommentsClose CommentsPermalink





Sec. 132. American Indians Into Psychology Program. CommentsClose CommentsPermalink





Sec. [Struck out->]128[<-Struck out] 133. Prevention, control, and elimination of communicable and infectious diseases.CommentsClose CommentsPermalink





Sec. 129 [Struck out->]129[<-Struck out] 134. Methods to increase clinician recruitment and retention issues.CommentsClose CommentsPermalink





Sec. 1305. Liability for payment. CommentsClose CommentsPermalink





Sec. [Struck out->]130[<-Struck out] 136. Offices of Indian Men’s Health and Indian Women’s Health.CommentsClose CommentsPermalink





Sec. 1317. Contract health service administration and disbursement formula. CommentsClose CommentsPermalink

Subtitle C--Health Facilities

Sec. 141. Indian health care delivery demonstration projectsHealth care facility priority system. CommentsClose CommentsPermalink





Sec. 142. Priority of certain projects protected. CommentsClose CommentsPermalink





Sec. 143. Indian health care delivery demonstration projects. CommentsClose CommentsPermalink





Sec. [Struck out->]142[<-Struck out] 144. Tribal management of federally owned quarters.CommentsClose CommentsPermalink





Sec. 143 [Struck out->]143[<-Struck out] 145. Other funding, equipment, and supplies for facilities.CommentsClose CommentsPermalink





Sec. 144 [Struck out->]144[<-Struck out] 146. Indian country modular component facilities demonstration program.CommentsClose CommentsPermalink





Sec. 145 [Struck out->]145[<-Struck out] 147. Mobile health stations demonstration program.CommentsClose CommentsPermalink

Subtitle D--Access to Health Services

Sec. 151. Treatment of payments under Social Security Act health benefits programs.CommentsClose CommentsPermalink





Sec. 152. Purchasing health care coverage.CommentsClose CommentsPermalink





Sec. 153. Grants to and contracts with the Service, Indian tribes, tribal organizations, and urban Indian organizations to facilitate outreach, enrollment, and coverage of Indians under Social Security Act health benefit programs and other health benefits programs.CommentsClose CommentsPermalink





Sec. 154. Sharing arrangements with Federal agencies.CommentsClose CommentsPermalink





Sec. 155. Eligible Indian veteran services.CommentsClose CommentsPermalink





Sec. 156. Nondiscrimination under Federal health care programs in qualifications for reimbursement for services.CommentsClose CommentsPermalink





Sec. 157. Access to Federal insurance.CommentsClose CommentsPermalink





Sec. 158. General exceptions.CommentsClose CommentsPermalink





Sec. 159. Navajo Nation Medicaid Agency feasibility study. CommentsClose CommentsPermalink

Subtitle E--Health Services for Urban Indians

Sec. 161. Facilities renovation. CommentsClose CommentsPermalink





Sec. 162. Treatment of certain demonstration projects. CommentsClose CommentsPermalink





Sec. [Struck out->]161[<-Struck out] 163. Requirement to confer with urban Indian organizations.CommentsClose CommentsPermalink





Sec. 162 [Struck out->]162[<-Struck out] 164. Expanded program authority for urban Indian organizations.CommentsClose CommentsPermalink





Sec. 163 [Struck out->]163[<-Struck out] 165. Community health representatives.CommentsClose CommentsPermalink





Sec. 166. Use of Federal Government facilities and sources of supply; health information technology. CommentsClose CommentsPermalink

Subtitle F--Organizational Improvements

Sec. 171. Establishment of the Indian Health Service as an agency of the Public Health Service.CommentsClose CommentsPermalink





Sec. 172. Office of Direct Service Tribes.CommentsClose CommentsPermalink





Sec. 173. Nevada area office.CommentsClose CommentsPermalink

Subtitle G--Behavioral Health Programs

Sec. 181. Behavioral health programs.CommentsClose CommentsPermalink

‘TITLE VII--BEHAVIORAL HEALTH PROGRAMS

‘Subtitle A--General Programs

‘Sec. 701. Definitions.CommentsClose CommentsPermalink

‘Sec. 702. Behavioral health prevention and treatment services.CommentsClose CommentsPermalink

‘Sec. 703. Memoranda of agreement with the Department of Interior.CommentsClose CommentsPermalink

‘Sec. 704. Comprehensive behavioral health prevention and treatment program.CommentsClose CommentsPermalink

‘Sec. 705. Mental health technician program.CommentsClose CommentsPermalink

‘Sec. 706. Licensing requirement for mental health care workers.CommentsClose CommentsPermalink

‘Sec. 707. Indian women treatment programs.CommentsClose CommentsPermalink

‘Sec. 708. Indian youth program.CommentsClose CommentsPermalink

‘Sec. 709. Inpatient and community-based mental health facilities design, construction, and staffing.CommentsClose CommentsPermalink

‘Sec. 710. Training and community education.CommentsClose CommentsPermalink

‘Sec. 711. Behavioral health program.CommentsClose CommentsPermalink

‘Sec. 712. Fetal alcohol spectrum disorders programs.CommentsClose CommentsPermalink

‘ [Struck out->]CommentsClose CommentsPermalink

Sec. 713. Child sexual abuse and prevention

treatment programs.

[<-Struck out]CommentsClose CommentsPermalink

‘ Sec. 713. Child sexual abuse prevention and treatment programs. CommentsClose CommentsPermalink

‘Sec. 714. Domestic and sexual violence prevention and treatment.CommentsClose CommentsPermalink

‘Sec. 715. Behavioral health research.CommentsClose CommentsPermalink

‘Subtitle B--Indian Youth Suicide Prevention

‘Sec. 721. Findings and purpose.CommentsClose CommentsPermalink

‘Sec. 722. Definitions.CommentsClose CommentsPermalink

‘Sec. 723. Indian youth telemental health demonstration project.CommentsClose CommentsPermalink

‘Sec. 724. Substance Abuse and Mental Health Services Administration grants.CommentsClose CommentsPermalink

‘Sec. 725. Use of predoctoral psychology and psychiatry interns.CommentsClose CommentsPermalink

‘Sec. 726. Indian youth life skills development demonstration program.CommentsClose CommentsPermalink

Subtitle H--Miscellaneous

Sec. 191. Confidentiality of medical quality assurance records; qualified immunity for participants.CommentsClose CommentsPermalink





Sec. 192. Arizona, North Dakota, and South Dakota as contract health service delivery areas; eligibility of California Indians.CommentsClose CommentsPermalink





Sec. 193. Methods to increase access to professionals of certain corps.CommentsClose CommentsPermalink





Sec. 194. Health services for ineligible persons.CommentsClose CommentsPermalink





Sec. 195. Annual budget submission.CommentsClose CommentsPermalink





Sec. 196. Prescription drug monitoring. CommentsClose CommentsPermalink





Sec. 197. Tribal health program option for cost sharing. CommentsClose CommentsPermalink





Sec. 198. Disease and injury prevention report. CommentsClose CommentsPermalink





Sec. 199. Other GAO reports. CommentsClose CommentsPermalink





Sec. 199A. Traditional health care practices. CommentsClose CommentsPermalink





Sec. 199B. Director of HIV/AIDS Prevention and Treatment. CommentsClose CommentsPermalink

TITLE II--AMENDMENTS TO OTHER ACTS

Sec. [Struck out->]204[<-Struck out] 201. Solicitation of proposals for safe harbors under the Social Security Act for facilities of Indian health programs and urban Indian organizations.

Sec. 202. Annual report regarding Indians served by health benefits programs under Social Security Act.

Sec. 203. Including costs incurred by Service, a federally qualified health center, an AIDS drug assistance program, certain hospitals, or a pharmaceutical manufacturer patient assistance program in providing prescription drugs toward the annual out of pocket threshold under part D.

Sec. 204. Medicare amendments.CommentsClose CommentsPermalink




Sec. 205. Expansion of payments under Medicare, Medicaid, and CHIP for all covered services furnished by Indian health programs.Sec. 206. Reauthorization of Native [Struck out->]206[<-Struck out] 202. Reauthorization of Native Hawaiian health care programs.CommentsClose CommentsPermalink

TITLE I--INDIAN HEALTH CARE IMPROVEMENT ACT REAUTHORIZATION AND AMENDMENTSCommentsClose CommentsPermalink

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:CommentsClose CommentsPermalink

‘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.’.CommentsClose CommentsPermalink





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





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





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





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





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





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





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





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





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





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





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





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





(c) Conforming Amendments-CommentsClose CommentsPermalink





(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’.CommentsClose CommentsPermalink





(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’.CommentsClose CommentsPermalink





(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’.CommentsClose CommentsPermalink

SEC. 102. FINDINGS.

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





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





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





‘(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.’.CommentsClose CommentsPermalink

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:CommentsClose CommentsPermalink

‘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--CommentsClose CommentsPermalink





‘(1) to ensure the highest possible health status for Indians and urban Indians and to provide all resources necessary to effect that policy;CommentsClose CommentsPermalink





‘(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;CommentsClose CommentsPermalink





‘(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;CommentsClose CommentsPermalink





‘(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;CommentsClose CommentsPermalink





‘(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;CommentsClose CommentsPermalink





‘(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; andCommentsClose CommentsPermalink





‘(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.’.CommentsClose CommentsPermalink

SEC. 104. DEFINITIONS.

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





(1) by striking the matter preceding subsection (a) and inserting ‘In this Act:’;CommentsClose CommentsPermalink





(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;CommentsClose CommentsPermalink





(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;CommentsClose CommentsPermalink





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





(5) by inserting ‘The term’ after each paragraph heading;CommentsClose CommentsPermalink





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





‘(2) BEHAVIORAL HEALTH-CommentsClose CommentsPermalink





‘(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 providingdisorders prevention and treatment for the purpose of providing comprehensive services.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





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





‘(4) COMMUNITY COLLEGE- The term ‘community college’ means--CommentsClose CommentsPermalink





‘(A) a tribal college or university; orCommentsClose CommentsPermalink





‘(B) a junior or community college.CommentsClose CommentsPermalink





‘(5) CONTRACT HEALTH SERVICE- The term ‘contract health service’ means any health service that is--CommentsClose CommentsPermalink





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





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





‘(6) DEPARTMENT- The term ‘Department’, unless otherwise designated, means the Department of Health and Human Services.’;CommentsClose CommentsPermalink





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





‘(7) DISEASE PREVENTION-CommentsClose CommentsPermalink





‘(A) IN GENERAL- The term ‘disease prevention’ means any activity for--CommentsClose CommentsPermalink





‘(i) the reduction, limitation, and prevention of--CommentsClose CommentsPermalink





‘(I) disease; andCommentsClose CommentsPermalink





‘(II) complications of disease; andCommentsClose CommentsPermalink





‘(ii) the reduction of consequences of disease.CommentsClose CommentsPermalink





‘(B) INCLUSIONS- The term ‘disease prevention’ includes an activity for--CommentsClose CommentsPermalink





‘(i) controlling--CommentsClose CommentsPermalink





‘(I) the development of diabetes;CommentsClose CommentsPermalink





‘(II) high blood pressure;CommentsClose CommentsPermalink





‘(III) infectious agents;CommentsClose CommentsPermalink





‘(IV) injuries;CommentsClose CommentsPermalink





‘(V) occupational hazards and disabilities;CommentsClose CommentsPermalink





‘(VI) sexually transmittable diseases; orCommentsClose CommentsPermalink





‘(VII) toxic agents; orCommentsClose CommentsPermalink





‘(ii) providing--CommentsClose CommentsPermalink





‘(I) fluoridation of water; orCommentsClose CommentsPermalink





‘(II) immunizations.’;CommentsClose CommentsPermalink





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





‘(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:CommentsClose CommentsPermalink





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





‘(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.CommentsClose CommentsPermalink





