,i #aaeth ,,congress #ast ,session ,h4 ,r4 #acfi ,,in ,,the ,,house ,,of ,,representatives ,march #f1 #bjag ,mr4 ,cole introduced the following bill2 which was referred to the ,committee on ,natural ,resources1 and in addition to the ,committees on ,energy and ,commerce1 ,ways and ,means1 and the ,budget1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend the ,indian ,health ,care ,improvement ,act to revise and extend that ,act1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,indian ,healthcare ,improvement ,act of #bjag4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,title ,i--,indian ,health ,care ,improvement ,act reauthorization and amendments ,sec4 #aja4 ,reauthorization4 ,sec4 #ajb4 ,findings4 ,sec4 #ajc4 ,declaration of national ,indian health policy4 ,sec4 #ajd4 ,definitions4 ,subtitle ,a--,indian health manpower ,sec4 #aaa4 ,community ,health ,aide ,program4 ,sec4 #aab4 ,health professional chronic shortage demonstration programs4 ,sec4 #aac4 ,exemption from payment of certain fees4 ,subtitle ,b--,health services ,sec4 #aba4 ,indian ,health ,care ,improvement ,fund4 ,sec4 #abb4 ,catastrophic ,health ,emergency ,fund4 ,sec4 #abc4 ,diabetes prevention1 treatment1 and control4 ,sec4 #abd4 ,other authority for provision of services2 shared services for long-term care4 ,sec4 #abe4 ,reimbursement from certain third parties of costs of health services4 ,sec4 #abf4 ,crediting of reimbursements4 ,sec4 #abg4 ,behavioral health training and community education programs4 ,sec4 #abh4 ,cancer screenings4 ,sec4 #abi4 ,patient travel costs4 ,sec4 #acj4 ,epidemiology centers4 ,sec4 #aca4 ,indian youth grant program4 ,sec4 #acb4 ,american ,indians ,into ,psychology ,program4 ,sec4 #acc4 ,prevention1 control1 and elimination of communicable and infectious diseases4 ,sec4 #acd4 ,methods to increase clinician recruitment and retention issues4 ,sec4 #ace4 ,liability for payment4 ,sec4 #acf4 ,offices of ,indian ,men's ,health and ,indian ,women's ,health4 ,sec4 #acg4 ,contract health service administration and disbursement formula4 ,subtitle ,c--,health facilities ,sec4 #ada4 ,health care facility priority system4 ,sec4 #adb4 ,priority of certain projects protected4 ,sec4 #adc4 ,indian health care delivery demonstration projects4 ,sec4 #add4 ,tribal management of federally owned quarters4 ,sec4 #ade4 ,other funding1 equipment1 and supplies for facilities4 ,sec4 #adf4 ,indian country modular component facilities demonstration program4 ,sec4 #adg4 ,mobile health stations demonstration program4 ,subtitle ,d--,access to health services ,sec4 #aea4 ,treatment of payments under ,social ,security ,act health benefits programs4 ,sec4 #aeb4 ,purchasing health care coverage4 ,sec4 #aec4 ,grants to and contracts with the ,service1 ,indian tribes1 tribal organizations1 and urban ,indian organizations to facilitate outreach1 enrollment1 and coverage of ,indians under ,social ,security ,act health benefit programs and other health benefits programs4 ,sec4 #aed4 ,sharing arrangements with ,federal agencies4 ,sec4 #aee4 ,eligible ,indian veteran services4 ,sec4 #aef4 ,nondiscrimination under ,federal health care programs in qualifications for reimbursement for services4 ,sec4 #aeg4 ,access to ,federal insurance4 ,sec4 #aeh4 ,general exceptions4 ,sec4 #aei4 ,navajo ,nation ,medicaid ,agency feasibility study4 ,subtitle ,e--,health services for urban ,indians ,sec4 #afa4 ,facilities renovation4 ,sec4 #afb4 ,treatment of certain demonstration projects4 ,sec4 #afc4 ,requirement to confer with urban ,indian organizations4 ,sec4 #afd4 ,expanded program authority for urban ,indian organizations4 ,sec4 #afe4 ,community health representatives4 ,sec4 #aff4 ,use of ,federal ,government facilities and sources of supply2 health information technology4 ,subtitle ,f--,organizational improvements ,sec4 #aga4 ,establishment of the ,indian ,health ,service as an agency of the ,public ,health ,service4 ,sec4 #agb4 ,office of ,direct ,service ,tribes4 ,sec4 #agc4 ,nevada area office4 ,subtitle ,g--,behavioral health programs ,sec4 #aha4 ,behavioral health programs4 ,subtitle ,h--,miscellaneous ,sec4 #aia4 ,confidentiality of medical quality assurance records2 qualified immunity for participants4 ,sec4 #aib4 ,limitation on use of funds appropraited to the ,indian ,health ,service4 ,sec4 #aic4 ,arizona1 ,north ,dakota1 and ,south ,dakota as contract health service delivery areas2 eligibility of ,california ,indians4 ,sec4 #aid4 ,methods to increase access to professionals of certain corps4 ,sec4 #aie4 ,health services for ineligible persons4 ,sec4 #aif4 ,annual budget submission4 ,sec4 #aig4 ,prescription drug monitoring4 ,sec4 #aih4 ,tribal health program option for cost sharing4 ,sec4 #aii4 ,disease and injury prevention report4 ,sec4 #bjj4 ,other ,,gao reports4 ,sec4 #bja4 ,traditional health care practices4 ,sec4 #bjb4 ,director of ,,hiv_/,,aids ,prevention and ,treatment4 ,title ,,ii--,amendments to other ,acts and miscellaneous provisions ,sec4 #bja4 ,elimination of sunset for reimbursement for all ,medicare part ,b services furnished by certain indian hospitals and clinics4 ,sec4 #bjb4 ,including costs incurred by aids drug assistance programs and indian health service in providing prescription drugs toward the annual out-of-pocket threshold under part ,d4 ,sec4 #bjc4 ,prohibition of use of ,federal funds for abortion4 ,sec4 #bjd4 ,reauthorization of ,native ,hawaiian health care programs4 ,i ,indian ,health ,care ,improvement ,act reauthorization and amendments #aja4 ,reauthorization 7a7 ,in general ,section #hbe of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afhjo7 is amended to read as follows3 #hbe4 ,authorization of appropriations ,there are authorized to be appropriated such sums as are necessary to carry out this ,act for fiscal year #bjag and each fiscal year thereafter1 to remain available until expended4 4 7b7 ,repeals ,the following provisions of the ,indian ,health ,care ,improvement ,act are repealed3 7#a7 ,section #abc 7#be ,u4,s4,c4 #afafp74 7#b7 ,paragraph 7#f7 of section #bji7m7 7#be ,u4,s4,c4 #afba;h7m774 7#c7 ,subsection 7g7 of section #baa 7#be ,u4,s4,c4 #afba;j74 7#d7 ,subsection 7e7 of section #baf 7#be ,u4,s4,c4 #afbao74 7#e7 ,section #bbd 7#be ,u4,s4,c4 #afbaw74 7#f7 ,section #cji 7#be ,u4,s4,c4 #afch;a74 7#g7 ,section #djg 7#be ,u4,s4,c4 #afdg74 7#h7 ,subsection 7c7 of section #eab 7#be ,u4,s4,c4 #affj;b74 7#i7 ,section #ead 7#be ,u4,s4,c4 #affj;d74 7#aj7 ,section #fjc 7#be ,u4,s4,c4 #affc74 7#aa7 ,section #hje 7#be ,u4,s4,c4 #afge74 7c7 ,conforming amendments 7#a7 ,section #bjd7;c77#a7 of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afba;c7c77#a77 is amended by striking through fiscal year #bjjj4 7#b7 ,section #bac of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afbal7 is amended by striking 7a7 ,the ,secretary and inserting ,the ,secretary4 7#c7 ,section #caj of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afch;b7 is amended by striking funds provided pursuant to the authorization contained in section #cji each place it appears and inserting funds made available to carry out this title4 #ajb4 ,findings ,section #b of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afja7 is amended-- 7#a7 by redesignating subsections 7a71 7b71 7c71 and 7d7 as paragraphs 7#a71 7#c71 7#d71 and 7#e71 respectively1 and indenting the paragraphs appropriately2 and 7#b7 by inserting after paragraph 7#a7 7as so redesignated7 the following3 7#b7 ,a major national goal of the ,united ,states is to provide the resources1 processes1 and structure that will enable ,indian tribes and tribal members to obtain the quantity and quality of health care services and opportunities that will eradicate the health disparities between ,indians and the general population of the ,united ,states4 4 #ajc4 ,declaration of national ,indian health policy ,section #c of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjb7 is amended to read as follows3 #c4 ,declaration of national ,indian health policy ,congress declares that it is the policy of this ,nation1 in fulfillment of its special trust responsibilities and legal obligations to ,indians-- 7#a7 to ensure the highest possible health status for ,indians and urban ,indians and to provide all resources necessary to effect that policy2 7#b7 to raise the health status of ,indians and urban ,indians to at least the levels set forth in the goals contained within the ,healthy ,people #bjaj initiative or successor objectives2 7#c7 to ensure maximum ,indian participation in the direction of health care services so as to render the persons administering such services and the services themselves more responsive to the needs and desires of ,indian communities2 7#d7 to increase the proportion of all degrees in the health professions and allied and associated health professions awarded to ,indians so that the proportion of ,indian health professionals in each ,service area is raised to at least the level of that of the general population2 7#e7 to require that all actions under this ,act shall be carried out with active and meaningful consultation with ,indian tribes and tribal organizations1 and conference with urban ,indian organizations1 to implement this ,act and the national policy of ,indian self-determination2 7#f7 to ensure that the ,united ,states and ,indian tribes work in a government-to-government relationship to ensure quality health care for all tribal members2 and 7#g7 to provide funding for programs and facilities operated by ,indian tribes and tribal organizations in amounts that are not less than the amounts provided to programs and facilities operated directly by the ,service4 4 #ajd4 ,definitions ,section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc7 is amended-- 7#a7 by striking the matter preceding subsection 7a7 and inserting ,in this ,act32 7#b7 in each of subsections 7c71 7j71 7k71 and 7l71 by redesignating the paragraphs contained in the subsections as subparagraphs and indenting the subparagraphs appropriately2 7#c7 by redesignating subsections 7a7 through 7q7 as paragraphs 7#ag71 7#ah71 7#ac71 7#ad71 7#bf71 7#bh71 7#bg71 7#bi71 7#a71 7#bj71 7#aa71 7#g71 7#ai71 7#aj71 7#ba71 7#h71 and 7#i71 respectively1 indenting the paragraphs appropriately1 and moving the paragraphs so as to appear in numerical order2 7#d7 in each paragraph 7as so redesignated71 by inserting a heading the text of which is comprised of the term defined in the paragraph2 7#e7 by inserting ,the term after each paragraph heading2 7#f7 by inserting after paragraph 7#a7 7as redesignated by paragraph 7#c77 the following3 7#b7 ,behavioral health 7,a7 ,in general ,the term behavioral health means the blending of substance 7alcohol1 drugs1 inhalants1 and tobacco7 abuse and mental health disorders prevention and treatment for the purpose of providing comprehensive services4 7,b7 ,inclusions ,the term behavioral health includes the joint development of substance abuse and mental health treatment planning and coordinated case management using a multidisciplinary approach4 7#c7 ,california ,indian ,the term ,california ,indian means any ,indian who is eligible for health services provided by the ,service pursuant to section #hji4 7#d7 ,community college ,the term community college means-- 7,a7 a tribal college or university2 or 7,b7 a junior or community college4 7#e7 ,contract health service ,the term contract health service means any health service that is-- 7,a7 delivered based on a referral by1 or at the expense of1 an ,indian health program2 and 7,b7 provided by a public or private medical provider or hospital that is not a provider or hospital of the ,indian health program4 7#f7 ,department ,the term ,department1 unless otherwise designated1 means the ,department of ,health and ,human ,services4 2 7#g7 by striking paragraph 7#g7 7as redesignated by paragraph 7#c77 and inserting the following3 7#g7 ,disease prevention 7,a7 ,in general ,the term disease prevention means any activity for-- 7i7 the reduction1 limitation1 and prevention of-- 7,i7 disease2 and 7,,ii7 complications of disease2 and 7ii7 the reduction of consequences of disease4 7,b7 ,inclusions ,the term disease prevention includes an activity for-- 7i7 controlling-- 7,i7 the development of diabetes2 7,,ii7 high blood pressure2 7,,iii7 infectious agents2 7,,iv7 injuries2 7,v7 occupational hazards and disabilities2 7,,vi7 sexually transmittable diseases2 or 7,,vii7 toxic agents2 or 7ii7 providing-- 7,i7 fluoridation of water2 or 7,,ii7 immunizations4 2 7#h7 by striking paragraph 7#i7 7as redesignated by paragraph 7#c77 and inserting the following3 7#i7 ,,fas ,the term fetal alcohol syndrome or ,,fas means a syndrome in which1 with a history of maternal alcohol consumption during pregnancy1 the following criteria are met3 7,a7 ,central nervous system involvement such as mental retardation1 developmental delay1 intellectual deficit1 microencephaly1 or neurologic abnormalities4 7,b7 ,craniofacial abnormalities with at least #b of the following3 microophthalmia1 short palpebral fissures1 poorly developed philtrum1 thin upper lip1 flat nasal bridge1 and short upturned nose4 7,c7 ,prenatal or postnatal growth delay4 2 7#i7 by striking paragraphs 7#aa7 and 7#ab7 7as redesignated by paragraph 7#c77 and inserting the following3 7#aa7 ,health promotion ,the term health promotion means any activity for-- 7,a7 fostering social1 economic1 environmental1 and personal factors conducive to health1 including raising public awareness regarding health matters and enabling individuals to cope with health problems by increasing knowledge and providing valid information2 7,b7 encouraging adequate and appropriate diet1 exercise1 and sleep2 7,c7 promoting education and work in accordance with physical and mental capacity2 7,d7 making available safe water and sanitary facilities2 7,e7 improving the physical1 economic1 cultural1 psychological1 and social environment2 7,f7 promoting culturally competent care2 and 7,g7 providing adequate and appropriate programs1 including programs for-- 7i7 abuse prevention 7mental and physical72 7ii7 community health2 7iii7 community safety2 7iv7 consumer health education2 7v7 diet and nutrition2 7vi7 immunization and other methods of prevention of communicable diseases1 including ,,hiv_/,,aids2 7vii7 environmental health2 7viii7 exercise and physical fitness2 7ix7 avoidance of fetal alcohol spectrum disorders2 7x7 first aid and ,,cpr education2 7xi7 human growth and development2 7xii7 injury prevention and personal safety2 7xiii7 behavioral health2 7xiv7 monitoring of disease indicators between health care provider visits through appropriate means1 including ,internet-based health care management systems2 7xv7 personal health and wellness practices2 7xvi7 personal capacity building2 7xvii7 prenatal1 pregnancy1 and infant care2 7xviii7 psychological well-being2 7xix7 reproductive health and family planning2 7xx7 safe and adequate water2 7xxi7 healthy work environments2 7xxii7 elimination1 reduction1 and prevention of contaminants that create unhealthy household conditions 7including mold and other allergens72 7xxiii7 stress control2 7xxiv7 substance abuse2 7xxv7 sanitary facilities2 7xxvi7 sudden infant death syndrome prevention2 7xxvii7 tobacco use cessation and reduction2 7xxviii7 violence prevention2 and 7xxix7 such other activities identified by the ,service1 a tribal health program1 or an urban ,indian organization to promote achievement of any of the objectives referred to in section #c7b74 7#ab7 ,indian health program ,the term ,indian health program means-- 7,a7 any health program administered directly by the ,service2 7,b7 any tribal health program2 and 7,c7 any ,indian tribe or tribal organization to which the ,secretary provides funding pursuant to section #bc of the ,act of ,june #be1 #aiaj 7#be ,u4,s4,c4 #dg7 7commonly known as the ,buy ,indian ,act74 2 7#aj7 by inserting after paragraph 7#ad7 7as redesignated by paragraph 7#c77 the following3 7#ae7 ,junior or community college ,the term junior or community college has the meaning given the term in section #cab7;e7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajeh7;e774 7#af7 ,reservation 7,a7 ,in general ,the term reservation means a reservation1 ,pueblo1 or colony of any ,indian tribe4 7,b7 ,inclusions ,the term reservation includes-- 7i7 former reservations in ,oklahoma2 7ii7 ,indian allotments2 and 7iii7 ,alaska ,native ,regions established pursuant to the ,alaska ,native ,claims ,settlement ,act 7#dc ,u4,s4,c4 #afja et seq474 2 7#aa7 by striking paragraph 7#bj7 7as redesignated by paragraph 7#c77 and inserting the following3 7#bj7 ,service unit ,the term ,service unit means an administrative entity of the ,service or a tribal health program through which services are provided1 directly or by contract1 to eligible ,indians within a defined geographic area4 2 7#ab7 by inserting after paragraph 7#ba7 7as redesignated by paragraph 7#c77 the following3 7#bb7 ,telehealth ,the term telehealth has the meaning given the term in section #ccj,k7a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;c-#af7;a774 7#bc7 ,telemedicine ,the term telemedicine means a telecommunications link to an end user through the use of eligible equipment that electronically links health professionals or patients and health professionals at separate sites in order to exchange health care information in audio1 video1 graphic1 or other format for the purpose of providing improved health care services4 7#bd7 ,tribal college or university ,the term tribal college or university has the meaning given the term in section #caf7;b7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajei;c7b774 7#be7 ,tribal health program ,the term tribal health program means an ,indian tribe or tribal organization that operates any health program1 service1 function1 activity1 or facility funded1 in whole or part1 by the ,service through1 or provided for in1 a contract or compact with the ,service under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq474 2 and 7#ac7 by striking paragraph 7#bf7 7as redesignated by paragraph 7#c77 and inserting the following3 7#bf7 ,tribal organization ,the term tribal organization has the meaning given the term in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej;b74 4 ,a ,indian health manpower #aaa4 ,community ,health ,aide ,program ,section #aai of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afafl7 is amended to read as follows3 #aai4 ,community ,health ,aide ,program 7a7 ,general purposes of program ,pursuant to the ,act of ,november #b1 #aiba 7#be ,u4,s4,c4 #ac7 7commonly known as the ,snyder ,act71 the ,secretary1 acting through the ,service1 shall develop and operate a ,community ,health ,aide ,program in the ,state of ,alaska under which the ,service-- 7#a7 provides for the training of ,alaska ,natives as health aides or community health practitioners2 7#b7 uses those aides or practitioners in the provision of health care1 health promotion1 and disease prevention services to ,alaska ,natives living in villages in rural ,alaska2 and 7#c7 provides for the establishment of teleconferencing capacity in health clinics located in or near those villages for use by community health aides or community health practitioners4 7b7 ,specific program requirements ,the ,secretary1 acting through the ,community ,health ,aide ,program of the ,service1 shall-- 7#a7 using trainers accredited by the ,program1 provide a high standard of training to community health aides and community health practitioners to ensure that those aides and practitioners provide quality health care1 health promotion1 and disease prevention services to the villages served by the ,program2 7#b7 in order to provide such training1 develop a curriculum that-- 7,a7 combines education regarding the theory of health care with supervised practical experience in the provision of health care2 7,b7 provides instruction and practical experience in the provision of acute care1 emergency care1 health promotion1 disease prevention1 and the efficient and effective management of clinic pharmacies1 supplies1 equipment1 and facilities2 and 7,c7 promotes the achievement of the health status objectives specified in section #c7b72 7#c7 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 7#a7 or can demonstrate equivalent experience2 7#d7 develop and maintain a system that identifies the needs of community health aides and community health practitioners for continuing education in the provision of health care1 including the areas described in paragraph 7#b77;,b71 and develop programs that meet the needs for such continuing education2 7#e7 develop and maintain a system that provides close supervision of community health aides and community health practitioners2 7#f7 develop a system under which the work of community health aides and community health practitioners is reviewed and evaluated to ensure the provision of quality health care1 health promotion1 and disease prevention services2 and 7#g7 ensure that-- 7,a7 pulpal therapy 7not including pulpotomies on deciduous teeth7 or extraction of adult teeth can be performed by a dental health aide therapist only after consultation with a licensed dentist who determines that the procedure is a medical emergency that cannot be resolved with palliative treatment2 and 7,b7 dental health aide therapists are strictly prohibited from performing all other oral or jaw surgeries1 subject to the condition that uncomplicated extractions shall not be considered oral surgery under this section4 7c7 ,program review 7#a7 ,neutral panel 7,a7 ,establishment ,the ,secretary1 acting through the ,service1 shall establish a neutral panel to carry out the study under paragraph 7#b74 7,b7 ,membership ,members of the neutral panel shall be appointed by the ,secretary from among clinicians1 economists1 community practitioners1 oral epidemiologists1 and ,alaska ,natives4 7#b7 ,study 7,a7 ,in general ,the neutral panel established under paragraph 7#a7 shall conduct a study of the dental health aide therapist services provided by the ,community ,health ,aide ,program under this section to ensure that the quality of care provided through those services is adequate and appropriate4 7,b7 ,parameters of study ,the ,secretary1 in consultation with interested parties1 including professional dental organizations1 shall develop the parameters of the study4 7,c7 ,inclusions ,the study shall include a determination by the neutral panel with respect to-- 7i7 the ability of the dental health aide therapist services under this section to address the dental care needs of ,alaska ,natives2 7ii7 the quality of care provided through those services1 including any training1 improvement1 or additional oversight required to improve the quality of care2 and 7iii7 whether safer and less costly alternatives to the dental health aide therapist services exist4 7,d7 ,consultation ,in carrying out the study under this paragraph1 the neutral panel shall consult with ,alaska tribal organizations with respect to the adequacy and accuracy of the study4 7#c7 ,report ,the neutral panel shall submit to the ,secretary1 the ,committee on ,indian ,affairs of the ,senate1 and the ,committee on ,natural ,resources of the ,house of ,representatives a report describing the results of the study under paragraph 7#b71 including a description of-- 7,a7 any determination of the neutral panel under paragraph 7#b77;,c72 and 7,b7 any comments received from ,alaska tribal organizations under paragraph 7#b77;,d74 7d7 ,nationalization of ,program 7#a7 ,in general ,except as provided in paragraph 7#b71 the ,secretary1 acting through the ,service1 may establish a national ,community ,health ,aide ,program in accordance with the program under this section1 as the ,secretary determines to be appropriate4 7#b7 ,requirement2 exclusion ,subject to paragraphs 7#c7 and 7#d71 in establishing a national program under paragraph 7#a71 the ,secretary-- 7,a7 shall not reduce the amounts provided for the ,community ,health ,aide ,program described in subsections 7a7 and 7b72 and 7,b7 shall exclude dental health aide therapist services from services covered under the program4 7#c7 ,election of ,indian tribe or tribal organization 7,a7 ,in general ,subparagraph 7,b7 of paragraph 7#b7 shall not apply in the case of an election made by an ,indian tribe or tribal organization located in a ,state 7other than ,alaska7 in which the use of dental health aide therapist services or midlevel dental health provider services is authorized under ,state law to supply such services in accordance with ,state law4 7,b7 ,action by ,secretary ,on an election by an ,indian tribe or tribal organization under subparagraph 7,a71 the ,secretary1 acting through the ,service1 shall facilitate implementation of the services elected4 7#d7 ,vacancies ,the ,secretary shall not fill any vacancy for a certified dentist in a program operated by the ,service with a dental health aide therapist4 7e7 ,effect of section ,nothing in this section shall restrict the ability of the ,service1 an ,indian tribe1 or a tribal organization to participate in any program or to provide any service authorized by any other ,federal law4 4 #aab4 ,health professional chronic shortage demonstration programs ,title ,i of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afaa et seq47 7as amended by section #aja7;b77 is amended by adding at the end the following3 #abc4 ,health professional chronic shortage demonstration programs 7a7 ,demonstration programs ,the ,secretary1 acting through the ,service1 may fund demonstration programs for ,indian health programs to address the chronic shortages of health professionals4 7b7 ,purposes of programs ,the purposes of demonstration programs under subsection 7a7 shall be-- 7#a7 to provide direct clinical and practical experience within an ,indian health program to health profession students and residents from medical schools2 7#b7 to improve the quality of health care for ,indians by ensuring access to qualified health professionals2 7#c7 to provide academic and scholarly opportunities for health professionals serving ,indians by identifying all academic and scholarly resources of the region2 and 7#d7 to provide training and support for alternative provider types1 such as community health representatives1 and community health aides4 7c7 ,advisory board ,the demonstration programs established pursuant to subsection 7a7 shall incorporate a program advisory board1 which may be composed of representatives of tribal governments1 ,indian health programs1 and ,indian communities in the areas to be served by the demonstration programs4 4 #aac4 ,exemption from payment of certain fees ,title ,i of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afaa et seq47 7as amended by section #aab7 is amended by adding at the end the following3 #abd4 ,exemption from payment of certain fees ,employees of a tribal health program or urban ,indian organization shall be exempt from payment of licensing1 registration1 and any other fees imposed by a ,federal agency to the same extent that officers of the commissioned corps of the ,public ,health ,service and other employees of the ,service are exempt from those fees4 4 ,b ,health services #aba4 ,indian ,health ,care ,improvement ,fund ,section #bja of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afba7 is amended to read as follows3 #bja4 ,indian ,health ,care ,improvement ,fund 7a7 ,use of funds ,the ,secretary1 acting through the ,service1 is authorized to expend funds1 directly or under the authority of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq471 which are appropriated under the authority of this section1 for the purposes of-- 7#a7 eliminating the deficiencies in health status and health resources of all ,indian tribes2 7#b7 eliminating backlogs in the provision of health care services to ,indians2 7#c7 meeting the health needs of ,indians in an efficient and equitable manner1 including the use of telehealth and telemedicine when appropriate2 7#d7 eliminating inequities in funding for both direct care and contract health service programs2 and 7#e7 augmenting the ability of the ,service to meet the following health service responsibilities with respect to those ,indian tribes with the highest levels of health status deficiencies and resource deficiencies3 7,a7 ,clinical care1 including inpatient care1 outpatient care 7including audiology1 clinical eye1 and vision care71 primary care1 secondary and tertiary care1 and long-term care4 7,b7 ,preventive health1 including mammography and other cancer screening4 7,c7 ,dental care4 7,d7 ,mental health1 including community mental health services1 inpatient mental health services1 dormitory mental health services1 therapeutic and residential treatment centers1 and training of traditional health care practitioners4 7,e7 ,emergency medical services4 7,f7 ,treatment and control of1 and rehabilitative care related to1 alcoholism and drug abuse 7including fetal alcohol syndrome7 among ,indians4 7,g7 ,injury prevention programs1 including data collection and evaluation1 demonstration projects1 training1 and capacity building4 7,h7 ,home health care4 7,i7 ,community health representatives4 7,j7 ,maintenance and improvement4 7b7 ,no offset or limitation ,any funds appropriated under the authority of this section shall not be used to offset or limit any other appropriations made to the ,service under this ,act or the ,act of ,november #b1 #aiba 7#be ,u4,s4,c4 #ac7 7commonly known as the ,snyder ,act71 or any other provision of law4 7c7 ,allocation2 use 7#a7 ,in general ,funds appropriated under the authority of this section shall be allocated to ,service units1 ,indian tribes1 or tribal organizations4 ,the funds allocated to each ,indian tribe1 tribal organization1 or ,service unit under this paragraph shall be used by the ,indian tribe1 tribal organization1 or ,service unit under this paragraph to improve the health status and reduce the resource deficiency of each ,indian tribe served by such ,service unit1 ,indian tribe1 or tribal organization4 7#b7 ,apportionment of allocated funds ,the apportionment of funds allocated to a ,service unit1 ,indian tribe1 or tribal organization under paragraph 7#a7 among the health service responsibilities described in subsection 7a77#e7 shall be determined by the ,service in consultation with1 and with the active participation of1 the affected ,indian tribes and tribal organizations4 7d7 ,provisions relating to health status and resource deficiencies ,for the purposes of this section1 the following definitions apply3 7#a7 ,definition ,the term health status and resource deficiency means the extent to which-- 7,a7 the health status objectives set forth in sections #c7a7 and #c7b7 are not being achieved2 and 7,b7 the ,indian tribe or tribal organization does not have available to it the health resources it needs1 taking into account the actual cost of providing health care services given local geographic1 climatic1 rural1 or other circumstances4 7#b7 ,available resources ,the health resources available to an ,indian tribe or tribal organization include health resources provided by the ,service as well as health resources used by the ,indian tribe or tribal organization1 including services and financing systems provided by any ,federal programs1 private insurance1 and programs of ,state or local governments4 7#c7 ,process for review of determinations ,the ,secretary shall establish procedures which allow any ,indian tribe or tribal organization to petition the ,secretary for a review of any determination of the extent of the health status and resource deficiency of such ,indian tribe or tribal organization4 7e7 ,eligibility for funds ,tribal health programs shall be eligible for funds appropriated under the authority of this section on an equal basis with programs that are administered directly by the ,service4 7f7 ,report ,by no later than the date that is #c years after the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag1 the ,secretary shall submit to ,congress the current health status and resource deficiency report of the ,service for each ,service unit1 including newly recognized or acknowledged ,indian tribes4 ,such report shall set out-- 7#a7 the methodology then in use by the ,service for determining tribal health status and resource deficiencies1 as well as the most recent application of that methodology2 7#b7 the extent of the health status and resource deficiency of each ,indian tribe served by the ,service or a tribal health program2 7#c7 the amount of funds necessary to eliminate the health status and resource deficiencies of all ,indian tribes served by the ,service or a tribal health program2 and 7#d7 an estimate of-- 7,a7 the amount of health service funds appropriated under the authority of this ,act1 or any other ,act1 including the amount of any funds transferred to the ,service for the preceding fiscal year which is allocated to each ,service unit1 ,indian tribe1 or tribal organization2 7,b7 the number of ,indians