102d CONGRESS
2d Session
S. 2481
AMENDMENT
S 2481 EAH
In the House of Representatives, U. S.,
October 3, 1992.
Resolved, That the bill from the Senate (S. 2481) entitled `An Act to amend
the Indian Health Care Improvement Act to authorize appropriations for
Indian health programs, and for other purposes', do pass with the following
AMENDMENT:
Strike out all after the enacting clause, and insert:

b1497ed003ef44e5dcf2651708c6b74086ef36544316ee078abfd9941f3a4f70

This Act may be cited as the `Indian Health Amendments of 1992'.

6e6a5018b53aafc43086a4499d0ee81ac11236ac7bd6e40eb4776e753326f139

Except as otherwise specifically provided, whenever in this Act a section
or other provision is amended or repealed, such amendment or repeal shall
be considered to be made to that section or other provision of the Indian
Health Care Improvement Act (25 U.S.C. 1601 et seq.).

9c24fd75e4c5b159f0ba8e681e95f62a2887df579275f6acc18731fc75b420b5

(a) FINDINGS- Section 2 of the Act (25 U.S.C. 1601) is amended--
(1) in the matter preceding paragraph (a), by striking `finds that--'
and inserting `finds the following:';
(2) in paragraph (d), by striking out the second sentence; and
(3) by striking out paragraphs (e), (f), and (g).
(b) DECLARATION OF POLICY- Section 3 of the Act (25 U.S.C. 1602) is amended
to read as follows:
`DECLARATION OF HEALTH OBJECTIVES
`SEC. 3. (a) The Congress hereby declares that it is the policy of this
Nation, in fulfillment of its special responsibilities and legal obligation
to the American Indian people, to assure the highest possible health status
for Indians and urban Indians and to provide all resources necessary to
effect that policy.
`(b) It is the intent of the Congress that the Nation meet the following
health status objectives with respect to Indians and urban Indians by the
year 2000:
`(1) Reduce coronary heart disease deaths to a level of no more than 100
per 100,000.
`(2) Reduce the prevalence of overweight individuals to no more than
30 percent.
`(3) Reduce the prevalence of anemia to less than 10 percent among children
aged 1 through 5.
`(4) Reduce the level of cancer deaths to a rate of no more than 130
per 100,000.
`(5) Reduce the level of lung cancer deaths to a rate of no more than 42
per 100,000.
`(6) Reduce the level of chronic obstructive pulmonary disease related
deaths to a rate of no more than 25 per 100,000.
`(7) Reduce deaths among men caused by alcohol-related motor vehicle
crashes to no more than 44.8 per 100,000.
`(8) Reduce cirrhosis deaths to no more than 13 per 100,000.
`(9) Reduce drug-related deaths to no more than 3 per 100,000.
`(10) Reduce pregnancies among girls aged 17 and younger to no more than
50 per 1,000 adolescents.
`(11) Reduce suicide among men to no more than 12.8 per 100,000.
`(12) Reduce by 15 percent the incidence of injurious suicide attempts
among adolescents aged 14 through 17.
`(13) Reduce to less than 10 percent the prevalence of mental disorders
among children and adolescents.
`(14) Reduce the incidence of child abuse or neglect to less than 25.2
per 1,000 children under age 18.
`(15) Reduce physical abuse directed at women by male partners to no more
than 27 per 1,000 couples.
`(16) Increase years of healthy life to at least 65 years.
`(17) Reduce deaths caused by unintentional injuries to no more than 66.1
per 100,000.
`(18) Reduce deaths caused by motor vehicle crashes to no more than 39.2
per 100,000.
`(19) Among children aged 6 months through 5 years, reduce the prevalence
of blood lead levels exceeding 15 ug/dl and reduce to zero the prevalence
of blood lead levels exceeding 25 ug/dl.
`(20) Reduce dental caries (cavities) so that the proportion of children
with one or more caries (in permanent or primary teeth) is no more than
45 percent among children aged 6 through 8 and no more than 60 percent
among adolescents aged 15.
`(21) Reduce untreated dental caries so that the proportion of children
with untreated caries (in permanent or primary teeth) is no more than 20
percent among children aged 6 through 8 and no more than 40 percent among
adolescents aged 15.
`(22) Reduce to no more than 20 percent the proportion of individuals aged
65 and older who have lost all of their natural teeth.
`(23) Increase to at least 45 percent the proportion of individuals aged
35 to 44 who have never lost a permanent tooth due to dental caries or
periodontal disease.
`(24) Reduce destructive periodontal disease to a prevalence of no more
than 15 percent among individuals aged 35 to 44.
`(25) Increase to at least 50 percent the proportion of children who
have received protective sealants on the occlusal (chewing) surfaces of
permanent molar teeth.
`(26) Reduce the prevalence of gingivitis among individuals aged 35 to 44
to no more than 50 percent.
`(27) Reduce the infant mortality rate to no more than 8.5 per 1,000
live births.
`(28) Reduce the fetal death rate (20 or more weeks of gestation) to no
more than 4 per 1,000 live births plus fetal deaths.
`(29) Reduce the maternal mortality rate to no more than 3.3 per 100,000
live births.
`(30) Reduce the incidence of fetal alcohol syndrome to no more than 2
per 1,000 live births.
`(31) Reduce stroke deaths to no more than 20 per 100,000.
`(32) Reverse the increase in end-stage renal disease (requiring maintenance
dialysis or transplantation) to attain an incidence of no more than 13
per 100,000.
`(33) Reduce breast cancer deaths to no more than 20.6 per 100,000 women.
`(34) Reduce deaths from cancer of the uterine cervix to no more than 1.3
per 100,000 women.
`(35) Reduce colorectal cancer deaths to no more than 13.2 per 100,000.
`(36) Reduce to no more than 11 percent the proportion of individuals who
experience a limitation in major activity due to chronic conditions.
`(37) Reduce significant hearing impairment to a prevalence of no more
than 82 per 1,000.
`(38) Reduce significant visual impairment to a prevalence of no more than
30 per 1,000.
`(39) Reduce diabetes-related deaths to no more than 48 per 100,000.
`(40) Reduce diabetes to an incidence of no more than 2.5 per 1,000 and
a prevalence of no more than 62 per 1,000.
`(41) Reduce the most severe complications of diabetes as follows:
`(A) End-stage renal disease, 1.9 per 1,000.
`(B) Blindness, 1.4 per 1,000.
`(C) Lower extremity amputation, 4.9 per 1,000.
`(D) Perinatal mortality, 2 percent.
`(E) Major congenital malformations, 4 percent.
`(42) Confine annual incidence of diagnosed AIDS cases to no more than
1,000 cases.
`(43) Confine the prevalence of HIV infection to no more than 100 per
100,000.
`(44) Reduce gonorrhea to an incidence of no more than 225 cases per 100,000.
`(45) Reduce chlamydia trachomatis infections, as measured by a decrease
in the incidence of nongonococcal urethritis to no more than 170 cases
per 100,000.
`(46) Reduce primary and secondary syphilis to an incidence of no more
than 10 cases per 100,000.
`(47) Reduce the incidence of pelvic inflammatory disease, as measured by
a reduction in hospitalization for pelvic inflammatory disease to no more
than 250 per 100,000 women aged 15 through 44.
`(48) Reduce viral hepatitis B infection to no more than 40 per 100,000
cases.
`(49) Reduce indigenous cases of vaccine-preventable diseases as follows:
`(A) Diphtheria among individuals aged 25 and younger, 0.
`(B) Tetanus among individuals aged 25 and younger, 0.
`(C) Polio (wild-type virus), 0.
`(D) Measles, 0.
`(E) Rubella, 0.
`(F) Congenital Rubella Syndrome, 0.
`(G) Mumps, 500.
`(H) Pertussis, 1,000.
`(50) Reduce epidemic-related pneumonia and influenza deaths among
individuals aged 65 and older to no more than 7.3 per 100,000.
`(51) Reduce the number of new carriers of viral hepatitis B among Alaska
Natives to no more than 1 case.
`(52) Reduce tuberculosis to an incidence of no more than 5 cases per
100,000.
`(53) Reduce bacterial meningitis to no more than 8 cases per 100,000.
`(54) Reduce infectious diarrhea by at least 25 percent among children.
`(55) Reduce acute middle ear infections among children aged 4 and younger,
as measured by days of restricted activity or school absenteeism, to no
more than 105 days per 100 children.
`(56) Reduce cigarette smoking to a prevalence of no more than 20 percent.
`(57) Reduce smokeless tobacco use by youth to a prevalence of no more
than 10 percent.
`(58) Increase to at least 65 percent the proportion of parents and
caregivers who use feeding practices that prevent baby bottle tooth decay.
`(59) Increase to at least 75 percent the proportion of mothers who breast
feed their babies in the early postpartum period, and to at least 50 percent
the proportion who continue breast feeding until their babies are 5 to 6
months old.
`(60) Increase to at least 90 percent the proportion of pregnant women
who receive prenatal care in the first trimester of pregnancy.
`(61) Increase to at least 70 percent the proportion of individuals who
have received, as a minimum within the appropriate interval, all of the
screening and immunization services and at least one of the counseling
services appropriate for their age and gender as recommended by the United
States Preventive Services Task Force.
`(c) It is the intent of the Congress that the Nation increase the proportion
of all degrees in the health professions and allied and associated health
profession fields awarded to Indians to 0.6 percent.
`(d) The Secretary shall submit to the President, for inclusion in each
report required to be transmitted to the Congress under section 801,
a report on the progress made in each area of the Service toward meeting
each of the objectives described in subsection (b).'.
(c) DEFINITIONS- Section 4 of the Act (25 U.S.C. 1603) is amended by adding
at the end the following new subsections:
`(m) `Service area' means the geographical area served by each area office.
`(n) `Health profession' means family medicine, internal medicine,
pediatrics, geriatric medicine, obstetrics and gynecology, podiatric
medicine, nursing, public health nursing, dentistry, psychiatry, osteopathy,
optometry, pharmacy, psychology, public health, social work, marriage and
family therapy, chiropractic medicine, environmental health and engineering,
and allied health professions.
`(o) `Substance abuse' includes inhalant abuse.
`(p) `FAE' means fetal alcohol effect.
`(q) `FAS' means fetal alcohol syndrome.'.

1a2dc6abb77014975c0769aca457aa10cf1f6a8b86515e2df2fd0c0619541e0a

Section 101 of the Act (25 U.S.C. 1611) is amended to read as follows:
`PURPOSE
`SEC. 101. The purpose of this title is to increase the number of Indians
entering the health professions and to assure an adequate supply of health
professionals to the Service, Indian tribes, tribal organizations, and
urban Indian organizations involved in the provision of health care to
Indian people.'.

03936727add0865554151878223253934e432f74205360242d900086521a44f0

TITLE I

-INDIAN HEALTH PROFESSIONALS

(a) RECRUITMENT PROGRAM- Section 102(a) of the Act (25 U.S.C. 1612(a))
is amended--
(1) by amending paragraph (1) to read as follows:
`(1) identifying Indians with a potential for education or training in
the health professions and encouraging and assisting them--
`(A) to enroll in courses of study in such health professions; or
`(B) if they are not qualified to enroll in any such courses of study,
to undertake such postsecondary education or training as may be required
to qualify them for enrollment;';
(2) in paragraph (2)--
(A) by striking out `school' both places it appears and inserting in lieu
thereof the following: `course of study'; and
(B) by striking out `clause (1)(A)' and inserting in lieu thereof the
following: `paragraph (1)'; and
(3) in paragraph (3)--
(A) by striking out `Indians,' and inserting in lieu thereof `Indians in,';
(B) by inserting a comma before `courses';
(C) by striking out `, in any school'; and
(D) by striking out `clause (1)(A)' and inserting in lieu thereof the
following: `paragraph (1)'.
(b) PREPARATORY SCHOLARSHIP PROGRAM- Section 103 of the Act (25 U.S.C. 1613)
is amended--
(1) by amending subsection (a)(2) to read as follows:
`(2) have demonstrated the capability to successfully complete courses of
study in the health professions.';
(2) in subsection (b)(1), by inserting before the period at the end the
following: `on a full-time basis (or the part-time equivalent thereof,
as determined by the Secretary)';
(3) by amending subsection (b)(2) to read as follows:
`(2) Pregraduate education of any grantee leading to a baccalaureate
degree in an approved course of study preparatory to a field of study
in a health profession, such scholarship not to exceed 4 years (or the
part-time equivalent thereof, as determined by the Secretary).';
(4) in subsection (c), by striking out `full time'; and
(5) by amending subsection (e) to read as follows:
`(e) The Secretary shall not deny scholarship assistance to an eligible
applicant under this section solely by reason of such applicant's eligibility
for assistance or benefits under any other Federal program.'.
(c) HEALTH PROFESSIONS SCHOLARSHIPS- Section 104 of the Act (25 U.S.C. 1613a)
is amended--
(1) in subsection (a)--
(A) by striking out `Indian communities' and inserting in lieu thereof
the following: `Indians, Indian tribes, tribal organizations, and urban
Indian organizations';
(B) by striking out `full time' and inserting in lieu thereof the following:
`full or part time'; and
(C) by striking out `of medicine' and all that follows through `social
work' and inserting in lieu thereof the following: `and pursuing courses
of study in the health professions';
(2) in subsection (b)--
(A) in paragraph (2)--
(i) by striking out `full time' and inserting in lieu thereof `full or
part time'; and
(ii) by striking out `health profession school' and inserting in lieu
thereof `course of study';
(B) in paragraph (3)--
(i) by striking `(3)' and inserting `(3)(A)';
(ii) by redesignating subparagraphs (A), (B), (C), and (D) as clauses (i),
(ii), (iii), and (iv), respectively; and
(iii) by inserting at the end the following new subparagraphs:
`(B) A recipient of an Indian Health Scholarship may, at the election of
the recipient, meet the active duty service obligation prescribed under
section 338C of the Public Health Service Act (42 U.S.C. 254m) by service
in a program specified in subparagraph (A) that--
`(i) is located on the reservation of the tribe in which the recipient is
enrolled; or
`(ii) serves the tribe in which the recipient is enrolled.
`(C) Subject to subparagraph (B), the Secretary, in making assignments of
Indian Health Scholarship recipients required to meet the active duty service
obligation prescribed under section 338C of the Public Health Service Act
(42 U.S.C. 254m), shall give priority to assigning individuals to service
in those programs specified in subparagraph (A) that have a need for health
professionals to provide health care services as a result of individuals
having breached contracts entered into under this section.'; and
(C) by adding at the end the following new paragraph:
`(4) In the case of an individual receiving a scholarship under this
section who is enrolled part time in an approved course of study--
`(A) such scholarship shall be for a period of years not to exceed the
part-time equivalent of 4 years, as determined by the Secretary;
`(B) the period of obligated service specified in section 338A(f)(1)(B)(iv)
of the Public Health Service Act (42 U.S.C. 254m(f)(1)(B)(iv)) shall be
equal to the greater of--
`(i) the part-time equivalent of one year for each year for which the
individual was provided a scholarship (as determined by the Secretary); or
`(ii) two years; and
`(C) the amount of the monthly stipend specified in section 338A(g)(1)(B)
of the Public Health Service Act (42 U.S.C. 254m(g)(1)(B)) shall be reduced
pro rata (as determined by the Secretary) based on the number of hours
such student is enrolled.';
(3) by amending subsection (c) to read as follows:
`(c) The Secretary shall, acting through the Service, establish a Placement
Office to develop and implement a national policy for the placement,
to available vacancies within the Service, of Indian Health Scholarship
recipients required to meet the active duty service obligation prescribed
under section 338C of the Public Health Service Act (42 U.S.C. 254m) without
regard to any competitive personnel system, agency personnel limitation,
or Indian preference policy.'; and
(4) by striking out subsection (d).
(d) EFFECTIVE DATE- The amendments made by subsection (c)(1)(C) and
subsection (c)(2)(B) shall apply with respect to scholarships granted under
section 104 of the Indian Health Care Improvement Act after the date of
the enactment of this Act.
(e) EXTERN PROGRAM- Section 105 of the Act (25 U.S.C. 1614) is amended--
(1) in subsection (a), by striking out `section 757 of the Public Health
Service Act' and inserting in lieu thereof `section 104'; and
(2) in subsection (b), by striking out `school of medicine' and all that
follows through `health professions' and inserting in lieu thereof `course
of study in the health professions'.