‘(C) Prenatal or postnatal growth delay.’;CommentsClose CommentsPermalink





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





‘(11) HEALTH PROMOTION- The term ‘health promotion’ means any activity for--CommentsClose CommentsPermalink





‘(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;CommentsClose CommentsPermalink





‘(B) encouraging adequate and appropriate diet, exercise, and sleep;CommentsClose CommentsPermalink





‘(C) promoting education and work in accordance with physical and mental capacity;CommentsClose CommentsPermalink





‘(D) making available safe water and sanitary facilities;CommentsClose CommentsPermalink





‘(E) improving the physical, economic, cultural, psychological, and social environment;CommentsClose CommentsPermalink





‘(F) promoting culturally competent care; andCommentsClose CommentsPermalink





‘(G) providing adequate and appropriate programs, including programs for--CommentsClose CommentsPermalink





‘(i) abuse prevention (mental and physical);CommentsClose CommentsPermalink





‘(ii) community health;CommentsClose CommentsPermalink





‘(iii) community safety;CommentsClose CommentsPermalink





‘(iv) consumer health education;CommentsClose CommentsPermalink





‘(v) diet and nutrition;CommentsClose CommentsPermalink





‘(vi) immunization and other methods of prevention of communicable diseases, including HIV/AIDS;CommentsClose CommentsPermalink





‘(vii) environmental health;CommentsClose CommentsPermalink





‘(viii) exercise and physical fitness;CommentsClose CommentsPermalink





‘(ix) avoidance of fetal alcohol spectrum disorders;CommentsClose CommentsPermalink





‘(x) first aid and CPR education;CommentsClose CommentsPermalink





‘(xi) human growth and development;CommentsClose CommentsPermalink





‘(xii) injury prevention and personal safety;CommentsClose CommentsPermalink





‘(xiii) behavioral health;CommentsClose CommentsPermalink





‘(xiv) monitoring of disease indicators between health care provider visits through appropriate means, including Internet-based health care management systems;CommentsClose CommentsPermalink





‘(xv) personal health and wellness practices;CommentsClose CommentsPermalink





‘(xvi) personal capacity building;CommentsClose CommentsPermalink





‘(xvii) prenatal, pregnancy, and infant care;CommentsClose CommentsPermalink





‘(xviii) psychological well-being;CommentsClose CommentsPermalink





‘(xix) reproductive health and family planning;CommentsClose CommentsPermalink





‘(xx) safe and adequate water;CommentsClose CommentsPermalink





‘(xxi) healthy work environments;CommentsClose CommentsPermalink





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





‘(xxiii) stress control;CommentsClose CommentsPermalink





‘(xxiv) substance abuse;CommentsClose CommentsPermalink





‘(xxv) sanitary facilities;CommentsClose CommentsPermalink





‘(xxvi) sudden infant death syndrome prevention;CommentsClose CommentsPermalink





‘(xxvii) tobacco use cessation and reduction;CommentsClose CommentsPermalink





‘(xxviii) violence prevention; andCommentsClose CommentsPermalink





‘(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).CommentsClose CommentsPermalink





‘(12) INDIAN HEALTH PROGRAM- The term ‘Indian health program’ means--CommentsClose CommentsPermalink





‘(A) any health program administered directly by the Service;CommentsClose CommentsPermalink





‘(B) any tribal health program; andCommentsClose CommentsPermalink





‘(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’).’;CommentsClose CommentsPermalink





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





‘(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)).CommentsClose CommentsPermalink





‘(16) RESERVATION-CommentsClose CommentsPermalink





‘(A) IN GENERAL- The term ‘reservation’ means a reservation, Pueblo, or colony of any Indian tribe.CommentsClose CommentsPermalink





‘(B) INCLUSIONS- The term ‘reservation’ includes--CommentsClose CommentsPermalink





‘(i) former reservations in Oklahoma;CommentsClose CommentsPermalink





‘(ii) Indian allotments; andCommentsClose CommentsPermalink





‘(iii) Alaska Native Regions established pursuant to the Alaska Native Claims Settlement Act (43 U.S.C. 1601 et seq.).’;CommentsClose CommentsPermalink





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





‘(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.’;CommentsClose CommentsPermalink





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





‘(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)).CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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)).CommentsClose CommentsPermalink





‘(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.).’; andCommentsClose CommentsPermalink





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





‘(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).’.CommentsClose CommentsPermalink

Subtitle A--Indian Health ManpowerCommentsClose CommentsPermalink

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:CommentsClose CommentsPermalink

‘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--CommentsClose CommentsPermalink





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





‘(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; andCommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(b) Specific Program Requirements- The Secretary, acting through the Community Health Aide Program of the Service, shall--CommentsClose CommentsPermalink





‘(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;CommentsClose CommentsPermalink





‘(2) in order to provide such training, develop a curriculum that--CommentsClose CommentsPermalink





‘(A) combines education regarding the theory of health care with supervised practical experience in the provision of health care;CommentsClose CommentsPermalink





‘(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; andCommentsClose CommentsPermalink





‘(C) promotes the achievement of the health status objectives specified in section 3(2);CommentsClose CommentsPermalink





‘(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;CommentsClose CommentsPermalink





‘(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;CommentsClose CommentsPermalink





‘(5) develop and maintain a system that provides close supervision of community health aides and community health practitioners;CommentsClose CommentsPermalink





‘(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; andCommentsClose CommentsPermalink





‘(7) ensure that--CommentsClose CommentsPermalink





‘(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; andCommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(c) Program Review-CommentsClose CommentsPermalink





‘(1) NEUTRAL PANEL-CommentsClose CommentsPermalink





‘(A) ESTABLISHMENT- The Secretary, acting through the Service, shall establish a neutral panel to carry out the study under paragraph (2).CommentsClose CommentsPermalink





‘(B) MEMBERSHIP- Members of the neutral panel shall be appointed by the Secretary from among clinicians, economists, community practitioners, oral epidemiologists, and Alaska Natives.CommentsClose CommentsPermalink





‘(2) STUDY-CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(B) PARAMETERS OF STUDY- The Secretary, in consultation with interested parties, including professional dental organizations, shall develop the parameters of the study.CommentsClose CommentsPermalink





‘(C) INCLUSIONS- The study shall include a determination by the neutral panel with respect to--CommentsClose CommentsPermalink





‘(i) the ability of the dental health aide therapist services under this section to address the dental care needs of Alaska Natives;CommentsClose CommentsPermalink





‘(ii) the quality of care provided through those services, including any training, improvement, or additional oversight required to improve the quality of care; andCommentsClose CommentsPermalink





‘(iii) whether safer and less costly alternatives to the dental health aide therapist services exist.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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--CommentsClose CommentsPermalink





‘(A) any determination of the neutral panel under paragraph (2)(C); andCommentsClose CommentsPermalink





‘(B) any comments received from Alaska tribal organizations under paragraph (2)(D).CommentsClose CommentsPermalink





‘(d) Nationalization of Program-CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(2) REQUIREMENT; EXCLUSION- In establishing a national program under paragraph (1), the Secretary-- CommentsClose CommentsPermalink





‘(A) shall not reduce the amounts provided for the Community Health Aide Program described in subsections (a) and (b); and CommentsClose CommentsPermalink





‘(B) shall exclude dental health aide therapist services from services covered under the program.’. CommentsClose CommentsPermalink

SEC. 112. HEALTH PROFESSIONAL CHRONIC SHORTAGE DEMONSTRATION PROGRAMS.

Title I of the Indian Health Care Improvement Act (25 U.S.C. 1611 et seq.) (as amended by section 101(b)) is amended by adding at the end the following:CommentsClose CommentsPermalink

‘SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE DEMONSTRATION PROGRAMS.

‘(a) Demonstration Programs- The Secretary, acting through the Service, may fund demonstration programs for Indian health programs to address the chronic shortages of health professionals.CommentsClose CommentsPermalink





‘(b) Purposes of Programs- The purposes of demonstration programs under subsection (a) shall be--CommentsClose CommentsPermalink





‘(1) to provide direct clinical and practical experience within an Indian health program to health profession students and residents from medical schools;CommentsClose CommentsPermalink





‘(2) to improve the quality of health care for Indians by ensuring access to qualified health professionals;CommentsClose CommentsPermalink





‘(3) to provide academic and scholarly opportunities for health professionals serving Indians by identifying all academic and scholarly resources of the region; andCommentsClose CommentsPermalink





‘(4) to provide training and support for alternative provider types, such as community health representatives, and community health aides.CommentsClose CommentsPermalink





‘(c) Advisory Board- The demonstration programs established pursuant to subsection (a) shall incorporate a program advisory board, which may be composed of representatives of tribal governments, Indian health programs, and Indian communities in the areas to be served by the demonstration programs.’.CommentsClose CommentsPermalink

SEC. 113. EXEMPTION FROM PAYMENT OF CERTAIN FEES.

Title I of the Indian Health Care Improvement Act (25 U.S.C. 1611 et seq.) (as amended by section 112) is amended by adding at the end the following:CommentsClose CommentsPermalink

‘SEC. 124. EXEMPTION FROM PAYMENT OF CERTAIN FEES.

‘Employees of a tribal health program or urban Indian organization shall be exempt from payment of licensing, registration, and any other fees imposed by a Federal agency to the same extent that officers of the commissioned corps of the Public Health Service and other employees of the Service are exempt from those fees.’.CommentsClose CommentsPermalink

Subtitle B--Health ServicesCommentsClose CommentsPermalink

SEC. 121. INDIAN HEALTH CARE IMPROVEMENT FUND.

SEC. [Struck out->]121[<-Struck out] 124. OTHER AUTHORITY FOR PROVISION OF SERVICES; SHARED SERVICES FOR LONG-TERM CARE.

(a) Other Authority for Provision of Services-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 205 of the Indian Health Care Improvement Act (25 U.S.C. 1621d) is amended to read as follows:CommentsClose CommentsPermalink

‘SEC. 205. OTHER AUTHORITY FOR PROVISION OF SERVICES.

‘(a) Definitions- In this section:CommentsClose CommentsPermalink





‘(1) ASSISTED LIVING SERVICE- The term ‘assisted living service’ means any service provided by an assisted living facility (as defined in section 232(b) of the National Housing Act (12 U.S.C. 1715w(b))), except that such an assisted living facility--CommentsClose CommentsPermalink





‘(A) shall not be required to obtain a license; butCommentsClose CommentsPermalink





‘(B) shall meet all applicable standards for licensure.CommentsClose CommentsPermalink





‘(2) HOME- AND COMMUNITY-BASED SERVICE- The term ‘home- and community-based service’ means 1 or more of the services specified in paragraphs (1) through (9) of section 1929(a) of the Social Security Act (42 U.S.C. 1396t(a)) (whether provided by the Service or by an Indian tribe or tribal organization pursuant to the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.)) that are or will be provided in accordance with applicable standards.CommentsClose CommentsPermalink





‘(3) HOSPICE CARE- The term ‘hospice care’ means--CommentsClose CommentsPermalink





‘(A) the items and services specified in subparagraphs (A) through (H) of section 1861(dd)(1) of the Social Security Act (42 U.S.C. 1395x(dd)(1)); andCommentsClose CommentsPermalink





‘(B) such other services as an Indian tribe or tribal organization determines are necessary and appropriate to provide in furtherance of that care.CommentsClose CommentsPermalink





‘(4) LONG-TERM CARE SERVICES- The term ‘long-term care services’ has the meaning given the term ‘qualified long-term care services’ in section 7702B(c) of the Internal Revenue Code of 1986.CommentsClose CommentsPermalink





‘(b) Funding Authorized- The Secretary, acting through the Service, Indian tribes, and tribal organizations, may provide funding under this Act to meet the objectives set forth in section 3 through health care-related services and programs not otherwise described in this Act for the following services:CommentsClose CommentsPermalink





‘(1) Hospice care.CommentsClose CommentsPermalink





‘(2) Assisted living services.CommentsClose CommentsPermalink





‘(3) Long-term care services.CommentsClose CommentsPermalink





‘(4) Home- and community-based services.CommentsClose CommentsPermalink





‘(c) Eligibility- The following individuals shall be eligible to receive long-term care services under this section:CommentsClose CommentsPermalink





‘(1) Individuals who are unable to perform a certain number of activities of daily living without assistance.CommentsClose CommentsPermalink





‘(2) Individuals with a mental impairment, such as dementia, Alzheimer’s disease, or another disabling mental illness, who may be able to perform activities of daily living under supervision.CommentsClose CommentsPermalink





‘(3) Such other individuals as an applicable tribal health program determines to be appropriate.CommentsClose CommentsPermalink





‘(d) Authorization of Convenient Care Services- The Secretary, acting through the Service, Indian tribes, and tribal organizations, may also provide funding under this Act to meet the objectives set forth in section 3 for convenient care services programs pursuant to section 307(c)(2)(A).’.CommentsClose CommentsPermalink





(2) REPEAL- Section 821 of the Indian Health Care Improvement Act (25 U.S.C. 1680k) is repealed.CommentsClose CommentsPermalink





(b) Shared Services for Long-Tterm Care- Section 822 of the Indian Health Care Improvement Act (25 U.S.C. 1680l) is amended to read as follows:CommentsClose CommentsPermalink

‘SEC. 822. SHARED SERVICES FOR LONG-TERM CARE.