eligible for health services in each ,service unit or ,indian tribe or tribal organization2 and 7,c7 the number of ,indians using the ,service resources made available to each ,service unit1 ,indian tribe or tribal organization1 and1 to the extent available1 information on the waiting lists and number of ,indians turned away for services due to lack of resources4 7g7 ,inclusion in base budget ,funds appropriated under this section for any fiscal year shall be included in the base budget of the ,service for the purpose of determining appropriations under this section in subsequent fiscal years4 7h7 ,clarification ,nothing in this section is intended to diminish the primary responsibility of the ,service to eliminate existing backlogs in unmet health care needs1 nor are the provisions of this section intended to discourage the ,service from undertaking additional efforts to achieve equity among ,indian tribes and tribal organizations4 7i7 ,funding designation ,any funds appropriated under the authority of this section shall be designated as the ,indian ,health ,care ,improvement ,fund4 4 #abb4 ,catastrophic ,health ,emergency ,fund ,section #bjb of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afba;a7 is amended to read as follows3 #bjb4 ,catastrophic ,health ,emergency ,fund 7a7 ,establishment ,there is established an ,indian ,catastrophic ,health ,emergency ,fund 7hereafter in this section referred to as the ,,chef7 consisting of-- 7#a7 the amounts deposited under subsection 7f72 and 7#b7 the amounts appropriated to ,,chef under this section4 7b7 ,administration ,,chef shall be administered by the ,secretary1 acting through the headquarters of the ,service1 solely for the purpose of meeting the extraordinary medical costs associated with the treatment of victims of disasters or catastrophic illnesses who are within the responsibility of the ,service4 7c7 ,conditions on use of fund ,no part of ,,chef or its administration shall be subject to contract or grant under any law1 including the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq471 nor shall ,,chef funds be allocated1 apportioned1 or delegated on an ,area ,office1 ,service ,unit1 or other similar basis4 7d7 ,regulations ,the ,secretary shall promulgate regulations consistent with the provisions of this section to-- 7#a7 establish a definition of disasters and catastrophic illnesses for which the cost of the treatment provided under contract would qualify for payment from ,,chef2 7#b7 provide that a ,service ,unit shall not be eligible for reimbursement for the cost of treatment from ,,chef until its cost of treating any victim of such catastrophic illness or disaster has reached a certain threshold cost which the ,secretary shall establish at-- 7,a7 the #bjjj level of #ai1jjj2 and 7,b7 for any subsequent year1 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 7,united ,states city average7 for the #ab-month period ending with ,december of the previous year2 7#c7 establish a procedure for the reimbursement of the portion of the costs that exceeds such threshold cost incurred by-- 7,a7 ,service ,units2 or 7,b7 whenever otherwise authorized by the ,service1 non-,service facilities or providers2 7#d7 establish a procedure for payment from ,,chef in cases in which the exigencies of the medical circumstances warrant treatment prior to the authorization of such treatment by the ,service2 and 7#e7 establish a procedure that will ensure that no payment shall be made from ,,chef to any provider of treatment to the extent that such provider is eligible to receive payment for the treatment from any other ,federal1 ,state1 local1 or private source of reimbursement for which the patient is eligible4 7e7 ,no offset or limitation ,amounts appropriated to ,,chef under this section shall not be used to offset or limit appropriations made to the ,service under the authority of the ,act of ,november #b1 #aiba 7#be ,u4,s4,c4 #ac7 7commonly known as the ,snyder ,act71 or any other law4 7f7 ,deposit of reimbursement funds ,there shall be deposited into ,,chef all reimbursements to which the ,service is entitled from any ,federal1 ,state1 local1 or private source 7including third party insurance7 by reason of treatment rendered to any victim of a disaster or catastrophic illness the cost of which was paid from ,,chef4 4 #abc4 ,diabetes prevention1 treatment1 and control ,section #bjd of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afba;c7 is amended to read as follows3 #bjd4 ,diabetes prevention1 treatment1 and control 7a7 ,determinations regarding diabetes ,the ,secretary1 acting through the ,service1 and in consultation with ,indian tribes and tribal organizations1 shall determine-- 7#a7 by ,indian tribe and by ,service unit1 the incidence of1 and the types of complications resulting from1 diabetes among ,indians2 and 7#b7 based on the determinations made pursuant to paragraph 7#a71 the measures 7including patient education and effective ongoing monitoring of disease indicators7 each ,service unit should take to reduce the incidence of1 and prevent1 treat1 and control the complications resulting from1 diabetes among ,indian tribes within that ,service unit4 7b7 ,diabetes screening ,to the extent medically indicated and with informed consent1 the ,secretary shall screen each ,indian who receives services from the ,service for diabetes and for conditions which indicate a high risk that the individual will become diabetic and establish a cost-effective approach to ensure ongoing monitoring of disease indicators4 ,such screening and monitoring may be conducted by a tribal health program and may be conducted through appropriate ,internet-based health care management programs4 7c7 ,diabetes projects ,the ,secretary shall continue to maintain each model diabetes project in existence on the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag1 any such other diabetes programs operated by the ,service or tribal health programs1 and any additional diabetes projects1 such as the ,medical ,vanguard program provided for in title ,,iv of ,public ,law #ajh-hg1 as implemented to serve ,indian tribes4 tribal health programs shall receive recurring funding for the diabetes projects that they operate pursuant to this section1 both at the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag and for projects which are added and funded thereafter4 7d7 ,dialysis programs ,the ,secretary is authorized to provide1 through the ,service1 ,indian tribes1 and tribal organizations1 dialysis programs1 including the purchase of dialysis equipment and the provision of necessary staffing4 7e7 ,other duties of the ,secretary 7#a7 ,in general ,the ,secretary shall1 to the extent funding is available-- 7,a7 in each area office1 consult with ,indian tribes and tribal organizations regarding programs for the prevention1 treatment1 and control of diabetes2 7,b7 establish in each area office a registry of patients with diabetes to track the incidence of diabetes and the complications from diabetes in that area2 and 7,c7 ensure that data collected in each area office regarding diabetes and related complications among ,indians are disseminated to all other area offices1 subject to applicable patient privacy laws4 7#b7 ,diabetes control officers 7,a7 ,in general ,the ,secretary may establish and maintain in each area office a position of diabetes control officer to coordinate and manage any activity of that area office relating to the prevention1 treatment1 or control of diabetes to assist the ,secretary in carrying out a program under this section or section #ccj;,c of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;c-#c74 7,b7 ,certain activities ,any activity carried out by a diabetes control officer under subparagraph 7,a7 that is the subject of a contract or compact under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq471 and any funds made available to carry out such an activity1 shall not be divisible for purposes of that ,act4 4 #abd4 ,other authority for provision of services2 shared services for long-term care 7a7 ,other authority for provision of services 7#a7 ,in general ,section #bje of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afba;d7 is amended to read as follows3 #bje4 ,other authority for provision of services 7a7 ,definitions ,in this section3 7#a7 ,assisted living service ,the term assisted living service means any service provided by an assisted living facility 7as defined in section #bcb7;b7 of the ,national ,housing ,act 7#ab ,u4,s4,c4 #agaew7b7771 except that such an assisted living facility-- 7,a7 shall not be required to obtain a license2 but 7,b7 shall meet all applicable standards for licensure4 7#b7 ,home- and community-based service ,the term home- and community-based service means #a or more of the services specified in paragraphs 7#a7 through 7#i7 of section #aibi7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acift7a77 7whether provided by the ,service or by an ,indian tribe or tribal organization pursuant to the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq477 that are or will be provided in accordance with applicable standards4 7#c7 ,hospice care ,the term hospice care means-- 7,a7 the items and services specified in subparagraphs 7,a7 through 7,h7 of section #ahfa7;dd77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7dd77#a772 and 7,b7 such other services as an ,indian tribe or tribal organization determines are necessary and appropriate to provide in furtherance of that care4 7#d7 ,long-term care services ,the term long-term care services has the meaning given the term qualified long-term care services in section #ggjb;,b7c7 of the ,internal ,revenue ,code of #aihf4 7b7 ,funding authorized ,the ,secretary1 acting through the ,service1 ,indian tribes1 and tribal organizations1 may provide funding under this ,act to meet the objectives set forth in section #c through health care-related services and programs not otherwise described in this ,act for the following services3 7#a7 ,hospice care4 7#b7 ,assisted living services4 7#c7 ,long-term care services4 7#d7 ,home- and community-based services4 7c7 ,eligibility ,the following individuals shall be eligible to receive long-term care services under this section3 7#a7 ,individuals who are unable to perform a certain number of activities of daily living without assistance4 7#b7 ,individuals with a mental impairment1 such as dementia1 ,alzheimer's disease1 or another disabling mental illness1 who may be able to perform activities of daily living under supervision4 7#c7 ,such other individuals as an applicable tribal health program determines to be appropriate4 7d7 ,authorization of convenient care services ,the ,secretary1 acting through the ,service1 ,indian tribes1 and tribal organizations1 may also provide funding under this ,act to meet the objectives set forth in section #c for convenient care services programs pursuant to section #cjg7;c77#b77;,a74 4 7#b7 ,repeal ,section #hba of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afhjk7 is repealed4 7b7 ,shared services for long-,term care ,section #hbb of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afhjl7 is amended to read as follows3 #hbb4 ,shared services for long-term care 7a7 ,long-,term care 7#a7 ,in general ,notwithstanding any other provision of law1 the ,secretary1 acting through the ,service1 is authorized to provide directly1 or enter into contracts or compacts under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq47 with ,indian tribes or tribal organizations for1 the delivery of long-term care 7including health care services associated with long-term care7 provided in a facility to ,indians4 7#b7 ,inclusions ,each agreement under paragraph 7#a7 shall provide for the sharing of staff or other services between the ,service or a tribal health program and a long-term care or related facility owned and operated 7directly or through a contract or compact under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq477 by the ,indian tribe or tribal organization4 7b7 ,contents of agreements ,an agreement entered into pursuant to subsection 7a7-- 7#a7 may1 at the request of the ,indian tribe or tribal organization1 delegate to the ,indian tribe or tribal organization such powers of supervision and control over ,service employees as the ,secretary determines to be necessary to carry out the purposes of this section2 7#b7 shall provide that expenses 7including salaries7 relating to services that are shared between the ,service and the tribal health program be allocated proportionately between the ,service and the ,indian tribe or tribal organization2 and 7#c7 may authorize the ,indian tribe or tribal organization to construct1 renovate1 or expand a long-term care or other similar facility 7including the construction of a facility attached to a ,service facility74 7c7 ,minimum requirement ,any nursing facility provided for under this section shall meet the requirements for nursing facilities under section #aiai of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr74 7d7 ,other assistance ,the ,secretary shall provide such technical and other assistance as may be necessary to enable applicants to comply with this section4 7e7 ,use of existing or underused facilities ,the ,secretary shall encourage the use of existing facilities that are underused1 or allow the use of swing beds1 for long-term or similar care4 4 #abe4 ,reimbursement from certain third parties of costs of health services ,section #bjf of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afba;e7 is amended to read as follows3 #bjf4 ,reimbursement from certain third parties of costs of health services 7a7 ,right of recovery ,except as provided in subsection 7f71 the ,united ,states1 an ,indian tribe1 or tribal organization shall have the right to recover from an insurance company1 health maintenance organization1 employee benefit plan1 third-party tortfeasor1 or any other responsible or liable third party 7including a political subdivision or local governmental entity of a ,state7 the reasonable charges billed by the ,secretary1 an ,indian tribe1 or tribal organization in providing health services through the ,service1 an ,indian tribe1 or tribal organization1 or1 if higher1 the highest amount the third party would pay for care and services furnished by providers other than governmental entities1 to any individual to the same extent that such individual1 or any nongovernmental provider of such services1 would be eligible to receive damages1 reimbursement1 or indemnification for such charges or expenses if-- 7#a7 such services had been provided by a nongovernmental provider2 and 7#b7 such individual had been required to pay such charges or expenses and did pay such charges or expenses4 7b7 ,limitations on recoveries from ,states ,subsection 7a7 shall provide a right of recovery against any ,state1 only if the injury1 illness1 or disability for which health services were provided is covered under-- 7#a7 workers' compensation laws2 or 7#b7 a no-fault automobile accident insurance plan or program4 7c7 ,nonapplicability of other laws ,no law of any ,state1 or of any political subdivision of a ,state and no provision of any contract1 insurance or health maintenance organization policy1 employee benefit plan1 self-insurance plan1 managed care plan1 or other health care plan or program entered into or renewed after the date of enactment of the ,indian ,health ,care ,amendments of #aihh1 shall prevent or hinder the right of recovery of the ,united ,states1 an ,indian tribe1 or tribal organization under subsection 7a74 7d7 ,no effect on private rights of action ,no action taken by the ,united ,states1 an ,indian tribe1 or tribal organization to enforce the right of recovery provided under this section shall operate to deny to the injured person the recovery for that portion of the person's damage not covered hereunder4 7e7 ,enforcement 7#a7 ,in general ,the ,united ,states1 an ,indian tribe1 or tribal organization may enforce the right of recovery provided under subsection 7a7 by-- 7,a7 intervening or joining in any civil action or proceeding brought-- 7i7 by the individual for whom health services were provided by the ,secretary1 an ,indian tribe1 or tribal organization2 or 7ii7 by any representative or heirs of such individual1 or 7,b7 instituting a separate civil action1 including a civil action for injunctive relief and other relief and including1 with respect to a political subdivision or local governmental entity of a ,state1 such an action against an official thereof4 7#b7 ,notice ,all reasonable efforts shall be made to provide notice of action instituted under paragraph 7#a77;,b7 to the individual to whom health services were provided1 either before or during the pendency of such action4 7#c7 ,recovery from tortfeasors 7,a7 ,in general ,in any case in which an ,indian tribe or tribal organization that is authorized or required under a compact or contract issued pursuant to the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq47 to furnish or pay for health services to a person who is injured or suffers a disease on or after the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag under circumstances that establish grounds for a claim of liability against the tortfeasor with respect to the injury or disease1 the ,indian tribe or tribal organization shall have a right to recover from the tortfeasor 7or an insurer of the tortfeasor7 the reasonable value of the health services so furnished1 paid for1 or to be paid for1 in accordance with the ,federal ,medical ,care ,recovery ,act 7#db ,u4,s4,c4 #bfea et seq471 to the same extent and under the same circumstances as the ,united ,states may recover under that ,act4 7,b7 ,treatment ,the right of an ,indian tribe or tribal organization to recover under subparagraph 7,a7 shall be independent of the rights of the injured or diseased person served by the ,indian tribe or tribal organization4 7f7 ,limitation ,absent specific written authorization by the governing body of an ,indian tribe for the period of such authorization 7which may not be for a period of more than #a year and which may be revoked at any time upon written notice by the governing body to the ,service71 the ,united ,states shall not have a right of recovery under this section if the injury1 illness1 or disability for which health services were provided is covered under a self-insurance plan funded by an ,indian tribe1 tribal organization1 or urban ,indian organization4 ,where such authorization is provided1 the ,service may receive and expend such amounts for the provision of additional health services consistent with such authorization4 7g7 ,costs and attorney's fees ,in any action brought to enforce the provisions of this section1 a prevailing plaintiff shall be awarded its reasonable attorney's fees and costs of litigation4 7h7 ,nonapplicability of claims filing requirements ,an insurance company1 health maintenance organization1 self-insurance plan1 managed care plan1 or other health care plan or program 7under the ,social ,security ,act or otherwise7 may not deny a claim for benefits submitted by the ,service or by an ,indian tribe or tribal organization based on the format in which the claim is submitted if such format complies with the format required for submission of claims under title ,,xviii of the ,social ,security ,act or recognized under section #aage of such ,act4 7i7 ,application to urban ,indian organizations ,the previous provisions of this section shall apply to urban ,indian organizations with respect to populations served by such ,organizations in the same manner they apply to ,indian tribes and tribal organizations with respect to populations served by such ,indian tribes and tribal organizations4 7j7 ,statute of limitations ,the provisions of section #bdae of title #bh1 ,united ,states ,code1 shall apply to all actions commenced under this section1 and the references therein to the ,united ,states are deemed to include ,indian tribes1 tribal organizations1 and urban ,indian organizations4 7k7 ,savings ,nothing in this section shall be construed to limit any right of recovery available to the ,united ,states1 an ,indian tribe1 or tribal organization under the provisions of any applicable1 ,federal1 ,state1 or tribal law1 including medical lien laws4 4 #abf4 ,crediting of reimbursements ,section #bjg of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afba;f7 is amended to read as follows3 #bjg4 ,crediting of reimbursements 7a7 ,use of amounts 7#a7 ,retention by program ,except as provided in sections #bjb7;a77#b7 and #hac1 all reimbursements received or recovered under any of the programs described in paragraph 7#b71 including under section #hac1 by reason of the provision of health services by the ,service1 by an ,indian tribe or tribal organization1 or by an urban ,indian organization1 shall be credited to the ,service1 such ,indian tribe or tribal organization1 or such urban ,indian organization1 respectively1 and may be used as provided in section #dja4 ,in the case of such a service provided by or through a ,service ,unit1 such amounts shall be credited to such unit and used for such purposes4 7#b7 ,programs covered ,the programs referred to in paragraph 7#a7 are the following3 7,a7 ,titles ,,xviii1 ,,xix1 and ,,xxi of the ,social ,security ,act4 7,b7 ,this ,act1 including section #hac4 7,c7 ,public ,law #hg-fic4 7,d7 ,any other provision of law4 7b7 ,no offset of amounts ,the ,service may not offset or limit any amount obligated to any ,service ,unit or entity receiving funding from the ,service because of the receipt of reimbursements under subsection 7a74 4 #abg4 ,behavioral health training and community education programs ,section #bji of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afba;h7 is amended by striking subsection 7d7 and inserting the following3 7d7 ,behavioral health training and community education programs 7#a7 ,study2 list ,the ,secretary1 acting through the ,service1 and the ,secretary of the ,interior1 in consultation with ,indian tribes and tribal organizations1 shall conduct a study and compile a list of the types of staff positions specified in paragraph 7#b7 whose qualifications include1 or should include1 training in the identification1 prevention1 education1 referral1 or treatment of mental illness1 or dysfunctional and self destructive behavior4 7#b7 ,positions ,the positions referred to in paragraph 7#a7 are-- 7,a7 staff positions within the ,bureau of ,indian ,affairs1 including existing positions1 in the fields of-- 7i7 elementary and secondary education2 7ii7 social services and family and child welfare2 7iii7 law enforcement and judicial services2 and 7iv7 alcohol and substance abuse2 7,b7 staff positions within the ,service2 and 7,c7 staff positions similar to those identified in subparagraphs 7,a7 and 7,b7 established and maintained by ,indian tribes and tribal organizations 7without regard to the funding source74 7#c7 ,training criteria 7,a7 ,in general ,the appropriate ,secretary shall provide training criteria appropriate to each type of position identified in paragraphs 7#b77;,a7 and 7#b77;,b7 and ensure that appropriate training has been1 or shall be provided to any individual in any such position4 ,with respect to any such individual in a position identified pursuant to paragraph 7#b77;,c71 the respective ,secretaries shall provide appropriate training to1 or provide funds to1 an ,indian tribe or tribal organization for training of appropriate individuals4 ,in the case of positions funded under a contract or compact under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq471 the appropriate ,secretary shall ensure that such training costs are included in the contract or compact1 as the ,secretary determines necessary4 7,b7 ,position specific training criteria ,position specific training criteria shall be culturally relevant to ,indians and ,indian tribes and shall ensure that appropriate information regarding traditional health care practices is provided4 7#d7 ,community education on mental illness ,the ,service shall develop and implement1 on request of an ,indian tribe1 tribal organization1 or urban ,indian organization1 or assist the ,indian tribe1 tribal organization1 or urban ,indian organization to develop and implement1 a program of community education on mental illness4 ,in carrying out this paragraph1 the ,service shall1 upon request of an ,indian tribe1 tribal organization1 or urban ,indian organization1 provide technical assistance to the ,indian tribe1 tribal organization1 or urban ,indian organization to obtain and develop community educational materials on the identification1 prevention1 referral1 and treatment of mental illness and dysfunctional and self-destructive behavior4 7#e7 ,plan ,not later than #ij days after the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag1 the ,secretary shall develop a plan under which the ,service will increase the health care staff providing behavioral health services by at least #ejj positions within #e years after the date of enactment of that ,act1 with at least #bjj of such positions devoted to child1 adolescent1 and family services4 ,the plan developed under this paragraph shall be implemented under the ,act of ,november #b1 #aiba 7#be ,u4,s4,c4 #ac7 7commonly known as the ,snyder ,act74 4 #abh4 ,cancer screenings ,section #bab of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afbak7 is amended by inserting and other cancer screenings before the period at the end4 #abi4 ,patient travel costs ,section #bac of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afbal7 is amended to read as follows3 #bac4 ,patient travel costs 7a7 ,definition of qualified escort ,in this section1 the term qualified escort means-- 7#a7 an adult escort 7including a parent1 guardian1 or other family member7 who is required because of the physical or mental condition1 or age1 of the applicable patient2 7#b7 a health professional for the purpose of providing necessary medical care during travel by the applicable patient2 or 7#c7 other escorts1 as the ,secretary or applicable ,indian ,health ,program determines to be appropriate4 7b7 ,provision of funds ,the ,secretary1 acting through the ,service and ,tribal ,health ,programs1 is authorized to provide funds for the following patient travel costs1 including qualified escorts1 associated with receiving health care services provided 7either through direct or contract care or through a contract or compact under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq477 under this ,act-- 7#a7 emergency air transportation and non-emergency air transportation where ground transportation is infeasible2 7#b7 transportation by private vehicle 7where no other means of transportation is available71 specially equipped vehicle1 and ambulance2 and 7#c7 transportation by such other means as may be available and required when air or motor vehicle transportation is not available4 4 #acj4 ,epidemiology centers ,section #bad of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afbam7 is amended to read as follows3 #bad4 ,epidemiology centers 7a7 ,establishment of centers 7#a7 ,in general ,the ,secretary shall establish an epidemiology center in each ,service area to carry out the functions described in subsection 7b74 7#b7 ,new centers 7,a7 ,in general ,subject to subparagraph 7,b71 any new center established after the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag may be operated under a grant authorized by subsection 7d74 7,b7 ,requirement ,funding provided in a grant described in subparagraph 7,a7 shall not be divisible4 7#c7 ,funds not divisible ,an epidemiology center established under this subsection shall be subject to the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq471 but the funds for the center shall not be divisible4 7b7 ,functions of centers ,in consultation with and on the request of ,indian tribes1 tribal organizations1 and urban ,indian organizations1 each ,service area epidemiology center established under this section shall1 with respect to the applicable ,service area-- 7#a7 collect data relating to1 and monitor progress made toward meeting1 each of the health status objectives of the ,service1 the ,indian tribes1 tribal organizations1 and urban ,indian organizations in the ,service area2 7#b7 evaluate existing delivery systems1 data systems1 and other systems that impact the improvement of ,indian health2 7#c7 assist ,indian tribes1 tribal organizations1 and urban ,indian organizations in identifying highest-priority health status objectives and the services needed to achieve those objectives1 based on epidemiological data2 7#d7 make recommendations for the targeting of services needed by the populations served2 7#e7 make recommendations to improve health care delivery systems for ,indians and urban ,indians2 7#f7 provide requested technical assistance to ,indian tribes1 tribal organizations1 and urban ,indian organizations in the development of local health service priorities and incidence and prevalence rates of disease and other illness in the community2 and 7#g7 provide disease surveillance and assist ,indian tribes1 tribal organizations1 and urban ,indian communities to promote public health4 7c7 ,technical assistance ,the ,director of the ,centers for ,disease ,control and ,prevention shall provide technical assistance to the centers in carrying out this section4 7d7 ,grants for studies 7#a7 ,in general ,the ,secretary may make grants to ,indian tribes1 tribal organizations1 ,indian organizations1 and eligible intertribal consortia to conduct epidemiological studies of ,indian communities4 7#b7 ,eligible intertribal consortia ,an intertribal consortium or ,indian organization shall be eligible to receive a grant under this subsection if the intertribal consortium is-- 7,a7 incorporated for the primary purpose of improving ,indian health2 and 7,b7 representative of the ,indian tribes or urban ,indian communities residing in the area in which the intertribal consortium is located4 7#c7 ,applications ,an application for a grant under this subsection shall be submitted in such manner and at such time as the ,secretary shall prescribe4 7#d7 ,requirements ,an applicant for a grant under this subsection shall-- 7,a7 demonstrate the technical1 administrative1 and financial expertise necessary to carry out the functions described in paragraph 7#e72 7,b7 consult and cooperate with providers of related health and social services in order to avoid duplication of existing services2 and 7,c7 demonstrate cooperation from ,indian tribes or urban ,indian organizations in the area to be served4 7#e7 ,use of funds ,a grant provided under paragraph 7#a7 may be used-- 7,a7 to carry out the functions described in subsection 7b72 7,b7 to provide information to1 and consult with1 tribal leaders1 urban ,indian community leaders1 and related health staff regarding health care and health service management issues2 and 7,c7 in collaboration with ,indian tribes1 tribal organizations1 and urban ,indian organizations1 to provide to the ,service information regarding ways to improve the health status of ,indians4 7e7 ,access to information 7#a7 ,in general ,an epidemiology center operated by a grantee pursuant to a grant awarded under subsection 7d7 shall be treated as a public health authority 7as defined in section #afd4eja of title #de1 ,code of ,federal ,regulations 7or a successor regulation77 for purposes of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7,public ,law #ajd-aia2 #aaj ,stat4 #aicf74 7#b7 ,access to information ,the ,secretary shall grant to each epidemiology center described in paragraph 7#a7 access to use of the data1 data sets1 monitoring systems1 delivery systems1 and other protected health information in the possession of the ,secretary4 7#c7 ,requirement ,the activities of an epidemiology center described in paragraph 7#a7 shall be for the purposes of research and for preventing and controlling disease1 injury1 or disability 7as those activities are described in section #afd4eab of title #de1 ,code of ,federal ,regulations 7or a successor regulation771 for purposes of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7,public ,law#ajd-aia2 #aaj ,stat4 #aicf74 4 #aca4 ,indian youth grant program ,section #baf7;b77#b7 of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afbao7b77#b77 is amended by striking section #bji7m7 and inserting section #gjh7;c74 #acb4 ,american ,indians ,into ,psychology ,program ,section #bag of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afbap7 is amended to read as follows3 #bag4 ,american ,indians ,into ,psychology ,program 7a7 ,grants authorized ,the ,secretary1 acting through the ,service1 shall make grants of not more than #cjj1jjj to each of #i colleges and universities for the purpose of developing and maintaining ,indian psychology career recruitment programs as a means of encouraging ,indians to enter the behavioral health field4 ,these programs shall be located at