1239ef12810bc3d0ab24e588df99390f7edc6023915b3cf99e6244b3aa834467

Section 104(b) of the Act (25 U.S.C. 1613a(b)) (as amended by section 102(c)
of this Act) is amended by adding at the end the following new paragraph:
`(5)(A) An individual who has, on or after the date of the enactment of
this paragraph, entered into a written contract with the Secretary under
this section and who--
`(i) fails to maintain an acceptable level of academic standing in the
educational institution in which he is enrolled (such level determined by
the educational institution under regulations of the Secretary),
`(ii) is dismissed from such educational institution for disciplinary
reasons,
`(iii) voluntarily terminates the training in such an educational
institution for which he is provided a scholarship under such contract
before the completion of such training, or
`(iv) fails to accept payment, or instructs the educational institution
in which he is enrolled not to accept payment, in whole or in part, of a
scholarship under such contract,
in lieu of any service obligation arising under such contract, shall be
liable to the United States for the amount which has been paid to him,
or on his behalf, under the contract.
`(B) If for any reason not specified in subparagraph (A) an individual
breaches his written contract by failing either to begin such individual's
service obligation under this section or to complete such service obligation,
the United States shall be entitled to recover from the individual an
amount determined in accordance with the formula specified in subsection
(l) of section 108 in the manner provided for in such subsection.'.

39c816c33ba41bc0a0c8aec55af600a85c1c7bfb947d9fc32b0b230d3cd9e35c

(a) CONTINUING EDUCATION ALLOWANCES- Section 106(a) of the Act (25
U.S.C. 1615(a)) is amended by inserting `nurses,' after `dentists,'.
(b) QUENTIN N. BURDICK AMERICAN INDIANS INTO NURSING PROGRAM- Section 112
of the Act (25 U.S.C. 1616e) is amended--
(1) by redesignating subsections (e) and (f) as subsections (f) and (g),
respectively; and
(2) by inserting after subsection (d) the following new subsection:
`(e) The Secretary shall provide one of the grants authorized under
subsection (a) to establish and maintain a program at the University of
North Dakota to be known as the `Quentin N. Burdick American Indians Into
Nursing Program'. Such program shall, to the maximum extent feasible,
coordinate with the Quentin N. Burdick Indian Health Programs established
under section 114(b) and the Quentin N. Burdick American Indians Into
Psychology Program established under section 217(b).'.
(c) TRAINING FOR NURSE MIDWIVES, NURSE ANESTHETISTS, AND NURSE PRACTITIONERS-
Section 112(g) of the Act (25 U.S.C. 1616e(g)) (as redesignated by subsection
(b)(1) of this section) is amended to read as follows:
`(g) Beginning with fiscal year 1993, of the amounts appropriated under the
authority of this title for each fiscal year to be used to carry out this
section, not less than $1,000,000 shall be used to provide grants under
subsection (a) for the training of nurse midwives, nurse anesthetists,
and nurse practitioners.'.
(d) RETENTION BONUS FOR NURSES- Section 117 (25 U.S.C. 1616j) of the Act
is amended--
(1) by redesignating subsections (b) through (e) as subsections (c) through
(f), respectively;
(2) by adding after subsection (a) the following new subsection (b):
`(b) Beginning with fiscal year 1993, not less than 25 percent of the
retention bonuses awarded each year under subsection (a) shall be awarded
to nurses.'; and
(3) by amending subsection (f) (as amended by paragraph (1)) to read
as follows:
`(f) The Secretary may pay a retention bonus to any physician or nurse
employed by an organization providing health care services to Indians
pursuant to a contract under the Indian Self-Determination Act if such
physician or nurse is serving in a position which the Secretary determines
is--
`(1) a position for which recruitment or retention is difficult; and
`(2) necessary for providing health care services to Indians.'.
(e) RESIDENCY PROGRAM- Title I of the Act is amended by adding at the end
the following new section:
`NURSING SCHOOL CLINICS
`SEC. 112A. (a) GRANTS- In addition to the authority of the Secretary
under section 112(a)(1), the Secretary, acting through the Service,
is authorized to provide grants to public or private schools of nursing
for the purpose of establishing, developing, operating, and administering
clinics to address the health care needs of Indians, and to provide primary
health care services to Indians who reside on or within 50 miles of Indian
country, as defined in section 1151 of title 18, United States Code.
`(b) PURPOSES- Grants provided under subsection (a) may be used to--
`(1) establish clinics, to be run and staffed by the faculty and students
of a grantee school, to provide primary care services in areas in or within
50 miles of Indian country (as defined in section 1151 of title 18, United
States Code);
`(2) provide clinical training, program development, faculty enhancement,
and student scholarships in a manner that would benefit such clinics; and
`(3) carry out any other activities determined appropriate by the Secretary.
`(c) AMOUNT AND CONDITIONS- The Secretary may award grants under this
section in such amounts and subject to such conditions as the Secretary
deems appropriate.
`(d) DESIGN- The clinics established under this section shall be designed
to provide nursing students with a structured clinical experience that
is similar in nature to that provided by residency training programs
for physicians.
`(e) REGULATIONS- The Secretary shall prescribe such regulations as may
be necessary to carry out the provisions of this section.
`(f) AUTHORIZATION TO USE AMOUNTS- Out of amounts appropriated to carry
out this title for each of the fiscal years 1993 through 2000 not more
than $5,000,000 may be used to carry out this section.'.

a298419417bd567116b989f9a602b5d2b8a09e61304f343b0a28b334f122f3d7

Section 107(b) of the Act (25 U.S.C. 1616(b)) is amended--
(1) in paragraph (2), in the material preceding subparagraph (A), by
inserting `and maintain' after `develop';
(2) in paragraph (2)(B), by adding at the end the following: `with
appropriate consideration given to lifestyle factors that have an impact on
Indian health status, such as alcoholism, family dysfunction, and poverty,';
(3) in paragraphs (3) and (5), by striking out `develop' each place it
appears  and inserting in lieu thereof `maintain'; and
(4) in paragraph (4), by striking out `develop and'.

422e6c2bafa860b4d01cfa620e2dbe4a0b43610129ac16b61ab28b52b689617f

(a) ELIGIBILITY REQUIREMENTS- Section 108 of the Act (25 U.S.C. 1616a(b))
is amended--
(1) in subsection (a)(1), by striking out `physicians,' and all that
follows through `professionals' and inserting in lieu thereof `health
professionals'; and
(2) in subsection (b)--
(A) in paragraph (1)(A)--
(i) by amending clause (i) to read as follows:
`(i) in a course of study or program in an accredited institution, as
determined by the Secretary, within any State and be scheduled to complete
such course of study in the same year such individual applies to participate
in such program; or'; and
(ii) in clause (ii), by striking out `medicine' and all that follows
through `health profession' and inserting in lieu thereof the following:
`a health profession';
(B) in paragraph (1)(B)--
(i) by inserting `and' at the end of clause (i), by striking out clause
(ii), and by redesignating clause (iii) as clause (ii);
(ii) in clause (i), by striking out `medicine, osteopathy, dentistry,
or other health profession' and inserting in lieu thereof the following:
`a health profession'; and
(iii) in clause (ii) (as redesignated by clause (i) of this subparagraph),
by striking out `medicine, osteopathy, dentistry, or other health profession'
and inserting in lieu thereof the following: `a health profession'; and
(C) in paragraph (2), by inserting `and' at the end of subparagraph (D),
by striking out paragraphs (3) and (4), and by inserting after paragraph
(2) the following:
`(3) submit to the Secretary an application for a contract described in
subsection (f).'.
(b) PRIORITY- Section 108(d) of the Act (25 U.S.C. 1616a(d)) is amended--
(1) in paragraph (1), by striking out `The' and inserting `Consistent with
paragraph (3), the'; and
(2) by adding at the end the following new paragraph:
`(3)(A) Subject to subparagraph (B), of the total amounts appropriated for
each of the fiscal years 1993, 1994, and 1995 for loan repayment contracts
under this section, the Secretary shall provide that--
`(i) not less than 25 percent be provided to applicants who are nurses,
nurse practitioners, or nurse midwives; and
`(ii) not less than 10 percent be provided to applicants who are mental
health professionals (other than applicants described in clause (i)).
`(B) The requirements specified in clause (i) or clause (ii) of subparagraph
(A) shall not apply if the Secretary does not receive the number of
applications from the individuals described in clause (i) or clause (ii),
respectively, necessary to meet such requirements.'.
(c) BECOMING A PARTICIPANT- Paragraph (1) of section 108(e) (25
U.S.C. 1616a(e)) is amended to read as follows:
`(1) An individual becomes a participant in the Loan Repayment Program
only upon the Secretary and the individual entering into a written contract
described in subsection (f).'.
(d) EXTENSION OF OBLIGATED SERVICE- Paragraph (2)(A) of section 108(e)
(25 U.S.C. 1616a(e)) is amended by inserting before the semicolon the
following: `, including extensions resulting in an aggregate period of
obligated service in excess of 4 years'.
(e) CLARIFICATION REGARDING UNDERGRADUATE LOANS- Paragraph (1) of section
108(g) (25 U.S.C. 1616a(g)) is amended in the matter preceding subparagraph
(A) by striking out `loans received by the individual for--' and inserting in
lieu thereof `loans received by the individual regarding the undergraduate or
graduate education of the individual (or both), which loans were made for--'.
(f) PAYMENT- Section 108(g)(2)(A) (25 U.S.C. 1616a(g)(2)(A)) is amended
to read as follows:
`(2)(A) For each year of obligated service that an individual contracts
to serve under subsection (f) the Secretary may pay up to $35,000 (or an
amount equal to the amount specified in section 338B(g)(2)(A) of the Public
Health Service Act) on behalf of the individual for loans described in
paragraph (1). In making a determination of the amount to pay for a year
of such service by an individual, the Secretary shall consider the extent
to which each such determination--
`(i) affects the ability of the Secretary to maximize the number of
contracts that can be provided under the Loan Repayment Program from the
amounts appropriated for such contracts;
`(ii) provides an incentive to serve in Indian health programs with the
greatest shortages of health professionals; and
`(iii) provides an incentive with respect to the health professional involved
remaining in an Indian health program with such a health professional
shortage, and continuing to provide primary health services, after the
completion of the period of obligated service under the Loan Repayment
Program.'.
(g) TAX LIABILITY- (1) Paragraph (3) of section 108(g) (25
U.S.C. 1616a(g)(3)) is amended to read as follows:
`(3) For the purpose of providing reimbursements for tax liability resulting
from payments under paragraph (2) on behalf of an individual, the Secretary--
`(A) in addition to such payments, may make payments to the individual
in an amount not less than 20 percent and not more than 39 percent of the
total amount of loan repayments made for the taxable year involved; and
`(B) may make such additional payments as the Secretary determines to be
appropriate with respect to such purpose.'.
(2) The amendment made by paragraph (1) shall apply only with respect
to contracts under section 108 of the Indian Health Care Improvement Act
entered into on or after the date of enactment of this Act.
(h) STAFFING NEEDS- Section 108(k) (25 U.S.C. 1616a(k)) is amended to read
as follows:
`(k) The Secretary, in assigning individuals to serve in Indian health
programs pursuant to contracts entered into under this section, shall--
`(1) ensure that the staffing needs of Indian health programs administered by
an Indian tribe or tribal or health organization receive consideration on an
equal basis with programs that are administered directly by the Service; and
`(2) give priority to assigning individuals to Indian health programs
that have a need for health professionals to provide health care services
as a result of individuals having breached contracts entered into under
this section.'.
(i) ANNUAL REPORT- Subsection (n) of section 108 is amended to read
as follows:
`(n) The Secretary shall submit to the President, for inclusion in each
report required to be submitted to the Congress under section 801, a report
concerning the previous fiscal year which sets forth--
`(1) the health professional positions maintained by the Service or by tribal
or Indian organizations for which recruitment or retention is difficult;
`(2) the number of Loan Repayment Program applications filed with respect
to each type of health profession;
`(3) the number of contracts described in subsection (f) that are entered
into with respect to each health profession;
`(4) the amount of loan payments made under this section, in total and by
health profession;
`(5) the number of scholarship grants that are provided under section 104
with respect to each health profession;
`(6) the amount of scholarship grants provided under section 104, in total
and by health profession;
`(7) the number of providers of health care that will be needed by Indian
health programs, by location and profession, during the three fiscal years
beginning after the date the report is filed; and
`(8) the measures the Secretary plans to take to fill the health professional
positions maintained by the Service or by tribes or tribal or Indian
organizations for which recruitment or retention is difficult.'.

105460a7bba740651f5eab3cdb6f10bb35a67089a13cbd4c5f41ee59119a7ba0

Section 109 of the Act (25 U.S.C. 1616b) is amended--
(1) by amending the heading to read as follows:
`RECRUITMENT ACTIVITIES'; AND
(2) by amending subsection (b) to read as follows:
`(b) The Secretary, acting through the Service, shall assign one individual
in each area office to be responsible on a full-time basis for recruitment
activities.'.

b4f20acd72f7eb6dd533a22c8b042e92aecc906914885e071c61c31e4b4526d5

Section 111 of the Act (25 U.S.C. 1616d) is amended--
(1) in subsection (b), by amending the last sentence to read as follows:
`In such event, with respect to individuals entering the program after
the date of the enactment of the Indian Health Amendments of 1992, the
United States shall be entitled to recover from such individual an amount
to be determined in accordance with the formula specified in subsection
(l) of section 108 in the manner provided for in such subsection.'; and
(2) by striking out subsection (d).

736ef297d15225812e217b1598d2fd05a11f5a67cc133ccdaf9c200d6fe41523

Section 114(b) of the Act (25 U.S.C. 1616g(b)) is amended--
(1) by inserting after `North Dakota,' the following: `to be known as the
`Quentin N. Burdick Indian Health Programs','; and
(2) by adding at the end the following: `Such program shall, to the maximum
extent feasible, coordinate with the Quentin N. Burdick American Indians
Into Psychology Program established under section 217(b) and the Quentin
N. Burdick American Indians Into Nursing Program established under section
112(e).'.

5648e8fdf70b759c295e19e4cc7df8ef208f013b918677ab4f22adae63dacdf8

Title I of the Act is amended by inserting after section 108 the following
new section:
`SCHOLARSHIP AND LOAN REPAYMENT RECOVERY FUND
`SEC. 108A. (a) There is established in the Treasury of the United States a
fund to be known as the Indian Health Scholarship and Loan Repayment Recovery
Fund (hereafter in this section referred to as the `Fund'). The Fund shall
consist of such amounts as may be appropriated to the Fund under subsection
(b). Amounts appropriated for the Fund shall remain available until expended.
`(b) For each fiscal year, there is authorized to be appropriated to the
Fund an amount equal to the sum of--
`(1) the amount collected during the preceding fiscal year by the Federal
Government pursuant to--
`(A) the liability of individuals under subparagraph (A) or (B) of section
104(b)(5) for the breach of contracts entered into under section 104; and
`(B) the liability of individuals under section 108(l) for the breach of
contracts entered into under section 108; and
`(2) the aggregate amount of interest accruing during the preceding fiscal
year on obligations held in the Fund pursuant to subsection (d) and the
amount of proceeds from the sale or redemption of such obligations during
such fiscal year.
`(c)(1) Amounts in the Fund and available pursuant to appropriation Acts may
be expended by the Secretary, acting through the Service, to make payments
to an Indian tribe or tribal organization administering a health care program
pursuant to a contract entered into under the Indian Self-Determination Act--
`(A) to which a scholarship recipient under section 104 or a loan repayment
program participant under section 108 has been assigned to meet the
obligated service requirements pursuant to sections; and
`(B) that has a need for a health professional to provide health care
services as a result of such recipient or participant having breached the
contract entered into under section 104 or section 108.
`(2) An Indian tribe or tribal organization receiving payments pursuant
to paragraph (1) may expend the payments to recruit and employ, directly
or by contract, health professionals to provide health care services.
`(d)(1) The Secretary of the Treasury shall invest such amounts of the Fund
as such Secretary determines are not required to meet current withdrawals
from the Fund. Such investments may be made only in interest-bearing
obligations of the United States. For such purpose, such obligations
may be acquired on original issue at the issue price, or by purchase of
outstanding obligations at the market price.
`(2) Any obligation acquired by the Fund may be sold by the Secretary of
the Treasury at the market price.'.

fee9c28059bed009a00737d2ccdf0de05b58b9da066b94a4a4e44c4aea43d0bf

Title I of the Act (as amended by section 104 of this Act) is amended by
adding at the end the following new section:
`COMMUNITY HEALTH AIDE PROGRAM FOR ALASKA
`SEC. 119. (a) Under the authority of the Act of November 2, 1921 (25
U.S.C. 13; popularly known as the Snyder Act), the Secretary shall maintain
a Community Health Aide Program in Alaska under which the Service--
`(1) provides for the training of Alaska Natives as health aides or
community health practitioners;
`(2) uses such aides or practitioners in the provision of health care,
health promotion, and disease prevention services to Alaska Natives living
in villages in rural Alaska; and
`(3) provides for the establishment of teleconferencing capacity in health
clinics located in or near such villages for use by community health aides
or community health practitioners.
`(b) The Secretary, acting through the Community Health Aide Program of
the Service, shall--
`(1) using trainers accredited by the Program, provide a high standard
of training to community health aides and community health practitioners
to ensure that such aides and practitioners provide quality health care,
health promotion, and disease prevention services to the villages served
by the Program;
`(2) in order to provide such training, develop a curriculum that--
`(A) combines education in the theory of health care with supervised
practical experience in the provision of health care;
`(B) provides instruction and practical experience in the provision of
acute care, emergency care, health promotion, disease prevention, and
the efficient and effective management of clinic pharmacies, supplies,
equipment, and facilities; and
`(C) promotes the achievement of the health status objectives specified
in section 3(b);
`(3) establish and maintain a Community Health Aide Certification Board
to certify as community health aides or community health practitioners
individuals who have successfully completed the training described in
paragraph (1) or can demonstrate equivalent experience;
`(4) develop and maintain a system which identifies the needs of community
health aides and community health practitioners for continuing education in
the provision of health care, including the areas described in paragraph
(2)(B), and develop programs that meet the needs for such continuing
education;
`(5) develop and maintain a system that provides close supervision of
community health aides and community health practitioners; and
`(6) develop a system under which the work of community health aides and
community health practitioners is reviewed and evaluated to assure the
provision of quality health care, health promotion, and disease prevention
services.'.