‘(a) Long-Term Care-CommentsClose CommentsPermalink





‘(1) IN GENERAL- Notwithstanding any other provision of law, the Secretary, acting through the Service, is authorized to provide directly, or enter into contracts or compacts under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) with Indian tribes or tribal organizations for, the delivery of long-term care (including health care services associated with long-term care) provided in a facility to Indians.CommentsClose CommentsPermalink





‘(2) INCLUSIONS- Each agreement under paragraph (1) shall provide for the sharing of staff or other services between the Service or a tribal health program and a long-term care or related facility owned and operated (directly or through a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.)) by the Indian tribe or tribal organization.CommentsClose CommentsPermalink





‘(b) Contents of Agreements- An agreement entered into pursuant to subsection (a)--CommentsClose CommentsPermalink





‘(1) may, at the request of the Indian tribe or tribal organization, delegate to the Indian tribe or tribal organization such powers of supervision and control over Service employees as the Secretary determines to be necessary to carry out the purposes of this section;CommentsClose CommentsPermalink





‘(2) shall provide that expenses (including salaries) relating to services that are shared between the Service and the tribal health program be allocated proportionately between the Service and the Indian tribe or tribal organization; andCommentsClose CommentsPermalink





‘(3) may authorize the Indian tribe or tribal organization to construct, renovate, or expand a long-term care or other similar facility (including the construction of a facility attached to a Service facility).CommentsClose CommentsPermalink





‘(c) Minimum Requirement- Any nursing facility provided for under this section shall meet the requirements for nursing facilities under section 1919 of the Social Security Act (42 U.S.C. 1396r).CommentsClose CommentsPermalink





‘(d) Other Assistance- The Secretary shall provide such technical and other assistance as may be necessary to enable applicants to comply with this section.CommentsClose CommentsPermalink





‘(e) Use of Existing or Underused Facilities- The Secretary shall encourage the use of existing facilities that are underused, or allow the use of swing beds, for long-term or similar care.’.CommentsClose CommentsPermalink

SEC. 122 [Struck out->]122[<-Struck out] 125. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS OF HEALTH SERVICES.

Section 206 of the Indian Health Care Improvement Act (25 U.S.C. 1621e) is amended to read as follows:CommentsClose CommentsPermalink

‘SEC. 206. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS OF HEALTH SERVICES.

‘(a) Right of Recovery- Except as provided in subsection (f), the United States, an Indian tribe, or tribal organization shall have the right to recover from an insurance company, health maintenance organization, employee benefit plan, third-party tortfeasor, or any other responsible or liable third party (including a political subdivision or local governmental entity of a State) the reasonable charges billed by the Secretary, an Indian tribe, or tribal organization in providing health services through the Service, an Indian tribe, or tribal organization, or, if higher, the highest amount the third party would pay for care and services furnished by providers other than governmental entities, to any individual to the same extent that such individual, or any nongovernmental provider of such services, would be eligible to receive damages, reimbursement, or indemnification for such charges or expenses if--CommentsClose CommentsPermalink





‘(1) such services had been provided by a nongovernmental provider; andCommentsClose CommentsPermalink





‘(2) such individual had been required to pay such charges or expenses and did pay such charges or expenses.CommentsClose CommentsPermalink





‘(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--CommentsClose CommentsPermalink





‘(1) workers’ compensation laws; orCommentsClose CommentsPermalink





‘(2) a no-fault automobile accident insurance plan or program.CommentsClose CommentsPermalink





‘(c) Nonapplicability 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 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).CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(e) Enforcement-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The United States, an Indian tribe, or tribal organization may enforce the right of recovery provided under subsection (a) by--CommentsClose CommentsPermalink





‘(A) intervening or joining in any civil action or proceeding brought--CommentsClose CommentsPermalink





‘(i) by the individual for whom health services were provided by the Secretary, an Indian tribe, or tribal organization; orCommentsClose CommentsPermalink





‘(ii) by any representative or heirs of such individual, orCommentsClose CommentsPermalink





‘(B) instituting a separate 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.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(3) RECOVERY FROM TORTFEASORS-CommentsClose CommentsPermalink





‘(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 Reauthorization and Extension Act 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.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(g) Costs and Attorney’s Fees- In any action brought to enforce the provisions of this section, a prevailing plaintiff shall be awarded its reasonable attorney’s fees and costs of litigation.CommentsClose CommentsPermalink





‘(h) Nonapplicability 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.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.’.CommentsClose CommentsPermalink

SEC. 123 [Struck out->]123[<-Struck out] 126. CREDITING OF REIMBURSEMENTS.

Section 207 of the Indian Health Care Improvement Act (25 U.S.C. 1621f) is amended to read as follows:CommentsClose CommentsPermalink

‘SEC. 207. CREDITING OF REIMBURSEMENTS.

‘(a) Use of Amounts-CommentsClose CommentsPermalink





‘(1) RETENTION BY PROGRAM- Except as provided in sections 202(a)(2) and 813, all reimbursements received or recovered under any of the programs described in paragraph (2), including under section 813, 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.CommentsClose CommentsPermalink





‘(2) PROGRAMS COVERED- The programs referred to in paragraph (1) are the following:CommentsClose CommentsPermalink





‘(A) Titles XVIII, XIX, and XXI of the Social Security Act.CommentsClose CommentsPermalink





‘(B) This Act, including section 813.CommentsClose CommentsPermalink





‘(C) Public Law 87-693.CommentsClose CommentsPermalink





‘(D) Any other provision of law.CommentsClose CommentsPermalink





‘(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).’.CommentsClose CommentsPermalink

SEC. 124 [Struck out->]124[<-Struck out] 127. BEHAVIORAL HEALTH TRAINING AND COMMUNITY EDUCATION PROGRAMS.

Section 209 of the Indian Health Care Improvement Act (25 U.S.C. 1621h) is amended by striking subsection (d) and inserting the following:CommentsClose CommentsPermalink





‘(d) Behavioral Health Training and Community Education Programs-CommentsClose CommentsPermalink





‘(1) STUDY; LIST- The Secretary, acting through the Service, and the Secretary of the Interior, in consultation with Indian tribes and tribal organizations, shall conduct a study and compile a list of the types of staff positions specified in paragraph (2) whose qualifications include, or should include, training in the identification, prevention, education, referral, or treatment of mental illness, or dysfunctional and self destructive behavior.CommentsClose CommentsPermalink





‘(2) POSITIONS- The positions referred to in paragraph (1) are--CommentsClose CommentsPermalink





‘(A) staff positions within the Bureau of Indian Affairs, including existing positions, in the fields of--CommentsClose CommentsPermalink





‘(i) elementary and secondary education;CommentsClose CommentsPermalink





‘(ii) social services and family and child welfare;CommentsClose CommentsPermalink





‘(iii) law enforcement and judicial services; andCommentsClose CommentsPermalink





‘(iv) alcohol and substance abuse;CommentsClose CommentsPermalink





‘(B) staff positions within the Service; andCommentsClose CommentsPermalink





‘(C) staff positions similar to those identified in subparagraphs (A) and (B) established and maintained by Indian tribes and tribal organizations (without regard to the funding source).CommentsClose CommentsPermalink





‘(3) TRAINING CRITERIA-CommentsClose CommentsPermalink





‘(A) IN GENERAL- The appropriate Secretary shall provide training criteria appropriate to each type of position identified in paragraphs (2)(A) and (2)(B) and ensure that appropriate training has been, or shall be provided to any individual in any such position. With respect to any such individual in a position identified pursuant to paragraph (2)(C), the respective Secretaries shall provide appropriate training to, or provide funds to, an Indian tribe or tribal organization for training of appropriate individuals. In the case of positions funded under a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), the appropriate Secretary shall ensure that such training costs are included in the contract or compact, as the Secretary determines necessary.CommentsClose CommentsPermalink





‘(B) POSITION SPECIFIC TRAINING CRITERIA- Position specific training criteria shall be culturally relevant to Indians and Indian tribes and shall ensure that appropriate information regarding traditional health care practices is provided.CommentsClose CommentsPermalink





‘(4) COMMUNITY EDUCATION ON MENTAL ILLNESS- The Service shall develop and implement, on request of an Indian tribe, tribal organization, or urban Indian organization, or assist the Indian tribe, tribal organization, or urban Indian organization to develop and implement, a program of community education on mental illness. In carrying out this paragraph, the Service shall, upon request of an Indian tribe, tribal organization, or urban Indian organization, provide technical assistance to the Indian tribe, tribal organization, or urban Indian organization to obtain and develop community educational materials on the identification, prevention, referral, and treatment of mental illness and dysfunctional and self-destructive behavior.CommentsClose CommentsPermalink





‘(5) PLAN- Not later than 90 days after the date of enactment of the Indian Health Care Improvement Reauthorization and Extension Act of 2009, the Secretary shall develop a plan under which the Service will increase the health care staff providing behavioral health services by at least 500 positions within 5 years after the date of enactment of that Act, with at least 200 of such positions devoted to child, adolescent, and family services. The plan developed under this paragraph shall be implemented under the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the ‘Snyder Act’).’.CommentsClose CommentsPermalink

SEC. 128. CANCER SCREENINGS.

Section 212 of the Indian Health Care Improvement Act (25 U.S.C. 1621k) is amended to read as follows:‘SEC. 212. MAMMOGRAPHY AND OTHER CANCER SCREENING.

‘The Secretary, acting through the Service, shall provide for screening as follows:

‘(1) SCREENING MAMMOGRAPHY- Screening mammography (as defined in section 1861(jj) of the Social Security Act (42 U.S.C. 1395x(jj))) for Indian women at a frequency appropriate to those women under accepted and appropriate national standards, and under such terms and conditions as are consistent with standards established by the Secretary to ensure the safety and accuracy of screening mammography under part B of title XVIII of that Act (42 U.S.C. 1395j et seq.).

‘(2) OTHER CANCER SCREENING-

‘(A) IN GENERAL- Oby inserting ‘and other cancer screening that receives an A or B rating as recommended by the United States Preventive Services Task Force established under section 915(a)(1) of the Public Health Service Act (42 U.S.C. 299b-4(a)(1)).