various locations throughout the country to maximize their availability to ,indian students and new programs shall be established in different locations from time to time4 7b7 ,quentin ,n4 ,burdick program grant ,the ,secretary shall provide a grant authorized under subsection 7a7 to develop and maintain a program at the ,university of ,north ,dakota to be known as the ,quentin ,n4 ,burdick ,american ,indians ,into ,psychology ,program4 ,such program shall1 to the maximum extent feasible1 coordinate with the ,quentin ,n4 ,burdick ,indian health programs authorized under section #aag7;b71 the ,quentin ,n4 ,burdick ,american ,indians ,into ,nursing ,program authorized under section #aae7;e71 and existing university research and communications networks4 7c7 ,regulations ,the ,secretary shall issue regulations pursuant to this ,act for the competitive awarding of grants provided under this section4 7d7 ,conditions of grant ,applicants under this section shall agree to provide a program which1 at a minimum-- 7#a7 provides outreach and recruitment for health professions to ,indian communities including elementary1 secondary1 and accredited and accessible community colleges that will be served by the program2 7#b7 incorporates a program advisory board comprised of representatives from the tribes and communities that will be served by the program2 7#c7 provides summer enrichment programs to expose ,indian students to the various fields of psychology through research1 clinical1 and experimental activities2 7#d7 provides stipends to undergraduate and graduate students to pursue a career in psychology2 7#e7 develops affiliation agreements with tribal colleges and universities1 the ,service1 university affiliated programs1 and other appropriate accredited and accessible entities to enhance the education of ,indian students2 7#f7 to the maximum extent feasible1 uses existing university tutoring1 counseling1 and student support services2 and 7#g7 to the maximum extent feasible1 employs qualified ,indians in the program4 7e7 ,active duty service requirement ,the active duty service obligation prescribed under section #cch;,c of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bedm7 shall be met by each graduate who receives a stipend described in subsection 7d77#d7 that is funded under this section4 ,such obligation shall be met by service-- 7#a7 in an ,indian health program2 7#b7 in a program assisted under title ,v2 or 7#c7 in the private practice of psychology if1 as determined by the ,secretary1 in accordance with guidelines promulgated by the ,secretary1 such practice is situated in a physician or other health professional shortage area and addresses the health care needs of a substantial number of ,indians4 7f7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #b1gjj1jjj for fiscal year #bjag and each fiscal year thereafter4 4 #acc4 ,prevention1 control1 and elimination of communicable and infectious diseases ,section #bah of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afbaq7 is amended to read as follows3 #bah4 ,prevention1 control1 and elimination of communicable and infectious diseases 7a7 ,grants authorized ,the ,secretary1 acting through the ,service1 and after consultation with the ,centers for ,disease ,control and ,prevention1 may make grants available to ,indian tribes and tribal organizations for the following3 7#a7 ,projects for the prevention1 control1 and elimination of communicable and infectious diseases1 including tuberculosis1 hepatitis1 ,,hiv1 respiratory syncytial virus1 hanta virus1 sexually transmitted diseases1 and ,h4 pylori4 7#b7 ,public information and education programs for the prevention1 control1 and elimination of communicable and infectious diseases4 7#c7 ,education1 training1 and clinical skills improvement activities in the prevention1 control1 and elimination of communicable and infectious diseases for health professionals1 including allied health professionals4 7#d7 ,demonstration projects for the screening1 treatment1 and prevention of hepatitis ,c virus 7,,hcv74 7b7 ,application required ,the ,secretary may provide funding under subsection 7a7 only if an application or proposal for funding is submitted to the ,secretary4 7c7 ,coordination with health agencies ,indian tribes and tribal organizations receiving funding under this section are encouraged to coordinate their activities with the ,centers for ,disease ,control and ,prevention and ,state and local health agencies4 7d7 ,technical assistance2 report ,in carrying out this section1 the ,secretary-- 7#a7 may1 at the request of an ,indian tribe or tribal organization1 provide technical assistance2 and 7#b7 shall prepare and submit a report to ,congress biennially on the use of funds under this section and on the progress made toward the prevention1 control1 and elimination of communicable and infectious diseases among ,indians and urban ,indians4 4 #acd4 ,methods to increase clinician recruitment and retention issues 7a7 ,licensing ,section #bba of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afbat7 is amended to read as follows3 #bba4 ,licensing ,licensed health professionals employed by a tribal health program shall be exempt1 if licensed in any ,state1 from the licensing requirements of the ,state in which the tribal health program performs the services described in the contract or compact of the tribal health program under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq474 4 7b7 ,continuing education allowances ,section #ajf of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afae7 is amended to read as follows3 #ajf4 ,continuing education allowances ,in order to encourage scholarship and stipend recipients under sections #ajd1 #aje1 and #aae and health professionals1 including community health representatives and emergency medical technicians1 to join or continue in an ,indian health program and to provide services in the rural and remote areas in which a significant portion of ,indians reside1 the ,secretary1 acting through the ,service1 may-- 7#a7 provide programs or allowances to transition into an ,indian health program1 including licensing1 board or certification examination assistance1 and technical assistance in fulfilling service obligations under sections #ajd1 #aje1 and #aae2 and 7#b7 provide programs or allowances to health professionals employed in an ,indian health program to enable those professionals1 for a period of time each year prescribed by regulation of the ,secretary1 to take leave of the duty stations of the professionals for professional consultation1 management1 leadership1 and refresher training courses4 4 #ace4 ,liability for payment ,section #bbb of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afbau7 is amended to read as follows3 #bbb4 ,liability for payment 7a7 ,no patient liability ,a patient who receives contract health care services that are authorized by the ,service shall not be liable for the payment of any charges or costs associated with the provision of such services4 7b7 ,notification ,the ,secretary shall notify a contract care provider and any patient who receives contract health care services authorized by the ,service that such patient is not liable for the payment of any charges or costs associated with the provision of such services not later than #e business days after receipt of a notification of a claim by a provider of contract care services4 7c7 ,no recourse ,following receipt of the notice provided under subsection 7b71 or1 if a claim has been deemed accepted under section #bbj7;b71 the provider shall have no further recourse against the patient who received the services4 4 #acf4 ,offices of ,indian ,men's ,health and ,indian ,women's ,health ,section #bbc of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afbav7 is amended-- 7#a7 by striking the section designation and heading and all that follows through oversee efforts of the ,service to and inserting the following3 #bbc4 ,offices of ,indian ,men's ,health and ,indian ,women's ,health 7a7 ,office of ,indian ,men's ,health 7#a7 ,establishment ,the ,secretary may establish within the ,service an office1 to be known as the ,office of ,indian ,men's ,health4 7#b7 ,director 7,a7 ,in general ,the ,office of ,indian ,men's ,health shall be headed by a director1 to be appointed by the ,secretary4 7,b7 ,duties ,the director shall coordinate and promote the health status of ,indian men in the ,united ,states4 7#c7 ,report ,not later than #b years after the date of enactment of the,indian ,healthcare ,improvement ,act of #bjag1 the ,secretary1 acting through the ,service1 shall submit to ,congress a report describing-- 7,a7 any activity carried out by the director as of the date on which the report is prepared2 and 7,b7 any finding of the director with respect to the health of ,indian men4 7b7 ,office of ,indian ,women's ,health ,the ,secretary1 acting through the ,service1 shall establish an office1 to be known as the ,office of ,indian ,women's ,health1 to 2 and 7#b7 in subsection 7b7 7as so redesignated7 by inserting 7including urban ,indian women7 before of all ages4 #acg4 ,contract health service administration and disbursement formula ,title ,,ii of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afba et seq47 is amended by adding at the end the following3 #bbf4 ,contract health service administration and disbursement formula 7a7 ,submission of report ,as soon as practicable after the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag1 the ,comptroller ,general of the ,united ,states shall submit to the ,secretary1 the ,committee on ,indian ,affairs of the ,senate1 and the ,committee on ,natural ,resources of the ,house of ,representatives1 and make available to each ,indian tribe1 a report describing the results of the study of the ,comptroller ,general regarding the funding of the contract health service program 7including historic funding levels and a recommendation of the funding level needed for the program7 and the administration of the contract health service program 7including the distribution of funds pursuant to the program71 as requested by ,congress in ,march #bjji1 or pursuant to section #hcj4 7b7 ,consultation with tribes ,on receipt of the report under subsection 7a71 the ,secretary shall consult with ,indian tribes regarding the contract health service program1 including the distribution of funds pursuant to the program-- 7#a7 to determine whether the current distribution formula would require modification if the contract health service program were funded at the level recommended by the ,comptroller ,general2 7#b7 to identify any inequities in the current distribution formula under the current funding level or inequitable results for any ,indian tribe under the funding level recommended by the ,comptroller ,general2 7#c7 to identify any areas of program administration that may result in the inefficient or ineffective management of the program2 and 7#d7 to identify any other issues and recommendations to improve the administration of the contract health services program and correct any unfair results or funding disparities identified under paragraph 7#b74 7c7 ,subsequent action by ,secretary ,if1 after consultation with ,indian tribes under subsection 7b71 the ,secretary determines that any issue described in subsection 7b77#b7 exists1 the ,secretary may initiate procedures under subchapter ,,iii of chapter #e of title #e1 ,united ,states ,code1 to negotiate or promulgate regulations to establish a disbursement formula for the contract health service program funding4 4 ,c ,health facilities #ada4 ,health care facility priority system ,section #cja of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afca7 is amended-- 7#a7 by redesignating subsection 7d7 as subsection 7h72 and 7#b7 by striking subsection 7c7 and inserting the following3 7c7 ,health care facility priority system 7#a7 ,in general 7,a7 ,priority system ,the ,secretary1 acting through the ,service1 shall maintain a health care facility priority system1 which-- 7i7 shall be developed in consultation with ,indian tribes and tribal organizations2 7ii7 shall give ,indian tribes' needs the highest priority2 7iii7 7,i7 may include the lists required in paragraph 7#b77;,b77ii72 and 7,,ii7 shall include the methodology required in paragraph 7#b77;,b77v72 and 7,,iii7 may include such health care facilities1 and such renovation or expansion needs of any health care facility1 as the ,service may identify2 and 7iv7 shall provide an opportunity for the nomination of planning1 design1 and construction projects by the ,service1 ,indian tribes1 and tribal organizations for consideration under the priority system at least once every #c years1 or more frequently as the ,secretary determines to be appropriate4 7,b7 ,needs of facilities under ,,isdeaa agreements ,the ,secretary shall ensure that the planning1 design1 construction1 renovation1 and expansion needs of ,service and non-,service facilities operated under contracts or compacts in accordance with the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq47 are fully and equitably integrated into the health care facility priority system4 7,c7 ,criteria for evaluating needs ,for purposes of this subsection1 the ,secretary1 in evaluating the needs of facilities operated under a contract or compact under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq471 shall use the criteria used by the ,secretary in evaluating the needs of facilities operated directly by the ,service4 7,d7 ,priority of certain projects protected ,the priority of any project established under the construction priority system in effect on the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag shall not be affected by any change in the construction priority system taking place after that date if the project-- 7i7 was identified in the fiscal year #bjjh ,service budget justification as-- 7,i7 #a of the #aj top-priority inpatient projects2 7,,ii7 #a of the #aj top-priority outpatient projects2 7,,iii7 #a of the #aj top-priority staff quarters developments2 or 7,,iv7 #a of the #aj top-priority ,youth ,regional ,treatment ,centers2 7ii7 had completed both ,phase ,i and ,phase ,,ii of the construction priority system in effect on the date of enactment of such ,act2 or 7iii7 is not included in clause 7i7 or 7ii7 and is selected1 as determined by the ,secretary-- 7,i7 on the initiative of the ,secretary2 or 7,,ii7 pursuant to a request of an ,indian tribe or tribal organization4 7#b7 ,report2 contents 7,a7 ,initial comprehensive report 7i7 ,definitions ,in this subparagraph3 7,i7 ,facilities ,appropriation ,advisory ,board ,the term ,facilities ,appropriation ,advisory ,board means the advisory board1 comprised of #ab members representing ,indian tribes and #b members representing the ,service1 established at the discretion of the ,director-- 7aa7 to provide advice and recommendations for policies and procedures of the programs funded pursuant to facilities appropriations2 and 7bb7 to address other facilities issues4 7,,ii7 ,facilities ,needs ,assessment ,workgroup ,the term ,facilities ,needs ,assessment ,workgroup means the workgroup established at the discretion of the ,director-- 7aa7 to review the health care facilities construction priority system2 and 7bb7 to make recommendations to the ,facilities ,appropriation ,advisory ,board for revising the priority system4 7ii7 ,initial report 7,i7 ,in general ,not later than #a year after the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag1 the ,secretary shall submit to the ,committee on ,indian ,affairs of the ,senate and the ,committee on ,natural ,resources of the ,house of ,representatives a report that describes the comprehensive1 national1 ranked list of all health care facilities needs for the ,service1 ,indian tribes1 and tribal organizations 7including inpatient health care facilities1 outpatient health care facilities1 specialized health care facilities 7such as for long-term care and alcohol and drug abuse treatment71 wellness centers1 and staff quarters1 and the renovation and expansion needs1 if any1 of such facilities7 developed by the ,service1 ,indian tribes1 and tribal organizations for the ,facilities ,needs ,assessment ,workgroup and the ,facilities ,appropriation ,advisory ,board4 7,,ii7 ,inclusions ,the initial report shall include-- 7aa7 the methodology and criteria used by the ,service in determining the needs and establishing the ranking of the facilities needs2 and 7bb7 such other information as the ,secretary determines to be appropriate4 7iii7 ,updates of report ,beginning in calendar year #bjag1 the ,secretary shall-- 7,i7 update the report under clause 7ii7 not less frequently that once every #e years2 and 7,,ii7 include the updated report in the appropriate annual report under subparagraph 7,b7 for submission to ,congress under section #hja4 7,b7 ,annual reports ,the ,secretary shall submit to the ,president1 for inclusion in the report required to be transmitted to ,congress under section #hja1 a report which sets forth the following3 7i7 ,a description of the health care facility priority system of the ,service established under paragraph 7#a74 7ii7 ,health care facilities lists1 which may include-- 7,i7 the #aj top-priority inpatient health care facilities2 7,,ii7 the #aj top-priority outpatient health care facilities2 7,,iii7 the #aj top-priority specialized health care facilities 7such as long-term care and alcohol and drug abuse treatment72 and 7,,iv7 the #aj top-priority staff quarters developments associated with health care facilities4 7iii7 ,the justification for such order of priority4 7iv7 ,the projected cost of such projects4 7v7 ,the methodology adopted by the ,service in establishing priorities under its health care facility priority system4 7#c7 ,requirements for preparation of reports ,in preparing the report required under paragraph 7#b71 the ,secretary shall-- 7,a7 consult with and obtain information on all health care facilities needs from ,indian tribes and tribal organizations2 and 7,b7 review the total unmet needs of all ,indian tribes and tribal organizations for health care facilities 7including staff quarters71 including needs for renovation and expansion of existing facilities4 7d7 ,review of methodology used for health facilities construction priority system 7#a7 ,in general ,not later than #a year after the establishment of the priority system under subsection 7c77#a77;,a71 the ,comptroller ,general of the ,united ,states shall prepare and finalize a report reviewing the methodologies applied1 and the processes followed1 by the ,service in making each assessment of needs for the list under subsection 7c77#b77;,a77ii7 and developing the priority system under subsection 7c77#a71 including a review of-- 7,a7 the recommendations of the ,facilities ,appropriation ,advisory ,board and the ,facilities ,needs ,assessment ,workgroup 7as those terms are defined in subsection 7c77#b77;,a77i772 and 7,b7 the relevant criteria used in ranking or prioritizing facilities other than hospitals or clinics4 7#b7 ,submission to ,congress ,the ,comptroller ,general of the ,united ,states shall submit the report under paragraph 7#a7 to-- 7,a7 the ,committees on ,indian ,affairs and ,appropriations of the ,senate2 7,b7 the ,committees on ,natural ,resources and ,appropriations of the ,house of ,representatives2 and 7,c7 the ,secretary4 7e7 ,funding condition ,all funds appropriated under the ,act of ,november #b1 #aiba 7#be ,u4,s4,c4 #ac7 7commonly known as the ,snyder ,act71 for the planning1 design1 construction1 or renovation of health facilities for the benefit of #a or more ,indian ,tribes shall be subject to the provisions of section #ajb of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej;f7 or sections #ejd and #eje of that ,act 7#be ,u4,s4,c4 #deh;aaa-#c1 #deh;aaa-#d74 7f7 ,development of innovative approaches ,the ,secretary shall consult and cooperate with ,indian tribes and tribal organizations1 and confer with urban ,indian organizations1 in developing innovative approaches to address all or part of the total unmet need for construction of health facilities1 that may include-- 7#a7 the establishment of an area distribution fund in which a portion of health facility construction funding could be devoted to all ,service areas2 7#b7 approaches provided for in other provisions of this title2 and 7#c7 other approaches1 as the ,secretary determines to be appropriate4 4 #adb4 ,priority of certain projects protected ,section #cja of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afca7 7as amended by section #ada7 is amended by adding at the end the following3 7g7 ,priority of certain projects protected ,the priority of any project established under the construction priority system in effect on the date of enactment of this ,indian ,healthcare ,improvement ,act of #bjag shall not be affected by any change in the construction priority system taking place after that date if the project-- 7#a7 was identified in the fiscal year #bjjh ,service budget justification as-- 7,a7 #a of the #aj top-priority inpatient projects2 7,b7 #a of the #aj top-priority outpatient projects2 7,c7 #a of the #aj top-priority staff quarters developments2 or 7,d7 #a of the #aj top-priority ,youth ,regional ,treatment ,centers2 7#b7 had completed both ,phase ,i and ,phase ,,ii of the construction priority system in effect on the date of enactment of such ,act2 or 7#c7 is not included in clause 7i7 or 7ii7 and is selected1 as determined by the ,secretary-- 7,a7 on the initiative of the ,secretary2 or 7,b7 pursuant to a request of an ,indian tribe or tribal organization4 4 #adc4 ,indian health care delivery demonstration projects ,section #cjg of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afcg7 is amended to read as follows3 #cjg4 ,indian health care delivery demonstration projects 7a7 ,purpose and general authority 7#a7 ,purpose ,the purpose of this section is to encourage the establishment of demonstration projects that meet the applicable criteria of this section to be carried out by the ,secretary1 acting through the ,service1 or ,indian tribes or tribal organizations acting pursuant to contracts or compacts under the ,indian ,self ,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq47-- 7,a7 to test alternative means of delivering health care and services to ,indians through facilities2 or 7,b7 to use alternative or innovative methods or models of delivering health care services to ,indians 7including primary care services1 contract health services1 or any other program or service authorized by this ,act7 through convenient care services 7as defined in subsection 7c771 community health centers1 or cooperative agreements or arrangements with other health care providers that share or coordinate the use of facilities1 funding1 or other resources1 or otherwise coordinate or improve the coordination of activities of the ,service1 ,indian tribes1 or tribal organizations1 with those of the other health care providers4 7#b7 ,authority ,the ,secretary1 acting through the ,service1 is authorized to carry out1 or to enter into contracts or compacts under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq47 with ,indian tribes or tribal organizations to carry out1 health care delivery demonstration projects that-- 7,a7 test alternative means of delivering health care and services to ,indians through facilities2 or 7,b7 otherwise carry out the purposes of this section4 7b7 ,use of funds ,the ,secretary1 in approving projects pursuant to this section-- 7#a7 may authorize such contracts for the construction and renovation of hospitals1 health centers1 health stations1 and other facilities to deliver health care services2 and 7#b7 is authorized-- 7,a7 to waive any leasing prohibition2 7,b7 to permit use and carryover of funds appropriated for the provision of health care services under this ,act 7including for the purchase of health benefits coverage1 as authorized by section #djb7;a772 7,c7 to permit the use of other available funds1 including other ,federal funds1 funds from third-party collections in accordance with sections #bjf1 #bjg1 and #dja1 and non-,federal funds contributed by ,state or local governmental agencies or facilities or private health care providers pursuant to cooperative or other agreements with the ,service1 #a or more ,indian tribes1 or tribal organizations2 7,d7 to permit the use of funds or property donated or otherwise provided from any source for project purposes2 7,e7 to provide for the reversion of donated real or personal property to the donor2 and 7,f7 to permit the use of ,service funds to match other funds1 including ,federal funds4 7c7 ,health care demonstration projects 7#a7 ,definition of convenient care service ,in this subsection1 the term convenient care service means any primary health care service1 such as urgent care services1 nonemergent care services1 prevention services and screenings1 and any service authorized by section #bjc or #bje7;d71 that is offered-- 7,a7 at an alternative setting2 or 7,b7 during hours other than regular working hours4 7#b7 ,general projects 7,a7 ,criteria ,the ,secretary may approve under this section demonstration projects that meet the following criteria3 7i7 ,there is a need for a new facility or program1 such as a program for convenient care services1 or an improvement in1 increased efficiency at1 or reorientation of an existing facility or program4 7ii7 ,a significant number of ,indians1 including ,indians with low health status1 will be served by the project4 7iii7 ,the project has the potential to deliver services in an efficient and effective manner4 7iv7 ,the project is economically viable4 7v7 ,for projects carried out by an ,indian tribe or tribal organization1 the ,indian tribe or tribal organization has the administrative and financial capability to administer the project4 7vi7 ,the project is integrated with providers of related health or social services 7including ,state and local health care agencies or other health care providers7 and is coordinated with1 and avoids duplication of1 existing services in order to expand the availability of services4 7,b7 ,priority ,in approving demonstration projects under this paragraph1 the ,secretary shall give priority to demonstration projects1 to the extent the projects meet the criteria described in subparagraph 7,a71 located in any of the following ,service units3 7i7 ,cass ,lake1 ,minnesota4 7ii7 ,mescalero1 ,new ,mexico4 7iii7 ,owyhee and ,elko1 ,nevada4 7iv7 ,schurz1 ,nevada4 7v7 ,ft4 ,yuma1 ,california4 7#c7 ,innovative health services delivery demonstration project 7,a7 ,application or request ,on receipt of an application or request from an ,indian tribe1 a consortium of ,indian tribes1 or a tribal organization within a ,service area1 the ,secretary shall take into consideration alternative or innovated methods to deliver health care services within the ,service area 7or a portion of1 or facility within1 the ,service area7 as described in the application or request1 including medical1 dental1 pharmaceutical1 nursing1 clinical laboratory1 contract health services1 convenient care services1 community health centers1 or any other health care services delivery models designed to improve access to1 or efficiency or quality of1 the health care1 health promotion1 or disease prevention services and programs under this ,act4 7,b7 ,approval ,in addition to projects described in paragraph 7#b71 in any fiscal year1 the ,secretary is authorized under this paragraph to approve not more than #aj applications for health care delivery demonstration projects that meet the criteria described in subparagraph 7,c74 7,c7 ,criteria ,the ,secretary shall approve under subparagraph 7,b7 demonstration projects that meet all of the following criteria3 7i7 ,the criteria set forth in paragraph 7#b77;,a74 7ii7 ,there is a lack of access to health care services at existing health care facilities1 which may be due to limited hours of operation at those facilities or other factors4 7iii7 ,the project-- 7,i7 expands the availability of services2 or 7,,ii7 reduces-- 7aa7 the burden on ,contract ,health ,services2 or 7bb7 the need for emergency room visits4 7d7 ,technical assistance ,on receipt of an application or request from an ,indian tribe1 a consortium of ,indian tribes1 or a tribal organization1 the ,secretary shall provide such technical and other assistance as may be necessary to enable applicants to comply with this section1 including information regarding the ,service unit budget and available funding for carrying out the proposed demonstration project4 7e7 ,service to ineligible persons ,subject to section #hac1 the authority to provide services to persons otherwise ineligible for the health care benefits of the ,service1 and the authority to extend hospital privileges in ,service facilities to non-,service health practitioners as provided in section #hac1 may be included1 subject to the terms of that section1 in any demonstration project approved pursuant to this section4 7f7 ,equitable treatment ,for purposes of subsection 7c71 the ,secretary1 in evaluating facilities operated under any contract or compact under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq471 shall use the same criteria that the ,secretary uses in evaluating facilities operated directly by the ,service4 7g7 ,equitable integration of facilities ,the ,secretary shall ensure that the planning1 design1 construction1 renovation1 and expansion needs of ,service and non-,service facilities that are the subject of a contract or compact under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq47 for health services are fully and equitably integrated into the implementation of the health care delivery demonstration projects under this section4 4 #add4 ,tribal management of federally owned quarters ,title ,,iii of the ,indian ,health ,care ,improvement ,act 7as amended by section #aja7;b77 is amended by inserting after section #cjh 7#be ,u4,s4,c4 #afch7 the following3 #cji4 ,tribal management of federally owned quarters 7a7 ,rental rates 7#a7 ,establishment ,notwithstanding any other provision of law1 a tribal health program that operates a hospital or other health facility and the federally owned quarters associated with such a facility pursuant to a contract or compact under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq47 may establish the rental rates charged to the occupants of those quarters1 on providing notice to the ,secretary4 7#b7 ,objectives ,in establishing rental rates under this subsection1 a tribal health program shall attempt-- 7,a7 to base the rental rates on the reasonable value of the quarters to the occupants of the quarters2 and 7,b7 to generate sufficient funds to prudently provide for the operation and maintenance of the quarters1 and at the discretion of the tribal health program1 to supply reserve funds for capital repairs and replacement of the quarters4 7#c7 ,equitable funding ,a federally owned quarters the rental rates for which are established by a tribal health program under this subsection shall remain eligible to receive improvement and repair funds to the same extent that all federally owned quarters used to house personnel in programs of the ,service are eligible to receive those funds4 7#d7 ,notice of rate change ,a tribal health program that establishes a rental rate under this subsection shall provide occupants of the federally owned quarters a notice of any change in the rental rate by not later than the date that is #fj days notice before the effective date of the change4 7#e7 ,rates in ,alaska ,a rental rate established by a tribal health program under this section for a federally owned quarters in the ,state of ,alaska may be based on the cost of comparable private rental housing in the nearest established community with a year-round population of #a1ejj or more individuals4 7b7 ,direct collection of rent 7#a7 ,in general ,notwithstanding any other provision of law1 and subject to paragraph 7#b71 a tribal health program may collect rent directly from ,federal employees who occupy federally owned quarters if the tribal health program submits to the ,secretary and the employees a notice of the election of the tribal health program to collect rents directly from the employees4 7#b7 ,action by employees ,on receipt of a notice described in paragraph 7#a7-- 7,a7 the affected ,federal employees shall pay rent for occupancy of a federally owned quarters directly to the applicable tribal health program2 and 7,b7 the ,secretary shall not have the authority to collect rent from the employees through payroll deduction or otherwise4 7#c7 ,use of payments ,the rent payments under this subsection-- 7,a7 shall be retained by the applicable tribal health program in a separate account1 which shall be used by the tribal health program for the maintenance 7including capital repairs and replacement7 and operation of the quarters1 as the tribal health program determines to be appropriate2 