ffc00b83f9cac222f83f531204147d285df6318e1d721b16c3200dbdc60113fe

Title I of the Act (as amended by section 111 of this Act) is amended by
adding at the end the following new section:
`MATCHING GRANTS TO TRIBES FOR SCHOLARSHIP PROGRAMS
`SEC. 120. (a)(1) The Secretary shall make grants to Indian tribes and
tribal organizations for the purpose of assisting such tribes and tribal
organizations in educating Indians to serve as health professionals in
Indian communities.
`(2) Amounts available for grants under paragraph (1) for any fiscal year
shall not exceed 5 percent of amounts available for such fiscal year for
Indian Health Scholarships under section 104.
`(3) An application for a grant under paragraph (1) shall be in such form
and contain such agreements, assurances, and information as the Secretary
determines are necessary to carry out this section.
`(b)(1) An Indian tribe or tribal organization receiving a grant under
subsection (a) shall agree to provide scholarships to Indians pursuing
education in the health professions in accordance with the requirements
of this section.
`(2) With respect to the costs of providing any scholarship pursuant to
paragraph (1)--
`(A) 80 percent of the costs of the scholarship shall be paid from the grant
made under subsection (a) to the Indian tribe or tribal organization; and
`(B) 20 percent of such costs shall be paid from non-Federal contributions
by the Indian tribe or tribal organization through which the scholarship
is provided.
`(3) In determining the amount of non-Federal contributions that have
been provided for purposes of subparagraph (B) of paragraph (2), any
amounts provided by the Federal Government to the Indian tribe or tribal
organization involved or to any other entity shall not be included.
`(4) Non-Federal contributions required by subparagraph (B) of paragraph
(2) may be provided directly by the Indian tribe or tribal organization
involved or through donations from public and private entities.
`(c) An Indian tribe or tribal organization shall provide scholarships
under subsection (b) only to Indians enrolled or accepted for enrollment
in a course of study (approved by the Secretary) in one of the health
professions described in section 104(a).
`(d) In providing scholarships under subsection (b), the Secretary and the
Indian tribe or tribal organization shall enter into a written contract
with each recipient of such scholarship. Such contract shall--
`(1) obligate such recipient to provide service in an Indian health program
(as defined in section 108(a)(2)(A)), in the same service area where the
Indian tribe or tribal organization providing the scholarship is located,
for--
`(A) a number of years equal to the number of years for which the scholarship
is provided (or the part-time equivalent thereof, as determined by the
Secretary), or for a period of 2 years, whichever period is greater; or
`(B) such greater period of time as the recipient and the Indian tribe or
tribal organization may agree;
`(2) provide that the amount of such scholarship--
`(A) may be expended only for--
`(i) tuition expenses, other reasonable educational expenses, and reasonable
living expenses incurred in attendance at the educational institution; and
`(ii) payment to the recipient of a monthly stipend of not more than the
amount authorized by section 338A(g)(1)(B) of the Public Health Service Act
(42 U.S.C. 254m(g)(1)(B)), such amount to be reduced pro rata (as determined
by the Secretary) based on the number of hours such student is enrolled; and
`(B) may not exceed, for any year of attendance for which the scholarship
is provided, the total amount required for the year for the purposes
authorized in subparagraph (A);
`(3) require the recipient of such scholarship to maintain an acceptable
level of academic standing (as determined by the educational institution
in accordance with regulations issued by the Secretary); and
`(4) require the recipient of such scholarship to meet the educational
and licensure requirements necessary to be a physician, certified nurse
practitioner, certified nurse midwife, or physician assistant.
`(e)(1) An individual who has entered into a written contract with the
Secretary and an Indian tribe or tribal organization under subsection (d)
and who--
`(A) fails to maintain an acceptable level of academic standing in the
educational institution in which he is enrolled (such level determined by
the educational institution under regulations of the Secretary),
`(B) is dismissed from such educational institution for disciplinary reasons,
`(C) voluntarily terminates the training in such an educational institution
for which he is provided a scholarship under such contract before the
completion of such training, or
`(D) fails to accept payment, or instructs the educational institution
in which he is enrolled not to accept payment, in whole or in part, of a
scholarship under such contract,
in lieu of any service obligation arising under such contract, shall be
liable to the United States for the Federal share of the amount which has
been paid to him, or on his behalf, under the contract.
`(2) If for any reason not specified in paragraph (1), an individual
breaches his written contract by failing either to begin such individual's
service obligation required under such contract or to complete such
service obligation, the United States shall be entitled to recover from the
individual an amount determined in accordance with the formula specified in
subsection (l) of section 108 in the manner provided for in such subsection.
`(3) The Secretary may carry out this subsection on the basis of information
submitted by the tribes or tribal organizations involved, or on the basis of
information collected through such other means as the Secretary determines
to be appropriate.
`(f) The recipient of a scholarship under subsection (b) shall agree,
in providing health care pursuant to the requirements of subsection (d)(1)--
`(1) not to discriminate against an individual seeking such care on the
basis of the ability of the individual to pay for such care or on the
basis that payment for such care will be made pursuant to the program
established in title XVIII of the Social Security Act or pursuant to the
program established in title XIX of such Act; and
`(2) to accept assignment under section 1842(b)(3)(B)(ii) of the Social
Security Act for all services for which payment may be made under part B of
title XVIII of such Act, and to enter into an appropriate agreement with
the State agency that administers the State plan for medical assistance
under title XIX of such Act to provide service to individuals entitled to
medical assistance under the plan.
`(g) The Secretary may not make any payments under subsection (a) to an
Indian tribe or tribal organization for any fiscal year subsequent to the
first fiscal year of such payments unless the Secretary determines that,
for the immediately preceding fiscal year, the Indian tribe or tribal
organization has complied with requirements of this section.'.

f792bd770149561f3f6b3e54a15011ca06095f56daa7910bb3e1ea615323bc31

Title I of the Act (as amended by section 112 of this Act) is amended by
adding at the end the following new section:
`TRIBAL HEALTH PROGRAM ADMINISTRATION
`SEC. 121. The Secretary shall, by contract or otherwise, provide
training for individuals in the administration and planning of tribal
health programs.'.

0190db61b11855b738038fdb9353718441b0140c1d7d993650407fd7190e0722

(a) NURSING PROGRAM GRANTS- Section 112(a)(2) of the Act (25
U.S.C. 1616e(a)(2)) is amended by inserting before the comma the following:
`and tribally controlled postsecondary vocational institutions (as defined in
section 390(2) of the Tribally Controlled Vocational Institutions Support
Act of 1990 (20 U.S.C. 2397h(2))'.
(b) TRIBAL CULTURE AND HISTORY PROGRAMS- Section 113(b)(1) of the Act (25
U.S.C. 1616f(b)(1) is amended by inserting before the comma `and tribally
controlled postsecondary vocational institutions (as defined in section
390(2) of the Tribally Controlled Vocational Institutions Support Act of
1990 (20 U.S.C. 2397h(2))'.

ff9bb6b62c0865a8e6e96b6ee0c3ec69c66b29de72a88e16a11d6419fa205e42

Section 106(b) of the Act (25 U.S.C. 1615(b)) is amended to read as follows:
`(b) Of amounts appropriated under the authority of this title for
each fiscal year to be used to carry out this section, not more than
$1,000,000 may be used to establish postdoctoral training programs for
health professionals.'.

bb13813cefc11d0d7e2dfe6978a2c3730657ded83a8a51bd0cc6b6e689c2f2a2

Title I of the Act (as amended by section 113 of this Act) is amended by
adding at the end the following new section:
`UNIVERSITY OF SOUTH DAKOTA PILOT PROGRAM
`SEC. 122. (a) The Secretary may make a grant to the School of Medicine of
the University of South Dakota (hereafter in this section referred to as
`USDSM') to establish a pilot program on an Indian reservation at one or
more service units in South Dakota to address the chronic manpower shortage
in the Aberdeen Area of the Service.
`(b) The purposes of the program established pursuant to a grant provided
under subsection (a) are--
`(1) to provide direct clinical and practical experience at a service unit
to medical students and residents from USDSM and other medical schools;
`(2) to improve the quality of health care for Indians by assuring access
to qualified health care professionals; and
`(3) to provide academic and scholarly opportunities for physicians,
physician assistants, nurse practitioners, nurses, and other allied
health professionals serving Indian people by identifying and utilizing
all academic and scholarly resources of the region.
`(c) The pilot program established pursuant to a grant provided under
subsection (a) shall--
`(1) incorporate a program advisory board composed of representatives
from the tribes and communities in the area which will be served by the
program; and
`(2) shall be designated as an extension of the USDSM campus and program
participants shall be under the direct supervision and instruction of
qualified medical staff serving at the service unit who shall be members
of the USDSM faculty.
`(d) The USDSM shall coordinate the program established pursuant to a grant
provided under subsection (a) with other medical schools in the region,
nursing schools, tribal community colleges, and other health professional
schools.
`(e) The USDSM, in cooperation with the Service, shall develop additional
professional opportunities for program participants on Indian reservations
in order to improve the recruitment and retention of qualified health
professionals in the Aberdeen Area of the Service.'.

a9e2baf5be012874939e8f16a56e4182ecd4791161af70811974082ee9336a9f

(a) AUTHORIZATION- Title I of the Act (as amended by section 116 of this
Act) is amended by adding at the end the following new section:
`AUTHORIZATION OF APPROPRIATIONS
`SEC. 123. There are authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 2000 to carry out
this title.'.
(b) CONFORMING AMENDMENTS- Title I of the Act is amended--
(1) in section 102, by striking out subsection (c);
(2) in section 105, by striking out subsection (d);
(3) in section 108, by striking out subsection (o);
(4) in section 110, by striking out subsection (c);
(5) in section 113, by striking out subsection (c);
(6) in section 114, by striking out subsection (e);
(7) in section 115, by striking out subsection (f); and
(8) in section 116, by striking out subsection (e).

1aaeb5a897a7092ed41aa1c0f98ecb78bb21fb71b53bbbb68e37354335a801e7

(a) IN GENERAL- Section 201 of the Act (25 U.S.C. 1621) is amended--
(1) in subsection (a)--
(A) in the material preceding paragraph (1), by striking out `subsection
(h)' and inserting in lieu thereof `this section';
(B) by amending paragraph (1) to read as follows:
`(1) eliminating the deficiencies in health status and resources of all
Indian tribes,'; and
(C) in paragraph (4), in the material preceding subparagraph (A)--
(i) by inserting after `responsibilities' the following: `, either through
direct or contract care or through contracts entered into pursuant to the
Indian Self-Determination Act,'; and
(ii) by striking out `resources deficiency' and inserting in lieu thereof
the following: `status and resource deficiencies';
(2) in subsection (b)--
(A) in paragraph (1), by striking out `subsection (h)' and inserting in
lieu thereof `this section';
(B) by striking out paragraph (2) and redesignating paragraph (3) as
paragraph (2); and
(C) in paragraph (2)(A) (as redesignated by subparagraph (B))--
(i) by striking out `subsection (h)' and inserting in lieu thereof
`this section';
(ii) in the first sentence, by striking out `but such allocation' through
`met';
(iii) in the second sentence--
(I) by striking out `(in accordance with paragraph (2))'; and
(II) by striking out `raise the deficiency level' and inserting in lieu
thereof the following: `reduce the health status and resource deficiency';
and
(D) in paragraph (2)(B) (as redesignated by subparagraph (B)), by inserting
after `consultation with' the following: `, and with the active participation
of,';
(3) in subsection (c)--
(A) by striking out paragraph (1) and redesignating paragraphs (2), (3),
and (4) as paragraphs (1), (2), and (3), respectively;
(B) by amending paragraph (1) (as redesignated by subparagraph (A) above)
to read as follows:
`(1) The term `health status and resource deficiency' means the extent
to which--
`(A) the health status objectives set forth in section 3(b) are not being
achieved; and
`(B) the Indian tribe does not have available to it the health resources it
needs, taking into account the actual cost of providing health care services
given local geographic, climatic, rural, or other circumstances.'; and
(C) in paragraph (3) (as redesignated by subparagraph (A) above)--
(i) by striking out `Under regulations, the' and inserting in lieu thereof
`The'; and
(ii) by striking out `health resources deficiency level' and inserting in
lieu thereof `extent of the health status and resource deficiency';
(4) in subsection (d)(1), by striking out `subsection (h)' and inserting
in lieu thereof `this section';
(5) in subsection (e)--
(A) in the material preceding paragraph (1)--
(i) by striking out `60 days' and inserting in lieu thereof `3 years';
(ii) by striking out `Indian Health Care Amendments of 1988' and inserting
in lieu thereof `Indian Health Amendments of 1992'; and
(iii) by striking out `health services priority system' and inserting in
lieu thereof `health status and resource deficiency';
(B) in paragraph (1), by striking out `health resources deficiencies'
and inserting in lieu thereof `health status and resource deficiencies';
(C) in paragraph (2),  by striking out `the level of health resources
deficiency for' and inserting in lieu thereof the following: `the extent
of the health status and resource deficiency of';
(D) in paragraph (3), by striking `raise all' and all that follows through
the semicolon and insert in lieu thereof the following: `eliminate the
health status and resource deficiencies of all Indian tribes served by
the Service; and'; and
(E) by striking out paragraphs (4) and (5) and redesignating paragraph
(6) as paragraph (4); and
(6) in subsection (f), by striking out `(f)(1)' and all that follows through
the paragraph designation for paragraph (2) and inserting in lieu thereof
`(f)'.
(b) EFFECTIVE DATE- Except with respect to the amendments made by subsection
(a)(5), the amendments made by subsection (a) shall take effect three
years after the date of the enactment of this Act. The amendments made
by subsection (a)(5) shall take effect upon the date of the enactment of
this Act.
(c) TECHNICAL AMENDMENT- The heading for section 201 of the Act (25
U.S.C. 1621) is amended to read as follows:
`INDIAN HEALTH CARE IMPROVEMENT FUND'.

5fbb254b4782114b707aecf654bcde9b78443fa6fba185d3805a9f5f79f0956d

TITLE II

-HEALTH SERVICES

(a) IN GENERAL- Section 202 of the Act (25 U.S.C. 1621a) is amended--
(1) in subsection (a)(1)(B), by striking out `under subsection (e)' and
inserting in lieu thereof `to the Fund under this section';
(2) in subsection (b)(2), by striking out `shall establish at not less
than $10,000 or not more than $20,000;' and inserting in lieu thereof the
following: `shall establish at--
`(A)  for 1993, not less than $15,000 or not more than $25,000; and
`(B) for any subsequent year, not less than the threshold cost of the
previous year increased by the percentage increase in the medical care
expenditure category of the consumer price index for all urban consumers
(United States city average) for the 12-month period ending with December
of the previous year;'; and
(3) in subsection (c), by striking out `Funds appropriated under subsection
(e)' and inserting in lieu thereof `Amounts appropriated to the Fund under
this section'.
(b) EFFECTIVE DATE- The amendment made by subsection (a)(2) shall take
effect January 1, 1993.

f9d04d42fa4badacaffd48b7e18656fc41fa8f71bc5cffd7f036b8f84a4f891c

Section 203 of the Act (25 U.S.C. 1621b) is amended--
(1) in subsection (a), by inserting before the period at the end the
following: `so as to achieve the health status objectives set forth in
section 3(b)';
(2) in subsection (b), in the material preceding paragraph (1), by striking
out `section 201(f)' and inserting in lieu thereof `section 801'; and
(3) by striking out subsection (c).