‘(B) REQUIREMENT- The Secretary shall ensure that screening provided for under this paragraph complies with the recommendations of the Task Force referred to in subparagraph (A) with respect to--

‘(i) frequency;

‘(ii) the population to be served;

‘(iii) the procedure or technology to be used;

‘(iv) evidence of effectiveness; and

‘(v) other matters that the Secretary determines to be appropriate.’.

SEC. 126s’ before the period at the end. CommentsClose CommentsPermalink

SEC. [Struck out->]126[<-Struck out] 129. PATIENT TRAVEL COSTS.

Section 213 of the Indian Health Care Improvement Act (25 U.S.C. 1621l) is amended to read as follows:CommentsClose CommentsPermalink

‘SEC. 213. PATIENT TRAVEL COSTS.

‘(a) Definition of Qualified Escort- In this section, the term ‘qualified escort’ means--CommentsClose CommentsPermalink





‘(1) an adult escort (including a parent, guardian, or other family member) who is required because of the physical or mental condition, or age, of the applicable patient;CommentsClose CommentsPermalink





‘(2) a health professional for the purpose of providing necessary medical care during travel by the applicable patient; orCommentsClose CommentsPermalink





‘(3) other escorts, as the Secretary or applicable Indian Health Program determines to be appropriate.CommentsClose CommentsPermalink





‘(b) Provision of Funds- The Secretary, acting through the Service and Tribal Health Programs, is authorized to provide funds for the following patient travel costs, including qualified escorts, associated with receiving health care services provided (either through direct or contract care or through a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.)) under this Act--CommentsClose CommentsPermalink





‘(1) emergency air transportation and non-emergency air transportation where ground transportation is infeasible;CommentsClose CommentsPermalink





‘(2) transportation by private vehicle (where no other means of transportation is available), specially equipped vehicle, and ambulance; andCommentsClose CommentsPermalink





‘(3) transportation by such other means as may be available and required when air or motor vehicle transportation is not available.’.CommentsClose CommentsPermalink

SEC. 127 [Struck out->]127[<-Struck out] 130. EPIDEMIOLOGY CENTERS.

Section 214 of the Indian Health Care Improvement Act (25 U.S.C. 1621m) is amended to read as follows:CommentsClose CommentsPermalink

‘SEC. 214. EPIDEMIOLOGY CENTERS.

‘(a) Establishment of Centers-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The Secretary shall establish an epidemiology center in each Service area to carry out the functions described in subsection (b).CommentsClose CommentsPermalink





‘(2) NEW CENTERS-CommentsClose CommentsPermalink





‘(A) IN GENERAL- Subject to subparagraph (B), any new center established after the date of enactment of the Indian Health Care Improvement Reauthorization and Extension Act of 2009 may be operated under a grant authorized by subsection (d).CommentsClose CommentsPermalink





‘(B) REQUIREMENT- Funding provided in a grant described in subparagraph (A) shall not be divisible.CommentsClose CommentsPermalink





‘(3) FUNDS NOT DIVISIBLE- An epidemiology center established under this subsection shall be subject to the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), but the funds for the center shall not be divisible. CommentsClose CommentsPermalink





‘(b) Functions of Centers- In consultation with and on the request of Indian tribes, tribal organizations, and urban Indian organizations, each Service area epidemiology center established under this section shall, with respect to the applicable Service area--CommentsClose CommentsPermalink





‘(1) collect data relating to, and monitor progress made toward meeting, each of the health status objectives of the Service, the Indian tribes, tribal organizations, and urban Indian organizations in the Service area;CommentsClose CommentsPermalink





‘(2) evaluate existing delivery systems, data systems, and other systems that impact the improvement of Indian health;CommentsClose CommentsPermalink





‘(3) assist Indian tribes, tribal organizations, and urban Indian organizations in identifying highest-priority health status objectives and the services needed to achieve those objectives, based on epidemiological data;CommentsClose CommentsPermalink





‘(4) make recommendations for the targeting of services needed by the populations served;CommentsClose CommentsPermalink





‘(5) make recommendations to improve health care delivery systems for Indians and urban Indians;CommentsClose CommentsPermalink





‘(6) provide requested technical assistance to Indian tribes, tribal organizations, and urban Indian organizations in the development of local health service priorities and incidence and prevalence rates of disease and other illness in the community; andCommentsClose CommentsPermalink





‘(7) provide disease surveillance and assist Indian tribes, tribal organizations, and urban Indian communities to promote public health.CommentsClose CommentsPermalink





‘(c) Technical Assistance- The Director of the Centers for Disease Control and Prevention shall provide technical assistance to the centers in carrying out this section.CommentsClose CommentsPermalink





‘(d) Grants for Studies-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The Secretary may make grants to Indian tribes, tribal organizations, Indian organizations, and eligible intertribal consortia to conduct epidemiological studies of Indian communities.CommentsClose CommentsPermalink





‘(2) ELIGIBLE INTERTRIBAL CONSORTIA- An intertribal consortium or Indian organization shall be eligible to receive a grant under this subsection if the intertribal consortium is--CommentsClose CommentsPermalink





‘(A) incorporated for the primary purpose of improving Indian health; andCommentsClose CommentsPermalink





‘(B) representative of the Indian tribes or urban Indian communities residing in the area in which the intertribal consortium is located.CommentsClose CommentsPermalink





‘(3) APPLICATIONS- An application for a grant under this subsection shall be submitted in such manner and at such time as the Secretary shall prescribe.CommentsClose CommentsPermalink





‘(4) REQUIREMENTS- An applicant for a grant under this subsection shall--CommentsClose CommentsPermalink





‘(A) demonstrate the technical, administrative, and financial expertise necessary to carry out the functions described in paragraph (5);CommentsClose CommentsPermalink





‘(B) consult and cooperate with providers of related health and social services in order to avoid duplication of existing services; andCommentsClose CommentsPermalink





‘(C) demonstrate cooperation from Indian tribes or urban Indian organizations in the area to be served.CommentsClose CommentsPermalink





‘(5) USE OF FUNDS- A grant provided under paragraph (1) may be used--CommentsClose CommentsPermalink





‘(A) to carry out the functions described in subsection (b);CommentsClose CommentsPermalink





‘(B) to provide information to, and consult with, tribal leaders, urban Indian community leaders, and related health staff regarding health care and health service management issues; andCommentsClose CommentsPermalink





‘(C) in collaboration with Indian tribes, tribal organizations, and urban Indian organizations, to provide to the Service information regarding ways to improve the health status of Indians.CommentsClose CommentsPermalink





‘(e) Access to Information-CommentsClose CommentsPermalink





‘(1) IN GENERAL- An epidemiology center operated by a grantee pursuant to a grant awarded under subsection (d) shall be treated as a public health authority (as defined in section 164.501 of title 45, Code of Federal Regulations (or a successor regulation)) for purposes of the Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191; 110 Stat. 1936).CommentsClose CommentsPermalink





‘(2) ACCESS TO INFORMATION- The Secretary shall grant to each epidemiology center described in paragraph (1) access to use of the data, data sets, monitoring systems, delivery systems, and other protected health information in the possession of the Secretary.CommentsClose CommentsPermalink





‘(3) REQUIREMENT- The activities of an epidemiology center described in paragraph (1) shall be for the purposes of research and for preventing and controlling disease, injury, or disability (as those activities are described in section 164.512 of title 45, Code of Federal Regulations (or a successor regulation)), for purposes of the Health Insurance Portability and Accountability Act of 1996 (Public Law [Struck out->]104-191; 110 Stat. 1936).[<-Struck out] 104-191; 110 Stat. 1936).‘(f) Funds Not Divisible- An epidemiology center established under this section shall be subject to the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), but the funds for the center shall not be divisible.’.CommentsClose CommentsPermalink

SEC. 12831. INDIAN YOUTH GRANT PROGRAM.

SEC. [Struck out->]128[<-Struck out] 133. PREVENTION, CONTROL, AND ELIMINATION OF COMMUNICABLE AND INFECTIOUS DISEASES.

Section 218 of the Indian Health Care Improvement Act (25 U.S.C. 1621q) is amended to read as follows:CommentsClose CommentsPermalink

‘SEC. 218. PREVENTION, CONTROL, AND ELIMINATION OF COMMUNICABLE AND INFECTIOUS DISEASES.

‘(a) Grants Authorized- The Secretary, acting through the Service, and after consultation with the Centers for Disease Control and Prevention, may make grants available to Indian tribes and tribal organizations for the following:CommentsClose CommentsPermalink





‘(1) Projects for the prevention, control, and elimination of communicable and infectious diseases, including tuberculosis, hepatitis, HIV, respiratory syncytial virus, hanta virus, sexually transmitted diseases, and H. pylori.CommentsClose CommentsPermalink





‘(2) Public information and education programs for the prevention, control, and elimination of communicable and infectious diseases.CommentsClose CommentsPermalink





‘(3) Education, training, and clinical skills improvement activities in the prevention, control, and elimination of communicable and infectious diseases for health professionals, including allied health professionals.CommentsClose CommentsPermalink





‘(4) Demonstration projects for the screening, treatment, and prevention of hepatitis C virus (HCV).CommentsClose CommentsPermalink





‘(b) Application Required- The Secretary may provide funding under subsection (a) only if an application or proposal for funding is submitted to the Secretary.CommentsClose CommentsPermalink





‘(c) Coordination With Health Agencies- Indian tribes and tribal organizations receiving funding under this section are encouraged to coordinate their activities with the Centers for Disease Control and Prevention and State and local health agencies.CommentsClose CommentsPermalink





‘(d) Technical Assistance; Report- In carrying out this section, the Secretary--CommentsClose CommentsPermalink





‘(1) may, at the request of an Indian tribe or tribal organization, provide technical assistance; andCommentsClose CommentsPermalink





‘(2) shall prepare and submit a report to Congress biennially on the use of funds under this section and on the progress made toward the prevention, control, and elimination of communicable and infectious diseases among Indians and urban Indians.’.CommentsClose CommentsPermalink

SEC. 129 [Struck out->]129[<-Struck out] 134. METHODS TO INCREASE CLINICIAN RECRUITMENT AND RETENTION ISSUES.

(a) Licensing- Section 221 of the Indian Health Care Improvement Act (25 U.S.C. 1621t) is amended to read as follows:CommentsClose CommentsPermalink

‘SEC. 221. LICENSING.

‘Licensed health professionals employed by a tribal health program shall be exempt, if licensed in any State, from the licensing requirements of the State in which the tribal health program performs the services described in the contract or compact of the tribal health program under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.).’.CommentsClose CommentsPermalink





(b) Treatment of Scholarships for Certain Purposes- Title I of the Indian Health Care Improvement Act (25 U.S.C. 1611 et seq.) (as amended by section 113) is amended by adding at the end the following:CommentsClose CommentsPermalink

‘SEC. 125. TREATMENT OF SCHOLARSHIPS FOR CERTAIN PURPOSES.

‘A scholarship provided to an individual pursuant to this title shall be considered to be a qualified scholarship for purposes of section 117 of the Internal Revenue Code of 1986.’.CommentsClose CommentsPermalink





(c) Continuing Education Allowances- Section 106 of the Indian Health Care Improvement Act (25 U.S.C. 1615) is amended to read as follows: CommentsClose CommentsPermalink

SEC. 1305. LIABILITY FOR PAYMENT.

SEC. [Struck out->]130[<-Struck out] 136. OFFICES OF INDIAN MEN’S HEALTH AND INDIAN WOMEN’S HEALTH.

Section 223 of the Indian Health Care Improvement Act (25 U.S.C. 1621v) is amended--CommentsClose CommentsPermalink





(1) by striking the section designation and heading and all that follows through ‘oversee efforts of the Service to’ and inserting the following:CommentsClose CommentsPermalink

‘SEC. 223. OFFICES OF INDIAN MEN’S HEALTH AND INDIAN WOMEN’S HEALTH.