and 7,b7 shall not be made payable to1 or otherwise be deposited with1 the ,united ,states4 7#d7 ,retrocession of authority ,if a tribal health program that elected to collect rent directly under paragraph 7#a7 requests retrocession of the authority of the tribal health program to collect that rent1 the retrocession shall take effect on the earlier of-- 7,a7 the first day of the month that begins not less than #ahj days after the tribal health program submits the request2 and 7,b7 such other date as may be mutually agreed on by the ,secretary and the tribal health program4 4 #ade4 ,other funding1 equipment1 and supplies for facilities ,title ,,iii of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afca et seq47 is amended by adding at the end the following3 #caa4 ,other funding1 equipment1 and supplies for facilities 7a7 ,authorization 7#a7 ,authority to transfer funds ,the head of any ,federal agency to which funds1 equipment1 or other supplies are made available for the planning1 design1 construction1 or operation of a health care or sanitation facility may transfer the funds1 equipment1 or supplies to the ,secretary for the planning1 design1 construction1 or operation of a health care or sanitation facility to achieve-- 7,a7 the purposes of this ,act2 and 7,b7 the purposes for which the funds1 equipment1 or supplies were made available to the ,federal agency4 7#b7 ,authority to accept funds ,the ,secretary may-- 7,a7 accept from any source1 including ,federal and ,state agencies1 funds1 equipment1 or supplies that are available for the construction or operation of health care or sanitation facilities2 and 7,b7 use those funds1 equipment1 and supplies to plan1 design1 construct1 and operate health care or sanitation facilities for ,indians1 including pursuant to a contract or compact under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq474 7#c7 ,effect of receipt ,receipt of funds by the ,secretary under this subsection shall not affect any priority established under section #cja4 7b7 ,interagency agreements ,the ,secretary may enter into interagency agreements with ,federal or ,state agencies and other entities1 and accept funds1 equipment1 or other supplies from those entities1 to provide for the planning1 design1 construction1 and operation of health care or sanitation facilities to be administered by ,indian health programs to achieve-- 7#a7 the purposes of this ,act2 and 7#b7 the purposes for which the funds were appropriated or otherwise provided4 7c7 ,establishment of standards 7#a7 ,in general ,the ,secretary1 acting through the ,service1 shall establish1 by regulation1 standards for the planning1 design1 construction1 and operation of health care or sanitation facilities serving ,indians under this ,act4 7#b7 ,other regulations ,notwithstanding any other provision of law1 any other applicable regulations of the ,department shall apply in carrying out projects using funds transferred under this section4 7d7 ,definition of sanitation facility ,in this section1 the term sanitation facility means a safe and adequate water supply system1 sanitary sewage disposal system1 or sanitary solid waste system 7including all related equipment and support infrastructure74 4 #adf4 ,indian country modular component facilities demonstration program ,title ,,iii of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afca et seq47 7as amended by section #ade7 is amended by adding at the end the following3 #cab4 ,indian country modular component facilities demonstration program 7a7 ,definition of modular component health care facility ,in this section1 the term modular component health care facility means a health care facility that is constructed-- 7#a7 off-site using prefabricated component units for subsequent transport to the destination location2 and 7#b7 represents a more economical method for provision of health care facility than a traditionally constructed health care building4 7b7 ,establishment ,the ,secretary1 acting through the ,service1 shall establish a demonstration program under which the ,secretary shall award no less than #c grants for purchase1 installation and maintenance of modular component health care facilities in ,indian communities for provision of health care services4 7c7 ,selection of locations 7#a7 ,petitions 7,a7 ,solicitation ,the ,secretary shall solicit from ,indian tribes petitions for location of the modular component health care facilities in the ,service areas of the petitioning ,indian tribes4 7,b7 ,petition ,to be eligible to receive a grant under this section1 an ,indian tribe or tribal organization must submit to the ,secretary a petition to construct a modular component health care facility in the ,indian community of the ,indian tribe1 at such time1 in such manner1 and containing such information as the ,secretary may require4 7#b7 ,selection ,in selecting the location of each modular component health care facility to be provided under the demonstration program1 the ,secretary shall give priority to projects already on the ,indian ,health ,service facilities construction priority list and petitions which demonstrate that erection of a modular component health facility-- 7,a7 is more economical than construction of a traditionally constructed health care facility2 7,b7 can be constructed and erected on the selected location in less time than traditional construction2 and 7,c7 can adequately house the health care services needed by the ,indian population to be served4 7#c7 ,effect of selection ,a modular component health care facility project selected for participation in the demonstration program shall not be eligible for entry on the facilities construction priorities list entitled ,,ihs ,health ,care ,facilities ,,fy #bjaa ,planned ,construction ,budget and dated ,may #g1 #bjji 7or any successor list74 7d7 ,eligibility 7#a7 ,in general ,an ,indian tribe may submit a petition under subsection 7c77#a77;,b7 regardless of whether the ,indian tribe is a party to any contract or compact under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq474 7#b7 ,administration ,at the election of an ,indian tribe or tribal organization selected for participation in the demonstration program1 the funds provided for the project shall be subject to the provisions of the ,indian ,self-,determination and ,education ,assistance ,act4 7e7 ,reports ,not later than #a year after the date on which funds are made available for the demonstration program and annually thereafter1 the ,secretary shall submit to ,congress a report describing-- 7#a7 each activity carried out under the demonstration program1 including an evaluation of the success of the activity2 and 7#b7 the potential benefits of increased use of modular component health care facilities in other ,indian communities4 7f7 ,authorization of appropriations ,there are authorized to be appropriated #ej1jjj1jjj to carry out the demonstration program under this section for the first #e fiscal years1 and such sums as may be necessary to carry out the program in subsequent fiscal years4 4 #adg4 ,mobile health stations demonstration program ,title ,,iii of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afca et seq47 7as amended by section #adf7 is amended by adding at the end the following3 #cac4 ,mobile health stations demonstration program 7a7 ,definitions ,in this section3 7#a7 ,eligible tribal consortium ,the term eligible tribal consortium means a consortium composed of #b or more ,service units between which a mobile health station can be transported by road in up to #h hours4 ,a ,service unit operated by the ,service or by an ,indian tribe or tribal organization shall be equally eligible for participation in such consortium4 7#b7 ,mobile health station ,the term mobile health station means a health care unit that-- 7,a7 is constructed1 maintained1 and capable of being transported within a semi-trailer truck or similar vehicle2 7,b7 is equipped for the provision of #a or more specialty health care services2 and 7,c7 can be equipped to be docked to a stationary health care facility when appropriate4 7#c7 ,specialty health care service 7,a7 ,in general ,the term specialty health care service means a health care service which requires the services of a health care professional with specialized knowledge or experience4 7,b7 ,inclusions ,the term specialty health care service includes any service relating to-- 7i7 dialysis2 7ii7 surgery2 7iii7 mammography2 7iv7 dentistry2 or 7v7 any other specialty health care service4 7b7 ,establishment ,the ,secretary1 acting through the ,service1 shall establish a demonstration program under which the ,secretary shall provide at least #c mobile health station projects4 7c7 ,petition ,to be eligible to receive a mobile health station under the demonstration program1 an eligible tribal consortium shall submit to the ,secretary1 a petition at such time1 in such manner1 and containing-- 7#a7 a description of the ,indian population to be served2 7#b7 a description of the specialty service or services for which the mobile health station is requested and the extent to which such service or services are currently available to the ,indian population to be served2 and 7#c7 such other information as the ,secretary may require4 7d7 ,use of funds ,the ,secretary shall use amounts made available to carry out the demonstration program under this section-- 7#a7 7,a7 to establish1 purchase1 lease1 or maintain mobile health stations for the eligible tribal consortia selected for projects2 and 7,b7 to provide1 through the mobile health station1 such specialty health care services as the affected eligible tribal consortium determines to be necessary for the ,indian population served2 7#b7 to employ an existing mobile health station 7regardless of whether the mobile health station is owned or rented and operated by the ,service7 to provide specialty health care services to an eligible tribal consortium2 and 7#c7 to establish1 purchase1 or maintain docking equipment for a mobile health station1 including the establishment or maintenance of such equipment at a modular component health care facility 7as defined in section #cab7;a771 if applicable4 7e7 ,reports ,not later than #a year after the date on which the demonstration program is established under subsection 7b7 and annually thereafter1 the ,secretary1 acting through the ,service1 shall submit to ,congress a report describing-- 7#a7 each activity carried out under the demonstration program including an evaluation of the success of the activity2 and 7#b7 the potential benefits of increased use of mobile health stations to provide specialty health care services for ,indian communities4 7f7 ,authorization of appropriations ,there are authorized to be appropriated #e1jjj1jjj per year to carry out the demonstration program under this section for the first #e fiscal years1 and such sums as may be needed to carry out the program in subsequent fiscal years4 4 ,d ,access to health services #aea4 ,treatment of payments under ,social ,security ,act health benefits programs ,section #dja of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afda7 is amended to read as follows3 #dja4 ,treatment of payments under ,social ,security ,act health benefits programs 7a7 ,disregard of ,medicare1 ,medicaid1 and ,,chip payments in determining appropriations ,any payments received by an ,indian health program or by an urban ,indian organization under title ,,xviii1 ,,xix1 or ,,xxi of the ,social ,security ,act for services provided to ,indians eligible for benefits under such respective titles shall not be considered in determining appropriations for the provision of health care and services to ,indians4 7b7 ,nonpreferential treatment ,nothing in this ,act authorizes the ,secretary to provide services to an ,indian with coverage under title ,,xviii1 ,,xix1 or ,,xi of the ,social ,security ,act in preference to an ,indian without such coverage4 7c7 ,use of funds 7#a7 ,special fund 7,a7 #ajj percent pass-through of payments due to facilities ,notwithstanding any other provision of law1 but subject to paragraph 7#b71 payments to which a facility of the ,service is entitled by reason of a provision of title ,,xviii or ,,xix of the ,social ,security ,act shall be placed in a special fund to be held by the ,secretary4 ,in making payments from such fund1 the ,secretary shall ensure that each ,service unit of the ,service receives #ajj percent of the amount to which the facilities of the ,service1 for which such ,service unit makes collections1 are entitled by reason of a provision of either such title4 7,b7 ,use of funds ,amounts received by a facility of the ,service under subparagraph 7,a7 by reason of a provision of title ,,xviii or ,,xix of the ,social ,security ,act shall first be used 7to such extent or in such amounts as are provided in appropriation ,acts7 for the purpose of making any improvements in the programs of the ,service operated by or through such facility which may be necessary to achieve or maintain compliance with the applicable conditions and requirements of such respective title4 ,any amounts so received that are in excess of the amount necessary to achieve or maintain such conditions and requirements shall1 subject to consultation with the ,indian tribes being served by the ,service unit1 be used for reducing the health resource deficiencies 7as determined in section #bja7;c77 of such ,indian tribes1 including the provision of services pursuant to section #bje4 7#b7 ,direct payment option ,paragraph 7#a7 shall not apply to a tribal health program upon the election of such program under subsection 7d7 to receive payments directly4 ,no payment may be made out of the special fund described in such paragraph with respect to reimbursement made for services provided by such program during the period of such election4 7d7 ,direct billing 7#a7 ,in general ,subject to complying with the requirements of paragraph 7#b71 a tribal health program may elect to directly bill for1 and receive payment for1 health care items and services provided by such program for which payment is made under title ,,xviii1 ,,xix1 or ,,xxi of the ,social ,security ,act or from any other third party payor4 7#b7 ,direct reimbursement 7,a7 ,use of funds ,each tribal health program making the election described in paragraph 7#a7 with respect to a program under a title of the ,social ,security ,act shall be reimbursed directly by that program for items and services furnished without regard to subsection 7c77#a71 except that all amounts so reimbursed shall be used by the tribal health program for the purpose of making any improvements in facilities of the tribal health program that may be necessary to achieve or maintain compliance with the conditions and requirements applicable generally to such items and services under the program under such title and to provide additional health care services1 improvements in health care facilities and tribal health programs1 any health care-related purpose 7including coverage for a service or service within a contract health service delivery area or any portion of a contract health service delivery area that would otherwise be provided as a contract health service71 or otherwise to achieve the objectives provided in section #c of this ,act4 7,b7 ,audits ,the amounts paid to a tribal health program making the election described in paragraph 7#a7 with respect to a program under title ,,xviii1 ,,xix1 or ,,xxi of the ,social ,security ,act shall be subject to all auditing requirements applicable to the program under such title1 as well as all auditing requirements applicable to programs administered by an ,indian health program4 ,nothing in the preceding sentence shall be construed as limiting the application of auditing requirements applicable to amounts paid under title ,,xviii1 ,,xix1 or ,,xxi of the ,social ,security ,act4 7,c7 ,identification of source of payments ,any tribal health program that receives reimbursements or payments under title ,,xviii1 ,,xix1 or ,,xxi of the ,social ,security ,act shall provide to the ,service a list of each provider enrollment number 7or other identifier7 under which such program receives such reimbursements or payments4 7#c7 ,examination and implementation of changes 7,a7 ,in general ,the ,secretary1 acting through the ,service and with the assistance of the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall examine on an ongoing basis and implement any administrative changes that may be necessary to facilitate direct billing and reimbursement under the program established under this subsection1 including any agreements with ,states that may be necessary to provide for direct billing under a program under title ,,xix or ,,xxi of the ,social ,security ,act4 7,b7 ,coordination of information ,the ,service shall provide the ,administrator of the ,centers for ,medicare ,medicaid ,services with copies of the lists submitted to the ,service under paragraph 7#b77;,c71 enrollment data regarding patients served by the ,service 7and by tribal health programs1 to the extent such data is available to the ,service71 and such other information as the ,administrator may require for purposes of administering title ,,xviii1 ,,xix1 or ,,xxi of the ,social ,security ,act4 7#d7 ,withdrawal from program ,a tribal health program that bills directly under the program established under this subsection may withdraw from participation in the same manner and under the same conditions that an ,indian tribe or tribal organization may retrocede a contracted program to the ,secretary under the authority of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq474 ,all cost accounting and billing authority under the program established under this subsection shall be returned to the ,secretary upon the ,secretary's acceptance of the withdrawal of participation in this program4 7#e7 ,termination for failure to comply with requirements ,the ,secretary may terminate the participation of a tribal health program or in the direct billing program established under this subsection if the ,secretary determines that the program has failed to comply with the requirements of paragraph 7#b74 ,the ,secretary shall provide a tribal health program with notice of a determination that the program has failed to comply with any such requirement and a reasonable opportunity to correct such noncompliance prior to terminating the program's participation in the direct billing program established under this subsection4 7e7 ,related provisions under the ,social ,security ,act ,for provisions related to subsections 7c7 and 7d71 see sections #ahhj1 #aiaa1 and #bajg7;e77#a77;,d7 of the ,social ,security ,act4 4 #aeb4 ,purchasing health care coverage ,section #djb of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afdb7 is amended to read as follows3 #djb4 ,purchasing health care coverage 7a7 ,in general ,insofar as amounts are made available under law 7including a provision of the ,social ,security ,act1 the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq471 or other law1 other than under section #djd7 to ,indian tribes1 tribal organizations1 and urban ,indian organizations for health benefits for ,service beneficiaries1 ,indian tribes1 tribal organizations1 and urban ,indian organizations may use such amounts to purchase health benefits coverage 7including coverage for a service1 or service within a contract health service delivery area1 or any portion of a contract health service delivery area that would otherwise be provided as a contract health service7 for such beneficiaries in any manner1 including through-- 7#a7 a tribally owned and operated health care plan2 7#b7 a ,state or locally authorized or licensed health care plan2 7#c7 a health insurance provider or managed care organization2 7#d7 a self-insured plan2 or 7#e7 a high deductible or health savings account plan4 7b7 ,financial need ,the purchase of coverage under subsection 7a7 by an ,indian tribe1 tribal organization1 or urban ,indian organization may be based on the financial needs of such beneficiaries 7as determined by the #a or more ,indian tribes being served based on a schedule of income levels developed or implemented by such #a or more ,indian tribes74 7c7 ,expenses for self-,insured plan ,in the case of a self-insured plan under subsection 7a77#d71 the amounts may be used for expenses of operating the plan1 including administration and insurance to limit the financial risks to the entity offering the plan4 7d7 ,construction ,nothing in this section shall be construed as affecting the use of any amounts not referred to in subsection 7a74 4 #aec4 ,grants to and contracts with the ,service1 ,indian tribes1 tribal organizations1 and urban ,indian organizations to facilitate outreach1 enrollment1 and coverage of ,indians under ,social ,security ,act health benefit programs and other health benefits programs ,section #djd of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afdd7 is amended to read as follows3 #djd4 ,grants to and contracts with the ,service1 ,indian tribes1 tribal organizations1 and urban ,indian organizations to facilitate outreach1 enrollment1 and coverage of ,indians under ,social ,security ,act health benefit programs and other health benefits programs 7a7 ,indian tribes and tribal organizations ,the ,secretary1 acting through the ,service1 shall make grants to or enter into contracts with ,indian tribes and tribal organizations to assist such tribes and tribal organizations in establishing and administering programs on or near reservations and trust lands1 including programs to provide outreach and enrollment through video1 electronic delivery methods1 or telecommunication devices that allow real-time or time-delayed communication between individual ,indians and the benefit program1 to assist individual ,indians-- 7#a7 to enroll for benefits under a program established under title ,,xviii1 ,,xix1 or ,,xxi of the ,social ,security ,act and other health benefits programs2 and 7#b7 with respect to such programs for which the charging of premiums and cost sharing is not prohibited under such programs1 to pay premiums or cost sharing for coverage for such benefits1 which may be based on financial need 7as determined by the ,indian tribe or tribes or tribal organizations being served based on a schedule of income levels developed or implemented by such tribe1 tribes1 or tribal organizations74 7b7 ,conditions ,the ,secretary1 acting through the ,service1 shall place conditions as deemed necessary to effect the purpose of this section in any grant or contract which the ,secretary makes with any ,indian tribe or tribal organization pursuant to this section4 ,such conditions shall include requirements that the ,indian tribe or tribal organization successfully undertake-- 7#a7 to determine the population of ,indians eligible for the benefits described in subsection 7a72 7#b7 to educate ,indians with respect to the benefits available under the respective programs2 7#c7 to provide transportation for such individual ,indians to the appropriate offices for enrollment or applications for such benefits2 and 7#d7 to develop and implement methods of improving the participation of ,indians in receiving benefits under such programs4 7c7 ,application to urban ,indian organizations 7#a7 ,in general ,the provisions of subsection 7a7 shall apply with respect to grants and other funding to urban ,indian organizations with respect to populations served by such organizations in the same manner they apply to grants and contracts with ,indian tribes and tribal organizations with respect to programs on or near reservations4 7#b7 ,requirements ,the ,secretary shall include in the grants or contracts made or provided under paragraph 7#a7 requirements that are-- 7,a7 consistent with the requirements imposed by the ,secretary under subsection 7b72 7,b7 appropriate to urban ,indian organizations and urban ,indians2 and 7,c7 necessary to effect the purposes of this section4 7d7 ,facilitating cooperation ,the ,secretary1 acting through the ,centers for ,medicare ,medicaid ,services1 shall develop and disseminate best practices that will serve to facilitate cooperation with1 and agreements between1 ,states and the ,service1 ,indian tribes1 tribal organizations1 or urban ,indian organizations with respect to the provision of health care items and services to ,indians under the programs established under title ,,xviii1 ,,xix1 or ,,xxi of the ,social ,security ,act4 7e7 ,agreements relating to improving enrollment of ,indians under ,social ,security ,act health benefits programs ,for provisions relating to agreements of the ,secretary1 acting through the ,service1 for the collection1 preparation1 and submission of applications by ,indians for assistance under the ,medicaid and children's health insurance programs established under titles ,,xix and ,,xxi of the ,social ,security ,act1 and benefits under the ,medicare program established under title ,,xviii of such ,act1 see subsections 7a7 and 7b7 of section #aaci of the ,social ,security ,act4 7f7 ,definition of premiums and cost sharing ,in this section3 7#a7 ,premium ,the term premium includes any enrollment fee or similar charge4 7#b7 ,cost sharing ,the term cost sharing includes any deduction1 deductible1 copayment1 coinsurance1 or similar charge4 4 #aed4 ,sharing arrangements with ,federal agencies ,section #dje of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afde7 is amended to read as follows3 #dje4 ,sharing arrangements with ,federal agencies 7a7 ,authority 7#a7 ,in general ,the ,secretary may enter into 7or expand7 arrangements for the sharing of medical facilities and services between the ,service1 ,indian tribes1 and tribal organizations and the ,department of ,veterans ,affairs and the ,department of ,defense4 7#b7 ,consultation by ,secretary required ,the ,secretary may not finalize any arrangement between the ,service and a ,department described in paragraph 7#a7 without first consulting with the ,indian tribes which will be significantly affected by the arrangement4 7b7 ,limitations ,the ,secretary shall not take any action under this section or under subchapter ,,iv of chapter #ha of title #ch1 ,united ,states ,code1 which would impair-- 7#a7 the priority access of any ,indian to health care services provided through the ,service and the eligibility of any ,indian to receive health services through the ,service2 7#b7 the quality of health care services provided to any ,indian through the ,service2 7#c7 the priority access of any veteran to health care services provided by the ,department of ,veterans ,affairs2 7#d7 the quality of health care services provided by the ,department of ,veterans ,affairs or the ,department of ,defense2 or 7#e7 the eligibility of any ,indian who is a veteran to receive health services through the ,department of ,veterans ,affairs4 7c7 ,reimbursement ,the ,service1 ,indian tribe1 or tribal organization shall be reimbursed by the ,department of ,veterans ,affairs or the ,department of ,defense 7as the case may be7 where services are provided through the ,service1 an ,indian tribe1 or a tribal organization to beneficiaries eligible for services from either such ,department1 notwithstanding any other provision of law4 7d7 ,construction ,nothing in this section may be construed as creating any right of a non-,indian veteran to obtain health services from the ,service4 4 #aee4 ,eligible ,indian veteran services ,title ,,iv of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afda et seq47 7as amended by section #aja7;b77 is amended by adding at the end the following3 #djg4 ,eligible ,indian veteran services 7a7 ,findings2 purpose 7#a7 ,findings ,congress finds that-- 7,a7 collaborations between the ,secretary and the ,secretary of ,veterans ,affairs regarding the treatment of ,indian veterans at facilities of the ,service should be encouraged to the maximum extent practicable2 and 7,b7 increased enrollment for services of the ,department of ,veterans ,affairs by veterans who are members of ,indian tribes should be encouraged to the maximum extent practicable4 7#b7 ,purpose ,the purpose of this section is to reaffirm the goals stated in the document entitled ,memorandum of ,understanding ,between the ,,va_/,veterans ,health ,administration ,and ,,hhs_/,indian ,health ,service and dated ,february #be1 #bjjc 7relating to cooperation and resource sharing between the ,veterans ,health ,administration and ,service74 7b7 ,definitions ,in this section3 7#a7 ,eligible ,indian veteran ,the term eligible ,indian veteran means an ,indian or ,alaska ,native veteran who receives any medical service that is-- 7,a7 authorized under the laws administered by the ,secretary of ,veterans ,affairs2 and 7,b7 administered at a facility of the ,service 7including a facility operated by an ,indian tribe or tribal organization through a contract or compact with the ,service under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq477 pursuant to a local memorandum of understanding4 7#b7 ,local memorandum of understanding ,the term local memorandum of understanding means a memorandum of understanding between the ,secretary 7or a designee1 including the director of any area office of the ,service7 and the ,secretary of ,veterans ,affairs 7or a designee7 to implement the document entitled ,memorandum of ,understanding ,between the ,,va_/,veterans ,health ,administration ,and ,,hhs_/,indian ,health ,service and dated ,february #be1 #bjjc 7relating to cooperation and resource sharing between the ,veterans ,health ,administration and ,indian ,health ,service74 7c7 ,eligible ,indian veterans expenses 7#a7 ,in general ,notwithstanding any other provision of law1 the ,secretary shall provide for veteran-related expenses incurred by eligible ,indian veterans as described in subsection 7b77#a77;,b74 7#b7 ,method of payment ,the ,secretary shall establish such guidelines as the ,secretary determines to be appropriate regarding the method of payments to the ,secretary of ,veterans ,affairs under paragraph 7#a74 7d7 ,tribal approval of memoranda ,in negotiating a local memorandum of understanding with the ,secretary of ,veterans ,affairs regarding the provision of services to eligible ,indian veterans1 the ,secretary shall consult with each ,indian tribe that would be affected by the local memorandum of understanding4 7e7 ,funding 7#a7 ,treatment ,expenses incurred by the ,secretary in carrying out subsection 7c77#a7 shall not be considered to be ,contract ,health ,service expenses4 7#b7 ,use of funds ,of funds made available to the ,secretary in appropriations ,acts for the ,service 7excluding funds made available for facilities1 ,contract ,health ,services1 or contract support costs71 the ,secretary shall use such sums as are necessary to carry out this section4 4 #aef4 ,nondiscrimination under ,federal health care programs in qualifications for reimbursement for services ,title ,,iv of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afda et seq47 7as amended by section #aee7 is amended by adding at the end the following3 #djh4 ,nondiscrimination under ,federal health care programs in qualifications for reimbursement for services 7a7 ,requirement ,to satisfy generally applicable participation requirements 7#a7 ,in general ,a ,federal health care program must accept an entity that is operated by the ,service1 an ,indian tribe1 tribal organization1 or urban ,indian organization as a provider eligible to receive payment under the program for health care services furnished to an ,indian on the same basis as any other provider qualified to participate as a provider of health care services under the program if the entity meets generally applicable ,state or other requirements for participation as a provider of health care services under the program4 7#b7 ,satisfaction of ,state or local licensure or recognition requirements ,any requirement for participation as a provider of health care services under a ,federal health care program that an entity be licensed or recognized under the ,state or local law where the entity is located to furnish health care services shall be deemed to have been met in the case of an entity operated by the ,service1 an ,indian tribe1 tribal organization1 or urban ,indian organization if the entity meets all the applicable standards for such licensure or recognition1 regardless of whether the entity obtains a license or other documentation under such ,state or local law4 ,in accordance with section #bba1 the absence of the licensure of a health professional employed by such an entity under the ,state or local law where the entity is located shall not be taken into account for purposes of determining whether the entity meets such standards1 if the professional is licensed in another ,state4 7b7 ,application of exclusion from participation in ,federal health care programs 7#a7 ,excluded entities ,no entity operated by the ,service1 an ,indian tribe1 tribal organization1 or urban ,indian organization that has been excluded