1360a99ecba86a48929105499b0809d307df86231695c00d265f884c954b9820

Section 204 of the Act (25 U.S.C. 1621c) is amended--
(1) by amending subsection (c) to read as follows:
`(c)(1) The Secretary shall continue to maintain through fiscal year 2000
each model diabetes project in existence on the date of the enactment of
the Indian Health Amendments of 1992 and located--
`(A) at the Claremore Indian Hospital in Oklahoma;
`(B) at the Fort Totten Health Center in North Dakota;
`(C) at the Sacaton Indian Hospital in Arizona;
`(D) at the Winnebago Indian Hospital in Nebraska;
`(E) at the Albuquerque Indian Hospital in New Mexico;
`(F) at the Perry, Princeton, and Old Town Health Centers in Maine;
`(G) at the Bellingham Health Center in Washington;
`(H) at the Fort Berthold Reservation;
`(I) at the Navajo Reservation;
`(J) at the Papago Reservation;
`(K) at the Zuni Reservation; or
`(L) in the States of Alaska, California, Minnesota, Montana, Oregon,
or Utah.
`(2) The Secretary may establish new model diabetes projects under this
section taking into consideration applications received under this section
from all service areas, except that the Secretary may not establish a greater
number of such projects in one service area than in any other service area
until there is an equal number of such projects established with respect to
all service areas from which the Secretary receives qualified applications
during the application period (as determined by the Secretary).'; and
(2) in subsection (d)--
(A) in paragraph (2), by striking out `and' after the semicolon;
(B) in paragraph (3), by striking out the period and inserting in lieu
thereof the following: `; and'; and
(C) by adding at the end the following new paragraph:
`(4) evaluate the effectiveness of services provided through model diabetes
projects established under this section.'.

676f0c09415249217158ddb1c0c5b83c77952602de6a1984f32f656726074a3a

Section 209 of the Act (25 U.S.C. 1621h) is amended--
(1) in subsection (j) (as redesignated by section 902(3)(B) of this Act),
by striking out `submit to the Congress an annual report' and inserting
in lieu thereof the following: `submit to the President, for inclusion in
each report required to be transmitted to the Congress under section 801,
a report'; and
(2) by adding at the end the following new subsections:
`(l) LICENSING REQUIREMENT FOR MENTAL HEALTH CARE WORKERS- Any person
employed as a psychologist, social worker, or marriage and family therapist
for the purpose of providing mental health care services to Indians in
a clinical setting under the authority of this Act or through a contract
pursuant to the Indian Self-Determination Act shall--
`(1) in the case of a person employed as a psychologist, be licensed as a
clinical psychologist or working under the direct supervision of a licensed
clinical psychologist;
`(2) in the case of a person employed as a social worker, be licensed as a
social worker or working under the direct supervision of a licensed social
worker; or
`(3) in the case of a person employed as a marriage and family therapist,
be licensed as a marriage and family therapist or working under the direct
supervision of a licensed marriage and family therapist.
`(m) INTERMEDIATE ADOLESCENT MENTAL HEALTH SERVICES- (1) The Secretary,
acting through the Service, may make grants to Indian tribes and tribal
organizations to provide intermediate mental health services to Indian
children and adolescents, including--
`(A) inpatient and outpatient services;
`(B) emergency care;
`(C) suicide prevention and crisis intervention; and
`(D) prevention and treatment of mental illness, and dysfunctional and
self-destructive behavior, including child abuse and family violence.
`(2) Funds provided under this subsection may be used--
`(A) to construct or renovate an existing health facility to provide
intermediate mental health services;
`(B) to hire mental health professionals;
`(C) to staff, operate, and maintain an intermediate mental health facility,
group home, or youth shelter where intermediate mental health services
are being provided; and
`(D) to make renovations and hire appropriate staff to convert existing
hospital beds into adolescent psychiatric units.
`(3) Funds provided under this subsection may not be used for the purposes
described in section 216(b)(1).
`(4) An Indian tribe or tribal organization receiving a grant under this
subsection shall ensure that intermediate adolescent mental health services
are coordinated with other tribal, Service, and Bureau of Indian Affairs
mental health, alcohol and substance abuse, and social services programs
on the reservation of such tribe or tribal organization.
`(5) The Secretary shall establish criteria for the review and approval
of applications for grants made pursuant to this subsection.
`(6) There are authorized to be appropriated to carry out this section
$10,000,000 for fiscal year 1993 and such sums as may be necessary for
each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.'.

21563ea3cff556e46053907e491b534e581f4ba234149ddac91e4fb3fdb92009

(a) HOSPICE CARE- Title II of the Act is amended by inserting after section
204 the following:
`HOSPICE CARE FEASIBILITY STUDY
`SEC. 205. (a) The Secretary, acting through the Service and in consultation
with representatives of Indian tribes, tribal organizations, Indian Health
Service personnel, and hospice providers, shall conduct a study--
`(1) to assess the feasibility and desirability of furnishing hospice care
to terminally ill Indians; and
`(2) to determine the most efficient and effective means of furnishing
such care.
`(b) Such study shall--
`(1) assess the impact of Indian culture and beliefs concerning death and
dying on the provision of hospice care to Indians;
`(2) estimate the number of Indians for whom hospice care may be appropriate
and determine the geographic distribution of such individuals;
`(3) determine the most appropriate means to facilitate the participation
of Indian tribes and tribal organizations in providing hospice care;
`(4) identify and evaluate various means for providing hospice care,
including--
`(A) the provision of such care by the personnel of a Service hospital
pursuant to a hospice program established by the Secretary at such
hospital; and
`(B) the provision of such care by a community-based hospice program under
contract to the Service; and
`(5) identify and assess any difficulties in furnishing such care and the
actions needed to resolve such difficulties.
`(c) Not later than the date which is 12 months after the date of the
enactment of this section, the Secretary shall transmit to the Congress
a report containing--
`(1) a detailed description of the study conducted pursuant to this
section; and
`(2) a discussion of the findings and conclusions of such study.
`(d) For the purposes of this section--
`(1) the term `terminally ill' means any Indian who has a medical prognosis
(as certified by a physician) of a life expectancy of six months or less; and
`(2) the term `hospice program' means any program which satisfies the
requirements of section 1861(dd)(2) of the Social Security Act (42
U.S.C. 1395x(dd)(2)); and
`(3) the term `hospice care' means the items and services specified in
subparagraphs (A) through (H) of section 1861(dd)(1) of the Social Security
Act (42 U.S.C. 1395x(dd)(1)).'.
(b) MANAGED CARE- Title II of the Act is amended by adding at the end the
following new section:
`MANAGED CARE FEASIBILITY STUDY
`SEC. 210. (a) The Secretary, acting through the Service, shall conduct a
study to assess the feasibility of allowing an Indian tribe to purchase,
directly or through the Service, managed care coverage for all members of
the tribe from--
`(1) a tribally owned and operated managed care plan; or
`(2) a State licensed managed care plan.
`(b) Not later than the date which is 12 months after the date of the
enactment of this section, the Secretary shall transmit to the Congress
a report containing--
`(1) a detailed description of the study conducted pursuant to this
section; and
`(2) a discussion of the findings and conclusions of such study.'.
(c) CONTRACT CARE- Title II of the Act (as amended by subsection (b)
of this Act) is amended by adding at the end the following new section:
`CALIFORNIA CONTRACT HEALTH SERVICES DEMONSTRATION PROGRAM
`SEC. 211. (a) The Secretary shall establish a demonstration program to
evaluate the use of a contract care intermediary to improve the accessibility
of health services to California Indians.
`(b)(1) In establishing such program, the Secretary shall enter into an
agreement with the California Rural Indian Health Board to reimburse the
Board for costs (including reasonable administrative costs) incurred,
during the period of the demonstration program, in providing medical
treatment under contract to California Indians described in section 809(b)
throughout the California contract health services delivery area described
in section 810 with respect to high-cost contract care cases.
`(2) Not more than 5 percent of the amounts provided to the Board under
this section for any fiscal year may be for reimbursement for administrative
expenses incurred by the Board during such fiscal year.
`(3) No payment may be made for treatment provided under the demonstration
program to the extent payment may be made for such treatment under the
Catastrophic Health Emergency Fund described in section 202 or from amounts
appropriated or otherwise made available to the California contract health
service delivery area for a fiscal year.
`(c) There is hereby established an advisory board which shall advise the
California Rural Indian Health Board in carrying out the demonstration
pursuant to this section. The advisory board shall be composed of
representatives, selected by the California Rural Indian Health Board, from
not less than 8 tribal health programs serving California Indians covered
under such demonstration, at least one half of whom are not affiliated
with the California Rural Indian Health Board.
`(d) The demonstration program described in this section shall begin on
January 1, 1993, and shall terminate on September 30, 1997.
`(e) Not later than July 1, 1998, the California Rural Indian Health Board
shall submit to the Secretary a report on the demonstration program carried
out under this section, including a statement of its findings regarding
the impact of using a contract care intermediary on--
`(1) access to needed health services;
`(2) waiting periods for receiving such services; and
`(3) the efficient management of high-cost contract care cases.
`(f) For the purposes of this section, the term `high-cost contract care
cases' means those cases in which the cost of the medical treatment provided
to an individual--
`(1) would otherwise be eligible for reimbursement from the Catastrophic
Health Emergency Fund established under section 202, except that the cost
of such treatment does not meet the threshold cost requirement established
pursuant to section 202(b)(2); and
`(2) exceeds $1,000.
`(g) There are authorized to be appropriated for each of the fiscal years
1993, 1994, 1995, 1996, and 1997 such sums as may be necessary to carry
out the purposes of this section.'.

12327707777f2d68729bc376b8e2aa9828fc60d2f0424461dc798e876d5f90e7

(a) IN GENERAL- Title II of the Act (as amended by section 206(c) of this
Act) is amended by adding at the end the following new section:
`COVERAGE OF SCREENING MAMMOGRAPHY
`SEC. 212. The Secretary, through the Service, shall provide for screening
mammography (as defined in section 1861(jj) of the Social Security Act)
for Indian and urban Indian women 35 years of age or older at a frequency,
determined by the Secretary (in consultation with the Director of the
National Cancer Institute), appropriate to such women, and under such
terms and conditions as are consistent with standards established by the
Secretary to assure the safety and accuracy of screening mammography under
part B of title XVIII of the Social Security Act.'.
(b) CONFORMING AMENDMENT- Section 201(a)(4)(B) of the Act (25
U.S.C. 1621(a)(4)(B)) is amended by striking the semicolon at the end and
inserting the following: `, including screening mammography in accordance
with section 212;'.

befbf450256a9a0685b5da78541696fcfccc331b4cf34eecb1203569ff070441

Title II of the Act (as amended by section 207 of this Act) is amended by
adding at the end the following new section:
`PATIENT TRAVEL COSTS
`SEC. 213. (a) The Secretary, acting through the Service, shall provide
funds for the following patient travel costs associated with receiving
health care services provided (either through direct or contract care or
through contracts entered into pursuant to the Indian Self-Determination
Act) under this Act--
`(1) emergency air transportation; and
`(2) nonemergency air transportation where ground transportation is
infeasible.
`(b) There are authorized to be appropriated to carry out this section
$15,000,000 for fiscal year 1993 and such sums as may be necessary for
each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.'.

7758093b4b2ee6fd27f9ff0d2e4945c81e55eeb1557f8e51fd711d82d7c7a145

(a) RECOVERY BY INDIAN TRIBE- Section 206 of the Act (25 U.S.C. 1621e)
is amended--
(1) by inserting `, an Indian tribe, or a tribal organization' after
`United States' each place it appears;
(2) in subsection (a), by inserting `, an Indian tribe, or a tribal
organization' after `Service';
(3) in subsection (a) and subsection (e)(1)(A), by inserting `, an Indian
tribe, or a tribal organization' after `Secretary' each place it appears; and
(4) in subsection (b), by striking `, or any political subdivision of
a State,'.
(b) SPECIAL RULE WITH RESPECT TO SELF-INSURANCE PLAN- Section 206 of the
Act (25 U.S.C. 1621e) is amended--
(1) by striking `(a) The' and inserting the following: `(a) Except as
provided in subsection (f), the'; and
(2) by adding at the end the following new subsection:
`(f) The United States shall not have a right of recovery under this
section if the injury, illness, or disability for which health services
were provided is covered under a self-insurance plan funded by an Indian
tribe or tribal organization.'.

f494c2ae85c99b3baa66fb4e03e3f5e361b9644de79450cc44c89b832e95d987

Title II of the Act (as amended by section 208 of this Act) is amended by
adding at the end the following new section:
`EPIDEMIOLOGY CENTERS
`SEC. 214. (a)(1) The Secretary shall establish an epidemiology center in
each Service area to carry out the functions described in paragraph (3).
`(2) To assist such centers in carrying out such functions, the Secretary
shall perform the following:
`(A) In consultation with the Centers for Disease Control and Indian tribes,
develop sets of data (which to the extent practicable, shall be consistent
with the uniform data sets used by the States with respect to the year
2000 health objectives) for uniformly defining health status for purposes
of the objectives specified in section 3(b). Such sets shall consist of
one or more categories of information. The Secretary shall develop formats
for the uniform collecting and reporting of information on such categories.
`(B) Establish and maintain a system for monitoring the progress made toward
meeting each of the health status objectives described in section 3(b).
`(3) In consultation with Indian tribes and urban Indian communities,
each area epidemiology center established under this subsection shall,
with respect to such area--
`(A) collect data relating to, and monitor progress made toward meeting,
each of the health status objectives described in section 3(b) using the
data sets and monitoring system developed by the Secretary pursuant to
paragraph (2);
`(B) evaluate existing delivery systems, data systems, and other systems
that impact the improvement of Indian health;
`(C) assist tribes and urban Indian communities in identifying their highest
priority health status objectives and the services needed to achieve such
objectives, based on epidemiological data;
`(D) make recommendations for the targeting of services needed by tribal,
urban, and other Indian communities;
`(E) make recommendations to improve health care delivery systems for
Indians and urban Indians;
`(F) work cooperatively with tribal providers of health and social services
in order to avoid duplication of existing services; and
`(G) provide technical assistance to Indian tribes and urban Indian
organizations in the development of local health service priorities and
incidence and prevalence rates of disease and other illness in the community.
`(4) Epidemiology centers established under this subsection shall be subject
to the provisions of the Indian Self-Determination Act (25 U.S.C. 450f
et seq.).
`(5) The director of the Centers for Disease Control shall provide
technical assistance to the centers in carrying out the requirements of
this subsection.
`(6) The Service shall assign one epidemiologist from each of its area
offices to each area epidemiology center to provide such center with
technical assistance necessary to carry out this subsection.
`(b)(1) The Secretary may make grants to Indian tribes, tribal organizations,
and eligible intertribal consortia or Indian organizations to conduct
epidemiological studies of Indian communities.
`(2) An intertribal consortia or Indian organization is eligible to receive
a grant under this subsection if--
`(A) it is incorporated for the primary purpose of improving Indian
health; and
`(B) it is representative of the tribes or urban Indian communities in
which it is located.
`(3) An application for a grant under this subsection shall be submitted
in such manner and at such time as the Secretary shall prescribe.
`(4) Applicants for grants under this subsection shall--
`(A) demonstrate the technical, administrative, and financial expertise
necessary to carry out the functions described in paragraph (5);
`(B) consult and cooperate with providers of related health and social
services in order to avoid duplication of existing services; and
`(C) demonstrate cooperation from Indian tribes or urban Indian organizations
in the area to be served.
`(5) A grant awarded under paragraph (1) may be used to--
`(A) carry out the functions described in subsection (a)(3);
`(B) provide information to and consult with tribal leaders, urban Indian
community leaders, and related health staff, on health care and health
services management issues; and
`(C) provide, in collaboration with tribes and urban Indian communities,
the Service with information regarding ways to improve  the health status
of Indian people.
`(6) There are authorized to be appropriated to carry out the purposes of
this subsection not more than $12,000,000 for fiscal year 1993 and such
sums as may be necessary for each of the fiscal years 1994, 1995, 1996,
1997, 1998, 1999, and 2000.'.