‘(a) Office of Indian Men’s Health-CommentsClose CommentsPermalink





‘(1) ESTABLISHMENT- The Secretary may establish within the Service an office, to be known as the ‘Office of Indian Men’s Health’.CommentsClose CommentsPermalink





‘(2) DIRECTOR-CommentsClose CommentsPermalink





‘(A) IN GENERAL- The Office of Indian Men’s Health shall be headed by a director, to be appointed by the Secretary.CommentsClose CommentsPermalink





‘(B) DUTIES- The director shall coordinate and promote the health status of Indian men in the United States.CommentsClose CommentsPermalink





‘(3) REPORT- Not later than 2 years after the date of enactment of the Indian Health Care Improvement Reauthorization and Extension Act of 2009, the Secretary, acting through the Service, shall submit to Congress a report describing--CommentsClose CommentsPermalink





‘(A) any activity carried out by the director as of the date on which the report is prepared; andCommentsClose CommentsPermalink





‘(B) any finding of the director with respect to the health of Indian men.CommentsClose CommentsPermalink





‘(b) Office of Indian Women’s Health- The Secretary, acting through the Service, shall establish an office, to be known as the ‘Office of Indian Women’s Health’, to’; andCommentsClose CommentsPermalink





(2) in subsection (b) (as so redesignated) by inserting ‘(including urban Indian women)’ before ‘of all ages’.CommentsClose CommentsPermalink

SEC. 137. CONTRACT HEALTH SERVICE ADMINISTRATION AND DISBURSEMENT FORMULA.

Title II of the Indian Health Care Improvement Act (25 U.S.C. 1621 et seq.) is amended by adding at the end the following: CommentsClose CommentsPermalink

‘SEC. 226. CONTRACT HEALTH SERVICE ADMINISTRATION AND DISBURSEMENT FORMULA.

‘(a) In General- Not later than 90 days after the date of enactment of this section, the Secretary, acting through the Service, shall Submission of Report- As soon as practicable after the date of enactment of the Indian Health Care Improvement Reauthorization and Extension Act of 2009, the Comptroller General of the United States shall submit to the Secretary, the Committee on Indian Affairs of the Senate, and the Committee on Natural Resources of the House of Representatives, and make available to each Indian tribe, a report describing the results of the study of the Comptroller General regarding the funding of the contract health service program (including historic funding levels and a recommendation of the funding level needed for the program) and the administration of the contract health service program (including the distribution of funds pursuant to the program), as requested by Congress in March 2009, or pursuant to section 830. CommentsClose CommentsPermalink





‘(b) Consultation With Tribes- On receipt of the report under subsection (a), the Secretary shall consult with Indian tribes regarding the contract health service program, including the distribution of funds pursuant to the program-- CommentsClose CommentsPermalink





‘(1) to determine whether the current distribution formula would require modification if the contract health service program were funded at the level recommended by the Comptroller General; CommentsClose CommentsPermalink





‘(2) to identify any inequities in the current distribution formula under the current funding level or inequitable results for any Indian tribe under the funding level recommended by the Comptroller General; CommentsClose CommentsPermalink





‘(3) to identify any areas of program administration that may result in the inefficient or ineffective management of the program; and CommentsClose CommentsPermalink





‘(4) to identify any other issues and recommendations to improve the administration of the contract health services program and correct any unfair results or funding disparities identified under paragraph (2). CommentsClose CommentsPermalink





‘(c) Subsequent Action by Secretary- If, after consultation with Indian tribes under subsection (b), the Secretary determines that any issue described in subsection (b)(2) exists, the Secretary may initiate procedures under subchapter III of chapter 5 of title 5, United States Code, to negotiate and promulgate such regulations or amendments to establish aor promulgate regulations to establish a disbursement formula for contract health service funds.

‘(b) Regulations-

‘(1) PROPOSED REGULATIONS- Proposed regulations to implement this section shall be published in the Federal Register by the Secretary no later than 24 months after the date of enactment of this section and shall have no less than a 120-day comment periodthe contract health service program funding.’. CommentsClose CommentsPermalink

Section 301 of the Indian Health Care Improvement Act (25 U.S.C. 1631) is amended-- CommentsClose CommentsPermalink





(1) by redesignating subsection (d) as subsection (h); and CommentsClose CommentsPermalink





(2) by striking subsection (c) and inserting the following: CommentsClose CommentsPermalink





‘(c) Health Care Facility Priority System- CommentsClose CommentsPermalink





‘(1) IN GENERAL- CommentsClose CommentsPermalink





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





‘(i) shall be developed in consultation with Indian tribes and tribal organizations; CommentsClose CommentsPermalink





‘(ii) shall give Indian tribes’ needs the highest priority; CommentsClose CommentsPermalink





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





‘(II) shall include the methodology required in paragraph (2)(B)(v); and CommentsClose CommentsPermalink





‘(III) may include such health care facilities, and such renovation or expansion needs of any health care facility, as the Service may identify; and CommentsClose CommentsPermalink





‘(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. CommentsClose CommentsPermalink





‘(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. CommentsClose CommentsPermalink





‘(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. CommentsClose CommentsPermalink





‘(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 Reauthorization and Extension Act of 2009 shall not be affected by any change in the construction priority system taking place after that date if the project-- CommentsClose CommentsPermalink





‘(i) was identified in the fiscal year 2008 Service budget justification as-- CommentsClose CommentsPermalink





‘(I) 1 of the 10 top-priority inpatient projects; CommentsClose CommentsPermalink





‘(II) 1 of the 10 top-priority outpatient projects; CommentsClose CommentsPermalink





‘(III) 1 of the 10 top-priority staff quarters developments; or CommentsClose CommentsPermalink





‘(IV) 1 of the 10 top-priority Youth Regional Treatment Centers; CommentsClose CommentsPermalink





‘(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 CommentsClose CommentsPermalink





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





‘(I) on the initiative of the Secretary; or CommentsClose CommentsPermalink





‘(II) pursuant to a request of an Indian tribe or tribal organization. CommentsClose CommentsPermalink





‘(2) EXPIRATION OF AUTHORITY- The authority to promulgate regulation under paragraph (1) shall expire 36 months after the date ofREPORT; CONTENTS- CommentsClose CommentsPermalink





‘(A) INITIAL COMPREHENSIVE REPORT- CommentsClose CommentsPermalink





‘(i) DEFINITIONS- In this subparagraph: CommentsClose CommentsPermalink





‘(I) FACILITIES APPROPRIATION ADVISORY BOARD- The term ‘Facilities Appropriation Advisory Board’ means the advisory board, comprised of 12 members representing Indian tribes and 2 members representing the Service, established at the discretion of the Director-- CommentsClose CommentsPermalink

‘(aa) to provide advice and recommendations for policies and procedures of the programs funded pursuant to facilities appropriations; and CommentsClose CommentsPermalink

‘(bb) to address other facilities issues. CommentsClose CommentsPermalink

‘(II) FACILITIES NEEDS ASSESSMENT WORKGROUP- The term ‘Facilities Needs Assessment Workgroup’ means the workgroup established at the enactment of this section.

‘(c) Procedures-

‘(1) IN GENERAL- 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, who shall be nominated by and be representatives ofdiscretion of the Director-- CommentsClose CommentsPermalink

‘(aa) to review the health care facilities construction priority system; and CommentsClose CommentsPermalink

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

‘(ii) INITIAL REPORT- CommentsClose CommentsPermalink





‘(I) IN GENERAL- Not later than 1 year after the date of enactment of the Indian Health Care Improvement Reauthorization and Extension Act 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, and staff quarters, and the renovation and expansion needs, if any, of such facilities) developed by the Service, Indian tribes, and tribal organizations for the Facilities Needs Assessment Workgroup and the Facilities Appropriation Advisory Board. CommentsClose CommentsPermalink





‘(II) INCLUSIONS- The initial report shall include-- CommentsClose CommentsPermalink

‘(aa) the methodology and criteria used by the Service in determining the needs and establishing the ranking of the facilities needs; and CommentsClose CommentsPermalink

‘(bb) such other information as the Secretary determines to be appropriate. CommentsClose CommentsPermalink

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





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





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





‘(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: CommentsClose CommentsPermalink





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





‘(ii) Health care facilities lists, which may include-- CommentsClose CommentsPermalink





‘(I) the 10 top-priority inpatient health care facilities; CommentsClose CommentsPermalink





‘(II) the 10 top-priority outpatient health care facilities; CommentsClose CommentsPermalink





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





‘(IV) the 10 top-priority staff quarters developments associated with health care facilities. CommentsClose CommentsPermalink





‘(iii) The justification for such order of priority. CommentsClose CommentsPermalink





‘(iv) The projected cost of such projects. CommentsClose CommentsPermalink





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





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





‘(A) consult with and obtain information on all health care facilities needs from Indian tribes and tribal organizations; and CommentsClose CommentsPermalink





‘(B) review the total unmet needs of all Indian tribes and tribal organizations from each Service areaor health care facilities (including staff quarters), including needs for renovation and expansion of existing facilities. CommentsClose CommentsPermalink





‘(d) Review of Methodology Used for Health Facilities Construction Priority System- CommentsClose CommentsPermalink





‘(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-- CommentsClose CommentsPermalink





‘(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 CommentsClose CommentsPermalink





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





‘(2) REQUIREMENTS- The committee shall confer with, and accommodate participation by, representatives of Indian tribes, inter-tribal consortia, tribal organizations, and individual tribal members.‘(3) ADAPTATION OF PROCEDURESSUBMISSION TO CONGRESS- The Comptroller General of the United States shall submit the report under paragraph (1) to-- CommentsClose CommentsPermalink





‘(A) the Committees on Indian Affairs and Appropriations of the Senate; CommentsClose CommentsPermalink





‘(B) the Committees on Natural Resources and Appropriations of the House of Representatives; and CommentsClose CommentsPermalink





‘(C) the Secretary. CommentsClose CommentsPermalink





‘(e) Funding Condition- All funds appropriated under the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the ‘Snyder Act’), for the planning, design, construction, or renovation of health facilities for the benefit of 1 or more Indian Tribes shall be subject to the provisions of section 102 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450f) or sections 504 and 505 of that Act (25 U.S.C. 458aaa-3, 458aaa-4). CommentsClose CommentsPermalink





‘(f) Development of Innovative Approaches- 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 tribesconsult and cooperate with Indian tribes and tribal organizations, and confer with urban Indian organizations, in developing innovative approaches to address all or part of the total unmet need for construction of health facilities, that may include-- CommentsClose CommentsPermalink





‘(1) the establishment of an area distribution fund in which a portion of health facility construction funding could be devoted to all Service areas; CommentsClose CommentsPermalink





‘(2) approaches provided for in other provisions of this title; and CommentsClose CommentsPermalink





‘(3) other approaches, as the Secretary determines to be appropriate.’. CommentsClose CommentsPermalink

Section 301 of the Indian Health Care Improvement Act (25 U.S.C. 1631) (as amended by section 141) is amended by adding at the end the following: CommentsClose CommentsPermalink





‘(g) Priority of Certain Projects Protected- The priority of any project established under the construction priority system in effect on the date of enactment of this Indian Health Care Improvement Reauthorization and Extension Act of 2009 shall not be affected by any change in the construction priority system taking place after that date if the project-- CommentsClose CommentsPermalink





‘(1) was identified in the fiscal year 2008 Service budget justification as-- CommentsClose CommentsPermalink





‘(A) 1 of the 10 top-priority inpatient projects; CommentsClose CommentsPermalink





‘(B) 1 of the 10 top-priority outpatient projects; CommentsClose CommentsPermalink





‘(C) 1 of the 10 top-priority staff quarters developments; or CommentsClose CommentsPermalink





‘(D) 1 of the 10 top-priority Youth Regional Treatment Centers; CommentsClose CommentsPermalink





‘(2) had completed both Phase I and Phase II of the construction priority system in effect on the date of enactment of such Act; or CommentsClose CommentsPermalink





‘(3) is not included in clause (i) or (ii) and is selected, as determined by the Secretary-- CommentsClose CommentsPermalink





‘(A) on the initiative of the Secretary; or CommentsClose CommentsPermalink





‘(B) pursuant to a request of an Indian tribe or tribal organization.’. CommentsClose CommentsPermalink

SEC. 143. INDIAN HEALTH CARE DELIVERY DEMONSTRATION PROJECTS.