from participation in any ,federal health care program or for which a license is under suspension or has been revoked by the ,state where the entity is located shall be eligible to receive payment or reimbursement under any such program for health care services furnished to an ,indian4 7#b7 ,excluded individuals ,no individual who has been excluded from participation in any ,federal health care program or whose ,state license is under suspension shall be eligible to receive payment or reimbursement under any such program for health care services furnished by that individual1 directly or through an entity that is otherwise eligible to receive payment for health care services1 to an ,indian4 7#c7 ,federal health care program defined ,in this subsection1 the term1 ,federal health care program has the meaning given that term in section #aabh;,b7f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7f771 except that1 for purposes of this subsection1 such term shall include the health insurance program under chapter #hi of title #e1 ,united ,states ,code4 7c7 ,related provisions ,for provisions related to nondiscrimination against providers operated by the ,service1 an ,indian tribe1 tribal organization1 or urban ,indian organization1 see section #aaci7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i7;c774 4 #aeg4 ,access to ,federal insurance ,title ,,iv of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afda et seq47 7as amended by section #aef7 is amended by adding at the end the following3 #dji4 ,access to ,federal insurance ,notwithstanding the provisions of title #e1 ,united ,states ,code1 ,executive order1 or administrative regulation1 an ,indian tribe or tribal organization carrying out programs under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq47 or an urban ,indian organization carrying out programs under title ,v of this ,act shall be entitled to purchase coverage1 rights1 and benefits for the employees of such ,indian tribe or tribal organization1 or urban ,indian organization1 under chapter #hi of title #e1 ,united ,states ,code1 and chapter #hg of such title if necessary employee deductions and agency contributions in payment for the coverage1 rights1 and benefits for the period of employment with such ,indian tribe or tribal organization1 or urban ,indian organization1 are currently deposited in the applicable ,employee's ,fund under such title4 4 #aeh4 ,general exceptions ,title ,,iv of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afda et seq47 7as amended by section #aeg7 is amended by adding at the end the following3 #daj4 ,general exceptions ,the requirements of this title shall not apply to any excepted benefits described in paragraph 7#a77;,a7 or 7#c7 of section #bgia7;c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia74 4 #aei4 ,navajo ,nation ,medicaid ,agency feasibility study ,title ,,iv of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afda et seq47 7as amended by section #aeh7 is amended by adding at the end the following3 #daa4 ,navajo ,nation ,medicaid ,agency feasibility study 7a7 ,study ,the ,secretary shall conduct a study to determine the feasibility of treating the ,navajo ,nation as a ,state for the purposes of title ,,xix of the ,social ,security ,act1 to provide services to ,indians living within the boundaries of the ,navajo ,nation through an entity established having the same authority and performing the same functions as single-,state medicaid agencies responsible for the administration of the ,state plan under title ,,xix of the ,social ,security ,act4 7b7 ,considerations ,in conducting the study1 the ,secretary shall consider the feasibility of-- 7#a7 assigning and paying all expenditures for the provision of services and related administration funds1 under title ,,xix of the ,social ,security ,act1 to ,indians living within the boundaries of the ,navajo ,nation that are currently paid to or would otherwise be paid to the ,state of ,arizona1 ,new ,mexico1 or ,utah2 7#b7 providing assistance to the ,navajo ,nation in the development and implementation of such entity for the administration1 eligibility1 payment1 and delivery of medical assistance under title ,,xix of the ,social ,security ,act2 7#c7 providing an appropriate level of matching funds for ,federal medical assistance with respect to amounts such entity expends for medical assistance for services and related administrative costs2 and 7#d7 authorizing the ,secretary1 at the option of the ,navajo ,nation1 to treat the ,navajo ,nation as a ,state for the purposes of title ,,xix of the ,social ,security ,act 7relating to the ,state children's health insurance program7 under terms equivalent to those described in paragraphs 7#b7 through 7#d74 7c7 ,report ,not later then #c years after the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag1 the ,secretary shall submit to the ,committee on ,indian ,affairs and ,committee on ,finance of the ,senate and the ,committee on ,natural ,resources and ,committee on ,energy and ,commerce of the ,house of ,representatives a report that includes-- 7#a7 the results of the study under this section2 7#b7 a summary of any consultation that occurred between the ,secretary and the ,navajo ,nation1 other ,indian ,tribes1 the ,states of ,arizona1 ,new ,mexico1 and ,utah1 counties which include ,navajo ,lands1 and other interested parties1 in conducting this study2 7#c7 projected costs or savings associated with establishment of such entity1 and any estimated impact on services provided as described in this section in relation to probable costs or savings2 and 7#d7 legislative actions that would be required to authorize the establishment of such entity if such entity is determined by the ,secretary to be feasible4 4 ,e ,health services for urban ,indians #afa4 ,facilities renovation ,section #eji of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afei7 is amended by inserting or construction or expansion of facilities after renovations to facilities4 #afb4 ,treatment of certain demonstration projects ,section #eab of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #affj;b7 is amended to read as follows3 #eab4 ,treatment of certain demonstration projects ,notwithstanding any other provision of law1 the ,tulsa ,clinic and ,oklahoma ,city ,clinic demonstration projects shall-- 7#a7 be permanent programs within the ,service's direct care program2 7#b7 continue to be treated as ,service units and operating units in the allocation of resources and coordination of care2 and 7#c7 continue to meet the requirements and definitions of an urban ,indian organization in this ,act1 and shall not be subject to the provisions of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq474 4 #afc4 ,requirement to confer with urban ,indian organizations 7a7 ,conferring with urban ,indian organizations ,title ,v of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afea et seq47 7as amended by section #aja7;b77 is amended by adding at the end the following3 #ead4 ,conferring with urban ,indian organizations 7a7 ,definition of confer ,in this section1 the term confer means to engage in an open and free exchange of information and opinions that-- 7#a7 leads to mutual understanding and comprehension2 and 7#b7 emphasizes trust1 respect1 and shared responsibility4 7b7 ,requirement ,the ,secretary shall ensure that the ,service confers1 to the maximum extent practicable1 with urban ,indian organizations in carrying out this ,act4 4 7b7 ,contracts with1 and grants to1 urban ,indian organizations ,section #ejb of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afeb7 is amended to read as follows3 #ejb4 ,contracts with1 and grants to1 urban ,indian organizations 7a7 ,in general ,pursuant to the ,act of ,november #b1 #aiba 7#be ,u4,s4,c4 #ac7 7commonly known as the ,snyder ,act71 the ,secretary1 acting through the ,service1 shall enter into contracts with1 or make grants to1 urban ,indian organizations to assist the urban ,indian organizations in the establishment and administration1 within urban centers1 of programs that meet the requirements of this title4 7b7 ,conditions ,subject to section #ejf1 the ,secretary1 acting through the ,service1 shall include such conditions as the ,secretary considers necessary to effect the purpose of this title in any contract into which the ,secretary enters with1 or in any grant the ,secretary makes to1 any urban ,indian organization pursuant to this title4 4 #afd4 ,expanded program authority for urban ,indian organizations ,title ,v of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afea et seq47 7as amended by section #afc7;a77 is amended by adding at the end the following3 #eae4 ,expanded program authority for urban ,indian organizations ,notwithstanding any other provision of this ,act1 the ,secretary1 acting through the ,service1 is authorized to establish programs1 including programs for awarding grants1 for urban ,indian organizations that are identical to any programs established pursuant to sections #bah1 #gjb1 and #gjh7;g74 4 #afe4 ,community health representatives ,title ,v of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afea et seq47 7as amended by section #afd7 is amended by adding at the end the following3 #eaf4 ,community health representatives ,the ,secretary1 acting through the ,service1 may enter into contracts with1 and make grants to1 urban ,indian organizations for the employment of ,indians trained as health service providers through the ,community ,health ,representative ,program under section #ajg in the provision of health care1 health promotion1 and disease prevention services to urban ,indians4 4 #aff4 ,use of ,federal ,government facilities and sources of supply2 health information technology ,title ,v of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afea et seq47 7as amended by section #afe7 is amended by adding at the end the following3 #eag4 ,use of ,federal ,government facilities and sources of supply 7a7 ,in general ,the ,secretary may permit an urban ,indian organization that has entered into a contract or received a grant pursuant to this title1 in carrying out the contract or grant1 to use1 in accordance with such terms and conditions for use and maintenance as are agreed on by the ,secretary and the urban ,indian organizations-- 7#a7 any existing facility under the jurisdiction of the ,secretary2 7#b7 all equipment contained in or pertaining to such an existing facility2 and 7#c7 any other personal property of the ,federal ,government under the jurisdiction of the ,secretary4 7b7 ,donations ,subject to subsection 7d71 the ,secretary may donate to an urban ,indian organization that has entered into a contract or received a grant pursuant to this title any personal or real property determined to be excess to the needs of the ,service or the ,general ,services ,administration for the purposes of carrying out the contract or grant4 7c7 ,acquisition of property ,the ,secretary may acquire excess or surplus personal or real property of the ,federal ,government for donation1 subject to subsection 7d71 to an urban ,indian organization that has entered into a contract or received a grant pursuant to this title if the ,secretary determines that the property is appropriate for use by the urban ,indian organization for purposes of the contract or grant4 7d7 ,priority ,if the ,secretary receives from an urban ,indian organization or an ,indian tribe or tribal organization a request for a specific item of personal or real property described in subsection 7b7 or 7c71 the ,secretary shall give priority to the request for donation to the ,indian tribe or tribal organization1 if the ,secretary receives the request from the ,indian tribe or tribal organization before the earlier of-- 7#a7 the date on which the ,secretary transfers title to the property to the urban ,indian organization2 and 7#b7 the date on which the ,secretary transfers the property physically to the urban ,indian organization4 7e7 ,executive agency status ,for purposes of section #eja7;a7 of title #dj1 ,united ,states ,code1 an urban ,indian organization that has entered into a contract or received a grant pursuant to this title may be considered to be an ,executive agency in carrying out the contract or grant4 #eah4 ,health information technology ,the ,secretary1 acting through the ,service1 may make grants to urban ,indian organizations under this title for the development1 adoption1 and implementation of health information technology 7as defined in section #cjjj of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj771 telemedicine services development1 and related infrastructure4 4 ,f ,organizational improvements #aga4 ,establishment of the ,indian ,health ,service as an agency of the ,public ,health ,service ,section #fja of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #affa7 is amended to read as follows3 #fja4 ,establishment of the ,indian ,health ,service as an agency of the ,public ,health ,service 7a7 ,establishment 7#a7 ,in general ,in order to more effectively and efficiently carry out the responsibilities1 authorities1 and functions of the ,united ,states to provide health care services to ,indians and ,indian tribes1 as are or may be hereafter provided by ,federal statute or treaties1 there is established within the ,public ,health ,service of the ,department the ,indian ,health ,service4 7#b7 ,director ,the ,service shall be administered by a ,director1 who shall be appointed by the ,president1 by and with the advice and consent of the ,senate4 ,the ,director shall report to the ,secretary4 ,effective with respect to an individual appointed by the ,president1 by and with the advice and consent of the ,senate1 after ,january #a1 #bjjh1 the term of service of the ,director shall be #d years4 ,a ,director may serve more than #a term4 7#c7 ,incumbent ,the individual serving in the position of ,director of the ,service on the day before the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag shall serve as ,director4 7#d7 ,advocacy and consultation ,the position of ,director is established to1 in a manner consistent with the government-to-government relationship between the ,united ,states and ,indian ,tribes-- 7,a7 facilitate advocacy for the development of appropriate ,indian health policy2 and 7,b7 promote consultation on matters relating to ,indian health4 7b7 ,agency ,the ,service shall be an agency within the ,public ,health ,service of the ,department1 and shall not be an office1 component1 or unit of any other agency of the ,department4 7c7 ,duties ,the ,director shall-- 7#a7 perform all functions that were1 on the day before the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag1 carried out by or under the direction of the individual serving as ,director of the ,service on that day2 7#b7 perform all functions of the ,secretary relating to the maintenance and operation of hospital and health facilities for ,indians and the planning for1 and provision and utilization of1 health services for ,indians1 including by ensuring that all agency directors1 managers1 and chief executive officers have appropriate and adequate training1 experience1 skill levels1 knowledge1 abilities1 and education 7including continuing training requirements7 to competently fulfill the duties of the positions and the mission of the ,service2 7#c7 administer all health programs under which health care is provided to ,indians based upon their status as ,indians which are administered by the ,secretary1 including programs under-- 7,a7 this ,act2 7,b7 the ,act of ,november #b1 #aiba 7#be ,u4,s4,c4 #ac72 7,c7 the ,act of ,august #e1 #aied 7#db ,u4,s4,c4 #bjja et seq472 7,d7 the ,act of ,august #af1 #aieg 7#db ,u4,s4,c4 #bjje et seq472 and 7,e7 the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq472 7#d7 administer all scholarship and loan functions carried out under title ,i2 7#e7 directly advise the ,secretary concerning the development of all policy- and budget-related matters affecting ,indian health2 7#f7 collaborate with the ,assistant ,secretary for ,health concerning appropriate matters of ,indian health that affect the agencies of the ,public ,health ,service2 7#g7 advise each ,assistant ,secretary of the ,department concerning matters of ,indian health with respect to which that ,assistant ,secretary has authority and responsibility2 7#h7 advise the heads of other agencies and programs of the ,department concerning matters of ,indian health with respect to which those heads have authority and responsibility2 7#i7 coordinate the activities of the ,department concerning matters of ,indian health2 and 7#aj7 perform such other functions as the ,secretary may designate4 7d7 ,authority 7#a7 ,in general ,the ,secretary1 acting through the ,director1 shall have the authority-- 7,a7 except to the extent provided for in paragraph 7#b71 to appoint and compensate employees for the ,service in accordance with title #e1 ,united ,states ,code2 7,b7 to enter into contracts for the procurement of goods and services to carry out the functions of the ,service2 and 7,c7 to manage1 expend1 and obligate all funds appropriated for the ,service4 7#b7 ,personnel actions ,notwithstanding any other provision of law1 the provisions of section #ab of the ,act of ,june #ah1 #aicd 7#dh ,stat4 #ihf2 #be ,u4,s4,c4 #dgb71 shall apply to all personnel actions taken with respect to new positions created within the ,service as a result of its establishment under subsection 7a74 4 #agb4 ,office of ,direct ,service ,tribes ,title ,,vi of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #affa et seq47 7as amended by section #aja7;b77 is amended by adding at the end the following3 #fjc4 ,office of ,direct ,service ,tribes 7a7 ,establishment ,there is established within the ,service an office1 to be known as the ,office of ,direct ,service ,tribes4 7b7 ,treatment ,the ,office of ,direct ,service ,tribes shall be located in the ,office of the ,director4 7c7 ,duties ,the ,office of ,direct ,service ,tribes shall be responsible for-- 7#a7 providing ,service-wide leadership1 guidance and support for direct service tribes to include strategic planning and program evaluation2 7#b7 ensuring maximum flexibility to tribal health and related support systems for ,indian beneficiaries2 7#c7 serving as the focal point for consultation and participation between direct service tribes and organizations and the ,service in the development of ,service policy2 7#d7 holding no less than biannual consultations with direct service tribes in appropriate locations to gather information and aid in the development of health policy2 and 7#e7 directing a national program and providing leadership and advocacy in the development of health policy1 program management1 budget formulation1 resource allocation1 and delegation support for direct service tribes4 4 #agc4 ,nevada area office ,title ,,vi of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #affa et seq47 7as amended by section #agb7 is amended by adding at the end the following3 #fjd4 ,nevada area office 7a7 ,in general ,not later than #a year after the date of enactment of this section1 in a manner consistent with the tribal consultation policy of the ,service1 the ,secretary shall submit to ,congress a plan describing the manner and schedule by which an area office1 separate and distinct from the ,phoenix ,area ,office of the ,service1 can be established in the ,state of ,nevada4 7b7 ,failure ,to submit plan 7#a7 ,definition of operations funds ,in this subsection1 the term operations funds means only the funds used for-- 7,a7 the administration of services1 including functional expenses such as overtime1 personnel salaries1 and associated benefits2 or 7,b7 related tasks that directly affect the operations described in subparagraph 7,a74 7#b7 ,withholding of funds ,if the ,secretary fails to submit a plan in accordance with subsection 7a71 the ,secretary shall withhold the operations funds reserved for the ,office of the ,director1 subject to the condition that the withholding shall not adversely impact the capacity of the ,service to deliver health care services4 7#c7 ,restoration ,the operations funds withheld pursuant to paragraph 7#b7 may be restored1 at the discretion of the ,secretary1 to the ,office of the ,director on achievement by that ,office of compliance with this section4 4 ,g ,behavioral health programs #aha4 ,behavioral health programs ,title ,,vii of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #affe et seq47 is amended to read as follows3 ,,vii ,behavioral health programs ,a ,general programs #gja4 ,definitions ,in this subtitle3 7#a7 ,alcohol-related neurodevelopmental disorders2 ,,arnd ,the term alcohol-related neurodevelopmental disorders or ,,arnd means1 with a history of maternal alcohol consumption during pregnancy1 central nervous system abnormalities1 which may range from minor intellectual deficits and developmental delays to mental retardation4 ,,arnd children may have behavioral problems1 learning disabilities1 problems with executive functioning1 and attention disorders4 ,the neurological defects of ,,arnd may be as severe as ,,fas1 but facial anomalies and other physical characteristics are not present in ,,arnd1 thus making diagnosis difficult4 7#b7 ,assessment ,the term assessment means the systematic collection1 analysis1 and dissemination of information on health status1 health needs1 and health problems4 7#c7 ,behavioral health aftercare ,the term behavioral health aftercare includes those activities and resources used to support recovery following inpatient1 residential1 intensive substance abuse1 or mental health outpatient or outpatient treatment4 ,the purpose is to help prevent or deal with relapse by ensuring that by the time a client or patient is discharged from a level of care1 such as outpatient treatment1 an aftercare plan has been developed with the client4 ,an aftercare plan may use such resources as a community-based therapeutic group1 transitional living facilities1 a #ab-step sponsor1 a local #ab-step or other related support group1 and other community-based providers4 7#d7 ,dual diagnosis ,the term dual diagnosis means coexisting substance abuse and mental illness conditions or diagnosis4 ,such clients are sometimes referred to as mentally ill chemical abusers 7,m,i,c,as74 7#e7 ,fetal alcohol spectrum disorders 7,a7 ,in general ,the term fetal alcohol spectrum disorders includes a range of effects that can occur in an individual whose mother drank alcohol during pregnancy1 including physical1 mental1 behavioral1 and_/or learning disabilities with possible lifelong implications4 7,b7 ,inclusions ,the term fetal alcohol spectrum disorders may include-- 7i7 fetal alcohol syndrome 7,,fas72 7ii7 partial fetal alcohol syndrome 7partial ,,fas72 7iii7 alcohol-related birth defects 7,,arbd72 and 7iv7 alcohol-related neurodevelopmental disorders 7,,arnd74 7#f7 ,,fas or fetal alcohol syndrome ,the term ,,fas or fetal alcohol syndrome means a syndrome in which1 with a history of maternal alcohol consumption during pregnancy1 the following criteria are met3 7,a7 ,central nervous system involvement1 such as mental retardation1 developmental delay1 intellectual deficit1 microencephaly1 or neurological abnormalities4 7,b7 ,craniofacial abnormalities with at least #b of the following3 7i7 ,microophthalmia4 7ii7 ,short palpebral fissures4 7iii7 ,poorly developed philtrum4 7iv7 ,thin upper lip4 7v7 ,flat nasal bridge4 7vi7 ,short upturned nose4 7,c7 ,prenatal or postnatal growth delay4 7#g7 ,rehabilitation ,the term rehabilitation means medical and health care services that-- 7,a7 are recommended by a physician or licensed practitioner of the healing arts within the scope of their practice under applicable law2 7,b7 are furnished in a facility1 home1 or other setting in accordance with applicable standards2 and 7,c7 have as their purpose any of the following3 7i7 ,the maximum attainment of physical1 mental1 and developmental functioning4 7ii7 ,averting deterioration in physical or mental functional status4 7iii7 ,the maintenance of physical or mental health functional status4 7#h7 ,substance abuse ,the term substance abuse includes inhalant abuse4 #gjb4 ,behavioral health prevention and treatment services 7a7 ,purposes ,the purposes of this section are as follows3 7#a7 ,to authorize and direct the ,secretary1 acting through the ,service1 ,indian tribes1 and tribal organizations1 to develop a comprehensive behavioral health prevention and treatment program which emphasizes collaboration among alcohol and substance abuse1 social services1 and mental health programs4 7#b7 ,to provide information1 direction1 and guidance relating to mental illness and dysfunction and self-destructive behavior1 including child abuse and family violence1 to those ,federal1 tribal1 ,state1 and local agencies responsible for programs in ,indian communities in areas of health care1 education1 social services1 child and family welfare1 alcohol and substance abuse1 law enforcement1 and judicial services4 7#c7 ,to assist ,indian tribes to identify services and resources available to address mental illness and dysfunctional and self-destructive behavior4 7#d7 ,to provide authority and opportunities for ,indian tribes and tribal organizations to develop1 implement1 and coordinate with community-based programs which include identification1 prevention1 education1 referral1 and treatment services1 including through multidisciplinary resource teams4 7#e7 ,to ensure that ,indians1 as citizens of the ,united ,states and of the ,states in which they reside1 have the same access to behavioral health services to which all citizens have access4 7#f7 ,to modify or supplement existing programs and authorities in the areas identified in paragraph 7#b74 7b7 ,plans 7#a7 ,development ,the ,secretary1 acting through the ,service1 ,indian tribes1 and tribal organizations1 shall encourage ,indian tribes and tribal organizations to develop tribal plans1 and urban ,indian organizations to develop local plans1 and for all such groups to participate in developing areawide plans for ,indian ,behavioral ,health ,services4 ,the plans shall include1 to the extent feasible1 the following components3 7,a7 ,an assessment of the scope of alcohol or other substance abuse1 mental illness1 and dysfunctional and self-destructive behavior1 including suicide1 child abuse1 and family violence1 among ,indians1 including-- 7i7 the number of ,indians served who are directly or indirectly affected by such illness or behavior2 or 7ii7 an estimate of the financial and human cost attributable to such illness or behavior4 7,b7 ,an assessment of the existing and additional resources necessary for the prevention and treatment of such illness and behavior1 including an assessment of the progress toward achieving the availability of the full continuum of care described in subsection 7c74 7,c7 ,an estimate of the additional funding needed by the ,service1 ,indian tribes1 tribal organizations1 and urban ,indian organizations to meet their responsibilities under the plans4 7#b7 ,national clearinghouse ,the ,secretary1 acting through the ,service1 shall coordinate with existing national clearinghouses and information centers to include at the clearinghouses and centers plans and reports on the outcomes of such plans developed by ,indian tribes1 tribal organizations1 urban ,indian organizations1 and ,service areas relating to behavioral health4 ,the ,secretary shall ensure access to these plans and outcomes by any ,indian tribe1 tribal organization1 urban ,indian organization1 or the ,service4 7#c7 ,technical assistance ,the ,secretary shall provide technical assistance to ,indian tribes1 tribal organizations1 and urban ,indian organizations in preparation of plans under this section and in developing standards of care that may be used and adopted locally4 7c7 ,programs ,the ,secretary1 acting through the ,service1 shall provide1 to the extent feasible and if funding is available1 programs including the following3 7#a7 ,comprehensive care ,a comprehensive continuum of behavioral health care which provides-- 7,a7 community-based prevention1 intervention1 outpatient1 and behavioral health aftercare2 7,b7 detoxification 7social and medical72 7,c7 acute hospitalization2 7,d7 intensive outpatient_/day treatment2 7,e7 residential treatment2 7,f7 transitional living for those needing a temporary1 stable living environment that is supportive of treatment and recovery goals2 7,g7 emergency shelter2 7,h7 intensive case management2 7,i7 diagnostic services2 and 7,j7 promotion of healthy approaches to risk and safety issues1 including injury prevention4 7#b7 ,child care ,behavioral health services for ,indians from birth through age #ag1 including-- 7,a7 preschool and school age fetal alcohol spectrum disorder services1 including assessment and behavioral intervention2 7,b7 mental health and substance abuse services 7emotional1 organic1 alcohol1 drug1 inhalant1 and tobacco72 7,c7 identification and treatment of co-occurring disorders and comorbidity2 7,d7 prevention of alcohol1 drug1 inhalant1 and tobacco use2 7,e7 early intervention1 treatment1 and aftercare2 7,f7 promotion of healthy approaches to risk and safety issues2 and 7,g7 identification and treatment of neglect and physical1 mental1 and sexual abuse4 7#c7 ,adult care ,behavioral health services for ,indians from age #ah through #ee1 including-- 7,a7 early intervention1 treatment1 and aftercare2 7,b7 mental health and substance abuse services 7emotional1 alcohol1 drug1 inhalant1 and tobacco71 including sex specific services2 7,c7 identification and treatment of co-occurring disorders 7dual diagnosis7 and comorbidity2 7,d7 promotion of healthy approaches for risk-related behavior2 7,e7 treatment services for women at risk of giving birth to a child with a fetal alcohol spectrum disorder2 and 7,f7 sex specific treatment for sexual assault and domestic violence4 7#d7 ,family care ,behavioral health services for families1 including-- 7,a7 early intervention1 treatment1 and aftercare for affected families2 7,b7 treatment for sexual assault and domestic violence2 and 7,c7 promotion of healthy approaches relating to parenting1 domestic violence1 and other abuse issues4 7#e7 ,elder care ,behavioral health services for ,indians #ef years of age and older1 including-- 7,a7 early intervention1 treatment1 and aftercare2 7,b7 mental health and substance abuse services 7emotional1 alcohol1 drug1 inhalant1 and tobacco71 including sex specific services2 7,c7 identification and treatment of co-occurring disorders 7dual diagnosis7 and comorbidity2 7,d7 promotion of healthy approaches to managing conditions related to aging2 7,e7 sex specific treatment for sexual assault1 domestic violence1 neglect1 physical and mental abuse and exploitation2 and 7,f7 identification and treatment of dementias regardless of cause4 7d7 ,community behavioral health plan 7#a7 ,establishment ,the governing body of any ,indian tribe1 tribal organization1 or urban ,indian organization may adopt a resolution for the establishment of a community behavioral health plan providing for the identification and coordination of available resources and programs to identify1 prevent1 or treat substance abuse1 mental illness1 or dysfunctional and self-destructive behavior1 including child abuse and family violence1 among its members or its service population4 ,this plan should include behavioral health services1 social services1 intensive outpatient services1 and continuing aftercare4 7#b7 ,technical assistance ,at the request of an ,indian tribe1 tribal organization1 or urban ,indian organization1 the ,bureau of ,indian ,affairs and the ,service shall cooperate with and provide technical assistance to the ,indian tribe1 tribal organization1 or urban ,indian organization in the development and implementation of such plan4 7#c7 ,funding ,the ,secretary1 acting through the ,service1 ,indian tribes1 and tribal organizations1 may make funding available to ,indian tribes and tribal organizations which adopt a resolution pursuant to paragraph 7#a7 to obtain technical assistance for the development of a community behavioral health plan and to provide administrative support in the implementation of such plan4 7e7 ,coordination for availability of services ,the ,secretary1 acting through the ,service1 shall coordinate behavioral health planning1 to the extent feasible1 with other ,federal agencies and with ,state agencies1 to encourage comprehensive behavioral health services for ,indians regardless of their place of residence4 7f7 ,mental health care need assessment ,not later than #a year after the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag1 the ,secretary1 acting through the ,service1 shall make an assessment of the need for inpatient mental health care among ,indians and the availability and cost of inpatient mental health facilities which can meet such need4 ,in making such assessment1 the ,secretary shall consider the possible conversion of existing1 