1c4ab41c40759eab60322a4630f022e24051f939ef4e73d888a653ec13cbeba6

Title II of the Act (as amended by section 210 of this Act) is amended by
adding at the end the following new section:
`COMPREHENSIVE SCHOOL HEALTH EDUCATION PROGRAMS
`SEC. 215. (a) The Secretary, acting through the Service and in consultation
with the Secretary of the Interior, may award grants to Indian tribes to
develop comprehensive school health education programs for children from
preschool through grade 12 in schools located on Indian reservations.
`(b) Grants awarded under this section may be used to--
`(1) develop health education curricula;
`(2) train teachers in comprehensive school health education curricula;
`(3) integrate school-based, community-based, and other public and private
health promotion efforts;
`(4) encourage healthy, tobacco-free school environments;
`(5) coordinate school-based health programs with existing services and
programs available in the community;
`(6) develop school programs on nutrition education, personal health,
and fitness;
`(7) develop mental health wellness programs;
`(8) develop chronic disease prevention programs;
`(9) develop substance abuse prevention programs;
`(10) develop accident prevention and safety education programs;
`(11) develop activities for the prevention and control of communicable
diseases; and
`(12) develop community and environmental health education programs.
`(c) The Secretary shall provide technical assistance to Indian tribes
in the development of health education plans, and the dissemination of
health education materials and information on existing health programs
and resources.
`(d) The Secretary shall establish criteria for the review and approval
of applications for grants made pursuant to this section.
`(e) Recipients of grants under this section shall submit to the Secretary
an annual report on activities undertaken with funds provided under this
section. Such reports shall include a statement of--
`(1) the number of preschools, elementary schools, and secondary schools
served;
`(2) the number of students served;
`(3) any new curricula established with funds provided under this section;
`(4) the number of teachers trained in the health curricula; and
`(5) the involvement of parents, members of the community, and community
health workers in programs established with funds provided under this
section.
`(f)(1) The Secretary of the Interior, acting through the Bureau of Indian
Affairs and in cooperation with the Secretary, shall develop a comprehensive
school health education program for children from preschool through grade
12 in schools operated by the Bureau of Indian Affairs.
`(2) Such program shall include--
`(A) school programs on nutrition education, personal health, and fitness;
`(B) mental health wellness programs;
`(C) chronic disease prevention programs;
`(D) substance abuse prevention programs;
`(E) accident prevention and safety education programs; and
`(F) activities for the prevention and control of communicable diseases.
`(3) The Secretary of the Interior shall--
`(A) provide training to teachers in comprehensive school health education
curricula;
`(B) ensure the integration and coordination of school-based programs with
existing services and health programs available in the community; and
`(C) encourage healthy, tobacco-free school environments.
`(g) There are authorized to be appropriated to carry out this section
$15,000,000 for fiscal year 1993 and such sums as may be necessary for
each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.'.

8e8220c11cf9bfd2f751097f3bc674a2551879df5e474dbc87df5713d6cffb94

Title II of the Act (as amended by section 211 of this Act) is amended by
adding at the end the following new section:
`INDIAN YOUTH GRANT PROGRAM
`SEC. 216. (a) The Secretary, acting through the Service, is authorized
to make grants to Indian tribes, tribal organizations, and urban Indian
organizations for innovative mental and physical disease prevention and
health promotion and treatment programs for Indian preadolescent and
adolescent youths.
`(b)(1) Funds made available under this section may be used to--
`(A) develop prevention and treatment programs for Indian youth which
promote mental and physical health and incorporate cultural values,
community and family involvement, and traditional healers; and
`(B) develop and provide community training and education.
`(2) Funds made available under this section may not be used to provide
services described in section 209(m).
`(c) The Secretary shall--
`(1) disseminate to Indian tribes information regarding models for the
delivery of comprehensive health care services to Indian and urban Indian
adolescents;
`(2) encourage the implementation of such models; and
`(3) at the request of an Indian tribe, provide technical assistance in
the implementation of such models.
`(d) The Secretary shall establish criteria for the review and approval
of applications under this section.
`(e) There are authorized to be appropriated to carry out this section
$5,000,000 for fiscal year 1993 and such sums as may be necessary for each
of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.'.

4039f1aedd8a5216141de33a4cf7d1375b9ab958fe2afecc333a31c5c1e8e1e4

Title II of the Act (as amended by section 212 of this Act) is amended by
adding at the end the following new section:
`AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM
`SEC. 217. (a) The Secretary may provide grants to at least 3 colleges
and universities for the purpose of developing and maintaining American
Indian psychology career recruitment programs as a means of encouraging
Indians to enter the mental health field.
`(b) The Secretary shall provide one of the grants authorized under
subsection (a) to develop and maintain a program at the University of
North Dakota to be known as the `Quentin N. Burdick American Indians Into
Psychology Program'. Such program shall, to the maximum extent feasible,
coordinate with the Quentin N. Burdick Indian Health Programs authorized
under section 114(b), the Quentin N. Burdick American Indians Into Nursing
Program authorized under section 112(e), and existing university research
and communications networks.
`(c)(1) The Secretary shall issue regulations for the competitive awarding
of the grants provided under this section.
`(2) Applicants for grants under this section shall agree to provide a
program which, at a minimum--
`(A) provides outreach and recruitment for health professions to Indian
communities including elementary, secondary and community colleges located
on Indian reservations that will be served by the program;
`(B) incorporates a program advisory board comprised of representatives
from the tribes and communities that will be served by the program;
`(C) provides summer enrichment programs to expose Indian students to the
varied fields of psychology through research, clinical, and experiential
activities;
`(D) provides stipends to undergraduate and graduate students to pursue
a career in psychology;
`(E) develops affiliation agreements with tribal community colleges, the
Service, university affiliated programs, and other appropriate entities
to enhance the education of Indian students;
`(F) to the maximum extent feasible, utilizes existing university tutoring,
counseling and student support services; and
`(G) to the maximum extent feasible, employs qualified Indians in the
program.
`(d) The active duty service obligation prescribed under section 338C
of the Public Health Service Act (42 U.S.C. 254m) shall be met by each
graduate student who receives a stipend described in subsection (c)(2)(D)
that is funded by a grant provided under this section. Such obligation
shall be met by service--
`(1) in the Indian Health Service;
`(2) in a program conducted under a contract entered into under the Indian
Self-Determination Act;
`(3) in a program assisted under title V of this Act; or
`(4) in the private practice of psychology if, as determined by the
Secretary, in accordance with guidelines promulgated by the Secretary,
such practice is situated in a physician or other health professional
shortage area and addresses the health care needs of a substantial number
of Indians.'.

5cf30366aacf09f1959285337ca01c37bf6e8e62b5ebf4a47280366de9d72aba

Title II of the Act (as amended by section 213 of this Act) is amended by
adding at the end the following new section:
`PREVENTION, CONTROL, AND ELIMINATION OF TUBERCULOSIS
`SEC. 218. (a) The Secretary, acting through the Service after consultation
with the Centers for Disease Control, may make grants to Indian tribes
and tribal organizations for--
`(1) projects for the prevention, control, and elimination of tuberculosis;
`(2) public information and education programs for the prevention, control,
and elimination of tuberculosis; and
`(3) education, training, and clinical skills improvement activities
in the prevention, control, and elimination of tuberculosis for health
professionals, including allied health professionals.
`(b) The Secretary may make a grant under subsection (a) only if an
application for the grant is submitted to the Secretary and the application
is in such form, is made in such manner, and contains the assurances
required by subsection (c) and such other agreements, assurances, and
information as the Secretary may require.
`(c) To be eligible for a grant under subsection (a), an applicant must
provide assurances satisfactory to the Secretary that--
`(1) the applicant will coordinate its activities for the prevention,
control, and elimination of tuberculosis with activities of the Centers
for Disease Control, and State and local health agencies; and
`(2) the applicant will submit to the Secretary an annual report on its
activities for the prevention, control, and elimination of tuberculosis.
`(d) In carrying out this section, the Secretary--
`(1) shall establish criteria for the review and approval of applications
for grants under subsection (a), including requirement of public health
qualifications of applicants;
`(2) shall, subject to available appropriations, make at least one grant
under subsection (a) within each area office;
`(3) may, at the request of an Indian tribe or tribal organization,
provide technical assistance; and
`(4) shall prepare and submit a report to the Committee on Energy and
Commerce and the Committee on Interior and Insular Affairs of the House
and the Select Committee on Indian Affairs of the Senate not later than
February 1, 1994, and biennially thereafter, on the use of funds under
this section and on the progress made toward the prevention, control,
and elimination of tuberculosis among Indian tribes and tribal organizations.
`(e) The Secretary may, at the request of a recipient of a grant under
subsection (a), reduce the amount of such grant by--
`(1) the fair market value of any supplies or equipment furnished the
grant recipient; and
`(2) the amount of the pay, allowances, and travel expenses of any officer
or employee of the Government when detailed to the grant recipient and
the amount of any other costs incurred in connection with the detail of
such officer or employee,
when the furnishing of such supplies or equipment or the detail of such an
officer or employee is for the convenience of and at the request of such
grant recipient and for the purpose of carrying out a program with respect to
which the grant under subsection (a) is made. The amount by which any such
grant is so reduced shall be available for payment by the Secretary of the
costs incurred in furnishing the supplies or equipment, or in detailing the
personnel, on which the reduction of such grant is based, and such amount
shall be deemed as part of the grant and shall be deemed to have been paid
to the grant recipient.'.

79e05b857f02dac5d0512275df7139b527d0f2225c5767927eb3c6fbf360ae7c

Title II of the Act (as amended by section 214 of this Act) is amended by
adding at the end the following new sections:
`CONTRACT HEALTH SERVICES PAYMENT STUDY
`SEC. 219. (a) The Secretary, acting through the Service and in consultation
with representatives of Indian tribes and tribal organizations operating
contract health care programs under the Indian Self-Determination Act (25
U.S.C. 450f et seq.) or under self-governance compacts, Service personnel,
private contract health services providers, the Indian Health Service
Fiscal Intermediary, and other appropriate experts, shall conduct a study--
`(1) to assess and identify administrative barriers that hinder the timely
payment for services delivered by private contract health services providers
to individual Indians by the Service and the Indian Health Service Fiscal
Intermediary;
`(2) to assess and identify the impact of such delayed payments upon the
personal credit histories of individual Indians who have been treated by
such providers; and
`(3) to determine the most efficient and effective means of improving
the Service's contract health services payment system and ensuring the
development of appropriate consumer protection policies to protect individual
Indians who receive authorized services from private contract health services
providers from billing and collection practices, including the development
of materials and programs explaining patients' rights and responsibilities.
`(b) The study required by subsection (a) shall--
`(1) assess the impact of the existing contract health services regulations
and policies upon the ability of the Service and the Indian Health
Service Fiscal Intermediary to process, on a timely and efficient basis,
the payment of bills submitted by private contract health services providers;
`(2) assess the financial and any other burdens imposed upon individual
Indians and private contract health services providers by delayed payments;
`(3) survey the policies and practices of collection agencies used
by contract health services providers to collect payments for services
rendered to individual Indians;
`(4) identify appropriate changes in Federal policies, administrative
procedures, and regulations, to eliminate the problems experienced by
private contract health services providers and individual Indians as a
result of delayed payments; and
`(5) compare the Service's payment processing requirements with private
insurance claims processing requirements to evaluate the systemic differences
or similarities employed by the Service and private insurers.
`(c) Not later than 12 months after the date of the enactment of this
section, the Secretary shall transmit to the Congress a report that
includes--
`(1) a detailed description of the study conducted pursuant to this
section; and
`(2) a discussion of the findings and conclusions of such study.
`PROMPT ACTION ON PAYMENT OF CLAIMS
`SEC. 220. (a) The Service shall respond to a notification of a claim by
a provider of a contract care service with either an individual purchase
order or a denial of the claim within 5 working days after the receipt of
such notification.
`(b) If the Service fails to respond to a notification of a claim in
accordance with subsection (a), the Service shall accept as valid the
claim submitted by the provider of a contract care service.
`(c) The Service shall pay a completed contract care service claim within
30 days after completion of the claim.
`DEMONSTRATION OF ELECTRONIC CLAIMS PROCESSING
`SEC. 221. (a) Not later than June 15, 1993, the Secretary shall develop and
implement, directly or by contract, 2 projects to demonstrate in a pilot
setting the use of claims processing technology to improve the accuracy
and timeliness of the billing for, and payment of, contract health services.
`(b) The Secretary shall conduct one of the projects authorized in
subsection (a) in the Service area served by the area office located in
Phoenix, Arizona.
`LIABILITY FOR PAYMENT
`SEC. 222. (a) A patient who receives contract health care services that
are authorized by the Service shall not be liable for the payment of any
charges or costs associated with the provision of such services.
`(b) The Secretary shall notify a contract care provider and any patient who
receives contract health care services authorized by the Service that such
patient is not liable for the payment of any charges or costs associated
with the provision of such services.'.

2fa2d2656c102269b55eca640bfa4f534a4a8a46b69a5ea40cdbd2044c61ed75

Title II of the Act (as amended by section 215 of this Act) is amended by
adding at the end the following new section:
`OFFICE OF INDIAN WOMEN'S HEALTH CARE
`SEC. 223. There is established within the Service an Office of Indian
Women's Health Care to oversee efforts of the Service to monitor and
improve the quality of health care for Indian women of all ages through
the planning and delivery of programs administered by the Service, in
order to improve and enhance the treatment models of care for Indian women.'.

15361d29d1242e030b85bb715f421ad3c63f5681a922302a1221ed1a75ceb701

(a) AUTHORIZATION- Title II of the Act (as amended by section 216 of this
Act) is amended by adding at the end the following new section:
`AUTHORIZATION OF APPROPRIATIONS
`SEC. 224. Except as provided in sections 209(m), 211, 213, 214(b)(5),
215, and 216, there are authorized to be appropriated such sums as may
be necessary for each fiscal year through fiscal year 2000 to carry out
this title.'.
(b) CONFORMING AMENDMENTS- Title II of the Act is amended--
(1) in section 201(h), by striking out the first sentence and striking out
`subsection' and inserting in lieu thereof `section'.
(2) in section 202, by striking out subsection (e);
(3) in section 204(e), by striking out the first sentence and striking out
`subsection (c)' and inserting in lieu thereof `this section'; and
(4) in section 209 (as amended by section 902(3)(B) of this Act)--
(A) by striking out subsections (c)(5), (d)(6), (f)(4), and (g)(5);
(B) in subsection (h)--
(i) by striking out paragraph (2) and by striking out `(1)';
(ii) by redesignating subparagraphs (A) and (B) as paragraphs (1) and
(2), respectively;
(iii) by striking out `subparagraph (A)' and inserting `paragraph (1)'; and
(iv) by striking out `subparagraph (B)' and inserting `paragraph (2)';
(C) in subsection (i), by striking out paragraph (2) and by striking out
`(1)';
(D) in subsection (d)(3)(B), by striking out `this subsection' and inserting
in lieu thereof `this section'; and
(E) in subsection (k)(6), by striking out the first sentence and in the
second sentence by striking out `subsection' and inserting in lieu thereof
`section'.

aa53e6ec1ba7dc40da7cf32fe9f8b0932e5bcb39419f412580bd382e44ebc532

Section 301 of the Act (25 U.S.C. 1631) is amended--
(1) in subsection (a)(2), by striking out `Hospitals' and inserting
`Health Care Organizations';
(2) in subsection (b)(1)--
(A) in the material preceding subparagraph (A), by striking out `other'
before `outpatient';
(B) by striking out `and' at the end of subparagraph (D);
(C) by striking out the period at the end of subparagraph (E) and inserting
in lieu thereof a semicolon; and
(D) by adding at the end the following new subparagraphs:
`(F) the level of utilization of such hospital or facility by all eligible
Indians; and
`(G) the distance between such hospital or facility and the nearest
operating Service hospital.';
(3) by striking out subsection (c) and redesignating subsections (d) and
(e) as subsections (c) and (d), respectively;
(4) in subsection (c)(1) (as redesignated by paragraph (2) of this
subsection), by amending the material preceding subparagraph (A) to read
as follows:
`(c)(1) The Secretary shall submit to the President, for inclusion in
each report required to be transmitted to the Congress under section 801,
a report which sets forth--'; and
(5) by striking out paragraph (2) of subsection (c) (as redesignated by
paragraph (2)) and redesignating paragraphs (3), (4), and (5) of such
subsection as paragraphs (2), (3), and (4), respectively.

b5c7b02c1dddcf1d187dd5bb8398a10e6cf184e0da3d1e27a58f3c82a55444bf

TITLE III

-HEALTH FACILITIES

Section 302 of the Act (25 U.S.C. 1632) is amended--
(1) by amending subsection (e) to read as follows:
`(e)(1) The Secretary is authorized to provide financial assistance to
Indian tribes and communities in an amount equal to the Federal share of
the costs of operating, managing, and maintaining the facilities provided
under the plan described in subsection (c).
`(2) For the purposes of paragraph (1), the term `Federal share' means 80
percent of the costs described in paragraph (1).
`(3) With respect to Indian tribes with fewer than 1,000 enrolled members,
the non-Federal portion of the costs of operating, managing, and maintaining
such facilities may be provided, in part, through cash donations or in
kind property, fairly evaluated.';
(2) in subsection (f)(1), by striking out `subsection (h)' and inserting
in lieu thereof `this section'; and
(3) in subsection (g)--
(A) in paragraph (1), by striking out `The Secretary' through `report'
and inserting in lieu thereof the following: `The Secretary shall submit
to the President, for inclusion in each report required to be transmitted
to the Congress under section 801, a report'; and
(B) by striking out paragraph (2) and redesignating paragraphs (3), (4),
(5), and (6) as paragraphs (2), (3), (4), and (5), respectively.