Section 307 of the Indian Health Care Improvement Act (25 U.S.C. 1637) is amended to read as follows: CommentsClose CommentsPermalink

‘SEC. 307. INDIAN HEALTH CARE DELIVERY DEMONSTRATION PROJECTS.

‘(a) In GeneralPurpose and General Authority- CommentsClose CommentsPermalink





‘(1) PURPOSE- The purpose of this section is to encourage the establishment of demonstration projects that meet the applicable criteria of this section to be carried out by the Secretary, acting through the Service, or Indian tribes or tribal organizations acting pursuant to contracts or compacts under the Indian Self Determination and Education Assistance Act (25 U.S.C. 450 et seq.)-- CommentsClose CommentsPermalink





‘(A) to test alternative means of delivering health care and services to Indians through facilities; or CommentsClose CommentsPermalink





‘(B) to use alternative or innovative methods or models of delivering health care services to Indians (including primary care services, contract health services, or any other program or service authorized by this Act) through convenient care services (as defined in subsection (c)), community health centers, or cooperative agreements or arrangements with other health care providers that share or coordinate the use of facilities, funding, or other resources, or otherwise coordinate or improve the coordination of activities of the Service, Indian tribes, or tribal organizations, with those of the other health care providers. CommentsClose CommentsPermalink





‘(2) AUTHORITY- The Secretary, acting through the Service, is authorized to carry out, or to enter into contracts or compacts under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) with Indian Tribes or tribal organizations to carry out, a health care delivery demonstration project totribes or tribal organizations to carry out, health care delivery demonstration projects that-- CommentsClose CommentsPermalink





‘(A) test alternative means of delivering health care and services to Indians through facilities.‘(b) ; or CommentsClose CommentsPermalink





‘(B) otherwise carry out the purposes of this section. CommentsClose CommentsPermalink





‘(b) Use of Funds- The Secretary, in approving projects pursuant to this section-- CommentsClose CommentsPermalink





‘(1) may authorize such contracts for the construction and renovation of hospitals, health centers, health stations, and other facilities to deliver health care services; and CommentsClose CommentsPermalink





‘(2) is authorized-- CommentsClose CommentsPermalink





‘(A) to waive any leasing prohibition; CommentsClose CommentsPermalink





‘(B) to permit carryover of funds appropriated for the provision of health care servicesuse and carryover of funds appropriated for the provision of health care services under this Act (including for the purchase of health benefits coverage, as authorized by section 402(a)); CommentsClose CommentsPermalink





‘(C) to permit the use of other available funds, including other Federal funds, funds from third-party collections in accordance with sections 206, 207, and 401, and non-Federal funds contributed by State or local governmental agencies or facilities or private health care providers pursuant to cooperative or other agreements with the Service, 1 or more Indian tribes, or tribal organizations; CommentsClose CommentsPermalink





‘(D) to permit the use of funds or property donated or otherwise provided from any source for project purposes; CommentsClose CommentsPermalink





‘(E) to provide for the reversion of donated real or personal property to the donor; and CommentsClose CommentsPermalink





‘(F) to permit the use of Service funds to match other funds, including Federal funds. CommentsClose CommentsPermalink





‘(c) Health Care Demonstration Projects- CommentsClose CommentsPermalink





‘(1) DEFINITION OF CONVENIENT CARE SERVICE- In this subsection, the term ‘convenient care service’ means any primary health care service, such as urgent care services, nonemergent care services, prevention services and screenings, and any service authorized by section 203 or 205(d), that is offered-- CommentsClose CommentsPermalink





‘(A) at an alternative setting; or CommentsClose CommentsPermalink





‘(B) during hours other than regular working hours. CommentsClose CommentsPermalink





‘(2) GENERAL PROJECTS- CommentsClose CommentsPermalink





‘(A) CRITERIA- The Secretary may approve under this section demonstration projects that meet the following criteria: CommentsClose CommentsPermalink





‘(i) There is a need for a new facility or program, such as a program for convenient care services, or the reorientation of an existing facility or program.‘(ii)an improvement in, increased efficiency at, or reorientation of an existing facility or program. CommentsClose CommentsPermalink





‘(ii) A significant number of Indians, including Indians with low health status, will be served by the project. CommentsClose CommentsPermalink





‘(iii) The project has the potential to deliver services in an efficient and effective manner. CommentsClose CommentsPermalink





‘(iv) The project is economically viable. CommentsClose CommentsPermalink





‘(v) For projects carried out by an Indian tribe or tribal organization, the Indian tribe or tribal organization has the administrative and financial capability to administer the project. CommentsClose CommentsPermalink





‘(vi) The project is integrated with providers of related health and social servicesor social services (including State and local health care agencies or other health care providers) and is coordinated with, and avoids duplication of, existing services in order to expand the availability of services. CommentsClose CommentsPermalink





‘(B) PRIORITY- In approving demonstration projects under this paragraph, the Secretary shall give priority to demonstration projects, to the extent the projects meet the criteria described in subparagraph (A), located in any of the following Service units: CommentsClose CommentsPermalink





‘(i) Cass Lake, Minnesota. CommentsClose CommentsPermalink





‘(ii) Mescalero, New Mexico. CommentsClose CommentsPermalink





‘(iii) Owyhee and Elko, Nevada. CommentsClose CommentsPermalink





‘(iv) Schurz, Nevada. CommentsClose CommentsPermalink





‘(v) Ft. Yuma, California. CommentsClose CommentsPermalink





‘(3) INNOVATIVE HEALTH SERVICES DELIVERY DEMONSTRATION PROJECT- CommentsClose CommentsPermalink





‘(A) CRITERIA- The Secretary shall look at innovative ways to deliver health care services, such asAPPLICATION OR REQUEST- On receipt of an application or request from an Indian tribe, a consortium of Indian tribes, or a tribal organization within a Service area, the Secretary shall take into consideration alternative or innovated methods to deliver health care services within the Service area (or a portion of, or facility within, the Service area) as described in the application or request, including medical, dental, alternative medicine, pharmaceutical, nursing, and clinical laboratory services, in American Indian and Alaska Native communities, including convenient care service, community health centers, and other health care models which, contract health services, convenient care services, community health centers, or any other health care services delivery models designed to improve access to quality health promotion and, or efficiency or quality of, the health care, health promotion, or disease prevention services.‘(B) and programs under this Act. CommentsClose CommentsPermalink





‘(B) APPROVAL- In addition to projects described in paragraph (2), in any fiscal year, the Secretary is authorized under this paragraph to approve not more than 10 applications for health care delivery demonstration projects that--

‘(i) include a convenient care service program as an alternative means of delivering health care services to Indians; and

‘(ii) meet the criteria described in subparagraph (C). CommentsClose CommentsPermalink




‘(C) CRITERIA- The Secretary shall approve under subparagraph (B) demonstration projects that meet all of the following criteria: CommentsClose CommentsPermalink





‘(i) The criteria set forth in paragraph (2)(A). CommentsClose CommentsPermalink





‘(ii) There is a lack of access to health care services at existing health care facilities, which may be due to limited hours of operation at those facilities or other factors. CommentsClose CommentsPermalink





‘(iii) The project-- CommentsClose CommentsPermalink





‘(I) expands the availability of services; or CommentsClose CommentsPermalink





‘(II) reduces-- CommentsClose CommentsPermalink

‘(aa) the burden on Contract Health Services; or CommentsClose CommentsPermalink

‘(bb) the need for emergency room visits. CommentsClose CommentsPermalink

‘(d) Peer Review Panels- The Secretary may provide for the establishment of peer review panels, as necessary, to review and evaluate applications using the criteria described in paragraphs (2)(A) and (3)(C) of subsection (c).‘(e) Technical Assistance- The Secretary shall provide Technical Assistance- On receipt of an application or request from an Indian tribe, a consortium of Indian tribes, or a tribal organization, the Secretary shall provide such technical and other assistance as may be necessary to enable applicants to comply with this section.‘(f, including information regarding the Service unit budget and available funding for carrying out the proposed demonstration project. CommentsClose CommentsPermalink





‘(e) Service to Ineligible Persons- Subject to section 813, 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 813, may be included, subject to the terms of that section, in any demonstration project approved pursuant to this section. CommentsClose CommentsPermalink





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





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

SEC. 142 [Struck out->]142[<-Struck out] 144. TRIBAL MANAGEMENT OF FEDERALLY OWNED QUARTERS.

Title III of the Indian Health Care Improvement Act (as amended by section 101(b)) is amended by inserting after section 308 (25 U.S.C. 1638) the following:CommentsClose CommentsPermalink

‘SEC. 309. TRIBAL MANAGEMENT OF FEDERALLY OWNED QUARTERS.

‘(a) Rental Rates-CommentsClose CommentsPermalink





‘(1) ESTABLISHMENT- Notwithstanding any other provision of law, a tribal health program that operates a hospital or other health facility and the federally owned quarters associated with such a facility pursuant to a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) may establish the rental rates charged to the occupants of those quarters, on providing notice to the Secretary.CommentsClose CommentsPermalink





‘(2) OBJECTIVES- In establishing rental rates under this subsection, a tribal health program shall attempt--CommentsClose CommentsPermalink





‘(A) to base the rental rates on the reasonable value of the quarters to the occupants of the quarters; andCommentsClose CommentsPermalink





‘(B) to generate sufficient funds to prudently provide for the operation and maintenance of the quarters, and at the discretion of the tribal health program, to supply reserve funds for capital repairs and replacement of the quarters.CommentsClose CommentsPermalink





‘(3) EQUITABLE FUNDING- A federally owned quarters the rental rates for which are established by a tribal health program under this subsection shall remain eligible to receive improvement and repair funds to the same extent that all federally owned quarters used to house personnel in programs of the Service are eligible to receive those funds.CommentsClose CommentsPermalink





‘(4) NOTICE OF RATE CHANGE- A tribal health program that establishes a rental rate under this subsection shall provide occupants of the federally owned quarters a notice of any change in the rental rate by not later than the date that is 60 days notice before the effective date of the change.CommentsClose CommentsPermalink





‘(5) RATES IN ALASKA- A rental rate established by a tribal health program under this section for a federally owned quarters in the State of Alaska 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.CommentsClose CommentsPermalink





‘(b) Direct Collection of Rent-CommentsClose CommentsPermalink





‘(1) IN GENERAL- Notwithstanding any other provision of law, and subject to paragraph (2), a tribal health program may collect rent directly from Federal employees who occupy federally owned quarters if the tribal health program submits to the Secretary and the employees a notice of the election of the tribal health program to collect rents directly from the employees.CommentsClose CommentsPermalink





‘(2) ACTION BY EMPLOYEES- On receipt of a notice described in paragraph (1)--CommentsClose CommentsPermalink





‘(A) the affected Federal employees shall pay rent for occupancy of a federally owned quarters directly to the applicable tribal health program; andCommentsClose CommentsPermalink





‘(B) the Secretary shall not have the authority to collect rent from the employees through payroll deduction or otherwise.CommentsClose CommentsPermalink





‘(3) USE OF PAYMENTS- The rent payments under this subsection--CommentsClose CommentsPermalink





‘(A) shall be retained by the applicable tribal health program in 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, as the tribal health program determines to be appropriate; andCommentsClose CommentsPermalink





‘(B) shall not be made payable to, or otherwise be deposited with, the United States.CommentsClose CommentsPermalink





‘(4) RETROCESSION OF AUTHORITY- If a tribal health program that elected to collect rent directly under paragraph (1) requests retrocession of the authority of the tribal health program to collect that rent, the retrocession shall take effect on the earlier of--CommentsClose CommentsPermalink





‘(A) the first day of the month that begins not less than 180 days after the tribal health program submits the request; andCommentsClose CommentsPermalink





‘(B) such other date as may be mutually agreed on by the Secretary and the tribal health program.’.CommentsClose CommentsPermalink

SEC. 143 [Struck out->]143[<-Struck out] 145. OTHER FUNDING, EQUIPMENT, AND SUPPLIES FOR FACILITIES.