underused ,service hospital beds into psychiatric units to meet such need4 #gjc4 ,memoranda of agreement with the ,department of ,interior 7a7 ,contents ,not later than #a year after the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag1 the ,secretary1 acting through the ,service1 and the ,secretary of the ,interior shall develop and enter into a memoranda of agreement1 or review and update any existing memoranda of agreement1 as required by section #dbje of the ,indian ,alcohol and ,substance ,abuse ,prevention and ,treatment ,act of #aihf 7#be ,u4,s4,c4 #bdaa7 under which the ,secretaries address the following3 7#a7 ,the scope and nature of mental illness and dysfunctional and self-destructive behavior1 including child abuse and family violence1 among ,indians4 7#b7 ,the existing ,federal1 tribal1 ,state1 local1 and private services1 resources1 and programs available to provide behavioral health services for ,indians4 7#c7 ,the unmet need for additional services1 resources1 and programs necessary to meet the needs identified pursuant to paragraph 7#a74 7#d7 7,a7 ,the right of ,indians1 as citizens of the ,united ,states and of the ,states in which they reside1 to have access to behavioral health services to which all citizens have access4 7,b7 ,the right of ,indians to participate in1 and receive the benefit of1 such services4 7,c7 ,the actions necessary to protect the exercise of such right4 7#e7 ,the responsibilities of the ,bureau of ,indian ,affairs and the ,service1 including mental illness identification1 prevention1 education1 referral1 and treatment services 7including services through multidisciplinary resource teams71 at the central1 area1 and agency and ,service unit1 ,service area1 and headquarters levels to address the problems identified in paragraph 7#a74 7#f7 ,a strategy for the comprehensive coordination of the behavioral health services provided by the ,bureau of ,indian ,affairs and the ,service to meet the problems identified pursuant to paragraph 7#a71 including-- 7,a7 the coordination of alcohol and substance abuse programs of the ,service1 the ,bureau of ,indian ,affairs1 and ,indian tribes and tribal organizations 7developed under the ,indian ,alcohol and ,substance ,abuse ,prevention and ,treatment ,act of #aihf 7#be ,u4,s4,c4 #bdja et seq477 with behavioral health initiatives pursuant to this ,act1 particularly with respect to the referral and treatment of dually diagnosed individuals requiring behavioral health and substance abuse treatment2 and 7,b7 ensuring that the ,bureau of ,indian ,affairs and ,service programs and services 7including multidisciplinary resource teams7 addressing child abuse and family violence are coordinated with such non-,federal programs and services4 7#g7 ,directing appropriate officials of the ,bureau of ,indian ,affairs and the ,service1 particularly at the agency and ,service unit levels1 to cooperate fully with tribal requests made pursuant to community behavioral health plans adopted under section #gjb7;c7 and section #dbjf of the ,indian ,alcohol and ,substance ,abuse ,prevention and ,treatment ,act of #aihf 7#be ,u4,s4,c4 #bdab74 7#h7 ,providing for an annual review of such agreement by the ,secretaries which shall be provided to ,congress and ,indian tribes and tribal organizations4 7b7 ,specific provisions required ,the memoranda of agreement updated or entered into pursuant to subsection 7a7 shall include specific provisions pursuant to which the ,service shall assume responsibility for-- 7#a7 the determination of the scope of the problem of alcohol and substance abuse among ,indians1 including the number of ,indians within the jurisdiction of the ,service who are directly or indirectly affected by alcohol and substance abuse and the financial and human cost2 7#b7 an assessment of the existing and needed resources necessary for the prevention of alcohol and substance abuse and the treatment of ,indians affected by alcohol and substance abuse2 and 7#c7 an estimate of the funding necessary to adequately support a program of prevention of alcohol and substance abuse and treatment of ,indians affected by alcohol and substance abuse4 7c7 ,publication ,each memorandum of agreement entered into or renewed 7and amendments or modifications thereto7 under subsection 7a7 shall be published in the ,federal ,register4 ,at the same time as publication in the ,federal ,register1 the ,secretary shall provide a copy of such memoranda1 amendment1 or modification to each ,indian tribe1 tribal organization1 and urban ,indian organization4 #gjd4 ,comprehensive behavioral health prevention and treatment program 7a7 ,establishment 7#a7 ,in general ,the ,secretary1 acting through the ,service1 shall provide a program of comprehensive behavioral health1 prevention1 treatment1 and aftercare1 which may include1 if feasible and appropriate1 systems of care1 and shall include-- 7,a7 prevention1 through educational intervention1 in ,indian communities2 7,b7 acute detoxification1 psychiatric hospitalization1 residential1 and intensive outpatient treatment2 7,c7 community-based rehabilitation and aftercare2 7,d7 community education and involvement1 including extensive training of health care1 educational1 and community-based personnel2 7,e7 specialized residential treatment programs for high-risk populations1 including pregnant and postpartum women and their children2 and 7,f7 diagnostic services4 7#b7 ,target populations ,the target population of such programs shall be members of ,indian tribes4 ,efforts to train and educate key members of the ,indian community shall also target employees of health1 education1 judicial1 law enforcement1 legal1 and social service programs4 7b7 ,contract health services 7#a7 ,in general ,the ,secretary1 acting through the ,service1 may enter into contracts with public or private providers of behavioral health treatment services for the purpose of carrying out the program required under subsection 7a74 7#b7 ,provision of assistance ,in carrying out this subsection1 the ,secretary shall provide assistance to ,indian tribes and tribal organizations to develop criteria for the certification of behavioral health service providers and accreditation of service facilities which meet minimum standards for such services and facilities4 #gje4 ,mental health technician program 7a7 ,in general ,pursuant to the ,act of ,november #b1 #aiba 7#be ,u4,s4,c4 #ac7 7commonly known as the ,snyder ,act71 the ,secretary shall establish and maintain a mental health technician program within the ,service which-- 7#a7 provides for the training of ,indians as mental health technicians2 and 7#b7 employs such technicians in the provision of community-based mental health care that includes identification1 prevention1 education1 referral1 and treatment services4 7b7 ,paraprofessional training ,in carrying out subsection 7a71 the ,secretary1 acting through the ,service1 shall provide high-standard paraprofessional training in mental health care necessary to provide quality care to the ,indian communities to be served4 ,such training shall be based upon a curriculum developed or approved by the ,secretary which combines education in the theory of mental health care with supervised practical experience in the provision of such care4 7c7 ,supervision and evaluation of technicians ,the ,secretary1 acting through the ,service1 shall supervise and evaluate the mental health technicians in the training program4 7d7 ,traditional health care practices ,the ,secretary1 acting through the ,service1 shall ensure that the program established pursuant to this section involves the use and promotion of the traditional health care practices of the ,indian tribes to be served4 #gjf4 ,licensing requirement for mental health care workers 7a7 ,in general ,subject to section #bba1 and except as provided in subsection 7b71 any individual employed as a psychologist1 social worker1 or marriage and family therapist for the purpose of providing mental health care services to ,indians in a clinical setting under this ,act is required to be licensed as a psychologist1 social worker1 or marriage and family therapist1 respectively4 7b7 ,trainees ,an individual may be employed as a trainee in psychology1 social work1 or marriage and family therapy to provide mental health care services described in subsection 7a7 if such individual-- 7#a7 works under the direct supervision of a licensed psychologist1 social worker1 or marriage and family therapist1 respectively2 7#b7 is enrolled in or has completed at least #b years of course work at a post-secondary1 accredited education program for psychology1 social work1 marriage and family therapy1 or counseling2 and 7#c7 meets such other training1 supervision1 and quality review requirements as the ,secretary may establish4 #gjg4 ,indian women treatment programs 7a7 ,grants ,the ,secretary1 consistent with section #gjb1 may make grants to ,indian tribes1 tribal organizations1 and urban ,indian organizations to develop and implement a comprehensive behavioral health program of prevention1 intervention1 treatment1 and relapse prevention services that specifically addresses the cultural1 historical1 social1 and child care needs of ,indian women1 regardless of age4 7b7 ,use of grant funds ,a grant made pursuant to this section may be used-- 7#a7 to develop and provide community training1 education1 and prevention programs for ,indian women relating to behavioral health issues1 including fetal alcohol spectrum disorders2 7#b7 to identify and provide psychological services1 counseling1 advocacy1 support1 and relapse prevention to ,indian women and their families2 and 7#c7 to develop prevention and intervention models for ,indian women which incorporate traditional health care practices1 cultural values1 and community and family involvement4 7c7 ,criteria ,the ,secretary1 in consultation with ,indian tribes and tribal organizations1 shall establish criteria for the review and approval of applications and proposals for funding under this section4 7d7 ,allocation of funds for urban ,indian organizations #bj percent of the funds appropriated pursuant to this section shall be used to make grants to urban ,indian organizations4 #gjh4 ,indian youth program 7a7 ,detoxification and rehabilitation ,the ,secretary1 acting through the ,service1 consistent with section #gjb1 shall develop and implement a program for acute detoxification and treatment for ,indian youths1 including behavioral health services4 ,the program shall include regional treatment centers designed to include detoxification and rehabilitation for both sexes on a referral basis and programs developed and implemented by ,indian tribes or tribal organizations at the local level under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq474 ,regional centers shall be integrated with the intake and rehabilitation programs based in the referring ,indian community4 7b7 ,alcohol and substance abuse treatment centers or facilities 7#a7 ,establishment 7,a7 ,in general ,the ,secretary1 acting through the ,service1 shall construct1 renovate1 or1 as necessary1 purchase1 and appropriately staff and operate1 at least #a youth regional treatment center or treatment network in each area under the jurisdiction of an area office4 7,b7 ,area office in ,california ,for the purposes of this subsection1 the area office in ,california shall be considered to be #b area offices1 #a office whose jurisdiction shall be considered to encompass the northern area of the ,state of ,california1 and #a office whose jurisdiction shall be considered to encompass the remainder of the ,state of ,california for the purpose of implementing ,california treatment networks4 7#b7 ,funding ,for the purpose of staffing and operating such centers or facilities1 funding shall be pursuant to the ,act of ,november #b1 #aiba 7#be ,u4,s4,c4 #ac74 7#c7 ,location ,a youth treatment center constructed or purchased under this subsection shall be constructed or purchased at a location within the area described in paragraph 7#a7 agreed upon 7by appropriate tribal resolution7 by a majority of the ,indian tribes to be served by such center4 7#d7 ,specific provision of funds 7,a7 ,in general ,notwithstanding any other provision of this title1 the ,secretary may1 from amounts authorized to be appropriated for the purposes of carrying out this section1 make funds available to-- 7i7 the ,tanana ,chiefs ,conference1 ,incorporated1 for the purpose of leasing1 constructing1 renovating1 operating1 and maintaining a residential youth treatment facility in ,fairbanks1 ,alaska2 and 7ii7 the ,southeast ,alaska ,regional ,health ,corporation to staff and operate a residential youth treatment facility without regard to the proviso set forth in section #d7l7 of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej;b7l774 7,b7 ,provision of services to eligible youths ,until additional residential youth treatment facilities are established in ,alaska pursuant to this section1 the facilities specified in subparagraph 7,a7 shall make every effort to provide services to all eligible ,indian youths residing in ,alaska4 7c7 ,intermediate adolescent behavioral health services 7#a7 ,in general ,the ,secretary1 acting through the ,service1 may provide intermediate behavioral health services1 which may 1 if feasible and appropriate1 incorporate systems of care1 to ,indian children and adolescents1 including-- 7,a7 pretreatment assistance2 7,b7 inpatient1 outpatient1 and aftercare services2 7,c7 emergency care2 7,d7 suicide prevention and crisis intervention2 and 7,e7 prevention and treatment of mental illness and dysfunctional and self-destructive behavior1 including child abuse and family violence4 7#b7 ,use of funds ,funds provided under this subsection may be used-- 7,a7 to construct or renovate an existing health facility to provide intermediate behavioral health services2 7,b7 to hire behavioral health professionals2 7,c7 to staff1 operate1 and maintain an intermediate mental health facility1 group home1 sober housing1 transitional housing or similar facilities1 or youth shelter where intermediate behavioral health services are being provided2 7,d7 to make renovations and hire appropriate staff to convert existing hospital beds into adolescent psychiatric units2 and 7,e7 for intensive home- and community-based services4 7#c7 ,criteria ,the ,secretary1 acting through the ,service1 shall1 in consultation with ,indian tribes and tribal organizations1 establish criteria for the review and approval of applications or proposals for funding made available pursuant to this subsection4 7d7 ,federally owned structures 7#a7 ,in general ,the ,secretary1 in consultation with ,indian tribes and tribal organizations1 shall-- 7,a7 identify and use1 where appropriate1 federally owned structures suitable for local residential or regional behavioral health treatment for ,indian youths2 and 7,b7 establish guidelines for determining the suitability of any such federally owned structure to be used for local residential or regional behavioral health treatment for ,indian youths4 7#b7 ,terms and conditions for use of structure ,any structure described in paragraph 7#a7 may be used under such terms and conditions as may be agreed upon by the ,secretary and the agency having responsibility for the structure and any ,indian tribe or tribal organization operating the program4 7e7 ,rehabilitation and aftercare services 7#a7 ,in general ,the ,secretary1 ,indian tribes1 or tribal organizations1 in cooperation with the ,secretary of the ,interior1 shall develop and implement within each ,service unit1 community-based rehabilitation and follow-up services for ,indian youths who are having significant behavioral health problems1 and require long-term treatment1 community reintegration1 and monitoring to support the ,indian youths after their return to their home community4 7#b7 ,administration ,services under paragraph 7#a7 shall be provided by trained staff within the community who can assist the ,indian youths in their continuing development of self-image1 positive problem-solving skills1 and nonalcohol or substance abusing behaviors4 ,such staff may include alcohol and substance abuse counselors1 mental health professionals1 and other health professionals and paraprofessionals1 including community health representatives4 7f7 ,inclusion of family in youth treatment program ,in providing the treatment and other services to ,indian youths authorized by this section1 the ,secretary1 acting through the ,service1 shall provide for the inclusion of family members of such youths in the treatment programs or other services as may be appropriate4 ,not less than #aj percent of the funds appropriated for the purposes of carrying out subsection 7e7 shall be used for outpatient care of adult family members related to the treatment of an ,indian youth under that subsection4 7g7 ,multidrug abuse program ,the ,secretary1 acting through the ,service1 shall provide1 consistent with section #gjb1 programs and services to prevent and treat the abuse of multiple forms of substances1 including alcohol1 drugs1 inhalants1 and tobacco1 among ,indian youths residing in ,indian communities1 on or near reservations1 and in urban areas and provide appropriate mental health services to address the incidence of mental illness among such youths4 7h7 ,indian youth mental health ,the ,secretary1 acting through the ,service1 shall collect data for the report under section #hja with respect to-- 7#a7 the number of ,indian youth who are being provided mental health services through the ,service and tribal health programs2 7#b7 a description of1 and costs associated with1 the mental health services provided for ,indian youth through the ,service and tribal health programs2 7#c7 the number of youth referred to the ,service or tribal health programs for mental health services2 7#d7 the number of ,indian youth provided residential treatment for mental health and behavioral problems through the ,service and tribal health programs1 reported separately for on- and off-reservation facilities2 and 7#e7 the costs of the services described in paragraph 7#d74 #gji4 ,inpatient and community-based mental health facilities design1 construction1 and staffing ,not later than #a year after the date of enactment of the,indian ,healthcare ,improvement ,act of #bjag1 the ,secretary1 acting through the ,service1 may provide1 in each area of the ,service1 not less than #a inpatient mental health care facility1 or the equivalent1 for ,indians with behavioral health problems4 ,for the purposes of this subsection1 ,california shall be considered to be #b area offices1 #a office whose location shall be considered to encompass the northern area of the ,state of ,california and #a office whose jurisdiction shall be considered to encompass the remainder of the ,state of ,california4 ,the ,secretary shall consider the possible conversion of existing1 underused ,service hospital beds into psychiatric units to meet such need4 #gaj4 ,training and community education 7a7 ,program ,the ,secretary1 in cooperation with the ,secretary of the ,interior1 shall develop and implement or assist ,indian tribes and tribal organizations to develop and implement1 within each ,service unit or tribal program1 a program of community education and involvement which shall be designed to provide concise and timely information to the community leadership of each tribal community4 ,such program shall include education about behavioral health issues to political leaders1 tribal judges1 law enforcement personnel1 members of tribal health and education boards1 health care providers including traditional practitioners1 and other critical members of each tribal community4 ,such program may also include community-based training to develop local capacity and tribal community provider training for prevention1 intervention1 treatment1 and aftercare4 7b7 ,instruction ,the ,secretary1 acting through the ,service1 shall provide instruction in the area of behavioral health issues1 including instruction in crisis intervention and family relations in the context of alcohol and substance abuse1 child sexual abuse1 youth alcohol and substance abuse1 and the causes and effects of fetal alcohol spectrum disorders to appropriate employees of the ,bureau of ,indian ,affairs and the ,service1 and to personnel in schools or programs operated under any contract with the ,bureau of ,indian ,affairs or the ,service1 including supervisors of emergency shelters and halfway houses described in section #dbac of the ,indian ,alcohol and ,substance ,abuse ,prevention and ,treatment ,act of #aihf 7#be ,u4,s4,c4 #bdcc74 7c7 ,training models ,in carrying out the education and training programs required by this section1 the ,secretary1 in consultation with ,indian tribes1 tribal organizations1 ,indian behavioral health experts1 and ,indian alcohol and substance abuse prevention experts1 shall develop and provide community-based training models4 ,such models shall address-- 7#a7 the elevated risk of alcohol abuse and other behavioral health problems faced by children of alcoholics2 7#b7 the cultural1 spiritual1 and multigenerational aspects of behavioral health problem prevention and recovery2 and 7#c7 community-based and multidisciplinary strategies for preventing and treating behavioral health problems4 #gaa4 ,behavioral health program 7a7 ,innovative programs ,the ,secretary1 acting through the ,service1 consistent with section #gjb1 may plan1 develop1 implement1 and carry out programs to deliver innovative community-based behavioral health services to ,indians4 7b7 ,awards2 criteria ,the ,secretary may award a grant for a project under subsection 7a7 to an ,indian tribe or tribal organization and may consider the following criteria3 7#a7 ,the project will address significant unmet behavioral health needs among ,indians4 7#b7 ,the project will serve a significant number of ,indians4 7#c7 ,the project has the potential to deliver services in an efficient and effective manner4 7#d7 ,the ,indian tribe or tribal organization has the administrative and financial capability to administer the project4 7#e7 ,the project may deliver services in a manner consistent with traditional health care practices4 7#f7 ,the project is coordinated with1 and avoids duplication of1 existing services4 7c7 ,equitable treatment ,for purposes of this subsection1 the ,secretary shall1 in evaluating project applications or proposals1 use the same criteria that the ,secretary uses in evaluating any other application or proposal for such funding4 #gab4 ,fetal alcohol spectrum disorders programs 7a7 ,programs 7#a7 ,establishment ,the ,secretary1 consistent with section #gjb1 acting through the ,service1 ,indian ,tribes1 and ,tribal ,organizations1 is authorized to establish and operate fetal alcohol spectrum disorders programs as provided in this section for the purposes of meeting the health status objectives specified in section #c4 7#b7 ,use of funds 7,a7 ,in general ,funding provided pursuant to this section shall be used for the following3 7i7 ,to develop and provide for ,indians community and in-school training1 education1 and prevention programs relating to fetal alcohol spectrum disorders4 7ii7 ,to identify and provide behavioral health treatment to high-risk ,indian women and high-risk women pregnant with an ,indian's child4 7iii7 ,to identify and provide appropriate psychological services1 educational and vocational support1 counseling1 advocacy1 and information to fetal alcohol spectrum disorders-affected ,indians and their families or caretakers4 7iv7 ,to develop and implement counseling and support programs in schools for fetal alcohol spectrum disorders-affected ,indian children4 7v7 ,to develop prevention and intervention models which incorporate practitioners of traditional health care practices1 cultural values1 and community involvement4 7vi7 ,to develop1 print1 and disseminate education and prevention materials on fetal alcohol spectrum disorders4 7vii7 ,to develop and implement1 in consultation with ,indian ,tribes and ,tribal ,organizations1 and in conference with urban ,indian ,organizations1 culturally sensitive assessment and diagnostic tools including dysmorphology clinics and multidisciplinary fetal alcohol spectrum disorders clinics for use in ,indian communities and urban ,centers4 7viii7 ,to develop and provide training on fetal alcohol spectrum disorders to professionals providing services to ,indians1 including medical and allied health practitioners1 social service providers1 educators1 and law enforcement1 court officials and corrections personnel in the juvenile and criminal justice systems4 7,b7 ,additional uses ,in addition to any purpose under subparagraph 7,a71 funding provided pursuant to this section may be used for #a or more of the following3 7i7 ,early childhood intervention projects from birth on to mitigate the effects of fetal alcohol spectrum disorders among ,indians4 7ii7 ,community-based support services for ,indians and women pregnant with ,indian children4 7iii7 ,community-based housing for adult ,indians with fetal alcohol spectrum disorders4 7#c7 ,criteria for applications ,the ,secretary shall establish criteria for the review and approval of applications for funding under this section4 7b7 ,services ,the ,secretary1 acting through the ,service1 ,indian ,tribes1 and ,tribal ,organizations1 shall-- 7#a7 develop and provide services for the prevention1 intervention1 treatment1 and aftercare for those affected by fetal alcohol spectrum disorders in ,indian communities2 and 7#b7 provide supportive services1 including services to meet the special educational1 vocational1 school-to-work transition1 and independent living needs of adolescent and adult ,indians with fetal alcohol spectrum disorders4 7c7 ,applied research projects ,the ,secretary1 acting through the ,substance ,abuse and ,mental ,health ,services ,administration1 shall make grants to ,indian ,tribes1 ,tribal ,organizations1 and urban ,indian ,organizations for applied research projects which propose to elevate the understanding of methods to prevent1 intervene1 treat1 or provide rehabilitation and behavioral health aftercare for ,indians and urban ,indians affected by fetal alcohol spectrum disorders4 7d7 ,funding for urban ,indian ,organizations ,ten percent of the funds appropriated pursuant to this section shall be used to make grants to urban ,indian ,organizations funded under title ,v4 #gac4 ,child sexual abuse prevention and treatment programs 7a7 ,establishment ,the ,secretary1 acting through the ,service1 shall establish1 consistent with section #gjb1 in every ,service area1 programs involving treatment for-- 7#a7 victims of sexual abuse who are ,indian children or children in an ,indian household2 and 7#b7 other members of the household or family of the victims described in paragraph 7#a74 7b7 ,use of funds ,funding provided pursuant to this section shall be used for the following3 7#a7 ,to develop and provide community education and prevention programs related to sexual abuse of ,indian children or children in an ,indian household4 7#b7 ,to identify and provide behavioral health treatment to victims of sexual abuse who are ,indian children or children in an ,indian household1 and to their family members who are affected by sexual abuse4 7#c7 ,to develop prevention and intervention models which incorporate traditional health care practices1 cultural values1 and community involvement4 7#d7 ,to develop and implement culturally sensitive assessment and diagnostic tools for use in ,indian communities and urban centers4 7c7 ,coordination ,the programs established under subsection 7a7 shall be carried out in coordination with programs and services authorized under the ,indian ,child ,protection and ,family ,violence ,prevention ,act 7#be ,u4,s4,c4 #cbja et seq474 #gad4 ,domestic and sexual violence prevention and treatment 7a7 ,in general ,the ,secretary1 in accordance with section #gjb1 is authorized to establish in each ,service area programs involving the prevention and treatment of-- 7#a7 ,indian victims of domestic violence or sexual abuse2 and 7#b7 other members of the household or family of the victims described in paragraph 7#a74 7b7 ,use of funds ,funds made available to carry out this section shall be used-- 7#a7 to develop and implement prevention programs and community education programs relating to domestic violence and sexual abuse2 7#b7 to provide behavioral health services1 including victim support services1 and medical treatment 7including examinations performed by sexual assault nurse examiners7 to ,indian victims of domestic violence or sexual abuse2 7#c7 to purchase rape kits2 and 7#d7 to develop prevention and intervention models1 which may incorporate traditional health care practices4 7c7 ,training and certification 7#a7 ,in general ,not later than #a year after the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag1 the ,secretary shall establish appropriate protocols1 policies1 procedures1 standards of practice1 and1 if not available elsewhere1 training curricula and training and certification requirements for services for victims of domestic violence and sexual abuse4 7#b7 ,report ,not later than #ah months after the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag1 the ,secretary shall submit to the ,committee on ,indian ,affairs of the ,senate and the ,committee on ,natural ,resources of the ,house of ,representatives a report that describes the means and extent to which the ,secretary has carried out paragraph 7#a74 7d7 ,coordination 7#a7 ,in general ,the ,secretary1 in coordination with the ,attorney ,general1 ,federal and tribal law enforcement agencies1 ,indian health programs1 and domestic violence or sexual assault victim organizations1 shall develop appropriate victim services and victim advocate training programs-- 7,a7 to improve domestic violence or sexual abuse responses2 7,b7 to improve forensic examinations and collection2 7,c7 to identify problems or obstacles in the prosecution of domestic violence or sexual abuse2 and 7,d7 to meet other needs or carry out other activities required to prevent1 treat1 and improve prosecutions of domestic violence and sexual abuse4 7#b7 ,report ,not later than #b years after the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag1 the ,secretary shall submit to the ,committee on ,indian ,affairs of the ,senate and the ,committee on ,natural ,resources of the ,house of ,representatives a report that describes1 with respect to the matters described in paragraph 7#a71 the improvements made and needed1 problems or obstacles identified1 and costs necessary to address the problems or obstacles1 and any other recommendations that the ,secretary determines to be appropriate4 #gae4 ,behavioral health research 7a7 ,in general ,the ,secretary1 in consultation with appropriate ,federal agencies1 shall make grants to1 or enter into contracts with1 ,indian tribes1 tribal organizations1 and urban ,indian organizations or enter into contracts with1 or make grants to appropriate institutions for1 the conduct of research on the incidence and prevalence of behavioral health problems among ,indians served by the ,service1 ,indian tribes1 or tribal organizations and among ,indians in urban areas4 ,research priorities under this section shall include-- 7#a7 the multifactorial causes of ,indian youth suicide1 including-- 7,a7 protective and risk factors and scientific data that identifies those factors2 and 7,b7 the effects of loss of cultural identity and the development of scientific data on those effects2 7#b7 the interrelationship and interdependence of behavioral health problems with alcoholism and other substance abuse1 suicide1 homicides1 other injuries1 and the incidence of family violence2 and 7#c7 the development of models of prevention techniques4 7b7 ,emphasis ,the effect of the interrelationships and interdependencies referred to in subsection 7a77#b7 on children1 and the development of prevention techniques under subsection 7a77#c7 applicable to children1 shall be emphasized4 ,b ,indian youth suicide prevention #gba4 ,findings and purpose 7a7 ,findings ,congress finds that-- 7#a7 7,a7 the rate of suicide of ,american ,indians and ,alaska ,natives is #a4i times higher than the national average rate2 and 7,b7 the rate of suicide of ,indian and ,alaska ,native youth aged #ae through #bd is-- 7i7 #c4e times the national average rate2 and 7ii7 the highest rate of any population group in the ,united ,states2 7#b7 many risk behaviors and contributing factors for suicide are more prevalent in ,indian country than in other areas1 including-- 7,a7 history of previous suicide attempts2 7,b7 family history of suicide2 7,c7 history of depression or other mental illness2 7,d7 alcohol or drug abuse2 7,e7 health disparities2 7,f7 stressful life events and losses2 7,g7 easy access to lethal methods2 7,h7 exposure to the suicidal behavior of others2 7,i7 isolation2 and 7,j7 