5d88dd48b3095a06be0ab94534266ee7a627c48605534b97282ea77ba9d018f2

Section 306 of the Act (25 U.S.C. 1636) is amended to read as follows:
`GRANT PROGRAM FOR THE CONSTRUCTION, EXPANSION, AND MODERNIZATION OF SMALL
AMBULATORY CARE FACILITIES
`SEC. 306. (a)(1) The Secretary, acting through the Service, shall make
grants to tribes and tribal organizations for the construction, expansion,
or modernization of facilities for the provision of ambulatory care services
to eligible Indians (and noneligible persons as provided in subsection
(c)(1)(C)). A grant made under this section may cover up to 100 percent
of the costs of such construction, expansion, or modernization. For the
purposes of this section, the term `construction' includes the replacement
of an existing facility.
`(2) A grant under paragraph (1) may only be made to a tribe or tribal
organization operating an Indian health facility (other than a facility
owned or constructed by the Service, including a facility originally owned or
constructed by the Service and transferred to a tribe or tribal organization)
pursuant to a contract entered into under the Indian Self-Determination Act.
`(b)(1) A grant provided under this section may be used only for the
construction, expansion, or modernization (including the planning and
design of such construction, expansion, or modernization) of an ambulatory
care facility--
`(A) located apart from a hospital;
`(B) not funded under section 301 or section 307; and
`(C) which, upon completion of such construction, expansion, or modernization
will--
`(i) have a total capacity appropriate to its projected service population;
`(ii) serve no less than 500 eligible Indians annually; and
`(iii) provide ambulatory care in a service area (specified in the contract
entered into under the Indian Self-Determination Act) with a population
of not less than 2,000 eligible Indians.
`(2) The requirements of clauses (ii) and (iii) of paragraph (1)(C) shall
not apply to a tribe or tribal organization applying for a grant under
this section whose tribal government offices are located on an island.
`(c)(1) No grant may be made under this section unless an application
for such a grant has been submitted to and approved by the Secretary. An
application for a grant under this section shall be submitted in such
form and manner as the Secretary shall by regulation prescribe and shall
set forth reasonable assurance by the applicant  that, at all times after
the construction, expansion, or modernization of a facility carried out
pursuant to a grant received under this section--
`(A) adequate financial support will be available for the provision of
services at such facility;
`(B) such facility will be available to eligible Indians without regard
to ability to pay or source of payment; and
`(C) such facility will, as feasible without diminishing the quality
or quantity of services provided to eligible Indians, serve noneligible
persons on a cost basis.
`(2) In awarding grants under this section, the Secretary shall give
priority to tribes and tribal organizations that demonstrate--
`(A) a need for increased ambulatory care services; and
`(B) insufficient capacity to deliver such services.
`(d) If any facility (or portion thereof) with respect to which funds have
been paid under this section, ceases, at any time after completion of the
construction, expansion, or modernization carried out with such funds,
to be utilized for the purposes of providing ambulatory care services to
eligible Indians, all of the right, title, and interest in and to such
facility (or portion thereof) shall transfer to the United States.'.

9f5dfa14ab015ce52c52b62d1536d391fee26671a313e68204adc902aafbd0cb

(a) AWARDING OF GRANTS- Section 307(c) of the Act (25 U.S.C. 1637(c)(3))
is amended--
(1) in paragraph (1)(A), by inserting `or program' immediately after
`facility' each place it appears;
(2) in paragraph (3)(A)--
(A) by striking `The' and inserting `On or before September 30, 1995,
the'; and
(B) by adding before the colon the following: `and for which a completed
application has been received by the Secretary'; and
(3) by striking subparagraph (B) and inserting the following:
`(B) The Secretary may also enter into contracts or award grants under
this section taking into consideration applications received under this
section from all service areas. The Secretary may not award a greater
number of such contracts or grants in one service area than in any other
service area until there is an equal number of such contracts or grants
awarded with respect to all service areas from which the Secretary receives
applications during the application period (as determined by the Secretary)
which meet the criteria specified in paragraph (1).'.
(b) REPORTS- Section 307(h) of the Act (25 U.S.C. 1637(h)) is amended to
read as follows:
`(h)(1) The Secretary shall submit to the President, for inclusion in the
report which is required to be submitted to the Congress under section 801
for fiscal year 1997, an interim report on the findings and conclusions
derived from the demonstration projects established under this section.
`(2) The Secretary shall submit to the President, for inclusion in the
report which is required to be submitted to the Congress under section
801 for fiscal year 1999, a final report on the findings and conclusions
derived from the demonstration projects established under this section,
together with legislative recommendations.'.

1e0dd196dc4a74085785cfaebef2e50401da0acb2e62a2d7e88cf9150e7a0c39

Section 305 of the Act (25 U.S.C. 1634) is amended to read as follows:
`EXPENDITURE OF NONSERVICE FUNDS FOR RENOVATION
`SEC. 305. (a)(1) Notwithstanding any other provision of law, the Secretary
is authorized to accept any major renovation or modernization by any
Indian tribe of any Service facility, or of any other Indian health
facility operated pursuant to a contract entered into under the Indian
Self-Determination Act, including--
`(A) any plans or designs for such renovation or modernization; and
`(B) any renovation or modernization for which funds appropriated under
any Federal law were lawfully expended,
but only if the requirements of subsection (b) are met.
`(2) The Secretary shall maintain a separate priority list to address the
needs of such facilities for personnel or equipment.
`(3) The Secretary shall submit to the President, for inclusion in each
report required to be transmitted to the Congress under section 801,
the priority list maintained pursuant to paragraph (2).
`(b) The requirements of this subsection are met with respect to any
renovation or modernization if--
`(1) the tribe or tribal organization--
`(A) provides notice to the Secretary of its intent to renovate or
modernize; and
`(B) applies to the Secretary to be placed on a separate priority list to
address the needs of such new facilities for personnel or equipment; and
`(2) the renovation or modernization--
`(A) is approved by the appropriate area director of the Service; and
`(B) is administered by the tribe in accordance with the rules and
regulations prescribed by the Secretary with respect to construction or
renovation of Service facilities.
`(c) If any Service facility which has been renovated or modernized
by an Indian tribe under this section ceases to be used as a Service
facility during the 20-year period beginning on the date such renovation or
modernization is completed, such Indian tribe shall be entitled to recover
from the United States an amount which bears the same ratio to the value of
such facility at the time of such cessation as the value of such renovation
or modernization (less the total amount of any funds provided specifically
for such facility under any Federal program that were expended for such
renovation or modernization) bore to the value of such facility at the
time of the completion of such renovation or modernization.'.

5963fb231aa938535d6de1535f8385f5641896aad1bed09aa587de1a86fe4299

Title III of the Act is amended by adding at the end the following new
section:
`LAND TRANSFER
`SEC. 308. The Bureau of Indian Affairs is authorized to transfer,
at no cost, up to 5 acres of land at the Chemawa Indian School, Salem,
Oregon, to the Service for the provision of health care services. The land
authorized to be transferred by this section is that land adjacent to land
under the jurisdiction of the Service and occupied by the Chemawa Indian
Health Center.'.

78c5af0c9fdc2b6d4ca856722df3f153908803b56eb2c923fedc07e6140d7cb2

(a) AUTHORIZATION- Title III of the Act (as amended by section 306 of this
Act) is amended by adding at the end the following new section:
`AUTHORIZATION OF APPROPRIATIONS
`SEC. 309. There are authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 2000 to carry out
this title.'.
(b) CONFORMING AMENDMENTS- Title III of the Act is amended--
(1) in section 302, by striking out subsection (h); and
(2) in section 307, by striking out subsection (i).

baa5067932c24b5d9a3834bad595c8dd6d8e5e134e63cfe9e775013292edc808

Title III of the Act (as amended by section 307 of this Act) is amended
by adding at the end the following new section:
`APPLICABILITY OF BUY AMERICAN REQUIREMENT
`SEC. 310. (a) The Secretary shall ensure that the requirements of the Buy
American Act apply to all procurements made with funds provided pursuant
to the authorization contained in section 309.
`(b) The Secretary shall submit to the Congress a report on the amount of
procurements from foreign entities made in fiscal years 1993 and 1994 with
funds provided pursuant to the authorization contained in section 309. Such
report shall separately indicate the dollar value of items procured with
such funds for which the Buy American Act was waived pursuant to the Trade
Agreement Act of 1979 or any international agreement to which the United
States is a party.
`(c) If it has been finally determined by a court or Federal agency that
any person intentionally affixed a label bearing a `Made in America'
inscription, or any inscription with the same meaning, to any product sold
in or shipped to the United States that is not made in the United States,
such person shall be ineligible to receive any contract or subcontract made
with funds provided pursuant to the authorization contained in section 309,
pursuant to the debarment, suspension, and ineligibility procedures described
in sections 9.400 through 9.409 of title 48, Code of Federal Regulations.
`(d) For purposes of this section, the term `Buy American Act' means title
III of the Act entitled `An Act making appropriations for the Treasury
and Post Office Departments for the fiscal year ending June 30, 1934,
and for other purposes', approved March 3, 1933 (41 U.S.C. 10a et seq.).'.

592899e94404b26b72c46a905fe7dbc2e0513aff3a85bf163555a1a79cee7fe4

MEDICARE AND MEDICAID PROGRAMS.
(a) MEDICARE PROGRAM- Section 401 of the Act (42 U.S.C. 1395qq note)
is amended to read as follows:
`TREATMENT OF PAYMENTS UNDER MEDICARE PROGRAM
`SEC. 401. (a) Any payments received by a hospital or skilled nursing
facility of the Service (whether operated by the Service or by an Indian
tribe or tribal organization pursuant to a contract under the Indian
Self-Determination Act) for services provided to Indians eligible for
benefits under title XVIII of the Social Security Act shall not be considered
in determining appropriations for health care and services to Indians.
`(b) Nothing in this Act authorizes the Secretary to provide services
to an Indian beneficiary with coverage under title XVIII of the Social
Security Act, as amended, in preference to an Indian beneficiary without
such coverage.'.
(b) MEDICAID PROGRAM- (1) Section 402 of the Act is amended to read
as follows:
`TREATMENT OF PAYMENTS UNDER MEDICAID PROGRAM
`SEC. 402. (a) Notwithstanding any other provision of law, payments to
which any facility of the Service (including a hospital, nursing facility,
intermediate care facility for the mentally retarded, or any other type
of facility which provides services for which payment is available under
title XIX of the Social Security Act) is entitled under a State plan by
reason of section 1911 of such Act shall be placed in a special fund to be
held by the Secretary and used by him (to such extent or in such amounts as
are provided in appropriation Acts) exclusively for the purpose of making
any improvements in the facilities of such Service which may be necessary
to achieve compliance with the applicable conditions and requirements of
such title. In making payments from such fund, the Secretary shall ensure
that each service unit of the Service receives at least 80 percent of the
amounts to which the facilities of the Service, for which such service
unit makes collections, are entitled by reason of section 1911 of the
Social Security Act.
`(b) Any payments received by such facility for services provided to
Indians eligible for benefits under title XIX of the Social Security Act
shall not be considered in determining appropriations for the provision
of health care and services to Indians.'.
(2) The increase (from 50 percent) in the percentage of the payments from
the fund to be made to each service unit of the Service specified in the
amendment made by paragraph (1) shall take effect beginning with payments
made on January 1, 1993.

e447b06efa83bf7f1c8de17cc8c45613695d61e148e7770a1af1683351ce5b84

TITLE IV

-ACCESS TO HEALTH SERVICES

Section 403 of the Act (25 U.S.C. 1671 note) is amended by striking out
`The Secretary' and all that follows through `section 701' and inserting in
lieu thereof the following: `The Secretary shall submit to the President,
for inclusion in the report required to be transmitted to the Congress
under section 801,'.

88dbcd694685ad7843f48cf9b7ab59b7cd3435ff8a830d4696a164a836333635

Section 404 of the Act (25 U.S.C. 1622) is amended--
(1) by amending subsection (b)(4) to read as follows:
`(4) develop and implement--
`(A) a schedule of income levels to determine the extent of payments of
premiums by such organizations for coverage of needy individuals; and
`(B) methods of improving the participation of Indians in receiving
the benefits provided under titles XVIII and XIX of the Social Security
Act.'; and
(2) by amending subsection (c) to read as follows:
`(c) The Secretary, acting through the Service, may enter into an agreement
with an Indian tribe, tribal organization, or urban Indian organization
which provides for the receipt and processing of applications for medical
assistance under title XIX of the Social Security Act and benefits under
title XVIII of the Social Security Act at a Service facility or a health
care facility administered by such tribe or organization pursuant to a
contract under the Indian Self-Determination Act.'.

e9c9d7cf15506fff344ba6f386a63c1c93b6b4fca51baf60463805c6894d06f3

Section 405 of the Act (42 U.S.C. 1395qq note) is amended--
(1) in subsection (c)(2), by striking `1995' and inserting `1996'; and
(2) in subsection (e), by striking `1995' and inserting `1996'.

5ea97bc6e1ece2be6ca02ec677c448e5ae04d4f5270ae7e83ec8f9e90fe13ff6

Title IV of the Act is amended by adding at the end the following new
section:
`AUTHORIZATION FOR EMERGENCY CONTRACT HEALTH SERVICES
`SEC. 406. With respect to an elderly or disabled Indian receiving
emergency medical care or services from a non-Service provider or in a
non-Service facility under the authority of this Act, the time limitation
(as a condition of payment) for notifying the Service of such treatment
or admission shall be 30 days.'.

1c32ae213f39fdbc4e191dcd10fea3a39fcbfb2e04a2528154f721c7a7a63937

Title IV of the Act is amended by adding at the end the following new
section:
`AUTHORIZATION OF APPROPRIATIONS
`SEC. 407. There are authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 2000 to carry out
this title.'.

0815d356057960a72d72a5fac1babc3eb0724c717c39922ebfa4b274a2a42375

(a) IN GENERAL- Section 502 of the Act (25 U.S.C. 1652) is amended--
(1) by striking `contracts with' and inserting the following: `contracts
with, or make grants to,';
(2) by inserting after `enters into with' the following: `, or in any
grant the Secretary makes to,'; and
(3) by amending the heading to read as follows:
`CONTRACTS WITH, AND GRANTS TO, URBAN INDIAN ORGANIZATIONS'.
(b) CONFORMING AMENDMENTS- (1) Section 503 of the Act (25 U.S.C. 1653)
is amended--
(A) in subsection (a), in the material preceding paragraph (1)--
(i) by inserting `, or make grants to,' after `contracts with'; and
(ii) by inserting `or grant' after `such contract';
(B) in subsection (b)--
(i) in the material preceding paragraph (1), by inserting `or receive
grants' after `enter into contracts'; and
(ii) in paragraph (5), by inserting `or to meet the requirements for
receiving a grant' after `Secretary';
(C) in subsection (c)(1), by inserting before the period at the end the
following: `or receiving grants under subsection (a)';
(D) in subsection (d)(1), by inserting before the period at the end the
following: `or receiving grants under subsection (a)';
(E) in subsection (e)(1), by inserting before the period at the end the
following: `or receiving grants under subsection (a)';
(F) in subsection (f), by inserting `or receiving grants under subsection
(a)' after `this section'; and
(G) by amending the heading to read as follows:
`CONTRACTS AND GRANTS FOR THE PROVISION OF HEALTH CARE AND REFERRAL SERVICES'.
(2) Section 504 of the Act (25 U.S.C. 1654) is amended--
(A) by striking `SEC. 504.' and all that follows through the end of
subsection (a) and inserting the following:
`SEC. 504. (a) Under authority of the Act of November 2, 1921 (25 U.S.C. 13),
popularly known as the Snyder Act, the Secretary, through the Service, may
enter into contracts with, or make grants to, urban Indian organizations
situated in urban centers for which contracts have not been entered into,
or grants have not been made, under section 503. The purpose of a contract
or grant made under this section shall be the determination of the matters
described in subsection (b)(1) in order to assist the Secretary in assessing
the health status and health care needs of urban Indians in the urban
center involved and determining whether the Secretary should enter into
a contract or make a grant under section 503 with respect to the urban
Indian organization which the Secretary has entered into a contract with,
or made a grant to, under this section.';
(B) in subsection (b)--
(i) in the material preceding paragraph (1), by inserting `, or grant made,'
after `contract entered into'; and
(ii) in paragraph (2), by striking `within one year' and all that follows
through the period at the end and inserting the following: `, or carry out
the requirements of the grant, within one year after the date on which the
Secretary and such organization enter into such contract, or within one
year after such organization receives such grant, whichever is applicable.';
(C) in subsection (c), by inserting `, or grant made,' after `entered
into'; and
(D) by amending the heading to read as follows:
`CONTRACTS AND GRANTS FOR THE DETERMINATION OF UNMET HEALTH CARE NEEDS'.
(3) Section 505 of the Act (25 U.S.C. 1655) is amended--
(A) in subsection (a), by inserting `compliance with grant requirements
under this title and' before `compliance with,';
(B) in subsection (b)--
(i) by inserting `or received a grant' after `entered into a contract'; and
(ii) by inserting before the period at the end the following: `or the
terms of such grant';
(C) in subsection (c)--
(i) by inserting `the requirements of a grant or complied with' after
`complied with';
(ii) by inserting `or grant' after `such contract' each place it appears';
(iii) by inserting `or make a grant' after `enter into a contract'; and
(iv) by inserting `or grant' after `whose contract';
(D) in subsection (d), by inserting `or grant' after `a contract' each
place it appears; and
(E) by amending the heading to read as follows:
`EVALUATIONS; RENEWALS'.
(4) Section 506 of the Act (25 U.S.C. 1656) is amended--
(A) in subsection (b), by inserting `or grants' after `any contracts';
(B) in subsection (d), by inserting `or grant' after `contract' each place
it appears;
(C) in subsection (e)--
(i) by inserting `, or grants to,' after `Contracts with'; and
(ii) by inserting `or grants' after `such contracts'; and
(D) by amending the heading to read as follows:
`OTHER CONTRACT AND GRANT REQUIREMENTS'.
(5) Section 507 of the Act (25 U.S.C. 1657) is amended--
(A) in subsection (a)--
(i) in the material preceding paragraph (1), by inserting `, or a grant
received,' after `entered into'; and
(ii) in paragraphs (1) and (2), by inserting `or grant' after `contract'
each place it appears; and
(B) in subsections (b) and (c), by inserting `or grant' after `contract'
each place it appears.
(6) Section 509 of the Act (25 U.S.C. 1659) (as amended by section
902(5)(A) of this Act) is amended by inserting `or grant recipients' after
`contractors' each place it appears.
(7) Section 510(a) of the Act (25 U.S.C. 1660(a)) (as amended by section
902(5)(B) of this Act) is amended by inserting before the period at the
end the following: `and for providing central oversight of the programs
and services authorized under this title'.