Title III of the Indian Health Care Improvement Act (25 U.S.C. 1631 et seq.) is amended by adding at the end the following:CommentsClose CommentsPermalink

‘SEC. 311. OTHER FUNDING, EQUIPMENT, AND SUPPLIES FOR FACILITIES.

‘(a) Authorization-CommentsClose CommentsPermalink





‘(1) AUTHORITY TO TRANSFER FUNDS- The head of any Federal agency to which funds, equipment, or other supplies are made available for the constructionplanning, design, construction, or operation of a health care or sanitation facility may transfer the funds, equipment, or supplies to the Secretary for the constructionplanning, design, construction, or operation of a health care or sanitation facility to achieve-- CommentsClose CommentsPermalink





‘(A) the purposes of this Act; andCommentsClose CommentsPermalink





‘(B) the purposes for which the funds, equipment, or supplies were made available to the Federal agency.CommentsClose CommentsPermalink





‘(2) AUTHORITY TO ACCEPT FUNDS- The Secretary may--CommentsClose CommentsPermalink





‘(A) accept from any source, including Federal and State agencies, funds, equipment, or supplies that are available for the construction or operation of health care or sanitation facilities; andCommentsClose CommentsPermalink





‘(B) use those funds, equipment, and supplies to plan, design, and construct health care facilities for [Struck out->]and construct health care facilities[<-Struck out] , construct, and operate health care or sanitation facilities for Indians, including pursuant to a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.).CommentsClose CommentsPermalink





‘(3) EFFECT OF RECEIPT- Receipt of funds by the Secretary under this subsection shall not affect any priority established under section 301.CommentsClose CommentsPermalink





‘(b) Interagency Agreements- The Secretary may enter into interagency agreements with Federal or State agencies and other entities, and accept funds, equipment, or other supplies from those entities, to provide for the planning, design, [Struck out->]and construction of health care facilities [<-Struck out] construction, and operation of health care or sanitation facilitiesto be administered by Indian health programs to achieve--CommentsClose CommentsPermalink





‘(1) the purposes of this Act; andCommentsClose CommentsPermalink





‘(2) the purposes for which the funds were appropriated or otherwise provided.CommentsClose CommentsPermalink





‘(c) Establishment of Standards- CommentsClose CommentsPermalink





‘(1) IN GENERAL- The Secretary, acting through the Service, shall establish, by regulation, standards for the planning, design, and construction of health careconstruction, and operation of health care or sanitation facilities serving Indians under this Act. CommentsClose CommentsPermalink





‘(2) OTHER REGULATIONS- Notwithstanding any other provision of law, any other applicable regulations of the Department shall apply in carrying out projects using funds transferred under this section. CommentsClose CommentsPermalink





‘(d) Definition of Sanitation Facility- In this section, the term ‘sanitation facility’ means a safe and adequate water supply system, sanitary sewage disposal system, or sanitary solid waste system (including all related equipment and support infrastructure).’. CommentsClose CommentsPermalink

SEC. 144 [Struck out->]144[<-Struck out] 146. INDIAN COUNTRY MODULAR COMPONENT FACILITIES DEMONSTRATION PROGRAM.

Title III of the Indian Health Care Improvement Act (25 U.S.C. 1631 et seq.) (as amended by section143 [Struck out->]143[<-Struck out] 145) is amended by adding at the end the following:CommentsClose CommentsPermalink

‘SEC. 312. INDIAN COUNTRY MODULAR COMPONENT FACILITIES DEMONSTRATION PROGRAM.

‘(a) Definition of Modular Component Health Care Facility- In this section, the term ‘modular component health care facility’ means a health care facility that is constructed--CommentsClose CommentsPermalink





‘(1) off-site using prefabricated component units for subsequent transport to the destination location; andCommentsClose CommentsPermalink





‘(2) represents a more economical method for provision of health care facility than a traditionally constructed health care building.CommentsClose CommentsPermalink





‘(b) Establishment- The Secretary, acting through the Service, shall establish a demonstration program under which the Secretary shall award no less than 3 grants for purchase, installation and maintenance of modular component health care facilities in Indian communities for provision of health care services.CommentsClose CommentsPermalink





‘(c) Selection of Locations-CommentsClose CommentsPermalink





‘(1) PETITIONS-CommentsClose CommentsPermalink





‘(A) SOLICITATION- The Secretary shall solicit from Indian tribes petitions for location of the modular component health care facilities in the Service areas of the petitioning Indian tribes.CommentsClose CommentsPermalink





‘(B) PETITION- To be eligible to receive a grant under this section, an Indian tribe or tribal organization must submit to the Secretary a petition to construct a modular component health care facility in the Indian community of the Indian tribe, at such time, in such manner, and containing such information as the Secretary may require.CommentsClose CommentsPermalink





‘(2) SELECTION- In selecting the location of each modular component health care facility to be provided under the demonstration program, the Secretary shall give priority to projects already on the Indian Health Service facilities construction priority list and petitions which demonstrate that erection of a modular component health facility--CommentsClose CommentsPermalink





‘(A) is more economical than construction of a traditionally constructed health care facility;CommentsClose CommentsPermalink





‘(B) can be constructed and erected on the selected location in less time than traditional construction; andCommentsClose CommentsPermalink





‘(C) can adequately house the health care services needed by the Indian population to be served.CommentsClose CommentsPermalink





‘(3) EFFECT OF SELECTION- A modular component health care facility project selected for participation in the demonstration program shall not be eligible for entry on the facilities construction priorities list entitled ‘IHS Health Care Facilities FY 2011 Planned Construction Budget’ and dated May 7, 2009 (or any successor list).CommentsClose CommentsPermalink





‘(d) Eligibility-CommentsClose CommentsPermalink





‘(1) IN GENERAL- An Indian tribe may submit a petition under subsection (c)(1)(B) regardless of whether the Indian tribe is a party to any contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.).CommentsClose CommentsPermalink





‘(2) ADMINISTRATION- At the election of an Indian tribe or tribal organization selected for participation in the demonstration program, the funds provided for the project shall be subject to the provisions of the Indian Self-Determination and Education Assistance Act.CommentsClose CommentsPermalink





‘(e) Reports- Not later than 1 year after the date on which funds are made available for the demonstration program and annually thereafter, the Secretary shall submit to Congress a report describing--CommentsClose CommentsPermalink





‘(1) each activity carried out under the demonstration program, including an evaluation of the success of the activity; andCommentsClose CommentsPermalink





‘(2) the potential benefits of increased use of modular component health care facilities in other Indian communities.CommentsClose CommentsPermalink





‘(f) Authorization of Appropriations- There are authorized to be appropriated $50,000,000 to carry out the demonstration program under this section for the first 5 fiscal years, and such sums as may be necessary to carry out the program in subsequent fiscal years.’.CommentsClose CommentsPermalink

SEC. 145 [Struck out->]145[<-Struck out] 147. MOBILE HEALTH STATIONS DEMONSTRATION PROGRAM.

Title III of the Indian Health Care Improvement Act (25 U.S.C. 1631 et seq.) (as amended by section144 [Struck out->]144[<-Struck out] 146) is amended by adding at the end the following:CommentsClose CommentsPermalink

‘SEC. 313. MOBILE HEALTH STATIONS DEMONSTRATION PROGRAM.

‘(a) Definitions- In this section:CommentsClose CommentsPermalink





‘(1) ELIGIBLE TRIBAL CONSORTIUM- The term ‘eligible tribal consortium’ means a consortium composed of 2 or more Service units between which a mobile health station can be transported by road in up to 8 hours. A Service unit operated by the Service or by an Indian tribe or tribal organization shall be equally eligible for participation in such consortium.CommentsClose CommentsPermalink





‘(2) MOBILE HEALTH STATION- The term ‘mobile health station’ means a health care unit that--CommentsClose CommentsPermalink





‘(A) is constructed, maintained, and capable of being transported within a semi-trailer truck or similar vehicle;CommentsClose CommentsPermalink





‘(B) is equipped for the provision of 1 or more specialty health care services; andCommentsClose CommentsPermalink





‘(C) can be equipped to be docked to a stationary health care facility when appropriate.CommentsClose CommentsPermalink





‘(3) SPECIALTY HEALTH CARE SERVICE-CommentsClose CommentsPermalink





‘(A) IN GENERAL- The term ‘specialty health care service’ means a health care service which requires the services of a health care professional with specialized knowledge or experience.CommentsClose CommentsPermalink





‘(B) INCLUSIONS- The term ‘specialty health care service’ includes any service relating to--CommentsClose CommentsPermalink





‘(i) dialysis;CommentsClose CommentsPermalink





‘(ii) surgery;CommentsClose CommentsPermalink





‘(iii) mammography;CommentsClose CommentsPermalink





‘(iv) dentistry; orCommentsClose CommentsPermalink





‘(v) any other specialty health care service.CommentsClose CommentsPermalink





‘(b) Establishment- The Secretary, acting through the Service, shall establish a demonstration program under which the Secretary shall provide at least 3 mobile health station projects.CommentsClose CommentsPermalink





‘(c) Petition- To be eligible to receive a mobile health station under the demonstration program, an eligible tribal consortium shall submit to the Secretary, a petition at such time, in such manner, and containing--CommentsClose CommentsPermalink





‘(1) a description of the Indian population to be served;CommentsClose CommentsPermalink





‘(2) a description of the specialty service or services for which the mobile health station is requested and the extent to which such service or services are currently available to the Indian population to be served; andCommentsClose CommentsPermalink





‘(3) such other information as the Secretary may require.CommentsClose CommentsPermalink





‘(d) Use of Funds- The Secretary shall use amounts made available to carry out the demonstration program under this section--CommentsClose CommentsPermalink





‘(1)(A) to establish, purchase, lease, or maintain mobile health stations for the eligible tribal consortia selected for projects; andCommentsClose CommentsPermalink





‘(B) to provide, through the mobile health station, such specialty health care services as the affected eligible tribal consortium determines to be necessary for the Indian population served;CommentsClose CommentsPermalink





‘(2) to employ an existing mobile health station (regardless of whether the mobile health station is owned or rented and operated by the Service) to provide specialty health care services to an eligible tribal consortium; andCommentsClose CommentsPermalink





‘(3) to establish, purchase, or maintain docking equipment for a mobile health station, including the establishment or maintenance of such equipment at a modular component health care facility (as defined in section 312(a)), if applicable.CommentsClose CommentsPermalink





‘(e) Reports- Not later than 1 year after the date on which the demonstration program is established under subsection (b) and annually thereafter, the Secretary, acting through the Service, shall submit to Congress a report describing--CommentsClose CommentsPermalink





‘(1) each activity carried out under the demonstration program including an evaluation of the success of the activity; andCommentsClose CommentsPermalink





‘(2) the potential benefits of increased use of mobile health stations to provide specialty health care services for Indian communities.CommentsClose CommentsPermalink





‘(f) Authorization of Appropriations- There are authorized to be appropriated $5,000,000 per year to carry out the demonstration program under this section for the first 5 fiscal years, and such sums as may be needed to carry out the program in subsequent fiscal years.’.CommentsClose CommentsPermalink

Subtitle D--Access to Health ServicesCommentsClose CommentsPermalink

SEC. 151. TREATMENT OF PAYMENTS UNDER SOCIAL SECURITY ACT HEALTH BENEFITS PROGRAMS.