incarceration2 7#c7 according to national data for #bjje1 suicide was the second-leading cause of death for ,indians and ,alaska ,natives of both sexes aged #aj through #cd2 7#d7 7,a7 the suicide rates of ,indian and ,alaska ,native males aged #ae through #bd are-- 7i7 as compared to suicide rates of males of any other racial group1 up to #d times greater2 and 7ii7 as compared to suicide rates of females of any other racial group1 up to #aa times greater2 and 7,b7 data demonstrates that1 over their lifetimes1 females attempt suicide #b to #c times more often than males2 7#e7 7,a7 ,indian tribes1 especially ,indian tribes located in the ,great ,plains1 have experienced epidemic levels of suicide1 up to #aj times the national average2 and 7,b7 suicide clustering in ,indian country affects entire tribal communities2 7#f7 death rates for ,indians and ,alaska ,natives are statistically underestimated because many areas of ,indian country lack the proper resources to identify and monitor the presence of disease2 7#g7 7,a7 the ,indian ,health ,service experiences health professional shortages1 with physician vacancy rates of approximately #ag percent1 and nursing vacancy rates of approximately #ah percent1 in #bjjg2 7,b7 #ij percent of all teens who die by suicide suffer from a diagnosable mental illness at time of death2 7,c7 more than #ab of teens who die by suicide have never been seen by a mental health provider2 and 7,d7 #a_/c of health needs in ,indian country relate to mental health2 7#h7 often1 the lack of resources of ,indian tribes and the remote nature of ,indian reservations make it difficult to meet the requirements necessary to access ,federal assistance1 including grants2 7#i7 the ,substance ,abuse and ,mental ,health ,services ,administration and the ,service have established specific initiatives to combat youth suicide in ,indian country and among ,indians and ,alaska ,natives throughout the ,united ,states1 including the ,national ,suicide ,prevention ,initiative of the ,service1 which has worked with ,service1 tribal1 and urban ,indian health programs since #bjjc2 7#aj7 the ,national ,strategy for ,suicide ,prevention was established in #bjja through a ,department of ,health and ,human ,services collaboration among-- 7,a7 the ,substance ,abuse and ,mental ,health ,services ,administration2 7,b7 the ,service2 7,c7 the ,centers for ,disease ,control and ,prevention2 7,d7 the ,national ,institutes of ,health2 and 7,e7 the ,health ,resources and ,services ,administration2 and 7#aa7 the ,service and other agencies of the ,department of ,health and ,human ,services use information technology and other programs to address the suicide prevention and mental health needs of ,indians and ,alaska ,natives4 7b7 ,purposes ,the purposes of this subtitle are-- 7#a7 to authorize the ,secretary to carry out a demonstration project to test the use of telemental health services in suicide prevention1 intervention1 and treatment of ,indian youth1 including through-- 7,a7 the use of psychotherapy1 psychiatric assessments1 diagnostic interviews1 therapies for mental health conditions predisposing to suicide1 and alcohol and substance abuse treatment2 7,b7 the provision of clinical expertise to1 consultation services with1 and medical advice and training for frontline health care providers working with ,indian youth2 7,c7 training and related support for community leaders1 family members1 and health and education workers who work with ,indian youth2 7,d7 the development of culturally relevant educational materials on suicide2 and 7,e7 data collection and reporting2 7#b7 to encourage ,indian tribes1 tribal organizations1 and other mental health care providers serving residents of ,indian country to obtain the services of predoctoral psychology and psychiatry interns2 and 7#c7 to enhance the provision of mental health care services to ,indian youth through existing grant programs of the ,substance ,abuse and ,mental ,health ,services ,administration4 #gbb4 ,definitions ,in this subtitle3 7#a7 ,administration ,the term ,administration means the ,substance ,abuse and ,mental ,health ,services ,administration4 7#b7 ,demonstration project ,the term demonstration project means the ,indian youth telemental health demonstration project authorized under section #gbc7;a74 7#c7 ,telemental health ,the term telemental health means the use of electronic information and telecommunications technologies to support long-distance mental health care1 patient and professional-related education1 public health1 and health administration4 #gbc4 ,indian youth telemental health demonstration project 7a7 ,authorization 7#a7 ,in general ,the ,secretary1 acting through the ,service1 is authorized to carry out a demonstration project to award grants for the provision of telemental health services to ,indian youth who-- 7,a7 have expressed suicidal ideas2 7,b7 have attempted suicide2 or 7,c7 have behavioral health conditions that increase or could increase the risk of suicide4 7#b7 ,eligibility for grants ,grants under paragraph 7#a7 shall be awarded to ,indian tribes and tribal organizations that operate #a or more facilities-- 7,a7 located in an area with documented disproportionately high rates of suicide2 7,b7 reporting active clinical telehealth capabilities2 or 7,c7 offering school-based telemental health services to ,indian youth4 7#c7 ,grant period ,the ,secretary shall award grants under this section for a period of up to #d years4 7#d7 ,maximum number of grants ,not more than #e grants shall be provided under paragraph 7#a71 with priority consideration given to ,indian tribes and tribal organizations that-- 7,a7 serve a particular community or geographic area in which there is a demonstrated need to address ,indian youth suicide2 7,b7 enter into collaborative partnerships with ,service or other tribal health programs or facilities to provide services under this demonstration project2 7,c7 serve an isolated community or geographic area that has limited or no access to behavioral health services2 or 7,d7 operate a detention facility at which ,indian youth are detained4 7#e7 ,consultation with ,administration ,in developing and carrying out the demonstration project under this subsection1 the ,secretary shall consult with the ,administration as the ,federal agency focused on mental health issues1 including suicide4 7b7 ,use of funds 7#a7 ,in general ,an ,indian tribe or tribal organization shall use a grant received under subsection 7a7 for the following purposes3 7,a7 ,to provide telemental health services to ,indian youth1 including the provision of-- 7i7 psychotherapy2 7ii7 psychiatric assessments and diagnostic interviews1 therapies for mental health conditions predisposing to suicide1 and treatment2 and 7iii7 alcohol and substance abuse treatment4 7,b7 ,to provide clinician-interactive medical advice1 guidance and training1 assistance in diagnosis and interpretation1 crisis counseling and intervention1 and related assistance to ,service or tribal clinicians and health services providers working with youth being served under the demonstration project4 7,c7 ,to assist1 educate1 and train community leaders1 health education professionals and paraprofessionals1 tribal outreach workers1 and family members who work with the youth receiving telemental health services under the demonstration project1 including with identification of suicidal tendencies1 crisis intervention and suicide prevention1 emergency skill development1 and building and expanding networks among those individuals and with ,state and local health services providers4 7,d7 ,to develop and distribute culturally appropriate community educational materials regarding-- 7i7 suicide prevention2 7ii7 suicide education2 7iii7 suicide screening2 7iv7 suicide intervention2 and 7v7 ways to mobilize communities with respect to the identification of risk factors for suicide4 7,e7 ,to conduct data collection and reporting relating to ,indian youth suicide prevention efforts4 7#b7 ,traditional health care practices ,in carrying out the purposes described in paragraph 7#a71 an ,indian tribe or tribal organization may use and promote the traditional health care practices of the ,indian tribes of the youth to be served4 7c7 ,applications 7#a7 ,in general ,subject to paragraph 7#b71 to be eligible to receive a grant under subsection 7a71 an ,indian tribe or tribal organization shall prepare and submit to the ,secretary an application1 at such time1 in such manner1 and containing such information as the ,secretary may require1 including-- 7,a7 a description of the project that the ,indian tribe or tribal organization will carry out using the funds provided under the grant2 7,b7 a description of the manner in which the project funded under the grant would-- 7i7 meet the telemental health care needs of the ,indian youth population to be served by the project2 or 7ii7 improve the access of the ,indian youth population to be served to suicide prevention and treatment services2 7,c7 evidence of support for the project from the local community to be served by the project2 7,d7 a description of how the families and leadership of the communities or populations to be served by the project would be involved in the development and ongoing operations of the project2 7,e7 a plan to involve the tribal community of the youth who are provided services by the project in planning and evaluating the behavioral health care and suicide prevention efforts provided1 in order to ensure the integration of community1 clinical1 environmental1 and cultural components of the treatment2 and 7,f7 a plan for sustaining the project after ,federal assistance for the demonstration project has terminated4 7#b7 ,efficiency of grant application process ,the ,secretary shall carry out such measures as the ,secretary determines to be necessary to maximize the time and workload efficiency of the process by which ,indian tribes and tribal organizations apply for grants under paragraph 7#a74 7d7 ,collaboration ,the ,secretary1 acting through the ,service1 shall encourage ,indian tribes and tribal organizations receiving grants under this section to collaborate to enable comparisons regarding best practices across projects4 7e7 ,annual report ,each grant recipient shall submit to the ,secretary an annual report that-- 7#a7 describes the number of telemental health services provided2 and 7#b7 includes any other information that the ,secretary may require4 7f7 ,reports to ,congress 7#a7 ,initial report 7,a7 ,in general ,not later than #b years after the date on which the first grant is awarded under this section1 the ,secretary shall submit to the ,committee on ,indian ,affairs of the ,senate and the ,committee on ,natural ,resources and the ,committee on ,energy and ,commerce of the ,house of ,representatives a report that-- 7i7 describes each project funded by a grant under this section during the preceding #b-year period1 including a description of the level of success achieved by the project2 and 7ii7 evaluates whether the demonstration project should be continued during the period beginning on the date of termination of funding for the demonstration project under subsection 7g7 and ending on the date on which the final report is submitted under paragraph 7#b74 7,b7 ,continuation of demonstration project ,on a determination by the ,secretary under clause 7ii7 of subparagraph 7,a7 that the demonstration project should be continued1 the ,secretary may carry out the demonstration project during the period described in that clause using such sums otherwise made available to the ,secretary as the ,secretary determines to be appropriate4 7#b7 ,final report ,not later than #bgj days after the date of termination of funding for the demonstration project under subsection 7g71 the ,secretary shall submit to the ,committee on ,indian ,affairs of the ,senate and the ,committee on ,natural ,resources and the ,committee on ,energy and ,commerce of the ,house of ,representatives a final report that-- 7,a7 describes the results of the projects funded by grants awarded under this section1 including any data available that indicate the number of attempted suicides2 7,b7 evaluates the impact of the telemental health services funded by the grants in reducing the number of completed suicides among ,indian youth2 7,c7 evaluates whether the demonstration project should be-- 7i7 expanded to provide more than #e grants2 and 7ii7 designated as a permanent program2 and 7,d7 evaluates the benefits of expanding the demonstration project to include urban ,indian organizations4 7g7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #a1ejj1jjj for each of fiscal years #bjag through #bjai4 #gbd4 ,substance ,abuse and ,mental ,health ,services ,administration grants 7a7 ,grant applications 7#a7 ,efficiency of grant application process ,the ,secretary1 acting through the ,administration1 shall carry out such measures as the ,secretary determines to be necessary to maximize the time and workload efficiency of the process by which ,indian tribes and tribal organizations apply for grants under any program administered by the ,administration1 including by providing methods other than electronic methods of submitting applications for those grants1 if necessary4 7#b7 ,priority for certain grants 7,a7 ,in general ,to fulfill the trust responsibility of the ,united ,states to ,indian tribes1 in awarding relevant grants pursuant to a program described in subparagraph 7,b71 the ,secretary shall take into consideration the needs of ,indian tribes or tribal organizations1 as applicable1 that serve populations with documented high suicide rates1 regardless of whether those ,indian tribes or tribal organizations possess adequate personnel or infrastructure to fulfill all applicable requirements of the relevant program4 7,b7 ,description of grant programs ,a grant program referred to in subparagraph 7,a7 is a grant program-- 7i7 administered by the ,administration to fund activities relating to mental health1 suicide prevention1 or suicide-related risk factors2 and 7ii7 under which an ,indian tribe or tribal organization is an eligible recipient4 7#c7 ,clarification regarding ,indian tribes and tribal organizations ,notwithstanding any other provision of law1 in applying for a grant under any program administered by the ,administration1 no ,indian tribe or tribal organization shall be required to apply through a ,state or ,state agency4 7#d7 ,requirements for affected ,states 7,a7 ,definitions ,in this paragraph3 7i7 ,affected ,state ,the term affected ,state means a ,state-- 7,i7 the boundaries of which include #a or more ,indian tribes2 and 7,,ii7 the application for a grant under any program administered by the ,administration of which includes statewide data4 7ii7 ,indian population ,the term ,indian population means the total number of residents of an affected ,state who are ,indian4 7,b7 ,requirements ,as a condition of receipt of a grant under any program administered by the ,administration1 each affected ,state shall-- 7i7 describe in the grant application-- 7,i7 the ,indian population of the affected ,state2 and 7,,ii7 the contribution of that ,indian population to the statewide data used by the affected ,state in the application2 and 7ii7 demonstrate to the satisfaction of the ,secretary that-- 7,i7 of the total amount of the grant1 the affected ,state will allocate for use for the ,indian population of the affected ,state an amount equal to the proportion that-- 7aa7 the ,indian population of the affected ,state2 bears to 7bb7 the total population of the affected ,state2 and 7,,ii7 the affected ,state will take reasonable efforts to collaborate with each ,indian tribe located within the affected ,state to carry out youth suicide prevention and treatment measures for members of the ,indian tribe4 7,c7 ,report ,not later than #a year after the date of receipt of a grant described in subparagraph 7,b71 an affected ,state shall submit to the ,secretary a report describing the measures carried out by the affected ,state to ensure compliance with the requirements of subparagraph 7,b77ii74 7b7 ,no non-,federal share requirement ,notwithstanding any other provision of law1 no ,indian tribe or tribal organization shall be required to provide a non-,federal share of the cost of any project or activity carried out using a grant provided under any program administered by the ,administration4 7c7 ,outreach for rural and isolated ,indian tribes ,due to the rural1 isolated nature of most ,indian reservations and communities 7especially those reservations and communities in the ,great ,plains region71 the ,secretary shall conduct outreach activities1 with a particular emphasis on the provision of telemental health services1 to achieve the purposes of this subtitle with respect to ,indian tribes located in rural1 isolated areas4 7d7 ,provision of other assistance 7#a7 ,in general ,the ,secretary1 acting through the ,administration1 shall carry out such measures 7including monitoring and the provision of required assistance7 as the ,secretary determines to be necessary to ensure the provision of adequate suicide prevention and mental health services to ,indian tribes described in paragraph 7#b71 regardless of whether those ,indian tribes possess adequate personnel or infrastructure-- 7,a7 to submit an application for a grant under any program administered by the ,administration1 including due to problems relating to access to the ,internet or other electronic means that may have resulted in previous obstacles to submission of a grant application2 or 7,b7 to fulfill all applicable requirements of the relevant program4 7#b7 ,description of ,indian tribes ,an ,indian tribe referred to in paragraph 7#a7 is an ,indian tribe-- 7,a7 the members of which experience-- 7i7 a high rate of youth suicide2 7ii7 low socioeconomic status2 and 7iii7 extreme health disparity2 7,b7 that is located in a remote and isolated area2 and 7,c7 that lacks technology and communication infrastructure4 7#c7 ,authorization of appropriations ,there are authorized to be appropriated to the ,secretary such sums as the ,secretary determines to be necessary to carry out this subsection4 7e7 ,early intervention and assessment services 7#a7 ,definition of affected entity ,in this subsection1 the term affected entity means any entity-- 7,a7 that receives a grant for suicide intervention1 prevention1 or treatment under a program administered by the ,administration2 and 7,b7 the population to be served by which includes ,indian youth4 7#b7 ,requirement ,the ,secretary1 acting through the ,administration1 shall ensure that each affected entity carrying out a youth suicide early intervention and prevention strategy described in section #ebj;,e7c77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;bb-#cf7;c77#a771 or any other youth suicide-related early intervention and assessment activity1 provides training or education to individuals who interact frequently with the ,indian youth to be served by the affected entity 7including parents1 teachers1 coaches1 and mentors7 on identifying warning signs of ,indian youth who are at risk of committing suicide4 #gbe4 ,use of predoctoral psychology and psychiatry interns ,the ,secretary shall carry out such activities as the ,secretary determines to be necessary to encourage ,indian tribes1 tribal organizations1 and other mental health care providers to obtain the services of predoctoral psychology and psychiatry interns-- 7#a7 to increase the quantity of patients served by the ,indian tribes1 tribal organizations1 and other mental health care providers2 and 7#b7 for purposes of recruitment and retention4 #gbf4 ,indian youth life skills development demonstration program 7a7 ,purpose ,the purpose of this section is to authorize the ,secretary1 acting through the ,administration1 to carry out a demonstration program to test the effectiveness of a culturally compatible1 school-based1 life skills curriculum for the prevention of ,indian and ,alaska ,native adolescent suicide1 including through-- 7#a7 the establishment of tribal partnerships to develop and implement such a curriculum1 in cooperation with-- 7,a7 behavioral health professionals1 with a priority for tribal partnerships cooperating with mental health professionals employed by the ,service2 7,b7 tribal or local school agencies2 and 7,c7 parent and community groups2 7#b7 the provision by the ,administration or the ,service of-- 7,a7 technical expertise2 and 7,b7 clinicians1 analysts1 and educators1 as appropriate2 7#c7 training for teachers1 school administrators1 and community members to implement the curriculum2 7#d7 the establishment of advisory councils composed of parents1 educators1 community members1 trained peers1 and others to provide advice regarding the curriculum and other components of the demonstration program2 7#e7 the development of culturally appropriate support measures to supplement the effectiveness of the curriculum2 and 7#f7 projects modeled after evidence-based projects1 such as programs evaluated and published in relevant literature4 7b7 ,demonstration grant program 7#a7 ,definitions ,in this subsection3 7,a7 ,curriculum ,the term curriculum means the culturally compatible1 school-based1 life skills curriculum for the prevention of ,indian and ,alaska ,native adolescent suicide identified by the ,secretary under paragraph 7#b77;,a74 7,b7 ,eligible entity ,the term eligible entity means-- 7i7 an ,indian tribe2 7ii7 a tribal organization2 7iii7 any other tribally authorized entity2 and 7iv7 any partnership composed of #b or more entities described in clause 7i71 7ii71 or 7iii74 7#b7 ,establishment ,the ,secretary1 acting through the ,administration1 may establish and carry out a demonstration program under which the ,secretary shall-- 7,a7 identify a culturally compatible1 school-based1 life skills curriculum for the prevention of ,indian and ,alaska ,native adolescent suicide2 7,b7 identify the ,indian tribes that are at greatest risk for adolescent suicide2 7,c7 invite those ,indian tribes to participate in the demonstration program by-- 7i7 responding to a comprehensive program requirement request of the ,secretary2 or 7ii7 submitting1 through an eligible entity1 an application in accordance with paragraph 7#d72 and 7,d7 provide grants to the ,indian tribes identified under subparagraph 7,b7 and eligible entities to implement the curriculum with respect to ,indian and ,alaska ,native youths who-- 7i7 are between the ages of #aj and #ai2 and 7ii7 attend school in a region that is at risk of high youth suicide rates1 as determined by the ,administration4 7#c7 ,requirements 7,a7 ,term ,the term of a grant provided under the demonstration program under this section shall be not less than #d years4 7,b7 ,maximum number ,the ,secretary may provide not more than #e grants under the demonstration program under this section4 7,c7 ,amount ,the grants provided under this section shall be of equal amounts4 7,d7 ,certain schools ,in selecting eligible entities to receive grants under this section1 the ,secretary shall ensure that not less than #a demonstration program shall be carried out at each of-- 7i7 a school operated by the ,bureau of ,indian ,education2 7ii7 a ,tribal school2 and 7iii7 a school receiving payments under section #hjjb or #hjjc of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ggjb1 #ggjc74 7#d7 ,applications ,to be eligible to receive a grant under the demonstration program1 an eligible entity shall submit to the ,secretary an application1 at such time1 in such manner1 and containing such information as the ,secretary may require1 including-- 7,a7 an assurance that1 in implementing the curriculum1 the eligible entity will collaborate with #a or more local educational agencies1 including elementary schools1 middle schools1 and high schools2 7,b7 an assurance that the eligible entity will collaborate1 for the purpose of curriculum development1 implementation1 and training and technical assistance1 with #a or more-- 7i7 nonprofit entities with demonstrated expertise regarding the development of culturally sensitive1 school-based1 youth suicide prevention and intervention programs2 or 7ii7 institutions of higher education with demonstrated interest and knowledge regarding culturally sensitive1 school-based1 life skills youth suicide prevention and intervention programs2 7,c7 an assurance that the curriculum will be carried out in an academic setting in conjunction with at least #a classroom teacher not less frequently than twice each school week for the duration of the academic year2 7,d7 a description of the methods by which curriculum participants will be-- 7i7 screened for mental health at-risk indicators2 and 7ii7 if needed and on a case-by-case basis1 referred to a mental health clinician for further assessment and treatment and with crisis response capability2 and 7,e7 an assurance that supportive services will be provided to curriculum participants identified as high-risk participants1 including referral1 counseling1 and follow-up services for-- 7i7 drug or alcohol abuse2 7ii7 sexual or domestic abuse2 and 7iii7 depression and other relevant mental health concerns4 7#e7 ,use of funds ,an ,indian tribe identified under paragraph 7#b77;,b7 or an eligible entity may use a grant provided under this subsection-- 7,a7 to develop and implement the curriculum in a school-based setting2 7,b7 to establish an advisory council-- 7i7 to advise the ,indian tribe or eligible entity regarding curriculum development2 and 7ii7 to provide support services identified as necessary by the community being served by the ,indian tribe or eligible entity2 7,c7 to appoint and train a school- and community-based cultural resource liaison1 who will act as an intermediary among the ,indian tribe or eligible entity1 the applicable school administrators1 and the advisory council established by the ,indian tribe or eligible entity2 7,d7 to establish an on-site1 school-based1 ,,ma- or ,ph4,d4-level mental health practitioner 7employed by the ,service1 if practicable7 to work with tribal educators and other personnel2 7,e7 to provide for the training of peer counselors to assist in carrying out the curriculum2 7,f7 to procure technical and training support from nonprofit or ,state entities or institutions of higher education identified by the community being served by the ,indian tribe or eligible entity as the best suited to develop and implement the curriculum2 7,g7 to train teachers and school administrators to effectively carry out the curriculum2 7,h7 to establish an effective referral procedure and network2 7,i7 to identify and develop culturally compatible curriculum support measures2 7,j7 to obtain educational materials and other resources from the ,administration or other appropriate entities to ensure the success of the demonstration program2 and 7,k7 to evaluate the effectiveness of the curriculum in preventing ,indian and ,alaska ,native adolescent suicide4 7c7 ,evaluations ,using such amounts made available pursuant to subsection 7e7 as the ,secretary determines to be appropriate1 the ,secretary shall conduct1 directly or through a grant1 contract1 or cooperative agreement with an entity that has experience regarding the development and operation of successful culturally compatible1 school-based1 life skills suicide prevention and intervention programs or evaluations1 an annual evaluation of the demonstration program under this section1 including an evaluation of-- 7#a7 the effectiveness of the curriculum in preventing ,indian and ,alaska ,native adolescent suicide2 7#b7 areas for program improvement2 and 7#c7 additional development of the goals and objectives of the demonstration program4 7d7 ,report to ,congress 7#a7 ,in general ,subject to paragraph 7#b71 not later than #ahj days after the date of termination of the demonstration program1 the ,secretary shall submit to the ,committee on ,indian ,affairs and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,natural ,resources and the ,committee on ,education and ,labor of the ,house of ,representatives a final report that-- 7,a7 describes the results of the program of each ,indian tribe or eligible entity under this section2 7,b7 evaluates the effectiveness of the curriculum in preventing ,indian and ,alaska ,native adolescent suicide2 7,c7 makes recommendations regarding-- 7i7 the expansion of the demonstration program under this section to additional eligible entities2 7ii7 designating the demonstration program as a permanent program2 and 7iii7 identifying and distributing the curriculum through the ,suicide ,prevention ,resource ,center of the ,administration2 and 7,d7 incorporates any public comments received under paragraph 7#b74 7#b7 ,public comment ,the ,secretary shall provide a notice of the report under paragraph 7#a7 and an opportunity for public comment on the report for a period of not less than #ij days before submitting the report to ,congress4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #a1jjj1jjj for each of fiscal years #bjag through #bjbj4 4 ,h ,miscellaneous #aia4 ,confidentiality of medical quality assurance records2 qualified immunity for participants ,title ,,viii of the ,indian ,health ,care ,improvement ,act 7as amended by section #aja7;b77 is amended by inserting after section #hjd 7#be ,u4,s4,c4 #afgd7 the following3 #hje4 ,confidentiality of medical quality assurance records2 qualified immunity for participants 7a7 ,definitions ,in this section3 7#a7 ,health care provider ,the term health care provider means any health care professional1 including community health aides and practitioners certified under section #aai1 who is-- 7,a7 granted clinical practice privileges or employed to provide health care services at-- 7i7 an ,indian health program2 or 7ii7 a health program of an urban ,indian organization2 and 7,b7 licensed or certified to perform health care services by a governmental board or agency or professional health care society or organization4 7#b7 ,medical quality assurance program ,the term medical quality assurance program means any activity carried out before1 on1 or after the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag by or for any ,indian health program or urban ,indian organization to assess the quality of medical care1 including activities conducted by or on behalf of individuals1 ,indian health program or urban ,indian organization medical or dental treatment review committees1 or other review bodies responsible for quality assurance1 credentials1 infection control1 patient safety1 patient care assessment 7including treatment procedures1 blood1 drugs1 and therapeutics71 medical records1 health resources management review1 and identification and prevention of medical or dental incidents and risks4 7#c7 ,medical quality assurance record ,the term medical quality assurance record means the proceedings1 records1 minutes1 and reports that-- 7,a7 emanate from quality assurance program activities described in paragraph 7#b72 and 7,b7 are produced or compiled by or for an ,indian health program or urban ,indian organization as part of a medical quality assurance program4 7b7 ,confidentiality of records ,medical quality assurance records created by or for any ,indian health program or a health program of an urban ,indian organization as part of a medical quality assurance program are confidential and privileged4 ,such records may not be disclosed to any person or entity1 except as provided in subsection 7d74 7c7 ,prohibition on disclosure and testimony 7#a7 ,in general ,no part of any medical quality assurance record described in subsection 7b7 may be subject to discovery or admitted into evidence in any judicial or administrative proceeding1 except as provided in subsection 7d74 7#b7 ,testimony ,an individual who reviews or creates medical quality assurance records for any ,indian health program or urban ,indian organization who participates in any proceeding that reviews or creates such records may not be permitted or required to testify in any judicial or administrative proceeding with respect to such records or with respect to any finding1 recommendation1 evaluation1 opinion1 or action taken by such person or body in connection with such records except as provided in this section4 7d7 ,authorized disclosure and testimony 7#a7 ,in general ,subject to paragraph 7#b71 a medical quality assurance record described in subsection 7b7 may be disclosed1 and an individual referred to in subsection 7c7 may give testimony in connection with such a record1 only as follows3 7,a7 ,to a ,federal agency or private organization1 if such medical quality assurance record or testimony is needed by such agency or organization to perform licensing or accreditation functions related to any ,indian health program or to a health program of an urban ,indian organization to perform monitoring1 required by law1 of such program or organization4 7,b7 ,to an administrative or judicial proceeding commenced by a