ba025f39a4b4adef353fa148fa3507c22f0371d90b52a0d686219988e69e215b

TITLE V

-HEALTH SERVICES FOR URBAN INDIANS

Title V of the Act is amended by inserting after section 510 (as redesignated
by section 902(5)(B) of this Act) the following new section:
`GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE RELATED SERVICES
`SEC. 511. (a) GRANTS- The Secretary may make grants for the provision of
health-related services in prevention of, treatment of, rehabilitation of,
or school and community-based education in, alcohol and substance abuse in
urban centers to those urban Indian organizations with whom the Secretary
has entered into a contract under this title or under section 201.
`(b) GOALS OF GRANT- Each grant made pursuant to subsection (a) shall set
forth the goals to be accomplished pursuant to the grant. The goals shall
be specific to each grant as agreed to between the Secretary and the grantee.
`(c) CRITERIA- The Secretary shall establish criteria for the grants made
under subsection (a), including criteria relating to the--
`(1) size of the urban Indian population;
`(2) accessibility to, and utilization of, other health resources available
to such population;
`(3) duplication of existing Service or other Federal grants or contracts;
`(4) capability of the organization to adequately perform the activities
required under the grant;
`(5) satisfactory performance standards for the organization in meeting the
goals set forth in such grant, which standards shall be negotiated and agreed
to between the Secretary and the grantee on a grant-by-grant basis; and
`(6) identification of need for services.
`The Secretary shall develop a methodology for allocating grants made pursuant
to this section based on such criteria.
`(d) TREATMENT OF FUNDS RECEIVED BY URBAN INDIAN ORGANIZATIONS- Any funds
received by an urban Indian organization under this Act for substance
abuse prevention, treatment, and rehabilitation shall be subject to the
criteria set forth in subsection (c).'.

ac4977bff681158c34aa28cbf44afbbcab5e49c0641cbbb47e9f433a9cd0f9ca

Title V of the Act (as amended by section 502 of this Act) is amended by
adding at the end the following new section:
`TREATMENT OF CERTAIN DEMONSTRATION PROJECTS
`SEC. 512. (a) Notwithstanding any other provision of law, the Oklahoma
City Clinic demonstration project and the Tulsa Clinic demonstration
project shall be treated as service units in the allocation of resources
and coordination of care and shall not be subject to the provisions of the
Indian Self-Determination Act for the term of such projects. The Secretary
shall provide assistance to such projects in the development of resources
and equipment and facility needs.
`(b) The Secretary shall submit to the President, for inclusion in the
report required to be submitted to the Congress under section 801 for
fiscal year 1999, a report on the findings and conclusions derived from
the demonstration projects specified in subsection (a).'.

82f60f8885f5bf0bb1a89c524923f93cee56fc7e3b3e90245819762d72b76629

Title V of the Act (as amended by section 503 of this Act) is amended by
adding at the end the following new section:
`URBAN NIAAA TRANSFERRED PROGRAMS
`SEC. 513. (a) The Secretary shall, within the Branch of Urban Health
Programs of the Service, make grants or enter into contracts for the
administration of urban Indian alcohol programs that were originally
established under the National Institute on Alcoholism and Alcohol Abuse
(hereafter in this section referred to as `NIAAA') and transferred to
the Service.
`(b) Grants provided or contracts entered into under this section shall
be used to provide support for the continuation of alcohol prevention and
treatment services for urban Indian populations and such other objectives as
are agreed upon between the Service and a recipient of a grant or contract
under this section.
`(c) Urban Indian organizations that operate Indian alcohol programs
originally funded under NIAAA and subsequently transferred to the Service
are eligible for grants or contracts under this section.
`(d) For the purpose of carrying out this section, the Secretary may
combine NIAAA alcohol funds with other substance abuse funds currently
administered through the Branch of Urban Health Programs of the Service.
`(e) The Secretary shall evaluate and report to the Congress on the
activities of programs funded under this section at least every two years.'.

41301117c814335694eb36d693b98d3c9175a75d7cccd0e64c6f52b6b84548f6

(a) AUTHORIZATION- Title V of the Act (as amended by section 504 of this
Act) is amended by adding at the end the following new section:
`AUTHORIZATION OF APPROPRIATIONS
`SEC. 514. There are authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 2000 to carry out
this title.'.
(b) CONFORMING AMENDMENTS- Title V of the Act (25 U.S.C. 1650 et seq.) is
amended--
(1) in section 503--
(A) in subsection (c), by striking out `(c)(1)' and inserting `(c)' and
by striking out paragraph (2);
(B) in subsection (d), by striking out paragraph (4);
(C) in subsection (e), by striking out paragraph (4); and
(D) in subsection (f), by striking out paragraph (5); and
(2) in section 509 (as redesignated by section 902(5)(A) of this Act),
by striking out the last sentence.

cf2af62f54fd481887b518ba75adbc39eb6b225a74b60c7c9c1cf1352aba840b

Section 601(c) of the Act (15 U.S.C. 1661(c)) is amended--
(1) in paragraph (2), by striking out `and' after the semicolon;
(2) in paragraph (3), by striking out the period at the end and inserting
in lieu thereof `; and'; and
(3) by adding at the end the following new paragraph:
`(4) all scholarship and loan functions carried out under title I.'.

390845c312ede875de32277c48ba745d59b29834e45ada0626f077c8d18d19f6

TITLE VI

-ORGANIZATIONAL IMPROVEMENTS

(a) CONFIRMATION BY SENATE-
(1) IN GENERAL- Section 601(a) of the Act (25 U.S.C. 1661(a)) is amended
in the second sentence by striking `Secretary' and inserting `President,
by and with the advice and consent of the Senate'.
(2) EFFECTIVE DATE- The amendment made by paragraph (1) shall take effect
January 1, 1993.
(b) INTERIM APPOINTMENT- The President may appoint an individual to serve
as Interim Director of the Service from January 1, 1993, until such time
as a Director is appointed and confirmed as provided in section 601(a)
of the Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.) (as
amended by subsection (a) of this section).
(c) TERM- Section 601(a) of the Act (25 U.S.C. 1661(a)) is amended by adding
at the end the following: `Effective with respect to an individual appointed
by the President, by and with the advice and consent of the Senate, after
January 1, 1993, the term of service of the Director shall be 4 years. A
Director may serve more than 1 term.'.

0a34ad3b98abb6e4e3ad3425df6ac5f5db7cba683136133fbd8bdf6c07a26a5d

Title VI of the Act (25 U.S.C. 1661 et seq.) is amended by adding at the
end the following new section:
`AUTHORIZATION OF APPROPRIATIONS
`SEC. 603. There are authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 2000 to carry out
this title.'.

b555c992dab300f271d12d2c820b40d52be97ad561fdb51e26779b31c364c545

(a) TITLE HEADING- Title VII of the Act (25 U.S.C. 1671 et seq.) is
redesignated as title VIII and the title heading is amended to read
as follows:
`TITLE VIII--MISCELLANEOUS'
(b) REDESIGNATION OF SECTIONS- Sections 701 through 720 of the Act (25
U.S.C. 1671 et seq.) are hereby redesignated as sections 801 through 820,
respectively.
(c) CONFORMING AMENDMENTS- The Act is amended--
(1) in section 207(a), by striking out `section 713' and inserting in lieu
thereof `section 813';
(2) in section 307(e), by striking out `section 713' and inserting in lieu
thereof `section 813'; and
(3) in section 405(b)--
(A) in paragraph (1), by striking out `sections 402(c) and 713(b)(2)(A)'
and inserting in lieu thereof `sections 402(a) and 813(b)(2)(A)'; and
(B) in paragraph (4), by striking out `section 402(c)' each place it
appears and inserting in lieu thereof `section 402(a)'.
(d) REFERENCES- Any reference in a provision of law other than the Indian
Health Care Improvement Act to sections redesignated by subsection (b)
shall be deemed to refer to the section as so redesignated.

4216037041b2b71713ebfc996c6cf9d9524f242869e54f91415a35ff5c0eae09

TITLE VII

-SUBSTANCE ABUSE PROGRAMS

366f664a498496e5a8dbfaca9bfcadc40c45a58044e1ec538c99c895816e7310

OF 1986 AMENDMENTS.
The Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986
(25 U.S.C. 2401 et seq.) is amended--
(1) in section 4206--
(A) in subsection (c)--
(i) in paragraph (2)--
(I) by striking `(2) the' and inserting `(B) the';
(II) by striking `(3) the' and inserting `(C) the';
(III) by striking `(4) the' and inserting `(D) the';
(IV) in subparagraph (D) (as redesignated by subclause (III)), by striking
`and' at the end;
(V) in subparagraph (E), by striking the period at the end and inserting
`, and'; and
(VI) by adding at the end the following new subparagraph:
`(F) an evaluation component to measure the success of efforts made.'; and
(ii) by adding at the end the following new paragraph:
`(3) All Tribal Action Plans shall be updated every 2 years.'; and
(B) in subsection (d), by amending paragraph (2) to read as follows:
`(2) There are authorized to be appropriated for grants under this
subsection not more than $2,000,000 for fiscal year 1993 and such sums as
are necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998,
1999, and 2000.'; and
(C) by adding at the end the following new subsection:
`(f)(1) The Secretary of the Interior may make grants to Indian tribes
adopting a resolution pursuant to subsection (a) to implement and develop
community and in-school training, education, and prevention programs on
alcohol and substance abuse, fetal alcohol syndrome and fetal alcohol effect.
`(2) Funds provided under this section may be used for, but are not limited
to, the development and implementation of tribal programs for--
`(A) youth employment;
`(B) youth recreation;
`(C) youth cultural activities;
`(D) community awareness programs; and
`(E) community training and education programs.
`(3) There are authorized to be appropriated to carry out the provisions
of this subsection $5,000,000 for fiscal year 1993 and such sums as are
necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999,
and 2000.';
(2) in section 4207(b), by amending paragraph (3) to read as follows:
`(3) The Assistant Secretary of the Interior for Indian Affairs shall
appoint such employees to work in the Office of Alcohol and Substance
Abuse, and shall provide such funding, services, and equipment as may be
necessary to enable the Office of Alcohol and Substance Abuse to carry
out its responsibilities.';
(3) in section 4210, by amending subsection (b) to read as follows:
`(b) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated
to carry out this section $500,000 for fiscal year 1993 and such sums
as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997,
1998, 1999, and 2000.';
(4) in section 4212(a), by striking out `1989, 1990, 1991, and 1992'
and inserting in lieu thereof `1993, 1994, 1995, 1996, 1997, 1998, 1999,
and 2000';
(5) in section 4213(e), by amending paragraphs (1) and (2) to read as
follows:
`(1) For the planning and design, construction, and renovation of,
or purchase or lease of land or facilities for, emergency shelters and
half-way houses to provide emergency care for Indian youth, there are
authorized to be appropriated $10,000,000 for fiscal year 1993 and such
sums as may be necessary for each of the fiscal years 1994, 1995, 1996,
1997, 1998, 1999, and 2000.
`(2) For the staffing and operation of emergency shelters and half-way
houses, there are authorized to be appropriated $5,000,000 for fiscal year
1993 and $7,000,000 for each of the fiscal years 1994, 1995, 1996, 1997,
1998, 1999, and 2000.';
(6) in section 4216(a)(1)--
(A) in subparagraph (A), by striking `and' at the end;
(B) in subparagraph (B), by striking the period at the end and inserting
`, and'; and
(C) by adding at the end the following new subparagraph:
`(C) the Makah Indian Tribe of Washington for the investigation and control
of illegal narcotic traffic on the Makah Indian Reservation arising from
its proximity to international waters.';
(7) by amending section 4216(a)(3) to read as follows:
`(3) For the purpose of providing the assistance required by this subsection,
there are authorized to be appropriated--
`(A) $500,000 under paragraph (1)(A) for fiscal year 1993 and such sums
as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997,
1998, 1999, and 2000,
`(B) $500,000 under paragraph (1)(B) for fiscal year 1993 and such sums
as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997,
1998, 1999, and 2000, and
`(C) $500,000 under paragraph (1)(C) for fiscal year 1993 and such sums
as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997,
1998, 1999, and 2000.';
(8) by amending section 4216(b) to read as follows:
`(b)(1) MARIJUANA ERADICATION AND INTERDICTION- The Secretary of the
Interior, in cooperation with appropriate Federal, tribal, and State and
local law enforcement agencies, shall establish and implement a program for
the eradication of marijuana cultivation, and interdiction, investigation,
and control of illegal narcotics trafficking within Indian country as
defined in section 1152 of title 18, United States Code. The Secretary shall
establish a priority for the use of funds appropriated under paragraph
(2) for those Indian reservations where the scope of the problem is most
critical, and such funds shall be available for contracting by Indian tribes
pursuant to the Indian Self-Determination Act (25 U.S.C. 450f et seq.).
`(2) For the purpose of establishing the program required by paragraph
(1), there are authorized to be appropriated $2,000,000 for fiscal year
1993 and such sums as may be necessary for each of the fiscal years 1994,
1995, 1996, 1997, 1998, 1999, and 2000.';
(9) in section 4218, by amending subsection (b) to read as follows:
`(b) AUTHORIZATION- For the purposes of providing the training required
by subsection (a), there are authorized to be appropriated $2,000,000 for
fiscal year 1993 and such sums as may be necessary for each of the fiscal
years 1994, 1995, 1996, 1997, 1998, 1999 and 2000.'; and
(10) in section 4220(b), by amending paragraphs (1) and (2) to read
as follows:
`(1) For the purpose of constructing or renovating juvenile detention centers
as provided in subsection (a), there are authorized to be appropriated
$10,000,000 for fiscal year 1993 and such sums as may be necessary for
each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.
`(2) For the purpose of staffing and operating juvenile detention centers,
there are authorized to be appropriated $7,000,000 for fiscal year 1993
and such sums as may be necessary for each of the fiscal years 1994, 1995,
1996, 1997, 1998, 1999, and 2000.'.

39bedd4b02322009ef813a7fbc257829bdf1f9018776c18b235c905befbf3858

Section 801 of the Act (25 U.S.C. 1671) (as redesignated by section 701(b)
of this Act) is amended to read as follows:
`REPORTS
`SEC. 801. The President shall, at the time the budget is submitted under
section 1105 of title 31, United States Code, for each fiscal year transmit
to the Congress a report containing--
`(1) a report on the progress made in meeting the objectives of this Act,
including a review of programs established or assisted pursuant to this Act
and an assessment and recommendations of additional programs or additional
assistance necessary to, at a minimum, provide health services to Indians,
and ensure a health status for Indians, which are at a parity with the health
services available to and the health status of, the general population;
`(2) a report on whether, and to what extent, new national health care
programs, benefits, initiatives, or financing systems have had an impact
on the purposes of this Act and any steps that the Secretary may have
taken to consult with Indian tribes to address such impact;
`(3) a report on the use of health services by Indians--
`(A) on a national and area or other relevant geographical basis;
`(B) by gender and age;
`(C) by source of payment and type of service; and
`(D) comparing such rates of use with rates of use among comparable
non-Indian populations.
`(4) a separate statement which specifies the amount of funds requested
to carry out the provisions of section 201;
`(5) a separate statement of the total amount obligated or expended in
the most recently completed fiscal year to achieve each of the objectives
described in section 814, relating to infant and maternal mortality and
fetal alcohol syndrome;
`(6) the reports required by sections 3(d), 108(n), 203(b), 209(j), 301(c),
302(g), 305(a)(3), 403, 708(e), and 817(a), and 822(f);
`(7) for fiscal year 1995, the report required by sections 702(c)(3)
and 713(b);
`(8) for fiscal year 1997, the interim report required by section 307(h)(1);
and
`(9) for fiscal year 1999, the reports required by sections 307(h)(2),
512(b), 711(f), and 821(g).'.