Section 401 of the Indian Health Care Improvement Act (25 U.S.C. 1641) is amended to read as follows:CommentsClose CommentsPermalink

‘SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SECURITY ACT HEALTH BENEFITS PROGRAMS.

‘(a) Disregard of Medicare, Medicaid, and CHIP 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.CommentsClose CommentsPermalink





‘(b) Nonpreferential Treatment- Nothing in this Act authorizes the Secretary to provide services to an Indian with coverage under title XVIII, XIX, or XI of the Social Security Act in preference to an Indian without such coverage.CommentsClose CommentsPermalink





‘(c) Use of Funds-CommentsClose CommentsPermalink





‘(1) SPECIAL FUND-CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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 reducing the health resource deficiencies (as determined in section 201(c)) of such Indian tribes, including the provision of services pursuant to section 205.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(d) Direct Billing-CommentsClose CommentsPermalink





‘(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 or from any other third party payor.CommentsClose CommentsPermalink





‘(2) DIRECT REIMBURSEMENT-CommentsClose CommentsPermalink





‘(A) USE OF FUNDS- Each tribal health program making the election described in paragraph (1) with respect to a program under a title of the Social Security Act shall be reimbursed directly by that program for items and services furnished without regard to subsection (c)(1), except that all amounts so reimbursed shall be used by the tribal health program for the purpose of making any improvements in facilities of the tribal health program that may be necessary to achieve or maintain compliance with the conditions and requirements applicable generally to such items and services under the program under such title and to provide additional health care services, improvements in health care facilities and tribal health programs, any health care-related purpose (including coverage for a service or service within a contract health service delivery area or any portion of a contract health service delivery area that would otherwise be provided as a contract health service), or otherwise to achieve the objectives provided in section 3 of this Act.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(3) EXAMINATION AND IMPLEMENTATION OF CHANGES-CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.’.CommentsClose CommentsPermalink

SEC. 152. PURCHASING HEALTH CARE COVERAGE.

Section 402 of the Indian Health Care Improvement Act (25 U.S.C. 1642) is amended to read as follows:CommentsClose CommentsPermalink

‘SEC. 402. PURCHASING HEALTH CARE COVERAGE.

‘(a) In General- Insofar as amounts are made available under law (including a provision of the Social Security Act, the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), or other law, other than under section 404) 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 (including coverage for a service, or service within a contract health service delivery area, or any portion of a contract health service delivery area that would otherwise be provided as a contract health service) for such beneficiaries in any manner, including through--CommentsClose CommentsPermalink





‘(1) a tribally owned and operated health care plan;CommentsClose CommentsPermalink





‘(2) a State or locally authorized or licensed health care plan;CommentsClose CommentsPermalink





‘(3) a health insurance provider or managed care organization;CommentsClose CommentsPermalink





‘(4) a self-insured plan; orCommentsClose CommentsPermalink





‘(5) a high deductible or health savings account plan.CommentsClose CommentsPermalink





‘(b) Financial Need- The purchase of coverage under subsection (a) by an Indian tribe, tribal organization, or urban Indian organization may be based on the financial needs of such beneficiaries (as determined by the 1 or more Indian tribes being served based on a schedule of income levels developed or implemented by such 1 ore more Indian tribes).CommentsClose CommentsPermalink





‘(c) 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.CommentsClose CommentsPermalink





‘(d) Construction- Nothing in this section shall be construed as affecting the use of any amounts not referred to in subsection (a).’.CommentsClose CommentsPermalink

SEC. 153. GRANTS TO AND CONTRACTS WITH THE SERVICE, INDIAN TRIBES, TRIBAL ORGANIZATIONS, AND URBAN INDIAN ORGANIZATIONS TO FACILITATE OUTREACH, ENROLLMENT, AND COVERAGE OF INDIANS UNDER SOCIAL SECURITY ACT HEALTH BENEFIT PROGRAMS AND OTHER HEALTH BENEFITS PROGRAMS.

Section 404 of the Indian Health Care Improvement Act (25 U.S.C. 1644) is amended to read as follows:CommentsClose CommentsPermalink

‘SEC. 404. GRANTS TO AND CONTRACTS WITH THE SERVICE, INDIAN TRIBES, TRIBAL ORGANIZATIONS, AND URBAN INDIAN ORGANIZATIONS TO FACILITATE OUTREACH, ENROLLMENT, AND COVERAGE OF INDIANS UNDER SOCIAL SECURITY ACT HEALTH BENEFIT PROGRAMS AND OTHER HEALTH BENEFITS PROGRAMS.

‘(a) Indian Tribes and Tribal Organizations- 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--CommentsClose CommentsPermalink





‘(1) to enroll for benefits under a program established under title XVIII, XIX, or XXI of the Social Security Act and other health benefits programs; andCommentsClose CommentsPermalink





‘(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).CommentsClose CommentsPermalink





‘(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--CommentsClose CommentsPermalink





‘(1) to determine the population of Indians eligible for the benefits described in subsection (a);CommentsClose CommentsPermalink





‘(2) to educate Indians with respect to the benefits available under the respective programs;CommentsClose CommentsPermalink





‘(3) to provide transportation for such individual Indians to the appropriate offices for enrollment or applications for such benefits; andCommentsClose CommentsPermalink





‘(4) to develop and implement methods of improving the participation of Indians in receiving benefits under such programs.CommentsClose CommentsPermalink





‘(c) Application to Urban Indian Organizations-CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(2) REQUIREMENTS- The Secretary shall include in the grants or contracts made or provided under paragraph (1) requirements that are--CommentsClose CommentsPermalink





‘(A) consistent with the requirements imposed by the Secretary under subsection (b);CommentsClose CommentsPermalink





‘(B) appropriate to urban Indian organizations and urban Indians; andCommentsClose CommentsPermalink





‘(C) necessary to effect the purposes of this section.CommentsClose CommentsPermalink





‘(d) Facilitating Cooperation- The Secretary, acting through the Centers for Medicare & Medicaid Services, shall develop and disseminate best practices that will serve to facilitate cooperation with, and agreements between, States and the Service, Indian tribes, tribal organizations, or urban Indian organizations with respect to the provision of health care items and services to Indians under the programs established under title XVIII, XIX, or XXI of the Social Security Act.CommentsClose CommentsPermalink





‘(e) Agreements Relating to Improving Enrollment of Indians Under Social Security Act Health Benefits Programs- For provisions relating to agreements of the Secretary, acting through the Service, 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.CommentsClose CommentsPermalink





‘(f) Definition of Premiums and Cost Sharing- In this section:CommentsClose CommentsPermalink





‘(1) PREMIUM- The term ‘premium’ includes any enrollment fee or similar charge.CommentsClose CommentsPermalink





‘(2) COST SHARING- The term ‘cost sharing’ includes any deduction, deductible, copayment, coinsurance, or similar charge.’.CommentsClose CommentsPermalink

SEC. 154. SHARING ARRANGEMENTS WITH FEDERAL AGENCIES.

Section 405 of the Indian Health Care Improvement Act (25 U.S.C. 1645) is amended to read as follows:CommentsClose CommentsPermalink

‘SEC. 405. SHARING ARRANGEMENTS WITH FEDERAL AGENCIES.

‘(a) Authority-CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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--CommentsClose CommentsPermalink





‘(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;CommentsClose CommentsPermalink





‘(2) the quality of health care services provided to any Indian through the Service;CommentsClose CommentsPermalink





‘(3) the priority access of any veteran to health care services provided by the Department of Veterans Affairs;CommentsClose CommentsPermalink





‘(4) the quality of health care services provided by the Department of Veterans Affairs or the Department of Defense; orCommentsClose CommentsPermalink





‘(5) the eligibility of any Indian who is a veteran to receive health services through the Department of Veterans Affairs.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.’.CommentsClose CommentsPermalink

SEC. 155. ELIGIBLE INDIAN VETERAN SERVICES.

Title IV of the Indian Health Care Improvement Act (25 U.S.C. 1641 et seq.) (as amended by section 101(b)) is amended by adding at the end the following:CommentsClose CommentsPermalink

‘SEC. 407. ELIGIBLE INDIAN VETERAN SERVICES.

‘(a) Findings; Purpose-CommentsClose CommentsPermalink





‘(1) FINDINGS- Congress finds that--CommentsClose CommentsPermalink





‘(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; andCommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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).CommentsClose CommentsPermalink





‘(b) Definitions- In this section:CommentsClose CommentsPermalink





‘(1) ELIGIBLE INDIAN VETERAN- The term ‘eligible Indian veteran’ means an Indian or Alaska Native veteran who receives any medical service that is--CommentsClose CommentsPermalink





‘(A) authorized under the laws administered by the Secretary of Veterans Affairs; andCommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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).CommentsClose CommentsPermalink





‘(c) Eligible Indian Veterans Expenses-CommentsClose CommentsPermalink





‘(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).CommentsClose CommentsPermalink





‘(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).CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(e) Funding-CommentsClose CommentsPermalink





‘(1) TREATMENT- Expenses incurred by the Secretary in carrying out subsection (c)(1) shall not be considered to be Contract Health Service expenses.CommentsClose CommentsPermalink





‘(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.’.CommentsClose CommentsPermalink

SEC. 156. NONDISCRIMINATION UNDER FEDERAL HEALTH CARE PROGRAMS IN QUALIFICATIONS FOR REIMBURSEMENT FOR SERVICES.

Title IV of the Indian Health Care Improvement Act (25 U.S.C. 1641 et seq.) (as amended by section 155) is amended by adding at the end the following:CommentsClose CommentsPermalink

‘SEC. 408. NONDISCRIMINATION UNDER FEDERAL HEALTH CARE PROGRAMS IN QUALIFICATIONS FOR REIMBURSEMENT FOR SERVICES.

‘(a) Requirement To Satisfy Generally Applicable Participation Requirements-CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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 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.CommentsClose CommentsPermalink





‘(b) Application of Exclusion From Participation in Federal Health Care Programs-CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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)).’.CommentsClose CommentsPermalink

SEC. 157. ACCESS TO FEDERAL INSURANCE.

Title IV of the Indian Health Care Improvement Act (25 U.S.C. 1641 et seq.) (as amended by section 156) is amended by adding at the end the following:CommentsClose CommentsPermalink

‘SEC. 409. ACCESS TO FEDERAL INSURANCE.

‘Notwithstanding the provisions of title 5, United States Code, Executive order, or administrative regulation, an Indian tribe or tribal organization carrying out programs under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) or an urban Indian organization carrying out programs under title V of this Act shall be entitled to purchase coverage, rights, and benefits for the employees of such Indian tribe or tribal organization, or urban Indian organization, under chapter 89 of title 5, United States Code, and chapter 87 of such title if necessary employee deductions and agency contributions in payment for the coverage, rights, and benefits for the period of employment with such Indian tribe or tribal organization, or urban Indian organization, are currently deposited in the applicable Employee’s Fund under such title.’.CommentsClose CommentsPermalink

SEC. 158. GENERAL EXCEPTIONS.

Title IV of the Indian Health Care Improvement Act (25 U.S.C. 1641 et seq.) (as amended by section 157) is amended by adding at the end the following:CommentsClose CommentsPermalink

‘SEC. 410. GENERAL EXCEPTIONS.

‘The requirements of this title shall not apply to any excepted benefits described in paragraph (1)(A) or (3) of section 2791(c) of the Public Health Service Act (42 U.S.C. 300gg-91).’.CommentsClose CommentsPermalink