present or former ,indian health program or urban ,indian organization provider concerning the termination1 suspension1 or limitation of clinical privileges of such health care provider4 7,c7 ,to a governmental board or agency or to a professional health care society or organization1 if such medical quality assurance record or testimony is needed by such board1 agency1 society1 or organization to perform licensing1 credentialing1 or the monitoring of professional standards with respect to any health care provider who is or was an employee of any ,indian health program or urban ,indian organization4 7,d7 ,to a hospital1 medical center1 or other institution that provides health care services1 if such medical quality assurance record or testimony is needed by such institution to assess the professional qualifications of any health care provider who is or was an employee of any ,indian health program or urban ,indian organization and who has applied for or been granted authority or employment to provide health care services in or on behalf of such program or organization4 7,e7 ,to an officer1 employee1 or contractor of the ,indian health program or urban ,indian organization that created the records or for which the records were created4 ,if that officer1 employee1 or contractor has a need for such record or testimony to perform official duties4 7,f7 ,to a criminal or civil law enforcement agency or instrumentality charged under applicable law with the protection of the public health or safety1 if a qualified representative of such agency or instrumentality makes a written request that such record or testimony be provided for a purpose authorized by law4 7,g7 ,in an administrative or judicial proceeding commenced by a criminal or civil law enforcement agency or instrumentality referred to in subparagraph 7,f71 but only with respect to the subject of such proceeding4 7#b7 ,identity of participants ,with the exception of the subject of a quality assurance action1 the identity of any person receiving health care services from any ,indian health program or urban ,indian organization or the identity of any other person associated with such program or organization for purposes of a medical quality assurance program that is disclosed in a medical quality assurance record described in subsection 7b7 shall be deleted from that record or document before any disclosure of such record is made outside such program or organization4 7e7 ,disclosure for certain purposes 7#a7 ,in general ,nothing in this section shall be construed as authorizing or requiring the withholding from any person or entity aggregate statistical information regarding the results of any ,indian health program or urban ,indian organization's medical quality assurance programs4 7#b7 ,withholding from ,congress ,nothing in this section shall be construed as authority to withhold any medical quality assurance record from a committee of either ,house of ,congress1 any joint committee of ,congress1 or the ,government ,accountability ,office if such record pertains to any matter within their respective jurisdictions4 7f7 ,prohibition on disclosure of record or testimony ,an individual or entity having possession of or access to a record or testimony described by this section may not disclose the contents of such record or testimony in any manner or for any purpose except as provided in this section4 7g7 ,exemption from ,freedom of ,information ,act ,medical quality assurance records described in subsection 7b7 may not be made available to any person under section #eeb of title #e1 ,united ,states ,code4 7h7 ,limitation on civil liability ,an individual who participates in or provides information to a person or body that reviews or creates medical quality assurance records described in subsection 7b7 shall not be civilly liable for such participation or for providing such information if the participation or provision of information was in good faith based on prevailing professional standards at the time the medical quality assurance program activity took place4 7i7 ,application to information in certain other records ,nothing in this section shall be construed as limiting access to the information in a record created and maintained outside a medical quality assurance program1 including a patient's medical records1 on the grounds that the information was presented during meetings of a review body that are part of a medical quality assurance program4 7j7 ,regulations ,the ,secretary1 acting through the ,service1 shall promulgate regulations pursuant to section #hjb4 7k7 ,continued protection ,disclosure under subsection 7d7 does not permit redisclosure except to the extent such further disclosure is authorized under subsection 7d7 or is otherwise authorized to be disclosed under this section4 7l7 ,inconsistencies ,to the extent that the protections under part ,c of title ,,ix of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bbi;b-#ba et seq47 7as amended by the ,patient ,safety and ,quality ,improvement ,act of #bjje 7,public ,law #aji-da2 #aai ,stat4 #dbd77 and this section are inconsistent1 the provisions of whichever is more protective shall control4 7m7 ,relationship to other law ,this section shall continue in force and effect1 except as otherwise specifically provided in any ,federal law enacted after the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag4 4 #aib4 ,limitation on use of funds appropraited to the ,indian ,health ,service ,section #hjf of the ,indian ,health ,care ,improvement ,act is amended-- 7#a7 by striking ,any limitation and inserting the following3 7a7 ,,hhs appropriations ,any limitation 2 and 7#b7 by adding at the end the following3 7b7 ,limitations pursuant to other ,federal law ,any limitation pursuant to other ,federal laws on the use of ,federal funds appropriated to the ,service shall apply with respect to the performance or coverage of abortions4 4 #aic4 ,arizona1 ,north ,dakota1 and ,south ,dakota as contract health service delivery areas2 eligibility of ,california ,indians ,title ,,viii of the ,indian ,health ,care ,improvement ,act is amended-- 7#a7 by striking section #hjh 7#be ,u4,s4,c4 #afgh7 and inserting the following3 #hjh4 ,arizona as contract health service delivery area 7a7 ,in general ,the ,state of ,arizona shall be designated as a contract health service delivery area by the ,service for the purpose of providing contract health care services to members of ,indian tribes in the ,state of ,arizona4 7b7 ,maintenance of services ,the ,service shall not curtail any health care services provided to ,indians residing on reservations in the ,state of ,arizona if the curtailment is due to the provision of contract services in that ,state pursuant to the designation of the ,state as a contract health service delivery area by subsection 7a74 2 7#b7 by inserting after section #hjh 7#be ,u4,s4,c4 #afgh7 the following3 #hjh;,a4 ,north ,dakota and ,south ,dakota as contract health service delivery area 7a7 ,in general ,the ,states of ,north ,dakota and ,south ,dakota shall be designated as a contract health service delivery area by the ,service for the purpose of providing contract health care services to members of ,indian tribes in the ,states of ,north ,dakota and ,south ,dakota4 7b7 ,maintenance of services ,the ,service shall not curtail any health care services provided to ,indians residing on any reservation1 or in any county that has a common boundary with any reservation1 in the ,state of ,north ,dakota or ,south ,dakota if the curtailment is due to the provision of contract services in those ,states pursuant to the designation of the ,states as a contract health service delivery area by subsection 7a74 2 and 7#c7 by striking section #hji 7#be ,u4,s4,c4 #afgi7 and inserting the following3 #hji4 ,eligibility of ,california ,indians 7a7 ,in general ,the following ,california ,indians shall be eligible for health services provided by the ,service3 7#a7 ,any member of a federally recognized ,indian tribe4 7#b7 ,any descendant of an ,indian who was residing in ,california on ,june #a1 #aheb1 if such descendant-- 7,a7 is a member of the ,indian community served by a local program of the ,service2 and 7,b7 is regarded as an ,indian by the community in which such descendant lives4 7#c7 ,any ,indian who holds trust interests in public domain1 national forest1 or reservation allotments in ,california4 7#d7 ,any ,indian of ,california who is listed on the plans for distribution of the assets of rancherias and reservations located within the ,state of ,california under the ,act of ,august #ah1 #aieh 7#gb ,stat4 #fai71 and any descendant of such an ,indian4 7b7 ,clarification ,nothing in this section may be construed as expanding the eligibility of ,california ,indians for health services provided by the ,service beyond the scope of eligibility for such health services that applied on ,may #a1 #aihf4 4 #aid4 ,methods to increase access to professionals of certain corps ,section #hab of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afhj;b7 is amended to read as follows3 #hab4 ,national ,health ,service ,corps 7a7 ,no reduction in services ,the ,secretary shall not remove a member of the ,national ,health ,service ,corps from an ,indian health program or urban ,indian organization or withdraw funding used to support such a member1 unless the ,secretary1 acting through the ,service1 has ensured that the ,indians receiving services from the member will experience no reduction in services4 7b7 ,treatment of ,indian health programs ,at the request of an ,indian health program1 the services of a member of the ,national ,health ,service ,corps assigned to the ,indian health program may be limited to the individuals who are eligible for services from that ,indian health program4 4 #aie4 ,health services for ineligible persons ,section #hac of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afhj;c7 is amended to read as follows3 #hac4 ,health services for ineligible persons 7a7 ,children ,any individual who-- 7#a7 has not attained #ai years of age2 7#b7 is the natural or adopted child1 stepchild1 foster child1 legal ward1 or orphan of an eligible ,indian2 and 7#c7 is not otherwise eligible for health services provided by the ,service1 shall be eligible for all health services provided by the ,service on the same basis and subject to the same rules that apply to eligible ,indians until such individual attains #ai years of age4 ,the existing and potential health needs of all such individuals shall be taken into consideration by the ,service in determining the need for1 or the allocation of1 the health resources of the ,service4 ,if such an individual has been determined to be legally incompetent prior to attaining #ai years of age1 such individual shall remain eligible for such services until #a year after the date of a determination of competency4 7b7 ,spouses ,any spouse of an eligible ,indian who is not an ,indian1 or who is of ,indian descent but is not otherwise eligible for the health services provided by the ,service1 shall be eligible for such health services if all such spouses or spouses who are married to members of each ,indian tribe being served are made eligible1 as a class1 by an appropriate resolution of the governing body of the ,indian tribe or tribal organization providing such services4 ,the health needs of persons made eligible under this paragraph shall not be taken into consideration by the ,service in determining the need for1 or allocation of1 its health resources4 7c7 ,health facilities providing health services 7#a7 ,in general ,the ,secretary is authorized to provide health services under this subsection through health facilities operated directly by the ,service to individuals who reside within the ,service unit and who are not otherwise eligible for such health services if-- 7,a7 the ,indian tribes served by such ,service unit requests such provision of health services to such individuals1 and 7,b7 the ,secretary and the served ,indian tribes have jointly determined that the provision of such health services will not result in a denial or diminution of health services to eligible ,indians4 7#b7 ,,isdeaa programs ,in the case of health facilities operated under a contract or compact entered into under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq471 the governing body of the ,indian tribe or tribal organization providing health services under such contract or compact is authorized to determine whether health services should be provided under such contract or compact to individuals who are not eligible for such health services under any other subsection of this section or under any other provision of law4 ,in making such determinations1 the governing body of the ,indian tribe or tribal organization shall take into account the consideration described in paragraph 7#a77;,b74 ,any services provided by the ,indian tribe or tribal organization pursuant to a determination made under this subparagraph shall be deemed to be provided under the agreement entered into by the ,indian tribe or tribal organization under the ,indian ,self-,determination and ,education ,assistance ,act4 ,the provisions of section #cad of ,public ,law #aja-eab 7#ajd ,stat4 #aiei71 as amended by section #cjh of ,public ,law #ajc-ach 7#ajg ,stat4 #adaf71 shall apply to any services provided by the ,indian tribe or tribal organization pursuant to a determination made under this subparagraph4 7#c7 ,payment for services 7,a7 ,in general ,persons receiving health services provided by the ,service under this subsection shall be liable for payment of such health services under a schedule of charges prescribed by the ,secretary which1 in the judgment of the ,secretary1 results in reimbursement in an amount not less than the actual cost of providing the health services4 ,notwithstanding section #bjg of this ,act or any other provision of law1 amounts collected under this subsection1 including ,medicare1 ,medicaid1 or children's health insurance program reimbursements under titles ,,xviii1 ,,xix1 and ,,xxi of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 shall be credited to the account of the program providing the service and shall be used for the purposes listed in section #dja7;d77#b7 and amounts collected under this subsection shall be available for expenditure within such program4 7,b7 ,indigent people ,health services may be provided by the ,secretary through the ,service under this subsection to an indigent individual who would not be otherwise eligible for such health services but for the provisions of paragraph 7#a7 only if an agreement has been entered into with a ,state or local government under which the ,state or local government agrees to reimburse the ,service for the expenses incurred by the ,service in providing such health services to such indigent individual4 7#d7 ,revocation of consent for services 7,a7 ,single tribe service area ,in the case of a ,service ,area which serves only #a ,indian tribe1 the authority of the ,secretary to provide health services under paragraph 7#a7 shall terminate at the end of the fiscal year succeeding the fiscal year in which the governing body of the ,indian tribe revokes its concurrence to the provision of such health services4 7,b7 ,multitribal service area ,in the case of a multitribal ,service ,area1 the authority of the ,secretary to provide health services under paragraph 7#a7 shall terminate at the end of the fiscal year succeeding the fiscal year in which at least #ea percent of the number of ,indian tribes in the ,service ,area revoke their concurrence to the provisions of such health services4 7d7 ,other services ,the ,service may provide health services under this subsection to individuals who are not eligible for health services provided by the ,service under any other provision of law in order to-- 7#a7 achieve stability in a medical emergency2 7#b7 prevent the spread of a communicable disease or otherwise deal with a public health hazard2 7#c7 provide care to non-,indian women pregnant with an eligible ,indian's child for the duration of the pregnancy through postpartum2 or 7#d7 provide care to immediate family members of an eligible individual if such care is directly related to the treatment of the eligible individual4 7e7 ,hospital privileges for practitioners 7#a7 ,in general ,hospital privileges in health facilities operated and maintained by the ,service or operated under a contract or compact pursuant to the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq47 may be extended to non-,service health care practitioners who provide services to individuals described in subsection 7a71 7b71 7c71 or 7d74 ,such non-,service health care practitioners may1 as part of the privileging process1 be designated as employees of the ,federal ,government for purposes of section #acdf7;b7 and chapter #aga of title #bh1 ,united ,states ,code 7relating to ,federal tort claims7 only with respect to acts or omissions which occur in the course of providing services to eligible individuals as a part of the conditions under which such hospital privileges are extended4 7#b7 ,definition ,for purposes of this subsection1 the term non-,service health care practitioner means a practitioner who is not-- 7,a7 an employee of the ,service2 or 7,b7 an employee of an ,indian tribe or tribal organization operating a contract or compact under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq47 or an individual who provides health care services pursuant to a personal services contract with such ,indian tribe or tribal organization4 7f7 ,eligible ,indian ,for purposes of this section1 the term eligible ,indian means any ,indian who is eligible for health services provided by the ,service without regard to the provisions of this section4 4 #aif4 ,annual budget submission ,title ,,viii of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afga et seq47 is amended by adding at the end the following3 #hbf4 ,annual budget submission ,effective beginning with the submission of the annual budget request to ,congress for fiscal year #bjag1 the ,president shall include1 in the amount requested and the budget justification1 amounts that reflect any changes in-- 7#a7 the cost of health care services1 as indexed for ,united ,states dollar inflation 7as measured by the ,consumer ,price ,index72 and 7#b7 the size of the population served by the ,service4 4 #aig4 ,prescription drug monitoring ,title ,,viii of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afga et seq47 7as amended by section #aie7 is amended by adding at the end the following3 #hbg4 ,prescription drug monitoring 7a7 ,monitoring 7#a7 ,establishment ,the ,secretary1 in coordination with the ,secretary of the ,interior and the ,attorney ,general1 shall establish a prescription drug monitoring program1 to be carried out at health care facilities of the ,service1 tribal health care facilities1 and urban ,indian health care facilities4 7#b7 ,report ,not later than #ah months after the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag1 the ,secretary shall submit to the ,committee on ,indian ,affairs of the ,senate and the ,committee on ,natural ,resources of the ,house of ,representatives a report that describes-- 7,a7 the needs of the ,service1 tribal health care facilities1 and urban ,indian health care facilities with respect to the prescription drug monitoring program under paragraph 7#a72 7,b7 the planned development of that program1 including any relevant statutory or administrative limitations2 and 7,c7 the means by which the program could be carried out in coordination with any ,state prescription drug monitoring program4 7b7 ,abuse 7#a7 ,in general ,the ,attorney ,general1 in conjunction with the ,secretary and the ,secretary of the ,interior1 shall conduct-- 7,a7 an assessment of the capacity of1 and support required by1 relevant ,federal and tribal agencies-- 7i7 to carry out data collection and analysis regarding incidents of prescription drug abuse in ,indian communities2 and 7ii7 to exchange among those agencies and ,indian health programs information relating to prescription drug abuse in ,indian communities1 including statutory and administrative requirements and limitations relating to that abuse2 and 7,b7 training for ,indian health care providers1 tribal leaders1 law enforcement officers1 and school officials regarding awareness and prevention of prescription drug abuse and strategies for improving agency responses to addressing prescription drug abuse in ,indian communities4 7#b7 ,report ,not later than #ah months after the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag1 the ,attorney ,general shall submit to the ,committee on ,indian ,affairs of the ,senate and the ,committee on ,natural ,resources of the ,house of ,representatives a report that describes-- 7,a7 the capacity of ,federal and tribal agencies to carry out data collection and analysis and information exchanges as described in paragraph 7#a77;,a72 7,b7 the training conducted pursuant to paragraph 7#a77;,b72 7,c7 infrastructure enhancements required to carry out the activities described in paragraph 7#a71 if any2 and 7,d7 any statutory or administrative barriers to carrying out those activities4 4 #aih4 ,tribal health program option for cost sharing ,title ,,viii of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afga et seq47 7as amended by section #aif7 is amended by adding at the end the following3 #hbh4 ,tribal health program option for cost sharing 7a7 ,in general ,nothing in this ,act limits the ability of a tribal health program operating any health program1 service1 function1 activity1 or facility funded1 in whole or part1 by the ,service through1 or provided for in1 a compact with the ,service pursuant to title ,v of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #deh;aaa et seq47 to charge an ,indian for services provided by the tribal health program4 7b7 ,service ,nothing in this ,act authorizes the ,service-- 7#a7 to charge an ,indian for services2 or 7#b7 to require any tribal health program to charge an ,indian for services4 4 #aii4 ,disease and injury prevention report ,title ,,viii of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afga et seq47 7as amended by section #aig7 is amended by adding at the end the following3 #hbi4 ,disease and injury prevention report ,not later than #ah months after the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag1 the ,secretary shall submit to the ,committee on ,indian ,affairs of the ,senate and the ,committees on ,natural ,resources and ,energy and ,commerce of the ,house of ,representatives describing-- 7#a7 all disease and injury prevention activities conducted by the ,service1 independently or in conjunction with other ,federal departments and agencies and ,indian tribes2 and 7#b7 the effectiveness of those activities1 including the reductions of injury or disease conditions achieved by the activities4 4 #bjj4 ,other ,,gao reports ,title ,,viii of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afga et seq47 7as amended by section #aih7 is amended by adding at the end the following3 #hcj4 ,other ,,gao reports 7a7 ,coordination of services 7#a7 ,study and evaluation ,the ,comptroller ,general of the ,united ,states shall conduct a study1 and evaluate the effectiveness1 of coordination of health care services provided to ,indians-- 7,a7 through ,medicare1 ,medicaid1 or ,,schip2 7,b7 by the ,service2 or 7,c7 using funds provided by-- 7i7 ,state or local governments2 or 7ii7 ,indian tribes4 7#b7 ,report ,not later than #ah months after the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag1 the ,comptroller ,general shall submit to ,congress a report-- 7,a7 describing the results of the evaluation under paragraph 7#a72 and 7,b7 containing recommendations of the ,comptroller ,general regarding measures to support and increase coordination of the provision of health care services to ,indians as described in paragraph 7#a74 7b7 ,payments for contract health services 7#a7 ,in general ,the ,comptroller ,general shall conduct a study on the use of health care furnished by health care providers under the contract health services program funded by the ,service and operated by the ,service1 an ,indian tribe1 or a tribal organization4 7#b7 ,analysis ,the study conducted under paragraph 7#a7 shall include an analysis of-- 7,a7 the amounts reimbursed under the contract health services program described in paragraph 7#a7 for health care furnished by entities1 individual providers1 and suppliers1 including a comparison of reimbursement for that health care through other public programs and in the private sector2 7,b7 barriers to accessing care under such contract health services program1 including barriers relating to travel distances1 cultural differences1 and public and private sector reluctance to furnish care to patients under the program2 7,c7 the adequacy of existing ,federal funding for health care under the contract health services program2 7,d7 the administration of the contract health service program1 including the distribution of funds to ,indian health programs pursuant to the program2 and 7,e7 any other items determined appropriate by the ,comptroller ,general4 7#c7 ,report ,not later than #ah months after the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag1 the ,comptroller ,general shall submit to ,congress a report on the study conducted under paragraph 7#a71 together with recommendations regarding-- 7,a7 the appropriate level of ,federal funding that should be established for health care under the contract health services program described in paragraph 7#a72 7,b7 how to most efficiently use that funding2 and 7,c7 the identification of any inequities in the current distribution formula or inequitable results for any ,indian tribe under the funding level1 and any recommendations for addressing any inequities or inequitable results identified4 7#d7 ,consultation ,in conducting the study under paragraph 7#a7 and preparing the report under paragraph 7#c71 the ,comptroller ,general shall consult with the ,service1 ,indian tribes1 and tribal organizations4 4 #bja4 ,traditional health care practices ,title ,,viii of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afga et seq47 7as amended by section #aii7 is amended by adding at the end the following3 #hca4 ,traditional health care practices ,although the ,secretary may promote traditional health care practices1 consistent with the ,service standards for the provision of health care1 health promotion1 and disease prevention under this ,act1 the ,united ,states is not liable for any provision of traditional health care practices pursuant to this ,act that results in damage1 injury1 or death to a patient4 ,nothing in this subsection shall be construed to alter any liability or other obligation that the ,united ,states may otherwise have under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej et seq47 or this ,act4 4 #bjb4 ,director of ,,hiv_/,,aids ,prevention and ,treatment ,title ,,viii of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afga et seq47 7as amended by section #aii;,a7 is amended by adding at the end the following3 #hcb4 ,director of ,,hiv_/,,aids ,prevention and ,treatment 7a7 ,establishment ,the ,secretary1 acting through the ,service1 shall establish within the ,service the position of the ,director of ,,hiv_/,,aids ,prevention and ,treatment 7referred to in this section as the ,director74 7b7 ,duties ,the ,director shall-- 7#a7 coordinate and promote ,,hiv_/,,aids prevention and treatment activities specific to ,indians2 7#b7 provide technical assistance to ,indian tribes1 tribal organizations1 and urban ,indian organizations regarding existing ,,hiv_/,,aids prevention and treatment programs2 and 7#c7 ensure interagency coordination to facilitate the inclusion of ,indians in ,federal ,,hiv_/,,aids research and grant opportunities1 with emphasis on the programs operated under the ,ryan ,white ,comprehensive ,aids ,resources ,emergency ,act of #aiij 7,public ,law #aja-cha2 #ajd ,stat4 #egf7 and the amendments made by that ,act4 7c7 ,report ,not later than #b years after the date of enactment of the ,indian ,healthcare ,improvement ,act of #bjag1 and not less frequently than once every #b years thereafter1 the ,director shall submit to ,congress a report describing1 with respect to the preceding #b-year period-- 7#a7 each activity carried out under this section2 and 7#b7 any findings of the ,director with respect to ,,hiv_/,,aids prevention and treatment activities specific to ,indians4 4 ,,ii ,amendments to other ,acts and miscellaneous provisions #bja4 ,elimination of sunset for reimbursement for all ,medicare part ,b services furnished by certain indian hospitals and clinics 7a7 ,reimbursement for all medicare part b services furnished by certain indian hospitals and clinics ,section #ahhj7;e77#a77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieqq7e77#a77;,a77 is amended by striking during the #e-year period beginning on and inserting on or after4 7b7 ,effective date ,the amendments made by this section shall apply to items or services furnished on or after ,january #a1 #bjag4 #bjb4 ,including costs incurred by aids drug assistance programs and indian health service in providing prescription drugs toward the annual out-of-pocket threshold under part ,d 7a7 ,in general ,section #ahfj;,d-#b7;b77#d77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajb7;b77#d77;,c77 is amended-- 7#a7 in clause 7i71 by striking and at the end2 7#b7 in clause 7ii7-- 7,a7 by striking such costs shall be treated as incurred only if and inserting subject to clause 7iii71 such costs shall be treated as incurred only if2 7,b7 by striking 1 under section #ahfj;,d-#ad1 or under a ,state ,pharmaceutical ,assistance ,program2 and 7,c7 by striking the period at the end and inserting 2 and2 and 7#c7 by inserting after clause 7ii7 the following new clause3 7iii7 such costs shall be treated as incurred and shall not be considered to be reimbursed under clause 7ii7 if such costs are borne or paid-- 7,i7 under section #ahfj;,d-#ad2 7,,ii7 under a ,state ,pharmaceutical ,assistance ,program2 7,,iii7 by the ,indian ,health ,service1 an ,indian tribe or tribal organization1 or an urban ,indian organization 7as defined in section #d of the ,indian ,health ,care ,improvement ,act72 or 7,,iv7 under an ,,aids ,drug ,assistance ,program under part ,b of title ,,xxvi of the ,public ,health ,service ,act4 4 7b7 ,effective date ,the amendments made by subsection 7a7 shall apply to costs incurred on or after ,january #a1 #bjag4 #bjc4 ,prohibition of use of ,federal funds for abortion ,no funds authorized or appropriated by this ,act 7or an amendment made by this ,act7 may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion1 except in the case where a woman suffers from a physical disorder1 physical injury1 or physical illness that would1 as certified by a physician1 place the woman in danger of death unless an abortion is performed1 including a life-endangering physical condition caused by or arising from the pregnancy itself1 or unless the pregnancy is the result of an act of rape or incest4 #bjd4 ,reauthorization of ,native ,hawaiian health care programs 7a7 ,reauthorization ,the ,native ,hawaiian ,health ,care ,act of #aihh 7#db ,u4,s4,c4 #aagja et seq47 is amended by striking #bjja each place it appears in sections #f7;h77#a71 #g7;b71 and #aj7;c7 7#db ,u4,s4,c4 #aagje7;h77#a71 #aagjf7;b71 #aagji7;c77 and inserting #bjai4 7b7 ,health and education 7#a7 ,in general ,section #f7;c7 of the ,native ,hawaiian ,health ,care ,act of #aihh 7#db ,u4,s4,c4 #aagje7 is amended by adding at the end the following3 7#d7 ,health and education ,in order to enable privately funded organizations to continue to supplement public efforts to provide educational programs designed to improve the health1 capability1 and well-being of ,native ,hawaiians and to continue to provide health services to ,native ,hawaiians1 notwithstanding any other provision of ,federal or ,state law1 it shall be lawful for the private educational organization identified in section #gbjb7af7 of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #geab7af77 to continue to offer its educational programs and services to ,native ,hawaiians 7as defined in section #gbjg of that ,act 7#bj ,u4,s4,c4 #geag77 first and to others only after the need for such programs and services by ,native ,hawaiians has been met4 4 7#b7 ,effective date ,the amendment made by paragraph 7#a7 takes effect on ,december #e1 #bjjf4 7c7 ,definition of health promotion ,section #ab7b7 of the ,native ,hawaiian ,health ,care ,act of #aihh 7#db ,u4,s4,c4 #aagaa7b77 is amended-- 7#a7 in subparagraph 7,f71 by striking and at the end2 7#b7 in subparagraph 7,g71 by striking the period at the end and inserting 1 and2 and 7#c7 by adding at the end the following3 7,h7 educational programs with the mission of improving the health1 capability1 and well-being of ,native ,hawaiians4 4