8a6e43ca335383f921964f77e7a11f9445cc887881bf76085b1b7ecb731bf4e3

TITLE VIII

-MISCELLANEOUS

Section 802 of the Act (25 U.S.C. 1672) (as redesignated by section 701(b)
of this Act) is amended to read as follows:
`REGULATIONS
`SEC. 802. Prior to any revision of or amendment to rules or regulations
promulgated pursuant to this Act, the Secretary shall consult with Indian
tribes and appropriate national or regional Indian organizations and shall
publish any proposed revision or amendment in the Federal Register not less
than sixty days prior to the effective date of such revision or amendment
in order to provide adequate notice to, and receive comments from, other
interested parties.'.

257e49045646928f5dce3ecfb7f55835737ddc52bc40428086209e317f5580f6

DELIVERY AREA.
Section 808 of the Act (25 U.S.C. 1678) (as redesignated by section 701(b)
of this Act) is amended by striking out `1991' and inserting in lieu thereof
`2000'.

2561ec3802927a06e690220387479402e218cda5023b915bf7b4aa668dc057b3

Section 814 of the Act (25 U.S.C. 1680d) (as redesignated by section 701(b)
of this Act) is amended--
(1) by striking out `(a)'; and
(2) by striking out subsection (b).

7a094b8f45cffeffe0e3f1640fe1124528d410d3015db20e617da9780e7d59e7

Section 817(a) of the Act (25 U.S.C. 1680(g)) (as redesignated by section
701(b) of this Act) is amended by striking out `Secretary has submitted
to the Congress' and inserting in lieu thereof the following: `Secretary
has submitted to the President, for inclusion in the report required to
be transmitted to the Congress under section 801,'.

5cd3ed8606e521bec2a9a01a489ebd632449aebf8f5c742a45a11f67271a5709

Section 819 of the Act (25 U.S.C. 1680i) (as redesignated by section 701(b)
of this Act) is amended to read as follows:
`CHILD SEXUAL ABUSE TREATMENT PROGRAMS
`SEC. 819. (a) The Secretary and the Secretary of the Interior shall,
for each fiscal year through fiscal year 1995, continue the demonstration
programs involving treatment for child sexual abuse provided through the
Hopi Tribe and the Assiniboine and Sioux Tribes of the Fort Peck Reservation.
`(b) Beginning October 1, 1995, the Secretary and the Secretary of the
Interior may establish, in any service area, demonstration programs
involving treatment for child sexual abuse, except that the Secretaries
may not establish a greater number of such programs in one service area
than in any other service area until there is an equal number of such
programs established with respect to all service areas  from which the
Secretary receives qualified applications during the application period
(as determined by the Secretary).'.

e924ae3a5bddb1a0e19d98b283b6d0213d41d0af01a2fdf2e425ec383877e22d

Section 820 of the Act (25 U.S.C. 1680j) (as redesignated by section 701(b)
of this Act) is amended to read as follows:
`TRIBAL LEASING
`SEC. 820. Indian tribes providing health care services pursuant to a
contract entered into under the Indian Self-Determination Act may lease
permanent structures for the purpose of providing such health care services
without obtaining advance approval in appropriation Acts.'.

c91ccfaa0e55ec552f8c64d5801399f38231b116792d07911eb2552ec24be60c

JOINT VENTURE PROJECTS.
Section 818 of the Act (25 U.S.C. 1680h) (as redesignated by section 701(b)
of this Act) is amended--
(1) in subsection (d)--
(A) in paragraph (1), by inserting before the period at the end the
following: `, or, in the case of a demonstration project for which a grant
is made after September 30, 1990, three years after the date on which such
grant is made'; and
(B) in paragraph (2), by striking `1994' and inserting `1996'; and
(2) by amending subsection (e) to read as follows:
`(e)(1) The Secretary, acting through the Service, shall make arrangements
with Indian tribes to establish joint venture demonstration projects under
which an Indian tribe shall expend tribal, private, or other available
nontribal funds, for the acquisition or construction of a health facility
for a minimum of 20 years, under a no-cost lease, in exchange for agreement
by the Service to provide the equipment, supplies, and staffing for the
operation and maintenance of such a health facility. A tribe may utilize
tribal funds, private sector, or other available resources, including loan
guarantees, to fulfill its commitment under this subsection.
`(2) The Secretary shall make such an arrangement with an Indian tribe
only if the Secretary first determines that the Indian tribe has the
administrative and financial capabilities necessary to complete the timely
acquisition or construction of the health facility described in paragraph
(1).
`(3) An Indian tribe or tribal organization that has entered into a written
agreement with the Secretary under this subsection, and that breaches or
terminates without cause such agreement, shall be liable to the United
States for the amount that has been paid to the tribe, or paid to a third
party on the tribe's behalf, under the agreement. The Secretary has the
right to recover tangible property (including supplies), and equipment,
less depreciation, and any funds expended for operations and maintenance
under this section. The preceding sentence does not apply to any funds
expended for the delivery of health care services, or for personnel or
staffing, shall be recoverable.'.

f32bd851a36bd57148e069d959504591dcccaeadc5868c261d8d2b334cf776ba

Title VIII of the Act (as redesignated by subsections (a) and (b) of section
701 of this Act) is amended by adding at the end the following new section:
`HOME- AND COMMUNITY-BASED CARE DEMONSTRATION PROJECT
`SEC. 821. (a) The Secretary, acting through the Service, is authorized
to enter into contracts with, or make grants to, Indian tribes or tribal
organizations providing health care services pursuant to a contract entered
into under the Indian Self-Determination Act, to establish demonstration
projects for the delivery of home- and community-based services to
functionally disabled Indians.
`(b)(1) Funds provided for a demonstration project under this section
shall be used only for the delivery of home- and community-based services
(including transportation services) to functionally disabled Indians.
`(2) Such funds may not be used--
`(A) to make cash payments to functionally disabled Indians;
`(B) to provide room and board for functionally disabled Indians;
`(C) for the construction or renovation of facilities or the purchase of
medical equipment; or
`(D) for the provision of nursing facility services.
`(c) Not later than 180 days after the date of the enactment of this
section, the Secretary, after consultation with Indian tribes and tribal
organizations, shall develop and issue criteria for the approval of
applications submitted under this section. Such criteria shall ensure
that demonstration projects established under this section promote the
development of the capacity of tribes and tribal organizations to deliver,
or arrange for the delivery of, high quality, culturally appropriate home-
and community-based services to functionally disabled Indians;
`(d) The Secretary shall provide such technical and other assistance as
may be necessary to enable applicants to comply with the provisions of
this section.
`(e) At the discretion of the tribe or tribal organization, services
provided under a demonstration project established under this section
may be provided (on a cost basis) to persons otherwise ineligible for the
health care benefits of the Service.
`(f) The Secretary shall establish not more than 24 demonstration projects
under this section. The Secretary may not establish a greater number of
demonstration projects under this section in one service area than in any
other service area until there is an equal number of such demonstration
projects established with respect to all service areas from which the
Secretary receives applications during the application period (as determined
by the Secretary) which meet the criteria issued pursuant to subsection (c).
`(g) The Secretary shall submit to the President, for inclusion in the
report which is required to be submitted under section 801 for fiscal
year 1999, a report on the findings and conclusions derived from the
demonstration projects conducted under this section, together with
legislative recommendations.
`(h) For the purposes of this section, the following definitions shall apply:
`(1) The term `home- and community-based services' means one or more of
the following:
`(A) Homemaker/home health aide services.
`(B) Chore services.
`(C) Personal care services.
`(D) Nursing care services provided outside of a nursing facility by,
or under the supervision of, a registered nurse.
`(E) Respite care.
`(F) Training for family members in managing a functionally disabled
individual.
`(G) Adult day care.
`(H) Such other home- and community-based services as the Secretary may
approve.
`(2) The term `functionally disabled' means an individual who is determined
to require home- and community-based services based on an assessment
that uses criteria (including, at the discretion of the tribe or tribal
organization, activities of daily living) developed by the tribe or tribal
organization.
`(i) There are authorized to be appropriated for each of the fiscal years
1993, 1994, 1995, 1996, and 1997 such sums as may be necessary to carry
out this section. Such sums shall remain available until expended.'.

54d85a96945742ebb57d8caea8eaf5a9bc98c09e8370c8fbceed5163b2470817

Title VIII of the Act (as redesignated by subsections (a) and (b) of
section 701 and amended by section 809 of this Act) is amended by adding
at the end the following new section:
`SHARED SERVICES DEMONSTRATION PROJECT
`SEC. 822. (a) The Secretary, acting through the Service and notwithstanding
any other provision of law, is authorized to enter into contracts with Indian
tribes or tribal organizations to establish not more than 6 shared services
demonstration projects for the delivery of long-term care to Indians. Such
projects shall provide for the sharing of staff or other services between
a Service facility and a nursing facility owned and operated (directly or
by contract) by such Indian tribe or tribal organization.
`(b) A contract entered into pursuant to subsection (a)--
`(1) may, at the request of the Indian tribe or tribal organization,
delegate to such tribe or tribal organization such powers of supervision
and control over Service employees as the Secretary deems necessary to
carry out the purposes of this section;
`(2) shall provide that expenses (including salaries) relating to services
that are shared between the Service facility and the tribal facility be
allocated proportionately between the Service and the tribe or tribal
organization; and
`(3) may authorize such tribe or tribal organization to construct, renovate,
or expand a nursing facility (including the construction of a facility
attached to a Service facility), except that no funds appropriated for
the Service shall be obligated or expended for such purpose.
`(c) To be eligible for a contract under this section, a tribe or tribal
organization, shall, as of the date of the enactment of this Act--
`(1) own and operate (directly or by contract) a nursing facility;
`(2) have entered into an agreement with a consultant to develop a plan
for meeting the long-term needs of the tribe or tribal organization; or
`(3) have adopted a tribal resolution providing for the construction of
a nursing facility.
`(d) Any nursing facility for which a contract is entered into under this
section shall meet the requirements for nursing facilities under section
1919 of the Social Security Act.
`(e) The Secretary shall provide such technical and other assistance as
may be necessary to enable applicants to comply with the provisions of
this section.
`(f) The Secretary shall submit to the President, for inclusion in each
report required to be transmitted to the Congress under section 801,
a report on the findings and conclusions derived from the demonstration
projects conducted under this section.'.

029a3ec6044797b04001bee4e96483f1551c3eb87c12e6fa4421258b10fac8ed

Title VIII of the Act (as redesignated by subsections (a) and (b) of
section 701 and amended by section 810 of this Act) is amended by adding
at the end the following new section:
`RESULTS OF DEMONSTRATION PROJECTS
`SEC. 823. The Secretary shall provide for the dissemination to Indian
tribes of the findings and results of demonstration projects conducted
under this Act.'.

cbd6afb850943d2cb5089208e003a9618151c86cdd5f34012f107619db4c6421

Title VIII of the Act (as redesignated by subsections (a) and (b) of
section 701 and amended by section 811 of this Act) is amended by adding
at the end the following new section:
`PRIORITY FOR INDIAN RESERVATIONS
`SEC. 824. (a) Beginning on the date of the enactment of this section,
the Bureau of Indian Affairs and the Service shall, in all matters
involving the reorganization or development of Service facilities, or in
the establishment of related employment projects to address unemployment
conditions in economically depressed areas, give priority to locating such
facilities and projects on Indian lands if requested by the Indian tribe
with jurisdiction over such lands.
`(b) For purposes of this section, the term `Indian lands' means--
`(1) all lands within the limits of any Indian reservation; and
`(2) any lands title which is held in trust by the United States for the
benefit of any Indian tribe or individual Indian, or held by any Indian tribe
or individual Indian subject to restriction by the United States against
alienation and over which an Indian tribe exercises governmental power.'.

6ab24ac958114bc9c943634cdd09af9687a903334890b68695f0d978f92f6302

(a) AUTHORIZATION- Title VIII of the Act (as redesignated by subsections
(a) and (b) of section 701 and amended by section 812 of this Act) is
amended by adding at the end the following new section:
`AUTHORIZATION OF APPROPRIATIONS
`SEC. 825. Except as provided in section 821, there are authorized to be
appropriated such sums as may be necessary for each fiscal year through
fiscal year 2000 to carry out this title.'.
(b) CONFORMING AMENDMENTS- Section 807 of the Act (25 U.S.C. 1677)
(as redesignated by subsections (a) and (b) of section 701 of this Act)
is amended by striking out subsection (f).

c12bad90e220e0c289f5f5b9f4f798874e7a730e9ff239c54629ccb2e83be0f3

The Indian Self-Determination and Education Assistance Act (25 U.S.C. 450f
note) is amended--
(1) in section 301, by inserting after `Interior' the following: `and the
Secretary of Health and Human Services (hereafter in this title referred
to as the `Secretaries') each';
(2) in sections 302, 303, 304, and 305, by striking `Secretary' each place
it appears and inserting in lieu thereof `Secretaries';
(3) in section 303(a)(1), by inserting after `Interior' the following:
`and the Indian Health Service of the Department of Health and Human
Services'; and
(4) by adding after section 309 the following new section:
`SEC. 310. For the purposes of providing one year planning and negotiations
grants to the Indian tribes identified by section 302, with respect to the
programs, activities, functions, or services of the Indian Health Service,
there are authorized to be appropriated such sums as may be necessary to
carry out such purposes. Upon completion of an authorized planning activity
or a comparable planning activity by a tribe, the Secretary is authorized
to negotiate and implement a Compact of Self-Governance and Annual Funding
Agreement with such tribe.'.

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The Act is amended--
(1) in section 116, by striking out subsection (d);
(2) in section 204(a)--
(A) by striking out paragraph (2);
(B) by striking out `(a)(1)' and inserting in lieu thereof `(a)';
(C) by redesignating subparagraphs (A) and (B) as paragraphs (1) and (2),
respectively; and
(D) in paragraph (2) (as redesignated by subparagraph (C)), by striking out
`subparagraph (A)' and inserting in lieu thereof `paragraph (1)';
(3) in section 602, by striking out subsection (a)(3); and
(4) by striking out section 803 (as redesignated by section 701(b) of
this Act).

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TITLE IX

-TECHNICAL CORRECTIONS

The Act is amended--
(1) in section 4(c), by striking out `sections 102, 103, and 201(c)(5),'
and inserting in lieu thereof the following: `sections 102 and 103,';
(2) in title I--
(A) in section 102(b)(1), by striking `: Provided, That the' and inserting
in lieu thereof `. The';
(B) in section 105(c), by striking out `Department of Health, Education,
and Welfare' and inserting in lieu thereof `Department of Health and
Human Services';
(C) in section 108(d)(1)(A), by striking out `Indian Health' and inserting
in lieu thereof `Indian health'; and
(D) in section 108(i), by striking out `Service manpower programs' and
inserting in lieu thereof `health professional programs of the Service'.
(3) in title II--
(A) by striking out `sec. 209. mental health prevention and treatment
services.' and inserting in lieu thereof the following:
`MENTAL HEALTH PREVENTION AND TREATMENT SERVICES
`SEC. 209.'; and
(B) in section 209, by redesignating subsections (c) through (l) as
subsections (b) through (k), respectively;
(4) in title III--
(A) by striking out `sec. 307. indian health care delivery demonstration
project.' and inserting in lieu thereof the following:
`INDIAN HEALTH CARE DELIVERY DEMONSTRATION PROJECT
`SEC. 307.'; and
(B) in section 301(d) (as redesignated by section 301(2) of this Act),
by striking out `sections 102 and 103(b)' and inserting in lieu thereof
`section 102';
(5) in title V--
(A) by striking out `sec. 409. facilities renovation.' and inserting in
lieu thereof the following:
`FACILITIES RENOVATION
`SEC. 509.'; and
(B) by striking out `sec. 511. urban health programs branch.' and inserting
in lieu thereof the following:
`URBAN HEALTH PROGRAMS BRANCH
`SEC. 510.';
(6) in section 601(c)(3)(D), by striking out `(25 U.S.C. 2005, et seq.)' and
inserting in lieu thereof `(42 U.S.C. 2005 et seq.)';
(7) in section 601(d)(1)(C), by striking out `appropriate' and inserting
in lieu thereof `appropriated';
(8) in section 813(b)(2)(A) (as redesignated by section 701(b) of this
Act), by striking out `section 402(c)' and inserting in lieu thereof
`section 402(a)'; and
(9) by amending the heading for section 816 (as redesignated by section
701(b)) to read as follows:
`INDIAN HEALTH SERVICE AND DEPARTMENT OF VETERANS AFFAIRS HEALTH FACILITIES
AND SERVICES SHARING'.
Attest:
Clerk.
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Indian Health Care Amendments Act of 1992 — S. 2481

Other Sections